Adolescent marijuana use and adult occupational attainment: a longitudinal study from age 18 to 28

This report uses data from a nationally representative longitudinal sample to examine the relationship of marijuana use by high school seniors to occupational attainment 10 years later. Analyses were conducted separately by gender, with and without controlling for other variables. Control variables, all measured when respondents were seniors, were: academic performance, educational aspirations, and occupational aspirations. Results indicate that the influence of marijuana use on occupational attainment is considerably different for males and females.

Lowered legal blood alcohol limits for young drivers: effects on drinking, driving, and driving-after-drinking behaviors in 30 states

OBJECTIVES

This study evaluated the effects on drinking and driving of lowered allowable blood alcohol concentration (BAC) limits for drivers younger than 21 years in 30 US states between 1984 and 1998.

METHODS

Outcome measures were based on self-reports from a cross-sectional sample of more than 5000 high school seniors in 30 states surveyed before and after BAC limits were implemented in their states.

RESULTS

Frequency of driving after any drinking and driving after 5 or more drinks declined 19% and 23%, respectively. Lower BAC limits did not affect overall amount of drinking or total number of miles driven.

CONCLUSIONS

Significant beneficial effects of lowered youth BAC limits have appeared despite limited publicity and enforcement of the new laws.

Are risk and protective factors for substance use consistent across historical time?: national data from the high school classes of 1976 through 1997

Researchers have seldom examined whether risk and protective factors are consistently linked to substance use across historical time. Using nationally representative data collected from 22 consecutive cohorts of high school seniors (approximate N = 188,000) from the Monitoring the Future (MTF) project, we investigated whether correlates of substance use changed across historical time. We found a high degree of consistency across historical time in predictors of past month cigarette use, past month alcohol use, past year marijuana use, and past year cocaine use. Some predictors such as religiosity, political beliefs, truancy, and frequent evenings out were consistently linked to substance use. The consistency of other predictors such as region, parental education, and college plans was contingent in part upon historical time period, the particular substance, and its level of use.

Understanding the links among school misbehavior, academic achievement, and cigarette use: a national panel study of adolescents

Relations among academic achievement, school bonding, school misbehavior, and cigarette use from 8th to 12th grade were examined in two national panel samples of youth (n = 3056). A series of competing conceptual models developed a priori was tested using structural equation modeling (SEM). The findings suggest that during middle adolescence the predominant direction of influence is from school experiences to cigarette use. School misbehavior and low academic achievement contribute to increased cigarette use over time both directly and indirectly. Two-group SEM analyses involving two cohorts-gender and ethnicity- revealed that our findings are robust. In addition, comparisons between high school dropouts and nondropouts and between eighth-grade cigarette use initiators and nonusers revealed few differences in direction or magnitude of effects. Results suggest that prevention programs that attempt to reduce school misbehavior and academic failure, as well as to help students who misbehave and have difficulty in school constructively avoid negative school- and health-related outcomes, are likely to be effective in reducing adolescent cigarette use.

The epidemiology of alcohol, tobacco and other drug use among black youth

OBJECTIVE

Although there is a growing literature on racial/ethnic differences in alcohol, tobacco and other drug use among adolescents, relatively little is known about the social epidemiology of drug use within the black youth population. The purpose of this article is to address this knowledge gap.

METHOD

Data from the Monitoring the Future Project are used to examine empirically the prevalence, trends and sociodemographic correlates of drug use among nationally representative samples of black eighth, tenth and twelfth graders (approximate N = 25,000).

RESULTS

Alcohol is the drug most widely used by black youth, followed by tobacco and marijuana. By twelfth grade, seven in 10 black secondary students have used alcohol, less than 50% have smoked cigarettes, 25% have used marijuana and less than 2% have used cocaine. Trend data indicate that, although alcohol use has been relatively stable over time, cigarette and marijuana use are increasing. Gender and family structure are significant sociodemographic correlates of drug use, with use being, on average, higher among males than females, and higher among students who do not live with either of their parents than among those who live with at least one of their parents. The relationships between drug use and socioeconomic status, urbanicity and region vary depending on students' grade level and the specific drug in question.

CONCLUSIONS

These findings provide an important empirical baseline for future research on the epidemiology and etiology of drug use among young black people.

Changing patterns of drug use among US military recruits before and after enlistment

OBJECTIVES

The US armed forces adopted "zero tolerance" policies concerning illicit drug use in 1980 and later developed policies to discourage tobacco and alcohol abuse. This article examines drug use among young active-duty recruits both before and after enlistment, compared with nonmilitary age-mates, and documents historical shifts in such drug use across 2 decades.

METHODS

Analyses employed longitudinal panel data from 20 nationally representative samples of high school seniors (cohorts of 1976-1995), each surveyed just before graduation and again within 2 years. Separate analyses for men (n = 12,082) and women (n = 15,345) contrasted those who entered military service, college, and civilian employment.

RESULTS

Illicit drug use declined more among young military recruits than among their civilian counterparts. Analyses of male recruits at multiple time periods showed (1) declines in the prevalence of marijuana use and cocaine use after the initiation of routine military drug testing and (2) lower proportions of smokers of half a pack or more of cigarettes per day who entered service after the initiation of tobacco bans during basic training.

CONCLUSIONS

Recent military drug policies appear to deter illicit drug use among enlistees and discourage some smokers from enlisting.

Drinking and driving among US high school seniors, 1984-1997

OBJECTIVES

This article reports the prevalence of, and trends in, driving after drinking and riding in a car with a driver who has been drinking among American high school seniors, based on data from more than a decade (1984-1997) of annual national surveys.

METHODS

Logistic regressions were used to assess the effects of demographic factors (gender, region of country, population density, parental education, and race/ethnicity) and selected "lifestyle" factors (religious commitment, high school grades, truancy, illicit drug use, evenings out per week, and miles driven per week).

RESULTS

Rates of adolescent driving after drinking and riding with a driver who had been drinking declined significantly from the mid-1980s to the early or mid-1990s, but the declines have not continued in recent years. Rates of driving or riding after drinking were higher among high school seniors who are male. White, living in the western and northeastern regions of the United States, and living in rural areas. Truancy, number of evenings out, and illicit drug use all related significantly positively with the dependent variables, whereas grade point average and religious commitment had a negative relationship. Miles driven per week related positively to driving after drinking.

Changes at the high end of risk in cigarette smoking among US high school seniors, 1976-1995

OBJECTIVES

This study identified high school seniors at low, moderate and high risk for cigarette use to examine changes in the prevalence of daily smoking within risk groups from 1976 to 1995.

METHODS

Data were taken from the Monitoring the Future Projects national surveys of high school seniors. Risk classification was based on grade point average, truancy, nights out per week, and religious commitment. Logistic regression models were used to estimate trends for all seniors and separately for White (n = 244,221), African American (n = 41,005), and Hispanic (n = 18,457) made and female subgroups.

RESULTS

Risk group distribution (low = 45%, moderate = 30%, high = 25%) changed little over time. Between 1976 and 1990, greater absolute declines in smoking occurred among high-risk students (17 percentage points) than among low-risk students (6 percentage points). Particularly large declines occurred among high-risk African Americans and Hispanics. Smoking increased in all risk groups in the 1990s.

CONCLUSIONS

Among high school seniors, a large part of the overall change in smoking occurred among high-risk youth. Policies and programs to reduce smoking among youth must have broad appeal, especially to those at the higher end of the risk spectrum.

Explaining recent increases in students' marijuana use: impacts of perceived risks and disapproval, 1976 through 1996

OBJECTIVES

Marijuana use among high school seniors increased during most of the 1970s, decreased throughout the 1980s, and has been increasing again during the 1990s. Earlier analyses of the classes of 1976 through 1986 attributed the historic trends during that period to specific changes in views about marijuana. This study examined whether recent increases in marijuana use among seniors and among students in earlier grades reflect similar processes.

METHODS

Multivariate regression analyses were conducted on data from large annual nationwide surveys of high school seniors from 1976 through 1996 (approximate n = 61,000) and 8th and 10th graders from 1991 through 1996 (n's = 87,911 and 82,475, respectively).

RESULTS

Individual lifestyle factors (grades, truancy, religious commitment, evenings out for recreation) correlated substantially with marijuana use but did not explain the historic changes in marijuana use. Rather, decreases in perceived risk of harmfulness and in disapproval can account for the recent increases in all 3 grades and for earlier decreases among seniors.

CONCLUSIONS

These findings indicate that perceived risks and disapproval are important determinants of marijuana use. Accordingly, prevention efforts should include realistic information about risks and consequences of marijuana use.

Alcohol use among adolescents

Several ongoing national surveys, including the Monitoring the Future study, the National Household Survey on Drug Abuse, and the Youth Risk Behavior Survey, are investigating the drinking behaviors of adolescents in the United States. These studies have found that the majority of adolescents under the age of 18 have consumed alcohol, although the minimum legal drinking age is 21. Drinking rates may even have increased in recent years in some age groups. No substantial differences exist among various sociodemographic subgroups with respect to drinking rates, although alcohol consumption generally is lowest among African-Americans and highest among whites. Moreover, alcohol consumption increases sharply throughout adolescence. Various attitudinal and behavioral factors, such as religious involvement, truancy, and average grade level, also influence adolescents' drinking behaviors. Almost two-thirds of 12th graders who report consuming alcohol experience at least one alcohol-related problem. Most adolescents drink to experience the pleasurable effects of alcohol, such as having a good time with friends.

The recanting of earlier reported drug use by young adults

One approach to determining the validity of self-reported drug use measures is to examine the extent of logically inconsistent responses over time. Because lifetime use logically should never decline, the rate of subsequent recanting of earlier reported lifetime use provides relevant evidence on validity. In this chapter, recanting rates are examined in nationally representative samples of high school seniors (18-year-olds) surveyed in the Monitoring the Future study as they are followed up on seven occasions through age 32. For the illegal drugs examined (marijuana, cocaine, and lysergic acid diethylamide (LSD)), recanting rates prove to be quite modest, but for the psychotherapeutic drugs, they were more substantial, possibly because of their greater definitional ambiguity. In general, there were no large individual differences in recanting rates as a function of sex, household composition, community size, or education level. Consistent with previous work, minorities (particularly African Americans) had somewhat higher rates of recanting on the illegal drugs. So did respondents in certain occupations, namely, the military and police/firefighting. In general, however, the evidence is quite good for validity of self-reported (by mail) lifetime use of the illegal drugs in young adulthood.

Getting drunk and growing up: trajectories of frequent binge drinking during the transition to young adulthood

OBJECTIVE

The purpose of this study was: (1) to identify different trajectories of frequent binge drinking during the transition to young adulthood; (2) to validate the trajectories by relating them to behaviors and attitudes concerning alcohol and other drug use; and (3) to distinguish among the trajectories according to demographic characteristics and lifestyle experiences typical of the transition to young adulthood.

METHOD

Four waves of national panel data were obtained from the Monitoring the Future project; 9,945 weighted cases from the 1976-85 high school senior year cohorts were surveyed at biennial intervals between ages 18 and 24. Frequent binge drinking was defined as having five or more drinks in a row at least twice in the past two weeks.

RESULTS

Six distinct frequent binge drinking trajectory groups were specified a priori and confirmed with cluster analysis: Never, Rare, Chronic, Decreased, Increased and "Fling." Repeated measures ANOVAS revealed that the trajectories corresponded to patterns of change and stability in problems with alcohol, attitudes about heavy drinking, peer heavy drinking and illicit drug use. Results from logistic regression analyses predicting diverging and converging trajectories provided some support for the general hypothesis that trajectories of Chronic and Increased frequent binge drinking over time are associated with difficulties in negotiating the transition to young adulthood.

CONCLUSIONS

The findings provide strong evidence for wide developmental variation in drinking patterns in the population, variation that is obscured by more aggregate-level considerations. The developmental variation in frequent binge drinking during the transition to young adulthood reflects systematic variation in success and difficulties with negotiating the transition.

Adolescent substance use. Epidemiology and implications for public policy

This article discusses the epidemiology of adolescent substance use, including licit drugs and illicit drugs. The focus is on nationally representative samples of eighth-, tenth-, and twelfth-grade students from both public and private schools. Prevalence rates and recent trends are discussed for subgroups based on gender, geographic region, population density, parental education, and racial or ethnic groups. Some implications for public policy are presented.

Hepatitis C virus infection in sexually active homosexual men

While hepatitis C virus (HCV) is known to be transmitted parenterally, the role of sexual transmission remains unclear. In order to examine the association of sexual risk factors with HCV seroprevalence at a time when unprotected sexual practices were still quite common, 435 homosexual men recruited from a municipal sexually transmitted disease clinic with behavioural data and serologic specimens from 1983-1984 were evaluated. Overall, 25% of men reporting injecting drug use (IDU) and 5% of men with no IDU were anti-HCV positive; the rate in the non-IDU was significantly higher than age-matched rates in blood donors (summary odds ratio 3.5, 95% confidence interval 2.8-4.2). In addition to IDU, amphetamine and phencyclidine use were also associated with anti-HCV positivity on univariate analysis. Sexual risk factors for anti-HCV positivity included anal receptive intercourse, 'fisting', having an IDU sexual partner, a self-reported history of genital herpes and HIV seropositivity. On multivariate analysis, only IDU was significantly associated with anti-HCV positivity. Thus, sexual practices appear to play a minor role in transmission of HCV.

Long-term HIV-1 infection without immunologic progression

OBJECTIVE

To identify and describe a subgroup of men infected with HIV for 10-15 years without immunologic progression, and to evaluate the effect of sexually transmitted diseases (STD) and recreational drug use on delayed HIV disease progression.

DESIGN

Inception cohort study.

SETTING

Municipal STD clinic.

PARTICIPANTS

A total of 588 men with well documented dates of HIV seroconversion and 197 HIV-seronegative controls.

MAIN OUTCOME MEASURES

AIDS, CD4+ count, rate of CD4+ cell loss, CD8+ count, beta 2-microglobulin, complete blood count, p24 antigen and HIV-related symptoms.

RESULTS

Of 588 men, 69% had developed AIDS by 14 years after HIV seroconversion (95% confidence interval, 64-73%). Of 539 men with HIV seroconversion dates prior to 1983, 42 men (8%) were healthy long-term HIV-positives (HLP), HIV-infected > or = 10 years without AIDS and with CD4+ counts > 500 x 10(6)/l. When compared with progressors (men with HIV seroconversion prior to 1983 but with AIDS or CD4+ counts < 200 x 10(6)/l), HLP had a significantly slower rate of CD4+ decline (6 versus 85 x 10(6)/l cells/year), and less abnormal immunologic, hematologic and clinical parameters. However, when compared with HIV-uninfected controls, HLP demonstrated lower CD4+ counts and mild hematologic abnormalities. There were no consistent differences between HLP and progressors in prior exposure to recreational drugs or STD.

CONCLUSION

There are individuals with long-term HIV infection who appear clinically and immunologically healthy 10-15 years after HIV seroconversion, with stable CD4+ counts. Lack of exposure to STD or recreational drugs does not appear to explain the delayed course of disease progression in HLP.

High school educational success and subsequent substance use: a panel analysis following adolescents into young adulthood

In this investigation, two indicators of high school educational success (grade point average and college plans) were examined to determine their influence on cigarette, alcohol, and illicit drug use during the transition to young adulthood. Panel data were obtained from the 1978-81 Monitoring the Future nationally representative samples of high school seniors. The sample for this analysis included 3,399 White respondents (weighted cases) followed three to four years post-high school. Structural equation models that included background and mediating characteristics were developed and tested using LISREL VII. Consistent with a selection hypothesis, high school GPA had a negative indirect effect on post-high school substance use that operated largely via senior-year substance use. College plans during high school had a similar negative effect on post-high school cigarette use, but consistent with a differential-socialization hypothesis, they had a positive indirect effect on post-high school alcohol use that operated primarily via student and marital status during young adulthood. College plans had no impact on post-high school illicit drug use.

Epidemiology of human immunodeficiency virus type 1 infection among homosexual men participating in hepatitis B vaccine trials in Amsterdam, New York City, and San Francisco, 1978-1990

Homosexual/bisexual men from Amsterdam, The Netherlands, New York, New York, and San Francisco, California, were entered into trials of the efficacy of hepatitis B vaccine shortly before the acquired immunodeficiency syndrome (AIDS) epidemic was recognized (1978-1980). The authors analyzed data, including serial blood samples tested for antibody to human immunodeficiency virus type 1 (HIV-1) as well as demographic and behavioral information, to characterize the spread of HIV-1 infection within the cohorts. By the end of 1982, the cumulative incidence of HIV-1 infection within the cohorts. By the end of 1982, the cumulative incidence of HIV-1 infection was 7.5% in Amsterdam, 26.8% in New York City, and 42.6% in San Francisco. Covariate analysis showed that differences in sexual activity (number of male sexual partners) and correlates of sexual activity (age and hepatitis B incidence) accounted for the differences in incidence of HIV-1 infection between the New York City and San Francisco cohorts. These covariates did not explain the lower incidence in the Amsterdam cohort. In conclusion, significant differences were found in the spread of HIV-1 in cohorts of homosexual men in Amsterdam, New York City, and San Francisco. These dissimilarities were probably due to a combination of differences in sexual activity at the time the epidemic began and a later introduction of HIV-1 in Amsterdam.

Herpes zoster and human immunodeficiency virus infection

The interaction of herpes zoster and the human immunodeficiency virus (HIV) was evaluated in a cohort study of 287 homosexual men with well-defined dates of HIV seroconversion and 499 HIV-seronegative homosexual men. The incidence of herpes zoster was significantly higher among HIV-seropositive men (29.4 cases/1000 person-years) than among HIV-seronegative men (2.0 cases/1000 person-years); the overall age-adjusted relative risk (RR) was 16.9 (95% confidence interval [CI], 8.7-32.6). When compared with that of age-matched population controls from 1945 to 1959, the incidence of zoster was significantly higher among seropositive men (RR, 26.7; 95% CI, 19.3-37.1) and slightly higher among seronegative men (RR, 1.85; 95% CI, 1.0-3.3); the latter may reflect increasing background rates over several decades. The risk of herpes zoster was not associated with duration of HIV infection and was not predictive of faster progression to AIDS.

Serum beta 2-microglobulin and prediction of progression to AIDS in HIV infection

Identification of laboratory tests that can help predict progression to acquired immunodeficiency syndrome (AIDS) in people infected with human immunodeficiency virus (HIV) is important for clinical management and counselling. We have assessed the usefulness of CD4 lymphocyte count, serum beta 2-microglobulin concentration, and the presence of p24 antigen as predictors of AIDS. We studied 214 homosexual and bisexual men with well-defined dates of HIV seroconversion. For each participant, we defined the baseline date as the earliest date before the development of AIDS on which the three laboratory tests were done. beta 2-microglobulin concentration at baseline was in all analyses an independent predictor of AIDS, even after stratification by baseline CD4 count, duration of HIV infection, or use of zidovudine before or at baseline. For example, among men with at least 0.5 x 10(9)/l CD4 cells who were negative for p24 antigen, the risks of AIDS at 12 months and 24 months were 1% and 5%, respectively, for those whose beta 2-microglobulin concentrations were below 4.0 mg/l, compared with 17% and 27%, respectively for those with beta 2-microglobulin concentrations above that cut-off point (p less than 0.001). Among men with an estimated duration of infection of 5 years or less, beta 2-microglobulin concentration was the strongest independent predictor of AIDS. Measurement of serum beta 2-microglobulin adds important prognostic information to CD4 count in determining the risk of progression to AIDS in HIV-infected subjects, including those whose CD4 cell count has not yet fallen.

Impact of HIV infection on mortality and accuracy of AIDS reporting on death certificates

To assess the impact of HIV infection on mortality and the accuracy of AIDS reporting on death certificates, we analyzed data from 6704 homosexual and bisexual men in the San Francisco City Clinic cohort. Identification of AIDS cases and deaths in the cohort was determined through multiple sources, including the national AIDS surveillance registry and the National Death Index. Through 1990, 1518 deaths had been reported in the cohort and 1292 death certificates obtained. Of the 1292 death certificates, 1162 were for known AIDS cases, but 9% of the AIDS cases did not have HIV infection or AIDS noted on the death certificate. Only 0.7% of the decedents had AIDS listed as a cause of death and had not been reported to AIDS surveillance. AIDS and HIV infection was the leading cause of death in the cohort, with the highest proportionate mortality ratio (85%) and standardized mortality ratio (153 in 1987), and the largest number of years of potential life lost (32,008 years). The devastating impact of HIV infection on mortality is increasing and will require continued efforts to prevent and treat HIV infection.

Effects of minimum drinking age laws on alcohol use, related behaviors and traffic crash involvement among American youth: 1976-1987

This study has two separate but related purposes: (1) to delineate cross-sectional differences among U.S. high school seniors and young adults that may be due to variations in recent years in state-level minimum drinking age laws and (2) to examine the effects of recent changes in minimum drinking age laws on alcohol consumption and other relevant attitudes and behaviors. Analyses used existing data collected by the Monitoring the Future project, an ongoing study involving annual, nationally representative surveys of high school seniors and annual follow-up surveys by mail of recent graduates. A separate, coordinated study used time-series analyses of official reports to examine effects of increases in the minimum drinking age in several states on rates of fatal crashes. Time-series results were compared with findings from self-report data. The major findings include: higher minimum drinking ages were associated with lower levels of alcohol use among high school seniors and recent high school graduates, even after multivariate controls; lower levels of alcohol use were observed across a number of demographic variables; the lower levels of use persisted into the early 20s, even after all respondents were of legal age; and lowered involvement in alcohol-related fatal crashes among drivers under 21 appeared due to lower alcohol consumption rates--in particular, less drinking in bars or taverns.

Racial/Ethnic differences in smoking, drinking, and illicit drug use among American high school seniors, 1976-89

BACKGROUND

This paper reports racial/ethnic differences in the use of licit and illicit drugs by high school seniors in the United States.

METHODS

The study uses questionnaire data from annual, nationally representative surveys of seniors from 1976 through 1989. Combined sample sizes were 57,620 for 1976-79; 75,772 for 1980-84; and 73,527 for 1985-89.

RESULTS

Native American had the highest prevalence rates for cigarettes, alcohol, and most illicit drugs; White students had the next highest rates for most drugs. Asian Americans had the lowest prevalence rates, and Black students had levels nearly as low except for marijuana. Prevalence rates for the Hispanic groups were mostly in the intermediate ranges except for relatively high cocaine use among the males. Trend patterns for most forms of drug use were similar across subgroups, although cigarette use declined more sharply for Black than White seniors, resulting in greater Black-White differences in recent years.

CONCLUSIONS

This study, other school-based studies, and general population surveys all show relatively low levels of drug use by most non-White youth, especially Black Americans and Asian Americans. Multivariate analyses indicate that such subgroup differences in high school seniors' drug use are not primarily attributable to family composition, parents' education, region, or urban-rural distinctions.

Outcome of hepatitis B virus infection in homosexual men and its relation to prior human immunodeficiency virus infection

To investigate the effect of human immunodeficiency virus type 1 (HIV-1) infection on subsequent hepatitis B virus (HBV) infection, HIV antibody was sought in homosexual men who developed HBV infection during a hepatitis B vaccine trial. Among 134 unvaccinated HIV-1-negative men, 7% became HBV carriers, 64% had viremia, and 42% had clinical illness. Among vaccinated HIV-1-negative men, HBV infection severity decreased with number of vaccine doses administered. When adjusted for prior hepatitis B vaccination status, persons with HIV-1 infection preceding HBV infection had a significantly higher risk of developing HBV carriage, viremia, prolonged ALT elevation, and clinical illness. Among HIV-1-infected men, the risk of HBV carriage was increased in unvaccinated persons (21%) and those who failed to respond to vaccination (31%) and further increased in those who received vaccine doses at the time they developed new HBV infection (56%-80%), suggesting inactivated hepatitis B vaccine may temporarily impair the immune response to HBV infection in HIV-1-infected persons. HIV-1 infection was also associated with reduced alanine aminotransferase elevations during the first 36 months of follow-up of men who became HBV carriers.

HIV seroconversion in two homosexual men after receptive oral intercourse with ejaculation: implications for counseling concerning safe sexual practices

Seroconversion for HIV antibody occurred in two homosexual men who reported no anal intercourse for greater than or equal to 5 years and multiple episodes of receptive oral intercourse with ejaculation. Neither man reported intravenous drug use or receipt of blood products. The last antibody-negative specimen was also negative by the polymerase chain reaction and p24 antigen assays. All sexually active persons should be clearly counselled that receptive oral intercourse with ejaculation carries a potential risk of HIV transmission.

Course of HIV-I infection in a cohort of homosexual and bisexual men: an 11 year follow up study

OBJECTIVE--To characterise the natural history of sexually transmitted HIV-I infection in homosexual and bisexual men. DESIGN--Cohort study. SETTING--San Francisco municipal sexually transmitted disease clinic. PATIENTS--Cohort included 6705 homosexual and bisexual men originally recruited from 1978 to 1980 for studies of sexually transmitted hepatitis B. This analysis is of 489 cohort members who were either HIV-I seropositive on entry into the cohort (n = 312) or seroconverted during the study period and had less than or equal to 24 months between the dates of their last seronegative and first seropositive specimens (n = 177). A subset of 442 of these men was examined in 1988 or 1989 or had been reported to have developed AIDS. MAIN OUTCOME MEASURES--Development of clinical signs and symptoms of HIV-I infection, including AIDS, AIDS related complex, asymptomatic generalised lymphadenopathy, and no signs or symptoms of infection. MEASUREMENTS AND MAIN RESULTS--Of the 422 men examined in 1988 or 1989 or reported as having AIDS, 341 had been infected from 1977 to 1980; 49% (167) of these men had died of AIDS, 10% (34) were alive with AIDS, 19% (65) had AIDS related complex, 3% (10) had asymptomatic generalised lymphadenopathy, and 19% (34) had no clinical signs or symptoms of HIV-I infection. Cumulative risk of AIDS by duration of HIV-I infection was analysed for all 489 men by the Kaplan-Meier method. Of these 489 men, 226 (46%) had been diagnosed as having AIDS. We estimated that 13% of cohort members will have developed AIDS within five years of seroconversion, 51% within 10 years, and 54% within 11.1 years. CONCLUSION--Our analysis confirming the importance of duration of infection to clinical state and the high risk of AIDS after infection underscores the importance of continuing efforts both to prevent transmission of HIV-I and to develop further treatments to slow or stall the progression of HIV-I infection to AIDS.

Sexual behavior before AIDS: the hepatitis B studies of homosexual and bisexual men

Data on sexual practices, collected during studies of hepatitis B virus (HBV) infection in 1978 and 1979, were analyzed for 4910 homosexual and bisexual men from Chicago, Denver, Los Angeles, San Francisco, and St Louis. Data on sexual practices in 1978 showed that white participants had larger numbers of non-steady male sexual partners and engaged in oral-genital activities more frequently but were equally likely to engage in anal intercourse as black and Hispanic participants. San Francisco participants had more non-steady sex partners and were more likely to engage in receptive anal intercourse with non-steady partners than participants from all other sites. Analysis of data on 606 HBV-antibody-negative men interviewed on three occasions in 1978 and 1979 showed no changes in risk indices for insertive and receptive anal intercourse between these years, except in San Francisco where significant declines occurred in insertive anal intercourse and receptive anal intercourse without ejacultion in a small, highly select group of participants.

Detection of human immunodeficiency virus DNA using the polymerase chain reaction in a well-characterized group of homosexual and bisexual men

The polymerase chain reaction (PCR) for human immunodeficiency virus type 1 (HIV-1) DNA was performed on specimens from 197 homosexual and bisexual men enrolled in studies of HIV-1 infection. Thirty cycles of amplification were conducted, followed by detection with probes corresponding to two gag primer pairs (SK 38/39 and SK 101/145). Of 107 men who were HIV-1 antibody-negative, 105 (98%) were PCR-negative. Two who were initially PCR-positive antibody-negative were PCR- and antibody-negative on repeat testing of both the same specimen and specimens drawn 8-10 months later; this suggests that the first PCR results were false-positive. Of 90 men who were antibody-positive, PCR was positive in 87 (97%), including all 13 with AIDS, all 22 with AIDS-related conditions, all 11 with generalized lymphadenopathy only, and 41 (93%) of 44 without signs or symptoms of HIV-1 infection. On repeat testing, all 3 PCR-negative, antibody-positive men were PCR-positive. In this population and with this technique, PCR had excellent agreement with the HIV-1 antibody test.

Kaposi's sarcoma in a cohort of homosexual and bisexual men. Epidemiology and analysis for cofactors

Acquired immunodeficiency syndrome (AIDS) surveillance data for both the United States and San Francisco indicate that Kaposi's sarcoma is more common in homosexual and bisexual men with AIDS than in other adults with AIDS, and that the proportion of newly diagnosed AIDS cases presenting with Kaposi's sarcoma has been significantly declining over time. The changing epidemiology of Kaposi's sarcoma was analyzed in a well-characterized cohort of homosexual and bisexual men; laboratory and interview data from a sample of these men were evaluated for determinants of and cofactors associated with Kaposi's sarcoma. Among 1,341 men with AIDS, the proportion presenting with Kaposi's sarcoma declined from 79% in 1981 to 25% in 1989. Compared with other men with AIDS, men with Kaposi's sarcoma had a shorter interval from human immunodeficiency virus (HIV) seroconversion to AIDS diagnosis (median, 77 vs. 86 months). Men with and without Kaposi's sarcoma did not significantly differ with respect to number of sexual partners, history of certain sexually transmitted or enteric diseases, use of certain recreational drugs (including nitrite inhalants), or participation in certain specific sexual practices. The decline in Kaposi's sarcoma may at least partly be due to a shorter latency period from infection to disease. Although cofactors for the development of Kaposi's sarcoma may exist, many previously hypothesized agents were not supported by this analysis.

High-risk sexual behavior and knowledge of HIV antibody status in the San Francisco City Clinic Cohort

To evaluate the effectiveness of human immunodeficiency virus (HIV) testing and counseling among homosexual and bisexual men participating in the San Francisco City Clinic Cohort, compared behavioral data from 181 men who learned their HIV antibody status between 1985 and 1987 with data from 128 men who were tested but declined to receive their results. Overall, significant declines in risk indices for unprotected receptive and insertive anal intercourse occurred between 1983-1984 and 1986-1987, but these declines were independent of both knowledge of HIV status and actual serostatus. Those who chose to learn their HIV status were also no more likely to report depression or to learn their HIV status were also no more likely to report depression or anxiety subsequent to testing. Regression analyses showed no relationship between length of time since learning one's HIV status, mental health symptoms, and the persistence of high-risk behavior in 1986-1987. Although these results do not negate the value of HIV testing and counseling, they suggest that other motivating factors such as frequent access to risk-reduction information may provide sufficient impetus for behavioral change.

Prevalence, incidence, and progression of human immunodeficiency virus infection in homosexual and bisexual men in hepatitis B vaccine trials, 1978-1988

Between 1978 and 1980, 359 hepatitis B seronegative homosexual and bisexual men were recruited from the San Francisco municipal sexually transmitted disease clinic for hepatitis B vaccine trials. Of the 359 participants, 320 (89%) consented to have their stored blood samples tested for human immunodeficiency virus antibodies. The prevalence of human immunodeficiency virus infection in these 320 vaccine trial participants rose from 0.3% in 1978 to 50.9% in 1988. The annual incidence of human immunodeficiency virus infection showed that seroconversion peaked in 1980-1982, dropped significantly in 1983, and has remained low. Men less than 30 years old on entry into the study seroconverted earlier in the epidemic and had higher incidence rates than men 30 years or older (p = 0.07). No statistical difference in seroconversion rates was found for other demographic variables. Using a Kaplan-Meier survival curve of the cumulative proportion of men without acquired immunodeficiency syndrome by duration of human immunodeficiency virus infection, an estimated 39% (95% confidence interval 27%-51%) will develop acquired immunodeficiency syndrome within 9.2 years of infection. Cox proportional hazard stepwise analysis showed no correlation between age at seroconversion, race, or year of seroconversion and progression to acquired immunodeficiency syndrome.

Neurological and neuropsychological manifestations of HIV-1 infection: association with AIDS-related complex but not asymptomatic HIV-1 infection

To determine whether neurological and neuropsychological abnormalities are associated with clinical manifestations of human immunodeficiency virus type 1 (HIV-1) infection in men who do not have acquired immunodeficiency syndrome (AIDS), we performed a historical prospective and cross-sectional study. One hundred HIV-1 seropositive homosexual or bisexual men, of whom 26 had AIDS-related complex, 31 had generalized lymphadenopathy, and 43 had no signs or symptoms of HIV-1 infection, and 157 HIV-1 seronegative men were enrolled from a cohort of 6,701 men who were originally recruited between 1978 and 1980 for studies of hepatitis B virus infection. Evaluation included medical history, physical examination, and neuropsychological tests. Of 26 HIV-1 seropositive subjects with AIDS-related complex, 11 (42%) reported neurological, cognitive, or affective symptoms compared with 30 (19%) of 157 HIV-1 seronegative subjects (relative risk = 2.2, p = 0.02). On neuropsychological testing, subjects with AIDS-related complex performed at a significantly lower level than the HIV-1 seronegative group (p = 0.001). A significantly higher percentage of subjects with AIDS-related complex (8[31%]of 26) than HIV-1 seronegative subjects (19 [12%] of 157) had abnormal results on two or more neuropsychological tests (rate ratio = 2.5, p = 0.03). Symptoms and impairment on neuropsychological tests were correlated only within the group who had AIDS-related complex. Subjects with generalized lymphadenopathy and subjects who had no signs or symptoms of HIV-1 infection were not different from HIV-1 seronegative subjects with respect to symptoms or performance on neuropsychological tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Delta hepatitis in homosexual men in the United States

To assess the incidence and prevalence of delta hepatitis in homosexual men, we tested serum specimens for delta markers in participants in two previous studies: a hepatitis B vaccine trial among homosexual men conducted in the early 1980's and the Centers for Disease Control sentinel counties hepatitis study for 1983-1984. In the vaccine trial, men found to be hepatitis B surface antigen positive at the time of enrollment and those men who had serologic evidence of new hepatitis B virus infection during follow-up were tested. In the sentinel counties study that determined risk factors for viral hepatitis in reported cases, all homosexual men with acute and chronic hepatitis B virus infections were tested for delta markers. Specimens were tested for delta antigen and IgM and total delta antibody. In seven different cities, among 321 men found to be HBsAg positive at the time of screening, eight (2%) were positive for any delta marker. Among 290 men with new hepatitis B virus infections during follow-up, three (two coinfections, one superinfection) had serologic evidence of delta hepatitis. In the sentinel counties study, 0/63 acute hepatitis B virus infections in homosexual men were associated with delta hepatitis. This study indicates that the delta agent is an infrequent cause of viral hepatitis in homosexual men in the United States.

Period, age, and cohort effects on substance use among young Americans: a decade of change, 1976-86

In an earlier article in this Journal, we reported analyses that differentiated among period, age, and cohort effects on substance use among American youth 18 to 24 years old, from the high school classes of 1976 to 1982 during the period of 1976 to 1982. The present analyses extend the classes and years to 1986, and the age range to 18-28. A cohort-sequential design is employed, based on annual surveys of nationally representative samples of high school seniors, plus annual follow-up surveys of each senior class. Twelve different classes of drugs, both licit and illicit, are examined. Several different types of period, age, and cohort effects over the last decade are identified. Alcohol use (monthly and occasions of heavy use), and the use of marijuana, cocaine, amphetamines, methaqualone, barbiturates, LSD, psychedelics other than LSD, and tranquilizers all showed period effects. Occasions of heavy drinking, cigarette smoking, monthly and daily use of alcohol, and annual prevalence of cocaine, amphetamines, barbiturates, LSD, and narcotics other than heroin showed age effects. Class effects were seen for cigarette smoking and daily marijuana use.

Estimating AIDS infection rates in the San Francisco cohort

Between 1978 and 1980 a cohort of approximately 6700 homosexual and bisexual men were recruited from the San Francisco City Clinic to participate in studies of sexually transmitted hepatitis B. Testing frozen blood specimens collected at intervals from these patients provides a means of tracking the spread of the AIDS virus since 1978. The rate of spread of HIV was estimated by fitting different survival curves to interval-censored serological data using maximum likelihood techniques. The curves were compared using the Akaike Information Criterion (AIC) to select that which best describes the data. The best was found to be a log-logistic model, which suggested that between 1978 and 1981 the virus spread rapidly, infecting 44% of the then uninfected cohort members. More recently the rate of spread has declined, with an additional 32% of the cohort becoming infected between 1981 and 1987.

Prior herpes simplex virus type 2 infection as a risk factor for HIV infection

Antibodies to cytomegalovirus (CMV), Epstein-Barr virus (EBV), and herpes simplex viruses types 1 and 2 (HSV-1, HSV-2) in three sequential serum samples from 62 men who did and 61 men who did not develop human immunodeficiency virus (HIV) infection at the time of the final (third) serum specimen were studied. Antibody titers to CMV, EBV, and HSV-1 did not significantly rise in or differ between men who did or did not get HIV infection. However, we found that 32 (68%) of 47 HIV seroconverters had antibodies to HSV-2 at the time the third specimen was drawn, whereas only 26 (46%) of 57 men who remained HIV seronegative had HSV-2 antibody positivity. Seroconversion to HSV-2 between any two serum specimens was found in 11 (42%) of the 26 HIV seroconverters but in only five (14%) of 35 men who remained HIV seronegative. The association between HSV-2 seropositivity (or seroconversion) and subsequent or concurrent HIV seroconversion remained when we controlled for factors known to influence HIV infection, including age, number of sexual partners, and percentage of sexual acts involving receptive anal intercourse. These serologic studies do not support the role of CMV, EBV, or HSV-1 in HIV infection but do suggest that HSV-2 infection is a risk factor for subsequent or concurrent HIV infection.

Male-to-female transmission of human immunodeficiency virus

Ninety-seven female sexual partners of 93 men infected with human immunodeficiency virus were studied. All of the women had sexual contact within the year before their partner had been diagnosed as having acquired immunodeficiency syndrome or was found to have a positive reaction on the human immunodeficiency virus serologic test. Fifty-seven percent were the partners of bisexual men. Overall, 23% of the women were infected (95% confidence interval, 15% to 32%). The total number of exposures to the index case (sexual contacts with ejaculation) and the specific practice of anal intercourse, also with the infected partner, were associated with transmission. Neither condom use, total number of sexual partners since 1978, nor lifetime number of sexually transmitted diseases was associated with infection.

Risk factors for human immunodeficiency virus (HIV) infections in homosexual men

To clarify risk factors for infection with the human immunodeficiency virus (HIV) we selected at random 785 homosexual men who had participated in studies of hepatitis B in San Francisco in 1978-80 for a follow-up study of the acquired immunodeficiency syndrome. Although most had not been contacted in over five years, 492 (63 per cent) were located and enrolled. The 240 (67 per cent) who had developed antibodies to HIV, as measured by an enzyme-linked immunosorbent assay (ELISA), were compared with 119 who had remained seronegative. In multivariate analyses, receptive anal intercourse with ejaculation by nonsteady sexual partners, many sexual partners per month, and other indicators of high levels of sexual activity were highly associated with seroconversions. None of the sexual practices that we studied appeared to offer protection against HIV infection.

Psychotherapeutic, licit, and illicit use of drugs among adolescents. An epidemiological perspective

Using data from an ongoing series of large national surveys of American high school seniors, levels and trends in the use of a number of classes of drugs are reported for the decade 1975-1985. Among the classes included are the medically supervised and the illicit use of the major psychotherapeutic drugs; the use of illegal drugs such as marijuana, cocaine, hallucinogens, and heroin; and the use of cigarettes and alcohol. Physicians' prescriptions to adolescents for minor tranquilizers, barbiturates, and amphetamines are found to have changed over the decade, with considerably fewer seniors reporting such prescriptions today. The prevalence of prescribed opiate-type drugs remains unchanged. The illicit use of these psychotherapeutics has changed in similar ways, and the hypothesis that there is some causal connection between medically supervised use and non-medically supervised use is explored and given some substantiation. Nearly all of the illicitly used drugs have shown some decline in popularity during the past five years, with cocaine use being the notable exception. Alcohol use remained stable at high levels until very recently. Cigarette smoking showed some important declines in the middle of the decade but has since leveled out.

Long-term immunogenicity and efficacy of hepatitis B vaccine in homosexual men

To study the duration of antibody persistence and protection provided by the hepatitis B vaccine, we followed 773 homosexual men for five years after completion of vaccination. Among the 635 participants in whom antibody levels above 9.9 sample ratio units (SRU) developed after vaccination, 15 percent lost antibody altogether, and in another 27 percent, antibody levels declined below 10 SRU within five years. The extent of the maximal antibody response strongly predicted the persistence of protective antibody. Hepatitis B infection occurred in 55 men; 8 of these infections were clinically important (characterized by the presence of the hepatitis B surface antigen and elevation of liver-enzyme levels), and two of the patients became hepatitis B virus carriers. The long-term risk of hepatitis B infection was inversely related to the maximal antibody response to vaccine. Most severe infections occurred among those who responded poorly or had no response to the vaccination. The risk of late infection with hepatitis B in those with an initially adequate vaccine response increased markedly when antibody levels decreased below 10 SRU, but only 1 of 34 late infections resulted in viremia and liver inflammation. A second series of vaccinations induced a moderate antibody response in 50 percent of the subjects who initially had no response or a poor response; however, the persistence of antibody was poor. Both antibody loss and the risk of severe disease should be considered when booster-dose strategies for the hepatitis B vaccine are being designed.

The acquired immunodeficiency syndrome in a cohort of homosexual men. A six-year follow-up study

A cohort of 6875 homosexual men, initially seen at the San Francisco City Clinic between 1978 and 1980, were studied to determine the incidence and prevalence of the acquired immunodeficiency syndrome, related conditions, and infection with the human T-lymphotropic virus, type III/lymphadenopathy-associated virus (HTLV-III/LAV). By December 1984, 2.4% of the men had the syndrome; mortality attributable to the syndrome in 1984 was 600/100 000. For each man with the syndrome in a representative sample of 474 cohort members seen in 1984, 7.5 men had generalized lymphadenopathy, 1.1 had other prodromal findings, and 0.8 had hematologic abnormalities. Prevalence of serum antibodies to HTLV-III/LAV, measured by an enzyme-linked immunosorbent assay, increased from 4.5% in 1978 to 67.4% in 1984. Of 31 persons who were seropositive and without the syndrome between 1978 and 1980, 2 developed the syndrome and 8 developed related conditions during a median follow-up of 61 months. Over a 6-year period, two thirds of cohort members were infected with HTLV-III/LAV and almost one third developed related conditions.

Drug use among young adults: the impacts of role status and social environment

In this article we report findings from panel analyses in which we examined drug use during the first three years following high school, a period during which many young people make important transitions in social environments, primary activity, and marital status. Post-high-school drug use is highly predictable from senior year drug use; however, usage rates for alcohol, marijuana, and other illicit drugs (but not cigarettes) seem also to be influence by post-high-school living arrangements. More specifically, those who continued to live with their parents showed little or no change in their drug use; but among those who moved out of the parental home, those who married showed a decrease in use, those living with a partner of the opposite sex showed some increase in drug use, and those who entered other living arrangements (which include dormitories) also showed an increase in use. These relations were largely unaffected by the inclusion of student status, employment status, and other predictor dimensions.

Drug use among young adults: the impacts of role status and social environment

In this article we report findings from panel analyses in which we examined drug use during the first three years following high school, a period during which many young people make important transitions in social environments, primary activity, and marital status. Post-high-school drug use is highly predictable from senior year drug use; however, usage rates for alcohol, marijuana, and other illicit drugs (but not cigarettes) seem also to be influence by post-high-school living arrangements. More specifically, those who continued to live with their parents showed little or no change in their drug use; but among those who moved out of the parental home, those who married showed a decrease in use, those living with a partner of the opposite sex showed some increase in drug use, and those who entered other living arrangements (which include dormitories) also showed an increase in use. These relations were largely unaffected by the inclusion of student status, employment status, and other predictor dimensions.

Cigarette smoking among high school seniors: did the rate decline?

Some questions about adolescent smoking levels as reported in national surveys were recently raised by M. B. Mittelmark, D. M. Murray, R. N. Luepker, and T. F. Pechacek, [Prev. Med. 11, 708-712 (1982)]: such levels may be underreported, calling into question the decline in adolescent smoking. The present article suggests that the most plausible interpretation of available data is that smoking is, in general, validly reported and that there was a real decline in smoking rates among high school seniors during the period 1977-1981.

Period, age, and cohort effects on substance use among American youth, 1976-82

Period, age, and cohort effects on substance use are differentiated for American youth 18 to 24 years old during the period from 1976 to 1982. The data are provided by the Monitoring the Future project, an ongoing study which employs a cohort-sequential design. Weighted least squares regression is used to find plausible and parsimonious models to account for the observed variation in 12 different classes of drugs, both licit and illicit. The point is made that there are no definitive ways to differentiate among the types of effects; thus, any interpretation is open to debate. Period effects involving increased use occurred for cocaine, amphetamines, and methaqualone, while decreases occurred for barbiturates, tranquilizers, and psychedelics other than LSD. Marijuana showed a curvilinear period effect, first increasing then decreasing. Effects of age were more complex. There were increases in the year after high school for daily cigarette use, but not for monthly use. Monthly and daily alcohol use increased with age. A measure of heavy drinking showed a curvilinear trend, first increasing and then decreasing. Annual use of cocaine showed an increase between the ages of 18 and 21. Annual use of narcotics other than heroin showed a linear age decrease. Clear class (or cohort) effects appeared for cigarette use, with each successive class smoking less.

Reliability and consistency in self-reports of drug use

The reliability and stability of self-reports of licit and illicit drug use are estimated using longitudinal data, and found to be rather high. An apparent inconsistency in reporting (less use over a 12-month period than would be expected based on use reported over a 30-day period) is examined (1) for association with personal characteristics and (2) for individual consistency over time. Neither individual consistency nor significant associations are found, although there appears to be a tendency for discrepant reporting of marijuana and alcohol use to be correlated within time. The data used are from the Monitoring the Future project, an ongoing nationwide study of high school seniors, with follow-up surveys after graduation.

Smoking, drinking, and drug use among American high school students: correlates and trends, 1975-1979

This paper uses findings from five nationally representative surveys of high school seniors from 1975 through 1979 to examine the correlates of licit and illicit drug use, and to consider whether recent changes in youthful drug use are linked to any changes in the correlates. Males still exceed females in use of alcohol and marijuana, but no longer in cigarette smoking. Black seniors now report less drug use than Whites. Other dimensions of family background, region, and urbanicity show only modest associations with drug use. Above average drug use occurs among those less successful in adaptation to the educational environment, as indicated by truancy and low grades; those who spend many evenings out for recreation; and those with heavy time commitments to a job and/or relatively high incomes. Drug use is below average among seniors with strong religious commitments and conservative political views. From 1975 through 1979, among seniors cigarette use peaked and subsequently declined, marijuana use rose and then leveled off, and the (still infrequent) use of cocaine rose rapidly. However, these shifts in drug use were not accompanied by substantial shifts in the above correlates of use. The findings thus suggest that the kinds of young people most at risk remain much the same, while the types and amounts of substances they use shift somewhat from year to year.