Daily associations of alcohol use with sexual behavior and condom use during spring break

Abstract

Introduction and Aims

Spring Break is associated with high levels of alcohol use and related consequences, and with risky sexual behavior, among North-American college students. However, the extent to which Spring Break drinking and sexual behaviors are related has not been well-documented.

Design and Methods

Undergraduate students (n = 263) were surveyed prior to and immediately after Spring Break, including retrospective reports of daily behavior for each day of Spring Break.

Results

Hierarchical linear modeling was used to predict penetrative sex and condom use. Binge drinking on a day was associated with a greater likelihood of penetrative sex and of condom use, moderated by relationship status. Binge drinking led to a greater increase in penetrative sex among single students. Single students were more likely to use condoms after drinking; those in a relationship were less likely to use condoms after drinking.

Discussion and Conclusions

Single college students are more likely to have sex after binge drinking on Spring Break, but also more likely to use condoms after drinking, than students in a relationship. Intervention efforts may need to acknowledge relationship status.

Spring Break is associated with peak levels of alcohol use, including binge drinking [1-3], for North-American college students. These behaviors lead to consequences including hangovers, vomiting, passing out, injuries and regrettable sexual situations, with data showing that typically lighter-drinking students face a particularly high risk [4]. Spring Break trips are an especially high-risk context, with students engaging in more alcohol use and sexual behavior on days they are on Spring Break trips, compared to Spring Break days they are not on trips with their friends [5]. Primary motives for going on Spring Break include opportunities for drinking and sex, and students report sexual behavior as a result of drinking during Spring Break [6-8]. Spring Break is associated with permissive sexual norms and behaviors [9,10], and condom use is reportedly rare [6,8]. However, available evidence for the links between alcohol and sexual behavior comes from cross-sectional or pre-post designs that do not include measurement of dayto-day covariations in the behaviors.

Methods

Participants and Procedures

Participants were college students (n = 263; 55% women) who were screened into the Spring Break Behavior and Health study [5]. Eligible students were: (i) 18-21 years old; (ii) planning to go on a Spring Break trip; and (iii) willing to be contacted. Eligible students (n = 320) were mailed a pre-notification letter and emailed a link to a web survey (Wave 1), with a response rate of 84% (n = 270). At Wave 2, 97% of students provided data (N_people = 263), including reports of behavior during each of the 10 days of Spring Break (N_days = 2569). The Spring Break Behavior and Health study was designed to test a brief web-based intervention, prior to Spring Break, to reduce alcohol use and risky sexual behaviors. Students were randomly assigned to intervention and control groups. In the present analyses intervention is a control variable.

Measures

Within-person measures were available for each day of Spring Break (10 days total) and used as Level 1 predictors and dependent variables in the hierarchical linear models.

To assess Spring Break Trip, participants reported where they spent each night of Spring Break. Spring Break trip with friends was coded as 1; all else was coded as 0.

Sexual Behavior was assessed for each day [had penetrative (i.e. vaginal or anal) sex = 1, did not = 0). On days students reported having sex, they were asked if they used a condom every time they had penetrative sex that day (0 = no, 1 = yes).

Students were asked about alcohol use for each day as the number of standard drinks consumed. Binge drinking was defined as 4+ drinks for women and 5+ drinks for men.

Between-persons (Level 2) predictors included gender (male = 1, female = 0) and relationships status, with 0 = “I am not dating anyone right now” and 1 = in a casual or serious relationship.

Plan of Analysis

Two hierarchical linear models document associations between binge drinking and sexual behaviors, using a Bernoulli distribution for dichotomous dependent variables. Between-persons predictors were gender, person-mean binge drinking across days (calculated for each person to isolate the effect of drinking on a given day), person-mean number of days spent on a Spring Break trip (to isolate the effect of being on a trip on a given day), and relationship status. Within-person predictors were whether they were on a Spring Break trip that day and whether they engaged in binge drinking that day, as well as whether binge drinking that day was moderated by relationship status.

Results

Descriptive statistics are shown in Table 1. Hierarchical linear models results are shown in Table 2. Of all Spring Break days, 6% were days on which participants had sex. Participants used condoms on 55% of days they had sex. Between-persons (i.e. on average over days), average level of binge drinking, and average trip days were not significantly associated with sexual behavior or condom use. Men and students who were in a dating relationship were more likely to report having sex, but there were no differences in condom use during Spring Break. Within-person, being on a trip that day was associated with more sexual behavior but there were no differences in condom use. Binge drinking that day was associated with a greater likelihood of penetrative sex and of condom use. The effects of binge drinking on a given day were moderated by relationship status. Binge drinking led to a greater increase in penetrative sex among single students. Students who were in a relationship were less likely to use condoms after drinking; single students were more likely to use condoms after drinking.

Table 1.

Descriptive statistics of daily sexual behaviors and binge drinking during Spring Break

	M (SD)	Range	n
Between-Persons (Level 2)
Male gender	0.44 (0.50)	0-1	263
Person mean binge days	0.19 (0.25)	0-1	263
Person mean trip days	0.38 (0.35)	0-1	263
In a dating relationship	0.47 (0.50)	0-1	263
Within Person (Level 1)
Days on a trip	0.37 (0.48)	0-1	2590
Binge drinking	0.18 (0.39)	0-1	2573
Sexual behavior	0.06 (0.24)	0-1	2594
Condom use	0.55 (0.50)	0-1	164

Note: Person mean binge days and person mean trip days represent the average proportion of days students reported engaging in binge drinking and being on trips, respectively.

Table 2.

Multilevel models predicting sexual behavior and condom use by binge drinking during Spring Break

	Sex OR [CI]	Condom use OR [CI]
Average over days intercept, β0	0.00 [0.000, 0.001]***	1.28 [0.023, 71.6]
Male gender, γ01	2.14 [0.867, 5.26]†	1.79 [0.112, 28.7]
Intervention, γ02	1.78 [0.703, 4.53]	0.17 [0.011, 2.53]
Average binge drinking, γ03	1.21 [0.084, 17.4]	0.14 [0.000, 103]
Average trip days, γ04	1.76 [0.305, 10.2]	3.37 [0.061, 186]
In a relationship, γ05	32.61 [10.18, 104]***	3.91 [0.104, 147]
Average fluctuations with trip, β1
Intercept, γ10	2.48 [0.892, 6.93]†	1.72 [0.732, 4.06]
Average fluctuations with binge drinking, β2
Intercept, γ20	13.20 [2.08, 83.9]**	9.13 [1.55, 54.0]*
In a relationship S1, γ21	0.08 [0.009, 0.758]*	0.00 [0.000, 0.017]***

Note: n = 263 people and n = 2569 days for sex; n = 52 people (i.e. only among those who had sex during Spring Break) and n = 161 days (i.e. only among days with sex) for condom use.

^†P < 0.10

^*P < 0.05

^**P < 0.01

^***P < 0.001

Discussion

Binge drinking is associated with both a greater likelihood of having sex and, among days students have sex, a greater likelihood of condom use. This effect is moderated by relationship status, such that binge drinking is associated with increases in sex and condom use only among students who do not report being in a dating relationship. These results suggest that single students are more likely to pair drinking and sex on Spring Break, which may mediate the effect of a Spring Break trip on sexual risk [5]. Single students may be more willing and prepared to use condoms, although they may also be more likely to have previously unknown partners, placing them at higher risk for sexually transmitted infections. Since barriers to condom use on Spring Break include alcohol, impulsivity and being unprepared [9], students with expectations of drinking-related sex with a new partner may be more likely to use condoms. The extent to which this generalises beyond Spring Break should be examined.

Situational and environmental characteristics influence behaviors, and students report that their behaviors are influenced by being in the atmosphere of Spring Break [6,9]. For example, students are more likely to have sex on days they are on trips than other days [5]. Specific norms for Spring Break, including permissive attitudes toward uncommitted sex [9,10], may provide an opportunity for interventions to support the social acceptability of buying and carrying condoms when intending to have sex. This may be a key strategy for interventions designed to reduce health risks associated with Spring Break and other high-risk events.