This article was updated at 11:46 am, Sunday, December 22nd, 2013 to correct several editorial errors.
Use of alcohol is often cited as a major factor in sexual risk-taking and sexual intercourse especially among college students. A new study, however, turns this assumption on its head, finding high rates of protected sex using condoms among college-age women. The type of sexual partner and young women’s expectations of how alcohol affects their decisions have much more to do with their decision about about condom use than whether they were drinking or even how much they drank.
These researchers chose only to study women because they wanted to look beyond gender differences and do a systematic analysis of what affects young women’s sexual decisions. It’s worth noting that the study does not suggest that women are on their own in the choice to either get drunk or use condoms. Obviously young men were involved in each of the acts of intercourse reported in the study, and they too were (or should have been) part of the decision-making process. It goes without saying that all efforts to increase condom use—irrespective of whether the participants are drunk or sober—should be aimed at both men and women.
Now, back to the study at hand. The year-long research project followed some 500 young women in their first year at a university in the Northeast. Researchers asked them about a variety of health behaviors, including substance use, diet, exercise, sleep, and sexual behavior, as well as psychosocial adjustment. Researchers focused on students who had had sexual intercourse at least once during their first year in school. In monthly surveys, students were asked about their most recent experience of vaginal or anal intercourse, including what their relationship with the partner was like, how long they’d been in the relationship, how much alcohol, if any, they had consumed before having sex, if they’d smoked marijuana beforehand, and if they used a condom or any other birth control method. Participants were also asked how often they consumed more than four drinks at a time (categorized as heavy episodic drinking) and how often they smoked marijuana. Finally, researchers used a variety of scales to measure participants’ expectations relating to alcohol and sexual risk, and their level of impulsive behavior.
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The results are based on responses from 297 women and 1,856 reports of intercourse. (Since women were only asked about the two most recent events in a given month, each participant could report on no more than 24 events total.) Despite all of the focus on binge drinking on college campuses, only 20 percent of the events involved any drinking, only 13 involved heavy episodic drinking, and only six percent involved marijuana use. While this study looked to analyze these events in much more detail, I think it’s important for us to take a moment to note that most sex among these first year students happened largely without the influence of alcohol or pot.
Use of substances preceding or during intercourse was much higher with new partners than established partners. In particular, alcohol use was more common with relatively unknown casual partners (acquaintances and strangers) than with friends, and more common with friends than with ex-boyfriends. Marijuana use, however, did not differ across casual partner types.
The participants used condoms in 61 percent of act of intercourse reported. Condom use was less common when intercourse involved romantic partners (58 percent) than with casual partners (72 percent). Specifically, women were least likely to use condoms with established romantic partners (55 percent) and most likely to use them with friends (74 percent) and acquaintances (79 percent). This is not surprising, as many women switch from condoms to other long-term methods of contraception as relationships become more serious.
What may be surprising, however, is that drinking in and of itself did not affect condom use. In fact, when researchers looked only at the relationship between alcohol and condoms, they found that events involving alcohol were more likely to involve condoms. Condoms were used in 70 percent of events involving drinking and 59 percent of events that did not involve alcohol. This does not mean, however, that tipsy girls are more likely to reach for the rubber. It goes back to relationship type—both condoms and alcohol are more likely to be used with casual partners.
There are two prevailing theories about how alcohol affects sexual decision making. The first is called “alcohol myopia theory.” (Yes, researchers have basically turned “beer goggles” into a legitimate topic of academic study.) As the authors explain it, this theory suggests that alcohol changes the way we process information. We can still process cues such as arousal that make us want to have sex, but we can’t adequately think through those more complex ideas such as the possibility of sexually-transmitted infections or the fear of future rejection that might make us more cautious. Under this theory, women would be less likely to use condoms if they were drinking alcohol. The recent study, however, found otherwise:
After controlling for partner type, we found no associations between drinking and condom use, contrary to what might be predicted by alcohol myopia theory. Even in situations involving heavy drinking (four or more drinks), during which we might expect disinhibition to lead to decreases in safe-sex behavior, we found no evidence of decreased condom use across this sample of women.
The researchers did find, however, that in events during which women did use alcohol, condom use decreased as the number of drinks increased. They concluded that only extremely high levels of drinking reduce the probability of condom use.
There is a second theory about alcohol and sex that the findings of this study support. Expectancy theory says that the behavior of individuals after drinking is driven by their beliefs about alcohol’s effects on behavior. Essentially, how you behave while drunk is a self-fulfilling prophecy—if you think you are going to take more sexual risks because of alcohol, you probably will. Researchers used a six-point scale to measure women’s expectations and found that those women who believed alcohol use increased sexual risk-taking were somewhat less likely to use condoms in events involving alcohol. This suggests we need to address expectations with women before they drink.
In my peer sex educator days, I wrote a workshop called Bedspins, which explored sex and alcohol. The basic premise was: We’re not going to tell you not to drink, we’re not going to tell you not to have sex, and we’re not even going to tell you not to drink and have sex at the same time, but you do have to think about it, preferably before you get blitzed. In one of the activities, I handed out index cards with either an S (sober) or D (drunk) on the back and had participants finish this sentence based on their assigned sobriety or lack thereof: “On Friday night I went to this party and met this really cute guy/girl. We started talking, and ____.” Not surprisingly, people were more likely to end the story with sex if they thought they were drunk at the time. I always liked to sneak in one card about mind-blowing sober sex just to buck expectations. This was 20 years ago, but clearly we still need to challenge the same assumptions because whether it is serving as a motivator of risky behavior or an after-the-fact excuse for it, expectations set the stage for actions.
That said, the researchers noted that in their sample of college-age women, “strong alcohol-sexual risk expectancy beliefs were relatively uncommon.” Only 13 percent of women in the study scored above a three on the six-point scale.
I think there’s a lot of good news in this study. For the most part sex was happening without alcohol and with a condom. Condoms were also more likely with new or casual partners, which seems to suggest that when women do forgo them it is part of a conscious decision based on the state of their relationship and possibly other birth control methods. Given the high rates of serial monogamy in college, however, I might suggest even more condom use, but in general I think this study gives us a view of young women making responsible sexual decision and I hope we all give them credit for it.