Sexual behavior among high school students in Brazil: alcohol
consumption and legal and illegal drug use associated with unprotected sex

Sanchez, Zila M.; Nappo, Solange A.; Cruz, Joselaine I.; Carlini, Elisaldo A.; Carlini, Claudia M.; Martins, Silvia S.

doi:10.6061/clinics/2013(04)09

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CLINICAL SCIENCE • Clinics 68 (4) • Apr 2013 • https://doi.org/10.6061/clinics/2013(04)09 copy

Sexual behavior among high school students in Brazil: alcohol consumption and legal and illegal drug use associated with unprotected sex

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

Alcohol and other drug use appears to reduce decision-making ability and increase the risk of unsafe sex, leading to possible unplanned pregnancies, sexually transmitted diseases/human immunodeficiency virus/HIV transmission, and multiple sexual partners. This study aimed to test the hypothesis that risky sexual behaviors among adolescents are associated with legal and illegal drug use.

METHODS:

A national cross-sectional survey of 17,371 high-school students was conducted in 2010. Students were selected from 789 public and private schools in each of the 27 Brazilian state capitals by a multistage probabilistic sampling method and answered a self-report questionnaire. Weighted data were analyzed through basic contingency tables and logistic regressions testing for differences in condom use among adolescents who were sexually active during the past month.

RESULTS:

Approximately one third of the high school students had engaged in sexual intercourse in the month prior to the survey, and nearly half of these respondents had not used a condom. While overall sexual intercourse was more prevalent among boys, unsafe sexual intercourse was more prevalent among girls. Furthermore, a lower socioeconomic status was directly associated with non-condom use, while binge drinking and illegal drug use were independently associated with unsafe sexual intercourse.

CONCLUSION:

Adolescent alcohol and drug use were associated with unsafe sexual practices. School prevention programs must include drug use and sexuality topics simultaneously because both risk-taking behaviors occur simultaneously.

Sexual Risky Behavior; Binge Drinking; Illegal Drug Use; School Survey; Adolescents

	Recent sexual intercourse (N = 16,998)								Recent sexual intercourse and condom use^a only among those who had sex during the past month; b recent use refers to use during the 30 days prior to the survey. ) (N = 4,483)
		No			Yes				With Condom			Non-Condom
		N	%	SE	N	%	SE	p-value	N	%	SE	N	%	SE	p-value
Gender	female	7330	58.4	0.7	2112	49.7	0.1	<0.0001	1007	42.1	1.6	1095	60.2	1.5	<0.0001
	male	5144	41.6	0.7	2377	50.3	0.1		1616	57.9	1.6	753	39.8	1.5
Age	13 to 15	5425	43.7	1.7	985	20.9	1.3	<0.0001	640	22.9	1.5	341	18.3	1.6	0.011
	16 to 18	7072	56.3	1.7	3515	79.1	1.3		1988	77.1	1.5	1513	81.7	1.6
Socioeconomic Status (SES)	A	2209	13.3	1.4	719	12.2	1.1	0.75	461	13.4	1.4	255	10.7	1.2	0.001
	B	4873	43.7	1.1	1650	44.2	1.5		970	46.7	2.1	673	40.5	1.9
	C	3307	38.6	1.2	1271	39.1	1.1		702	36.2	1.9	565	43.1	1.9
	D/E	428	4.4	0.3	163	4.5	0.3		82	3.6	0.5	81	5.7	7.8
Brazilian Region	North	2649	11.1	1.1	1003	10.3	0.8	0.01	635	11.4	0.9	363	8.9	1.0	0.21
	Northeast	4819	28.3	1.7	1568	25.1	1.5		890	23.9	1.6	673	26.8	2.0
	Southeast	1943	41.4	2.1	790	46.3	2.2		437	46.2	2.3	348	46.4	2.8
	South	1082	7.2	0.9	465	7.9	0.9		270	8.2	1.0	193	7.6	1.0
	Middle West	2004	12.0	1.0	675	10.4	0.9		396	10.4	1.0	278	10.3	0.9
Type of School	private	5651	24.5	1.7	1532	17.5	1.5	<0.0001	941	18.0	1.6	585	16.9	1.9	0.51
	public	6846	75.5	1.7	2969	82.5	1.5		1687	82.0	1.6	1270	83.1	1.9
Recent Tobacco^b	yes	566	4.8	0.3	724	16.5	1.1	<0.0001	368	14.3	1.0	354	19.3	1.7	0.001
	no	11889	95.2	0.3	3748	83.5	1.1		2245	85.7	1.0	1487	80.7	1.7
Recent Binge^b	yes	1697	13.4	0.7	1581	37.2	1.4	<0.0001	884	34.6	1.6	696	40.9	1.8	0.002
	no	10525	86.6	0.7	2634	62.8	1.4		1581	65.4	1.6	1036	59.1	1.8
Recent Alcohol^b	yes	3346	26.4	0.9	2344	53.6	1.3	<0.0001	1319	51.2	1.5	1022	57.1	1.9	0.002
	no	8993	73.6	0.9	2035	46.4	1.3		1240	48.8	1.5	780	42.9	1.9
Recent Illegal Drug Use^b	yes	571	4.2	0.3	653	14.5	0.8	<0.0001	342	12.8	0.9	308	16.8	1.2	0.004
	no	11925	95.8	0.3	3848	85.5	0.8		2286	87.2	0.9	1547	83.2	1.2
Total		12497	70.6	0.7	4501	29.4	0.7		2628	57.6	1.3	1855	42.4	1.3

	Recent sexual intercourse (N = 16,202)						Sexual intercourse without condom use^b (N = 3,551)
	cOR	IC	p-value	aOR	IC	p-value	cOR	IC	p-value	aOR	IC	p-value
Male	1.42	1.27;1.58	<0.0001	1.32	1.18;1.48	<0.0001	0.48	0.40;0.57	<0.0001	0.45	0.36;0.55	<0.0001
Age	1.65	1.55;1.74	<0.0001	1.52	1.43;1.61	<0.0001	1.12	1.04;1.21	0.002	1.17	1.07;1.28	0.001
SES^a reference group for socioeconomic status was the highest level (A). b reference group was participants who reported sex with condom use. )	1.03	0.95;1.11	0.40	.	.	.	1.28	1.12;1.44	<0.0001	1.21	1.05;1.39	0.006
Brazilian region	1.01	0.97;1.06	0.43	.	.	.	1.01	0.95;1.07	0.69	.	.	.
Public school	1.52	1.30;1.78	<0.0001	1.59	1.36;1.87	<0.0001	1.07	0.86;1.34	0.51	.	.	.
Recent tobacco	3.88	3.27;4.61	<0.0001	1.69	1.33;2.13	<0.0001	1.43	1.15;1.77	0.001	.	.	.
Recent binge	3.82	3.29;4.43	<0.0001	1.73	1.39;2.14	<0.0001	1.31	1.10;1.55	0.002	1.32	1.07;1.63	0.008
Recent alcohol	3.22	2.88;3.61	<0.0001	1.72	1.46;2.03	<0.0001	1.27	1.08;1.48	0.003	.	.	.
Recent illegal drug	3.89	3.31;4.56	<0.0001	2.02	1.69;2.03	<0.0001	1.37	1.10;1.70	0.004	1.43	1.03;1.90	0.012

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E-mail: clinics@hc.fm.usp.br

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[1] Sanchez ZM wrote the first draft of the manuscript and performed the statistical analyses. Cruz JI performed the literature search and wrote the first draft of the discussion. Nappo SA critically revised the manuscript for important intellectual content. Carlini EA and Carlini CM substantially contributed to the conception, design, and acquisition of the student survey data. Martins SS supervised the statistical analyses and writing process. All of the authors approved the final version of the manuscript.