INTRODUCTION

Alcohol is the most widely used drug among adolescents ¹ and is an important risk factor for the adoption of other health risk behaviors ² . Drinking helps adolescents socialize and become accepted in a group, reduces shyness and insecurity, and facilitates social and emotional contacts ³ . Furthermore, it has been associated with the early onset of sexual activity ⁴ .

Alcohol use/abuse is one of the main causes of adolescents engaging in unsafe sexual practices, such as having multiple sexual partners, casual partners, not using condoms, and prostitution, resulting in greater exposure to sexually transmitted diseases and unwanted pregnancies ^4,5 .

The link between unprotected sex and alcohol use appears to be affected by the amount of alcohol consumed, interfering with the development of critical judgment ⁶ . Regarding consumption patterns, adolescents tend to drink excessively when they drink ⁷ . Although excessive, episodic or continuous drinking before or during sexual intercourse is associated with higher rates of risky sexual behavior, moderate drinking has also been shown to be related to unsafe sex ⁵ .

It is important to understand the relationship between alcohol consumption and unsafe sexual practices among adolescents and its consequences for the implementation of public policies to prevent and combat alcohol consumption during this phase of growth and development ⁸ .

The objective of this study was to verify the association between alcohol consumption and sexual behavior among adolescent students in Olinda, Pernambuco.

METHOD

This study is part of the project “Comprehensive Health Care for Adolescents in Public Services in Olinda”. This study was approved by the Ethics Committee of the University of Pernambuco (Brazil) (Opinion No. 568,996) for its implementation, and participants and guardians signed the Free and Informed Consent Form.

The sample selection was performed randomly, using two stratified stages: in the first stage, schools were selected and in the second, classes were selected. Five schools and twelve classes were selected for this study, aiming to ensure greater heterogeneity of the data. The schools and classes were selected using the Randomizer program .

To calculate the sample size of the “Comprehensive Health Care (…)” project, the following were considered: a 95% confidence interval, a power of 80%, Odds Ratioof 1.5, a design effect of 1.2 and a frequency of 50% due to the various risk behavior variables involved, and an additional 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 students from the state public school system in the city of Olinda, Pernambuco, were used.

Data collection was carried out in April 2014 through the collective application in the classroom of the validated version of the Youth Risk Behavior Survey ⁹ . The questionnaires were administered by previously trained researchers and the participants were instructed to respond in writing and individually, with the guarantee of anonymity of the responses and confidentiality of the information. The questionnaire took 30-60 minutes to apply, and was carried out without the presence of the teacher.

The data were tabulated with double entry using Epidata 3.1 software, and any errors detected were corrected. Descriptive and inferential statistical analyses were performed. Pearson’s chi-square test was used, assuming significance at p values ​​<0.05. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS for Windows version 19.0).

RESULTS

A total of 171 adolescent students of both genders, aged 13 to 19 years, participated in the study. Four questionnaires were excluded from the study: three for not providing information on gender and one for having more than 20% of the questions unanswered. The majority of the respondents (72%) were aged 15 to 17 years, 56% were female, single (87.7%), without children (93%) and had a monthly family income of less than one minimum wage to two minimum wages (59.1%).

Regarding alcohol consumption, 27.5% of the adolescents investigated reported having consumed alcohol in the last 30 days and 33.9% reported being under 13 years of age when they first drank alcohol. Regarding sexual behavior, almost half (45.6%) of the adolescents investigated reported having had sexual intercourse at some point in their lives, 11% reported being 13 years of age or younger when they had their first sexual experience and 29.8% had had four or more sexual partners in their lives.

Alcohol consumption in the last 30 days and having had sexual intercourse were significantly associated (p<0.001). Likewise, an association was found between the age at which alcohol consumption began and the age at which sexual intercourse began (p=0.002) (Table 1).

DISCUSSION

The prevalence of alcohol consumption in adolescence is high worldwide. In Brazil, alcohol is also the drug of choice among children and adolescents ¹ . In the present study, the prevalence of adolescents who had consumed alcohol was 55% for lifetime use and 27.5% for use in the last month.

Regarding the age at which they first tried alcohol, one third of the students surveyed (33.9%) reported that they were under 13 years old when they consumed alcohol for the first time. A study conducted in Rio Grande do Sul found a similar average age (13.5 years) ¹⁰ . In another study conducted with students from the city of Campinas, the average age at which they first tried alcohol was lower, around 12 years old ¹¹ . This is a worrying fact, as it anticipates serious health risks such as the initiation of other drug use, which usually occurs through alcohol consumption ¹² .

Excessive alcohol use in the last month was reported in the present study by 19.3% of the students. However, this pattern of consumption was not significantly associated with sexual behavior, although it is recognized in the literature that the amount of alcohol consumed can influence the sexual behavior of adolescents ^13,14 . In addition, excessive consumption of alcoholic beverages before or during sexual intercourse can be associated with non-use of condoms, multiple sexual partners, casual partners, sexual relations with sex workers and use of injectable drugs ¹⁵ .

Regarding sexual behavior, it was observed that almost half of the adolescents investigated (45.6%) had already had sexual intercourse. Most participants did not engage in risky sexual behavior, such as: use of alcoholic beverages before intercourse and non-use of condoms in the last intercourse. However, an association was found between consumption of alcoholic beverages in the last 30 days and having had sexual intercourse (p<0.001). A similar result was found in the city of Serafina Corrêa – RS, in a study with high school adolescents ¹⁰ . This behavior may be related to the fact that alcohol plays an encouraging role, facilitating affective contacts among adolescents ¹⁶ .

The age at which alcohol was first experimented with and the age at which sexual intercourse was first practiced were significantly associated in the present study (p=0.002). It is possible that this association is due to the disinhibitory effect of alcohol, which facilitates early sexual intercourse ¹⁰. This association is also attributed to the belief of adolescents that alcohol use makes “flirting” easier, increases libido and improves performance during sexual intercourse ¹⁷ .

Alcohol consumption interferes with the adolescent’s critical judgment, which makes negotiation and, consequently, the use of condoms during sexual relations more difficult. Although alcohol consumption and non-use of condoms were not associated in the population studied, several studies have found this association ^5,15,18,19 .

Regarding limitations, it is important to highlight that although the data were obtained using a self-administered questionnaire, there is the possibility of information bias. Even with guaranteed anonymity, it is possible that some adolescents felt uncomfortable and thus omitted information, especially about sexual behavior, either due to self-censorship, fear of their parents finding out or memory error, among other reasons.

It is extremely important to understand the interrelationships between alcohol consumption and adolescent sexual behavior, since young people have been identified as an important population group in terms of epidemiological risk for sexually transmitted diseases ²⁰ . Furthermore, the negative consequences of alcohol abuse constitute a serious public health problem ¹ .

Therefore, the results found suggest the need for prevention campaigns to review their approach strategies, focusing on health risk behaviors, especially in relation to the adoption of educational measures for healthy sexual relationships. Furthermore, an alternative to minimize this problem of alcohol abuse among adolescents would be to try to involve them in healthier activities, such as practicing sports.

CONCLUSION

Alcohol consumption and sexual behavior were associated, especially with the age at which they began, suggesting the need to develop public policies aimed at education and promoting adolescent health, with the implementation of educational practices in the school environment and health units. Therefore, it is of fundamental importance that campaigns be carried out to raise awareness of the risks related to alcohol consumption and its negative consequences for the sexual and reproductive health of young people in their early adolescence, before the age of 12.