EXCESSIVE ALCOHOL USE IS A PERVASIVE public health problem affecting college campuses. A recent nationwide survey found that U.S. college students report an average of 72 past-year drinking days, 44 heavy drinking days (i.e., five/four or more drinks for men/ women), and 21 episodes of intoxication

(Chen et al., 2004/ 2005). Importantly, heavy drinking in college students has been associated with unplanned and unprotected sex (Dunn et al., 2003; Wechsler et al., 2000), high numbers of sexual partners (Guo et al., 2001), unplanned pregnancy (Perkins, 2002), and sexually transmitted infections (STIs; Chesson et al., 2003; Cook et al., 2002). Engaging in unprotected sexual behavior after drinking places college students at risk for STIs and associated sequelae, which include cancer, infertility, and increased risk for HIV (Cates, 1999).

The relationship between alcohol consumption and sexual risk taking in college students has been demonstrated at both global and situational levels. Global associations test if individuals who drink alcohol are more likely to engage in risky sex, whereas event-specific associations test if the likelihood of engaging in risky sex on a given occasion varies as a function of drinking on that same occasion (Cooper, 2002). Event-level methods are generally regarded as providing the most reliable estimate of co-occurrence (e.g., Schroder et al., 2003) because they ensure that drinking and sexual behavior occur on the same occasion, which provides a more credible evaluation of the hypothesis that alcohol consumption increases sexual risk taking (Weinhardt and Carey, 2000).

Studies using event-level data have found strong support for the relationship between alcohol use and the likelihood of having sex with a new partner (Cooper et al., 1994, 1998; Corbin and Fromme, 2002; Graves, 1995; Testa and Collins, 1997; Weinhardt and Carey, 2000) or a casual partner (Brown and Vanable, 2007; Dunn et al., 2003). Across studies, however, findings from event-level analyses regarding the relation between alcohol and condom use with college students have been mixed (Corbin and Fromme, 2002; Graves, 1995; Leigh, 2002; MacDonald et al., 1996). Relationship context and, in particular, the timing of sex within the course of the relationship, appear to be important moderating factors. For example, a recent meta-analysis of event-level studies showed that individuals who drank in conjunction with their first sexual experience were less likely to use condoms than those who did not drink, but drinking was unrelated to condom use in recent sexual encounters for both repeat and new sexual partnerships (Leigh, 2002). Although this review highlights the complex relationship between alcohol use and sexual risk taking, it is limited to a single behavior (i.e., condom use) and does not explore other potentially important aspects of the sexual encounter, including discussions related to sexual safety and use of other contraceptives to protect against pregnancy (e.g., birth control pill, spermicidal jelly).

Another significant limitation of the literature on alcohol and sexual risk behavior is that few studies have assessed oral sex experiences. Nearly half (47%) of college students report having engaged in oral sex in the past 30 days (American College Health Association, 2005), and lifetime rates of oral sex are at least equivalent to rates of vaginal sex (Mosher et al., 2005). Moreover, although viewed by many adolescents and young adults as benign (Sanders and Reinisch, 1999), oral sex is associated with increased risk for several STIs, including pharyngeal gonorrhea, syphilis, human papillomavirus, and possibly Hepatitis B and HIV (Edwards and Came, 1998a,b). Despite the prevalence of oral sex among young adults and the risk for STIs associated with this sexual activity, previous studies have either neglected measuring oral sex altogether (i.e., defined sexual experience as involvement in vaginal sex only), combined oral sex with sexual contact other than intercourse (Cooper and Orcutt, 1997), or asked about "sexual activity" without differentiating between oral and vaginal sex experiences (O'Hare, 1998). As a result, the relationship between alcohol use and oral sex remains poorly understood.

In summary, although previous research has identified a global association between drinking and sexual risk behavior among college students (for a review, see Cooper, 2002), there have been relatively few studies that examined event-level data and no studies that we are aware of that examined the association between drinking and oral sex. In addition, the relationship between drinking and risky sexual behavior appears to depend on the timing of sex within the relationship (i.e., first versus repeat sexual encounter). Finally, because an ultimate goal of research on alcohol and risky sexual activity is to inform interventions, it is important to investigate these relations in samples of college students presenting for alcohol interventions (Barnett and Read, 2005; Barnett et al., 2004; O'Hare, 2005).

The purpose of the present study was to use event-level analyses to examine the relationship between alcohol use, relationship status, and sexual risk taking in the context of oral and vaginal sexual encounters in a sample of college students who were required to attend alcohol education following an on-campus, alcohol-related medical or disciplinary event. Individuals were assessed before receiving any intervention. Our general hypothesis was that alcohol use would be more likely among individuals in newer sexual partnerships and that relationship variables associated with more casual sexual partnerships would predict drinking in conjunction with a sexual experience. Specifically, we hypothesized that sexual encounters involving less well-known and less-committed partnerships would be associated with an increased likelihood of drinking and that alcohol use would be associated with fewer discussions of topics relevant to risky sexual practices (e.g., sexual history, history of HIV or STIs). In addition, we hypothesized that drinking--in conjunction with vaginal sex--would be associated with a reduced likelihood of using contraceptives. Finally, because previous studies have not examined risks associated with drinking during oral sex, we hypothesized that drinking would be more likely to occur in new oral sex partnerships and that alcohol use would be associated with fewer discussions related to practicing safe oral sex.

Method

Participants

Student participants (N = 225) attended a private university in the Northeast and completed a baseline assessment as part of a clinical trial of a brief intervention for students required to attend a session of alcohol education following medical evaluation for intoxication or a disciplinary hearing for an alcohol-related violation. For the present analyses, we excluded participants (n = 4) who did not respond to items assessing if they had ever been involved in oral or vaginal sex. Of the remaining 221 participants, 51.1% were women and 48.9% were men. The average (SD) age of participants was 18.82 years (0.87), and the majority were freshmen (67.9%). For race and ethnicity, the majority of participants endorsed white (73.8%); the remaining endorsed Hispanic (12.2%), Asian (12.7%), black (3.6%), American Indian (2.3%), and "other" (9.0%). Proportions do not equal 100% because 26 participants (11.8%) reported that they were members of more than one race or ethnic category.

Procedures

During the academic semesters from fall 2000 to spring 2004, students were recruited by the research project coordinator when they called the university office in response to the mandated referral. Students were invited to participate in the study as an alternative to having a session with a university health educator. No other compensation for baseline participation was provided. Sixty-five percent of eligible participants agreed to participate in the study; they did not differ in age or class year from those who declined.

Participants completed a brief researcher-administered interview and a self-report battery of questionnaires. Analyses are based on self-report data provided by the participants at the time of their enrollment in the study. Participants completed the assessment in a private room and were assured their data would not be included in any university records and would remain confidential. All procedures were approved by the university institutional review board.

Measures

Demographic information included age, year in school, and race and ethnicity.

Alcohol consumption during the 30 days preceding the interview was measured with the Timeline Followback (Sobell and Sobell, 1992, 1996), which is a reliable and valid calendar method of collecting detailed alcohol use information. Number of standard drinks (e.g., 12 oz of beer, 4 oz of wine, 1.25 oz of distilled spirits) per day were recorded and summarized into three indicators of alcohol use: (1) number of drinking days; (2) number of heavy drinking days (five or more drinks for men, four or more for women); and (3) average number of drinks per week.

Sexual experiences were assessed by questions measuring whether any prior sexual activity (defined as oral or vaginal sex) had ever occurred, the number and gender of prior partners, the number of times diagnosed with an STI, the number of times tested for HIV, and the number of times the participant had been pregnant or gotten a partner pregnant. The following questions were asked separately for oral and vaginal sex experiences in the past 3 months: number of times they had sex with a regular partner while under the influence of alcohol, number of times they had sex with someone they just met or did not know well while under the influence of alcohol, number of times they had sex with a regular partner when they did not want to because they were too drunk to stop, and number of times they had sex with someone they just met or did not know well because they were too drunk to stop (Cooper et al., 1994).

Items measuring event-level experiences were adapted from Cooper et al. (1994) and Temple and Leigh (1992). In this set of questions, participants were asked about the most recent time they had oral sex and the most recent time they had vaginal sex. If this sexual experience was not the first sexual experience with that partner, they were asked about the first sexual experience with that partner. For each of these experiences, they were asked the date, how long they had known the partner (from 1 ["just met that day/night"] to 6 ["longer than 1 year"]), how committed they were to the relationship with the partner at the time of the sexual experience (from 1 ["not at all committed"] to 5 ["completely committed"]), and the degree to which they expected the sexual experience would occur (from 1 ["I didn't expect it at all"] to 5 ["I was completely certain it would happen"]). For each experience, participants were also asked how many alcoholic drinks they had consumed and how many drinks their partner had consumed. For oral sex experiences, participants were asked if they also had vaginal sex. For vaginal sex experiences, they were asked if they also had oral sex. For experiences that involved vaginal sex, participants were asked to indicate the type of contraceptive that was used (condoms, birth control pill, spermicidal jelly, intrauterine device, diaphragm). We then created two groups representing (1) use of condoms and (2) use of contraceptives other than condoms (i.e., used one of birth control pill, spermicidal jelly, intrauterine device, or diaphragm). In the set of questions about the first sexual experience with a partner, participants were asked if they had discussed their sexual history and their partner's sexual history, STI and HIV status, protection against STIs, protection against pregnancy (vaginal sex only), and emotional commitment. Responses to these questions were combined into a single score representing the number of topics discussed (possible range 0-4 for oral sex and 0-5 for vaginal sex). For repeat partners (i.e., when the most recent sex experience was not the first with that partner), participants were asked the number of times they previously had oral or vaginal sex with that partner.

Data analysis

Outliers (responses greater than three standard deviations above the mean) were identified on the average drinks per week measure and were adjusted to equal one unit greater than the largest nonoutlying value. We conducted separate analyses for repeat experiences with a recent partner (oral and vaginal sex) and first experiences with a recent partner (oral and vaginal sex). In addition, because we were interested in the specific relationship between drinking and oral sex experiences, all analyses involving oral sex were limited to those encounters that involved oral sex only (i.e., not oral sex and vaginal sex). All vaginal sex encounters were included in the analyses whether or not oral sex also occurred. For all analyses involving relationship parameters (i.e., how long known partner, how committed to partner, how much expected sex to occur, number of previous sexual experiences), the dependent variable was alcohol use before or in conjunction with the sexual encounter (1 = alcohol use vs 0 = no alcohol use). We conducted separate logistic regression analyses to determine the likelihood of drinking as a function of relationship characteristics. We also examined the impact of drinking on measures related to safe sexual practices (i.e., discussions related to sexual history and contraceptive use, actual contraceptive use). Independent t tests were conducted to examine the differences between drinking and nondrinking groups on the number of sex-related topics discussed, and logistic regression analyses were used to examine the impact of drinking on contraceptive use. Because of the substantial number of comparisons conducted throughout this study, we used a Bonferroni adjustment to guard against Type I error. The critical value for statistical significance was based on the number of analyses within the two sets of comparisons: (1) recent repeat oral and vaginal sex experiences and (2) first oral and vaginal sex experiences with a recent partner. Actual alpha levels for each of these analyses are indicated in the following section.

Results

Sample characteristics

On average, participants consumed alcohol on 5.40 (3.61) days in the past 30 days, drank an average of 6.99 (6.65) drinks per week, and had 2.86 (2.96) heavy drinking days in the past 30 days.

Characteristics of sexual activity for the sample

The majority of the sample (80.5% of the sample, n = 178) reported some lifetime sexual activity (i.e., involvement in either oral or vaginal sex). Sexual activity characteristics for the total sample and for men and women separately are listed in Table 1, along with information concerning sexual activity in the context of drinking within the past 3 months.

Event-level analyses of recent sexual experiences as a function of drinking before the experience

We first examined the association between alcohol use at the time of the sexual experience and the newness of the sexual relationship (i.e., first time partner vs regular partner). When oral sex was considered, consuming alcohol was not associated with partner status ([chi square] = 2.89, 1 df, n = 92; B [SE] = 0.73 [0.43]; Wald = 2.84, p = .092; odds ratio [OR] = 2.07, 95% confidence interval [CI]: 0.89-4.81). For vaginal sex, however, experiences preceded by drinking were approximately six times more likely to involve a new partner ([chi square] = 22.36, 1 df, n = 134; B = 1.80 [0.40]; Wald = 20.62, p < .001; OR = 6.02, 95% CI: 2.77-13.06). Because the first sexual experience with a partner is potentially more risky than a recurrent sexual experience, we conducted separate analyses with these two overlapping groups (i.e., experiences with a repeat partner and experiences with a first-time partner). These groups overlap, because, in the analyses of first-time partners, we included first experiences with a repeat partner.

Experiences with a repeat partner. Event-level analyses for participants whose most recent sexual experience was with a repeat partner were conducted separately for oral and vaginal sex (Table 2). Of the 46 participants whose most recent oral sex experience was not their first with that partner, 15 (32.6%) reported drinking; of the 86 participants whose most recent vaginal sex experience was not their first with that partner, 20 (23.3%) reported drinking. On average (SD), participants who drank consumed 4.73 (3.03) and 3.75 (2.27) drinks in conjunction with oral and vaginal sex, respectively. Partner's alcohol consumption was consistent with participant drinking; 80.0% and 90.0% of participants who reported consuming alcohol reported that their partner was also drinking for oral and vaginal sex, respectively.

Logistic regression was used to examine predictors of alcohol use during recent oral and vaginal sex experiences (see Table 2) and to examine the impact of drinking on contraceptive use (i.e., condom use and use of contraceptives other than condoms) within vaginal sex experiences. Significance for these analyses was based on a Bonferroni adjusted p value of .005 (.05/10). For oral sex experiences, the relationship parameters did not significantly predict drinking (see Table 2). For vaginal sex experiences, there was a significant effect for partner commitment, whereby less commitment to a partner was associated with a greater likelihood of drinking during sex.

Alcohol use was not significantly associated with condom use during a recent vaginal sex experience (B [SE] = -.07 [0.54]; Wald = 0.02, p = .890; OR = 0.93, 95% CI: 0.32-2.66) and was not significantly associated with using contraception other than condoms (B [SE] = -0.97 [0.52]; Wald = 3.40, p = .065; OR = 0.38, 95% CI: 0.14-1.06).

Experiences with a first-time partner. Additional event-level analyses were conducted to examine drinking-related differences among first oral and vaginal sex experiences. Logistic regression was used to examine predictors of alcohol use for oral and vaginal sex experiences (see Table 2). In addition, we examined drinking-related differences in the average number of sex-related topics discussed before first oral and vaginal sex experiences, as well as the impact of drinking on condom and other contraceptive use in the context of first vaginal sex experiences. The Bonferroni adjusted p value for these analyses was .006 (.05/8). This category consisted of participants whose most recent sexual experience involved a new partner, as well as participants who described their first experience with a partner with whom they have since had repeat involvement. In other words, these first-time experiences may or may not have been a participant's most recent sexual experience, but in all cases it was their first sexual experience with their most recent partner. Of the 129 participants who described a first oral sex experience, 31.8% had consumed alcohol before that experience. Of the 134 who described a first vaginal sex experience, 34.3% consumed alcohol. On average, participants who consumed alcohol during a new-partner oral sex experience consumed 5.05 (3.83) drinks. For new vaginal sex experiences, average consumption was 6.15 (3.43) drinks. As with recent sexual experiences with a repeat partner, participants' reports of their partners' alcohol consumption was consistent with their own drinking. For oral sex, 92.7% of participants who were drinking reported that their partner was also drinking, and this percentage was slightly higher (97.8%) for vaginal sex. As detailed in Table 2, for first oral and vaginal sex experiences, those who knew their partner for a shorter amount of time were more likely to have consumed alcohol in conjunction with the sexual encounter.

In addition, participants who consumed alcohol discussed significantly fewer sex-related topics during both oral sex (t = 4.44, 127 df, p < .001) and vaginal sex (t = 5.65, 131 dr, p < .001). For first oral sex experiences, those who consumed alcohol discussed an average of 0.34 (0.69) sex-related topics, whereas those who did not consume alcohol discussed an average of 1.72 (1.94) topics. For first vaginal sex experiences, participants who consumed alcohol reported discussing an average of 0.89 (1.38) topics, whereas those who did not consume alcohol reported discussing an average of 2.94 (2.22) topics. Finally, although the findings were not significant at the Bonferroni adjusted level of significance, there was a tendency for participants who consumed alcohol in conjunction with this new vaginal sex experience to be less likely to use condoms (B [SE] = -1.08 [0.52]; Wald = 4.36, p = .037; OR = 0.34, 95% CI: 0.120.94) and other forms of contraception (B [SE] = -0.97 [0.38]; Wald = 6.34, p = .011; OR = 0.38, 95% CI: 0.180.80). Specifically, 90.9% of participants who did not consume alcohol used condoms, compared with 77.3% of participants who consumed alcohol. Regarding contraception other than condoms, 56.8% of participants who did not consume alcohol used contraceptives other than condoms, whereas 33.3% of participants who consumed alcohol used other forms of contraception.

Discussion

The purpose of the present study was to examine event-level relationships between alcohol use and sexual behavior in a sample of college students who had been identified by campus officials as being at some risk related to their alcohol use. Although previous researchers have examined the impact of alcohol use on sexual risk taking among similar at-risk groups (e.g., O'Hare, 1998, 2005) and have examined both new and repeat event-level relationships (e.g., Brown and Vanable, 2007; Corbin and Fromme, 2002; for reviews, see Cooper, 2002; Leigh, 2002), previous findings have been mixed, limited to specific sexual risk behaviors (e.g., condom use), and restricted to vaginal sex experiences. We extended previous work in this area by examining event-level relationships among drinking, sexual behavior, and sexual risk taking for both oral and vaginal sex, and across recent first and repeat sexual encounters. Overall, our sample of at-risk drinkers reported high rates of risky sexual activity and inconsistent use of protective behaviors. We found that the newness of the sexual partnership was related to alcohol consumption, that fewer sex-related topics were discussed when participants had consumed alcohol, and that there was a tendency for alcohol consumption to be associated with a reduced likelihood of using condoms and other forms of contraception.

Our findings suggest that college students are more likely to drink in conjunction with new and less-committed sexual partnerships. Vaginal sex experiences with a new partner were more likely to include alcohol than encounters with a repeat partner. Moreover, for recent vaginal sex experiences with a repeat partner, those who were less committed to their partner were more likely to consume alcohol. Similarly, for recent vaginal and oral sex experiences with a new partner, alcohol use was more likely among those who had known their partners for less time. Although the findings for recent oral sex were not significant, the pattern of results suggests that alcohol use was more likely to occur when the partner was less well known and when there were fewer previous sexual encounters with the partner. To ensure that the findings for new sexual partnerships were not solely the result of the impact of first-ever partnerships, which have been identified as particularly susceptible to the effects of alcohol (e.g., Leigh, 2002), we identified participants who indicated that their most recent partner was also their first ever partner and repeated the analyses without these participants. There were no differences in the findings once these individuals were removed.

The findings provide some support for our hypothesis that drinking in conjunction with vaginal sex would be associated with less frequent contraceptive use. Although the findings did not reach statistical significance, the pattern of results suggests that the use of condoms and other contraceptives was less common among those who consumed alcohol before vaginal sex with a new partner. Conversely, for repeat sexual encounters, drinking was not associated with contraceptive use. Our findings are consistent with previous research showing that condom use in general may be less likely in the context of sex with a regular partner (Dermen and Cooper, 2000). In the present study, a smaller proportion of repeat partners, compared with new partners, used condoms overall, suggesting that once sexual partners move past the initial encounter, they may discount potential risks.

Our findings are consistent with laboratory research demonstrating that alcohol administration lowers the perceived risk for unsafe sexual practices with a new partner but not with a regular partner (Fromme et al., 1999) and suggest that new and unexpected sexual partnerships are associated with an increased likelihood of consuming alcohol. Indeed, previous researchers have identified a link between alcohol use and new sexual partnerships or "hookups" among college students (Paul and Hayes, 2002). In our sample, new vaginal sex partnerships were associated with an increased likelihood of drinking. In addition, alcohol consumption in the context of new sexual partnerships was associated with fewer discussions of issues pertaining to safe sexual practices. This may be best explained by alcohol myopia theory (e.g., MacDonald et al., 1996; Steele and Josephs, 1990), which postulates that alcohol disinhibits risky behaviors in some situations owing to its effects on information processing. According to this theory, drinking reduces the likelihood of attending to less salient cues, such as those that may inhibit sexual behavior (e.g., risk of contracting an STI) and increases awareness of highly salient cues, such as sexual arousal. The disinhibitory effects of alcohol will be most pronounced when there is conflict between cues of almost equal salience and strength, such as might occur when confronted with the high arousal and high risk potential of a new sexual partnership. Perceived risk may be lower for regular partners because of previous conversations about sexual history or the rationalization that there is minimal incremental risk with additional sexual experiences, thereby minimizing conflict and the influence of alcohol on decisions regarding contraception (Cooper, 2002).

The present study is unique in its focus on the impact of drinking on both oral and vaginal sex experiences. We found that drinking, in conjunction with a first oral sex experience, was significantly associated with fewer discussions of issues relevant to safe sexual practices. This relationship between alcohol use and discussions of oral sex risk is particularly concerning. Because oral sex experiences are unlikely to involve contraceptive use (American College Health Association, 2005), discussions of sexual risk may actually be the primary form of risk reduction within oral sex experiences. Unfortunately, the impact of alcohol use on risk taking within oral sex may be overlooked. Although many adolescents and young adults have engaged in oral sex (Mosher et al., 2005) and oral sex has been implicated in the transmission of several STIs (Edwards and Came, 1998a,b), young adults tend to believe that oral sex is not risky (Remez, 2000) or is not "real" sex (Sanders and Reinisch, 1999). In the present sample, 98.3% of sexually active participants were engaging in oral sex, with approximately one quarter (24.7%) engaging in oral but not vaginal sex. Thus, a substantial percentage of college students who are engaging in oral but not vaginal sex may feel they are exempt from messages targeting the relationship between drinking and STI risk prevention, despite the risk associated with the co-occurrence of these activities.

Limitations and future directions

Although detailed analysis of recent and first sexual experiences provided support for the association between alcohol consumption and risky sexual activity, several limitations should be noted. First, although the pattern of findings suggests that newer and less-committed relationships are more likely to involve alcohol, because of the small sample size and the use of a conservative alpha level the number of statistically significant findings were fewer than anticipated. Replication of these findings with a larger sample is needed. In addition, further research should include a larger proportion of sexual experiences that involve oral sex only. For example, participants should be asked to report on two separate sexual encounters: one involving oral sex only and a second involving vaginal sex. Second, our event-level analyses included only the most recent episode (and first with the most recent partner) per individual, which limits our ability to make inferences about the causal role of relationship variables and alcohol. For example, unmeasured third variables, such as sensation seeking, could be associated with both heavy drinking and risky sexual activity (George and Stoner, 2000). In addition, sexual experiences during the first year of college may be more likely to involve alcohol, as well as less well-known partners and reduced relationship commitment. Future research involving prospective within-subject methodology (e.g., daily monitoring and momentary assessments; Neal et al., 2006) and longitudinal methods (e.g., sexual experiences across the college years) may provide more compelling evidence for a causal relationship between relationship status and drinking, as well as drinking and sexual risk taking. Third, although this study is novel in its examination of oral sex experiences independent of vaginal sex encounters--based on prior research indicating low rates of contraceptive use during oral sex among college students (American College Health Association, 2005)--we did not assess important risk behaviors associated with oral sex (e.g., nonuse of condoms, dental dams). Our findings suggest that alcohol use during recent oral sex experiences is associated with fewer discussions regarding important protective behaviors, including use of contraceptives, but further research is needed to determine if drinking--in conjunction with oral sex--is associated with reduced use of protection against STIs. Finally, the generalizability of our findings is limited to primarily heterosexual college students who had a recent alcohol-related incident. In the present study, only a small percentage of students reported same-gender partnerships for recent repeat (n = 4, 8.7%) and new (n = 6, 4.7%) oral sex experiences, and no students indicated recent involvement in anal sex. Although lifetime oral sex is the most common sexual behavior among college students with same-gender partners, a significant proportion of these students also report involvement in anal sex (Lindley et al., 2003), which represents the greatest risk for HIV transmission. Further research is needed to explore the relationship between drinking and sexual risk taking within oral and anal experiences with a same-gender partner. In addition, further research is needed to determine if college students in general, and not just those who come to the attention of authorities, experience greater sexual risk taking in conjunction with drinking across sexual encounters (i.e., new and repeat recent partnerships) and sexual behaviors (i.e., vaginal and oral sex).

Despite these caveats, given the high rates of risky sexual activity and the association between newer sexual relationships and alcohol use in this sample of college drinkers, campus alcohol intervention programs should address alcohol-related risky sexual activity. For example, Ingersoll et al. (2005) found that a brief motivational intervention successfully reduced heavy drinking and increased effective contraception use among sexually active college women. The present findings suggest that intervention content should highlight the greater risk associated with drinking in conjunction with new sexual partnerships and the often overlooked connection between drinking and oral sex experiences.

Received: June 7, 2006. Revision: May 30, 2007.

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* This study was supported by National Institute on Alcohol Abuse and Alcoholism grants AA12158 and AA07459.

[(dagger)] Abby L. Goldstein is now with the Department of Psychology, York University, Toronto, Ontario, Canada M3J 1P3. Correspondence may be sent to her at that address or via email at: abbyg@yorku.ca. C. Teal Pedlow is with the Department of Psychology, University of Massachusetts Dartmouth, North Dartmouth, MA. James G. Murphy is with the Department of Psychology, University of Memphis, Memphis, TN.

ABBY L. GOLDSTEIN, PH.D., [(dagger)] NANCY P. BARNETT, PH.D., C. TEAL PEDLOW, PH.D., [(dagger)] AND JAMES G. MURPHY, PH.D. [(dagger)]

Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island

TABLE 1. Sexual activity characteristics among sexually
active male (n = 89) and female (n = 89) participants

                                       Male      Female      Total

Variable                              n     %    n     %     n    %

Sexual activity
  Oral and vaginal sex                66   74.1  65     73  131  73.6
  Oral sex only                       22   24.7  22   24.7   44  24.7
  Vaginal sex only                     1    1.1   2    2.2    3   1.7
Gender of partner
  Opposite gender only                80   89.9  82   92.1  162    91
  Both opposite and same gender        4    4.5   2    2.2    6   3.4
  Same gender only                     3    3.4   1    1.1    4   2.2
Ever diagnosed with STI                2    2.2   2    2.2    4   2.2
Ever tested for HIV                   10   11.2  18   20.2   28  15.7
Ever pregnant or impregnated partner   1    1.1   1    1.1    2   1.1
Sex under the influence of alcohol,
  Someone you just met
    Any sex                           27   30.3  19   21.3   46  25.8
    Oral sex                          25   28.1  16     18   41    23
    Vaginal sex                       14   15.7  14   15.7   28  15.7
  Someone you knew
    Any sex                           30   33.7  42   47.2   72  40.4
    Oral sex                          26   29.2  36   40.4   62  34.8
    Vaginal sex                       20   22.5  30   33.7   50  28.1
Sex because too drunk to stop (a)
  Someone you just met
    Any sex                            6    6.7   7    7.8   13   7.3
    Oral sex                           5    5.6   2    2.2    7   3.9
    Vaginal sex                        2    2.2   5    5.6    7   3.9
  Someone you knew
    Any sex                            0    0     4    4.5    4   2.3
    Oral sex                           0    0     3    3.4    3   1.7
    Vaginal sex                        0    0     1    4.5    1   0.6

Notes: STI = sexually transmitted infection. (a) In the past 3 months.

TABLE 2. Logistic regression analyses predicting and first sexual
experiences with a partner alcohol use (yes vs no) from
characteristics of recent repeat

Variable                                     B (SE)          Wald

Most recent oral sex with a repeat
partner (n = 46)
  How long known partner                     -.66 (0.30)    5.00
  How committed to partner                   -.49 (0.25)    3.93
  Expected oral sex to occur                 -.35 (0.33)    1.15
  No. times prior oral sex with partner      -.17 (0.08)    5.15
Most recent vaginal sex with a repeat
partner (n = 86)
  How long known partner                     -.34 (0.28)    1.51
  How committed to partner                   -.69 (0.23)    9.26 (a)
  Expected vaginal sex to occur              -.34 (0.24)    2.02
  No. times prior vaginal sex with partner   -.02 (0.01)    4.17
First oral sex with partner (n = 129)
  How long known partner                     -.74 (0.16)   20.38 (b)
  Expected oral sex to occur                 -.42 (0.18)    5.27
First vaginal sex with partner (n = 134)
  How long known partner                     -.68 (0.15)   21.66 (b)
  Expected vaginal sex to occur              -.36 (0.15)    5.84

Variable                                       p     OR (95% CI)

Most recent oral sex with a repeat
partner (n = 46)
  How long known partner                      .025   0.52 (0.29-0.92)
  How committed to partner                    .048   0.61 (0.38-1.00)
  Expected oral sex to occur                  .284   0.70 (0.37-1.34)
  No. times prior oral sex with partner       .023   0.84 (0.72-0.98)
Most recent vaginal sex with a repeat
partner (n = 86)
  How long known partner                      .219   0.71 (0.42-1.22)
  How committed to partner                    .002   0.50 (0.32-0.78)
  Expected vaginal sex to occur               .156   0.71 (0.45-1.14)
  No. times prior vaginal sex with partner    .041   0.98 (0.96-1.00)
First oral sex with partner (n = 129)
  How long known partner                     <.001   0.48 (0.35-0.66)
  Expected oral sex to occur                  .022   0.66 (0.46-0.94)
First vaginal sex with partner (n = 134)
  How long known partner                     <.001   0.51 (0.38-0.67)
  Expected vaginal sex to occur               .016   0.70 (0.52-0.94)

Notes: Oral sex experiences included only oral sex; vaginal sex
experiences may also have included oral sex. How long known
partner anchors were 1 =just met that day/night, 2 = less than
1 week, 3 = 1-4 weeks, 4 = 1-5 months, 5 = 6 months-1 year, and
6 = known longer than 1 year. How committed to partner anchors
were 1 = not at all committed; 3 = not sure, ambivalent; and
5 = completely committed. Expected sex to occur anchors were 1
= didn't expect it at all, 3 = I really didn't know, and 5 =
I was completely certain it would happen. OR = odds ratio; 95%
CI = 95% confidence interval. (a) Significant using Bonferroni
p value of .005; (b) significant using Bonferroni p value of .006.