Age of Sexual Debut and Cannabis Use in the United States

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.

Association between cannabis use and sexual behavior among adolescents aged 12–15 years in 21 low- and middle-income countries

“…These findings are in line with previous research documenting an association between cannabis use and increased risk of early sexual activity in adolescent samples in the USA and French Guiana. (Ayhan et al, 2015;Cha et al, 2016;El-Menshawi et al, 2019;Rosenbaum & Kandel, 1990) Moreover, they extend the evidence base by (i) replicating this association in a broad range of LMICs across the globe, (ii) providing evidence of a link between cannabis use and other sexual behavior (i.e. having multiple sexual partners), and (iii) showing a dose-dependent increase in odds of risky sexual behavior with increasing frequency of cannabis use.…”

“…Recently, there has been increasing interest in how cannabis use may influence sexual behaviors. For example, studies have shown that cannabis users are more likely to initiate sex at an earlier age in adolescence and young adulthood, (Ayhan et al, 2015;Cha, Masho, & Mezuk, 2016;El-Menshawi, Castro, Rodriguez de la Vega, Ruiz Peláez, & Barengo, 2019;Rosenbaum & Kandel, 1990) while cannabis use has been associated with risky health behaviors such as having multiple sex partners among adults. (Andrade, Carroll, & Petry, 2013) It has been hypothesized that cannabis use may increase risks for these behaviors via its adverse impact on neurodevelopment or decision-making capabilities, (Chen et al, 2017) while it is also possible that other factors such as personality traits, self-concept, social status, and attractiveness may also be implicated in this association.…”

“…(Benotsch, Koester, Luckman, Martin, & Cejka, 2011;Cavazos-Rehg et al, 2011;Kingree, Braithwaite, & Woodring, 2000;Vasilenko, Kugler, & Rice, 2016) The extant literature on cannabis use and sexual behavior among adolescents is, however, limited in focusing primarily on one aspect of sexual activity (timing of sexual debut) and data are only available from high-income settings (i.e., French Guiana, USA). (Ayhan et al, 2015;Cha et al, 2016;El-Menshawi et al, 2019;Rosenbaum & Kandel, 1990) Clearly, further research on the associations between adolescent cannabis use and other sexual behaviors is required to provide further insight into the risks associated with cannabis use, particularly in LMICs where differences in social and cultural factors mean attitudes towards and prevalence of cannabis use and sexual behavior vary considerably. (Bogt, Schmid, Gabhainn, Fotiou, & Vollebergh, 2006;Koski, Clark, & Nandi, 2017) The present study therefore aimed to investigate the relationship between cannabis use and two sexual behaviors (ever had sex, multiple partners) in a large representative sample of adolescents aged 12-15 years from 21 LMICs.…”

How old are young people when they start having sex? Unravelling the applicability of Cox proportional hazards regression

“…Although this question is thus of great interest to educators, policymakers, and young people themselves, there is no simple way to answer it. Studies on patterns of sexual initiation or on the causes or consequences of an early sexual debut often present the conditional mean ages of first sexual experiences (i.e., the mean age in the group for whom the first sexual experience had already happened) (Cha et al 2016;Epstein et al 2018;Tornello et al 2014;Halpern and Haydon 2012;Haydon et al 2012), conditional median ages (i.e., the midpoint of the frequency distribution of the ages at which sexually experienced adolescents had sex for the first time) (Liu et al 2015), or conditional quartiles (Holway 2015). Apart from their conditional nature (i.e., the exclusion of sexually inexperienced people), these estimates are often based on right-censored data, meaning that they include participants, and therefore experiences, up to a certain age.…”

A perspective review of cannabis use and sexual offenses

“…They are also more likely to engage in risky behaviors, including less frequent condom use (Buckner et al., 2018; Schumacher et al., 2018) and alcohol use during sexual activity, particularly among adolescents (Metrik et al., 2016; Schauer et al., 2020). Cannabis users are more likely to initiate sex at an earlier age in adolescence and young adulthood (Cha et al., 2016; El‐Menshawi et al., 2019). Studies have also shown that sexual initiation before age 15 is associated with increased rates of adolescent pregnancies and sexually transmitted diseases (Cavazos‐Rehg et al., 2011; Vasilenko et al., 2016).…”