Evidence against Alcohol as a Proximal Cause of Sexual Risk Taking among College Students
Velez-Blasini, Carlos J., The Journal of Sex Research
A relatively large number of studies have examined what role if any alcohol plays in explaining sexual risk taking. Given the ubiquity of these behaviors, a clear understanding of their relationship potentially would be of great importance in efforts intended to reduce the incidence of unwanted pregnancy, sexually transmitted diseases, and other related problematic events such as date rape. Plagued by a variety of methodological shortcomings, past research has fallen short of conclusively proving or disproving the widely held assumption that alcohol causes an increase in the likelihood of risky behaviors during sexual events. These limitations, along with the fact that different methodologies have yielded conflicting results, suggest the need for further research in this area.
At the global level, evidence suggests that heavier drinking is associated with increased sexual risk taking (Halpern-Felsher, Millstein, & Ellen, 1996), a trend that has been established in a large number of investigations with a variety of populations (see, for example, Biglan et al., 1990; Graves, 1995; Hingson, Strunin, Berlin, & Heeren, 1990; Wechsler, Davenport, Dowdall, Moeykens, & Castillo, 1994). Two major flaws, however, can be identified in these studies: first, due to the correlational nature of their designs, they do not suggest a causal sequence; and, second, they have not examined the actual cooccurrence of alcohol use with risky sex (Leigh & Stall, 1993, p. 1036). To circumvent these problems, some studies have examined the relationship between alcohol and risky sex at the situational level by asking respondents to estimate the frequency of drinking proximal to intercourse and frequency of having unprotected sex within a period of time. Some of these studies also have supported an association between these behaviors (Halpern-Felsher et al., 1996). Cooper (2002), however, has suggested that given the relatively high prevalence of both alcohol and risky sex, a "nontrivial proportion" (p. 105) of instances of cooccurrence of these behaviors in certain populations (such as college students) might occur solely by chance.
A relatively smaller number of what have been described by Halpern-Felsher et al. (1996) as event-level studies have attempted to address these methodological limitations by asking respondents to report their alcohol and sexually risky behaviors on specific multiple occasions (e.g., first intercourse ever, first intercourse with most recent partner). This approach allows for within-subjects analyses, thus emphasizing cooccurrence and controlling for the possibility that stable individual differences lead people to simultaneously engage in the behaviors in question (Cooper, 2002). Several of these studies (Cooper, Pierce, & Huselid, 1994; Corbin & Fromme, 2002; Dermen & Cooper, 2000; Dermen, Cooper, & Agocha, 1998) found evidence suggesting that alcohol use led to, at best, a moderate increase in risky sexual behaviors (i.e., condom use, HIV discussion, unknown partner). In a review of the literature, Halpern-Felsher et al. (1996) concluded that these effects are likely circumscribed only to the earliest sexual experiences.
Research also has examined the relationship between alcohol and risky sex using daily activity logs for periods of time ranging from a few weeks to up to 3 months (see Fortenberry, Costa, Jessor, & Donovan, 1997; Harvey & Beckman, 1986; Leigh, 1993; Morrison, Gillmore, Hoppe, Gaylord, & Leigh, 2003). Contrary to previous evidence, in none of these studies was alcohol use related to an increase of risky sexual behavior or sexual risk taking.
Several studies also have explored the relationship between alcohol and risky sex using experimental designs. In a prototypical study, MacDonald, Zanna, and Fong (1996) asked sober or intoxicated male participants to watch a brief video vignette depicting a couple in a sexual situation up to the point before intercourse at which the two individuals came to the realization that a condom was not available. …