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. Author manuscript; available in PMC: 2014 Oct 17.
Published in final edited form as: Int J Med Biol Front. 2012;18(6):393–398.

Cannabis Use Disorders Predispose to the Development of Sexually Transmitted Diseases among Youth

Jack R Cornelius 1, Levent Kirisci 1, Duncan B Clark 1
PMCID: PMC4200539  NIHMSID: NIHMS513230  PMID: 25328372

Abstract

Background

Previous cross-sectional studies involving adults suggest that sexually transmitted diseases (STD) such as cocaine use disorders and opioid use disorders are associated with the development of sexually transmitted diseases (STD). However, it is less clear whether cannabis use disorders (CUD) are associated with the development of STDs, or whether those associations extend to adolescent populations. Longitudinal studies examining those associations are particularly scarce. The current report provides findings from a longitudinal study that examined the relationship between STD and CUD among youth transitioning to young adulthood.

Method

The subjects in this longitudinal study were initially recruited when the index sons of these fathers were 10-12 years of age, and subsequent assessments were conducted at age 12-14, 16, 19, and 22. Multivariate logistic regression and path analyses were conducted.

Results

At age 22, of the 345 subjects, 30 subjects were diagnosed with one or more STD, and 105 were diagnosed with a CUD. STDs were almost four times as common among those with a CUD as among those without a CUD, which was a significant difference. Path analyses demonstrated that peer deviance mediated the association between a measure of risk for SUD knows as the TLI and CUD, and that peer deviance mediated the association between TLI and STD. Risky sexual behaviors were common.

Conclusions

These finding suggest that cannabis use disorders (CUD) predispose to the development of sexually transmitted disorders (STD) among youth. These findings also suggest that peer deviance mediates the development of STD and of CUD among teenagers making the transition to young adulthood.

1. Introduction

Persons with a variety of substance use disorders have been shown to be at high risk for sexually transmitted diseases (STD) because of unsafe sexual practices associated with substance use (Lally et al., 2002). Previously, it had been shown that substance use disorders (SUD) involving “hard” drugs such as heroin and cocaine are associated with the development of STDs, but studies involving the association of cannabis use disorders (CUD) and STDs had been lacking. For example, persons with cocaine use disorders (Hser et al., 1999) and persons with heroin dependence (Kelly et al., 2000) have been shown to be at elevated risk for STDs. However, very little information is available regarding whether cannabis use disorders are associated with STDs (Nadeau et al., 2000). Recently, one cross-sectional study involving African-American girls demonstrated that those who used cannabis had a significantly higher incidence of STDs than those who were non-marijuana users (DiClemente et al., 2008) and also engaged in more unsafe sexual practices. However, it is unclear whether those findings concerning cannabis and STDs extend to populations of persons with CUD who are not female and African-American, or whether an association of CUD and STDs would be noted in a longitudinal study.

The current report provides findings from a longitudinal study that examined the relationship between CUD and STD among teenagers transitioning to young adulthood. We hypothesized that CUD would be associated with the development of STDs in that population. We also hypothesized that peer deviance would mediate the development of STD and of CUD, based on our recent findings (Cornelius et al., 2007; Kirisci et al., 2009).

2. Material and methods

The subjects in this study were part of a longitudinal research study known as the Center for Education and Drug Abuse Research, or CEDAR, whose primary purpose is to examine the etiology of SUD. The children were recruited through their biological fathers, and were initially assessed in late childhood at ages 10 through 12 years of age. The recruitment procedure was designed to yield a group of children at high average risk (HAR) for SUD, identified by having fathers with a lifetime history of drug use disorders (abuse or dependence involving illicit substances) and a comparison group at low average risk (LAR), identified by having fathers without SUD or other major mental disorders. Fathers were considered to have a SUD if they ever met DSM criteria for abuse or dependence involving substances other than nicotine, caffeine, or alcohol. Diagnoses were made according to DSM-III-R, the most recent DSM edition when the study was initiated.

Multiple recruitment sources were used to minimize bias that could potentially occur if all of the subjects were recruited from one source. Approximately 89% of the families were recruited from the community through public service announcements and advertisements a well as by direct telephone contact conducted by a market research firm, and 11% were recruited from clinical sources (Cornelius et al, 2007; Cornelius et al., 2008). Psychosis, mental retardation, and neurological injury were exclusionary criteria for participation of the family. Prior to participation in the study, written informed consent was obtained from husbands and wives, and assent was obtained from minor children. The children were the focus of the current study. The study was approved by the University of Pittsburgh Institutional Review Board. The subjects were recruited at age 10-12, and follow-up evaluations were conducted at ages 12-14, 16, 19, and 22, which covered the peak years for initiation of CUD.

Assessments were comprehensive in scope, and included reports on alcohol and other substance use history, mental disorders, personality assessments, and measures of family, cognitive, and psychosocial functioning (Clark et al., 2001; Vanyukov et al., 2009). Diagnostic evaluation was conducted with an expanded version of the Structured Clinical Interview for DSM-III-R (SCID)(Spitzer et al., 1987), which was the most recent DSM edition when the study was initiated. Offspring psychopathology was assessed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version (K-SADS-E) (Orvaschel et al., 1982). The onset date of each diagnosis was determined to the nearest month. Each family member was individually administered the research protocol in a private room by a different clinical associate. The diagnostic interviews were documented by a staff of experienced clinical associates. Training the clinical associates involved observation of several interviews and conducting joint interviews in the presence of an experienced interviewer. The training procedures were found to produce inter-rater reliabilities exceeding 0.80 for all major diagnostic categories. Diagnoses were determined in a consensus conference using the best estimate diagnostic procedure (Clark et al, 2001). The diagnostic data, in conjunction with all available pertinent medical records and social and legal history, were reviewed in a clinical case conference chaired by a board-certified psychiatrist and another psychiatrist or psychologist and the clinical associates who conducted the interviews.

Another variable included in these analyses included an index created at CEDAR known as the Transmissible Liability Index, also known as the TLI, (Vanyukov, et al., 2009; Kirisci, Tarter, et al, 2009) assessing the risk of developing SUD based on evaluations drawn from self reports, mother reports, and teacher reports. The TLI reportedly has 80% heritability, and in a family study predicted SUD outcome by age 19 with 68% accuracy (Vanyukov et al, 2009). Each standard deviation increment on the mean TLI score of the sample was associated with an increase of 70% probability that CUD would be manifest during the ensuing year. TLI has been shown to be a significant predictor of CUD (Kirisci et al., 2009). Also included was a measure of affiliation with deviant peers at age 16, which has been shown to be associated with the development of CUD and other SUD (Cornelius et al., 2007), as well as demographic information including SES of parental household when the child entered the study, race, and gender.

Logistic regression analyses (Hosmer & Lemeshow, 2000; Kirisci et al., 2009) were conducted to determine the extent to which CUD contributed to the development of STDs after allowing for the effects of deviant peers, the TLI, and demographic factors. A path analysis was conducted to assess mediational effects. Mediated paths were tested using the method described by Sobel (1982).

3. Results

A total of 345 subjects were included in this study, including 30 subjects with lifetime STDs and 105 persons with lifetime CUD. The 30 subjects with STDs included 15 male participants (50.0%) and 15 female participants (50.0%), of whom 13 were Caucasian (43.3%) and 17 were African American (56.7%). The 110 subjects who met diagnostic criteria for a CUD included 83 male participants and 22 female participants, including 64 Caucasian participants and 41 participants of other races. STDs were almost four times as common among those with a cannabis use disorder as compared to those with no history of a CUD, which was a significant difference. Specifically, STDs were reported in 4.7% of those with no history of a lifetime CUD, while 17.3% of those with a history of a lifetime CUD reported a history of at least one STD (Chi-square=15.0, df=1, p<0.001). The most common STD in the sample was clamydia (n=17, 53.3%), followed by genital warts (n=7, 23.3%), gonorrhea (n=4, 13.3%), trichomoniasis (n=4, 13.3%), other STD (n=4, 13.3%), herpes (n=3, 10.0%), and pelvic inflammatory disease (n=1, 3.3%). No cases of syphilis or HIV infection were noted.

Logistic regression demonstrated that CUD were associated with STD (OR=4.71, Wald=9.51, p=0.002), deviance of peers (OR=2.27, Wald=27.39, p≤=0.001), the TLI of the offspring (OR=1.56, Wald=9.11, p=0.003), and Caucasian race (OR=2.46, Wald=8.24, p=0.00). In addition, as shown in Figure 1, path analysis confirmed the results of logistic regression analysis: TLI predicted deviance of peers (beta=.13, z=3.75, p<.001) and CUD (beta=.16, z=4.10, p<.001), deviance of peers predicted STD (beta=.11, z=3.34, p<.001) and CUD (beta=.32, z=9.00, p<.001), and finally, CUD and STD were correlated (beta=.20, z=3.88, p<.001). Peer deviance mediated the association between TLI and CUD (beta=.04, z=3.39, p=.001), and peer deviance mediated the association between TLI and STD (beta=.01, z=2.35, p=.019). Risky sexual behaviors were common. For example, 29.4% of females and 22.7% of males reported a history of vaginal intercourse without a condom while under the influence of alcohol or other drugs.

4. Discussion

The findings of this longitudinal study suggest that CUD are associated with the development of STDs. Specifically, STDs were almost four times as common among those with a cannabis use disorder as compared to those with no history of a CUD, which was a clinically significant and statistically significant difference. These findings confirm and extend the findings of DiClemente and colleagues (2008), who had conducted a cross-sectional study involving a population of African-American girls. Previously it had been shown that other substance use disorders involving “hard” drugs such as heroin and cocaine (Hser et al., 1999; Kelly et al., 2000) are associated with STDs, but studies involving the association of CUD and STDs had been lacking. Our current findings also suggest that peer deviance mediates the development of STD and of CUD among youth making the transition to young adulthood. Thus, the study hypotheses were confirmed by the findings of the study.

There are limitations to our research design that should be noted when interpreting our findings. First, the sample was not a random sample from across the United States, so the results may not generalize to the United States as a whole. Also, the study sample was primarily male, so the results of the study may not generalize to women. In addition, the number of study subjects was limited. However, this study had the methodological advantage of being a longitudinal study, while most studies assessing STDs in persons with SUD have been cross-sectional studies. Future studies are warranted to further clarify the association between CUD and STDs and to clarify optimal prevention strategies for prevention of STDs among young persons with CUD (Lally et al., 2002; Cornelius et al, 2007).

Acknowledgments

This research was supported in part by grants from the National Institute on Drug Abuse (P50 DA05605, R01 DA019142, R01 DA14635, K02 DA017822, and the NIDA Clinical Trials Network); from the National Institute on Alcohol Abuse and Alcoholism (R01 AA013370, R01 AA015173, R01 AA14357, R01 AA13397, K24 AA15320, and K02 AA000291), and a Veterans Affairs MIRECC grant to VISN 4.

Footnotes

Presented in part at the 17th Annual Scientific Meeting of the Society for Prevention Research (SPR), Washington, DC, May 26-29, 2009.

Address reprint requests to: Jack R. Cornelius, M.D., M.P.H., Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, PAARC Suite, Pittsburgh, PA 15213

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