Kaylin M. Greene

American Indians, Substance Use, and Sexual Behavior: Do predictors of Sexually Transmitted Infections explain the Race Gap among Young Adults?

Background In this study, we examined whether substance use and risky sexual behaviors predicted sexually transmitted infections (STIs) among American Indian (AI) and white young adults. Furthermore, we explored whether these factors explained the race disparity in STIs. Methods We conducted a cross-sectional analysis of wave 3 of the National Longitudinal Study of Adolescent Health collected in 2001 to 2002. Young adult participants (aged 18–26 years) provided urine specimens that were tested for chlamydia, gonorrhea, and trichomoniasis infection. Estimates of the association between AI with any STI were adjusted for sexual and other risk behavior correlates using multivariate regression techniques. Results Nine percent of AIs (n = 367) and 3.6% of whites (n = 7813) tested positive for an STI. Race differences were found for substance use (injection drug use, 3.1% AI vs. 1.3% white; alcohol use frequency, 2.01% AI vs. 2.5% white; binge drinking frequency, 1.25% AI vs. 1.53% white). Among sexually active respondents, AIs were more likely to have paid for sex (9%) than whites (3%). After adjustment, early sexual initiation (adjusted odds ratio, 1.69; 95% confidence interval, 1.19–2.41), no condom use at last sex (adjusted odds ratio, 1.47; 95% confidence interval, 1.08–2.01), and AI race (adjusted odds ratio, 2.45; 95% confidence interval 1.46–4.11) were significantly associated with having an STI. Conclusions Individual-level sexual and other risk behaviors do not fully explain disparities in STIs among AIs compared with white young adults. Further examination of network and community factors is needed to explain these disparities.

Adult social roles and alcohol use among American Indians

American Indians are disproportionately burdened by alcohol-related problems. Yet, research exploring predictors of alcohol use among American Indians has been limited by cross-sectional designs and reservation-based samples. Guided by a life course developmental perspective, the current study used a subsample of American Indians (n=927) from the National Longitudinal Study of Adolescent Health (Add Health) to explore alcohol use (current drinking, usual number of drinks, and binge drinking) among this population. We examined whether adult social roles (i.e., cohabitation, marriage, parenthood, college enrollment, and full-time work) were linked to the rise and fall of alcohol use. Multi-level models demonstrated that adult social roles were linked to alcohol use at the within- and between-person levels. Becoming a parent was linked to a lower likelihood of being a current drinker, fewer alcoholic drinks, and less frequent binge drinking. Transitioning to full-time work was associated with a higher likelihood of being a current drinker and more frequent binge drinking. Results point to the importance of exploring within-group trajectories of alcohol use and highlight the protective and risky nature of adult social roles among American Indians.

Developmental Assets and Risky Sexual Behaviors Among American Indian Youth

This study examined the relationship between developmental assets during early and mid-adolescence and early adult sexual behaviors among American Indians using a subsample from the National Longitudinal Study of Adolescent Health (N = 465). Grounded in an assets framework, the authors explored the protective role of personal, family, school, and community assets as well as cumulative assets for sexual behaviors including early sexual debut, number of sexual partners, and frequency of condom use. The results indicated that certain assets during early and mid-adolescence, such as self-control, family support, and school attachment, were protective for various risky sexual behaviors in early adulthood. Furthermore, cumulative assets emerged as an important predictor of sexual behaviors. These findings highlight the utility of applying a developmental assets framework to understand protective factors among American Indian youth.

Perceptions of driving after marijuana use compared to alcohol use among rural American young adults

INTRODUCTION AND AIMS Substance use contributes to motor vehicle crashes, the leading cause of death among young adults. The current qualitative study examined perceptions of the acceptability and harms associated with driving after marijuana versus alcohol use in rural America. Illuminating rural perspectives is critical given that the motor vehicle fatality rate is twice as high in rural as in urban areas in the USA. DESIGN AND METHODS In 2015-2016, 72 young adults aged 18-25 years (Mage  = 20.2; 50.7% female) living in Montana, USA, participated in 11 focus groups. A list of descriptive codes was generated inductively and two individuals coded participant comments. Discussion, memoing and concept mapping were used to uncover broader themes and transcripts were reviewed for evidence of these themes. RESULTS There was shared consensus that, with regard to crash risk, driving after marijuana use was safer than driving after alcohol use. While alcohol was thought to impair driving ability universally, marijuanas impacts depended on individual characteristics (e.g. compensatory behaviours) and the marijuana itself (e.g. type). Participants expressed conflicting beliefs about policies surrounding marijuana use and driving but were more knowledgeable about alcohol-related policies. Participants viewed older adults and those in frontier areas as more disapproving of driving after marijuana use. DISCUSSION AND CONCLUSIONS Misinformation about the consequences of driving after marijuana use is common, demonstrating the need for future research and educational interventions. Developing and disseminating guidelines for driving after marijuana use would help marijuana users make informed decisions and mitigate driving-related risks.

Context and culture: Reasons young adults drink and drive in rural America

Montana, a large and rural U.S. state, has a motor vehicle fatality rate almost double the national average. For young adults, the alcohol-related motor vehicle fatality rate in the state is almost three times the national average. Yet little research has explored the underlying reasons that young people in rural areas drink and drive. Drawing from the theory of triadic influence (TTI) and a series of qualitative focus group discussions, the current study examined how aspects of the landscape and culture of rural America promote and hinder drinking and driving among young people. In 2015 and 2016, 72 young adults (36 females) aged 18-25 years old (mean age = 20.2) participated in 11 semi-structured focus groups in 8 rural counties in Montana. Discussions were transcribed, and two reviewers independently coded text segments. Themes were identified and an inductive explanatory model was created. The results demonstrated that aspects of the social context (e.g., peer pressure and parental modeling), rural cultural values (e.g., independence, stoicism, and social cohesion), and the legal and physical environment (e.g., minimal police presence, sparse population, and no alternative transportation) promoted drinking and driving. The results also identified salient protective factors in each of these domains. Our findings demonstrate the importance of examining underlying distal determinants of drinking and driving. Furthermore, they suggest that future research and interventions should consider the complex ways in which cultural values and environmental factors intersect to shape the risky health behaviors of rural populations.