Mixed Drinks and Mixed Messages: Adolescent Girls' Perspectives on Alcohol and Sexuality

Abstract

Experimentation with alcohol and sexuality is a normative aspect of adolescent development. Yet both present distinct risks to adolescent females and are especially problematic when they intersect. Although youth are often cautioned about the dangers associated with having sex and using alcohol, popular entertainment media frequently depict the combination of alcohol and sexuality as carefree fun. It is unclear how adolescent females interpret these contradictory messages in their everyday lives. Focus group interviews were used to explore young women's understandings of the relation between alcohol and sexuality. Young women, ages 14–17 years (N = 97, 61% White), and their mothers were recruited through advertisements in local newspapers to participate in separate, simultaneous focus group interviews. Only data from the 15 daughters' groups are presented here. Qualitative analysis revealed that participants recognized the risks associated with combining alcohol and sex, yet they also perceived sexual advantages to drinking alcohol. Advantages included facilitating social and sexual interactions and excusing unsanctioned sexual behavior. Alcohol was also seen as increasing the likelihood of sexual regret and coercion through impaired judgment and self-advocacy abilities. Educational and prevention efforts need to consider adolescent developmental and social needs, as well as the influences of the larger cultural context in which youth function.

Sexual experimentation and exploration are normal and healthy aspects of adolescent development (e.g. Brooks-Gunn & Paikoff, 1997; Fortenberry, 2003; Tolman & McClelland, 2011; Welsh, Rostosky & Kawaguchi, 2000). Yet, despite its normative developmental function, adolescent sexual behavior is also often proscribed due to the potential for adverse, life-altering outcomes. During adolescence, young women are particularly vulnerable to a variety of serious sex-related dangers, including unplanned pregnancy, sexually transmitted infections (STIs), and sexual victimization. For example, young women ages 15–19 years-old report the highest rates of chlamydia and gonorrhea among American women in all age groups (Centers for Disease Control and Prevention, 2010), and 42% of rapes in the United States are perpetrated against young women under the age of 18 years (Black et al., 2011). Such statistics are alarming and warrant redress, yet it is equally important that responses accurately target the sources of sexual risk. Often, rates of negative sexual experiences are used to equate sexual behavior, especially that of adolescent females, with danger (Bay-Cheng, 2010). This generalization neglects the healthy potential of adolescent sexuality and deflects critical attention away from the circumstances and factors that attach undue risk to normative sexual behavior. Also neglected are the perspectives of adolescents themselves, including an understanding of the motives and beliefs that influence adolescent sexual decision making. Such an understanding is vital to promoting the development of healthy sexuality.

Risks of Combining Alcohol with Sexuality

Alcohol use in conjunction with sexual activity is one factor that has been consistently linked to increased sexual risk for adolescent females as well as adult women (e.g. Abbey, 2002; Champion et al., 2004; Cooper, 2002; Dunn, Bartee, & Perko, 2003). Studies indicate that when alcohol consumption and sexual interactions coincide, the risks of negative sexual outcomes often increase. Alcohol consumption prior to intercourse has been linked to risky partner choice and reduced discussion of protective behaviors (Cooper, 2002; Dunn et al., 2003). Among youth who are sexually inexperienced, alcohol use is associated with unplanned sexual activity, partners who are not well known, and decreased condom use (Cooper, 2002; Livingston, Testa, Hequembourg, & Windle, 2010; Poulin & Graham, 2001). Women's alcohol use has also been associated with sexual victimization, and drinking that leads to incapacitation renders women particularly vulnerable to sexual assault (see Abbey, 2002; Testa & Livingston, 2009; Testa & Parks, 1996 for reviews).

Adolescent females are highly vulnerable to alcohol-related sexual consequences due in part to their relative inexperience with alcohol and sex which renders them ill-equipped to recognize or extricate themselves from potentially risky sexual situations (Livingston, Hequembourg, Testa, & VanZile-Tamsen, 2007). Because both alcohol use and sex are unsanctioned for adolescents, these behaviors tend to be carried out in illicit contexts (e.g. at an unsupervised party). The lack of protective oversight and increased exposure to risky peers that characterize such contexts increase the likelihood of negative outcomes (Small & Kerns, 1993; Livingston et al., 2007). Although the risks associated with combining alcohol and sexual behaviors, especially for young women, are well-documented (e.g. Dunn et al., 2003), it is unclear to what extent adolescent females are aware of and understand these risks.

Contradictory Cultural Messages

Popular American discourses are simultaneously replete with documentation of the risks associated with sexual behavior and absent of attention to its positive potential and developmental purpose (Welsh et al., 2000). It is not surprising that under such circumstances, social institutions (e.g. family, school, church) and policies promote sexual abstinence among youth. These efforts often extend to restricting youths' access to sexuality-related material out of fear that exposure will be construed by youth as encouragement or tacit approval. Such practices also mean that adolescent females often approach their first sexual interactions and relationships with little factual knowledge and few opportunities to discuss and reflect on their experiences, desires, and expectations (Bay-Cheng, Livingston, & Fava, in press). Without access to diverse perspectives and supports, they may rely by default on traditional sexual scripts, gender stereotypes, media, and peer expectations to guide their behaviors (Brown & Keller, 2000; Impett, Schooler, & Tolman, 2006).

The disadvantage of relying on such sources of information is that they provide conflicting messages about female sexuality. For example, traditional gendered sexual norms cast adolescent females' sexuality as problematic and in need of social control (Bay-Cheng, 2003; Welsh et al., 2000), dictating that “good” girls stifle their own sexual interests and desires (Fine, 1988; Gavey, 2005; Holland, Ramazanoglu, Sharpe, & Thomson, 1994; Tolman, 2002). Young women (as well as adult women) are charged with the responsibility of being sexual gatekeepers and warding off sexual advances by men, who are cast as driven by irrepressible sexual urges (Gavey, 2005; Morokoff, 2000). Such norms presuppose female sexual urges to be of negligible magnitude and equate women's sexual abstinence with their moral fortitude and social worth. Accordingly, alcohol use by women is discouraged because it is believed to undermine their gate-keeping abilities by diminishing their capacity to discriminate among sexual partners, ward off sexual advances, and control their own sexual impulses (Plant, 1997).

In direct conflict with these expectations of sexual innocence, adolescent females also are bombarded with messages about how they can (and should) solicit and satisfy male sexual desire. The long-standing paradoxical expectations of resisting and complying with male sexual overtures are further complicated by popular “raunch culture” (Levy, 2005), in which women are depicted as wantonly and willfully sexual. As part of this culture, current trends in media portrayals of women have shifted from presenting women as passive sexual objects to ostensibly agentic sexual subjects: knowledgeable, sexy, and ready for sexual adventure (see Gill, 2008). Such portrayals are cast as reflecting women's sexual liberation, but at their core these media representations function as yet another strand of objectified, idealized female sexuality (Gill, 2008; Halliwell, Malson, & Tischner, 2011; Levy, 2005). The psychological toll taken by pressure to play the part of a “girl gone wild” for the pleasure of male observers (e.g. Yost & McCarthy, 2012) can manifest in body dissatisfaction and self-objectification (Halliwell et al., 2011), discomfort, and distress (Yost & McCarthy, 2012). Under such circumstances, the conventional notion of a “double bind” might be too simplistic a description of young women's entanglement within a complex knot of multiple, seemingly opposed normative injunctions: to abstain, to resist, to comply, to seduce, to express, to arouse, and to perform.

Although the meaning and ramifications of popular culture manifestations of female sexuality may be subject to debate (for example, see exchanges in the Journal of Sex Research Graham, 2009, vol 46, issue 4] and Sex Roles [Frieze, 2012, vol 66, issue 11–12]), there is no denying that alcohol is a common prop in these performances. Content analyses of youth-targeted entertainment (e.g. movies, television, and music) document the proliferation of alcohol and other drug use references and their frequent co-occurrence with representations of heterosexual interactions or sexualized images of women (Primack, Dalton, Carroll, Agarwal, & Fine, 2008). Popular culture narratives are often misleading in their neglect or underestimation of the risks involved in engaging in sexual behavior while intoxicated (Brown & Keller, 2000). Thus, whereas young women may be warned about the grave dangers of alcohol and sex separately, they are being simultaneously entertained and socialized by popular media accounts of fun-filled, alcohol-fueled sexual escapades. It is unknown how adolescent females receive and reconcile these two divergent messages: one that carries the gravity of statistics and foreboding and the other, with the allure of excitement and pleasure.

In light of the contradictory messages delivered to young women, it is important to understand how adolescents themselves view the relationship between alcohol and sexuality. Of the studies that have examined perceptions of alcohol and sexuality, most have involved college students and have focused on perceptions of sexual risk (e.g. Lindgren, Pantalone, Lewis, & George, 2009; Norris, Nurius, & Dimeff, 1996; Vander Ven & Beck, 2009). These studies have offered important insights into young adult women's expectations about and motives for combining alcohol and sex; however, the perceptions of college students likely differ from those of younger adolescents who have relatively less exposure to and experience with both alcohol and sex (see Young, Grey, Abbey, Boyd, & McCabe, 2008).

In one exception, Coleman and Cater's (2005) study focused on the role of alcohol in younger adolescents' sexual risk behavior. They asked adolescent males and females to provide detailed information about a sexual encounter that occurred while they were under the influence of alcohol. Adolescent females reported greater sexual risk and regret than did adolescent males, yet they also felt that alcohol excused indiscriminant and unprotected sexual behavior. This idea that alcohol might be used in a post-hoc (or even pre-meditated) manner to excuse certain behaviors has emerged repeatedly in the literature with college students (e.g. Lindgren et al., 2009; Vander Ven & Beck, 2009), and Coleman and Cater's findings suggest that, like college students, some adolescents may perceive a benefit from combining alcohol and sex. Unfortunately, however, little is known empirically about adolescents' perceptions of positive experiences associated with alcohol use and sex because prior research has focused predominately on investigating risk-related perceptions and outcomes among adolescents.

Goals of the Current Study

It is understandable that the preponderance of research regarding alcohol and sex is concentrated on identifying the attendant dangers, of which there are many—especially for adolescent females. Yet researchers must also contend with the possibility that adolescent females may not perceive these same behaviors as risky, and they may actually perceive possible benefits to combining alcohol and sexual activity, as well. Given their exposure to contradictory representations of the ramifications for women of combining sex and drinking (e.g. as courting sexual violation or as an expression of sexual liberation), our goal in the current study was to examine adolescent females' perceptions of the relation between alcohol use and sexual behavior. We were particularly interested in identifying gaps in their knowledge of alcohol-related sexual risk and in gaining insight into perceived motives or benefits associated with using alcohol in conjunction with sex.

The information gleaned from our study may be used both to identify and clarify common beliefs and misperceptions held by adolescent females regarding the intersection between alcohol and sexuality. Because the goal of our study was to understand how adolescent females view the complex relationship between alcohol and sexuality rather than to assess their individual experiences, we opted to use focus group interviews to explore participants' perceptions of these behaviors in their social networks. Compared with individual interviews, focus group interviews are particularly useful for studying social norms within a subculture, in this case the youth subculture (Wilkinson, 1999). Focus groups allow for relatively naturalistic opportunities to observe how youth make meaning through social exchange, as well as shift the balance of power from the researcher to the participants, giving participants a voice and shedding light on factors or processes that the researcher may not have previously considered (Morgan, 1996; Robinson, 1999; Wilkinson, 1999). Focus group interviews also are useful for eliciting a multiplicity of views within a group context, thereby providing insights into complex behaviors, underlying assumptions, and motivations (Morgan, 1996; Robinson, 1999; Wilkinson, 1999). These insights emerge when group members question each other and explain themselves, affording the researcher a unique opportunity to observe points of consensus and contention (Morgan, 1996).

In order to develop successful interventions, practitioners need a clear understanding of the full range of misconceptions, knowledge gaps, motives, and needs of the target group. These factors must then be addressed so that the target audience has the appropriate resources needed to make informed decisions (Bruine de Bruin, Downs, & Fischhoff, 2007; Downs & Fischhoff, 2009). Focus groups provide a valuable research tool to investigate these factors, particularly among socially under-represented groups such as adolescent females, and provide culturally-relevant data to inform future prevention efforts.

Method

Participants

Participants were 97 adolescent females, ages 14–17 years-old (M = 15.23, SD = 1.10), residing in a medium-sized city in the northeastern United States. Participants were recruited from advertisements in local community newspapers seeking adolescent females and their mothers “for research on teen behavior.” The advertisement indicated that eligible mother-daughter pairs would be invited “to participate in separate, simultaneous focus groups to discuss their views and opinions of teen risk behavior.” Eligible adolescents were required to reside in the same household as their mother at the time of the study in order to ensure that both would be amenable and available to participate in the larger study. Both mother and daughter had to agree to participate. Because of our interest in understanding dominant social views on this topic, all girls in this age range were eligible, regardless of alcohol use and sexual experience.

A total of 124 mother-daughter dyads screened eligible for participation. Of these, nine withdrew prior to participation, most often citing scheduling or transportation barriers. Thirteen dyads were dropped because the daughter aged out before participating (n = 3), questionable veracity (n = 2), or they could not be contacted to schedule (n = 8), and five dyads cancelled appointments and could not be rescheduled before the study ended. The final participation rate was 78%. Fifty-nine participants (61%) self-identified as White (non-Hispanic), 28 (29%) as Black (non-Hispanic), 5 (5%) Hispanic/Latina, 2 (2%) as Asian, 1 (1%) as Native American, and 2 (2%) as multiracial. Median household income was between $40,000 and $54, 900, which is consistent with the median household income for the surrounding county. Thirty seven (38%) of the girls' mothers had a college degree, and 48 (50%) of the adolescents lived with both parents.

Procedure and Protocol

The current study, conducted by the first author, was designed to examine perceptions of teen risk and mother-daughter communication about risk behavior. The inclusion of both mothers and their daughters in the study eased potential transportation barriers for adolescent females interested in participating and ensured the acquisition of parental consent. Mother-daughter pairs responding to the advertisement were screened for eligibility over the phone, with mothers providing verbal consent for their daughters to be screened. A total of 15 focus groups were conducted with adolescent females, with each group comprised of 4–11 participants (Mode = 5, M = 6). To promote age-appropriate discussions, groups were organized based on daughters' ages, consisting of either 14–15 year olds (9 groups) or 16–17 year olds (6 groups). Group interviews were conducted at a university research facility located in an urban area, accessible by public transportation.

Upon arrival, the study's procedures were explained to mothers and daughters together, and written parental consent and adolescent assent were obtained. Mothers' and daughters' groups were run in separate, closed rooms, and all participants were reassured that any information they provided in their groups would not be disclosed to their parent/child by the researchers. However, as per the university institutional review board's guidelines, participants were cautioned that due to the group setting, confidentiality could not be guaranteed by the researchers. Given this possible breach of confidentiality and our primary interest in understanding the perceived norms of youth culture rather than details of participants' personal experiences, participants were told not to reveal any personal or sensitive information about themselves, but rather to discuss their general views on the topic. All discussions were led by female facilitators, lasted 1.5 hours, and were audio recorded and transcribed. Each participant received $25 for her participation.

Because the current study focuses on understanding adolescent females' perceptions of alcohol and sex, only data from daughters' focus groups were analyzed here. Questions posed to daughters were designed to stimulate discussions of alcohol use, sexual behavior, and sexual risks among females their age (e.g. “What do girls your age think of drinking in general?”; “How important is it for girls your age to have a boyfriend or to be in a relationship?”). General discussions of alcohol use or dating behavior were used to transition into discussions of the intersection between alcohol and sex. Key questions included: “Do you think alcohol and sex go together? Why or why not?”; “What role, if any, does alcohol play [in sexual behaviors]?”; “Some people say that if you drink, you'll be more likely to end up doing something sexual or having sex. Is this true? Why or why not?”; and “Some people say that people who want to have sex may drink first. Is this true? Why or why not?” The key questions were structured broadly to elicit a wide range of responses about alcohol and sex, so as to capture both positive and negative perceptions about the nature of the relationship. Qualitative analysis focused on responses to the key questions; however, if a response to a general question addressed the intersection between alcohol and sex, it was included as well.

Analysis Strategy

The data were analyzed using thematic analysis (Braun & Clarke, 2006). As per guidelines for analysis of focus group data (Krueger & Casey, 2000), the group—rather than individuals comprising the groups—served as the unit of analysis. Following procedures outlined by Braun and Clarke (2006), the data were approached inductively, beginning with a general interest in how group participants conceived of the relationship between alcohol and sex. The first and second authors initiated analyses by independently reading through the transcripts from each group, followed by line-by-line open coding to establish categories and subcategories. Only comments pertaining specifically to the role of alcohol in sexual behavior were coded as part of this analysis. These preliminary coding categories were then reviewed, their parameters refined, and those categories that were less prominent and thematically coherent were discarded. The initial coding scheme was refined over the course of a constant comparative process. Both authors coded a transcript individually and then compared their respective results, gradually building consensus regarding the meaning of individual codes and their relation to one another. Blocks of text that contained more than one theme or perspective received more than one code. Once consensus was reached with regard to the definitions and applications of the coding categories, the first author revisited the transcripts, using the final coding scheme. Upon completion of coding, categories were reviewed to identify unifying themes and subthemes (Braun & Clarke, 2006).

The final coding scheme included four perspectives reflecting beliefs about the role of alcohol in sexual behavior: Facilitation, Excuse, Impairment, and Vulnerability (see Table 1). Following the establishment of these coding categories, the third author, who was not involved in prior stages of data collection or analysis, performed an audit of the coding scheme using seven randomly selected transcripts. Kappa agreement between the first and third authors for the coding categories ranged from .81 to .88, indicating that there was substantial reviewer agreement (Viera & Garrett, 2005). Based on these comparisons, the authors were satisfied that the codes had been consistently and precisely applied.

Table 1.

Coding Categories for Perspectives on Alcohol and Sexuality

Coding Category	Cohen's Kappa (% Agreement)	Number of Narrative Times Category Was Coded	Number (%) of Groups Category Was Present	Description of Coding Category	Example
Advantages of Alcohol Use
Facilitation	.88 (97%)	33	14 (93%)	Participants indicate that alcohol is used to facilitate social or sexual interactions.	“That's the only reason people go out and party, is to loosen up, meet people and maybe hook-up.”
Excuse	.88 (98%)	14	9 (60%)	Participants describe how adolescent females use alcohol to excuse regretted or unsanctioned sexual behavior. Excuse may be used before or after sexual encounter.	“You could do it like also as an excuse. Like so if he broke up with you or whatever, you could be like, `Oh, I was drunk. I didn't know what I was doing.'”
Sexual Disadvantages of Alcohol Use
Impairment	.81 (91%)	84	15 (100%)	Participants express the belief that alcohol impairs judgment and sexual decision-making. Often used in reference to regretted sexual encounters. Only judgments related to sexual behaviors were coded.	“If you're sober you're definitely thinking about what could happen to me if I have sex, but if you're drunk you're not really thinking about it. Like, `oh, it's just one night; just one time.'”
Vulnerability	.86 (93%)	76	14 (93%)	Participants state that getting drunk makes adolescent females vulnerable to unwanted sexual advances, assaults, STIs or pregnancy. Also coded when participants indicate that males target adolescent females who are drinking to pressure them for sex.	“`Well, just get her a little drunk and she'll do it.' Guys can use girls too easily when they're drunk.”

Results

Participants across all 15 groups expressed the view that alcohol use played an instrumental role in sexual behavior. The overarching theme emerging from the data reflected a shared belief that alcohol had transformational powers capable of radically altering an individual's personality, cognitions, and behaviors. Through this alcohol-induced transformation, individuals relinquished control of and responsibility for their behavior: “Alcohol make you a different person. It make you do things that you never thought you would do, say things you don't mean. It just all comes out. Can't nobody stop you, but at that point everybody knows, `Oh, it's alcohol that's making her do this'” (Member of a 16–17 year-old group).

This potential for transformation was perceived as offering both sexual advantages and disadvantages to adolescent females. The primary advantage identified by the participants arose from the perception that alcohol liberated young women from traditional sexual norms that restrict female sexual desire and agency. Participants believed that alcohol could directly liberate young women through physiological effects of alcohol that lead to disinhibition (Facilitation), or indirectly through the shared belief that disinhibition provides cover for what might otherwise be considered promiscuous behavior (Excuse). In this way, alcohol use was viewed as a means of removing barriers to sexual encounters, thereby functioning to bridge the gap between the conflicting expectations of sexual restraint and sexual prowess.

Participants also offered two perspectives on how alcohol use can sexually endanger adolescent females. They described how alcohol use can undermine females' personal agency and render them vulnerable to exploitation by males. Again, this effect could be direct, through diminishing a young woman's capacity to make good decisions or effectively stave off unwanted sexual advances (Impairment), or indirectly by holding her accountable, even in cases of forced intercourse (Vulnerability). The number of instances in which each of these perspectives was expressed in the data, the percentage of groups expressing these perspectives and Kappa agreement for each perspective are presented in Table 1.

Group responses were compared to determine whether there were age-related differences in the expression of perspectives across groups. Chi square analysis indicated that there were no significant age-related differences in the expression of any of the perspectives. The 16–17 year-old groups were unanimous in their expression of perspectives associated with the sexual disadvantages of consuming alcohol (i.e., Impairment and Vulnerability) and all but one of the groups in this age range (83%) talked about the social/sexual facilitation function of drinking. Similarly, all of the 14–15 year-old groups expressed the Facilitation and Impairment perspectives and all but one group described how alcohol use can contribute to sexual vulnerability. The Excuse perspective was expressed by only two of the 16–17 year-old groups, compared to seven of the 14–15 year-olds, suggesting that younger adolescents may be more likely than older adolescents to use alcohol to excuse sexual behavior (78% vs. 33%). However, possibly due to the small number of cases, this difference was not statistically significant.

Sexual Advantages of Alcohol Use

When asked to discuss the intersection between alcohol and sex, participants identified two primary advantages to drinking. They described how alcohol granted adolescent females the license to pursue potential partners or engage in sexual activities (e.g. with a new partner) that would not be possible or acceptable under sober conditions. This freedom occurred as a function of their perception that alcohol facilitates the pursuit of social and sexual encounters and excuses behavior that violates perceived social and sexual norms.

Facilitation

One of the key transformational properties of alcohol identified by participants in our study was increased confidence. This was discussed in 14 of the 15 groups. Participants in these groups described how increased confidence freed adolescent females from social anxiety and facilitated social interactions, giving them the courage to interact more comfortably with peers in general. For example:

A lot of times people think that whenever they're drunk they can feel like they can do whatever they want. Usually, it kind of brings them out of their shell. Like, maybe they're shy when they're sober, but when they're drunk they're more open and they, like, interact with people better (Member of a 14–15 year-old group).

Participants also described how some adolescent females deliberately use alcohol because they believed it would enable them to overcome inhibitions associated with talking to adolescent males: “I think a lot of times people drink because they want to be more comfortable with themselves… So, it's like they almost want to get into a situation where they will feel more comfortable with boys or something” (Member of a 16–17 year-old group). In other cases, participants suggested that some adolescent females drink alcohol as a means of obtaining attention, particularly from males: “Like, a lot of what happens is girls really like boys and they don't know what to do. And it seems like they [boys] give `em attention if they're [the girls] drunk” (Member of a 14 –15 year-old group).

Although it was generally agreed upon that alcohol could be used to garner attention from peers and prospective partners, a few participants indicated that adolescent females who use alcohol to secure attention were somehow needy or unable to procure it through other means: “The girls who don't [respect themselves] are usually the ones who drink because some of the time they'll be drinking to get attention from people” (Member of a 14–15 year-old group). This suggests that individuals lacking in social competence may be especially prone to use alcohol to attain social and sexual goals.

Alcohol also facilitated sexual behavior by enabling young women to overcome ambivalence about sexual involvement. Participants described how adolescent females struggle to balance emerging sexual desire and the perceived social expectation to be sexually active with their fears about sex and uncertainty about their sexual readiness. Through its transformative power, alcohol was believed to alleviate anxieties associated with engaging in sexual activity, as illustrated in the following quotes:

Mostly, yeah, because you might have that girl that, like, maybe wants to, but, you know, doesn't feel that she's ready for it. Maybe she doesn't have the confidence for it or anything. Then, but once you drink something, you have…obviously you feel a false sense of confidence when you drink, you feel like you're invincible. “I can do anything,” and then not worry about the consequences (Member of a 16–17 year-old group).

“And also, drinking it, um, takes away a lot of your, like, `Um, should I really do this?' factor. It's just like, `Oh, well. I'm intoxicated, so I'll do this.' I think that's what it is” (Member of a 14–15 year-old group).

Excuse

Participants also felt alcohol was liberating insofar as it could be used as an excuse for regretted sexual behavior. This perspective was expressed in nine of the 15 groups. Participants described how adolescent females must walk the fine line between being perceived as a “prude” and a “slut,” both of which could draw ostracism. Yet, there were no clear guidelines as to how to straddle this line as evidenced in the following exchange by members of a 14–15 year-old group:

• Participant 1: …Like in our society, girls are more considered like hoes or whores or sluts or skanks if they have sex…

• Participant 2: Or the girl might not want to feel like an outcast. Say if all of her friends are around or whatever and they bring up a discussion about sex, she's going to feel like the outcast `cause she can't say nothing, `cause she never had sex.

• Participant 3: Yeah. I think girls worry about being left behind.

For adolescent females, the perceived social costs of choosing the wrong partner, under the wrong circumstances, or doing the wrong thing sexually were quite high. Participants' preoccupation with social consequences during the discussions suggested that social repercussions were viewed as being more imminent than the threat of pregnancy or disease, although these risks were clearly acknowledged as well: “I'd say for girls, the biggest down-side is just the risk that a guy can talk about you, or um, that you can get called names like a `ho,' `whore,' `slut,' `skank'. I think that's pretty much the biggest worry girls have when it comes to risks” (Member of a 14–15 year-old group).

Alcohol was employed as a buffer against these concerns because engaging in sexual activity that was later deemed inappropriate or that occurred with a socially undesirable partner could then be excused by and blamed on the alcohol. Participants argued that because many adolescent females believe that alcohol transforms an individual, causing a loss of self-control and judgment, it is common for young women to use alcohol as an excuse to avoid being held accountable for their actions. As one 14–15 year-old participant notes, “[T]hey'll come to school and all these rumors will be started, `Oh, I was drunk. It wasn't my fault.' It's just the way you get out of something.” Other participants explained it in the following ways: “[B]ut they go out and I guess that they kind of blame it on the alcohol. `Well, I hooked up with so-and-so; I didn't mean it but I was so drunk.' It's just, I don't know, it's all fake to me” (Member of a 16–17 year-old group); and “Yeah. And then, I mean, also you're gonna be less likely to be judged because everyone's like, `Oh, she was just drunk,' or, `Oh, he was just drunk. They were both just hammered'” (Member of a 14–15 year-old group).

It is important to note that although there was general agreement about the societal belief in alcohol's disinhibiting power, not all participants subscribed to the belief that alcohol has this effect or that it provides an acceptable excuse for unsanctioned behavior. The theme of using alcohol as an excuse to engage in sexual behavior was expressed by only 9 of the 15 groups. At least one participant from 7 of the 15 groups challenged the perspective that alcohol directly facilitates sex, or argued that not all adolescent females use alcohol for this purpose: “Cause like if you want to have sex with a person, then you want to have sex with the person; then you don't really have to get drunk” (Member of a 14–15 year old group). Participants in two of the groups stated that intoxication was not a legitimate excuse for doing something sexual, as evidenced by the participant comment in the previous quote: “…it's all fake to me.”

Sexual Disadvantages of Alcohol Use

Discussions of the benefits of drinking were tempered by discussions of the dangers of alcohol use. Sexual risks associated with alcohol use were discussed more frequently than were benefits (see Table 1). The general consensus across all the groups was that although drinking could be sexually liberating, it also had the potential to put young women at risk by impairing their judgment and signaling that they were vulnerable targets for sexually aggressive males. Focus group dialogue indicated that the adolescent females perceived a fine line between drinking enough to attain the social lubrication benefits of alcohol and losing control of the situation—a line that was difficult to locate until it had been crossed: “A lot of girls think it makes you sort of carefree. They just sort of feel it's fun to drink, or whatever, but it's fun until something bad happens, or until you get into an unsafe situation” (Member of a 16–17 year-old group); and “I think their intent of going to drink is to have fun and then they don't realize that sometimes it gets to the point where it's not fun, but yet you can't do anything about it; it's too late” (Member of a 16–17 year-old group).

Impairment

Participants from all 15 groups expressed the concern that by drinking enough alcohol to facilitate and possibly excuse sexual behavior, a young woman runs a risk of drinking so much that her judgment becomes impaired, causing her to lose control over the situation and make poor choices about her sexual behavior.

You're not going to think logically like you normally would. You're just going to think about the moment, and if some guy asks you, like the way alcohol may have an effect on you, you might just sleep with him and wake up the next day and regret it (Member of a 16–17 year-old group).

The preceding example suggests that sexual agency is jeopardized when a young woman consumes so much alcohol that she loses the ability to discriminate and make choices about what she wishes to do and with whom she wishes to do it.

Vulnerability

Although participants viewed alcohol as a means for pursuing sexual liaisons and thus being more sexually agentic, young women from 14 of the 15 groups also believed that alcohol use amplified adolescent females' vulnerability to sexually predatory and aggressive men. According to participants, males were more likely to coerce adolescent females who were drinking alcohol. In some cases, drinking contributed directly to vulnerability through extreme impairment. In these cases Vulnerability was coded in addition to Impairment. For example: “You can get taken advantage of a lot of times if you are a girl. Some boys are just kind of disgusting and they feel like that when a girl is drunk they can get what they want from her” (Member of a 14–15 year-old group).

However, in other cases, simply having an alcoholic beverage, regardless of whether or not a young woman was impaired, increased vulnerability as a result of social expectations about alcohol and sex. Previous research suggests that a woman consuming alcoholic beverages is more likely to be perceived as impaired, sexually available, and likely to engage in sexual activity (Farris, Treat, & Viken, 2010; George, Cue, Lopez, Crowe, & Norris, 1995; George, Gournic, & McAfee, 1988; Lindgren et al., 2009), thereby increasing her vulnerability to unwanted advances, even if she is not intoxicated. Furthermore, the act of accepting a drink sets up the social expectation that the man is owed something, regardless of the young woman's impairment (Muehlenhard, Friedman, & Thomas, 1985). Consistent with this point, a commonly held view within the focus groups was that young men intentionally use alcohol to obtain sex from young women and that by accepting a drink from a male, a female is tacitly agreeing to do something sexual. The following quote illustrates how the participants believed that adolescent males monitor and promote female intoxication with the expectation of obtaining sex:

They're like, “Oh, did you drink tonight?” Ok, so they say, “I had, like, a little bit of something to drink,” and they're like, “Oh. Do you want more?” Guys bring alcohol to the parties for the girls…. They think it's a kind of quid pro quo. Something for something. They give `em alcohol, they give the girls alcohol and then they expect something in return. If they don't get something in return they get really upset over it, and they're like, “You can't do that to me!” Then the girl realizes, feels bad, and he's like, “No, that was part of deal. I gave you alcohol. You have to do something for me, now.” It's just like that and guys outright ask people, “Did you drink? Did you drink?” And if they do then it makes them more, like, want them more. Which is kind of weird (Member of a 14–15 year-old group).

The preceding quote also illustrates the pervasiveness and continued relevance of gendered sexual norms that prioritize male sexual desires and demand women to be both responsible for and responsive to those desires. Other participants in the same 14–15 year-old age group reinforced the view that young men are entitled to sex when they provide young women with alcohol:

• Participant 1: Like, I didn't realize that until I talked to this one guy about it. `Cause I always saw guys giving alcohol to girls and stuff, and I didn't realize that they really do expect something in return. I didn't understand that `til I talked to my friend that's a guy and he was, like, telling me, “Yeah, guys really expect something in return.…”

• Participant 2: Yeah. They'll be like, “No, I don't want money, I want something else.” Then, it's just like, you feel, especially if you're drunk, you're gonna be like, “Oh, well, I have to, because he did do this and it's my fault.” Then you just think like that.

Participants seemed resigned to this as a normative social exchange. However, they did express some doubts and reservations about it, as implied by the participant above who described males' increased desire for intoxicated females as “weird.”

Despite such misgivings, participants did not discuss the potential for adolescent females to challenge or refuse the grounds of this exchange. Instead, the common view among participants was that females who do not wish to accede to males' sexual expectations should not drink or should do so only after taking some protective action, such as having friends watch out for one another. Participants across both age groups took the position that women who had negative sexual experiences brought these on themselves through their own behavior, particularly their overuse of alcohol. They were also reluctant to label a coerced sexual experience as rape if alcohol was involved. This was exemplified in the following exchange regarding a hypothetical situation in which a young woman is sexually assaulted after drinking alcohol with a male:

• Participant 1: I think that if the girl is drunk, she put herself in the situation and she can't say it was really rape, because she was intoxicated at the time. So, if she couldn't do anything about protecting herself, because she put herself in that situation.

• Participant 2: She chose to drink.

• Participant 3: Yeah.

• Participant 4: Uh-huh.

• Interviewer: So, it's her fault?

• Participant 1: It's not her fault that he attacked her, but it would be her fault that she was in that situation.

• Participant 2: She was in the situation.

• Participant 3: It wouldn't be entirely the guy's fault. She put herself in the situation.

• Participant 4: If she hadn't gotten drunk, it probably never would've happened.

• Participant 1: No, because she would have been in control (Members of a 14–15 year-old group).

The preceding quotes illustrate the contradictory nature of adolescent females' beliefs about alcohol and sex. On the one hand, alcohol use was valued for its liberating effects, allowing adolescent females to transcend traditional gender norms and actively pursue social and sexual interactions. However, participants also acknowledged alcohol's role in increasing vulnerability, albeit in a way that places responsibility for negative outcomes on adolescent females who choose to drink and thereby wittingly subject themselves to potential danger and blame.

Discussion

Our study examined adolescent females' understandings of the relationship between drinking and sexual activity and of their perceptions of alcohol-related sexual risks. Data from focus group interactions offered a unique opportunity to explore diverse perspectives of these relationships and allowed for the emergence of themes or issues that were participant-driven. This approach was particularly helpful in understanding the views of 14–17 year-old adolescent females, whose experiences and beliefs are often overlooked or discounted. In the case of the current study, by focusing on social perspectives, we were able to obtain insight into how larger social influences like traditional gendered norms influence adolescent females' perceptions of alcohol and sex.

Coping With Mixed Messages

Themes expressed in the focus group interviews reflected the competing social messages regarding sex that adolescent females must negotiate. The long-standing expectation that women solicit male sexual desire is arguably amplified in the midst of “raunch culture” such that adolescent females feel pressure not only to elicit male sexual desire but also to act out their own desires and to do so in ways that are pleasurable to male observers (Gill, 2008; Lamb & Peterson, 2012; Levy, 2005; Yost & McCarthy, 2012). Even as sexualized performance pressure mounts, women have not been relieved of gendered moral standards of sexual gatekeeping and purity (Crawford & Popp, 2003). Thus drinking serves as a strategy—albeit a double-edged one—for negotiating the paradoxical knot (no longer “just” a double bind) of complex gendered sexual expectations. Drinking offers young women the opportunity to engage in the sexual and sexualized behaviors expected of them on one front (and that might be interesting and exciting to them). At the same time, the widely accepted notion of alcohol's transformative effects places a temporary stay on the traditional, moralist norms that sanction adolescent females' sexual expression, discount their sexual desire, and relegate them to passive or receptive sexual roles (Fine, 1988; Gavey, 2005; Tolman, 2002). However, drinking offers only a temporary reprieve and may in fact compound perceptions of adolescent females' moral culpability. Both in our focus groups and previous studies (e.g. Parks, Miller, Collins, & Zetes-Zanatta, 1998; Young, McCabe, & Boyd, 2007), women who drink are often blamed for any negative consequences, particularly unwanted and coercive sex.

Participants in our study believed that alcohol use offers several sexual advantages to adolescent females. First, it facilitates social and sexual encounters by increasing confidence and attracting attention from peers and prospective romantic or sexual partners. It also enhances the immediate benefits of sexual involvement while dampening attention to more distal inhibiting factors, such as concerns about readiness, pregnancy, or disease. Finally, it deflects negative criticism that may be incurred following a regretted sexual encounter. It could be argued that these “advantages” serve to reduce, rather than promote, sexual agency—causing young women to silence their own concerns about readiness, partner choice, and sexual safety.

That participants' view these qualities as advantageous makes sense within a developmental context. The integration of sexuality into one's identity and the development of intimacy are normal and critical developmental tasks of adolescence. As part of this developmental process, adolescents rely on feedback from their social environment to shape their view of themselves and to determine socially acceptable ways of expressing their sexuality (Holland et al., 1994; Welsh et al., 2000). As such, adolescents are highly sensitive to social rewards (Steinberg, 2008). Thus, it is not surprising that themes related to forming social connections and garnering and maintaining peer approval emerge as primary advantages of alcohol use.

The adolescent females in our study also were clearly aware of the risks associated with combining alcohol and sex. They discussed at length the ways in which drinking impaired young women's judgment and decision-making ability with regard to sexual encounters. They also saw drinking as increasing adolescent females' susceptibility to various forms of unwanted sexual experiences. For one, they believed that adolescent males were attuned to, attracted to, and encouraging of adolescent females' drinking because it lowered their ability to refuse sexual advances. They also believed that adolescent males purposefully tried to initiate quid pro quo sequences in which they would supply alcohol and females would be expected to repay them with sexual activity. This was depicted not as an exchange that adolescent females negotiated for themselves; rather, participants described it as one to which young women were resigned or somehow obligated to uphold.

The finding that participants held other women accountable for sexual assault if they have been drinking is disturbing. Unfortunately, it is consistent with other research showing that women who are assaulted when under the influence of alcohol are viewed as being responsible for their own victimization (e.g. Parks et al., 1998; Young et al., 2007). The higher level of self-blame among victims of incapacitated rape compared to forcible rape may inhibit victims of incapacitated rape from seeking assistance from law enforcement and health professionals (Brown, Testa, & Messman-Moore, 2009). In addition to the harm caused to the victim, failure to report such incidents perpetuates and sanctions the misperception that it is acceptable to force sex on a person who is impaired or incapacitated. Intervention efforts aimed at adolescents, law enforcement, and health care providers need to challenge the view that, by drinking, women bring ruin upon themselves, and they should make it clear that perpetrators are accountable for aggressive and assaultive behavior.

The four perspectives emerging from our analysis (Facilitation, Excuse, Impairment, and Vulnerability) have some overlap with previous research on sex-related alcohol expectancies (e.g. Dermen & Cooper, 1994a, 1994b; Leigh, 1990), particularly as they relate to disinhibition and enhancement. These four perspectives were not hypothesized a priori, thus the results provide further validation that such expectancies continue to operate in modern adolescent culture. The current analysis also sheds light on the source of these expectancies, placing them within the sociocultural context experienced by adolescent females. For example, alcohol use is seen by some as a means for circumventing traditional roles and restrictions that inhibit adolescent females' sexual behavior. A novel approach to intervention may be to challenge the assumptions that underlie such expectancies.

Practice and Implications

These results suggest that interventions aimed solely at increasing knowledge of the sexual risks associated with alcohol use are unlikely to be effective. Participants in our study were aware of alcohol's risks but nonetheless believed that young women are motivated to drink because of the strong potential for achieving positive social outcomes. In reality, the likelihood of experiencing a positive social outcome on a given drinking occasion (e.g. attention from a prospective partner) surpasses the likelihood of experiencing a serious negative consequence, such as contracting an STI (Goldberg, Halpern-Felsher, & Millstein, 2002). The high potential for obtaining an immediate positive benefit is likely to be more salient in the decision-making process among adolescent females than concerns about a less probable, more distal risk (Goldberg et al., 2002). Further, previous research (Bay-Cheng, Livingston, & Fava, 2011; Livingston & Testa, 2000; Norris et al., 1996) indicates that although young women may be cognizant of sex-related risks, they downplay their own perceived vulnerability by maintaining a self-serving bias, believing that whereas others may be at risk, they themselves possess qualities (e.g. being smart or socially competent) that leave them well defended.

Educational efforts may do better to teach adolescents skills needed to obtain social objectives, such as effective communication, development of healthy relationships, and negotiation of safe sexual interactions. Especially promising are interventions that provide adolescents with models and skills for promoting sexual health and well-being. For example, Griffin, Botvin, and Nichols (2006) used a comprehensive Life Skills Training approach to reduce substance use among 7^th, 8^th, and 9^th graders. The program taught adolescents cognitive-behavioral skills for effective communication, resisting peer and media influences to engage in substance use, managing anxiety, developing personal relationships, and asserting one's rights. Although the intervention was aimed at reducing substance use and did not specifically address sexual risk, follow-ups conducted several years later revealed that participants who had received the intervention in adolescence engaged in less HIV-risk behavior as young adults and that this relationship was mediated via lower rates of alcohol and drug use. Such comprehensive skill-based interventions hold promise for reducing a variety of adolescent risk behaviors because it provides adolescents with skills and tools needed to meet social goals in a healthy manner.

Limitations and Directions for Future Research

As with all research, there are a number of limitations to consider in the interpretation of the data from the current study. First, our convenience sample was limited to adolescent females and their mothers who saw the advertisements in the local newspapers and were willing to participate in the corresponding groups. The study did not set out to examine cultural differences in perspectives of alcohol and sex, and although efforts were made to balance the racial and ethnic composition of each focus group, this did not always occur—which may have inhibited participants from offering opinions that diverged from the dominant view. As is typical in focus group research, the unit of analysis for this study was the group and not the individuals within the group (Krueger & Casey, 2000). The majority of the groups in our study were racially and ethnically mixed, thus, conducting group-level analysis may have obscured cultural differences, and there were not enough racially homogenous groups to make racially-based intergroup comparisons in theme expression. In the future, conducting research with racially and ethnically homogeneous groups and expanding the discussion to include use of other substances (e.g. marijuana) that may influence sexual behavior would yield critical information on cultural differences in substance use and sexual behavior.

One of the major limitations of focus group research is that the group setting makes it impossible to ensure confidentiality. Concerns about confidentiality, along with our interest in eliciting dominant social views on the topic, formed the basis of our decision to not ask participants to report on their personal experiences. Thus, it is impossible to know to what extent participants' views of the relation between alcohol and sex were colored by their own experiences. Despite this, our study achieved its goals of identifying common social views held by adolescent females on the topics of alcohol and sex and of exploring how adolescents may be using alcohol to attain social and sexual goals. The use of a focus group format also permitted disagreement among group members which can be used to identify potential areas for intervention (e.g. not everyone thinks alcohol provides a legitimate excuse for engaging in high risk sexual behavior). Insights obtained from these data can be used to guide future studies using larger representative samples of adolescent females and individualized sources of data collection (e.g. surveys, interviews) to examine developmental changes in alcohol and sex-related perceptions and behavior over time.

Finally, focus groups are highly useful for obtaining insight into common social perceptions of an issue or topic, but given the small sample size and nature of the group interview format, results must be interpreted with caution. The interviewer encouraged participation from all group members, and in all groups, every member did contribute to the discussion. However, it is possible that if a participant held views that differed from those of the group, she may have been reluctant to express them. The findings of qualitative studies such as the present one are bolstered through triangulation with other sources of data. Because our findings have independently replicated some of the results reported by Coleman and Cater (2005) in a sample of British adolescents of the same age, we are encouraged that the perceptions of adolescent alcohol use and sexual behavior reported here reflect common perceptions of alcohol and sex and are not simply artifacts of our sample.

Although the explicit purpose of our study was to examine adolescent females' perceptions of the relation between drinking and sexual behavior, a more comprehensive understanding of this association requires input from adolescent males. Research with adult samples indicates that men perceive women who drink as being more sexually interested and available (Abbey, 2002; Farris et al., 2010; George et al., 1995, George et al., 1988; Lindgren et al., 2009) and that both men and women hold gender role stereotypic beliefs about the effects of alcohol on sexual behavior—believing that alcohol consumption increases aggression and sex drive in men and sexual affect and vulnerability to sexual coercion among women (see Abbey, 2002; Testa, 2002 for reviews). It is unclear, however, whether adolescents who are just beginning to experiment with alcohol and sex also hold these views and are influenced by them. For example, do young men really believe that they should receive sexual favors in return for providing alcohol to young women? Do they believe that it is acceptable to force sex on a young woman who is highly intoxicated or incapacitated? One study suggests that adolescent males with a history of dating violence perpetration do not view having sex with someone who is incapacitated as coercive, because there typically is no physical force or resistance (Rothman et al., 2008); however more research is needed to determine whether these findings generalize to a more representative sample. Identifying misperceptions and motivations for adolescent males' alcohol use can be used to further inform effective interventions designed to facilitate healthy social and sexual interactions among adolescents.

Future research should also consider the role of media on adolescent females' perceptions of alcohol and sexual behavior and how media consumption influences adolescent sexual risk behavior. Aside from the psychological, physical, and academic consequences of adolescent sexualization (American Psychological Association Task Force on the Sexualization of Girls, 2007), it is also important to consider the prominent role played by alcohol in media representations that both sexualize young women and equate being fun and desirable with some degree of intoxication. Given the central role of societal perceptions in how these young women talk about alcohol use, it would be useful to better understand how current media affect those perceptions and the degree to which changes in media content could alter perceptions to foster healthier outcomes for adolescents. Helping adolescents to critically evaluate and challenge the sexuality-based messages conveyed by traditional gender norms and the media may also be fruitful in helping them make more informed, deliberate, and sober decisions about sex.

Conclusions

As adolescent females forge their sexual identity they must negotiate conflicting thoughts, feelings and cultural messages regarding sexuality. For some, alcohol consumption offers an attractive means for overcoming sexual ambivalence through mitigating concerns about potential consequences and increasing confidence. Participants in this study were aware of risks associated with combining alcohol and sex, but indicated that young women are not always deterred by such knowledge, especially when there is a strong potential for social rewards. Adolescent females may benefit from opportunities to discuss and challenge cultural messages regarding female sexuality and the development of skills to promote healthy, safe, and sober interactions.