Academic journal article
By Morrison, Diane M.; Leigh, Barbara C.; Gillmore, Mary Rogers
The Journal of Sex Research , Vol. 36, No. 1
Intoxication, from use of alcohol or other drugs, is commonly thought to be a cause of unsafe sex, particularly of the failure to use condoms conscientiously. Research on this association has yielded mixed findings. A number of studies document general associations between high rates of substance use and high rates of sexual behavior risk (e.g., Anderson & Dahlberg, 1992; Biglan et al., 1990; Penkower et al., 1991; Rolls, Goldberg, & Sharrar, 1990). Other studies have gone further to demonstrate links between substance use in conjunction with sexual activity and sexual risk-taking (cf., Cooper, Peirce, & Huselid, 1994; Hingson, Strunin, Berlin, & Heeren, 1990). As Leigh and Stall (1993) point out, associations of substance use and unsafe sex may be attributable to a number of causes, including confounding personality or situational characteristics. The crucial data needed to answer the question of whether intoxication has a causal relationship to sexual risk-taking are reports of several sexual encounters, varying by levels of intoxication, from the same individuals. Such an analysis would control for personality characteristics and lifestyle characteristics.
One method for gathering such data is a daily diary, three variants of which are described in this paper. Data from daily diaries can be used to examine the co-occurrence of intoxication and unsafe sex intra-individually, at the incident level; that is, to answer the question of whether the same person is less likely to use protection when intoxicated than when sober. Diaries have been used successfully to track both alcohol consumption (e.g., Hilton, 1989; Poikolainen & Karkkainen, 1983) and sexual behavior (e.g., Harvey & Beckman, 1986; Hornsby & Wilcox, 1989; Reading, 1983). They have also been used to assess the co-occurrence of intoxication and sexual behavior (Harvey & Beckman, 1986; Leigh, 1993; Weatherbum et al., 1993) and to assess condom use (Leigh, 1993; McLaws, Oldenburg, Ross, & Cooper, 1990; Weatherbum et al., 1993).
Using a daily diary methodology in this context presents some novel challenges. There are several behaviors to assess each day: use of alcohol, use of other drugs, occasions of sexual intercourse, and condom use. There may be multiple instances of each behavior, and all must be captured. The temporal order of, and lag between, substance use and sexual intercourse is important, since substance use after intercourse, or a long time before intercourse, would not lead to intoxication at the time of intercourse. The quantity of the substance used will also influence the level of intoxication. The number of questions asked to elicit all this information results in a daily questionnaire that is considerably longer than those used in previous research. In addition, many potential respondents have already been exposed to public health messages that teach that "high = high risk." Such a belief might influence respondents' recollections of condom use, or affect the perceived social desirability of reporting condom use. A potential solution to this problem is to embed questions about substance use, sexual intercourse, and condom use in a larger daily questionnaire, disguising the hypothesis that underlies the questions. This leads to an even longer daily diary, however, and greater respondent burden.
Both substance use and intercourse are typically sporadic, rather than daily, behaviors. This necessitates a fairly long data collection phase to ensure that most respondents will record at least a few instances of both target behaviors (intercourse and substance use). Respondents must therefore complete daily diaries over a long period of time, further increasing respondent burden.
In addition, the respondents of interest for such a study are individuals whose sexual behavior puts them at risk for unintended pregnancy or disease, and who drink alcohol or use substances at least occasionally. …