To evaluate the consistency of the relationship between early drug use in adolescence and illegal drug use in adulthood as proposed in the “gateway theory” and to determine whether pre-existing depressive symptoms modifies this relationship. We used contractual data from the National Longitudinal Study of Adolescent to Adult health data spanning a 14 year period. We assessed the relationship between gateway drugs at baseline (age 11–20 years) and drug use in adulthood using generalized estimating equation (GEE) regression models. Gateways drugs used in early adolescence were significantly associated with marijuana use, illegal drugs and cocaine in older adolescence, but over time these relationships were not consistent in adulthood. Changes in the pattern of psychoactive drug use were important predictors of drug use in adulthood. A history of higher depressive symptoms was associated with higher frequencies of psychoactive drug use over time. Users of mental health services in adolescence were less likely to use drugs in older adolescence and in adulthood. Relationships between early drug use and later drug use in adulthood cannot be solely explained by the gateway hypothesis. Collectively, adolescent drug prevention and treatment programs should apply theory-based and evidence-proven multisectoral intervention strategies rather than providing a brief counseling on individual's behaviors. This evidence should include understanding that changes in behavior should involve broader analyses of the underlying social context for drug use and in particular the role of the community social norms in driving a group's behaviors.

Background Insecticide-treated mosquito nets (ITNs) are one of the most effective tools for preventing malaria in sub-Saharan Africa. Objective This study examined knowledge, attitude, and practice on the use of ITNs in the prevention of malaria among pregnant women and guardians of children under five in the Democratic Republic of the Congo. Methods A total of 5,138 pregnant women and guardians of children under five were interviewed. Results The majority of participants (>80%) knew the signs and symptoms of malaria; 81.6% reported having an ITN in the household, but 78.4% reported using it the night before the interview. Only 71.4% of pregnant women used ITN the night compared to 68.2% of children under five. In the Logistic Regression model, women who believed that it is normal to use ITNs were 1.9 times more likely to use it than those who did not (OR: 1.930); women who were confident in their abilities to use ITNs were 1.9 times more likely than those who were not confident (OR: 1.915); and women who had a good attitude towards ITNs were also more likely to use ITNs compared to those who did not (OR: 1.529). Conclusion New and innovative evidence-based behavior change interventions are needed to increase the utilization of ITNs among vulnerable groups.

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This study explored the relationship between bullying, sexual violence and substance use among adolescents. Methods:A cross-sectional study of 14,765 adolescents using the 2017 Youth Risk Behavior Surveillance System (YRBSS) survey was conducted. Multivariate logistic regression analyses were performed, with substance use as the outcome and bullying and sexual violence as explanatory variables in separate models. Results:The odds of substance in bisexual adolescence was twice as heterosexuals [AOR: 2.00; 95%CI: 1.26-3.22]. Adolescents who experienced electronic bullying had 67% higher odds of substance use than those who did not experience electronic bullying [AOR: 1.67; 95%CI: 1.09-2.55]. Also, adolescents who had experienced sexual violence were had higher odds of reporting substance use than those who had not experienced sexual violence [AOR: 1.68; 95%CI: 1.15-2.45]. Additionally, those who had experienced either school bullying or electronic bullying reported higher rates of sexual violence than those who had not experienced any bullying. Conclusion:We found a strong association between bullying, sexual violence, and substance use. A multifaceted approach is needed to resolve these problems effectively.

African-Americans represent 12% of the total United States population, but account for more recent human immunodeficiency virus (HIV) diagnoses (44%), people estimated to be living with HIV disease (40%), and HIV-related deaths (44%) than any other racial/ethnic group in the United States. This paper examines the prevalence of HIV testing and its correlates among African Americans during the pre-exposure HIV prophylaxis era. Secondary analysis of the 2016 National Health Interview Survey (NHIS) data was carried out using descriptive and logistic regression analyses to determine the prevalence of recent HIV testing and factors associated with HIV testing. Of the 33,028 individuals included in the Sample Adult Core, 3,777 (11.43%) were African Americans, the sample for this study. Among them, an estimated 2,050 respondents (54.3%) reported to have ever tested for HIV. Respondents aged 25 to 34 years of age were more likely to have ever tested for HIV compared to individuals aged 25 years or younger (OR: 2.47, P<0.001). Respondents who had a paid employment were more likely to have ever tested for HIV compared to those who were unemployed (OR: 1.74, P<0.05). There was no difference in HIV testing among the marital status categories. Since HIV testing is critical to improve prevention efforts, more research is needed to understand the characteristics of individuals who get tested for HIV to inform the design of innovative interventions to motivate younger adults and individuals from different marital status categories to seek HIV testing.