Alcohol Use and Sexual Risk Behavior in Young Women: A Qualitative Study

Abstract

Alcohol use and sexual behavior co-occur frequently in young women, increasing risk for HIV and other sexually transmitted infections. To inform preventive interventions, we used qualitative methods to better understand how women think about the contribution of alcohol use to sexual risk-taking. Young women (N = 25; M = 22.8 years; 64% White) were recruited from a community-based reproductive health clinic to attend focus groups; a semi-structured agenda was used to investigate both a priori explanatory mechanisms as well as participant-driven explanations for the alcohol-sex association. Women reported that alcohol reduced their social anxiety, helped them to feel outgoing and confident, and lowered inhibitions and other barriers to sexual encounters (consistent with alcohol expectancies). During drinking events, women described being less concerned with risks, less discriminating regarding sexual partners, and less likely to insist on safer sex practices (consistent with alcohol myopia). These empirical findings support previous theory-based guidance for tailoring preventive programs for alcohol use and sexual risk reduction for young women.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Chandra A, Mosher WD, Copen C, Sionean C. Sexual behavior, sexual attraction, and sexual identity in the United States: Data from the 2006–2008 National Survey of Family Growth. National health statistics reports. Hyattsville: National Center for Health Statistics; 2011.

    Google Scholar 

  2. 2.

    D’Souza G, Cullen K, Bowie J, Thorpe R, Fakhry C. Differences in oral sexual behaviors by gender, age, and race explain observed differences in prevalence of oral human papillomavirus infection. PLoS ONE. 2014;9(1):e86023. https://doi.org/10.1371/journal.pone.0086023.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC, Weinstock H. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40(3):187–93. https://doi.org/10.1097/OLQ.0b013e318286bb53.

    Article  PubMed  Google Scholar 

  4. 4.

    Finer LB, Zolna MR. Declines in unintended pregnancy in the United States, 2008–2011. N Engl J Med. 2016;374(9):843–52. https://doi.org/10.1056/NEJMsa1506575.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Centers for Disease Control and Prevention. Vital signs: binge drinking prevalence, frequency, and intensity among adults—United States, 2010. MMWR Morb Mortal Wkly Rep. 2012;61(1):14–9.

    Google Scholar 

  6. 6.

    Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2016 National Survery on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD. 2017. https://www.samhsa.gov/data/.

  7. 7.

    Baliunas D, Rehm J, Irving H, Shuper P. Alcohol consumption and risk of incident human immunodeficiency virus infection: a meta-analysis. Int J Public Health. 2010;55(3):159–66. https://doi.org/10.1007/s00038-009-0095-x.

    Article  PubMed  Google Scholar 

  8. 8.

    Cook RL, Clark DB. Is there an association between alcohol consumption and sexually transmitted diseases? A systematic review. Sex Transm Dis. 2005;32(3):156–64.

    Article  Google Scholar 

  9. 9.

    Scott-Sheldon LAJ, Carey KB, Cunningham K, Johnson BT, Carey MP. Alcohol use predicts sexual decision-making: a systematic review and meta-analysis of the experimental literature. AIDS Behav. 2016;20(Suppl 1):S19–39. https://doi.org/10.1007/s10461-015-1108-9.

    Article  PubMed  Google Scholar 

  10. 10.

    Aicken CR, Nardone A, Mercer CH. Alcohol misuse, sexual risk behaviour and adverse sexual health outcomes: evidence from Britain’s national probability sexual behaviour surveys. J Public Health. 2011;33(2):262–71. https://doi.org/10.1093/pubmed/fdq056.

    Article  Google Scholar 

  11. 11.

    Cook RL, Comer DM, Wiesenfeld HC, Chang CC, Tarter R, Lave JR, Clark DB. Alcohol and drug use and related disorders: An underrecognized health issue among adolescents and young adults attending sexually transmitted disease clinics. Sex Transm Dis. 2006;33(9):565–70. https://doi.org/10.1097/01.olq.0000206422.40319.54.

    Article  PubMed  Google Scholar 

  12. 12.

    Cooper ML. Alcohol use and risky sexual behavior among college students and youth: evaluating the evidence. J Stud Alcohol Drugs. 2002;14:101–17.

    Google Scholar 

  13. 13.

    Hutton HE, McCaul ME, Chander G, Jenckes MW, Nollen C, Sharp VL, Erbelding EJ. Alcohol use, anal sex, and other risky sexual behaviors among HIV-infected women and men. AIDS Behav. 2013;17(5):1694–704. https://doi.org/10.1007/s10461-012-0191-4.

    Article  PubMed  Google Scholar 

  14. 14.

    Carey KB, Senn TE, Walsh JL, Scott-Sheldon LA, Carey MP. Alcohol use predicts number of sexual partners for female but not male STI clinic patients. AIDS Behav. 2016;20(Suppl 1):S52–9. https://doi.org/10.1007/s10461-015-1177-9.

    Article  PubMed  Google Scholar 

  15. 15.

    Hutton HE, McCaul ME, Santora PB, Erbelding EJ. The relationship between recent alcohol use and sexual behaviors: gender differences among sexually transmitted disease clinic patients. Alcohol Clin Exp Res. 2008;32(11):2008–15. https://doi.org/10.1111/j.1530-0277.2008.00788.x.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Scott-Sheldon LAJ, Carey MP, Vanable PA, Senn TE, Coury-Doniger P, Urban MA. Alcohol consumption, drug use, and condom use among STD clinic patients. J Stud Alcohol Drugs. 2009;70(5):762–70.

    Article  Google Scholar 

  17. 17.

    Oldson L. Why women are more at-risk for STDs than men. 2013. https://www.sexualhealth.com/why-women-are-more-at-risk-for-stds-than-men_n_1592/.

  18. 18.

    Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2016. GA: Atlanta; 2017.

    Google Scholar 

  19. 19.

    Morris AB, Albery IP. Alcohol consumption and HIV risk behaviours: integrating the theories of alcohol myopia and outcome-expectancies. Addict Res Theory. 2001;9(1):73–86.

    Article  Google Scholar 

  20. 20.

    Moss AC, Albery IP. A dual-process model of the alcohol-behavior link for social drinking. Psychol Bull. 2009;135(4):516–30. https://doi.org/10.1037/a0015991.

    Article  PubMed  Google Scholar 

  21. 21.

    Stoner SA, George WH, Peters LM, Norris J. Liquid courage: alcohol fosters risky sexual decision-making in individuals with sexual fears. AIDS Behav. 2007;11(2):227–37. https://doi.org/10.1007/s10461-006-9137-z.

    Article  PubMed  Google Scholar 

  22. 22.

    Goldman MS, Reich RR, Darkes J. Expectancy as a unifying construct in alcohol-related cognition. Handbook of implicit cognition and addiction;2006. P 105–119.

  23. 23.

    Steele CM, Josephs RA. Alcohol myopia. Its prized and dangerous effects. Am Psychol. 1990;45(8):921–33.

    CAS  Article  Google Scholar 

  24. 24.

    Fusch PI, Ness LR. Are we there yet? Data saturation in qualitative research. Qual Rep. 2015;20(9):1408–16.

    Google Scholar 

  25. 25.

    Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

    Article  Google Scholar 

  26. 26.

    Guest G, MacQueen KM, Namey EE. Applied thematic analysis. Thousand Oaks: Sage; 2011.

    Google Scholar 

  27. 27.

    Dermen KH, Cooper ML. Sex-related alcohol expectancies among adolescents: I. Scale development. Psychol Addict Behav. 1994;8(3):152–60.

    Article  Google Scholar 

  28. 28.

    Maisto SA, Carey MP, Carey KB, Gordon CM, Schum JL. Effects of alcohol and expectancies on HIV-related risk perception and behavioral skills in heterosexual women. Exp Clin Psychopharmacol. 2004;12(4):288–97. https://doi.org/10.1037/1064-1297.12.4.288.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Dermen KH, Cooper ML. Inhibition conflict and alcohol expectancy as moderators of alcohol’s relationship to condom use. Exp Clin Psychopharmacol. 2000;8(2):198–206.

    CAS  Article  Google Scholar 

  30. 30.

    Krueger RA, Casey MA. Focus groups: a practical guide for applied research. 5th ed. Thousand Oaks, CA: Sage Publications; 2014.

    Google Scholar 

  31. 31.

    Moyer VA. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: US preventive services task force recommendation statement. Ann Intern Med. 2013;159(3):210–8.

    PubMed  Google Scholar 

  32. 32.

    American College of Obstetricians and Gynecologists. At-risk drinking and alcohol dependence: obstetric and gynecologic implications. ACOG Committee Opinion No. 496. American College of Obstetricians and Gynecologists. 2011.

  33. 33.

    Cooper ML, O’Hara RE, Martins J. Does drinking improve the quality of sexual experience?: sex-specific alcohol expectancies and subjective experience on drinking versus sober sexual occasions. AIDS Behav. 2016;20(Suppl 1):S40–51. https://doi.org/10.1007/s10461-015-1136-5.

    Article  PubMed  Google Scholar 

  34. 34.

    Scott-Sheldon LAJ, Terry DL, Carey KB, Garey L, Carey MP. Efficacy of expectancy challenge interventions to reduce college student drinking: a meta-analytic review. Psychol Addict Behav. 2012;26(3):393–405. https://doi.org/10.1037/a0027565.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 35.

    Lau-Barraco C, Dunn ME. Evaluation of a single-session expectancy challenge intervention to reduce alcohol use among college students. Psychol Addict Behav. 2008;22(2):168–75. https://doi.org/10.1037/0893-164X.22.2.168.

    Article  PubMed  Google Scholar 

  36. 36.

    Sikkema KJ, Winett RA, Lombard DN. Development and evaluation of an HIV-risk reduction program for female college students. AIDS Educ Prev. 1995;7(2):145–59.

    CAS  PubMed  Google Scholar 

  37. 37.

    Weinhardt LS, Carey MP, Carey KB, Verdecias RN. Increasing assertiveness skills to reduce HIV risk among women living with a severe and persistent mental illness. J Consult Clin Psychol. 1998;66(4):680–4.

    CAS  Article  Google Scholar 

  38. 38.

    Hurlbert DF. The role of assertiveness in female sexuality: a comparative study between sexually assertive and sexually nonassertive women. J Sex Marital Ther. 1991;17(3):183–90. https://doi.org/10.1080/00926239108404342.

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgements

We gratefully acknowledge the contributions of the study participants as well as the staff at the Providence Health Center. The findings and conclusions in this article are those of the authors and do not necessarily reflect the views of Planned Parenthood Federation of America, or the National Institutes of Health.

Funding

This research was funded by Grant R34-AA023158 from the National Institute on Alcohol Abuse and Alcoholism to Michael P. Carey.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Kate B. Carey.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Carey, K.B., Guthrie, K.M., Rich, C.M. et al. Alcohol Use and Sexual Risk Behavior in Young Women: A Qualitative Study. AIDS Behav 23, 1647–1655 (2019). https://doi.org/10.1007/s10461-018-2310-3

Download citation

Keywords

  • Alcohol
  • Sexual behavior
  • Women
  • Qualitative research
  • Theory