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Nightlife scenes have been characterized as risk environments where social ecology and network ties facilitate substance use. In contrast to other substances, the prescription drug problem also has been shaped by the healthcare system. How network ties to professionals in these domains are associated with prescription drug misuse remains a key area of study.We analyzed a sample of 404 young adults who misuse prescription drugs, recruited from nightlife venues primarily via time-space sampling. We evaluated nine types of network ties via friends and family (5 nightlife professions and 4 healthcare professions) as well as total ties in each occupational domain and their relationship to three different outcomes - frequency of misuse, escalation to non-oral use, and substance-related problems. Negative binomial, logistic, and linear regression methods were employed. We then examined mechanisms by which these network associations may operate.Ties to party promoters (p .05) and bouncers (p .01) were positively associated with all three outcomes. A single outcome each was associated with ties to DJs (problems, p .01), musicians (frequency, p .05), and bartenders (escalation, p .05). The total number of network ties in the nightlife domain was positively associated with all three outcomes, with each additional tie increasing frequency (20.3%, p .001), odds of escalation (OR = 42.9%, p .01), and problems (12.5%, p .01). The number of sources, peer norm context, and social bonding were explanatory mechanisms for all three outcomes for nightlife networks. Specific occupational ties and the total number of ties to healthcare professionals were not associated with any outcome.Embeddedness in nightlife networks is related to patterns of prescription drug misuse, and some of this association can be explained by multiple mechanisms of social networks. By contrast, ties to healthcare professionals are not associated with patterns of misuse among such young adults.

Background China has the highest global prevalence of cigarette smokers, accounting for more than 40% of the total cigarette consumption in the world. Considering the shortage of smoking cessation services in China, and the acceptability, feasibility, and efficacy of mobile-phone-based text messaging interventions for quitting smoking in other countries, we conducted a mobile-phone-based smoking cessation study in China. Methods and findings We conducted a randomized controlled trial in China across 30 cities and provinces from August 17, 2016, to May 27, 2017. Adult smokers aged 18 years and older with the intention to quit smoking were recruited and randomized to a 12-week high-frequency messaging (HFM) or low-frequency messaging (LFM) intervention (“Happy Quit”) or to a control group in a 5:2:3 ratio. The control group received only text messages unrelated to quitting. The primary outcome was biochemically verified continuous smoking abstinence at 24 weeks. Secondary outcomes included (1) self-reported 7-day point prevalence of abstinence (i.e., not even a puff of smoke, for the last 7 days) at 1, 4, 8, 12, 16, 20, and 24 weeks; (2) self-reported continuous abstinence at 4, 12, and 24 weeks; and (3) self-reported average number of cigarettes smoked per day. A total of 1,369 participants received 12 weeks of intervention or control text messages with continued follow-up for 12 weeks. The baseline characteristics of participants among the HFM (n = 674), LFM (n = 284), and control (n = 411) groups were similar. The study sample included 1,295 (94.6%) men; participants had a mean age of 38.1 (SD 9.79) years and smoked an average of 20.1 (SD 9.19) cigarettes per day. We included the participants in an intention-to-treat analysis. Biochemically verified continuous smoking abstinence at 24 weeks occurred in 44/674 participants in the HFM group (6.5%), 17/284 participants in the LFM group (6.0%), and 8/411 participants (1.9%) in the control group; participants in both the HFM (odds ratio [OR] = 3.51, 95% CI 1.64–7.55, p < 0.001) and the LFM (OR = 3.21, 95% CI 1.36–7.54], p = 0.002) intervention groups were more likely to quit smoking than those in the control group. However, there was no difference in quit rate between the HFM and LFM interventions. We also found that the 7-day point quit rate from week 1 to week 24 ranged from approximately 10% to more than 26% with the intervention and from less than 4% to nearly 12% without the intervention. Those who continued as smokers in the HFM group smoked 1 to 3 fewer cigarettes per day than those in the LFM group over the 24 weeks of trial. Among study limitations, the participants were able to use other smoking cessation services (although very few participants reported using them), cotinine tests can only detect smoking status for a few days, and the proportion of quitters was small. Conclusions Our findings demonstrate that a mobile-phone-based text messaging intervention (Happy Quit), with either high- or low-frequency messaging, led to smoking cessation in the present study, albeit in a low proportion of smokers, and can therefore be considered for use in large-scale intervention efforts in China. Mobile-phone-based interventions could be paired with other smoking cessation services for treatment-seeking smokers in China. Trial registration ClinicalTrials.gov NCT02693626., Jinsong Tang and colleagues report on a randomized trial done in China, aiming to evaluate a smoking cessation intervention based on texting., Author summary Why was this study done? China has the highest prevalence of cigarette smokers, accounting for more than 40% of the total cigarette consumption in the world. Smoking cessation remains the single most effective prevention measure for lung cancer and other smoking-related disorders and health conditions. The availability of smoking cessation services in China is extremely limited. Mobile-phone-based text messaging interventions for quitting smoking have proven cost-effective in other countries. What did the researchers do and find? We conducted a randomized controlled trial across various cities and provinces in China. The “Happy Quit” intervention consisted of text messages based on the principles of cognitive behavioral therapy. Messages were aimed at improving self-efficacy and behavioral capability for quitting. A total of 1,369 participants—674 in the high-frequency messaging group, 284 in the low-frequency messaging group, and 411 in the control group—received 12 weeks of intervention or control text messages, with an additional 12 weeks of follow-up. We found that biochemically verified continuous smoking abstinence at 24 weeks was 6.5% in the high-frequency messaging group, 6.0% in the low-frequency messaging group, and 1.9% in the control group. What do these findings mean? The findings of our trial suggest that a mobile-phone-based text messaging intervention (Happy Quit), with either high- or low-frequency messaging, is effective for Chinese cigarette smokers. This intervention should be considered for inclusion with smoking cessation services, and could be made widely available for smokers seeking treatment in China.

Smoke-free air laws and the denormalization of smoking are important contributors to reductions in smoking during the 21st century. Yet, tobacco policy and denormalization may intersect in numerous ways to affect smoking. We merge data from the National Longitudinal Survey of Youth 1997, Tobacco Use Supplement of the Current Population Survey, American Nonsmokers’ Right Foundation, and Census to produce a unique examination of the intersection of smoking bans and denormalization and their influence on any smoking and heavy smoking among young adults. Operationalizing denormalization as complete unacceptability of smoking within nightlife venues, we examine 1) whether smoking bans and denormalization have independent effects on smoking, 2) whether denormalization mediates the influence of smoking bans on smoking, and 3) whether denormalization moderates the impact of smoking bans on smoking. For any smoking, denormalization has a significant independent effect beyond the influence of smoking bans. For heavy smoking, denormalization mediates the relationship between smoking bans and habitual smoking. Denormalization does not moderate the relationship of smoking bans with either pattern of smoking. This research identifies that the intersection of denormalization and smoking bans plays an important role in lowering smoking, yet they remain distinct in their influences. Notably, smoking bans are efficacious even in locales with lower levels of denormalization, particularly for social smoking.

Given the growth in methamphetamine use in China during the 21st century, we assessed perceived psychosocial barriers to drug treatment among this population. Using a sample of 303 methamphetamine users recruited via Respondent Driven Sampling, we use Latent Class Analysis (LCA) to identify possible distinct latent groups among Chinese methamphetamine users on the basis of their perceptions of psychosocial barriers to drug treatment. After covariates were included to predict latent class membership, the 3-step modeling approach was applied. Our findings indicate that the Chinese methamphetamine using population was heterogeneous on perceptions of drug treatment barriers; four distinct latent classes (subpopulations) were identified--Unsupported Deniers, Deniers, Privacy Anxious, and Low Barriers--and individual characteristics shaped the probability of class membership. Efforts to link Chinese methamphetamine users to treatment may require a multi-faceted approach that attends to differing perceptions about impediments to drug treatment.

Alcohol consumption is associated with sexual behavior and outcomes, though research indicates a variety of moderating factors, including demographic characteristics. To better target interventions aimed at alcohol-related sexual risk behavior, our analyses simultaneously examine demographic predictors of both day- and event-level associations between alcohol consumption and sexual behavior in a sample of young adults (N = 301) who are sexually active and consume alcohol. Young adults (aged 18–29) recruited using time-space sampling and incentivized snowball sampling completed a survey and a timeline follow-back calendar reporting alcohol consumption and sexual behavior in the past 30 days. On a given day, a greater number of drinks consumed was associated with higher likelihood of sex occurring, particularly for women and single participants. During a given sexual event, number of drinks consumed was not associated with condom use, nor did any demographic predictors predict that association. Findings highlight associations between alcohol and sexual behavior, though not between alcohol and sexual risk behavior, highlighting the need for additional research exploring the complex role of alcohol in sexual risk behavior and the need to develop prevention efforts to minimize the role of alcohol in the initiation of sexual encounters.

Purpose Alternative consumption practices of prescription drug misuse have been less well monitored than general prevalence. We describe prescription drug smoking among socially active youth and highlight correlates of this practice. We also examine its association with drug problems, drug dependence, and mental health. Methods We surveyed 404 young adults recruited from nightlife venues in New York via time-space sampling. We use linear and logistic regression models to examine the probability of smoking prescription drugs and its association with drug problems, dependence, and mental health. Qualitative findings supplement the survey data. Results Males have higher odds than females (odds ratio [OR] = 3.4), and heterosexuals have higher odds than sexual minority youth (OR = 2.3) of smoking prescription drugs. Those involved in electronic dance music nightlife have higher odds (OR = 2.1) than those who do not participate in that scene, whereas those in college bar scenes have lower odds (OR = .4) of having smoked prescription drugs. Prescription drug smokers report more drug problems (β = .322) and greater symptoms of dependence net (β = .298) of the frequency of misuse and other characteristics. Prescription drug smokers do not report greater mental health problems. Qualitative interview data support these survey findings. Conclusions Prescription drug smoking is a significant drug trend among socially active youth. It is associated with drug problems and symptoms of dependence net of frequency of misuse. Prevention and intervention efforts for youth who misuse prescription drugs should address the issue of prescription drug smoking, and this may be an area for clinicians to address with their adolescent patients.

Though research indicates a complex link between substance use and sexual risk behavior, there is limited research on the association between sexual risk behavior and prescription drug misuse. In light of alarming increases in prescription drug misuse and the role of demographic characteristics in sexual risk behavior and outcomes, the current study examined demographic differences (gender, sexual identity, age, relationship status, parental class background, and race/ethnicity) in sexual risk behavior, sexual behavior under the influence of prescription drugs, and sexual risk behavior under the influence of prescription drugs in a sample of 402 young adults (ages 18 to 29) who misused prescription drugs. Nearly half of the sexually active young adult prescription drug misusers in this sample reported recent sex under the influence of prescription drugs; more than three-quarters reported recent sex without a condom; and more than one-third reported recent sex without a condom after using prescription drugs. Zero-inflated Poisson regression models indicated that White race, younger age, higher parental class, and being a heterosexual man were all associated with sexual risk behavior, sex under the influence of prescription drugs, and sexual risk under the influence of prescription drugs. Findings have implications for the targeting of prevention and intervention efforts.

In this article, we present the results of a systematic review of state, county, and municipal restrictions on the use of electronic cigarettes (e-cigarettes) in public spaces within the United States, alongside an overview of the current legal landscape. The lack of federal guidance leaves lower-level jurisdictions to debate the merits of restrictions on use in public spaces without sufficient scientific research. As we show through a geographic assessment of restrictions, this has resulted in an inconsistent patchwork of e-cigarette use bans across the United States of varying degrees of coverage. Bans have emerged over time in a manner that suggests a "bottom up" diffusion of e-cigarette clean air policies. Ultimately, the lack of clinical and scientific knowledge on the risks and potential harm reduction benefits has led to precautionary policymaking, which often lacks grounding in empirical evidence and results in spatially uneven diffusion of policy.

Objectives. To examine the influence of undocumented immigration in the United States on 4 different metrics of drug and alcohol problems: drug arrests, drug overdose fatalities, driving under the influence (DUI) arrests, and DUI deaths. Methods. We combined newly developed state-level estimates of the undocumented population between 1990 and 2014 from the Center for Migration Studies with arrest data from the Federal Bureau of Investigation Uniform Crime Reports and fatality information from the Fatality Analysis Reporting System and the Centers for Disease Control and Prevention Underlying Cause of Death database. We used fixed-effects regression models to examine the longitudinal association between increased undocumented immigration and drug problems and drunk driving. Results. Increased undocumented immigration was significantly associated with reductions in drug arrests, drug overdose deaths, and DUI arrests, net of other factors. There was no significant relationship between increased undocumented immigration and DUI deaths. Conclusions. This study provides evidence that undocumented immigration has not increased the prevalence of drug or alcohol problems, but may be associated with reductions in these public health concerns.

Prescription drug misuse among young adults has surged over the past decade. Yet, the contexts surrounding this misuse remain unclear, particularly subcultural contexts. Many urban young adults participate in youth cultures. This paper describes the subcultural contexts of prescription drug misuse within youth subcultures. Drawing on ethnographic data collected over 12 months from different youth cultural scenes, the authors describe the subcultural bases of prescription drug misuse. The symbolic boundaries and subcultural capital inherent in these scenes shape the ways youth think about drugs and behave accordingly. While young adults are often lumped together, ethnographic data show considerable variation across these subcultures with regard to what may enable or inhibit prescription drug misuse. The broader subcultural ethos in each scene, as well as attitudes towards other types of drugs, frame the ways that prescription drugs are perceived and used within each of these scenes. In this regard, the findings highlight the role of symbolic boundaries and subcultural capital in drug use among young adults by shaping their routine practices. These data highlight that education campaigns about prescription drug misuse should account for the variability in youth cultural scenes to maximize the efficacy of these messages aimed at young adults.

While a significant minority of prescription drug misusers report purchasing prescription drugs, little is known about prescription drug selling. We build upon past research on illicit drug markets, which increasingly recognizes networks and nightlife as influential, by examining prescription drug market involvement.We use data from 404 young adult prescription drug misusers sampled from nightlife scenes. Using logistic regression, we examine recent selling of and being approached to sell prescription drugs, predicted using demographics, misuse, prescription access, and nightlife scene involvement.Those from the wealthiest parental class and heterosexuals had higher odds (OR=6.8) of selling. Higher sedative and stimulant misuse (OR=1.03), having a stimulant prescription (OR=4.14), and having sold other illegal drugs (OR=6.73) increased the odds of selling. College bar scene involvement increased the odds of selling (OR=2.73) and being approached to sell (OR=2.09). Males (OR=1.93), stimulant users (OR=1.03), and sedative prescription holders (OR=2.11) had higher odds of being approached.College bar scene involvement was the only site associated with selling and being approached; such participation may provide a network for prescription drug markets. There were also differences between actual selling and being approached. Males were more likely to be approached, but not more likely to sell than females, while the opposite held for those in the wealthiest parental class relative to lower socioeconomic statuses. Given that misuse and prescriptions of sedatives and stimulants were associated with prescription drug market involvement, painkiller misusers may be less likely to sell their drugs given the associated physiological dependence.

Introduction and Aims Prescription drug misuse is a considerable problem among young adults, and the identification of types of misuse among this population remains important for prevention and intervention efforts. We use latent class analysis to identify possible distinct latent groups of prescription drug misusers across multiple prescription drug types (pain killers, sedatives and stimulants). Design and Methods Our data are comprised of a sample of 404 young adults recruited from nightlife scenes via time–space sampling. Through the specification of a zero-inflated Poisson latent class analysis, we evaluate differences in class membership by various demographic factors as well as assess the relationship between class membership and health outcomes, including indications of dependence, problems associated with substance use and mental health. Results Our assessment of fit indices led to a four-class solution (dabblers, primary stimulant users, primary downers users and extensive regulars). No demographic differences existed between latent classes. The extensive regular class report the greatest number of symptoms related to dependence, greatest number of problems related to misuse and the greatest mental health problems. The dabblers report the fewest problems and symptoms, while the other two classes experiences problems and symptoms in between the classes on the extremes. Discussion and Conclusions Prevention efforts should take into account that young adults who misuse prescription drug have different profiles of misuse, and there may be a need for varied interventions to target these different types of misuse. [Kelly BC, Rendina HJ, Vuolo M, Wells BE, Parsons JT. A typology of prescription drug misuse: A latent class approach to differences and harms. Drug Alcohol Rev 2015;34:211–20]

Although substance abuse treatment has been considerably scaled up in China, impediments to accessing these services remain among drug users. The authors examine the primary psychosocial barriers to drug treatment in this population and evaluate factors associated with these barriers. Barriers to accessing drug treatment were measured using the Barriers to Treatment Inventory (BTI). A Structural Equation Model was used to examine whether the internal barriers were associated with treatment history and frequent methamphetamine use as well as how demographic characteristics influence such barriers. We found four primary factors of internal barriers to drug treatment – absence of problem, negative social support, fear of treatment, and privacy concerns – to fit well. Demographic factors, notably age and employment status, indirectly influence barriers to treatment via other factors. Frequency of methamphetamine use and drug treatment history are directly associated with the absence of problem and negative social support dimensions of the BTI, and it is through these pathways that demographic factors such as age and employment status shape barriers to treatment. The findings indicate that perceived absence of a problem and negative social support are the barriers most influenced by the personal domains of Chinese drug users’ lives. Efforts to engage drug users in China about drug treatment options may consider how these barriers are differentially perceived in order to effectively reach this population.

The reported declining significance of gay neighborhoods has raised questions about the role of gay enclaves as a locus for community building. Using Wellman and Leighton's community “lost,” “saved,” and “liberated” frameworks, we examine the degree to which gay enclave residence and network socializing are associated with experiences of gay community among men in the New York City area. Multilevel models indicate that enclave residence is neither directly nor indirectly associated with perceived community cohesion or community attachment. Increased socializing with gay men and heterosexuals were, respectively, positively and negatively associated with our community outcomes. Increased socializing with lesbians was associated with greater community attachment, while socializing with bisexuals was associated with greater perceived community cohesion. Our findings lend support for a “gay community liberated” perspective; experiences of gay community are shaped principally by network relations rather than re...

This article aims to introduce and demonstrate the application of the standardization and decomposition analysis (SDA) method to gauge differences in HIV prevalence rates among injection drug users (IDUs) across regions (Northeast, South, Midwest, and West) in the U.S. Using the SDA, the regional HIV prevalence rates were standardized and a rate difference between regions was decomposed into component effects, such as the "real" rate difference, and component effects attributed to differences in specific compositions of confounding factors. A total of 9,824 injection drug users (IDUs) retrieved from the national database of the National Institute on Drug Abuse's Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program (COOP) projects constitute the sample for the study. A computer program DECOMP was used to implement the multi-population SDA.

The use of marijuana has become a normative illicit practice within many youth subcultures. As such it remains important to identify how subcultures shape the nuances of their respective participants' marijuana consumption practices and how these practices shape social interaction patterns. This research highlights how different subcultural contexts influence interaction rituals surrounding marijuana consumption. Findings are based on twelve months of ethnographic fieldwork within the hip-hop and jam band scenes. We assess how the symbolic systems framing subcultural norms and values influence marijuana consumption practices and how these in turn reinforce the subcultural system. We examine the implications these practices have for producing varied levels of consumption and providing different experiences of community.

The decision to initiate, maintain, or quit cigarette smoking is structured by both social networks and health beliefs. Self-exempting beliefs affect people's decisions in favor of a behavior even when they recognize the harm associated with it. This study incorporated the literatures on social networks and self-exempting beliefs to study the problem of daily smoking by exploring their mediatory relationships and the mechanisms of how smoking behavior is developed and maintained. Specifically, this article hypothesizes that social networks affect daily smoking directly as well as indirectly by facilitating the formation of self-exempting beliefs. The sample comes from urban male residents in Hangzhou, China randomly selected and interviewed through multistage sampling in 2011. Using binary mediation analysis with logistic regression to test the hypotheses, the authors found that (a) daily smoking is associated with having smokers in several social network arenas and (b) self-exempting beliefs about smoking mediate the association between coworker network and daily smoking, but not for family network and friend network. The role of social network at work place in the creation and maintenance of self-exempting beliefs should be considered by policymakers, prevention experts, and interventionists.

Objective “Gay community” is often conceptualized as a “melting pot” in which gay, lesbian, and bisexual (GLB) persons are united and integrated into one sexual minority community. Evidence, however, indicates that GLB community may also be conceptualized as a mosaic of sexual minority communities with differing goals and ideologies. We test the validity of these conceptions of community with respect to two facets of the personal experiences of GLB individuals: socializing with GLB persons and GLB community cohesion perceptions. Methods Analyses of the 2005 Sex and Love survey of New York City area GLB persons. Results GLB persons tended to socialize most with their own sexual identity group. Compared to gay men, only bisexual women reported higher perceptions of GLB community cohesion. Conclusion Our findings indicate the presence of a mosaic sexual minority community. The extent of sexual-identity-group-specific socializing patterns suggests that personal perceptions of GLB cohesion may either be idealized rather than based on routine interactions or reflect assessments of within-group (not across-group) cohesion.

Drug treatment services of varying types have been scaled up in China over the past decade. Yet, barriers to treatment remain among the population of drug users in China. In this paper, we use a person-centered approach to examine external barriers to drug treatment among a sample of Chinese drug users. Specifically, we used a latent class analysis to determine a typology of external barriers to treatment among a sample of 262 drug users. The results of the analyses suggest three-classes of drug users with respect to their perceptions of external barriers to treatment – Major Barriers, Low Barriers, and Systems-level Barriers – indicating that drug users are a heterogeneous population on this matter. Age and types of drugs used were predictors of class membership. In this regard, different tactics must be utilized in order to successfully reach this wide ranging group of individuals.

In recent decades, methamphetamine developed a peculiar geographic distribution in the United States, with limited diffusion in the Northeast. While use within gay clubs received attention, methamphetamine in club subcultures more broadly remains less clear. Using quantitative and qualitative data, we provide a descriptive assessment of methamphetamine use in club subcultures. Methamphetamine use in club subcultures often has instrumental purposes. The context of initiation into methamphetamine use and its close connection to cocaine shape later patterns of use. Viewing meth solely as a gay party drug misses a significant part of the population and may misguide public health strategies to reduce methamphetamine use in the Northeast.

Introduction and Aims The emergence of novel psychoactive substances has been reported in clinical studies and recent studies of users. The use of these substances in European nightlife scenes is well documented. Little research has been done to identify the prevalence of these drugs among young adults active in other regions. We focus our sample on socially active young adults to gain an indication of the prevalence and understanding of demographic factors associated with past year mephedrone (‘meph’, ‘bath salts’) and synthetic cannabinoid (‘spice’, ‘K2’) use. Design and Methods This study reports on the results of a field-based survey of 1740 patrons at nightlife venues in New York City. Results Within the sample, 8.2% reported use of synthetic cannabinoids and 1.1% reported the use of mephedrone. Gay and bisexual men reported higher prevalence of mephedrone use. Latinos reported higher prevalence of synthetic cannabinoid use. Multivariate analyses indicate that sexual minority identity is associated with mephedrone use and younger age and Latino ethnicity are associated with synthetic cannabinoid use. Discussion and Conclusion The findings suggest that the use of synthetic cannabinoids and mephedrone among adults in US nightlife scenes remains relatively low in comparison with European nightlife scenes, and is low relative to other drug use among young people within these scenes. [Kelly BC, Wells BE, Pawson M, LeClair A, Parsons JT, Golub SA. Novel psychoactive drug use among younger adults involved in US nightlife scenes. Drug Alcohol Rev 2013;32:588–593]

Insomnia and the inability to sleep affect people’s health and well-being. However, its systematic estimates of prevalence and distribution in the general population in China are still lacking. A population-based cluster sampling survey was conducted in the rural and urban areas of Hunan, China. Subjects (n = 26,851) were sampled from the general population, with a follow-up using the Pittsburgh Sleep Quality Index (PSQI) for interview to assess quality of sleep and Insomnia (PSQI score >5). While the overall prevalence of insomnia was 26.6%, and little difference was found between males (26.3%) and females (27.0%); the mean PSQI score was 4.26 (±2.67), and significant higher in females (4.32 ± 2.70) than males (4.21 ± 2.64, p = 0.003). Individuals in the rural areas tended to report a higher PSQI score (4.45 ± 2.81) than urban residents did (4.18 ± 2.60) (p

Youth cultures are important dimensions of the lives of many young people. They not only influence how young people think, but their behaviors as well, including drug use. This chapter describes the use of cannabis within three youth cultures: the hip-hop scene, the jam band scene, and the rave scene. Each section describes the subcultural basis of marijuana use by the young people who participate in them. We begin with a description of the significance of marijuana use within the hip-hop scene, and highlight the symbolic significance of smoking marijuana in the form of blunts. Next, we cover marijuana’s entrenchment within the jam band subculture, and highlight the key role its use plays in forming and sustaining a sense of community within the scene. Finally, we describe the rave scene, and the ways in which marijuana has been incorporated into wider patterns of drug use by members of electronic dance music scenes.

Teenage girls in age-discordant relationships remain of concern for healthy development and well-being. We examine whether factors from several sociological frameworks—self-esteem, deviance, social ecology, family cohesion, and religious involvement—predict entry into such relationships. With longitudinal data on 1,537 adolescent girls, we use structural equation modeling to assess risk and protective factors by age group. Results indicate that few social factors predict entry to such relationships; only religious involvement for the youngest adolescents and self-esteem for middle adolescents predict entry. While adolescent girls who date older males are largely like their peers, any impact of social factors may vary by the developmental stage that adolescent girls occupy.

Conceptualizations of HIV risk have changed over the 35 years since the identification of a cluster of mortality among gay men in Los Angeles (1). From these early days, condoms have served as a critical primary prevention tool. The entrenchment of condom use as the central prevention strategy during the ensuing years left a legacy by which it remained the focal point in considerations of risk. Yet, increasingly during the intervening years, concerns arose about the absence of condoms as a marker of risk. Men increasingly questioned a “one size fits all” approach to defining risk and the impact that had on their lives. Jin and colleagues (2) have provided us with useful empirical evidence for conversations about the nature of risk in the sexual encounters of men who have sex with other men, and such approaches are more feasible with methodological advances facilitating refined data collection. The pattern of sexual partnering described in their results explains why they assert “any condomless anal intercourse is no longer an accurate measure of HIV sexual risk behavior.” Simply put, risk reduction efforts are widespread during episodes of condomless anal sex among these men. In response to the desire to provide alternative strategies to condom use, numerous harm reduction practices emerged over time. Serosorting, negotiated safety, strategic positioning, and withdrawal before ejaculation all became incorporated into the sexual routines of gay men and other MSM even prior to the more recent biomedical approaches, such as PrEP and viral load sorting. Importantly, many of these risk reduction methods emerged in a bottom-up fashion and serve as a reminder of the critical role that communities themselves play in public health promotion. The evidence provided by Jin and colleagues affords an understanding of how HIV-negative men approach sexual encounters with respect to the range of risk reduction options available to them. Among the HIV-negative men they followed over the course of several years, six out of seven episodes of condomless anal intercourse occurred with a regular HIV-negative partner. This critically underscores that most condomless anal sex occurs within the context of a regular sexual relationship with someone who is known to be HIV-negative, which alone is an important indicator that risk is misspecified when “unprotected anal intercourse” is defined simply by a lack of condom use. But, the authors further provide us with information about the use of other risk reduction strategies during condomless sex, both with casual partners and with regular partners of unknown or discordant serostatus. They find that HIV-negative men who have HIV-positive regular partners are heavily reliant upon evaluating viral load and condomless anal sex most often occurred when their partner had an undetectable viral load. This consideration of viral load is a critical component of the wider treatment as prevention strategy indicating that an HIV-positive partner’s undetectable viral load considerably reduces risk of transmission (3, 4); these men strategically put this information to use with serodiscordant regular partners. In addition, the results indicate that HIV-negative men rely heavily upon strategic positioning and withdrawal as risk reduction techniques during condomless sexual encounters with status unknown or serodiscordant partners. While acknowledging that these strategies are by no means foolproof, they do confer an element of protection beyond instances in which such strategies are not used (5), further complicating notions of protection and its absence. A more holistic consideration of risk is even more important as biomedical advances have more fully diminished the need to solely focus on condoms in prevention among gay men and other MSM. This approach has been institutionalized with the U.S. CDC’s 2014 move to not equate condomless sex with unprotected sex. Yet, the paper by Jin and colleagues is also implicitly an important reminder of the crucial roles that testing and treatment continue to play in inhibiting the transmission of HIV with these risk reduction strategies. While the usage of the sexual risk reduction strategies have rendered notions of condomless sex as “unprotected” inaccurate, these strategies are undoubtedly optimized when current, correct information about serostatus and viral load are available. In the absence of up-to-date information, the decision-making processes underlying the intent of these strategies are undermined. For these reasons, the advocacy of strategies that provide alternatives to condom use must be accompanied by the advocacy of regular testing and treatment. Increasing HIV testing among MSM recently has been highlighted as critical for achieving substantial reductions in HIV incidence (6), and the promotion of testing as often as quarterly is a cost-effective public health strategy (7). Yet, rates of testing among MSM remain suboptimal even in well-resourced regions (8), and disparities in resources for testing and treatment remain considerable; not all men have similar opportunities to avail themselves of such resources. Nonetheless, the widespread use of risk reduction strategies highlights the foundational role of the accuracy of information provided by regular testing and treatment in the navigation of risk and the need to promote such engagement with health-care professionals. Reconsiderations of risk are critical during the course of any epidemic as a scientific knowledge base is developed. Yet, reconsiderations of condomless sex as unprotected are not simply a matter of epidemiology or the production of medical and scientific knowledge. The prospect of more nuanced considerations of risk has ramifications in the personal lives and experiences of the men who consider alternatives to condom use. Changes in the way health professionals think about protection and risk provide for many men a validation in the expansion of partnering options, the enhancement of intimacy within couples, and the provision of a greater sense of agency over sex lives. Thus, beyond the pragmatic concerns of disease prevention among health professionals, prevention strategies born out of alternative notions of risk have deeply meaningful implications for how romantic and sexual partnering is experienced by gay men. More nuanced assessments of risk will not only simply lead to better science but also lend legitimacy to the experiences gay men and other MSM are striving for, which will have a broader impact on their well-being.

Introduction and Aims Youth cultures play a key role in the social organisation of drug trends among young people; the current prescription drug misuse trend is no different. The authors evaluated whether patterns of prescription drug misuse differed across several youth cultures. Design and Methods Using field survey methods and time–space sampling during 2011, the authors assessed the patterns and prevalence of prescription drug misuse among young adults who are socially active in various urban youth cultures (n = 1781). Results The prevalence of lifetime prescription drug misuse is highest within indie rock scenes (52.5%), electronic dance music scenes (52.1%), lesbian parties (53.8%) and alt scenes (50.9%). Prescription drug misuse was lowest among young adults in hip-hop scenes (25.0%). These findings were upheld in logistic regression analyses that accounted for demographic differences across youth cultures: indie rock scenes (adjusted odds ratio = 2.11), electronic dance music scenes (adjusted odds ratio = 2.20), lesbian parties (adjusted odds ratio = 2.30) and alt scenes (adjusted odds ratio = 2.65) all reported statistically significant (P

Gay neighbourhoods have historically served as vital places for gay socialising, and gay social networks are important sources of social support. Yet, few studies have examined the influence of these forms of community on sexual health. Informed by theoretical frameworks on neighbourhoods and networks, we employ multi-level modelling to test hypotheses concerning whether gay neighbourhoods and social network factors are associated with five sexual risk behaviours: receptive and insertive unprotected anal intercourse (UAI), barebacking identity, recent internet use for finding sexual partners, and 'Party and Play' (PnP). Our analyses of a community-based sample of gay men in New York City reveal little evidence for the direct effect of gay enclaves on sexual risk with the exception of PnP, which was more likely among gay enclave residents. Having a network composed predominantly of other gay men was associated with insertive UAI, PnP, and internet use for meeting sexual partners. This network type also mediated the association between gay neighbourhoods and higher odds of insertive UAI as well as PnP. Our findings highlight the sexual health implications of two important facets of gay community and, in doing so, indicate the need to better contextualise the sexual health risks faced by gay men.

Intimate partner violence among gays and lesbians has gained increased attention in recent years. The present study assessed mutual partner violence within a gay, lesbian, bisexual (GLB) community sample to explore how mutual partner violence relates to the use of psychoactive substances. The results suggest that individuals engaging in mutual partner violence are more likely to report the use of numerous drugs than other subjects. However, this finding holds more consistently among men. The results also indicate that the exchange of violence is more significant for substance use than the particular type of violence involved. The authors suggest that minority stress may be an underlying mechanism of both substance use and partner violence and may contribute to the intersection of these deviant phenomena in the GLB community.

During recent years, there has been increasing interest in "legal highs" among youth and young adults. Salvia divinorum is a legally available hallucinogenic plant, primarily utilized in smokable form, that produces a brief but intense hallucinogenic experience for the user. Data are presented from an ethnographic project to provide a qualitative profile of salvia use among young adults. Most users report primarily using in home settings such as apartments and houses, although a significant minority report use in environments such as parks, bars, and parties. The intense nature of the substance creates a differential subjective experience. Some describe the intensity of the hallucinogenic experience in positive ways. Others find the experience so intense that they would not continue to use the substance. With regard to the health effects of salvia, most young adults report no significant negative health effects from salvia use, although some report a mental cloudiness. Beyond their own experiences, users did not report any negative health events among peers. The lack of reports of negative effects may reinforce social norms favorable towards salvia use. Overall, young adults report a relatively low risk profile for salvia divinorum, which may be influenced, in part, by its legal status.

Gay neighborhoods serve as vital places for gay men’s socializing, yet few studies have examined their contributions to gay men’s health—either directly or indirectly via residents’ social networks. Drawing from theoretical perspectives on community and networks, we test hypotheses concerning whether gay neighborhoods and social network factors are associated with patterns of recent illicit drug use among a sample of 740 urban gay men from New York City. Higher odds of drug use were observed among individuals who resided in gay neighborhoods, had networks composed predominantly of other gay men, and had increased socialization with gay men. Network factors did not mediate associations between gay neighborhoods and drug use. These findings highlight the need to better contextualize the health risks faced by gay men by accounting for both neighborhood and network structures.

Existing research has demonstrated the significance of situational antecedents to substance use. The current study used a cluster analytic approach to identify groups of club drug users who report using substances in similar situations (assessed by the Inventory of Drug Taking Situations) with longitudinal data from 400 active drug users. A three-cluster solution emerged in baseline data and was replicated in 12-month follow-up data. Groups were identified as Situationally Restricted, Pleasure Driven, and Situationally Broad users. Group differences were observed on measures of mental health, attitudes towards substance use, amount of substance use, and rates of substance dependence. Cluster membership predicted substance dependence after controlling for past dependence, current use, and current depression/anxiety.

Previous research on adolescent girls in relationships with older partners suggests a range of negative outcomes for the adolescent. Using three waves of data from the National Longitudinal Survey of Adolescent Health and a life course perspective, we explore the connection between involvement in age discordant relationships (girls dating males three or more years older) and the course of depressive symptoms among adolescent girls. Our analyses are conducted on the 1,307 girls with data at all three waves who had been in a relationship in the last 18 months. The sample is 55% White, 22% Black, 7% other race and 16% Latina. When comparing early adolescent girls (13-15) and late adolescent girls (16-18), the younger girls are no more likely to have depressive symptoms before entry into the age discordant relationship, yet have greater depressive symptoms shortly after the relationship onset and 5 years later. Older adolescent girls in age discordant relationships, however, have similar levels of depressive symptoms at any time point relative to their peers. These data suggest that a girl's developmental stage influences whether or not she experiences emotional distress as a result of being in an age discordant relationship.

Although non-medical prescription drug use has dramatically increased in many populations during the past decade, this phenomenon remains understudied among men who have sex with men (MSM). Using a community-based sample of MSM, we provide data on the high prevalence of lifetime and recent non-medical prescription drug use among MSM for a range of prescription drug classes such as pain killers, sedatives, sleep aids, stimulants, and erectile dysfunction medications. The paper also highlights differences in rates of recent non-medical prescription drug use within this population, noting that White MSM, HIV-positive MSM, gay-identified MSM, and MSM over 40 were typically more likely to have recently used a range of prescription drugs than their counterparts. After controlling for various factors, the findings demonstrate that age, HIV-positive status, gay identity, low educational level, and White race are significant correlates of both lifetime and recent non-medical prescription drug use among MSM. The data suggest that prevention and treatment efforts for this population are likely to require some tailoring, particularly for HIV-positive MSM who may have different needs than other MSM given their health concerns and medication regimens.

The present study examined patterns of recent club drug use among 400 young adults (18-29) recruited using time-space sampling in NYC. Subjects had used at least one of six club drugs (methylenedioxymethamphetamine (MDMA), ketamine, gamma-hydroxybutyrate (GHB), cocaine, methamphetamine, and D-lysergic acid diethylamide (LSD)) within the prior 3 months. We used latent class analysis (LCA) to estimate latent groups based on patterns of recent club drug use and examined differences in demographic and psychological variables by class. A 3-class model fit the data best. Patterns were: Primary cocaine users (42% of sample), Mainstream users (44% of sample), and Wide-range users (14% of sample). Those most likely to be Primary cocaine users were significantly less likely to be heterosexual males and had higher educational attainment than the other two classes. Those most likely to be Wide-range users were less likely to be heterosexual females, more likely to be gay/bisexual males, dependent on club drugs, had significantly greater drug and sexual sensation seeking, and were more likely to use when experiencing physical discomfort or pleasant times with others compared to the other two groups. Findings highlight the utility of using person-centered approaches to understand patterns of substance use, as well as highlight several patterns of club drug use among young adults.

Alcohol consumption has been linked to a variety of sexual risk behaviors. However, much research addresses this connection among college students, ignoring other social contexts in which this association may be prevalent, such as club settings.As such, this study assessed patterns of drinking and sexual activity among young adults who frequent nightclubs.Using time-space sampling, we surveyed 308 young adults (ages 18-29) in New York City clubs.Participants reported binge drinking on 52% of drinking days. Roughly, 62% reported recent sex under the influence, and 29% of them reported being less safe in sexual situations as a result of their drinking. Men reported more days of drinking and binge drinking than women, and were more likely to report recent sex under the influence. Younger participants were more likely to report being less safe sexually while intoxicated. Recent binge drinking was associated with sex after drinking.These data suggest the need for targeted intervention and prevention efforts at nightclubs.

Within the existing body of research, the information pertaining to sexual compulsivity (SC) among women, both homo- and heterosexual, remains rather limited in comparison to men. The aim of this study was to assess the prevalence of SC in a community sample of gay and bisexual men and lesbian and bisexual women and to identify differences in sexual practices based on classification as sexually compulsive within gender. Supporting previous research, the findings indicated that gay and bisexual men were significantly higher in SC when compared to lesbian and bisexual women. Similarly, sexually compulsive gay and bisexual men were more likely to report drug use with sex than their non-sexually compulsive peers, suggesting that "party n' play" may play a larger role for men with SC. In addition, the findings demonstrated empirical support for the proposition that lesbian and bisexual women with symptoms of SC were more likely to engage in specialized sexual behaviors in comparison to their non-sexually compulsive peers. These data suggest that SC manifests differently in gay, lesbian, and bisexual men and women.

Objectives. Ketamine, methylenedioxymethamphetamine (MDMA/ecstasy), cocaine, gamma-hydroxybutyrate (GHB), methamphetamine, and d-lysergic acid diethylamide (LSD/acid) have been identified as “club drugs” because of their link to club culture among young adults. Yet little is known about users' demographic differences in the prevalence of club drugs. This study sought to provide a comprehensive profile of users' demographic differences in prevalence of club drug use and dependence. Methods. Using time-space sampling, a stratified sample of 400 18- to 29-year-old club-going young adults was recruited into the Club Drugs and Health Project. Results. Though participants reported using an array of club drugs, almost all participants (90.0%) were cocaine users. Although there were several sexual orientation and gender differences in recent drug exposure, patterns of use (measured in days) were fairly similar across gender, sexual orientation, and age. Finally, a majority of individuals (58.5%) met or exceeded criteria for club drug dependence, with most (61.7%) indicating cocaine was the one drug causing them significant problems. Conclusions. Cocaine is a major drug in club culture. It is essential to develop culturally appropriate drug education and prevention initiatives for young adults using club drugs.

Club drug users have been shown to tend towards patterns of polydrug use, which has been linked to adverse health outcomes, such as impaired mental health, overdose, dependence, infectious disease exposure, and decreased cognitive functioning.We analyzed data from the Club Drugs and Health Project, a study designed to examine the patterns and contexts of club drug use among young adults. Four-hundred recent club drug users were recruited through time-space sampling.Among recent cocaine users (n = 361), 61.2% were polydrug users. Male gender was predictive of polydrug cocaine use (OR = 1.66). Gay, lesbian, and bisexual (GLB) sexual orientation, White race, and Non-Latino ethnicity were not. No differences in mental health factors were found between cocaine polydrug users and users of only cocaine. However, polydrug users were significantly more likely to score high on drug-related sensation seeking as well as to use drugs to deal with unpleasant emotions and to have pleasant times with others.Prevention and intervention efforts should account for contextual and motivational factors in attempting to reduce polydrug use and its negative effects.

INTRODUCTION In an analysis of smoking using a longitudinal sample of US young adults, we extend research on tobacco vending machine restrictions beyond its prior focus on minors by examining the influence of total vending machine restrictions, which apply to adult-only facilities and represents the only remaining vending machine exemption since the enactment of the Family Smoking Prevention and Tobacco Control Act. We identify whether the passage of a restriction influences an individual's smoking on repeated observations, and if the propensity is lower among those who live in locations with a restriction. METHODS Combining a repository of US tobacco policies at all geographic levels with the nationally-representative geocoded National Longitudinal Survey of Youth 1997 and Census data, we use multilevel logistic regression to examine the impact of total vending machine restrictions on any past 30-day smoking and past 30-day smoking of one pack per day among young adults (ages 19-31), while accounting for other tobacco control policy, community, and individual covariates. RESULTS We find that total vending machine restrictions decrease any recent smoking (OR = 0.451; p < .01), net of other covariates. Though the passage of a restriction does not alter an individual's smoking over time, living longer in an area that has a restriction lowers the propensity that an individual will smoke at all (OR = 0.442; p < .05). We find no effect of total vending machine restrictions on smoking a pack daily. CONCLUSIONS Total vending machine restrictions appear to be an effective, yet highly underutilized, means of tobacco control. IMPLICATIONS Past scientific inquiries examining vending machine restrictions have focused upon minor access, adolescent perceptions of availability, and subsequent smoking. The potential for total vending machine restrictions, which extend to adult-only facilities, to influence patterns of smoking among those of legal age, remains significant. Those who are subject to total vending machine restrictions for longer periods are less likely to have recently smoked, but individuals do not change their smoking behavior in response to the passage of a restriction. These restrictions do not affect heavy smokers. Such policies are an effective but underutilized policy mechanism to prevent smoking among young adults.

To examine the social triggers of sexual compulsivity amongst a diverse sample of gay and bisexual men.Qualitative interviews were conducted with 180 gay and bisexual men in the United States who self-identified that their sex lives were spinning out of control. The data were analyzed using a grounded theory approach to explore the range of social triggers that were driving sexual compulsions.An open-ended interview and a structured clinical interview were conducted with each participant. The interviews examined their experiences with sexual compulsivity over time and the impact of their problematic sexual behaviors on their lives.Two types of social triggers emerged from the data: event-centered triggers and contextual triggers. Event-centered triggers arise from sudden, unforeseen events. Two major event-centered triggers were identified: relationship turmoil and catastrophes. Contextual triggers, on the other hand, have a certain element of predictability, and included such things as location, people, the use of drugs, and pornography.This framework of triggers has clinical implications for the prevention and treatment of sexual compulsivity. Clinicians can utilize the framework of social triggers in the therapeutic process to provide insight into ways to effectively work through symptoms of sexual compulsivity. Awareness of the contextual aspects of sexual compulsivity may be critical to understanding the behaviors of sexually compulsive clients. Thus, therapeutic assessments should focus upon the social context in addition to the psychological components of the disorder.

Club drugs present a range of risks similar to the range of psychoactive effects resulting from the use of the substances in this classification. These drugs remain in wide use amongst those in rave and club subcultures. This paper explores a range of risk management practices used by youth who utilize club drugs within rave and club subcultures. Through the use of ethnographic methods during a two-year period of fieldwork, the author collected data on club drug use and risk taking among “Bridge and Tunnel” youth. The resulting paper provides a descriptive typology of a series of risk management practices and explores how these practices are strategically deployed in an effort to maximize enjoyment and minimize danger.

As part of a larger study on prescription drug misuse among young adults active in urban nightlife scenes, we examined participants' motivations for misuse. Prescription painkillers, stimulants and sedatives were the primary substances of interest.Participants were recruited from nightlife venues in New York using time-space sampling. Subjects completed a mixed-methods assessment at project research offices. The data presented here are from a subsample of 70 qualitative interviews conducted during the baseline assessment.We identified experimentation and a "work hard, play hard" ethos as key motivations for misusing prescription drugs and argue that these motivations are specific, though not necessarily unique, to the participants' social location as young adults. These findings highlight the role of life stage and social context in the misuse of prescription drugs.Future studies of prescription drug misuse should pay attention to the larger social contexts in which users are embedded and, therefore, make decisions about how and why to misuse. Moving beyond the very broad concepts of "recreation" and "self-medication" presently established in the research, policies targeting young adults may want to tailor intervention efforts based on motivations.

Objectives. We examined the mutual effects of smoking bans and taxes on smoking among a longitudinal cohort of young adults. Methods. We combined a repository of US tobacco policies at the state and local level with the nationally representative geocoded National Longitudinal Survey of Youth 1997 (2004–2011) from ages 19 to 31 years and Census data, to examine the impact of tobacco policies on any current and daily pack smoking. The analytic sample amounts to 19 668 observations among 4341 individuals within 487 cities. Results. For current smoking, we found significant effects for comprehensive smoking bans, but not excise taxes. We also found an interaction effect, with bans being most effective in locales with no or low taxes. For daily pack smoking, we found significant effects for taxes, but limited support for bans. Conclusions. Social smoking among young adults is primarily inhibited by smoking bans, but excise taxes only deter such smoking in the absence of a ban. Heavy smokers are primarily deterred by taxes. Although both policies have an impact on young adult smoking behaviors, their dual presence does not intensify each policy’s efficacy.

Some scholars argue that the maintenance of social networks contributes to the lower prevalence of deviant behaviours and fewer adverse health effects among migrants. But others suggest that if migrants are embedded in homogeneous networks, such networks may enable the formation of a deviant subculture that promotes risk taking. Facing this dilemma, the present study investigates how native-place networks influence sexual risk behaviours (SRBs), specifically the pursuit of commercial sex and condomless sex with sex workers, for male rural-urban migrants. Using a multi-stage sample of 1,591 male rural-urban migrants from two major migrant-influx cities within China, we assessed migrants' general friend network ties and native place networks (townsmen in migrants' local networks) and tested their associations with SRBs. Multiple logistic regression analyses indicate that native-place network ties are associated with paying for sex (OR = 1.33, p

Bongs and blunts constitute significant elements of marijuana consumption in the United States, especially among youth. The author draws upon ethnographic methods to provide rich descriptions of these practices amongst a network of suburban marijuana users. The author first provides a description of bong use in a suburban home prior to detailing the same youth network engaging in the process of rolling and smoking a blunt in a public environment. Ultimately, the author examines and contrasts these two features of American marijuana consumption.