摘要：Objectives. We examined relations between early alcohol use and subsequent alcohol and sexual risk behaviors among urban adolescents. Methods. A total of 1034 African American and Hispanic youths completed surveys assessing alcohol and sexual behaviors at 7th and 10th grade. After we controlled for early sexual initiation, we examined relations between early drinking and subsequent alcohol and sexual behaviors. Results. Early drinking was associated with alcohol and sexual risks through mid-adolescence. Early drinkers were more likely to report subsequent alcohol problems, unprotected sexual intercourse, multiple partners, being drunk or high during sexual intercourse, and pregnancy. Among females, early drinking was also related to sexual initiation and recent sexual intercourse. Conclusions. Prevention programs should address combined risks of early alcohol use and sexual intercourse, especially where levels of HIV and other sexually transmitted infections are elevated. National studies have documented lower prevalences of alcohol initiation and use among African American than among White adolescents. 1, 2 Recent trends in some cities, however, raise concerns about the drinking behaviors of urban, predominately minority, adolescents. In 1997, for example, 31.1% of adolescents nationally and 30.5% of adolescents in New York City, NY, reported drinking before the age of 13 years; by 2001, these figures decreased to 29.1% nationwide but increased to 34.7% in New York City, where 39.3% of African American adolescents reported early alcohol use. 3 Early drinking is by itself cause for action, given its association with lifetime alcohol abuse and dependence. 4– 6 It may be particularly consequential for adolescents who live in communities where substantial proportions of youths initiate sexual intercourse before high school and where the chance of exposure to HIV and other sexually transmitted infections is elevated. 7– 11 Research on adolescent risk behaviors documents the co-occurrence of alcohol use, sexual risk taking, and other problem behaviors. 12, 13 Youths who drink, for example, are more likely to report multiple sexual partners and inconsistent condom use. 14– 16 Early drinking also predicts later risk taking. Following an ethnically diverse sample from early adolescence to young adulthood, Guo et al. 17 found a connection between early patterns of use (e.g., binge drinking) and subsequent sexual risks. Ellickson et al. 18 also reported links between early drinking and problem behaviors, including pregnancy and parenthood by 12th grade. 18 Early drinking may shape subsequent functioning through multiple pathways, for example, by affecting judgment, school performance, peer selection, and exposure to environments that reward risk taking. 12, 13, 19, 20 Although other substances (e.g., marijuana, cocaine) have been associated with sexual risk taking, drinking may be especially relevant for younger adolescents, who are more likely to be using alcohol than other drugs. 21, 22 Disentangling the effects of early drinking on later risk taking is difficult, however, partly because early use often coincides with other problem behaviors. Although several studies of substance use have tracked large numbers of students from elementary through high school years, 23– 25 information on the sustained influence of both early alcohol use and sexual initiation is limited, especially for subsets of the population such as economically disadvantaged urban youths. 26– 28 It is also possible that drinking is associated with some behaviors, such as decisions to have sexual intercourse and having multiple partners, but not others, such as condom use. In the latter case, other factors, such as the type of relationship in which drinking and sexual intercourse occur, may come into play. 29– 34 Additionally, some research suggests that different risk and protective factors may influence sexual risk taking and substance use 28, 35 ; thus, early drinking may differentially affect later substance use and sexual choices. We examined relations between early initiation of alcohol use and subsequent risk behaviors in a large sample of urban youths followed from 7th through 10th grade. This sample represents a segment of young adolescents for whom sexual initiation often occurs at an age when, nationwide, youths of the same age may start experimenting with alcohol but have not yet begun to have sexual intercourse. We investigated whether youths who reported early drinking were more likely to report recent alcohol use, alcohol misuse, and sexual risk taking as 10th-grade students. We explored whether relations between early alcohol initiation and subsequent risk taking differed for males and females. We focused on gender differences for several reasons. In response to a survey conducted by the Kaiser Family Foundation, girls and young women were more likely than boys and young men to report that peers are engaging in unprotected sexual intercourse while under the influence of alcohol. 36 For females, these encounters may be particularly dangerous because of greater biological susceptibility to gonorrhea and chlamydia and HIV infection. Additionally, female drinkers may develop problems at lower levels of drinking than males, and the progression from use to misuse occurs more rapidly. 37 We also considered whether early alcohol use remained a risk factor after we controlled for sociodemographic characteristics, early sexual initiation, and early use of cigarettes. 38 Controlling for these potential confounders provides a more stringent test of the effects of early alcohol initiation.
