Illicit drug use, sexual debut, and sexual risk among female college students: A prospective study

Purpose: This study investigated the relationship of illicit drug use with subsequent sexual debut and high-risk sexual behavior in female college students. Methods: Stratified random sampling with oversampling for illicit drug users was used to recruit 553 female students, aged 17-19, from a large, mid-Atlantic public university. Participants were interviewed in person during their first year (T1) and second year (T2) of college about past-year drug and alcohol use, religiosity, and vaginal intercourse. Logistic regression models examined three outcomes: sexual debut (having vaginal intercourse for the first time between T1 and T2); multiple sex partners and unprotected sex (not using condoms with every sexual encounter) at T2. Results: Among 149 women who never had sex by T1, 42% had sexual debut by T2. Drug users were 2.1 times more likely than non-users to have debuted (p=.03). Among the 418 sexually experienced women at T2, 86% had sex before T1 (“early debut”); 35% had multiple sex partners and 64% had unprotected sex in the past 6 months. The T1 number of drugs used (AOR=1.26, 95% CI=1.07-1.49) and early sexual debut (AOR=2.33, 95% CI=1.12-4.81) both independently predicted having multiple sex partners, even controlling for religiosity and drinking frequency. Early sexual debut was the only independent predictor of unprotected sex (AOR=2.78, 95% CI=1.56-4.94). Conclusions: Drug use is associated with sexual debut, multiple sex partners and unprotected sex, independent of alcohol consumption. Findings suggest the need for prevention activities that simultaneously address drug and alcohol use with sexual health in female college students.