Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 14 nº 3 - Jul/Sep - 2017

Original Article Imprimir 

Páginas 24 a 29


Alcohol and sexual behavior among high school students in Brazil

Alcohol y comportamiento sexual entre estudiantes de enseñanza media en Brasil

Álcool e comportamento sexual entre estudantes do ensino médio no Brasil

Autores: Ana Carolina de Queiroz Costa1; Jakelline Cipriano dos Santos Raposo2; Paula Andréa de Melo Valença3; Carolina da Franca Bandeira Ferreira Santos4; Viviane Colares Soares de Andrade Amorim5

1. Master's Degree in Adolescent Medicine, Pernambuco Dental School, Pernambuco University (FOP - UPE). Recife, Pernambuco State, Brazil. Nurse, Hospital das Clínicas, Pernambuco Federal University (UFPE). Recife, Pernambuco State, Brazil
2. Master's Degree in Adolescent Medicine, Pernambuco Dental School, Pernambuco University (FOP - UPE). Recife, Pernambuco State, Brazil. Nursing Technician, Pernambuco Federal Institute (IFPE). Vitória de Santo Antão, Pernambuco State, Brazil
3. Post-Doctoral Pupil, Pernambuco University (UPE). Recife, Pernambuco State, Brazil. PhD in Child and Adolescent Health,, Pernambuco Federal University (UFPE). Recife, Pernambuco State, Brazil. Master's Degree in Adolescent Medicine, Pernambuco Dental School, Pernambuco University (FOP - UPE). Recife, Pernambuco State, Brazil
4. Post-Doctoral Pupil, Pernambuco University (UPE). Recife, Pernambuco State, Brazil. PhD in Pediatric Dentistry, Pernambuco University (UPE). Adjunct Professor, Pernambuco University (UPE). Recife, Pernambuco State, Brazil
5. Post-PhD in Pediatric Dentistry, University of Iowa (UIOWA). Iowa, USA. PhD and Associate Professor in Pediatric Dentistry, Pernambuco University (UPE). Recife, Pernambuco State, Brazil. Adjunct Professor, Pernambuco Federal University (UFPE). Recife, Pernambuco State, Brazil

Paula Andréa de Melo Valença
Universidade de Pernambuco
Av. Agamenon Magalhães, s/n, Santo Amaro
Recife, PE, Brasil. CEP: 50100-010
valensa@gmail.com

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How to cite this article

Keywords: Alcoholism, adolescent, sexual behavior.
Palabra Clave: Alcoholismo, adolescente, comportamiento sexual.
Descritores: Alcoolismo, adolescente, comportamento sexual.

Abstract:
OBJECTIVE: Verify the association between alcohol consumption and sexual behavior among adolescent students.
METHODS: This is a cross-sectional studyinvolving 171 adolescents of both genders, aged between 13-19 years, enrolled and attending high school in state public school at Olinda - PE, Brazil. The sample selection was random, performed by cluster in two stages: in the first stage the schools were selected, and in the second, the classes. The information was collected in the classroom from the validated questionnaire Youth Risk Behavior Survey (YRBS). The variables considered regarding alcohol consumption were: alcohol consumption in the past 30 days and age of alcohol consumption for the first time. With regard to sexual behavior were considered: if you have had sexual intercourse, age at first intercourse, number of sexual partners in life, use of alcohol / drugs before sexual intercourse and condom use.
RESULTS: Association was found between alcohol consumption in the last 30 days and the have had sexual intercourse.
CONCLUSION: Alcohol consumption and sexual behavior were associated, and the onset age of both suggests the need of public policies for adolescent health.

Resumen:
OBJETIVO: Verificar asociación entre consumo de alcohol y comportamiento sexual entre adolescentes escolares.
MÉTODOS: se trata de un estudio con delineamiento transversal, donde participaron 171 adolescentes de ambos géneros, en la franja etaria de 13 a 19 años, que cursaban la enseñanza media de la red pública estadual de Olinda/PE, Brasil. La selección de la muestra fue aleatoria, realizada por conglomerado en de los etapas: en la primera etapa las escuelas fueron sorteadas, y en la segunda, los grupos. Las informaciones fueron recolectadas a través del cuestionario validado Youth Risk Behavior Survey (YRBS). Las variables consideradas en cuanto al consumo de alcohol fueron: consumo de alcohol en los últimos 30 días y la edad en que consumió alcohol por primera vez. Con relación al comportamiento sexual, fueron consideradas: si ya tuvo relación sexual, edad de la primera relación, número de compañeros sexuales en la vida, uso de alcohol/droga antes de la relación y uso del preservativo.
RESULTADOS: Fue encontrada asociación entre el consumo de alcohol en los últimos 30 días y el hecho de ya haber tenido relación sexual.
CONCLUSIÓN: El consumo de alcohol y comportamiento sexual fueron asociados, y a la edad de inicio de ambos, sugiere la necesidad políticas públicas dirigidas a la salud de los adolescentes.

Resumo:
OBJETIVO: Verificar associação entre consumo de álcool e comportamento sexual entre adolescentes escolares.
MÉTODOS: Trata-se de um estudo com delineamento transversal onde participaram 171 adolescentes de ambos os gêneros, na faixa etária de 13 a 19 anos que cursavam o ensino médio da rede pública estadual de Olinda/PE, Brasil. A seleção da amostra foi aleatória, realizada por conglomerado em dois estágios: no primeiro estágio as escolas foram sorteadas, e no segundo, as turmas. As informações foram coletadas a partir do questionário validado Youth Risk Behavior Survey (YRBS). As variáveis consideradas quanto ao consumo de álcool foram: consumo de álcool nos últimos 30 dias e idade que consumiu álcool pela primeira vez. Com relação ao comportamento sexual foram consideradas: se já teve relacionamento sexual, idade da primeira relação, número de parceiro sexual na vida, uso do álcool/droga antes da relação e uso do preservativo.
RESULTADOS: Foi encontrada associação entre o consumo de álcool nos últimos 30 dias e o fato de já ter tido relacionamento sexual.
CONCLUSÃO: O consumo de álcool e comportamento sexual foram associados, e a à idade de início de ambos sugere a necessidade políticas públicas voltadas à saúde dos adolescentes.

INTRODUCTION

The most widely-used drug among adolescents1, alcohol is an important risk factor for pursuing other types of health-hazardous conduct2. Drinking eases adolescent socialization and their acceptance in a group, with less shyness and lack of confidence, fostering affective and social contacts3, although also associated with early sexual initiation 4.

Alcohol use/abuse is one of the main reasons why adolescents engage in unsafe sex such as: multiple partners, casual hook-ups, not using condoms and prostitution, thus leading to greater exposure to sexually transmissible diseases and unwanted pregnancies 4,5.

The link between unprotected sex and drinking may be affected by the amount of alcohol consumed, adversely affecting critical judgements6. In terms of consumption patterns, when adolescents drink, they tend to do so excessively7. Although binging or drinking heavily before or during intercourse is associated with higher-risk sexual behaviors, even drinking moderately has also shown links to unsafe sex5.

It is important to explore the relationship between alcohol consumption and unsafe sex among adolescents, together with the consequences for implementing government policies designed to prevent and combat the consumption of alcoholic beverages during this growth and development phase8.

The objective of this study was to examine associations between alcohol consumption and sexual behaviors among adolescent schoolchildren in Olinda, Pernambuco State.


METHOD

This study is part of the "Comprehensive Healthcare for Adolescents at Government Facilities in Olinda". This study was approved by the Ethics Committee, Pernambuco University (Opinion Nº 568.996), with respondents and their parents or guardians signing Deeds of Informed Consent.

The sample was selected randomly in two stratified stages: during the first stage, the schools were selected through a random draw, with the classes drawn during the second stage. Five schools and twelve classes were selected for this study, in order to ensure greater data heterogeneity. The schools and classes were selected at random through the Randomizer software.

In order to calculate the sample for the "Comprehensive Healthcare (...)" project, the following aspects were taken into consideration: Confidence Interval of 95%, power of 80%, Odds Ratio of 1.5, delineation effect of 1.2 and frequency of 50% , due to the various high-risk conduct variables involved, adding 10% for losses, resulting in a final sample size of 1,077 adolescents. For this pilot study, 16% of the total sample of high school pupils was used in the Pernambuco State government network in Olinda.

The data were collected in April 2014 through collective completion in classrooms of the validated version of the Youth Risk Behavior Survey9. The questionnaires were handed out by pre-trained researchers, with the respondents asked to reply in writing, individually, with anonymity guaranteed for their replies, and keeping this information confidential. The questionnaire completion time was between 30 and 60 minutes, with no teachers present.

The data were double entry tabulated using the Epidata 3.1 software, with errors corrected. A descriptive and inferential statistical analysis was conducted, using Pearson´s chi-squared test with a significance value of p<0.05. The data were analyzed through the Statistical Package for the Social Sciences (SPSS) program for Windows, version 19.0.


RESULTS

This study encompassed 171 boys and girls in school, between 13 and 19 years of age. Four questionnaires were excluded from the study: three because they did not provide information on gender, and one because more than 20% of the questions were left blank. Most (72%) of the respondents were between 15 and 17 years of age; 56% were female, unmarried (87.7%), without children (93%) and with a monthly family income of less than one or up to two minimum wages (59.1%).

In terms of alcoholic beverage consumption, 27.5% of these adolescents reported that they had consumed alcohol during the past thirty days, with 33.9% stating that they were less than 13 years old when they drank alcohol for the first time. In terms of sexual behavior, almost half (45.6%) of these adolescents reported that they had already engaged in sexual intercourse at some point in their lives; 11% said that they were 13 years old or less at sexual initiation, and, and 29.8% reported four or more sexual partners during their lives.

 Alcoholic beverage consumption during the past thirty days and already engaging in sexual intercourse were significantly associated (p<0.001). Similarly, an association was found between the age of the first drink and the age of the first sexual intercourse (p=0.002) (Table 1).




DISCUSSION

The prevalence of alcohol consumption during adolescence is high all over the world. In Brazil as well, alcohol the drug of choice among children and adolescents1. In this study, the prevalence of adolescents who had drunk alcohol at some point during their lives reached 55%, and 27.5% during the past month.

For the age of trying out alcohol for the first time, one third (33.9%) of the youngsters researched stated that they were under 13 years old when they drank alcohol for the first time. A study conducted in Rio Grande do Sul State found a similar mean age (13.5 years)10. Another survey of pupils in the city of Campinas found the mean alcohol experimentation age was lower, at around 12 years of age11. This is a matter of much concern, paving the way for other drugs that are often ushered in through alcohol consumption12.

Drinking excessively during the past month was reported by 19.3% of the pupils in this study. However, this consumption pattern was not significantly associated with sexual behavior, although it is acknowledged in the literature that the amount of alcohol drunk may influence sexual behavior among adolescents13,14. Furthermore, excessive alcohol consumption before or before or during intercourse may be associated with not using condoms, multiple partners, casual hook-ups, intercourse with sex workers and injectable drug use.

With regard to sexual behavior, it was noted that almost half (45.6%) of the adolescents in this survey had already engaged in sexual intercourse. Most of them were not involved in high-risk sexual conducts such as drinking alcohol before intercourse and not using condoms during the last intercourse. However, an association was found between alcohol consumption during the past thirty days and having already engaged in sexual intercourse (p<0.001). A similar result was found in the town of Serafina Corrêa, Rio Grande do Sul State, in a study with secondary school pupils10. This behavior may be related to the fact that alcohol plays an encouraging role, ensuring easier affective contacts among these adolescents16.

The age of first experimentation with alcohol and age of first sexual intercourse were significantly associated in this study (p=0.002). It is possible that this association derives from the loosening-up effect of alcohol that paves the way for sexual intercourse at a young age10. This association is also linked to the belief among youngsters that drinking alcohol makes "flirting" easier, boosting the libido and improving sexual performance17.

Alcohol consumption undermines critical judgements among adolescents, hampering negotiations and consequently condom use during intercourse. Although alcohol consumption and not using condoms were not associated in the population under study, several other projects have found this link5,15,18,19.

In terms of constraints, it is important to stress that although the data were obtained through a self-completed questionnaire, there is a possibility of bias or distortion. Even with anonymity assured, it is possible that some adolescents felt uneasy and thus omitted information, especially on their sexual behavior, due to either self-censure, fears of their parents finding out or simply forgetting, among other reasons.

Knowledge of the links between alcohol consumption and sexual behavior among adolescents is extremely important, as these youngsters have been tagged as an important population group in terms of epidemiological risk for sexually transmitted diseases 20. Furthermore, the negative consequences arising from alcohol abuse are also a severe public health problem1.

These results suggest the need for prevention campaigns to review their approach strategies, focusing on health-hazardous behaviors, particularly in terms of adopting educational measures urging healthy sexual intercourse. Furthermore, one alternative for dealing with the problem of abusive alcohol consumption among adolescents would be to involve them in healthier activities, including sports.


CONCLUSION

Alcohol consumption and sexual behavior were associated, with the initiation age for both behaviors suggesting the need for government policies focused on adolescent health promotion and education, with educational projects in classrooms and government health clinics. It is thus crucial to run campaigns spotlighting alcohol-related risks and the negative consequences on the sexual and reproductive health of youngsters during early adolescence, before reaching twelve years of age.


REFERENCES

1. World Health Organization. Global status report on alcohol and health 2014. Geneva: World Health Organization; 2014.

2. Jones SE, Oeltmann J, Wilson TW, Brener ND, Hill CV. Binge drinking among undergraduate college students in the United States: implications for other substance use. J Am Coll Health 2001; 50(1):33-38. 3. Bouzas I. O álcool. Adolesc Saúde. 2007; 4(4):5.

4. Liu A, Kilmarx P, Jenkins RA, Manopaiboon C, Mock PA, Jeeyapunt S, et al. Sexual initiation, substance use, and sexual behavior and knowledge among vocational students in northern Thailand. Int Fam Plan Perspect 2006; 32(3):126-135.

5. Cardoso LRD, Malbergier A, Figueiredo TFB. O consumo de álcool como fator de risco para a transmissão das DSTs/HIV/Aids. Rev Psiq Clín 2008; 35(1):70-75.

6. Sen B. Does alcohol-use increase the risk of sexual intercourse among adolescents? Evidence from the NLSY97. Journal of Health Economics 2002; 21(6):1085-1093.

7. Sanchez ZM, Martins SS, Opaleye ES, Moura YG, Locatelli DP, Noto AR. Social factors associated to binge drinking: a cross-sectional survey among Brazilian students in private high schools. BMC Public Health 2011; 11:201.

8. Sampaio Filho FJL, Sousa PRM, Vieira NFC, Nóbrega MFB, Gubert FA, Pinheiro PNC. Percepção de risco de adolescentes escolares na relação consumo de álcool e comportamento sexual. Rev Gaúcha Enferm 2010;31(3):508-514.

9. Guedes DP, Lopes CC. Validação da versão brasileira do Youth Risk Behavior Survey 2007. Rev Saúde Pública 2010;44(5):840-50.

10. Miozzo L, Dalberto ER, Silveira DX, Terra MB. Consumo de substâncias psicoativas em uma amostra de adolescentes e sua relação com o comportamento sexual. J Bras Psiquiatr 2013; 62(2): 93-100.

11. Soldera M, Dalgalarrondo P, Correa Filho HR, Silva CAM. Uso pesado de álcool por estudantes do ensino fundamental e médio das escolas centrais e periféricas de Campinas (SP): prevalência e fatores associados. Rev Bras Psiquiatr 2004; 26(3):174-179.

12. Cavalcante MBPT, Alves MDS, Barroso MGT. Adolescência, álcool e drogas: uma revisão na perspectiva da promoção da saúde. Esc Anna Nery Rev Enferm 2008; 12(3):555-559.

13. Malow RM, Dévieux JG, Rosenberg R, Samuels DM, Jean-Gilles MM. Alcohol use severity and HIV sexual risk among juvenile offenders. Subst Use Misuse 2006; 41(13): 1769-1788.

14. Silveira CM, Wang YP, Andrade AG, Andrade L. Heavy drinking in the São Paulo epidemiologic catchment area study in Brazil: gender and socio-demographics correlates. J Stud Alcoh 2007; 68(1):18-27.

15. Lepusic D, Radovic-Radovcic S. Alcohol - A Predictor of Risky Sexual Behavior Among Female Adolescents. Acta Clin Croat 2013; 52(1):3-9.

16. Stoner SA, George WH, Peters LM, Norris J. Liquid Courage: Alcohol Fosters Risky Sexual Decision-Making in Individuals with Sexual Fears. AIDS Behav 2007; 11(2):227-237.

17. Fachini A, Furtado EF. Uso de Álcool e Expectativas do Beber entre Universitários: uma Análise das Diferenças entre os Sexos. Psicologia: Teoria e Pesquisa 2013; 29(4):421-428.

18. Bertoni N, Bastos FI, Mello MB, Makuch MY, Sousa MH, Osis MJ, Faúndes A. Uso de álcool e drogas e sua influência sobre as práticas sexuais de adolescentes de Minas Gerais, Brasil. Cad. Saúde Pública 2009;25(6):1350-1360.

19. Patrick ME. Daily associations of alcohol use with sexual behavior and condom use during spring break. Drug Alcohol Rev 2013; 32(2):215-217.

20. Kaestle CE, Halpern CT, Miller WC, Ford CA. Young age at first sexual intercourse and sexually transmitted infections in adolescents and young adults. Am J Epidemiol 2005; 161(8):774-780.
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