Diary study of substance use and unsafe sex among adolescents with substance use disorders.

PURPOSE: This study tested event-level associations between substance use and condom use, as well as potential covariates, among adolescents with substance use disorders (SUDs).
METHODS: A total of 134 adolescents (age, 15-21 y), 72% with SUDs, participated in telephone diary data collection of sexual events over a 6-week period. Effects on condom use of event-level substance use, partner type, salience of costs associated with unprotected sex, and subject-level SUD and sensation-seeking were tested in random intercept logistic regression models. A total of 637 sexual events were available for analysis.
RESULTS: Event-level alcohol and drug use as well as subject-level SUD and sensation-seeking were not associated with condom use in multivariate models. However, all other event-level measures were significant, including an interaction between partner type and salience of preventing acquired immune deficiency syndrome (AIDS). The importance of preventing AIDS was associated only with condom use with regular partners. Prevention of pregnancy was associated with condom use independent of partner type.
CONCLUSIONS: As in other event-level studies, substance use was not related to condom use in our study. Novel results in our study showed that the salience of preventing negative outcomes is a significant predictor of condom use even in the context of event-level substance use and partner type. These results suggest that prevention efforts for substance-using youth should not focus on preventing substance use as a way to prevent unsafe sex, but should emphasize the potential costs of unsafe sex even with known partners.