Psychological Distress, Substance Use, and HIV/STI Risk Behaviors Among Youth
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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.
KeywordsHigh risk youth Psychological distress Anxiety Depression Substance use HIV/STI risk
This work was supported by two National Institute of Drug Abuse grants (5R01DA007484-11; “A longitudinal study of school dropout and substance use”, and 1R03AA017240-01; “Protective factors for alcohol use among urban adolescents”) awarded to Dr. Zimmerman. Dr. Elkington is supported by the Center Grant P30 MH43520 to the HIV Center for Clinical and Behavioral Studies, Anke A. Ehrhardt, PhD, Principal Investigator, from the National Institute of Mental Health. All authors have nothing to disclose.
- Bachanas, P., Morris, M., Lewis-Gess, J., Sarett-Cuasay, E. J., Flores, A. L., Sirl, K., et al. (2002a). Psychological adjustment, substance use, HIV knowledge, and risky sexual behavior in at-risk minority females: Developmental differences during adolescence. Journal of Pediatric Psychology, 27(4), 373–384.CrossRefPubMedGoogle Scholar
- Brooks-Gunn, J., & Paikoff, R. (1997). Sexuality and developmental transitions during adolescence. In J. Schulenberg, J. Maggs, & K. Hurrelmann (Eds.), Health risks and developmental transactions during adolescence (pp. 190–219). New York, NY: Cambridge University Press.Google Scholar
- Centers for Disease Control and Prevention. (2008a). Sexually transmitted disease surveillance 2007. Retrieved July 20, 2009, from http://www.cdc.gov/std/stats07/toc.htm.
- Centers for Disease Control and Prevention. (2008b). Youth risk surveillance—United States 2007. MMWR, 57(SS-4). Retrieved July 9, 2009, from http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbss07_mmwr.pdf.
- Centers for Disease Control and Prevention. (2008c). HIV/AIDS among youth. Retrieved August 26, 2009, from http://www.cdc.gov/hiv/resources/factsheets/youth.htm.
- Cook, R. L., Comer, D. M., Wisenfeld, H. C., Chang, C., Tarter, R., Lave, J. R., et al. (2006). Alcohol and drug use and related disorders: An underrecognized health issue among adolescents and young adults attending sexually transmitted disease clinics. Sexually Transmitted Diseases, 33(9), 565–570.CrossRefPubMedGoogle Scholar
- Derogatis, L. R., & Spencer, P. M. (1982). The Brief Symptom Inventory (BSI): Administration and procedures. Manual-I. Baltimore, MD: Clinical Psychometric Research.Google Scholar
- Donenberg, G. R., Emerson, E., Bryant, F. B., Wilson, H., & Weber-Shifrin, E. (2001). Understanding AIDS-risk behavior among adolescents in psychiatric care: Links to psychopathology and peer relationships. Journal of the American Academy of Child Adolescent Psychiatry, 40(6), 642–653.CrossRefGoogle Scholar
- Dworkin, S., Pinto, R. M., Hunter, J., Rapkin, B., & Remien, R. (2008). Keeping the spirit of community partnerships alive in the scale up of HIV/AIDS prevention: Critical reflections on the roll-out of DEBI (diffusion of effective behavioral interventions). American Journal of Community Psychology, 42(1–2), 51–59.CrossRefPubMedGoogle Scholar
- Elkington, K. S., Bauermeister, J. A., Brackis-Cott, E., Dolezal, C., & Mellins, C. A. (2009). Substance use and sexual risk behaviors in perinatally human immunodeficiency virus-exposed youth: The role of caregivers, peers and HIV status. Journal of Adolescent Health, 45(2), 133–141.CrossRefPubMedGoogle Scholar
- Elkington, K. S., Teplin, L. A., Mericle, A. A., Welty, L. J., Romero, E. G., & Abram, K. M. (2008). HIV/STI risk behaviors in delinquent youth with psychiatric disorders: A longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 901–911.CrossRefPubMedGoogle Scholar
- Kandel, D. B., Johnson, J. G., Bird, H. R., Canino, G., Goodman, S. H., Lahey, B. B., et al. (1997). Psychiatric disorders associated with substance use among children and adolescents: Findings from the methods for the epidemiology of child and adolescent mental disorders (MECA) study. Journal of Abnormal Child Psychiatry, 25(2), 121–132.CrossRefGoogle Scholar
- MacKinnon, D. P., Warsi, G., & Dwyer, J. H. (1995b). A simulation study of mediated effect measures: Erratum. Multivariate Behavioral Research, 30(3), ii.Google Scholar
- McKinnon, K. (1996). Sexual and drug-use risk behavior. In F. Cournos & N. Bakalar (Eds.), AIDS and people with severe mental illness: A handbook for mental health professionals (pp. 17–46). New Haven, CT: Yale University Press.Google Scholar
- Mellins, C. A., Elkington, K. S., Bauermeister, J. A., Brackis-Cott, E., Dolezal, C., McKay, M., et al. (2009). Sexual and drug use behavior in perinatally-HIV-infected youth: Mental health and family influences. Journal of the American Academy of Child and Adolescent Psychiatry, 48(8), 810–819.CrossRefPubMedGoogle Scholar
- Ott, M., Millstein, S., & Halpern-Felsher, B. (2004). Positive motivations for sex among male and female teens. Paper presented at the Annual Meeting of the Society for Adolescent Medicine, St. Louis, MO.Google Scholar
- Raudenbush, S., & Bryk, A. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
- Rogers, J. L. (1996). Sexual transitions in adolescence. In J. A. Graber, J. Brooks-Gunn, & A. C. Peterson (Eds.), Transitions through adolescence: Interpersonal domains and context (pp. 85–110). Mahwah, NJ: Erlbaum.Google Scholar
- Rubin, A. G., Gold, D. O., & Primack, B. A. (in press). Associations between depressive symptoms and sexual risk behavior in a diverse sample of female adolescents. Journal of Pediatric and Adolescent Gynocology.Google Scholar
- Scientific Software International. (2009). Hierarchical linear models. Chicago, IL: SSI Inc.Google Scholar
- Shrier, L., Harris, S., & Beardslee, W. (2002). Temporal associations between depressive symptoms and self-reported sexually transmitted disease among adolescents. Archives of Pediatric and Adolescent Medicine, 156(6), 599–606.Google Scholar