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ABSTRACT
Background: Understanding the interrelationships between risky health behaviors is critical for health promotion efforts. Conceptual frameworks for understanding substance misuse (e.g. stepping-stone models) have not yet widely incorporated other risky behaviors, including those related to sexual health. Objectives: The goals of this study were to assess the relationship between early sexual debut and cannabis use, examine the role of licit substance use in this association, and evaluate differences by gender and race/ethnicity. Methods: Data came from the National Comorbidity Survey-Replication (NCS-R). Primary analysis was restricted to respondents who reported sexual debut at ≥12 years (n = 5,036). Age at sexual debut was categorized as early (<18 years), average (18 years) and late (>18 years). Logistic regression was used to assess the relationship between age at sexual debut and cannabis use. Interaction terms were used to evaluate effect modification by gender and race/ethnicity. Results: Later age of sexual debut was associated with lower odds of cannabis use relative to the average age of debut (AOR = 0.50, 95% CI = 0.37–0.66). For every year that respondents delayed their sexual debut, the relative odds of lifetime cannabis use declined by 17%. After accounting for alcohol and tobacco use the association between early sexual debut and cannabis was attenuated (AOR = 0.90, 95% CI = 0.68–1.20), while later age of debut remained protective (AOR = 0.57, 95% CI = 0.42–0.78). Results were generally consistent across race/ethnicity and gender. Conclusions: Multifactorial intervention strategies targeting both sexual health and substance use may be warranted.
Glossary
Age of sexual debut: Age of sexual initiation
Marijuana or cannabis: A greenish-gray mixture of the dried shredded leaves and flowers of Cannabis sativa: Used for recreational or medicinal purposes.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Funding
This work was supported by the Agency for Healthcare Research and Quality [grant number 1R01HS021504-01A1] and the National Institute of Mental Health [grant number K01-MH093642].
Additional information
Notes on contributors
Susan Cha
Susan Cha, MPH, PhD, is a Research Associate in Epidemiology at Virginia Commonwealth University (VCU), School of Medicine. Previously, she was a Congressional Fellow on Women and Public Policy at the Women’s Research and Education Institute where she worked to enhance research capacity and advance legislation related to adolescent substance use and teen pregnancy prevention. Susan has authored several publications in the areas of intimate partner violence, perinatal health, and racial/ethnic disparities. Her research interests include sexual and reproductive health, risky behaviors, violence, and access to health care.
Saba W. Masho
Saba W. Masho, MD, MPH, Dr PH., is an Associate Professor in the Departments of Family Medicine and Population Health and Obstetrics and Gynecology at Virginia Commonwealth University. She is the director of Community Engaged Research at the VCU Institute of Women’s Health. She is a principal investigator and co-investigator of research projects in the area of perinatal health, provision of comprehensive care to underserved pregnant women, violence, and women’s health. Dr. Masho has authored several peer-reviewed journal articles in the areas of maternal and child health and violence.
Briana Mezuk
Briana Mezuk, PhD, is an Associate Professor in the Department of Family Medicine and Population Health, Division of Epidemiology at Virginia Commonwealth University (VCU). She received her PhD in Mental Health from Johns Hopkins School of Public Health and completed a postdoctoral fellowship with the Robert Wood Johnson Health & Society Scholars Program at the University of Michigan. Her research uses epidemiologic methods to examine the interrelationships between mental and physical health over the lifespan, with a focus on depression and disorders of metabolism such as frailty and type 2 diabetes.