Adolescent cannabis use and repeated voluntary unprotected sex in women.

paper Cited Public

Authors: Agrawal, Arpana; Few, Lauren; Nelson, Elliot C; Deutsch, Arielle; Grant, Julia D; Bucholz, Kathleen K; Madden, Pamela A F; Heath, Andrew C; Lynskey, Michael T
Year: 2016
Journal: Addiction (Abingdon, England)
PMID: 27317963
DOI: 10.1111/add.13490
PMCID: PMC5056799

BACKGROUND AND AIMS: Substance use has been implicated in the onset and maintenance of risky sexual behaviors, which have particularly devastating consequences in young women. This study examined whether (i) adolescent onset of cannabis use is associated with repeated voluntary unprotected sex in women and (ii) whether this association persists after accounting for correlated familial influences. DESIGN: General population sample of female twins. SETTING: Midwestern United States. PARTICIPANTS: A total of 2784 sexually active twin women (15.5% African American) aged 18-27 years (assessed 2002-05), including 119 dizygotic (DZ) and 115 monozygotic (MZ) discordant pairs. MEASUREMENTS: Self-report interview data on cannabis use that first occurred prior to age 17 (27.1%) and repeated voluntary unprotected sex (27.2%). Key covariates included early onset of regular drinking, regular smoking, sexual debut and menstruation as well as conduct disorder symptoms and childhood sexual abuse. FINDINGS: Compared with never users and those who started using cannabis at a later age, adolescent cannabis users were more likely to report repeated voluntary unprotected sex [odds ratio (OR) = 2.69; 95% confidence interval (CI) = 2.24-3.22]. Genetic (r = 0.57, 95% CI = 0.38-0.87) and non-shared environmental (r = 0.21, 95% CI = 0.02-0.38) factors contributed to the association. After accounting for correlated familial factors, there was a consistent elevation in the likelihood of repeated voluntary unprotected sex in the exposed twin relative to her genetically identical never/late-onset user co-twin (unadjusted OR = 2.25, 95% CI = 1.14-4.44), even after adjustment for covariates (adjusted OR = 2.27, 95% CI = 1.08-4.80). CONCLUSIONS: Women who start using cannabis during adolescence appear to be more likely to report voluntary engagement in repeated unprotected sex than women who never use cannabis or who initiate cannabis use after adolescence. The results appear to be independent of shared genetic influences.

#	Section	Preview
20	DISCUSSION	In the present study, the relationship between adolescent onset of cannabis use and repeated…
21	DISCUSSION	The co-twin’s adolescent cannabis use status is indicative of genetic loading and the pattern of…
22	DISCUSSION	to rVUS as a function of co-twin’s adolescent-onset cannabis use status. Similarly, even though…
23	DISCUSSION	Our measure of rVUS is unique in that it involves repeated non-use of standardized methods of birth…
24	DISCUSSION	The increased likelihood of rVUS in women who reported cannabis use during adolescence, relative to…
25	DISCUSSION	including romantic partners (OR 1.79 [95% CI 1.47-2.18]; also associated with adolescent cannabis…
26	DISCUSSION	Possibly, the specific characteristics of the male partners and the quality of sexual relationships…
27	DISCUSSION	Perhaps most critically, women who reported rVUS and adolescent cannabis use were more likely to…
28	DISCUSSION	It is also possible that unmeasured non-familial factors, particularly those that preceded the onset…
29	DISCUSSION	Finally, our finding of elevated odds of rVUS in adolescent cannabis users persisted even when they…
30	DISCUSSION	Some limitations are noteworthy. First, our results may not extrapolate to other demographics. Our…
31	DISCUSSION	in those who also reported rVUS as well as in early-onset compared with never/late-onset cannabis…
32	DISCUSSION	Women who start using cannabis during adolescence are considerably more likely to repeatedly engage…

Name	Type
≥3 pregnancies local	phenotype
adolescent cannabis use	phenotype
Adolescent-onset twins local	cohort
adolescents	cohort
African-Americans	cohort
age	phenotype
age at first pregnancy local	phenotype
age at first romantic date local	phenotype
age at onset of cannabis use local	phenotype
alcohol	phenotype
amygdala	anatomy
birth control	drug
cannabis use	phenotype
Concordant exposed twins local	cohort
concordantly never/late-onset users local	cohort
Concordant unexposed twins local	cohort
condom local	drug
condom non-use local	phenotype
conduct disorder	phenotype
conscientiousness	phenotype
Consensual sexual activity local	phenotype
contraceptive alternatives local	drug
corticostriatal responsivity local	phenotype
delinquencies local	phenotype
discordant MZ pairs local	cohort
Discordant twins (exposed) local	cohort
Discordant twins (unexposed) local	cohort
dorsolateral prefrontal cortex	anatomy
drug dependence	phenotype
drugs	drug
drug-using male peers local	phenotype
earlier age at first romantic date local	phenotype
earlier age at sexual debut local	phenotype
Early adolescent cannabis use local	phenotype
Early life factors local	phenotype
early maturation	phenotype
early neglect and trauma local	phenotype
early-onset cannabis users local	cohort
early-onset cannabis users local	phenotype
early onset of cannabis use local	phenotype
early-onset substance use behaviors local	phenotype
early pubertal timing	phenotype
Early regular alcohol use local	phenotype
Early regular cigarette smoking local	phenotype
early regular use of alcohol local	phenotype
early regular use of tobacco local	phenotype
early sexual debut local	phenotype
Early sexual debut local	phenotype
early sexual maturation local	phenotype
European-American women local	cohort
ever pregnant local	phenotype
full sample	cohort
girls and young women local	cohort
Identical twin pairs local	cohort
illicit drugs	phenotype
impulsivity	phenotype
late-onset user co‑twins local	cohort
male counterparts local	cohort
male partners local	cohort
Missouri local	cohort
Missouri Adolescent Female Twin Study	cohort
Monozygotic twins discordant for adolescent cannabis use local	cohort
multiple sexual partners local	phenotype
MZ twins discordant for adolescent cannabis use local	cohort
never/late-onset cannabis use local	phenotype
never/late-onset cannabis users local	cohort
never/late-onset cannabis users local	phenotype
non-conforming cohort of male peers local	cohort
number of romantic male partners local	phenotype
older male peers local	cohort
older peers local	phenotype
partner discomfort local	phenotype
Patient Protection and Affordable Care Act local	other
physical abuse	phenotype
pregnancy	phenotype
promiscuity	phenotype
repeated voluntary unprotected sex local	phenotype
Repeated voluntary unprotected sex local	phenotype
risky sexual behavior	phenotype
risky sexual behaviors local	phenotype
Risky sexual behaviors local	phenotype
romantic partners local	phenotype
rVUS local	variant
self-evaluation of early maturation local	phenotype
self-regulation	phenotype
Sexual activity local	phenotype
Sexual behaviors local	phenotype
Sexually active female twins aged 18-27 local	cohort
sexually active high school students local	cohort
sexually transmitted infections	phenotype
Study Respondents local	cohort
substance use	phenotype
Twin cohort	cohort
Twin women local	cohort
unexposed co-twin local	cohort
unintended pregnancy local	phenotype
Un-paired twins local	cohort
unprotected sex	phenotype
users	cohort
ventral striatal reactivity local	phenotype
ventral striatum	anatomy
women	cohort
younger individuals (age ≤21 years) local	phenotype

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