Psychological Distress,Substance Use,and HIV/STI Risk Behaviors Among Youth

Psychological distress has been inconsistently associated with sexual risk behavior in youth, suggesting additional factors, such as substance use, may explain this relationship. The mediating or moderating role of substance use on the relationship between psychological distress and sexual risk behaviors was prospectively examined over the four high school years in a sample of urban youth (N = 850; 80% African American; 50% female). Growth curve modeling was used to estimate changes in sexual risk across adolescence and to test its association to psychological distress symptoms and frequency of substance use. Substance use was associated with psychological distress. Greater psychological distress was associated with increased sexual intercourse frequency, decreased condom use, and increased number of partners. Substance use fully mediated the relationship between psychological distress and intercourse frequency and condom use, and partially mediated the relationship between psychological distress and number of partners. We found no differences in mediation by sex or race/ethnicity and no evidence to support moderation of psychological distress and substance use on sexual risk. Findings suggest that psychological distress is associated with sexual risk because youth with greater psychological distress are also more likely to use substances. Practical implications for adolescent HIV/STI prevention are discussed.     

Social Networks of Homeless Youth in Emerging Adulthood

Little is known about the social networks of homeless youth in emerging adulthood despite the importance of this information for interventions to reduce health risks. This study examined the composition of social networks, and the risks and supports present within them, in a random sample of 349 homeless youth (33.4% female, 23.9% African American, 17.7% Hispanic) between the ages of 18 and 24. Social network members who were met on the street were among the most likely to be perceived as engaging in risky sex, as well as to engage in substance use with the youth. Youth were more likely to count on relatives and sex partners for support compared to other network members, but they also were more likely to use substances with sex partners and perceived them as engaging in risky sex. Interventions may need to recognize the importance of intimate relationships during the developmental stage of emerging adulthood by enhancing supportive bonds and reducing substance use and risky sex in these relationships.     

The Longitudinal Relationships Between Rural Adolescents’ Prosocial Behaviors and Young Adult Substance Use

While many adolescents and young adults experiment with substances (e.g., alcohol, cigarette smoking, marijuana), recent research suggests that rural youth and young adults may be more at risk for substance use than their urban counterparts. This study was designed to examine the longitudinal relationships between rural adolescents’ prosocial behaviors and substance use in young adulthood. Furthermore, we examined the potential mediating effects of adolescent substance use, academic investment, and delinquency. Rural youth (N = 531; 263 girls) were surveyed in grades 10–12 (Time 1; M age = 16.17; SD = .91) and again in early adulthood (Time 2). Measures of prosocial behaviors, substance use, academic investment, and deviant activities were assessed at Time 1. At Time 2, measures of marijuana use, cigarette smoking, and getting drunk were administered. Overall, the findings showed that rural adolescents who frequently exhibit prosocial behaviors are less likely to engage in substance use in young adulthood than those who exhibit relatively low levels of prosocial behaviors. These findings indicate that prosocial behaviors may have positive health consequences, establishing behavioral trajectories that lead to lower levels of risky health behaviors in adulthood in rural populations.     

Predictors of Homelessness Among Street Living Youth

While few studies have identified predictors of exiting homelessness among adults, even fewer studies have attempted to identify these predictors among homeless youth. The current study explored predictors of change in homelessness among 180 homeless youth between the ages of 14 and 22, recruited through an urban drop-in center. All youth were assessed at baseline, 3 and 6 months. The sample included 118 males and the reported ethnicity included Latino (n = 54), Anglo (n = 73), Native American (n = 24), African American (n = 6) and mixed ethnicity or “other” (n = 23). Four distinct patterns of change in homelessness were identified among youth which included those who (1) had fairly low rates of homelessness at each follow-up point, (2) started in the mid-range of homelessness, increased at 3 months and sharply declined at 6-months (MHL), (3) reported high rates of homelessness at baseline and low rates at each follow-up point (HLL), and finally, (4) remained consistently homeless across time (HMH). These patterns of change were most strongly predicted by social connections and engagement in HIV risk behaviors. The findings from this study suggest that developing trust and linkages between homeless youth and service providers may be a more powerful immediate target of intervention than targeting child abuse issues, substance use and mental health problems.

Sexual Behavior and Perceived Peer Norms: Comparing Perinatally Hiv-infected and Hiv-affected Youth

A large proportion of perinatally HIV-infected (PHIV) children are becoming adolescents and exploring their sexuality. This study explored the prevalence of sexual behaviors (kissing, touching, engaging in oral sex, or having vaginal/anal intercourse) in a sample of predominantly ethnic minority youths (N = 339; 54.1% Black and 30.4% Latino; 51% female; ages 9–16) perinatally exposed to HIV (61% HIV+). Using logistic regression, we tested the association between sexual behavior and HIV status, demographic characteristics, and peer influences regarding sexual behavior. PHIV youth were less likely to be sexually active. Among sexually active youth, PHIV youth were more likely to engage in touching behavior than HIV-negative youth and were less likely to engage in penetrative sex. Youths reporting that a greater number of their peers believed that sexually active boys were “cool” or “popular” were more likely to report sexual behavior. The association between sexual behavior and peers believing sexually active girls were “cool” or “popular” varied by age, gender, and HIV status. Furthermore, friends’ sexual activity was associated with sexual intercourse. Prevention programs should strengthen messages addressing peer norms regarding sexuality, as well as address specific issues related to adolescent HIV.

Ethnic Label Use in Adolescents from Traditional and Non-Traditional Immigrant Communities

Understanding adolescents’ use of ethnic labels is a key developmental issue, particularly given the practical significance of identity and self-definition in adolescents’ lives. Ethnic labeling was examined among adolescents in the traditional immigrant receiving area of Los Angeles (Asian n = 258, Latino n = 279) and the non-traditional immigrant receiving area of North Carolina (Asian n = 165, Latino n = 239). Logistic regressions showed that adolescents from different geographic settings use different ethnic labels, with youth from NC preferring heritage and panethnic labels and youth from LA preferring hyphenated American labels. Second generation youth were more likely than first generation youth to use hyphenated American labels, and less likely to use heritage or panethnic labels. Greater ethnic centrality increased the odds of heritage label use, and greater English proficiency increased the odds of heritage-American label use. These associations significantly mediated the initial effects of setting. Further results examine ethnic differences as well as links between labels and self-esteem. The discussion highlights implications of ethnic labeling and context.     

Risky Sexual Behavior: A Race-specific Social Consequence of Obesity

Scant attention has been given to the consequence of actual weight status for adolescents’ sexual wellbeing. In this article, we investigate the race-specific connection between obesity and risky sexual behavior among adolescent girls. Propensity scores and radius matching are used to analyze a sample of 340 adolescents aged 16–17 who participated in the National Longitudinal Survey of Youth Young Adult Survey in 2000 or 2002. Nearly even numbers of these participants identified as white and black (183 and 157, respectively). We find that compared to their non-obese white peers, obese white adolescent girls exhibit higher rates of multiple sex partners and sex with older partners, and are also less likely to use condoms. None of these factors are significantly related to high BMI within the black sample. These findings indicate that the negative social consequences of obesity extend beyond future economic and marriage outcomes to adolescent white women’s sexual outcomes. They also highlight the importance of context: the implications of being obese during adolescence depend on cultural meanings of obesity.     

Who Gives and Who Gets: Why,When, and with Whom Young People Engage in Oral Sex

Surprisingly little is known about oral sex experiences among emerging adults, including the motives behind their participation in this sexual activity. The current study examined the characteristics of emerging adults’ most recent oral sex experience. A total of 431 young people (M age = 21.7 years; 71.7% female) completed an on-line survey assessing their sexual history, context (partner type, co-occurring sexual behaviors), and motives (physical, emotional, goal attainment, and insecurity) for engaging in their most recent heterosexual oral sex interaction. The majority of oral sex encounters occurred within the context of a committed relationship and during an interaction that also included intercourse. Cunnilingus was rare unless reciprocated with fellatio. Overall, both males’ and females’ reports indicate that they were motivated to engage in oral sex by sexual desire and attraction to their partner, or to enhance an emotional connection with their partner. Insecurity and goal attainment motives were uncommon. Males reported more physical motives than did females, and females reported more emotional and insecurity motives than did males. The findings provide insights into youths’ oral sex experiences, and make clear how essential it is to understand the broader sexual and partnership context in which a given sexual activity occurs. These findings have implications for policies aimed at the development of effective sexual health education programs.     

Protective Predictors of Alcohol Use Trajectories Among Canadian Aboriginal Youth

Some Aboriginal youth are at disproportionate risk of using substances and developing abuse and dependence disorders. However, not all Aboriginal youth misuse substances and limited research has examined the protective factors conferring against substance use among these youth. The present study aimed to identify protective factors related to the alcohol use trajectories from early adolescence to emerging adulthood among off-reserve Canadian Aboriginal youth. Participants (N = 330; 50.3% male) aged 12–23 were selected from cycles 2–7 of Statistics Canada’s NLSCY. Multilevel modeling was employed to identify protective factors for two constructs of alcohol use. Participation in weekly activities and optimism were found to be protective for both the frequency of alcohol use and heavy drinking trajectories. Attendance of religious services was also found to be protective for heavy drinking behaviors. In contrast, positive peer relationships were a risk factor for frequency of alcohol use, but not heavy drinking. The results provide preliminary evidence of important developmental factors to integrate into substance use intervention programs targeting Aboriginal youth.     

Pubertal Timing and Early Sexual Intercourse in the Offspring of Teenage Mothers

Early puberty is associated with stressful family environments, early sexual intercourse, and teenage pregnancy. We examined pubertal timing and sexual debut among the 14-year-old offspring of teenage mothers. Mothers (71% Black, 29% White) were recruited as pregnant teenagers (12–18 years old). Data were collected during pregnancy and when offspring were 6, 10 and 14 years old (n = 318). Adolescents (50% male) compared the timing of their pubertal maturation to same-sex peers. There was a significant 3-way interaction effect of race, sex, and pubertal timing on sexual debut (n = 305). This effect remained significant in a model controlling for maternal age at first intercourse, substance use, exposure to trauma, authoritative parenting, and peer sexual activity (n = 255). Early maturation was associated with early sex in daughters, and may be one pathway for the inter-generational transfer of risk for teenage pregnancy among daughters of teenage mothers.     

Sexual Attraction and Trajectories of Mental Health and Substance Use During the Transition from Adolescence to Adulthood

Previous research suggests that sexual minority youth have poorer health-related outcomes than their heterosexual peers. The purpose of this study is to determine whether sexual orientation disparities in mental health and substance use increase, decrease, or remain the same during the transition from adolescence to adulthood. Data are from Waves 1–4 of the National Longitudinal Study of Adolescent Health (n = 8,322; 55% female). Respondents were in grades 7–12 at Wave 1 and aged 24–32 at Wave 4. Latent growth curve modeling is used to compare the mental health and substance use trajectories of youth who consistently report heterosexual attraction versus those who consistently report lesbian, gay, or bisexual (LGB) attraction, those who report a transition to LGB attraction, and those who report a transition to heterosexual attraction. Among women and men, sexual orientation disparities in depressive symptoms and suicidal thoughts persist, but do not increase, during the transition from adolescence to adulthood. The same pattern is observed for disparities in smoking, heavy drinking, and marijuana use among women. Among men, disparities in substance use are only observed between those who report consistent heterosexual attraction and those who transition to heterosexual attraction. Disparities between these groups persist over time for heavy drinking and marijuana use but decrease over time for smoking. While this study finds evidence of numerous disparities in mental health and substance use outcomes during adolescence and young adulthood, particularly among young women, there is no indication that these disparities get larger over time.     

Acculturation and Sexual Risk Behaviors Among Latina Adolescents Transitioning to Young Adulthood

Latinas in the United States are at a disproportionate risk for STDs and sexual risk behaviors. Among Latinas, acculturation has been found to be one of the most important predictors of these behaviors. Therefore, this study examined the longitudinal association between Latina adolescents’ level of acculturation and multiple sexual risk outcomes, including self-report STD diagnosis, four or more life-time sex partners, regret of sexual initiation after alcohol use, and lack of condom use during young adulthood. Based on the National Longitudinal Study of Adolescent Health (Add Health), this study includes a nationally representative sample of 1,073 Latina adolescents (ages 11–20 at Wave 1) transitioning into young adulthood (ages 18–27 at Wave 3). Our findings indicate that more acculturated Latinas who spoke English at home were more likely to have STDs and to exhibit sexual risk behaviors than Latinas who were foreign-born and did not use English at home. Interventions that aim to promote sexual and reproductive health among young Latinas should take into consideration their different levels of acculturation. This approach holds greater potential for reducing health disparities among Latinas.     

Who,What, Where,When, and Why: Demographic and Ecological Factors Contributing to Hostile School Climate for Lesbian,Gay, Bisexual,and Transgender Youth

This study examines how locational (region and locale), community-level (school district poverty and adult educational attainment), and school district-level (district size and ratios of students to key school personnel) variables are related to indicators of hostile school climate for lesbian, gay, bisexual, and transgender (LGBT) youth. Indicators of hostile climate included frequency of homophobic remarks and victimization regarding sexual orientation and gender expression. We used data from a national survey of LGBT secondary school students (N = 5,420; 57.6% female; 65.5% White; mean age = 15.9). Results from regression analyses demonstrated that LGBT youth in rural communities and communities with lower adult educational attainment may face particularly hostile school climates. School district characteristics contributed little to the variation in LGBT youth’s experiences. Findings highlight the importance of considering the multiple contexts that LGBT youth inhabit, particularly as they pertain to educational experiences.     

Youth Substance Use and Body Composition: Does Risk in One Area Predict Risk in the Other?

Both substance use and obesity are prevalent among youth. As youth age, substance use rates increase and over the past three decades, obesity rates among youth have tripled. While these two factors have both short- and long-term health impacts, little research has explored how substance use and obesity among youth may be related. This study explores the bi-directional longitudinal relationships between substance use and body composition. Participants (N = 704; 50.7% female) were mostly white (86.4%) with a baseline mean age of 14.7 years. Objectively measured body composition was used to calculate body mass index z-scores (BMI z-score) and percent body fat. Cross-lagged structural equation models, accounting for clustering at the school level, were run to determine the longitudinal association between body composition and self-reported substance use (alcohol, cigarette, and marijuana), adjusting for socio-demographic characteristics, pubertal status, and weight satisfaction. Baseline alcohol use predicted decreased BMI z-score at follow-up and a similar association with percent body fat approached significance. Baseline cigarette use predicted increased percent body fat. No longitudinal associations were seen between baseline body composition and future substance use. Our results suggest that substance use contributes to subsequent body composition; however, body composition does not contribute to subsequent substance use. Continued research that explores these relationships longitudinally is greatly needed.     

Sexual Orientation, Partnership Formation, and Substance Use in the Transition to Adulthood

Evidence suggests that lesbian and gay young adults use substances more frequently than their heterosexual peers. Based on the life course perspective, we argue that this difference may be due to the unavailability of marriage as a turning point in the lives of lesbian/gay young adults. We use data from a nationally representative sample of youth (N = 13,581, 52.4% female, 68.6% white, ages 18—26) to examine sexual orientation differences in substance use and explore whether these differences vary by romantic partnership formation in young adulthood. We find that the formation of more serious partnerships (e.g., cohabitation, marriage) is associated with less frequent substance use among heterosexual young adults, though this pattern does not hold for lesbian and gay young adults. We conclude that the partnership options available to lesbians and gay men do not provide the same health-protective benefits that marriage does for heterosexuals.     

Prevalence and Predictors of Sexual Risks Among Homeless Youth

This study examined prevalence of sexual risks among homeless adolescents and described factors associated with those risks. Community-based outreach methods were used successfully to access this difficult-to-reach population. The sample included 203 homeless youth aged 15–22 recruited from community sites. Questionnaire items addressed demographics, sexual behaviors, alcohol/drug use, STI history and testing, and pregnancy history. In cross-sectional analysis, 58.7% of males and 75.6% of females reported recent sexual intercourse. Of those, one third of males and half of the females used no barrier method with at least one partner. Both gender (female) and race/ethnicity (non-Black) were associated with having intercourse without a barrier contraceptive method. Over one fifth reported a history of survival sex or receiving money, drugs, clothing, shelter, or food for sex. These results show disturbingly high rates of a number of sexual risks, reinforcing the need for targeted interventions with this highly vulnerable population.     

Adolescents’ Media-related Cognitions and Substance Use in the Context of Parental and Peer Influences

Two cross-sectional studies investigated media influences on adolescents’ substance use and intentions to use substances in the context of exposure to parental and peer risk and protective factors. A total of 729 middle school students (n = 351, 59% female in Study 1; n = 378, 43% female in Study 2) completed self-report questionnaires. The sample in Study 1 was primarily African-American (52%) and the sample in Study 2 was primarily Caucasian (63%). Across the two studies, blocks of media-related cognitions made unique contributions to the prediction of adolescents’ current substance use and intentions to use substances in the future above and beyond self-reported peer and parental influences. Specifically, identification with and perceived similarity to media messages were positively associated with adolescents’ current substance use and intentions to use substances in the future, and critical thinking about media messages and media message deconstruction skills were negatively associated with adolescents’ intention to use substances in the future. Further, peer influence variables (e.g., peer pressure, social norms, peer substance use) acted as risk factors, and for the most part, parental influence variables (e.g., parental pressure to not use, perceived parental reaction) acted as protective factors. These findings highlight the importance of developing an increased understanding of the role of media messages and media literacy education in the prevention of substance use behaviors in adolescence.     

Comparison of HIV Risks among Gay,Lesbian, Bisexual and Heterosexual Homeless Youth

Youth who are homeless and gay, lesbian or bisexual (GLB) are one of the most disenfranchised and marginalized groups in our society. The purpose of this study is to examine and compare HIV in GLB homeless youth with their heterosexual counterparts. Participants for this study included 268 youth involved in treatment outcome studies with substance abusing homeless youth. Results suggest that GLB youth have greater HIV risks and that these risks are greater among bisexual females. In examining the predictors of sexual health risks, survival sex emerged as the most significant. Survival sex was high among females regardless of their sexual orientation and also among gay males. Implications of these findings suggest that a greater emphasis needs to be paid to preventive interventions among this population. Rashmi Gangamma is a Ph.D student in the Department of Human Development and Family Science at The Ohio State University. She completed her Masters in Social Work at Mangalore University, India, and M.Phil in Psychiatric Social Work from the National Institute of Mental Health and NeuroSciences (NIMHANS), Bangalore, India. Her research interests include qualitative research methodology, family therapy process and GLBT issues. Natasha Slesnick, Ph.D. is an Associate Professor of Human Development and Family Science at the Ohio State University. She received her Ph.D. in 1996 from the University of New Mexico. Her research and clinical focus is on families and adolescents with issues pertaining to homelessness, substance use, childhood abuse, depression and high risk behaviors. Her current research projects concentrate on the development and evaluation of effective interventions for runaway and homeless youth and their families. Paula Toviessi is a Ph.D candidate in the Department of Human Development and Family Science at The Ohio State University. She completed her B.S. in Psychology at Norfolk State University and her M.S. in Marriage and Family Therapy at Purdue University, Calumet. She is currently conducting research on family health and the health decision-making process. Julianne Serovich, Ph.D., is Professor and Chair in the Department of Human Development and Family Science, The Ohio State University. She received her Ph.D. in 1991 from the University of Georgia. Her primary program of research centers on investigating the role of HIV disclosure to family and friends in reducing sexual risk related behaviors in men and mental health outcomes in women. To this end she has conducted 3 major studies investigating HIV disclosure behaviors in gay males, and heterosexual males and females.     

Willingness to Remain Friends and Attend School with Lesbian and Gay Peers: Relational Expressions of Prejudice Among Heterosexual Youth

In this study, heterosexual students’ willingness to remain friends with peers who disclose that they are gay or lesbian and their willingness to attend schools that include gay and lesbian students were examined among two large middle school and high school samples (Sample 1: n = 20,509; 50.7% girls; Sample 2: n = 16,917; 50.2% girls). Boys were less willing than girls to remain friends or attend schools with gay and lesbian peers, as were students in earlier grades than were students in later grades. Further, there was small, yet significant, variability in these scores across schools. Greater racial diversity within the school partially accounted for this school-level variability; students in more racially diverse schools reported greater willingness to remain friends and attend school with gay and lesbian peers. Findings suggest that while intervention programs must continue to address blatant and overt physical aggression against sexual minority youth, there is also a significant need for programming to address the more subtle expressions of sexual prejudice that contribute to unwelcoming and unsafe school climates.     

Longitudinal Outcomes for Youth Receiving Runaway/Homeless Shelter Services

This research examined outcomes and use of specific types of services 6 weeks, 3 and 6 months post-discharge for a large sample of runaway/homeless youth using crisis shelter services. Data were collected for 371 runaway/homeless youth using emergency shelter and crisis services at eleven agencies across a four-state midwestern region. Outcomes were assessed for runaway behavior, family relationships, substance use, school behavior, employment, sexual behavior, and self-esteem. Additionally, the impact of services on outcomes was assessed. Findings indicated that although youth achieved a wide variety of positive outcomes 6 weeks post-discharge, there were signs of attenuation of certain outcomes by the 6 month follow-up. Service use after discharge did not demonstrate a strong impact on maintaining outcomes. The substantive findings reported here present encouraging evidence for providers of services for runaway/homeless youth. Crisis shelter services appear to facilitate broad-based short-term gains, but do not appear sufficient to maintain these gains over an extended period.