232. Associations Between Alcohol Use And Condom/Contraceptive Use Among College Students

Abstract

Alcohol use has generally been associated with risky sexual behaviors among adolescents. However, studies to date have largely focused on condom use and HIV/STI risk related to alcohol use. Given this limitation and the increased accessibility of long-acting reversible contraceptives (LARC) in the past several years, our aim was to explore associations between recent alcohol use and condom/contraceptive behaviors among college students. The present analysis uses baseline data collected for an RCT testing a brief clinical intervention to reduce alcohol-related sexual violence risk at twenty-eight college campuses. Students ages 18-24 seeking care at participating college health or counseling centers were eligible (n=2291). Baseline surveys completed prior to their clinical visit measured demographics, alcohol use (number of days that drank any alcohol and days that binge drank (4/5+ drinks in 2 hours for women/men) in the past 30 days), and recent sexual behaviors (frequency of condom use, contraceptive use at last vaginal sex for self/partner). Participants who were missing biological sex (n=3) or never had vaginal sex (n=572) were excluded. Descriptive statistics characterized recent alcohol and contraceptive use behaviors. Logistic regression models tested associations between alcohol use patterns and condom/contraceptive use and were stratified by biological sex. Models accounted for campus-level clustering and adjusted for race/ethnicity, age, and self/partner use of alcohol at last sexual encounter. Participants (n=1716) were mostly female (75%) and non-Hispanic white (68%), Hispanic (14%) or Black (11%), with mean age 20.1 years (SD=1.5). Median number of drinking days and binge drinking days were 3.35 (IQR: 0.53-7.34) and 0.41 (IQR: 0-2.77), respectively. Half of men (52%) and women (48%) reported consistent condom use when having sex in the past 4 months. Few women (8%) and men (3%) reported (partner) LARC use at last sex; 63% and 56% reported other hormonal contraceptive use, respectively. In adjusted logistic regression models, number of drinking days among women (7+ days: AOR=0.55, 95%CI 0.37-0.82) and number of binge drinking days among women (4+ days: AOR=0.52 [0.39-0.71]) and men (4+ days: AOR=0.58 [0.35-0.95]) were all associated with less consistent condom use. Among women, drinking 7+ days was associated with using any hormonal contraception at last sex (AOR=1.64 [1.02-2.63]) and, in particular, non-LARC hormonal contraceptives (AOR=1.69 [1.09-2.61]). A novel finding in this study is that college women who drink frequently (but not necessarily binge drink) were more likely to use a hormonal method of contraception compared to those with lower alcohol consumption; these same women, however, were also half as likely to use condoms consistently compared to their counterparts who are not frequent drinkers. This suggests that while these women may be at increased risk for STIs, they have some measure of protection from unintended pregnancy. Alcohol use among men was not associated with reports of their partners’ use of hormonal contraception, but reduced condom use among binge drinking men suggest they may still be at risk for STIs.