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Early risk.

An 11-item sexual behavior questionnaire developed for the California Families Project was administered to participants beginning in the 9 th grade. For the purposes of this study only a single item was used, “Have you had sexual intercourse during the past 12 months?” Participants responded with either “yes” or “no.” This item was converted into a series of dichotomous “sexual debut” variables by re-coding the initial item such that for a given grade, “yes” responses were only assigned to participants who reported having sexual intercourse during the past 12 months in that grade and no prior grades. This approach resulted in four separate variables that captured five distinct levels of sexual activity initiation: no debut (52.5% of participants), debut reported in 9 th grade (11.1%), 10 th grade (12.6%), 11 th grade (14%), and 12 th grade (9.8%). More boys reported debut in 9 th grade than girls (40 versus 25), but this gap narrowed over time, with 31 boys and 28 girls reporting debut in 12 th grade. In total 153 of 315 boys (49%), and 128 of 316 girls (41%), reported sexual debut at some point during the study.

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The psychometric properties of the substance use and early risk questionnaires were evaluated using graded item response models [34]. Although it could be argued that the substance use experimentation and frequency variables (see below) are more consistent with a formative measurement model than the reflective model assumed in item response theory (e.g., lifetime experimentation with substances is a function of its indicators, not vice versa), these models still provide a useful means of holistically quantifying the degree of interrelatedness between items and are thus simply used descriptively to those ends here. Summary statistics from these models are presented in text to provide a concise overview of scale functioning. For ease of interpretation discrimination values are converted to standardized factor loadings, and information values are converted to estimates of reliability [35]. The average reliability estimates presented specifically capture the average information provided by a scale (converted to reliability) between -2 and 2 standard deviations from the mean.

Substance Use Frequency was measured using nine different items from the Alcohol, Tobacco, and Other Drug Use scale that inquired about the regularity of substance use and intoxication/getting high over the past 3 months. Participants responded a 5 point scale that ranged from 0 (“never”) to 4 (“almost every day”) to each item. Responses across the scale were summed to generate a total substance use frequency score (possible range between 0 and 36). Average within-wave factor loadings ranged from λ = .84 to .95 across time. The average reliability between -2 and 2 standard deviations was low in earlier waves, but increased over time, growing from r_xx = .05 in 5 th grade to r_xx = .48 in 12 th grade. Again, few endorsements in earlier waves and asymmetric information functions contributed to these reliability estimates.

Data Availability: The data used in the analyses reported here, along with sample syntax files, can be found in the online supplemental material on the Open Science Framework (https://osf.io/95c8w/).

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Sexual debut, or first sexual intercourse, is a normative part of adolescent development [1]. However, sexual debut is also associated with certain problematic outcomes, such as substance use [2–3]. Thus, there is a tension in the literature between recognizing that sexual debut is a normal part of development that should not be pathologized, and understanding why sexual debut is correlated with problem behaviors [3–4]. This issue has important implications—for example, for sex education policies—which increases the need for rigorous evidence about the nature of the association between sexual debut and substance use. Accordingly, we investigated the temporal associations between sexual debut and substance use in a sample of youth followed annually from late childhood until the 12 th grade.

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Method

Competing interests: The authors have declared that no competing interests exist.

Parsing the potential contribution of each possible explanation requires methods that can disaggregate within-person changes from between-person differences. That is, methods that can isolate a direct predictive effect of sexual debut on substance use (i.e., within-person change) by accounting for general age-related trends (i.e., within-person change), and the fact that some youth are more likely to sexually debut and use substances than others (i.e., between-person differences). One such method compares members of twin pairs discordant for sexual debut on substance use to estimate the direct effects of sexual debut while broadly controlling for between-person differences (e.g., shared genetic and environmental risk factors) and age related trends. Findings using this approach suggest that genetic and shared environmental influences largely account for the association between sexual debut and substance use, implying a primarily between-person effect [4, 12, 20, 21, 22].

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Descriptive statistics for the substance use variables are reported in Table 1. The average substance use trajectories for youth reporting sexual debut at different times are presented in Fig 2. Earlier debuting youth consistently reported more experimentation, frequency of use, intent to use, and access to substances. Descriptive information for the risk composite variables, based on when youth sexually debuted, is presented in Table 2. Risk scores tended to be higher for youth with earlier sexual debuts.

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Participants and procedures

Funding: This research was supported by a grant from the National Institute on Drug Abuse (DA017902; https://www.drugabuse.gov/) to Richard W. Robins and Rand D. Conger and by the National Institute on Alcohol Abuse and Alcoholism grant number T32 AA007477. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Despite the strengths of the discordant twin design, they have limitations: they often rely on retrospective reports years after the event, feature only one or two occasions of measurement, are based primarily on European/European-origin samples, and require a sample of many twin pairs meaningfully discordant on the timing of sexual debut. Thus, it is critical to test the generalizability of their conclusions using other methods, particularly longitudinal methods [3, 22, 23, 24]. Longitudinal studies initiated before sexual activity and substance use are relatively normative (e.g., reach 50% prevalence) are particularly useful as it is possible to test the direct effect from sexual debut to substance use while controlling for long-term age-related changes, and long standing between-person differences in those trends [3].

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Indeed, the TVIC is particularly informative as it simultaneously captures all three potential accounts for the association between sexual debut and substance use. First, the slope factor mean and variance (SLOPE in Fig 1, panel c) capture the general age-related trends in substance use that track with sexual development in adolescence. Second, the regression paths from debut timing and early risk to the slope factor (DEBUT GRADE and RISK in Fig 1, panel c) capture stable between person differences in substance use, reflecting the extent to which some youth are simply more likely be sexually active and use substances across adolescence. Third, the regression paths from sexual debut to the residual factors (DEBUT in Fig 1, panel c) capture the direct effect of sexual debut, or the extent to which the act of sexual debut in a given grade is associated with increased substance use after conditioning substance use on the general age-related trends in substance use, and stable individual differences in those trends (i.e., the within-person effect of sexual debut after accounting for general maturational trends).

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Different lines represent trajectories for youth debuting at different grades.

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Received: May 10, 2019; Accepted: January 14, 2020; Published: February 6, 2020

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Sexual debut, or first intercourse, predicts problem behaviors such as substance use. This association could reflect a direct effect of debut itself, general developmental trends, or the fact that some youth are more predisposed to a wide array of problem behaviors (e.g., risky sex, substance use). Understanding the association between sexual debut and substance use thus requires methods that can distinguish between these various accounts. In this study the association between sexual debut and substance use was investigated in a longitudinal sample of Mexican-origin youth (N = 674) assessed annually from 5 th (M_age = 10.86 years, SD = 0.51) through 12 th grade (M_age = 17.69 years, SD = 0.48). The longitudinal aspect of the data allowed the direct effect of sexual debut on substance use to be tested while accounting for long-term trends in substance use, and stable individual differences in those trends based on early risk and debut timing. Substance use increased over time, and early risk and debut were consistently associated with more substance use. Sexual debut also modestly predicted an increase in substance use after accounting for these effects, however. Taken together, results provide some evidence consistent with each of the potential explanations for the association between sexual debut and substance use across adolescence.

Two substance use variables were measured using the Alcohol, Tobacco, and Other Drug Use scale [36]. Substance Experimentation was measured with nine items that assessed whether youth had ever tried a wide range of substances (cannabis, tobacco, hard drugs, and multiple forms of alcohol), and if they ever had experiences becoming intoxicated or getting “high”. Participants responded either “yes” or “no” to each item. Responses were summed to generate a total lifetime experimentation score (possible range between 0 and 9). Items were highly intercorrelated, with the within-wave average factor loadings ranging from λ = .76 to .88 across time. The average reliability between -2 and 2 standard deviations was low in earlier waves, but increased over time, growing from r_xx = .21 in 5 th grade to r_xx = .62 in 12 th grade. The lower reliability values here primarily reflect the fact that 1) in earlier years there was very little substance use (i.e., variability), and 2) the information functions were asymmetric such that reliability was considerably lower below the mean than above. That is, the scale provides more information about youth that use substances than those that use little to no substances. As this is consistent with the aim the scale the asymmetric information functions, and the correspondingly moderate average reliability estimates, are not necessarily problematic here.

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Given that the observed trajectories were markedly non-linear (see Fig 2), the latent basis specification was selected as it provides a parsimonious means of simultaneously capturing general maturational trends as precisely as possible while adjusting for broad individual differences in substance use over time. Notably, the latent basis specification does impose the same shaped growth form on each individual [49]. Spline models have been recommended as an alternative specification to consider because of this, especially when the goal is to compare different growth functions [49]. In the present application however identifying the shape of the growth trajectory per se, and the covariates of that trajectory, was not a major goal. That is, it is well-established that substance use broadly increases from 5 th grade through 12 th grade—both on average and for most individuals (the trajectories of individuals who consistently abstain would be captured well in both latent basis and spline models)—and the growth model covariates were specifically selected because they are reliable predictors of adolescent substance use in the literature (as is precocious sexual activity). Accordingly, these potentially major limitations of the latent basis specification were somewhat less relevant here.

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Copyright: © 2020 Clark et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Substance Use Intentions were measured using a 9-item scale that assesses willingness to use substances, and plans to use those substances in the next year [37]. Participants responded on either a 3 or 4 point scale that ranged from 0 “Do not plan to/Definitely will not/Not at all willing” to either 3 “Very willing”, or 4 “Do plan to/Definitely will.” Scores for this measure were computed by summing the individual items (possible range between 0 and 33). The average within-wave factor loadings ranged from λ = .85 to .91 across time. The average reliability between -2 and 2 standard deviations was low in earlier waves, but increased over time, growing from r_xx = .27 in 5 th grade to in r_xx = .68 12 th grade. Information functions were again skewed to the left.