Steven Martino

Substance use Trajectories from Early Adolescence to Emerging Adulthood: A Comparison of Smoking, Binge Drinking, and Marijuana use

Over the past several years, there has been growing interest in identifying distinct developmental trajectories of substance use. Using data from the RAND Adolescent/Young Adult Panel Study (N = 6,527), we synthesize our prior findings on patterns of smoking, binge drinking, and marijuana use from early adolescence (age 13) to emerging adulthood (age 23). We also present new data on how these trajectory classes compare on key psychosocial and behavioral outcomes during emerging adulthood. For each type of substance use, we found two periods of vulnerability: early adolescence and the transition to emerging adulthood. As expected, early users were at relatively high risk for poor outcomes at age 23 compared to consistent low-level users and abstainers, even if they reduced their use during adolescence. However, youths who were not early users, but steadily increased their use over time, also tended to be at relatively high risk. Results suggest that multiple prevention approaches might be needed to successfully reach at-risk youths.

Marijuana use from adolescence to young adulthood: Multiple developmental trajectories and their associated outcomes

This study used latent growth mixture modeling to identify discrete developmental patterns of marijuana use from early adolescence (age 13) to young adulthood (age 23) among a sample of 5,833 individuals. After the a priori removal of abstainers, 4 trajectory groups were identified: early high users, who decreased from a relatively high level of use at age 13 to a more moderate level: stable light users, who maintained a low level of use: steady increasers, who consistently increased use; and occasional light users, who began use at age 14 and used at low levels thereafter. Analyses of covariance comparing the trajectory groups on behavioral, socioeconomic, and health outcomes at age 29 revealed that abstainers consistently had the most favorable outcomes, whereas early high users consistently had the least favorable outcomes.

Does Watching Sex on Television Predict Teen Pregnancy? Findings From a National Longitudinal Survey of Youth

OBJECTIVE. There is increasing evidence that youth exposure to sexual content on television shapes sexual attitudes and behavior in a manner that may influence reproductive health outcomes. To our knowledge, no previous work has empirically examined associations between exposure to television sexual content and adolescent pregnancy. METHODS. Data from a national longitudinal survey of teens (12–17 years of age, monitored to 15–20 years of age) were used to assess whether exposure to televised sexual content predicted subsequent pregnancy for girls or responsibility for pregnancy for boys. Multivariate logistic regression models controlled for other known correlates of exposure to sexual content and pregnancy. We measured experience of a teen pregnancy during a 3-year period. RESULTS. Exposure to sexual content on television predicted teen pregnancy, with adjustment for all covariates. Teens who were exposed to high levels of television sexual content (90th percentile) were twice as likely to experience a pregnancy in the subsequent 3 years, compared with those with lower levels of exposure (10th percentile). CONCLUSIONS. This is the first study to demonstrate a prospective link between exposure to sexual content on television and the experience of a pregnancy before the age of 20. Limiting adolescent exposure to the sexual content on television and balancing portrayals of sex in the media with information about possible negative consequences might reduce the risk of teen pregnancy. Parents may be able to mitigate the influence of this sexual content by viewing with their children and discussing these depictions of sex.

Multiple Trajectories of Peer and Parental Influence and their Association with the Development of Adolescent Heavy Drinking

This study used latent growth mixture modeling to identify discrete developmental patterns of heavy drinking, perceived parental disapproval of substance use, and association with peers who drink from early to late adolescence among a sample of 5,591 youth. We also examined associations among these trajectories to determine how the development of heavy drinking relates to the development of perceived parental disapproval of substance use and association with peer drinkers, both separately and jointly. We found that youth who perceived that their parents maintained consistently strong disapproval of substance use throughout adolescence were much more likely to abstain from heavy drinking during this period than were youth who reported that their parents’ disapproval for substance use either decreased or was maintained at only a moderate level. Furthermore, we found that across a variety of peer contexts—stable high association with drinking peers, stable low association, and increasing association—youth were at lowest risk for developing problematic patterns of heavy drinking when they perceived that their parents maintained strong disapproval of substance use throughout adolescence.

Lapse-induced surges in craving influence relapse in adult smokers: an experimental investigation.

OBJECTIVES Nearly all smokers who lapse experience a full-blown relapse, but the mediating mechanisms that contribute to this relationship are not well understood. A better understanding of these mechanisms would help to advance more effective relapse prevention treatments for smokers. The purpose of this study is to experimentally evaluate the effects of a programmed smoking lapse on smoking relapse and the effects of postlapse changes in craving on relapse. METHOD Adult smokers (n = 63) who quit smoking with a brief cognitive-behavioral intervention and self-help materials were randomly assigned to one of two experimental conditions after 48 h of abstinence: No lapse (a no-smoking control/30-min waiting period) or lapse (smoking two cigarettes of their favored brand during a 30-min period). All participants were then followed daily for 14 days. Craving and biochemically verified self-reported abstinence were assessed on each follow-up day. Time (days) to relapse (7 consecutive days of smoking) was the main dependent measure. RESULTS Results of Cox regression analysis revealed that participants in the lapse condition relapsed more quickly than participants in the no-lapse condition (hazard ratio [HR] = 2.12, 95% confidence interval [CI] = [1.03, 4.35]). These effects were attributable, in part, to episodic increases in craving among participants in the lapse condition only (HR = 12.42, 95% CI = [2.00, 77.1]). CONCLUSIONS Previously abstinent smokers who lapse are at risk for increased cigarette cravings and consequently, full-blown relapse. These results have implications for both cognitive-behavioral treatments for relapse prevention and for medications designed to help smokers manage cravings.

Measuring Developmental Changes in Alcohol Expectancies

The goal of this study was to measure shifts in alcohol expectancies from childhood into adolescence while controlling for changes in the psychometric properties of the instrument. One thousand nine hundred ninety-three 4th-grade and 1,632 9th-grade students from South Dakota rated the likelihood that 23 outcomes would result from alcohol use. These expectancies were modeled using a 2-factor confirmatory factor analysis. After differences in the psychometric properties of the instrument were controlled, the cohorts were distinguished by a large difference in Alcohol Positivity, with older participants viewing alcohols effects more positively. Additionally, older participants displayed greater Alcohol Potency, believing that alcohol has a larger impact on all outcomes. There were also significant differences in the interpretation of the alcohol expectancies items across cohorts.

Complexity, Public Reporting, and Choice of Doctors: A Look Inside the Blackest Box of Consumer Behavior

Health care consumers often make choices that are imperfectly informed and inconsistent with their expressed preferences. Past research suggests that these shortcomings become more pronounced as choices become more complex, through either additional options or more performance metrics. But it is unclear why this is true: Consumer choice remains a “black box” that research has scarcely illuminated. In this article, we identify four pathways through which complexity may impair consumer choice. We examine these pathways using data from an experiment in which consumers (hypothetically) selected a primary care physician. Some of the loss of decision quality accompanying more complex choice sets can be explained by consumers’ skills and decision-making style, but even after accounting for these factors, complexity undermines the quality of decision making in ways that cannot be fully explained. We conclude by discussing implications for report designers, sponsors, and policy makers aspiring to promote consumer empowerment and health care quality.

Virginity Pledges Among the Willing: Delays in First Intercourse and Consistency of Condom Use

PURPOSE We examine longitudinal relationships between virginity pledging in adolescence and both sexual initiation and condom use. Prior studies have had mixed results and may not adequately control for prepledge differences between pledgers and nonpledgers. METHODS Data came from a national sample of 12- to 17-year-olds surveyed in 2001 and reinterviewed 1 and 3 years later. Logistic regression models estimated the association between making a pledge and each outcome. Selection bias was reduced through propensity-score weighting and a rich set of demographic and psychosocial covariates. RESULTS Pledgers and nonpledgers differed substantially in preexisting characteristics. However, after propensity weighting and statistical controls, pledging was still associated with delayed intercourse. We estimate that in the absence of pledging 42.4% of virgins with characteristics indicating an inclination to pledge initiate intercourse within 3 years; in the presence of the pledge, 33.6% of such youth initiate intercourse. Among those who had sex during this period, pledging was unassociated with condom use. Among those who did not have sex during this period, pledging was unassociated with engagement in noncoital sexual behavior. CONCLUSIONS Making a virginity pledge appears to be an effective means of delaying sexual intercourse initiation among those inclined to pledge without influencing other sexual behavior; pledging does not appear to affect sexual safety among pledgers who fail to remain abstinent.

Substance use and vulnerability to sexual and physical aggression: a longitudinal study of young adults

Using data from 2,170 individuals who participated in Waves 8 (age 23) and 9 (age 29) of a multiyear panel study, this study examined whether alcohol and marijuana use in young adulthood increase one’s risk for experiencing subsequent sexual or physical assault victimization, whether victims’ own violent behavior or involvement in the sale of drugs explain any effects of substance use on victimization, and whether these associations differ by gender. Controlling for prior victimization, we found that marijuana use, but not alcohol use, predicted women’s and men’s subsequent sexual victimization and men’s subsequent physical assault victimization, and that heavy alcohol use, but not marijuana use, predicted women’s subsequent physical assault victimization. Whereas the links from marijuana use to victimization were explained by users’ own violent behavior, the link from alcohol use to women’s physical assault victimization was not.

If you provide the test, they will take it: factors associated with HIV/STI Testing in a representative sample of homeless youth in Los Angeles.

Homeless youth are at high risk for human immunodeficiency virus (HIV) and other sexually transmitted infections (STI), yet those at greatest risk may never have been tested for HIV or STI. In a probability sample of sexually active homeless youth in Los Angeles (n = 305), this study identifies factors associated with HIV/STI testing status. Most youth (85%) had ever been tested and 47% had been tested in the past 3 months. Recent testing was significantly more likely among youth who self-identified as gay, were Hispanic, injected drugs, and used drop-in centers, and marginally more likely among youth with more depressive symptoms. Drop-in center use mediated the association of injection drug use with HIV/STI testing. HIV/STI testing was unrelated to sexual risk behavior. Drop-in centers can play an important role in facilitating testing, including among injection drug users, but more outreach is needed to encourage testing in other at-risk subgroups.