Understanding the relationship between alcohol and sex: Latino and white college students and problematic sexual experiences while drinking

OBJECTIVES: The authors examined whether the relationship between alcohol expectancies and sexual experiences while drinking differed between Latino and white college students. PARTICIPANTS: The authors considered students if they were white or Latino, unmarried, aged 18-25 years, reported any drinking, and had at least 1 sexual partner in the present school year. METHODS: The investigators collected surveys from a random sample of 13,868 undergraduate students from the 14 California public university campuses. They used tests of group differences and hierarchical multiple regressions. RESULTS: Social-facilitation alcohol expectancies were associated with the total number of different alcohol-related sexual experiences among Latino students. Neither social facilitation nor sexual-enhancement alcohol expectancies were differentially predictive of white or Latino students' frequency of sexual experiences. CONCLUSIONS: Additional research is necessary to determine whether concepts targeted by alcohol prevention programs operate in a differential manner for Latino students.     

The Role of Positive Alcohol Expectancies in Underage Binge Drinking Among College Students

Abstract

Objective: This study explored associations between positive alcohol expectancies, and demographics, as well as academic status and binge drinking among underage college students. Participants: A sample of 1,553 underage college students at 3 public universities and 1 college in the Southeast who completed the Core Alcohol and Drug Survey in the Spring 2013 semester. Methods: A series of bivariate analyses and logistic regression models were used to examine associations between demographic and academic status variables as well as positive alcohol expectancies with self-reported binge drinking. Positive alcohol expectancies were examined in multivariable models via 2 factors derived from principal component analyses. Results: Students who endorsed higher agreement of these 2 emergent factors (sociability, sexuality) were more likely to report an occurrence of binge drinking in the past 2 weeks. Conclusions: Study results document associations between positive alcohol expectancies and binge drinking among underage students; implications for prevention and treatment are discussed.     

Condom Use in Heavy Drinking College Students: The Importance of Always Using Condoms

Abstract

Objective: The authors examined whether alcohol use decreased condom use. Participants: The subjects were heavy-drinking students on 5 different college campuses. Methods: A face-to-face interview, administered between November of 2004 and February of 2007, gathered information about condom use, alcohol use, and other behaviors. Multivariate logistic regression was used to assess predictors of condom use. Results: Of the 1715 participants, 64% reported that they did not always use condoms. Male students who drank heavily were less likely to always use condoms (adjusted odds ratio [AOR] 0.61). Participants with more sexual partners used condoms less when drinking (AOR 1.93 for men, 1.45 for women). Conclusions: Many students do not use condoms consistently, especially those who drink heavily or have multiple sexual partners. Clinicians at student health need to encourage all students to use condoms every time they have intercourse.     

Legal-Age Students' Provision of Alcohol to Underage College Students: An Exploratory Study

Objective: The authors investigated the magnitude and cultural context of legal-age university students' provision of alcohol to underage students and how such alcohol provision might be deterred.

Participants: 130 legal-age students at a midwestern university in the United States were randomly selected.

Methods: The authors assessed 16 focus groups and a thematic analysis.

Results: Most participants reported frequent alcohol provision. Most denied moral responsibility for any negative consequences that recipients might suffer. Small numbers of participants, chiefly women, would decrease alcohol provision after education on the sexual risks to underage females. Larger numbers would decrease provision in response to consistent law enforcement, severe legal and disciplinary penalties, and education on severe penalties.

Conclusions: Legal-age students' provision of alcohol to underage students is an integral part of college students' drinking culture. As a deterrent, an enforcement-based campaign may be more effective than an educational campaign on the possible negative consequences of alcohol for underage students.     

Fear,Shame, and Health Promotion

Abstract

Drinking games are associated with excess alcohol use and alcohol-related problems, yet it is unclear whether they are unique to the college environment or whether students come to college familiar with such games. The authors queried 1,252 students attending voluntary summer orientation programs about their experiences with drinking games. A majority (63%) indicated they had played drinking games and viewed them as a means to get drunk quickly and to socialize, control others, or get someone else drunk. Logistic regression analyses revealed that familiarity with drinking situations was associated with a greater likelihood of playing drinking games. Students who reported drinking more frequently and consuming greater quantities of alcohol than others, having lifetime marijuana use, and initiating alcohol consumption between the ages of 14 and 16 years were significantly more likely to have participated in drinking games. These findings demonstrate the importance of considering students' participation in drinking games when campus officials address alcohol use.     

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.     

Alcohol Use in Students Seeking Primary Care Treatment at University Health Services

Abstract

Objective: Given the high rate of at-risk drinking in college students, the authors examined drinking behaviors and associated factors in students being seen in student health services for primary care visits from October 30, 2004, to February 15, 2007. Methods: Analyses were based on a Health Screening Survey completed by 10,234 college students seeking general medical treatment. Results: Alcohol use was similar to other studies with 57% (n = 5,840) meeting the National Institute on Alcohol Abuse and Alcoholism criteria for at-risk drinking. Twenty-six percent of the students reported smoking at least once in the last 3 months. Risk factors for at-risk drinking included young age, white males, drinking at a fraternity/sorority house, and use of tobacco. Conclusions: These findings support the widespread implementation of alcohol screening and intervention in university health services.     

Partying Before the Party: Examining Prepartying Behavior Among College Students

Objective: The authors examined the phenomenon known to college students as prepartying, which is the consumption of alcohol prior to attending an event or activity (eg, party, bar, concert) at which more alcohol may be consumed. Participants: To explore the extent of this behavior, the authors surveyed 227 college students about each drinking event over a 1-month period. Results: Principal results revealed that 64% of participants engaged in prepartying (75% of drinkers) and that prepartying is involved in approximately 45% of all drinking events. Prepartying was predictive of more drinking throughout the day of the drinking event and alcohol-related negative consequences. Men and women engaged in this behavior at similar rates, and prepartying was most related to social reasons for drinking. Conclusion: Because prepartying is well-known among students, the authors suggest that clinicians and researchers target it to better understand college drinking and to help students understand the associated dangers.     

Perceived Norms and Alcohol Consumption: Differences Between College Students From Rural and Urban High Schools

Objective: The authors examined perceived norms and drinking among college students who attended high schools in rural and urban communities. Participants and Methods: Undergraduates (99 men and 85 women) who attended high schools in communities with populations ranging from less than 100 to more than 400,000 completed surveys assessing perceived norms and alcohol consumption. Results: Analyses revealed that students from smaller towns and in smaller high school graduating classes reported heavier drinking and that perceived norms were positively associated with drinking. Perceived norms were unrelated to population variables, and the relationship between perceived norms and drinking did not vary as a function of population variables. Results suggest that differences in drinking as a function of coming from more rural areas contribute to drinking behavior in college independently of perceived norms. Conclusions: College students may adjust to campus drinking norms relatively quickly, and longitudinal research would be useful in understanding this transition.     

Longitudinal Evaluation of Peer Health Education on a College Campus: Impact on Health Behaviors

Objective: The authors investigated the longitudinal impact of peer health education on the health behaviors of undergraduate students pertaining to alcohol and drug use, eating and nutrition, and sexual health. Participants: From fall 2003 to spring 2006, the authors annually administered a Web-based survey to a cohort of 2,000 randomly selected undergraduate students. Results: Students who had contact with peer health educators were significantly more likely over time than other students to report less alcohol consumption and fewer related negative consequences. Results also show that students who had contact with peer health educators initially endorsed engaging in unhealthy weight management and fat talk behaviors during their first year but decreased these unhealthy behaviors by their third year. No significant differences in sexual health behaviors were found. Conclusions: Results indicate that peer health educators play an important role in promoting healthy behaviors in the areas of alcohol and drug use and in eating and nutrition.     

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.     

Drinking Patterns,Problems, and Motivations Among Collegiate Bisexual Women

Objective and Participants: The authors compared the drinking behaviors, motivations, and problems of collegiate bisexual women with those of heterosexual women (N = 2,788; n = 86 bisexual women). Methods: Data came from the 2003 Student Life Survey, a random population-based survey at a large midwestern university. The authors explored the hypothesis that bisexual women would be more likely than heterosexual women to report drinking motivations related to stress and coping as a result of sexual identity stigma. Results: They found that bisexual women drank significantly less than did heterosexual women. There were few differences between the 2 groups in drinking motivations and problems. Bisexual women reported a comparable number of problems related to their drinking but were significantly more likely to report contemplating suicide after drinking than were heterosexual women. Conclusions: More research is needed to understand the finding that despite lower levels of alcohol consumption, bisexual women reported a comparable number of drinking problems. College health educators and health care providers need to be aware of findings related to heightened suicidal risk among bisexual women.     

The Role of Sex-Related Alcohol Expectancies in Alcohol-Involved Consensual and Nonconsensual Sex Among Women of Asian/Pacific Islander and Women of European Race/Ethnicity

Alcohol-involved sexual experiences, including incapacitated sexual assault and alcohol-involved sex, are major public health concerns among college women. Further, racial/ethnic diversity among college students is increasing, particularly with regard to increases in college students of Asian/Pacific Islander (API) race/ethnicity. Of relevance, evidence suggests differences in sexual assault rates across ethnicities and cultures; however, no known study to date has examined differences by ethnicity and first language in expectancies and experiences specifically surrounding alcohol and sex. The current study sought to examine differences in incapacitated sexual assault, alcohol-involved sex, and heavy episodic drinking, as well as differences in sex-related alcohol expectancies among native English-speaking college women of European (EU) race/ethnicity, native English-speaking women of API race/ethnicity, and non–native English-speaking women of API race/ethnicity (NNES-API). EU reported higher frequency of heavy episodic drinking, alcohol-involved sex, and incapacitated sexual assault compared to API and NNES-API. In addition, API reported more frequent alcohol-involved sex and incapacitated sexual assault compared to NNES-API, in part due to API’s stronger endorsement of sexual disinhibition–related alcohol expectancies (indirect effects: β = ?.04, p = .04, and β = ?.07, p = .04, respectively). Findings highlight the important role of expectancies in acculturation and influence on actual alcohol-involved sex and sexual assault.     

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.     

No Fear,Just Relax and Play: Social Anxiety,Alcohol Expectancies,and Drinking Games Among College Students

Abstract

Objective: The authors examined the association between social anxiety and drinking game (DG) involvement as well as the moderating role of social anxiety–relevant alcohol outcome expectancies (AOE) in social anxiety and DG involvement among college students. Participants: Participants were 715 students (74.8% women, M _age = 19.46, SD = 1.22) from 8 US colleges. Methods: Data were collected via self-report survey from Fall 2005 to Spring 2007. Results: Tension Reduction and Liquid Courage AOE moderated the association between social anxiety and DG participation. Tension Reduction AOE and DG participation were positively related among those with high social anxiety, but were associated negatively for those with low social anxiety. Liquid Courage AOE were associated with increased DG participation for those with low social anxiety, but not for those with high social anxiety. Conclusions: Findings suggest that social anxiety acts as a protective or a risk factor for DG participation among college students, depending upon AOE.     

The Association of Multiple Risk Factors With Fruit and Vegetable Intake Among a Nationwide Sample of College Students

Few college students meet fruit and vegetable intake recommended requirements, and most receive no information from their institutions about this issue. The avoidable disease burden among students is large, the necessary information infrastructure exists, and Healthy People 2010 objectives indicate efforts should be taken to increase intake. Objective: The authors examined the association of high-risk behaviors and fruit and vegetable intake to inform design of multiple risk factor interventions. Participants and Methods: The authors obtained data from a sample of 40,209 18- to 25-year-old college students who completed the American College Health Association-National College Health Assessment during the spring 2002 and 2003 semesters. Results: Predictors of high fruit and vegetable intake for men and women included better: seatbelt and helmet use, physical activity, perceived health, sleep, self-care behaviors, and grades. Other notable predictors of high intake were reduced likelihood of cigarette smoking, alcohol use, drinking and driving, and feeling hopeless in both sexes; reduced likelihood of drinking and driving among men; and a greater likelihood of anorexia among women. Conclusions: The authors discuss implications of these findings.     

Campus Response to Novel Influenza H1N1

In the fall of 2004, a midwestern public university changed its tailgating policy from one that did not allow alcohol consumption to one that did. Objective, Participants, and Methods: The authors surveyed students before and after the policy change to measure consumption, problems, perceptions of peer consumption, and reported game attendance. Results: Results showed no change in drinking quantities or prevalence of problems after the policy change; however, there was an increase in students' misperceptions, with students overestimating drinking quantities and the number of students who drank while tailgating. Last, students' predictions about their game attendance if alcohol was allowed were higher than their reported attendance after the policy change. Conclusions: Conclusions suggest that although drinking quantities may not be influenced by policies at tailgating events, misperceptions may be influenced. Administrators should note that the policy did not affect students' self-reported game attendance.     

Daily Associations Between Drinking and Sex Among College Students: A Longitudinal Measurement Burst Design

Daily links between alcohol use and sexual behaviors were examined in a longitudinal study of college students. Hierarchical linear models predicted sexual behaviors by characteristics of persons (N = 731, Level 3), semesters (N = 4,345, Level 2), and days (N = 56,372, Level 1). On a given day, consuming more drinks and binge drinking were associated with greater odds of kissing, touching, oral sex, and penetrative sex. Consistent with alcohol myopia and expectancy theories, associations between binge drinking and sexual behaviors were stronger for students not in romantic relationships, for students with stronger alcohol–sex expectancies, and for oral and penetrative sex. Findings suggest that within‐day links between alcohol use and sexual behaviors are evident across college, with variations based on individual and relationship factors.     

Development of a Questionnaire to Assess University Students’ Intentions to Use Behavioral Alcohol-Reduction Strategies

Abstract

Objective: To evaluate the psychometric properties of a new self-report questionnaire designed to assess college students’ intentions to employ 31 specific alcohol-reduction strategies. Method: Students attending a large public university were recruited to complete alcohol-reduction, drinking history, and personality questionnaires online. Results: Based on item–total correlations and principal components analysis, the authors eliminated 3 items and calculated average intention ratings across the remaining 28 items. The resulting scale had appropriate unidimensionality and excellent internal consistency. Correlations of intention questionnaire scores with measures of drinking history, alcohol outcome expectancies, sensation seeking, and impression management provided some support for criterion and discriminant validity of the questionnaire. Conclusion: This questionnaire could be employed as an outcome measure to evaluate prevention programs and as a clinical tool to identify clients who have little intention to employ drinking reduction strategies in heavy drinking situations.