Jonathan G. Tubman

Cumulative sexual intercourse patterns among middle adolescents: Problem behavior precursors and concurrent health risk behaviors

PURPOSE The purpose of this study is to document associations among problem behaviors in childhood and early adolescence and several health risk behaviors in middle adolescence, including a cumulative index of sexual intercourse risk. METHOD A nontreatment sample of 1167 10th and 11th grade students was recruited from three homogeneous suburban high schools in western New York. Intercourse activity and number of sexual partners were assessed four times at 6-month intervals over a 2-year period via self-report questionnaires administered in classroom settings. RESULTS Sexual intercourse activity, once initiated, was found to be relatively persistent, rather than sporadic, for most adolescents. Repeated intercourse experience with multiple partners over the assessed time periods was associated with higher levels of externalizing childhood behavior problems, earlier onset of antisocial behaviors and substance use, and higher concurrent substance use. An avoidant, withdrawn behavioral style in childhood was associated with lower rates of sexual involvement in adolescence. CONCLUSIONS Temporal linkages among childhood precursors and adolescent sexual behaviors were identified as critical to understanding adolescent risk behaviors. These cross-time relationships may identify potential targets for future intervention/prevention efforts among high risk subsamples of children and adolescents.

Understanding and treating juvenile offenders: A review of current knowledge and future directions

Juvenile delinquency is one of our most pressing social problems, with negative emotional, physical, and economic effects felt throughout society. Considering the prevalence, stability, and detrimental impact of juvenile offending, the development of effective treatments is of utmost importance. This article provides an overview of available evidence regarding several key issues pertaining to treatment for juvenile offenders. First, the etiology, continuity, and long-term consequences of juvenile offending are reviewed. Second, factors associated with treatment outcome are discussed. Third, information regarding the most commonly used intervention strategies are provided. These strategies include family/systems, parent and social skills training, cognitive-behavioral, peer group counseling, wilderness programs, and boot camps. Finally, gaps in knowledge, research implications, and future directions are presented.

Associations Between Early-Adolescent Substance Use and Subsequent Young-Adult Substance Use Disorders and Psychiatric Disorders Among a Multiethnic Male Sample in South Florida

OBJECTIVES We examined the associations among early-adolescent substance use, subsequent young-adult substance use disorders, and psychiatric disorders among a community sample of males. METHODS Early-adolescent data were collected in classroom surveys (1990-1993), and young-adult data were collected in face-to-face interviews (1998-2000). RESULTS We found strong associations between early-adolescent substance use and young-adult substance use disorders and psychiatric disorders. The magnitudes of these associations varied by racial/ethnic group and were strongest among African Americans and foreign-born Hispanics, who reported the lowest early-adolescent substance use. CONCLUSIONS Early-adolescent substance use is most strongly associated with a later pattern of dysfunction among the racial/ethnic groups that reported the lowest levels of early use. The implications of our findings in the context of primary and secondary prevention are discussed.

Patterns of sexual risk behaviors and psychiatric disorders in a community sample of young adults

This cross-sectional study documents significant associations between patterns of sexual risk behaviors and psychiatric diagnoses in a multiethnic community sample of young adults (N = 1803) in South Florida. Self-report data regarding sexual behavior and psychiatric symptoms were collected in structured interviews in a follow-up of an earlier school-based study. Cluster analysis was used to group participants with regard to levels of sexual risk behaviors during the past year. Chi-square analysis and ANOVA identified significant associations between cluster membership and (a) lifetime and (b) past year diagnoses for affective disorders, conduct disorder, antisocial personality disorder, alcohol abuse/dependence, marijuana abuse/dependence, and other drug abuse/dependence. In addition, higher levels of sexual risk behaviors were associated with higher levels of cumulative lifetime psychiatric disorders. Implications for selected prevention of sexually transmitted diseases (STDs) and the treatment of psychiatric disorders in young adulthood are discussed.

Continuity of difficult temperament in adolescence: relations with depression, life events, family support, and substance use across a one-year period

This longitudinal study examined the continuity of temperamental difficulty among a school-based sample of middle adolescents (n=975) over a one-year period. Of the participants, 25% were classified as difficult at one or both measurement occasions and over 40% were classified as temperamentally discontinuous. Repeated measures multivariate analyses of covariance analyses identified mean differences in psychosocial functioning by temperamental continuity groups and by gender. Temperamental difficulty was associated with higher levels of depression, stressful life events, use of some substances, and lower levels of perceived family support. Gender differences were indicated for family support, depression, life events, and alcohol use.

Childhood Maltreatment Histories, Alcohol and Other Drug Use Symptoms, and Sexual Risk Behavior in a Treatment Sample of Adolescents

OBJECTIVES We tested a structural model of relations among self-reported childhood maltreatment, alcohol and other drug abuse and dependence symptoms, and sexual risk behavior in a sample of adolescents receiving outpatient treatment of substance use problems. METHODS Structured interviews were administered to an ethnically diverse sample of 394 adolescents (114 girls, 280 boys; mean = 16.30 years; SD = 1.15 years; 44.9% Hispanic, 20.6% African American, 25.4% White non-Hispanic, and 9.1% other) in 2 outpatient treatment settings. RESULTS Path analyses yielded findings consistent with a mediation model. Alcohol abuse and dependence symptoms mediated (1) relations between emotional neglect scores and sex with co-occurring alcohol use and (2) relations between sexual abuse scores and sex with co-occurring alcohol use. Drug abuse and dependence symptoms mediated relations between (1) neglect scores and (2) sexual intercourse with co-occurring alcohol or drug use, as well as unprotected sexual intercourse. CONCLUSIONS Efforts to treat alcohol or drug use problems among adolescents or to prevent transmission of HIV or other sexually transmitted infections among youths with substance use problems may require tailoring treatment or prevention protocols to address client histories of maltreatment.

Co-Occurring Substance Use and Delinquent Behavior during Early Adolescence Emerging Relations and Implications for Intervention Strategies

Self-reported substance use and delinquent behavior were assessed yearly, 3 times beginning in the sixth or seventh grade, for a multiethnic sample of middle school students (n= 5,045). Both substance use and delinquent behavior became more prevalent across early adolescence, but only a small fraction of adolescents were using illicit substances at the end of the study. The proportion of adolescents reporting neither substance use nor delinquent behavior dropped significantly in contrast to the proportion reporting both behaviors. Co-occurring problem behaviors were associated with significantly higher mean levels of each behavior, with increasing group differences over time. In addition, more persistent copatterning of substance use and delinquency was associated with significantly higher levels of nearly every indicator of these problem behaviors at Year 3.

Longitudinal substance use and adult adjustment

Relationships among long-term use patterns of tobacco, alcohol, marijuana, and other substances from late childhood to young adulthood and adjustment in young adulthood were examined. The sample consisted of 133 participants from the New York Longitudinal Study. Cluster analysis revealed four groups of individuals for each of the substance categories, as well as for use of multiple substances, over the five points of measurement. Cluster membership was related to adjustment differences in young adulthood. Results from a series of ANOVAs indicated that individuals consistently using the highest amounts of alcohol and other drugs exhibited the highest levels of psychiatric symptoms. Follow-up analyses indicated that negative emotional-behavioral states in middle childhood precede problematic patterns of substance use. Implications for intervention in childhood are discussed.

Abuse Experiences in a Community Sample of Young Adults: Relations with Psychiatric Disorders, Sexual Risk Behaviors, and Sexually Transmitted Diseases

This study documents significant associations among lifetime abuse experiences, psychiatric diagnoses, and sexual risk behaviors in a multiethnic community sample of young men and women (N = 1803) in South Florida. Self-report data were collected via structured interviews as part of a longitudinal follow-up of a larger school-based study. Participants were grouped according to extent of lifetime abuse experiences. Cumulative lifetime abuse experiences were associated with increased risk for a broad range of individual lifetime psychiatric disorders, as well as cumulative lifetime psychiatric disorders. Both cumulative abuse experiences and cumulative psychiatric disorders were independently associated with (a) higher levels of sexual risk behaviors and (b) higher risk for lifetime sexually transmitted diseases (STDs). Implications for selective prevention of sexual risk behaviors and STDs among young adults with histories of abuse and psychiatric disorders are discussed.

“About last night”: The social ecology of sexual behavior relative to alcohol use among adolescents and young adults in substance abuse treatment

Data were collected in face-to-face interviews from 120 substance-abusing adolescents and young adults (87 men, 33 women; M age = 17.2 years old) recruited from residential and nonresidential treatment facilities in South Florida. Participants described two recent sexual events, one with and one without concurrent alcohol use. Participants described social aspects of these sexual events, actual and intended behaviors, and their feelings about sex in the two alcohol-use contexts. High levels of discrete, risky behaviors occurred in both contexts. Event analysis produced only limited evidence suggesting a higher level of risk in the alcohol-use context. Participants reported less positive feelings about sex when alcohol was used.