STAPPENBECK ET AL. 223
Patterns of Alcohol Use and Expectancies Predict Sexual
Risk Taking Among Non–Problem Drinking Women
CYNTHIA A. STAPPENBECK, PH.D.,a,* JEANETTE NORRIS, PH.D.,b PRESTON A. KIEKEL, PH.D.,b
DIANE M. MORRISON, PH.D.,c WILLIAM H. GEORGE, PH.D.,d KELLY CUE DAVIS, PH.D.,c TINA ZAWACKI, PH.D.,e
ANGELA J. JACQUES-TIURA, PH.D.,f AND DEVON ALISA ABDALLAH, PH.D.b
aDepartment of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
bAlcohol and Drug Abuse Institute, University of Washington, Seattle, Washington
cSchool of Social Work, University of Washington, Seattle, Washington
dDepartment of Psychology, University of Washington, Seattle, Washington
eDepartment of Psychology, University of Texas at San Antonio, San Antonio, Texas
fPediatric Prevention Research Center, Wayne State University School of Medicine, Detroit, Michigan
ABSTRACT. Objective: Although alcohol consumption and sexual
risk taking are associated, not everyone who drinks alcohol engages
in risky sexual behavior. The purposes of the present study were to
identify patterns of alcohol use behaviors and alcohol expectancies
among women who are non–problem drinkers and to examine how
these patterns are associated with indices of sexual risk. Method: Data
from 758 non–problem drinking women who have sex with men and
were not in committed relationships were analyzed using latent profi le
analysis to determine patterns of alcohol use and alcohol-related ex-
pectancies. Results: Of the four patterns observed, three classes had
similar alcohol-related expectancies but differed with respect to drink-
ing behavior (moderate drinking, regular heavy episodes, and frequent
heavy episodes), and the fourth class consisted of moderate drinkers
with low expectancies (low expectancies). Results revealed that those
in the frequent heavy episodes class had the greatest number of sexual
partners in the past year and drank the most alcohol before having sex
compared with the other women. Both the regular and frequent heavy
episodes classes reported greater likelihood of having unprotected sex in
the future, more positive beliefs about casual sex, and greater subjective
intoxication before having sex than women in the moderate drinking or
low expectancies classes. Women in the low expectancies class reported
less positive beliefs about condoms than those in the moderate drinking
and regular heavy episodes classes. Conclusions: Results suggest that
different patterns of expectancies and drinking behaviors are associated
with different indices of sexual risk taking and highlight the importance
of individually tailored programs for prevention of sexually transmitted
infections. (J. Stud. Alcohol Drugs, 74, 223–232, 2013)
Alcoholism Grants R01AA014512 and T32AA007455.
*Correspondence may be sent to Cynthia A. Stappenbeck at 1107 NE
45th Street, Suite 201, Seattle, WA 98105, or via email at: firstname.lastname@example.org.
Received: April 19, 2012. Revision: October 17, 2012.
This research was supported by National Institute on Alcohol Abuse and
of women, as many as 75.5% reported at least one occa-
sion of heavy drinking in the past year (Testa et al., 2003),
and 8% reported consuming seven or more drinks in 1 day
during the past 12 months (Cochrane et al., 1992). In ad-
dition, rates of sexually transmitted infections (STIs) are
high among women in the United States. Women currently
account for more than one quarter of all new HIV/AIDS
diagnoses, 80% of which are transmitted via heterosexual
contact (Hall et al., 2008b). Women also had the majority of
1.5 million chlamydia and gonorrhea cases reported to the
Centers for Disease Control and Prevention (CDC) in 2008
(CDC, 2009), diseases associated with severe health con-
sequences. To improve prevention and intervention efforts
among women, more information is needed on the associa-
ATES OF WOMEN’S ALCOHOL CONSUMPTION in
the United States are high: Among community samples
tions between alcohol use and sexual risk taking. Therefore,
the goals of the current investigation were to determine the
patterns of alcohol use and alcohol-related expectancies
among a community sample of women who are non–prob-
lem drinkers and examine how these patterns relate to sexual
Alcohol consumption has been associated with sexual
risk taking, including unprotected consensual sex (Brown
and Vanable, 2007; Cooper, 2002; Leigh and Morrison,
1991; Theall et al., 2007). Heavy episodic drinking has been
related specifi cally to unplanned sex, unprotected sex, and
having multiple sex partners (Halpern-Felsher et al., 1996;
Hingson et al., 2003; Wechsler et al., 1995). In one study,
female heavy drinkers were found to be 2.8 times as likely
to engage in unprotected sex and 2.1 times as likely to have
multiple sex partners in the past year as female nondrinkers
(Huang et al., 2010). More frequent drinking may result in
women spending more time in places often associated with
an increased likelihood of casual sex and sexual risk taking,
including bars and parties, which may contribute to these as-
sociations (Bersamin et al., 2012; Parks and Miller, 1997). In
addition, alcohol use and sexual risk behavior may co-occur
224 JOURNAL OF STUDIES ON ALCOHOL AND DRUGS / MARCH 2013
as a result of common personality factors, such as sensation
seeking and impulsivity (Caspi et al., 1995; Kalichman et al.,
Alcohol intoxication is known to impair executive cogni-
tive functioning and decision-making processes in ways that
can directly increase the likelihood of sexual risk behavior
(Giancola, 2000). The acute effects of alcohol can also
increase risk-taking behavior by narrowing an individual’s
focus to only the most salient cues in the environment, a
process referred to as alcohol myopia (Steele and Josephs,
1990; Taylor and Leonard, 1983). In a sexual encounter in-
volving alcohol, the most salient cue may be sexual arousal
rather than the potential risk associated with a sexual partner
(e.g., Davis et al., 2007; George et al., 2009; MacDonald et
al., 2000), thereby increasing the likelihood of risk-taking
behavior (Adefuye et al., 2009).
Alcohol expectancies may also help explain the associa-
tion between alcohol use and behavioral risks such as sexual
risk taking. Alcohol expectancy theory posits that behaviors
exhibited after drinking are likely to be consistent with
previously held beliefs about the effects of alcohol (MacAn-
drew and Edgerton, 1969). Thus, intoxicated individuals
will behave based on what they have learned to expect from
alcohol. In general, positive alcohol outcome expectancies
have been associated with more risk taking than negative
beliefs about alcohol (Fromme et al., 1997). Alcohol-related
sexual beliefs have been related to unsafe sexual outcomes
including unprotected sex (Abbey et al., 2005; Cooper,
2002; George and Stoner, 2000). Research suggests that
positive expectancies about the sexual-enhancement effects
of alcohol predict more frequent substance use in sexual
contexts (Kalichman et al., 1998). Indeed, alcohol-related
sexual-enhancement expectancies have been associated with
an increased number of sexual partners (Hendershot et al.,
2007) and drinking before sex (White et al., 2009). More-
over, alcohol expectancies have been shown to interact with
acute intoxication to predict sexual risk taking (Gordon et
al., 1997) in addition to infl uencing risk behavior directly
(Maisto et al., 2002).
Although it is often thought of as a classifi cation unto
itself, social (or moderate) drinking can take many forms de-
pending on the quantity and frequency of consumption. This
variation in drinking patterns may be associated with differ-
ences in alcohol expectancies and contribute to outcomes.
Moreover, alcohol and sexual risk taking are associated;
however, not everyone who drinks alcohol engages in such
behavior (Leigh et al., 2008). This suggests that a more fi ne-
grained assessment of specifi c patterns of drinking behavior
and alcohol expectancies is needed. Existing literature in this
area is limited to variable-centered approaches that do not
allow for the examination of drinking profi les or subtypes,
whereas the known heterogeneity among non–problem drink-
ers can be characterized using person-oriented approaches
such as latent profi le analysis. Based on previous research
suggesting that alcohol use and alcohol-related expectan-
cies both independently and jointly infl uence sexual risk
taking (Gordon et al., 1997; Maisto et al., 2002), the use of
a person-oriented approach provides an examination of a
constellation of behaviors and beliefs to identify individuals
at greatest risk for engaging in these behaviors and to help
inform tailored intervention and prevention efforts.
The purposes of the present study were to (a) identify
patterns of alcohol use behaviors and expectancies among
a community sample of heterosexual women who are non–
problem drinkers using latent profi le analysis and (b) deter-
mine how such patterns of alcohol behavior and expectancies
are associated with indices of sexual risk taking. Examina-
tions of profi les of individuals are by nature exploratory;
however, we expected that distinct profi les based on alcohol
use behavior and expectancies would emerge through latent
profi le analyses. Further, we hypothesized that profi les char-
acterized by heavier and more frequent alcohol consumption,
stronger positive alcohol expectancies, and weaker negative
alcohol expectancies would be associated with greater sexual
we recruited 758 women from the community (Mage = 23.5
years, SD = 4.2) for fi ve experiments about alcohol and so-
cial interactions. The experiments involved an experimental
protocol; however, only background questionnaire data were
used in the analyses presented here. Participants’ ethnic
breakdown was 66.2% White, 7.1% African American, 7.9%
Asian American/Pacifi c Islander, 2.6% American Indian/
Native Alaskan, 9.0% multiracial, and 7.1% other; 8.6%
identifi ed as Hispanic. Sixty-four percent were employed
either full- or part-time, and 46% were either full- or part-
time students. Thirty-one percent were currently attending a
4-year college or university full time. Demographic differ-
ences among the experiments were examined. Participants
in the two experiments focused on 18- to 20-year-olds were
less likely to be employed and more likely to be a full-time
student at a 4-year college or university than participants
from the three samples of 21- to 35-year-olds. There were
no ethnic differences across experiments.
By means of posted fl yers and online advertisements,
man Subjects Division. Participants for all experiments
were recruited in a similar manner. Those interested in
participating contacted the lab and were screened by phone
to ensure eligibility. Participants were required to be single
non–problem drinkers between the ages of 18 and 35 years.
All procedures were approved by the university’s Hu-
STAPPENBECK ET AL. 225
Abstainers and those with a history of problem drinking
(e.g., history of negative reactions to alcoholic beverages,
concern about drinking) were excluded (National Institute
on Alcohol Abuse and Alcoholism [NIAAA], 2005). Three
of the samples targeted women of legal drinking age (i.e.,
21–35 years) who had the additional requirement of not cur-
rently taking medications or having any medical conditions
that would contraindicate alcohol consumption. Because the
target sample for each experiment was single women who
have had sex with men, all participants had to report on the
screening that they had had consensual sexual intercourse
with a man at least once in their lifetime and were not cur-
rently in a committed and exclusive relationship.
On arrival to the laboratory, the participant was seated
in a private room, provided informed consent, and was left
alone to complete a set of background measures on the com-
puter. At the end of the experimental session, participants
were debriefed, paid $15 per hour, and given information
about HIV and STI prevention.
ethnicity, and student/occupational status.
Alcohol expectancies. The Alcohol Expectancies Ques-
tionnaire (AEQ; George et al., 1995) was used to assess
alcohol expectancies. The AEQ includes 24 items rated on
6-point scales ranging from 0 (disagree strongly) to 5 (agree
strongly). Items were averaged to create three subscales
refl ecting positive expectancies (social/physical pleasure,
social expressiveness, sexual enhancement) and two sub-
scales refl ecting negative expectancies (cognitive/physical
impairment, careless unconcern), which all had adequate
internal reliability (Cronbach’s α was .67, .85, .80, .81, and
Alcohol behaviors. A modifi ed version of the Daily
Drinking Questionnaire (Collins et al., 1985) was used to as-
sess alcohol consumption. Participants reported the number
of standard drinks (defi ned as 12 oz. of beer, 5 oz. of wine,
or 1.5 oz. of distilled spirits) they consumed on each day of
a typical week in the past month, as well as the number of
hours they typically spent drinking each day. From responses
to the Daily Drinking Questionnaire, we calculated the
average weekly frequency and average quantity consumed
per drinking day. The number of heavy episodic drinking
episodes per week was calculated to refl ect the standard
defi nition of having consumed four or more drinks in 2 hours
Sexual behaviors. The Sexual Experiences Inventory
was adapted from interview and questionnaire assessments
to assess sexual experiences (Capaldi et al., 2002; Leigh
et al., 1993). Participants reported on their past 3-month
frequency of vaginal intercourse with a man and the propor-
tion of occasions a condom was used (0 = never, 1 = about
Demographic information. Participants provided their age,
a quarter of the time, 2 = about half of the time, 3 = about
three quarters of the time, and 4 = always) as well as their
number of past-year and lifetime intercourse male partners.
Items created for the purposes of this study were used to as-
sess how often participants drank alcohol before having sex
(i.e., “How often do you consume alcohol before sexual ac-
tivity?”) on a 5-point scale (0 = never, 1 = about a quarter of
the time, 2 = about half of the time, 3 = about three quarters
of the time, and 4 = always), and their subjective intoxica-
tion (i.e., “During those times you consumed alcohol before
sexual activity, how intoxicated were you?”) on a 7-point
scale (0 = not at all, 6 = extremely).
Unprotected sex likelihood. Participants completed an
eight-item questionnaire developed for this research that as-
sessed their unprotected sex intentions (Purdie et al., 2011).
The fi ve items that were averaged to form the Unprotected
Sex Likelihood Behavior subscale were the likelihood par-
ticipants would have sexual intercourse without a condom
in the future (a) with a new male partner, (b) with a steady
male partner, (c) with a male ex-partner, (d) with a male
partner whose sex risk is unknown, and (e) with no birth
control. The Unprotected Sex Likelihood Outcome subscale
comprised three items in which participants reported the
likelihood that they would contract an STI, contract HIV,
and get pregnant when they did not want to. All responses
were rated on 7-point scales ranging from 0 (not at all likely)
to 6 (very likely). Internal reliability was good for both the
Unprotected Sex Likelihood Behavior and Unprotected Sex
Likelihood Outcome subscales (Cronbach’s α was .79 and
Casual sex attitudes. Participants’ attitudes toward ca-
sual sex were assessed with a subscale of the Sociosexual
Orientation Inventory (Simpson and Gangestad, 1991). This
subscale included three attitudinal items (e.g., “I can imag-
ine myself being comfortable and enjoying casual sex with
different partners”) answered on 9-point scales (0 = strongly
disagree, 8 = strongly agree) and then averaged. These items
demonstrated good internal reliability (Cronbach’s α = .82).
Higher values refl ect more positive attitudes toward casual
Condom use beliefs. Condom use beliefs were assessed
with the Condom Use Outcome Beliefs scale (Morrison et
al., 1995) drawn from a study based on the theory of planned
behavior (Ajzen, 1991). Participants fi rst reported the like-
lihood that each of 12 items (e.g., “not getting pregnant,”
“less physical pleasure from sex for me”) would occur if a
condom was used in the next 3 months using 7-point scales
(0 = very unlikely, 6 = very likely). Next, using 7-point scales
(-3 = very bad, 3 = very good), participants reported how
bad or good it would be if the event described in each item
occurred. The two responses for each item were multiplied
together and then averaged across all items. Higher values
refl ect more positive beliefs about condoms, which have
been associated with greater intentions to use condoms
226 JOURNAL OF STUDIES ON ALCOHOL AND DRUGS / MARCH 2013
and actual condom use (Campbell et al., 1992; Hall et al.,
Data analytic strategy
determine underlying latent groups of individuals based on
their responses to selected variables (Bartholomew, 1999;
McLachlan, 1988). These analyses were conducted using
Mplus Version 6 (Muthén and Muthén, 1998–2010) to iden-
tify profi les of women based on their positive and negative
alcohol expectancies and alcohol use behavior (i.e., typical
frequency, quantity, and number of heavy drinking episodes
per week). Properties of each of the variables were exam-
ined before conducting the latent profi le analysis, and no
problems with skewness or kurtosis were identifi ed. Eight
measures were entered into the analyses, and classes were
added iteratively. We evaluated whether the addition of a
class improved model fi t in order to determine the appro-
priate number of classes to maintain. Because there is no
consensus on the single best indicator to determine model fi t
(Nylund et al., 2007), multiple fi t statistics were examined.
The Akaike information criterion (AIC) and the Bayesian
information criterion (BIC) are expected to decrease as the
model improves. The Lo–Mendell–Rubin test (LMR) com-
pares a k class solution to a k – 1 class solution (where k =
a given number of latent classes; Lo et al., 2001). The LMR
provides a test for improvement in model fi t for the addition
of each class with signifi cant p values indicative of improved
model fi t for the k class solution. Entropy provides a measure
of the extent to which the latent classes are distinct from one
another, with values close to 1 indicative of clearer classifi -
cation (Ramaswamy et al., 1993).
Latent profi le analysis is an analytic method used to
analysis. The LMR was nonsignifi cant for the fi ve-class
solution and above, indicating that the addition of the fi fth
and subsequent classes did not improve model fi t beyond the
four-class solution. Although the AIC and BIC decreased for
all models tested, the relative decrease in both the AIC and
BIC was small from the three-class to the four-class solution.
Taken together, these results suggest that the four-class solu-
tion should be retained. In addition, the four-class solution
was associated with the highest entropy value, indicating
that this model more clearly distinguished among the groups
according to their alcohol expectancies and behaviors.
Standardized means for the variables included in the la-
tent profi le analysis are presented in Figure 1. As shown in
Table 2, Class 1 (n = 110; 14.5%) was characterized by the
lowest positive and negative expectancies for alcohol and
infrequent moderate drinking (low expectancies). Women in
Class 2 (n = 388; 51.2%) endorsed higher cognitive/physi-
Table 1 shows model fi t statistics for the latent profi le
TABLE 1. Model fi t indices for the latent profi le analysis of women’s alco-
hol expectancies and alcohol behaviors
Model AIC BIC LMR Entropy
Notes: The best fi tting model is indicated in bold. AIC = Akaike informa-
tion criterion; BIC = Bayesian information criterion; LMR = Lo–Mendell–
**p < .01.
cal impairment alcohol expectancies than those in the other
classes and were infrequent moderate drinkers (moderate
drinking). Class 3 (n = 227; 30.0%) was characterized by
average alcohol expectancies, heavy drinking, and regular
heavy episodic drinking (regular heavy episodes). Women
in Class 4 (n = 33; 4.3%) reported higher social/physical
pleasure alcohol expectancies than those in the other classes
and were frequent heavy drinkers (frequent heavy episodes).
Predicting sexual risk perceptions and behaviors
in sexual risk behaviors, generalized linear models were
conducted (Table 3). Age and a dichotomous variable for
full-time attendance at a 4-year college or university were
included in all models to control for observed demographic
differences and because the association between alcohol and
sexual behavior may vary by age and be infl uenced by the
traditional college environment. Signifi cant univariate tests
were followed up with pairwise comparisons using the Sidak
procedure to control for alpha infl ation and protect against
Type 1 error.
Sex-related attitudes and beliefs. Women’s unprotected
sex intentions, condom use outcome beliefs, and attitudes
about casual sex were examined. There was a signifi cant
difference among classes on the Unprotected Sex Likelihood
Behavior subscale such that those in the regular and frequent
heavy episodes classes reported greater behavioral intentions
to have unprotected sex than their counterparts. There was
also a signifi cant difference among classes on their condom
use outcome beliefs such that women in the low expectan-
cies class endorsed less positive beliefs about condom use
than those in the moderate drinking and regular heavy epi-
sodes classes but not less than those in the frequent heavy
episodes class. Classes also signifi cantly differed in their
positive attitudes toward casual sex, with women in the low
expectancies and moderate drinking classes reporting less
positive attitudes toward casual sex than those in the regular
and frequent episodes classes and those in the regular heavy
episodes class reporting less positive casual sex attitudes
than those in the frequent heavy episodes class. There were
no differences among classes on the Unprotected Sex Likeli-
hood Outcome subscale.
To examine whether the classes predicted differences
STAPPENBECK ET AL. 227
FIGURE 1. Standardized means of alcohol expectancies and alcohol behaviors included in the latent profi le analysis
TABLE 2. Means (and standard deviations) of alcohol expectancies and alcohol behaviors by class
(n = 388)
heavy episodes heavy episodes
(n = 227)
(n = 110) (n = 33)
Alcohol use frequency per week
Alcohol use quantity per drinking day
Heavy drinking episodes per week
Note: Means with differing subscripts are signifi cantly different at p < .05.
3 months (i.e., the frequency of vaginal sex and frequency
of condom use) was examined, in addition to the number
of partners in the past 12 months and lifetime as well as
co-occurring alcohol and sexual behavior. Signifi cant dif-
ferences among the classes emerged on the number of
vaginal sex partners women had had in the past 12 months,
Sexual risk behavior. Women’s sexual behavior in the last with those in the frequent heavy episodes class reporting
the greatest number of partners compared with those in the
other classes, and those in the regular heavy episodes class
reporting more than those in the low expectancies class.
The classes also differed in the frequency with which they
drank before sex, with those in the frequent heavy episodes
class reporting more frequent alcohol use before having sex,
228 JOURNAL OF STUDIES ON ALCOHOL AND DRUGS / MARCH 2013
followed by, in order, those in the regular heavy episodes,
moderate drinking, and low expectancies classes. A similar
pattern emerged for the extent to which these women re-
ported feeling intoxicated before having sex, except that in
this case the regular and frequent heavy episodes classes did
not differ signifi cantly. There were no differences among the
classes on the frequency of sex and condom use in the past
3 months or number of lifetime sexual partners.
gest that there are several different patterns of alcohol use
behaviors and alcohol-related expectancies among female
non–problem drinkers. Three classes emerged refl ecting
different patterns of alcohol use ordered from moderate to
heavy on three dimensions of use: average weekly frequency,
typical quantity per drinking day, and average number of
heavy drinking episodes per week. There was considerable
variability among the classes with respect to their alcohol
use frequency, quantity, and number of heavy drinking epi-
sodes. Those in the frequent heavy episodes class typically
consumed alcohol 2 more days per week, had approximately
four more drinks per drinking day, and engaged in heavy
episodic drinking about four more times per week than those
in the low expectancies and moderate drinking classes. One
of the lighter drinking classes (the low expectancies class)
was further differentiated from the other classes by having
signifi cantly lower positive and negative alcohol-related
This difference in alcohol-related expectancies may
be because women in the low expectancies class have not
developed strong expectations for the effects of alcohol
because they have less experience drinking alcohol them-
selves and have likely had less exposure to other individu-
als who consume alcohol (Aas et al., 1995). Women in the
moderate drinking, regular heavy episodes, and frequent
Consistent with hypotheses, the present results sug-
heavy episodes classes reported similar expectations for the
effects of alcohol with two exceptions. First, those in the
moderate drinking class anticipated greater cognitive and
physical impairment from alcohol compared with women in
the regular and frequent heavy episodes classes, and second,
the expectation for social and physical pleasure increased in
accordance with each class’s increased alcohol use quantity.
These differences in alcohol expectancies may offer insight
into the alcohol use behavior observed in each class. It may
be that those in the moderate drinking class limited their
consumption to avoid the expected impairment associated
with alcohol intoxication, or, when they drank, they actu-
ally did experience more impairment than heavier drinkers
because of less tolerance. In contrast, increased expectation
for (and perhaps increased experience of) alcohol’s pleasur-
able effects may provide a motivation for increased drinking
to achieve these desired effects among those in the regular
and frequent heavy episodes classes (Bekman et al., 2011;
Fromme et al., 1993).
We hypothesized that sexual risk taking would differ
among the classes of women such that those characterized
by heavier and more frequent alcohol consumption, more
positive alcohol expectancies, and less negative alcohol ex-
pectancies would report greater sexual risk taking. Several
indices of sexual risk were examined with partial support
for this hypothesis. We found that those with frequent heavy
episodes—who also held the most positive beliefs about the
social and physical pleasure of alcohol—had more positive
attitudes about casual sex, had the greatest number of sexual
partners in the past year, and drank more alcohol before hav-
ing sex. Both regular and heavy episodes classes reported
higher likelihood of having unprotected sex in the future
and greater subjective intoxication before having sex than
the lighter drinking classes. These women may represent a
subgroup whose alcohol and sexual behaviors were moti-
vated by sensation seeking and impulsivity (Hendershot et
al., 2007). Alternatively, those in the frequent heavy episodes
TABLE 3. Means (and standard deviations) of sexual risk perceptions and behaviors and differences among classes
(n = 388)
(n = 227)
(n = 33)
(n = 110)
Wald χ2 (df = 3)
Unprotected sex likelihood
Condom use outcome beliefs
Positive attitudes—casual sex
Vaginal sex frequency
Condom use frequency
Number of partners past year
Number of partners lifetime
Drink before sex
Intoxicated before sex
Notes: Means with differing subscripts represent signifi cant differences between classes at p < .05. GzLM = generalized linear
***p < .001.
STAPPENBECK ET AL. 229
class may consume alcohol in order to achieve the expected
pleasurable effects of alcohol, which in turn may serve to
focus their attention on experiences consistent with their
expectations, including sexual arousal. This process may lead
to an increase in their sexual risk taking, especially when
they have been drinking.
It is noteworthy that there were no differences among
classes on the frequency of vaginal sex, frequency of con-
dom use, or the number of lifetime sexual partners. Although
these behaviors were reported at comparable rates among
all women, differences in other beliefs and behaviors sug-
gest that their sexual risk is not equivalent. Indeed, those in
the frequent heavy episodes class felt most positively about
casual sex and reported more sexual partners in the past
year, indicating that they could have been having sex with
a greater number of casual partners recently whose sexual
history and STI/HIV diagnoses were unknown, thereby
putting themselves at greater risk for STIs. The regular and
frequent heavy episodes classes reported greater intentions
to have unprotected sex in the future compared with those in
the moderate drinking and low expectancies classes. In ac-
cordance with the theory of planned behavior (Ajzen, 1991),
intentions to engage in risky behaviors have been associated
with an increased involvement in those risky behaviors in the
future (Combs-Lane and Smith, 2002). Moreover, despite a
similar frequency of condom use, the motivation for using
condoms could have differed among classes. For example,
the frequent heavy episodes class may have been motivated
to use condoms because they had a greater number of part-
ners in the past year.
That those in the frequent heavy episodes class were
more likely to drink before sex and that both the regular and
frequent heavy episodes classes felt more intoxicated before
sex than lighter drinking women was not surprising given
that these women reported greater quantity and frequency
of alcohol use. However, it is concerning because greater
alcohol use and intoxication are associated with impaired
decision-making processes and a narrowing of one’s at-
tention that may decrease the perception of risk associated
with a sexual situation (Fromme et al., 1999; Maisto et al.,
2004; Steele and Josephs, 1990; Taylor and Leonard, 1983).
Indeed, recent experimental research has demonstrated a
link between acute alcohol intoxication and sexual apprais-
als among women asked to project themselves into a story
depicting a sexual interaction. Results showed that alcohol
consumption was positively associated with primary ap-
praisals of sexual potential, which subsequently positively
predicted appraisals of sexual pleasure (Norris et al., 2012).
Using similar experimental methodology, additional investi-
gations found that alcohol consumption directly or indirectly
increased women’s likelihood to engage in unprotected sex
(George et al., 2009; Norris et al., 2009). Zawacki (2011)
also found that during live social interactions in the labora-
tory, intoxication decreased women’s sexual risk appraisal
of men, which in turn increased women’s unprotected sex
Perhaps most surprising was the fi nding that women in
the low expectancies class—who were moderate drinkers
with low positive and negative alcohol expectancies—re-
ported less positive condom use beliefs than the moderate
drinking and regular heavy episodes classes and did not dif-
fer from the frequent heavy episodes class. For these women
in the low expectancies class, condom use may be associated
with having casual sex, about which they also expressed less
positive attitudes. We speculate that this might be related to
differences in patterns of contraceptive use. A recent exami-
nation of contraceptive use in young adults’ dating relation-
ships found that hormonal contraception alone, compared
with condoms alone or dual methods, was more common
when sex was initiated after the dating relationship began
rather than before and as relationship duration and level of
intimacy increased (Manlove et al., 2011). Women in the low
expectancies class may be more likely to use only hormonal
contraception methods earlier in the course of what they
perceive to be a committed relationship. Although this would
certainly increase their risk for STIs, which are not prevented
by hormonal contraceptive methods, they may still be at
lower overall risk because they generally have fewer partners
or because they have longer term partners who present less
The moderate drinking class represented a particularly
interesting subgroup. These women had similar drinking
behaviors to those in the low expectancies class; however,
their expectancies were quite different. Moreover, the mod-
erate drinking class had similar expectancies to those in the
regular and frequent heavy episodes classes but differed
in their alcohol use. The moderate drinking class may be
at slightly greater risk than those in the low expectancies
class and at less risk than the regular and frequent heavy
episodes classes. These differences in risk cannot easily be
explained, as it appears that their increased risk relative to
the low expectancies class was likely attributable to high
alcohol expectancies, whereas their decreased risk relative
to the regular and frequent heavy episodes class was likely
attributable to less alcohol use. These fi ndings highlight the
importance of additional person-oriented analyses that exam-
ine the constellation of expectancies and alcohol use to shed
further light on the experiences of these women.
Present fi ndings should be considered in light of several
limitations. Some aspects of the current study limit the gen-
eralizability of the fi ndings; the sample was self-selected,
for example, and abstainers and women with a history of
problem drinking were excluded from participating. Prob-
lem drinkers represent a small percentage of women who
consume alcohol (Hasin et al., 2007), and the goal of this
study was to understand patterns associated with non–
problem drinking. Women indicating that they were in a
committed exclusive relationship were also excluded from
230 JOURNAL OF STUDIES ON ALCOHOL AND DRUGS / MARCH 2013
the study, which further limits generalizability. Although
women in committed and exclusive relationships generally
have lower STI/HIV risk (Adimora et al., 2002; Morris and
Kretzschmar, 1995), in this study the partner’s perception of
the level of commitment in the relationship and whether the
partner was exclusive in the relationship was not assessed.
This exclusion criterion was necessary for the experimental
portion of the study not described here; however, we may
have excluded a subset of women at risk for STIs and HIV
if they believed their relationship was exclusive but their
partner did not. Moreover, the number of women categorized
into the frequent heavy episodes class was small, likely be-
cause of the inclusion/exclusion criteria established for the
experimental portion of the present research.
An additional limitation is that the present study was
cross-sectional. We were therefore unable to examine
whether alcohol use behaviors or alcohol-related expec-
tancies increased subsequent sexual risk taking, whether
the opposite was true, or whether there was a reciprocal
relationship. Future studies should include longitudinal
assessments to determine the patterns of alcohol use and
associations with sexual risk taking over time to begin to
examine these important issues. Such studies could also in-
clude measurement of personality attributes that potentially
underlie elevated levels of both drinking and sexual risk
taking, such as impulsivity and sensation seeking. Last, the
fact that no differences on condom use frequency emerged
among classes may have been related to a lack of sensitivity
of the assessment. Condom use frequency was assessed with
a single item in which participants reported the proportion
of time they used a condom, with limited response options
and without reference to partner type. Given the differences
in condom use beliefs and attitudes toward sex with casual
partners among classes, it would stand to reason that a more
fi ne-grained assessment of their actual condom use behavior
might have revealed differences.
Together these results highlight the variability among
heterosexual female non–problem drinkers that were able
to be captured through the use of a person-oriented analytic
approach and suggest the importance of continuing to ex-
amine patterns of both alcohol use behaviors and alcohol
expectancies in predicting sexual risk taking. Although mod-
erate drinking was associated with some indices of sexual
risk taking, women who reported heavier drinking exhibited
the highest STI risk indicators, especially those who also
reported greater expectations for the social/physical pleasure
effects of alcohol. It is noteworthy that the current investiga-
tion excluded problem drinkers; therefore, these heavy drink-
ing women are not likely to present for treatment related to
their alcohol use specifi cally. Nevertheless, it is important
to develop alcohol-focused STI risk-reduction interventions
for heavy drinking women that can be implemented whether
or not they seek traditional alcohol treatment. It may also be
important to include information about the possible infl uence
of social/physical pleasure expectancies in the association
between alcohol use and sexual risk taking. Lighter drink-
ing women will likely not need alcohol-focused STI risk-
reduction interventions; however, they would still benefi t
from general STI education and risk-reduction strategies.
Although many STI intervention efforts are targeted toward
young women on college campuses, results of the current
investigation suggest that efforts should be broadened to ad-
dress the needs of women more generally, including the pos-
sibility of providing educational material to women seeking
medical services at primary care or women’s health clinics
or developing smart phone applications that can be widely
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