Chiao et al. BMC Public Health 2012, 12:527 http://www.biomedcentral.com/1471-2458/12/527 R E S E A R C H A R T I C L E Open Access Exploring the relationship between premarital sex and cigarette/alcohol use among college students in Taiwan: a cohort study Chi Chiao1*, Chin-Chun Yi2 and Kate Ksobiech3 Abstract Background: Cigarette/alcohol use and premarital sex, and their subsequent consequences on the well-being of college students, are international health promotion issues. However, little is known about the temporal relationship of these risk behaviors among Taiwanese college students. Methods: This study utilizes data from the Taiwan Youth Project, a cohort sample of 20-year-olds (N = 2,119) with a 2-year follow-up, to explore the relationship between adolescent cigarette/alcohol use, and subsequent premarital sex. To incorporate the Taiwanese context where the normative value of abstinence until marriage remains strong, multivariate logistic regression models included data on premarital sex attitudes, stressful life events, peer influence, as well as family and individual factors which might influence this relationship. Results: The sample consists of 49% male and 51% female college students. About 16% of the sample report having had premarital sex by age 20. After excluding sexually active youth, 20% of males and 13% of females report engaging in premarital sex in the 2-year follow-up interview. Multivariate logistic regression analyses reveal adolescent alcohol use is significantly associated with a higher likelihood of engaging in premarital sex for both genders; adolescent smoking is significantly associated with premarital sexual activity among males, but not females. Our results indicate liberal premarital sexual attitudes and stressful personal events are also significantly associated with premarital sexual activity. Conclusions: These findings suggest health promotion programs for college students need to take developmental and gender perspectives into account. Future research to incorporate a broader, multi-cultural context into risk reduction materials is recommended. Keywords: Premarital sex, Adolescent cigarette and alcohol use, Peer influence, College students, Taiwan Background Risky health behaviors such as cigarette/alcohol use, as well as the onset of sexual activity, are common from late adolescence to young adulthood in East Asian coun- tries such as Taiwan. These behaviors increase an indivi- dual’s subsequent mental and physical health risks to some degree [1-4]. Studies indicate nearly one-quarter of male youth in Taiwan self-report cigarette use at least once by the end of high-school, and the smoking rate more than doubles to 48% by the end of college [5]. * Correspondence: cchiao@ym.edu.tw 1Insitute of Health and Welfare Policy, Research Center for Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C Full list of author information is available at the end of the article Although female cigarette use was somewhat lower among Taiwanese high school students (4-5%), smoking prevalence, particularly for youth, has continued to rise since Taiwan opened its tobacco market to foreign com- panies in 1987 [6]. A recent population-based survey in Taiwan reports alcohol use by age 18 at about 38% [1]; not surprisingly, that percentage is predicted to increase as adolescents move into early adulthood [7]. Similarly, the same study [7] reports premarital sex by age 18 among female adolescents in Taiwan is 22% among 15–19 year-old cohorts, but only 17% among those 20–24 year-old cohorts. Social norms regarding premari- tal sex are apparently becoming more liberal in recent times. © 2012 Chiao et al.; licensee Biomed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.