Sara A. Vasilenko

Changes in gender and racial/ethnic disparities in rates of cigarette use, regular heavy episodic drinking, and marijuana use: ages 14 to 32.

BACKGROUND The purpose of this study is to investigate disparities in substance use behaviors across gender and race/ethnicity as a flexible function of age from mid-adolescence through young adulthood. METHODS Using data from the National Longitudinal Study of Adolescent Health, the time-varying effect model (TVEM) was used to examine gender and racial/ethnic differences in the prevalence of cigarette use, regular heavy episodic drinking (HED), and marijuana use as a smooth function of developmental age. RESULTS Prevalence of cigarette use, regular HED, and marijuana use was higher for males than females overall, although gender differences varied with age. With regard to race, prevalence of each substance was higher for White than Hispanic or Black individuals; these differences increased considerably from ages 16 to 20, particularly for cigarette use. Differences in cigarette use by race/ethnicity were found across age, but were largest at age 18, when cigarette use peaks for White individuals, but continues to climb throughout the 20s among Hispanic and Black individuals. CONCLUSIONS These results suggest that substance use, particularly for certain population subgroups, increases past early adolescence. Disparities in substance use behaviors fluctuate considerably throughout adolescence and young adulthood, suggesting that targeted intervention programs are more critical at particular ages. These findings also demonstrate that TVEM can advance our understanding of health risk behaviors and their correlates across developmental time.

Short-Term Positive and Negative Consequences of Sex Based on Daily Reports Among College Students

Because sexual behavior may be associated with a broader range of outcomes than physical consequences like sexually transmitted infections and pregnancy, it is important to understand consequences of sex that may influence mental and social well-being in emerging adulthood. This article describes the short-term intrapersonal and interpersonal consequences reported by college students on days they engage in vaginal sex and what factors predict experiencing particular consequences. Data are from first-year college students who reported vaginal sex on at least one of 28 sampled days (mean age = 18.5 years; 53% female; 30% Hispanic/Latino [HL]; of non-HL participants, 30% were African American, 22% were Asian American, 35% were European American, and 12% were multiracial; N = 209 people and N = 679 person days). Participants reported positive consequences more frequently than negative consequences. Non-use of contraception and sex with a non-dating partner were associated with greater odds of reporting negative consequences. These findings have implications for messages about casual sex and use of contraception in sex education and sexual health programming.

Advancing the Understanding of Craving During Smoking Cessation Attempts: A Demonstration of the Time-Varying Effect Model

INTRODUCTION Advancing the understanding of smoking cessation requires a complex and nuanced understanding of behavior change. To this end, ecological momentary assessments (EMA) are now being collected extensively. The time-varying effect model (TVEM) is a statistical technique ideally suited to model processes that unfold as behavior and nicotine dependence change. Coefficients are expressed dynamically over time and are represented as smooth functions of time. METHODS The TVEM approach is demonstrated using data from a smoking-cessation trial. Time-varying effects of baseline nicotine dependence (a time-invariant covariate) and negative affect (a time-varying covariate) on urge to smoke during a quit attempt were estimated for monotherapy, combination therapy, and placebo groups. SAS syntax for conducting TVEM is provided so that readers can adapt it for their research. RESULTS During the first 2 days after quitting, the association between negative affect and craving was significantly stronger among individuals in the placebo group, suggesting an early positive impact of treatment. For the monotherapy and combination therapy groups, during the second week of the quit attempt, baseline dependence was less strongly related to craving compared with the placebo group, indicating a different positive impact of treatments later in the quit attempt. CONCLUSIONS The results reveal information about the underlying dynamics that unfold during a quit attempt and how monotherapy and combination therapy impact those processes. This suggests possible mechanisms to target in an intervention and indicates timepoints that hold the greatest promise for effective treatment. TVEM is a straightforward approach to examining time-varying processes embedded in EMA.

Predictors of Multiple Sexual Partners From Adolescence Through Young Adulthood

PURPOSE To examine time-varying associations between predictors of recent multiple sexual partners from middle adolescence through young adulthood. METHODS We examined whether the odds of multiple partners in the past year were differentially predicted by substance use and depression over time, using data from a nationally representative longitudinal study (N = 11,963, 52.2% female, 18.3% African-American, 11.9% Hispanic, 3.5% Asian, 2.6% other race, M age at Wave I = 16.1 years, SD = 1.8). Data were analyzed using the time-varying effect model, which estimates associations between predictors and an outcome as a function of near-continuous time. RESULTS The proportion of participants having multiple partners increased over time, leveling off at around 30% after age 20. Significant positive associations between substance use and multiple partners were strongest early in adolescence and decreased sharply by around age 18. The significant positive association between depression and sexual behavior weakened with age, remaining significant in young adulthood for women but not men. CONCLUSIONS These findings suggest that factors associated with having multiple recent sexual partners change from middle adolescence through young adulthood. The time-varying effect model can be used to identify risk factors that are especially salient at different ages, thus identifying which age periods may hold the greatest promise for intervention.

Body Image and First Sexual Intercourse in Late Adolescence.

Sexual behavior is associated with body image, but the directionality of this association is unclear. This study used longitudinal data from a sample of previously abstinent college students (N = 100, 45% female, 49% European American, 26% Latino American, 25% African American) to test whether satisfaction with appearance changed after first intercourse. Male students were more satisfied with their appearance after first intercourse, whereas female students became slightly less satisfied with their appearance. These findings demonstrate that first intercourse can lead to changes in well-being, even if the transition takes places in late adolescence. In addition, they suggest that gendered cultural expectations regarding sexual behavior are associated with differing psychological outcomes for male and female adolescents.

Time-Varying Processes Involved in Smoking Lapse in a Randomized Trial of Smoking Cessation Therapies

INTRODUCTION Researchers have increasingly begun to gather ecological momentary assessment (EMA) data on smoking, but new statistical methods are necessary to fully unlock information from such data. In this paper, we use a new technique, the logistic time-varying effect model (logistic TVEM), to examine the odds of smoking in the 2 weeks after a quit attempt. METHODS Data are from a subsample of participants from a randomized, placebo-controlled trial of smoking cessation pharmacotherapies who achieved initial abstinence (N = 1,106, 58% female). Participants completed up to 4 EMA assessments per day during the 2 weeks after their quit day. Predictors include baseline nicotine dependence, EMA measures of craving and negative affect, and whether an individual was assigned to a placebo, monotherapy, or combination therapy condition. Time-varying effects of these predictors were estimated using logistic TVEM. RESULTS Cravings were a significant predictor of smoking throughout the entire 2 weeks postquit, whereas the effect of baseline dependence became nonsignificant by the second week, and the effect of negative affect increased over time. Individuals in the monotherapy and combination therapy conditions had decreased odds of smoking compared with placebo in the first week postquit, but these differences were nonsignificant in the second week. CONCLUSIONS Findings suggest that pharmacotherapies are more effective compared with placebo earlier in a quit attempt, when the effect of baseline nicotine dependence on smoking is stronger, whereas the effect of craving and negative affect increased over time. Future cessation therapies may be more successful by providing additional support in the second week after quit attempt.

Age-varying associations between substance use behaviors and depressive symptoms during adolescence and young adulthood.

BACKGROUND Substance use and depression often co-occur, complicating treatment of both substance use and depression. Despite research documenting age-related trends in both substance use and depression, little research has examined how the associations between substance use behaviors and depression changes across the lifespan. METHODS This study examines how the associations between substance use behaviors (daily smoking, regular heavy episodic drinking (HED), and marijuana use) and depressive symptoms vary from adolescence into young adulthood (ages 12-31), and how these associations differ by gender. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we implemented time-varying effect models (TVEM), an analytic approach that estimates how the associations between predictors (e.g., substance use measures) and an outcome (e.g., depressive symptoms) vary across age. RESULTS Marijuana use and daily smoking were significantly associated with depressive symptoms at most ages from 12 to 31. Regular HED was significantly associated with depressive symptoms during adolescence only. In bivariate analyses, the association with depressive symptoms for each substance use behavior was significantly stronger for females at certain ages; when adjusting for concurrent substance use in a multivariate analysis, no gender differences were observed. CONCLUSIONS While the associations between depressive symptoms and both marijuana and daily smoking were relatively stable across ages 12-31, regular HED was only significantly associated with depressive symptoms during adolescence. Understanding age and gender trends in these associations can help tailor prevention efforts and joint treatment methods in order to maximize public health benefit.

Understanding the Role of Cessation Fatigue in the Smoking Cessation Process

BACKGROUND To understand the dynamic process of cessation fatigue (i.e., the tiredness of trying to quit smoking) with respect to its average trend, effect on relapse, time-varying relations with craving and negative affect, and differences among genders and treatment groups. METHOD Randomized placebo-controlled clinical trial. Participants received either placebo, monotherapy (bupropion SR, nicotine patch, nicotine lozenge), or combined pharmacotherapy (bupropion SR+nicotine lozenge, nicotine patch+nicotine lozenge). Data were collected from 1504 daily smokers who were motivated to quit smoking. The participants completed baseline assessments and ecological momentary assessments for 2 weeks post-quit. RESULTS Cessation fatigue reduced the likelihood of 6-month post-quit abstinence (OR=0.97, 95% CI (0.95, 0.99)), and was positively associated with craving and negative affect. After controlling for these two factors, average cessation fatigue increased over time. Compared to men, women experienced greater fatigue (t=-10.69, p<0.0001) and a stronger relation between fatigue and craving (t=-8.80, p<0.0001). The relationship between fatigue and negative affect was significantly stronger in men (t=5.73, p<0.0001). Cessation fatigue was significantly reduced by combined pharmacotherapy (t=-13.4, p<0.0001), as well as monotherapy (t=-6.2, p<0.0001). CONCLUSIONS Cessation fatigue was closely related to craving, negative affect, and cessation outcomes. Women reported greater cessation fatigue than men. Current treatments appeared to reduce fatigue and weaken its relations with craving and negative affect.

“It Felt Good but Weird at the Same Time”: Emerging Adults’ First Experiences of Six Different Sexual Behaviors

Although sexual behavior is multidimensional, little research has focused on the experience of nonintercourse behaviors for adolescents and emerging adults. This article uses open-ended coded data from a longitudinal study of college students (N = 346; M age = 18.5, 52% female, 27% Hispanic/Latino [HL], 25% non-HL European American, 23% non-HL Asian American, 16% non-HL African American, 9% non-HL multiracial) to examine what emotional responses emerging adults report about their first experiences of six sexual behaviors. The four most common emotional reactions were happy, excited, fearful, and indifferent. Descriptions were largely positive, although mixed reactions were relatively common and emotional reactions varied by behavior. Results suggest the importance of including multiple types of sexual behaviors, as well as their possible positive and negative outcomes, in sexuality education programs.

New methods shed light on age of onset as a risk factor for nicotine dependence.

INTRODUCTION Early onset of substance use is a risk factor for later drug use, abuse, and dependence. This study examines how the rate of nicotine dependence differs as a function of age of onset of regular smoking in continuous time, in order to identify critical age periods that are most predictive of later dependence for males and females. METHODS Time-varying effect modeling (TVEM) can reveal specific ages of onset that confer greatest risk for adult nicotine dependence. The rate of dependence in adulthood is modeled as a flexible function of age of onset using a subset of adults (N = 15,748) from the National Epidemiologic Survey on Alcohol and Related Conditions who ever smoked regularly. RESULTS The peak risk of adult nicotine dependence coincides with onset of regular use at approximately 10 years old, with an elevated risk persisting to 20 years. The risk of dependence is significantly higher for females compared to males for onset of regular use between ages 9 and 18. CONCLUSIONS Results suggest that the risk of adult nicotine dependence is highest when onset of regular smoking occurs at around 10 years, though the associated risk is high for ages of onset into young adulthood. Early onset of regular use is a relatively stronger risk factor for adolescent females than males. Smoking prevention programs should focus on late childhood through early adolescence, particularly among females. TVEM provides a more nuanced understanding of the risk associated with different ages of onset of health risk behaviors.