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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
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Background Research has suggested that marijuana use is associated with sexual risk behaviors
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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
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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
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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
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Methods: Data Daily sexual diaries: –Alternating 90-day intervals, over 27 months –Daily record of coitus, mood, marijuana use, condom use and relationship variables
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Methods: Outcome Variables Marijuana-Associated Coitus (no/yes) Condom Use (no/yes)
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Methods: Predictor Variables Domains: –Regular coital behaviors –Partnership characteristics –Intrapersonal factors
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Methods: Predictor Variables Regular 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)
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Methods: Predictor Variables Partnership Characteristics Partner support (4-items, =0.93) Time with partner (1 item; scale: 1-4)
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Methods: Predictor Variables Intrapersonal Variables Vaginal bleeding (no/yes) Positive mood (3-items, =0.84) Negative mood (3-items; =0.81) Sexual interest (1 item, scale: 1-4)
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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
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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
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Results: Bivariate Coitus Not Associated With Marijuana Coitus Associated With Marijuana VariableMean (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
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Results: Bivariate NoYesTotal No 2857 (75.1%) 617 (76.5%) 3474 (75.4%) Yes 947 (24.9%) 189 (23.5%) 1136 (25.6%) Total 38048064610 Marijuana Associated Coitus Condom Use Х 2 (1) = 29.273, p<.000
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B = -0.072* B = 0.13*B = -0.02* B = 0.75* B = 0.35* *p<.05
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B = -0.01* B = 0.82* B = -0.01* B = -0.02* B = -0.04* B = -0.01* *p<.05
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B = -0.072* B = 0.75* B = -0.04* *p<.05 B = 0.13* B = 0.35*
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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
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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
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Limitations Does not assess motivations for sex No method for disentangling within day effects Unclear how marijuana changes usual patterns of condom use
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Implications STI prevention efforts may benefit from targeting regular coital behaviors: –Recent marijuana use –Recent marijuana associated coitus –Usual condom use
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Sources of Support NIAID U01AI3194 NIAID T32AI07637 NICHD R01 HD044387-03 HRSA/T71 MC00008-14-00
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