Sexual behavior among high school students in Brazil: alcohol consumption and legal and illegal drug use associated with unprotected sex

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Abstract

OBJECTIVE:

Alcohol and other drug use appears to reduce decision-making ability and increase the risk of unsafe sex, leading to possible unplanned pregnancies, sexually transmitted diseases/human immunodeficiency virus/HIV transmission, and multiple sexual partners. This study aimed to test the hypothesis that risky sexual behaviors among adolescents are associated with legal and illegal drug use.

METHODS:

A national cross-sectional survey of 17,371 high-school students was conducted in 2010. Students were selected from 789 public and private schools in each of the 27 Brazilian state capitals by a multistage probabilistic sampling method and answered a self-report questionnaire. Weighted data were analyzed through basic contingency tables and logistic regressions testing for differences in condom use among adolescents who were sexually active during the past month.

RESULTS:

Approximately one third of the high school students had engaged in sexual intercourse in the month prior to the survey, and nearly half of these respondents had not used a condom. While overall sexual intercourse was more prevalent among boys, unsafe sexual intercourse was more prevalent among girls. Furthermore, a lower socioeconomic status was directly associated with non-condom use, while binge drinking and illegal drug use were independently associated with unsafe sexual intercourse.

CONCLUSION:

Adolescent alcohol and drug use were associated with unsafe sexual practices. School prevention programs must include drug use and sexuality topics simultaneously because both risk-taking behaviors occur simultaneously.

Related collections

Most cited references 54

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Alcohol use and risky sexual behavior among college students and youth: evaluating the evidence.

M Lynne Cooper (2002)

To evaluate the empirical associations between alcohol use and risky sex at two levels of analysis. Global associations test whether individuals who engage in one behavior are more likely to engage in the other, whereas event-specific associations test whether the likelihood of engaging in one behavior on a given occasion varies as a function of engaging in the other on that same occasion. Studies examining the association between drinking and risky sex in samples of college students and youth were reviewed. Those published in the past 10 years and using event-level methodology or random sampling were emphasized. Findings were generally consistent across levels of analysis, but differed across types of risky behaviors. Drinking was strongly related to the decision to have sex and to indiscriminate forms of risky sex (e.g., having multiple or casual sex partners), but was inconsistently related to protective behaviors (e.g., condom use). Moreover, the links among alcohol use, the decision to have sex and indiscriminate behaviors were found in both between-persons and within-persons analyses, suggesting that these relationships cannot be adequately explained by stable individual differences between people who do and do not drink. Analysis of event characteristics showed that drinking was more strongly associated with decreased protective behaviors among younger individuals, on first intercourse experiences and for events that occurred on average longer ago. Future efforts aimed at reducing alcohol use in potentially sexual situations may decrease some forms of risky sex, but are less likely to affect protective behaviors directly.

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Sexual uses of alcohol and drugs and the associated health risks: A cross sectional study of young people in nine European cities

Mark Bellis, Karen Hughes, Amador Calafat … (2008)

Background Young people in European countries are experiencing high levels of alcohol and drug use and escalating levels of sexually transmitted infections. Individually these represent major public health priorities. Understanding of the association between sex and substance use, and specifically the strategic roles for which young people utilise substances to facilitate sexual activity, remains limited. Methods Respondent driven sampling methodology was used in nine European cities to survey 1,341 16–35 year olds representing youth and younger adults who routinely engage in nightlife. Participants self-completed questionnaires, designed to gather demographic, social, and behavioural data on historic and current substance use and sexual behaviour. Results Respondents reported strategic use of specific substances for different sexual purposes. Substances differed significantly in the purposes for which each was deployed (e.g. 28.6% of alcohol users use it to facilitate sexual encounters; 26.2% of cocaine users use it to prolong sex) with user demographics also relating to levels of sexual use (e.g. higher levels of: ecstasy use by males to prolong sex; cocaine use by single individuals to enhance sensation and arousal). Associations between substance use and sex started at a young age, with alcohol, cannabis, cocaine or ecstasy use before age 16 all being associated with having had sex before the age of 16 (odds ratios, 3.47, 4.19, 5.73, 9.35 respectively). However, sexes differed and substance use under 16 years was associated with a proportionately greater increase in early sex amongst girls. Respondents' current drug use was associated with having multiple sexual partners. Thus, for instance, regular cocaine users (c.f. never users) were over five times more likely to have had five or more sexual partners in the last 12 months or have paid for sex. Conclusion An epidemic of recreational drug use and binge drinking exposes millions of young Europeans to routine consumption of substances which alter their sexual decisions and increase their chances of unsafe and regretted sex. For many, substance use has become an integral part of their strategic approach to sex, locking them into continued use. Tackling substances with both physiological and psychological links to sex requires approaching substance use and sexual behaviour in the same way that individuals experience them; as part of the same social process.

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Interventions to prevent substance use and risky sexual behaviour in young people: a systematic review.

Rosemary Geddes, Sally Haw, John Frank … (2012)

To identify and assess the effectiveness of experimental studies of interventions that report on multiple risk behaviour outcomes in young people. A systematic review was performed to identify experimental studies of interventions to reduce risk behaviour in adolescents or young adults and that reported on both any substance (alcohol, tobacco and illicit drug) use and sexual risk behaviour outcomes. Two authors reviewed studies independently identified through a comprehensive search strategy and assessed the quality of included studies. The report was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. From 1129 papers, 18 experimental studies met our inclusion criteria, 13 of which were assigned a strong or moderate quality rating. The substantial heterogeneity between studies precluded the pooling of results to give summary estimates. Intervention effects were mixed, with most programmes having a significant effect on some outcomes, but not others. The most promising interventions addressed multiple domains (individual and peer, family, school and community) of risk and protective factors for risk behaviour. Programmes that addressed just one domain were generally less effective in preventing multiple risk behaviour. There is some, albeit limited, evidence that programmes to reduce multiple risk behaviours in school children can be effective, the most promising programmes being those that address multiple domains of influence on risk behaviour. Intervening in the mid-childhood school years may have an impact on later risk behaviour, but further research is needed to determine the effectiveness of this approach. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

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Author and article information

Journal

Journal ID (nlm-ta): Clinics (Sao Paulo)

Journal ID (iso-abbrev): Clinics (Sao Paulo)

Title: Clinics

Publisher: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

ISSN (Print): 1807-5932

ISSN (Electronic): 1980-5322

Publication date (Print): April 2013

Volume: 68

Issue: 4

Pages: 489-494

Affiliations

[I ]Escola Paulista de Medicina da Universidade Federal de São Paulo, Brazilian Center of Information of Psychotropic Drugs, Department of Preventive Medicine, São Paulo/SP, Brazil.

[II ]Columbia University, Department of Epidemiology, New York/NY, USA.

Author notes

Sanchez ZM wrote the first draft of the manuscript and performed the statistical analyses. Cruz JI performed the literature search and wrote the first draft of the discussion. Nappo SA critically revised the manuscript for important intellectual content. Carlini EA and Carlini CM substantially contributed to the conception, design, and acquisition of the student survey data. Martins SS supervised the statistical analyses and writing process. All of the authors approved the final version of the manuscript.

E-mail: zila.sanchez@ 123456gmail.com Tel.: 55 11 5576-4997

Article

Publisher ID: cln_68p489

DOI: 10.6061/clinics/2013(04)09

PMC ID: 3634973

PubMed ID: 23778342

SO-VID: 844c7d73-a26e-4f50-a079-aa8fac83dc67

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 20 August 2012

Date revision received : 22 October 2012

Date accepted : 19 December 2012

Page count

Pages: 6

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