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Article |

Depression, Sexually Transmitted Infection, and Sexual Risk Behavior Among Young Adults in the United States FREE

Maria R. Khan, PhD; Jay S. Kaufman, PhD; Brian Wells Pence, PhD; Bradley N. Gaynes, MD; Adaora A. Adimora, MD; Sharon S. Weir, PhD; William C. Miller, MD, PhD
[+] Author Affiliations

Author Affiliations: Department of Epidemiology, School of Public Health (Drs Khan, Kaufman, Adimora, Weir, and Miller), Department of Psychiatry (Dr Gaynes), and Division of Infectious Diseases, Department of Medicine, School of Medicine (Drs Adimora and Miller), The University of North Carolina at Chapel Hill; National Development and Research Institutes and Public Health Solutions, New York, New York (Dr Khan); and Department of Community and Family Medicine and Duke Global Health Institute and Center for Health Policy, Duke University, Durham, North Carolina (Dr Pence).


Arch Pediatr Adolesc Med. 2009;163(7):644-652. doi:10.1001/archpediatrics.2009.95.
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Objective  To measure associations among depression, sexual risk behaviors, and sexually transmitted infection (STI) among white and black youth in the United States.

Design  Analysis of prospective cohort study data. Wave I of the National Longitudinal Study of Adolescent Health occurred in 1995 when participants were in grades 7 through 12. Six years later, all Wave I participants who could be located were invited to participate in Wave III and to provide a urine specimen for STI testing.

Setting  In-home interviews in the continental United States, Alaska, and Hawaii.

Participants  Population-based sample. A total of 10 783 Wave I (adolescence) and Wave III (adulthood) white and black respondents with sample weight variables.

Main Exposures  Chronic depression (detected at Waves I and III) and recent depression (detected at Wave III only) vs no adult depression (not detected at Wave III).

Outcome Measures  Multiple sexual partners and inconsistent condom use in the past year and a current positive test result for Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis (adulthood).

Results  Recent or chronic depression in adulthood was more common for blacks (women, 19.3%; men, 11.9%) than for whites (women, 13.0%; men, 8.1%). Among all groups (white men and women, and black men and women), adult depression was associated with multiple partners but not with condom use. Among black men, depression was strongly associated with STI (recent: adjusted prevalence ratio, 2.36; 95% confidence interval, 1.26-4.43; chronic: adjusted prevalence ratio, 3.05; 95% confidence interval, 1.48-6.28); having multiple partners did not mediate associations between depression and STI.

Conclusions  Integration of mental health and STI programs for youth is warranted. Further research is needed to elucidate how depression may influence the prevalence of STI among black men.

Approximately 19 million new sexually transmitted infections (STIs) occur in the United States each year,1 with nearly half occurring in adolescents and young adults aged 15 to 24 years.2 Improved understanding of factors that contribute to STI in adolescents and young adults is needed to assist prevention efforts.

Depression is a modifiable factor associated with high-risk sexual behaviors and STI among youth in the United States.310 While sexual risk behaviors and STI are risk factors for depression,6,9,10 depression also may increase susceptibility to risk behaviors and infection.11 Depression may impair cognitive function and memory1215; decrease impulse control16,17; contribute to psychosocial impairment,13 including emotional reactivity in peer relationships18; reduce motivation13; and increase fatalism.19 These depression-related effects may inhibit clear perception of STI risk and the ability to prevent risk behavior. Depression also is associated with substance use,13,2035 a consistent correlate of STI and related behaviors.29,30,3649 While depression and substance use may influence STI risk by promoting high-risk sexual behaviors, adolescents affected by 1 or both of these disorders also may be more likely to have high-risk peers and sexual networks characterized by high levels of STI; this may increase the risk of sex with an infected partner5052 and STI acquisition. Diagnosis and treatment of adolescent depression, important in themselves, also may constitute a component of adolescent STI prevention.

To our knowledge, only 1 study has assessed the longitudinal relationship between depression and STI among adolescents, using data from Wave I (adolescence) and Wave II (1 year later) of the National Longitudinal Study of Adolescent Health (Add Health).6 In adjusted analyses, the presence of major depression predicted STI among boys but not among girls. An important limitation was that measurement of STI was based on self-report. Add Health Wave III is available and provides data on depression in adolescence and adulthood and on biologically confirmed STI in young adulthood. Given the limited research into depression and STI from adolescence into adulthood, further study of depression and STI in the Add Health sample was warranted.

The purpose of this study was to measure the association between depression in adolescence and adulthood and sexual risk behaviors and biologically confirmed STI in adulthood using Waves I and III of Add Health. We investigated whether the associations between depression and outcomes differed for men vs women and for whites vs blacks, to obtain population-specific information needed to maximize intervention resources.

Add Health is a prospective cohort study designed to investigate factors of health from adolescence into adulthood.53 The original study population was a stratified, random, school-based sample representative of US middle and high school students. During Add Health Wave I (1995), more than 20 000 adolescents completed a baseline interview assessing characteristics that included sexual behavior and depression. Parents were also interviewed. During Wave III (2001-2002), Wave I participants were reinterviewed and urine specimens were collected for determination of Chlamydia trachomatis and Neisseria gonorrhoeae infection with use of ligase chain reaction (Abbott LCx Probe System; Abbott Laboratories, Abbott Park, Illinois) and of Trichomonas vaginalis infection with use of polymerase chain reaction (Amplicor CT/NG Urine Specimen Prep Kit; Roche Diagnostic Systems, Indianapolis, Indiana). The study design has been described in detail elsewhere.5459

We used measures from Waves I and III for this analysis of depression and STI. Ethical approval for this research was obtained from The University of North Carolina at Chapel Hill School of Public Health Institutional Review Board.

MEASURES
Exposure: Depression

Depression was assessed using a modified version of the Center for Epidemiologic Studies Depression Scale (CES-D).60 The original CES-D is composed of 20 items, each of which assesses the frequency of experiencing depressive symptoms in the past week (responses are rated as 0, never or rarely; 1, sometimes; 2, a lot of the time; or 3, most of the time/all of the time). Four items assess positive symptoms (eg, frequency of happiness, whether one enjoys life) and are reversed before the score is computed. The composite score (based on the 20-item CES-D) ranges from 0 to 60, with higher scores indicating increased severity of depression. The scores of 24 for females and 22 for males have been determined to be sensitive and specific indicators of major depressive disorder among adolescents.61

We used a modified version of the CES-D composed of a subset of 9 items common to both Waves I and III (eSupplement) to calculate each participant's depression score at Wave I and at Wave III (possible score range, 0-27).

Following the methods of Shrier et al,5,6 we identified sex-specific cut points for major depressive disorder based on a modified CES-D that were proportional to the cut points for major depressive disorder based on the complete 20-item CES-D.61 With our 9-item CES-D, scores of 9.9 among males and 10.4 among females indicated major depressive disorder. For convenience, we identified male or female respondents with a score of 10 or greater as having a high likelihood of major depressive disorder. We subsequently refer to this high likelihood of major depressive disorder as “depression.”

Based on our categorizations of depression at Waves I and III, we defined a 3-level depression exposure variable. We coded respondents with depression in adulthood (Wave III) who also had depression in adolescence (Wave I) as having chronic depression, respondents with depression in adulthood (Wave III) who did not have depression in adolescence (Wave I) as having recent depression, and respondents who were not depressed in adulthood (Wave III) as having no adult depression.

Outcomes: Sexual Risk Behaviors and STI (Wave III)

We measured associations between recent and chronic depression and the following sexual risk behaviors in the year before Wave III: 2 or more sexual partners, 6 or more sexual partners, 10 or more sexual partners, 0% condom use, and less than 100% condom use (yes vs no). We also examined the association between depression and biologically confirmed STI at Wave III (a positive test result for C trachomatis, N gonorrhoeae, or T vaginalis on Wave III urine specimen vs a negative result for all 3 tests).

POTENTIAL CONFOUNDING VARIABLES

We considered each of the following covariates as a potential confounding variable based on its a priori causal relationship with the exposure and outcome: age; marital history; maternal education measured by Wave I self-report if the mother was interviewed, otherwise by adolescent's report; Wave III low functional income status in the past year; age at first vaginal intercourse; self-reported STI at Wave I (self-report of diagnosis with chlamydial infection, gonorrhea, trichomoniasis, syphilis, genital herpes, or human immunodeficiency virus vs no self-reported STI diagnosis); Wave I frequent alcohol consumption in the past year, defined as drinking at least 3 days per week; Wave I lifetime marijuana use; and Wave I lifetime crack or cocaine use.

DATA ANALYSIS

For all analyses, we used survey commands in Stata Version 9.1 (StataCorp, College Station, Texas) to account for stratification, clustering, and unequal selection probabilities, yielding nationally representative estimates.

We used bivariable analyses to calculate weighted prevalences and 95% confidence intervals (CIs) of Wave III STI by demographic, socioeconomic, mental health, and behavioral variables. We also investigated whether depression and mental health care differed between whites and blacks.

We estimated unadjusted prevalence ratios (PRs) and 95% CIs for associations between depression and outcomes (multiple partner indicators, condom use indicators, and STI) by sex and race (white vs black) using a Poisson model without an offset, specifying a log link and probability weights.62,63 Adjusted models included demographic, socioeconomic, depression, and adolescent STI risk and substance use variables.

Among populations in which we observed an association between depression and sexual risk behaviors (indicators of multiple sexual partners or inconsistent condom use) as well as STI, we explored whether the behavioral variables predicted by depression were mediators of the depression-STI relationship. We compared associations between depression and STI adjusted for original confounding variables with associations further adjusted for the intermediate sexual behavior determinants. If the associations between depression and STI were attenuated on further adjustment for the behavioral intermediates, we assumed these variables mediated the association between depression and STI.

Of the 18 924 participants in the weighted Wave I sample, 14 322 (75.7%) were located and reinterviewed during Wave III and had no missing values for sample weight variables.

The STI testing procedures, participation, and results have been described in detail previously.58,64,65 Of the 14 322 Wave III participants, 1130 (7.9%) refused to provide a urine specimen, 226 (1.6%) were unable to provide a urine specimen, 421 (2.9%) provided urine specimens that could not be processed due to shipping or laboratory problems, and 951 (6.6%) did not have results for all 3 STI tests. The prevalence of missing or incomplete STI data was not significantly different by race/ethnicity.

We conducted analyses among the 10 783 respondents with complete sample weight variables. Of these, the 8794 Wave III participants (81.6%) with a result for all 3 tests (C trachomatis, N gonorrhoeae, and T vaginalis) were included in the analyses of depression and STI.

WAVE III STI PREVALENCE BY RESPONDENT CHARACTERISTICS

Of the respondents in the analytic sample, 50.4% were men and 49.6% were women; their mean age was 21.8 years; and 80.9% were white and 19.1% were black (Table 1).

Table Graphic Jump LocationTable 1. Respondent Characteristics and Sexually Transmitted Infection (STI) in Wave III Among 10 783 White and Black US Adults Aged 18 to 25 Yearsa

The overall weighted prevalence of infection at Wave III with C trachomatis, N gonorrhoeae, or T vaginalis was 6.1% (95% CI, 5.0%-7.2%) (Table 1). The prevalence of STI was higher in women than in men (unadjusted odds ratio, 1.61; 95% CI, 1.32-1.96) and markedly higher in blacks than in whites (odds ratio, 6.99; 95% CI, 5.38-9.09).

DEPRESSION AND MENTAL HEALTH CARE

Of the total Wave III sample, 11.5% had depression in adulthood: 7.2% had recent depression and 4.3% had chronic depression. Prevalence of recent or chronic depression was highest among black women (19.3%), followed by white women (13.0%), black men (11.9%), and white men (8.1%) (Table 1). Among those who were categorized as having recent or chronic depression at Wave III, blacks were much less likely than whites to report having received psychological or emotional counseling (blacks: 10.1%, whites: 20.9%) or prescription medication for depression or stress (blacks: 5.4%, whites: 17.0%) in the year before the survey.

DEPRESSION AND MULTIPLE PARTNERS IN THE PAST YEAR
White Men

Among white men, neither recent nor chronic depression vs no adult depression was associated with having 2 or more partners in the past year in bivariable analyses and analyses adjusting for demographic, socioeconomic, and adolescent STI risk and substance use variables (recent: adjusted PR, 1.23; 95% CI, 0.96-1.56; chronic: adjusted PR, 1.14; 95% CI, 0.79-1.62) (Table 2).

Table Graphic Jump LocationTable 2. Prevalence Ratios (PRs) and 95% Confidence Intervals (CIs) for the Associations Between Recent and Chronic Depression and Multiple Partners in the Year Before Wave III Among White and Black US Adults Aged 18 to 25 Years

While recent depression was not associated with having 6 or more partners in the past year (adjusted PR, 1.15; 95% CI, 0.46-2.87), chronic depression appeared to be associated with this outcome (adjusted PR, 2.15; 95% CI, 0.90-5.15). This estimate was imprecise due to the low number of chronically depressed white men available for the analysis.

Recent and chronic depressions were not associated with having 10 or more partners in the past year (recent: adjusted PR, 0.56; 95% CI, 0.12-2.61; chronic: adjusted PR, 1.66; 95% CI, 0.23-12.0).

White Women

Among white women, recent depression was moderately associated with having 2 or more partners in the past year (adjusted PR, 1.45; 95% CI, 1.19-1.77) (Table 2). Chronic depression was weakly and insignificantly associated with this outcome (adjusted PR, 1.24; 95% CI, 0.90-1.70).

In this group, recent and chronic depressions were strongly associated with having 6 or more partners in the past year (recent: adjusted PR, 2.13; 95% CI, 1.06-4.25; chronic: adjusted PR, 2.40; 95% CI, 0.98-5.90) and 10 or more partners in the past year (recent: adjusted PR, 6.87; 95% CI, 2.53-18.6; chronic: adjusted PR, 8.42; 95% CI, 3.23-22.0).

Black Men

Among black men, recent depression was not associated with having 2 or more partners in the past year (adjusted PR, 0.88; 95% CI, 0.67-1.16) (Table 2). Chronic depression was not associated with having 2 or more partners in the past year in unadjusted analyses (unadjusted PR, 1.10; 95% CI, 0.73-1.67) but was weakly associated with this outcome in adjusted analyses (adjusted PR, 1.37; 95% CI, 0.96-1.95).

In this group, recent depression was not associated with having 6 or more partners in the past year (adjusted PR, 1.06; 95% CI, 0.53-2.11). While chronic depression was not associated with having 6 or more partners in the past year in bivariable analyses (unadjusted PR, 1.74; 95% CI, 0.66-4.54), it was strongly associated with the outcome in adjusted analyses (adjusted PR, 2.48; 95% CI, 1.05-5.82).

Among black men, recent and chronic depressions were not associated with having 10 or more partners in the past year (recent: adjusted PR, 0.51; 95% CI, 0.12-2.11; chronic: adjusted PR, 2.23; 95% CI, 0.77-6.47).

Black Women

Black women with recent or chronic depression did not appear to have a higher prevalence of 2 or more partners in the past year than black women with no depression (recent: adjusted PR, 1.12; 95% CI, 0.87-1.45; chronic: adjusted PR, 0.87; 95% CI, 0.64-1.18) (Table 2).

Among black women, recent depression was strongly associated with having 6 or more partners in the past year (adjusted PR, 2.58; 95% CI, 1.08-6.17). Black women with chronic depression were much less likely to have had 6 or more partners in the past year than black women with no depression (adjusted PR, 0.10; 95% CI, 0.01-0.76).

In this group, small stratum-specific sample size prevented estimation of the associations between depression and having 10 or more partners in the past year.

DEPRESSION AND CONDOM USE IN THE PAST YEAR

In all subgroups, recent and chronic depressions were not associated with inconsistent condom use (< 100% condom use or 0% condom use) (Table 3).

Table Graphic Jump LocationTable 3. Prevalence Ratios (PRs) and 95% Confidence Intervals (CIs) for the Associations Between Recent and Chronic Depression and Inconsistent Condom Use in the Year Before Wave III Among White and Black US Adults Aged 18 to 25 Years
DEPRESSION AND STI
White Men

Among white men, STI was not associated with recent depression (adjusted PR, 0.47; 95% CI, 0.15-1.51) or chronic depression (adjusted PR, 0.77; 95% CI, 0.16-3.72) (Table 4).

Table Graphic Jump LocationTable 4. Prevalence Ratios (PRs) and 95% Confidence Intervals (CIs) for the Associations Between Recent and Chronic Depression and Sexually Transmitted Infection (STI) Among White and Black US Adults Aged 18-25 Years
White Women

Among white women, STI was not associated with recent depression (adjusted PR, 1.23; 95% CI, 0.54-2.77) (Table 4). White women with chronic depression had lower levels of STI than those with no depression in adulthood (adjusted PR, 0.20; 95% CI, 0.05-0.81).

Black Men

Among black men, STI was strongly associated with recent and chronic depressions in unadjusted analyses (recent: unadjusted PR, 1.93; 95% CI, 0.94-3.95; chronic: unadjusted PR, 2.07; 95% CI, 1.04-4.10) (Table 4). In analyses adjusting for confounding factors, these estimates strengthened (recent: adjusted PR, 2.36; 95% CI, 1.26-4.43; chronic: adjusted PR, 3.05; 95% CI, 1.48-6.28).

Black Women

Among black women, in unadjusted and adjusted analyses, STI was not associated with recent depression (adjusted PR, 1.01; 95% CI, 0.63-1.61) or chronic depression (adjusted PR, 1.08; 95% CI, 0.66-1.76) (Table 4).

INVESTIGATION OF SEXUAL RISK BEHAVIORS THAT MEDIATE THE ASSOCIATION BETWEEN DEPRESSION AND STI AMONG BLACK MEN

Does engagement in multiple partnerships mediate the depression-STI relationship among black men? Among black men, chronic depression was associated with multiple sexual partners and STI. We sought to identify whether multiple partners mediated the relationship between chronic depression and STI. In analyses adjusted for original confounding factors and for variables hypothesized to mediate the depression-STI association (indicators of having 2, 6, or ≥10 partners in the past year), the association was not attenuated. In fact, the association between chronic depression and STI somewhat strengthened (adjusted PR, 3.44; 95% CI, 1.89-6.24). Having 6 or more partners in the past year did not mediate the association between chronic depression and STI.

Although recent depression was associated with STI among black men, it was not associated with multiple partners or condom use. Other sexual behaviors or nonbehavioral factors not measured in this study appeared to account for the strong association between recent depression and STI.

Among this nationally representative sample, white and black young adults with recent or chronic depression were much more likely to have multiple sexual partners, an important determinant of STI, than were those identified as having no depression in adulthood. In black men, depression was associated with 2 to 3 times the prevalence of STI. In all groups, associations between depression and STI-related behaviors and infection remained when adjusted for demographic, socioeconomic, and adolescent STI risk and substance use variables, suggesting that depression may influence STI risk independent of these factors. Because our analysis included components of a longitudinal study, including measurement of depression from adolescence and control of baseline STI risk, we interpret these findings to suggest that depression through adolescence likely contributed to STI risk among young adults. Our observations support earlier findings that depression appears to predict STI and related behaviors among adolescents and young adults.6,9 Given the strong associations between depression and STI risk, these findings highlight a need for improved integration of mental health and STI screening and prevention programs for adolescents and young adults in white and black communities.

For black men, although chronic depression was associated with having multiple sexual partners, this behavior did not appear to mediate the association between depression and STI. Other factors underlie the association between depression and STI in black men. It is possible that chronic depression contributed to other sexual risk-taking behaviors that we did not measure. In addition, chronically depressed black men may have high-risk social and sexual networks and, hence, experience greater risk of coming into contact with an infected sexual partner than do black men who are not depressed. This may be the case, in part, because depression is strongly associated with substance use,13,2035 and substance users have networks with high levels of STI.5052 This study has pointed to a robust association between depression and STI risk in black men. Because this study has not elucidated the mechanisms through which depression may increase the prevalence of STI in this group, it highlights the need for further research into the effects of depression on STI risk for black men and their sexual partners.

For all groups (white men and women, and black men and women), depression-related increases in multiple partners did not appear to translate into higher infection levels. For whites, this finding was not surprising given the low prevalence of infection in white sexual networks. However, if infection were introduced into sexual networks of recently and chronically depressed whites, depression-associated increases in multiple partners may facilitate STI transmission.

For blacks, although depression was associated with having multiple partners, the prevalence of STI was alarmingly high among blacks with both high and low levels of depression and multiple partners. These findings validate an earlier Add Health study that found STI prevalence is disproportionately high in blacks compared with that in whites, even in blacks with relatively low levels of risk behaviors.66 The study concluded that factors other than individual-level risk behaviors likely drive high infection rates in blacks. Sexual mixing between high- and low-risk groups is much more common for blacks than for whites and likely contributes to disproportionate STI transmission in black populations.66 It is possible that structural and contextual factors play a more important role than individual-level behaviors in driving STI transmission in blacks, by contributing to sexual mixing patterns and the concentration of infection in black communities.

The prevalence of depression was higher for blacks than for whites, and we observed a race differential in levels of counseling and treatment for depression. These differences support existing evidence of a race disparity in mental health care6769 and further indicate that undiagnosed, untreated depression constitutes an important public health concern for blacks. These results documented the high prevalence of depression and inadequate diagnosis of and care for mental health needs in blacks, as well as strong associations between depression and STI risk in this group, highlighting the importance of improving mental health care in black communities.

The most important limitation of this research was our inability to conduct a fully longitudinal study, because we sought to examine chronic depression from adolescence into adulthood and STI in adulthood. In particular, the long time between data collection in adolescence (Wave I) and young adulthood (Wave III) limited our ability to definitively assess the causal role of depression in sexual risk behavior and STI. To establish whether adolescent depression is causally associated with acquisition of STI in adulthood among blacks, a longitudinal study should be conducted to accurately measure depression, STI, and important covariates such as substance use at frequent intervals to disentangle the specific effects of each variable of interest on STI.

This research was also potentially limited by our use of the CES-D. Our 9-item modified CES-D was not validated against a clinical diagnosis of depression, which may have resulted in misclassification of depression. Furthermore, we assumed that the CES-D functioned similarly in white and black groups. While some research has shown that the CES-D measures differing underlying phenomena for different racial/ethnic adolescent groups,70 other studies have suggested that the scale functions comparably in both white and African American populations71 and has good sensitivity and moderate specificity to detect depression in black populations.72

This study provided further evidence that US youth at high risk for STI also experience a disproportionate risk of depression, highlighting the need for improved integration of mental health and STI diagnosis, treatment, and prevention. Because levels of depression and STI were higher and the associations between these variables were stronger for blacks than for whites, black youth should be a priority when allocating resources to improve mental health care. Improved diagnosis and care for depression are needed not only because depression constitutes an important public health concern in itself but also because addressing depression may lead to improved physical health, including lower risk for STI.

Correspondence: Maria R. Khan, PhD, National Development and Research Institutes, 71 W 23rd St, New York, NY 10010 (maria_khan@unc.edu; khan@ndri.org).

Accepted for Publication: November 20, 2008.

Author Contributions: Drs Khan and Miller had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Khan and Miller. Acquisition of data: Khan. Analysis and interpretation of data: Khan, Kaufman, Pence, Gaynes, Adimora, Weir, and Miller. Drafting of the manuscript: Khan. Critical revision of the manuscript for important intellectual content: Khan, Kaufman, Pence, Gaynes, Adimora, Wier, and Miller. Statistical analysis: Khan, Kaufman, Pence, and Miller. Administrative, technical, and material support: Gaynes and Adimora. Study supervision: Kaufman, Gaynes, Adimora, and Miller.

Financial Disclosure: Dr Gaynes has received grants and research support from the National Institute of Mental Health, the Agency for Healthcare Research and Quality, the M-3 Company, Bristol-Myers Squibb Company, and Novartis. He has been an advisor or consultant for Bristol-Myers Squibb Company.

Funding/Support: This research used data from Add Health, a project designed by J. Richard Udry, PhD, Peter S. Bearman, PhD, and Kathleen Mullan Harris, PhD, and funded by grant P01-HD31921 from the National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Dr Khan was supported as a postdoctoral fellow in the Behavioral Sciences Training in Drug Abuse Research program sponsored by Public Health Solutions and the National Development and Research Institutes, Inc, with funding from the National Institute on Drug Abuse (grant 5T32 DA07233).

Additional Contributions: We thank Anna Schyette, PhD, and Daniel Adkins, PhD, for their helpful comments. Special acknowledgment is due to Ronald R. Rindfuss, PhD, and Barbara Entwisle, PhD, for assistance in the original study design.

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Rounsaville  BJAnton  SFCarroll  KBudde  DPrusoff  BAGawin  F Psychiatric diagnoses of treatment-seeking cocaine abusers. Arch Gen Psychiatry 1991;48 (1) 43- 51
PubMed Link to Article
Hasin  DSGlick  H Depressive symptoms and DSM-III-R alcohol dependence: general population results. Addiction 1993;88 (10) 1431- 1436
PubMed Link to Article
Latkin  CAMandell  W Depression as an antecedent of frequency of intravenous drug use in an urban, nontreatment sample. Int J Addict 1993;28 (14) 1601- 1612
PubMed
Stephens  RSRoffman  RASimpson  EE Adult marijuana users seeking treatment. J Consult Clin Psychol 1993;61 (6) 1100- 1104
PubMed Link to Article
Kalichman  SCKelly  JAJohnson  JRBulto  M Factors associated with risk for HIV infection among chronic mentally ill adults. Am J Psychiatry 1994;151 (2) 221- 227
PubMed
Brooner  RKKing  VLKidorf  MSchmidt  CW  JrBigelow  GE Psychiatric and substance use comorbidity among treatment-seeking opioid abusers. Arch Gen Psychiatry 1997;54 (1) 71- 80
PubMed Link to Article
Castillo Mezzich  ATarter  REGiancola  PRLu  SKirisci  LParks  S Substance use and risky sexual behavior in female adolescents. Drug Alcohol Depend 1997;44 (2-3) 157- 166
PubMed Link to Article
Dinwiddie  SH Characteristics of injection drug users derived from a large family study of alcoholism. Compr Psychiatry 1997;38 (4) 218- 229
PubMed Link to Article
Khantzian  EJ The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harv Rev Psychiatry 1997;4 (5) 231- 244
PubMed Link to Article
Hawkins  WELatkin  CHawkins  MJChowdury  D Depressive symptoms and HIV-risk behavior in inner-city users of drug injections. Psychol Rep 1998;82 (1) 137- 138
PubMed Link to Article
Mueser  KTDrake  REWallach  MA Dual diagnosis: a review of etiological theories. Addict Behav 1998;23 (6) 717- 734
PubMed Link to Article
Mandell  WKim  JLatkin  CSuh  T Depressive symptoms, drug network, and their synergistic effect on needle-sharing behavior among street injection drug users. Am J Drug Alcohol Abuse 1999;25 (1) 117- 127
PubMed Link to Article
Rao  UDaley  SEHammen  C Relationship between depression and substance use disorders in adolescent women during the transition to adulthood. J Am Acad Child Adolesc Psychiatry 2000;39 (2) 215- 222
PubMed Link to Article
Strunin  LHingson  R Alcohol, drugs, and adolescent sexual behavior. Int J Addict 1992;27 (2) 129- 146
PubMed
Graves  KLLeigh  BC The relationship of substance use to sexual activity among young adults in the United States. Fam Plann Perspect 1995;27 (1) 18- 22, 33
PubMed Link to Article
Hudgins  R McCusker  JStoddard  A Cocaine use and risky injection and sexual behaviors. Drug Alcohol Depend 1995;37 (1) 7- 14
PubMed Link to Article
Shrier  LEmans  SWoods  EDuRant  R The association of sexual risk behaviors and problem drug behaviors in high school students. J Adolesc Health 1997;20 (5) 377- 383
Link to Article
Iguchi  MYBux  DA  Jr Reduced probability of HIV infection among crack cocaine–using injection drug users. Am J Public Health 1997;87 (6) 1008- 1012
PubMed Link to Article
Wingood  GMDiClemente  RJ The influence of psychosocial factors, alcohol, drug use on African-American women's high-risk sexual behavior. Am J Prev Med 1998;15 (1) 54- 59
PubMed Link to Article
Molitor  FRuiz  JDFlynn  NMikanda  JNSun  RKAnderson  R Methamphetamine use and sexual and injection risk behaviors among out-of-treatment injection drug users. Am J Drug Alcohol Abuse 1999;25 (3) 475- 493
PubMed Link to Article
Booth  REKwiatkowski  CFChitwood  DD Sex related HIV risk behaviors: differential risks among injection drug users, crack smokers, and injection drug users who smoke crack. Drug Alcohol Depend 2000;58 (3) 219- 226
PubMed Link to Article
Gorman  EMCarroll  RT Substance abuse and HIV: considerations with regard to methamphetamines and other recreational drugs for nursing practice and research. J Assoc Nurses AIDS Care 2000;11 (2) 51- 62
PubMed Link to Article
Kral  AHBluthenthal  RNLorvick  JGee  LBacchetti  PEdlin  BR Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: risk-factor analysis. Lancet 2001;357 (9266) 1397- 1401
PubMed Link to Article
Strathdee  SAGalai  NSafaiean  M  et al.  Sex differences in risk factors for HIV seroconversion among injection drug users: a 10-year perspective. Arch Intern Med 2001;161 (10) 1281- 1288
PubMed Link to Article
 Drug-associated HIV transmission continues in the United States. National Center for HIV, STD and TB Prevention, Divisions of HIV/AIDS Prevention, Centers for Disease Control and Prevention. http://www.cdc.gov/hiv/pubs/facts/idu.htm. Accessed March 2006
Somlai  AMKelly  JA McAuliffe  TLKsobiech  KHackl  KL Predictors of HIV sexual risk behaviors in a community sample of injection drug-using men and women. AIDS Behav 2003;7 (4) 383- 393
PubMed Link to Article
Meade  CS Sexual risk behavior among persons dually diagnosed with severe mental illness and substance use disorder. J Subst Abuse Treat 2006;30 (2) 147- 157
PubMed Link to Article
Klovdahl  ASPotterat  JJWoodhouse  DEMuth  JBMuth  SQDarrow  WW Social networks and infectious disease: the Colorado Springs Study. Soc Sci Med 1994;38 (1) 79- 88
PubMed Link to Article
Rothenberg  RBWoodhouse  DEPotterat  JJMuth  SQDarrow  WWKlovdahl  AS Social networks in disease transmission: the Colorado Springs Study. NIDA Res Monogr 1995;1513- 19
PubMed
Friedman  SRBolyard  MMateu-Gelabert  P  et al.  Some data-driven reflections on priorities in AIDS network research. AIDS Behav 2007;11 (5) 641- 651
PubMed Link to Article
 National Longitudinal Study of Adolescent Health. Carolina Population Center, University of North Carolina at Chapel Hill. http://www.cpc.unc.edu/addhealth.. Accessed March 16, 2007
Udry  JR References, instruments, and questionnaires consulted in the development of the Add Health in-home adolescent interview. Carolina Population Center, University of North Carolina at Chapel Hill 1991;http://www.cpc.unc.edu/projects/addhealth/data/using/guides/refer.pdf/view. Accessed March 16, 2007
Bearman  PSJones  JUdry  JR The National Longitudinal Study of Adolescent Health. Carolina Population Center, University of North Carolina at Chapel Hill 1997;http://www.cpc.unc.edu/projects/addhealth. Accessed March 16, 2007
Resnick  MDBearman  PSBlum  RW  et al.  Protecting adolescents from harm: findings from the National Longitudinal Study on Adolescent Health. JAMA 1997;278 (10) 823- 832
PubMed Link to Article
Chantala  KTabor  J Strategies to perform a design-based analysis using the Add Health Data. Carolina Population Center, University of North Carolina at Chapel Hill 1999;http://www.cpc.unc.edu/projects/addhealth/data/using/guides/weight1.pdf/view. Accessed March 16, 2007
Sieving  REBeuhring  TResnick  MD  et al.  Development of adolescent self-report measures from the National Longitudinal Study of Adolescent Health. J Adolesc Health 2001;28 (1) 73- 81
PubMed Link to Article
Cohen  MFeng  QFord  CA  et al.  Biomarkers in Wave III of the Add Health Study, Carolina Population Center. University of North Carolina at Chapel Hill 2003;http://www.cpc.unc.edu/projects/addhealth/data/using/guides/biomark.pdf/view. Accessed March 16, 2007
Radloff  L The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977;1385- 401
Link to Article
Roberts  RELewinsohn  PSeeley  J Screening for adolescent depression: a comparison of depression scales. J Am Acad Child Adolesc Psychiatry 1991;30 (1) 58- 66
PubMed Link to Article
McNutt  LAWu  CXue  XHafner  JP Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol 2003;157 (10) 940- 943
PubMed Link to Article
Zou  G A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004;159 (7) 702- 706
PubMed Link to Article
Miller  WCFord  CAMorris  M  et al.  Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA 2004;291 (18) 2229- 2236
PubMed Link to Article
Miller  WCSwygard  HHobbs  MM  et al.  The prevalence of trichomoniasis in young adults in the United States. Sex Transm Dis 2005;32 (10) 593- 598
PubMed Link to Article
Hallfors  DDIritani  BJMiller  WCBauer  DJ Sexual and drug behavior patterns and HIV and STD racial disparities: the need for new directions. Am J Public Health 2007;97 (1) 125- 132
PubMed Link to Article
Wells  KKlap  RKoike  ASherbourne  C Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. Am J Psychiatry 2001;158 (12) 2027- 2032
PubMed Link to Article
Alegría  MCanino  GRios  R  et al.  Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites. Psychiatr Serv 2002;53 (12) 1547- 1555
PubMed Link to Article
Elster  AJarosik  JVanGeest  JFleming  M Racial and ethnic disparities in health care for adolescents: a systematic review of the literature. Arch Pediatr Adolesc Med 2003;157 (9) 867- 874
PubMed Link to Article
Perreira  KMDeeb-Sossa  NHarris  KMBollen  K What are we measuring? an evaluation of the CES-D across race/ethnicity and immigrant generation. Soc Forces 2005;831567- 1602
Link to Article
Nguyen  HTKitner-Triolo  MEvans  MKZonderman  AB Factorial invariance of the CES-D in low socioeconomic status African Americans compared with a nationally representative sample. Psychiatry Res 2004;126 (2) 177- 187
PubMed Link to Article
Thomas  JLJones  GNScarinci  ICMehan  DJBrantley  PJ The utility of the CES-D as a depression screening measure among low-income women attending primary care clinics: the Center for Epidemiologic Studies-Depression. Int J Psychiatry Med 2001;31 (1) 25- 40
PubMed Link to Article

Figures

Tables

Table Graphic Jump LocationTable 1. Respondent Characteristics and Sexually Transmitted Infection (STI) in Wave III Among 10 783 White and Black US Adults Aged 18 to 25 Yearsa
Table Graphic Jump LocationTable 2. Prevalence Ratios (PRs) and 95% Confidence Intervals (CIs) for the Associations Between Recent and Chronic Depression and Multiple Partners in the Year Before Wave III Among White and Black US Adults Aged 18 to 25 Years
Table Graphic Jump LocationTable 3. Prevalence Ratios (PRs) and 95% Confidence Intervals (CIs) for the Associations Between Recent and Chronic Depression and Inconsistent Condom Use in the Year Before Wave III Among White and Black US Adults Aged 18 to 25 Years
Table Graphic Jump LocationTable 4. Prevalence Ratios (PRs) and 95% Confidence Intervals (CIs) for the Associations Between Recent and Chronic Depression and Sexually Transmitted Infection (STI) Among White and Black US Adults Aged 18-25 Years

References

Centers for Disease Control and Prevention, Trends in Reportable Sexually Transmitted Diseases in the United States, 2006: National Surveillance Data for Chlamydia, Gonorrhea, and Syphilis.  Atlanta, GA Centers for Disease Control and Prevention2007;
Weinstock  HBerman  SCates  W  Jr Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health 2004;36 (1) 6- 10
PubMed Link to Article
Biro  FMRosenthal  SL Psychological sequelae of sexually transmitted diseases in adolescents. Obstet Gynecol Clin North Am 1992;19 (1) 209- 218
PubMed
Ramrakha  SCaspi  ADickson  NMoffitt  TEPaul  C Psychiatric disorders and risky sexual behaviour in young adulthood: cross sectional study in birth cohort. BMJ 2000;321 (7256) 263- 266
PubMed Link to Article
Shrier  LAHarris  SKSternberg  MBeardslee  WR Associations of depression, self-esteem, and substance use with sexual risk among adolescents. Prev Med 2001;33 (3) 179- 189
PubMed Link to Article
Shrier  LAHarris  SKBeardslee  WR Temporal associations between depressive symptoms and self-reported sexually transmitted disease among adolescents. Arch Pediatr Adolesc Med 2002;156 (6) 599- 606
PubMed Link to Article
Kaltiala-Heino  RKosunen  ERimpela  M Pubertal timing, sexual behaviour and self-reported depression in middle adolescence. J Adolesc 2003;26 (5) 531- 545
PubMed Link to Article
Kosunen  EKaltiala-Heino  RRimpela  MLaippala  P Risk-taking sexual behaviour and self-reported depression in middle adolescence: a school-based survey. Child Care Health Dev 2003;29 (5) 337- 344
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Hallfors  DDWaller  MWBauer  DFord  CAHalpern  CT Which comes first in adolescence: sex and drugs or depression? Am J Prev Med 2005;29 (3) 163- 170
PubMed Link to Article
Waller  MWHallfors  DDHalpern  CTIritani  BJFord  CAGuo  G Gender differences in associations between depressive symptoms and patterns of substance use and risky sexual behavior among a nationally representative sample of U.S. adolescents. Arch Womens Ment Health 2006;9 (3) 139- 150
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Lehrer  JAShrier  LAGortmaker  SBuka  S Depressive symptoms as a longitudinal predictor of sexual risk behaviors among US middle and high school students. Pediatrics 2006;118 (1) 189- 200
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Channon  S Executive dysfunction in depression: the Wisconsin card sorting test. J Affect Disord 1996;39 (2) 107- 114
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Rao  U Links between depression and substance abuse in adolescents: neurobiological mechanisms. Am J Prev Med 2006;31 ((6,) ((suppl 1))) S161- S174
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Elliott  RSahakian  BJHerrod  JJRobbins  TWPaykel  ES Abnormal response to negative feedback in unipolar depression: evidence for a diagnosis specific impairment. J Neurol Neurosurg Psychiatry 1997;63 (1) 74- 82
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Elliott  R The neuropsychological profile in unipolar depression. Trends Cogn Sci 1998;2447- 454
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Lejoyeux  MArbaretaz  M McLoughlin  MAdes  J Impulse control disorders and depression. J Nerv Ment Dis 2002;190 (5) 310- 314
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Hanson  KLLuciana  MSullwold  K Reward-related decision-making deficits and elevated impulsivity among MDMA and other drug users. Drug Alcohol Depend 2008;96 (1-2) 99- 110
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Aseltine  RH  JrGore  SColten  M Depression and the social development context of adolescence. J Pers Soc Psychol 1994;67 (2) 252- 263
PubMed Link to Article
Kalichman  SCKelly  JAMorgan  MRompa  D Fatalism, current life satisfaction, and risk for HIV infection among gay and bisexual men. J Consult Clin Psychol 1997;65 (4) 542- 546
PubMed Link to Article
Rounsaville  BJWeissman  MMCrits-Christoph  KWilber  CKleber  H Diagnosis and symptoms of depression in opiate addicts: course and relationship to treatment outcome. Arch Gen Psychiatry 1982;39 (2) 151- 156
PubMed Link to Article
Ross  HEGlaser  FBGermanson  T The prevalence of psychiatric disorders in patients with alcohol and other drug problems. Arch Gen Psychiatry 1988;45 (11) 1023- 1031
PubMed Link to Article
Regier  DAFarmer  MERae  DS  et al.  Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990;264 (19) 2511- 2518
PubMed Link to Article
Rounsaville  BJAnton  SFCarroll  KBudde  DPrusoff  BAGawin  F Psychiatric diagnoses of treatment-seeking cocaine abusers. Arch Gen Psychiatry 1991;48 (1) 43- 51
PubMed Link to Article
Hasin  DSGlick  H Depressive symptoms and DSM-III-R alcohol dependence: general population results. Addiction 1993;88 (10) 1431- 1436
PubMed Link to Article
Latkin  CAMandell  W Depression as an antecedent of frequency of intravenous drug use in an urban, nontreatment sample. Int J Addict 1993;28 (14) 1601- 1612
PubMed
Stephens  RSRoffman  RASimpson  EE Adult marijuana users seeking treatment. J Consult Clin Psychol 1993;61 (6) 1100- 1104
PubMed Link to Article
Kalichman  SCKelly  JAJohnson  JRBulto  M Factors associated with risk for HIV infection among chronic mentally ill adults. Am J Psychiatry 1994;151 (2) 221- 227
PubMed
Brooner  RKKing  VLKidorf  MSchmidt  CW  JrBigelow  GE Psychiatric and substance use comorbidity among treatment-seeking opioid abusers. Arch Gen Psychiatry 1997;54 (1) 71- 80
PubMed Link to Article
Castillo Mezzich  ATarter  REGiancola  PRLu  SKirisci  LParks  S Substance use and risky sexual behavior in female adolescents. Drug Alcohol Depend 1997;44 (2-3) 157- 166
PubMed Link to Article
Dinwiddie  SH Characteristics of injection drug users derived from a large family study of alcoholism. Compr Psychiatry 1997;38 (4) 218- 229
PubMed Link to Article
Khantzian  EJ The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harv Rev Psychiatry 1997;4 (5) 231- 244
PubMed Link to Article
Hawkins  WELatkin  CHawkins  MJChowdury  D Depressive symptoms and HIV-risk behavior in inner-city users of drug injections. Psychol Rep 1998;82 (1) 137- 138
PubMed Link to Article
Mueser  KTDrake  REWallach  MA Dual diagnosis: a review of etiological theories. Addict Behav 1998;23 (6) 717- 734
PubMed Link to Article
Mandell  WKim  JLatkin  CSuh  T Depressive symptoms, drug network, and their synergistic effect on needle-sharing behavior among street injection drug users. Am J Drug Alcohol Abuse 1999;25 (1) 117- 127
PubMed Link to Article
Rao  UDaley  SEHammen  C Relationship between depression and substance use disorders in adolescent women during the transition to adulthood. J Am Acad Child Adolesc Psychiatry 2000;39 (2) 215- 222
PubMed Link to Article
Strunin  LHingson  R Alcohol, drugs, and adolescent sexual behavior. Int J Addict 1992;27 (2) 129- 146
PubMed
Graves  KLLeigh  BC The relationship of substance use to sexual activity among young adults in the United States. Fam Plann Perspect 1995;27 (1) 18- 22, 33
PubMed Link to Article
Hudgins  R McCusker  JStoddard  A Cocaine use and risky injection and sexual behaviors. Drug Alcohol Depend 1995;37 (1) 7- 14
PubMed Link to Article
Shrier  LEmans  SWoods  EDuRant  R The association of sexual risk behaviors and problem drug behaviors in high school students. J Adolesc Health 1997;20 (5) 377- 383
Link to Article
Iguchi  MYBux  DA  Jr Reduced probability of HIV infection among crack cocaine–using injection drug users. Am J Public Health 1997;87 (6) 1008- 1012
PubMed Link to Article
Wingood  GMDiClemente  RJ The influence of psychosocial factors, alcohol, drug use on African-American women's high-risk sexual behavior. Am J Prev Med 1998;15 (1) 54- 59
PubMed Link to Article
Molitor  FRuiz  JDFlynn  NMikanda  JNSun  RKAnderson  R Methamphetamine use and sexual and injection risk behaviors among out-of-treatment injection drug users. Am J Drug Alcohol Abuse 1999;25 (3) 475- 493
PubMed Link to Article
Booth  REKwiatkowski  CFChitwood  DD Sex related HIV risk behaviors: differential risks among injection drug users, crack smokers, and injection drug users who smoke crack. Drug Alcohol Depend 2000;58 (3) 219- 226
PubMed Link to Article
Gorman  EMCarroll  RT Substance abuse and HIV: considerations with regard to methamphetamines and other recreational drugs for nursing practice and research. J Assoc Nurses AIDS Care 2000;11 (2) 51- 62
PubMed Link to Article
Kral  AHBluthenthal  RNLorvick  JGee  LBacchetti  PEdlin  BR Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: risk-factor analysis. Lancet 2001;357 (9266) 1397- 1401
PubMed Link to Article
Strathdee  SAGalai  NSafaiean  M  et al.  Sex differences in risk factors for HIV seroconversion among injection drug users: a 10-year perspective. Arch Intern Med 2001;161 (10) 1281- 1288
PubMed Link to Article
 Drug-associated HIV transmission continues in the United States. National Center for HIV, STD and TB Prevention, Divisions of HIV/AIDS Prevention, Centers for Disease Control and Prevention. http://www.cdc.gov/hiv/pubs/facts/idu.htm. Accessed March 2006
Somlai  AMKelly  JA McAuliffe  TLKsobiech  KHackl  KL Predictors of HIV sexual risk behaviors in a community sample of injection drug-using men and women. AIDS Behav 2003;7 (4) 383- 393
PubMed Link to Article
Meade  CS Sexual risk behavior among persons dually diagnosed with severe mental illness and substance use disorder. J Subst Abuse Treat 2006;30 (2) 147- 157
PubMed Link to Article
Klovdahl  ASPotterat  JJWoodhouse  DEMuth  JBMuth  SQDarrow  WW Social networks and infectious disease: the Colorado Springs Study. Soc Sci Med 1994;38 (1) 79- 88
PubMed Link to Article
Rothenberg  RBWoodhouse  DEPotterat  JJMuth  SQDarrow  WWKlovdahl  AS Social networks in disease transmission: the Colorado Springs Study. NIDA Res Monogr 1995;1513- 19
PubMed
Friedman  SRBolyard  MMateu-Gelabert  P  et al.  Some data-driven reflections on priorities in AIDS network research. AIDS Behav 2007;11 (5) 641- 651
PubMed Link to Article
 National Longitudinal Study of Adolescent Health. Carolina Population Center, University of North Carolina at Chapel Hill. http://www.cpc.unc.edu/addhealth.. Accessed March 16, 2007
Udry  JR References, instruments, and questionnaires consulted in the development of the Add Health in-home adolescent interview. Carolina Population Center, University of North Carolina at Chapel Hill 1991;http://www.cpc.unc.edu/projects/addhealth/data/using/guides/refer.pdf/view. Accessed March 16, 2007
Bearman  PSJones  JUdry  JR The National Longitudinal Study of Adolescent Health. Carolina Population Center, University of North Carolina at Chapel Hill 1997;http://www.cpc.unc.edu/projects/addhealth. Accessed March 16, 2007
Resnick  MDBearman  PSBlum  RW  et al.  Protecting adolescents from harm: findings from the National Longitudinal Study on Adolescent Health. JAMA 1997;278 (10) 823- 832
PubMed Link to Article
Chantala  KTabor  J Strategies to perform a design-based analysis using the Add Health Data. Carolina Population Center, University of North Carolina at Chapel Hill 1999;http://www.cpc.unc.edu/projects/addhealth/data/using/guides/weight1.pdf/view. Accessed March 16, 2007
Sieving  REBeuhring  TResnick  MD  et al.  Development of adolescent self-report measures from the National Longitudinal Study of Adolescent Health. J Adolesc Health 2001;28 (1) 73- 81
PubMed Link to Article
Cohen  MFeng  QFord  CA  et al.  Biomarkers in Wave III of the Add Health Study, Carolina Population Center. University of North Carolina at Chapel Hill 2003;http://www.cpc.unc.edu/projects/addhealth/data/using/guides/biomark.pdf/view. Accessed March 16, 2007
Radloff  L The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977;1385- 401
Link to Article
Roberts  RELewinsohn  PSeeley  J Screening for adolescent depression: a comparison of depression scales. J Am Acad Child Adolesc Psychiatry 1991;30 (1) 58- 66
PubMed Link to Article
McNutt  LAWu  CXue  XHafner  JP Estimating the relative risk in cohort studies and clinical trials of common outcomes. Am J Epidemiol 2003;157 (10) 940- 943
PubMed Link to Article
Zou  G A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 2004;159 (7) 702- 706
PubMed Link to Article
Miller  WCFord  CAMorris  M  et al.  Prevalence of chlamydial and gonococcal infections among young adults in the United States. JAMA 2004;291 (18) 2229- 2236
PubMed Link to Article
Miller  WCSwygard  HHobbs  MM  et al.  The prevalence of trichomoniasis in young adults in the United States. Sex Transm Dis 2005;32 (10) 593- 598
PubMed Link to Article
Hallfors  DDIritani  BJMiller  WCBauer  DJ Sexual and drug behavior patterns and HIV and STD racial disparities: the need for new directions. Am J Public Health 2007;97 (1) 125- 132
PubMed Link to Article
Wells  KKlap  RKoike  ASherbourne  C Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. Am J Psychiatry 2001;158 (12) 2027- 2032
PubMed Link to Article
Alegría  MCanino  GRios  R  et al.  Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites. Psychiatr Serv 2002;53 (12) 1547- 1555
PubMed Link to Article
Elster  AJarosik  JVanGeest  JFleming  M Racial and ethnic disparities in health care for adolescents: a systematic review of the literature. Arch Pediatr Adolesc Med 2003;157 (9) 867- 874
PubMed Link to Article
Perreira  KMDeeb-Sossa  NHarris  KMBollen  K What are we measuring? an evaluation of the CES-D across race/ethnicity and immigrant generation. Soc Forces 2005;831567- 1602
Link to Article
Nguyen  HTKitner-Triolo  MEvans  MKZonderman  AB Factorial invariance of the CES-D in low socioeconomic status African Americans compared with a nationally representative sample. Psychiatry Res 2004;126 (2) 177- 187
PubMed Link to Article
Thomas  JLJones  GNScarinci  ICMehan  DJBrantley  PJ The utility of the CES-D as a depression screening measure among low-income women attending primary care clinics: the Center for Epidemiologic Studies-Depression. Int J Psychiatry Med 2001;31 (1) 25- 40
PubMed Link to Article

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Depression, Sexually Transmitted Infection, and Sexual Risk Behavior Among Young Adults in the United States
Arch Pediatr Adolesc Med.2009;163(7):644-652.eSupplement

eSupplement -Download PDF (30 KB). This file requires Adobe Acrobat®.
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