Educational attainment: Genetic variance accounted for 51% of the total variance, but within women and men, 40% and 58% of the total variance respectively

Nature, Nurture, and the Meaning of Educational Attainment: Differences by Sex and Socioeconomic Status. Thalida Em Arpawong et al. Twin Research and Human Genetics, March 13 2023. https://doi.org/10.1017/thg.2023.6

Abstract: Estimated heritability of educational attainment (EA) varies widely, from 23% to 80%, with growing evidence suggesting the degree to which genetic variation contributes to individual differences in EA is highly dependent upon situational factors. We aimed to decompose EA into influences attributable to genetic propensity and to environmental context and their interplay, while considering influences of rearing household economic status (HES) and sex. We use the Project Talent Twin and Sibling Study, drawn from the population-representative cohort of high school students assessed in 1960 and followed through 2014, to ages 68−72. Data from 3552 twins and siblings from 1741 families were analyzed using multilevel regression and multiple group structural equation models. Individuals from less-advantaged backgrounds had lower EA and less variation. Genetic variance accounted for 51% of the total variance, but within women and men, 40% and 58% of the total variance respectively. Men had stable genetic variance on EA across all HES strata, whereas high HES women showed the same level of genetic influence as men, and lower HES women had constrained genetic influence on EA. Unexpectedly, middle HES women showed the largest constraints in genetic influence on EA. Shared family environment appears to make an outsized contribution to greater variability for women in this middle stratum and whether they pursue more EA. Implications are that without considering early life opportunity, genetic studies on education may mischaracterize sex differences because education reflects different degrees of genetic and environmental influences for women and men.

Discussion

In this article, we addressed a long-standing question on the importance of nature, via genetic endowment, and nurture, via shared and unique environmental influences, for EA. We found that the balance of nature and nurture underlying EA is not uniform between sexes. First, men and women who were raised in homes with higher household economic status had more years of EA and greater variability in EA than those raised in homes with lower household economic status. Second, we found that overall, there was larger genetic and total variance underlying EA for men than women. Third, nature makes the largest contribution for individuals from the highest family-of-origin economic backgrounds for both men and women. When sex and household economic stratum are both considered, absolute genetic variance contributes similar amounts for men across the economic strata, as well as for women from only the highest economic strata. For women in the lowest and middle economic strata, genetic variance contributes much less to the variability in EA compared to women in the highest economic stratum and to male counterparts across all economic strata. Unexpectedly, for women from the middle economic stratum, it appears that family rearing environment, which may in part reflect parents’ own genetic endowments, may take on an outsized role in contributing to EA. These results confirm that critical interrelationships exist, with nurture moderating effects of nature to alter the range of influence possible on EA. Greater total variance and expression of genetic potential for EA is afforded differently by degree of household economic resources when growing up and in combination with sex or gender.

Findings from this study help us understand the etiology of EA and that EA does not mean the same thing across people, especially for older women today, who were born in the early 1940s. Differences in household economic resources contribute to a disparity in total years of education attained, evidenced by lower overall means and less variability in years of EA for both men and women in the lowest household economic brackets. The finding on differing sources of variance for EA for women by socioeconomic strata was not detectable when examining phenotypic HES × sex effects in predicting EA. This points out that null results in phenotypic models that test sex interactions do not preclude there being differences in etiologies for men and women, particularly with regard to outcomes like EA that are likely influenced by complex processes related to gender socialization and expectations.

Overall, genetic variance accounted for more variation in men’s EA than women’s, at 58% and 40% of the total variance respectively. This is consistent with the ranges for sex-specific calculations reported in prior literature (Baker et al., Reference Baker, Treloar, Reynolds, Heath and Martin1996; Branigan et al., Reference Branigan, McCallum and Freese2013; Heath et al., Reference Heath, Berg, Eaves, Solaas, Corey, Sundet, Magnus and Nance1985; Nielsen & Roos, Reference Nielsen and Roos2015). In turn, the role of nurture was greater for women than for men. This finding supports the interpretation that socio-cultural factors and opportunities shape different trajectories of expression of genetic endowment for men and women (Allan, Reference Allan2011; Klein et al., Reference Klein, Ortman, Campbell, Greenberg, Hollingsworth, Jacobs, Kachuck, McClelland, Pollard, Sadker, Sadker, Schmuck, Scott and Wiggins1994). In this cohort, men were able to pursue genetically driven talents for EA irrespective of socioeconomic strata of their families of origin, but women did not have the same benefit unless in the highest HES group. These findings are in line with prior research that has not detected SES-by-sex differences in the heritability of EA (Branigan et al., Reference Branigan, McCallum and Freese2013; Silventoinen et al., Reference Silventoinen, Krueger, Bouchard, Kaprio and McGue2004) in countries that implement social policies to promote equity in access to educational opportunities (Ahola et al., Reference Ahola, Hedmo, Thomsen and Vabø2014; Gorard & Smith, Reference Gorard and Smith2004; Kyrö & Nyyssölä, Reference Kyrö and Nyyssölä2006). Our findings also support evidence thus far on sex differences by country and birth cohort that show EA likely reflects accumulated genetic sensitivities to the environment (gene-by-SES and gene-by-sex) that are different depending on environmental circumstances (Heath et al., Reference Heath, Berg, Eaves, Solaas, Corey, Sundet, Magnus and Nance1985; Silventoinen et al., Reference Silventoinen, Krueger, Bouchard, Kaprio and McGue2004), and therefore support for G × E effects, by sex and socio-economic group. This points to the results reflecting an opportunity structure and differences in men’s and women’s lived experiences, not biological sex differences.

Shared family estimates from this study are substantially smaller than what is reported in the most recent meta-analysis of proportional variance, yet closer to what is expected given prior knowledge of twin and family studies of other traits (Turkheimer, Reference Turkheimer and DiLalla2004). Shared environmental variance encompasses family-level resources, including the measured component of household economic status and nonmeasured components, such as family activities and behaviors modeled at home to facilitate exposure to scholarly interests or success in academic pursuits, an living in social and built environments that promote EA. These are not entirely distinguishable from the larger community-level environmental factors that members from the same household share, such as better school quality, or access to healthcare services that promote mental and emotional health. Among women in the middle socioeconomic stratum, the shared family environment appears to make a particularly weighty contribution to greater variability in whether these women pursue higher educational attainment. Conceptually, the family-level resources can have genetic components (e.g., through genetic-environment correlation, effects of assortative mating), but given that twin correlations for both MZ and DZ women were similar and large, this implies that twin and sibling members of the family experience them as a part of their shared, social environment.

Environmental factors on EA that are resources unique to the individual could include parent expectations placed on individual children, peer encouragement, varied learning opportunities offered by teachers, or experiences after school that reinforce scholarly pursuits. When comparing estimates by sex and HES strata, differences in unique, individual-specific experiences are relatively small. Although it is possible these factors have profound influence on particular individuals, findings suggest that adolescents who grew up with more influences from both unique factors and socioeconomic resources in the family are more variable in whether they pursue higher educational opportunities.

The balance of nature and nurture components holds implications for use of EA to predict later life outcomes for different groups. While there are robust and consistent correlations in the literature between education and cognitive function (Opdebeeck et al., Reference Opdebeeck, Martyr and Clare2016; Ritchie & Tucker-Drob, Reference Ritchie and Tucker-Drob2018), our prior work showed that genetic variance underlying earlier life cognitive ability overlaps only 11% with genetic variance sources for EA (Arpawong et al., Reference Arpawong, Zavala, Gatz, Gruenewald and Prescott2018). This finding suggests that the strong relationship between education and cognition is predominantly driven by overlapping nurture components, including life experiences and resources. Relatedly, while education has shown strong predictive ability for cognitive impairment and dementia (Caamaño-Isorna et al., Reference Caamaño-Isorna, Corral, Montes-Martínez and Takkouche2006), it has also shown differential ability to predict dementia risk by sex. In particular, education has the lowest predictive value for risk of dementia among women in more impoverished countries (Sharp & Gatz, Reference Sharp and Gatz2011). Given our findings, we speculate that constrained potential in lower resourced countries and for women means that irrespective of genetic potential, there is less opportunity for these women to attain education; hence, this reduces the overlapping genetic variance between education and cognition. If access to education is driven by within-country environmental factors (e.g., access to resources to pay for education, social prioritization of academic achievement for boys vs. girls), this likely reduces the genetic correlations for EA and cognitive status. In contrast, in higher resourced countries and for men, genetic endowment has more opportunity for expression and thus greater overlap.

In this Project Talent sample, we had limited power to test effects of other social constraints, such as racial/ethnic inequalities. Additionally, we are unable to assess mechanisms by which socioeconomic bracket influences educational differences beyond the variance components quantified, or for those who would not have attended high school given the recruitment design for Project Talent and compulsory schooling laws. Furthermore, we cannot conclude causal associations. For instance, common concerns about causal inference in observational studies center on issues of reverse causation and confounding (McGue et al., Reference McGue, Osler and Christensen2010). With the present study, we use a longitudinal design where genetics and household economic status precede educational attainment, thus alleviating the first concern. With the second concern, invoking the twin design enables us to control for genetics and shared family environment, and thereby account for the degree of influences from unmeasured environmental factors, or potential confounders (McGue et al., Reference McGue, Osler and Christensen2010). Thus, although we are not able to establish causality with this study, we are able to make inferences for the direction of effects. A limitation to the design is our inability to make general inferences about siblings because those included are all siblings of twins, and siblings within the same age range of twins, and thus are not representative of the experience of all siblings within families. Lastly, results are likely cohort specific because our estimates align well with prior research evaluating variance sources in education in individuals born between 1940 and 1961 (Heath et al., Reference Heath, Berg, Eaves, Solaas, Corey, Sundet, Magnus and Nance1985). Follow-up analyses in younger cohorts will be important to compare differences in findings.

Epidemic: Overall, this study lends support to the idea that smartphones can be beneficial for individuals, particularly during times when face-to-face interaction is limited

Did smartphones enhance or diminish well-being during the COVID-19 pandemic? Jennifer L. Heyman and Kostadin Kushlev. Front. Psychol., March 13 2023, Volume 14 - 2023 | https://doi.org/10.3389/fpsyg.2023.1094196

Introduction: As smartphones have become increasingly integrated into people’s lives, researchers have attempted to answer whether they are beneficial or detrimental to well-being. Of particular interest to the current study is the role that smartphones played during the first year of the COVID-19 Pandemic.

Methods: In an intensive longitudinal study, we explore how varying uses of smartphones relate to well-being using the Displacement-Interference-Complementarity framework.

Results: Consistent with pre-pandemic research, we show that people felt better, calmer, and more energetic when they used their phones more for complementary purposes (i.e., to access information, entertainment, and connection not otherwise available). In contrast to most pre-pandemic research, however, we find no evidence that any type of phone use predicted lower well-being during the pandemic.

Discussion: Overall, this study lends support to the idea that smartphones can be beneficial for individuals, particularly during times when face-to-face interaction is limited.

Discussion

We find that in a time of high social distancing during the COVID-19 pandemic, people reaped the benefits of phone use for well-being without incurring the costs associated with phone use in pre-pandemic research. Specifically, consistent with pre-pandemic research (e.g., Kushlev et al., 2017), we find that people who used their phones in a complementary way—to access information, entertainment, and connection not otherwise available—felt better, calmer, and more energetic. Furthermore, we show that the same individuals felt better, calmer and more energetic on days when they used their phones for complementary purposes. Pre-pandemic research also shows, however, that phone use often undermines well-being, especially when it displaces (Lanaj et al., 2014; Hughes and Burke, 2018) or interferes with other activities (Dwyer et al., 2018; Kushlev and Dunn, 2019). In contrast, we found no evidence that phone interference or displacement predicted lower well-being during the initial stages of the pandemic. Thus, though the pre-pandemic literature has generally linked phone use and screentime with poorer well-being (Twenge and Campbell, 2019), we find that phone use during the pandemic was associated with higher, not lower well-being.

In line with previous research, phone complementarity was related to higher levels of well-being. That is, the greater affordance to information and opportunities provided by a phone was related to people having better moods, feeling calmer, and feeling more energetic. The ease of access to information and opportunities may have become even more important during the COVID-19 Pandemic when face-to-face social contact was severely limited, which significantly increased people’s level of stress (Halliburton et al., 2021). Therefore, using one’s phone to maintain existing relationships and gain access to information may have facilitated in maintaining some semblance of pre-pandemic life, thus predicting higher well-being.

People typically feel worse when their phone use displaces activities critical for well-being, such as sleep (Lanaj et al., 2014). We find little evidence that phone displacement undermined well-being during the pandemic. This may be because there were fewer positive activities that phone use could displace during the pandemic when social activities and events were discouraged. Presumably, however, people needed just as much sleep during the pandemic as they did pre-pandemic. As lockdowns disrupted routines, sleep–wake cycles were delayed during the pandemic (Sinha et al., 2020). Thus, in the relative lack of routine during the pandemic, phone use may have been less likely to displace sleep. Finally, as the pandemic introduced new stressors, phone displacement might have been beneficial for well-being by displacing more stressful activities (Kushlev and Leitao, 2020) and introducing a welcome source of distraction (Sheppes and Meiran, 2007; Quoidbach et al., 2010).

In contrast to pre-pandemic research, we found no evidence that phone interference predicted lower well-being. Just as with displacement, this lack of effect may be due to the relative lack of rewarding activities associated with social distancing. Indeed, most previous research on the interference effects of phones has shown that phones decrease well-being precisely by interfering with face-to-face social interactions (Dwyer et al., 2018; Kushlev and Dunn, 2019). In addition, during the COVID-19 Pandemic, phones may have also interfered with activities harmful to well-being, such as rumination. Overall, then, though null findings should be interpreted with caution, our evidence suggests that phone use may not have been as harmful during the COVID-19 Pandemic.

Our findings were generally consistent with the Displacement–Interreference–Complementarity Framework: During a time of limited rewarding activities, complementary phone use continued to predict higher well-being, whereas well-documented phone interference and displacement effects were absent. According to the framework, however, at higher levels of social distancing, phone complementarity effects should have been stronger and phone displacement and interference effects should have been weaker. But we found little evidence that these effects depended on how much people socially distanced. Other research during the pandemic, however, showed that the benefits of online social interactions for well-being were greater when social distancing measures were more extreme (Marinucci et al., 2022). Specifically, online social interactions predicted lower distress only during the severe isolation stage in Italy that included prohibiting people from leaving their homes except for work and urgent health reasons. The social distancing measures that our participants in the United States experienced were much milder in comparison and participants, on average, reported high but not extreme levels of practicing social distancing (M = 3.12 on a scale from 1–not at all to 4–completely). Relatedly, people in our sample did not differ much in the extent to which they practiced social distancing, potentially preventing us from detecting moderating effects. Indeed, the extent to which people varied in their social distancing practices was low in this sample at both the within (SD = 0.58) and between (SD = 0.71) person levels.

This study had several important limitations that should be discussed. First, participants self-report on their levels of phone displacement, interference, and complementarity. However, people tend to misestimate the extent to which they use their phones. Future research should use more objective techniques, such as phone tracking, or peer reports in accordance with self-reports to gain a better understanding of how people are using their phones and the extent to which it relates to well-being. In addition, we used ad hoc measures of displacement, interference, and complementarity. Though theoretically justified, it is important for future research to develop validated measures of these constructs. For example, we measured phone displacement as the amount of time people spent on their phones in bed, the extent to which they used their phones more than they wanted to, and their total screentime. This crude measure of displacement fails to distinguish between screen time that displaces positive versus negative activities. As such, future research should utilize more precise measures of phone displacement, perhaps by explicitly asking people if they chose to use their phones over partaking in specific other activities. Furthermore, this study was conducted solely in the United States. However, other countries tend to use their phones in different ways (Langer et al., 2017) and have had different responses to the COVID-19 Pandemic (Kennedy et al., 2020). Therefore, future research should collect a more diverse sample to improve the generalizability of these results.

In sum, there is consistent evidence to suggest that using one’s phone for complementary purposes is associated with increases in well-being, as indicated by better mood, feeling calmer, and feeling more energetic, whereas spending more time on one’s phone and reporting that one’s phone interferes with daily life are generally not significantly associated with feeling good, calm, or energetic. Furthermore, we do not find consistent evidence that social distancing influences these associations. This study highlights the idea that phone use can be beneficial to individual’s well-being if it is used to complement their existing experiences.

Prevalence of Intoxicating Substance Use Before or During Sex Among Young Adults: Young adults show a high prevalence of the use intoxicating substances before or during sex, with women competing with men in every respect

Prevalence of Intoxicating Substance Use Before or During Sex Among Young Adults: A Systematic Review and Meta-Analysis. María Isabel Gómez-Núñez, Cristian Molla-Esparza, Natalia Gandia Carbonell & Laura Badenes Ribera. Archives of Sexual Behavior, Mar 10 2023. https://link.springer.com/article/10.1007/s10508-023-02572-z

Abstract: Drug use before or during sex is a high-risk sexual behavior associated with adverse health risks and outcomes, such as increasing the likelihood of overdoses and of acquiring sexually-transmitted diseases. This systematic review and meta-analysis of three scientific databases examined the prevalence of the use of intoxicating substances, those tending to excite or stupefy the user on a psychoactive level, before or during sex, among young adults (18–29 years old). A total of 55 unique empirical studies met the inclusion criteria (48,145 individuals; 39% males), were assessed for risk of bias using the tools of Hoy et al. (2012), and were analyzed via a generalized linear mixed-effects model. The results produced a global mean prevalence of this sexual risk behavior of 36.98% (95% CI: 28.28%, 46.63%). Nonetheless, significant differences were identified between different intoxicating substances, with the use of alcohol (35.10%; 95% CI: 27.68%, 43.31%), marijuana (27.80%; 95% CI: 18.24%, 39.92%), and ecstasy (20.90%; 95% CI: 14.34%, 29.45%) significantly more prevalent than that of cocaine (4.32%; 95% CI: 3.64%, 5.11%), heroin (.67%; 95% CI: .09%, 4.65%), methamphetamine (7.10%; 95% CI: 4.57%, 10.88%), and GHB (6.55%; 95% CI: 4.21%, 10.05%). Moderator analyses showed that the prevalence of alcohol use before or during sex differed according to geographical sample origin, and increased as the proportion of ethnic whites in samples increased. The remaining demographic (e.g., gender, age, reference population), sexual (e.g., sexual orientation, sexual activity), health (e.g., drug consumption, STI/STD status), methodological (e.g., sampling technique), and measurement (e.g., timeframe) variables that were examined did not moderate prevalence estimates. Implications for sexual development interventions were discussed.

Discussion

This study provides a systematic review and meta-estimate of the prevalence of the use of intoxicating substances before or during sex among young adults. To the best of our knowledge, this is the first study that specifically examines the prevalence of this behavior in this age grouping. Previous literature has mainly focused on analyzing SDU in MSM communities (Edmundson et al., 2018; Guerra et al., 2020; Íncera-Fernández et al., 2021; Lafortune et al., 2021; Maxwell et al., 2019), which makes it difficult to assess comparability.

Our results have revealed a high global prevalence of the use of intoxicating substances before or during sex, that is, 28–47% of young adults. This high prevalence estimate concurs with those reported in the abovementioned review studies that specifically focused on examining SDU among MSM (Edmundson et al., 2018; Maxwell et al., 2019). Nonetheless, comparisons should be made with caution, considering the differences in the meta-analytical samples. The results obtained in this research also indicate that the prevalence of using an intoxicating substance before or during sex varies significantly according to the specific substance used. The consumption of alcohol, marijuana, and ecstasy had significantly higher prevalences than those referring to the use of cocaine, heroin, methamphetamine, and GHB, perhaps due to differences in their acceptance, accessibility, cost, addictive potential, and short- and medium-term health and social consequences (Bourne et al., 2014; Graupensperger et al., 2021; Jackson et al., 2021; Rosińska et al., 2018). It is also likely that higher prevalence rates and the decision to use one or another substance depends on the particular effects it causes during sex. Alcohol may be used to become disinhibited before sex (Herbenick et al., 2021), even though it may make it more difficult to reach orgasm and reduce quality of sex (George, 2019; Palamar et al., 2018a). Ecstasy, on the other hand, may affect sexual experience the most, for example, by prolonging erection duration (Coyer et al., 2022). Future research should go more deeply into the reasons that lead to the choice of one or another drug, considering the sexual act as a complex process (e.g., from flirtation right through to after-sex behaviors), distinguishing the type and quantity of substances consumed, and the order in which they are consumed, if more than one is involved. The decision to consume one drug or another before or during sex may also be associated with individual characteristics (e.g., conception of sexuality and attitudes towards substance use for pleasure-seeking) and demographic characteristics (e.g., age and work-related aspects, including income level) and, for example, older cohorts may use higher-cost and harder-to-access substances (e.g., methamphetamine and cocaine). Regarding the geographical origin of samples, it was found that the estimated prevalence of alcohol use before or during sex varied significantly and was lowest on the African continent. Geographical comparisons pose a particular challenge due to significant continent-level, country-level, region-level, and population subgroup differences. Though this study’s comparisons are made for descriptive purposes only, several multi-level societal and individual factors may explain the observed differences in alcohol consumption patterns, including economic development, cultural aspects, such as cultural norms and religious beliefs, and societal and political aspects, such as rules concerning drug access and use, and the effectiveness of alcohol control policies (Addo et al., 2018). Future studies may further explore such factors in order to gain more insight into the driving forces behind such variations.

The meta-regression analyses of this study additionally indicate that the prevalence of using intoxicating substances before or during sex differs significantly as a function of the ethnic composition of samples. When considering alcohol, the prevalence was significantly higher in studies with a higher proportion of ethnic whites in their samples. This is in agreement with a previous meta-analysis suggesting that risky sex and drug-use behaviors were reported most frequently by studies that sampled more ethnic whites (Cunningham et al., 2017). However, to our knowledge, reasons for such differences have not been examined yet in the literature. Previous empirical studies have suggested that individual developmental trajectories and socio-cultural and economic factors may help explain ethnic trends and differences in drug use among adolescents and young adults (Chen & Jacobson, 2012; Evans et al., 2017; Vaughn et al., 2018), with white youths having higher rates of illicit drug and alcohol abuse (Johnston et al., 2019; Jones et al., 2020). Future research might explore such aspects in order to improve our understanding of protective and risk exposure factors that may elucidate potential ethnic differences in the use of intoxicating substances before or during sex. However, when considering the global prevalence, a significant inverse relationship is seen. This opposing result is not directly interpretable, since there may be compensatory effects deriving from raw measures that do not distinguish between substances (Cunningham et al., 2017). Other demographic and sexual variables, such as gender, age or sexual orientation, did not show statistically significant effects on the prevalence of intoxicating substance use before or during sex. Regarding gender, for example, the findings of our meta-analysis concur with recent empirical studies suggesting that women present rates of alcohol or other substance use similar to that of men (Ford et al., 2021b; McKetta et al., 2022), although these studies did not focus on consumption before or during sexual activity. Developmental and sociocultural factors may explain the non-difference concerning these variables. For example, young adulthood is a developmental period characterized by the reinforcement of one’s own sexual identity and orientation, in which drugs and sex may be taken as a means of experiencing a variety of sexual practices in common pleasure-seeking (Arnett, 2005, 2007, 2014), regardless of the abovementioned individual participant characteristics (Bourne et al., 2015a; Piyaraj et al., 2018; Schmidt et al., 2016). This, together with previous arguments on the acceptance and accessibility of intoxicating substances in this age group, could offer a potential explanation of the results obtained in this study. Likewise, it should also be taken into account that a large part of our meta-analytical samples are studies with university or community samples, which possess certain common characteristics in their samples (e.g., age range, sexual-developmental stage, educational stage). As several researchers have observed, drug consumption and sex are common occurrences in college contexts and populations (Ford et al., 2021b; McKetta et al., 2022).

In addition to the above, the low quality of both our meta-analytic sample and its measures are an important aspect to highlight in our research. The majority of the studies reviewed had a high risk of bias, employing a cross-sectional design and non-probabilistic sampling techniques, with poor quality measures. The analysis of the measures used in the primary studies is a differential contribution of this review, yielding important gaps that need to be addressed. Indeed, sex under the influence of intoxicating substances appears to have hitherto been measured using “summary measures”, for example, mono-items with dichotomous response options, that not allow researchers to fully characterize the phenomenon (Wells et al., 2015). What may be more important than assessing whether participants have practiced sex under the influence of intoxicating substance or not is the frequency in which they have engaged in such activity. This is because the higher the frequency, the greater the probability of exposure to risks and consequences. Another result to be highlighted is that operational elements such as the specific sexual act (how), relationship type (with who), intentionality (purpose), willingness (whether solicited or not), and drug used were not made explicit in the majority of the studies reviewed. These elements were, indeed, often left up to the interpretation of respondents. The indefiniteness of key operational elements may, therefore, be behind the high dispersion in prevalence estimates. However, regarding drug type, our meta-analytical results do demonstrate that prevalence differences between individual drugs exist. Empirical research has also found that sexual practices under the influence of alcohol or other drugs differ somewhat, with the most frequently reported being exploratory acts (e.g., caressing or touching) (71%) and vaginal penetration (64%), while anal sex (12%) and sex with erotic toys (8%) were the least frequently reported (Castaño et al., 2012). Relevant circumstances such as unprotected sex or relationship type were indicated in only a few studies (Wells et al., 2015), while the willingness of participants was not made explicit in any measure. Nonetheless, it has been found that alcohol consumption before sex increases the probability of unprotected sex and higher-risk sexual encounters (i.e., with non-primary partners), increasing the likelihood of exposure to STIs and other risks (Rizwan et al., 2014). It should be noted that, although the result was not statistically significant, the proportion of STD/STI infections in the samples increased as the proportion of the use of alcohol before or during sex increased. Another key aspect is the specification of intentionality and purpose involved in the use of intoxicating substances before or during sex. Both are key indicators when differentiating between planned substance use with the purpose of enhancing sexual experience (e.g., SDU, chemsex) from substance use preceding casual sexual activity. All such measure quality related aspects reasonably warrant the wide credibility/prediction intervals obtained in our study. The lack of similar operationalizations with a minimum of precision makes it difficult to perform plausible comparisons among studies. Thus, clarifying these elements in operational definitions is a priority for future research that will allow a distinction to be made between planned and unplanned drug use before or during sex.

Educational Implications

Based on the results of this study and the prevalence of the use of intoxicating substances before or during sex, developing educational prevention programs referring to substance abuse and sexual risks remains imperative. Research recommends that such programs should revolve around four fundamental principles. Firstly, preventative efforts should be approached from an integrative perspective that contemplates biopsychological, social-communitarian and sexual aspects through multidisciplinary support (Donnadieu-Rigole et al., 2020). In particular, based on the results of the present study, educational interventions should take into account social-communitarian characteristic of participants, such as geographical and ethnic origins (e.g., focusing on more disadvantaged or higher risk populations, or on areas with higher SDU prevalence rates). Secondly, educational measures should take into account the implications, that is, the effects and consequences, of different substances and types of sexual practices (Lafortune et al., 2021; Saengdidtha et al., 2016). This is emphasized in studies that associate, for instance, substance use before or during sexual activity with negative health outcomes such as overdoses (Hammoud et al., 2017; Hegazi et al., 2017) or risky sexual practices such as unprotected sex (D’Anna et al., 2021; Ristuccia et al., 2018). Parents and educators should also inform young people on the implications and sexual health risks involved in having sexual experiences with someone you know personally, as opposed to someone met more casually. Thirdly, information on ethical issues relating to willingness and consent should be provided (Muehlenhard et al., 2016). Fourthly, young people might be encouraged to make greater use of sexual health resources if interventions were to focus more on the enjoyment of safe sex and sexual pleasure-seeking, in addition to discussing sexual risk behaviors (Ford et al., 2021a). Perhaps, a good starting point for educational interventions aimed at addressing SDU would be an analysis of needs and motivations that lead young adults to use intoxicating substances before or during sex. If the pursuit of pleasure emerges as the main motivation, it would, therefore, be a fundamental element to take into account in order to improve and adapt sexual health interventions. Interventions informing youths about decisions concerning where (e.g., spaces), how (e.g., substance characteristics in terms of effects and consequences; information on contraceptive methods; management of sexual acts and potential implications) and with whom they have sex may help them both to be more fully aware of their sexual practices and to avoid negative sexual experiences and adverse health outcomes. Ideally, such educational measures should be introduced at fairly early ages. Although it was non-significant, results of this meta-analysis showed that rates of alcohol use before or during sex increased as the proportion of sexually active participants in samples increased. Thus, it would be logical to start intervening at ages when young people begin to experiment with drugs and have their first sexual relations, with continuity spreading across into other educational courses and contexts, such as compulsory secondary education and university, and beyond school curricula, through ad hoc preventative educational programs, accessible community services, and information campaigns.

Limitations

This study has certain evident limitations, the main one being the low quality meta-analytical sample. Indeed, the predominant use of observational designs, non-probabilistic sampling techniques and non-validated measures was seen to introduce high levels of risk of bias in the primary studies. Secondly, the meta-analytical results showed a significant between-study variability, only partially explained by certain moderator variables. Undeniably, a considerable part of such variability remains unexplained and thus interpretable by means of the set of moderators and covariates considered. The high heterogeneity may also be attributed to a variety of other aspects such as research objectives, sample sizes, sample population characteristics and the specific measures used. Thirdly, several reviewed articles provided only a crude prevalence regarding the use of intoxicating substances before or during sex, without specifying the particular substance used, forcing us to analyze this as a generalized proxy. However, such results should be taken with caution because they may be biased and not necessarily reflect the effective prevalence rate. Fourthly, it was not possible to estimate the prevalence of the use of certain substances such as crack, speed, sedatives, LSD and ketamine before or during sex due to insufficient data. Furthermore, in the case of the global prevalence and of the use of alcohol, it was not possible to examine the effect of certain categorical and quantitative moderators due to an insufficient number of studies at some level. Fifthly, socioeconomic status could not be analyzed as a moderating variable due to deficiencies and divergences in how empirical studies have recorded and reported it (e.g., self-reported income level, social class, education level, occupation). Yet another limitation of this meta-analysis is that, despite including studies from a variety of countries, certain regions were particularly underrepresented. Data from developing countries and non-occidental countries were scarce. Lastly, because only 5 studies reported prevalence data of at least two or more substances, due to software limitations, it was not possible to compute a multi-level/multivariate meta-analysis assuming a generalized linear model. Developing this possibility would allow us to simultaneously analyze data from studies with multiple non-normally distributed outcomes, taking into account the dependence among effect sizes from the same study. Given all the above limitations, the generalizability of the meta-analytical results should be considered with caution.

ChatGPT does not yet pass a neuropsychological assessment routinely used to evaluate prefrontal functioning in humans, suffering from poor planning abilities and difficulty in recognizing absurdities

Loconte, Riccardo and Orrù, Graziella and Tribastone, Mirco and Pietrini, Pietro and Sartori, Giuseppe, Challenging ChatGPT ' Intelligence' with Human Tools: A Neuropsychological Investigation on Prefrontal Functioning of a Large Language Model. SSRN, Mar 6 2023: http://dx.doi.org/10.2139/ssrn.4377371

Abstract: The Artificial Intelligence (AI) research community has used ad-hoc benchmarks to measure the 'intelligence' level of Large Language Models (LLMs). Previous research has found that LLMs struggle with cognitive tasks that required the integrity of the human prefrontal lobes, known as 'prefrontal functions.' In December 2022, OpenAI released ChatGPT, a new chatbot that quickly gained popularity for its ability to understand and respond to human instructions. To investigate ChatGPT’s level of 'intelligence,' we conducted a neuropsychological evaluation with the same tests routinely used to evaluate prefrontal functioning in humans, since human 'intelligence' requires the functional integrity of the frontal lobes. While ChatGPT is well-known to exhibit outstanding performance on generative linguistic tasks, its performance on prefrontal tests was inhomogeneous, with some tests well above average, others in the lower range, and others frankly impaired. Specifically, we have identified poor planning abilities and difficulty in recognising semantic absurdities and understanding others’ intentions and mental states. This inconsistent profile highlights how LLMs’ emergent abilities do not yet mimic human cognitive functioning. In addition, our results indicate that standardised neuropsychological batteries developed to assess human cognitive functions may be suitable for challenging ChatGPT performance.

Keywords: artificial intelligence, Large Language Models, ChatGPT, Prefrontal Functioning, Neuropsychological Evaluation