The Association of Substance Use Before Sex and Condomless Sex: The Moderating Effects of Sexual Risk Behaviors,Perceived Sex Approval,and HIV/STI Risk Perception Among Youth

Abstract

Youth are disproportionately affected by substance use and associated sexual risk behaviors, increasing STI and HIV susceptibility. This study analyzed the interplay between alcohol/drug use before sex (ABS/DBS), perceived sex approval (e.g., perceived familial or peer approval in engaging in sex), and HIV/STI risk perception among youth aged 13–21 (n = 150). We assessed how these factors influenced condomless vaginal/anal sex (VAS) and oral sex practices. Results showed significant interactions between perceived sex approval and lifetime ABS for lifetime condomless VAS, and between HIV/STI risk perception and lifetime ABS for current condomless oral sex. These findings underline the influence of perceived sex approval and HIV/STI risk perception on youth’s sexual behaviors. Implications for targeted interventions are discussed.

Keywords

sexual behavior/risk emerging adulthood/adult transition sexual behavior HIV/STI condom use alcohol and drug use/abuse/addiction

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References

Abel

Brunton

(2005). Young people’s use of condoms and their perceived vulnerability to sexually transmitted infections. Australian and New Zealand Journal of Public Health, 29(3), 254–260. https://doi.org/10.1111/j.1467-842x.2005.tb00764.x

Adeomi

A. A.

Adeoye

O. A.

Asekun-Olarinmoye

E. O.

Abodunrin

O. L.

Olugbenga-Bello

A. I.

Sabageh

A. O.

(2014). Evaluation of the effectiveness of peer education in improving HIV knowledge, attitude, and sexual behaviours among in-school adolescents in osun state, Nigeria. AIDS Research and Treatment, 2014(1), 1–10. https://doi.org/10.1155/2014/131756

Anderson

J. E.

Kann

Holtzman

Arday

Truman

Kolbe

(1990). HIV/AIDS knowledge and sexual behavior among high school students. Family Planning Perspectives, 22(6), 252–255. https://doi.org/10.2307/2135681

Asare

(2015). Using the Theory of Planned Behavior to determine the condom use behavior among college students. American Journal of Health Studies, 30(1), 43–50. https://doi.org/10.47779/ajhs.2015.168

Barrientos

J. E.

Bozon

Ortiz

Arredondo

(2007). HIV prevalence, AIDS knowledge, and condom use among female sex workers in Santiago, Chile. Cadernos de Saude Publica, 23(8), 1777–1784. https://doi.org/10.1590/S0102-311X2007000800004

Bersamin

M. M.

Fisher

D. A.

Walker

Hill

D. L.

Grube

J. W.

(2007). Defining virginity and abstinence: Adolescents’ interpretations of sexual behaviors. The Journal of Adolescent Health, 41(2), 182–188. https://doi.org/10.1016/j.jadohealth.2007.03.011

Bersamin

M. M.

Walker

Fisher

D. A.

Grube

J. W.

(2006). Correlates of oral sex and vaginal intercourse in early and middle adolescence. Journal of Research on Adolescence, 16(1), 59–68. https://doi.org/10.1111/j.1532-7795.2006.00120.x

Boehnke

Andreas Hadjar Dirk Baier . (2007). Parent-child value similarity: The role of zeitgeist. Journal of Marriage and Family, 69(3), 778–792.

Centers for Disease Control and Prevention. (n.d., a). HIV basics. Retrieved April 26, 2023, from https://www.cdc.gov/hiv/basics/statistics.html

10.

Centers for Disease Control and Prevention. (n.d., b) HIV by age: HIV incidence. Retrieved April 26, 2023, from https://www.cdc.gov/hiv/group/age/incidence.html

11.

Centers for Disease Control and Prevention. (n.d., c) Tobacco use and United States students. Retrieved April 26, 2023, from https://www.cdc.gov/healthyyouth/data/yrbs/factsheets/2017_US_tobacco.htm#:~:text=18.8%25drankalcoholoruseddrugsbeforelastsexualintercourse.&text=1.5%25everinjectedanyillegaldrug.

12.

Centers for Disease Control and Prevention. (2019). Substance use and sexual risk behaviors among youth Retrieved April 26, 2023, from. https://www.cdc.gov/healthyyouth/factsheets/substance_use_fact_sheet-basic.htm

13.

Cherie

Berhane

(2012). Oral and anal sex practices among high school youth in Addis Ababa, Ethiopia. BMC Public Health, 12(1), 5. https://doi.org/10.1186/1471-2458-12-5

14.

Cho

H. S.

Yang

(2023). Relationship between alcohol consumption and risky sexual behaviors among adolescents and young adults: A meta-analysis. International Journal of Public Health, 68, 1605669. https://doi.org/10.3389/ijph.2023.1605669

15.

Cordova

Bauermeister

J. A.

Warner

, Youth Leadership Council, Wells

MacLeod

Neilands

T. B.

Mendoza Lua

Delva

Fessler

K. B.

Smith

Jr Khreizat

Boyer

(2024). Efficacy of a digital health preventive intervention for adolescents with HIV or sexually transmitted infections and substance use disorder: Protocol for a randomized controlled trial. JMIR Research Protocols, 13, e47216. https://doi.org/10.2196/47216

16.

Cordova

Coleman-Minahan

Romo

Borrayo

E. A.

Bull

(2022). The Role of social capital, sex communication, and sex refusal self-efficacy in sexual risk behaviors and HIV testing among a diverse sample of youth. Adolescents, 2(1), 30–42. https://doi.org/10.3390/adolescents2010004

17.

Cordova

Munoz-Velazquez

Mendoza Lua

Fessler

Warner

Delva

Adelman

, Youth Leadership Council, Fernandez

Bauermeister

(2020). Pilot study of a multilevel mobile health app for substance use, sexual risk behaviors, and testing for sexually transmitted infections and HIV among youth: Randomized controlled trial. JMIR mHealth and uHealth, 8(3), e16251. https://doi.org/10.2196/16251

18.

Cunny

K. A.

Perri

3rd (1991). Single-item vs multiple-item measures of health-related quality of life. Psychological Reports, 69(1), 127–130. https://doi.org/10.2466/pr0.1991.69.1.127

19.

Dallo

Martins

R. A.

(2018). Associação entre as condutas de risco do uso de álcool e sexo desprotegido em adolescentes numa cidade do Sul do Brasil. Ciencia e Saude Coletiva, 23(1), 303–314. https://doi.org/10.1590/1413-81232018231.14282015

20.

Darabi

Kaveh

M. H.

Khalajabadi Farahani

Yaseri

Majlessi

Shojaeizadeh

(2017). The effect of a theory of planned behavior-based educational intervention on sexual and reproductive health in Iranian adolescent girls: A randomized controlled trial. Journal of Research in Health Sciences, 17(4), 400.

21.

DiClemente

R. J.

Durbin

Siegel

Krasnovsky

Lazarus

Comacho

(1992). Determinants of condom use among junior high school students in a minority, inner-city school district. Pediatrics, 89(2), 197–202.

22.

Dir

A. L.

Gilmore

A. K.

Moreland

A. D.

Davidson

T. M.

Borkman

A. L.

Rheingold

A. A.

Danielson

C. K.

(2018). What’s the harm? Alcohol and marijuana use and perceived risks of unprotected sex among adolescents and young adults. Addictive Behaviors, 76, 281–284. https://doi.org/10.1016/j.addbeh.2017.08.035

23.

Dittus

P. J.

Jaccard

(2000). Adolescents’ perceptions of maternal disapproval of sex: Relationship to sexual outcomes. Journal of Adolescent Health, 26(4), 268–278. https://doi.org/10.1016/S1054-139X(99)00096-8

24.

Edwards

Carne

(1998). Oral sex and transmission of non-viral STIs. Sexually Transmitted Infections, 74(2), 95–100. https://doi.org/10.1136/sti.74.2.95

25.

García-Torres

M. M.

Muñoz-Velázquez

Warner

Cordova

(2021). The preliminary efficacy of a mhealth preventive intervention on PrEP willingness for uptake, attitudes and beliefs among adolescents. Journal of Adolescent Health, 68(2), S4–S5. https://doi.org/10.1016/j.jadohealth.2020.12.015

26.

Grossman

Hadley

Brown

L. K.

Houck

C. D.

Peters

Tolou-Shams

, & Project SHIELD Study Group (2008). Adolescent sexual risk: Factors predicting condom use across the stages of change. AIDS and Behavior, 12(6), 913–922. https://doi.org/10.1007/s10461-008-9396-y

27.

Habel

M. A.

Leichliter

J. S.

Dittus

P. J.

Spicknall

I. H.

Aral

S. O.

(2018). Heterosexual anal and oral sex in adolescents and adults in the United States, 2011-2015. Sexually Transmitted Diseases, 45(12), 775–782. https://doi.org/10.1097/OLQ.0000000000000889

28.

Hadley

Brown

L. K.

Lescano

C. M.

Kell

Spalding

Diclemente

Donenberg

(2009). Parent-adolescent sexual communication: Associations of condom use with condom discussions. AIDS and Behavior, 13(5), 997–1004. https://doi.org/10.1007/s10461-008-9468-z

29.

Halpern-Felsher

B. L.

Cornell

J. L.

Kropp

R. Y.

Tschann

J. M.

(2005). Oral versus vaginal sex among adolescents: Perceptions, attitudes, and behavior. Pediatrics, 115(4), 845–851. https://doi.org/10.1542/peds.2004-2108

30.

Hammond

M. A.

Khurana

Stormshak

E. A.

(2021). Adolescent measures of family socioeconomic status: Reliability, validity, and effects on substance use behaviors in adolescence and young adulthood. Preventive Medicine Reports, 21, 101317. https://doi.org/10.1016/j.pmedr.2021.101317

31.

Hayes

A. F.

(2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (3rd ed). Guilford Publications.

32.

Hoeppner

B. B.

Kelly

J. F.

Urbanoski

K. A.

Slaymaker

(2011). Comparative utility of a single-item versus multiple-item measure of self-efficacy in predicting relapse among young adults. Journal of Substance Abuse Treatment, 41(3), 305–312. https://doi.org/10.1016/j.jsat.2011.04.005

33.

Holway

G. V.

Hernandez

S. M.

(2018). Oral sex and condom use in a U.S. national sample of adolescents and young adults. The Journal of Adolescent Health, 62(4), 402–410. https://doi.org/10.1016/j.jadohealth.2017.08.022

34.

Hutchinson

M. K.

Jemmott

J. B.

Sweet Jemmott

Braverman

Fong

G. T.

(2003). The role of mother–daughter sexual risk communication in reducing sexual risk behaviors among urban adolescent females: A prospective study. Journal of Adolescent Health, 33(2), 98–107. https://doi.org/https://doi.org/10.1016/S1054-139X(03)00183-6

35.

Jaccard

Dittus

P. J.

Gordon

V. V.

(1996). Maternal correlates of adolescent sexual and contraceptive behavior. Family Planning Perspectives, 28(4), 159–165. https://doi.org/10.2307/2136192

36.

Jackson

K. M.

Roberts

M. E.

Colby

S. M.

Barnett

N. P.

Abar

C. C.

Merrill

J. E.

(2014). Willingness to drink as a function of peer offers and peer norms in early adolescence. Journal of Studies on Alcohol and Drugs, 75(3), 404–414. https://doi.org/10.15288/jsad.2014.75.404

37.

Jemmott

J. B.

3rd Jemmott

L. S.

Fong

G. T.

(1998). Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: A randomized controlled trial. JAMA, 279(19), 1529–1536. https://doi.org/10.1001/jama.279.19.1529

38.

Johnston

L. D.

Miech

R. A.

O’Malley

P. M.

Bachman

J. G.

Schulenberg

J. E.

Patrick

M. E.

(2018). Deep Blue. Monitoring the future national survey results on drug use, 1975-2018: Overview, key findings on adolescent drug use. Institute for Social Research, University of Michigan. Retrieved April 26, 2023, from https://deepblue.lib.umich.edu/bitstream/handle/2027.42/148123/Overview%202018%20FINAL%20print%201-30.pdf?sequence=1&isAllowed=y.

39.

Jones

R. C.

DePalma

J. A.

(1999). How reliable are sexual behavior questionnaires? The American Journal of Nursing, 99(6), 38.

40.

Khuzwayo

Taylor

(2018). Exploring the socio-ecological levels for prevention of sexual risk behaviours of the youth in uMgungundlovu District Municipality, KwaZulu-Natal. African Journal of Primary Health Care & Family Medicine, 10(1), e1–e8. https://doi.org/10.4102/phcfm.v10i1.1590

41.

Kingree

J. B.

Braithwaite

Woodring

(2000). Unprotected sex as a function of alcohol and marijuana use among adolescent detainees. Journal of Adolescent Health, 27(3), 179–185. https://doi.org/10.1016/S1054-139X(00)00101-4

42.

Kinsler

Sneed

C. D.

Morisky

D. E.

Ang

(2004). Evaluation of a school-based intervention for HIV/AIDS prevention among Belizean adolescents. Health Education Research, 19(6), 730–738. https://doi.org/10.1093/her/cyg091

43.

Lammers

van Wijnbergen

S. J.

Willebrands

(2013). Condom use, risk perception, and HIV knowledge: A comparison across sexes in Nigeria. HIV/AIDS, 5, 283–293. https://doi.org/10.2147/HIV.S31687

44.

Leval

Sundström

Ploner

Dahlström

L. A.

Widmark

Sparén

(2011). Assessing perceived risk and STI prevention behavior: A national population-based study with special reference to HPV. PLoS One, 6(6), e20624. https://doi.org/10.1371/journal.pone.0020624

45.

MacPhail

Campbell

(2001). ‘I think condoms are good but, aai, I hate those things’: Condom use among adolescents and young people in a Southern African township. Social Science & Medicine, 52(11), 1613–1627. https://doi.org/10.1016/s0277-9536(00)00272-0

46.

Miller

B. C.

(2002). Family influences on adolescent sexual and contraceptive behavior. Journal of Sex Research, 39(1), 22–26. https://doi.org/10.1080/00224490209552115

47.

Page-Shafer

Shiboski

C. H.

Osmond

D. H.

Dilley

McFarland

Shiboski

S. C.

Klausner

J. D.

Balls

Greenspan

J. S.

(2002). Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men. AIDS, 16(17), 2350–2352. https://doi.org/10.1097/00002030-200211220-00022

48.

Ploem

Byers

E. S.

(1997). The effects of two AIDS risk-reduction interventions on heterosexual college women’s AIDS-related knowledge, attitudes and condom use. Journal of Psychology & Human Sexuality, 9(1), 1–24. https://doi.org/10.1300/j056v09n01_01

49.

Potard

Courtois

Rusch

(2008). The influence of peers on risky sexual behaviour during adolescence. The European Journal of Contraception & Reproductive Health Care, 13(3), 264–270. https://doi.org/10.1080/13625180802273530

50.

Qing

Wang

Yang

Chen

Zhang

Tan

Deng

(2022). Study on HIV/AIDS knowledge, sexual attitudes, sexual behaviors, and preventive services among young students in Chongqing, China. Frontiers in Public Health, 10, 982727. https://doi.org/10.3389/fpubh.2022.982727

51.

Raiford

J. L.

Diclemente

R. J.

Wingood

G. M.

(2009). Effects of fear of abuse and possible STI acquisition on the sexual behavior of young African American women. American Journal of Public Health, 99(6), 1067–1071. https://doi.org/10.2105/AJPH.2007.131482

52.

Sanchez

Z. M.

Nappo

S. A.

Cruz

J. I.

Carlini

E. A.

Carlini

C. M.

Martins

S. S.

(2013). Sexual behavior among high school students in Brazil: Alcohol consumption and legal and illegal drug use associated with unprotected sex. Clinics, 68(4), 489–494. https://doi.org/10.6061/clinics/2013(04)09

53.

Shamu

Khupakonke

Farirai

Slabbert

Chidarikire

Guloba

Nkhwashu

(2020). Knowledge, attitudes and practices of young adults towards HIV prevention: An analysis of baseline data from a community-based HIV prevention intervention study in two high HIV burden districts, South Africa. BMC Public Health, 20(1), 1249. https://doi.org/10.1186/s12889-020-09356-3

54.

Shiferaw

Alemu

Assefa

Tesfaye

Gibermedhin

Amare

(2014). Perception of risk of HIV and sexual risk behaviors among University students: Implication for planning interventions. BMC Research Notes, 7(1). https://doi.org/10.1186/1756-0500-7-162

55.

Siegel

D. M.

Aten

M. J.

Roghmann

K. J.

(1998). Self-reported honesty among middle and high school students responding to a sexual behavior questionnaire. Journal of Adolescent Health, 23(1), 20–28. https://doi.org/10.1016/S1054-139X(97)00274-7

56.

Solomon

Knafo

(2007). Value similarity in adolescent friendships. In Rhodes

T. C.

(Ed.), Focus on Adolescent Behavior Research (pp. 133–155). Nova Science Publishers.

57.

Somers

C. L.

Anagurthi

(2014). Parents’ attitudes about adolescents’ premarital sexual activity: The role of inter-parent consistency/inconsistency in sexual outcomes. Health Education Journal, 73(5), 545–553. https://doi.org/10.1177/0017896913506702

58.

Strome

Moore-Petinak

Waselewski

Chang

(2022). Youths’ knowledge and perceptions of health risks associated with unprotected oral sex. Annals of Family Medicine, 20(1), 72–76. https://doi.org/10.1370/afm.2761

59.

Taberna

Mena

Pavón

M. A.

Alemany

Gillison

M. L.

Mesía

(2017). Human papillomavirus-related oropharyngeal cancer. Annals of Oncology, 28(10), 2386–2398. https://doi.org/10.1093/annonc/mdx304

60.

Tucker

J. S.

Ryan

G. W.

Golinelli

Ewing

Wenzel

S. L.

Kennedy

D. P.

Green

H. D.

Jr. Zhou

(2012). Substance use and other risk factors for unprotected sex: Results from an event-based study of homeless youth. AIDS and Behavior, 16(6), 1699–1707. https://doi.org/10.1007/s10461-011-0017-9

61.

U.S. Census Bureau. (2023, a). Quickfacts: United States. Retrieved March 10, 2024, from https://www.census.gov/quickfacts/fact/table/US/SEX255222

62.

U.S. Census Bureau. (2023, b). Quickfacts: Ypsilanti, Michigan. Retrieved March 10, 2024, from https://www.census.gov/quickfacts/fact/table/ypsilanticitymichigan/PST045223

63.

van de Bongardt

Reitz

Sandfort

Deković

(2015). A meta-analysis of the relations between three types of peer norms and adolescent sexual behavior. Personality and Social Psychology Review, 19(3), 203–234. https://doi.org/10.1177/1088868314544223

64.

Villarruel

A. M.

Jemmott

J. B. I. I. I.

Jemmott

L. S.

Ronis

D. L.

(2004). Predictors of sexual intercourse and condom use intentions among Spanish-dominant Latino youth: A test of the Planned Behavior Theory. Nursing Research, 53(3), 172–181.

65.

Wulfert

Wan

C. K.

(1993). Condom use: A self-efficacy model. Health Psychology, 12(5), 346–353. https://doi.org/10.1037//0278-6133.12.5.346

66.

Wang

Chen

(2022). Perception of peer condom use buffers the associations between HIV knowledge, self-efficacy, and condom-use intention among adolescents: A moderated mediation model. Prevention Science, 23(6), 879–888. https://doi.org/10.1007/s11121-021-01324-6