Cited by 241Adolescent Sexual and Reproductive HealthSubstance Abuse Treatment and OutcomesSexuality, Behavior, and Technology

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Relationship of alcohol use and risky sexual behavior: A review and analysis of findings

Halpern-Felsher, Bonnie L., Millstein, Susan G., Ellen, Jonathan M.·1996·Journal of Adolescent Health

DOI 10.1016/s1054-139x(96)00024-9

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Abstract

In this review article, three methodologic approaches that have been used to examine the association between adolescents' alcohol use and their involvement in risky sex are discussed: global correlation studies, situational covariation studies, and event analyses. The strengths and limitations of each of these research methods are discussed. An extensive review of the most rigorous studies, which used event analysis to examine the alcohol-risky sex link, reveals positive results for first-time sexual events but equivocal findings for other types of sexual relationships. It is argued that differences in the types of sexual relationships studied have been confounded, limiting our ability to evaluate the extent to which alcohol has a causal influence on adolescents' condom use. It is suggested that future investigations consider the nature of the sexual relationship, and go beyond studying the length or status of the relationship to explore how variation in relationship dimensions such as trust and intimacy affect adolescents' sexual behavior.

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Boden, J. M., & Fergusson, D. M. (2011) · Wiley eBooks · doi:10.1002/9781118785089.ch3 · Cited by 72
Alcohol, drugs, and condom use among drug offenders: An event-based analysis
Leigh, B. C., Ames, S. L., & Stacy, A. W. (2007) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2007.08.012 · Cited by 70
“…(Leigh and Stall, 1993; Leigh, 2002), and research on this link has shown inconsistent findings (for reviews, see Dingle and Oei, 1997; Donovan and McEwan, 1995; Halpern-Felsher, Millstein, and Ellen, 1996; Leigh, 2002; Leigh and Stall, 1993; Rhodes and Stimson, 1994; Weinhardt and Carey, 2000).”
Result
Nightlife Violence: A Gender-Specific View on Risk Factors for Violence in Nightlife Settings: A Cross-Sectional Study in Nine European Countries
Schnitzer, S., Bellis, M. A., Anderson, Z., Hughes, K. E., Calafat, A., Juan, M., & Kokkevi, A. (2009) · Journal of Interpersonal Violence · doi:10.1177/0886260509340549 · Cited by 69
Initiating Sexual Experiences: How Do Young Adolescents Make Decisions Regarding Early Sexual Activity?
Michels, T. M., Kropp, R. Y., Eyre, S. L., & Halpern‐Felsher, B. L. (2005) · Journal of Research on Adolescence · doi:10.1111/j.1532-7795.2005.00112.x · Cited by 70
Self-citation
Relationship of Binge Drinking and Other Health-Compromising Behaviors among Urban Adolescents in China
Xing, Y., Ji, C.-Y., & Zhang, L. (2006) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2006.03.014 · Cited by 67
Aggregate and event-level associations between substance use and sexual behavior among gay and bisexual men: Comparing retrospective and prospective data
Rendina, H. J., Moody, R. L., Ventuneac, A., Grov, C., & Parsons, J. T. (2015) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2015.06.045 · Cited by 66
“Numerous reviews have provided evidence for this association (Drumright et al., 2006b; Halpern-Felsher et al., 1996; Leigh and Stall, 1993; Vosburgh et al., 2012), but inconsistencies in the operationalization of substance use and sexual behavior—particularly regarding types of substance and sexual…”
Sexual behavior and drinking style among teenagers: a population-based study in Finland
Lavikainen, H., Lintonen, T., & Kosunen, E. (2009) · Health Promotion International · doi:10.1093/heapro/dap007 · Cited by 64
Parenting Practices, Parents' Underestimation of Daughters' Risks, and Alcohol and Sexual Behaviors of Urban Girls
O’Donnell, L. N., Stueve, A., Durán, R., Myint‐U, A., Agronick, G. S., Doval, A. S., & Wilson‐Simmons, R. (2008) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2007.10.008 · Cited by 64
The Longitudinal Relationship Between Drug Use and Risky Sexual Behaviors Among Colombian Adolescents
Brook, D. W., Brook, J. S., Pahl, T., & Montoya, I. D. (2002) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpedi.156.11.1101 · Cited by 63
Cognitive Mediation of Women's Sexual Decision Making: The Influence of Alcohol, Contextual Factors, and Background Variables
Norris, J., Masters, N. T., & Zawacki, T. (2004) · Annual Review of Sex Research · doi:10.1080/10532528.2004.10559821 · Cited by 61
The effects of energy drink in combination with alcohol on performance and subjective awareness
Alford, C., Hamilton-Morris, J., & Verster, J. C. (2012) · Psychopharmacology · doi:10.1007/s00213-012-2677-1 · Cited by 62
Correlates of Incident Infections for HIV, Syphilis, and Hepatitis B Virus in A Cohort of Men Who Have Sex with Men in Beijing
Li, D., Jia, Y., Ruan, Y., Liu, Y., Li, Q., Liang, H., Zhou, Z., Luo, F., Zhang, X., Jiang, S., et al. (2010) · AIDS Patient Care and STDs · doi:10.1089/apc.2010.0083 · Cited by 57
“45,46 These reports are consistent with the ﬁndings in this study and suggest that the intervention efforts targeted at MSM also need to directly address the use of alcohol in China.”
The epidemiology of alcohol consumption in Ethiopia: a systematic review and meta-analysis
Ayano, G., Yohannis, K., Abraha, M., & Duko, B. (2019) · Substance Abuse Treatment Prevention and Policy · doi:10.1186/s13011-019-0214-5 · Cited by 59
The Association Between Sexual Aggression and HIV Risk Behavior in Heterosexual Men
Peterson, Z. D., Janssen, E., & Heiman, J. R. (2009) · Journal of Interpersonal Violence · doi:10.1177/0886260509334414 · Cited by 57
Acute Alcohol Consumption Directly Increases HIV Transmission Risk: A Randomized Controlled Experiment
Shuper, P. A., Joharchi, N., Monti, P. M., Loutfy, M. R., & Rehm, J. T. (2017) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000001549 · Cited by 60
Alcohol Use and Sexual Risk Taking Among Hazardously Drinking Drug Injectors Who Attend Needle Exchange
Stein, M. D., Anderson, B. J., Charuvastra, A., & Friedmann, P. D. (2001) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.2001.tb02151.x · Cited by 56
Alcohol use and extramarital sex among men in Cameroon
Kongnyuy, E. J., & Wiysonge, C. S. (2007) · BMC International Health and Human Rights · doi:10.1186/1472-698x-7-6 · Cited by 55
“Most research on the relationship between alcohol use and sexual behaviour has been largely limited to developed countries [9-11], with few studies conducted in subSaharan Africa [12-14].”
Alcohol misuse, sexual risk behaviour and adverse sexual health outcomes: evidence from Britain's national probability sexual behaviour surveys
Aicken, C. R. H., Nardone, A., & Mercer, C. H. (2010) · Journal of Public Health · doi:10.1093/pubmed/fdq056 · Cited by 53
Condom use with a casual partner: What distinguishes college students' use when intoxicated?
Abbey, A., Parkhill, M. R., Buck, P. O., & Saenz, C. (2007) · Psychology of Addictive Behaviors · doi:10.1037/0893-164x.21.1.76 · Cited by 53
“Many researchers became pessimistic about the usefulness of alcohol interventions when later methodologically rigorous studies demonstrated that the relationship between alcohol consumption and risky sexual behavior was more complicated than first thought (Halpern-Felsher et al., 1996; Weinhardt & Carey, 2000).”
Background
Risky Drinking, Risky Sex: A National Study of New Zealand University Students
CONNOR, J. L., Psutka, R., Cousins, K., Gray, A. R., & Kypri, K. (2013) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.12175 · Cited by 52
Especially for Daughters: Parent Education to Address Alcohol and Sex-Related Risk Taking Among Urban Young Adolescent Girls
O’Donnell, L. N., Myint‐U, A., Durán, R., & Stueve, A. (2010) · Health Promotion Practice · doi:10.1177/1524839909355517 · Cited by 51
Trends in Sexual Risk Behaviors, by Nonsexual Risk Behavior Involvement, U.S. High School Students, 1991–2007
Santelli, J. S., Carter, M. W., Orr, M., & Dittus, P. (2008) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2008.08.020 · Cited by 50
“behaviors is based on a substantial body of literature that documents significant associations among various risk behaviors in adolescent populations [7–12].”
Background
Psychological and behavioural factors associated with sexual risk behaviour among Slovak students
Kalina, O., Gecková, A. M., Jarčuška, P., Orosová, O., van Dijk, J. P., & Reijneveld, S. A. (2009) · BMC Public Health · doi:10.1186/1471-2458-9-15 · Cited by 50
Factors Associated With the Sexual Behavior of Canadian Aboriginal Young People and Their Implications for Health Promotion
Devries, K. M., Free, C., Morison, L. A., & Saewyc, E. (2009) · American Journal of Public Health · doi:10.2105/ajph.2007.132597 · Cited by 47
Alcohol use and HIV risk behaviors among HIV-infected hospitalized patients in St. Petersburg, Russia
Krupitsky, E. M., Horton, N. J., Williams, E. C., Lioznov, D. A., Kuznetsova, M., Zvartau, E. E., & Samet, J. H. (2005) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2005.01.015 · Cited by 49
“Several studies have demonstrated that people with heavy alcohol use tend to engage in riskier behaviors, such as sex with multiple partners, unprotected vaginal and anal intercourse, and injection drug use (Bagnall et al., 1990; Fenaughty and Fisher, 1998; Halpern-Felsher et al., 1996).”
Background
A cluster‐randomized controlled trial evaluating the effects of delaying onset of adolescent substance abuse on cognitive development and addiction following a selective, personality‐targeted intervention programme: the Co‐Venture trial
O’Leary-Barrett, M., Mâsse, B. R., Pihl, R. O., Stewart, S. H., Séguin, J. R., & Conrod, P. (2017) · Addiction · doi:10.1111/add.13876 · Cited by 55
Sexual Risk-Taking Behaviors, Gambling, and Heavy Drinking Among U.S. College Athletes
Huang, J., Jacobs, D. F., & Derevensky, J. L. (2009) · Archives of Sexual Behavior · doi:10.1007/s10508-009-9521-7 · Cited by 47
“Of particular interest and relevance to the current study is that alcohol use, especially HED, has also been documented in numerous studies to be related to unplanned/unprotected sex and having multiple sex partners in the adolescent and college student populations ( Halpern-Felsher, Millstein, & Ellen, 1996; Hingson,…”
Background
Adverse Adolescent Reproductive Health Outcomes After Pelvic Inflammatory Disease
Trent, M., Haggerty, C. L., Jennings, J. M., Lee, S., Bass, D. C., & Ness, R. B. (2011) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/archpediatrics.2010.256 · Cited by 47
“These findings may reflect the highly contextual and evolving nature of condom use based on relationship status.(16,17) Recent studies have suggested that reports of unprotected vs protected sexual intercourse do not correlate well with the presence of semen biomarkers in adult women.”
Relationship Between Methamphetamine Use and Risky Sexual Behavior in Adolescents
Yen, C. (2004) · The Kaohsiung Journal of Medical Sciences · doi:10.1016/s1607-551x(09)70101-9 · Cited by 45
“studies have shown a positive relationship between alcohol and risky sex in first-time sexual encounters [5].”
Background
Contraceptive adherence among women Veterans with mental illness and substance use disorder
Callegari, L. S., Zhao, X., Nelson, K. M., & Borrero, S. B. (2015) · Contraception · doi:10.1016/j.contraception.2015.01.013 · Cited by 45
“While our findings are consistent with a growing body of literature in the general population linking mental illness to inconsistent contraceptive use [24,25,31–34], prior studies among Veterans report conflicting findings [21,22].”
Result
Non-use of contraception: determinants among Ugandan university students
Mehra, D., Agardh, A., Petterson, K. O., & Östergren, P. (2012) · Global Health Action · doi:10.3402/gha.v5i0.18599 · Cited by 45
Alternative methods in the investigation of adolescents’ sexual life
Michaud, P., Narring, F., & Ferron, C. (1999) · Journal of Adolescent Health · doi:10.1016/s1054-139x(98)00158-x · Cited by 45
Brief motivational intervention to reduce alcohol and HIV/sexual risk behavior in emergency department patients: A randomized controlled trial.
Monti, P. M., Mastroleo, N. R., Barnett, N. P., Colby, S. M., Kahler, C. W., & Operario, D. (2016) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000097 · Cited by 44
Alcohol and Risky Behaviors
Corte, C. M., & Sommers, M. S. (2005) · Annual Review of Nursing Research · doi:10.1891/0739-6686.23.1.327 · Cited by 42
Risk Perceptions, Condom Use, and Sexually Transmitted Diseases Among Adolescent Females According to Social Network Position
Bettinger, J. A., Adler, N. E., Curriero, F. C., & Ellen, J. M. (2004) · Sexually Transmitted Diseases · doi:10.1097/01.olq.0000137906.01779.55 · Cited by 43
Self-citation

Authors: Halpern-Felsher, B. L., Millstein, S. G., & Ellen, J. M.
Affiliations: University of California, San Francisco (US)
ORCID: Ellen, Jonathan M.
Venue: Journal of Adolescent Health
Publisher: Elsevier BV
Published: 1996-11
Volume: 19
Issue: 5
Pages: 331-336
ISSN: 1054-139X (ISSN-L)
DOI: 10.1016/s1054-139x(96)00024-9
OpenAlex: W2034597056
Cited by: 241
References: 42
Citations by year: 2025: 2 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 4 · 2019: 6 · 2018: 8 · 2017: 10 · 2016: 8 · 2015: 20 · 2014: 12 · 2013: 12 · 2012: 15
FWCI: 1.19
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Adolescent Health (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (5r01aa009185-03)
U.S. Public Health Service (MCJ000978A)
National Institute on Alcohol Abuse and Alcoholism (R01 AA09185)
National Institute of Allergy and Infectious Diseases (AI-3499)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Adolescent Sexual and Reproductive Health
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
Keywords: adolescent alcohol use, sexual risk behavior, condom use, event analysis, sexual relationships, confounding
MeSH terms: Adolescent, Adolescent Behavior, Alcohol Drinking, Humans, Research Design, Risk Factors, Risk-Taking, Sexual Behavior, Sexual Partners, Time Factors, Condoms

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Relationship of alcohol use and risky sexual behavior: A review and analysis of findings

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