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This paper contributes new evidence on the association between immigrant status and health by describing and attempting to explain patterns of co-occurring sex and drug use behaviors among Asian and Latino adolescents in the United States. Nine patterns of sex and drug use behaviors were identified from a cluster analysis of data from 3,924 Asian and Latino youth (grades 7-12) who participated in the National Longitudinal Study of Adolescent Health (Add Health). The relationship between immigrant status and risk cluster membership was evaluated with multinomial logistic regression. Compared to foreign-born youth, U.S. born Asian and Latino adolescents were more likely to engage in sex and drug risk behaviors. Family and residential characteristics associated with immigrant status partly accounted for this finding. The results indicate that among Asian and Latino adolescents, assimilation to U.S. risk behavior norms occurs rapidly and is evident by the second generation.

CONTEXT: Most sexual health interventions focus on heterosexual sexual risk behavior. Health practitioners face a lack of information about the sexual health of sexual minority young adults (aged 18–26). METHODS: Three indicators of sexual minority status (identity, behavior and romantic attractions) were assessed in 10,986 young adults who participated in Wave 3 of the National Longitudinal Study of Adolescent Health (2001–2002). Logistic regression analyses examined associations between these indicators and individuals' perceived risk for STDs and actual infection with STDs. Data from the 1,154 respondents who had current or recent bacterial STDs were investigated further to determine whether they had underestimated their risk. RESULTS: Outcomes varied by sexual minority status indicator and by sex. Bisexual females had significantly higher odds of STDs than heterosexual females (odds ratios, 1.4), and females attracted to both sexes had significantly higher odds of STDs than females attracted only to males (1.8). In contrast, none of the sexual minority status indicators predicted STDs for males. Among respondents who had an STD, females who reported only same-sex sexual relationships were more likely to believe they were at very low risk for STDs than were females reporting only opposite-sex sexual relationships (17.2); homosexual females had a higher likelihood of this outcome than heterosexual females (19.7). CONCLUSIONS: Health practitioners need to assist sexual minority young adults, particularly females, in understanding their risk for STDs and in taking safer-sex precautions.

This paper examines the relationships between alcohol outlet density, alcohol use, and perpetration of intimate partner violence (IPV) among young adult women in the US. Data were from Wave III of the National Longitudinal Study of Adolescent Health (Add Health; N  = 4,430 in present analyses). Multinomial logistic regression was used to examine occurrence of past year IPV perpetration toward a male partner based on tract-level on-premise and off-premise alcohol outlet density, controlling for individuals’ demographic, alcohol use, and childhood abuse characteristics and neighborhood socio-demographic factors. Higher off-premise alcohol outlet density was found to be associated with young women’s perpetration of physical only IPV, controlling for individual-level and ecological factors. Alcohol use had an independent association with IPV perpetration but was not a mediator of the outlet density-IPV relationship. Findings suggest that considering alcohol-related environmental factors may help efforts aimed at preventing young women’s use of physical violence toward partners.

CONTEXT: Sexual and substance use behaviors covary in adolescence. Prevalence of HIV and other sexually transmitted diseases (STDs) differs according to race and gender, yet few studies have systematically investigated risk behavior patterns by subgroup, particularly with nationally representative data. METHODS: A priori considerations and K-means cluster analysis were used to group 13,998 non-Hispanic black and white participants in the National Longitudinal Study of Adolescent Health, Wave 1, according to self-reported substance use and sexual behavior. Multinomial logit analyses examined racial and gender differences by cluster. RESULTS: Among 16 clusters, the two defined by the lowest risk behaviors (sexual abstinence and little or no substance use) comprised 47% of adolescents; fewer than 1% in these groups reported ever having received an STD diagnosis. The next largest cluster-characterized by sexual activity (on average, with one lifetime partner) and infrequent substance use-contained 15% of participants but nearly one-third of adolescent with STDs. Blacks were more likely than whites to be in this group. Black males also were more likely than white males to be in three small clusters characterized by high-risk sexual behaviors (i.e., having had sex with a male or with at least 14 partners, or for drugs or money). Black females generally were the least likely to be in high-risk behavior clusters but the most likely to report STDs. CONCLUSIONS: Adolescents' risk behavior patterns vary by race and gender, and do not necessarily correlate with their STD prevalence. Further investigation of adolescents' partners and sexual networks is needed.

Sexual minorities are overrepresented among the runaway population, and sexual minority runaways are at greater risk for adverse health outcomes than their heterosexual peers. Our knowledge of this vulnerable population has been restricted by methodological limitations of existing studies. This study used a nationally representative sample of U.S. adolescents to explore the association between same-sex romantic attractions and relationships and run away behavior over a 2 year period. Results indicated that although the association between sexual orientation and running away appears to be partially attenuated by other risk factors for running away, there remains a significant positive association between same-sex romantic attractions and running away. Furthermore, youth with no romantic or sexual relationships were significantly less likely to report running away compared to youth with only opposite-sex relationships. These associations remained significant even after controlling for other risk factors.

This study examined whether alcohol outlet density is associated with male physical and sexual victimization by a female partner. Data were from the National Longitudinal Study of Adolescent Health (Add Health). A total of 3,179 young adult men identified a current heterosexual relationship and had complete intimate partner violence (IPV) victimization data. Almost 16% of this sample reported being the victim of physical only IPV in their relationship over the previous 12 months; an additional 6.4% were victims of sexual only or sexual and physical IPV. Multivariate analyses indicated high alcohol outlet density was associated with greater odds of experiencing physical IPV only (odds ratio [OR] = 2.07). Heavy drinkers experienced increased odds of physical and sexual IPV victimization. Alcohol outlet density should be addressed in prevention efforts.

Sexual and substance use behaviors covary in adolescence. Prevalence of HIV and other sexually transmitted diseases (STDs) differs according to race and gender, yet few studies have systematically investigated risk behavior patterns by subgroup, particularly with nationally representative data.CONTEXTSexual and substance use behaviors covary in adolescence. Prevalence of HIV and other sexually transmitted diseases (STDs) differs according to race and gender, yet few studies have systematically investigated risk behavior patterns by subgroup, particularly with nationally representative data.A priori considerations and K-means cluster analysis were used to group 13,998 non-Hispanic black and white participants in the National Longitudinal Study of Adolescent Health, Wave 1, according to self-reported substance use and sexual behavior. Multinomial logit analyses examined racial and gender differences by cluster.METHODSA priori considerations and K-means cluster analysis were used to group 13,998 non-Hispanic black and white participants in the National Longitudinal Study of Adolescent Health, Wave 1, according to self-reported substance use and sexual behavior. Multinomial logit analyses examined racial and gender differences by cluster.Among 16 clusters, the two defined by the lowest risk behaviors (sexual abstinence and little or no substance use) comprised 47% of adolescents; fewer than 1% in these groups reported ever having received an STD diagnosis. The next largest cluster-characterized by sexual activity (on average, with one lifetime partner) and infrequent substance use-contained 15% of participants but nearly one-third of adolescent with STDs. Blacks were more likely than whites to be in this group. Black males also were more likely than white males to be in three small clusters characterized by high-risk sexual behaviors (i.e., having had sex with a male or with at least 14 partners, or for drugs or money). Black females generally were the least likely to be in high-risk behavior clusters but the most likely to report STDs.RESULTSAmong 16 clusters, the two defined by the lowest risk behaviors (sexual abstinence and little or no substance use) comprised 47% of adolescents; fewer than 1% in these groups reported ever having received an STD diagnosis. The next largest cluster-characterized by sexual activity (on average, with one lifetime partner) and infrequent substance use-contained 15% of participants but nearly one-third of adolescent with STDs. Blacks were more likely than whites to be in this group. Black males also were more likely than white males to be in three small clusters characterized by high-risk sexual behaviors (i.e., having had sex with a male or with at least 14 partners, or for drugs or money). Black females generally were the least likely to be in high-risk behavior clusters but the most likely to report STDs.Adolescents' risk behavior patterns vary by race and gender, and do not necessarily correlate with their STD prevalence. Further investigation of adolescents' partners and sexual networks is needed.CONCLUSIONSAdolescents' risk behavior patterns vary by race and gender, and do not necessarily correlate with their STD prevalence. Further investigation of adolescents' partners and sexual networks is needed.

The efficacy of reduced intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (HCT) for Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia (ALL) is uncertain. We analyzed 197 adults with Ph+ ALL in first complete remission; 67 patients receiving RIC were matched with 130 receiving myeloablative conditioning (MAC) for age, donor type and HCT year. Over 75% received pre-HCT tyrosine kinase inhibitors (TKIs), mostly imatinib; 39% (RIC) and 49% (MAC) were minimal residual disease (MRD) neg pre-HCT. At a median 4.5 years follow-up, 1-year transplant-related mortality (TRM) was lower in RIC (13%) than MAC (36%; P =0.001) while the 3-year relapse rate was 49% in RIC and 28% in MAC ( P =0.058). Overall survival (OS) was similar (RIC 39% (95% confidence interval (CI) 27–52) vs 35% (95% CI 27–44); P =0.62). Patients MRD pos pre-HCT had higher risk of relapse with RIC vs MAC (hazard ratio (HR) 1.97; P =0.026). However, patients receiving pre-HCT TKI in combination with MRD negativity pre-RIC HCT had superior OS (55%) compared with a similar MRD population after MAC (33%; P =0.0042). In multivariate analysis, RIC lowered TRM (HR 0.6; P =0.057), but absence of pre-HCT TKI (HR 1.88; P =0.018), RIC (HR 1.891; P =0.054) and pre-HCT MRD pos (HR 1.6; P =0.070) increased relapse risk. RIC is a valid alternative strategy for Ph+ ALL patients ineligible for MAC and MRD neg status is preferred pre-HCT.