Mood, Marijuana-Associated Coitus and Condom Use Among Adolescent Women: An Event-Level Analysis
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Transcript of Mood, Marijuana-Associated Coitus and Condom Use Among Adolescent Women: An Event-Level Analysis
Mood, Marijuana-Associated Coitus and Condom Use Among
Adolescent Women:An Event-Level Analysis
Devon J. Hensel, Ph.D.
J. Dennis Fortenberry, M.D., M.S.
Donald P. Orr, M.D.
Section of Adolescent Medicine
Indiana University School of Medicine
Background
• Research has suggested that marijuana use is associated with sexual risk behaviors
Background
• Existing event level studies have produced mixed results
• Failure to also consider other factors related to marijuana use and to sexual risk:– Partnership characteristics– Regular patterns of sexual behavior– Intrapersonal
Objective
• To model the effects of marijuana-associated coitus as a mediator of event-level mood, sexual interest and relationship variables on condom use among adolescent women
Methods: Sample
• Adolescent women (N=267):– 14 to 17 years of age at enrollment
– Reported ever trying marijuana
– 89.9% African American
– Recruited from three primary care adolescent clinics in Indianapolis, Indiana
Methods: Data
• Daily sexual diaries:
– Alternating 90-day intervals, over 27 months
– Daily record of coitus, mood, marijuana use, condom use and relationship variables
Methods: Outcome Variables
• Marijuana-Associated Coitus (no/yes)
• Condom Use (no/yes)
Methods: Predictor Variables
• Domains:
–Regular coital behaviors
–Partnership characteristics
–Intrapersonal factors
Methods: Predictor VariablesRegular Coital Behaviors
• Recent sexual activity (past 7 days: no/yes)
• Recent marijuana use (past 7 days, not associated with sex: no/yes)
• Recent marijuana-associated coitus (past 7 days: no/yes)
• Usual condom use (past 7 days: no/yes)
Methods: Predictor VariablesPartnership Characteristics
• Partner support (4-items, =0.93)
• Time with partner (1 item; scale: 1-4)
Methods: Predictor VariablesIntrapersonal Variables
• Vaginal bleeding (no/yes)
• Positive mood (3-items, =0.84)
• Negative mood (3-items; =0.81)
• Sexual interest (1 item, scale: 1-4)
Vaginal Bleeding
Marijuana-Associated
Coitus
Usual Condom
Use
Sexual Interest
Partner Support
Positive Mood
Recent Sexual
Behavior Negative Mood
Time With Partner
Recent Marijuana
Use
Recent Marijuana-Associated
Coitus Condom
Use
Vaginal Bleeding
Marijuana-Associated
Coitus
Usual Condom
Use
Sexual Interest
Partner Support
Positive Mood
Recent Sexual
Behavior Negative Mood
Time With Partner
Recent Marijuana
Use
Recent Marijuana-Associated
Coitus Condom
Use
Vaginal Bleeding
Marijuana-Associated
Coitus
Usual Condom
Use
Sexual Interest
Partner Support
Positive Mood
Recent Sexual
Behavior Negative Mood
Time With Partner
Recent Marijuana
Use
Recent Marijuana-Associated
Coitus Condom
Use
Vaginal Bleeding
Marijuana-Associated
Coitus
Usual Condom
Use
Sexual Interest
Partner Support
Positive Mood
Recent Sexual
Behavior Negative Mood
Time With Partner
Recent Marijuana
Use
Recent Marijuana-Associated
Coitus Condom
Use
Methods: Procedure
• Structural equation modeling
• Full information maximum likelihood (FIML)– Alternative analyses: generalized estimating
logistic regression– Compare robustness of FIML to within subject
correlation of observations
• AMOS, 5.0
Results: All Diary Days
• N = 84,931 (partner) diary days
• Coitus: 5.4% (4610/84,931) of all days
• Coitus associated with marijuana: 17.48% (806/4610) of all coital events
Results: Bivariate
Coitus Not Associated With Marijuana
Coitus Associated With Marijuana
Variable Mean (SE) Mean (SE)
Partner Support* 3.21 (.02) 2.96 (.05)
Positive Mood* 9.86 (.08) 9.17 (.02)
Negative Mood* 5.49 (.06) 6.50 (.12)
Sexual Interest 2.79 (.03) 2.78 (.05)
Time With Partner 4.43 (.01) 4.50 (.03)
*p<.000
Results: Bivariate
No Yes Total
No2857
(75.1%)617
(76.5%)3474
(75.4%)
Yes947
(24.9%)189
(23.5%)1136
(25.6%)
Total 3804 806 4610
Marijuana Associated Coitus
Condom Use
Х2(1) = 29.273, p<.000
Negative Mood
Recent Sexual
Behavior
Partner Support
Sexual Interest
Vaginal Bleeding
Recent Marijuana-Associated
Coitus
Recent Marijuana
Use
Time With Partner
Positive Mood
Marijuana-Associated
Coitus
Usual Condom
Use
Condom Use
B = -0.072*
B = 0.13* B = -0.02*
B = 0.75*
B = 0.35*
*p<.05
Negative Mood
Recent Sexual
Behavior
Partner Support
Sexual Interest
Vaginal Bleeding
Recent Marijuana-Associated
Coitus
Recent Marijuana
Use
Time With Partner
Positive Mood
Marijuana-Associated
Coitus
Usual Condom
Use
Condom Use
B = -0.01*
B = 0.82*
B = -0.01*
B = -0.02*
B = -0.04*B = -0.01*
*p<.05
Negative Mood
Recent Sexual
Behavior
Partner Support
Sexual Interest
Vaginal Bleeding
Recent Marijuana-Associated
Coitus
Recent Marijuana
Use
Time With Partner
Positive Mood
Marijuana-Associated
Coitus
Usual Condom
Use
Condom Use
B = -0.072*
B = 0.75*
B = -0.04*
*p<.05
B = 0.13*
B = 0.35*
Discussion
• Substance-associated coitus: less than 20% of all coital events
• Marijuana-associated coitus appears to be associated with decreased condom use
• Effect size comparable to most other predictors
Discussion
• This association may not be causal
• Event level behavior reflected established patterns of behaviors
• Negative mood may suggest that both marijuana and coitus used to elevate mood
Limitations
• Does not assess motivations for sex
• No method for disentangling within day effects
• Unclear how marijuana changes usual patterns of condom use
Implications
• STI prevention efforts may benefit from targeting regular coital behaviors:– Recent marijuana use– Recent marijuana associated coitus– Usual condom use
Sources of Support
• NIAID U01AI3194
• NIAID T32AI07637
• NICHD R01 HD044387-03
• HRSA/T71 MC00008-14-00