Several studies have indicated that alcohol consumption is associated with sexual risk-taking among teenagers. But is drinking a cause or simply a correlate of risky behavior? In this issue of Perspectives on Sexual and Reproductive Health (see article), Diane M. Morrison and colleagues challenge the widely held hypothesis that drinking causes risky sexual practices, and point out that previous studies did not measure whether risky behaviors occurred together and were not able to prove a causal relationship. To address the methodological limitations of these studies, Morrison's team analyzed daily diary accounts of a sample of high-risk adolescents' health behavior to see whether drinking was associated with condom nonuse during intercourse.
Of note, in analyses comparing each young person with himself or herself (instead of with others), the rate of condom use was the same for sexual encounters preceded by drinking as for those not preceded by drinking. Furthermore, in multivariate analyses, neither having consumed alcohol nor the number of drinks consumed prior to sexual intercourse was associated with condom use. However, condom use significantly increased when teenagers expected to have sex or had intercourse with a casual partner; it decreased when another method of birth control was used. Surprisingly, participants who had had a sexually transmitted disease (STD) in the past were no more likely to use condoms during sexual intercourse than those who did not have a history of STD.
Although the results do not confirm causality between alcohol consumption and decreased condom use, Morrison and her coauthors stress that the findings do not "preclude the possibility that drinking could affect condom use, one way or another, for some individuals or on some occasions." Nevertheless, they suggest that rather than focusing on decreasing alcohol use, interventions aimed at adolescents should encourage them to carry condoms regularly and to discuss their sexual behavior and STD history with their partners.
In another study of high-risk adolescents, Christine M. Markham and colleagues are the first to explore whether strong family connectedness--an established protective factor against risky behavior among regular high school students--is correlated with decreased risky sexual behavior among alternative school students, who are more likely to engage in risky behavior than their regular school peers (see article). In their sample of alternative high school students in Houston, youth who reported having high levels of family connectedness had reduced odds of ever having had sex, recently having had sex without a condom and having been involved in a pregnancy. High family connectedness was associated with delayed sexual activity among females and with a lack of pregnancy involvement among males. Markham and her coauthors conclude that programs geared to reducing risky sexual behavior among alternative high school students should take into account the positive influence of family relationships.
=subhead Also in This Issue
• The IUD was once a popular choice for contraception among Navajo women, a population with a high rate of unintended pregnancy, but use has fallen dramatically in recent years. Although decline may stem from women's concerns about the method, providers' knowledge and attitudes about the IUD are also barriers to its expanded use. Using survey data from Navajo Area Indian Health Service providers, Eve Espey and colleagues (see article) show that providers' apprehensions about the method's safety and side effects prevent them from recommending the IUD. Women's health specialists feel better able than other providers to offer IUD services, and they insert more devices than others. To increase IUD use among Navajo women, the authors stress that all primary care providers who offer services to women must be educated about and well trained in providing the method.
• It is important to examine how young men view their reproductive health so as to design programs and services that best meet their needs. In a qualitative study of a sample of urban high school students, Arik V. Marcell and colleagues (see article) discover that the context in which reproductive health fits into adolescent men's lives is complex and multilayered. The young men considered education a chief priority in their lives, whereas their health was not a major concern. They were concerned that pregnancy could have a negative impact on life goals, but characterized the risk of STDs as a health issue. Reflecting their notions about masculinity, young men emphasized that having sex is part of the male's role in a relationship and that men should handle most health problems themselves. Thus, the authors recommend that programs serving young men consider the ways in which their life priorities and other concerns affect their reproductive health care-seeking behavior.