Is Cigarette and Alcohol Use Associated With High-Risk Sexual Behaviors Among Youth in China?

Background: Very few studies have explored the association between cigarette or alcohol use and high-risk sexual behaviors (HRSBs) among Chinese youth. Aim: To identify the associations between cigarette and/or alcohol use and HRSBs in unmarried youth 15 to 24 years old in China. Methods: Data were obtained from a nationally representative survey of youth 15 to 24 years old in China. Population numbers, prevalences, and proportions were calculated where appropriate. The chi(2) test was used to examine the different proportions of cigarette and alcohol use behaviors and HRSBs in female vs male youth. Logistic regression with propensity score-based weighting was used to elucidate the separate and combined associations of cigarette use and alcohol use with each HRSB. Outcomes: The sexual behaviors of condom non-use during the first sexual experience, sexual activity with multiple partners, being forced to have sexual intercourse, taking part in casual sex, engaging in commercial sex, taking part in anal sex, and condom non-use during the most recent sexual encounter were classified as HRSBs. Results: Of youth 15 to 24 years old, 23.2% ever used cigarettes, 38.1% used alcohol, and 19.9% used cigarettes and alcohol. Compared with cigarette and alcohol non-use, cigarette and alcohol use showed a significantly increased risk of condom non-use during the first sexual experience (odds ratio = 2.9, 95% CI = 2.5-3.3), sexual activity with multiple partners (4.9, 3.8-6.2), forced sex (2.7, 1.1-6.9), casual sex (4.0, 3.1-5.3), commercial sex (2.9, 2.1-3.9), anal copulation (3.1, 2.1-4.6), condom non-use during the most recent sexual encounter (2.5, 2.1-3.0), and any HSRB (3.2, 2.8-3.6) among youth. The relations between cigarette and alcohol use and HRSBs were stronger among female youth than among male youth for all HRSBs. Clinical Implications: More efforts should be made to implement HIV and AIDS prevention that consider the role of cigarette and alcohol use in precipitating HRSBs. Strengths and Limitations: This study provided a more detailed evaluation with greater confidence of the association between cigarette and/or alcohol use and HRSBs with sex disparity taken into account using nationally representative data, although no detailed information about cigarette and alcohol use behaviors such as dependence and cessation was gathered in this survey. Conclusion: Youth who use cigarette and alcohol are at greater risk of HRSBs, especially female youth. Copyright (C) 2017, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.