Metabolic Syndrome and Economic Strain Among Sexual Minority Young Adults.

PURPOSE: The study tested if sexual orientation is associated with metabolic syndrome (MetS) in young adulthood (ages 24-32), and if economic strain impacts associations. METHODS: Gender-stratified logistic regressions were fit among 11,575 young adults (1644 sexual minority [SM]) in Wave IV of The National Longitudinal Study of Adolescent to Adult Health. RESULTS: MetS was not associated with sexual orientation for either gender, yet economic strain was more prevalent among both SM males and females. Additional MetS risk factors (smoking, binge drinking, and lower education) emerged for SM females. CONCLUSION: Although MetS did not differ by sexual orientation, emergent sexual orientation disparities among females suggest increased future risk.

Adherence to gender-typical behavior and high frequency substance use from adolescence into young adulthood.

Substance use is prevalent among adolescents in the U.S., especially males. Understanding the cross-sectional and longitudinal associations between gender norms and substance use is necessary to tailor substance use prevention messages and efforts appropriately. This study investigates the relationship between adherence to gender-typical behavior (AGB) and substance use from adolescence into young adulthood. Participants in the National Longitudinal Study of Adolescent to Adult Health completed self-report measures on the frequency of binge drinking, cigarette smoking and marijuana use as well as various behaviors and emotional states that captured the latent construct of AGB. Sex-stratified logistic regression models revealed cross-sectional and longitudinal relationships between AGB and high frequency substance use. For example, an adolescent male who is more gender-adherent, compared to less adherent males, has 75% higher odds of high frequency binge drinking in adolescence and 22% higher odds of high frequency binge drinking in young adulthood. Sex-stratified multinomial logistic regression models also revealed cross-sectional and longitudinal relationships between AGB and patterns of use. For example, a more gender-adherent adolescent male, compared to one who is less adherent, is 256% more likely to use all three substances in adolescence and 66% more likely to use all three in young adulthood. Cross-sectional and longitudinal results for females indicate greater gender-adherence is associated with lower odds of high frequency substance use. These findings indicate adherence to gender norms may influence substance use behaviors across the developmental trajectory, and inform strategies for prevention efforts.

Directions of the relationship between substance use and depressive symptoms from adolescence to young adulthood.

PURPOSE: Both substance use and depression are common in adolescence and often comorbid. Past research has produced conflicting results on whether there is a temporal relationship and if so, in which direction it operates and how it may vary by sex. The purpose of this paper is to explore the longitudinal, potentially bidirectional, relationships between high-frequency substance use and depressive symptoms from adolescence into young adulthood for males and females. METHODS: Using data from the National Longitudinal Study of Adolescent to Adult Health we investigated longitudinal associations between high frequency substance use (alcohol, cigarettes, and marijuana) and depressive symptoms. The linear mixed effects models were stratified by sex and used a lagged measure of the dependent variable to test temporal relationships. A random intercept was used for respondent ID. RESULTS: Increases in depressive symptoms were significantly associated with a later increase of about a half day in marijuana use frequency for males and nearly a two day increase in smoking frequency for females. Conversely, increases in smoking frequency were significantly associated with approximately a 0.6-point increase for females and 0.4-point increase for males in depressive symptoms at a later wave. CONCLUSIONS: Results indicate a bidirectional relationship between smoking and depressive symptoms for females. For males, there was evidence supporting self-medication with marijuana and for smoking being associated with later increases in depressive symptoms. Results inform how substance use and depression screening, prevention and treatment efforts should be paired and targeted for males and females.

Predicting Preterm Birth Among Women Screened by North Carolina's Pregnancy Medical Home Program.

OBJECTIVE: To determine which combination of risk factors from Community Care of North Carolina's (CCNC) Pregnancy Medical Home (PMH) risk screening form was most predictive of preterm birth (PTB) by parity and race/ethnicity. METHODS: This retrospective cohort included pregnant Medicaid patients screened by the PMH program before 24 weeks gestation who delivered a live birth in North Carolina between September 2011-September 2012 (N = 15,428). Data came from CCNC's Case Management Information System, Medicaid claims, and birth certificates. Logistic regression with backward stepwise elimination was used to arrive at the final models. To internally validate the predictive model, we used bootstrapping techniques. RESULTS: The prevalence of PTB was 11 %. Multifetal gestation, a previous PTB, cervical insufficiency, diabetes, renal disease, and hypertension were the strongest risk factors with odds ratios ranging from 2.34 to 10.78. Non-Hispanic black race, underweight, smoking during pregnancy, asthma, other chronic conditions, nulliparity, and a history of a low birth weight infant or fetal death/second trimester loss were additional predictors in the final predictive model. About half of the risk factors prioritized by the PMH program remained in our final model (ROC = 0.66). The odds of PTB associated with food insecurity and obesity differed by parity. The influence of unsafe or unstable housing and short interpregnancy interval on PTB differed by race/ethnicity. CONCLUSIONS: Evaluation of the PMH risk screen provides insight to ensure women at highest risk are prioritized for care management. Using multiple data sources, salient risk factors for PTB were identified, allowing for better-targeted approaches for PTB prevention.

Discordance of HIV and HSV-2 biomarkers and self-reported sexual behaviour among orphan adolescents in Western Kenya.

BACKGROUND: This paper examines the discordance between biological data of HIV and herpes simplex virus type 2 (HSV-2) infections and self-reported questionnaire responses among orphan adolescents in Western Kenya. METHODS: In 2011, 837 orphan adolescents from 26 primary schools were enrolled in an HIV prevention trial. At baseline, blood samples were drawn for HIV and HSV-2 infection biomarker testing, and participants completed an audio computer-assisted self-interviewing survey. RESULTS: Comparing biological data with self-reported responses indicated that 70% of HIV-positive (7 out of 10) and 64% of HSV-2-positive (18 out of 28 positive) participants reported never having had sex. Among ever-married adolescents, 65% (57 out of 88) reported never having had sex. Overall, 10% of study participants appeared to have inconsistently reported their sexual behaviour. Logistic regression analyses indicated that lower educational level and exam scores were significant predictors of inconsistent reporting. CONCLUSIONS: Our study demonstrates the discordance between infections measured by biomarkers and self-reports of having had sex among orphan adolescents in Kenya. In order to detect programme effects accurately in prevention research, it is necessary to collect both baseline and endline biological data. Furthermore, it is recommended to triangulate multiple data sources about adolescent participants' self-reported information about marriage and pregnancies from school records and parent/guardians to verify the information. Researchers should recognise potential threats to validity in data and design surveys to consider cognitive factors and/or cultural context to obtain more accurate and reliable information from adolescents regarding HIV/sexually transmitted infection risk behaviours. CLINICAL TRAIL REGISTRATION NUMBER: NCT01501864.

Risk of substance abuse and dependence among young adult sexual minority groups using a multidimensional measure of sexual orientation.

OBJECTIVE: We examined associations between two definitions of sexual minority status (SMS) and substance abuse and/or dependence among young adults in a national population. METHODS: A total of 14,152 respondents (7,529 women and 6,623 men) interviewed during wave four of the National Longitudinal Study of Adolescent Health were included in the study (age range: 24-32 years). We used two definitions of SMS based on self-reported attraction, behavior, and identity: 1-indicator SMS (endorsing any dimension) and 3-indicator SMS (endorsing all dimensions). Outcomes included nicotine dependence as well as ≥3 signs of substance dependence, any sign of substance abuse, and lifetime diagnosis of abuse or dependence for alcohol, marijuana, and a composite measure of other drugs. Weighted logistic regression models were fit to estimate the odds of each outcome for each of the sexual minority groups (compared with the heterosexual majority), controlling for sociodemographic covariates. RESULTS: SMS women were more likely than exclusively heterosexual women to experience substance abuse and dependence, regardless of substance or SMS definition. In adjusted models for women, 3-indicator SMS was most strongly associated with abuse/dependence (adjusted odds ratio [AOR] range: 2.74-5.17) except for ≥3 signs of cannabis dependence, where 1-indicator SMS had the strongest association (AOR=3.35). For men, the 1-indicator SMS group had higher odds of nicotine dependence (AOR=1.35) and the 3-indicator SMS group had higher odds of ≥3 signs of alcohol dependence (AOR=1.64). CONCLUSIONS: Young adult female sexual minority groups, regardless of how defined, are at a higher risk than their heterosexual peers of developing alcohol, drug, or tobacco abuse and dependence.

Adolescent expectations of early death predict adult risk behaviors.

Only a handful of public health studies have investigated expectations of early death among adolescents. Associations have been found between these expectations and risk behaviors in adolescence. However, these beliefs may not only predict worse adolescent outcomes, but worse trajectories in health with ties to negative outcomes that endure into young adulthood. The objectives of this study were to investigate perceived chances of living to age 35 (Perceived Survival Expectations, PSE) as a predictor of suicidal ideation, suicide attempt and substance use in young adulthood. We examined the predictive capacity of PSE on future suicidal ideation/attempt after accounting for sociodemographics, depressive symptoms, and history of suicide among family and friends to more fully assess its unique contribution to suicide risk. We investigated the influence of PSE on legal and illegal substance use and varying levels of substance use. We utilized the National Longitudinal Study of Adolescent Health (Add Health) initiated in 1994-95 among 20,745 adolescents in grades 7-12 with follow-up interviews in 1996 (Wave II), 2001-02 (Wave III) and 2008 (Wave IV; ages 24-32). Compared to those who were almost certain of living to age 35, perceiving a 50-50 or less chance of living to age 35 at Waves I or III predicted suicide attempt and ideation as well as regular substance use (i.e., exceeding daily limits for moderate drinking; smoking ≥ a pack/day; and using illicit substances other than marijuana at least weekly) at Wave IV. Associations between PSE and detrimental adult outcomes were particularly strong for those reporting persistently low PSE at both Waves I and III. Low PSE at Wave I or Wave III was also related to a doubling and tripling, respectively, of death rates in young adulthood. Long-term and wide-ranging ties between PSE and detrimental outcomes suggest these expectations may contribute to identifying at-risk youth.

Protective connections and educational attainment among young adults with childhood-onset chronic illness.

BACKGROUND: Youth with childhood-onset chronic illness (COCI) are at risk of poor educational attainment. Specific protective factors that promote college graduation in this population have not been studied previously. In this study, we examine the role protective factors during adolescence play in promoting college graduation among young adults with COCI. METHODS: Data were collected from 10,925 participants in the National Longitudinal Study of Adolescent Health (Add Health). Protective factors present before 18 years of age included mentoring, parent relationship quality, school connectedness, and religious attendance. College graduation was the outcome of interest assessed when participants had a mean age of 28 years. Analysis was stratified by presence of COCI. RESULTS: About 2% of participants (N = 230) had 1 of 4 COCIs (cancer, diabetes, epilepsy, or heart disease). All 4 protective factors were associated with college graduation for youth without COCI. In the final multivariate model, only school connectedness was associated with college graduation for youth with COCI. CONCLUSION: School connectedness is of particular importance in promoting educational attainment for youth with COCI.

Human papillomavirus vaccine discussions: an opportunity for mothers to talk with their daughters about sexual health.

PURPOSE: Mother-daughter communication about sex is associated with healthier behavior during adolescence. We sought to characterize mothers' communication with their daughters about human papillomavirus (HPV) vaccine and the potential for these discussions to provide an opportunity for talking about sexual health. METHODS: During December 2009, we conducted an online survey with a nationally representative sample of US mothers of girls aged 11 to 14 years (n = 900; response rate = 66%). We used 3 complimentary approaches to assess HPV vaccine as an opportunity for mother-daughter communication about sex. Estimates are weighted. RESULTS: Sixty-five percent of mothers reported talking with their daughters about HPV vaccine, of whom 41% said that doing so led to a conversation about sex. Mothers who had talked with their daughters about HPV vaccine were more likely than those who had not to have also talked with their daughters about sex (92% vs. 74%, OR = 3.25, CI = 1.57-6.68, P < 0.05), in multivariate analyses. Among mothers who talked about sex when they talked about HPV vaccine, many felt that HPV vaccine provided a good reason to do so (64%) or that it made it easier to start a conversation (33%). CONCLUSIONS: HPV vaccine discussions provide a cue to mother-daughter communication about sex that is as important as some more widely recognized cues. Discussions about HPV vaccine are an acceptable opportunity for mothers to talk with their daughters at an age when communication about sex is most influential. It may be possible for parents to capitalize on HPV vaccine discussions already happening in many families to promote sexual health.

Growing up with a chronic illness: social success, educational/vocational distress.

OBJECTIVES: We compared adult educational, vocational, and social outcomes among young adults with and without childhood-onset chronic illness in a nationally representative U.S. sample. METHODS: We used data from Wave IV (2008) of the National Longitudinal Study of Adolescent Health. We compared respondents who reported childhood-onset cancer, heart disease, diabetes, or epilepsy with young adults without these chronic illnesses in terms of marriage, having children, living with parents, romantic relationship quality, educational attainment, income, and employment. Multivariate models controlled for sociodemographic factors and adult-onset chronic illness. RESULTS: As compared with those without childhood chronic illness, respondents with childhood chronic illness had similar odds of marriage (odds ratios [OR] = .89, 95% CI: .65-1.24), having children (OR = .99, 95% CI: .70-1.42), and living with parents (OR = 1.49, 95% CI .94-2.33), and similar reports of romantic relationship quality. However, the chronic illness group had lower odds of graduating college (OR = .49, 95% CI: .31-.78) and being employed (OR = .56, 95% CI: .39-.80), and higher odds of receiving public assistance (OR = 2.13, 95% CI: 1.39-3.25), and lower mean income. CONCLUSIONS: Young adults growing up with chronic illness succeed socially, but are at increased risk of poorer educational and vocational outcomes.

Young adult outcomes of children growing up with chronic illness: an analysis of the National Longitudinal Study of Adolescent Health.

OBJECTIVE: To examine young adult outcomes in a nationally representative US cohort of young adults growing up with a chronic illness. DESIGN: Secondary analysis of nationally representative data from wave III (in 2001) of the National Longitudinal Study of Adolescent Health. SETTING: United States. PARTICIPANTS: The analytic sample comprised 13 236 young adults aged 18 to 28 years at wave III. MAIN EXPOSURE: Self-report of a chronic physical illness (asthma, cancer, diabetes mellitus, or epilepsy) in adolescence. Respondents with asthma or nonasthmatic chronic illness (cancer, diabetes mellitus, or epilepsy) were compared with individuals without these conditions. MAIN OUTCOME MEASURES: Self-report of high school graduation, ever having employment, currently having employment, living with a parent/guardian, and ever receiving public assistance. RESULTS: Three percent of young adults had nonasthmatic chronic illness (cancer, diabetes, or epilepsy), and 16.0% had asthma. Most young adults with chronic illness graduated high school (81.3%) and currently had employment (60.4%). However, compared with healthy young adults, those with nonasthmatic chronic illness were significantly less likely to graduate high school, ever have had employment, or currently have employment and were more likely to receive public assistance. Compared with young adults with asthma, those with nonasthmatic chronic illness again had significantly worse young adult outcomes on all measures. CONCLUSIONS: Most young adults growing up with a chronic illness graduate high school and have employment. However, these young adults are significantly less likely than their healthy peers to achieve these important educational and vocational milestones.

Early adolescent sexual initiation as a problem behavior: a comparative study of five nations.

PURPOSE: Using a Problem Behavior Theory framework, this article examines the extent to which psychosocial correlates of early sexual initiation (before age 16) vary across developed nations. METHODS: Fifteen-year-old participants (n = 5,624) in the 1997-1998 World Health Organization collaborative Health Behavior in School-Aged Children survey (Finland, Scotland, France, and Poland) and the 1996 U.S. Add Health survey self-reported substance use (alcohol and tobacco), school attachment, positive parental communication, and early sexual intercourse experience. Stratifying by gender, we performed univariate, bivariate, and multivariable analyses controlling for family socioeconomic status, family structure, and nation fixed effects. RESULTS: Self-reported early sexual experience, substance use, school attachment, and positive communication with parents varied significantly across nations for both boys and girls. In both crude and adjusted analyses, substance use was positively associated with early sexual experience among boys and girls across nations, although associations were stronger in Europe than in the United States (adjusted odds ratio [AOR]; range, 1.56-3.74). School attachment was similarly inversely related to early sexual experience among boys and girls across nations (AOR range, .63-.94). However, positive parent communication was significantly inversely related to early sexual experience only among U.S. females (AOR .50). CONCLUSIONS: Findings overall supported the fit of early adolescent sexual initiation as a risk behavior within a Problem Behavior Theory framework cross-nationally, suggesting that similar factors could be targeted to prevent early sexual initiation across some developed nations. However, further research is warranted examining the temporality of these relationships.

Reproductive health of young adults with physical disabilities in the U.S.

OBJECTIVE: Previous research shows reduced cervical and breast cancer screening among women with physical disabilities. However, other indicators of reproductive health have been largely ignored. We aimed to compare the reproductive health of young adults in the U.S. with and without physical disabilities in a nationally-representative sample. METHODS: Data are from 13,819 respondents aged 18-26 who participated in Waves I (1994-1995) and III (2001-2002) of the National Longitudinal Study of Adolescent Health (Add Health). Using logistic regression, we examined associations between physical disability and multiple reproductive health indicators including sexually transmitted infection (STI) testing, STI diagnosis, receipt of a gynecologic exam, and cervical cancer screening. Analyses were stratified by sex and adjusted for the complex study design. RESULTS: We identified 5.8% of respondents as having a physical disability. In multivariate analyses, females with physical disabilities had lower odds of having a Pap smear in the past 12 months than females without disabilities (OR=0.77; 95% CI: 0.61, 0.97). Physical disability was not associated with other reproductive health indicators among females or males. CONCLUSION: We found few differences in examined reproductive health indicators of young adults with and without physical disabilities, but findings suggest differences in some screening services that merit additional study.

Adolescent depression and suicide risk: association with sex and drug behavior.

BACKGROUND: Depression is common among adolescents, and suicide is the third leading cause of death among 15- to 19-year-olds. Although both health problems have been associated with drug use and early sexual intercourse, the relationship has not been systematically studied in a nationally representative sample. METHODS: Sixteen patterns of combined sex and drug use behaviors were obtained using cluster analysis of responses to Wave I of the National Longitudinal Study of Adolescent Health conducted from September 1994 through December 1995. Bivariate and multivariate analyses tested correlations between behavior patterns and current depression, serious suicidal ideation, and previous suicide attempt, controlling for gender, race/ethnicity, Hispanic ethnicity, family structure, and parent education. RESULTS: Compared to youth who abstain from risk behaviors, involvement in any drinking, smoking, and/or sexual activity was associated with significantly increased odds of depression, suicidal ideation, and suicide attempts. Odds ratios were highest among youth who engaged in illegal drug use. There were few differences between boys and girls who abstain from sex and drug behaviors. Girls were less likely than boys to engage in high-risk behaviors, but those who did tended to be more vulnerable to depression, suicidal ideation, and suicide attempt. CONCLUSIONS: Teens engaging in risk behaviors are at increased odds for depression, suicidal ideation, and suicide attempts. Although causal direction has not been established, involvement in any sex or drug use is cause for concern, and should be a clinical indication for mental health screening for girls; both boys and girls should be screened if engaging in any marijuana or illegal drug use.