Abstract
Adults aged 18 to 29 are at significant sexual risk for HIV infection. Substance use and violence are known to be associated with sexual risk in certain groups, but few studies have examined these relationships in the general population of young adults. No studies have tested whether the contributions of substance use and violence to sexual risk are independent, and few have looked at whether drug use associations with risk are specific to certain substances. Using structural modeling techniques, we examined data for 3,437 adults aged 23–24, testing for associations between three measures of sexual risk for HIV, various forms of substance use, victimization and partner violence. Alcohol use and victimization predicted high risk sex in independent samples of single and married/cohabiting adults. Marijuana use, problem drug use, and partner violence were inconsistently related to sexual risk across measures and subsamples. HIV-prevention interventions designed for young adults in the general population should target individuals who use alcohol frequently and who are victims of violence, and should address both factors, in addition to sexual risk behavior.
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Amaro, H. (1995). Love, sex, and power. Considering women’s realities in HIV prevention. American Psychologist, 50, 437–447.
Anderson, J. C., and David, W. Gerbing. (1988). Structural Equation Modeling in Practice: A Review and Recommended Two-Step Approach. Psychological Bulletin, 103, 411–423.
Bell, R. M., Gareleck, C., and Ellickson, P. L. (1990). Baseline Nonresponse in Project ALERT: Does It Matter? (N-2933-CHF). Santa Monica, Calif: RAND.
Bentler, P. M. (1988). Causal modeling via structural equation systems. In J. R. Nesselroade, and R. B. Cattell (Eds.), Handbook of multivariate experimental psychology, 2nd Ed. (pp. 317–335). New York: Plenum. (chapter in edited book).
Binson, D., Dolcini, M. M., Pollack, L. M., and Catania, J. A. (1993). Data from the National AIDS Behavioral Surveys. IV. Multiple sexual partners among young adults in high risk cities. Family Planning Perspectives, 25, 268–272.
Boney-McCoy, S., and Finkelhor, D. (1996). Is youth victimization related to trauma symptoms and depression after controlling for prior symptoms and family relationships? A longitudinal, prospective study. Journal of Consulting & Clinical Psychology, 64, 1406–1416.
Brener, N. D., McMahon, P. M., Warren, C. W., and Douglas, K. A. (1999). Forced sexual intercourse and associated health-risk behaviors among female college students in the United States. Journal of Consulting & Clinical Psychology, 67, 252–259.
Browne, M. W., and Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. B. J. S. Long (Ed.), Testing structural equation models (pp. 136–162). Newbury Park, CA: Sage.
Caetano, R., Cunradi, C. B., Clark, C. L., and Schafer, J. (2000). Intimate partner violence and drinking patterns among white, black, and Hispanic couples in the U.S. Journal of Substance Abuse, 11, 123–138.
Catania, J. A., Coates, T. J., Stall, R., Turner, H., Peterson, J., Hearst, N., Doncini, M. M., Hudes, E., Gagnon, J., Wiley, J., and Groves, R. (1992). Prevalence of AIDS-related risk factors and condom use in the United States. Science, 258, 1101–1106.
Coker, A. L., Smith, P. H., McKeown, R. E., and King, M. J. (2000). Frequency and correlates of intimate partner violence by type: physical, sexual, and psychological battering. American Journal of Public Health, 90, 553–559.
el-Bassel, N., Fontdevila, J., Gilbert, L., Voisin, D., Richman, B. L., and Pitchell, P. (2001). HIV risks of men in methadone maintenance treatment programs who abuse their intimate partners: a forgotten issue. Journal of Substance Abuse, 13, 29–43.
Ellickson, P. L., Collins, R. L., and Bell, R. M. (1999). Adolescent use of illicit drugs other than marijuana: how important is social bonding and for which ethnic groups? Substance Use & Misuse, 34, 317–346.
Ellickson, P. L., and Bell, R. M. (1990). Drug Prevention in Junior High A Multi-Site Longitudinal Test (R-3919-CHF). Santa Monica: RAND.
Ellickson, P. L., McGuigan, K. A., Adams, V., Bell, R. M., and Hays, R. D. (1996). Teenagers and alcohol misuse in the United States: by any definition, it’s a big problem. Addiction, 91, 1489–1503.
Graves, K. L., and Leigh, B. C. (1995). The relationship of substance use to sexual activity among young adults in the United States. Family Planning Perspectives, 27, 18–22, 33.
Hu, L., and Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55.
Jessor, R., and Jessor, S. L. (1977). Problem behavior and psychosocial development. New York: Academic Press.
Kantor, G. K., and Jasinski, J. L. (1998). Dynamics and risk factors in partner violence. In J. L. J. a. L. M. Williams (Ed.), Partner Violence: A Comprehensive Review of 20 Years of Research (pp. 1–43). Thousand Oaks, CA: Sage.
Koss, M. P. (1985). The hidden rape victim: Personality, attitudinal, and situational characteristics. Psychology of Women Quarterly, 9, 193–212.
Leigh, B. C., Temple, M. T., and Trocki, K. F. (1993). The sexual behavior of US adults: results from a national survey. American Journal of Public Health, 83, 1400–1408.
Little, R. J. A. (1992). Regression with Missing X’s: A Review. Journal of the American Statistical Association, 87, 1227–1237.
Longshore, D., and Anglin, M. D. (1995). Number of sex partners and crack cocaine use: Is crack an independent marker for HIV risk behavior? Journal of Drug Issues, 25, 1–10.
MacDonald, T. K., Zanna, M. P., and Fong, G. T. (1998). Alcohol and intentions to engage in risky health-related behaviors: Experimental evidence for a causal relationship. In J. G. Adair (Ed.), Advances in Ppsychological Science, (pp. 407–428). Hove, England: Psychology Press/Erlbaum (UK) Taylor & Francis.
Martin, S. L., Kilgallen, B., Tsui, A. O., Maitra, K., Singh, K. K., and Kupper, L. L. (1999). Sexual behaviors and reproductive health outcomes: associations with wife abuse in India. Journal of the American Medical Association, 282, 1967–1972.
Michael, R., Laumann, E. O., Gagnon, J., and Smith, T. W. (1988). Number of sex partners and potential risk of sexual exposure. Morbidity and Mortality Weekly Report, 37, 565–567.
Murphy, C. M., O’Farrell, T. J., Fals-Stewart, W., and Feehan, M. (2001). Correlates of intimate partner violence among male alcoholic patients. Journal of Consulting and Clinical Psychology, 69, 528–540.
Muthen, L. K., and Muthen, B. O. (1998). Mplus User’s Guide. Los Angeles, CA: Muthen & Muthen.
Mynatt, C. R., and Allgeier, E. R. (1990). Risk factors, self-attributions, and adjustment problems among victims of sexual coercion. Journal of Applied Psychology, 20, 130–153.
Norton, R., and Colliver, J. (1988). Prevalence and patterns of combined alcohol and marijuana use. Journal of Studies on Alcohol, 49, 378–380.
Parker, D. A., Harford, T. C., and Rosenstock, I. M. (1994). Alcohol, other drugs, and sexual risk-taking among young adults. Journal of Substance Abuse, 6, 87–93.
Paul, J. P., Stall, R., and Davis, F. (1993). Sexual risk for HIV transmission among gay/bisexual men in substance- abuse treatment. AIDS Education and Prevention, 11–24.
Reinisch, E., Bell, R. M., and Ellickson, P. L. (1991). How Accurate Are Adolescent Reports of Drug Use? Santa Monica, CA: RAND Corporation.
Santelli, J. S., Brener, N. D., Lowry, R., Bhatt, A., and Zabin, L. S. (1998). Multiple sexual partners among U.S. adolescents and young adults. Family Planning Perspectives, 30, 271–275.
Skinner, H. A. (1982). The drug abuse screening test. Addictive Behaviors, 7, 363–371.
Stall, R., McKusick, L., Wiley, J., Coates, T. J., and Ostrow, D. G. (1986). Alcohol and drug use during sexual activity and compliance with safe sex guidelines for AIDS: the AIDS Behavioral Research Project. Health Education Quarterly, 13, 359–371.
Steiger, J. H., and Lind, J. M. (1980). Statistically based tests for the number of common factors. Iowa City, IA: Psychometric Society.
Straus, M. A. (1999). The controversy over domestic violence by women: A methological, theoretical, and sociology of science analysis. In X. B. A. S. Oskamp (Ed.), Violence in Intimate Relationships (pp. 17–44). Thousand Oaks, CA: Sage.
Temple, M. T., Leigh, B. C., and Schafer, J. (1993). Unsafe sexual behavior and alcohol use at the event level: results of a national survey. Journal of Acquired Immune Deficiency Syndrome, 6, 393–401.
Tucker, L. R., and Lewis, C. (1973). A reliability coefficient for maximum likelihood factor analysis. Psychometrika, 38(1), 1–10.
Vlahov, D., Graham, N., Hoover, D., Flynn, C., Bartlett, J. G., Margolick, J. B., Lyles, C. M., Nelson, K. E., Smith, D., Holmberg, S., and Farzadegan, H. (1998). Prognostic indicators for AIDS and infectious disease death in HIV- infected injection drug users: plasma viral load and CD4+ cell count. Journal of the American Medical Association, 279, 35–40.
Wingood, G. M., and DiClemente, R. J. (1997). The effects of an abusive primary partner on the condom use and sexual negotiation practices of African-American women. American Journal of Public Health, 87, 1016–1018.
Zierler, S., Witbeck, B., and Mayer, K. (1996). Sexual violence against women living with or at risk for HIV infection. American Journal of Preventative Medicine, 12, 304–310.
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Collins, R.L., Ellickson, P.L., Orlando, M. et al. Isolating the Nexus of Substance Use, Violence and Sexual Risk for HIV Infection Among Young Adults in the United States. AIDS Behav 9, 73–87 (2005). https://doi.org/10.1007/s10461-005-1683-2
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DOI: https://doi.org/10.1007/s10461-005-1683-2