Pilot Randomized Trial of an Expressive Writing Intervention to Reduce Sexual HIV-Transmission Risk and Substance Use Among Emerging Adult Gay and Bisexual Men.

This pilot randomized controlled trial evaluated the feasibility, acceptability, and preliminary efficacy of expressive writing to reduce HIV-related sexual risk taking and symptoms of drug dependence among emerging adult gay and bisexual men (EAGBM) through linguistic mechanisms involving use of words associated with cognitive processing (e.g., think, cause), positive emotion (e.g., love, nice), and negative emotion (e.g., hurt, shame). Between 2014 and 2015, EAGBM (n = 78; aged 18-29) completed a baseline survey and were randomized to complete three 15-min expressive writing or equivalent control-group writing sessions and follow-up assessments 2 months post-baseline. EAGBM in the expressive writing condition utilized significantly more positive emotion, negative emotion, and cognitive processing words. Path model results indicated the intervention condition resulted in significant reductions in symptoms of drug dependence and frequency of condomless anal sex (CAS) through paths mediated by positive emotion words, and significant increases in CAS through a path mediated by negative emotion words.

Changing Trends in Substance Use and Sexual Risk Disparities among Sexual Minority Women as a Function of Sexual Identity, Behavior, and Attraction: Findings from the National Survey of Family Growth, 2002-2015.

Components of sexual minority (SM) status-including lesbian or bisexual identity, having same-sex partners, or same-sex attraction-individually predict substance use and sexual risk behavior disparities among women. Few studies have measured differing associations by sexual orientation components (identity, behavior, and attraction), particularly over time. Data were drawn from the 2002-2015 National Survey of Family Growth female sample (n = 31,222). Multivariable logistic regression (adjusted for age, race/ethnicity, education, marital/cohabitation status, survey cycle, and population-weighted) compared past-year sexual risk behavior, binge drinking, drug use, and sexually transmitted infection treatment among sexual minority women (SMW) versus sexual majority women (SMJW) by each sexual orientation component separately and by all components combined, and tested for effect modification by survey cycle. In multivariable models, SM identity, behavior, and attraction individually predicted significantly greater odds of risk behaviors. SM identity became nonsignificant in final adjusted models with all three orientation components; non-monosexual attraction and behavior continued to predict significantly elevated odds of risk behaviors, remaining associated with sexual risk behavior and drug use over time (attenuated in some cases). Trends in disparities over time between SMW versus SMJW varied by sexual orientation indicator. In a shifting political and social context, research should include multidimensional sexual orientation constructs to accurately identify all SMW-especially those reporting non-monosexual behavior or attraction-and prioritize their health needs.

Declines in Sexual Frequency among American Adults, 1989-2014.

American adults had sex about nine fewer times per year in the early 2010s compared to the late 1990s in data from the nationally representative General Social Survey, N = 26,620, 1989-2014. This was partially due to the higher percentage of unpartnered individuals, who have sex less frequently on average. Sexual frequency declined among the partnered (married or living together) but stayed steady among the unpartnered, reducing the marital/partnered advantage for sexual frequency. Declines in sexual frequency were similar across gender, race, region, educational level, and work status and were largest among those in their 50s, those with school-age children, and those who did not watch pornography. In analyses separating the effects of age, time period, and cohort, the decline was primarily due to birth cohort (year of birth, also known as generation). With age and time period controlled, those born in the 1930s (Silent generation) had sex the most often, whereas those born in the 1990s (Millennials and iGen) had sex the least often. The decline was not linked to longer working hours or increased pornography use. Age had a strong effect on sexual frequency: Americans in their 20s had sex an average of about 80 times per year, compared to about 20 times per year for those in their 60s. The results suggest that Americans are having sex less frequently due to two primary factors: An increasing number of individuals without a steady or marital partner and a decline in sexual frequency among those with partners.

Sexual Inactivity During Young Adulthood Is More Common Among U.S. Millennials and iGen: Age, Period, and Cohort Effects on Having No Sexual Partners After Age 18.

Examining age, time period, and cohort/generational changes in sexual experience is key to better understanding sociocultural influences on sexuality and relationships. Americans born in the 1980s and 1990s (commonly known as Millennials and iGen) were more likely to report having no sexual partners as adults compared to GenX'ers born in the 1960s and 1970s in the General Social Survey, a nationally representative sample of American adults (N = 26,707). Among those aged 20-24, more than twice as many Millennials born in the 1990s (15 %) had no sexual partners since age 18 compared to GenX'ers born in the 1960s (6 %). Higher rates of sexual inactivity among Millennials and iGen also appeared in analyses using a generalized hierarchical linear modeling technique known as age-period-cohort analysis to control for age and time period effects among adults of all ages. Americans born early in the 20th century also showed elevated rates of adult sexual inactivity. The shift toward higher rates of sexual inactivity among Millennials and iGen'ers was more pronounced among women and absent among Black Americans and those with a college education. Contrary to popular media conceptions of a "hookup generation" more likely to engage in frequent casual sex, a higher percentage of Americans in recent cohorts, particularly Millennials and iGen'ers born in the 1990s, had no sexual partners after age 18.

Demographic Predictors of Event-Level Associations between Alcohol Consumption and Sexual Behavior.

Alcohol consumption is associated with sexual behavior and outcomes, though research indicates a variety of moderating factors, including demographic characteristics. To better target interventions aimed at alcohol-related sexual risk behavior, our analyses simultaneously examine demographic predictors of both day- and event-level associations between alcohol consumption and sexual behavior in a sample of young adults (N = 301) who are sexually active and consume alcohol. Young adults (aged 18-29) recruited using time-space sampling and incentivized snowball sampling completed a survey and a timeline follow-back calendar reporting alcohol consumption and sexual behavior in the past 30 days. On a given day, a greater number of drinks consumed was associated with higher likelihood of sex occurring, particularly for women and single participants. During a given sexual event, number of drinks consumed was not associated with condom use, nor did any demographic predictors predict that association. Findings highlight associations between alcohol and sexual behavior, though not between alcohol and sexual risk behavior, highlighting the need for additional research exploring the complex role of alcohol in sexual risk behavior and the need to develop prevention efforts to minimize the role of alcohol in the initiation of sexual encounters.

Changes in American Adults' Reported Same-Sex Sexual Experiences and Attitudes, 1973-2014.

We examined change over time in the reported prevalence of men having sex with men and women having sex with women and acceptance of those behaviors in the nationally representative General Social Survey of U.S. adults (n's = 28,161-33,728, ages 18-96 years), 1972-2014. The number of U.S. adults who had at least one same-sex partner since age 18 doubled between the early 1990s and early 2010s (from 3.6 to 8.7 % for women and from 4.5 to 8.2 % for men). Bisexual behavior (having sex with both male and female partners) increased from 3.1 to 7.7 %, accounting for much of the rise, with little consistent change in those having sex exclusively with same-sex partners. The increase in same-sex partners was larger for women than for men, consistent with erotic plasticity theory. Attitudes toward same-sex sexual behavior also became substantially more accepting, d = .75, between the early 1970s and early 2010s. By 2014, 49 % of American adults believed that same-sex sexual activity was "not wrong at all," up from 11 % in 1973 and 13 % in 1990. Controlling for acceptance reduced, but did not eliminate, the increase in same-sex behavior over time. Mixed effects (hierarchical linear modeling) analyses separating age, time period, and cohort showed that the trends were primarily due to time period. Increases in same-sex sexual behavior were largest in the South and Midwest and among Whites, were mostly absent among Blacks, and were smaller among the religious. Overall, same-sex sexual behavior has become both more common (or at least more commonly reported) and more accepted.

Changes in American Adults' Sexual Behavior and Attitudes, 1972-2012.

In the nationally representative General Social Survey, U.S. Adults (N = 33,380) in 2000-2012 (vs. the 1970s and 1980s) had more sexual partners, were more likely to have had sex with a casual date or pickup or an acquaintance, and were more accepting of most non-marital sex (premarital sex, teen sex, and same-sex sexual activity, but not extramarital sex). The percentage who believed premarital sex among adults was "not wrong at all" was 29 % in the early 1970s, 42 % in the 1980s and 1990s, 49 % in the 2000s, and 58 % between 2010 and 2012. Mixed effects (hierarchical linear modeling) analyses separating time period, generation/birth cohort, and age showed that the trend toward greater sexual permissiveness was primarily due to generation. Acceptance of non-marital sex rose steadily between the G.I. generation (born 1901-1924) and Boomers (born 1946-1964), dipped slightly among early Generation X'ers (born 1965-1981), and then rose so that Millennials (also known as Gen Y or Generation Me, born 1982-1999) were the most accepting of non-marital sex. Number of sexual partners increased steadily between the G.I.s and 1960s-born GenX'ers and then dipped among Millennials to return to Boomer levels. The largest changes appeared among White men, with few changes among Black Americans. The results were discussed in the context of growing cultural individualism and rejection of traditional social rules in the U.S.

Motivations for Prescription Drug Misuse among Young Adults: Considering Social and Developmental Contexts.

AIMS: As part of a larger study on prescription drug misuse among young adults active in urban nightlife scenes, we examined participants' motivations for misuse. Prescription painkillers, stimulants and sedatives were the primary substances of interest. METHODS: Participants were recruited from nightlife venues in New York using time-space sampling. Subjects completed a mixed-methods assessment at project research offices. The data presented here are from a subsample of 70 qualitative interviews conducted during the baseline assessment. FINDINGS: We identified experimentation and a "work hard, play hard" ethos as key motivations for misusing prescription drugs and argue that these motivations are specific, though not necessarily unique, to the participants' social location as young adults. These findings highlight the role of life stage and social context in the misuse of prescription drugs. CONCLUSION: Future studies of prescription drug misuse should pay attention to the larger social contexts in which users are embedded and, therefore, make decisions about how and why to misuse. Moving beyond the very broad concepts of "recreation" and "self-medication" presently established in the research, policies targeting young adults may want to tailor intervention efforts based on motivations.

Self-reported penis size and experiences with condoms among gay and bisexual men.

As researchers and community-based providers continue to encourage latex condom use as a chief strategy to prevent HIV transmission among men who have sex with men, research is needed to better explore the intersecting associations among penis size (length and circumference), condom feel, ease of finding condoms, recent experience of condom failure (breakage and slippage), and unprotected anal sex. Data were taken from a 2010 community-based survey of self-identified gay and bisexual men in New York City (n = 463). More than half (51.4 %) reported penile length as 6-8 in. long (15-20 cm) and 31.5 % reported penile circumference as 4-6 in. around (10-15 cm). Variation in self-reported penile dimensions was significantly associated with men's attitudes toward the typical/average condom, difficulty finding condoms that fit, and the experience of condom breakage. Men who had engaged in recent unprotected insertive anal intercourse reported significantly higher values for both penile length and circumference, and these men were significantly more likely to report that the average/typical condom was "too tight." Most men had measured their length (86.2 %) and/or circumference (68.9 %), suggesting that penile measurement might be a common and acceptable practice among gay and bisexual men. As HIV and STI prevention providers continue to serve as leading distributers of free condoms, these findings further highlight the need for condom availability to be in a variety of sizes. Improving condom fit and attitudes toward condoms may also improve condom use and minimize condom slippage and breakage.

Correlates of concurrent energy drink and alcohol use among socially active adults.

BACKGROUND: Research indicates that energy drink consumption and the combined use of energy drinks and alcohol are popular among young adults, although this research has typically focused on college students. Because of the potential for harms associated with this combination, it is critical to understand use among adults in nightlife scenes who may be most at risk for harms associated with combined energy drink and alcohol consumption. OBJECTIVES: By focusing our sample on individuals in a range of nightlife scenes, we aim to gain a deeper understanding of the demographic factors associated with energy drink use and combined energy drink and alcohol consumption to benefit the targeting of intervention and prevention efforts beyond college campuses. METHODS: Using a field-based survey in New York City to survey adults active in various nightlife scenes, this study reports on the survey results of 1476 venue patrons at venues in five nightlife scenes in addition to college bar scenes. RESULTS: Men, younger individuals, Latinos, and sexual minority individuals reported higher prevalence of recent energy drink consumption. Younger individuals, men, and those recruited in gay venues reported higher prevalence of combining alcohol and energy drinks. CONCLUSION: These findings provide information useful to target education and prevention efforts. They also suggest the need for additional research to understand differences in motivations for use and in the behavioral and alcohol-related outcomes associated with consuming energy drinks and combining them with alcohol.

An Intersectional Feminist Analysis of Women's Experiences of Authenticity in Pornography.

Most pornography research has examined negative consequences of use among heterosexual men. Scant research has explored the benefits of using pornography among women, though research does indicate several potential benefits, including increased sexual self-esteem, sexual knowledge, and sexual communication. Research suggests that women may maximize these benefits when they perceive pornography to be authentic. To more fully understand the importance and perceptions of authenticity in pornography, we analyzed qualitative interviews with 24 women in the U.S. who reported recent pornography use. Ages ranged from 22 to 53 (M = 30.33, SD = 6.91), 62.5% were white, and most (79.2%) reported a sexual identity other than heterosexual. Thematic analyses indicated that authenticity was important for most women's enjoyment of pornography, partially via its utility in reducing guilt and emotional labor (i.e., the work needed to enjoy or believe the content). Furthermore, women's intersectional identities, such as race and sexual orientation, influenced their experiences of guilt and emotional labor. Finally, women determined authenticity within pornography in three primary ways: analyzing appearance, performance, and intimacy. Results suggest research, clinical, and educational opportunities to support women's sexual exploration and pleasure via engagement with pornography.

Longitudinal associations between adolescent alcohol use and adulthood sexual risk behavior and sexually transmitted infection in the United States: assessment of differences by race.

OBJECTIVES: We examined race differences in the longitudinal associations between adolescent alcohol use and adulthood sexually transmitted infection (STI) risk in the United States. METHODS: We estimated multivariable logistic regression models using Waves I (1994-1995: adolescence) and III (2001-2002: young adulthood) of the National Longitudinal Study of Adolescent Health (n = 10 783) to estimate associations and assess differences between Whites and African Americans. RESULTS: In adjusted analyses, adolescent alcohol indicators predicted adulthood inconsistent condom use for both races but were significantly stronger, more consistent predictors of elevated partnership levels for African Americans than Whites. Among African Americans but not Whites, self-reported STI was predicted by adolescent report of any prior use (adjusted odds ratio [AOR] = 1.47; 95% confidence interval [CI] = 1.00, 2.17) and past-year history of getting drunk (AOR = 1.53; 95% CI = 1.01, 2.32). Among Whites but not African Americans, biologically confirmed STI was predicted by adolescent report of past-year history of getting drunk (AOR = 1.68; 95% CI = 1.07, 2.63) and consistent drinking (AOR = 1.65; 95% CI = 1.03, 2.65). CONCLUSIONS: African American and White adolescent drinkers are priority populations for STI prevention. Prevention of adolescent alcohol use may contribute to reductions in adulthood STI risk.

An integrated theoretical approach to substance use and risky sexual behavior among men who have sex with men.

Research demonstrates a consistent association between substance use and sexual risk, particularly among men who have sex with men (MSM). The present study builds upon two existing theories (Cognitive Escape Theory and Expectancy Theory) to examine the synergistic role of sexual conflict (surrounding unsafe sex) and expectancies in sexual behavior among 135 MSM. Two conflicts were examined: (1) The conflict between motivation to practice safer sex and temptation for unprotected sex; and (2) The conflict between motivation to practice safer sex and perceived benefits of unprotected sex. Factorial ANOVAs (2 × 2; high versus low expectancies and conflict versus no conflict) revealed a significant interaction between conflict and expectancies-individuals who reported high levels of conflict were more sensitive to the effect of expectancies than were those experiencing low levels of sexual conflict. Results demonstrate the synergistic effects of conflict and expectancies and highlight the importance of integrating existing theories to more fully consider the intrapsychic operation and experience of sexual conflicts.

Patterns of alcohol consumption and sexual behavior among young adults in nightclubs.

BACKGROUND: Alcohol consumption has been linked to a variety of sexual risk behaviors. However, much research addresses this connection among college students, ignoring other social contexts in which this association may be prevalent, such as club settings. OBJECTIVES: As such, this study assessed patterns of drinking and sexual activity among young adults who frequent nightclubs. METHODS: Using time-space sampling, we surveyed 308 young adults (ages 18-29) in New York City clubs. RESULTS: Participants reported binge drinking on 52% of drinking days. Roughly, 62% reported recent sex under the influence, and 29% of them reported being less safe in sexual situations as a result of their drinking. Men reported more days of drinking and binge drinking than women, and were more likely to report recent sex under the influence. Younger participants were more likely to report being less safe sexually while intoxicated. Recent binge drinking was associated with sex after drinking. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: These data suggest the need for targeted intervention and prevention efforts at nightclubs.

Linguistic correlates of the Communication Patterns Questionnaire: The correspondence of language and quantitative measures of perceived communication patterns among emerging adult gay male couples.

Up to two-thirds of new HIV infections among sexual minority men are estimated to occur within main partnerships, with the greatest burden among younger partners ages 18 to 29. Various interpersonal processes, such as perceived communication patterns, influence HIV behavioral health among these couples. Although they represent correlates of health for gay couples, it is unclear how these abstract dynamics manifest in the context of everyday speech. The present study investigated linguistic predictors of perceived communication patterns among partnered gay men. Individual interviews from both members of 21 emerging adult couples were analyzed using Linguistic Inquiry Word Count. Couples' total first-person singular (I-talk) and plural (We-talk) pronoun use were positively associated with total dyadic constructive communication scores. Negative emotion word use was negatively associated with constructive communication scores. Results suggest that language use provides important markers of interpersonal processes that predict HIV behavioral health among gay couples, suggesting the potential of language use to inform HIV prevention interventions for partnered gay men in emerging adult couples.

Sexual Orientation and Pregnancy Among Adolescent Women in the National Survey of Family Growth, 2002-2015.

Purpose: Given elevated pregnancy rates, fluctuating sexual identity, and varying sexual experience among adolescent sexual minority women (ASMW; lesbian/bisexual identity, attraction to/sex with females), research should assess adolescent pregnancy by sexual attraction with identity and experience. This study examined associations of three aspects of sexuality-identity, attraction, and experience-with pregnancy among ASMW versus non-ASMW. Methods: Population-weighted data were drawn from the 2002 to 2015 National Survey of Family Growth (NSFG), 15- to 19-year-old female subsample (n = 5481). Multivariable logistic regression models (adjusted for age, race/ethnicity, and survey cycle) compared pregnancy among ASMW versus non-ASMW by sexual identity, attraction, and experience separately, and in a combined model in which interaction of aspects of sexuality and survey cycle was tested. The combined model was then stratified by survey cycle. Results: Although not significant in the combined model, sexual minority versus heterosexual identity (adjusted odds ratio [aOR] = 1.74, 95% confidence interval [CI] = 1.21-2.51, p = 0.003) and sexual minority versus exclusive male attraction (aOR = 1.49, 95% CI = 1.10-2.01, p = 0.011) individually predicted higher pregnancy odds. There was significant interaction between attraction and survey cycles. Sexual minority attraction predicted significantly decreased pregnancy odds (aOR = 0.59, 95% CI = 0.38-0.90, p = 0.014) in combined 2002 to mid-September 2013 NSFG data, but increased odds (aOR = 1.59, 95% CI = 0.63-4.02, p = 0.324) in the rest of 2013-2015. Conclusion: These results suggest the importance of measuring sexual attraction when examining pregnancy disparities among ASMW. Sex education and teen pregnancy prevention programs should reflect sexual diversity.

Differences in club drug use between heterosexual and lesbian/bisexual females.

Although there has been much empirical research documenting current trends in club drug use among gay and bisexual men, little research has addressed the variance among lesbian, bisexual, or heterosexual women. Using data collected through time-space sampling from dance clubs in New York City during 2005 (N=1104), this study explored sexual identity variance among women in the reported use of six club drugs: methamphetamine, cocaine, MDMA, ketamine, GHB, and LSD. Significant differences were found in that younger women were more likely to be active club drug users. Lesbian and bisexual women reported significantly higher lifetime rates of ecstasy, cocaine, methamphetamine, and LSD use compared to heterosexual women. These data suggest a need to better understand the influence of sexual orientation and sexual culture in relation to club drug use and to tailor health promotion efforts to meet the needs of various groups of club drug using women.

From Sexual Assault to Sexual Risk: A Relational Pathway?

Among women and gay and bisexual men, sexual assault is associated with increased rates of sexual risk behavior and negative sexual health outcomes. Although the mechanisms of these effects are potentially myriad, the current analyses examine the role of perceived partner pressure for condomless sex in mediating the association between adult sexual assault (ASA) and recent anal or vaginal sex without a condom. In a sample of 205 young adult women and gay and bisexual men, ASA was indirectly associated with condomless anal and/or vaginal sex via perceptions of partner pressure for condomless sex, χ2(1) = 5.66, p = .02, after controlling for race, age, gender and sexual identity, and relationship status. The elucidation of this relational mechanism points to several potential intervention and prevention strategies that may reduce actual and perceived pressure for sex without a condom, including strategies designed to facilitate the prioritization of health and safety over relational goals and the improvement of partner selection and perceptions of partner pressure.

Influences of motivational contexts on prescription drug misuse and related drug problems.

Prescription drug misuse has emerged as a significant problem among young adults. While the effects of motivational contexts have been demonstrated for illicit drugs, the role of motivational contexts in prescription drug misuse remains understudied. Using data from 400 young adults recruited via time-space sampling, we examined the role of motivational contexts in the frequency of misuse of three prescription drug types as well as drug-related problems and symptoms of dependency. Both negative and positive motivations to use drugs are associated with increases in prescription drug misuse frequency. Only negative motivations are associated directly with drug problems and drug dependence, as well as indirectly via prescription pain killer misuse. Addressing positive and negative motivational contexts of prescription drug misuse may not only provide a means to reduce misuse and implement harm reduction measures, but may also inform the content of treatment plans for young adults with prescription drug misuse problems.

A typology of prescription drug misuse: a latent class approach to differences and harms.

INTRODUCTION AND AIMS: Prescription drug misuse is a considerable problem among young adults, and the identification of types of misuse among this population remains important for prevention and intervention efforts. We use latent class analysis to identify possible distinct latent groups of prescription drug misusers across multiple prescription drug types (pain killers, sedatives and stimulants). DESIGN AND METHODS: Our data are comprised of a sample of 404 young adults recruited from nightlife scenes via time-space sampling. Through the specification of a zero-inflated Poisson latent class analysis, we evaluate differences in class membership by various demographic factors as well as assess the relationship between class membership and health outcomes, including indications of dependence, problems associated with substance use and mental health. RESULTS: Our assessment of fit indices led to a four-class solution (dabblers, primary stimulant users, primary downers users and extensive regulars). No demographic differences existed between latent classes. The extensive regular class report the greatest number of symptoms related to dependence, greatest number of problems related to misuse and the greatest mental health problems. The dabblers report the fewest problems and symptoms, while the other two classes experiences problems and symptoms in between the classes on the extremes. DISCUSSION AND CONCLUSIONS: Prevention efforts should take into account that young adults who misuse prescription drug have different profiles of misuse, and there may be a need for varied interventions to target these different types of misuse.