Unsafe sex refers to behaviours that increase the risk of sexually transmitted infections (STIs) and unwanted pregnancy. Unsafe sex and the adverse health outcomes that can result are important areas of public health research. The prevalence of unsafe sex is particularly concerning among adolescent and young adult populations given that they typically demonstrate low levels of sexual health knowledge and high rates of short-term or casual sexual partnerships. Excessive alcohol use has been positively associated with being sexually active and with risky sexual practice. Given the increases in prevalence of these behaviours in Australia over the past decade, this association offers an important focus for empirical research.
In Australia, the Secondary Students and Sexual Health (SSASH) study reports nationally representative data on the sexual behaviour of young people aged 15 and 17 years over time, using a repeated cross-sectional methodology. In 1997, 34% of students reported experiencing sex in their lifetime and this figure had increased to 40% in the 2008 study. Similarly, the rate of young people having sex with multiple partners had increased significantly in Australia, with the proportion of those reporting sex with three or more people in the previous year rising from 16% in 1997 to 30% in 2008. The study also found that although the majority of students (64%) reported using a condom when they had sex the last time, this rate had not increased since 1997.
Rates of harmful alcohol use by young people have also increased in Australia. A nationally representative study of secondary students in Australia found that between 1999 and 2008 the proportion of young people aged 12 to 17 years drinking harmful levels of alcohol increased from 26% to 29%. In a cross-national study of young people's (Grades 5, 7 & 9) alcohol use and related harms conducted in Victoria, Australia, and Washington State, United States (US), Toumbourou et al. found the rates of alcohol use and related harms for the Victorian sample of the study were noticeably higher than those for young people in Washington State.
Although situational factors such as excessive drinking are clearly important in terms of understanding adolescent sexual practice, other factors, such as the formation of normative behaviour through socialisation, may also play a role. Family and school are important socialisation sites. Family factors have been shown to influence a range of adolescent behaviour including risky sexual practices, with cohesive and supportive family environments found to be protective. Risky adolescent sexual practice is also associated with experiences in school and education with studies demonstrating that educational attainment and connectedness to school are protective.
This paper responds to the need for current Australian information by analysing data relating to young people's sexual behaviour and its association with alcohol – specifically binge (five or more drinks) and compulsive drinking (unable to stop). In this paper we define risky sex as sex with multiple partners in the past year, sex without using a condom at the most recent sexual encounter and sex in the past year that the young person later regretted due to alcohol use. We also examine the association between drinking behaviour and young people's exposure to sexual intercourse in the past year. Given the high prevalence of alcohol use demonstrated among Australian youth, we chose to model two measures of excessive episodic drinking to test the comparative effects these different drinking behaviours may have on sexual risk taking. Moreover, we seek to explore the relationship between young people's sexual behaviour and drinking, taking into account possible confounders such as school and family factors. More specifically, we hypothesise that young people who engage in excessive drinking (binge or compulsive drinking) will be at greater risk of engaging in risky sex, independent of their level of connectedness to and performance at school, and the quality of their family environment.
Authors: Paul Agius, Angela Taft, Sheryl Hemphill, John Toumbourou and Barbara McMorris.