Gender differences in alcohol consumption and adverse drinking consequences: cross-cultural patterns.

AIMS: To examine the consistency and/or variability of gender differences in drinking behavior cross-culturally. DESIGN, SETTING, PARTICIPANTS: Women's and men's responses in 16 general population surveys from 10 countries, analyzed by members of the International Research Group on Gender and Alcohol. MEASUREMENTS: Comparable measures of drinking, versus abstention, typical drinking frequencies and quantities, heavy episodic drinking, intoxication, morning drinking, and alcohol-related family and occupational problems. FINDINGS: Women and men differed little in the probability of currently drinking versus abstaining, but men consistently exceeded women in typical drinking frequencies and quantities and in rates of heavy drinking episodes and adverse drinking consequences, while women were consistently more likely than men to be life-time abstainers. In older age groups, both men and women drank smaller quantities of alcohol and were more likely to stop drinking altogether, but drinking frequencies did not change consistently with age. CONCLUSIONS: A theoretical synthesis proposes that gender roles may amplify biological differences in reactions to alcohol, and that gender differences in drinking behavior may be modified by macrosocial factors that modify gender role contrasts.

A description of the gender differences in risk behaviors in young adults with genital herpes.

The purpose of this paper is to describe gender differences in risk behaviors--substance use and sexual behavior--in young adults with genital herpes. Two-hundred fifty-two young adults with genital herpes were recruited into the study via newspaper advertisements in a West Coast metropolitan area. As a part of a large randomized clinical trial, participants completed questionnaires measuring demographic characteristics and the risk behaviors of substance use and sexual behavior. Participants had a mean age of 27.1 years and were largely Caucasian, employed, college-educated, and heterosexual. Women were two years younger than men and had less income. Gender differences were found in both substance use and sexual behavior. Men were more likely to report current use of illicit drugs than were women. Men were also more likely to report a history of gonorrhea, and urethral discharge. Women reported initiating sex at an older age and having fewer sexual partners over their lifetimes than men. There were no gender differences in use of condoms or spermicides specifically to prevent transmission of genital herpes. Further study is needed of these young adults as they are at high risk for transmission of the disease and also for contracting other sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection. Sensitive interventions are needed with this high-risk population.

The relationship of alcohol use to sexual activity in a U.S. national sample.

Recent reports have indicated that the use of alcohol is related to sexual behavior (such as unprotected intercourse) that is high-risk for HIV infection. However, most of these studies have collected data from convenience samples, using measures of varying specificity. This paper describes a study designed to investigate the relationship of alcohol use to unsafe sexual activity in a representative sample of adults. Data were collected from 2058 respondents as part of a survey of a multi-stage area probability sample of the adult household population of the 48 contiguous United States. The interview instrument included measures of alcohol use, sexual activity and condom use. Logistic regression analyses showed that heavier drinkers were more likely to be sexually active, and if sexually active, were more likely to have had more than one sexual partner in the previous year. However, drinking variables were in general not significantly related to condom use. These results suggest that alcohol use may be more strongly related to lifestyle variables (general sexual activity and number of sexual partners) than to more concrete behavioral variables such as condom use. Because these data are correlational, the findings are also consistent with the notion of a general constellation of risk-taking or sensation-seeking activities that includes alcohol use and sexual activity.

Sex, alcohol and sexually transmitted diseases: a national survey.

The analysis of a representative national survey of households provides strong evidence that alcohol overshadows illicit drug use as a risk factor for sexually transmitted diseases (STDs). Men and women who report a history of STDs are significantly more likely to have a history of problem drinking, independent of high-risk sexual activities and demographic characteristics. However, a high rate of change in sexual partners over the past five years also increases the chance of STD infection. Sexual orientation is a major STD risk factor among men but not among women. Although both black men and black women are at greater risk of STDs than are those in other racial or ethnic groups, results indicate that black women's greater likelihood of having sex with men who have multiple partners, rather than their own rates of partner change, makes the crucial difference between their risk and that of white women.

Sexual behavior of American adolescents: results from a U.S. national survey.

PURPOSE: This paper reports on data from a 1990 U.S. national survey of the sexual behavior of male and female adolescents aged 12-17. METHODS: A household survey using a multi-stage area probability sample of the United States was undertaken in 1990. Adolescents were interviewed about sexual history, contraceptive use, and motivations, attitudes, and expectations with regard to sexual behavior and risk. RESULTS: The majority of 17-year-olds and about half of 16-year-olds, both male and female, had initiated sexual activity, with males initiating at younger ages than females. Sexual activity was episodic; only half of sexually experienced adolescents reported having sex in the month prior to the interview. Many sexually active respondents expressed less desire to have sex than confidence that they would have sex. Over half of respondents reported using a condom at most recent intercourse, with boys being more likely than girls to report condom use. Condom use at last intercourse was unrelated to perceptions of risk and concern about AIDS. CONCLUSIONS: Given the importance of some of the undesirable consequences of sexual activity in adolescents, such as AIDS and unwanted pregnancy, accurate and up-to-date information on sexual behavior of this age group is crucially important. The results of this study underscore the need for in-depth, population-based research on adolescent sexual behavior.

PIP: Research was conducted at Temple University over the period January-July 1990 using a multi-stage area probability sample of the 48 contiguous states of the US. 598 in-person interviews were completed with individuals aged 12-17 years in an effort to learn about their sexual histories, contraceptive use, and motivations, attitudes, and expectations with regard to sexual behavior and risk. Findings are presented in weighted percentages to better ensure representativeness of the national population. 5%, 6%, 24%, 29%, 48%, and 67% of interviewed boys aged 12, 13, 14, 15, 16, and 17 years, respectively, had ever had sexual intercourse. 0%, 3%, 3%, 37%, 48%, and 56% of interviewed girls aged 12, 13, 14, 15, 16, and 17 years, respectively, had ever had sexual intercourse. Overall, 29% of boys and 28% of girls had ever had sexual intercourse. About 25% of white respondents compared to 40% of black respondents had ever had sexual intercourse; among Hispanics, 35% of boys compared to 13% of girls have ever had intercourse. Overall, 16% of girls reported that they had been pregnant and 9% reported ever having a sexually transmitted disease (STD). Less than 4% of boys, however, reported involvement in pregnancies and none reported an history of STD. There were no significant ethnic group differences. Sexually active boys and girls had had sexual intercourse an average of 17.2 and 14.2 times in their lives, respectively, with virtually all sexually active respondents having intercourse during the preceding twelve months. In those twelve months, the boys and girls had had intercourse an average of 10.2 and 11.3 times, respectively. 58.1% of the sexually active boys and 63.4% of the sexually active girls had had sexual intercourse in the preceding 30 days. The vast majority of lifetime sexual intercourse among the sexually active respondents therefore occurred during the twelve months preceding the interview. Sexual activity was otherwise episodic given the percentage of respondents who reported having intercourse during the preceding 30 days. Many sexually active respondents expressed less desire to have sex than confidence that they would have sex. 33% of the boys and 15% of the girls expect and desire to have sex, while 17% of the boys and 3% of the girls desire, but do not expect to have sex. 67% of the boys and 47% of the girls reported using a condom during most recent intercourse, although condom use at last intercourse was unrelated to perceptions of risk and concern about AIDS.

The sexual behavior of US adults: results from a national survey.

OBJECTIVES: One consequence of the acquired immunodeficiency syndrome (AIDS) epidemic has been to highlight the need for population-based estimates of the number of individuals engaging in sexual behaviors that place them at risk for human immunodeficiency virus (HIV) infection. This paper describes the prevalence of various sexual behaviors in a nationally representative sample of adults in the United States. METHODS: Data were collected as part of a household probability survey of adults (n = 2058) in the United States. Data collected on sexual behavior included sexual orientation, frequency of intercourse, condom use, and number of sexual partners. RESULTS: Nearly all respondents were sexually experienced. Of those who were currently sexually active, 13% (1% of married respondents) had had sex with more than one partner in the previous year. Of those reporting having intercourse with more than one partner in the previous year, 7% used condoms consistently and 23% used condoms consistently with their casual partners. CONCLUSIONS: A significant proportion of individuals were found to have intercourse with multiple partners without using condoms. A minority of these respondents acknowledged that their behavior may place them at risk for HIV transmission.

Illicit drug use among young adults with genital herpes.

Although an association exists between illicit drug use and sexually transmitted diseases (STDs) in known high-risk populations such as prostitutes, gay men, and intravenous drug users, little is known with respect to middle-class, heterosexual populations thought to be at less risk. We examined findings related to illicit drug use among young adults with genital herpes from a larger study of young adults' adaptation to chronic disease. In this cross-sectional retrospective study, 70 subjects age 18 to 35 years were interviewed and asked to fill out questionnaires. The sample was predominantly white, heterosexual, employed, and college educated. Responses to open-ended questions related to illicit drug use were coded and compared with findings from two other surveys: a national household survey, Pacific region, metropolitan areas; and a household survey of a San Francisco Bay area county. All but eight subjects (88.6%) reported that they had used an illicit drug at some time in the past. The median number of drugs used was 4; the maximum number was 11. Only six drug-using subjects reported that they had restricted their use to marijuana. Those with genital herpes were more likely to report ever using an illicit drug at some time in the past, and, more specifically, in the past year, than subjects in the two comparison surveys. Such findings suggest that programs screen for illicit drug use as a risk factor in middle-class young adults with genital herpes and other STDs, and for STDs in persons referred for drug abuse treatment.

Behavioral risk factors for sexually transmitted diseases in American households.

The analysis of a representative survey of households (n = 968) in a San Francisco Bay Area county provides strong evidence for the role of problem drinking as a risk factor for sexually transmitted diseases independent of drinking patterns and drug use. Among women, age, race, early age at first intercourse, history of multiple partners, drinking patterns, as well as current symptoms of problem drinking were all associated with reported STD rates. Stepwise logistic regression analysis showed, however, that female problem drinkers are nearly four and a half times more likely (adjusted O.R. = 4.65, 95% C.I. = 1.30, 16.70) than other women to have had STDs independent of all these potential risk factors. Problem drinking puts women at a greater risk for STDs than a history of multiple sex partners (adjusted O.R. = 2.75, 95% C.I. = 0.98, 7.75). This finding is also observed among men, among whom STDs were associated with a history of multiple sex partners (adjusted O.R. = 4.12, 95% C.I. = 1.90, 8.94) and the lifetime prevalence of drinking problems (adjusted O.R. = 4.95, 95% C.I. = 2.13, 11.50). Frequent bar-going, drunkenness episodes, high volume drinking, feeling disinhibited while drinking and drug use increase the risk for STDs via their effects on the rate of sex partner change. Problem drinking determines STD rates independent of these factors. The implications of these findings for future research and health policy are discussed.

Alcohol consumption and unsafe sex: a comparison of heterosexuals and homosexual men.

Recent studies have suggested that drinking in conjunction with sexual activity is related to unsafe sexual activities known to increase the risk of AIDS transmission. However, these studies have used general measures of frequency of both drinking and sexual behavior, giving insufficient information to establish that drinking and risky sex occur in the same sexual encounters. This article presents data from a mail survey of the adult population of San Francisco in which respondents were queried about the circumstances of specific sexual encounters that took place in conjunction with alcohol consumption. The results showed that subjective intoxication was related to practice of unsafe sex among homosexual men and heterosexual women but not among heterosexual men. In addition, respondents whose sexual partners were met in locations construed as "pickup" environments were more likely to practice safe sex. A focus on specific sexual events can contribute to a better understanding of the dynamics of sexual encounters and of the predictors of risky sex in these encounters.

Preliminary results on sexual risk-taking in a general population sample.

This preliminary analysis has shown that there is a considerable amount of sexual risk taking among what is largely a heterosexual population. Although it is not likely that people will faithfully use condoms with regular or main partners, only a few people use them with new or occasional partners. The fact that 20 percent of the adult population took some sexual risks in the last 12 months is quite significant from a public health perspective. This is likely a lower bound estimate since adolescents were not included and it is likely that respondents would fail to report liasons rather than inventing ones that did not happen. The association of alcohol and risk-taking is only looked at in a very global sense here. Future analyses will look closely at the entire sexual encounter event and when and under what circumstances alcohol is important. Also in future analyses we will be looking closely at the cultural belief systems which generate this alcohol and risk-taking association to see if there are mechanisms for prevention strategies.

Long-term effects of incestuous abuse in childhood.

The authors studied two groups of adult women with histories of incest, a nonclinical sample (N = 152) and an outpatient sample (N = 53). Women in the community sample reported a range of long-term effects from the incest. The great majority said they had been upset by their incest experiences, but about half said they had recovered well from their trauma. Most women who had suffered forceful, prolonged, or highly intrusive sexual abuse, or who had been abused by their father or stepfather, reported long-lasting negative effects. The patient sample reported histories comparable to the most severe traumatic histories in the community sample.