Macau is a small city in southern China with a population of 0.6 million, Chinese and overseas capital has been investing in the gaming industry since the mid-2000s, turning this former Portuguese colony into an entertainment city [1
]. Despite its rapid economic growth and social change, Macau is relatively underdeveloped in youth research [2
]. Ample research evidence in the West has suggested that negative peer influence and poor school attachment affects the sexual behavior of young people [5
], while substance abuse can also have an impact on adolescent sexual behavior [9
]. Given that Macau is a mixture of Eastern and Western cultures, it is worthwhile examining whether similar findings will be observed among young people in the context of Macau. A study on the relations between school attachment and commitment, negative peer influence, substance abuse, and sexual misconducts among Macau youth would be most valuable.
Negative human activities, such as substance abuse and risky sexual behavior, which are common in the West, are also prevalent among adolescents in Macau [3
]. In the West, research studies indicate that there is a strong relationship between substance abuse and risky sexual behavior among adolescents [10
]. While risky sexual behavior focuses more on negative health aspects, such as sexually transmitted diseases, there is relatively little research attention regarding sexual misconduct of adolescents in Chinese communities. Sexual misconduct puts the emphasis on the legitimacy and appropriateness rather than the health consequences of sexual behavior. There has been very limited attention given to the study on adolescent sexual misconduct. Little is known regarding the relationship between substance abuse and sexual misconduct for adolescents under 18 years old in Macau. There is a need to fill the research gap and explore whether negative peer influence, poor school attachment, and substance abuse are factors that contribute to sexual misconduct. Since Macau is a sociocultural fusion of Chinese and Western countries, a study on the relationship between substance abuse and sexual misconduct may have wider implications for cities with fast growing economies and social changes. This helps shed light on policy formation.
The present study investigates the relationship between peer influence, school attachment, and substance abuse and sexual misconduct among Macau youths. Its objective is not to investigate the prevalence of substance abuse, but to examine whether substance abuse is related to sexual misconduct among youths in Macau.
1.1. Adolescent Sexual Misconduct
The situation of sexual misconduct among adolescents worldwide is rather bleak. A survey in the United States (U.S.) documented that 7.4% of students between Grade 9–Grade 12 reported having been physically forced to have sexual intercourse without consent [11
]. The prevalence of this kind of sexual coercion was higher among females (11.3%) than males (3.5%). A survey in the U.S. on sexual assault (including rape, sodomy, and caressing) indicates that 37% of children under the age of 6 years, 42% of children between ages 6–11, and 33% of adolescents between ages 12–17 were sexually victimized by a juvenile offender under the age of 18 [12
]. On the other side of the world, the prevalence of compensated dating (Yuan Jiao
; an Eastern form of underage prostitution, literally means the “exchange of intimate sexual behavior with monetary rewards) in Hong Kong has been estimated to be 2.7%. These adolescents were more likely to exhibit risky sexual behavior and resulted in unintended pregnancy [13
Sexual misconduct is a broad term that encompasses any inappropriate behavior of a sexual nature that is of lesser offense than sexual crime (such as rape), but is regarded as violating the social norms of society. Examples of sexual misconduct include, but are not limited to, unwelcome kissing or body touching, participating in erotic games, prostitution or compensated dating, sexual coercion, and so on. The definition of sexual misconduct also varies according to the age and mental capacity of the individuals, but it is not solely determined by the behavior per se. A behavior can be defined as sexual misconduct when it is committed by or to a person of underage or of under-functioning mental capacity (e.g., under the effect of alcohol or drugs), but the same behavior may not be a misconduct when performed by an adult who has obtained consent from another adult of normal mental functioning. For example, visiting a sex worker or participating in erotic games can be regarded as sexual misconduct when an adolescent under the age of eighteen performs it.
The laws of Macau (and China where Macau is its special administrative region) define young people under eighteen years old as a minor. Chinese parents have held a highly conservative attitude towards the sexual behavior of minor. Previous research on Chinese parents found that, while they recognized the changing social norms regarding sexuality, they were ambivalent regarding the sexual activities of unmarried children aged 18–24, and were largely opposed to pre-marital sexual activity [14
]. Among Taiwanese school students, the fear of being judged, parental rejection, and pregnancy control their desire for premarital sex [15
]. In mainland China, research found that the communication regarding adolescent romantic and sexual engagement experience between young people and their parents was consequence-based and prohibitive in nature, such as health risks, sociocultural risks, and detriments to education and future prospect, but it lacked useful romantic and sexual knowledge [16
]. All in all, the research findings in these Eastern societies reflect the concerns about further loosening of the conventional sociocultural beliefs in romance, sexuality, family, and marriage.
1.2. Susceptibility to Peer Influences
Peers can have a substantial influence on adolescents. Studies have shown that it is innate for humans to mingle with like-minded individuals [17
]. Like family, peer interaction serves as a crucial socializing agent during adolescence. Studies have shown that youths’ respective peer groups support their engagement in sexual abstinence and those who are sexually active. Being in groups of people who participate in early sex, youths might gradually perceive the practice as morally acceptable, especially in long-term relationships if precaution has been taken [19
]. In effect, it has been supported by studies that a peer group exerts significant influences in affecting or enhancing decisions regarding sexual activities [7
While affiliating with peers who engage in sexual misconduct or early sex can enhance such deviant behavior, it has been found that a greater sense of personal control over sexual behavior is one of the strongest factors in delaying sexual debut among youths [19
]. Such resistance to conform to peer norms seems to be an effective protective factor against inappropriate sexual activities. Nevertheless, the similar concept of susceptibility to peer influence as a resilient agent has been minimally studied. Many studies that contribute to this concept are outdated [21
], and one can question the validity of using such results to explain the present situation.
1.3. School Attachment
School attachment or connectedness can be perceived as the youth’s view on relationships with people at school, affiliation with the school, and approach toward the school’s importance [24
]. It is the close emotional relationships with those at school and the commitment to strive for success in school that inhibits deviant behavior, such as sexual activity [25
]. Sabia [26
], provides several theoretical reasons as to why youths taking part in early sexual behavior might become less attached to school, which implies that early sexual behavior can further influence subsequent attachment to school. From teen pregnancies or sexually transmitted infections to psychological or physiological effects of early teen sex, interest, and concentration in school will gradually be lost, as engaging in sexual activities impedes their schooling.
Several theories highlight the different factors that link youth sexual behavior and school attachment. Early sexual behavior can affect decision making in schools, as highlighted by the problem behavior syndrome theory [27
]. This theory predicts that problem behaviors, like early sexual experiences, trigger a change in an adolescent’s mindset to explore other anti-social behaviors, such as skipping school and taking part in delinquent behaviors that would lead to suspension from school. The economic theory of fertility implies that those who are suspended from school have low educational aspirations, feel secluded at school, and skip lessons are most likely to engage in sexual behavior at an early age [34
Many cross-sectional and longitudinal studies have been conducted to provide empirical support for the association between adolescent sexual conduct and school connectedness. Studies have found that attachment to school can be a protective factor in adolescent sexual and reproductive health (ASRH) outcomes of ever having sex [35
], early sexual debut [38
], and frequency of sex [40
]. Furthermore, Sabia [26
] found that there is a negative relationship between school attachment and adolescent sexual misconduct. Early teen sex is found to be associated with a higher probability of unexplained absences and even suspension from school, weakened school attraction, and low aspirations to attending college. Madkour, Farhat, and Halpern [42
] also reported that school attachment is inversely related to early sexual experience between both genders, and Carter et al. [5
] identified school engagement as a protective factor in predicting risky sexual behavior.
Basile and colleagues [43
] reported that youths identified as sexual violence perpetrators had lower school belongingness at earlier time points in middle school when compared to non-perpetrators, albeit reaching similar levels in high school. Other studies that were conducted in the US have found that youths who drop out of school tend to increase their sexual behavior. They are more likely to initiate sex earlier, fail in using contraception, become pregnant, and give birth [44
]. All in all, many studies have illustrated that youths who have lower school attachment are more likely to engage in sexually inappropriate behavior.
1.4. Substance Abuse
Interestingly, literature regarding the relationship between substance abuse and risky sexual behavior can indirectly explain the relationship between substance abuse and sexual misconduct. Researchers claimed that substance abuse leads to risky sexual behavior due to the disinhibition effect [10
]. In other words, adolescents who abuse a substance are less likely to exercise self-restraint and exhibit sexual misconduct or inappropriate sexual advances. On the other hand, other researchers [e.g., 49] took the opposite stance and claimed that risky sexual behavior leads to substance abuse. The plan to partake in sexual behavior or sexual misconduct may cause one to abuse a substance [49
]. Therefore, instead of regarding substance abuse as having a disinhibition effect, substances are used in a deliberate manner and they serve as a way of engaging in sexual misconduct.
Empirically, youth deviant behavior, such as substance abuse, has been shown to be associated with having liberal sexual opinions or being sexually active [33
]. Prior studies have shown that the role of substance abuse positively correlates with engagement in risky sexual behavior among youths [9
]. Anderson and Mueller [56
] reinforced these findings, although a strong association exists relating risky sex with illicit drug use and not with alcohol use. The effects of illicit drugs and alcohol can be used as an approach to pave the way for an intimate experience with a new partner or to enhance the level of sexual pleasure [57
]. However, experimentation with substances during adolescence might be an unintentional catalyst for sexual behavior [58
], and both of the variables can be seen as part of a thrill-seeking personality trait [59
]. Grossman et al. [57
] also asserted that substance abuse has many negative impacts, because it can hinder personal decision making and judgment, resulting in multiple sexual partners, failure to use any contraceptive methods, and communication impairments that affect personal relationships. According to alcohol myopia theory [60
], alcohol influences one’s information processing, which causes the continuous processing of immediate, instigating cues (e.g., arousal), while also suppressing the processing of distal and complex ones (e.g., concerns about pregnancy). These findings show that, due to the disinhibition effect of substance abuse on complicated information processing, the use of substances increases sexual misconduct.
Other research [61
] suggests that the relationship between sexual behavior and substance abuse is not absolute, but it might involve other intervening variables. For example, a reason for substance abuse when choosing to engage in inappropriate sex might be due to one’s attempt to cope with society’s pessimistic view of sexual behavior [61
]. Cooper, Peirce, and Huselid [62
] further argued, “if the acute effects of alcohol cause one to take more risks, then drinking and risk behaviors should be temporally linked” (p. 251). This adds uncertainty to the relationship between substance abuse and inappropriate sex.
1.5. The Present Study
None of the aforementioned literature is related to youth sexual misconduct in Macau. Macau, dubbed the “Las Vegas of the East”, which has a unique mixture of Chinese and Western sociocultural characteristics, deserves a study of its own. Against this backdrop, the present study aims to investigate the impact of substance abuse on the sexual behavior of adolescents in Macau. The studies that are reviewed above have demonstrated that taking drugs, drinking, smoking, school attachment, and susceptibility to peer pressure can have a significant impact on the rise of sexual behavior. Although these factors on sexual behavior have been discussed in Western research, the relative intensity of these factors in predicting sexual behavior among youths living in a Chinese casino city is unclear. Although personal control, resistance against peer pressure, and attachment to school serve as protective factors against risky sexual behavior [19
], the use of substances (e.g., alcohol) can cause a disinhibiting effect that loosens the protective barrier against risky sex. Additionally, there are studies showing inconsistent effects of substances (e.g., alcohol) among different age groups [63
]. The present study collected data from a large sample of Macau youths in 2014 [64
] to fill the gaps regarding youth substance abuse. We hypothesise that substance abuse might be the crucial factor triggering sexual behavior among youths in Macau by focusing on the possible mediating effect of substance abuse (taking drugs, drinking, and smoking) in the intrapersonal and interpersonal domains.
The results of the present study showed that susceptibility to peer influence, drug-taking, drinking, smoking, and school attachment are related to sexual misconduct in adolescents under 18 years old. Among all of the factors affecting adolescent sexual misconduct, substance abuse (including drugs, alcohol, and cigarettes) has the largest predictive power. Additionally, substance abuse displayed a significant mediating effect in the relationship between susceptibility to negative influence from peers as well as school attachment and sexual behavior. The results reflect that substance abuse is a significant crucial factor that triggers sexual misconduct among adolescents in the Macau context. It is important to note that the present results are consistent with ample research findings, suggesting a positive association between substance abuse and risky sexual behavior [10
The present study lends support to the issue of directionality of substance abuse and sexual behavior. Some of the researchers asserted that substance abuse leads to risky sexual behavior [48
], while others took the opposite stance and claimed that risky sexual behavior leads to substance abuse. Recent research confirms that early sex (at age 15 or younger) is predictive of substance abuse in adulthood [71
]. The intention to participate in sexual behavior (e.g., on a date) might cause one to abuse a substance [49
], or it provides an excuse for sexual advances that might be considered to be inappropriate. In other words, instead of regarding substance abuse as having a disinhibition effect, substances are used in a planned manner and they serve as an excuse for engaging in sexual behavior. Cooper [49
] claims, “(T)he intention or desire to have sex may precede and cause drinking, rather than the reverse” (p. 20).
The evidence in the present study confirms that susceptibility to negative peer influence, low school attachment and commitment, and substance abuse are significantly predictive of sexual misconduct. This is consistent with Western findings that substance abuse increases sexual activities [33
], particularly risky ones [e.g.,9,49,51]. It is also in line with Western findings that peer group influences affect youths’ decisions regarding sexual activities [7
], and that non-attachment to school has impact on sexual misconduct [35
]. However, a major discovery of the present study, which has not been reported in the Western studies, is that, as shown in our mediation analyses, substance abuse is a significant partial mediator that contributes to the association between peer influence, as well as school attachment and sexual misconduct. This reflects that substance abuse not only acts as a catalyst that triggers one’s sexual activity [33
] and decreases one’s ability in executing decision making and judgment to control sexual behavior [57
], but it also strengthens the effects of negative peer influence and low school attachment on sexual misconduct.
It is pertinent to carry out preventive intervention programmes in reducing rates of substance abuse at an early age, which, in turn, can reduce sexual misconduct among adolescents, since adolescent sexual misconduct is unlawful or unsanctioned behavior, and the present results confirm that substance abuse can predict sexual misconduct. Due to the legal and health consequences of substance abuse, there is an urgent need to enable adolescents to acquire the sufficient skills and awareness to reject inherently gratifying materials. One implication is to break a behavioral chain at an early stage that is to intervene before substance abuse turns into a stubborn habit. There would be a delay in the onset of substance abuse among early adolescents if effective prevention programmes were implemented, resulting in a reduction of subsequent harms later in life. Lynskey [73
] estimated that between 8% to around 12% fewer adolescents would have refrained from binge drinking, smoking regularly, and using marijuana. Though it is difficult to achieve long-lasting results in preventive work in schools, community interventions can be effective—for example, an increase the price of tobacco products, conducting anti-smoking campaigns in the media (including social media), and enforcing legislation ensuring that adolescents have difficulty purchasing tobacco products [74
]. On the other hand, the screening of and treatment for adolescents regarding substance abuse by primary care physicians can also be useful [75
Since the present results suggest that many adolescents below 18 years old engage in sexual misconduct, a practical implication is to promote better sexual health and minimize the possible negative impacts by offering sex education before one’s first sexual intercourse. According to the Macau Youth Research Association [76
], sex education in Macau is insufficient and conservative. Sex education in Chinese societies is predominantly based on an abstinence-only approach [77
]. The abstinence-only approach to sex education is theoretically sound, but such programmes often fail in practice. For instance, Shepherd, Sly, and Girard [78
] compared the effectiveness of comprehensive sexuality and abstinence-only education programmes for students that were aged between 12–14 years. The results found that adolescents in the abstinence-only education were more likely to engage in unprotected sex. The effectiveness of group-based comprehensive sex education programmes implies that there is an urgent need to carry out such programmes to tackle adolescent sexual misconduct [79
Although research on the bidirectional or reciprocal relationship between substance abuse and risky sexual behavior have been carried out [80
], the process and mechanisms of substance abuse on adolescent sexual misconduct are not clear. Future research should examine the complex relationship between substance abuse and sexual misconduct. It is crucial to explore the bidirectional relationship between these important constructs. A longitudinal design with a focus on examining the causal relationship between substance abuse and sexual misconduct, while also taking important variables, such as different types of substance abuse, violence, sexual orientation, sexting behavior, and the process of decision making, could shed more light on the controversy.
As stated by the Government Information Bureau [82
], youths in Macau are susceptible to peer influence in drug taking. This reflects that interpersonal factors could also influence Macau youths’ sexual misconduct. Western studies indicate that substance abuse is associated with other factors, including inadequate decision making, low impulse control, and avoidance of society’s negative view of sexual behavior [62
]. The results of the present study show that substance abuse is significantly linked with sexual misconduct. Additionally, such substance abuse is partly instigated by susceptibility to peer influence and school attachment. Based on these results, the implication is that, if the objective is to promote adolescent health and minimize sexual misconduct, then it is pertinent that substance abuse preventive intervention is carried out systematically and sex education programmes are implemented in secondary schools as a form of accompanying intervention. In recent years, the Social Work Bureau of Macau [64
] has funded NGOs to run several Community Youth Work Teams in different districts to work with youth at risk of substance abuse. The Bureau has also financed the Integrated Youth and Family Service Centres that provide service for families and children and to students in schools. The results of the present study suggest that the Bureau’s investment in these two youth services is in the right direction and is addressing a pressing problem that is faced by the Macau youths.
Nevertheless, a major weakness of the present study may lie in the measurement of sexual misconduct. Despite the statistically high reliability coefficient of the sexual misconduct scale, its content validity is open for discussion. In general, sexual misconduct can be regarded as any sexual behavior that is unsanctioned and deemed to be inappropriate the social norms. Among the four items measuring sexual misconduct, the item regarding sexual intercourse by adolescents may not be considered to be a sexual misconduct in some cultures, due to the fact that early sexual initiation is rather common amongst adolescents in some countries. For example, various reports in the United States found that about forty to more than fifty percent of American youths aged 15–17 had sexual intercourse [57
]. On the contrary, only around 6–7% of the same aged adolescents in Hong Kong have sexual intercourse experience, and the mean age of first coital experience among youths is 19 years of age [84
]. There is no official statistics regarding adolescent sexuality in Macau, but we believe that the situation should be similar to that of Hong Kong. When considering the fact that early sexual initiation has been widely recognized as an important social and health issue (e.g., [13
]), and that coital experience among adolescents below the age of eighteen is violating the sexual norms in Chinese societies [14
], we have included sexual intercourse in the measurement of sexual conduct. Further research may be needed to strengthen the construct validity of sexual misconduct.
The cross-sectional design is another limitation of this study. We are able to confirm that adolescent substance abuse plays a crucial role in explaining their sexual misconduct. However, readers must be cautious in interpreting this relationship as a causal one. Given the complexity of motivation for substance abuse and sexual misconduct, the current research was insufficient in specifying the causal direction between sexual misconduct and substance abuse, but our findings have confirmed the role of substance abuse. A longitudinal research design is needed to uncover the causal relationship. Moreover, there is a heavy reliance on recall of events and behavior by filling out a self-report questionnaire. Although a self-report method has the advantage over direct observation or private interview, especially for sensitive topics, such as sexual experience [86
], the self-report strategy has the inherent limitation of tendency of self-enhancement bias or social desirability responding [87
]. In the future, researchers may explore the use of mobile phone apps or social networking sites to collect more immediate information regarding the participants’ feeling and experiences, especially about behaviors that are sensitive, such as sexual experience, drug taking, or alcoholic consumption.
To conclude, the study confirms the significant role of substance abuse (including drug, smoking, and drinking) of young adolescents in explaining the relationship between negative peer influence, low school commitment and sexual misconduct. Substance abuse has both the direct and indirect effects on sexual misconduct among young adolescents in Macau.