Mood, Marijuana-Associated Coitus and Condom Use Among Adolescent Women: An Event-Level Analysis

1. 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

2. Background • Research has suggested that marijuana use is associated with sexual risk behaviors

3. 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

4. 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

5. 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

6. Methods: Data • Daily sexual diaries: • Alternating 90-day intervals, over 27 months • Daily record of coitus, mood, marijuana use, condom use and relationship variables

7. Methods: Outcome Variables • Marijuana-Associated Coitus (no/yes) • Condom Use (no/yes)

8. Methods: Predictor Variables • Domains: • Regular coital behaviors • Partnership characteristics • Intrapersonal factors

9. 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)

10. Methods: Predictor VariablesPartnership Characteristics • Partner support (4-items, =0.93) • Time with partner (1 item; scale: 1-4)

11. 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)

16. 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 Methods: Procedure

17. 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

18. Results: Bivariate *p<.000

19. Results: Bivariate Marijuana Associated Coitus Condom Use Х2(1) = 29.273, p<.000

20. B = -0.072* B = 0.75* B = 0.35* B = 0.13* B = -0.02* *p<.05

21. B = -0.01* B = -0.01* B = -0.04* B = -0.01* B = -0.02* B = 0.82* *p<.05

22. B = -0.072* B = 0.75* B = 0.35* B = -0.04* B = 0.13* *p<.05

23. 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

24. 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

25. Limitations • Does not assess motivations for sex • No method for disentangling within day effects • Unclear how marijuana changes usual patterns of condom use

26. Implications • STI prevention efforts may benefit from targeting regular coital behaviors: • Recent marijuana use • Recent marijuana associated coitus • Usual condom use

27. Sources of Support • NIAID U01AI3194 • NIAID T32AI07637 • NICHD R01 HD044387-03 • HRSA/T71 MC00008-14-00