Moderation of Risks to Sexual Health by Substance Use in College Students With ADHD

Ashley M. Rohacek, BS ; Madison K. Firkey, MS ; Sarah E. Woolf-King, PhD, MPH ; Kevin M. Antshel, PhD

J Clin Psychiatry 2022;83(4):21m14240

ABSTRACT

Objective: Poor sexual health is a public health concern for college students and individuals with attention-deficit/hyperactivity disorder (ADHD), yet limited information is available on the sexual health of college students with ADHD. Here, the sexual health of college students with and without ADHD was described and moderators of risk to sexual health were identified.

Methods: A secondary data analysis of the National College Health Assessment III (Fall 2019, Spring 2020, and Fall 2020 administrations) was conducted using a sample of sexually active undergraduate students (N = 36,236). Logistic regressions were used to compare sexual behaviors and health outcomes of college students with and without self-reported ADHD and test for interactions between ADHD and substance use–related moderators of risk to sexual health (ie, alcohol use, binge drinking, and cannabis use).

Results: Compared to non-ADHD peers, college students with ADHD reported more past-year sexual partners (adjusted odds ratio [aOR] = 1.27; P < .01), lower rates of condom use (aOR = 0.77; P < .001), and higher rates of condomless sex while drinking (aOR = 1.52; P < .001). College students with ADHD reported more sexually transmitted infection diagnoses (aOR = 1.29; P < .01), a greater number of unplanned pregnancies (aOR = 1.72; P < .001), and more emergency contraception use (aOR = 1.19; P < .001). Alcohol use, binge drinking, and cannabis use moderated the relationship between ADHD and sexual health.

Conclusions: College students with ADHD represent a vulnerable population for poor sexual health and are differentially impacted by substance use. Indicated sexual health prevention strategies and treatment for college students with ADHD are warranted.

Continue Reading...

Members enjoy unlimited free PDF downloads as part of their subscription! Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.

Subscribe Now

Already a member? Login

Buy PDF for $40

Please sign in or purchase this PDF for $40.

References (58)

American College Health Association. American College Health Association-National College Health Assessment III: Reference Group Executive Summary Fall 2020. https://www.acha.org/documents/ncha/NCHA-III_Fall_2020_Reference_Group_Executive_Summary_updated.pdf. 2020. Accessed December 29, 2021.
Arnold LE, Hodgkins P, Kahle J, et al. Long-term outcomes of ADHD: academic achievement and performance. J Atten Disord. 2020;24(1):73–85. PubMed CrossRef
Weyandt L, DuPaul GJ, Verdi G, et al. The performance of college students with and without ADHD: neuropsychological, academic, and psychosocial functioning. J Psychopathol Behav Assess. 2013;35(4):421–435. CrossRef
World Health Organization. Report of a Technical Consultation on Sexual Health. Geneva: World Health Organization; 2002:28-31.
Herbenick D, Reece M, Schick V, et al. Sexual behavior in the United States: results from a national probability sample of men and women ages 14–94. J Sex Med. 2010;7(suppl 5):255–265. PubMed CrossRef
Fromme K, Stroot E, Kaplan D. Comprehensive effects of alcohol: development and psychometric assessment of a new expectancy questionnaire. Psychol Assess. 1993;5(1):19–26. CrossRef
Kerr DCR, Washburn IJ, Morris MK, et al. Event-level associations of marijuana and heavy alcohol use with intercourse and condom use. J Stud Alcohol Drugs. 2015;76(5):733–737. PubMed CrossRef
Barkley RA, Fischer M, Smallish L, et al. Young adult outcome of hyperactive children: adaptive functioning in major life activities. J Am Acad Child Adolesc Psychiatry. 2006;45(2):192–202. PubMed CrossRef
Brown LK, Hadley W, Stewart A, et al; Project STYLE Study Group. Psychiatric disorders and sexual risk among adolescents in mental health treatment. J Consult Clin Psychol. 2010;78(4):590–597. PubMed CrossRef
Flory K, Molina BSG, Pelham WE Jr, et al. Childhood ADHD predicts risky sexual behavior in young adulthood. J Clin Child Adolesc Psychol. 2006;35(4):571–577. PubMed CrossRef
Galéra C, Messiah A, Melchior M, et al. Disruptive behaviors and early sexual intercourse: the GAZEL Youth Study. Psychiatry Res. 2010;177(3):361–363. PubMed CrossRef
Hosain GMM, Berenson AB, Tennen H, et al. Attention deficit hyperactivity symptoms and risky sexual behavior in young adult women. J Womens Health (Larchmt). 2012;21(4):463–468. PubMed CrossRef
Isaksson J, Stickley A, Koposov R, et al. The danger of being inattentive - ADHD symptoms and risky sexual behaviour in Russian adolescents. Eur Psychiatry. 2018;47:42–48. PubMed CrossRef
Sarver DE, McCart MR, Sheidow AJ, et al. ADHD and risky sexual behavior in adolescents: conduct problems and substance use as mediators of risk. J Child Psychol Psychiatry. 2014;55(12):1345–1353. PubMed CrossRef
Rokeach A, Wiener J. The romantic relationships of adolescents With ADHD. J Atten Disord. 2018;22(1):35–45. PubMed CrossRef
Argenyi MS, James TG. Sexual risk behavior and sexually transmitted infections among college students with disabilities. Sex Transm Dis. 2021;48(11):851–854. PubMed CrossRef
Chen MH, Hsu JW, Huang KL, et al. Sexually transmitted infection among adolescents and young adults with attention-deficit/hyperactivity disorder: a nationwide longitudinal study. J Am Acad Child Adolesc Psychiatry. 2018;57(1):48–53. PubMed CrossRef
Nigg JT. Annual Research Review: On the relations among self-regulation, self-control, executive functioning, effortful control, cognitive control, impulsivity, risk-taking, and inhibition for developmental psychopathology. J Child Psychol Psychiatry. 2017;58(4):361–383. PubMed CrossRef
Shoham R, Sonuga-Barke EJS, Aloni H, et al. ADHD-associated risk taking is linked to exaggerated views of the benefits of positive outcomes. Sci Rep. 2016;6(1):34833. PubMed CrossRef
Shoham R, Sonuga-Barke E, Yaniv I, et al. What drives risky behavior in ADHD: insensitivity to its risk or fascination with its potential benefits? J Atten Disord. 2021;25(14):1988–2002. PubMed CrossRef
Huggins SP, Rooney ME, Chronis-Tuscano A. Risky sexual behavior among college students with ADHD: is the mother-child relationship protective? J Atten Disord. 2015;19(3):240–250. PubMed CrossRef
Scott-Sheldon LAJ, Carey KB, Cunningham K, et al; MASH Research Team. Alcohol use predicts sexual decision-making: a systematic review and meta-analysis of the experimental literature. AIDS Behav. 2016;20(suppl 1):S19–S39. PubMed CrossRef
Scott-Sheldon LAJ, Carey MP, Carey KB. Alcohol and risky sexual behavior among heavy drinking college students. AIDS Behav. 2010;14(4):845–853. PubMed CrossRef
Steele CM, Josephs RA. Alcohol myopia. Its prized and dangerous effects. Am Psychol. 1990;45(8):921–933. PubMed CrossRef
Abbey A, Saenz C, Buck PO, et al. The effects of acute alcohol consumption, cognitive reserve, partner risk, and gender on sexual decision making. J Stud Alcohol. 2006;67(1):113–121. PubMed CrossRef
MacDonald T, Zanna M, Fong G. Why common sense goes out the window: effects of alcohol on intentions to use condoms. Pers Soc Psychol Bull. 1996;22(8):763–775. CrossRef
Ortner CNM, MacDonald TK, Olmstead MC. Alcohol intoxication reduces impulsivity in the delay-discounting paradigm. Alcohol Alcohol. 2003;38(2):151–156. PubMed CrossRef
Smith BH, Molina BSG, Pelham WE. The clinically meaningful link between alcohol use and attention deficit hyperactivity disorder. Alcohol Res Health. 2002;26(2):122–129.
Mochrie KD, Whited MC, Cellucci T, et al. ADHD, depression, and substance abuse risk among beginning college students. J Am Coll Health. 2020;68(1):6–10. PubMed CrossRef
Garcia M, Rouchy E, Galéra C, et al. The relation between ADHD symptoms, perceived stress and binge drinking in college students. Psychiatry Res. 2020;284:112689. PubMed CrossRef
Rooney M, Chronis-Tuscano A, Yoon Y. Substance use in college students with ADHD. J Atten Disord. 2012;16(3):221–234. PubMed CrossRef
Andrade LF, Carroll KM, Petry NM. Marijuana use is associated with risky sexual behaviors in treatment-seeking polysubstance abusers. Am J Drug Alcohol Abuse. 2013;39(4):266–271. PubMed CrossRef
Berry MS, Johnson MW. Does being drunk or high cause HIV sexual risk behavior? a systematic review of drug administration studies. Pharmacol Biochem Behav. 2018;164:125–138. PubMed CrossRef
Green B, Kavanagh D, Young R. Being stoned: a review of self-reported cannabis effects. Drug Alcohol Rev. 2003;22(4):453–460. PubMed CrossRef
Metrik J, Kahler CW, Reynolds B, et al. Balanced placebo design with marijuana: pharmacological and expectancy effects on impulsivity and risk taking. Psychopharmacology (Berl). 2012;223(4):489–499. PubMed CrossRef
Lane SD, Cherek DR, Tcheremissine OV, et al. Acute marijuana effects on human risk taking. Neuropsychopharmacology. 2005;30(4):800–809. PubMed CrossRef
Alderson RM, Kasper LJ, Hudec KL, et al. Attention-deficit/hyperactivity disorder (ADHD) and working memory in adults: a meta-analytic review. Neuropsychology. 2013;27(3):287–302. PubMed CrossRef
Miller DJ, Derefinko KJ, Lynam DR, et al. Impulsivity and attention deficit-hyperactivity disorder: subtype classification using the UPPS Impulsive Behavior Scale. J Psychopathol Behav Assess. 2010;32(3):323–332. PubMed CrossRef
Bavarian N, Flay BR, Smit E. An exploratory multilevel analysis of nonprescription stimulant use in a sample of college students. J Drug Issues. 2014;44(2):132–149. CrossRef
Kerr DCR, Bae H, Alley ZM. Enhancing gender and ethnic representativeness of NCHA-II data with survey weights: the examples of substance use prevalence and state marijuana legalization. J Am Coll Health. 2021;69(4):370–377. PubMed CrossRef
IBM Corp. IBM SPSS Statistics for Windows, Version 23.0. IBM Corp; 2015.
Vasilenko SA, Linden-Carmichael A, Lanza ST, et al. Sexual behavior and heavy episodic drinking across the transition to adulthood: differences by college attendance. J Res Adolesc. 2018;28(2):473–487. PubMed CrossRef
Ashenhurst JR, Wilhite ER, Harden KP, et al. Number of sexual partners and relationship status are associated with unprotected sex across emerging adulthood. Arch Sex Behav. 2017;46(2):419–432. PubMed CrossRef
Wymbs BT, Canu WH, Sacchetti GM, et al. Adult ADHD and romantic relationships: what we know and what we can do to help. J Marital Fam Ther. 2021;47(3):664–681. PubMed CrossRef
Kolar D, Keller A, Golfinopoulos M, et al. Treatment of adults with attention-deficit/hyperactivity disorder. Neuropsychiatr Dis Treat. 2008;4(2):389–403. PubMed
Preuss CV, Kalava A, King KC. Prescription of Controlled Substances: Benefits and Risks. In: StatPearls. StatPearls Publishing; 2021. https://www.ncbi.nlm.nih.gov/books/NBK537318/. Accessed August 4, 2021.
Jamison CD, Greenwood-Ericksen M, Richardson CR, et al. Association between Chlamydia and routine place for healthcare in the United States: NHANES 1999-2016. PLoS One. 2021;16(5):e0251113. PubMed CrossRef
Charach A, Yeung E, Climans T, et al. Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. J Am Acad Child Adolesc Psychiatry. 2011;50(1):9–21. PubMed CrossRef
Kumar S, Devendran Y, Madhumitha NS, et al. Correlates and treatment outcome of risky sexual behaviour in young males with ADHD and comorbid alcohol use disorder: a prospective study. J Psychosexual Health. 2019;1(1):62–69. CrossRef
Chorniy A, Kitashima L. Sex, drugs, and ADHD: the effects of ADHD pharmacological treatment on teens’ risky behaviors. Labour Econ. 2016;43:87–105. CrossRef
Wilens TE, Faraone SV, Biederman J, et al. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? a meta-analytic review of the literature. Pediatrics. 2003;111(1):179–185. PubMed CrossRef
Coghill D, Sonuga-Barke EJS. Annual research review: categories versus dimensions in the classification and conceptualisation of child and adolescent mental disorders–implications of recent empirical study. J Child Psychol Psychiatry. 2012;53(5):469–489. PubMed CrossRef
Chen SF, Wang LY, Chiang JH, et al. Bipolar disorder is associated with an increased risk of sexually transmitted infections: a nationwide population-based cohort study. Sex Transm Dis. 2018;45(11):735–740. PubMed CrossRef
Chen EY, Brown MZ, Lo TTY, et al. Sexually transmitted disease rates and high-risk sexual behaviors in borderline personality disorder versus borderline personality disorder with substance use disorder. J Nerv Ment Dis. 2007;195(2):125–129. PubMed CrossRef
Asherson P, Young AH, Eich-Höchli D, et al. Differential diagnosis, comorbidity, and treatment of attention-deficit/hyperactivity disorder in relation to bipolar disorder or borderline personality disorder in adults. Curr Med Res Opin. 2014;30(8):1657–1672. PubMed CrossRef
Firkey MK, Sheinfil AZ, Woolf-King SE. Substance use, sexual behavior, and general well-being of US college students during the COVID-19 pandemic: A brief report. J Am Coll Health. 2021;1–7. PubMed CrossRef
Schoenfelder EN, Kollins SH. Topical review: ADHD and health-risk behaviors: toward prevention and health promotion. J Pediatr Psychol. 2016;41(7):735–740. PubMed CrossRef
Molina BSG, Hinshaw SP, Swanson JM, et al; MTA Cooperative Group. The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. J Am Acad Child Adolesc Psychiatry. 2009;48(5):484–500. PubMed CrossRef