title: Factors associated with alcohol and/or drug use at sexual debut among sexually active university students: cross-sectional findings from Lebanon.
abstract: BACKGROUND
  Sexual activity accompanied by substance use can impair youth decision-making and enhance risk-taking behaviors. Less is known, however, about the sexual values, perceptions and subsequent sexual practices of youth whose sexual debut occurs while using alcohol/drugs.
  
  
  METHODS
  A cross-sectional anonymous online survey was conducted in April-August 2012 among undergraduate and graduate university students (aged 18 to 30) attending the 4th largest private university in Beirut. Pearson's Chi-square and regression models were run using Stata/IC 10.0.
  
  
  RESULTS
  940 university students had engaged in oral, anal and/or vaginal sex, of whom 10% admitted to having had consumed alcohol or taken drugs at sexual debut, a behavior that was more common in the males, less religious, non-Arabs, students living alone or who had lived abroad. Students who used alcohol/drugs at sexual debut were twice as likely to have: their first oral and vaginal sex with an unfamiliar partner [odds ratio (OR) = 2.6, 95% confidence interval (CI): (1.6, 4.2) and OR = 2.1 (1.2, 3.5), respectively], controlling for sex, nationality, current relationship status, living abroad after the age of 12, and spirituality. Students who had sex the first time while using alcohol/drugs were three times as likely to report having had 11 or more subsequent sexual partners versus one or two [OR = 3.0 (1.5-6.0)]; and almost twice as likely to ever engage in something sexual they did not want to do [OR = 1.7 (1.1, 2.8)]. Perceived peer pressure to have sex by a certain age [OR = 1.8 (1.1, 2.9)], and perceived peer norms to consume alcohol/drugs before sex [OR = 4.8 (2.3, 9.9)] were also strong correlates of having sex for the first time while using alcohol and/or drugs.
  
  
  CONCLUSIONS
  Findings stress the importance of sexuality education for youth, and the need to begin understanding the true interplay--beyond association--between youth sexual practices and substance use behaviors from a broader public health perspective.
authors: Lilian A
authors: LA
authors: Ghandour
authors: Farah
authors: F
authors: Mouhanna
authors: Rola
authors: R
authors: Yasmine
authors: Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon. fk01@aub.edu.lb.
authors: Faysal
authors: F
authors: El Kak
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data; D013334:Students; D019966:Substance-Related Disorders; D011795:Surveys and Questionnaires; D014495:Universities; D055815:Young Adult