Startseite Prevalence and correlates of sexual intercourse under influence of alcohol among Thai adolescents: lessons from a nationwide school-based survey
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Prevalence and correlates of sexual intercourse under influence of alcohol among Thai adolescents: lessons from a nationwide school-based survey

  • Omid Dadras ORCID logo EMAIL logo
Veröffentlicht/Copyright: 27. Juni 2024
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International Journal of Adolescent Medicine and Health
Aus der Zeitschrift International Journal of Adolescent Medicine and Health Band 36 Heft 4

Abstract

Objectives

Having sex under the influence of alcohol is a risky behavior and this study explored its prevalence and correlates among school-going Thai adolescents.

Methods

The data from the 2021 Thailand Global School-based Student Health Survey (GSHS), including a nationally representative sample of students in grades 7–12th, was used to extract the relevant variables including demographic, psychosocial, substance use, and risky sex behaviors. Logistic regression was used to assess the odds of engaging in sex while intoxicated across the independent variables while accounting for age and sex differences.

Results

Approximately 30.45 % of respondents reported alcohol intoxication and 37.75 % reported engaging in sexual intercourse while intoxicated at least once. Older adolescents (>14 years), males, and those in 11 and 12 grades were more likely to engage in sexual intercourse while intoxicated. Psychosocial factors such as loneliness and anxiety-induced insomnia were associated with increased likelihood, particularly among females. Substance use, including marijuana and amphetamine use, as well as cigarette smoking, correlated with higher odds of engaging in sexual intercourse while intoxicated. Both genders who engaged in sex while intoxicated reported having multiple sexual partners, with males more likely to use condoms.

Conclusions

The intricate relationship between poor mental health, substance use, and risky sex behaviors along with their association with sex under alcohol influence emphasizes the need for a holistic approach to address the common risk factors and implement effective school-based screening strategies to identify the risk groups, educate them, and prevent the burden of risky sex under alcohol intoxication.

Keywords: sexual behaviors; psychological distress; substance use; alcohol intoxication; Thailand; adolescents

Introduction

Adolescence is a period of significant change and transition, often marked by risky behaviors [1]. The immaturity and delayed development of the prefrontal cortex in adolescents are associated with increased impulsivity and the inability to make prudent plans or anticipate the consequences of risk-taking behaviors, contributing to behaviors like risk-taking, drug use, car accidents, and unprotected sexual activity [2], [3], [4]. Studies consistently show that alcohol is the drug of choice among youth, with a significant percentage engaging in heavy episodic drinking [5, 6]. Heavy drinking has been linked to increased sexual behavior even when individuals did not initially express willingness to engage in such activities [7]. Additionally, engaging in sexual intercourse under the influence of alcohol poses significant health risks and challenges for adolescents, including an increased risk of sexually transmitted infections (STDs), unintended pregnancy, and HIV infection [8, 9]. However, the association between alcohol use and risky sex is complex and influenced by social, physiological, and individual personality traits [10]. Therefore, to promote adolescent health and well-being, targeted interventions and preventive strategies should address these factors and their interactions [11]. This is particularly crucial for individuals with problematic drinking behaviors that lead to intoxication, as these behaviors significantly increase the risk of engaging in sexual intercourse without proper protection.

In Thailand, as in many other countries, adolescent sexual behavior and alcohol use are areas of concern for public health professionals and policymakers. A range of factors have been identified as influencing the intersection of alcohol use and sexual behavior among Thai adolescents. These include older age, other substance use, physical fighting, and lack of parental connectedness [12, 13]. However, there is a notable gap in research regarding the factors associated with engaging in sexual intercourse while intoxicated among Thai adolescents. This knowledge gap is significant because the consumption of alcohol severely impairs decision-making abilities, heightening the likelihood of engaging in high-risk sexual behaviors under influence [14], with being intoxicated posing the highest risk. This issue is particularly pertinent for adolescent girls, as they may face unique challenges and vulnerabilities in navigating the intersection of alcohol use and sexual activity [15]. Therefore, understanding the sex-specific factors that impact decision-making with regards to engaging in sexual intercourse under alcohol intoxication can assist in identifying the risk groups and developing effective screening and preventive measures both within and outside schools to mitigate alcohol-related harms among exposed adolescents.

Against this background, using data from the 2021 Thailand Global School-based Student Health Survey (GSHS), our study aimed to examine a wide range of demographic, psychosocial, substance use, and risky sex behavior factors to identify their independent associations with engaging in sexual intercourse under alcohol influence among Thai adolescents. The findings of this study have the potential to inform evidence-based interventions and policies aimed at reducing risk behaviors and promoting adolescent health and well-being in Thailand and beyond.

Methods

Data source

This study used the data from the GSHS 2021; a nationally representative school-based survey targeting students in grades 7–12, typically attended by adolescents aged 13–17. The GSHS 2021 covered various domains including alcohol use, dietary behaviors, drug use, hygiene, mental health, physical activity, protective factors, sexual behaviors, tobacco use, and experiences of violence and unintentional injury. Participants provided self-reported responses to each survey question using a computer scannable answer sheet.

Sampling and response rate

The GSHS 2021 utilized a two-stage cluster sample design to ensure data representativeness across all students in grades 7–12 in Thailand. In the first stage, schools were selected with probability proportional to their enrollment size. Subsequently, classes were randomly chosen, and all students within the selected classes were eligible for participation. The school response rate for the survey was 92 %, and the student response rate was 90 %, resulting in an overall response rate of 83 %. A total of 5,661 students participated in the Thailand GSHS 2021.

Study variables

The dependent variable was ever engaged in sexual intercourse while intoxicated which was defined by asking the question “Have you ever had sexual intercourse when you had drank so much alcohol that you were really drunk”.

Independent variables were selected based on the previous literature and availability in Thailand GSHS 2021 and categorized into four groups as follows: 1) Demographic variables including age, sex, grade; 2) Psychosocial variables including felt lonely in the past year (rarely/never, most of time/always), anxiety-induced insomnia in the past year (rarely/never, most of time/always), suicide ideation/attempt in the past year (yes, no), cyberbullied/bullied at or outside school in the past year (yes, no), being physically attacked/engage in a physical fight in the past year (yes, no), missed school without permission in past month, parent understand their problem/know about the free time (rarely/never, most of time/always), have a close friend (yes, no); 3) Substance use including marijuana use in the past month (yes, no), ever amphetamine use (yes, no), cigarette use in the past month (yes, no); 4) Risky sex behaviors including two or more lifetime sexual partners and used condom in last sex.

Statistical analysis

The descriptive statistics were employed to describe the distribution of sample demography, psychosocial, substance use, and risky sex behaviors across opposite sex and the corresponding prevalence of ever engaged in sexual intercourse while intoxicated separately for male and female Thai adolescents in grades 7–12. Logistic regression analysis was then used to examine the likelihood of engaging in sexual intercourse while intoxicated across the explanatory variables, while adjusting for age, separately for the opposite sex (male, female). This approach allowed for the examination of the relationship between the predictors (independent variables) and the outcome (dependent variable) while accounting for potential differences between males and females and the confounding effect of age. The results were reported as odds ratios (OR) and 95 % confidence intervals (95% CI). Sampling design and weights were applied by defining the survey strata, primary sampling unit, and weight using STATA 17 (StataCorp LLC). The statistical significance level was set at p<0.05.

Results

A total of 5,661 Thai students in grades 7–12th participated in GSHS 2021. Approximately 30.45 % reported alcohol intoxication and 37.75 % reported engaging in sexual intercourse while intoxicated at least once in their lifetime.

Associated demographic factors with sexual intercourse while intoxicated

As Table 1 indicates, adolescents aged over 14 years were nearly twice as likely to engage in sexual intercourse while intoxicated compared to those aged 14 or younger (OR=1.97, 95 % CI: 1.26–3.08). Females were less likely to report engaging in sexual intercourse under alcohol influence compared to males (OR=0.66, 95 % CI: 0.45–0.97). There was a significant association between grade level and engaging in sexual intercourse while intoxicated. Adolescents in higher grades exhibited higher odds of engaging in sexual intercourse under alcohol influence compared to those in seventh grade, with a significant trend of increasing odds across higher grades. Eleventh and 12th-grade students had the highest odds, with ORs of 2.78 (95 % CI: 1.04–7.39) and 4.40 (95 % CI: 2.30–8.44), respectively, indicating a substantial increase in risk compared to seventh-grade students.

Table 1:

The demographic characteristics and their association with engaging in sexual intercourse under alcohol influence among Thai adolescents in grades 7–12th.

Total, n (%) Reported alcohol intoxication, n (%) Ever engaged in sexual intercourse while intoxicated
n (%) OR (95% CI)b
Total 5,661 (100) 1,337 (100) 449 (100) –
Age group
 ≤14 2,648 (42.63) 442 (22.41) 88 (26.98) Reference
 >14 3,013 (57.37) 895 (36.33) 361 (42.14) 1.97 (1.26, 3.08)a
Sex
 Male 2,504 (46.89) 564 (29.25) 202 (43.52) Reference
 Female 3,135 (53.11) 767 (31.49) 247 (33.81) 0.66 (0.45–0.97)a
Grade
 7th 1,743 (22.47) 235 (16.39) 40 (24.46) Reference
 8th 905 (21.82) 204 (30.66) 56 (33.50) 1.56 (0.84, 2.89)
 9th 1,288 (21.13) 356 (31.88) 96 (34.66) 1.14 (0.68, 1.93)
 10th 573 (12.33) 119 (28.82) 36 (34.66) 1.64 (0.81, 3.30)
 11th 509 (11.44) 135 (41.16) 63 (47.36) 2.78 (1.04, 7.39)a
 12th 627 (10.81) 282 (45.95) 157 (58.77) 4.40 (2.30, 8.44)a
Total 5,661 (100) 1,337 (30.45) 449 (37.75) –

  1. ap<0.05. bOR (95% CI): Odds ratio and 95 % confidence interval, adjusted for age.

Associated psychosocial factors with sexual intercourse while intoxicated

Although both male and female adolescents who reported feeling lonely most of the time or always were nearly twice as likely to engage in sexual intercourse while intoxicated compared to those who rarely or never felt lonely, it was only significant for female adolescents (OR=1.81, 95 % CI: 1.22–2.70). Among both male and female adolescents, those who experienced anxiety-induced insomnia most of the time or always had significantly higher odds of engaging in sexual intercourse under alcohol influence compared to those who rarely or never experienced anxiety-induced insomnia (male: OR=2.44; female: OR=1.72).

Male adolescents who reported suicide ideation in the past year had significantly higher odds of engaging in sexual intercourse while intoxicated compared to those who did not report such thoughts (OR=3.60, 95 % CI: 1.60–8.12). Similarly, the likelihood of engaging in sexual intercourse under alcohol influence among male adolescents was 5 times higher among those who reported attempting suicide in the past year (OR=5.04, 95 % CI: 2.33–10.92). Female adolescents who reported suicide ideation in the past year were twice as likely to engage in sexual intercourse while intoxicated compared to those who did not report such thoughts (OR=2.08, 95 % CI: 1.31–3.28). Additionally, female adolescents who reported attempting suicide in the past year had significantly higher odds of engaging in sexual intercourse under alcohol influence compared to those who did not attempt suicide (OR=2.57, 95 % CI: 1.37–4.82).

Male adolescents who experienced cyberbullying in the past year were significantly more likely to engage in sexual intercourse while intoxicated compared to those who did not report such experiences (OR=2.74, 95 % CI: 1.67–4.51). Similarly, male adolescents who reported being physically attacked in the past year had significantly higher odds of engaging in sexual intercourse under alcohol influence compared to those who did not report such incidents (OR=1.62, 95 % CI: 0.85–3.08). Additionally, male adolescents who engaged in a physical fight in the past year were significantly more likely to engage in sexual intercourse under alcohol influence compared to those who did not engage in such fights (OR=2.61, 95 % CI: 1.61–4.23). Female adolescents who experienced cyberbullying in the past year were significantly more likely to engage in sexual intercourse while intoxicated compared to those who did not report such experiences (OR=1.59, 95 % CI: 1.04–2.42). Similarly, female adolescents who reported being physically attacked in the past year had significantly higher odds of engaging in sexual intercourse under alcohol influence compared to those who did not report such incidents (OR=2.48, 95 % CI: 1.44–4.28). Moreover, female adolescents who engaged in a physical fight in the past year were significantly more likely to engage in sexual intercourse under alcohol influence compared to those who did not engage in such fights (OR=1.68, 95 % CI: 0.82–3.43).

Regardless of sex, adolescents who missed school without permission in the past month were significantly more likely to engage in sexual intercourse while intoxicated compared to those who did not miss school without permission (male: OR=3.70; female: OR=4.04). Other factors such as parental understanding of problems and having close friends showed varying associations with engaging in sexual intercourse under alcohol influence, though not all associations were statistically significant (Table 2).

Table 2:

The association of psychosocial factors with engaging in sexual intercourse under alcohol influence among Thai adolescents in grades 7–12th.

Variable Ever engaged in sexual intercourse while intoxicated
Male Female
n (%) OR (95% CI) n (%) OR (95% CI)1
Felt lonely in the past year
 Rarely/never 156 (41.02) Reference 169 (30.92) Reference
 Most of time/always 44 (51.93) 1.81 (0.98, 3.33) 76 (41.36) 1.81 (1.22, 2.70)a
Anxiety-induced insomnia in the past year
 Rarely/never 153 (40.33) Reference 172 (31.33) Reference
 Most of time/always 45 (58.28) 2.44 (1.33, 4.48)a 73 (40.91) 1.72 (1.17, 2.51)a
Suicide ideation in the past year
 No 156 (39.62) Reference 161 (30.23) Reference
 Yes 32 (64.25) 3.60 (1.60, 8.12)a 81 (42.25) 2.08 (1.31, 3.28)a
Suicide attempt in the past year
 No 160 (39.24) Reference 170 (30.20) Reference
 Yes 39 (70.02) 5.04 (2.33, 10.92)a 77 (44.26) 2.57 (1.37,4.82)a
Cyberbullied in the past year
 No 135 (38.22) Reference 189 (32.36) Reference
 Yes 57 (58.71) 2.74 (1.67, 4.51)a 49 (38.35) 1.59 (1.04, 2.42)a
Bullying at school in the past year
 No 150 (41.68) Reference 198 (33.68) Reference
 Yes 42 (45.81) 1.30 (0.63, 2.68) 44 (34.30) 1.37 (0.74,2.53)
Bullying outside school in the past year
 No 150 (39.29) Reference 210 (33.21) Reference
 Yes 43 (63.10) 3.33 (1.46, 7.59)a 32 (35.84) 1.46 (0.79, 2.71)
Being physically attacked in the past year
 No 135 (40.75) Reference 186 (31.29) Reference
 Yes 62 (48.75) 1.62 (0.85, 3.08) 54 (46.04) 2.48 (1.44, 4.28)a
Engage in a physical fight in the past year
 No 186 (37.13) Reference 187 (33.17) Reference
 Yes 96 (52.72) 2.61 (1.61, 4.23)a 60 (36.07) 1.68 (0.82, 3.43)
Missed school without permission in past month
 No 107 (33.97) Reference 162 (28.88) Reference
 Yes 92 (62.24) 3.70 (2.32, 5.89)a 84 (54.95) 4.04 (2.12, 7.69)a
Parent understand problem
 Rarely/never 157 (45.04) Reference 186 (34.63) Reference
 Most of time/always 36 (34.69) 0.67 (0.41, 1.09) 54 (29.63) 0.72 (0.51, 1.01)
Parents know about free time
 Rarely/never 142 (44.98) Reference 133 (33.39) Reference
 Most of time/always 57 (39.72) 0.77 (0.45, 1.33) 113 (34.55) 0.99 (0.56, 1.73)
Have close friend
 No 182 (42.01) Reference 226 (33.74) Reference
 Yes 16 (64.46) 3.00 (0.86, 10.50) 19 (34.41) 1.22 (0.56, 2.69)

  1. ap<0.05. bOR (95%CI): Odds ratio and 95 % confidence interval, adjusted for age.

Associated substance use and sex behaviors with sexual intercourse while intoxicated

Both male and female adolescents who reported marijuana use in the past month had significantly higher odds of engaging in sexual intercourse while intoxicated compared to non-users (male: OR=3.22; female: OR=4.23). Similarly, the likelihood of engaging in sexual intercourse under alcohol influence was significantly higher among those who reported ever amphetamine use in both males and females (male: OR=3.68; female: OR=4.80). Additionally, adolescent males and females who reported cigarette use in the past month had nearly two- and four-times higher odds of engaging in sexual intercourse while intoxicated, respectively (Table 3). All female and male adolescents who ever engaged in sexual intercourse while intoxicated reported having two or more lifetime sexual partners and the association was statistically significant (Table 4). In addition, among those who ever engaged in sexual intercourse while intoxicated, a higher proportion of male adolescents reported using a condom in their last sexual encounter compared to females (72.44 vs. 63.82 %, respectively).

Table 3:

The association of substance use with engaging in sexual intercourse under alcohol influence among Thai adolescents in grades 7–12th.

Variable Ever engaged in sexual intercourse while intoxicated
Male Female
n (%) OR (95% CI) n (%) OR (95% CI)b
Marijuana use in the past month
 No 139 (38.57) Reference 218 (32.20) Reference
 Yes 40 (61.02) 3.22 (1.53, 6.76)a 19 (55.54) 4.23 (1.71, 10.48)a
Ever amphetamine use
 No 155 (39.56) Reference 227 (32.88) Reference
 Yes 37 (69.41) 3.68 (1.63, 8.32)a 10 (57.45) 4.80 (1.00, 23,14)a
Cigarette use in the past month
 No 102 (37.18) Reference 193 (31.15) Reference
 Yes 93 (54.74) 2.06 (1.14, 3.71)a 48 (52.25) 4.22 (2.45, 7.26)a

  1. ap<0.05. bOR (95%CI): Odds ratio and 95 % confidence interval, adjusted for age.

Table 4:

The history of risky sex behaviors with engaging in sexual intercourse under alcohol influence among Thai adolescents in grades 7–12th.

Variable Ever engaged in sexual intercourse while intoxicated
Male Female
n (%) n (%)
≥ Two lifetime sexual partners
 No 88 (26.32) 142 (22.55)
 Yes 113 (100) 102 (100)
 p-value (Fisher exact test) <0.001 <0.001
Used condom in last sexa
 No 49 (27.56) 71 (36.18)
 Yes 122 (72.44) 130 (63.82)

  1. aAmong those who ever engaged in sexual intercourse while intoxicated. Fisher exact test was use due to the small sample size and inappropriateness of chi-square test.

Discussion

Alcohol can enhance the risk of sexual intercourse and unprotected sex by reducing inhibitions, impairing judgment, and affecting sexual arousal and responsiveness. The consequences of such accidents can be severe, including unplanned pregnancies, STIs, and sexual assault. The present study investigated the factors that are associated with higher odds of engaging in sexual intercourse while intoxicated among Thai adolescent in grades 7–12th. The findings showed that adolescents aged over 14 years showed a higher likelihood of engaging in sexual intercourse while intoxicated compared to younger adolescents aged 14 or below. This can be attributed to the lower availability of alcohol and difficulties in accessing alcohol among younger adolescents and therefore, lower drinking or binge drinking compared to older adolescents [16, 17]. Nonetheless, underage drinking poses various risks, including causing deaths, injuries, impaired judgment, increased risk of assault, and other problems later in life [18, 19]. Our study also found that females were less likely to report engaging in sexual intercourse while intoxicated compared to males. This trend may be attributed to a heightened societal disapproval in Thailand towards women participating in sexual activities, potentially resulting in lower reporting rates among females [10]. Moreover, cultural norms and expectations could shape perceptions regarding acceptable alcohol consumption and sexual conduct, thereby contributing to variations in reporting behavior between genders [20, 21]. The findings also indicated higher likelihood of engaging in sexual intercourse while intoxicated among adolescents in higher grades, particularly 11th and 12th-grade students, possibly influenced by their older age. Nevertheless, this highlights the necessity for specific interventions and educational initiatives that can clearly communicate and emphasize the risks linked to alcohol-related risky behaviors among older adolescents in Thai schools, with a particular focus on male students.

The findings from our study shed light on the intricate relationship between psychosocial factors and engaging in sexual intercourse while intoxicated among adolescents in Thailand. While feeling of loneliness was associated with increased likelihood of engaging in sexual intercourse while intoxicated, this association was only statistically significant for female adolescents. This is in line with previous studies in which females with depression symptoms exhibited higher risky behaviors such as binge drinking, unprotected sex with a non-regular partner and with two or more partners [22, 23]. This underscores the importance of considering nuanced psychological factors and gender-specific differences when addressing risky sexual behaviors among adolescents. Similarly, adolescents who reported experiencing anxiety-induced insomnia most of the time or always had significantly higher odds of engaging in sexual intercourse under alcohol influence. Research indicates that anxiety induced sleep difficulties can contribute to alcohol misuse among youth [24] and make them vulnerable to engaging in risk-taking behaviors like sexual risk-taking [25]. Binge drinking is more severe among individuals with mental health problems, highlighting the link between excessive alcohol consumption and psychological distress [26]. Besides, we observed higher odds of engaging in sexual intercourse while intoxicated among adolescents with other psychological issues such as suicide ideation and attempts. This raises concerns about the mental well-being of adolescents and its impact on their sexual decision-making, particularly when the inhibitory mechanisms are being impaired under alcohol influence [27]. Additionally, these mental health issue can also be emerged or aggravated by other psychosocial harms such as bullying (tradition and cyberbullying) and physical fights [28], and therefore, all conditions associated with poor mental health can pose the adolescent at a higher risk of engaging in risky sex behaviors while intoxicated. These findings underscore the intertwined relationship between psychological factors such as loneliness, anxiety, and suicidal behaviors, and their impact on adolescent sexual behaviors while intoxicated, highlighting the importance of addressing mental health issues in interventions targeting risky sexual behaviors among exposed adolescents [17], emphasizing the importance of providing special care and attention to this vulnerable group in school screening and educational programs.

School absenteeism or truancy was another significant factor associated with engaging in sex while intoxicated among the Thai students in this study. Research indicates a strong association between truancy and alcohol-related problems, with higher levels of truancy being correlated with more frequent drinking, drunkenness, and alcohol-related issues [29, 30]. Truant adolescents are more likely to engage in unprotected sex when drinking alcohol and report involuntary or regrettable sexual encounters with girls being more vulnerable to it [29]. Furthermore, studies have shown that truancy is a better predictor of substance use than low GPA, emphasizing the significance of truancy as a risk indicator for substance use among youth [31] and those with higher school absenteeism without permission are more likely to engage in high-risk behaviors such as binge drinking and risky sexual behaviors [30, 32]. Thus, truancy can be an important predictor of engaging in sexual intercourse among binge drinker and should be considered in screening programs to identify this risky group and specifically target them in educational and preventive programs.

Our findings also indicate a strong correlation between substance use and engaging in sexual intercourse while intoxicated among Thai adolescents in this study. Regardless of sex, adolescents who reported marijuana and cigarette smoking in the past month as well as those who reported ever amphetamine use demonstrated significantly higher odds of engaging in sexual intercourse while intoxicated compared to non-users. A range of studies have consistently found a link between substance use and sexual risk behavior such as inconsistent condom use among adolescents, leading to increased risks of STDs, HIV, and pregnancy [33], [34], [35], [36], [37], [38]. Additionally, the frequency of substance use correlates with an increased likelihood of engaging in sexual activity and having multiple partners [38] as was evident in our study. This can be exponentiated by the disinhibitory effect of alcohol and lead to catastrophic outcomes. Thus, identifying exposed adolescent and addressing their substance use disorders are crucial to reduce the likelihood of risky sexual intercourse under the influence of alcohol. Besides, given the strong association between substance use and mental health issues such as depression, anxiety and suicidal behaviors [39], [40], [41] and their association with engaging in sexual intercourse among Thai adolescents while intoxicated underscore the importance of a holistic approach in addressing the common risk factors that shared by these factors. Addressing the underlying risk factors early can help identify at-risk youth and implement effective screening programs to identify them and address them through appropriate prevention measures and interventions.

Limitations

The findings of the present study should be interpreted under some limitation. First, potential underreporting or misreporting of sensitive behaviors due to the self-reported nature of the data could lead to information bias and affect the validity of the results, especially among female adolescents. Second, the cross-sectional design of the study prevents the establishment of causality and only provides a snapshot of associations at a single point in time. Furthermore, the study’s reliance on data from the Thailand Global School-based Student Health Survey may limit the generalizability of findings to adolescents outside of the school setting or those who are not enrolled in formal education. Moreover, the study did not account for contextual factors such as cultural norms, peer influences, or family dynamics, which could influence both substance use and sexual behaviors among adolescents in Thailand. Future qualitative studies are recommended to explore additional influential factors and to characterize protective and facilitating factors associated with engaging in sexual intercourse under the influence of alcohol among adolescents.

Conclusions

This study reveals the intricate interplay between psychosocial factors, substance use, and lifetime multiple partnership and their relationship with engaging in sexual intercourse under alcohol intoxication in opposite sex among Thai adolescents. The results indicate that male gender, older age, and being in grades 11 and 12th are associated with a higher likelihood of engaging in sexual intercourse while intoxicated, suggesting the need for targeted interventions and sex education in school. Psychosocial factors such as loneliness, anxiety-induced insomnia, and suicidal behaviors as well as truancy were significantly associated with engaging in sexual intercourse under alcohol influence and should be targeted in screening programs to identify this risk group. The strong correlation between psychological issues, substance use, and engaging in risky sexual behaviors under alcohol influence emphasizes the need for a holistic approach to address the common risk factors and implement effective school-based screening and prevention strategies to identify the risk groups and mitigate the risk of sexual intercourse under alcohol intoxication among exposed youth.

Data availability and protection

The GSHS 2021 is a publicly available dataset and is available on the World Health Organization NCD Microdata Repository website at: https://extranet.who.int/ncdsmicrodata/index.php/catalog/. The policies and procedures for releasing and publishing GSHS data are guided by key principles: the data is owned by the country-level agency that conducts or sponsors the survey; public health and scientific progress benefit most from the prompt and open sharing of data and analyses; the privacy of participating schools and students must be safeguarded; and the quality of the data must be preserved.

Corresponding author: Omid Dadras, Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, Bergen 5009, Norway; and Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway, E-mail:

Acknowledgments

This paper analyzed data from the Thailand GSHS 2021 which received support by the World Health Organization and the US Centers for Disease Control and Prevention.

  1. Research ethics: This was a secondary analysis of the Thailand Global School-Based Student Health Survey conducted in 2021 (GSHS 2021). The GSHS 2021 obtained ethics approval from the relevant national ethics committee in Thailand, and the secondary analysis of the data does not require further Ethical Approval.

  2. Informed consent: Informed consent was obtained from all individuals included in this study.

  3. Author contributions: OD contributed to the conception of the study, data analysis, and writing the manuscript.

  4. Competing interests: The authors state no conflict of interest.

  5. Research funding: None declared.

  6. Data availability: Not applicable.

References

1. Vahedi, Z, Sibalis, A, Sutherland, JE. Are media literacy interventions effective at changing attitudes and intentions towards risky health behaviors in adolescents? A meta-analytic review. J Adolesc 2018;67:140–52. https://doi.org/10.1016/j.adolescence.2018.06.007.Suche in Google Scholar PubMed

2. Cavazos-Rehg, PA, Spitznagel, EL, Bucholz, KK, Nurnberger, J, Edenberg, HJ, Kramer, JR, et al.. Predictors of sexual debut at age 16 or younger. Arch Sex Behav 2010;39:664–73. https://doi.org/10.1007/s10508-008-9397-y.Suche in Google Scholar PubMed PubMed Central

3. Romer, D. Adolescent risk taking, impulsivity, and brain development: implications for prevention. Dev Psychobiol 2010;52:263–76. https://doi.org/10.1002/dev.20442.Suche in Google Scholar PubMed PubMed Central

4. Casey, BJ, Jones, RM, Hare, TA. The adolescent brain. Ann N Y Acad Sci 2008;1124:111–26. https://doi.org/10.1196/annals.1440.010.Suche in Google Scholar PubMed PubMed Central

5. Patrick, ME, Schulenberg, JE. Alcohol use and heavy episodic drinking prevalence and predictors among national samples of American eighth- and tenth-grade students. J Stud Alcohol Drugs 2010;71:41–5. https://doi.org/10.15288/jsad.2010.71.41.Suche in Google Scholar PubMed PubMed Central

6. Dawson, DA, Grant, BF, Stinson, FS, Chou, PS. Another look at heavy episodic drinking and alcohol use disorders among college and noncollege youth. J Stud Alcohol 2004;65:477–88. https://doi.org/10.15288/jsa.2004.65.477.Suche in Google Scholar PubMed

7. Scaglione, NM, Ward, RM, Buben, A, Turrisi, R. Alcohol’s role in sexual decision making in first-year college women: an event-level assessment. Psychol Women Q 2024;48:03616843231186319.10.1177/03616843231186319Suche in Google Scholar PubMed PubMed Central

8. Desai, S, Affrunti, N. CDC releases youth risk data trends. Communique 2023;51:25–6.Suche in Google Scholar

9. Mugisha, F, Zulu, EM. The influence of alcohol, drugs and substance abuse on sexual relationships and perception of risk to HIV infection among adolescents in the informal settlements of Nairobi. J Youth Stud 2004;7:279–93. https://doi.org/10.1080/1367626042000268926.Suche in Google Scholar

10. Choudhry, V, Agardh, A, Stafström, M, Östergren, P-O. Patterns of alcohol consumption and risky sexual behavior: a cross-sectional study among Ugandan university students. BMC Publ Health 2014;14:1–11. https://doi.org/10.1186/1471-2458-14-128.Suche in Google Scholar PubMed PubMed Central

11. Inanc, H, Meckstroth, A, Keating, B, Adamek, K, Zaveri, H, McDonald, K, et al.. Factors influencing youth sexual activity: conceptual models for sexual risk avoidance and cessation. In OPRE Research Brief #2020-153. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services; 2020.Suche in Google Scholar

12. Pengpid, S, Peltzer, K. Alcohol use and associated factors among adolescent students in Thailand. W Indian Med J 2012;61:890–6. https://doi.org/10.7727/wimj.2012.059.Suche in Google Scholar PubMed

13. Peltzer, K, Pengpid, S. Prevalence and social correlates of sexual intercourse among school-going adolescents in Thailand. Sci World J 2011;11:1812–20. https://doi.org/10.1100/2011/532109.Suche in Google Scholar PubMed PubMed Central

14. Coleman, LM, Cater, S. A qualitative study of the relationship between alcohol consumption and risky sex in adolescents. Arch Sex Behav 2005;34:649–61. https://doi.org/10.1007/s10508-005-7917-6.Suche in Google Scholar PubMed

15. Dunn, MS, Bartee, RT, Perko, MA. Self-reported alcohol use and sexual behaviors of adolescents. Psychol Rep 2003;92:339–48. https://doi.org/10.2466/pr0.92.1.339-348.Suche in Google Scholar

16. Windle, M. Alcohol use among adolescents and young adults. Alcohol Res Health 2003;27:79–85.Suche in Google Scholar

17. Cho, HS, Yang, Y. Relationship between alcohol consumption and risky sexual behaviors among adolescents and young adults: a meta-analysis. Int J Public Health 2023;68:1605669. https://doi.org/10.3389/ijph.2023.1605669.Suche in Google Scholar PubMed PubMed Central

18. Miller, JW, Naimi, TS, Brewer, RD, Jones, SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics 2007;119:76–85. https://doi.org/10.1542/peds.2006-1517.Suche in Google Scholar PubMed

19. Pechansky, F, Szobot, CM, Scivoletto, S. Alcohol use among adolescents: concepts, epidemiological characteristics and etiopathogenic factors. Rev Bras Psiquiatr 2004;26:S14–7. https://doi.org/10.1590/s1516-44462004000500005.Suche in Google Scholar PubMed

20. Wakabayashi, M, McKetin, R, Banwell, C, Yiengprugsawan, V, Kelly, M, Seubsman, SA, et al.. Alcohol consumption patterns in Thailand and their relationship with non-communicable disease. BMC Publ Health 2015;15:1297. https://doi.org/10.1186/s12889-015-2662-9.Suche in Google Scholar PubMed PubMed Central

21. Assanangkornchai, S, Sam-Angsri, N, Rerngpongpan, S, Lertnakorn, A. Patterns of alcohol consumption in the Thai population: results of the national household survey of 2007. Alcohol Alcohol 2010;45:278–85. https://doi.org/10.1093/alcalc/agq018.Suche in Google Scholar PubMed

22. Coyle, RM, Lampe, FC, Miltz, AR, Sewell, J, Jane Anderson, F, Apea, V, et al.. Associations of depression and anxiety symptoms with sexual behaviour in women and heterosexual men attending sexual health clinics: a cross-sectional study. Sex Transm Infect 2019;95:254–61. https://doi.org/10.1136/sextrans-2018-053689.Suche in Google Scholar PubMed PubMed Central

23. Delonga, K, Torres, HL, Kamen, CS, Evans, SN, Lee, SS, Koopman, C, et al.. Loneliness, internalized homophobia, and compulsive internet use: factors associated with sexual risk behavior among a sample of adolescent males seeking services at a community LGBT center. Sex Addict Compuls 2011;18:61–74. https://doi.org/10.1080/10720162.2011.581897.Suche in Google Scholar

24. Popovici, I, French, MT. Binge drinking and sleep problems among young adults. Drug Alcohol Depend 2013;132:207–15. https://doi.org/10.1016/j.drugalcdep.2013.02.001.Suche in Google Scholar PubMed PubMed Central

25. WHO. Mental health of adolescents; 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health.Suche in Google Scholar

26. Piano, MR, Mazzuco, A, Kang, M, Phillips, SA. Binge drinking episodes in young adults: how should we measure them in a research setting? J Stud Alcohol Drugs 2017;78:502–11. https://doi.org/10.15288/jsad.2017.78.502.Suche in Google Scholar PubMed PubMed Central

27. Hallfors, DD, Waller, MW, Ford, CA, Halpern, CT, Brodish, PH, Iritani, BJ. Adolescent depression and suicide risk: association with sex and drug behavior. Am J Prev Med 2004;27:224–31. https://doi.org/10.1016/s0749-3797(04)00124-2.Suche in Google Scholar

28. Selkie, EM, Kota, R, Chan, YF, Moreno, M. Cyberbullying, depression, and problem alcohol use in female college students: a multisite study. Cyberpsychol Behav Soc Netw 2015;18:79–86. https://doi.org/10.1089/cyber.2014.0371.Suche in Google Scholar PubMed PubMed Central

29. Mounteney, J, Haugland, S, Skutle, A. Truancy, alcohol use and alcohol-related problems in secondary school pupils in Norway. Health Educ Res 2010;25:945–54. https://doi.org/10.1093/her/cyq044.Suche in Google Scholar PubMed

30. Houck, C, Hadley, WS, Tolou-Shams, M, Brown, LK. Truancy is associated with sexual risk among early adolescents. J Dev Behav Pediatr 2012;33:728–31. https://doi.org/10.1097/dbp.0b013e31827134a5.Suche in Google Scholar PubMed PubMed Central

31. Hallfors, D, Vevea, JL, Iritani, B, Cho, H, Khatapoush, S, Saxe, L. Truancy, grade point average, and sexual activity: a meta-analysis of risk indicators for youth substance use. J Sch Health 2002;72:205–11. https://doi.org/10.1111/j.1746-1561.2002.tb06548.x.Suche in Google Scholar PubMed

32. Graves, HR, Hernandez, L, Kahler, CW, Spirito, A. Marijuana use, alcohol use, and sexual intercourse among truant adolescents. Subst Abuse 2020;41:451–5. https://doi.org/10.1080/08897077.2019.1621237.Suche in Google Scholar PubMed PubMed Central

33. Guadamuz, TE, Cheung, DH, Boonmongkon, P, Ojanen, TT, Damri, T, Samoh, N, et al.. Illicit drug use and social victimization among Thai sexual and gender minority adolescents. Subst Use Misuse 2019;54:2198–206. https://doi.org/10.1080/10826084.2019.1638936.Suche in Google Scholar PubMed PubMed Central

34. Kongjareon, Y, Samoh, N, Peerawaranun, P, Guadamuz, TE. Pride-based violence, intoxicated sex and poly-drug use: a vocational school-based study of heterosexual and LGBT students in Bangkok. BMC Psychiatr 2022;22:148. https://doi.org/10.1186/s12888-022-03777-7.Suche in Google Scholar PubMed PubMed Central

35. Manopaiboon, C, Kilmarx, PH, Limpakarnjanarat, K, Jenkins, RA, Chaikummao, S, Supawitkul, S, et al.. Sexual coercion among adolescents in northern Thailand: prevalence and associated factors. Southeast Asian J Trop Med Publ Health 2003;34:447–57.Suche in Google Scholar

36. Storholm, ED, Ewing, BA, Holliday, SB, Stein, BD, Meredith, LS, Shadel, WG, et al.. Using marijuana, drinking alcohol or a combination of both: the association of marijuana, alcohol and sexual risk behaviour among adolescents. Sex Health 2018;15:254–60. https://doi.org/10.1071/sh16218.Suche in Google Scholar

37. Tapert, SF, Aarons, GA, Sedlar, GR, Brown, SA. Adolescent substance use and sexual risk-taking behavior. J Adolesc Health 2001;28:181–9. https://doi.org/10.1016/s1054-139x(00)00169-5.Suche in Google Scholar PubMed

38. Control CfD, Prevention. Substance use and sexual risk behaviors among youth; 2018. Retrieved from CDC_DASH website www.cdc.gov/healthyyouth.Suche in Google Scholar

39. Teesson, M, Degenhardt, L, Hall, WD, Lynskey, MT, Toumbourou, JW, Patton, GC, editors. Substance use and mental health in longitudinal perspective. UK; Hoboken NJ: John Wiley & Sons; 2005:43–51 pp.10.1002/9780470713624.ch4Suche in Google Scholar

40. Shlosberg, D, Zalsman, G, Shoval, G. Emerging issues in the relationship between adolescent substance use and suicidal behavior. Isr J Psychiatr Relat Sci 2014;51:262–7.Suche in Google Scholar

41. Halladay, JE, Mackillop, J, Munn, C, Jack, SM, Georgiades, K. Cannabis use as a risk factor for depression, anxiety, and suicidality: epidemiological associations and implications for nurses. J Addict Nurs 2020;31:92–101. https://doi.org/10.1097/jan.0000000000000334.Suche in Google Scholar PubMed

Received: 2024-03-21
Accepted: 2024-06-10
Published Online: 2024-06-27

© 2024 the author(s), published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

Artikel in diesem Heft

  1. Frontmatter
  2. Review
  3. A multifaceted approach to identifying and managing juvenile delinquency by integrating psycho-physiological indicators
  4. Original Articles
  5. Improving young patient – practitioner communication about sexual health during medical visits
  6. Effect of a context-specific health education intervention on knowledge of health risk behaviors among adolescents in Nigerian public and private secondary schools: a comparative study
  7. Development and validation of Adolescent Sexual and Reproductive Health – Knowledge, Attitude, and Self-Efficacy Questionnaires (ASRH-KASeQ)
  8. Effectiveness of an educational intervention on knowledge and practice of young midwifery college students about IUD and Pap smear, Babol, Iran
  9. Knowledge, attitudes, and practices regarding self-medication for acne among medical students in Beni-Suef University
  10. Comparing the quality of life of adolescent girls with and without polycystic ovary syndrome and identifying the predictor factors
  11. Prevalence and correlates of sexual intercourse under influence of alcohol among Thai adolescents: lessons from a nationwide school-based survey
  12. What about adolescents’ mental health after the pandemics? An analyses of a grade II hospital
  13. Suicide risk among adolescents in Sarawak, Malaysia: prevalence and determining factors
  14. Body image concern and demographic characteristics as predictors of anxiety in adolescent girls
  15. Letter to the Editor
  16. Compulsive digital use: the risk and link of loneliness among adolescents
https://doi.org/10.1515/ijamh-2024-0045
Schlagwörter für diesen Artikel
sexual behaviors; psychological distress; substance use; alcohol intoxication; Thailand; adolescents
Creative Commons
BY 4.0

Artikel in diesem Heft

  1. Frontmatter
  2. Review
  3. A multifaceted approach to identifying and managing juvenile delinquency by integrating psycho-physiological indicators
  4. Original Articles
  5. Improving young patient – practitioner communication about sexual health during medical visits
  6. Effect of a context-specific health education intervention on knowledge of health risk behaviors among adolescents in Nigerian public and private secondary schools: a comparative study
  7. Development and validation of Adolescent Sexual and Reproductive Health – Knowledge, Attitude, and Self-Efficacy Questionnaires (ASRH-KASeQ)
  8. Effectiveness of an educational intervention on knowledge and practice of young midwifery college students about IUD and Pap smear, Babol, Iran
  9. Knowledge, attitudes, and practices regarding self-medication for acne among medical students in Beni-Suef University
  10. Comparing the quality of life of adolescent girls with and without polycystic ovary syndrome and identifying the predictor factors
  11. Prevalence and correlates of sexual intercourse under influence of alcohol among Thai adolescents: lessons from a nationwide school-based survey
  12. What about adolescents’ mental health after the pandemics? An analyses of a grade II hospital
  13. Suicide risk among adolescents in Sarawak, Malaysia: prevalence and determining factors
  14. Body image concern and demographic characteristics as predictors of anxiety in adolescent girls
  15. Letter to the Editor
  16. Compulsive digital use: the risk and link of loneliness among adolescents
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