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Journal of Studies on Alcohol and Drugs logoLink to Journal of Studies on Alcohol and Drugs
. 2021 Aug 4;82(4):493–502. doi: 10.15288/jsad.2021.82.493

Establishing a New Measure of Alcohol-Related Sexual Consequences and Examining Its Association to Alcohol Consequences Among At-Risk Young Adults

Anne M Fairlie a,*, Anne E Jaffe b, Kelly Cue Davis c, Dana M Litt d, Debra Kaysen e, Jeanette Norris f, Melissa A Lewis d
PMCID: PMC8356789  PMID: 34343081

Abstract

Objective:

Alcohol-related sexual consequences are common among young adults, yet there is no standard measure to comprehensively assess this construct. To fill this gap, the current study evaluated a 41-item measure of alcohol-related sexual consequences in a sample of at-risk young adults.

Method:

A subsample (n = 318; 54% female; 71% White; mean age = 22.52 years) of young adults from a larger intervention study was identified for analyses based on recent drinking and sexual behavior. Participants were asked whether each of 41 sexual consequences occurred in the past month as a result of drinking alcohol. More than half of the sample reported vaginal sex without a condom, oral sex without a condom, and having sex without discussing condom use.

Results:

Only 1 of 41 items evidenced sex differences: men were more likely than women to report oral sex with someone they just met. Count regression models were conducted to determine unique associations among alcohol-related (e.g., alcohol use, expectancies) and sex-related variables (e.g., sexual behavior, expectancies) and alcohol-related sexual consequences and general alcohol consequences. Findings supported the alcohol-related sexual consequences measure as related to, but distinct from, general alcohol consequences, as it was more strongly related to sex-specific constructs.

Conclusions:

This study provides preliminary support for the Alcohol-Related Sexual Consequences Scale, a novel measure of alcohol-related sexual consequences, which may be useful for generating personalized feedback and assessing the efficacy of interventions targeting risky sexual behavior and drinking.

In past work, 25%–50% of young adults reported drinking before their most recent sexual encounter (Desiderato & Crawford, 1995; Fairlie et al., 2018; MacNair-Semands & Simono, 1996), and 40% of college students who engaged in recent sexual behavior drank before or during the encounter (Patrick & Maggs, 2009). When sexual encounters occur in the context of drinking, risky behaviors are more likely. Young adults commonly report consequences of alcohol use that involve risky sexual behaviors, such as having sex with someone they just met or someone they normally would not, as well as having sex without a condom or birth control (Cooper, 2002; Orchowski & Barnett, 2012).

Some studies indicate that drinking reduces the likelihood of condom use; findings are mixed whether this holds only in the context of a steady (romantic) partner (Scott-Sheldon et al., 2010) or casual partners (Brown & Vanable, 2007; Kiene et al., 2009; LaBrie et al., 2005). Alcohol use and risky sexual behaviors commonly co-occur (Carey et al., 2016; Hingson et al., 2005, 2009; Scott-Sheldon et al., 2016; Tan et al., 2015), yet sexual behaviors are not well represented in current assessments of alcohol-related consequences; this study addresses this gap.

Consequences of unprotected sex after drinking can include contracting sexually transmitted infections (STIs) and unwanted pregnancy (Mattson et al., 2001; Orchowski & Barnett, 2012; Satterwhite et al., 2013). The connection between heavy drinking and STIs is observable at the population level, as past-year STI rates are higher for heavier-drinking young adults (Substance Abuse and Mental Health Services Administration, 2007). Heavy drinking in the 3 months before conception was also more common in women with unintended pregnancies than in women with intended pregnancies (Naimi et al., 2003). Moreover, alcohol use and regretted sex also frequently co-occur (Kypri et al., 2009; Mallett et al., 2006; Morojele et al., 2004; Orchowski et al., 2012). Alcohol can also impair the sexual experience in the moment. In laboratory experiments, consuming alcohol decreased sexual arousal in women and men (George et al., 2006, 2011).

In addition to regretted but consensual sex, sexual assault—including unwanted sexual contact, attempted rape, and completed rape—has been associated with alcohol consumption (Abbey et al., 2014; Bryan et al., 2016). Communities that report heavier drinking also report higher rates of sexual victimization (Testa & Livingston, 2018), and the likelihood of sexual victimization is higher on days women drink (Parks et al., 2008). Perpetrators may be more frequently encountered in drinking contexts (Testa & Livingston, 2018); these perpetrators may target visibly intoxicated women (Davis et al., 2015), and high levels of intoxication may reduce one's capacity to use effective resistance strategies (Norris et al., 2006). Thus, in these situations, sexual assault can be conceptualized as an alcohol-related sexual consequence. In sum, alcohol-related sexual consequences can be multifaceted, including unprotected sex, STIs, unwanted pregnancy, regretted sex, and sexual assault. A more comprehensive assessment of these alcohol-related sexual consequences is needed.

Existing measures to assess consequences of alcohol consumption

Several notable scales have been used to assess alcohol consequences in young adults. One widely used scale is the Rutgers Alcohol Problem Index (RAPI; White & Labouvie, 1989). This 23-item measure assesses past-year alcohol-related problems in multiple domains, including academic problems, interpersonal difficulties, and physiological symptoms. Although the RAPI is a strong instrument to assess alcohol-related consequences, this measure does not specifically include items that focus on alcohol consequences related to sex. To measure a broader range of alcohol-related consequences in young adult men and women, Read et al. (2006) developed the Young Adult Alcohol Consequences Questionnaire (YAACQ). The 48-item YAACQ assesses past-year drinking consequences across eight domains. Two of these items assess alcohol-related sexual consequences. The first item, “As a result of drinking, I neglected to protect myself or partner from an STD [sexually transmitted disease] or unwanted pregnancy,” does not distinguish between the occurrence of unprotected sex and resulting consequences (STI or pregnancy). The second item, “My drinking has gotten me into sexual situations that I later regretted,” combines the occurrence of intoxicated regretted sex and subsequent attributions that drinking was to blame for the sexual encounter. Further, this question broadly assesses sexual regret regardless of the reason, which might include having sex on a first date or with casual partners (Cooper, 2002, 2006) or engaging in particular regretted sexual acts (e.g., oral sex, anal sex). The 24-item Brief-YAACQ (administered in the current study) includes this regretted sex item but does not assess protection against STI/pregnancy. Although theYAACQ excels at capturing a broad range of consequences, it cannot distinguish between the occurrence of specific sexual acts, regret of specific sexual acts, or the use of a condom versus other types of contraception.

The Young Adult Alcohol Problems Screening Test (YAAPST; Hurlbut & Sher, 1992; Larimer et al., 1999; Wood et al., 2001) assesses consequences of alcohol consumption in young adults, such as academic concerns. Regarding sex-related alcohol consequences, theYAAPST includes one item assessing unprotected sex and three items regarding regretted or unwanted sexual experiences. Although these scales have well-demonstrated reliability and validity (Hurlbut & Sher, 1992; Miller et al., 2002), they do not capture the full range of potential negative sexual consequences relevant to young adults. In addition, the use of compound items can make it difficult to interpret responses. For example, in the item “Because you had been drinking, have you ever neglected to use birth control or neglected to protect yourself from a sexually transmitted disease?” it is unclear if responses refer to failure to use a birth control pill or failure to use a condom. This clarification is relevant as one method protects from sexually transmitted diseases and one does not. Taken together, a measure that provides greater specificity and allows for a more comprehensive assessment of alcohol-related sexual outcomes is needed.

Importantly, other critical sexual outcomes are not adequately assessed in existing measures of alcohol-related consequences among young adults. For example, poor sexual performance has been linked to alcohol intoxication (George et al., 2006, 2011), but sexual dysfunction is not included in current assessments of alcohol consequences. Measures of sexual assault, such as the Sexual Experiences Scale (SES; Koss et al., 2007) often assess incapacitated rape (i.e., penetrative sex when one is unable to consent because of alcohol or other drugs). However, these measures are often limited by combining alcohol and other substances and do not assess other forms of alcohol-related sexual assault (e.g., unwanted sexual advances).

Current study

For research that focuses on the role of alcohol in sexual decision making, a comprehensive measure of alcohol-related sexual consequences is needed to understand young adults’ experience of a broad range of negative sexual consequences. Accordingly, we introduce the Alcohol-Related Sexual Consequences Scale. First, we present descriptive information on this new measure. We examine the frequency of each alcohol-related sexual consequence in a convenience sample of young adults who reported drinking and not being in a monogamous relationship. We also test for differences by biological sex, given that women may experience greater susceptibility to certain consequences, such as STIs, in the context of relationship maintenance and STI prevention (Centers for Disease Control and Prevention, 2018), and we explored differences based on the types of sexual experiences (entirely heterosexual or not). Second, we examined convergent and divergent validity. Specifically, we examined associations among demographic, alcohol-related, and sex-related covariates in predicting both alcohol-related sexual consequences (on the new measure) and alcohol consequences. It was hypothesized that the sex-related covariates would be positively associated with alcohol-related sexual consequences above and beyond alcohol consequences, thus demonstrating convergent validity whereby sex-related constructs show robust associations with alcohol-related sexual consequences. Alcohol-related covariates were hypothesized to be positively associated alcohol consequences above and beyond alcohol-related sexual consequences, thus demonstrating divergent validity whereby alcohol-related constructs show robust associations with alcohol consequences rather than alcohol-related sexual consequences.

Method

Participants and procedure

Participants were part of a larger intervention study (N = 402) focusing on alcohol use and risky sex among young adults and were recruited nationally using various methods (e.g., Facebook, Craigslist). Eligibility criteria pertinent to the current study include (a) age 18–25, (b) not in a monogamous relationship, (c) past-month vaginal or anal sex without a condom after drinking, (d) consume an alcoholic drink at least once a week over the past 3 months, and (e) one past-month episode of heavy episodic drinking (see Lewis et al., 2019, for full list).

For the current analyses, participants were excluded for the following reasons: (a) no past-month alcohol consumption before/during vaginal/anal sex at baseline (74 excluded), (b) no past-month drinking at baseline (1 excluded), (c) missing values on 10 of 41 alcohol-related sexual consequences items (1 excluded), (d) identified as “married/committed partners (i.e., living together for 1 year or more, same-sex domestic partnership at baseline)” at baseline (8 excluded).

The resulting analytic sample consisted of 318 participants (Mage = 22.52, SD = 1.89; 54.1% female). Most participants (70.5%) identified as Caucasian/White, followed by 10.5% multiple races, 9.5% Black/African American, 5.7% Asian/Asian American, 2.5% other, 0.6% American Indian/Alaskan Native, and 0.6% Native Hawaiian/Pacific Islander. Approximately 13.6% identified as Hispanic or Latino. The majority (59.1%) indicated that they were single (not dating), 35.2% were dating (but not in a serious relationship), 5.3% were dating seriously, and 0.3% were separated/divorced. Most (77.4%) identified as straight/heterosexual, 11.3% as bisexual, 4.1% as gay/lesbian, 4.1% as queer/questioning, and 3.0% as another orientation or preferred not to answer.

Measures

All data used here were collected at baseline (before intervention). Demographic information included age and biological sex (0 = female, 1 = male). Participants were asked to describe their sexual experience on a scale from 1 (entirely heterosexual experience) to 7 (entirely homosexual experience); responses were coded to compare “entirely heterosexual experience” with all other responses.

Alcohol-related sexual consequences scale

A 41-item measure was used to assess alcohol-related sexual consequences (Table 1; see Supplemental Table A for participant instructions and complete items). (Supplemental material appears as an online-only addendum to this article on the journal's website.) Items were adapted from measures of alcohol-related consequences (Hurlbut & Sher, 1992; Koss et al., 2007; Read et al., 2006). To assess other alcohol-related sexual consequences common in the literature but not captured by previous measures, investigator-generated items were added. Sexual behavior included digital, oral, vaginal, and anal sex. Casual partner was defined as “a sexual partner that you do not have a monogamous relationship with (i.e., sex only with each other) or someone you have known for less than 24 hours.” Participants indicated whether they had experienced each item as a result of drinking alcohol in the past month (1 = yes, 0 = no). Items were summed to create a total score (Cronbach's α = .88).

TABLE 1.

Proportion of sample endorsing each alcohol-related sexual consequence comparing men and women

graphic file with name jsad.2021.82.493tbl1a.jpg

graphic file with name jsad.2021.82.493tbl1b.jpg

Alcohol-related sexual consequence Proportion endorsing each item Test comparing women and men
Full sample (n = 318) Women (n = 172) Men (n = 146) χ2 p
Digital sex later regretteda .08 .08 .07 0.19 .66
Oral sex later regretteda .15 .15 .16 0.03 .88
Vaginal sex later regretteda .22 .27 .17 4.33 .04
Anal sex that I later regretteda .05 .05 .05 0.03 .87
Cheated on romantic partnerb .08 .12 .04 6.67 .01
Relationship issues with romantic partnera .14 .16 .12 0.70 .40
Got a bad reputationb .12 .15 .10 1.80 .18
Neglected to use birth control other than a condoma .21 .21 .22 0.08 .77
Had sex with my partner without talking about using birth control other than a condomb .33 .32 .34 0.18 .67
Had sex with my partner without talking about condom useb .56 .56 .56 0.00 .97
Oral sex without a condoma .66 .65 .66 0.04 .84
Oral sex without a dental dama .52 .49 .55 1.52 .22
Vaginal sex without a condoma .66 .65 .67 0.14 .71
Anal sex without a condoma .15 .10 .21 7.02 .01
Sex without a condom even though partner wanted to use oneb .09 .08 .11 1.14 .29
Unable to lubricate (or attain an erection)b .17 .19 .14 1.40 .24
Unable to climaxb .30 .33 .26 1.90 .17
Digital sex with someone I wouldn't have sex with when soberb .08 .08 .08 0.00 .98
Oral sex with someone I wouldn't have sex with when soberb .13 .12 .14 0.53 .47
Vaginal sex with someone I wouldn't have had sex with when soberb .19 .20 .17 0.37 .55
Anal sex with someone I wouldn't have had sex with when soberb .03 .04 .03 0.42 .52
Digital sex with someone I had just metb .12 .08 .16 5.17 .02
Oral sex with someone I had just metb .22 .13 .33 18.56*** <.001
Vaginal sex with someone I had just metb .23 .19 .28 3.50 .06
Anal sex with someone I had just metb .06 .02 .10 10.76 .001
In a sexual situation that I wouldn't have been in if I was soberb .39 .39 .40 0.11 .74
In a sexual situation in which I felt unsafeb .06 .07 .05 0.67 .41
Went further sexually than my partner wanted tob .06 .04 .08 1.74 .19
Went further sexually than what I am usually comfortable with when sobera .18 .23 .13 4.94 .03
Had sex and became (or got my partner) unintentionally pregnantb .01 .01 .01 0.20 .65
Had sex and was worried about pregnancyb .20 .26 .12 9.84 .002
Had sex and acquired a sexually transmitted infection (STI)b .02 .02 .03 0.35 .55
Had sex and was scared that I acquired an STIb .14 .16 .12 0.74 .39
Had sex in exchange for money or goods (i.e., drugs, rent)b .03 .05 .02 1.59 .21
Someone fondled etc. or removed clothes without my consentc .09 .09 .08 0.12 .73
Someone had oral sex with me without my consent when I was too drunkc .03 .02 .04 1.61 .21
Forced sexual contact (with vagina/penis/anus) without my consent when I was too drunkc .03 .03 .03 0.15 .70
Sexual contact (with anus) without my consent when I was too drunkc .02 .02 .03 0.38 .54
Someone tried to have oral sex with me without my consent when I was too drunkc .04 .05 .02 2.23 .14
Someone tried to have sexual contact (with vagina/penis/anus) without my consent when I was too drunkc .05 .07 .03 1.97 .16
A man tried to put his penis into my anus, or someone tried to stick fingers or objects into my anus without my consent when I was too drunkc .02 .02 .01 0.38 .54
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Notes: All chi-square tests had one degree of freedom. A corrected α of p < .001 was used because of the number of chi-square tests conducted (critical value = 10.83). See Supplemental Table A for the full text of the 41 items as well as the instructions that were provided to the participants.

a

Adapted from item on the Young Adult Alcohol Problems Screening Test (YAAPST) and/or Young Adult Alcohol Consequences Questionnaire (YAACQ);

b

new item created for this measure;

c

adapted from item on the Sexual Experiences Scale (SES).

***

Corrected α of p < .001.

Sexual behavior

Past-month sexual behavior was assessed using items adapted from Lewis et al. (2007, 2014). Participants reported the number of casual sexual partners they had (including oral, vaginal, or anal sex). Participants also reported the number of drinks consumed, on average, before or during any sex. Finally, participants reported the number of times they had consumed alcohol before or during sex with a casual partner. Responses were open ended.

Alcohol use and consequences

The seven-item Daily Drinking Questionnaire (DDQ; Collins et al., 1985; Kivlahan et al., 1990) measured the number of drinks participants consumed each day of a typical week during the past month. The sum score reflects the number of drinks consumed in a typical week. Alcohol-related consequences in the past month were measured by the 24-item Brief-Young Adult Alcohol Consequences Questionnaire (B-YAACQ; Kahler et al., 2005). Participants responded whether each consequence occurred (1 = yes, 0 = no). A 23-item sum score was calculated, which excluded the sex-related consequence item (“My drinking has gotten me into sexual situations I later regretted”).

Sex-related alcohol expectancies

On a 13-item sex-related alcohol expectancies measure (Dermen & Cooper, 1994), participants rated how much they agree that an effect would occur after having a few drinks from 1 (strongly disagree) to 6 (strongly agree). Mean scores were calculated for each subscale, including sexual enhancement expectancies (five items, α = .88, e.g., “I feel closer to a sexual partner”), sexual risk-taking expectancies (four items, α = .88, e.g., “I am less likely to take precautions before having sex”), and sexual disinhibition expectancies (four items, α = .82, e.g., “I am more likely to have sex on a first date”).

Alcohol expectancies

The 15-item Brief Comprehensive Effects of Alcohol scale (Fromme et al., 1993; Ham et al., 2005) assesses what participants would expect to happen if they were under the influence of alcohol. Responses range from 1 (disagree) to 4 (agree). Mean scores were computed for the positive expectancy subscale (eight items; α = .71; e.g., “act sociable”) and the negative expectancy subscale (seven items; α = .70; e.g., “be clumsy”).

Data analyses

Chi-square tests were conducted for each of the 41 items to examine differences by biological sex. A Bonferroni correction was used with an α of p < .001 for chi-square tests. Raw values are reported for all descriptive statistics; several variables (age, alcohol expectancies, and sexual expectancies) were rescaled (setting minimum to zero) for the regression models to allow for an interpretable intercept. The primary study outcomes were count variables (i.e., number of negative consequences experienced), and thus negative binomial regression models were estimated to accommodate the overdispersed count outcomes.

Models were estimated in Mplus Version 8.4 (Muthén & Muthén, 2019) and Monte Carlo integration was used. Three-step hierarchical models were conducted for both outcomes: number of alcohol-related sexual consequences and number of alcohol consequences. In Step 1, demographic and alcohol-based predictors were included: biological sex, age, total drinks per week, and alcohol expectancies. In Step 2, sex-related predictors were added: number of casual sexual partners, number of drinks before or during sex, number of times consumed alcohol before or during sex with a casual partner, sexual enhancement expectancies, sexual risk-taking expectancies, and sexual disinhibition expectancies. In Step 3, the alternate alcohol consequences measure was added (e.g., alcohol consequences to predict alcohol-related sexual consequences). Models were designed to demonstrate convergent validity (i.e., sex-related constructs would show robust associations with alcohol-related sexual consequences in Step 3) and divergent validity (i.e., alcohol-related constructs would show robust associations with alcohol consequences rather than alcohol-related sexual consequences in Step 3).

Results

Descriptive statistics

The majority (92.5%) of participants reported experiencing at least one alcohol-related sexual consequence. More than half of the sample (53.5%) reported that drinking often got them into sexual situations they later regretted (BYAACQ item). The following past-month alcohol-related sexual consequences were experienced by more than 50% of participants: vaginal sex without a condom, oral sex without a condom, oral sex without a dental dam, and having sex without talking about condom use (Table 1). Descriptive statistics for the variables included in the regression analyses are shown in Table 2, and correlations are shown in Supplemental Table B. The number of alcohol-related sexual consequences (M = 6.94, SD = 5.62, range: 0–40) and alcohol consequences (M = 10.69, SD = 5.50, range: 0–23) were correlated, r = .52. Squaring this correlation (i.e., computing R2) revealed that only 27.0% of the variance was shared between measures. The majority (66.6%) of participants drank more than twice weekly in the past month; 29.2% drank once or twice weekly and 4.1% drank less than weekly. Participants reported an average of 1.98 (SD = 1.53, range: 1–15) past-month sexual partners, including casual partners. When drinking before or during sex, participants consumed 4.98 drinks on average (SD = 2.80, range: 1–14).

TABLE 2.

Descriptive statistics for variables in regression models

graphic file with name jsad.2021.82.493tbl2.jpg

Variable n Range M (SD) or %
Alcohol-related sexual consequences 318 0-40 6.94 (5.62)
Alcohol consequences 318 0-23 10.69 (5.50)
Male sex 318 0-1 46%
Age 318 18-26 22.52 (1.89)
Total drinks per week 315 3-69 20.34(13.22)
Positive alcohol expectancies 318 1.5-4 3.01 (0.47)
Negative alcohol expectancies 318 1-4 2.58 (0.55)
No. of casual partners 318 0-7 1.59 (1.30)
No. of drinks before/during sex 318 0-14 4.98 (2.80)
No. of times alcohol before/during sex with casual partner 317 0-30 2.87 (3.46)
Sexual enhancement expectancies 312 1-6 3.93 (1.19)
Sexual risk-taking expectancies 309 1-6 3.84 (1.43)
Sexual disinhibition expectancies 316 1-6 3.81 (1.29)
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Notes: Original scales are shown here for age, alcohol expectancies, and sexual expectancies; variables were rescaled for the regression models to have a minimum of zero and allow for an interpretable intercept.

Analyses to test for item-level differences by sex found only 1 of 41 significant chi-square tests (corrected α, p < .001), showing men were more likely than women to report oral sex with someone they just met (Table 1). A supplemental analysis compared individuals who reported entirely heterosexual experiences (55% of sample) with those who did not (45% of sample). Based on a corrected α of p < .001, only 1 of the 41 chi-square tests was significant, χ2(n = 318) = 11.80; individuals who reported entirely heterosexual experiences were more likely to report having vaginal sex without a condom (74.3%) than individuals who did not report entirely heterosexual experiences (55.9%).

Conditional predictors of alcohol-related sexual consequences

In Step 1 of the negative binomial regression model predicting alcohol-related sexual consequences (Table 3), drinks per week and negative alcohol expectancies were positively associated with the outcome. In Step 2 where sex-related predictors were added to the model, past-month casual sexual partners, sexual risk-taking expectancies, and sexual disinhibition expectancies were positively associated with alcohol-related sexual consequences. Also, negative alcohol expectancies were still positively associated with alcohol-related sexual consequences, but total drinks per week was no longer significant. In Step 3, alcohol consequences were added to the model and exhibited a positive association with alcohol-related sexual consequences. When controlling for alcohol consequences, past-month casual sexual partners, sexual risk-taking expectancies, and sexual disinhibition expectancies remained positively associated with alcohol-related sexual consequences (demonstrating convergent validity), but negative alcohol expectancies was no longer significant.

TABLE 3.

Results of negative binomial regression models predicting alcohol-related sexual consequences

graphic file with name jsad.2021.82.493tbl3.jpg

Step 1 Step 2 Step 3
Predictor B SE p B SE p B SE p
Demographic variables
 Male sex 0.002 0.082 .980 −0.072 0.073 .321 −0.050 0.071 .476
 Age 0.002 0.022 .918 −0.016 0.021 .453 −0.011 0.019 .569
Alcohol-related variables
 Total drinks per week 0.011 0.003 <001*** 0.003 0.003 .340 −0.001 0.003 .766
Positive alcohol expectancies 0.144 0.103 .160 −0.065 0.105 .536 −0.043 0.097 .658
 Negative alcohol expectancies 0.363 0.084 <.001*** 0.229 0.079 .004** 0.062 0.076 .416
Sex-related variables
 No. of casual partners 0.124 0.033 <.001*** 0.099 0.031 .001**
 No. of drinks before/during sex 0.019 0.017 .257 0.016 0.016 .324
No. of times alcohol before/during sex with casual partner 0.009 0.009 .323 0.008 0.008 .319
 Sexual enhancement expectancies 0.025 0.041 .535 −0.005 0.039 .901
 Sexual risk-taking expectancies 0.109 0.032 .001** 0.101 0.031 .001**
 Sexual disinhibition expectancies 0.153 0.039 <.001*** 0.109 0.038 .004**
Alternate consequence variable
 Alcohol consequences 0.048 0.009 <.001***
Other parameters
 Intercept 0.794 0.261 .002** 0.502 0.279 .072 0.537 0.246 .029*
 Dispersion 0.433 0.051 <.001*** 0.285 0.046 <.001*** 0.236 0.038 <.001***
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*

p < .05;

**

p < .01;

***

p < .001.

Conditional predictors of alcohol consequences

In Step 1 of the negative binomial regression model predicting alcohol consequences (Table 4), drinks per week and negative alcohol expectancies were positively associated with the outcome. In Step 2, sexual disinhibition expectancies were positively associated with alcohol consequences. Also, drinks per week and negative alcohol expectancies remained positively associated with alcohol consequences. In Step 3, alcohol-related sexual consequences exhibited a positive association with alcohol consequences. When controlling for alcohol-related sexual consequences, drinks per week and alcohol expectancies remained positively associated with alcohol consequences (demonstrating divergent validity), and sexual disinhibition expectancies also remained positively associated with alcohol consequences.

TABLE 4.

Results of negative binomial regression models predicting alcohol consequences

graphic file with name jsad.2021.82.493tbl4.jpg

Step 1 Step 2 Step 3
Predictor B SE p B SE p B SE p
Demographic variables
 Male sex −0.016 0.055 .774 −0.042 0.052 .428 −0.021 0.051 .679
 Age −0.008 0.014 .569 −0.018 0.013 .179 −0.017 0.013 .190
Alcohol-related variables
 Total drinks per week 0.012 0.002 <.001*** 0.009 0.002 <.001*** 0.009 0.002 <.001***
 Positive alcohol expectancies 0.082 0.056 .145 −0.042 0.067 .535 −0.041 0.065 .531
 Negative alcohol expectancies 0.367 0.045 <.001*** 0.307 0.045 <.001*** 0.270 0.043 <.001***
Sex-related variables
 No. of casual partners 0.041 0.021 .054 0.023 0.023 .320
 No. of drinks before/during sex 0.004 0.009 .665 0.001 0.010 .934
 No. of times alcohol before/during sex with casual partner 0.001 0.006 .873 −0.004 0.008 .587
 Sexual enhancement expectancies 0.049 0.026 .057 0.048 0.024 .051
 Sexual risk-taking expectancies 0.029 0.022 .187 0.015 0.022 .488
 Sexual disinhibition expectancies 0.082 0.025 .001** 0.058 0.024 .016*
Alternate consequence variable
 Alcohol-related sexual consequences 0.022 0.005 <.001***
Other parameters
 Intercept 1.385 0.140 <.001*** 1.283 0.144 v.001*** 1.338 0.139 <.001***
 Dispersion 0.118 0.020 <.001*** 0.088 0.019 <.001*** 0.075 0.017 <.001***
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*

p < .05;

**

p < .01;

***

p < .001.

Discussion

The current study presents a newly developed measure of alcohol-related sexual consequences. This 41-item Alcohol-Related Sexual Consequences Scale reflects important consequences experienced by young adults that are potential indicators of alcohol-related sexual risk-taking. Although other measures assess either alcohol-related consequences (Hurlbut & Sher, 1992; Read et al., 2006; White & Labouvie, 1989) or sexual assault (Koss et al., 2007), there are sexual consequences of alcohol use not typically assessed; the comprehensive measure presented here addresses this gap.

As intended, the novel assessment captured more detailed information about a greater range of alcohol-related sexual consequences than a general assessment of alcohol consequences. Specifically, 92.5% of at-risk young adults in the current sample reported at least one alcohol-related sexual consequence, compared with only 53.5% who endorsed the one sex-related item on the B-YAACQ (“My drinking has gotten me into sexual situations I later regretted”; endorsed by 37.6% of regular-drinking college students; Kahler et al., 2005). The new Alcohol-Related Sexual Consequences Scale consists of 41 items that can be used to determine which consequences are most common in a given population. For example, in the current sample of young adults who had past-month vaginal or anal sex without a condom after drinking, oral sex without a condom or dental dam was also very common, reported by more than half the sample. In addition, more than half of participants reported past-month sex without talking to their partner about condom use. Some alcohol-related sexual consequences were rare, including past-month acquired STI and pregnancy, which participants may not recognize until more than 1 month after a sexual encounter. Differences in prevalence between items highlight the capacity of this novel measure to assess both common and rare-but-serious alcohol-related sexual consequences. Further, only 1 of 41 items evidenced differences between males and females, and only 1 item evidenced differences based on having entirely heterosexual experiences or not.

Moreover, the number of alcohol-related sexual consequences endorsed on this novel measure was related to, yet distinct from, the number of alcohol consequences reported from the previously validated B-YAACQ (Kahler et al., 2005). Specifically, in this sample, 73% of the variance in alcohol-related sexual consequences and general alcohol consequences was nonshared variance. As hypothesized, we found evidence of convergent and divergent validity in that, when controlling for alcohol consequences, sex-related predictors (number of casual sexual partners, sexual risk-taking expectancies) were uniquely predictive of alcohol-related sexual consequences but not alcohol consequences. Sexual disinhibition expectancies were uniquely associated with both alcohol-related sexual consequences (as anticipated) and alcohol consequences (unanticipated), which may reflect a general association between disinhibition expectancies and problem drinking (Leeman et al., 2009).

Further, as hypothesized, we found evidence of divergent validity in that when controlling for alcohol-related sexual consequences, alcohol-related predictors (drinks per week, negative alcohol expectancies) were uniquely associated with alcohol consequences (Orchowski et al., 2012) but did not uniquely predict alcohol-related sexual consequences. Of note, the general alcohol consequences measure was associated with alcohol-related sexual consequences. This association may reflect both shared method variance in willingness to self-report consequences as well as a true association between general and sexual alcohol-related consequences, which may result from a common cause (e.g., alcohol sensitivity or dependence). That being said, the new Alcohol-Related Sexual Consequences Scale is uniquely associated with sexual constructs and also assesses sexual consequences not captured by a general alcohol consequences measure, making it well suited to assess alcohol consequences specific to sexual behavior.

Recommendations for using this scale

One intervention strategy involves highlighting consequences to change behavioral intentions (Abraham & Michie, 2008; Webb & Sheeran, 2006). The current Alcohol-Related Sexual Consequences Scale could be used in personalized feedback interventions to create targeted treatment or “hooks” to increase motivations to change behavior. Highlighting sexual consequences that the individual links to alcohol use, including more frequent, less severe behaviors, can start a conversation about the role that alcohol plays in undesirable sexual outcomes and motivate change in drinking behaviors. Research has also indicated that treatments only targeting drinking or sexual behavior may not generalize across behaviors when they co-occur (Lewis et al., 2014). This novel measure may help capture clinical change in co-occurring alcohol use and sexual behaviors, although more research is needed to evaluate whether this measure is sensitive to change during treatment.

Limitations

Regarding limitations, we note that some aspects of alcohol-related sexual behaviors are not included in this measure, such as dating violence and electronic communication (“sexting”). Second, this measure may not adequately capture events that are difficult to link to drinking (e.g., participants may not know which encounter led to an STI and thus whether they were drinking when it was acquired). Further, participants were instructed to report on experiences that they identified as being a “result of drinking,” rather than experiences that happened while drinking. The measure may not capture all consequences that occurred while drinking because a consequence may have been attributed to another factor, like being tired or stressed. Third, this measure is only relevant to individuals who both drink alcohol and have sex. Given that the current high-risk sample was recruited to observe typically low base-rate alcohol-related sexual consequences among nonmonogamous young adults, findings may not generalize across younger or older samples and may differ by the specific inclusion criteria used. Finally, the sample was largely heterosexual. Although we found that generally there were relatively few differences in responses based on the type of sexual experiences (entirely heterosexual or not), we did not have sufficient numbers of sexual minorities to conduct focused subgroup analyses.

Future directions and conclusions

Current findings offer preliminary support for the Alcohol-Related Sexual Consequences Scale, which is a novel, more comprehensive assessment of alcohol-related sexual consequences. Given that some item texts are lengthy, future researchers may test whether items can be shortened, while maintaining breadth and specificity. Branching logic could be considered to first query the type of experience (e.g., sexual experiences with someone you just met) and, if affirmative, specifics regarding the nature of sexual acts could be assessed (e.g., vaginal sex, anal sex). Further, although low base rates and inter-item coverage prevented factor analytic work in the current sample, we suggest that future research with larger high-risk samples be conducted to allow for psychometric research, including examination of subscales. Future research should further validate this measure by determining whether it predicts unique variance in outcomes (e.g., distress), over and above existing measures (e.g., general alcohol consequences). Longitudinal research is needed to determine predictive validity and increase our ability to identify those who may benefit from targeted prevention services. This measure can also contribute to future studies examining the influence of alcohol on sexual consequences and interventions aimed at reducing alcohol-related sexual risk taking.

Footnotes

Data collection and manuscript preparation were supported by National Institute on Alcohol Abuse and Alcoholism Grant R21AA021767 (awarded to Melissa A. Lewis). Manuscript preparation was supported for Anna E. Jaffe in part by National Institute on Alcohol Abuse and Alcoholism Grant T32AA007455 (principal investigator: Mary E. Larimer). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Alcohol Abuse and Alcoholism or the National Institutes of Health.

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