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Research Summaries

All Research Summaries

Exploring Associations in Developmental Trends of Adolescent Substance Use and Risky Sexual Behavior in a High-Risk Population

Original article by: Susan C. Duncan, Lisa A. Strycker, and Terry E. Duncan

Three researchers from the Oregon Research Institute designed a study to examine the association between the development of adolescent alcohol, cigarette, and marijuana use and risky sexual behavior over time. The authors of this paper discuss their findings in relation to understanding both sexual and non-sexual problem behaviors and analyzing both the development and change in these behaviors over the period of adolescence.


Research has shown that adolescents who use one substance are more likely to use other substances, and those who develop quickly in the use of one substance are more than likely to develop faster in the use of other substances. Research has also shown that there is a relationship between substance use and other problem behaviors. However, few studies have examined the development of this relationship over time.

High levels of adolescent substance use and high-risk sexual behavior are concerns in our society. A decrease in the age of onset of sexual activity, as well as an increase in the range of sexual behaviors among teens, contribute to this concern. These factors combined with the trend toward marrying at a later age account for a larger window of time for high-risk behavior and may be one reason for the increase in the number of cases of sexually transmitted infections (STIs) among adolescents. Studies have further demonstrated that, among both genders, sexual contact often occurs after drinking, and that both sexual activity and frequency, as well as sexual risk-taking, are often associated with adolescent substance use.

Participants and Methodology

The 664 participants in this study were recruited among 16,339 adolescents ages 14 to 17 living in a large metropolitan area in the Pacific Northwest whose families were members of the Kaiser Permanente Organization (HMO). Adolescents and their parents completed questionnaires administered in their homes by research staff. The questionnaires included items asking about substance use and sexual behaviors.

Complete data were available for 257 participants, assessing substance use and risky sexual behavior at three points over 18 months. The majority of the participants were Caucasians (88%) from two-parent families (80.4%). The household cigarette, alcohol and marijuana use among the sample was much higher than the national norms estimated by the National Institute on Drug Abuse National Household Survey on Drug Abuse (NIDA, 1989).

Results and Discussion

The goal of this study was to take a closer look at the development of and relationships between four variables: alcohol use, cigarette use, marijuana use, and risky sexual behavior over an 18-month period. Developmental increases were present for both genders, with no significant differences between males and females. In regard to correlations between substance use and risky sexual behavior, the results supported evidence found in other studies. The basic findings are as follows:

  • Youth who had high levels of alcohol or cigarette use also had high levels of marijuana use at the initial time point.

  • Youth who increased rapidly in the use of one substance showed a similar use pattern with the other two substances over the length of the study.

  • The behaviors of all four variables were significantly related, suggesting that adolescents engaging in one behavior were engaging in the other behaviors as well.

  • An increase in cigarette use over time was related to an increase in risky sexual behavior over time.

Previous literature discusses cigarette use in many cases as a precursor of adolescent risky sexual behavior. Evidence from this study supports previous research by showing that cigarette use is among the most influential risk factors for adolescents. Future prevention projects, as well as research studies, should focus on this relationship.

Results from this particular study suggest a need for more research on development of high-risk behaviors during adolescence. Keterlinus et al. (1994) indicate the need for more integrative views in research in order to examine the development and consequences of problem behaviors rather than singling out specific behaviors and studying them separately.


There were several limitations in this study, including:

  1. the short time-span of the study,

  2. a reliance on self-reporting, and

  3. findings may be generalizable only to similar populations.

Implications for Practice

  • Young people need accurate information about the effects and risks of different substances.

  • Prevention education about substance use, especially tobacco use, should start early.

  • A harm reduction approach to educate young people on the risks of mixing substance use and sexual activity may be effective in reducing potential negative outcomes such as STI transmission and unintended pregnancy.

  • Sexual risk-taking prevention efforts aimed at youth who report use of tobacco or other substances should be strengthened.
Duncan, S.C., Strycker, L.A., and Duncan, T.E. (1999) "Exploring Association in Developmental Trends of Adolescent Substance Use and Risky Sexual Behavior in a High-Risk Population." Journal of Behavioral Medicine, 1999; Vol. 22, No. 1: 21-34.