Young Adult Nightclub Participants Who Attend Adult Entertainment Clubs: Sexual Risk and Substance Use Behaviors

Abstract

This secondary analysis of cross-sectional baseline data from an intervention trial study examines demographics, sexually transmitted infection (STI) history, substance use and sexual risk behaviors among young adult nightclub participants who do (n=79) and do not (n=419) frequent “strip” or adult entertainment clubs (AECs) in Miami, Florida. AEC patrons were older (p=.003), and more likely to identify as Black race (p<.001), and report STI history (p<.005). Compared to those who do not, AEC patrons also reported greater recent (past 90-day) frequencies of alcohol (p=.029) and ecstasy (p<.001) use, higher numbers of recent sex partners (p=.043) and were more likely to report recently being high during sex a majority of the time (p=.031). Increased HIV/STI prevention efforts among young adult AEC patrons appear warranted.

Introduction

Popularly known as “strip clubs,” adult entertainment clubs (AECs) are venues in which performers exhibit nudity to facilitate social and economic exchange with customers [1]. Research examining AECs has predominately focused on women dancers and documented elevated reports of substance use and increased risk for HIV or other sexually transmitted infections (STIs) [2–5].

Literature describing AEC patrons is limited. However, sociological studies describe AECs as environments in which patrons can express sexual desires, present facets of their personalities which are typically hidden, and act in ways that would be considered deviant in other contexts [6]. Additionally, AECs provide patrons with a leisure activity that allows for fantasy fulfillment and relative protection from police enforcement of illegal activities [7]. The pursuit of sex is also prevalent [1,6,7].

AECs serve as recreational spaces in which alcohol and drugs are accessed and consumed [8] and risky sexual behaviors are common [2, 3]. As such, AECs may be similar to other nightlife venues in which the consumption of alcohol and other drugs is related to the environmental context and associated sensations and experiences [9]. Nightlife venues, including bars, nightclubs, and electronic dance music parties, are known risk environments [10–12], especially for young adults in the club scene who report myriad poor health outcomes related to substance use and sexual behaviors [13].

Despite this context, literature examining sexual and other risk behaviors among AEC patrons is scant. The present study examines demographics, STI history, substance use and sexual risk behaviors among young adult nightclub participants who do and do not frequent AECs in Miami, Florida.

Methods

Participants and procedures

Data are drawn from baseline assessments of a behavioral substance use and sexual risk reduction intervention trial that was designed for young adults in the club drug scene. The primary outcomes and detailed methods and procedures of the trial are published [13]. The protocol is registered with ClinicalTrials.gov #NCT01362634. A total of 498 participants completed comprehensive health and social risk assessments and were included in analyses. All participants were between the ages of 18–39 and met the same past 90-day eligibility criteria: 1) sex with a partner of a different gender; 2) use one or more club drugs (defined as powder cocaine, ecstasy, GHB, methamphetamine, ketamine, and LSD) at least three times; 4) non-medical use (e.g., use for fun, to relax, get high, or come down from another substance) of one or more psychoactive prescription medications at least once; and 5) regular attendance (i.e., once or more per month) at large recognized local nightclubs. Eligibility was restricted to men and women who reported sex with a partner of a different gender so that the sexual risk reduction components of the intervention could be carefully targeted and meaningful to participants. Individuals who also reported sex with a person of the same gender were not excluded from the study.

Recruitment

Participants were recruited through respondent-driven sampling (RDS) [14], a form of chain referral sampling, which has been shown to quickly reduce sources of respondent bias (such as age, race/ethnicity, gender, and drug of choice) as successive branches or waves of respondents are enrolled and then solicited for additional contacts [14, 15]. In this study, initial respondents (“seeds”) were recruited through outreach at local nightclubs and existing contacts in the club scene. Each seed and subsequent study participant was provided with recruitment coupons to give to other club drug users in their social network, with the understanding that they would earn $50 for the recruitment of each additional eligible respondent. Each respondent/recruiter was limited to five coupons to prevent a few participants with large social networks from biasing the overall sample toward those with similar demographic and drug using profiles (homophily) [14].

Informed consent was obtained from all participants prior to study participation. Participants were given a $50 stipend for their time and travel expenses following the interview. This study was approved by the Nova Southeastern University Institutional Review Board.

Measures

Baseline assessments were primarily comprised of the Global Appraisal of Individual Needs (ver. 5.4) [16], which has several core sections (background, substance use, physical health, sexual behaviors, mental health, victimization, criminal justice involvement, and education/work/financial situation), with each section containing questions on the recency of problems, breadth of symptoms and recent (past 90-day) and past-year prevalences in days or times.

Demographics

Demographic measures included age, years of education, gender, race/ethnicity, sexual orientation, and history of sexually transmitted infections (i.e., syphilis, gonorrhea, and chlamydia). Race/ethnicity was assessed by asking participants if they identified as Hispanic or Latino, followed by what race they consider themselves to be.

Substance use

Recent frequencies of substance use, in days (range 0-90), were assessed by asking, “In the past 90 days, since [anchor point], how many days have you used [substance]”.

Sexual behaviors

Participants were asked to report the number of recent sexual partners. Recent condomless vaginal sex frequencies were assessed with the questions, “In the past 90 days, how many different times have you had vaginal sex?” and “Of those ‘X’ times you had vaginal sex, how many times was it without a condom even if for only part of the time, like starting without one or taking it off before finishing?” The same questions were repeated for anal sex. We also asked whether, during the past 90 days, a participant had bought sex, (i.e., “use money or drugs to purchase or get sex”), traded sex (i.e., “have sex to get drugs, gifts, or money”), or had sex with a person who injects drugs, all coded yes vs. not. Being high during sex was assessed with the question, “How often in the past 90 days were you ‘high’ on either alcohol or drugs when you were having sex with another person?” Responses were based on a five-point scale ranging from “never” to “almost all the time.” For analysis, this measure was dichotomized into being “high during sex half the time or more” versus not.

AEC participation

Participants who reported an AEC in their top three most frequented clubs were coded as “AEC patron” versus not.

Method of Analysis

To compare AEC patrons (n=79) and non-patrons (n=419), analysis of variance (ANOVA) tests were used to examine continuous variables and bivariate regression models were constructed to examine dichotomous measures. Presentation of findings include means and standard deviations (SD) or odds ratios (OR) and test statistics. Statistical inferences were based on a type I error rate of 0.05. All analyses were conducted using IBM SPSS Statistics ver. 27.

Results

The sample profile (N=498) is shown is Table I. The mean age was 25 years; slightly less than half of the sample was female (44.6%), and a majority completed 12 or more years of education (84.7%). The sample include participants who identified as Hispanic (64.3%), African American/Black (20.9%), White (12%), and other race/ethnicity (2.8%). Heterosexual identity was reported by 78.3% of the sample.

Table I:

Profile of the study sample

	M	(SD)	N	%
Age	25.3	(5.413)
Education (≥12 years)			422	84.7%
Women			222	44.6%
Race/ethnicity
Hispanic			320	64.3%
African American/Black			104	20.9%
White			60	12.0%
Other race/ethnicity			14	2.8%
Sexual identity
Heterosexual/straight			390	78.3%
Bisexual			94	18.9%
Homosexual/gay			11	2.2%
Other sexual identity			3	.6%

Nearly 16% of participants reported recent and frequent AEC patronage. Table 2 shows that AEC patrons were older (26.90 years vs. 24.86 years, F=8.664, p=.003), more likely to be African American/Black (OR=7.010, p<.001), and less likely to be Hispanic (OR=.272, p<.001). Compared to others, AEC patrons were more than twice as likely to report a history of STI (OR=2.337, p<.011), greater recent frequencies of days using alcohol (53.10 days vs. 46.20 days, F=4.767p<.029) and ecstasy (38.97 days vs. 28.46 days, F=13.046, p<.001), and more than twice the odds of being high during sex a majority of the time during the past 90 days (OR=2.163, p=.031). Mean number of recent sex partners was also higher among AEC patrons (9.96 partners vs. 6.60 partners, F=4.099, p=.043).

Table II:

Bivariate logistic regression and ANOVA models of demographics, STI history, substance use, and sexual risk behaviors associated with AEC patronage among young adult nightclub participants (N=498)

	Bivariate regressions models							ANOVA
	AEC patrons (N=79)		Non-patrons (N=419)		OR	95% CI	P	AEC patrons (N=79)		Non-patrons (N=419)		F	P
	N	%	N	%				M	SD	M	SD
Demographics and Background
Age								26.90	(4.994)	24.86	(5.439)	8.664	0.003
Education (≥12 years)	65	82.3%	357	85.2%	0.806	0.426, 1.525	0.508
Women	41	51.9%	181	43.2%	1.419	0.876, 2.297	0.155
Hispanic	30	38.0%	290	69.2%	0.272	0.165, 0.449	<0.001
African American/Black	43	54.4%	61	14.6%	7.010	4.170, 11.784	<0.001
White	5	6.3%	55	13.1%	0.447	0.173, 1.155	0.096
Other race/ethnicity	1	1.3%	13	3.1%	0.399	0.052, 3.097	0.038
Heterosexual identity	59	74.7%	331	79.0%	0.784	0.448, 1.372	0.394
STI history	19	24.1%	50	11.9%	2.337	1.290, 4.235	0.005
Days Substance Use 1
Alcohol								53.10	(26.482)	46.20	(25.644)	4.767	0.029
Marijuana								63.81	(31.866)	62.24	(32.249)	0.158	0.691
Cocaine (powder)								35.91	(27.815)	31.37	(26.108)	1.965	0.162
Crack cocaine								5.77	(17.169)	7.06	(17.931)	0.347	0.556
Ecstasy								38.97	(25.119)	28.46	(23.477)	13.046	<0.001
LSD								5.86	(13.672)	6.29	(12.615)	0.076	0.783
Hallucinogens								8.38	(18.367)	7.75	(14.949)	0.108	0.743
Methamphetamine								3.23	(11.883)	4.84)	14.503	0.864	0.353
GHB								3.37	(13.001)	2.74	(10.859)	0.209	0.648
Heroin								7.61	(21.095)	6.96	(20.462)	0.067	0.797
Rx benzodiazepines								35.34	(28.726)	34.92	(30.541)	0.013	0.909
Rx opioids								37.46	(26.283)	31.32	(29.397)	2.988	0.085
HIV/STI Risk Behavior
Number of sex partners1								9.96	(22.465)	6.60	(11.095)	4.099	0.043
Condomless vaginal sex times1								39.13	(31.879)	43.24	(56.549)	0.393	0.531
Condomless anal sex times1								11.44	(16.192)	10.17	(22.534)	0.094	0.760
Buy sex2					1.679	0.858, 3.286	0.131
Trade/sell sex2					1.654	0.879, 3.115	0.119
Sex with a person who injects drugs2					0.718	0.313, 1.646	0.433
High for sex ≥ half the time1					2.163	1.074, 4.357	0.031

¹past 90 days;

²past year

Discussion

Media reports suggest that in recent years, due to declining customers and profits, AECs have attempted to appeal to new, younger clientele by incorporating new technologies and musical acts [17, 18]. Miami, a city with a long history of trend-setting nightlife, has a number of AECs that include 24-hour nightclubs featuring DJs and dancing, in addition to women performers [19]. Thus, in Miami and elsewhere, it appears that the culture inside of these venues is changing and young adult clientele may experience novel substance use and sexual environments that entail greater health risks compared to traditional nightclub venues.

This study documented an emerging trend of AEC patronage among a sample of young adults. Findings indicate higher AEC patronage among African American/Black individuals, compared to other race/ethnicities. AEC patrons also report increased STI history and greater frequencies of alcohol and ecstasy use, and being high during sex., as well as more sex partners. Literature describing substance use and sexual behaviors among AEC patrons is scant, however these results cohere with similar findings from other samples of nightlife participants [10–12], and African Americans who report the use of ecstasy and sexual risk taking [20]. Substance use and risky sexual behaviors reported by AEC patrons indicates that these participants are placing themselves and others at elevated risk for HIV/STI infection. Considering the high levels of substance use, risky sexual behaviors and other health and social problems experienced among this sample [13], the heightened vulnerabilities of young adult AEC patrons is concerning.

It is notable that women and individuals who do not identify as heterosexual also attended AECs. However, nightlife environments function as settings for leisure activities, socialization, and even acquisition of social capital [21]. When combined with novel marketing and entertainment offerings, the demographic diversity of AEC patrons reported here appears to be representative of the changing nature of these venues.

Some limitations should be noted. The ability to generalize the findings to other young adults is limited by the study eligibility requirements, and the high frequencies of reported risk behaviors and health and social problems among the sample. Analyses included many relevant items related to behavioral risks associated with AEC participation, and no correction for multiple comparisons were made. All data are based on self-report.

Despite these limitations, the findings from this study illustrate a novel trend among young adults in the nightclub scene. Future research should examine AECs as risk environments in more depth to better understand motivations for AEC participation among young adults, as well as experiences inside of clubs. Subsequent findings would inform prevention and intervention efforts that target substance use and risky sexual behaviors in these settings.

Availability of data and material:

Data are available by request.