Attention-deficit/hyperactivity disorder symptom clusters differentially predict prenatal health behaviors in pregnant women.

OBJECTIVE: To date, most investigations of mental health in pregnant women have focused on depression or substance use. This study aimed to (a) delineate the relationships between symptoms of attention-deficit/hyperactivity disorder (ADHD) and prenatal health behaviors and (b) explore whether the symptom clusters of ADHD differentially predict prenatal health behaviors (e.g., physical strain, healthy eating, prenatal vitamin use). METHOD: A total of 198 pregnant women (mean age = 27.94 years) completed measures of ADHD symptoms, prenatal health behaviors, and depression. RESULTS: Inattention, hyperactivity, and impulsivity/emotional lability all evidenced significant relationships with the prenatal health behaviors, each differentially predicting different prenatal health behaviors. CONCLUSION: As decreased engagement in adequate prenatal health behaviors puts both the mother and fetus at risk for negative birth outcomes, future research should work to develop a brief ADHD screen to be used in obstetric clinics and should investigate these relationships within a sample of women with a diagnosis of ADHD.

Use of the Internet to Meet Sexual Partners, Sexual Risk Behavior, and Mental Health in Transgender Adults.

The purpose of this study was to examine the use of the internet to meet sexual partners among transgender individuals and examine correlates of this use, including sexual risk behavior, discrimination experiences, and mental health. A sample of 166 transgender adults (112 male-to-female transgender women and 54 female-to-male transgender men) were recruited in community venues and anonymously completed measures assessing these variables. Most participants (64.5 %) were HIV-negative, 25.2 % were HIV-positive, and 10.3 % did not know their HIV status. Overall, 33.7 % of participants reported having met a sexual partner over the internet, which did not differ significantly between transgender women and men. Among these individuals, transgender women reported significantly more lifetime internet sexual partners (median = 3) than transgender men (median = 1). Use of the internet to meet sexual partners was associated with lower self-esteem but not with depression, anxiety, somatic distress or discrimination experiences. Among transgender women, use of the internet to meet sexual partners was associated with each of the 11 sexual risk behaviors examined, including having multiple partners, sex under the influence of drugs, number of unprotected anal or vaginal sex acts, and history of commercial sex work. The use of the internet to meet partners was not associated with sexual risk behavior among transgender men (0/11 variables assessed). Although the internet is a common mode of meeting sexual partners among some transgender adults, it may also be a potential venue for prevention interventions targeting transgender individuals at particularly high risk for HIV acquisition.

Coping styles used by sexual minority men who experience intimate partner violence.

AIMS AND OBJECTIVES: This study examined the coping styles used by sexual minority men who have experienced intimate partner violence, including sexual, emotional and physical victimisation, as well as physical injury. BACKGROUND: Although sexual minority men experience intimate partner violence at least as often as do heterosexuals, there is currently limited knowledge of intimate partner violence in this community or resources for sexual minority men who experience intimate partner violence. DESIGN: Cross-sectional design. METHOD: Sexual minority men (N = 89) were recruited as part of a national online survey and completed questionnaires assessing lifetime experiences of intimate partner violence as well as various coping strategies. In terms of intimate partner violence, 34·8% of participants reported having been targets of sexual abuse, 38·2% targets of physical abuse, 69·7% targets of psychological abuse and 28·1% had experienced an injury as a result of intimate partner violence during their lifetime. RESULTS: Canonical correlation analyses found that intimate partner violence victimisation explained 32·5% of the variance in adaptive and 31·4% of the variance in maladaptive coping behaviours. In the adaptive coping canonical correlation, standardised loadings suggested that sexual minority men who experienced intimate partner violence resulting in injury were more likely to use religious coping, but less likely to use planning coping. In the maladaptive coping canonical correlation, sexual minority men who had been targets of intimate partner sexual victimisation and intimate partner violence resulting in injury tended to engage in increased behavioural disengagement coping. CONCLUSION: This study revealed several coping behaviours that are more or less likely as the severity of different forms of intimate partner violence increases. RELEVANCE TO CLINICAL PRACTICE: The identification of these coping styles could be applied to the development and modification of evidence-based interventions to foster effective and discourage ineffective coping styles, thereby improving outcomes for sexual minority men who experience intimate partner violence.

Religiosity in the non-medical use of prescription medication in college students.

BACKGROUND: The non-medical use of prescription drugs (NMUPD) is a hazardous health behavior popular among young adults and college students. Past research has documented prevalence rates and risk factors associated with NMUPD, while little research has addressed protective factors. OBJECTIVE: The present study examined the associations of religiosity and NMUPD in a sample of college students. METHODS: Young adult (ages 18-25) college students (n = 767) completed an anonymous online survey assessing demographic variables, NMUPD, personality factors, perceptions of risk, mental health, and religiosity. RESULTS: Results showed that greater religiosity scores were consistently associated with lower odds of engaging in NMUPD in the past 3 months. These associations were partially mediated by the personality characteristics of conscientiousness and openness to experience as well as perceived risk of NMUPD. The effect of religiosity on NMUPD was moderated by Greek (i.e., fraternity or sorority) membership, such that those in a Greek organization showed no relation between religiosity and NMUPD, while religiosity served as a protective factor for NMUPD among those who did not have Greek membership. CONCLUSION: These results extend past research demonstrating that religiosity is protective against substance abuse/misuse. Greek status appears to negate the protective influence of religiosity on NMUPD.

Driving under the influence of prescription drugs used nonmedically: associations in a young adult sample.

BACKGROUND: Over the past 20 years, there has been a dramatic increase in the nonmedical use of prescription drugs (NMUPD). However, minimal attention has been given to driving under the influence of prescription drugs used nonmedically. METHODS: This study examines attitudes and characteristics that might be associated with driving while engaging in NMUPD. College students (N = 763) aged 18-25 years completed online surveys assessing demographic information, NMUPD, recreational use of other drugs, psychological variables, attitudes towards NMUPD and driving, and driving behavior. RESULTS: Overall, 28.0% of participants reported lifetime NMUPD; 12.2% reported ever driving while engaging in NMUPD; and 7.9% reported this behavior in the past 3 months. Participants who reported engaging in NMUPD while driving were significantly more likely to report the use of alcohol, marijuana, ecstasy, cocaine, methamphetamine, ketamine, GHB (γ-hydroxybutyric acid), rohypnol, and mephedrone. These participants also scored higher on measures of hopelessness, impulsivity, and sensation seeking. Individuals who engaged in NMUPD while driving also reported lower perceptions of the risks of this behavior and believed that NMUPD is more common in young adults. CONCLUSIONS: A significant percentage of college students engage in driving under the influence of prescription drugs. Public health interventions designed to increase driving safety may wish to focus attention on this type of drugged driving.

Racial/ethnic disparities in mental health over the first 2 years after traumatic brain injury: a model systems study.

OBJECTIVE: To determine whether racial/ethnic disparities occur in depression, anxiety, and satisfaction with life at 1 and 2 years postdischarge. DESIGN: A prospective, longitudinal, multicenter study of individuals with traumatic brain injury (TBI) participating in the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems project. Medical, demographic, and outcome data were obtained from the Model Systems database at baseline, as well as 1 and 2 years postdischarge. SETTING: A total of 16 TBI Model Systems hospitals in the United States. PARTICIPANTS: Individuals with moderate or severe TBI (N=1662) aged 16 years or older consecutively discharged between January 2008 and June 2011 from acute care and comprehensive inpatient rehabilitation at a Model Systems hospital. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The Patient Health Questionnaire-9, Generalized Anxiety Disorder 7-item scale, and Satisfaction with Life Scale assessed depression, anxiety, and satisfaction with life at 1 and 2-year follow-ups. RESULTS: After controlling for all possible covariates, hierarchal linear models found that black individuals had elevated depression across the 2 time points relative to white individuals. Asian/Pacific Islanders' depression increased over time in comparison to the decreasing depression in those of Hispanic origin, which was a greater decrease than in white individuals. Black individuals had lower life satisfaction than did white and Hispanic individuals, but only marginally greater anxiety over time than did white individuals and similar levels of anxiety as did Asian/Pacific Islanders and Hispanic individuals. CONCLUSIONS: Mental health trajectories of individuals with TBI differed as a function of race/ethnicity across the first 2 years postdischarge, providing the first longitudinal evidence of racial/ethnic disparities in mental health after TBI during this time period. Further research will be required to understand the complex factors underlying these differences.

Safer sex as the bolder choice: testosterone is positively correlated with safer sex behaviorally relevant attitudes in young men.

INTRODUCTION: Higher testosterone (T) is tied to risk-taking, especially in financial domains but also in health domains relevant to acquiring sexually transmitted infections (STIs). However, safer sex constructs could themselves carry the possibility of "social risk" due to sexual stigma or embarrassment, or could involve boldness or confidence because they could represent status displays of frequent sexual activity. AIM: To determine how T and behaviorally relevant attitudes about sexual risk-taking are linked, to better understand biopsychosocial aspects of sexual health related to STIs. METHODS: In 78 first-year male college students, we examined correlations between salivary T and behaviorally relevant safer sex attitudes assessed via questionnaires. MAIN OUTCOME MEASURES: T, via saliva; safer sex attitudes, via a composite and the University of California, Los Angeles Multidimensional Condom Attitudes Scale (MCAS). RESULTS: Higher T was significantly correlated with higher scores on the following: safer sex likelihood composite, r(73)=0.33, P=0.003; the MCAS safer sex resilience, r(32)=0.36, P=0.037; and the MCAS condom purchase comfort, r(32)=0.37, P=0.031. Associations between T and safer sex likelihood and resilience were still robust after controlling for potential confounds, though the association between T and purchase comfort diminished to a trend. CONCLUSIONS: Higher T was positively linked with safer sex attitudes, especially those most closely tied to STI risk avoidance. Thus, future research and interventions for STI prevention should address the possibility that safer sex may be paradoxically perceived as a "bold" or "risky" choice even as it decreases STI risk.

Rape and Posttraumatic Stress Disorder (PTSD): Examining the Mediating Role of Explicit Sex-Power Beliefs for Men Versus Women.

Many rape survivors exhibit symptoms of post-traumatic stress disorder (PTSD), and recent literature suggests survivors' beliefs about sex and control may affect PTSD symptoms. The present study examined beliefs about sex and power as potential mediators of the relationship between rape and PTSD symptoms for men versus women. Participants ( N = 782) reported lifetime history of rape, current PTSD symptoms, and beliefs about sex and power. Women reported higher levels of lifetime history of rape than men (19.7% for women; 9.7% for men). While rape history predicted PTSD symptoms for both genders, beliefs about sex and power were shown to be a significant partial mediator of this relationship for men, but not for women. Results extend the literature on rape and PTSD by suggesting that survivors' beliefs about sex and power are connected and can affect their PTSD symptoms. Additionally, results illustrate how sexual violence against men may reaffirm male gender roles that entail power and aggression, and ultimately affect trauma recovery.

Structural equation modeling of the effects of racism, LGBTQ discrimination, and internalized oppression on illicit drug use in LGBTQ people of color.

BACKGROUND: Experiences with lesbian, gay, bisexual, transgender, or queer (LGBTQ) discrimination and racism have both been associated with mental health problems and illicit drug use. However, the cumulative effects of both forms of discrimination--and resulting internalized oppression--on illicit drug use in LGBTQ people of color (POC) has not been examined in the research literature. METHODS: Using online questionnaires, this study collected self-report data from 200 LGBTQ POC about their experiences with racism, LGBTQ discrimination, internalized racism, internalized LGBTQ discrimination, and illicit drug use. RESULTS: Two structural equation models yielded adequate fit indices in which experiences with racism and LGBTQ discrimination led to more internalized oppression, which then led to greater illicit drug use magnitude. LGBTQ discrimination was directly related to increased internalized oppression, which was positively associated with illicit drug use magnitude; the relationship between LGBTQ discrimination and illicit drug use magnitude was mediated by internalized oppression in both models. However, racism and the interaction between racism and LGBTQ discrimination did not show valid direct effects on internalized oppression or indirect effects on illicit drug use magnitude. CONCLUSIONS: LGBTQ POC can be the targets of both racism and LGBTQ discrimination, although the current study found that the most psychologically damaging effects may come from LGBTQ discrimination. Interventions meant to decrease or prevent illicit drug use in LGBTQ POC may benefit from helping participants examine the links among LGBTQ discrimination, internalized oppression, and illicit drug use as a coping strategy, focusing on substituting more adaptive coping.

Non-medical use of prescription drugs and HIV risk behaviour in transgender women in the Mid-Atlantic region of the United States.

Male-to-female transgender women (TGW) experience high rates of substance use and HIV. A recent substance use trend is the use of prescription medication without a doctor's consent. No research to date has examined the associations between this non-medical use of prescription drugs and HIV risk behaviour in TGW. In the present study, TGW recruited from community venues (N = 104) in the Mid-Atlantic region of the United States completed surveys assessing demographic information, non-medical use of prescription drugs, other substance use, injection practices and sexual risk behaviour. Twenty-four per cent of the sample reported lifetime non-medical use of prescription drugs across the following categories: analgesics (21.2%), anxiolytics (14.4%), stimulants (12.5%) and sedatives (8.7%). Participants reporting non-medical use of prescription drugs were more likely to report other substance use, needle use to inject drugs, injecting silicone and sharing needles. In multivariable analyses, non-medical use of prescription drugs was associated with unprotected sex, sex after engaging in substance use, and commercial sex work, after controlling for demographic factors. Self-esteem and social support from family served as protective factors for non-medical use of prescription drugs. HIV-prevention programmes focused on TGW in the United States may wish to expand their assessment of substance use to include the use of prescription medications without a physician's consent.

Alcohol mixed with energy drinks are robustly associated with patterns of problematic alcohol consumption among young adult college students.

BACKGROUND: Young adults are a population at great risk for problematic health behaviors. Alcohol mixed with energy drink (AmED) consumption is a relatively popular health risk behavior among young adults. AmED consumption continues to illustrate negative outcomes in the research literature, having been linked with other substance use, high-risk sexual behavior, and sexual victimization. Limited research to date has examined associations between AmED consumption and patterns of alcohol dependence. METHODS: Undergraduate college students (n=757) filled out an online survey which assessed their drinking habits in the past week and month, including their consumption of AmED beverages, personality characteristics, substance use, and problematic alcohol consumption via the Alcohol Use Disorders Identification Test (AUDIT). RESULTS: A minority of participants reported AmED consumption in both the past month (11.6%) and past week (9.7%). Compared to their alcohol-only drinking counterparts, AmED consumers scored significantly higher on measures of impulsivity, and lower on anxiety sensitivity when compared to their alcohol-only drinking counterparts. In multivariate analyses, AmED consumption was robustly associated with patterns of alcohol dependence (AUDIT score≥8) among young adult college students, while controlling for energy drink use, alcohol use, personality factors, substance use, and demographic variables. CONCLUSIONS: AmED consumption in the past month is robustly associated with problematic alcohol consumption. The present study describes harmful outcomes associated with AmED consumption, and extends the literature on the combined effects of alcohol and energy drinks on young adult risk behaviors. Further research needs to address causal mechanisms for the AmED and problematic alcohol consumption relation.

The Use of the Internet to Meet Sexual Partners: A Comparison of Non-Heterosexually-Identified Men with Heterosexually-Identified Men and Women.

In 2008, we conducted online interviews with 65 self-identified adult heterosexual men and women and gay/bisexual men to explore perceptions and experiences with meeting people online. Reasons for meeting people online, desired partner characteristics, and the process of connecting for sex paralleled those observed in real-life; but the Internet allowed people to identify more partners and specific partner characteristics. "Background checks" of online partners, even though often believed to be false, increased familiarity and trust leading to reduced perceived need for condom use. Participants said online condom use negotiation was easier, but usually occurred in face-to-face contexts in practice. (99).

The use of alcohol mixed with energy drinks and experiences of sexual victimization among male and female college students.

Much research has documented negative associations with the consumption of alcohol mixed with energy drinks (AmED). To date, few research studies have examined the relation between AmED and sexual victimization. Furthermore, research on sexual victimization among men is less studied. The present study employed a sample of 253 men and 545 women to examine the differential associations between AmED consumption and sexual victimization as a function of gender. Results from this study suggest that AmED consumption is robustly associated with being sexually victimized among men, but not women. These results were robust while controlling for demographic factors and other substance use. Results add to the literature on sexual victimization by potentially identifying a new high-risk drinking behavior among males who have been sexually victimized.

The Non-Medical Use of Prescription Drugs and Lifetime Experiences of Sexual Victimization Among College Men.

The non-medical use of prescription drugs (NMUPD) has been linked with many negative outcomes in previous studies. Recent literature has begun to examine the role of NMUPD among sexual victimization survivors. The present study examined the associations between NMUPD, recreational drug use, and experiences of sexual victimization among college men. Undergraduate men (n = 253) elected to take an online survey examining drug use and lifetime sexual victimization experiences. A total of 17% of the sample reported instances of being sexually victimized in their lifetime across four domains (being coerced, threatened, physically forced, or taken advantage of while incapacitated). Results indicate that, across all domains of sexual victimization, non-medical sedative use was robustly associated with sexual victimization in a multivariate model controlling for recreational drug use and demographics. No other non-medically used drug class (anxiolytics, pain medications, and stimulants) was associated with experiences of sexual victimization in the multivariate model. Results expand past literature by illustrating specific drug classes used by survivors of sexual victimization. Implications for interventions for male sexual victimization survivors are discussed.

Evaluation of a group cognitive-behavioral dementia caregiver intervention in Latin America.

Research has identified unique cultural factors contributing to dementia caregiving in Latin America but very few caregiver interventions have been systematically piloted and evaluated in this region. The purpose of this study was to examine the effectiveness of a group cognitive-behavioral intervention in improving the mental health of dementia caregivers from Cali, Colombia. Sixty-nine caregivers of individuals with dementia were randomly assigned to the cognitive-behavioral intervention or an educational control condition, both spanning 8 weeks. Compared to controls, the treatment group showed higher satisfaction with life and lower depression and burden over the posttest and 3-month follow-ups although there was no effect of the condition on participants' stress levels.

Executive functioning in attention-deficit/hyperactivity disorder: questioning the notion of planning deficits with heart rate reactivity.

This study employed a paired stimulus paradigm to compare phasic changes in heart rate among children (age categories 6-8, 9-10, and 11-12) and adults (age categories 18-19 and 20-22) with attention-deficit/hyperactivity disorder (ADHD) and age-matched controls. A sample of 95 participants (19 ADHD-diagnosed children, 34 controls, 20 ADHD-diagnosed adults, and 22 controls) solved a planning task, the Tower of London, through 4 levels of difficulty. It was hypothesized that groups with ADHD would show greater heart rate acceleration and less final deceleration than would controls, and that these heart rate responses would change with age and difficulty level as well. Though heart rate differences were found among age categories and difficulty levels, none were found between participants with ADHD and controls. The lack of ADHD differences are not consistent with the behavioral evidence that planning by itself is one of the marked executive function deficits in ADHD. Because ADHD differences were not evident, the effects either were not present or were smaller than that of difficulty level and age. Possible explanations for this lack of difference and future directions are discussed.

Connecting health-related quality of life and mental health in dementia caregivers from Colombia, South America.

Research in Caucasian populations has begun to examine the broad associations between physical and mental health in dementia caregivers. However, the examination of this relationship in Latin America is largely absent from the literature despite the fact that the region will see a major increase in dementia cases over the next 20 years. The current study examined the associations between health-related quality of life (HRQOL) and mental health in 90 dementia caregivers from Colombia, South America. A canonical correlation found that higher caregiver HRQOL was related to better mental health, as expected. Caregivers with high vitality and low role limitations due to physical problems tended to have low depression and high satisfaction with life. Follow-up multiple regressions found that caregiver role limitations due to physical problems was uniquely associated with satisfaction with life, whereas vitality, role limitations due to physical problems, and pain were uniquely associated with burden (although the pain effect was likely error due to a suppressor effect). Additionally, vitality and social functioning were uniquely negatively related to depression. Because of the extremely high overlap between these two sets of variables, dementia interventions are needed in Latin America that target both caregiver mental and physical health, as both likely operate in unison and influence each other.

High-risk cocktails and high-risk sex: examining the relation between alcohol mixed with energy drink consumption, sexual behavior, and drug use in college students.

Alcohol mixed with energy drink (AmED) consumption has garnered considerable attention in the literature in recent years. Drinking AmED beverages has been associated with a host of negative outcomes. The present study sought to examine associations between AmED consumption and high-risk sexual behaviors in a sample of young adults. Participants (N=704; 59.9% female) completed an online survey assessing AmED consumption, other drug use, and sexual behavior. A total of 19.4% of the entire sample (and 28.8% of those who reported using alcohol) reported consuming AmED. Participants who reported consuming AmED were significantly more likely to report marijuana, cocaine, and ecstasy use. Those who reported consuming AmED also had increased odds of engaging in high-risk sexual behaviors, including unprotected sex, sex while under the influence of drugs, and sex after having too much to drink. Relationships between AmED consumption and sexual behavior remained significant after accounting for the influence of demographic factors and other substance use. Results add to the literature documenting negative consequences for AmED consumers, which may include alcohol dependence, binge drinking, and the potential for sexually transmitted infections via high-risk sexual behavior.

Sexting, substance use, and sexual risk behavior in young adults.

PURPOSE: Cell phone use has become more widespread over the past decade. Young adults are frequently early adopters of new technologies, including cell phones. Most previous research examining sexting, the act of sending sexually explicit or suggestive images via text message, has focused on the legal or social consequences of this behavior. The current study focused on the public health implications of sexting by examining associations between sexting, substance use, and sexual risk behavior in youth. METHODS: Young adults (N = 763) completed online questionnaires assessing demographics, cell phone use (e.g., texting, sexting), substance use, and sexual risk behaviors. RESULTS: Sexting was reported by a substantial minority of participants (44%). Compared with their nonsexting counterparts, participants who engaged in sexting were more likely to report recent substance use and high-risk sexual behaviors, including unprotected sex and sex with multiple partners. Of those who engaged in sexting, a considerable percentage (31.8%) reported having sex with a new partner for the first time after sexting with that person. In multivariate analyses, sexting was associated with high-risk sexual behavior, after accounting for demographic factors, total texting behaviors, and substance use. CONCLUSIONS: Results suggest that sexting is robustly associated with high-risk sexual behavior. Many individuals exchange explicit or provocative photos with long-term sexual partners, but at least some participants in this study were incurring new sexual risks after sexting. Additional research is needed to understand the contexts in which sexting occurs, motivations for sexting, and relationship of sexting to risk behavior.

BMI and depressive symptoms: the role of media pressures.

Obese and overweight individuals experience higher risk for depression and emotional distress. One factor that may contribute to depression in obese or overweight individuals is exposure to unrealistic images in the media. Indeed, overall media consumption is associated with body image dissatisfaction in adolescents and young adults. Despite these compelling links, prior work has not examined the mediating effect of media pressures on the link between BMI and depression. In the present study, young adults (N = 743) completed an online survey assessing demographic information, perceived pressure from the media to conform to a certain body standard, and symptoms of depression. Structural equation modeling analyses indicated a direct effect of BMI on media pressure, a direct effect of media pressure on depressive symptoms, and an indirect effect of BMI on depressive symptoms mediated by media pressures. Findings indicate that higher BMI levels are associated with greater depressive symptoms when there is greater perceived media pressure on body image. Results suggest the need for clinicians to assess media consumption and perceived pressure to conform to physical appearance standards in individuals who are obese or overweight as well as individuals at risk for eating disorders.