Patterns of Alcohol Consumption and Sexual Behavior among Young Adults in Nightclubs

Abstract

Background

Alcohol consumption has been linked to a variety of sexual risk behaviors. However, much research addresses this connection among college students, ignoring other social contexts in which this association may be prevalent, such as club settings.

Objectives

As such, this study assessed patterns of drinking and sexual activity among young adults who frequent nightclubs.

Methods

Using time-space sampling, we surveyed 308 young adults (ages 18–29) in New York City clubs.

Results

Participants reported binge drinking on 52% of drinking days. Roughly, 62% reported recent sex under the influence, and 29% of them reported being less safe in sexual situations as a result of their drinking. Men reported more days of drinking and binge drinking than women, and were more likely to report recent sex under the influence. Younger participants were more likely to report being less safe sexually while intoxicated. Recent binge drinking was associated with sex after drinking.

Conclusions and Scientific Significance

These data suggest the need for targeted intervention and prevention efforts at nightclubs.

INTRODUCTION

Research suggests the importance of social context to the health behaviors of young people (1). For example, fraternity events have been widely documented as key contexts of drinking behaviors among university students (2). Although fraternity contexts have been commonly examined, contextual research on drinking and sexual behavior has not extended much beyond college populations. Nightclubs remain important contexts that bring together diverse youth for socializing, often involving alcohol consumption and attracting potential mates. As such, alcohol use plays a key role in framing the sexual behaviors of those who form sexual connections at clubs. For these reasons, clubs remain critical, yet understudied, contexts for examining the intersections of alcohol use and sexual behaviors.

Several studies demonstrate that drinking increases the likelihood of risky sexual behavior (3, 4), with an association between alcohol consumption and multiple and casual partners (5, 6), and less consistent condom use (7). Alcohol consumption has also been linked to negative sexual outcomes, including sexual assault. Not only are women more likely to experience sexual victimization, but men are more likely to perpetrate sexual violence after drinking (8). Additionally, alcohol consumption is associated with increased rates of sexually transmitted diseases (STDs) (9), unintended pregnancy, and younger age at first pregnancy (10). The amount of alcohol consumed affects sexual behavior; heavy drinking is associated with sexual risk taking (7). When compared to those with blood alcohol content (BAC) of .02, those with BAC of .07 exhibit greater motivations to engage in risky sexual behavior (11). With binge drinking raising blood alcohol levels above .08, this effect of dose is quite significant.

Various factors moderate these associations. Research suggests that men are heavier drinkers and more frequently binge drink, though women report suffering greater physical harm and sexual assault (12). Age also impacts drinking behaviors, with studies consistently finding high rates of binge drinking among young adults (2, 13); in one study, the prevalence of binge drinking increased from 20.2% at age 18 to 43.7% at age 22 (14). Thus, youth in this age range may be at heightened risk for alcohol related sexual risk due to these elevated rates of drinking. However, it remains important to consider that in addition to alcohol as a potential cause of risk taking, some youth drink to allow themselves to engage in otherwise impermissible behaviors (15) or to alleviate guilt about engaging in risky behavior (16).

While the literature has contributed greatly to understandings of the association between alcohol consumption and sexual behavior, the prevalence of their combination is not as well documented. Large national surveys have typically examined the prevalence of alcohol consumption and the prevalence of sexual behavior, but not of the combination of the behaviors. Exceptions indicate that, among those participants who reported more than one partner in the past year, 28% of their sexual experiences occurred under the influence (17), 44% of new partner intercourse events involved alcohol, and 37% of youth reported having intercourse in their heaviest recent drinking event (18). Because club-going youth report high rates of substance use (19), it is likely that they also report elevated rates of alcohol consumption and possibly of combining alcohol and sexual activity. As such, determining prevalence rates of these behaviors in a club-going sample is critical to developing targeted intervention and prevention efforts.

PRESENT STUDY

We extended our sample beyond college students to young adults in community settings by surveying them at nightclubs. As young adulthood is a formative period for both sexual and substance use exploration (14), it is important to understand the intersection of risky sexual and drinking behaviors. As such, this study posed the following research questions:

1. What is the prevalence of alcohol use and sexual activity among club-going young adults?

2. What is the prevalence of perceived sexual risk as a result of alcohol use?

3. Are there between-group differences in these behaviors?

METHODS

Sampling

We utilized time-space sampling to systematically recruit young adults (20). Rather than randomizing households or phone numbers, we captured the range of variability among club-going young adults by randomizing the venues attended and days of attendance via a sampling frame of previously enumerated clubs and time periods of operation. At the venues, a staff member approached each individual entering or leaving the venue, identified him/herself, and requested verbal consent for participation in the anonymous survey. After obtaining consent, staff administered the survey via PDA. If the patron refused, staff noted the refusal and estimated the age, gender, and ethnicity of that patron. Recruiters were trained to not administer surveys to individuals who were visibly intoxicated—assessed via slurred speech, impaired coordination, glassy/unfocused eyes, and disorientation. No incentive was provided for participation. Further detail on these methods have been described elsewhere (21).

Measures

Participants self-reported demographic information (age, gender, sexual orientation, and race/ethnicity), Recent Drinking: The number of days during the last 90 days that they consumed any alcohol, Recent Binge Drinking: The number of days during the last 90 that they engaged in binge drinking (5 or more drinks in one sitting for men/4 or more drinks in one sitting for women (22)), Recent Sober Sexual Activity: Whether engaged in sex when not drinking during the last 90 days, Recent Sexual Activity after Drinking: Sex after drinking in the last 90 days, and Perceived Sexual Risk: Whether they had been less safe in sexual situations than intended as a result of their drinking during the last 90 days.

Analysis

Prevalence estimates were computed using SPSS. Differences in means between groups were analyzed through Analysis of Variance for each set of groups. Chi-square (χ²) analyses were utilized to compare the prevalence of drinking behaviors and sexual behaviors between groups.

Participants

Staff approached 658 people, with 369 consenting to the survey. A comparison of those who participated with those who did not participate suggested women were more likely than men to participate (63.7% of women vs. 49.6% of men, χ² = 13.27, p < .0001), and people of color were more likely to participate than Whites (65.9% vs. 51.7%, χ² = 11.63, p < .0001). After restricting the sample to those aged 18–29 who reported alcohol consumption, the final sample consisted of 308 young adults. The final sample was predominantly White, evenly split between males and females, with a majority reporting a heterosexual identity. The average age of participants was 24.23 (SD = 2.55). See Table 1 for sample characteristics.

TABLE 1.

Sample Characteristics.

	n	%
Gender
Male	141	45.8
Female	167	54.2
Sexual Identity
Heterosexual	278	90.3
Gay, Lesbian, or Bisexual	30	9.7
Race/Ethnicity
White	193	62.7
Latino	47	15.3
African- American	22	7.1
Asian/Pacific Islander	17	5.5
Mixed	16	5.2
Other	13	4.2
Age (in categories)
18–20	11	3.6
21–24	156	50.6
25–29	141	45.8

RESULTS

Participants reported drinking an average of 28.84 days out of the last 90 days (SD = 23.70, IQR 12–40). A majority (86.3%) reported at least one day of recent binge drinking. The average number of binge drinking days during the last 90 was 16.43 (SD = 18.91, IQR 2–24). On average, participants binge drank on a majority (52%) of the days which they reported drinking. Many participants (62.9%) reported sexual activity after drinking, suggesting that a large proportion of sexually active young adults at nightclubs engage in sex after drinking. Of those who reported sex after drinking, 29.3% reported being less safe in sexual situations as a result of their drinking.

Men reported significantly more days of drinking (33.71 vs. 24.75) and binge drinking (18.89 vs. 14.38) than women, and were twice as likely (OR = 2.04, 95% CI: 1.01–4.09) to report binge drinking during the last 90 days. Men were also nearly twice as likely to report having recent sex after drinking (70% vs. 55.7%; OR = 1.86, 95% CI: 1.16–2.94), though men and women were equally likely to report that alcohol consumption resulted in less safe sexual behavior (29.6% vs. 29%). There were no differences by sexual identity for alcohol consumption or the combination of alcohol and sexual behavior. White respondents reported significantly more days of drinking during the last 90 than participants of color (31.36 vs. 24.62); no other differences emerged.

We compared participants who were younger (18–24) to those who were 25 or older and found no significant differences in drinking behaviors. However, when examining the association between drinking and sexual behavior, younger individuals were less likely to report recent sex when not drinking (72.5% vs. 82.1% of the older individuals, OR = 1.75; 95% CI: 1.01–3.03). Younger individuals were more than twice as likely to report recently engaging in behavior perceived as less safe after drinking (37.3% vs. 20.3%; OR = 2.34; 95% CI: 1.22–4.50). See Table 2 for group behavioral difference analyses.

TABLE 2.

Group Behavioral Differences (<90 days.)

	Males		Females		t	df	P
	M	SD	M	SD
Drinking days	33.71	25.41	24.75	21.41	3.31	272	0.001
Binge Drinking days	18.89	21.44	14.38	16.3	2.04	253	0.042
Average% of Drinking Days that are Binge Days	0.52	0.36	0.52	0.38	0.14	304	0.889
	n	%	n	%	χ2	df	P
At least one day of binge drinking	126	90.6	138	82.6	4.11	1	0.043
Sex while not inebriated	111	79.3	125	74.9	0.843	1	0.359
Sex after drinking	98	70	93	55.7	6.64	1	0.01
Been “less safe than I wanted during sex because I had been drinking”	29	29.6	27	29	0.007	1	0.932

	Heterosexual		Gay/Lesbian/Bisexual		t	df	P
	M	SD	M	SD
Drinking days	28.36	23.22	33.23	27.84	−1.07	305	0.286
Binge Drinking days	16.3	18.67	17.63	21.31	−0.365	304	0.715
Average% of Drinking Days that are Binge Days	0.52	0.37	0.49	0.37	0.363	304	0.717
	n	%	n	%	χ2	df	P
At least one day of binge drinking	238	86.2	26	86.7	0.004	1	0.948
Sex while not inebriated	210	75.8	26	23.1	1.79	1	0.18
Sex after drinking	173	62.5	18	60	0.069	1	0.792
Been “less safe than I wanted during sex because I had been drinking”	53	30.6	3	16.7	1.54	1	0.215

	Whites		People of Color		t	df	P
	M	SD	M	SD
Drinking days	31.36	24.81	24.62	21.17	2.53	269	0.012
Binge Drinking days	17.75	19.03	14.23	18.58	1.57	304	0.116
Average% of Drinking Days that are Binge Days	0.53	0.36	0.51	0.39	0.435	304	0.116
	n	%	n	%	χ2	df	P
At least one day of binge drinking	170	88.5	94	82.5	2.24	1	0.135
Sex while not inebriated	148	76.7	88	77.2	0.01	1	0.919
Sex after drinking	119	61.7	72	63.2	0.069	1	0.793
Been “less safe than I wanted during sex because I had been drinking”	38	31.9	18	25	1.04	1	0.308

	Binge Drinkers		Non-Binge Drinkers		t	df	P
	M	SD	M	SD
Drinking days	31.6	23.57	10.74	14.85	−7.69	78.47	<.001
	n	%	n	%	χ2	df	P
Sex while not inebriated	203	76.9	32	76.2	0.01	1	0.92
Sex after drinking	180	68.2	11	26.2	27.24	1	<.001
Been “less safe than I wanted during sex because I had been drinking”	55	30.6	1	9.1	2.31	1	0.129

	18–24 year olds		25–29 year olds		t	df	P
	M	SD	M	SD
Drinking days	26.62	23	21.45	24.33	−1.78	305	0.075
Binge Drinking days	15.27	17.93	17.81	19.99	−1.17	304	0.242
Average % of Drinking Days that are Binge Days	0.53	0.38	0.51	0.35	0.647	304	0.518
	n	%	n	%	χ2	df	P
At least one day of binge drinking	144	86.7	120	85.7	0.068	1	0.794
Sex while not inebriated	115	72.5	121	82.1	4.02	1	0.057
Sex after drinking	102	61.1	89	63.6	0.201	1	0.723
Been “less safe than I wanted during sex because I had been drinking”	38	37.3	18	20.2	6.65	1	0.011

Individuals who reported binge drinking were six times more likely to report recent sex after drinking (68.2% vs. 26.2%; OR = 6.04, 95% CI = 2.89–12.59), though no other differences emerged between binge and non-binge drinkers. Individuals who reported recently engaging in sexual activity after drinking alcohol reported significantly more days of drinking (32.16 vs. 23.04) and binge drinking (20.11 vs. 10.33) during the last 90 days, than those who did not report recent sex after drinking. Individuals who reported recent sexual activity perceived as less safe than desired as a result of alcohol use also reported significantly more days of alcohol consumption, when compared to those who reported that alcohol had not recently influenced their sexual risk behaviors (37.32 vs. 30.02), though did not differ in frequency of binge drinking. See Table 3 for drinking and sexual behavior analyses.

Table 3.

Relationship between drinking and sexual behaviors (Recent < 90 days).

	Sex while not inebriated
	Yes		No		t	df	P
	M	SD	M	SD
Frequency of Drinking (days)	28.14	22.13	30.69	28.28	0.697	97	0.488
Frequency of Binge Drinking (days)	16.44	17.42	16.42	23.32	−0.005	94	0.996
Average% of Drinking Days that are Binge days	0.53	0.36	0.48	0.39	−1.09	304	0.276
	Sex under the influence
	Yes		No
	M	SD	M	SD
Frequency of Drinking (days)	32.16	23.11	23.04	23.61	−3.32	304	0.001
Frequency of Binge Drinking (days)	20.11	18.66	10.33	17.78	−4.52	304	<.001
Average% of Drinking Days that are Binge days	0.62	0.34	0.36	0.37	−6.38	304	<.001
	Been “less safe than I wanted durig sex because I had been drinking”
	Yes		No
	M	SD	M	SD
Frequency of Drinking (days)	37.32	22.06	30.02	23.27	−2.00	189	0.047
Frequency of Binge Drinking (days)	23.86	20.12	18.56	17.86	−1.8	189	0.074
Average % of Drinking Days that are Binge days	0.65	0.34	0.6	0.34	−0.939	189	0.349

DISCUSSION

This research provides important data on alcohol use among young adults who attend clubs, indicating that binge drinking is widespread in this population. Most important to note is that young adults in club contexts report higher rates of binge drinking than previous findings with other groups (23). Our findings suggest that clubs are key risk contexts for alcohol use among young adults, warranting further attention. The findings also highlight the incidence of sexual encounters experienced after drinking; many youth have sex under the influence. Furthermore, the findings highlight the prevalence of perceived sexual risk as a result of drinking. It is important to note that because our question was an expansive measure of subjective sense of risk, the participants responding affirmatively may have referred to condom use or to other behaviors they perceived as personally risky. In this regard, the findings illustrate an awareness of a connection between alcohol and sexual risk taking among young adults.

Club-going young adults reported drinking on roughly one third of the past 90 days and binge drinking on over half of drinking days. This indicates an alarming rate of binge drinking in this population and that the tendency towards binge drinking among those at nightclubs is cause for concern. Indicators of frequency of drinking are important, as research points toward frequency of drinking and heavy drinking as reliable gauges of alcohol abuse (24). Additionally, more frequent drinking and heavy drinking occasions provide more opportunities for alcohol-related harm (25). Thus, club-going young adults may constitute an at-risk population in need of targeted alcohol abuse prevention and intervention efforts.

An overwhelming majority of sexually active participants reported recent sex after drinking, with nearly a third reporting being less sexually safe than desired as a result of drinking. Those who reported perceived risk reported significantly more days of drinking. Binge drinkers, especially frequent binge drinkers, were more likely than non-binge drinkers to report recent sex after drinking. These results indicate a strong connection between drinking and sexual behavior among those at nightclubs. Regardless of whether drinking may causally facilitate sex or is used to permit impermissible behavior, individuals who are heavier drinkers may be at elevated risk for both alcohol-related consequences and the consequences associated with sexual risk behavior.

On average, men drank and binge drank more frequently than women, indicating that such gendered patterns also exist in nightclub contexts (26). Men were also more likely to report recent sex after drinking. As men often bear the responsibility of condom use in sexual situations (with literature focusing on women’s negotiation skills), it is critical to consider the role of alcohol consumption in safer sex decisions (27). Age was also a significant factor in alcohol consumption and sexual risk. Younger individuals were more likely to report recently being less safe sexually after drinking. With younger individuals more likely to report multiple partners (28) and incident STDs (29), identifying situational sexual risk factors is critical. These younger individuals represent an important group for prevention and intervention efforts, as early efforts may reduce future negative outcomes.

Although these results are compelling, a consideration of limitations is necessary. First, sampling during winter months may have limited recruitment; on the other hand, sampling after the winter holidays may have elevated reported rates of drinking. Additionally, the abbreviated measures prevented measurement of base rates of sexual activity, specific sexual risk behaviors, partner types, and specific patterns of alcohol consumption. Finally, we can make no causal claims about alcohol’s influence on sexual risk taking. As noted earlier, alcohol use may potentially induce sexual risk taking, but may also be intentionally used to facilitate otherwise impermissible behaviors in a manner that reduces guilt.

Despite the limitations, these findings have implications for health promotion efforts, particularly since they extend this area of research beyond college populations. They illustrate the high prevalence of these behaviors among young adults in nightclub contexts. Though few health promotion efforts specifically target youth at nightclubs, the rates of drinking, binge drinking, and sexual activity after drinking reported in this study highlight the urgent need for efforts targeting youth in these venues. A wide range of prevention and intervention activities should be considered. For example, alcohol expectancy challenges in venue settings have proven effective in reducing alcohol consumption and changing alcohol expectancies (30). Future research should explore such challenges and their efficacy in changing sexual alcohol expectancies.