Academic journal article Journal of School Health

Moderating Effects of Gender on Alcohol Use: Implications for Condom Use at First Intercourse

Academic journal article Journal of School Health

Moderating Effects of Gender on Alcohol Use: Implications for Condom Use at First Intercourse

Article excerpt

Promoting condom use among sexually active adolescents is a major goal of national public health strategies aimed at reducing sexually transmitted diseases (STDs) and unintended pregnancies among adolescents. (1) During the 1990s, condom use substantially increased among teens, such that by 2003, almost two thirds of teens reported using a condom at last intercourse. (2) Condom use at first intercourse also increased: by 1995, two thirds of both girls and boys reported using a condom at first sex, while only one fourth used no method. (3) Thus, among sexually experienced teens, condoms are the most commonly used contraceptive, especially at first intercourse. Assessing adolescents' contraceptive use at first sex is particularly relevant because it sets the stage for subsequent contraceptive behaviors. Teens who use contraception at first sex are more likely to consistently use it. (4,5)

Alcohol use has also increased among adolescents; almost 75% have had 1 or more drinks in their lifetime, and 45% have consumed alcohol in the past 30 days. (6,7) Alcohol use and sexual activity often co-occur: more than one quarter of sexually active teens reported using alcohol or drugs during their last sexual experience. (6) Alcohol use during sexual activity impairs judgment and reduces sexual inhibitions, (8-12) and a growing literature suggests that adolescent alcohol use is associated with a variety of sexual risk-taking behaviors. (9,13,14) The evidence is more mixed with respect to alcohol and condom use due to differences in measurement, samples, and study designs. Critical-incident studies that focus on behavior for a given sex act are an improvement because they anchor alcohol and condom use to the same event. (9,14) Although most prior studies did not account for amount of alcohol consumed, level of inebriation clearly impacts the likelihood of condom use. Moreover, because there are greater social sanctions against sexual activity for girls, the disinhibitory effect of alcohol may be greater for girls than for boys, (8,12,15) which may have a more detrimental impact on girls' condom use. Unfortunately, few studies have investigated the possible interaction between gender and alcohol consumption level on condom use.

Age at first sexual intercourse has been used as a marker for sexual risk taking, and teens with younger ages at first sex are less likely to use contraception than those who delay. (3,16,17) Although there is some debate regarding how adolescents make sexual and contraceptive decisions, (18,19) these decisions are probably related. It may be that younger teens are less able to negotiate condom use or that younger age at first sex is a marker for other underlying risk-taking propensities. In this study, age at first sex was considered a marker, but no causal assumptions were made.

Sociodemographic and family background characteristics are also associated with adolescent contraceptive behavior. Racial and ethnic variability in condom use reflect differences in social norms concerning the timing of sexual activity and contraceptive preferences and acceptability. (7,15,20) African American and Hispanic teens are less likely to use contraception at first sex than white teens? Although teens who are foreign born tend to delay sexual activity compared to US-born teens, (21) it is not clear whether this translates into increased condom use at first sex. This study examined the effects of both race/ethnicity and nativity status on condom use at first sex. Teens living in intact families are more likely to use contraception than those living in other family situations. (3,20) Higher family socioeconomic status is associated with delayed sexual onset and increased contraceptive use among teens. (3,22) Last, greater parental monitoring is associated with less sexual and contraceptive risk taking and lower rates of alcohol use. (23) The extent to which these family background factors have independent effects on condom use at first sex (beyond their effects on age at first sex) was examined. …

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