About the complex relationships between age of first intercourse, current sexual behavior and suicidal ideation and drinking behaviors. Cole D. France & Jennifer L. Dinius Department of Psychology, University of Nebraska-Lincoln Introduction Drinking behaviors have been extensively researched in many contexts, with special emphasis on drinking among college aged individuals. From this, several theoretical frameworks have been established to explain and predict these behaviors, with a mindset towards interventions. This is especially important, as studies have found that college students have higher levels of alcohol consumption than do others not enrolled in college, and large portions of the college population have symptoms of abuse or dependence. To explain this, some researchers have focused on risky behaviors among college students. Many relationships have been found between alcohol consumption and other risky behaviors such as driving while intoxicated, engaging in violence, risky sexual behaviors and suicidal behaviors (Brener, Barrios &Hassan 1999; Barrios, Everett, Simon, & Brener, 2000; Powell et al., 2001; Schaffer, Jeglic, & Stanley, 2008). These theories posit that those who are inclined towards risky behavior also have a propensity to use and/or abuse alcohol as well as other drugs. The relationship between drinking and suicide is especially concerning. Powell et al., (2001) found significant relationships between nearly completed suicide attempts and several drinking behaviors, especially drinking within three hours of attempts, and Brener, Barrios &Hassan (1999) found significant relationships between substance use, alcohol, tobacco, and narcotics, with suicidal behaviors. Swahn, Bossarte, & Sullivent (2008) also found a significant relationship between early initiation to drinking behaviors and violent or suicidal behaviors. These findings seem to suggest that those that are suicidal may be engaging in risky behaviors, including risky drinking behaviors, to cope with negative affect. Along this line, Cooper, Frone, Russell, Mudar (1995) suggest that alcohol is used to regulate both positive and negative emotions. According to this theory, individuals often drink to either enhance positive affect or to cope with negative affective states. The model proposes two distinct approaches to alcohol use and abuse, each of which can lead to the onset of substance use problems, but do so through different mechanisms. Studies that connect substance abuse or addiction to suicidal tendencies and other risky behaviors seem to support the coping aspect of this theory, but little has been done to connect the two theories. Lamis et al., (2009) looked at college students reason for living as it pertains to alcohol use, and found that there was no connection with the exception that those with a high alcohol risk had few objections to death by suicide while those in the low alcohol risk group had significant moral objects to this. This may suggest that those in the low risk group have other coping mechanisms to deal with negative affective states, leading to less alcohol related problems. The present study analyzes the possible connection between propensity to engage in risky behavior and coping with negative affective states. Using the National College Health Risk Behavior Survey (NCHRBS), this study compares interactions between risky sexual behaviors and suicidal tendencies as they relate to drinking behaviors. It is hypothesized that those college students that are high on risky behavior and have negative affect will show greater levels of alcohol consumption than those that are only either high on risky behavior or have negative affect, and those that are low on risky behavior and do not have negative affect will have lower levels of consumption. Significant interactions could provide support for both theories discussed above and for a connection between the two, such that those that engage in risky behaviors, such as risky or early sexual activity, and have negative affective states, represented by suicidal tendencies, are more likely to drink as a coping mechanism. Results As figure one indicates, there was a significant interaction between age of first intercourse, number of times respondent had sex in the last thirty days and if they considered suicide in the last twelve months F(17, 1904) = 2.19, MSE = 2.10, p = .003, r = .14. Using an LSDmmd of .70, comparisons revealed that, as hypothesized, for those who had considered suicide, participants who were high on both risky behaviors, were higher on number of drinking days than those with the same age of first intercourse but less sex in the last thirty days. Those first introduced to sex at ages 13-14 and had sex once or less, in the last thirty days were significantly lower on drinking days than those introduced to sex at 13-14 and have had sex ten times or more in the last thirty days. For those that first had sex at age 15-16, those that had sex once or less were significantly lower on drinking days in the last thirty than those that had sex twenty times or more. The same pattern was not found for those that had not considered suicide. Methods Participants This study includes data from a nationally representative sample of 1,961 undergraduate students currently enrolled at two and four year universities across the United States. Institutions were selected from a national list based on their ethnic make-up compared to national rates, and participants were randomly selected from their registered students. The sample includes 41.3% females, and 60.6% non-Hispanic white students, and 39.4% who identified as other. The mean age of the respondents was 20.47 years with a minimum of 18 and a maximum of 24. Materials and Proceedure Participants completed the National College Health Risk Behavior Survey (NCHRBS), a self-administered questionnaire booklet that is scanned by a computer. The survey, which consisted of 96 multiple-choice questions about risky behaviors, was mailed to students selected for participation and was available in both English and Spanish versions. Data collection took place between January and June of 1995. Analysis A 2 (Considered suicide in the last twelve months; yes, no) x 5 (Age of first intercourse; 13-14, 15-16, 17-18, 19-20, 21-24) x 6 (Number of times had sex in last thirty days; 0, 1, 2-3, 4-9, 10-19, 20+) analysis of variance (ANOVA) was conducted and results were judged at the .05 significance level. Interactions between risky behaviors and suicidal tendencies over the last twelve months were investigated as they relate to drinking behaviors. Discussion The significant interaction between age of first intercourse, number of times participant had sex in the last thirty days and suicidal ideation in the last twelve months, as they relate to the number of nights a participant drank in the last thirty, provides support for the coping theory, and the hypothesis that a propensity towards risky behavior and negative affect is related to drinking. This is tempered, however, by the lack of interaction between other suicidal tendencies, such as planning or attempting a suicide, and risky behaviors. The fact that a similar interaction on the related dependent variable, binge drinking, was not found also calls this result into question. There was a general trend in the significant interaction (see Figure 1), specifically, those that were high on both risk taking measures (early first sexual experience and high number of sexual experiences in the last thirty days) were significantly higher than those with fewer sexual experiences in the last thirty days but the same age of first intercourse, but only for those that had considered suicide. For those that had not considered suicide, there were significant differences between different combinations of the conditions (See Figure 2), however there was no general pattern. These results by themselves provide support for the hypothesis in that there is a difference in drinking patterns for levels of risk taking between those with suicidal ideation and those without. This could be explained by the coping/enhancement theory (Cooper, Frone, Russell & Mudar, 1995), as those that are high risk takers may drink more to cope than low risk takers, while both high and low risk takers drink to enhance their positive affect. Taking the other analyses into account, however, hinders these results somewhat. If the explanation for this difference is that high risk takers are more likely to use alcohol to cope with negative affect, then similar results would be expected across different drinking measures. This was not the case for the same interaction related to binge drinking, which was non-significant. Nor did these results hold when different measures were used for assessing negative affect, there was no significant interaction using planned suicide or attempted suicide in the last twelve months, regardless of which measure of drinking behaviors was used. It is possible that these negative effects are a result of low numbers, despite the total number of participants, this is divided into many different condition combinations, several of which had very low numbers. The effect sizes of these studies could be interpreted as large enough to care about, depending on the standard used, and considering the seriousness of the variables being studied a strong argument could be made to take a closer look. The connection between the risk taking and coping theories, despite the mixed results of this study, still seems to make sense, theoretically. Further study is needed on this subject, not only to provide a more complete theoretical framework, but also to understand and focus on the most effective places for intervention. If future research should support this, then a focus on teaching coping and stress management skills could have positive effects on future drinking patterns. Such research might look at these patterns among different populations, especially different age groups, as college students display unique drinking behaviors (Knight et al., 2002). It would also be beneficial to utilize different measures for risk taking, coping vs. enhancement and drinking behaviors, as such efforts might yield more consistent results. The NCHRBS has several other measures that could be utilized, but there are a multitude of others not explored, specifically those directed at coping versus enhancement. Table 1 Summary of Suicide ideation, Age of first intercourse and Number of times had sex in last thirty days. ____________________________________________________________________________ Number of times had sex in the last thirty days Age of first intercourse 0 1 2-3 4-9 10-20 20+ Has Considered Suicide 13-14 1.50 1.33 2.80 3.63 3.83 3.14 15-16 3.05 3.00 3.00 3.45 3.50 4.00 17-18 3.07 3.67 2.14 2.60 3.69 2.67 19-20 3.40 4.00 2.00 2.13 2.20 2.57 20-24 2.00 4.00 3.20 - 1.00 - Has not Considered 13-14 2.95 2.92 2.96 2.36 2.49 3.22 15-16 3.02 3.24 2.72 2.70 3.06 3.26 17-18 2.87 2.68 2.31 2.71 2.78 3.00 19-20 2.76 2.67 2.37 2.48 2.60 2.75 20-24 2.44 1.50 1.64 2.00 3.00 1.33 Figure 1. Number of Drinking Days in the Last Thirty