In this review article, three methodologic approaches that have been used to examine the association between adolescents' alcohol use and their involvement in risky sex are discussed: global correlation studies, situational covariation studies, and event analyses. The strengths and limitations of each of these research methods are discussed. An extensive review of the most rigorous studies, which used event analysis to examine the alcohol-risky sex link, reveals positive results for first-time sexual events but equivocal findings for other types of sexual relationships. It is argued that differences in the types of sexual relationships studied have been confounded, limiting our ability to evaluate the extent to which alcohol has a causal influence on adolescents' condom use. It is suggested that future investigations consider the nature of the sexual relationship, and go beyond studying the length or status of the relationship to explore how variation in relationship dimensions such as trust and intimacy affect adolescents' sexual behavior.
PIP: Research on the association between alcohol use and high-risk sexual practices among US adolescents has been compromised by methodological flaws. Global correlation studies, situational covariate studies, and event-history analyses have examined the impact of alcohol on adolescents' condom use. Although the correlation studies have found an association between alcohol consumption and risky sexual behavior, they can not identify potential causal effects. Situational covariate studies have examined effects from the use of alcohol during sexual events, but they also obscure the important temporal relationship between variables. Both global correlation and situational covariation studies fail to address the possibility that alcohol use and risky sexual behavior are caused by a third factor such as a general tolerance for deviance or a predisposition to risk taking. Critical incident or event analyses are limited by the recall bias inherent in retrospective data. Support for an alcohol-risky sex association emerges most consistently from studies that examined first-time sexual intercourse events, but this finding may not generalize to later experiences with new partners. Recent studies have recognized the importance of examining how sexual relationships themselves influence condom use. It is possible that alcohol will affect condom use only at specific points in the relationship. To control for the potentially confounding effects of the partner relationship on the alcohol-risky sex link, the natural history of these behaviors over the course of a relationship should be examined. The use of diaries is likely to yield more reliable information than retrospective questioning.