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