Are Drinkers Prone to Engage in Risky Sexual Behaviors?

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1 Amercan Internatonal Journal of Socal Scence Vol. 2 No. 5; July 2013 Are Drnkers Prone to Engage n Rsky Sexual Behavors? Ana Isabel Gl Lacruz Zaragoza Unversty Department of Busness Organzaton and Management Doctor Cerrada, 1, Zaragoza, Span Marta Gl Lacruz Zaragoza Unversty Department of Psychology and Socology Doctor Cerrada, 1, Zaragoza, Span Juan Olva Moreno Castlla la Mancha & FEDEA Unversty Department of Economc Analyss and Fnances Cobertzo de San Pedro Mártr s/n Toledo, Span Abstract Although many studes have explored the lnk between alcohol use and rsky sexual practces, the unobserved dfferences among ndvduals make t dffcult to assess whether the assocatons are casual n nature. We have obtaned data from the Spansh Health and Sexual Behavor Survey (2003) n order to analyze rsky sexual behavors usng four alternatve methodologes: controllng results wth a rch set of varables; dentfyng the mpact of alcohol use whle assumng there s an dentcal selecton outcome for observed and unobserved varables; estmatng alcohol consumpton and rsky sexual behavors smultaneously based on nstrumental varables; and usng reducedform equatons to analyze the mpact of alcohol polces on the lkelhood of rsky ntercourse. We provde emprcal evdence that alcohol abuse mght ncrease the probablty of rsky sex and, more mportantly, dfferent alcohol polces are not only effectve tools for reducng alcohol demand but also for controllng rsky sexual behavors. Keywords: alcohol, sexually transmtted dseases, unobserved ndvdual heterogenety. JEL Classfcaton: C3, D1, H3, I1. 1. Introducton Rsky sexual behavors have a wde range of extremely negatve consequences. Unwanted pregnances and sexually transmtted dseases (STDs) are just starters whch may culmnate n socal excluson, a lower lfe expectancy, or have other farreachng mplcatons. Preventve strateges to reduce the prevalence of STDs and early pregnancy have usually ponted out alcohol consumpton as a determnant of rsky sexual behavors. Thus, a polcy amed at reducng alcohol use (alcohol taxes, mnmum legal drnkng age or antdrug educaton campagns) mght also be effectve n controllng the spread of STDs and reducng underage pregnances. If alcohol consumpton determnes rsky sexual behavors, actons taken to reduce alcohol consumpton mght be a successful tool for combatng the spread of STDs and reducng the number of unwanted pregnances. A recent revew of economcs lterature reveals that ths causalty s not taken for granted. People mght drnk to forget ther problems or abuse alcohol as an excuse to justfy engagng n promscuous sex. If there are other forces affectng the decson to engage n rsky sexual behavors, adoptng measures to address the role of alcohol alone may not be suffcent. Sponsorng nformaton Ths research was completed as part of research project: Health Polces: CSO Innovaton and Scence Spansh Mnster. Sexual and reproductve behavour n Span: rsk factors for health. 35

2 Center for Promotng Ideas, USA The man goal of ths paper s to explore the nature of the lnk between alcohol use and sexual rsky behavors. The Spansh Health and Sexual Behavor Survey (2003) provdes us wth a sold source of data for analyzng how socodemographc characterstcs of the most vulnerable populaton groups affect the prevalence of rsky behavors (Spansh Mnstry of Health and Consumpton 2003). The valuable data t provdes has enabled us to dentfy and evaluate the factors leadng to rsky behavors. Estmates of the mpact of alcohol use on rsky sexual behavors are obtaned usng four alternatve econometrc approaches. The frst econometrc approach uses a rch set of control varables, ncludng atttudes and opnons. The second approach dentfes the mpact of alcohol use under the assumpton that there s an equal selecton of observed and unobserved varables. In the thrd approach we employ nstrumental varables for estmatng the structural relatonshp between alcohol consumpton and rsky sexual behavor. The fourth approach nvolves estmatng reducedform models of the mpact of alcohol prces and other alcohol control polcy varables on the lkelhood of rsky sexual behavor. The man contrbutons of ths paper are twofold. Frst, the majorty of studes publshed on ths topc focus on NorthAmercan adolescents (Carpenter 2005; Dee 2001; Grossman, Kaestner and Markowtz 2004; Grossman, Kaestner and Markowtz 2005; Grossman and Markowtz 2005; Rashad and Kaestner 2004; Rees, Argys and Haberte 2001; Sen 2002; Strunn and Hngson 1992). Very few studes have been performed on NorthAmercan adults (Schrbner, Cohen and Farley 1998), or young adults (Donovan and McEwan 1995; Kenkel 2006; Staton et al. 1999). Our study provdes emprcal evdence on the Spansh populaton wth ages rangng between 1849 years, thereby allowng us to examne whether the results obtaned for NorthAmercan adolescents and youth can be extrapolated to other countres or the adult populaton. Second, although most surveys desgned for smlar purposes, such as the North Amercan Natonal Survey of Famly Growth (2002), nclude standardzed questons (ever had sex; whether had sex n last 12 months; whether user of contraceptves; ever tested for HIV;etc.), the Spansh survey s unque n that t ncludes varables relatng to atttudes. The set of varables on atttudes allow us to check whether the estmated parameters reman robust after controllng for ndvdual perceptons and opnons. 2. Lterature Revew Numerous studes have shown a postve assocaton between alcohol use and rsky sexual practces (Donovan and McEwan, 1995). Despte the repercussons of rsky sexual behavors, economsts have pad relatvely lttle attenton to modelng these behavors, partcularly when we take nto account the work of professonals n other dscplnes, such as developmental psychology (Gruber, 2000). Nevertheless, n recent years, the lterature on the relatonshp between substance abuse and sexual behavor (n adolescents and youth) has grown extensvely. Almost all studes have found that substance abuse of alcohol and other drugs s postvely assocated wth several adolescent sexual behavors such as startng to have sexual ntercourse at a young age, havng multple sexual partners, and engagng n ntercourse wthout contracepton. However, the causal nature of ths relatonshp s dffcult to establsh. Sexual behavors and substance abuse are lkely to depend on a set of personal and socal varables, many of whch are not observed or go unmeasured (Rashad and Kaestner, 2004). Studes that try to estmate the causal lnk between alcohol use and varous measures of rsky sex, account for the econometrc endogenety of the alcohol use measures through methods ncludng nstrumental varables (IVs) and bvarate probt models (Kaestner and Joyce, 2001; Rees, Argys and Averett, 2001; Sen, 2002; Grossman et al., 2004; Grossman and Markowtz, 2005). For example, Grossman et al. (2004) examne the causal mpact of substance abuse on rsky sexual behavors durng adolescence. They found that alcohol use does not ncrease the lkelhood of havng sex or the lkelhood of havng multple partners, although alcohol use does lower the probablty of usng condoms and other forms of brth control among sexually actve teenagers. In ther papers, Kaestner and Joyce (2001) and Grossman and Markowtz (2005) acknowledge that ther nstrumental varable estmatons suffer from problems assocated wth weak nstruments. Rashad and Kaestener (2004) rase smlar concerns about the results of Rees, et al. (2001) and Sen (2002) who also use the nstrumental varable technque. In fact, Rees et al. (2001) and Sen (2002) reach dfferent conclusons based on the same lne of reasonng and smlar data bases. Rees et al. (2001), usng data drawn from the Natonal Longtudnal Study of Adolescent Health 1995, study the effects of marjuana and alcohol use on two sexual behavors: beng sexually actve, and usng some contraceptve method the last tme sexual ntercourse was had. 36

3 Amercan Internatonal Journal of Socal Scence Vol. 2 No. 5; July 2013 They fnd only weak evdence that marjuana and alcohol use nfluence sexual behavor, whch suggests that the lnk between substance abuse and sexual behavor found by prevous researchers may not n fact be causal. Sen (2002), armed wth data drawn from the Natonal Longtudnal Study of Youth 1997, reaches a dfferent concluson. He fnds that alcohol use does ncrease the lkelhood of sexual ntercourse among adolescents, even after accountng for the potental endogenety. Sen suggests that one possble reason for the dfferences between hs results and those of Rees et al. could le on what they consder as a drnkng unt. However, Rashad and Kaestner (2004) argue that the estmaton strategy employed by Rees et al. (2001) and Sen (2002), whle theoretcally plausble, mght generate based results f the nstruments are weak or nvald. Gven these research lmtatons, econometrc studes of the relatonshp between alcohol polces and rsky sex have also reached mxed conclusons. To overcome these techncal problems, one set of econometrc studes estmates the reducedform model or drect relatonshp between alcohol control polces and adverse outcomes related to rsky sex. Scrbner et al. (1998) report a negatve relatonshp between gonorrhea rates and the alcohol outletpopulaton rato wthn resdental urban areas. Chelson et al. (2000) show that gonorrhea and syphls rates fall as the state beer and lquor tax rses. Dee (2001) fnds mxed evdence that hgher drnkng mnmum ages reduce chldbearng among teenagers and youth. Carpenter (2005) demonstrates that the adopton of a Zero Tolerance law whch makes t llegal for underage drvers to have any traceable amount of alcohol n ther blood s assocated wth a statstcally sgnfcant reducton of gonorrhea rates among 15 to 19 years old whte males. The fact that there s no relatonshp between the Zero Tolerance laws and gonorrhea rates for slghtly older males who were not affected by the laws provdes evdence supportng a causal effect. Along the same lnes, Grossman et al. (2005) fnd that hgher beer taxes and the exstence of Zero Tolerance laws are assocated wth lower male gonorrhea rates, although other alcohol polces such as Blood Alcohol Content laws or dry countes appear not to have any effect. The lmtaton of usng reducedform estmatons s that the estmated results nform us ndrectly about the nfluence of alcohol consumpton on rsky sexual behavors, but t does not quantfy the magntude of ths nfluence. In ths paper we am to advance our understandng of the causalty between alcohol consumpton and rsky sexual behavors by followng the man gudelnes of earler studes and hghlghtng the role of the ndvdual s atttudes n the correcton of unobserved heterogenety bas. 3. Data We use data from the Spansh Health and Sexual Behavor Survey (2003). The HSBS was conducted by the Spansh Mnstry of Health and Consumer Affars between October and December, The HSBS focuses on persons between 18 and 49 years old lvng n sngle famly dwellngs n Span. To obtan a specfc level of relablty (at both natonal and regonal levels), the survey was gven to a sample group of 13,600 ndvduals dstrbuted among 1,700 census sectons. The HSBS survey contans the followng sectons: (A) Socodemographc characterstcs, ncludng varables such as age, gender, educatonal level, martal status, economc actvty, and professonal stuaton; (B) Lfestyles, ncludng questons related to the frequency of gong out at nght, alcohol consumpton and njected drug use; (C) Informaton and sexual experence, ncludng questons related to one s frst sexual relatonshp, partners, and current and past sexual relatonshps; (D) Sexual Health, (E) HIV tests; and (F) Atttudes and Perceptons. (See Table I) The questons related to lfestyles are very mportant to understand the patterns of rsky behavors. However the consderaton of lfestyles n the emprcal models s lmted because these varables mght ntroduce serous problems of endogenety. For example, people who enjoy gong out at nght mght drnk more, but at the same tme, people who lke drnkng alcoholc beverages mght spend more nghts gong out. Regardng alcohol consumpton, we consder two knds of measures: f the ndvdual consumes 3 or more alcoholc beverages on one occason at least once a week, and f the ndvdual has been drunk at least once n the last month. The advantage of the frst measure s that t represents a neutral ndex that combnes frequency and quantty. The queston s where to draw the lne between quanttes ndcatve of moderate alcohol consumpton and those of alcohol abuse. Two dfferent quanttes should be establshed for men and women. We use only one quantty for both sexes, because apart from beng the only avalable nformaton we have, t s the smplest way to show the results. In addton, precse measurements would requre that other mportant bologcal factors such as an ndvdual s heght or weght also be taken nto consderaton. The advantage of the second measure s that t nforms us about the nfluence of alcohol consumpton on the ndvdual capabltes. 37

4 Center for Promotng Ideas, USA Some people become nebrated after just one drnk, whereas others may not feel any symptoms whatsoever. The problem rests n t beng a selfreported measure that depends on the percepton of the ndvduals. On one hand, many people mght thnk they are fne after drnkng, but n fact they are drunk. Ths stuaton s common seen n car accdents where drvers who were under the nfluence of alcohol thought they could drve wthout any problem. On the other hand, the consumpton of alcoholc beverages s determned by the addctve characterstcs of tolerance and renforcement (Becker and Murphy, 1988). Ths explans why ndvduals who could consume a large number of drnks at one tme when they were youths may fnd that a fewer number of drnks has the same or an even stronger effect on them later n lfe. Accordng to the HSBS, 24% of men consume 3 or more alcoholc beverages per occason at least once a week, as compared to 7% of women. The percentage of ndvduals who have been drunk at least once n the month pror to the admnstraton of the survey are qute smlar for men and women. Wth rates around 45%, ths selfreported subjectve measure reveals greater alcohol abuse than the objectve quanttatve measure. Because the percentage for alcohol consumpton among males was astonshngly hgh, we performed an analyss by age dstrbuton. As expected, youths abuse alcohol more than adults. The values for women of varous ages vary only slghtly, whereas the values for men reveal a greater decrease wth age. Regardng rsky sexual behavors we consder two possble measures. The frst one dentfes ndvduals who had ntercourse wth occasonal partners n the last 12 months. The rsk les n havng relatons wth strangers, thus ther drug use or sexual habts may not be known. The second measure s narrower n that t dentfes ndvduals who had ntercourse wth occasonal partners wthout usng a male condom n the last 12 months. Condom use s the only effectve preventatve method aganst HIV, and other sexually transmtted dseases. The mean analyss of Table I reveals that for example, on average 37% and 21% of men and women who drank 3 or more alcoholc beverages per occason at least once a week had sexual relatonshps wth occasonal partners durng the 12 months before the survey, versus the 20% and 7% of men and women who dd not drnk 3 alcoholc beverages per occason every week. These dfferences are statstcally sgnfcant at 5% level. Along wth the ndvdual observatons provded by the HSBS, we use contextual data. Contextual varables nform us about alcohol polces whch are essental for the econometrc approaches of nstrumental varables and reducedform equatons. As a measure of the alcoholc beverages prces we use the fgures calculated by the Spansh Mnstry of Agrculture, Fsheres and Food from the Household Budget Inqury (2003). Other control polces we consder nclude dfference between the mnmum drnkng age and 18, f any, and the regonal publc expendture allocated to preventon, health care and socal work, research and nsttutonal coordnaton n antdrug programs. The Spansh Consttuton (art. 4) gves the Regonal Authortes the power to ntervene n publc health affars. 4. Emprcal Framework We use a standard econometrc framework to explore the relatonshp between alcohol consumpton and rsky sexual behavors. The results do not change substantally when we select only those ndvduals that are sexually actve because 95% of the subjects ntervewed have already had ntercourse. The selecton of sexually actve ndvduals mght be more meanngful for studes of adolescents and youths. In our sample, for example, 65% of 18 yearold women are sexually actve, but ths percentage s close to 100% for women above 30. Our emprcal framework s smlar to that used n prevous econometrc studes and falls wthn the canoncal econometrc approach for studes usng observatonal crosssectonal data ( ndexes ndvduals) to dentfy the causal effects of healthrelated behavors: H X D u H s the measure of rsky sexual behavor, D s a measure of alcohol use, X s a vector of socodemographc characterstcs (gender, age, cvl status, famly composton, level of educaton, workng status, among others) and u s a zeromean dsturbance term. The key parameter of nterest s because t provdes nformaton on the causal effect of alcohol use on rsky sexual behavors, controllng for dfferences n the observed ( X ) and unobserved ( u ) determnants of rsky sexual behavors. 38

5 Amercan Internatonal Journal of Socal Scence Vol. 2 No. 5; July 2013 The fundamental challenge n usng observatonal data to estmate s the possblty that even after controllng for observed characterstcs, the unobserved determnants ( u ) may vary wth the health behavor D. Consequently, a potental challenge to ths research mght be that unobserved determnants of rsky sexual behavors could vary wth alcohol use. Our ntal response to ths challenge s the smplest: we plan to nclude a very rch set of observed characterstcs ( X ) to model the mpact of alcohol use on rsky sexual behavors. The rch set of atttude varables ncluded n the HSBS s essental for defnng the set of control varables. Wthn the conceptual economc framework, and n lght of the nsghts of other socal scence research, t s natural to expect that ndvdual atttudes or preferences are mportant determnants of both H and D. For example, ndvduals wth conservatve atttudes may be less lkely to engage n rsky sex or get drunk. Controllng for the range of atttudes and perceved rsks reduces unobserved heterogenety and mproves our estmates of. We are aware that ncludng atttudes varables n the estmatons ntroduces a problem of endogenety. We do not analyze the estmated parameters of these varables because they may reflect bas. The mportance of ths strategy les on the fact that f the estmaton of s robust, ts value wll not vary sgnfcantly for the varables we consder n the model. Our second approach s to develop an unbased estmaton of followng the approach of Altonj et al. (2005), thus dentfcaton s acheved by assumng there s an equal selecton of observed and unobserved varables, and not by the ntroducng nstrumental varables. Ths approach s based on the assumpton that the determnants of the outcome can be dvded nto observed and unobserved determnants. The dentfcaton problem s that the endogenous varable s lkely to be correlated wth the unmeasured component. To solve ths problem, Altonj et al. (2005) argue that not only the unmeasured component s lkely to be correlated wth the endogenous varable, but also the measured component. They assume that the correlaton between the unobserved determnants of the outcome and the endogenous varable s equal to the correlaton between the observed determnants of the outcome and the endogenous varable (Equal Selecton Rule). Equal Selecton Rule s justfed n the fact that measured varables are chosen randomly from a large set of possble determnants. Ths assumpton s reasonable gven that most secondary data sets are not usually desgned for the specfc research queston under nvestgaton but for many other uses. The equal selecton rule provdes us wth an estmaton of the correlaton between the errors that we ntroduce n the estmaton of the bvarate probt model, thus the nstrumental varable technque s no longer requred to acheve dentfcaton. Our fnal two approaches to studyng the relatonshp between rsky sexual behavors and alcohol use treat alcohol use as econometrcally endogenous. These approaches address not only the problem of unobserved heterogenety, but also the possblty that there may be reverse causaton. The man mplcaton of ths reverse causalty s that the correlaton between alcohol ntake and the dsturbance term s not zero, what mght lead to an underestmaton of the treatment effect of alcohol ntake on rsky sexual behavors. To correct the problem of reverse causalty we wll estmate the rsky sexual behavors by treatng alcohol ntake as an endogenous varable. Wth ths n mnd, our focus s on the alcohol demand functon: D X P Y v Accordng to the demand functon, the ndvdual decson about consumng alcoholc beverages depends on the prce of the product ( P ) and the avalable budget ( Y ). Other alcohol control polces have smlar effects to the alcohol prce, so the way to ntroduce them n the alcohol demand functon s dentcal to the alcohol prces. The nfluence of the monetary varables on alcohol demand are descrbed by and. We also consder a set of socodemographc varables that we assume to be dentcal to the one that determnes the adopton of rsky sexual behavors. The vector of parameters related to socodemographc characterstcs s and v s the zeromean dsturbance term. To estmate rsky sexual behavors n reducedform, we substtute the alcohol ntake varable by the expresson of the alcohol demand functon n the frst equaton: H X P Y 39

6 Center for Promotng Ideas, USA Ths expresson allows us to understand the nfluence of structural polces on the reducton of rsky sexual behavors. The nfluence of the monetary varables on rsky sex s descrbed by and. The zeromean dsturbance term s reported as. To proceed wth ths methodology we need to ntroduce varables, commonly referred to as nstrumental varables, whch affect the demand for alcoholc beverages but not the outcome. The basc nstruments ntroduced for estmatng the rsky sexual behavors wth alcohol ntake as an endogenous varable are the prces of the alcoholc beverages and other alcohol control polces. In the proposed work, we wll conduct standard specfcaton tests to determne f our models face the problems assocated wth weak nstruments (Bound, Jeager and Baker 1995). 5. Results Once the emprcal framework has been descrbed, we move on to examne the relaton between alcohol consumpton and rsky sexual behavors usng the four alternatve methodologes descrbed n the emprcal framework. In order to know f the estmated mpact of alcohol use on rsky sexual behavors s consstent, we estmate rsky sexual behavors wth and wthout ndvdual perceptons and opnons. In the lst of atttude varables we nclude relgous atttudes, perceved HIV rsk by type of ntercourse, perceved HIV rsk n general, socal acceptance of HIV postve populaton, perceved effectveness at preventng spread of HIV, opnons on condoms and blood tests. If the unobserved heterogenety s mportant, the estmated parameter of alcohol consumpton wll be much lower usng a rch set of varables. The unvarate probt estmatons of Table II reveal that after controllng for a rch set of atttude varables the estmated margnal fxed effects of alcohol consumpton on rsky sexual behavors drop anywhere from 0.13 to 2.6 percentage ponts (where the estmated parameters are statstcally sgnfcant). Therefore, not controllng for unobserved heterogenety mght overestmate the mpact of alcohol use on rsky sexual behavors. The role of unobserved heterogenety seems to be as mportant for males as for females. Dfferent results come from both the choce of econometrcal model and the manner n whch the varables are defned. We observe that the mpact of the value for frequency and quantty of alcohol ntake s greater than the nfluence of the value ndcatng whether the ndvdual was drunk. Regardng rsky sexual behavors, the mpact of alcohol consumpton s greater for the probablty of sexual ntercourse wth occasonal partners than for the probablty of unprotected sex wth occasonal partners. (See Table II) In Table III, we show the estmated parameters of alcohol consumpton on rsky sexual behavors for male and female respondents mposng dfferent levels of correlaton between the resduals of both varables to acheve dentfcaton n bvarate probt models. The values of rho are defned n two ways: To begn, we show the estmatons of constraned bvarate probts for whch values of the correlaton coeffcent of rho (ρ) are fxed. Secondly, we assume there s an equal selecton between observed and unobserved varables. Fxng dfferent values of rho reveals how necessary t s to select unobserved characterstcs n order to elmnate the postve assocaton between alcohol consumpton and sexual rsky behavors. We consder that ρ takes values from 0.1 to In general, the stronger the correlaton between the unobserved characterstcs of alcohol consumpton and rsky sex, the lower the estmated parameter of alcohol consumpton n the estmaton of rsky ntercourse s gong to be. In fact, the postve relaton between alcohol consumpton and rsky sex mght not be taken for granted. Achevng dentfcaton by mposng the selecton rule reveals that there s an nsgnfcant amount of selecton of observed characterstcs for males. In the case of males, all four correspondng estmated parameters are statstcally sgnfcant. For females, the selecton of observed characterstc s greater, but the mpact of alcohol consumpton on rsky sex s lower. Ths result s derved from the only estmated parameter that s statstcally sgnfcant. Gven that only one parameter out of four s statstcally sgnfcant, the emprcal evdence for females s weaker than for ther male counterparts (See Table III) The smultaneous equaton system allows us to estmate alcohol consumpton and rsky sexual behavors at the same tme. Where both varables are estmated smultaneously, alcohol consumpton s not as strong an ndcator of the prevalence of rsky sexual behavors. In fact, only one parameter out of eght remans statstcally sgnfcant. The frst stage of the nstrumental varable technque provdes us wth mportant nformaton related to the determnants of the demand for alcohol. 40

7 Amercan Internatonal Journal of Socal Scence Vol. 2 No. 5; July 2013 Monetary varables affect demand as expected; hgher wages and lower prces encourage alcohol abuse. Regardng other alcohol polces, the number of years that a regonal government has had the mnmum drnkng age set at 18 years old s nversely related to the ncdence of alcohol abuse. The level of publc spendng on preventon and health care/socal work reduces alcohol abuse. In ths table, specal attenton s also pad to test the nstrumental varable technque. The endogenety test of Durbn Watson confrms that alcohol consumpton mght act lke an endogeneous explanatory varable, because n 5 out 8 tmes the null hypothess of nonendogenety s not accepted. Regardng the nstruments, the tests of ndvdual and jont sgnfcance show that n general the nstruments are statstcally sgnfcant. These results vary substantally across estmatons. The nstruments we consder mght not mprove the results of prevous research because they do not provde an explanaton for an ndvdual s level of alcohol consumpton. For example, the aggregated regonal alcohol prce scarcely explans the male probablty of consumng 3 or more alcoholc beverages per occason n 0.11%. The general explanatory power of the nstruments s around ths value, so we mght conclude they are weak. Ths weakness should lead us to consder the results of Table IV wth cauton. (See Table IV) Lastly, we contnue wth the reducedform equaton model that avods the problem of endogenety by excludng the endogenous explanatory varables from the estmatons. The man result s that the prce of alcoholc beverages mght prove a useful means for decreasng rsky sexual behavors. In addton, ndvduals wth hgher wages are more lkely to adopt rsky sexual behavors. The number of years that the law establshng 18 as the mnmum drnkng age has been n force has a drect postve effect on controllng rsky sexual behavors. Polcymakers may also be nterested n the fact that our results reveal that regons whch have nvested more money n drug preventon measures have lower ndvdual rates of rsky sexual behavors. (See Table V) 6. Conclusons and Polcy Implcatons Emprcal research can provde nternatonal and natonal polcy makers wth a useful analytcal tool to assess the effectveness of ther actons. In ths paper we have obtaned enough emprcal evdence to conclude that alcohol consumpton mght promote the adopton of rsky sexual behavors, and consequently, that alcohol polces mght also reduce the negatve outcomes assocated wth unsafe sex. Regardng specfc alcohol polces, there s emprcal evdence that ncreasng the prce of alcoholc beverages reduces the ncdence of rsky sex. The mnmum drnkng age s smlarly a postve nstrument to control not only the alcohol demand but also the prevalence of rsky sex. Our results provde evdence that preventve strateges of ths nature could become more effectve over tme. However these results must be nterpreted wth cauton as there may be regons n whch polcy makers are wllng to ntroduce reforms early f they beleve them to be n the best nterests of ther ctzens. In turn, ths result mght lead to common unobserved characterstcs n the area where survey respondents lve. Regardng general antdrug polces, we also demonstrate that allocatng publc expendture to fght aganst drugs has also postve effects for reducng of rsky sexual behavors. Not only s the sze of the budget mportant, but also how t s allocated among dfferent areas. For example, the area of preventon has postve outcomes n terms of lower rates of rsky sexual behavors, whereas the area of nsttutonal coordnaton s characterzed by ts effectveness n controllng rsky sex. The relevance of these results les n dentfyng alcohol polces as costeffectve strateges n the promoton of a healthy and stable socety. Controllng alcohol use also makes t possble to control other rsky actvtes, such as rsky sex. Bvarate probt estmatons n whch dentfcaton s acheved under the equal selecton rule prevent us from takng for granted a causal relatonshp between alcohol consumpton and rsky sex. In fact, the unobserved heterogenety mght be mportant and alcohol consumpton s certanly not the only determnant of rsky sex. Asde from alcohol controls, t s necessary to mplement specfc polces to reduce rsky sexual behavors, such as nformaton campagns amed at preventon whch encourage the use of male condoms. Gven the weakness of the nstruments, our results usng the nstrumental varable technque are not better than those obtaned n earler studes. It would be nterestng to check whether the results obtaned wth crosssecton surveys are consstent wth the results derved from panel data. The man advantage of usng panel data s that ndvdual heterogenety can be controlled for usng fxed effects. In addton, both alcohol consumpton and rsky sex mght be nfluenced by peer effects, so the omsson of peer effects mght overestmate the effects of the explanatory varables. 41

8 Center for Promotng Ideas, USA Lastly, t would be nterestng to perform a study of the ntergeneratonal effects of habts, means of transmsson and socal networks on alcohol consumpton and sexual ntercourse. To address these challenges, we recommend that future surveys be desgned to collect rch nformaton ncludng admnstratve and longtudnal data. References Altonj, J.G., Taber, C.R., & Elder, T.E. (2005). Selecton on observed and unobserved varables: assessng the effectveness of Catholc Schools. Journal of Poltcal Economy, 113, Becker, G., & Murphy, K. (1988). A theory of ratonal addcton. Journal of Poltcal Economy, 96, Bound, J., Jeager, D., & Baker, R. (1995). Problems wth nstrumental varables estmaton when the correlaton between the nstruments and the endogenous explanatory varable s weak. Journal of the Amercan Statstcal Assocaton, 53, Carpenter, C. (2005). Youth alcohol use and rsky sexual behavor: evdence from underage drunk drvng laws. Journal of Health Economcs, 24, Chesson, H., Harrson, P., & Kassler, W.J. (2000). Sex under the nfluence: The effect of alcohol polcy on sexually transmtted dsease rates n the US. Journal of Law and Economcs, 43, Dee, T. (2001). The effects of mnmum legal drnkng ages on the teen chldbearng. Journal of Human Resources, 36, Donovan, C., & McEwan, R. (1995). A Revew of the Lterature Examnng the Relatonshp between Alcohol Use and HIVRelated Sexual RskTakng n Young People. Addcton, 90, Grossman, M., Kaestner, R., & Markowtz, S. (2004). Get hgh and get stupd: The effect of marjuana use on teen sexual behavor. Revew of Economcs and Household, 2, Grossman, M., Kaestner, R., & Markowtz, S. (2005). An nvestgaton of the effects of alcohol polces on youth STDs. In B. Lndgren & M. Grossman (eds.). Advances n health economcs and health servces research. Substance abuse: Indvdual behavor, socal nteractons, markets and poltcs. Oxford: Elsever. Grossman, M., & Markowtz, S. (2005). I dd what last nght? Adolescent rsky sexual behavor and substance abuse. Eastern Economc Journal, 31, Gruber, J. (2000). Introductory chapter. In: Gruber J (ed.) Rsky behavor among youth: an economc analyss. Chcago: Chcago Press, Kenkel, D. (2006). Health behavors among young people. In A Jones (ed.). The Elgar companon to health economcs. Cheltenham: Edward Elgar Publshng, Rashad, I., & Kaestner, R. (2004). Teenage sex, drugs and alcohol use: problems dentfyng the cause of rsky behavors. Journal of Health Economcs, 23, Rees, D.I, Argys, I.M., & Averett, S.L. (2001). New evdence on the relatonshp between substance abuse and adolescent sexual behavor. Journal of Health Economcs, 20, Schrbner, R.A., Cohen, D.A., & Farley, T.A. (1998). A geographc relaton between alcohol avalablty and gonorrhea rates. Sexually Transmtted Dseases, 25, Sen, B. (2002). Does alcoholuse ncrease the rsk of sexual ntercourse among adolescents? Evdence from the NLSY97. Journal of Health Economcs, 21, Spansh Mnstry of Agrculture, Fsheres and Food (2003) Household Budget Inqury. IOP Web. Accessed Spansh Mnstry of Health and Consumpton (2003): General Methodology of Health and Sexual Habts Survey IOP Web. Accessed Staton, M., Leukefeld, C., Logan, T.K., Zmmerman, R., Lynam, D., Mlch, R., Martn, C., McClanhan, K., & Clayton, R. (1999). Gender dfferences n substance abuse and ntaton of sexual actvty. Populaton Research and Polcy Revew, 18, Strunn, L, & Hngson, R. (1992). Alcohol, drugs, and adolescent sexual behavor. Internatonal Journal of Addcton, 27, U.S. Department of Health and Human Servces (2002). Natonal Survey of Famly Growth Cycle 6: IOP Web. ftp://ftp.cdc.gov/pub/health_statstcs/nchs; Accessed

9 Amercan Internatonal Journal of Socal Scence Vol. 2 No. 5; July 2013 Table I. Sample means of selected characterstcs by gender and alcohol consumpton Males: Weekly alcohol consumpton (3 or more drnks) Females: Weekly alcohol consumpton (3 or more drnks) Yes Mean: No Mean: Yes Mean: No Mean: Sexual ntercourse wth occasonal partners (12 months) Unprotected sex wth occasonal partners (12 months) Socodemographc characterstcs Age Spansh natonalty Foregn natonalty Marred Sngle Dvorced/Separated Wdow Lvng wth partner Lvng wth parents Lvng wth chldren Lvng wth frends Prmary educaton Secondary educaton Professonal tranng College studes Workng Unemployed Studyng Housewfe/husband Other Relgous atttudes Catholc Other relgon Agnostc/Personal belefs Relgous servces more than once a week Relgous servces once a week Perceved rsk of contractng HIV by type of sexual ntercourse Wth a stable partner of the opposte sex Wth stable partner/occasonally of the opposte sex Wth dfferent partners Wth a stable partner of the same sex (men) Wth stable partner/occasonally of the same sex (men) Wth dfferent partners of the same sex (men) Wth partner of the same sex (women) Perceved rsk of contractng HIV n general Sexual ntercourse Drnkng from a glass used by a person wth HIV Socal acceptance of HIV postve populaton Wllng to work wth a person wth HIV Perceved effectveness of preventng spread of HIV Washng after sexual ntercourse Lmtng the number of sexual partners Usng a male condom Askng sexual partners to take an HIV test Usng spermcde Askng sexual partners about sexual past Usng a female condom Condom opnons Reduce pleasure for women Reduce pleasure for men Make t mpossble to feel the other person Provde addtonal pleasure because of safety Are safe Blood control HIV analyss/blood donaton ndcates that the dfferences between drnkers and non drnkers s statstcally sgnfcant (95%) We have also ncluded regonal dummy varables (North, South, Centre, East and Madrd) Ths table s susceptble of repetton dfferentatng the means by alcohol abuse % and 45.52% of men and women have been drunk at least once n the last month. 43

10 Center for Promotng Ideas, USA Table II. The nfluence of alcohol consumpton on the probabltes of rsky sexual behavors (Smple probts) Males Females Addtonal Covarates No Yes No Yes N Sexual ntercourse wth occasonal partners n the last 12 months Real probablty (%) Weekly alcohol consumpton wth 3 or more drnks per occason * (0.0501) [0.0830] * (0.0748) [0.0817] * (0.0929) [0.0663] * (0.1348) [0.0479] Estmated probablty (%) PseudoR 2 (%) Drunk last month on at least * * * one occason (0.0470) (0.0707) (0.0600) * (0.0872) [0.0179] [0.086] [0.0608] [0.0225] Estmated probablty (%) PseudoR 2 (%) Unprotected sex wth occasonal partners n the last 12 months Real probablty (%) Weekly alcohol consumpton wth 3 or more drnks per occason * (0.0582) [0.0521] * (0.0917) [0.0356] * (0.1108) [0.0380] (0.1869) [0.0109] Estmated probablty (%) PseudoR 2 (%) Drunk last month on at least one occason * (0.0569) * (0.090) (0.0738) * (0.1169) [0.0063] [0.0335] [0.0248] [0.0047] Estmated probablty (%) PseudoR 2 (%) Standard errors n parentheses. Margnal effects n brackets Basc set of covarates: Socodemographc characterstcs Addtonal covarates: Relgous atttudes, perceved HIV rsk by type of sexual ntercourse, perceved HIV rsk n general, socal acceptance of HIV postve populaton, perceved effectveness at preventng spread of HIV, opnons on condoms and blood tests. 44

11 Amercan Internatonal Journal of Socal Scence Vol. 2 No. 5; July 2013 Table III. The nfluence of alcohol consumpton on rsky sexual behavors Males Females Constraned Bvarate Probt BvarateProbt Constraned Bvarate Probt Cov X, X ρ = 0.1 ρ = 0.3 ρ = 0.5 Var X ρ = 0.1 ρ = 0.3 ρ = 0.5 BvarateProbt Cov X, X Var X Sexual ntercourse wth occasonal partners n the last 12 months Real probablty (%) Weekly alcohol consumpt on wth 3 or more drnks Estmated prob. (%) Drunk last month on at least one occason * ( ) [ ] * (0.0724) [ ] * (0.0681) [0.0500] * (0.0747) [0.0219] ˆ = * ( ) [ ] (0.1299) [ ] * (0.1217) [ ] ( ) [ ] * (0.0685) [ ] * (0.0645) [0.0852] * (0.0707) [0.0218] ˆ = ( ) [ ] * (0.0846) [ ] * (0.0799) [ ] Estmated prob. (%) Unprotected sex wth occasonal partners n the last 12 months Real probablty (%) Weekly alcohol consumpt on wth 3 or more drnks Estmated prob. (%) Drunk last month on at least one occason Estmated prob. (%) Notes: Table * ( ) [ ] (0.0891) [0.0067] * (0.0839) [0.0255] (0.0919) [0.0098] ˆ = ( ) [ ] * (0.1813) [ ] * (0.1706) [ ] ( ) [ ] * (0.0881) [0.0136] * (0.0831) [0.0444] * (0.0908) [0.0105] ˆ = ( ) [ ] * (0.1135) [ ] * (0.1075) [ ] * (0.1246) [0.0035] ˆ = (0.0867) [0.0001] ˆ = (0.1856) [0.0001] ˆ = (0.1168) [0.0013] ˆ =

12 Center for Promotng Ideas, USA Table IV. Alcohol consumpton and rsky sexual behavors under a framework of smultaneous equatons (Instrumental Varables Technque) 2 ND STAGE Weekly alcohol consumpton wth 3 or more drnks Sexual ntercourse wth occasonal partners (12 months) Unprotected sex wth occasonal partners (12 months) Males Females Males Females Prob: Prob: 7.97 Prob: 8.15 Prob: * (0.6842) (1.4178) (0.8571) (1.8651) [0.3332] [0.4900] [0.1748] [0.0969] Estmated probablty (%) PseudoR 2 (%) DW endogenety test χ 2 (1)=8.22 χ 2 (1)=2.41 χ 2 (1)=2.50 χ 2 (1)=3.40 Pr>χ 2 = Pr>χ 2 = Pr>χ 2 = Pr>χ 2 = Drunk last month on at least one (0.5213) (1.2540) (0.6730) (1.7067) occason [0.0559] [0.2564] [0.1296] [0.0279] Estmated probablty (%) PseudoR 2 (%) DW endogenety test χ 2 (1)=5.81 χ 2 (1)=3.08 χ 2 (1)=1.37 Pr>χ 2 = Pr>χ 2 = Pr>χ 2 = ST STAGE Weekly alcohol consumpton wth 3 or more drnks Ever Drunk last week χ 2 (1)=5.67 Pr>χ 2 = Males Females Males Females Wages * * Alcohol prce * Years legslaton n place * * Preventon (t1) * * Health care/socal work (t1) * * Research (t1) * Coordnaton (t1) * Test of jont sgnfcance χ 2 (9)=23.95 Pr>χ 2 = χ 2 (9)=12.02 Pr>χ 2 = χ 2 (9)=34.73 Pr>χ 2 = R 2 (%) R 2 R 2 mnus Wages (%) R 2 R 2 mnus Alcohol prce (%) R 2 R 2 mnus Year legs. (%) R 2 R 2 mnus Preventon (%) R 2 R 2 mnus Health care (%) R 2 R 2 mnus Research (%) R 2 R 2 mnus Coordnaton (%) χ 2 (9)=14.85 Pr>χ 2 = Standard errors n parentheses. Margnal effects n brackets. Basc set of covarates: Socodemographc characterstcs. Instruments for the varables related to alcohol consumpton: Regonal alcohol prces, regonal salares, and regonal antdrug polces. 46

13 Amercan Internatonal Journal of Socal Scence Vol. 2 No. 5; July 2013 Table V. The nfluence of alcohol polces on rsky sexual behavors (Reducedform equatons) Wage * (1.7308) [1.0191] Alcohol prce * (0.8433) [0.6957] Years legslaton n place * (0.0256) [0.0144] Preventon (t1) (0.2095) [0.1333] Health care/socal work (t1) (0.2126) [0.0679] Research (t1) (0.0778) [0.0068] Coordnaton (t1) (0.0406) [0.0013] Sexual ntercourse wth occasonal partners (12 months) Unprotected sex wth occasonal partners (12 months) Males Females Males Females (2.3170) (2.2370) (4.0813) [0.0142] [0.1513] [0.2474] (1.0917) [0.0530] (0.0351) [0.0019] (0.2791) [0.0368] (0.2883) [0.0228] (0.1078) [0.0109] (0.0578) [0.0120] (1.0959) [0.2234] (0.0334) [0.0008] (0.2731) [0.0166] (0.2705) [0.0013] (0.0999) [0.0144] (0.0494) [0.0036] * (2.3412) [0.2291] (0.0580) [0.0023] (0.5336) [0.0462] (0.4269) [0.0031] (0.1417) [0.0080] Real probablty (%) Estmated probablty (%) PseudoR 2 (%) Standard errors n parentheses. Margnal effects n brackets Basc set of covarates: Socodemographc characterstcs Monetary varables are expressed n logarthmc transformatons. Basc set of covarates: Socodemographc characterstcs * (0.0763) [0.0078] 47

14 Center for Promotng Ideas, USA Table V. The nfluence of alcohol polces on rsky sexual behavors (Reducedform equatons) Wage * (1.7308) [1.0191] Alcohol prce * (0.8433) [0.6957] Years legslaton n place * (0.0256) [0.0144] Preventon (t1) (0.2095) [0.1333] Health care/socal work (t1) (0.2126) [0.0679] Research (t1) (0.0778) [0.0068] Coordnaton (t1) (0.0406) [0.0013] Sexual ntercourse wth occasonal partners (12 months) Unprotected sex wth occasonal partners (12 months) Males Females Males Females (2.3170) (2.2370) (4.0813) [0.0142] [0.1513] [0.2474] (1.0917) [0.0530] (0.0351) [0.0019] (0.2791) [0.0368] (0.2883) [0.0228] (0.1078) [0.0109] (0.0578) [0.0120] (1.0959) [0.2234] (0.0334) [0.0008] (0.2731) [0.0166] (0.2705) [0.0013] (0.0999) [0.0144] (0.0494) [0.0036] * (2.3412) [0.2291] (0.0580) [0.0023] (0.5336) [0.0462] (0.4269) [0.0031] (0.1417) [0.0080] Real probablty (%) Estmated probablty (%) PseudoR 2 (%) Standard errors n parentheses. Margnal effects n brackets Basc set of covarates: Socodemographc characterstcs Monetary varables are expressed n logarthmc transformatons. Basc set of covarates: Socodemographc characterstcs * (0.0763) [0.0078] 48

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