The substance use, sexual behaviour and health needs of young tourists travelling to national and international holiday destinations Danielle Kelly Thesis submitted in partial fulfilment of the requirements of Liverpool John Moores University for the degree of Doctor of Philosophy July 2016 Abstract A growing literature base is identifying high levels of substance use and sexual risk taking among young tourists in holiday destinations. However, studies have predominantly focused on the behaviours of tourists visiting Mediterranean package holiday resorts or college students visiting spring break destinations. Limited research has focused on other types of tourists that exist in holiday destinations, or on types of holiday destination. Similarly, the health related behaviours of young tourists during their time in holiday locations have yet to be explored in any detail. This PhD study seeks to address these gaps by firstly examining the risk and health related behaviours of young British casual workers in Ibiza, Spain, using both quantitative and ethnographic methods. Secondly, the research measures the changes in individual tourist’s behaviours that take place pre and post-travel across a range of holiday destinations, using a novel three-stage longitudinal method. Thirdly, the research quantitatively measures the behaviours of tourists visiting the city break destination of Liverpool, UK. The primary contribution of all three studies is towards an evidence base for tailored health literature and services that take into consideration the differing behaviours of tourist groups that exist within varied contexts. The study of casual workers in Ibiza provides a comprehensive understanding of how they exist in a complex environment where they must negotiate risk, and the importance of targeting this group with appropriate and relatable harm reduction messages. The longitudinal study of holidaymakers contributes towards an understanding of the full tourist pathway and how three-stage studies may be appropriate for future research. Finally, the study of tourists in Liverpool is the first of its kind in both offering a glimpse of risk behaviours in the UK, and in providing data on risky sexual behaviour and substance use in a UK city break holiday destination. Table of contents ACKNOWLEDGEMENTS ............................................................................................................ 1 RATIONALE ............................................................................................................................. 2 AIMS ....................................................................................................................................... 5 THESIS OUTLINE ...................................................................................................................... 7 INTRODUCTION TO THE RESEARCHER .................................................................................... 12 CHAPTER 1: INTRODUCTION TO CONCEPTS ................................................................ 16 1.1. INTRODUCTION TO CONCEPTS ..................................................................................... 17 1.1.2. Young people and youth tourism ............................................................................ 17 1.1.3. The tourist worker continuum................................................................................. 20 1.1.4. Risk ......................................................................................................................... 25 1.1.5. Risk and theory ....................................................................................................... 28 CHAPTER 2: LITERATURE REVIEW ................................................................................. 35 2.1. LITERATURE REVIEW ...................................................................................................... 36 2.1.1. Introduction ............................................................................................................ 36 2.1.2. Risk related travel settings ..................................................................................... 38 2.1.3. Illicit drug use in tourists ........................................................................................ 46 2.1.4. Polydrug use ........................................................................................................... 51 2.1.5. Legal highs ............................................................................................................. 53 2.1.6. Binge drinking and drunkenness ............................................................................ 54 2.1.7. Sexual behaviour of tourists ................................................................................... 58 2.1.8. Substance use and sex............................................................................................. 62 2.1.9. Health initiatives and effects .................................................................................. 65 2.2. CONCLUSION .............................................................................................................. 74 CHAPTER 3: RESEARCH METHODOLOGY ..................................................................... 79 3.1. RESEARCH METHODOLOGY ............................................................................................ 80 3.1.1. Theoretical paradigms ............................................................................................ 80 3.1.2. Methods in tourism research .................................................................................. 86 3.1.3. The application of approaches to my own research ............................................... 91 3.1.4. Ethnographic methodology ..................................................................................... 95 CHAPTER 4: THE IBIZA CASUAL WORKER STUDY ................................................... 105 4.1. INTRODUCTION ............................................................................................................. 106 4.1.1. A brief history of Ibiza .......................................................................................... 107 4.1.2. Casual workers in Mediterranean resorts ....................................................... 111 4.2. QUANTITATIVE STUDY METHODS ................................................................................. 114 4.2.2. Questionnaire ....................................................................................................... 114 4.2.3. Recruitment ........................................................................................................... 115 4.2.4. Analysis of findings ............................................................................................... 116 4.3. QUANTITATIVE FINDINGS ......................................................................................... 118 4.3.1. Characteristics ................................................................................................. 118 4.3.2. Type of work ..................................................................................................... 118 4.2.3. Substance use ........................................................................................................ 120 4.2.4. Sexual behaviour .................................................................................................. 124 4.2.5. Substance use and sexual behaviour .................................................................... 127 4.2.6. Health information, advice and treatment ............................................................ 131 4.4. DISCUSSION OF QUANTITATIVE FINDINGS ................................................................. 132 4.4.1. CONCLUSION ........................................................................................................ 137 4.5. ETHNOGRAPHIC STUDY OF IBIZA CASUAL WORKERS .................................................... 139 4.5.1. Introduction .......................................................................................................... 139 4.5.2. Ethnographic methods .......................................................................................... 142 4.6. ETHNOGRAPHIC FINDINGS............................................................................................ 146 4.6.1. The social context of San Antonio ........................................................................ 146 4.6.2. Accommodation .................................................................................................... 149 4.6.3. Jobs and employment ............................................................................................ 152 4.6.4. Drug dealing ......................................................................................................... 159 4.6.5. Drug use ............................................................................................................... 165 4.6.6. Alcohol use ........................................................................................................... 168 4.6.7. Sexual behaviour .................................................................................................. 171 4.6.8. Health services ..................................................................................................... 175 4.6.9. Ibiza 24/7: a local health initiative ....................................................................... 180 4.7.