Alcohol use during adolescence is associated with sexual risk during young adulthood, but in different ways for whites and blacks, according to analyses of data from the National Longitudinal Study of Adolescent Health (Add Health).1 For example, among blacks, participants who reported during adolescence that they drank more than once a month had elevated odds of reporting multiple recent partners when interviewed as young adults; among whites, no such association was apparent in multivariate analysis. Whites who said as teenagers that they had gotten drunk in the past year were more likely than others to test positive for an STD when surveyed in young adulthood, but the same was not true for blacks. These and other findings expand on earlier work based on more limited measures and samples.
The analysts used data from two rounds of Add Health: Wave 1, which was conducted in 1994–1995 among youth with a median age of 16; and Wave 3, which was carried out in 2001–2002 and included collection of urine samples to be tested for chlamydia, gonorrhea and trichomonas infection. They conducted bivariate tests to compare whites and blacks with respect to socioeconomic and demographic characteristics, alcohol use at Wave 1 and sexual risk–related characteristics at Wave 3. Using logistic regression, they then estimated, separately for members of each racial group, associations between adolescent alcohol use and young adult sexual risk.
A total of 7,741 white and 3,042 black Add Health participants were included in the analyses. The sample was evenly split between males and females; at Wave 3, participants were 18–28 years old (mean, 22). Blacks reported having less educated mothers than whites at Wave 1 and more recent financial difficulty at Wave 3.
At the bivariate level, blacks and whites differed significantly on all measures assessing alcohol use during adolescence and sexual risk during young adulthood. As teenagers, greater proportions of whites than of blacks said that during the past year, they had consumed any alcohol (59% vs. 48%); gotten drunk (32% vs. 19%); and used alcohol "consistently," or more than once monthly (19% vs. 15%). As young adults, larger proportions of blacks than of whites reported that during the past year, they had had two or more partners (37% vs. 27%), six or more partners (6% vs. 3%), an STD (11% vs. 3%) or a partner with an STD history (13% vs. 5%); they also were more likely to test positive for an STD at Wave 3 (19% vs. 3%). Whites, however, were more likely than blacks to report inconsistent condom use in the past year (80% vs. 71% of those who had had vaginal intercourse during that period).
Adjusted analyses revealed that white participants’ odds of reporting in Wave 3 that they had recently had two or more partners were elevated only if they had said at Wave 1 that they had gotten drunk in the previous year (odds ratio, 1.2). A similar association held for blacks (1.6), for whom this behavior also was predicted by teenage reports of any alcohol use and of consistent drinking in the past year (1.4 and 1.9, respectively). White participants’ alcohol use during adolescence was not associated with their reports of having had six or more partners during the year before the Wave 3 survey, but all three measures of teenage alcohol use predicted this behavior for blacks (1.9–2.5). Marginally significant findings suggested that whites who had consumed any alcohol or gotten drunk in the year before Wave 1 were at increased risk of reporting inconsistent condom use as young adults (1.4–1.5); the odds of reporting this behavior were significantly elevated for blacks who reported any alcohol consumption at Wave 1 (1.6).
During young adulthood, sex with a partner who had an STD history was not associated with any adolescent drinking measure for either group. White participants’ own STD history was not related to alcohol use during adolescence, but blacks who had drunk any alcohol or gotten drunk prior to Wave 1 were at increased risk of having had an STD in the year before Wave 3 (odds ratio, 1.5 for each). By contrast, while the likelihood of testing positive for an STD at Wave 3 was unrelated to blacks’ Wave 1 reports of alcohol use, it was associated with whites’ reports of having been drunk and of consistent drinking during adolescence (1.7 for each).
Noting that some of the same factors may "fuel both adolescent alcohol use and [STD] risk in adulthood," the researchers acknowledge that their analyses may not have captured all potential confounders. In addition, participants’ reports of STD history may have biased the results. Despite these limitations, the analysts write, their findings highlight a need for a "multisystems approach" to preventing alcohol use and STD risk, in which "efforts are integrated and delivery methods are innovative and developmentally appropriate."—D. Hollander