Brian C. Kelly

Community and Drug Use among Gay Men: The Role of Neighborhoods and Networks

Gay neighborhoods serve as vital places for gay men’s socializing, yet few studies have examined their contributions to gay men’s health—either directly or indirectly via residents’ social networks. Drawing from theoretical perspectives on community and networks, we test hypotheses concerning whether gay neighborhoods and social network factors are associated with patterns of recent illicit drug use among a sample of 740 urban gay men from New York City. Higher odds of drug use were observed among individuals who resided in gay neighborhoods, had networks composed predominantly of other gay men, and had increased socialization with gay men. Network factors did not mediate associations between gay neighborhoods and drug use. These findings highlight the need to better contextualize the health risks faced by gay men by accounting for both neighborhood and network structures.

Polydrug Use Among Club-Going Young Adults Recruited Through Time-Space Sampling

The Club Drugs and Health Project was supported by a grant from the National Institute on Drug Abuse (R01-DA014925–02, Jeffrey T. Parsons, Principal Investigator). Christian Grov was supported as a postdoctoral fellow in the Behavioral Sciences training in drug abuse research program sponsored by Public Health Solutions and the National Development and Research Institutes, Inc. (NDRI) with funding from the National Institute on Drug Abuse (T32 DA07233). The authors recognize the contributions of the Club Drug and Health Project team—Michael Adams, Virginia Andersen, Anthony Bamonte, Jessica Colon, Armando Fuentes, Sarit A. Golub, Chris Hietikko, Eda Inan, Juline Koken, Jose E. Nanin, Anthony Surace, Julia Tomassilli, Jon Weiser, Brooke E. Wells, and the recruitment team. An earlier version of this paper was presented at the 2008 meeting of the College on Problems of Drug Dependence (CPDD). Though some researchers have indicated club drug users are more likely to be polydrug users, there remains little known about the prevalence and specific combinations of the substances they use. Between 2004 and 2006, and using time-space sampling, a stratified sample of 400, 18–29-year-old New York City club-going, drug-using young adults were recruited into the Club Drugs and Health Project. Most participants (91.7%) had engaged in polydrug usage and 1,670 combinations of drugs were reported. Ecstasy (86.6% of users) and cocaine (85.7% of users) were the two most-frequently reported club drugs used in combination with other substances. In terms of poly-club drug combinations, ecstasy appeared to be the “universal compliment” as this drug was most often cited in combinations with other club drugs (specifically ecstasy + ketamine, ecstasy + cocaine, ecstasy + gamma hydroxybutyrate or GHB). Other frequently cited drug combinations included cocaine and marijuana, ecstasy and marijuana, LSD and marijuana, and cocaine and alcohol. These data highlight the need to develop drug health-education and prevention messages targeted at polydrug usage.

Typology of club drug use among young adults recruited using time–space sampling

The present study examined patterns of recent club drug use among 400 young adults (18-29) recruited using time-space sampling in NYC. Subjects had used at least one of six club drugs (methylenedioxymethamphetamine (MDMA), ketamine, gamma-hydroxybutyrate (GHB), cocaine, methamphetamine, and D-lysergic acid diethylamide (LSD)) within the prior 3 months. We used latent class analysis (LCA) to estimate latent groups based on patterns of recent club drug use and examined differences in demographic and psychological variables by class. A 3-class model fit the data best. Patterns were: Primary cocaine users (42% of sample), Mainstream users (44% of sample), and Wide-range users (14% of sample). Those most likely to be Primary cocaine users were significantly less likely to be heterosexual males and had higher educational attainment than the other two classes. Those most likely to be Wide-range users were less likely to be heterosexual females, more likely to be gay/bisexual males, dependent on club drugs, had significantly greater drug and sexual sensation seeking, and were more likely to use when experiencing physical discomfort or pleasant times with others compared to the other two groups. Findings highlight the utility of using person-centered approaches to understand patterns of substance use, as well as highlight several patterns of club drug use among young adults.

Accounting for the social triggers of sexual compulsivity.

Abstract Aims. To examine the social triggers of sexual compulsivity amongst a diverse sample of gay and bisexual men. Design and Participants. Qualitative interviews were conducted with 180 gay and bisexual men in the United States who self-identified that their sex lives were spinning out of control. The data were analyzed using a grounded theory approach to explore the range of social triggers that were driving sexual compulsions. Measurement. An open-ended interview and a structured clinical interview were conducted with each participant. The interviews examined their experiences with sexual compulsivity over time and the impact of their problematic sexual behaviors on their lives. Findings. Two types of social triggers emerged from the data: event-centered triggers and contextual triggers. Event-centered triggers arise from sudden, unforeseen events. Two major event-centered triggers were identified: relationship turmoil and catastrophes. Contextual triggers, on the other hand, have a certain element of predictability, and included such things as location, people, the use of drugs, and pornography. Conclusions. This framework of triggers has clinical implications for the prevention and treatment of sexual compulsivity. Clinicians can utilize the framework of social triggers in the therapeutic process to provide insight into ways to effectively work through symptoms of sexual compulsivity. Awareness of the contextual aspects of sexual compulsivity may be critical to understanding the behaviors of sexually compulsive clients. Thus, therapeutic assessments should focus upon the social context in addition to the psychological components of the disorder.

Conceptions of Risk in the Lives of Club Drug-Using Youth

This paper describes current patterns of club drug use and local conceptions of risk among New York City area youth. The data is drawn from a NIDA-funded ethnographic study of club drug initiation among “Bridge and Tunnel” youth. The paper entails an examination of the harmony and discontinuity between folk models of risk within this population and professional models of risk. The author explores how club drug-using youth conceive of risks related to club drug use, specifically ecstasy, and how such conceptions compare and contrast with current professional models of risk. These conceptions of risk are crucial to understand, as they form an informal logic by which club drug practices are guided. Ultimately, the author examines how the relationship between folk models and professional models might inform health promotion efforts targeting youth.

COMPARING THE EFFECTIVENESS OF TWO FORMS OF TIME-SPACE SAMPLING TO IDENTIFY CLUB DRUG-USING YOUNG ADULTS.

Time-space sampling has been used to generate representative samples of both hard-to-reach and location-based populations. Because of its emphasis on multi-tiered randomization (i.e., time, space, and individual), some have questioned the feasibility of time-space sampling as a cost-effective strategy. In an effort to better understand issues related to drug use among club-going young adults (ages 18 to 29) in the New York City nightlife scene, two variations of time-space sampling methods were utilized and compared (Version 1: randomized venue, day, and individuals within venues: Version 2: randomized venue and day). A list of nightlife venues were randomized and survey teams approached potential participants as they entered or exited venues to conduct brief anonymous surveys. Over the course of 24 months, 18,169 approaches were conducted and 10,678 consented to complete the brief questionnaire (V1 response rate = 46.0%, V2 response rate = 62.5%). Drug use was fairly common, with nearly two-thirds of the sample reporting having ever tried an illegal drug and more than half of drug users specifically tried either MDMA/ecstasy and/or cocaine. There were few differences between young adults surveyed during Version 1 and Version 2. Time-space sampling is an effective strategy to quickly detect and screen club drug users. Although caution is urged, elimination of the third tier of randomization (i.e., individual level counting) from time-space sampling may significantly improve response rates while only minimally impacting sample characteristics.

Examining factorial structure and measurement invariance of the Brief Symptom Inventory (BSI)-18 among drug users

The purpose of this study is to examine the factorial structure of the Brief Symptom Inventory 18 (BSI-18) and test its measurement invariance among different drug using populations. A total sample of 710 drug users was recruited using respondent-drive sampling (RDS) from three states: Ohio (n=248), Arkansas (n=237), and Kentucky (n=225). The results of confirmatory factor analysis (CFA) show: 1) the BSI-18 has a three-factor structure (somatization, depression, and anxiety) with an underlying second-order factor (global severity index of distress); and 2) its factorial structure and metric (factor loadings) are invariant across populations under study. However, the scalars (intercepts) of the BSI-18 items are not invariant, and the means of the latent factors also varied across populations. Our findings provide evidence of a valid factorial structure of the BSI-18 that can be readily applied to studying drug using populations.

Prescription Drug Misuse Among Club Drug-Using Young Adults

Nonmedical prescription (Rx) drug use has recently increased, particularly among young adults. Using time-space sampling to generate a probability-based sample of club-going young adults (18-29), 400 subjects provided data on Rx drug misuse. Club-going young adults misuse Rx drugs at high rates. An overwhelming majority of the sample indicated lifetime use of pain killers, sedatives, and stimulants. A majority indicated recent pain killer use. Variations by gender and sexuality exist in this population. Young lesbian/bisexual women emerged as the group most likely to abuse Rx drugs. Research into the contexts influencing these patterns is imperative.

Patterns of Alcohol Consumption and Sexual Behavior among Young Adults in Nightclubs

Background: Alcohol consumption has been linked to a variety of sexual risk behaviors. However, much research addresses this connection among college students, ignoring other social contexts in which this association may be prevalent, such as club settings. Objectives: As such, this study assessed patterns of drinking and sexual activity among young adults who frequent nightclubs. Methods: Using time-space sampling, we surveyed 308 young adults (ages 18–29) in New York City clubs. Results: Participants reported binge drinking on 52% of drinking days. Roughly, 62% reported recent sex under the influence, and 29% of them reported being less safe in sexual situations as a result of their drinking. Men reported more days of drinking and binge drinking than women, and were more likely to report recent sex under the influence. Younger participants were more likely to report being less safe sexually while intoxicated. Recent binge drinking was associated with sex after drinking. Conclusions and Scientific Significance: These data suggest the need for targeted intervention and prevention efforts at nightclubs.

Prevalence and correlates of prescription drug misuse among socially active young adults

BACKGROUND Prescription drug misuse represents an emerging global drug trend. Data indicate that young adults are misusing prescription drugs at high rates. As such, continued surveillance of the patterns of prescription drug misuse among young adults is critical, particularly for those engaged in social scenes known to accommodate drug use. METHODS Prevalence and correlates of lifetime and recent prescription drug misuse among urban young adults recruited at nightlife venues using time-space sampling are assessed via prevalence estimates and logistic regression analyses. RESULTS In a diverse sample of 1207 young adults, 44.1% reported lifetime prescription drug misuse, and 20.3% reported misuse during the past three months. Stimulants were the most common class of drug respondents misused within the past six months (16.7%), followed by pain killers (16.5%) and sedatives (14.5%). While no gender or sexual orientation differences in misuse prevalence existed, Black youth reported the lowest prevalence of misuse. In multivariate analyses, increased age was associated with lower odds of recent misuse, females report lower odds of recent use, and Black, Asian, and Latino individuals had lower odds of recent misuse than Whites. These odds varied by prescription drug type. Negative binomial regression analyses indicate that, among prescription drug misusers, women misuse prescription drugs less frequently. Younger individuals more frequently misuse stimulants and older individuals more frequently misuse sedatives. Racial variation existed with frequency of use across classes. CONCLUSIONS This study illustrates the need for health promotion efforts targeting prescription drug misuse among young adults who are highly socially active. Future research should focus on motivations for and factors associated with prescription drug misuse within youth cultures. Further research may provide a fuller sense of how to reduce the impact of prescription drug misuse for nations whose prescription drug problem lags behind that of the U.S.