Joy D. Scheidell

Gender and racial/ethnic differences in patterns of adolescent alcohol use and associations with adolescent and adult illicit drug use

Abstract Objectives: The study objective was to use latent class analyses (LCAs) to identify gender- and racial/ethnic-specific groups of adolescent alcohol users and associations between alcohol use group and adolescent and adulthood illicit drug use in a nationally-representative US sample. Methods: We used Wave I (1994–1995, adolescence) of the National Longitudinal Study of Adolescent Health to conduct LCAs by gender and race/ethnicity and measure associations between class membership and Wave I and Wave III (2001–2002, young adulthood) drug use. Participants included white (n = 9548), African American (n = 4005) and Hispanic (n = 3184) participants. LCAs were based on quantity and frequency of adolescent alcohol use; physiological and social consequences of use; and peer use. Results: Males and females were characterized by different alcohol use typologies and consequences. Males in the highest severity class (i.e. drank both heavily and frequently) experienced disproportionate risk of alcohol-related consequences compared with abstainers and other alcohol-using groups. Females who drank heavily when drinking even if only occasionally, experienced high risk of alcohol-related consequences. Substantial proportions of males reported diverse alcohol-related problems, whereas females most commonly reported alcohol-related problems with dating and sexual experiences. Though levels of alcohol use and report of problems associated with use were higher among white versus minority populations, other racial/ethnic differences in patterns of alcohol use were minimal. Classification in any drinking class was a strong risk factor for adolescent and adulthood illicit drug use, with heavy drinkers at greatest risk of drug use. Conclusions: Gender-specific adolescent alcohol and substance use prevention programs are warranted.

The relationships of childhood trauma and adulthood prescription pain reliever misuse and injection drug use

BACKGROUND We examined associations between childhood trauma and adulthood prescription pain reliever misuse (PPRM) and injection drug use (IDU) in a nationally-representative U.S. sample to further understanding of factors associated with these epidemics. METHODS National Longitudinal Study of Adolescent to Adult Health data (N=12,288) yielded nine childhood traumas: neglect; emotional, physical, sexual abuse; parental incarceration and binge drinking; witnessed, threatened with, and experienced violence. We estimated adjusted odds ratios (AOR) and 95% confidence intervals for the association of each trauma and cumulative trauma and drug initiation in emerging and later adulthood. RESULTS Outcome prevalences were 20% (PPRM) and 1% (IDU) in emerging adulthood and 10% PPRM in adulthood. We observed dose-response relationships that varied across outcomes. Cumulative trauma (referent=none) was associated with 34-79% greater odds of PPRM (emerging adulthood) across one to five+ trauma categories. The gradient was most consistent and associations strongest for adulthood PPRM: one trauma AOR=1.46(1.12, 1.91); two AOR=1.71(1.23, 2.36); three AOR=2.16(1.43, 2.36); four AOR=2.70(1.42, 5.62); five+ AOR=3.09(1.52, 6.30). Dose-response was less consistent for IDU, but 4 and 5+ traumas were associated with approximately seven and five times the odds of IDU. Neglect, emotional abuse, and parental incarceration and binge drinking were associated with 25-55% increased odds of PPRM. Sexual abuse and witnessed violence were associated with nearly 3 and 5 times the odds of IDU. CONCLUSIONS Associations between childhood trauma and PPRM/IDU highlight the need for trauma-informed interventions for drug users and early trauma screening and treatment for prevention of drug misuse over the life course.

Associations between blood lead level and substance use and sexually transmitted infection risk among adults in the United States

The effects of low-level lead exposure on neuropsychological status in the United States (US) general adult population have been reported, and the relationship between neuropsychiatric dysfunction and health risk behaviors including substance use and sexual risk taking is well established. However, the potential influence of lead exposure on risk-taking behavior has received little attention. Using the National Health and Nutrition Examination Survey (NHANES) 2005-2010, we estimated multivariable logistic regression models to measure odds ratios (ORs) and 95% confidence intervals (CIs) for the cross-sectional associations between blood lead level and risk behaviors including binge drinking, drug use, and indicator of sexually transmitted infection (STI) risk. STI indicators included past 12 month sexual risk behaviors (age mixing with partners who were at least five years younger or older and multiple partnerships), self-reported STI, and biologically-confirmed herpes simplex virus type 2 (HSV-2) infection. Dose-response like relationships were observed between blood lead and substance use, age mixing with younger and older partners, self-reported STI, and HSV-2. In addition, participants with lead levels in highest quartile versus those with levels in the lowest quartile had over three times the odds of binge drinking and over twice the odds of injection drug or cocaine use in the past 12 months, while being in one of the top two quartiles was significantly associated with 30-70% increased odds of multiple partnerships, sex with older partners, and self-reported and biologically confirmed STI. Results from this study suggested that lead exposure may contribute to substance use, sexual risk-taking, and STI. However, given limitations inherent in the cross-sectional nature of the study, additional studies that use longitudinal data and measure detailed temporal information are warranted.

Borderline Personality Disorder Symptom Severity and Sexually Transmitted Infection and HIV Risk in African American Incarcerated Men.

Background Sexually transmitted infections (STI)/HIV rates are disproportionately high among men involved in the criminal justice system. Mental health disorders, including personality disorders, are also elevated among inmates. Borderline personality disorder (BPD) may be an important risk factor for STI/HIV, yet remains relatively understudied, particularly among inmates. Methods We used baseline data from Project DISRUPT, a cohort study of African American men being released from prison in North Carolina who were in heterosexual relationships at prison entry (n = 189), to assess their STI/HIV risk in the 6 months before incarceration and BPD symptoms focused on emotional lability and relationship dysfunction. We created a continuous BPD symptom severity score and a dichotomous BPD indicator split at the top quartile of the score (BPD-TQ) to examine associations between BPD and STI/HIV outcomes using logistic regression. We also examined associations between individual symptoms and outcomes. Results After adjustment for sociodemographics and antisocial personality disorder, BPD-TQ was associated with sexual risk behaviors including multiple partnerships (adjusted odds ratio, 2.58; 95% confidence interval, 1.24–5.36) and sex with nonmonogamous partners (adjusted odds ratio, 2.54; 95% confidence interval, 1.17–5.51). Prevalence of previous STI (47.5% vs. 29.6%) and prevalent chlamydial infection (6.9% vs. 3.1%) seemed higher in those in BPD-TQ, although the associations were not statistically significant. Associations were similar to those with the continuous score. Borderline personality disorder symptoms most associated with STI/HIV risk were abandonment worry, mood swings, and shifts in opinions. Conclusions Borderline personality disorder is strongly associated with STI/HIV risk in this sample. Researchers should further evaluate the relationship between STI/HIV and BPD, in addition to mood disorders.

Early age at childhood parental incarceration and STI/HIV-related drug use and sex risk across the young adult lifecourse in the US: Heightened vulnerability of black and Hispanic youth

BACKGROUND We measured associations between parental incarceration and STI/HIV-related drug use and sex risk, assessing differences by race, age at first parental incarceration, and potential mediators of the relationship. METHODS We used Waves I (adolescence), III (young adulthood), and IV (adulthood) of the National Longitudinal Study of Adolescent to Adult Health (n = 11,884) to measure associations between age of parental incarceration (never; <8; 8-17; ≥18 years old) and marijuana and cocaine use, multiple partnerships, and STI in adolescence and adulthood among white, Black, and Hispanic participants and assessed mediation by sexual and physical abuse, mental disorder symptoms, and drug use. RESULTS By Wave IV, approximately one in six had experienced a parental incarceration; higher prevalence observed among black (26%) and Hispanic (20%) versus white (15%) respondents (p < 0.0001). Parental incarceration at any age was moderately to strongly associated with STI/HIV risk outcomes. In multivariable models, parental incarceration at age <8 years old (versus never) remained strongly associated with STI/HIV risk in both adolescence and adulthood, with strongest associations among non-whites. Among black participants, parental incarceration at <8 years old was associated with over double the odds of adulthood use of marijuana (adjusted odds ratio (AOR): 2.53, 95% confidence interval: 1.62, 3.95) and cocaine (AOR: 4.41, 95% CI: 2.05, 9.48). Delinquency, drug use, and mood disorders appeared to partially mediate the relationship. CONCLUSIONS Children impacted by parental incarceration constitute priority populations for substance use and STI/HIV prevention and treatment. The unintended consequences of incarceration for children should be considered in decarceration discussions.

Patterns of Mood and Personality Factors and Associations With STI/HIV-Related Drug and Sex Risk Among African American Male Inmates

ABSTRACT Background: Research on the association between antisocial personality disorder (ASPD) with comorbid mental disorders and sexually transmitted infection (STI)/HIV risk among inmates is scant despite the high prevalence of psychopathology and of STI/HIV in this population. Methods: We used baseline data from Project DISRUPT, a cohort study conducted among incarcerated African American men (n = 207), to measure associations between ASPD and STI/HIV risk. We also conducted latent class analyses (LCAs) to identify subgroups defined by ASPD with comorbid stress, depression, and borderline personality disorder symptoms and measured associations between latent class membership and STI/HIV risk. Results: Approximately 15% had ASPD and 39% reported depression. Controlling for sociodemographics, stress, and depression, ASPD was independently associated with illicit [AOR = 3.23, 95% confidence interval (CI): 1.18–8.87] and injection drug use (AOR: 5.49, 95% CI: 1.23–24.42) but not with sexual risk. LCAs suggested that those at high risk of ASPD were likely to experience co-morbid mental disorders. ASPD comorbid with these disorders was linked to drug and sex risk. Conclusions: STI/HIV prevention for inmates should incorporate diagnosis and treatment of ASPD and comorbid disorders, and interventions to address ASPD-related factors (e.g., impulsivity) that drive STI/HIV risk.

Group sex event participation: a link to STI risk among African-American heterosexual men incarcerated in North Carolina

Group sex events (GSEs) among heterosexuals and other groups may facilitate STI transmission by contributing to rapid partner exchange and links to high-risk partners.1 ,2 Using baseline (in-prison) data from DISRUPT (Disruption of Intimate Stable Relationships Unique to the Prison Term) (n=142), a cohort study conducted among African-American men incarcerated in North Carolina, USA, who were in committed heterosexual relationships at prison entry, we measured preincarceration GSE participation and other …

Adverse Experiences in Childhood and Sexually Transmitted Infection Risk From Adolescence Into Adulthood

Background Childhood maltreatment, particularly sexual abuse, has been found to be associated with sexual risk behaviors later in life. We aimed to evaluate associations between a broad range of childhood traumas and sexual risk behaviors from adolescence into adulthood. Methods Using data from Waves I, III and IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), we used logistic regression to estimate the unadjusted odds ratio (OR) and adjusted OR (AOR) for associations between 9 childhood traumas and a cumulative trauma score and three sexual risk outcomes (multiple partnerships, sex trade involvement, and sexually transmitted infection [STI]) in adolescence, young adulthood, and adulthood. We also examined modification of these associations by gender. Results Associations between cumulative trauma score and sexual risk outcomes existed at all waves, though were strongest during adolescence. Dose-response–like relationships were observed during at least 1 wave of the study for each outcome. Violence exposures were strong independent correlates of adolescent sexual risk outcomes. Parental binge drinking was the only trauma associated with biologically confirmed infection in young adulthood (AOR, 1.46; 95% confidence interval [CI], 1.01–2.11), whereas parental incarceration was the trauma most strongly associated with self-reported STI in adulthood (AOR, 1.70; 95% CI, 1.11–2.58). A strong connection was also found between sexual abuse and sex trade in the young adulthood period (AOR, 2.17; 95% CI, 1.43–2.49). Conclusions A broad range of traumas are independent correlates of sex risk behavior and STI, with increasing trauma level linked to increasing odds of sexual risk outcomes. The results underscore the need to consider trauma history in STI screening and prevention strategies.

Child Sexual Abuse and HIV-Related Substance Use and Sexual Risk Across the Life Course Among Males and Females

ABSTRACT Child sexual abuse is associated with substance use and sexual risk behaviors during adolescence and adulthood, but no known studies have documented associations across the life course in a nationally representative U.S. sample. We used the National Longitudinal Study of Adolescent to Adult Health to measure associations between child sexual abuse and substance use and sexual risk behaviors during adolescence, young adulthood, and adulthood among males and females (n = 11,820). Approximately 10% of females and 7% of males reported child sexual abuse. Associations with substance use were strongest during adolescence and lessened over time. Increased odds of sexual risk among those with a history of child sexual abuse remained consistent through the life course. Significant gender differences existed for some associations (e.g., adulthood multiple partners: males adjusted odds ratio (AOR) = 1.73, 95%CI:1.18, 2.53; females AOR = 1.11, 95%CI:0.79, 1.56). Trauma-informed prevention interventions should address child sexual abuse among both males and females to prevent substance use and sexual risk behavior throughout the life course.

Depression, Executive Dysfunction, and Prior Economic and Social Vulnerability Associations in Incarcerated African American Men:

Low executive function (EF) and depression are each determinants of health. This study examined the synergy between deficits in EF (impaired cognitive flexibility; >75th percentile on the Wisconsin Card Sorting Test perseverative error score) and depressive symptoms (modified Centers for Epidemiologic Studies–Depression) and preincarceration well-being among incarcerated African American men (N = 189). In adjusted analyses, having impaired EF and depression was strongly associated with pre-incarceration food insecurity (odds ratio [OR] = 3.81, 95% confidence interval [CI] = [1.35, 10.77]), homelessness (OR = 3.00, 95% CI [1.02, 8.80]), concern about bills (OR = 3.76, 95% CI [1.42, 9.95]), low significant other support (OR = 4.63, 95% CI [1.62, 13.24]), low friend support (OR = 3.47, 95% CI [1.30, 9.26]), relationship difficulties (OR = 2.86, 95% CI [1.05, 7.80]), and binge drinking (OR = 3.62, 95% CI [1.22, 10.80]). Prison-based programs to treat depression and improve problem-solving may improve postrelease success.