Use of Drinking Protective Behavioral Strategies and Sexual Perceptions and Behaviors in U.S. College Students

Alcohol use among college students is linked to an increased likelihood of engaging in risky sexual behaviors, including casual sex and unprotected sex. These behaviors increase college students' risks for negative social and health-related consequences. This study examined the relationship between drinking behaviors and protective behavioral strategies (PBS), expectancies and perceptions of sexual risk, and actual alcohol-related sexual behaviors and consequences. Sexually active college students completed Web-based self-report measures of drinking behaviors and use of PBS, alcohol expectancies and perceptions of risk, and sexual behaviors and related consequences (n = 524; 57.1% women). Findings indicated that PBS were related to lower expectancies of sexual risk and sexual disinhibition, and among lighter drinkers, lower expectancies of sexual enhancement from alcohol. PBS were also related to decreased perceptions of sexual-related risks, some alcohol-related sexual behaviors, including number of drinks before/during sex, and number of sexual consequences, but were not related to abstaining during sex, frequency of alcohol-related sexual behaviors, or general condom use. These findings demonstrate a disconnect between perceived and actual risks among college students, such that decreased perceptions of risk may not be associated with protective behaviors. Prevention and intervention implications are discussed.     

Predictors of safer sex on the college campus: a social cognitive theory analysis.

In April and May 1989, the authors surveyed a sample of students enrolled on four college campuses in New Jersey (N = 923) concerning their HIV transmission-related behavior, knowledge, and a variety of conceptual variables taken primarily from social cognitive theory that were thought to be potentially predictive of safer sexual behavior. Analyses of sexually active, unmarried students' responses indicated that men expected more negative outcomes of condom use and were more likely to have sexual intercourse while under the influence of alcohol or other drugs, whereas women reported higher perceived self-efficacy to practice safer sex. Regression analyses indicated that, among the factors assessed, stronger perceptions of self-efficacy to engage in safer behavior, expecting fewer negative outcomes of condom use, and less frequency of sex in conjunction with alcohol or other drug use significantly predicted safer sexual behavior. Enhanced self-efficacy to discuss personal history with a new partner was associated with a greater number of risky encounters. Implications of these findings for intervention efforts with students are discussed.     

Sexual risk behaviors and alcohol: Higher base rates revealed using the unmatched‐count technique

HIV/AIDS is a disease whose only known prevention is behavioral. Risky sex is one of the ways in which people become infected with HIV, as well as other STDS. Estimating the base rates of risky sex and risky sex after drinking proves difficult. This study uses the unmatched‐count technique (UCT) to estimate base rates for sexual risk behaviors and sexual risk behaviors after drinking and compares the findings with those estimates found using conventional methods. UCT does not require the participant to directly answer sensitive questions, and, thus, may provide more accurate reporting than other methods. In a population of college students, the UCT revealed higher estimates of base rates for having had sex, having had sex without a condom, and having had sex without a condom after drinking than an anonymous self‐report survey. These higher estimates provide a better feel for the level of these risk behaviors, may help understand the relationship between alcohol and risky sex, and point to the need to target more interventions for condom use and condom use in the presence of drinking among college students.     

Predictors of Safer Sex on the College Campus: A Social Cognitive Theory Analysis

Abstract

In April and May 1989, the authors surveyed a sample of students enrolled on four college campuses in New Jersey (N ? 923) concerning their HIV transmission-related behavior, knowledge, and a variety of conceptual variables taken primarily from social cognitive theory that were thought to be potentially predictive of safer sexual behavior. Analyses of sexually active, unmarried students' responses indicated that men expected more negative outcomes of condom use and were more likely to have sexual intercourse while under the influence of alcohol or other drugs, whereas women reported higher perceived self-efficacy to practice safer sex. Regression analyses indicated that, among the factors assessed, stronger perceptions of self-efficacy to engage in safer behavior, expecting fewer negative outcomes of condom use, and less frequency of sex in conjuction with alcohol or other drug use significantly predicted safer sexual behavior. Enhanced self-efficacy to discuss personal history with a new partner was associated with a greater number of risky encounters. Implications of these findings for intervention efforts with students are discussed.     

Differences between actual and perceived student norms: an examination of alcohol use, drug use, and sexual behavior

Researchers in the social norms area have previously focused primarily on alcohol consumption, paying comparatively less attention to drug use and sexual behavior. The major purposes of this study were to (1) compare perceptions of peer norms in the areas of alcohol use, drug use, and sexual behavior with actual behavior and (2) determine if a relationship existed between a student's perceptions of normative behavior and a student's actual behavior. Participants were 833 college students at a large, public university in the Northeast. Study participants overestimated alcohol use, drug use, and sexual behavior among their peers. There was also a positive relationship between actual behavior and perceived peer norms, although the effect sizes for all behaviors were small to moderate. The authors provide further support for the tenets of social norms theory and suggest that social norms interventions are appropriate both campus-wide and to targeted high-risk groups.     

Differences Between Actual and Perceived Student Norms: An Examination of Alcohol Use,Drug Use,and Sexual Behavior

Researchers in the social norms area have previously focused primarily on alcohol consumption, paying comparatively less attention to drug use and sexual behavior. The major purposes of this study were to (1) compare perceptions of peer norms in the areas of alcohol use, drug use, and sexual behavior with actual behavior and (2) determine if a relationship existed between a student's perceptions of normative behavior and a student's actual behavior. Participants were 833 college students at a large, public university in the Northeast. Study participants overestimated alcohol use, drug use, and sexual behavior among their peers. There was also a positive relationship between actual behavior and perceived peer norms, although the effect sizes for all behaviors were small to moderate. The authors provide further support for the tenets of social norms theory and suggest that social norms interventions are appropriate both campus-wide and to targeted high-risk groups.     

Expectancies specific to condom use mediate the alcohol and sexual risk relationship

The present study tested the role of alcohol expectancies for condom use in mediating the alcohol and risky sex relationship. Expectancies for condom use are specific anticipations for alcohol's effect on one's ability to use a condom. College students (N = 563) reported on beliefs, intentions and actual sexual and drinking behavior. Among the sexually active, alcohol was directly related to future intention to use a condom in drinking situations for men, but not for women. In the men, alcohol expectancies for condom use mediated the relationship between drinking and condom intention. Beliefs that alcohol negatively impacts one's ability to use condoms were associated with more drinking and lower intentions to use a condom. These expectancies may help explain how alcohol affects risky sex in men. Gender differences and implications are discussed.     

Expectancies specific to condom use mediate the alcohol and sexual risk relationship

The present study tested the role of alcohol expectancies for condom use in mediating the alcohol and risky sex relationship. Expectancies for condom use are specific anticipations for alcohol's effect on one's ability to use a condom. College students (N = 563) reported on beliefs, intentions and actual sexual and drinking behavior. Among the sexually active, alcohol was directly related to future intention to use a condom in drinking situations for men, but not for women. In the men, alcohol expectancies for condom use mediated the relationship between drinking and condom intention. Beliefs that alcohol negatively impacts one's ability to use condoms were associated with more drinking and lower intentions to use a condom. These expectancies may help explain how alcohol affects risky sex in men. Gender differences and implications are discussed.     

Using social norms theory to explain perceptions and sexual health behaviors of undergraduate college students: an exploratory study

The authors and associates conducted a social norms-based intervention targeting high-risk sexual behaviors among undergraduate students at 4 college campuses. Social norms theory predicts that widely held misperceptions may encourage risky behavior in a misguided attempt to conform to perceived norms and that information correcting these misperceptions will lead to a decrease in such behaviors. Students overestimated their peers' levels of sexual activity, numbers of partners, incidence of sexually transmitted infections, and rates of unintended pregnancies, but underestimated rates of condom use. Rates of HIV test taking, however, were accurately estimated. Although some components of sexual risk behaviors lend themselves well to social norms-based interventions, others, specifically inconsistent condom use and avoiding HIV tests, do not. Although no changes in reported beliefs or practices were apparent at the end of a 9-month intervention period, longer or modified interventions may be needed to make a fair assessment of the efficacy of this approach.     

Safer Sex and the Health Belief Model

Abstract

The goal of the present study was to build on the Health Belief Model (HBM) by adding predictors of late adolescent safer sex behavior: perceptions of peer norms for sexual behavior, and sexual attitudes that emerge from socialization. Sexually active, late adolescent college students (N = 154, 62.3% female; mean age 20.8 years, 76% European American) participated in the study. Predictors from the original HBM included perceived vulnerability, condom use self-efficacy, and attitudes about condoms. In addition, peer norms for condom use and sexual behavior, general sexual attitudes, and endorsement of the sexual double standard were included as predictors of safer sex behavior. Attitudes about condoms, perceived vulnerability, condom use self-efficacy, and the sexual double standard emerged as significant correlates of condom use. General sexual attitudes and the sexual double standard were significantly correlated with alcohol use before or during sex. With the addition of these variables, the regression models accounted for 28% of the variance in condom use, and 14% of the variance in alcohol use before or during sex.     

Young adults and casual sex: the relevance of college drinking settings

This study investigated the relevance of college drinking settings on the likelihood of students having sexual intercourse with a stranger. A random sample of 7,414 undergraduates at 14 public California universities responded to questions regarding frequency of attendance at six different setting types since the beginning of the semester (e.g., Greek, residence-hall parties, and bars or restaurants), drinking behavior, and sexual activity. Multi-level modeling examined the association between each setting type and the occurrence of alcohol-related sexual intercourse with a stranger. Findings indicated strong, positive associations between frequency of attendance at Greek parties, residence-hall parties, off-campus parties, and the occurrence of alcohol-related sex with a stranger. Frequency of attending the six settings and proportion of times drunk at the settings were also positively associated with alcohol-related sex with a stranger. Efforts aimed at preventing outcomes associated with casual sex (e.g., pregnancy, sexually transmitted infections, or mental health) should target specific drinking settings where students might be at high risk for risky alcohol use and unsafe sex behaviors.     

What Is Hooking Up? Examining Definitions of Hooking Up in Relation to Behavior and Normative Perceptions

Research has demonstrated ambiguity about the definition of hooking up among college students. The current research examined whether there were multiple definitions of hooking up among college students and how different definitions might be associated with the participant's own hooking up behavior and normative perceptions of peer hooking up behavior. A random sample (N = 1,468) of undergraduates (56.4% female) completed a Web-based survey composed of measures of drinking and sexual behavior. Open-ended definitions of hooking up were content-coded and analyzed using a mixture model to explore discrete definitions of hooking up among college students. Findings indicated three clusters of student definitions of hooking up: Cluster 1 had the broadest definition, referring to sex in general, not specific sexual acts, and to making out. Cluster 2 placed an emphasis on interpersonal and social aspects. Cluster 3 defined hooking up as sex with notable references to specific sexual acts. Results further indicated that hooking up behavior and normative perceptions differentiated these three groups of definitions. Clinical implications regarding the inconsistency of student definitions of hooking up and how they may impact negative consequences associated with hooking up are discussed.     

What “likes” have got to do with it: Exposure to peers' alcohol-related posts and perceptions of injunctive drinking norms

Objective: Examine 1) whether observed social reinforcements (i.e., “likes”) received by peers' alcohol-related social media posts are related to first-year college students' perceptions of peer approval for risky drinking behaviors; and 2) whether associations are moderated by students' alcohol use status. Participants: First-year university students (N = 296) completed an online survey in September, 2014. Method: Participants reported their own alcohol use, friends' alcohol use, perceptions of the typical student's approval for risky drinking, and ranked 10 types of social media posts in terms of the relative numbers of “likes” received when posted by peers. Results: Observed social reinforcement (i.e., “likes”) for peers' alcohol-related posts predicted perceptions of peer approval for risky drinking behaviors among non-drinking students, but not drinking students. Conclusions: For first-year college students who have not yet initiated drinking, observing peers' alcohol-related posts to receive abundant “likes” may increase perceptions of peer approval for risky drinking.     

A longitudinal examination of risk and protective factors associated with drug use and unsafe sex among young African American females

This study prospectively examined associations among multiple theoretically informed risk (e.g., depression, sexual sensation seeking, and risky peers norms) and protective factors (e.g., social support, STI knowledge, and refusal to have sex self efficacy) on unsafe sex among 715 African American adolescent females aged 15–21 who participated in an STI/HIV prevention intervention. Generalized estimating equation models were used to assess associations between baseline characteristics and sexual risk over a 12-month follow-up period. Overall risk in this population was high: at baseline, nearly a third of women reported sex under the influence of alcohol or substances; ≥ 2 partners for vaginal sex, and casual sex partners in the 60 days prior to baseline, and nearly 75% of those reporting vaginal sex used condoms inconsistently. In multivariable analysis, when risk and protective factors were simultaneously considered, higher levels of sexual sensation seeking were associated with having multiple sex partners and inconsistent condom use. Greater perception of risky peer norms was associated with a higher risk of having sex under the influence of alcohol or drugs. In addition, higher sex refusal self-efficacy was protective against having multiple; casual; and concurrent sex partners. Incorporating these salient factors into prevention programs may be critical to the development of targeted interventions for this population.     

Sexual Decision Making for the “Better Than Average” College Student

Abstract

Objectives: To examine the impact of downward social comparison and the “known partner is a safe partner” heuristic on college students’ sexual decisions. Participants: One hundred-eighty heterosexual or bisexual undergraduate college students. Methods: Participants read dating vignettes that varied on perspective and familiarity and then rated the likelihood the couple would engage in sexual intercourse and use a condom. Results: There were no differences in rated likelihood based on familiarity, suggesting that the students did not view the 2 partner types as significantly different. Students rated the likelihood of sexual intercourse lower and condom use higher when the vignette was presented from the second person perspective. Conclusions: The students’ use of downward social comparison is consistent with the “better than average effect,” suggesting that the students perceive their own behavior as safe. The implication is that safer sex messages might be most effective if they focus on what students will gain by practicing safer sex behaviors, not just avoidance of a risk behavior.     

Effective targeted and community HIV/STD prevention programs

Community interventions and interventions targeting specific groups at risk of STDs/HIV have demonstrated significant impacts on sexual behavior, particularly condom use and safer sex. The scientific evidence suggests the factors that make these interventions particularly effective include the establishment of community, including business and CBO partnerships; maintainance of the intervention post-research funding; and buy-in by the community or target group. The modification of risky normative beliefs through the use of opinion leaders and role models, and through intervention delivery by peer educators, is an important facet of such interventions. Interventions delivered by health professionals, absent a community base, appear to be unsuccessful. Where cultures or subcultures are targeted, the close involvement of such groups in the design and delivery of messages is critical to their success. Diffusion of interventions through existing social networks further extends the intervention into the community and acts to reinforce and maintain changes in peer norms toward safer sexual behavior. The available data confirm that community or medical infrastructure-based interventions are effective in changing sexual behavior and can reach a wider range of the population than face-to-face programs if they incorporate peer educators as role models in modifying norms, and if diffusion of the intervention is integral to the design.     

A randomized test of a small-group interactive social norms intervention

Social norms interventions are a common approach to addressing the problem of college student drinking. An increasingly popular but not yet well-validated social-norms-based intervention consists of providing normative feedback to students in small groups. OBJECTIVE, PARTICIPANTS, AND METHODS: In this study, the authors used a randomized design to test an interactive form of small-group social norms correction with 502 first-year students during September and October 2001. Because the unit of random assignment was at the level of the classroom, the authors used hierarchical linear modeling to estimate variability. They investigated whether small-group interactive social norms correction could influence alcohol perceptions and behaviors above and beyond a noninteractive social norms education approach. RESULTS: Results indicate that the approach has a fairly substantial influence on student perceptions; however, the findings do not support an influence of interactive small-group social norms correction on measures of alcohol use behaviors. CONCLUSIONS: Given these findings, the use of interactive small-group social norms approach to influence student misperceptions may be considered as a primer for population-level preventive interventions.     

Correction of normative misperceptions: an alcohol abuse prevention program.

Normative misperception refers to the tendency of college students to misperceive campus drinking norms to be more liberal than they actually are. Initial investigations have demonstrated the effectiveness of normative education on reduction of alcohol use in primary and secondary education settings. This study examined the utility of a group program designed to challenge seventy-one male college students' misperceptions of college drinking norms. Participants were enrolled into either a normative education group or a control group representing traditional alcohol education efforts. Participants in the normative education groups demonstrated more accurate perceptions of campus drinking norms and a significant reduction in consequences of alcohol use while those in the control group did not. Changes in normative perceptions were among the strongest contributors to a function discriminating between those who decreased their drinking and those who did not. Results suggest that normative education may be an effective approach to modifying drinking behaviors.     

Social norms theory-based interventions: testing the feasibility of a purported mechanism of action

Social norms-based interventions targeting college student drinking behaviors have become increasingly popular. Such interventions purportedly modify student misperceptions of fellow student drinking behaviors, which leads to changes in individual drinking behavior. Despite claims of successful interventions, research demonstrating that social norms-based interventions modify student perceptions is lacking. OBJECTIVE: The authors conducted a laboratory experiment examining the feasibility of this mechanism of action and aimed to determine the validity of the campus-specific drinking norms hypothesis. PARTICIPANTS AND METHODS: The authors randomly assigned 60 students to 1 of 3 research conditions: Alcohol 101 (national drinking norms), a didactic presentation of campus specific drinking norms, or a control condition. RESULTS: Both intervention groups modified student misperceptions regarding peer alcohol use, and these changes were sustained 1 week later. CONCLUSIONS: Social norms-based interventions can contribute to more accurate drinking perceptions among college students.