Journal of Youth and Adolescence

, Volume 39, Issue 5, pp 514–527 | Cite as

Psychological Distress, Substance Use, and HIV/STI Risk Behaviors Among Youth

  • Katherine S. ElkingtonEmail author
  • José A. Bauermeister
  • Marc A. Zimmerman
Empirical Research


Psychological distress has been inconsistently associated with sexual risk behavior in youth, suggesting additional factors, such as substance use, may explain this relationship. The mediating or moderating role of substance use on the relationship between psychological distress and sexual risk behaviors was prospectively examined over the four high school years in a sample of urban youth (N = 850; 80% African American; 50% female). Growth curve modeling was used to estimate changes in sexual risk across adolescence and to test its association to psychological distress symptoms and frequency of substance use. Substance use was associated with psychological distress. Greater psychological distress was associated with increased sexual intercourse frequency, decreased condom use, and increased number of partners. Substance use fully mediated the relationship between psychological distress and intercourse frequency and condom use, and partially mediated the relationship between psychological distress and number of partners. We found no differences in mediation by sex or race/ethnicity and no evidence to support moderation of psychological distress and substance use on sexual risk. Findings suggest that psychological distress is associated with sexual risk because youth with greater psychological distress are also more likely to use substances. Practical implications for adolescent HIV/STI prevention are discussed.


High risk youth Psychological distress Anxiety Depression Substance use HIV/STI risk 



This work was supported by two National Institute of Drug Abuse grants (5R01DA007484-11; “A longitudinal study of school dropout and substance use”, and 1R03AA017240-01; “Protective factors for alcohol use among urban adolescents”) awarded to Dr. Zimmerman. Dr. Elkington is supported by the Center Grant P30 MH43520 to the HIV Center for Clinical and Behavioral Studies, Anke A. Ehrhardt, PhD, Principal Investigator, from the National Institute of Mental Health. All authors have nothing to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Katherine S. Elkington
    • 1
    Email author
  • José A. Bauermeister
    • 2
  • Marc A. Zimmerman
    • 2
  1. 1.HIV Center for Clinical and Behavioral StudiesColumbia University and New York State Psychiatric InstituteNew YorkUSA
  2. 2.Health Behavior and Health Education, School of Public HealthUniversity of MichiganAnn ArborUSA

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