Sexual orientation and adolescent substance use: a meta-analysis and methodological review

AIMS

Several decades of research have shown that lesbian, gay and bisexual (LGB) adults are at high risk for substance use and substance use disorders (SUDs). These problems may often start prior to young adulthood; however, relatively little is known about risk for substance use in LGB adolescents. The primary aims of this paper were to conduct a meta-analysis of the relationship between sexual orientation and adolescent substance use and a systematic review and critique of the methodological characteristics of this literature.

METHODS

Medical and social science journals were searched using Medline and PsychInfo. Studies were included if they tested the relationship between sexual orientation and adolescent substance use. Eighteen published studies were identified. Data analysis procedures followed expert guidelines, and used National Institutes of Health (NIH)-sponsored meta-analysis software.

RESULTS

LGB adolescents reported higher rates of substance use compared to heterosexual youth (overall odds ratio = 2.89, Cohen's d = 0.59). Effect sizes varied by gender, bisexuality status, sexual orientation definition and recruitment source. None of the studies tested mediation and only one tested moderation. One employed a matched comparison group design, one used a longitudinal design, and very few controlled for possible confounding variables.

CONCLUSIONS

The odds of substance use for LGB youth were, on average, 190% higher than for heterosexual youth and substantially higher within some subpopulations of LGB youth (340% higher for bisexual youth, 400% higher for females). Causal mechanisms, protective factors and alternative explanations for this effect, as well as long-term substance use outcomes in LGB youth, remain largely unknown.

Trajectories of alcohol and drug use and dependence from adolescence to adulthood: the effects of familial alcoholism and personality

This study describes trajectories of substance use and dependence from adolescence to adulthood. Identified consumption groups include heavy drinking/heavy drug use, moderate drinking/experimental drug use, and light drinking/rare drug use. Dependence groups include alcohol only, drug only, and comorbid groups. The heavy drinking/heavy drug use group was at risk for alcohol and drug dependence and persistent dependence and showed more familial alcoholism, negative emotionality, and low constraint. The moderate drinking/experimental drug use group was at risk for alcohol dependence but not comorbid or persistent dependence and showed less negative emotionality and higher constraint. Familial alcoholism raised risk for alcohol and drug use and dependence in part because children from alcoholic families were more impulsive and lower in agreeableness.

Why Are Self-Report and Behavioral Measures Weakly Correlated?

Accumulating evidence indicates weak correlations between self-report and behavioral measures of the same construct. We suggest that these weak correlations result from the poor reliability of many behavioral measures and the distinct response processes involved in the two measurement types. We also describe how researchers can benefit from appropriate use of these measures.

A prospective study of the effects of age of initiation of alcohol and drug use on young adult substance dependence

OBJECTIVE

Previous cross-sectional research has disagreed about whether an adolescent's age of onset of alcohol use is a unique predictor of later alcohol dependence or whether it is merely a correlate of those factors that produce alcohol dependence. The current study tests this question in a longitudinal sample, and extends the literature by testing whether age of onset of alcohol and drug use predicts alcohol and drug dependence.

METHOD

Data from an ongoing study of children of alcoholics and matched controls (n = 395) were collected during three annual interviews during adolescence and two 5-year follow-ups in young adulthood.

RESULTS

Taking a first drink of alcohol at or before age 13 was unrelated to the odds of alcohol and drug dependence when the adolescent did not also participate in early drug use or when correlated risk factors were taken into account. On the other hand, early drug use elevated the odds of drug dependence by young adulthood, even while controlling for shared risk factors.

CONCLUSIONS

The current study provides support for the notion that early-adolescent onset of alcohol use is a marker of risk for later dependence rather than a causal influence. Moreover, it provides evidence for the impact of early drug use on drug-substance dependence. Implications for theory and intervention are discussed.

Improving Present Practices in the Visual Display of Interactions

Interaction plots are used frequently in psychology research to make inferences about moderation hypotheses. A common method of analyzing and displaying interactions is to create simple-slopes or marginal-effects plots using standard software programs. However, these plots omit features that are essential to both graphic integrity and statistical inference. For example, they often do not display all quantities of interest, omit information about uncertainty, or do not show the observed data underlying an interaction, and failure to include these features undermines the strength of the inferences that may be drawn from such displays. Here, we review the strengths and limitations of present practices in analyzing and visualizing interaction effects in psychology. We provide simulated examples of the conditions under which visual displays may lead to inappropriate inferences and introduce open-source software that provides optimized utilities for analyzing and visualizing interactions.

Mediating and Moderated Effects of Adolescent Behavioral Undercontrol and Parenting in the Prediction of Drug Use Disorders in Emerging Adulthood

This study tested whether the effects of parental alcoholism on drug use disorders in emerging adulthood were mediated by behavioral undercontrol and parenting in adolescence and whether parenting buffered the relation between undercontrol and drug use disorders. Participants were 175 children of alcoholics and 190 matched control participants from an ongoing longitudinal study (L. Chassin, F. Rogosch, & M. Barrera, 1991). Results showed that undercontrol and parental discipline mediated 58% of the effect of parental alcoholism on drug use disorders. The relation between behavioral undercontrol and drug use disorders was further moderated by parental support. This effect was "protective but reactive" (S. S. Luthar, D. Cicchetti, & B. Becker, 2000); at high levels of behavioral undercontrol the protective effect of parental support was lost. Highly undercontrolled adolescents may have such a strong diathesis for drug use disorders that buffers may not have the same effect as in those with better control.

The diagnosis of schizophrenia by language analysis

Our aim was to test the findings of a study which claimed that, if the syntactic structure of schizophrenic speech were subjected to a detailed linguistic analysis, clear differences would be demonstrated between schizophrenic, manic and control populations. It was confirmed that schizophrenics do have less syntactically complex speech which contains more errors. Using linguistic variables in a discriminant function analysis, it was possible to predict diagnoses correctly in 79% of cases.

Marker or mediator? The effects of adolescent substance use on young adult educational attainment

AIMS

We tested the effects of adolescent substance use on college attendance and completion by young adulthood in the context of the behavioral and familial risk factors that influence substance use.

DESIGN, SETTING AND PARTICIPANTS

Longitudinal data were collected from a community sample of children of alcoholics (248) and matched controls (206) at three adolescent assessments (micro(age) = 13-15) and a long-term follow-up in young adulthood (micro(age) = 25).

MEASUREMENTS

College attendance and degree completion by age 25 were self-reported in young adulthood. During adolescence, self-reports of alcohol and drug use were assessed with log-transformed quantity/frequency measures; substance use risk factors [e.g. parental monitoring, externalizing and internalizing symptoms and Diagnostic and Statistical Manual version III (DSM-III) diagnosis of parental alcoholism] were assessed by both self- and parent-report, and adolescent reading achievement was assessed using a standardized assessment of reading achievement (Wide Range Achievement Test).

FINDINGS

Using growth curve modeling, we found that mean levels and growth in adolescent substance use mark, or identify, those adolescents who are at risk for reduced odds of attending and completing college. Moreover, adolescent substance use was not merely a marker of risk, in that growth in drug use (but not alcohol use) significantly mediated the effects of parental alcoholism and early externalizing behavior on later college completion, partially explaining the effects of these risk factors on college completion.

CONCLUSIONS

The current study provides evidence for both the marker and the mediator hypotheses, and identifies multiple pathways to higher educational attainment. The findings point to the importance of studying the effects of adolescent substance use in a broader developmental context of its correlated risk factors to specify more effectively the key pathways to later developmental outcomes.

Human gammadelta(+) T lymphocytes have in vitro graft vs leukemia activity in the absence of an allogeneic response

Refractory acute lymphoblastic leukemia (ALL) is often incurable, and relapse rates following allogeneic bone marrow transplantation (BMT) remain high. We have reported that patients who develop increased numbers of gammadelta(+) T cells soon after BMT are significantly less likely to relapse. We now show in seven donor/recipient pairs that donor-derived Vdelta1(+)CD4(-)CD8(-)gammadelta(+) T cells are activated and proliferate in response to recipient primary ALL blasts. In addition, these cells have been shown to bind and lyse the recipient ALL blasts. Separately, gammadelta(+) T cells proliferate poorly or not at all in mixed lymphocyte culture against HLA-mismatched unrelated stimulator cells. These observations suggest that allogeneic gammadelta(+) T cells could be an effective immunotherapeutic strategy against refractory disease without the risk of graft-versus-host disease.

Psychology's Replication Crisis and Clinical Psychological Science

Despite psychological scientists' increasing interest in replicability, open science, research transparency, and the improvement of methods and practices, the clinical psychology community has been slow to engage. This has been shifting more recently, and with this review, we hope to facilitate this emerging dialogue. We begin by examining some potential areas of weakness in clinical psychology in terms of methods, practices, and evidentiary base. We then discuss a select overview of solutions, tools, and current concerns of the reform movement from a clinical psychological science perspective. We examine areas of clinical science expertise (e.g., implementation science) that should be leveraged to inform open science and reform efforts. Finally, we reiterate the call to clinical psychologists to increase their efforts toward reform that can further improve the credibility of clinical psychological science.

Longitudinal modeling in developmental neuroimaging research: Common challenges, and solutions from developmental psychology

Hypotheses about change over time are central to informing our understanding of development. Developmental neuroscience is at critical juncture: although the majority of longitudinal imaging studies have observations with two time points, researchers are increasingly obtaining three or more observations of the same individuals. The goals of the proposed manuscript are to draw upon the long history of methodological and applied literature on longitudinal statistical models to summarize common problems and issues that arise in their use. We also provide suggestions and solutions to improve the design, analysis and interpretation of longitudinal data, and discuss the importance of matching the theory of change with the appropriate statistical model used to test the theory. Researchers should articulate a clear theory of change and to design studies to capture that change and use appropriately sensitive measures to assess that change during development. Simulated data are used to demonstrate several common analytic approaches to longitudinal analyses. We provide the code for our simulations and figures in an online supplement to aid researchers in exploring and plotting their data. We provide brief examples of best practices for reporting such models. Finally, we clarify common misunderstandings in the application and interpretation of these analytic approaches.

Gender and short-term recovery from cardiac surgery

BACKGROUND

There has been a lack of agreement regarding whether women have poorer outcomes than men following cardiac surgery.

OBJECTIVES

To examine the effect of gender on early recovery from cardiac surgery.

METHOD

Using a prospective descriptive design, 60 men and 60 women who had coronary artery bypass and/or valve surgery completed the study by participating in interviews in the immediate preoperative period and monthly through the third postoperative month. Measures of life quality, life satisfaction, expected/perceived recovery, functional status, global health status, and social support were examined.

RESULTS

Preoperatively, women were more functionally limited (p = 0.019), and reported lower life satisfaction (p = 0.001) and social support (p = 0.006), than men. At 3 months postoperatively, there were few significant differences in outcome measures though women continued to report lesser social support (p = 0.002); women realized significantly greater improvement than men in functional status (p = 0.008); and neither age nor gender consistently predicted recovery.

CONCLUSIONS

Recent studies focusing on gender differences in cardiac surgery recovery indicate fewer differences between men and women than once thought. However, the differences identified in this study (women's significantly greater improvement in functional status, lesser social support, and differences in the nature of work to which women return following their surgery) warrant concern and attention in clinical practice.

Individual differences in the development of self-regulation during pre-adolescence: connections to context and adjustment

Difficulties with self-regulation are implicated in the development of emotional and behavioral problems during adolescence. Although children's ability to regulate their behaviors continues to improve throughout childhood and adolescence, it remains unclear how contextual risk factors might influence this development during the transition to adolescence, or how variation in the development of self-regulation predicts adjustment. Using a community sample of 214 8-12 year-olds (T1 M = 9.5, SD = 1.01), we examined growth trajectories of effortful control and impulsivity over three years and tested predictors and outcomes of these trajectories. Although predictors of initial levels of self-regulation were largely equivalent for both effortful control and impulsivity, contextual risk factors were related to variations in the development of impulsivity but not effortful control. However, increases in effortful control, but not impulsivity, were associated with level and rate of change in adjustment problems and positive adjustment, suggesting that different dimensions of self-regulation have different antecedents and outcomes in pre-adolescence and adolescence.

Psychopathology in individuals with sexual dysfunction

The literature contains contradictory reports on the psychiatric status of individuals with sexual dysfunction. As a step toward resolving the controversy the authors administered the SCL-90-R to a large series of patients who sought treatment for sexual disorders (N = 325). Psychiatric evaluations were also done for each patient. Results showed disproportionate levels of psychological distress, reflected in SCL-90-R symptom profiles; approximately one-third of the 199 men and one-half of the 126 women in the series were also assigned psychiatric diagnoses. Findings provided evidence suggesting that the various sexual dysfunctions have characteristic symptom profiles; however, interpretation should be cautious because the cause-and-effect relationship between psychological distress and sexual dysfunctions remains complex and uncharted.

Effectiveness of Task-Shifted Trauma-Focused Cognitive Behavioral Therapy for Children Who Experienced Parental Death and Posttraumatic Stress in Kenya and Tanzania: A Randomized Clinical Trial

IMPORTANCE

Approximately 140 million children worldwide have experienced the death of one or both parents. These children, mostly in low- and middle-income countries, have higher rates of mental health problems than those who have not experienced parental death. Cognitive behavioral therapy (CBT) may improve the well-being of these children, but to our knowledge there have been no randomized clinical trials specifically focused on this population.

OBJECTIVES

To test the effectiveness of trauma-focused CBT (TF-CBT) for improving posttraumatic stress (PTS) in children in Kenya and Tanzania who have experienced parental death, to test the effects of TF-CBT on other mental health symptoms, and to examine the feasibility of task-shifting with greater reliance on experienced, local lay counselors as trainers and supervisors.

DESIGN, SETTING, AND PARTICIPANTS

A randomized clinical trial conducted in urban and rural areas of Tanzania and Kenya compared TF-CBT and usual care (UC) for 640 children aged 7 to 13 years who were recruited from February 13, 2013, to July 24, 2015. All children had experienced the death of one or both parents and had elevated PTS and/or prolonged grief. Interviewers were masked to study condition. Participants were followed up for 12 months after the randomized clinical trial. Statistical analysis was performed from February 3, 2017, to August 26, 2019. All analyses were on an intent-to-treat basis.

INTERVENTIONS

In the intervention condition, 320 children received 12 weeks of group TF-CBT delivered by lay counselors who were supervised weekly. In the UC condition, 320 children received community services typically offered to this population.

MAIN OUTCOMES AND MEASURES

The primary outcome was PTS, evaluated using a continuous, standardized measure. Other mental health symptoms and child-guardian relationship were also measured.

RESULTS

A total of 640 children (320 girls and 320 boys; mean [SD] age, 10.6 [1.6] years) were included in the study. Trauma-focused CBT was more effective than UC for PTS in 3 of 4 sites after treatment (end of 3-month randomized clinical trial): rural Kenya (Cohen d = 1.04 [95% CI, 0.72-1.36]), urban Kenya (Cohen d = 0.56 [95% CI, 0.29-0.83]), and urban Tanzania (Cohen d = 0.45 [95% CI, 0.10-0.80]). At 12-month follow-up, TF-CBT remained more effective than UC in both rural (Cohen d = 0.86 [95% CI, 0.64-1.07]) and urban (Cohen d = 0.99 [95% CI, 0.75-1.23]) Kenya. At 12-month follow-up in Tanzania, children who received TF-CBT and UC had comparable rates of improvement (rural Tanzania, Cohen d = 0.09 [95% CI, -0.08 to 0.26]; urban Tanzania, Cohen d = 0.11 [95% CI, -0.09 to 0.31]). A similar pattern was seen for secondary outcomes, with stronger effects observed in Kenya, where children experienced greater stress and adversity (eg, more food scarcity, poorer guardian health, and greater exposure to traumatic events).

CONCLUSIONS AND RELEVANCE

This study found that TF-CBT was more effective than UC in reducing PTS among children who experienced parental death in 3 of 4 sites in Kenya and Tanzania. At 12-month follow-up, TF-CBT was more effective in reducing PTS only among children in rural and urban Kenya.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01822366.

Developmental consistency in associations between depressive symptoms and alcohol use in early adolescence

OBJECTIVE

Despite frequent theorizing, prior literature on the association between depressive symptoms and alcohol use in adolescence has been inconsistent. Yet studies have varied widely with respect to age at assessments, time frame of prediction, and controls for comorbid conditions and demographic factors. The current study examined whether the associations between depressive symptoms and alcohol use were similar in valence and magnitude over a 4-year period in early adolescence.

METHOD

A sample of 521 young adolescents and their parents were interviewed every year from sixth (Mage = 12.0 years) through ninth grades. At each interview, symptom counts on depressive and conduct disorders were generated from the Diagnostic Interview Schedule for Children. Adolescents also reported on their alcohol use, which was converted to a binary variable. Autoregressive, cross-lagged panel models specifying depressive and conduct disorder symptoms as predictors of alcohol use 1 year later with equality constraints were tested and compared with models allowing path coefficients to vary over time.

RESULTS

For youth self-report, depressive symptoms were positively associated with alcohol use 1 year later over and above conduct problems and earlier alcohol use throughout early adolescence. By parental report, only very early adolescent depressive symptoms (sixth to seventh grades) were associated with alcohol use. Gender did not moderate findings for analyses with self- or parental-report data.

CONCLUSIONS

These results indicate that, even in the context of conduct disorder symptoms, depressive symptoms are important indicators of risk for use of alcohol across early adolescence.

Gender-specific mediational links between parenting styles, parental monitoring, impulsiveness, drinking control, and alcohol-related problems

OBJECTIVE

Recently, it has been suggested that traits may dynamically change as conditions change. One possible mechanism that may influence impulsiveness is parental monitoring. Parental monitoring reflects a knowledge regarding one's offspring's whereabouts and social connections. The aim of this investigation was to examine potential gender-specific parental influences to impulsiveness (general behavioral control), control over one's own drinking (specific behavioral control), and alcohol-related problems among individuals in a period of emerging adulthood.

METHOD

Direct and mediational links between parenting styles (permissive, authoritarian, and authoritative), parental monitoring, impulsiveness, drinking control, and alcohol-related problems were investigated. A multiple-group, SEM model with (316 women, 265 men) university students was examined.

RESULTS

In general, the overall pattern among male and female respondents was distinct. For daughters, perceptions of a permissive father were indirectly linked to more alcohol-related problems through lower levels of monitoring by fathers and more impulsive symptoms. Perceptions of an authoritative father were also indirectly linked to fewer impulsive symptoms through higher levels of monitoring by fathers among daughters. For men, perceptions of a permissive mother were indirectly linked to more alcohol-related problems through lower levels of monitoring by mothers and more impulsive symptoms. For sons, perceptions of mother authoritativeness were indirectly linked to fewer alcohol-related problems through more monitoring by mothers and fewer impulsive symptoms.

CONCLUSIONS

Monitoring by an opposite-gender parent mediated the link between parenting styles (i.e., permissive, authoritative) on impulsiveness.

Adolescent stressors, psychopathology, and young adult substance dependence: a prospective study

OBJECTIVE

There is much theory, but sparse empirical evidence, supporting the notion that internalizing symptoms and negative affect are the mechanism by which exposure to stressful life events influence the development of substance-use disorders in adolescence and young adulthood. However, many empirical studies have shown that, in addition to elevations in internalizing symptoms, exposure to stressful life events also produces elevations in externalizing behaviors and conduct problems, which are important risk factors for substance-use disorders. The current study tested adolescent externalizing and internalizing symptoms as competitive mediators of the effects of stressors on young adult drug dependence.

METHOD

Data from an ongoing study of children of alcoholics (n=223) and matched controls (n=204) were collected in two annual interviews in adolescence and two follow-ups in young adulthood.

RESULTS

Experiencing stressful life events during adolescence led to increases in both externalizing and internalizing symptoms, but only externalizing symptoms mediated the later effects of adolescent stressors on young adult drug dependence.

CONCLUSIONS

These findings suggest that understanding how stressors produce elevations in behavioral problems may provide important insights into understanding how broad environmental risk factors lead to substance dependence and suggests that processes other than affect regulation may operate in the pathway from the experiences of stressors to substance use and disorder.

Buffering effects of general and medication-specific social support on the association between substance use and HIV medication adherence

The success of highly active antiretroviral therapy (HAART) among persons living with HIV is largely dependent on strict medication adherence. Recent research suggests that alcohol and other drug use (AOD) may be an important barrier to HAART adherence. In this study, we examined the impact of AOD on HAART adherence as well as the moderating effects of general and medication-specific social support. The data were collected as part of a longitudinal randomized control trial with 224 HIV-positive patients at an HIV primary care clinic in the northwestern United States. Findings indicated that AOD use was negatively associated with HAART adherence and that medication-specific (but not general) social support moderated the AOD-adherence association at 3 (but not at 6 or 9) months. Results indicate the importance of medication-specific social support to treat comorbid AOD use and HIV; implications for future research and intervention programs for HIV-positive AOD users are discussed.

The daily association between affect and alcohol use: A meta-analysis of individual participant data

Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affect in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess affect and the number of alcoholic drinks consumed. Results indicate that people are not more likely to drink on days they experience high negative affect, but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance consumed more alcohol, but not on days they experienced higher negative and positive affect. Results were robust across different operationalizations of affect, study designs, study populations, and individual characteristics. These findings challenge the long-held belief that people drink more alcohol following increases in negative affect. Integrating these findings under different theoretical models and limitations of this field of research, we collectively propose an agenda for future research to explore open questions surrounding affect and alcohol use.

Changes in self-control problems and attention problems during middle school predict alcohol, tobacco, and marijuana use during high school

Although deficits in impulse control have been linked to adolescent use of alcohol and illicit drugs, less attention has been given to variability in change in impulse control across adolescence and whether this variability may be a signal of risk for early substance use. The goals of the current study were to examine growth in two aspects of impulse control, self-control problems and attention problems, across middle adolescence, and to test the prospective effects of level and change in these variables on levels and change over time in substance use. Data are from a community sample of 955 adolescents interviewed (along with their parents and teachers) annually from 6th to 11th grade. Results indicated that greater self-control problems and attentional problems in the 6th grade and increases in these problems over time were associated with higher levels of substance use at 11th grade. Our results suggest that modeling change over time enhances the understanding of how impulse control influences the development of substance use.

Psychosocial components of cardiac recovery and rehabilitation attendance

OBJECTIVE

To examine the relations between demographic factors, specific psychosocial factors, and cardiac rehabilitation attendance.

DESIGN

Cohort, repeated measures design.

SETTING

A large tertiary care centre in western Canada

PATIENTS

304 consecutive consenting patients discharged following acute myocardial infarction and/or coronary artery bypass graft surgery.

MAIN OUTCOME MEASURES

The Jenkins self-efficacy expectation scales and activity checklists of behaviour performance for maintaining health and role resumption, modified version of the self-motivation inventory, and the shortened social support scale.

RESULTS

Those who had higher role resumption behaviour performance scores at two weeks after discharge were significantly less likely to attend cardiac rehabilitation programmes. At six months after discharge, those who attended cardiac rehabilitation demonstrated higher health maintenance self-efficacy expectation and behaviour performance scores. Health maintenance self-efficacy expectation and behaviour performance improved over time. Women reported less social support but showed greater improvement in health maintenance self-efficacy expectation. Changes in self-efficacy scores were unrelated to-but changes in health maintenance behaviour performance scores were strongly associated with-cardiac rehabilitation attendance.

CONCLUSIONS

Cardiac patients and practitioners may have misconceptions about the mandate and potential benefits of rehabilitation programmes. Patients who resumed role related activities early and more completely apparently did not see the need to "rehabilitate" while those who attended cardiac rehabilitation programmes enhanced their secondary prevention behaviours.

The relation between adolescent substance use and young adult internalizing symptoms: findings from a high-risk longitudinal sample

The present study examined the role of adolescent substance use and its antecedent behavioral and familial risk factors in the prediction of young adult internalizing symptoms 10 years later, using a community sample of children of alcoholics (n = 194) and demographically matched controls (n = 209). Using growth curve modeling, the authors found that initial levels of adolescent alcohol and drug use (mu-sub(age) = 13) and growth in drug use during adolescence predicted higher levels of internalizing symptoms in young adulthood, even after including in the models shared risk factors for both internalizing symptoms and adolescent substance use. These effects remained significant after including concurrent substance use in adulthood, suggesting that adolescent substance use exerts a long-term impact on young adult internalizing symptoms over and above the effects of persistent substance use over time. The present investigation further revealed that initial levels of alcohol and drug use in adolescence mediate the relation between parental alcoholism and young adult internalizing symptoms. Findings provide evidence for the long-term effects of adolescent substance use on young adult functioning and can help inform both etiological and prevention research.

CD69 expression as an index of T-cell function: assay standardization, validation and use in monitoring immune recovery

BACKGROUND

CD69 is a surrogate marker of T-cell responsiveness to mitogen and Ag stimulus and can be used as a measure of T-lymphocyte activation. Quantitative flow cytometric determination of CD69 expression on T lymphocytes has several advantages over traditional lymphocyte proliferation assays, but this method has not yet been standardized for clinical applications.

METHODS

We qualified a commercially available assay using the manufacturer's procedures for measurement of T-cell response to a mitogen (PHA), superantigen (Staphylococcus endotoxin B; SEB) and Ca(2+) ionophore (phorbyl myristate acetate; PMA) with peripheral blood from healthy volunteers. Following this, we tested the usefulness of the assay in determining T-cell responses to PHA and SEB for six immunocompromised patients.

RESULTS

Healthy volunteers showed 17-fold increases in T-cell CD69 Ab bound per cell (ABC) with PHA stimulation compared with the baseline. SEB was also an effective T-cell activating agent, increasing CD69 ABC by 5-fold, comparable with results obtained with PMA stimulation. PHA- and SEB-stimulated T-cell CD69 ABC for patients 100 days post-BM transplant were generally below 1 SD of that from healthy volunteers. SEB-stimulated T-cell CD69 expression was significantly depressed for CD8(+) T cells while CD4(+) T-cell responses to SEB were generally within 1 SD of the mean for healthy volunteers.

DISCUSSION

These results suggest that quantitative measurement of CD69 surface expression by flow cytometry is a useful diagnostic tool for detailed assessment of T-lymphocyte and subset activation.

Co-occurrence of sexual risk behaviors and substance use across emerging adulthood: evidence for state- and trait-level associations

AIMS

  Prior research has suggested that problematic alcohol and drug use are related to risky sexual behaviors, either due to trait-level associations driven by shared risk factors such as sensation seeking or by state-specific effects, such as the direct effects of substance use on sexual behaviors. Although the prevalence of both high-risk sexual activity and alcohol problems decline with age, little is known about how the associations between substance use disorder symptoms and high-risk sexual behaviors change across young adulthood.

DESIGN, SETTING AND PARTICIPANTS

  Using a community sample (n = 790) interviewed every 3 years from age 21 to age 30 years, we tested trait- and state-level associations among symptoms of alcohol and drug abuse and dependence and high-risk sexual behaviors across young adulthood using latent growth curve models.

MEASUREMENTS

  We utilized diagnostic interviews to obtain self-report of past-year drug and alcohol abuse and dependence symptoms. High-risk sexual behaviors were assessed with a composite of four self-reported behaviors.

FINDINGS

  Results showed time-specific associations between alcohol disorder symptoms and risky sexual behaviors (r = 0.195, P < 0.001), but not associations between their trajectories of change. Conversely, risky sexual behaviors and drug disorder symptoms were associated only at the trait level, not the state level, such that the levels and rate of change over time of both were correlated (r = 0.35, P < 0.001).

CONCLUSIONS

  High-risk sexual behaviors during young adulthood seem to be driven both by trait and state factors, and intervention efforts may be successful if they are either aimed at high-risk individuals or if they work to disaggregate alcohol use from risky sexual activities.