Ibiza uncovered: changes in substance use and sexual behaviour amongst young people visiting an international night-life resort

Abstract

Background: Each year more young people travel to international resorts where levels of substance use, sex and associated health risks are unknown. This study measures changes in levels of substance use and sexual behaviour of young people from the UK when on holiday in a youth orientated international resort, Ibiza. Methods: Data were collected through a cross-sectional survey collecting matched information on individuals’ behaviour in the UK and abroad. Questionnaires were administered to 846 individuals aged between 15 and 35 at Ibiza Airport prior to their returning to the UK. Results: Young visitors to Ibiza significantly alter patterns of drug, alcohol and tobacco use. For ecstasy, in the UK 2.9% of users (9/313) used 5 or more days a week, while in Ibiza this rises to 42.6% (127/298). Fewer individuals use amphetamine, ketamine, cannabis, LSD, cocaine and GHB (γ-hydroxybutyrate) in Ibiza although those continuing to use in Ibiza consume at substantially higher rates than when in the UK (P<0.001). Using multiple drugs over a 1 or 2 week stay was common (31.9%). Most individuals (53.8%) had sex while in Ibiza; 26.2% had sex without a condom and 23.2% had more than one sexual partner. Overall, 7.3% of individuals went to hospital or to see a doctor while in Ibiza with male (P<0.001), older (P<0.05) and staying for shorter times (P<0.005) being the key risk factors. Conclusions: While the potential for substance related ill health is dramatically elevated in Ibiza, harm minimisation measures in such resorts remain scarce. Equally, although holiday companies attract a sexually active cohort, safe sex messages are either absent or ineffective. Coordinated information campaigns to protect the health of young people are urgently needed and will require European cooperation across both public and private organisations.

Introduction

Recent surveys of young people in the UK confirm excessive use of alcohol even in those under 18 (Hughes et al., 1997, ONS, 1998), describe an inability to reduce levels of smoking (Government Statistical Service, 1998) and identify rising levels of drug use (Ramsey and Partridge, 1999). This dramatic rise means that, along with high levels of drinking and tobacco use, over half of 16–24 year olds have now also tried an illegal substance (although regular users represent a smaller proportion; Aldridge et al., 1999, Ramsey and Partridge, 1999). Amongst other factors, regular use of substances such as ecstasy, cocaine and amphetamine has been associated with attendance at night-time social venues and recently, more specifically night clubs (Forsyth et al., 1997, Kilfoyle and Bellis, 1998, Calafat et al., 1999).

The recent growth of the clubbing phenomenon in the UK (Garratt, 1998) means that each week vast numbers of individuals, many using recreational drugs (Bean et al., 1997), attend late night dance venues and each summer a proportion of these seek holiday resorts abroad offering similar dance and social opportunities (Sellars, 1998). Currently, little is known about the substance use or sexual behaviour of young people on such packages even though drugs or sex abroad may carry disproportionate risks to health. For instance, drug supplies abroad may be less reliable increasing the dangers from consuming unexpected substances (Sherlock et al., 1999); hotter climates along with risk of gastro-intestinal infections increase the risk of dehydration (Department of Health, 1995) (especially in conjunction with drugs such as ecstasy, 3,4-methylenedioxymethamphetamine; McCann et al., 1996, Baker et al., 1997) and a holiday binge mentality (Smeaton et al., 1998) may lead to consumption of all things in excess (Josiam et al., 1998). Furthermore, basic protective measures such as condoms may not be as easily available (Carter, 1997) to protect from unwanted pregnancy or higher levels of HIV should opportunistic sex occur (Thomas et al., 1997). Unlike major clubs in the UK, some venues abroad often do not have or even know of safer dancing codes (Newcombe, 1994, London Drug Policy Forum, 1996) with water from club bars commanding prohibitive prices, harm minimisation literature rare and peer intervention groups or first aiders seldom available. Finally, when emergencies occur, health and judicial systems are often already stretched to breaking point as resorts with only small indigenous populations try to accommodate millions.

Paradoxically within such foreign settings, young peoples’ risk taking is likely to increase as individuals escape the social constraints of family and workplace (Ryan and Kinder, 1996, Carter, 1997, Carter et al., 1997). For some groups on holiday, increased consumption of alcohol (Josiam et al., 1998) and unsafe sexual behaviour (Gillies et al., 1992, Carter et al., 1997, Thomas et al., 1997) has already been documented. However, to date no studies have described the substance use and sexual behaviour of young people when visiting night-life orientated resorts abroad. Therefore, the following study aims to measure changes in those risk behaviours when young people from the UK takes annual holidays in such resorts elsewhere in Europe.

Amongst such resorts arguably the most popular in Europe for night clubs is Ibiza. This Balaeric island benefits from a long association with club music and recreational drug use, especially ecstasy (Calafat et al., 1998). In 1986 ecstasy was effectively launched from Ibiza as a popular dance drug described as the perfect accompaniment to a new style of music dubbed ‘Balearic beat’ (Calafat et al., 1998). Since then the popularity of Ibiza has grown, helped by the advent of cheap international airfares and packaged holidays aimed specifically at the youth market. As a result between January and September 1999, Ibiza attracted around 700 000 tourists from the UK alone and an island with an endemic population of 80 000 played host to more than one and a half million tourists (Fomento del Turismo de Ibiza, 1999). Consequently, Ibiza was chosen as the most appropriate setting for this survey.