Psychosocial factors and substance use in high-risk youth living with HIV: a multi-site study

Abstract

The purpose of the study was to test relationships between psychosocial factors and alcohol and illicit drug use among high-risk youth living with HIV (YLH). One hundred eighty-six high-risk youth with HIV (defined as those with a substance use problem, sexual risk problem, or medication adherence problem) were enrolled across five cities (ages 16–24).

Alcohol and illicit drug use were measured with the alcohol, smoking, and substance involvement screening test and a timeline follow-back interview. Questionnaires assessed constructs from the adapted Transtheoretical Model (TTM) including a continuous measure of motivational readiness in response to criticisms of the stage component. Path analysis was utilized to fit cross-sectional data collected via computer assisted personal interviewing (baseline data from intervention study). Separate models were fit for each commonly used substance. In the previous month, 47% used alcohol, 37% used cannabis, and 9% used other illicit drugs. Path models fit the data well and accounted for 30% of the variance in alcohol use and 47% in cannabis use. Higher self-efficacy predicted lower alcohol and cannabis use, but motivational readiness was only directly related to cannabis use. A reduction in pros of substance use was indirectly related to use. Social support and psychological distress were associated with TTM constructs. Interventions focusing on improving motivation and self-efficacy for healthy behaviors may reduce substance use in YLH.

Keywords:

• HIV
• adolescents
• young adults
• Transtheoretical Model
• substance use

Acknowledgements

This work was supported by The Adolescent Trials Network for HIV/AIDS Interventions (ATN) [U01-HD040533 from the National Institutes of Health through the National Institute of Child Health and Human Development (B. Kapogiannis, S. Lee)], with supplemental funding from the National Institutes on Drug Abuse (N. Borek) and Mental Health (P. Brouwers, S. Allison). The study was scientifically reviewed by the ATN's Behavioral Leadership Group. Network, scientific and logistical support was provided by the ATN Coordinating Center (C. Wilson, C. Partlow) at The University of Alabama at Birmingham Network operations and data management support was provided by the ATN Data and Operations Center at Westat, Inc. (J. Korelitz, J. Davidson, B. Harris). We acknowledge the contribution of the investigators and staff at the following ATN 004 sites that participated in this study: Children's Diagnostic and Treatment Center (Ana Puga, MD, Esmine Leonard, BSN, Zulma Eysallenne, RN); Childrens Hospital of Los Angeles (Marvin Belzer, MD, Cathy Salata, RN, Diane Tucker, RN, MSN); University of Maryland (Ligia Peralta, MD, Leonel Flores, MD, Esther Collinetti, BA); University of Pennsylvania and the Children's Hospital of Philadelphia (Bret Rudy, MD, Mary Tanney, MPH, MSN, CPNP, Adrienne DiBenedetto, BSN); University of Southern California (Andrea Kovacs, M.D.), and Wayne State University Horizons Project (K. Wright, D.O., P. Lam, M.A., V. Conners, B.A.). We sincerely thank the youth who participated in this project.