title: Association of Depressive Symptoms and Substance Use With Risky Sexual Behavior and Sexually Transmitted Infections Among African American Female Adolescents Seeking Sexual Health Care.
abstract: OBJECTIVE
  We examined how depression and substance use interacted to predict risky sexual behavior and sexually transmitted infections (STIs) among African American female adolescents.
  
  
  METHODS
  We measured depressive symptoms, substance use, sexual behavior, and STIs in 701 African American female adolescents, aged 14 to 20 years, at baseline and at 6-month intervals for 36 months in Atlanta, Georgia (2005-2007). We used generalized estimating equation models to examine effects over the 36-month follow-up period.
  
  
  RESULTS
  At baseline, more than 40% of adolescents reported significant depressive symptoms; 64% also reported substance use in the 90 days before assessment. Depression was associated with recently incarcerated partner involvement, sexual sensation seeking, unprotected sex, and prevalent STIs (all P < .001). In addition, adolescents with depressive symptoms who reported any substance use (i.e., marijuana, alcohol, Ecstasy) were more likely to report incarcerated partner involvement, sexual sensation seeking, unprotected sex, and have an incident STI over the 36-month follow-up (all P < .05).
  
  
  CONCLUSIONS
  African American female adolescents who reported depressive symptoms and substance use were more likely to engage in risky behavior and acquire incident STIs. This population might benefit from future prevention efforts targeting the intersection of depression and substance use.
authors.affiliation: Jerrold M. Jackson, Puja Seth, and Ralph J. DiClemente are with the Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA. Anne Lin is with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
authors.forename: Jerrold M
authors.initials: JM
authors.lastname: Jackson
authors.affiliation: Jerrold M. Jackson, Puja Seth, and Ralph J. DiClemente are with the Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA. Anne Lin is with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
authors.forename: Puja
authors.initials: P
authors.lastname: Seth
authors.affiliation: Jerrold M. Jackson, Puja Seth, and Ralph J. DiClemente are with the Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA. Anne Lin is with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: DiClemente
authors.affiliation: Jerrold M. Jackson, Puja Seth, and Ralph J. DiClemente are with the Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA. Anne Lin is with the Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
authors.forename: Anne
authors.initials: A
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001741:Black or African American / Q000706:statistics & numerical data*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D015995:Prevalence; D012309:Risk-Taking; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D055815:Young Adult