title: Age of Sexual Debut and Cannabis Use in the United States.
abstract: BACKGROUND
  Understanding the interrelationships between risky health behaviors is critical for health promotion efforts. Conceptual frameworks for understanding substance misuse (e.g. stepping-stone models) have not yet widely incorporated other risky behaviors, including those related to sexual health.
  
  
  OBJECTIVE
  The goals of this study were to assess the relationship between early sexual debut and cannabis use, examine the role of licit substance use in this association, and evaluate differences by gender and race/ethnicity.
  
  
  METHODS
  Data came from the National Comorbidity Survey-Replication (NCS-R). Primary analysis was restricted to respondents who reported sexual debut at ≥12 years (n = 5,036). Age at sexual debut was categorized as early (<18 years), average (18 years) and late (>18 years). Logistic regression was used to assess the relationship between age at sexual debut and cannabis use. Interaction terms were used to evaluate effect modification by gender and race/ethnicity.
  
  
  RESULTS
  Later age of sexual debut was associated with lower odds of cannabis use relative to the average age of debut (AOR = 0.50, 95% CI = 0.37-0.66). For every year that respondents delayed their sexual debut, the relative odds of lifetime cannabis use declined by 17%. After accounting for alcohol and tobacco use the association between early sexual debut and cannabis was attenuated (AOR = 0.90, 95% CI = 0.68-1.20), while later age of debut remained protective (AOR = 0.57, 95% CI = 0.42-0.78). Results were generally consistent across race/ethnicity and gender.
  
  
  CONCLUSIONS
  Multifactorial intervention strategies targeting both sexual health and substance use may be warranted.
authors.affiliation: a Department of Family Medicine and Population Health , School of Medicine, Virginia Commonwealth University , Richmond , Virginia , USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Cha
authors.affiliation: a Department of Family Medicine and Population Health , School of Medicine, Virginia Commonwealth University , Richmond , Virginia , USA.|b Department of Obstetrics and Gynecology, School of Medicine , Virginia Commonwealth University , Richmond , Virginia , USA.|c Institute for Women's Health , Virginia Commonwealth University , Richmond , Virginia , USA.
authors.forename: Saba W
authors.initials: SW
authors.lastname: Masho
authors.affiliation: a Department of Family Medicine and Population Health , School of Medicine, Virginia Commonwealth University , Richmond , Virginia , USA.|d Virginia Institute for Psychiatric and Behavioral Genetics , Virginia Commonwealth University , Richmond , Virginia , USA.
authors.forename: Briana
authors.initials: B
authors.lastname: Mezuk
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000523:psychology; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology* / Q000523:psychology; D044469:Racial Groups / Q000523:psychology / Q000706:statistics & numerical data; D012307:Risk Factors; D012309:Risk-Taking; D012737:Sex Factors; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Cannabis; marijuana; risky behaviors; sexual debut; sexual initiation; substance use