Relationship of alcohol use and risky sexual behavior: a review and analysis of findings
Halpern-Felsher, B.L.; Millstein, S.G.; Ellen, J.M.
Journal of Adolescent Health Official Publication of the Society for Adolescent Medicine 19(5): 331-336
1996
ISSN/ISBN: 1054-139X PMID: 8934293 DOI: 10.1016/s1054-139x(96)00024-9Document Number: 301973
Research on the association between alcohol use and high-risk sexual practices among US adolescents has been compromised by methodological flaws. Global correlation studies, situational covariate studies, and event-history analyses have examined the impact of alcohol on adolescents' condom use. Although the correlation studies have found an association between alcohol consumption and risky sexual behavior, they can not identify potential causal effects. Situational covariate studies have examined effects from the use of alcohol during sexual events, but they also obscure the important temporal relationship between variables. Both global correlation and situational covariation studies fail to address the possibility that alcohol use and risky sexual behavior are caused by a third factor such as a general tolerance for deviance or a predisposition to risk taking. Critical incident or event analyses are limited by the recall bias inherent in retrospective data. Support for an alcohol-risky sex association emerges most consistently from studies that examined first-time sexual intercourse events, but this finding may not generalize to later experiences with new partners. Recent studies have recognized the importance of examining how sexual relationships themselves influence condom use. It is possible that alcohol will affect condom use only at specific points in the relationship. To control for the potentially confounding effects of the partner relationship on the alcohol-risky sex link, the natural history of these behaviors over the course of a relationship should be examined. The use of diaries is likely to yield more reliable information than retrospective questioning.