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Cognitive predictors of intention -behavior consistency in safer sex practices
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Cognitive predictors of intention -behavior consistency in safer sex practices
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C O G N ITIV E PRED ICTO RS OF INTENTION-BEHAVTOR CO N SISTEN CY
IN SAFER SEX PRACTICES
By
N atalie M asson
A Dissertation Presented to the
FA C U LT Y OF THE G RA D U A TE SCH O O L
U N IV ER SITY OF SO U TH ERN CA LIFO RN IA
In Partial Fulfillm ent o f the
Requirements for the Degree
D OCTOR OF PHILO SO PH Y
(Clinical Psychology)
Decem ber, 1999
© 1999 N atalie M asson
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U M I Number 9987625
_ ___
UMI
UMI Microform9987625
Copyright 2001 by Bell & Howell Information and Learning Company.
All rights reserved. This microform edition is protected against
unauthorized copying under Title 17, United States Code.
Bell & Howell Information and Learning Company
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UNIVERSITY OF SOUTHERN CALIFORNIA
THE GRADUATE SCHOOL
UNIVEU1TY P A R K
LOS ANGELES. CALI FORNI A 90007
This dissertation, written by
Natalie Masson
under the direction of h£K. Dissertation
Committee, and approved by all its members,
has been presented to and accepted by The
Graduate School, in partial fulfillment of re
quirements for the degree of
DOCTOR OF PHILOSOPHY
Detn of Graduate Studies
Date ..N.p.YeiaUer..3.Q^..J.293...
DISSERTATION COMMITTEE
r *
Chairperson
.................
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ACKNOWLEDGEMENTS
I would like to thank the many people who contributed to this dissertation: reliable,
dedicated research assistants—Zintesia Page, Matt Fleishman, Laura Frazer, Leilani
Feliciano, and Jessica Richards; my trusting research advisor Gerald Davison; my
research compadre Robert ChemofF; my supportive family— Mom, Dad, and Lynne; my
dear friend Eugene Park; and finally, the hundreds of students who contributed to the data
set for this project by sharing intimate details o f their sexual thoughts and experiences.
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TABLE OF CONTENTS
Acknowledgements ............................................................................................ ii
List of T ables....................................................................................................... iv
List of F igures...................................................................................................... vi
Abstract ................................................................................................................ vii
Introduction........................................................................................................... I
Study 1
M ethods..................................................................................................... 26
R esults........................................................................................................36
Discussion..................................................................................................52
Study 2
Methods..................................................................................................... 58
Results.........................................................................................................67
Discussion..................................................................................................85
General Discussion................................................................................................89
Conclusion.............................................................................................................. 97
References.............................................................................................................. 98
Appendices........................................................................................................... 102
Appendix A: Questionnaire Measures............................................ 102
Appendix B: ATSS M aterials......................................................... 107
Appendix C: Sample ATSS Transcripts....................................... 114
Appendix D: Study I Questionnaires............................................ 123
Appendix E: Study 2 Questionnaires........................................... 161
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in-
LIST OF FIGURES
Figure 1. Delay Discounting Principle 6
Figure 2. Behavioral Economic Model of Self Control 6
Figure 3. Effect o f Immediate Consequence Attitudes on Self Control 9
Figure 4. Effect o f Attention Focus Strategies on Self Control 10
Figure 5. Interaction Between Immediate Consequence Attitudes and
Attention Focus Strategies 11
Figure 6. Mechanisms By Which Future Orientation May Affect Self 14
Control
Figure 7. Maladaptive Attention Focus by Intention-Behavior Consistency 43
(Males and Females With Safe Intentions)
Figure 8. Immediate Focus 74
Figure 9. Future Focus 74
Figure 10. Difference Score: Immediate Focus - Future Focus 74
Figure 11. Attention Focus Scores for Safe and Unsafe Groups (Males) 78
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V
Table 1.
Table 2.
Table 3.
Table 4.
Table 5.
Table 6.
Table 7.
Table 8.
Table 9.
Table 10.
Table 11.
Table 12.
Table 13.
Table 14.
Table 15.
LIST OF TABLES
Design Overview 17
Prior Intentions (All Subjects) 36
Prior Intentions and Subsequent Behavior (Subjects Who 37
Completed Both Questionnaires)
Intention-Behavior Consistency Among Subjects Who Had Safe 37
Intentions
Mean Intention Strength Responses Categorized by Behavior 39
Mean Intention Strength Responses Categorized by Intention- 39
Behavior Consistency
Possible Predictors o f Intention-Behavior Consistency: Mean 40
Scores and T-test Significance Values
Correlations Between Variables in Study 1 (Males, n=35) 41
Correlations Between Variables in Study 1 (Females, n=40) 41
Maladaptive Attention Focus: Means and T-test Significance 42
Values
Logistic Regression o f Predictor Variables on Intention-Behavior 44
Consistency (Males, n=35)
Logistic Regression o f Predictor Variables on Intention-Behavior 44
Consistency (Females, n=40)
Logistic Regression on Intention-Behavior Consistency (M ales 46
and females, n=75)
Percentages of Subjects, by Attention and Attitude, Who Had 48
Safe Intentions Then Engaged in Unprotected Intercourse at Next
Encounter
Percentages o f Subjects, by Attention and Attitude, Who 48
Experience "A Little" or More Difficulty Following Through
with Condom Use
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VI
Table 16. Percentages o f Subjects, by Attention and Attitude, Who
Experience "Moderate" or More Difficulty Following Through
with Condom Use
48
Table 17. Type o f Partner in Follow-up Sexual Encounter 50
Table 18. Comparison Between Males and Females on Study 1 Variables 51
Table 19. ATSS Validity Indicators 67
Table 20. Examples o f Engagement with the Scenario and Vividness of
Imagination
70
Table 21. Open-ended Comments Regarding ATSS Simulation 71
Table 22. Behavior Chosen in Simulated Situation 72
Table 23. Prior and In-action Comparisons of Temporal Focus 73
Table 24. Correlations Between Attention Focus Measures 76
Table 25. T-test Comparisons of Attention Focus Means by Behavior
(Males)
77
Table 26. Correlations Between Behavior and Attention Variables (Males) 77
Table 27. Correlations Between CFC and Other Variables 79
Table 28. Comparison o f Males and Females on Study 2 Variables 80
Table 29. Sample Condom-Related Thoughts (Males) 82
Table 30. Sample Condom-Related Thoughts (Females) 83
Table 31. Examples o f Internal Conflicts 84
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ABSTRACT
It is proposed that safer sex decision-making prior to and during a sexual
encounter differ in important ways that can lead to impulsive unsafe choices in the
moment. Two studies using separate but complementary methodologies were conducted
to examine the cognitive processes involved in decision making during a sexual
encounter. Subjects were male and female university students (primarily heterosexual
undergraduates). The first study used questionnaires to assess cognition and behavior
regarding an actual sexual encounter. The second study utilized a unique think-aloud
cognitive assessment protocol, Articulated Thoughts in Simulated Situations (ATSS), to
assess real-time cognition which subjects verbalized as they imagined themselves
engaged in a sexual encounter. Hypotheses were derived from three research areas
relevant to health behavior decision-making: behavioral economics, delay o f
gratification, and future orientation. Results indicate that cognitive processes related to
short-term effects o f condom use significantly predict whether individuals choose safer
sex in a simulated situation and whether they follow through with safer sex intentions in
actual situations. It is concluded that safer sex interventions and research should focus on
how people process immediate-oriented concerns (e.g., satisfaction in the moment) as
well as future-oriented concerns (e.g. pregnancy, disease) when they are actually engaged
in a sexual encounter. In addition, this research demonstrates that ATSS is an effective
approach for gaining insight to cognitive processes that occur during sexual encounters.
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1
INTRODUCTION
The predominant health behavior models that are applied to safer sex practices
assume that prior intention to perform a behavior corresponds closely with subsequent
behavior. Self-control research, however, indicates that thoughts during a sexual
encounter differ from those prior in important ways that contribute to lapses in self
control. The primary objective of the two studies presented is to investigate cognitive
processes that may lead people with safer sex intentions to change their minds in the
moment and engage in unsafe sex. Research from three domains— behavioral economics,
future orientation, and delay of gratification— provide the bases of this project’s
hypotheses.
A secondary objective is to employ a unique cognitive assessment protocol to tap
into thought processes present during a sexual encounter. Due to the intimate nature of
sexual activity, real-time assessment o f thought processes during an actual sexual
encounter is not possible. Research that investigates in-action sexual cognition typically
relies on retrospective self-reporting, a method subject to a multitude o f biases. In an
effort to more accurately assess sexual cognition, this research utilizes the Articulated
Thoughts in Simulated Situations (ATSS) paradigm, (Davison, Robins, & Johnson, 1983;
Davison, Navarre, & Vogel, 1995), which allows real-time sampling o f cognition while
an individual imagines being involved in a particular situation~in this case, a sexual
encounter. This protocol produces a representation of the natural flow o f thoughts that
occur as one experiences a situation that simulates real-life situations o f interest.
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2
The following section describes the general health behavior context that this set of
studies addresses. Specific self-control research and theories are then explained along
with the hypotheses o f this project. Next, noteworthy features of the research design are
described. Following this introduction, the methods, results, and discussion o f two
separate studies are presented. A general discussion o f both studies is then presented,
addressing the project’s methodological characteristics and drawing upon results o f the
two studies to offer recommendations for interventions and future research. Conclusions
are summarized in the last section. The appendices contain questionnaires from each
study, ATSS materials (instructions, stimulus tape script, and coding instructions) and
sample ATSS responses.
Safer sex interventions and health behavior models
Many costly health problems are influenced by the choices people make and are
therefore preventable through individual behavioral changes. Behaviors such as
smoking, drinking, and eating poorly contribute to some of the leading causes o f death in
developed countries (McGinnis & Foege, 1993). Certain sexual behavior, as well, can
have serious negative consequences including sexually transmitted diseases (e.g., herpes,
syphilis, and HIV/AIDS) and unwanted pregnancy. The likelihood of these sex-related
consequences can be reduced through "safer sex" practices such as using a condom
during intercourse and abstaining from sex with casual partners. To reduce the incidence
o f preventable health problems, intervention programs encouraging health protective
behaviors (e.g., quitting smoking, exercising, using condoms) have become a national
health priority (Glanz, Lewis & Rimer, 1997)
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Numerous health behavior models have proliferated as tools for guiding
intervention programs. The most commonly used models are classified as social
cognition models. Examples include the theory of reasoned action (Ajzen & Fishbein,
1980; Fishbein & Ajzen, 1975), the protection motivation theory, and the health belief
model (Conner & Norman, 1996). These models vary with respect to the particular
variables they incorporate, but they share a common format: social cognitive variables,
such as knowledge o f consequences, normative perceptions, and self-efficacy, are
combined to predict intention to perform a given behavior, which in turn predicts
behavior. (Some models do not explicitly include an intention variable, but it is implied
by the structure o f the model that intention likely precedes behavior.)
The social cognition models have been criticized on the grounds that they focus
exclusively on motivational processes (those involved in formation o f intentions) and
tend to disregard volitional processes (those involved in implementation of intentions)
(Conner & Norman, 1996; Bagozzi, 1992; Gold, 1993). The assumption in these models
that intention and behavior are directly linked suggests that volitional processes do not
play a role in health behavior. This assumption is not clearly supported by the data on
intention-behavior consistency. In a review of 93 studies, Sheppard, Hartwick, and
W arshaw (1988) found a wide range of correlations between intention and behavior, from
. 14 to .93. The assumption is also contradicted by volitional theories which propose that
carrying out an intention involves complex self-regulation processes (e g., Halish &
Kuhl, 1987; Carver & Scheier, 1996). Therefore, interventions based on the social
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4
cognition models may be successful in producing healthy intentions, but these intentions
might not ultimately be translated into corresponding healthy behavior.
In contrast to the social cognition models, which conceptualize behavior as
involving a single phase of decision-making, stage models, which are gaining increasing
popularity, conceptualize behavior implementation as a dynamic process (Norman &
Conner, 1996). Models such as the translheoretical modeI o f change propose a sequence
of processes, thereby addressing both motivational and volitional processes (Prochaska,
Redding, & Evers, 1997). Although these models provide a useful framework for
addressing volitional process, they do not provide detailed modeling of processes within
the volitional stages.
Existing research and theories on volitional processes could fill crucial gaps in
social cognition models and provide valuable detail for stage models. Relevant research
on volitional processes will be described in relation to safer sex practices.
Relevant research on volitional processes
The process o f implementing a health behavior intention typically involves
forgoing immediate gratification for future benefit. For example, using a condom may
mean reducing immediate pleasure for the sake of future health. Research in the field of
behavioral economics directly addresses the process of choosing between smaller
immediate and larger delayed outcomes (e.g., Ainslie, 1992; Logue, 1995; Rachlin,
1989). Maximizing immediate benefits is termed "impulsiveness," whereas maximizing
future benefits is considered "self control" (see Logue, 1995, pp.7-9 for a detailed
rationale for these definitions). Using this terminology, condom use is a self control
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choice, and unprotected intercourse is impulsive. Because safer sex practices in general
involve tradeoffs between self control and impulsiveness, theories from behavioral
economics are relevant to safer sex behavior.
The present set o f studies draws on research from behavioral economics as well as
two other research areas which address the interplay between immediate and future
outcomes: delay o f gratification and future orientation. These areas are investigated here
in the context o f a behavioral economic model. The concepts will be discussed as they
apply to safer sex behavior, which for this study will be operationalized as using a
condom during sexual intercourse or abstaining from intercourse. The next sections will
present each o f the three research domains, describing their basic perspectives and their
relation to volitional processes in safer sex behavior.
Behavioral Economics
Behavioral economic research is concerned with predicting choices people will
make given various options. In this field, economic theories have been applied to explain
choice between smaller immediate and larger delayed outcomes. A well-supported
economic premise is that perceptions of outcome values vary with delay to the outcome:
the longer the delay to the outcome, the less it is valued. Figure 1 illustrates this
principle, with the curved line indicating the subjective value o f an outcome as a function
o f the delay to the outcome. (Delay time = T - 1 , where T is the time the outcome will be
received and t is the time at which the outcome is evaluated.) The height o f the shaded
bar indicates the outcome value given no delay before receipt. As delay time increases,
subjective value decreases. For example, suppose someone is offered a prize o f $1000
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6
Delayed
outcome
< u
3
M
>
T
Time (t)
Figure 1. Delay Discounting Principle
Larger future outcome
o f se lf control behavior
Smaller immediate outcome
o f impulsive behavior
«
>
Time (t)
Self Control Impulsiveness
(Prior) (In Action)
Figure 2. Behavioral Economic Model of Self Control
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7
check. If the check could be cashed today, it would indeed be worth $1000. However, if
the check were not valid until one year from now, the individual might be just as satisfied
to receive $400 cash today. If the delay were two years, that prize might be judged as
worth about $200 in present value.
This temporal discounting principle has led to the formulation o f a self-control
model which explains how tradeoffs between immediate and future outcomes can lead to
impulsiveness. Figure 2 depicts the scenario o f choosing between a smaller immediate
outcome (which will occur at time Tj) and a larger future outcome (occurring at Tf). Prior
to implementing a behavior, when both the immediate and future outcomes are relatively
distant, the future outcome is valued more, leading to a self control choice. As time
passes, however, the immediate outcome becomes more preferable and the discount
curves cross, leading to an impulsive choice. The fact that final behavior choices are
often made immediately before the behavior is performed (when delay time to immediate
outcomes is short) explains how a self control intention may be followed by impulsive
behavior. This preference reversal phenomenon has been demonstrated in controlled
experiments with rats, pigeons, and humans (e.g. Green, Fisher, Perlow and Sherman,
1981; Green, Fristoe and Myerson, 1994; Kirby and Hermstein, 1995; Logue, 1988;
Rachlin and Green, 1972; Deluty, Whitehouse, Mellitz, & Hineline, 1983).
Compelling support for the model comes from several studies which have
demonstrated that rats and pigeons, normally impulsive, will "precommit" to self control
when given the option. That is, when making the choice far enough ahead o f time, they
would perform a behavior to eliminate the opportunity to reverse their decision later
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8
(Rachlin & Green, 1972; Deluty, Whitehouse, Mellitz, & Hineline, 1983). In humans,
this precommitment strategy is illustrated by common practices such as opting in advance
for direct deposit to a savings plan, thereby eliminating the opportunity to spend the
money impulsively.
A primary implication of this model is that attitudes regarding immediate
consequences may play a significant role in the link between intention and behavior. At
the time o f initial intention formation, both immediate and future outcomes o f the
behavior are discounted since they are both relatively distant. If the future outcomes
outweigh the immediate, a self-control intention is formed. For example, the future
benefits of using a condom (e.g., disease protection, contraception) may be judged as
more valuable than the immediate benefits of unprotected intercourse (e.g., spontaneity,
physical stimulation). At the time o f behavior choice, distant future outcomes will still be
severely discounted, but immediate outcomes loom large, because the delay is much
shorter. If the self control behavior is considered to have a very negative impact on
immediate outcomes (e.g., "Condoms feel terrible."), the discount curves may cross
(Figure 3a). If the attitude is less negative (e.g., "Condoms reduce pleasure somewhat."),
then even when these concerns loom large, the discount curves still may not cross (Figure
3b). (Note that, in this model, negative immediate consequences o f condom use and
positive immediate consequences o f unprotected sex function in the same way; they are
both interpreted as increasing the value of immediate impulsiveness outcomes.)
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9
- j
3
a
>
Time
u
3
Time
(a) Extremely negative attitude (b) Slightly negative attitude toward
toward condoms: "Condoms condoms: “Condoms reduce pleasure
feel terrible. " somewhat. "
Figure 3. Effect o f Immediate Consequence Attitudes on Self Control
Based on this model, it is hypothesized that the value of immediate outcomes
(relative to future) is higher during a sexual encounter than prior. It is also expected that,
among those who initially intend safer sex, behavior will be more strongly predicted by
immediate than future consequence attitudes, due to discounting o f future outcomes.
Also, prior intention strength may not be as strong a predictor as immediate consequences
attitudes, because prior intentions are formed based on values that will be reweighted
during the actual encounter.
Delay o f gratification
Although the behavioral economic model proposes that temporal discounting
processes can automatically and naturally produce impulsiveness, people are not always
driven to choose impulsiveness in the presence o f attractive immediate outcomes. Delay
of gratification research has investigated processes by which people overcome
impulsiveness and exercise self control. Findings from this research area are directly
relevant to safer sex and the behavioral economic model.
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10
A classic series of experiments which investigated children’s attempts to delay
gratification indicate that attention focus may influence self control (see Mischel, Shoda,
& Rodriguez, 1989, for a review of findings). In a typical experiment a child was
presented with two rewards of different values (e.g., two cookies versus four cookies).
The child was then left alone with the rewards and told that he or she could have the
smaller reward at any time or the larger reward if he or she waited a few moments until
the experimenter returned. Results from these experiments indicated that children who
were most successful at waiting distracted their attention from the desired rewards. In
trials where children were instructed to look at the rewards, those more successful at
waiting focused on the non-rewarding aspects of the objects by mentally transforming the
objects into something more neutral (e.g., focusing on the shape and color o f a cookie
rather than the flavor and smell) (Mischel & Moore, 1973; Moore, Mischel, & Zeiss,
1976; Mischel & Baker, 1975).
>
Time
o
>
Time
(a) Attending to attractive features of (b) Not attending to attractive features
unprotected sex: "Skin against skin. of unprotected sex: "llliat we 're
spontaneity...wouldfeel so good right doing right now fee ls so good...
now... ”
Figure 4. Effect of Attention Focus Strategies on Self Control
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II
Interpreted in the behavioral economic context, these findings indicate that
detracting attention from the appealing immediate consequences o f impulsiveness
outcomes may decrease the value placed on those outcomes. If this value is decreased far
enough that the discount curves no longer cross, the future outcome will be perceived as
more valuable at all times, and self control should be chosen. Applying these principles
to safer sex, focusing attention away from undesirable immediate consequences of
condom use (or the desirable consequences of unprotected intercourse) may decrease the
immediate appeal of unprotected intercourse, thereby increasing self control (Figure 4b);
in contrast, focusing on how great intercourse would feel without a condom, for example,
would likely lead to impulsiveness (Figure 4a). Assuming that the goal is to increase self
control, focusing on attractive immediate outcomes of unprotected intercourse is
maladaptive, whereas focusing elsewhere is adaptive.
Immediate z
Consequence
Attitudes
©
S .
Attention Focus
Strategics
T em pling Nontempting
Stimuli Stimuli
Im pulsiveness
Self
Control
S elf
Control
S elf
Control
Figure 5. Interaction Between Immediate Consequence Attitudes and
Attention Focus Strategies
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12
Combining implications from behavioral economics and delay o f gratification
research, it is proposed that attention focus strategies and immediate consequence
attitudes interact to influence behavior. Attention focus might moderate the effect o f
immediate consequence attitudes on behavior, such that immediate consequence attitudes
will influence behavior if one focuses on those consequences (maladaptive strategy) but
not if those consequences are ignored (adaptive). Conversely, those who hold positive
(or less negative) immediate consequence attitudes should be less affected by attention
focus strategies.
Future orientation
Whereas delay o f gratification research addresses processes related to immediate
consequences, future orientation research deals primarily with the other half o f the
equation— conceptualization of future events. Much o f this research is based on an
assumption that there is a dispositional quality to how people think about the future. For
example, some people may consider the future often and in great detail while others may
focus primarily on present concerns, viewing the future only abstractly. Future
orientation refers to the extent to which one thinks about the future, and is typically
viewed as an adaptive individual quality that corresponds with greater self control.
(Gjesme, 1983; Trommsdorf, 1983; Kamiol & Ross, 1996). Measures o f future
orientation have been positively correlated with a number o f health behaviors including
safer sex practices (Rothspan & Read, 1996; Whitley & Schofield, 1985; Sandler,
Watson & Levine, 1992).
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13
Although this relationship between future orientation and self-control has intuitive
appeal and has been supported empirically, studies tend to be vague in proposing precise
mechanisms by which future orientation influences behavior. How does thinking
extensively about the future increase the tendency to choose behaviors that maximize
future benefits? The most explicit proposal comes from Strathman, Gleicher, Boninger,
and Edwards (1994), who developed a narrowly-defined measure o f future orientation
called Consideration o f Future Consequences (CFC). This scale is designed to measure
"the extent to which individuals consider the potential distant outcomes o f their current
behaviors and the extent to which they are influenced by the potential outcomes." This
measure has been shown to be stable over time and to be correlated with general health
behaviors. Regarding the mechanism o f influence, Strathman et al. proposed that "people
who are high in CFC are expected to consider the future implications o f their behavior
and to use their distant goals as guides for their current actions." But this interpretation
still does not answer the question, "How do they use their distant goals to guide
behavior?"
From the behavioral economic model, several inferences can be made. First,
greater consideration o f future consequences could increase the value placed on future
outcomes, thereby increasing self control (Figure 6a). Second, individuals high in CFC
may use strategies to reduce the discounting rate o f future outcomes (Figure 6b). Third,
individuals high in CFC may use strategies to decrease the subjective value o f immediate
consequences (Figure 6c), perhaps via attitudes and attention focus— concepts that were
discussed previously. Any or all o f these explanations may be valid. Because this study
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14
focuses primarily on the role o f immediate consequences, further consideration will be
given only to the third possibility (modulation o f immediate consequence values through
attitudes and attention).
u
>
Time
(a) Increased value of future outcomes.
Time
(a) Decreased rate of discounting.
o
>
Time
(c) Reduction of immediate outcome
values via self control strategies
Figure 6. Mechanisms By Which Future Orientation May Affect Self Control
Specific processes by which future orientation influences behavior are proposed
here. High CFC indicates a high value for future outcomes, such as long-term health.
Motivated by future goals, people will develop skills to attain them. One necessary
ability for attaining many future goals is self control. Effective strategies for increasing
self control could include maintaining certain attitudes (perceiving the immediate
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15
consequences of self control as less aversive) and focusing attention away from
immediate temptations. Therefore, applied to safer sex, people with high future
orientation (as indicated by CFC) may be more likely to follow through with safer sex
intentions because they maintain less negative attitudes about condoms (immediate
consequences) and they tend not to focus on the immediate appeal of unprotected
intercourse (or on the unpleasantness o f condom use). More concisely, it is hypothesized
that the correlation between future orientation and safer sex behavior is mediated by both
immediate consequence attitudes and attention focus strategies.
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Research design overview
Two separate studies were conducted to test hypotheses derived from behavioral
economics, future orientation, and delay of gratification research. Because any single
assessment tool offers various advantages and disadvantages, use of multiple assessment
methods can provide compensation for shortcomings of individual methods (Campbell &
Fiske, 1959). The studies presented here utilize two very different cognitive assessment
approaches. The first study uses self-report questionnaires, whereas the second uses the
ATSS protocol. This dual method approach should allow more valid assessment o f a
broader range of variables and, therefore, more thorough assessment o f the hypothesized
processes. Noteworthy characteristics of each study with respect to assessment methods
and design will be discussed in the following paragraphs. An overview o f the design is
provided in Table 1 .
Study I design ( .Self-report questionnaires)
Study 1 used a two-part questionnaire procedure to assess (1) safer sex thoughts
prior to a sexual encounter and (2) behavior that occurred during a sexual encounter. In
an initial questionnaire, subjects thought ahead to their next expected sexual encounter
and reported condom attitudes and safer sex intentions regarding that encounter. After
their next sexual encounter, subjects completed a follow-up questionnaire to report
whether they had used a condom during intercourse, abstained from intercourse, or
engaged in unprotected intercourse.
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17
Study 1 - Questionnaires Study 2 - ATSS
Subjects
Undergraduate students. heterosexual,
unmarried
n = 250 (141 female. 109 male)
Undergraduate students, heterosexual,
unmarried
n = 80 (40 female. 40 male)
Primary
Assessment
Method
Self-report questionnaire of cognition and
behavior regarding an actual encounter
• Prior cogiution: assessed during in-
class session (regarding next expected
encounter)
• Behavior: assessed in follow-up
questionnaire (Condom use at next
encounter)
Verbal articulation of cognitions during a
simulated sexual situation
• Prior cognition: assessed during
simulation (thinking about upcoming
encounter)
• In-action cognition: assessed during
simulated encounter
Advantages
& Disad
vantages
(+) Actual situation
( - ) No in-action cognition assessed
( -) Non-control led stimulus situation
(+) Specificity of questioning
( -) Closed ended: responses constrained
( - ) Hypothetical situation
( + ) Real-time assess, of in-action cognition
(+) Controlled stimulus situation
( -) Non-dircct assessment, inference
(+) Opcn-cndcd: responses not
constrained by experimenter
Role o f
Immediate
Consequence
Attitudes
Attitude immediate----> Behavior
Attitude future — x -----> Behavior
Intention strength — x— > Behavior
Difference score (immediate focus - future
focus) increases in action:
Prior In-action
Immediate _ Future < Immediate _ Future
Focus focus focus focus
Role of
Attention
Attitude Immed. —> Belt
Attention
Foots .
M ai- Attitude Immed. -x-> Belt
Ada ptivc ness
Attention Focus ---- ► Behavior
Maladaptivcncss
Role of
Future
Orientation
Attitude Immed
CFC ^ Behavior
^^tten tio n Foots
CFC Behavior
Attention Focus
Maladaptiveness
CFC Behavior
Table 1. Design Overview
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18
The hypotheses o f this study deal with identifying predictors o f unsafe sex among
individuals who intend safer sex prior to their next encounter. Data collected through the
initial questionnaire are hypothesized to predict behavior during the next encounter.
Based on behavioral economic research, the first hypothesis is that immediate concerns
regarding safer sex will have a greater impact on behavior than will future concerns or
prior intention. Attitudes about immediate consequences o f condom use (e.g., effect of
condoms on physical sensation) will differentiate those who do and do not follow
through. It is expected that the more negative the immediate consequence attitudes, the
more likely one will decide in the moment not to use a condom. Strength o f intention to
use condoms and attitudes about future consequences (e.g. pregnancy, disease) are
expected not to be significant predictors of behavior.
Delay o f gratification research suggests the second hypothesis: focusing attention
on the negative immediate consequences of condom use (or the positive immediate
consequences o f unprotected intercourse) reduces self control. Attention focus strategies
The initial questionnaire will assess attention focus strategies typically used by subjects
in sexual situations. Among those who intend safer sex, it is predicted that attention
focus strategies predict whether individuals will engage in safer sex during their next
encounter.
The third hypothesis is derived from research on future orientation. It is expected
that those oriented toward thinking about the future are likely to develop effective self-
control strategies. Future orientation may influence self control through the strategies
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19
indicated by the first two hypotheses: maintaining less negative attitudes about
immediate consequence o f condom use, and focusing attention away from tempting
immediate aspects o f unprotected intercourse during a sexual encounter. Therefore, it is
hypothesized that future orientation (assessed in the initial questionnaire) predicts
behavior through its effects on immediate consequence attitudes and attention focus
strategies.
Advantages and disadvantages o f Study 1 assessment procedures
A primary advantage of closed-ended direct questioning is that it allows
assessment of specific cognitions. For example, condom attitudes were assessed with
respect to 38 different aspects of condom use (32 immediate, 6 future consequences),
providing assessment of a full range o f facets from emotional concerns (e.g., intimacy,
trust) to physical (spontaneity, physical stimulation) to health-related (e.g., pregnancy,
disease). Such variables would be difficult to assess without direct inquiry. An inevitable
disadvantage of closed-ended questioning, however, is that responses are constrained by
experimenter decisions in selecting items; potentially relevant thoughts that were not
considered by the experimenter are thereby excluded.
Self-reporting is another aspect of questionnaires which has both advantages and
disadvantages. For very specific cognitions that would be difficult to infer from behavior
(e.g., attitudes about the effect of condoms on intimacy), self-report may be the only
practical assessment means. Also, because no external judge is involved in inferring
meaning, self-report may even be more accurate at times than other inferential methods.
Limitations, however, are that validity of self-report depends on self-awareness, accurate
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2 0
recollection, and honesty. One may not be fully aware o f one's own thoughts, may not
remember accurately, or may distort information for social desirability reasons.
Assessing cognition and behavior with respect to a single actual sexual encounter
also has tradeoffs. Using an actual rather than hypothetical situation will likely lead to
data that is more representative o f what occurs in natural settings. Obviously, the
situation will be more realistic and relevant to the individual, as compared to a controlled
hypothetical situation. Also, assessing cognition and behavior around a single incident,
rather than over a period of time, allows subjects to respond more directly without
extensive processing o f information regarding a variety o f events. Questionnaire designs
commonly require reporting of general attitudes or behavior patterns, which could lose
richness or accuracy due to the subject's process of estimating and generalizing.
Although this single-event sampling technique will not produce a general representation
o f an individual’s safer sex thoughts and actions, averaging across subjects may produce
a dataset generalizable to the population being sampled.
Study 2 design (Thought articulation during a simulated sexual experience)
Sex-related cognitive processes that cannot be assessed well with questionnaires
are those present during a sexual encounter. Studies that attempt to assess in-action
thoughts typically do so retrospectively (e.g., "What were you thinking last time you had
unprotected intercourse?") This method, o f course, is subject to biases in recall, perhaps
due to forgetting or reconstructing the facts after the event to reduce cognitive
dissonance. Real-time cognitive assessment is impossible due to obvious issues o f
privacy and method interference. In Study 1, questionnaire assessment was used in a way
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2 1
such that in-action cognitive processes couid be inferred from information about prior
cognition and subsequent behavior. The design of Study 1, however, does not involve
actual assessment o f cognitive processes during the sexual encounter. Given that in
action cognition is a central construct o f this project’s hypotheses, questionnaire
assessment alone is not ideal for testing the processes o f interest. To compensate for
limitations of questionnaire assessment, Study 2 utilizes ATSS, an assessment protocol
designed specifically to directly assess in-action cognition. For this study, subjects
articulated their thoughts while imagining themselves in a sexual situation. This method
allowed in-action thought sampling in a controlled hypothetical situation.
The ATSS paradigm (Davison, Robins, & Johnson, 1983) offers an innovative
alternative to traditional assessment methods (for recent reviews see Davison, Navarre, &
Vogel, 1995; and Davison, Vogel, & Coffman, 1997). With this protocol, subjects
verbalize their thoughts while experiencing a simulated situation. The simulated
situation, which serves as a stimulus, is designed by the researcher to elicit cognitions of
interest. For example, for a study o f cognitive factors in hypertension, subjects
experienced a simulation of dealing with incompetent, inconsiderate auto mechanics~a
scenario designed to provoke angry, hostile, and aggressive responses (Davison,
Williams, Nezami, Bice, & DeQuattro, 1991).
Regardless o f content, an ATSS scenario is typically divided into short segments
each followed by a 30-second pause during which the subject verbalizes thoughts. The
protocol is designed to minimize the cognitive demands which could interfere with
expression of uncensored cognitive contents. Therefore, subjects are instructed to simply
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2 2
say their thoughts out loud, without concern for whether the responses are appropriate.
(Detailed instructions are shown in Appendix B.)
To elicit cognition related to safer sex, a scenario was developed to lead the
listener through a hypothetical sexual encounter— from meeting an attractive person of the
opposite sex, to dating, and finally to engaging in sexual activities. In order to elicit both
prior and in-action cognitions, the scenario progresses through segments which involve
thinking ahead about a possible encounter, ("As you get ready for the evening, you think
ahead to the date this evening...”) and eventually leads to segments involving an actual
encounter ("You're in the bedroom, naked..."). This moment-by-moment tracking of
cognitions allows analysis of cognitive changes across time.
Responses to the ATSS protocol were analyzed to assess variables o f interest—
particularly in-action cognitions which cannot be easily assessed using questionnaires.
For example, amount o f concern about immediate and future outcomes was inferred at
each step of the scenario by rating the intensity with which subjects spoke o f immediate
or future concerns. These constructs would be difficult to assess using questionnaires,
because individuals may not be aware of how much consideration they are giving to
various concerns moment by moment.
The first hypothesis is that relative attention to immediate factors increases as an
individual gets closer to the sexual encounter. The second hypothesis is that focusing
attention on negative immediate consequences o f safer sex (or positive immediate
consequences o f unsafe sex) will be associated with choosing unsafe sex. The final
hypothesis is that future orientation (as measured through a questionnaire instrument)
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impacts behavior choice through its effect on attention focus strategies. It is expected
that those with greater future orientation are more likely to use attention focus strategies
that are effective for delaying gratification, and are therefore more likely to choose safer
sex.
Advantages and disadvantages o f Study 2 assessment procedures
The ATSS paradigm offers several advantages over questionnaires. Because the
stimulus is developed by the experimenter and controlled by the experimental design,
specific types o f cognition can be targeted and uniformity o f stimuli can be maintained
across subjects. In natural settings, each individual would experience very different
situations, making comparisons and generalizations difficult. Also, the unstructured open-
ended nature of responding in ATSS allows a rich sampling o f thought processes.
Responses are not guided by experimenters' expectations as with questionnaire items. In
addition, as mentioned previously, ATSS provides real-time assessment o f cognition
which should increase the likelihood that responses represent thought processes that
would occur in an actual situation.
The fact that the scenarios are hypothetical poses three potential drawbacks. First,
situations may not be perceived as realistic to all subjects. Some individuals may not
normally enter situations described in the simulation, and therefore their responses may
not reflect reality. (On the other hand, their responses may reflect what they would think
and do if they did end up in such a situation, which could also be useful data.) Second,
responses in a hypothetical situation may be less representative of reality because
hypothetical thoughts and actions carry no real consequences (such as pregnancy or
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24
disease). Third, many factors present in a sexual situation, such as physiological arousal
and partner interaction, may influence cognitive processing and decision-making, but are
not necessarily part o f the hypothetical experience. Physiological arousal, however, has
been shown to accompany emotions generated by simulated experiences (Qualls, 1983;
Richardson, 1984; Sheikh & Kunzendorf 1984).
Other limitations of the method are related to data collection and interpretation.
While the unstructured nature o f the data has benefits of being less restrictive of
responses, it requires that meaning be inferred by data coders. For example, with regard
to ascertaining whether a subject is thinking about immediate or future outcomes, a
response during the sexual scenario such as "This is great" probably represents thoughts
about the immediate circumstances, but could also reflect thoughts about the future (e.g.,
"It's great that we're finally getting together because we will have so many good times
together"). O f course, self-report procedures also require a level o f inference: an
individual must infer the nature o f one’s own thoughts. The question, "Are you thinking
about immediate or future concerns?" requires the individual to evaluate present
thoughts, a process which may not necessarily produce accurate data. A final drawback
of the ATSS approach is that data collection is resource intensive compared with
questionnaire assessment. Assessing subjects one at a time limits the feasibility of
obtaining large sample sizes.
The two studies presented in this paper each assess sexual cognition and behavior
using completely different methods. Combining results from these studies provides an
opportunity to test the hypothesized relationships using two separate datasets and
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25
methodologies. In addition, while common methodologies used in safer-sex research are
limited in their utility for assessing in-action sexual cognition, this project implements
two approaches for gaining insight to decision-making during sexual encounters. The
ATSS protocol is particularly valuable for in-action assessment, because it allows direct
sampling o f thought processes that occur as a simulated sexual situation progresses.
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26
METHODS—STUDY 1
Self-Report Questionnaires
Subjects
Subjects were 250 (109 male, 141 female) unmarried students at the University of
Southern California. Ninety-four percent were undergraduate students, and the average
age was 20.5 years. The majority of subjects (n=225) were 17 to 22 years old, 18
subjects were 23 to 28 years old, and seven subjects were 30 to 46 years old. Subjects
were recruited through the psychology department subject pool (which awarded extra
credit points in exchange for research participation) and through campus newspaper ads
(offering S10 to each participant).
This sample of primarily undergraduate university students was considered an
appropriate source of data for this study, given the relevance o f condom use to this
population. (Many university undergraduates are sexually active but not committed to a
permanent relationship. Therefore, they are at risk for unwanted pregnancy and sexually
transmitted diseases and can benefit from safer sex practices such as condom use.)
Ethnicity. The ethnic breakdown of the sample is the following: 14 (5.6%)
African-American; 75 (30%) Asian; 12 (4.8%) Mid-Eastern; 101 (40%) Caucasian; 39
(15.6%) Hispanic; and 13 (5.2%) other or mixed ethnicity.
Sexual Orientation. The majority of subjects described themselves as
heterosexual (n=229) or primarily heterosexual (n=14). Seven subjects described
themselves as bisexual (n=5), primarily homosexual (I male subject) or homosexual (1
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27
male subject). Lesbian females were not included in the study because condom use
issues would not be relevant.
Number o f sexual partners. Subjects reported the number o f partners with whom
they had engaged in sexual intercourse. The majority o f subjects had engaged in sexual
intercourse before, and about half o f the sample had experienced intercourse with more
than one partner. Sixty (24%) reported having never had intercourse. 60 (24%) reported
having had one partner. 94 (38%) reported two to five partners, and 32 (13%) reported
six or more.
Subjects included in analyses. The majority o f analyses used data from the
subset o f subjects who met all o f the following conditions: (1) intended condom use (or
abstinence) at the time o f the first questionnaire, (2) had a sexual encounter within the
next 30 days, and (3) completed and returned the follow-up questionnaire. Out o f the 250
total subjects, 193 intended condom use or abstinence; out o f these subjects, 145 returned
their take-home questionnaires; out of these subjects, 75 (35 males. 40 females) reported
having a sexual encounter within the 30-day follow-up period. These 75 subjects (who
intended safer sex and reported on a follow-up encounter) formed the subset of cases
used in the majority o f analyses. The distribution of sexual orientation reported by
subjects was the following: 35 heterosexual males, 34 heterosexual females, 5 females
who preferred “primarily males”, and one female who preferred “males and females
equally.”
Impact o f missing take-home questionnaires. To provide a complete set o f data,
subjects were to fill out a take-home questionnaire after their next sexual encounter then
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28
return the questionnaire. If they did not have an encounter within the next 30 days, they
were to indicate so on the questionnaire and then return the questionnaire. The majority
of subjects returned take-home questionnaires (n=195, 78%).
O f the 55 who did not return the take-home questionnaire, 47 intended condom
use or abstinence (indicated by responses in the first questionnaire) and could possibly
have been included in the subset for the main analyses. However. 28 of these subjects
had reported having no sexual intercourse in the month preceding the time o f the first
questionnaire, and therefore, likely did not have a sexual encounter in the next 30 days
either. The other 19 subjects (15 males, 4 females) were sexually active in the previous
month and may have had sexual encounters in the next 30 days. Therefore,
approximately 19 additional subjects may have contributed useful data if they had
returned take-home questionnaires.
Procedure
Students involved in the psychology subject pool volunteered by listing student
identification numbers on a sign-up sheet. Subjects who heard about the experiment
through campus newspaper ads simply reported to the specified room at the time
questionnaires were being administered. The in-class questionnaires were administered
to groups of about 20 in a classroom setting. After subjects completed the first
questionnaire (which took about 45 minutes), they received a take-home packet (a sealed
envelope) with instructions to complete the enclosed questionnaire within 24 hours after
their next sexual encounter (or after 30 days if they did not have an encounter).
Complete copies o f both questionnaires are provided in Appendix D.
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29
Subjects who returned the packet before a specified deadline received full credit
for the experiment (for subject pool participants) or $10 cash (for those who responded to
the advertisement). Subjects who did not return the take-home questionnaire received no
class credit or money. To avoid creating incentive for engaging in or falsely reporting
sexual encounters, full credit (or pay) was given to all subjects who returned the take-
home packet, regardless of whether they had engaged in a subsequent encounter. To
protect subjects' privacy, names were not attached to any data or seen by experimenters.
Terminology
Intercourse — The terms “sexual intercourse” and “intercourse” are defined here
as penetrative vaginal or anal intercourse, with or without ejaculation.
Safe versus unsafe - For this study, intercourse with a condom or abstaining from
intercourse are considered “safe” whereas intercourse without a condom is termed
“unsafe.” In current literature it is common to refer to condom use and abstinence as
“safer sex” practices to clarify that such practices are not completely safe. In this report,
the terms “safe” and “safer” are used interchangeably.
Measures
In-class assessment: General measures
Consideration o f Future Consequences (CFC) - This 12-item indicator of future
orientation measures a general tendency to consider future outcomes in decision making.
Statements such as, “I consider how things might be in the future and try to influence
those things with my day to day behavior," are rated on a 5-point scale ranging from
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30
extremely uncharacteristic to extremely characteristic o f me. (See Appendix A for the
complete questionnaire.) A total score is computed by reverse scoring immediate-
oriented statements (items 3,4,5,6,10,11,and 12), then averaging all responses.
Attention Focus Maladaptiveness — Delay of gratification research suggests that
certain types o f thoughts are not effective for maintaining self-control in a situation that
presents tempting immediate rewards. Based on that research, a questionnaire was
developed to assess the extent to which an individual uses maladaptive attention focus
strategies regarding following through with condom use.
In this questionnaire, subjects were asked to think about previous times they have
been engaged in a sexual encounter and have felt tempted to have intercourse without a
condom although they had previously intended to use one. They were to indicate how
much they typically have each o f the following thoughts while in this type o f situation:
1. I think about how good it would be (in the moment) without a condom.
2. I think about how it would be worse (in the moment) to use a condom.
They were also asked how much each o f the following statements characterizes their
thought processes:
1. I try not to think about how good it would be to have unprotected sex.
2. I try not to think about the things I dislike about condoms.
Responses were on a five-point rating scale from 1 (not at all) to 5 (A loVall the time).
The total score was computed by adding the first two items and subtracting the second
two. Total scores can range from -10 to +10, with higher scores indicating greater
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31
attention focus maladaptiveness. (The complete questionnaire, which includes additional
items, can be seen in Appendix A.)
Difficulty following though with condom use — Subjects indicated the amount o f
difficulty they generally experience in following through with condom use. This item
read as follows: “Consider past sexual encounters in which you had some intention to
use a condom. In these situations, on average, how difficult was it for you to follow
through and use a condom?” The response scale consisted o f five levels: l=no problem
at all, 2 - a little difficult, 3 =moderate!y difficulty, 4=very difficult, and 5=extremely
difficult. Subjects could indicate “ Doesn 7 Apply” if they had never experienced such a
situation.
In-class assessment: Cognition regarding next expected encounter
The in-class questionnaire included items to assess thoughts regarding the next
expected sexual encounter (defined as next time the individual has sexual intercourse or
comes close to having intercourse but abstains because condom use was not possible).
To make this encounter salient, subjects were first asked to think about the incident and
write a brief paragraph describing what they expected would happen. Next they
responded to questionnaire items which assessed condom attitudes and safer sex
intentions.
Immediate- andfuture-consequence attitudes — The Condom Attitudes
Questionnaire (Appendix A) was developed to assess attitudes regarding immediate and
future consequences of using a condom (immediate-consequence attitudes and future-
consequence attitudes). Subjects rated the effect o f condom use on each o f 32
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32
immediately-occurring aspects (e.g., spontaneity, intimacy) and each of six future aspects
(e.g., protection from STDs, protection from pregnancy). The 38 questionnaire items
were derived from pilot data collected from undergraduates at the same university.
Response options range from extremely unpleasant (-3) to extremely pleasant (+3). (The
structure of the questions and the rating scale follow the format suggested by Azjen and
Fishbein (1980) for measuring the theory of reasoned action construct termed outcome
evaluations.)
Factor analysis o f the data collected from the 250 subjects in this study indicated
that questionnaire items formed two main factors, with immediate-consequence items and
future-consequence items grouped together as expected. Three items (messiness, the
excitement o f taking risks, and tastes/smells) were excluded from the immediate-
consequence subgroup based on results from reliability analyses which indicated that
these items decreased reliability o f the scale. The remaining 25 immediate-consequence
items were averaged to compute the immediate-consequence attitudes score, and the six
future-consequence attitude items were averaged to compute the future-consequence
attitudes score.
Primary Intention. This variable was assessed with the question, "Which do you
most intend during this encounter?" Response options were intercourse with a condom,
intercourse without a condom, and abstain from intercourse. Subjects were also asked to
indicate their primary intention in the event that it is “not possible to use a condom for
some reason.” Responses options were intercourse without a condom and abstain from
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33
intercourse. Responses to these questions were used to classify subjects’ intentions as
safe or unsafe.
Special consideration was given for those who indicated that they intended to use
a condom if it was possible, but have unprotected intercourse if condom use was not
possible for some reason (e.g., condom not available). These subjects were indicating
that their intentions depended on circumstances of the situation. Therefore, classification
as safe or unsafe was determined by taking into consideration the actual circumstances of
the follow-up situation. If condom use was not possible, intentions were considered
unsafe; if condom use was possible, intentions were classified as safe.
Intention Strength. Strength o f intention to practice safer sex was based on
responses to the questions, "How strongly do you intend to use a condom during this
encounter?" and “How strongly do you intend to abstain from intercourse during this next
encounter?” Response choices ranged from no, definitely intend not to (~ 1) to yes.
definitely intend to (-7), with neutral (-4) at the mid-point. The higher of the two
responses was used to indicate intention strength.
Follow-up questionnaire: After next encounter
Within 24 hours after their next sexual encounter, subjects were to open the take-
home packet and complete the enclosed questionnaire. In the questionnaire, they were
first asked to describe the incident in a brief paragraph so that the encounter would be
salient in their minds. Next they were to respond to questionnaire items regarding details
o f the encounter.
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Behavior — Behavior was assessed with yes/no questions: "Did you use a condom
during intercourse?" “Did you have intercourse without a condom?” and “Did you
abstain from intercourse?” Since behavior was analyzed as a dichotomous variable in
this study, those who used a condom or abstained were combined into one group (safe),
and those who had unprotected intercourse were considered unsafe. In addition, those
who indicated that they had had intercourse both with and without a condom were
classified as having intercourse without a condom, and therefore were included in the
unsafe group. For data analyses, safe behavior was coded as ‘0,’ unsafe as ‘ 1.’
Possibility o f using a condom — The yes/no question, “Was it possible to use a
condom during this encounter?” was followed by, “If no, why not?” . Respondents could
check off any o f three options: condom not available, partner refitsed, or other.
Intention-Behavior Consistency. Taking into consideration specific details of
intentions and behavior, subjects with safe intentions were classified as behaving in a
way that was either consistent or inconsistent with their prior intention. In
straightforward cases, those who used a condom or abstained were considered consistent
(coded as ‘0’ for data analyses) whereas those who had intercourse without a condom
were considered inconsistent (coded as ‘ 1 ’). (For purposes o f simplicity, condom use and
abstinence were regarded as safe strategies to be contrasted with unprotected intercourse,
which was regarded as unsafe. Therefore a subject who intended abstinence then had
intercourse with a condom would still be considered consistent as far as having intention
and behavior that are relatively safe compared to unprotected intercourse.)
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35
Special consideration was given for subjects who intended condom use then had
intercourse both with and without a condom. For example, for an individual who
intended to begin intercourse without a condom and put on a condom before ejaculating,
following through with this intention would be classified as consistent. However, for an
individual who intended to use a condom throughout intercourse, but during the
encounter started with a condom then took it off before finishing, the outcome was
classified as inconsistent.
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36
RESULTS - STUDY 1
Intention and behavior frequencies
Based on primary intention responses from the in-class questionnaire, intentions
for all subjects are shown in Table 2 categorized as (a) abstinence— for those who
intended to abstain from intercourse regardless of the circumstances, (b) condom—for
those who intended to use a condom or abstain if condom use was not possible, (c)
condom, if possible—for those who indicated that they would have intercourse without a
condom if condom use was not possible, or (d) no condom—for those who intended to
have unprotected intercourse. Table 3 shows how prior intention corresponded with
behavior at the next sexual encounter (for all subjects who completed both
questionnaires).
Table 2. Prior Intentions (All subjects)
Sex abstinence condom Condom, if
possible
No condom
Male (n=109) 23 46 19 21
Female (n=L41) 45 46 20 30
Total (n =250) 6S 92 59
It can be seen in Table 3 that the majority o f respondents reported behaving
consistently with prior intentions (although among females with condom intentions,
nearly half did not use a condom during the next encounter). The category which is
difficult to interpret with respect to intention-behavior consistency is the “condom, if
possible ” group. Whether their behavior was consistent with intention depends on
whether it was possible to use a condom during the encounter.
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37
Table 3. Prior Intentions and Subsequent Behavior
(Subjects who completed both questionnaires)
(a) M ale (n=50)
Behavior abstinence condom condom, if
possible
no condom
Safe (Condom or abstain) 18 5 2 4
Unsafe (No condom) 2 1 7 10
(h) Female (n=69)
Behavior abstinence condom condom, if
possible
no condom
Safe (Condom or abstain) 13 5 7 3
Unsafe (No condom) 4 12 21
Table 4. Intention-Behavior Consistency Among
Subjects Who Had Safe Intentions
Infention-Behavior
Consistency
Male
(n=35)
Female
(n=40)
Consistent (used a condom
or abstained)
20 28
Inconsistent (had intercourse
wi'liom a condom)
6 12
This issue is taken into consideration in Table 4, which shows rates of intention-
behavior consistency for those who had safe intentions. Subjects who intended to use a
condom “if possible,” were included in this subset only if they reported in the follow-up
that it was possible to use a condom during the encounter. Those who reported that it
was not possible to use a condom were excluded, because based on the circumstances of
that encounter, their primary intention was unprotected intercourse. Therefore, Table 4
includes all subjects categorized as intending abstinence or intending condom use and
some subjects from the “condom, if possible ” intention category. These results show that
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38
intentions and behavior were inconsistent for six out o f 35 males (17%) and 12 out of 40
females (30%). Although there is an apparent trend toward greater inconsistency among
females compared to males, a chi-square test indicated that the relationship between sex
and intention-behavior consistency is not significant at the .05 level (x2=1.69, p=. 19).
Social cognition model predictions
A basic premise o f many social cognition models, such as the theory o f reasoned
action, is that intention strength is a significant predictor o f behavior. When considering
all subjects in this study who had reported sexual activity within the 30-day follow-up
period (n=l 19), strength o f intention to use safe methods (condom or abstinence) does
significantly predict behavior at the next encounter (rP b= -.49, p<.001). However, when
considering only those with safe intentions (n=75), intention strength does not
significantly predict behavior (rPb = 13, p=.28). Considering that some subjects who
were classified as engaging in unsafe behavior actually had intercourse both with and
without a condom, analyses were also performed using the variable intention-behavior
consistency, rather than behavior. Point-biserial correlation and t-test results indicate that
intention strength was not a significant predictor o f intention-behavior consistency
(rpb = -. 16, p=. 17). T-tests comparing intention strength means are shown in Table 5 and
Table 6.
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39
Table 5. Mean Intention Strength Responses
Categorized by Behavior
Behavior
Safe (condom Unsafe (no
P
or abstain) condom) (2-tailed)
All subjects 5.98 3.73 <.001
n=57 n=62
Subjects with safe intentions 6.42 6.20 0.28
n=50 n=25
Table 6. Mean Intention Strength Responses
Categorized by Intention-Behavior Consistency
Intention-behavior
P
consistency
consistent inconsistent (2-tailed)
Subjects with safe intentions 6.42 6.11 0.17
I I
c
n=18
The results o f these analyses support the assumption of this study that intention
strength is not a significant predictor of behavior for those with safe intentions.
Therefore, social cognition models may have limited utility for predicting behavior
among those who intend to use condoms or abstain from intercourse. The three
hypotheses of this study propose variables related to volitional process that may influence
the translation o f safer sex intentions into behavior.
Hypothesis 1
The first hypothesis is that, for those with safe intentions, behavior is better
predicted by immediate-consequence attitudes than by intention strength or by future-
consequence attitudes. For both males and females, correlations between behavior and
each of the three predictor variables were non-significant at the .05 significance level.
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40
Mean scores of each variable for consistent and inconsistent subjects are shown in
Table 7. Significance values listed are from two-tailed t-tests. (Tables 8 and 9 show
correlation coeffecients and two-tailed significance levels for all variables considered in
Study 1.)
Table 7. Possible Predictors o f Intention-Behavior Consistency:
Mean Scores and T-test Significance Values
Variable
female male
consistent inconsistent
P
consistent inconsistent
P
intention strength 6.29 6.08 0.50 6.55 6.17 0.28
0 0
I I
c
n=12 n=29 j n=6
I mmediate-consequence 6.30 6.17 0.71 6.56 6.44 0.69
attitudes
0 0
C M
I I
G
n=12 n=29 n=6
| Future-consequence 4.17 4.08 0.75 4.15 j 4.46 0.40
| attitudes n=28 n=12 n=29 n=6
p -va lu es are f o r tw o-tailed significance tests
These results do not provide support for the hypothesis that immediate-
consequence attitudes are a better predictor than the other intention strength and fiiture-
consequence attitudes. Because none of the variables was a significant predictor, it was
not necessary to perform tests to compare the predictive power of these variables.
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41
Table 8. Correlations Between Variables in Study I
(Males, n=3S)
Intention-
behavior
consistency
Intention
strength
Future-
conseq.
attitudes
Inunediate-
conseq.
attitudes
Maladapt.
Attention
Focus
CFC
Pearson Int-Beh Consistency 1.00 -0.19 -0.07 0.15 0.28 -0.03
Correlation Intention strenglh -0.19 1.00 0.24 -0.08 -0.05 -0.10
Future-cons. att -0.07 0.24 1.00 0.25 -0.06 0.18
Immed.-cons. att 0.15 -0.08 0.25 1.00 -0.19 -0.16
Attention 0.2S -0.05 -0.06 -0.19 1.00 0.14
CFC -0.03 -0.10 0.18 -0.16 0.14 1.00
P-value Int-Beh Consistency 0.28 0.69 0.40 0.10 0.85
(two-tailed) Intention strength 0.28 0.16 0.63 0.76 0.55
Future-cons. att 0.69 0.16 0.15 0.73 0.30
Iinmcd.-cons. att 0.40 0.63 0.15 . 0.29 0.36
Attention 0.10 0.76 0.73 0.29 0.42
CFC 0.85 0.55 0.30 0.36 0.42
Table 9. Correlations Between Variables in Study I
(Females, n=40)
Intention-
bchavior
consistency
Intention
strength
Future-
conseq.
attitudes
Immediate-
conseq.
attitudes
Maladapt.
Attention
Focus
CFC
Pearson Int-Beh Consistency 1.00 -0.11 -0.06 -0.05 -0.01 -0.01
Correlation Intention strength -0.11 1.00 0.18 0.25 -0.12 0.06
Future-cons. att -0.06 0.18 1.00 0.42 0.14 -0.01
InimecL-cons. att -0.05 0.25 0.42 1.00 0.18 -0.05
Attention -0.01 -0.12 0.14 0.18 1.00 -0.14
CFC -0.01 0.06 -0.01 -0.05 -0.14 1.00
P-value Int-Beh Consistency . 0.50 0.71 0.75 0.94 0.95
(two-tailed) Intention strength 0.50 0.27 0.12 0.46 0.73
Future-cons. att 0.71 0.27 0 .0 1 0.39 0.96
Immed.-cons. att 0.75 0.12 0.01 . 0.26 0.78
Attention 0.94 0.46 0.39 0.26 0.39
CFC 0.95 0.73 0.96 0.78 0.39
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42
Hypothesis 2
The second hypothesis is that maladaptive attention focus (which will also be
referred to as “attention” for brevity) interacts with immediate-consequence attitudes to
predict behavior (for those with safe intentions). Before examining interaction effects,
main effects o f attention will be explored.
Maladaptive attention focus— main effects
Attention score differences between consistent and inconsistent subjects were
non-significant at the .05 level (using one-tailed t-tests), but there was a trend among
males toward lower attention scores for inconsistent subjects (p=.0502). Therefore,
males who reported more maladaptive attention strategies were more likely to behave
inconsistently with safe intentions. The point-biserial correlation between attention and
behavior for males was .28, indicating that attention accounted for 7.8% o f variance in
intention-behavior consistency. Mean attention scores for males and females are shown
in Table 10, and Figure 7 shows the distribution o f the scores in a box plots.
Table 10. Maladaptive Attention Focus: Means
and T-test Significance Values
Sex consistent inconsistent p-value
(one-tailed)
Male 0.48 2.33 0.0502
n=29 n=6
Female 0.64 0.58 0.47
n=28 n=12
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43
l-B consistency
H H Consistent
Inconsistent
N = 29 6 23 12
Male Female
S ex
Figure 7. Maladaptive Attention Focus by Intention-Behavior Consistency
(Males and females with safe intentions)
Interaction effects: attention and immediate-consequence attitudes
Logistic regression was used to test the interaction effect o f intention and
immediate-consequence attitudes on intention-behavior consistency. Separate analyses
were performed for males and females. With intention-behavior consistency as the
dependent variable, independent variables were entered as follows: Step 1— Intention
strength, future-consequence attitudes, and immediate consequence attitudes; Step 2—
attention; Step 3—the interaction of immediate-consequence attitudes and attention.
Tables 11 and 12 show the results of regression analyses for males and females.
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44
Table 11. L ogistic Regression o f Predictor Variables on Intention-Behavior Consistency
(Males, n=35)
M odel I
M odel 2
M odel 3
V ariable B
Statistics fo r each variable in the model
S.E. W ald df Sic R R-sq
Model fi t
Chi p
Intention Strength -0.473 0 549 0.742 1 0.389 0.000 0.000 1.986 0.575
Future Cons. Alt. -0.394 0.797 0 244 I 0.621 0.000 0.000
Immcd. Cons. Alt. 0.591 0.673 0.772 1 0.380 0.000 0.000
Constnnt 1.449 5.280 0.075 I 0.784
Intention Strength -0.667 0.654 1.040 1 0.308 0.000 0.000 5.107 0.024
Future Cons. Att -0.031 0.84S 0.001 1 0.971 0.000 0.000
Immcd. Cons. Alt. l.OSt) 0.687 2.472 1 0.116 0.125 0.016
Attention 0.660 0 360 3.357 1 0.067 0.2124 0.045
Constant -2.843 6.160 0.214 1 0.644
Intention Strength -1.236 0 838 2.174 1 0.140 -0.084 0.007 3.908 0.04S
Futtue Cons. Att. 0.668 1.159 0.332 I 0.564 0.000 0.000
Immcd. Cons. Att. -0.920 1.049 0.769 1 0.381 0.000 0.000
Attention -3.069 1.797 2.915 1 0.088 -0.1914 0.037
Iinmcd_Att*Attn 0.954 0.510 3 499 I 0.061 0.2449 0.060
Constant 4.746 7 087 0.448 1 0.503
T a b le 12. L o g istic R eg ressio n o f Predictor Variables on In ten tio n -B e h a vio r C onsistency
(F em ales , n — 40)
V ariable B
Statistics fo r each variable in the model
S.E. W ald df Sic R R-sq
Mode! f t
Chi so p
Intention Strength -0.249 0.414 0.361 0.54S 0.000 0.000 0.541 0 910
Immcd. Cons. Att. -0 076 0.359 0.044 0.833 0.000 0.000
Future Cons. Att. -0.038 0.517 0.005 0.942 0.000 0.000
Constant 1.320 3.042 0.188 0.664
Intention Strength -0.257 0.422 0.371 0.543 0.000 0.000 0.001 0.917
Immcd. Cons. Att. -0.072 0.361 0.039 0.843 0.000 0.000
Future Cons. Att. -0.029 0.525 0.003 0.956 0.000 0.000
Attention -0 016 0.153 0.011 0.917 0.000 0.000
Constant 1.320 3.044 0.188 0.665
Intention Strength 0.005 0.453 0.000 0.991 0.000 0.000 4.264 0.039
Imined. Cons. A il 0.096 0.425 0.051 0.821 0.000 0.000
Future Cons. Ail -1.567 1.14! 1.886 0 170 0.000 0.000
Attention -2.778 1.614 2.963 0.085 -0.141 0.020
Iinmcd_Att*Attn 0.701 0.411 2.908 0 088 0.137 0.019
Constant 4.495 3 917 1.317 0.251
M odel I
\fo d e l 2
M odel 3
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45
Among males, there was a significant improvement in the model’s predictive
power with the addition of attention on Step 2 (p<.05). Inspection o f the individual
regression weights with all variables entered by Step 2 indicates that the amount o f
unique variance accounted for by attention focus (4.5%) approaches significance at the
.05 level (p=.067). The interaction term, entered on Step 3, significantly improves the
model (p<.05). When considered with all other variables entered in the regression, the
contribution of the interaction term approaches significance at the .05 level (p=.061),
accounting for 6% of variance in intention-behavior consistency. For females, attention
(entered on Step 2) does not significantly improve the model, but the interaction term
does significantly improve the model (p<.05). Individual regression weights in Step 3
indicate that the unique variance accounted for by the interaction term is 1.9% (non
significant, p=.088).
These results indicate that including the interaction term provides significant
improvement over the model containing main effects o f intention strength, fiiture-
consequence attitudes, immediate-consequence attitudes and attention. However the
unique variance accounted for by the interaction term is not significant at the .05 level
when considered together with the other variables.
To measure the amount of variance accounted for by the interaction effect, a
regression analysis was performed with only the attention and immediate-consequence
attitude variables included. To maximize power, both males and females were included
in this analysis. The regression results are shown in Table 13. This model is statistically
significant (p<01), as are the main effect of attention and the interaction term (p<05).
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46
Variance accounted for by the interaction term is 4.9%, and attention accounts for 4.2%
of variance.
Table 13. Logistic Regression on Intention-Behavior Consistency
Males and Females (n=75)
Statistics fo r each variable in the model M odel Fit
Variable i B S.E. Wald i df i Si2 R R-sq Chi-Sq i p
Immcd. Cons. A tt.! -0.886 0.554 2.562 : i | 0.110 ; -0.083 0.007 7.169 | 0.007 :
Attention -1.894 0.813 5.42S l 0.020 ' -0.205 0.042
Immed_Att*Attn j 0.521 0.212 6.033 1 ; 0.014 ! 0.222 0.049
Constant ; 2.174 2.186 0.9S9 I 0.320 | t
To further illustrate this interaction effect, scores for immediate-consequence
attitudes and attention were divided into high and low categories based on the median o f
each variable. Table 14 (page 43) shows 2x2 tables with each quadrant containing the
percentage of individuals in each category who reported unsafe behavior in the follow-up
encounter. For example, data in the top left comer o f Table 14 (b) indicate that, among
females who had negative immediate-consequence attitudes and high maladaptive
attention focus, 50% (five out of 10) had unprotected intercourse in the follow-up
encounter.
Hypothesis 2 predicts that the highest rate of inconsistency would be among those
who held negative immediate-consequence attitudes and used maladaptive attention focus
strategies (upper left box); the lowest rate of inconsistency should be among those who
hold positive immediate-consequence attitudes and used adaptive attention focus
strategies (lower right box). This pattern is evident among the females, with 50%
inconsistency in the negative attitude, high maladaptive attention focus category and no
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47
inconsistency among those with positive attitudes and low maladaptive attention focus.
For males, there is also no inconsistency among those with positive attitudes and good
attention focus. However there is also a relatively low rate o f inconsistency (20%)
among those with negative attitudes and poor attention focus. This may be attributable to
the low base rate of inconsistency within the male sample overall (6/35=17%).
In order to explore this interaction effect with a larger sample, similar tables were
constructed considering subjects who had experienced sexual intercourse (n=l 19),
regardless o f whether they had safe intentions or completed the follow-up survey. In the
initial questionnaire, subjects indicated the amount o f difficulty they typically
experienced following through with condom use intentions in past situations. This
variable (as opposed to intention-behavior consistency during the next encounter) was
used as the outcome measure for these subjects.
Table 15 shows the proportion of those who reported “a little” or more difficulty
following through. Table 16 shows proportions o f those who reported having “moderate”
or more difficulty following through. For both males and females, a trend is evident
toward more experience of difficulty among those with negative attitudes and high
maladaptive attention focus, less difficulty for those with positive attitudes and low
maladaptive attention focus. These data provide additional illustration o f how
immediate-consequence attitudes and attention may interact to predict intention-behavior
consistency.
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48
Table 14. Percentages o f Subjects, by Attention and Attitude,
Who H ad Safe Intentions Then Engaged in Unprotected Intercourse a t N ext Encounter
(a) Male, n=40
Maladaptive A ttention Focus
high low
Immediate negative 20% 14%
Consequence (200) (1/7)
Attitudes positive 33% 0%
(3/9) (0/9)
Overall 17%
inconsistency rale (6/35)
(hi Female,
Ma/adapth'e Attention Focus
high low
50% 40%
(5/10) (4/10)
23% 0%
(3/13) (0/7)
30%
(12/40)
Table 15. Percentage o f Subjects, By Attention and Attitude,
Who Experience "A Little" or More Difficulty Following Through with Condom Use
(a) Male, n=79
Maladaptive A ttention Focus
high low
Immediate negative 92% 44%
Consequence (23/25) (8/18)
A ttitudes positive 50% 50%
(10/20) (8/16)
Overall 62%
difficulty rate (49/79)
(b) Female,
Maladaptive Attention Focus
high low
74%
(20/27)
71%
(15/21)
45%
( 1 0/22)
50%
(7/14)
62%
(52/84)
Table 16. Percentage o f Subjects, By Attention and Attitude,
lilto Experience "M oderate" or More Difficulty Following Through with Condom Use
(a) Male
Maladaptive A ttention Focus
high low
(b) Female
Maladaptive Attention Focus
Immediate negative 64% 17%
Consequence (16/25) (3/18)
Attitudes positive 35% 31%
(7/20) (5/16)
high low
52% 43%
(14/27) (9/21)
32% 29%
(7/22) (4/14)
Overall
difficulty rate
39%
(31/79)
40%
(34/84)
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49
Hypothesis 3
The third hypothesis proposes that, for those with safe intentions, consideration of
future consequences (CFC), predicts intention-behavior consistency through its effect on
maladaptive attention focus and immediate-consequence attitudes. It was expected that
higher CFC would be associated with more positive immediate-consequence attitudes,
lower maladaptive attention focus and lower intention-behavior consistency. Because the
directions o f the associations were hypothesized, one-tailed significance levels were
considered. CFC was not significantly correlated with any o f the proposed variables
(intention-behavior consistency, attention, or immediate-consequence attitudes) at the .05
level for either males or females (Tables 8 and 9. p. 36). Therefore, the hypothesis that
CFC predicts intention-behavior consistency through its affect on the other variables was
not supported.
Details of follow-up encounters (subjects with safe intentions)
Subjects indicated on take-home questionnaires the type o f partner they were
involved with in the sexual encounter. Table 17 shows partner types for males and
females, with subjects divided into consistent and inconsistent categories. A large
portion o f those in the inconsistent category reported being with a “long-term
monogamous” partner. Two females in the inconsistent category described their partners
as an ex-boyfriend (someone with whom they had once had a long-term monogamous
relationship); they had written this on their questionnaires in lieu o f checking one o f the
provided categories. Partners for these individuals were classified as “someone you’re
casually dating.”
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50
Table 17. Type o f Partner in Follow-up Sexual Encounter
Partner type
Intention-behavior consistency
consistent inconsistent
PARTNERS OF MALE SUBJECTS
long-term monogamous 10 5
monogamous, but without long-term commitment 4 0
someone you're casually dating 10 1
no dating relationship (chance encounter) 5 0
PARTNERS OF FEMALE SUBJECTS
long-term monogamous 20 6
monogamous, but without long-term commiunent 4
2
someone you're casually dating
2
3
no dating relationship (chance encounter) 2 1
Other details assessed in the follow-up questionnaire were whether it was possible
to use a condom, whether subjects were under the influence of drugs or alcohol, and the
extent to which subjects were sexually aroused during the encounter. Among the 28
subjects who reported inconsistent behavior, five subjects (four female and one male)
reported that a condom was not available, one female reported that it was not possible to
use a condom because she and her partner are monogamous, and 12 subjects reported that
it was possible to use a condom. Drug or alcohol use were indicated by five o f the 28
inconsistent subjects. Alcohol was used by four subjects (two male, two female) and
marijuana by one female. Only one female subject reported that her judgement was
“very affected” by alcohol at the time, whereas the others indicated that their judgment
was “not at all affected” by substances. According to self-reported levels o f sexual
arousal, relative levels o f arousal were the same for subjects in the consistent and
inconsistent groups (based on two-tailed t-tests; a=.05). Subjects’ ratings indicated that
most were “about as aroused as usual” or “somewhat more aroused than usual.”
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51
In summary, according to these data, intention-behavior inconsistency occurred
mostly with partners that were considered “long-term monogamous” partners. Substance
use and sexual arousal probably did not directly influence intention-behavior consistency.
Also, condom availability was not a factor for the majority o f subjects who reported
unprotected intercourse.
Sex Differences
Exploratory analyses were performed comparing males and females on each of
the variables measured in this study. No significant differences were found based on
two-tailed t-tests (a=.05). Comparisons of means for each variable are shown in
Table IS.
Tabic 18. Comparison Between Males anti Females on Study 1 Variables
male female
P
Variable n=35 n=40 (2-tailed)
CFC 3.67 3.79 0.24
Intention strength 6.49 6.23 0.18
Futurc-consequcnce attitudes 6.54 6.26 0.18
Immediate-consequence attitudes 4.20 4.14 0.75
Maladaptive attention focus 0.80 0.63 0.76
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52
DISCUSSION— STUDY 1
The goal o f this study was to test predictors o f intention-behavior consistency
among young adults who intend safer sex practices (condom use or abstinence). Initial
questionnaires assessed subjects’ safer sex intentions and condom attitudes regarding
their next expected sexual encounter. Data assessing future orientation and attention
focus strategies were also collected at that time. Subjects later returned follow-up
questionnaires reporting what happened during their next encounter.
Rates o f intention-behavior consistency
There was a sizable proportion of subjects who reported behavior that was
inconsistent with prior intention: 17% o f males and 30% of females who intended safer
sex had intercourse without a condom during the next encounter. Given that this data
represents behavior at only at the next encounter, if behavior were assessed across a
period of time, the number o f subjects showing some intention-behavior inconsistency
would likely be higher. Also, considering method interference, it is likely that subjects
were more likely to practice safer sex during their next encounter than at other times due
to (a) self-presentation concerns or (b) the increased salience o f safer sex concerns
brought about by completing a long questionnaire about condoms and risk factors. In
fact, in response to a question in the follow-up survey about whether being in the study
affected their behavior, a few subjects mentioned that filling out the first questionnaire
had influenced them to be more careful in the future. Therefore, the rates o f intention-
behavior inconsistency found in this sample are probably underestimates o f actual rates,
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53
which suggests that the construct intention-behavior consistency is an important variable
to investigate with respect to safer sex practices.
Proposed predictors o f intention-behavior consistency
Although intention strength has been proposed by social cognition models as an
important predictor of behavior, these results indicate that among those who primarily
intended safer sex, intention strength was not a significant predictor o f behavior. The
first hypothesis o f this study proposed that attitudes regarding immediate consequences
o f condom use would predict behavior more so than would intention strength or future-
consequence attitudes. This prediction was based on the behavioral economic model,
which suggests that the impact of immediate concerns on decision making may increase
in the moment, thereby potentially influencing individuals who had safe intentions to
change their minds. No significant relationship was found between immediate-
consequence attitudes and intention-behavior consistency, so this hypothesis was not
supported. The lack o f support for this hypothesis may be explained by the second
hypothesis, which predicts that attention focus moderates the relationship between
immediate-consequence attitudes and behavior.
The second hypothesis, that immediate-consequence attitudes and attention focus
interact to predict behavior, was supported for males and females. Delay o f gratification
research suggests that individuals utilize various cognitive strategies to reduce the impact
o f immediate temptations on their behavior. Presumably, then, those who are not
focusing as much on the immediate temptations of unprotected intercourse are less likely
to be swayed by negative feelings about condoms in the moment.
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54
Although this interaction effect accounted for only 5% o f variance in intention-
behavior consistency, the results are more compelling when subjects are classified as
high or low in maladaptive attention focus and having positive or negative attitudes with
respect to short-term effects o f condoms. Among male and female subjects who typically
used adaptive attention focus strategies and held positive immediate-consequence
attitudes, none had unprotected intercourse during their next encounter. Among females
who used poor attention focus strategies and had negative attitudes about immediate
effects of condoms, a high proportion (50%) had of unprotected intercourse despite prior
safe intentions. This association was not as strong among males, possibly due to the
relatively low incidence (6/35) of unprotected intercourse in the sample o f males.
This interaction relationship was explored with a larger sample, using another
indicator of intention-behavior consistency: self-reported difficulty following through
with condom use in past experiences. It was thought that general difficulty following
through with condom use may be related to intention-behavior consistency. As expected,
those who used poor attention focus strategies and held negative immediate-consequence
attitudes appeared to be more likely to have difficulty with self-control than did others.
In addition to interacting with attitude to predict behavior, the maladaptive
attention focus measure directly predicted intention-behavior consistency for males. This
measure accounted for 7.8% of variance in behavior when considered alone. Therefore,
maladaptive attention focus is a particularly important factor for males. This direct affect
of attention on behavior was not found among females.
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55
Therefore, focusing in the moment on the things that one dislikes about condoms
or likes about unprotected intercourse is a poor strategy to use for those who hope to
follow through with condom use, particularly if one considers immediate consequences
o f condom use very unpleasant.
The third hypothesis, regarding the dispositional quality of future orientation, was
not supported among males or females. General future orientation was not predictive of
whether individuals maintained intention-behavior consistency. Future orientation was
also not found to be related to measures o f maladaptive attention focus or immediate-
consequence attitudes. This lack o f association could indicate that the effect sizes were
too small to be detected with this sample size or that there is no relationship between the
variables. In either case, it appears that a general disposition toward considering future
outcomes is not an important factor in whether people follow through w'ith condom
intentions. Furthermore, the proposal that those characterized by high CFC, as a result of
striving toward future-oriented goals, would have developed cognitive styles such as
adaptive attention focus strategies or positive attitudes regarding short-term effects of
condoms, was not supported by these data.
Noteworthy sex differences found were (I) a trend toward higher intention-
behavior inconsistency among females and (2) a trend toward a direct effect o f attention
focus on intention-behavior consistency for males, but not females. Both of these trends
may be attributable to a difference between males and females in control over condom
use. Because it is often the male who initiates the actual physical act o f intercourse,
females can take a more passive role than males with regard to condom use. Generally,
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56
the male needs to make a conscious decision to use a condom or not, whereas the female
need not make any decision. Several female subjects’ open-ended descriptions o f their
encounters indicated that they took a passive stance and had intercourse without a
condom even though they preferred to use one. In these cases, a more relevant issue than
self-control may be assertiveness. This may also explain why attention directly affected
consistency for males but not females. Attention focus is related to self-control strategies
and would be more relevant with respect to behaviors that are under one’s volitional
control. Therefore, the fact that condom use can be a more passive behavior for females
could explain why attention focus was not as important a predictor for females as for
males.
Qualitative Impressions
The finding that many individuals changed their minds about safer sex shortly
after completing the initial questionnaire suggests that thought processes in the moment
may differ from those prior. This notion is reflected in the following excerpts from
subjects’ open-ended comments on questionnaires:
Follow-up questionnaire: Before intercourse I knew we should use a
condom. During. I remember saying "we shouldn 't really do this ”
but neither o f us wanted to stop. After, I thought we really should use
one every time. (Subject 84, female, age 19; Intended to abstain, had
intercourse without a condom)
Initial q u e stio n n a ire I will be thinking about how I need to use a
condom because I don 7 want to get her pregnant and have a baby
right now at this stage in my life. Follow-up questionnaire: We had
sex without a condom. I was happy and very excited. I didn 7 think
about using a condom. I thought condom use was good and still do,
but I just didn 7 want to use one this time. I have been dating my
girlfriendfor three years now and I am not worried about STDs or
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57
AIDS and we know her schedule for menstruation, (subject 87, male,
age 18, intended to use a condom, had intercourse without a condom)
Follow-up questionnaire: Thoughts before: We should use a
condom, but we don 7 lime one. Neither o f us have any STDs, and I
don 7 think (given the time o f my cycle, that I will become pregnant,
but if I do. he's a good friend and will support me through it).
During: We should really be using a condom, hut this is fun. After: I
can 7 believe we didn 7 use a condom. I hope I'm not pregnant,
(subject III. female, age 18, intended to abstain, had intercourse
without a condom)
Initial questionnaire: My thoughts about /condom use] are
somewhat disappointment in myself because I don 7 think about the
physical and emotional consequences o f my actions when I'm in the
situation, (subject 106, female, age 20: intended to abstain, had
intercourse without a condom)
These responses indicate that decision-making processes can change drastically
during a sexual encounter. According to the behavioral economic model, this change
occurs as a result o f immediate outcomes looming larger in the moment. To test that
explanation, it would be helpful to have an opportunity to investigate the moment-by-
moment thought processes of individuals engaged in sexual encounters. Although it
would not be feasible to collect such data from individuals in a real situation, the next
study looks at thoughts articulated by subjects as they imagined themselves engaged in a
sexual encounter.
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58
METHODS—STUDY 2
Articulated Thoughts in Sinmlatcd Situations
Subjects
The majority of subjects were recruited from the psychology subject pool using
the same methods described in Study 1. In addition, six male subjects were recruited
through campus advertisements and received S10 for participating. Requirements for
participation were that subjects had some prior sexual experiences, were unmarried, and
were heterosexual or bisexual. Data were collected from 40 males and 42 females. Two
female subjects did not follow the protocol correctly and were excluded from all
analyses, leaving 40 males and 40 females in the data set. The mean age of subjects was
21 years, the majority o f subjects being between the ages o f 18 and 23 (n=72, 90%). One
subject was 16 years old, and seven (9%) were ages 28 to 37. All but one subject were
undergraduate students.
The majority of subjects (n=67, 84%) reported having had sexual intercourse.
Thirteen subjects (16%) reported that they had never had intercourse, 26 (33%) reported
having had one partner, 25 (31%) reported having had two to five partners, and 15
subjects (20%) reported having been with six or more partners.
Nearly all subjects (n=76) described their sexual orientation as heterosexual.
Other sexual orientations indicated were bisexual (1 male, 1 female), primarily
heterosexual (1 male) and primarily homosexual (1 male).
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59
The ethnic representation in the sample is as follows: African-American, 8
(10%); Asian, 22 (28%); Caucasian, 32 (40%); Hispanic, 15 (19%); Mid-Eastern, two
(2.5%); and one subject who indicated “other” ethnicity.
Procedures
Volunteers signed up for one-hour individual appointments. The session consisted
o f the ATSS protocol followed by self-report questionnaires and typically took about 45
minutes. At the start o f a session, a subject was greeted by an experimenter (who was the
same sex as the subject) and was given a consent form to read and sign. The subject was
seated alone in a room with speakers (to project the audiotaped instructions and stimulus
scenarios) and a tape recorder (to record responses); instructions and the stimulus
scenario were played from an adjacent control room. After the instructions were played, a
practice tape (containing a non-sexual scenario) was played and the subject was asked to
practice the procedure with the experimenter present to provide corrective feedback if
necessary. Once the subject was comfortable with the procedure, the experimenter set
the tape recorder in the subject room to record and returned to the control room to play
the experimental stimulus tape. After the experimental tape was over, the subject
completed questionnaires regarding the scenario and the individual’s background and
experiences (Appendix E). At the end of the session, the experimenter provided contact
numbers for university counseling services in case personal concerns had arisen for the
individual.
A T SS stimulus tape. A typical ATSS stimulus tape leads the listener through a
scenario step by step (e.g., "You're at a party with a friend. You see familiar faces...")
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60
The listener's task is to imagine being involved in the scenario as vividly as possible so as
to become maximally engaged in the simulation. After each short presentation o f new
material, the scenario breaks for 30 seconds, during which the subject verbalizes thoughts
that are active while experiencing the simulation. The actual instructions that subjects
heard can be read in Appendix B.
The stimulus script used in this study (Appendix B) was developed to elicit
responses to a sexual situation which could raise safer-sex concerns. (Separate but
parallel tapes were developed for males and females.) Based on focus group discussions
and pilot testing, the scenarios were designed to be provocative and realistic to the
population being sampled.
The scenario begins with the subject meeting a potential partner at a party and
experiencing strong mutual attraction. After the party scenes, the narrator indicates that
three weeks pass during which the couple begins dating. The story continues with the
subject getting ready for another date with this individual. Preparation for the date
involves thinking ahead to the activities of the evening, some o f them sexual. These
segments (4 through 7) are designed to elicit prior thought about a sexual situation. The
story continues with the date progressing to the woman's apartment and building up to
increasingly intense levels o f sexual activity. Segments 8 through 14 are designed to elicit
in-action sex-related thoughts (those present during a sexual interaction).
Several objectives guided the construction of the scenario. First, a primary
objective was to induce maximal attraction and arousal to simulate the experience o f an
exciting sexual encounter. It was thought that the presence of strong arousal may be an
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6 1
important factor that influences decision-making during actual situations. Therefore,
attraction and arousal are mentioned frequently, but described with a level o f ambiguity
to make it applicable to a range of individual preferences. For example, 'her long blonde
hair is attractive' describes specific attributes that may or may not be applicable to the
listener, whereas 'the way she sits and the way she acts are exciting to you,' leaves
opportunity for the listener to imagine appealing details.
Second, it was considered preferable to present a situation that would maximize
variance in safer sex cognitions among subjects. Therefore, the interaction described is
neither extremely risky (e.g., a one-night-stand in which many would likely take safety
precautions) or relatively safe (e.g., a long-term monogamous relationship in which many
would deem condom use less necessary). Rather, it depicts an interaction with someone
who is somewhat a familiar but not extremely well-known (known only through brief
interactions in class and three weeks of dating) and whose attributes raise some suspicion
of risk (the friend comments that this attractive person can get any partner he/she wants).
This ambiguity of safety should help reveal individual differences in reactions to
potential risks.
Several other features were included based on feedback from focus groups and
pilot subjects. (1) It was important to convey a sense o f physical safety (particularly for
females) so that feelings of physical danger would not interfere with attraction and
arousal. This issue was addressed by having the narrator suggest that "you're feeling very
comfortable with him" and by having the couple return to her place rather than his at the
end o f the evening. (2) Sex o f subject and experimenter were matched in order to reduce
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62
the likelihood o f subjects censoring their responses. (3) Sex of the voices on the
instruction tapes and stimulus tapes were matched to the sex o f the subject. (4) Content
o f male and female tapes were carefully matched to make the stimuli as equivalent as
possible and to avoid biases in content.
References to risk o f sexual involvement were strategically placed. An initial
indication o f potential risk is included in segment 3 ("...I bet he can get any woman he
wants" or “...Y ou know a lot of guys are after her.") just to provide background
information implying that the partner may not be completely safe. For this study, it was
preferable that further segments provided no suggestion o f risk so that any risk-related
responses could be attributed to the individuals' natural thought patterns, rather than to
cues from the stimulus scenario. Therefore, no risk references are made until segments
15 and 16, so that segments prior to number 15 were not biased by direct risk references.
The scenario ends with a segment which allows subjects to provide an ending to
the scenario. The purpose of this step (which does not follow the typical ATSS protocol)
was simply to allow each subject to reach a self-directed point of closure. All other
segments directed subjects into situations that were not necessarily chosen by the subject.
I ariab les Measitres
Variables based on ATSS responses
Coding o f ATSS verbal responses was performed by two coders who read typed
transcripts and listened to the audiotaped data while coding. Although coding for ATSS
is often based only on the typed transcripts, it was important for this study to consider the
subject’s tone o f voice and inflections in order to rate the intensity o f immediate focus
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63
and future focus. The emphasis placed on words could influence ratings in these
categories. The following definitions were applied for ATSS variables:
• Im m ediate versus Future: For coding purposes, the temi immediate (or present)
referred to anything occurring at the present moment or expected to occur any time
during the evening of the date in the scenario. F uture references were for anything
that would occur after the evening of the date (e.g., future dates, negative health
outcomes).
• P rio r versus In-action. Prior thoughts corresponded with responses to segments 4
through 7 (looking ahead to the evening), whereas in-action thoughts corresponded
with segments 8 through 14 (during the encounter).
Using these definitions, the following variables were coded and computed.
Immediate focus andfuture focus (prior and in-action). Responses to each
ATSS segment were coded for intensity o f immediate focus and intensity of future focus.
A given segment would be coded 0 (low), 1 (medium), or 2 (high). Coding instructions
(Appendix B) defined these codes as follows:
0= low : use this w hen there is no m ention o f present future circum stances
I = m edium : use this when there is so m e mention, but w ith m ore cognitive rather than
em o tio n a l content: basically w hen the person is talking a b o u t it. b u t n o t really in to it.
2= high: use this w hen the person m entions present/future in a m ore em phatic way. w ith
so m e em o tio n a l involvem ent—like they're kin d o f into w hat they're sa yin g
Responses were averaged across prior segments (4-7) and in-action segments (8-14) to
produce separate prior and in-action scores o f immediate and future focus.
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Difference score: Immediate focus — Future focus. This difference score was
computed by subtracting the future focus score from the immediate focus score.
Attention to positive aspects in generaI (A TSS A TTN1) - Coders rated each
segment ‘O’ for absence or ‘ 1’ for presence of statements about positive things occurring
in the present moment (or expected to occur that evening). Examples: “This is great.”
“Oh yeah.” “I'm so excited.” “We're kissing and touching each other” (if expressed with
a positive tone). Scores were averaged across segments 4 through 17.
Maladaptive attention focus (A TSS_A TTN2) - coders rated each segment for the
presence (‘ 1 ’) or absence (‘0’) of the following types o f statements:
• Thoughts about how good it would be in the moment without a condom (or to
continue without interruption).
• Thoughts about how it would be worse in the moment to use a condom (or to
interrupt to get a condom).
Scores were summed across segments 4 through 17 for each category, and totals from
both categories were added together to compute the final score.
Coding reliability. Inter-rater reliability o f ATSS coding was tested using the
intra-class correlation test. Reliability was good (alpha ranging from .70 to .80) for all
variables except prior immediate focus and prior future focus which had relatively low
reliability levels (a=.49 and .58, respectively). Reliability levels were statistically
significant (p<.001) for all variables.
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65
Variables based on questionnaire responses
Consideration o f Future Consequences (CFQ. This scale is described in the
methods section o f Study 1.
Maladaptive attention focus, in past experiences (0 ATTN1). This measure is
described in the methods section of Study 1.
Maladaptive attention focus, during the simulation (0 A TTN2). The measure
described in Study 1 was used with a simple modification. For this measure, subjects
were asked to respond to the items indicating the thought processes they had during the
simulated scenario that they just experienced (rather than thinking back to prior actual
experiences).
Behavior — Behavior was assessed with yes/no questions regarding what subjects
imagined doing during the simulation: "Did you use a condom during intercourse?" “Did
you have intercourse without a condom?” and “Did you abstain from intercourse?” For
data analyses, abstaining or using a condom was categorized as “safe” behavior and
coded as ‘O’; intercourse without a condom was considered “unsafe” and coded as ‘ 1.’
Risk— Five questionnaire items were used to assess subjects’ perceptions o f
amount or risk associated with unprotected intercourse in the simulated scenario.
Subjects rated the likelihood, if they were to have intercourse without a condom, o f each
o f the following outcomes: getting HIV, giving your partner HIV, getting other STDs,
giving your partner other STDs, and getting (yourself or your partner) pregnant.
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66
Responses were on a seven-point scale from no chance (I) to certain to happen (7).
Responses to the five items were averaged to compute an overall risk perception score.
Condom importance— Subjects responded to the item “How important would it
be to use a condom in this situation?’’ Response options were on a five-point scale from
not at all (1) to extremely (5).
Condom likelihood—Subjects responded to the item “How likely is it that you
would use a condom in this situation?” Response options were on a five-point scale from
not at all (I) to extremely (5).
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67
RESULTS—STUDY 2
V alidity o f A TSS protocol
Questionnaire responses
To test the effectiveness o f the ATSS protocol, subjects were given a
questionnaire with several items addressing whether the simulation seemed realistic,
whether they candidly verbalized their thoughts and the extent to which the simulation
triggered emotional and sexual arousal. The response scale was as follows: l=not at all,
2=slighl/y, 2=moderately, -f=very, a n d 5=extremely. Table 19 shows mean and median
responses for males and females, as well as standard deviations o f the responses.
Table 19. ATSS Validity Indicators
Male Female
Q uestionnaire Item M ean Median Sul.
Dev.
M ean Median Std.
Dev.
Simulation Effectiveness
How realistic was llie scenario to you? 3.38 0.98 3.45 3 0.99
How much did it feel like this situation was really
happening (like you were really in the situation)?
3.00 3 0.S2 3.18 3 0.81
How intense did your emotions get? 2.71 3 0.93 2.93 3 0.94
How much were you sexually aroused? 2.00 2 1.06 1.98 2 1.00
Verbalization Representativeness
How similar were the thoughts you just verbalized to
the those you would have in an actual situation of
this kind?
3.99 4 0.92 3.81 4 1.05
How much did you let your thoughts go without
censoring your thoughts?
3.60 4 0.90 3.55 4 0.75
How much did you hold back from saying exactly
what was going tltrough your mind?
2.05 2 0.90 1.99 2 0.72
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68
The first four questions address the effectiveness of the simulation. The median
response was “moderate” for all items except for “How much were you sexually
aroused,” which had a median rating of “slightly.” These ratings suggest that the
situation was fairly realistic to most subjects and triggered some emotional reaction in
most, but had only a small effect on sexual arousal.
The last three questions deal with the extent to which the thoughts the subjects
verbalized were representative of thoughts they would have in an actual situation. The
median response was that thoughts were “very” similar to thoughts in a real situation and
that subjects “very” much let their thoughts go without censoring. With the censorship
question worded differently, the median response was that subjects held back only
“slightly” from saying exactly what was on their minds.
These results indicate that the simulation felt realistic and had a moderate impact
on emotional arousal but only a small impact on sexual arousal. In addition, it appears
that subjects were candid in verbalizing their thoughts and said things that closely reflect
what they would be thinking in an actual situation. It is concluded that the ATSS
protocol is valid as far as creating an effective simulation and eliciting representative
thought content. T-test results indicated no significant differences (a=.05, two-tailed)
between males and females on these measures.
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Qualitative impressions
In addition to validity indications from questionnaire responses, the content o f the
ATSS responses appeared to be valid based on qualitative impressions. Illustrative
excerpts from subjects responses are shown in Table 20. (Subject numbers preceded by
‘F” are females; ‘M ’ indicates males.) Full transcripts of two male and two female
subjects are provided in Appendix C. The excerpts contain examples o f emotional
engagement and vividness of imagination with respect to physical sensation, visual
images, actions, and even odors. In addition, coders who listened to the data felt that
subjects sounded genuine in their responses as they expressed a range o f emotional
reactions from hope and excitement to anger and disappointment. Subjects differed,
however, in the extent to which they were engaged with the process, some sounding very
expressive and engaged with the scenario, others sounding rather unexpressive and
uninvolved.
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Table 20. Examples o f Engagement with the Scenario and
Vividness o f Imagination
F9 [Segment 10] God, it feels so nice... it's just beautiful. Close to mine. It feels nice to be
close to him. My body just completely trembles with excitement. [Segment 12] God, this feels
so good, (pause) Gosh. I wish he was just here inside of me now. It feels so good. [Segment 13]
(Sigh) God he looks good. He looks so good. It makes me feel so good. It's just awesome. I
don’t want tin's to end. [Segment 14] God damn, 1 just wish he would just put it inside of me. I
can't wait anymore.
MS [Segment 12] (laughs) Oh. my God. Oh. man. Oh, God. This girl is the bomb. boy. Ah.
yes. yes. yes. yes, yes. Uh. I like her breasts. Mmm. Nice breasts, very nice breasts. It's like a
dream come true. man. Ah. yeah. Oh. man. Good thing I brought those condoms. Damn. I
barely know this girl. I barely know her. Oh. man. I'm too horny for this.
M38 [Segment 15] I kick ass I mean this girl's hot. all the guys want her and yet I have her. uhm
that's a really cool feeling, you know a lot of times you think oh you know she's too good for me
or oh man she has to already have a boyfriend ’cause girls like that just aren't single and yet here
I am with one uhm just a great feeling. I'm totally stoked. Wow. you know it's my turn in the
spot light I guess.
M32. Segment 5—Damn she smells good ...
M38. Segment 17— Uh, I get the condom get it on or better yet have her put it on me, which I
really like uhm we have sex I mean I'm on top of her. we're just rocking and then we roll over
and she's on top of me and that way I can like as we go through it I mean I can watch her. w atch
as she closes her eyes, being my little dream here you know she's had an orgasm too and we
totally enjoy this...
FI 5. segment 10—We’re kissing and it's very, very slow. Uhm not French kissing just barely
kissing and he starts to move his hands up my body and I let him and I start taking off his shirt
and I start kissing his breasts and kissing his mouth and I tell him how much I really like him and
how cute I think he is...
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O pen-ended fe e d b a c k fr o m subjects
Some subjects provided open-ended comments regarding the ATSS process when
they filled out the follow-up questionnaire. These comments are shown in Table 21.
Several females described difficulties they had getting engaged with the process. Some
indicated that they felt the scenario was not realistic for themselves or that the task of
verbalizing thoughts was difficult. Others indicated that they felt comfortable with the
process. Several males indicated that they enjoyed the scenario, felt it was realistic, and
felt the procedure worked well.
Table 21. Open-ended Comments Regarding A TSS Simulation
Females
• I w ould not be in this situation, so it w as hard to say w hat I would be thinking [F6]
• It's difficult to verbalize thoughts especially w hen you are concentrating on the fact that you'll
have to tu n e in and put pretend thoughts into w ords. It was also hard because I probably
w ould h av e reacted a little differently in each scenario as it went on. [F8]
• It's hard to picture m y self exactly in this scenario because o f my lack o f experience [F24]
• I felt self-conscious at first, but by the m iddle (beyond the scenario o f the party) I felt fine
and free to say w hat w as on niv mind. [F9]
• I w ould n ot have personally gone tow ard a kiss quite yet, but for the sak e o f the audio, I
pretended. I felt since the scenario w as less like m y real self, m y real em otions about the
scene really cam e out. [F29J
• I alw avs have trouble verbalizing w hat I'm thinking. I'm not necessarilv holding anvthing
back [F37J_______________________________________________ '
Males
• Y eah, I have to adm it, this little scenario did g et m e a little "worked up". B ut. m aybe because
I'm ju s t an open, hom y guy. [M20]
• This ex act scenario happened w/m e and m y girlfriend. I answ ered the ta p e exactly how I
reacted in real life. [M 22]
• Situation was described realistically. But seem ed a little too good to be true. T hought I did a
good jo b verbalizing thoughts. [M31 ]
• This tap e rocked. Real life. [M34]
• It sounds like this ladv was an A ll-Star sex m achine!! I like how the tap e portion w as done.
Once I g o t used to it, it felt alm ost natural w ith the form at. [M40]__________________
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72
B ehavioral Outcomes
For analyses involving prediction of behavior, subjects were categorized as
choosing “unsafe" sex (intercourse without a condom) or “safe” sex (condom use or
abstinence from intercourse). Behavior was determined based on subjects’ self-report in
the follow-up questionnaire. As shown in Table 22, nine male subjects imagined having
intercourse without a condom and 31 imagined abstaining form intercourse or having
intercourse with a condom. Among females, two imagined having unprotected
intercourse while 38 envisioned condom use or abstinence. Significantly more males than
females chose unsafe sex (x2=5 .17, p<05). Because there were only two females who
chose unprotected intercourse, analyses of behavior prediction for females will not be
conducted.
Table 22. Behavior Chosen in Simulated Situation
1
Safe (abstinence or
condom use)
Unsafe (intercourse
without condom)
Males 31 9
Females 38 2
Hypothesis 1
The first hypothesis is that the relative impact of immediate versus future
consequences is greater in action than prior. To test this hypothesis, three measures o f
temporal focus were considered:
(1) Immediate focus
(2) Future focus
(3) Difference score: immediate focus minus future focus
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73
The hypothesis predicts that the difference score increases from prior segments to in
action segments. Immediate focus and future focus measures were also investigated
separately in order to provide indication o f how these variables contribute to the
difference score.
Mean scores and percentage change from prior to in-action are shown in Table 23.
T-tests for differences between means were computed and two-tailed significance levels
are reported. Among males, there was a significant increase in immediate focus (p<.01)
and in the difference between immediate and future focus (p<.05). Future focus did not
increase significantly for males. There were no significant differences between prior and
in-action scores among females for any o f the tested variables, although there was a trend
toward an increase in future focus.
Table 23. Prior and In-action Comparisons o f Temporal Focus
(a) Males (n=40)
variable p rio r in action % change
P
immediate
focus
1.12 1.23 10%** 0.001
future focus 0.17 0.18 7% 0.664
immed-fiit 0.94 1.04 11%* 0.022
(b) Females (n=40)
V ariable p rio r in action % change
P
Immediate
focus
1.07 1.11 3% 0.138
future focus 0.23 0.28 26% 0.093
Immediate-
future
0.84 0.82 -3% 0.608
* p< .05, **p< .01 (tw o-tailedsignificance levels)
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74
1.25
m
I 0.95
male female
■ prior
B in-action
Figure 8. Immediate Focus
5 0.15
z
{ ■ prior
!■ in-action
male female
Figure 9. Future Focus
0 0.9
“ 0.8
■ p rior l
I :
{B in-action
male female
Figure 10. Difference Score:
Immediate Focus - Future Focus
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75
These relationships are displayed in Figures 8, 9, and 10. It can be seen in
Figure 10 that the difference between immediate and future focus remains stable for
females and increases slightly for males. Investigating data from only males who chose
safe behavior (n=31), similar significant results were found: immediate focus increased
significantly (p<.01) and the difference score (immediate — future focus) also increased
(p<05).
Therefore, Hypothesis 1 is supported for males but not for females. For males, an
increase in immediate focus with future focus remaining stable resulted in an increase in
the relative impact of immediate focus. For females, there was a trend toward increasing
future focus while immediate focus remained stable, which resulted in no significant
increase in the relative impact of immediate focus.
H y p o th e s is 2
It is hypothesized that greater focus of attention on pleasurable aspects of
unprotected intercourse (or unpleasant aspects of condom use during intercourse) is
associated with choosing unprotected intercourse. Several indicators of attention focus
are considered to test this hypothesis. Two were derived from ATSS responses:
• ATSS_ATTN1 (frequency o f generally positive thoughts about the present
situation)
• ATSS_ATTN2 (maladaptive attention focus: frequency of thoughts about how
good it would be to have intercourse without a condom or how bad it would be to
have intercourse with a condom).
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76
Two measures were based on questionnaire responses:
• Q A TTN 1 (maladaptive attention focus regarding condoms in past situations)
• Q ATTN2 (maladaptive attention focus regarding condoms in the simulated
scenario).
Correlations between the attention focus measures are shown in Table 24. For
males and females, there was a significant and strong correlation between the
questionnaire-based measures o f maladaptive attention focus during the simulation
(Q_ATTN2) and in prior sexual experiences (Q_ATTNl). For females (but not males),
there were also significant correlations between the coded measure o f maladaptive
attention focus during the scenario (ATSS_ATTN2) and both questionnaire measures.
The coded measure of general positive thoughts (ATSS_ATTN1) was not significantly
correlated with any o f the other measures for males or females.
Table 24. Correlations Between Attention Focus Measures
(a) Males (n=40)
ATSS_ATTN 1 ATSS_ATTN2
Q_ATTN1a Q _A TT N 2a
ATSS_ATTN1 1.00 -0.17 0.13 -0.04
ATSS_ATTN2 -0.17 1.00 0.09 -0.03
Q _A T T N la 0.13
0.09 1.00 0.78***
Q _A TT N 2a : -0.04
-0.03 0.78*** 1.00
(b) Females (n=40)
ATSS_ATTN1 ATSS_ATTN2 Q_ATTN1 Q_ATTN2 i
ATSS_ATTN 1 1.00 0.16 -0.02 0.07
ATSS_ATTN2 0.16 1.00 0.35* 0.43**
Q_ATTN1 -0.02 0.35* 1.00 0.56
Q_ATTN2 0.07 0.43** 0.56*** 1.00
* p<.05; ** p<01; *** p<.001 (two-tailed)
a n=38
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Considering males only, t-tests were conducted to compare attention scores
between those who chose safe and those who chose unsafe behavior. (One-tailed
significance levels were used because it was predicted that the unsafe group would have
higher attention scores than the safe group.) The unsafe group had higher scores than the
safe group with respect to each of the attention focus measures (p<.05; Table 25). Point
biserial correlations between behavior and the attention measures (Table 26) indicate that
the frequency o f positive thoughts in general that were verbalized (ATSS_ATTN1)
accounts for the least variance in behavior (6%), while the other attention measures each
account for 24% to 33% o f variance in behavior. Bar charts comparing attention scores
are shown in Figures 11(a) an I 1(b). According to these results. Hypothesis 2 is
supported for males.
Table 25. T-tcst Comparisons o f Attention Focus Afeans by Behavior (Males)
variable safe unsafe
P
ATSS_ATTN1 U.64 0.77 0.014
n=31 n=9
ATSS_ATTN2 0.19 1.06 0.022
n=3 I n=9
Q_ATTNl -0.72 3.22 0.001
n=29 n=9
Q_ATTN2 -1.62 2.89 <001
__________________________n=29 n=9
(one-tailedsignificance lc\-els)
Table 26. Correlations Between Behavior and Attention Variables (Males)
V a ria b le
rph r„h n
ATSS ATTN1 0.25* 0.063* 40
ATSS ATTN2 0.53* 0.277* 40
Q_ATTN1 0.49** 0.242** 38
Q_ATTN2 0.58*** 0.333*** 38
*p<.05, **p<.01, ***p< .00l (one-tailed)
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(a) Questionnaire Attention Scores x Behavior (Males)
fl^ATN! O' A TN2
i □ safe
!
IB u nsafe
(b) ATSS Attention Scores x Behavior
(Males)
1.2
1
C l
o
(J
0.8 -
to
e
o
0.6 -
«
c
0.4 -
<
0.2 ■
0 -
; □ safe
•B unsafe
ATSS ATTN1 ATSS ATTN2
Figure 11. Attention Focus Scores fo r Safe and Unsafe Groups (Males)
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Hypothesis 3
The third hypothesis is that CFC predicts behavior through its effect on attention
focus; those with higher future orientation are expected to focus less on tempting aspects
of unsafe sex and be less likely to choose unsafe sex. Because this hypothesis predicts
the direction of the relationships, one-tailed significance testing was used. Among males,
CFC was not significantly correlated (at the .05 level) with behavior or any o f the
attention focus measures (Table 27). Among females, CFC was not significantly
correlated with the attention focus measures; the relation between CFC and behavior was
not analyzed due to the low number of females who chose unsafe sex. Evidence
supporting this hypothesis was not found among males or females.
Table 27. Correlations Between CFC and Other Variables
(a) males
Variable r
l>
n
Behavior -0.06 0.36 40
ATSS ATTN1 0.10 0.28 40
ATSS ATTN2 -0.16 0.17 40
Q_ATTN1 -0.16 0.17 38
Q_ATTN2 0.04 0.41 38
(b) females
Variable r
P
n
ATSS ATTN1 -0.11 0.25 40
ATSS ATTN2 0.03 0.43 40
Q_ATTN1 -0.12 0.23 40
Q_ATTN2 -0.10 0.26 40
(one-tailed significance levels)
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Sex Differences
Exploratory analyses were conducted to test for differences between males and
females on the measures considered by the hypotheses o f the study. Three additional
variables were also considered in these comparisons: perceived risk o f unprotected
intercourse, importance o f condom use, and likelihood o f using a condom (all pertaining
to the simulated situation). T-tests were computed for most comparisons, whereas the
Mann-Whitney U test was used for four variables which were not normally distributed:
ATSS_ATTN1, immediate focus (prior), future focus (prior), and immediate focus (in
action). Table 28 compares mean scores for males and females. Because multiple
exploratory comparisons were being made, p-values less than .01 were considered
statistically significant (based on two-tailed tests).
Table 28. Comparison o f Males and Females on Study 2 Variables
(Significance levels based on T-tests and Mann- Whitney U tests)
m ale fem a le
Variable n mean n mean
CFC 40 3.91 40 4.00
ATSS ATTN1 40 0.67 40 0.52
**
ATSS ATTN2 40 0.39 40 0.09
*
Q_ATTN1 38 0.21 40 -0.03
Q_ATTN2 38 -0.55 40 -0.70
Immediate focus (prior) 40 0.56 40 0.53
future focus (prior) 40 0.09 40 0.11
difference: immediate-future (prior) 40 0.47 40 0.42
Immediate focus (in action) 40 0.61 40 0.55
**
future focus (in action) 40 0.09 40 0.14
*
difference: immediate-future (in-action) 40 0.52 40 0.41
**
risk 40 3.61 40 4.58
**
condom importance 39 4.36 40 4.90
**
condom likelihood 39 5.95 39 6.49
*p '.05. **p<01 (two-tailed)
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These data indicate that females judged unprotected intercourse as riskier
(regarding disease and pregnancy) and felt that condom use would be more important
than did men. In addition, males articulated more positive present-focused thoughts
throughout the simulation and focused more on the present in general, during the in
action portion o f the simulation. Also, as mentioned previously, males were more likely
than females to choose unsafe sex.
Qualitative Data Samples
Due to the open-ended nature o f ATSS responses, a rich sampling o f thought
processes were tapped using the simulated sexual scenario. Tables 29 and 30 show
excerpts o f responses related to condom use. The first two male subjects (M3 2 and M28)
chose unsafe sex and the last three (M38, M24, and M5) chose to have intercourse with a
condom. Among female subjects in Table 31, two chose to have intercourse with a
condom (F2I, F14). one chose unprotected intercourse (F15) and one chose to abstain
from intercourse (F9). Table 31 shows examples o f the types o f internal struggles
subjects experienced during the simulation. It often appeared that subjects were
conflicted over the tradeoffs between immediate gratification and future outcomes, as
would be predicted by the behavioral economic model. These internal conflicts seemed
to be voiced more often by females than by males.
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Table 29. Sample Condom-Related Thoughts (Males)
M 3 2 [Scg. 7] D am n I’m w ondering if she has a condom around. Oh w ell I’m not going to stop
th e m om ent to go interrupt to go find one. T h at would suck . Dam n sh e’s hot. [Seg. 15] M an I
w onder if like Julie is a sex addict, a sexaholic or som ething. I f she like sleeps with every guy she
dates. Am I going to get like a disease o r like AIDS? Oh w ho cares, she is so hot. I’m a guy. all I
care about is sex anyw ays, w hatever. [Scg. 16| 1 w onder if she has a condoin hands- . like, if she
does you know sh e’s getting buss- w ith other guys she know s. But 1 d o n 't w ant to break this
m om ent and ask for a condom o r go look for one. W hat are w e going to do. if we don’t have, arc
w e going to do it? I’m so turned on right, now- , shoot I don’t really care. Forget about the
condom .
\I2 8 [Scg. 16] Uhm, in the past 1 haven’t uh, uh worried about that so I probably
wouldn’t worry about it this time. I wouldn’t worry about it this time either, especially if
there wasn’t a condom anywhere around. Unless she mentioned it. if she said, if she says
no because I don’t have a condom. I’d stop but, otherwise I’d continue... [Seg. 17] 1
imagine the situation ending that we ended up having intercourse, uh me without a
condom and I started thinking about who she’s been with in the past, uh what her past
relationships were, sexual relationships, and at the same time. I would think about her
becoming pregnant, but the thing is in the action, I wouldn't really care. I’d kind of worry
about it later, and uhm, that’s about it.
M 38 [Seg. 16] Got to get a condom on, I mean sex feels better without one, it’s totally
true everyone knows it. most times a girl prefers it without one also, but I mean it’s like
the whole Rush-Lacter model, cost vs. potential benefit and the girl getting pregnant or
who knows, I mean I guess 1 don’t know very, I don’t know a whole lot about her she
might have had a few guys or a few hundred guys. I’m trying to be safe.
M 24 [Seg. 14] W ell here I go. this is the m om ent o f truth. This is w hat I’ve been thinking about,
so I guess I’m ju st going to do v hatever. L:hm make sure I’m grabbing a condom first 'cau se she
d o esn ’t look like sh e’s a novice o r am th in g at sex. so I'm glad I brought som e condom s ju st in
case since I'm going to need them , but hopefully it d o esn 't set o ff the m ood, but it’s a m ust for
me. [Seg. 16] O K th at’s like a m ust so uhm I'm not going to have sex. I d o n ’t care how hot she is.
and precisely the reason w hy if sh e's m ore hot then I'm going to kind o f keep m y distance m ore
and so 1 would not be having sex with som eone without a condom . I d o n 't care if it w as Pam ela
Lee. like no way. There has to be a condom . T here's ju st no w ay.
M 5 [Seg. 7] Ah, I ca n 't believe this happening— Oooh! Ah, m a n ....I hope it's happening. I
have to ...h a v e to go buy som e condom s, you know w hat I'm saying? G et som e condom s ju st in
case my dream s com e true. U h ...th a t'd be very tight. Yeah, buy som e condom s. [Seg. 14] I'm
g o n n a m ake sure she w ants to do this. G otta make sure she w ants to do this. Ah. boy. I'm gonna
ask her. I'm gonna ask her. N ah. ju st, alt, you gotta get the condom , get the condom . Ah. we
g o tta slow things down, gotta slow things, I gotta make sure she w ants to do this, I d o n 't know if
she w ants to do this. G otta ask her if she w ants to do this, m ake sure. Oh, God. Oh. m v God. I
barely know this girl. Oh, G od, she is a freak. She is the best freak. [Seg. 16] Aww. H cv. I need
to ask her. I f she wants m e to use a condom . Aw, man. I gotta put it on. I bought it. Shit, I
spend m oney on you. I better use it, you know what I'm s a rin ’. I ca n 't w aste that m oney. Slip
on m y Trojans. Go Trojans, (laughs)____________________
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Table 30. Sample Condom-Related Thoughts (Females)
F9 [Segment 16] Wait a minute. Wait a minute. This has to stop. 1 can't let this happen. He
can’t be sleeping with all these women and then, and then coming to me. He didn't even have a
condom. I don’t want to get pregnant. And 1 don't want to be one of those little whores either,
(pause) This is stupid. I shouldn't be doing this.
F21 [Segment 16] No way am I going to have sex with this guy unless he is wearing a condom, I
don't care how I feel, I, there's no way I am going to do that, that's totally unsafe. I can get
pregnant; I can get all kinds of diseases, no way.
F15 [Segment 14] We're very close to intercourse and maybe I'm thinking that a month ago I
would have said no because I was a virgin, but now that I am not I think it's OK for me to do it
w ith him and I’m thinking about asking him if he has a condom because I don’t know' if I ever
saw one in his pocket or not and I'm thinking about asking him that right now. [Segment 16] I
realize he is not wearing a condom so I'm thinking maybe I shouldn't do this, maybe I shouldn't
do this. I know he has been with other women, he might have something, but at the same time I'm
scared to ask him or to tell him > ou know put on a condom and I don't know' if he has one or not.
but I'm thinking about grabbing one from my drawer that I know' I have some there so that's
probably what I would do. [Segment 17] I imagine us having sexual intercourse and not using
protection just because I did not ask him and he did not bring it up and because we were so close
and I just decided to have sex w ith him. And I imagine us having sex the w hole night and he is
very, very good. But then I also imagine not seeing him ever again.
F14 [Segment 13] OK, OK at least he's not in yet. Well, is it too late to tell him to stop? No but
this feels so good. OK I guess I have protection. I guess it's all right. This feels so good. Oh yes.
this feels so good. [Segment 14] OK better put some protection on right now if I’m going all the
way. yes I am going all the way, I definitely want to go all the way. Protection time, better put a
condom on him and oh yeah, protection, focus, protection. Yes. right here. I need protection, yes
oh this feels so good. Protection, protection. OK it's on.____________
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Table 31. Examples o f Interna/ Conflicts
M 24 [Segm ent 17] I think that I w ould probably, probably have had sex w ith her. U hm , w hen
you get th a t far, it's kind o f hard to ju s t turn back. I mean every step y o u ’re kind o f you know
falling prey to like an influence, you know so it seems to me that I w ould probably g o ahead and
do it...
F9 [Segm ent 11] G od, w hat am I thinking for? Just, ju st do it. Keep. I hate having th ese second
thoughts. I w ish, I w i, I wish I w ould stop thinking so m uch and ju st do things. Ulih. W hat am I
feeling nervous for? (pause) I know I w ant it.
F I 5 [Segm ent 13 j I'm thinking about sexual intercourse. I can feel his bod y and his erection. A nd
I'm thinking about how good it feels and how I really, really w ant him to m ake love to m e and
I'm not thinking ab o u t any consequences even though they com e into m y m ind I ju s t push them
aw ay and ju st think about right now . about the moment.
F21 [Segm ent 7] I can ju s t im agine, like it's so tem pting to ju s t go all the w ay. I m ean, like w e
are so close already and I d o n 't know som etim es 1 just, phy sically I ju s t w ant to g o fu rth er than I
w ould if I actually stopped and think about it. B ut I d o n't know. I w o n d er if this is actually going
to happen tonight o r if I am ju st blow ing this w ay out o f proportion. [S egm ent 1 11 O h gosh, it's
so hard to think straight when he is telling m e all this stu ff and when I feel this w ay. I d o n 't
know , I m ean m aybe I should suggest that we go in there, but I d o n 't know if I w ant to do that. I
m ean how well do I know this guy? I wish I could just stop and think. [S egm ent 12] I alm ost feel
like at this point, w hy not? I mean w e 're both a little bit. drunk or a little bit loosened up a t least
and I m ean it's so hard to ju st stop things right now I mean w e 'v e already, w c started to m ove
farther than kissing and I d o n 't know , m aybe I'll ju st see w hat happens, I m ean is it th at w rong?
[Segm ent 13] I d o n 't know . I start to think, m aybe 1 d o n't want to do this I m ean. I d o n 't know , it
ju st doesn’t, may be I should ju st stop and do I really want to do this, do I really w an t to have sex
with him ? [Segm ent 14J It's so hard to know w hat I want to do. I'm so confused I m ean, m y body
is telling me you know go for it and m y m ind is say ing no. no you d o n 't w ant to do this. H ow
well do you know him ? Y o u 're being irrational. I don't know. I d o n 't k now w hat to do. I m ean it
keeps getting clo ser and closer, and it seem s like I can't stop m yself. [Segm ent 15] C ould get any
wom an he w ants, w ell m aybe that m eans he has had c \e ry w om an he w ants. I m ean have w e even
talked about this? H ave w e talked about having sex. have we talked about A ID S, o r any o th er
S T D 's. I m ean is this safe, is he w earing a condom ? I m ean I’m ju st letting m y self get o u t o f hand
here, m aybe I should stop and think about this.
F14 [Segm ent I I] O K this is not good. M y heart is telling me one thing, m y body is telling m e
another. N o. no. no. no w c ju st settled for kissing th at's it. I'm . it's not the tim e yet. I barely knew
him . This is not good. H ello I am not easy. I barely knew him. I betrer tell him to stop. [Segm ent
12] Oh this feels so good. This feels so good. O K I guess, w hat is this ab o u t the kissing and not
know ing him too m uch thing. Oh w ell, never m ind. Anybody w ho kisses m e like tin’s they m ust
have know n me or. I'v e never had anybody kissing me like this before. T his feels so good.
[Segm ent 15] Oh m y G od. w hat am I doing? I have sworn to G od. to m y se lf that I w ould not be
all o f these other w om en and now I am doing the sam e thing. O K I better stop right now . stop.
I'm getting, oh this is getting em barrassing. I am letting m y biological needs get ah ead o f me. No.
no. no I am intelligent. I am educated. I better tell him stop.__________________________________
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DISCUSSION— STUDY 2
This study utilized ATSS, a unique think-aloud protocol, to tap into thoughts that
go through peoples’ minds as they progress through a sexual encounter. Subjects
imagined themselves in a sexual situation as it was described step by step via audio-taped
narration, and they verbalized their thoughts during 30-second intervals between scenario
segments. Results of a follow-up survey indicated that most subjects found the scenario
realistic and the protocol reasonable to follow. Subjects’ ATSS responses appeared
candid and realistic. These outcomes indicate that ATSS is a valid tool for assessing in-
the-moment sexual cognition.
The proportion of subjects choosing to have unprotected intercourse was
significantly higher for males (nine out of 40; 22.5%) than for females (two out of 40;
5%). Exploratory comparisons o f males and females indicated that, in this scenario,
females judged unprotected intercourse as riskier than did males, and males were more
focused on present-oriented and pleasurable thoughts than were females. The more
cautious stance among females may explain the lower rate of unprotected intercourse in
the simulated situation. Due to the low number of females who chose unsafe sex,
analyses regarding behavior prediction among females were not conducted. Therefore,
Hypotheses 2 and 3 could only be considered for male subjects.
The first hypothesis o f this study was that the relative focus on immediate
concerns would increase in the moment, compared to prior to the sexual encounter, as
predicted by the behavioral economic model. This effect was found for males but not
females. Males demonstrated increased immediate focus during the encounter, while
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86
future focus stayed constant. For females, however, immediate focused thinking did not
increase, but there was a trend toward an increase in future focus.
Interpreting the amount one focuses on immediate or future concerns as an
indication o f the value one places on these concerns, these findings can be discussed in
the framework o f the behavioral economic model. For males, the values o f both
immediate and future outcomes were discounted during the period prior to the sexual
encounter. As the males approached the sexual situation (and the distance from
immediate outcomes decreased), the value of immediate concerns increased. Future
outcomes, however, were still distant and therefore were still discounted in their
perceived value. This increase in value of immediate outcomes may result in immediate
concerns outweighing future concerns, leading individuals to choose unprotected
intercourse preferring immediate gratification over future safety.
Whereas male subjects discounted future concerns such that the impact did not
increase in the moment, for females the impact of future concerns may have actually
increased slightly in the moment. Perhaps the general value placed on these future
outcomes was higher for females (e.g., they perceived the risks to be greater), or perhaps
the distance to the future outcomes was seen as closer by females than by males. It is
also possible that females have a disposition toward discounting future health values less
than do males. All these explanations would be consistent with the economic concept
that the value of delayed outcomes is discounted at some rate.
However, the finding that the immediate values did not increase in the moment
for females is not accounted for by these economic principles. Perhaps high levels o f
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87
concern about negative future outcomes caused a reduction in focus on present aspects of
the situation. It is reasonable to expect that fear about future negative consequences may
detract from feeling engaged in pleasurable aspects of the moment. However, this lack of
significant effect could also be attributable to measurement error, given that inter-rater
reliability was relatively low for the measures o f immediate and future focus prior to the
encounter.
Therefore, predictions o f the behavioral economic model were supported for
males. However, for females, it appears that greater cautiousness may have suppressed
the expected increase in immediate focus in the moment or perhaps measurement errors
obscured the expected effect.
The second hypothesis was that attention focus strategies would predict behavior
(safe or unsafe sex). Delay of gratification research suggests that focusing on tempting
stimuli is ineffective for maintaining self-control. In these data, it was found that males
who chose unprotected sex had used more maladaptive attention focus strategies than
those who chose to use a condom or abstain. (Maladaptive attention focus corresponded
with thoughts about desirable aspects of unprotected sex or undesirable aspects on
condom use). This effect was significant based on analyses o f ATSS responses as well as
scores from self-report questionnaire responses. These attention focus measures were
strong predictors, accounting for 28% to 33% o f variance in behavior.
It was also found that, among males, attention focus in prior sexual situations (as
indicated through self-report questionnaires) was predictive o f behavior in the simulated
scenario. Prior maladaptive attention focus accounted for 24% o f variance in ATSS
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88
behavior. Therefore, those who chose unprotected intercourse during the simulation used
poor attention focus strategies both during the simulation and in past sexual situations.
ATSS responses were also coded for frequency o f positive present-oriented
thoughts to investigate whether focusing on positive aspects in general was predictive of
safer sex behavior. This measure was a statistically significant predictor among males,
accounting for 6% o f variance in behavior, which is a relatively small amount when
compared to the predictive power of the other attention focus measures. Therefore, it
appears that males who chose unsafe sex generally focused somewhat more on immediate
gratification than did those who chose safer options.
The third hypothesis, that general future orientation predicts behavior through its
effect on attention focus, wr as not supported when considering male subjects. The
measure for future orientation (CFC) was not correlated with either behavior or
maladaptive attention focus. Two possible explanations are that (1) the effect o f general
future orientation on these variables is small and could not be detected with this sample
size, or (2) these variables are not impacted by future orientation.
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89
GENERAL DISCUSSION
The two studies presented each implemented a different methodology to test
cognitive predictors o f intention-behavior consistency in safer sex. In each study,
analyses were conducted to test hypotheses derived from research on behavioral
economics, delay of gratification and future orientation. This section presents discussion
o f methodological advantages and disadvantages, basic assumptions of the studies,
noteworthy findings, and implications for interventions and future research.
Methodological considerations
Results from the ATSS-based study indicate that ATSS is an effective method for
assessing real-time sexual cognition. Subjects’ responses were rich in content and appear
to represent the stream of thoughts that might actually occur during a sexual encounter.
Comparing this approach to more common assessment methods used in studying sexual
decision-making (e.g., retrospective recall, general self-report), this method offers far
greater potential for illuminating details of moment-by-moment cognitive processing in
sexual situations.
The questionnaire-based study and the ATSS-based study complemented each
other well, because most limitations of one assessment approach were offset by strengths
in the other. For example, whereas self-report questionnaires are not very effective for
assessing in-the-moment sexual cognition, ATSS was ideal for that task. A drawback of
ATSS was that the information collected was related to a hypothetical situation that may
not have been applicable to subjects or may not have been experienced as actually
happening. The questionnaire study on the other hand assessed thoughts and behavior
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90
related to a real encounter. A drawback of ATSS is that meanings are inferred by coders,
whereas in the questionnaire studies meanings of responses were more explicit. A
limitation o f the questionnaire study, however, is that responses were restricted by items
presented, whereas with ATSS, responses to each segment in the scenario were open-
ended and therefore allowed subjects to express any thoughts that came to their minds.
Both studies were somewhat limited due to moderate sample sizes. However, despite the
sample sizes, many significant results were found which will be discussed in the
following paragraphs.
Testing basic assumptions underlying the rationale fo r the study
Before exploring predictors of intention-behavior consistency, it seemed
reasonable to test the assumption of this study that intention and behavior are inconsistent
to a degree that makes the construct worth exploring. These data indicate that intention-
behavior inconsistency is not uncommon. Seventeen percent o f males and 30% o f
females who indicated safer sex intentions in the initial questionnaire had intercourse
without a condom during the next encounter. These numbers probably underestimate
actual rates given that this is a one-encounter sample, possibly biased toward safer
behavior due to method interference issues (such as cognitive dissonance and self
presentation biases).
Intention strength, a key predictor of behavior in many social cognition models,
was not a significant predictor for individuals with safe intentions. Given that many
people do not always follow through with safer sex intentions and that common models
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91
are not very useful for predicting behavior among those who intend safer sex, further
exploration o f intention-behavior consistency is warranted.
Research findings
Explanations for intention-behavior consistency were derived from research on
behavioral economics, delay o f gratification, and future orientation. The behavioral
economic model suggests that in-the-moment increase in value of immediate concerns
can lead to preference reversal. ATSS responses were analyzed to determine whether
individuals focused on immediate concerns more (relative to future concerns) in the
moment than prior. This effect was found for males, but not for females. Perhaps for
females greater cautiousness toward the situation functioned to inhibit focus on
immediate outcomes.
Another approach to exploring whether immediate concerns had an increased
impact on decision-making in the moment was to test whether attitudes about immediate
consequences o f condom use significantly predicted behavior. Based on results from the
questionnaire study, this effect was not found for males or females. However, significant
results were found when the interaction between attitudes and attention focus was
considered.
Delay o f gratification research suggests that the impact o f immediate temptations
can be moderated by attention focus strategies. Data from the questionnaire study
indicated that those who saw short-term effects of condoms as more negative and also
focused on tempting aspects o f unprotected intercourse were most likely to choose
unprotected intercourse during their next encounter despite prior safe intentions. In
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92
addition, they were also more likely to have had difficulty following through with
condom use intentions in past situations. On the other hand, those who had more
favorable attitudes toward short-term condom effects and did not focus as much on
tempting aspects o f unprotected sex were less likely to choose unprotected intercourse if
they originally intend safer sex. For males, attention focus appears to be a particularly
important behavior predictor given that it also had a direct effect on behavior.
In the A f SS study, attention focus with respect to unprotected intercourse (as
measured by questionnaires and coding of A f SS responses) was a significant and strong
predictor o f behavior among males. Attention focus in the simulated situation, as well as
in prior situations, accounted for 28 to 33% of variance in behavior for males. Also,
focus o f attention on general positive stimuli was predictive o f safer sex behavior for
males. (Due to low variance in behavior among females, these data were not interpreted
for females).
Although it was predicted that general future orientation would be associated with
safer behavior, more effective attention focus strategies, and more positive attitudes
toward short-term effects o f condoms, future orientation was not a significant predictor of
these variables in either study, f herefore, it appears that the dispositional quality of
future orientation is not an important factor in whether individuals follow through with
safer sex intentions.
The results from both studies together indicate that the way people think about the
immediate factors in a sexual situation influences how successful they are at following
through with safer sex intentions. This effect is likely due to an increased impact of
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93
immediate concerns on decision making in the moment. For females, although analyses
o f ATSS responses did not demonstrate this proposed increase in immediate focus, the
perceived risk of the particular situation may have inhibited this effect. Results from the
questionnaire study, which were based on actual situations that subjects experienced,
suggest that thoughts regarding immediate consequences do significantly impact behavior
among females; therefore, in actual situations, this increase in value of immediate
consequences may be seen among females as well.
Implications fo r interventions andfuture research
These studies indicate that an important factor influencing self-control in sexual
situations is the way people think about the short-term aspects of condoms and
unprotected sex. Therefore, interventions that focus primarily on persuading people
through information about negative future outcomes o f unprotected sex may succeed in
helping people form intentions to practice safe sex; however, these individuals may not
necessarily be successful at carrying out their intentions during an actual encounter.
Given that attitudes toward immediate consequences o f condoms were found to
influence behavior, an effective intervention approach may be to persuade people that
condoms do not have a very negative impact on a sexual experience. Safer sex
advertising designed to eroticise condoms is an example o f such an approach. A few
subjects in the studies did mention that they tried to make condom use fun or exciting.
But there are a number of realistic barriers to making attitudes toward short-term
effects o f condoms more positive. As one male stated during the simulated situation,
“Sex feels better without (a condom), it’s totally true, everyone knows it.” Aside from
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loss o f sensation, other common complaints about condoms were that stopping to get a
condom would “ruin the mood” or that bringing up the issue was awkward.
Even for people who do maintain negative attitudes regarding short-term effects
o f condoms, this research suggests that interventions designed to improve attention focus
strategies could be effective. Perhaps people could be taught to focus less in the moment
on the desirable aspects o f unprotected sex and the undesirable aspects o f condom use.
To determine effective ways to intervene at this level, several issues should be explored:
(1) If people should not think about tempting aspects o f unprotected sex, what should
they think about instead? (2) What are effective ways to influence the development of
better attention focus strategies? (3) Are the attention focus strategies individuals use in
sexual situations similar to those they apply in other situations that involve self control?
The latter issue raises the possibility that people who use ineffective attention
focus strategies in sexual situations may use these attention strategies elsewhere and may
typically experience difficulties with self control in general. If this is the case, teaching
general attention focus strategies (not necessarily specific to safer sex) may help people
develop self control skills that would generalize to multiple self control behaviors,
including safer sex. In studies conducted by Shoda, Mischel, and Peake (1990), children
who demonstrated effective attention focus strategies at age four were more academically
successful in school ten years later. The implication here is that the self control abilities
that individuals possessed at an early age allowed them to perform better in future
endeavors that required self control. Therefore, interventions that help develop effective
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95
attention focus strategies in general may indirectly improve self control with respect to
safer sex.
An important detail regarding attention focus strategies is that focusing on
general pleasurable aspects of the sexual situation was a significant predictor o f safer sex
practices (among males), but not as strong a predictor as the specific maladaptive
attention focus with respect to condoms. Therefore, for purposes of maintaining self-
control, general positive thoughts are not as problematic as those specifically referring to
how pleasurable it would be to have unprotected intercourse.
Since general future orientation was not found to be a significant predictor o f the
variables investigated in these studies, it can be concluded that the effects found apply to
those both high and low in future orientation. When considering ways to influence
factors such as condom attitudes and attention focus strategies, however, it may be
worthwhile to explore whether those high and low in future orientation respond
differently to interventions. For example, Strathman et al. (1994) found that, with respect
to environmental concerns, those high in future orientation were influenced more by
information about future benefits whereas those low in future orientation were more
persuaded by messages about short-term benefits. Such differences may be found in how
individuals develop attitudes with respect to condoms as well.
Sex differences should also be considered in interventions and future research.
Although in the simulated scenario females took a more cautious stance and were less
likely than males to choose unsafe sex, in the questionnaire study a fairly high percentage
o f females who intended safer sex had intercourse without a condom during their next
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96
encounter. Issues o f assertiveness and control over condom use may explain some of
these effects. Also, attention focus was a particularly significant factor in self-control for
males compared to females. Therefore, this would be a particularly relevant issue to
target in future research and interventions for males.
Although these studies investigated the role of immediate-oriented thoughts much
to the exclusion of future-oriented concerns, it should not be inferred that thoughts about
future outcomes are unimportant in safer sex decision-making. Rather, this research
suggests that the way people process immediate concerns in the moment is also an
important factor, although it is typically not incorporated into the social cognition models
which guide safer sex interventions.
Additional research is needed to increase our understanding of how immediate
and future concerns interact during a sexual encounter. For example, in these studies, it
appeared (based on qualitative impressions) that as subjects became more engrossed in
the pleasures o f the immediate situation they tended to rationalize future consequences
(“if I get pregnant he’ll help me take care of the baby because he’s a good friend”) or
push away future concerns (“I won’t think about that right now, I’ll worry about that
later”). The present research investigated ways that people thought about immediate
temptations but did not extensively explore cognition regarding future concerns. Further
research would be required in order to create a complete picture of the cognitive interplay
between immediate and future concerns during sexual situations.
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97
CONCLUSION
The studies reported in this paper draw attention to cognitive processes that occur
during sexual situations. Safer sex decision-making processes that occur prior to an
encounter are not necessarily replicated “in the heat of the moment” when immediate
consequences loom large relative to future consequences. These results suggest that
attitudes people have about the short-term effects of condom use and the extent to which
they focus on the appealing aspects of unprotected sex are important factors in whether
they will maintain self-control with respect to safer sex. Further research should be
conducted to determine how these factors can be influenced and also to investigate the
interplay between future- and present-oriented concerns during sexual situations.
Research and theory from the areas of behavioral economics, delay of gratification, and
future orientation may be helpful for guiding future research and interventions.
Regarding methodology, the ATSS protocol was found to be an effective
approach for tapping into moment-by-moment thought processes prior to and during an
imagined sexual encounter. The resulting verbal data were rich in detail and appeared to
be relatively candid depictions o f thoughts that individuals would have in an actual
situation. The methods used in the questionnaire study were also effective, allowing
sampling o f thoughts and behavior for an actual sexual encounter experienced by an
individual. Both the questionnaire and ATSS methods were feasible to implement and
could be useful for studying a wide range of safer sex issues.
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98
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APPENDIX A: QUESTIONNAIRE MEASURES
Consideration of Future Consequences Questionnaire
Condom Attitudes Questionnaire
Attention Focus Questionnaire
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Consideration o f Future Consequences Scale
For each of the statements below, please indicate whether or not the statement is characteristic of
you. If the statement is extremely uncharacteristic of you (not at all like you) please write a “ I"
to the left of the question; if the statement is extremely characteristic of you (very much like you)
please write a “5"’ next to the question. And. of course, use the numbers in the middle if you fall
between the extremes. Please keep the following scale in mind as you rate each of the statements
below.
1 2 3 4 5
extremely somewhat uncertain somewhat extremely
uncharacteristic uncharacteristic characteristic characteristic
1 . I consider how things might be in the future, and try to influence those things with my
day to day behavior.
2. Often I engage in a particular behavior in order to achieve outcomes that may not result
for many years.
3. I only act to satisfy- immediate concerns, figuring the future will take care of itself.
_4. My behavior is only influence by the immediate (i.e.. a matter of days or weeks)
outcomes of my actions.
_5. My convenience is a big factor in the decisions I make or the actions I take.
_6. I am willing to sacrifice my immediate happiness or well-being in order to achieve future
outcomes.
7. I think it is important to take warnings about negative outcomes seriously even if the
negative outcome will not occur for many years.
8. I think it is more important to perform a behavior with important distant consequences
than a behavior with less-important immediate consequences.
9. I generally ignore warnings about possible future problems because I think die problems
will be resolved before they reach crisis level.
10. I think that sacrificing now is usually unnecessary since future outcomes can be dealt
with at a later time.
11. I only act to satisfy- immediate concerns, figuring that I will take care of future problems
that may occur at a later date.
12. Since my day to day work has specific outcomes, it is more important to me than
behavior that has distant outcomes.
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Condom Attitudes Questionnaire
For the situation you described earlier...
Indicate the effect of using a condom during intercourse on each o f the following things:
THE EFFECT OF A CONDOM ON...
extremely
unpleasant
moderately
unpleasant
somewhat
unpleasant
neutral
somewhat
pleasant
moderately
pleasant
extremely
pleasant
1 . your physical stim ulation
1 2 3 4 5 6 7
2. your partner's physical stim ulation
i 2 3 4 5 6 7
3. m ood/atm osphere
i 2 3 4 5 6 7
4. spontaneity
l 2 3 4 5 6 7
5. continuity, not having interruptions
i 2 3 4 5 6 7
6. am ount of variety/creativity
i 2 3 4 5 6 7
7. release of sexual tension (for you)
l 2 3 4 5 6 7
8. release of sexual tension (for your
2 3 4 5 6 7
partner) -
9. feeling natural, skin-to-skin
i 2 3 4 5 6 7
10. m essiness (not having a m ess to clean up)
i 2 3 4 5 6 7
11. passion
1 2 3 4 5 6 7
12 . intimacy
i 2 3 4 5 6 7
13. em otional attraction
i 2 3 4 5 6 7
14. em otional bonding
i 2 3 4 5 6 7
15. love for each other
i 2 3 4 5 6 7
16. tru st of each other
1 2 3 4 5 6 7
17. how good you feel about yourself
1 2 3 4 5 6 7
18. how good you feel about your partner
1 2 3 4 5 6 7
19. m utual enjoym ent
1 2 3 4 5 6 7
20. how uninhibited you feel
1 2 3 4 5 6 7
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105
THE EFFECT OF A CONDOM ON...
extremely
unpleasant
moderately
unpleasant
somewhat
unpleasant
neutral
somewhat
pleasant
moderately
pleasant
extremely
pleasant
21. w hether you both sta y m onogam ous
1 2 3 4 5 6 7
22. the excitem ent o f taking risks
t 2 3 4 5 6 7
23. how m uch you please your partner
i 2 3 4 5 6 7
24. am ount of conflict w ith your partner
1 2 3 4 5 6 7
25. your p artn er's opinion of you
i 2 3 4 5 6 7
26. em barrassm ent
i 2 3 4 5 6 7
27. man staying hard, erect
i 2 3 4 5 6 7
28. how long the man lasts
i 2 3 4 5 6 7
29. having enough lubrication
i 2 3 4 5 6 7
30. convenience
l 2 3 4 5 6 7
31. tastes/sm ells
2 3 4 5 6 7
32. protecting you from HIV/AIDS
i 2 3 4 5 6 7
33. protecting your p artn er from HIV/AIDS
i 2 3 4 5 6 7
34. protecting you from other STDs
1 2 3 4 5 6 7
35. protecting your partner from other STDs
t 2 3 4 5 6 7
36. preventing pregnancy
i 2 3 4 5 6 7
37. how w orry-free, relaxed you are a t the
i 2 3 4 5 6 7
time
38. how worried you feel later
i 2 3 4 5 6 7
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A T T E N TIO N FOCUS Q U EST IO N N A IR E
Think about times when you've been in this situation...
You're m aking out, about to have intercourse... ea rlier y o u thought yo u sh o u ld use a
condom , but now yo u 're fe e lin g tem pted to g o a h e a d w ithout one.
How often does this happen to you when you're making out? (check one)
□ Every time or almost every time
a Very often
□ Sometimes
a Once in a while
□ Almost never
□ This has never happened to me.
Many different thoughts may pass through your mind in this situation.
How much do you have each of the following thoughts when you're in this type of situation?
(Note: If you have never been in this situation, just try to imagine how you would be thinking
this situation.)
1 - Not at all
2 - A Iittle/oncc in a w hile
3 - m oderately/som ew hat
4 - quite a bit/inost of the time
5 — A lot/all th e tim e
1 . I think about the risks of unprotected sex.
2. I think about how good it would be (in the moment) without a condom.
3. I tell myself that I must use a condom.
4. I think about how it would be worse (in the moment) to use a condom.
5. I think about how using a condom is beneficial in the long run.
6. I tell myself that having sex without a condom won't be too risky.
7. I think about how I’ d regret it soon after if I had unprotected sex.
8. I think about how I like taking risks.
9. I don't think about much of anything.
S om etim es p eop le w ill try to avoid th ink in g certain th ou gh ts. H ow m uch does each
statem en t d escribe your typical th ou ght process in th is situation?
I. I try' not to think about future consequences of unprotected sex.
2. I try not to think about how good it would be to have unprotected sex.
3. I try not to think about anything; I just block out all thoughts.
4. I try not to think about the things I dislike about condoms.
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107
APPENDIX B: ATSS MATERIALS
ATSS Instructions
ATSS Script
Coding Instruct ions
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108
ATSS Instructions
“Thank you again for participating in this study. We are interested in the kinds of thoughts
people have when they are in certain situations. When people go about their daily activities,
interacting with others and doing things, they have a kind of internal monologue going
through their heads, a constant stream o f thoughts or feelings which reflect their reactions
to things that are happening.
“We are going to ask you to listen to a make-believe situation and imagine that you are in
it. What we want you to do is to listen to this situation and tune in to what is running
through your mind, and then say these thoughts and feelings out loud. Your responses will
be recorded on a separate tape recorder.
“The scenario you’ll be listening to is divided into several segments. At the end o f each
segment, there will be a tone [SOUND OF TONE] followed by a pause o f thirty seconds
and then a second tone. During the 30-second pause, please say out loud whatever is going
through your mind. Try to imagine as clearly as you can that it is really you in the situation
right now. O f course, there are no right or wrong answers, so just say whatever comes to
mind without judging whether it seems appropriate or not. The more you can say, the
better; the more spontaneous and honest you can be, the better. Try to keep talking for the
full 30 seconds until you hear the tone again, which signals that the story is about to
continue.
“Please note that your task is not to speak back to any one o f the voices on the tape as
though you were having a conversation with one o f them. Rather, you should tune into
your own private thoughts and say them out ioud.
“The story you will hear is designed to be realistic. We are asking you to imagine that it is
actually happening to you. You might not necessarily find yourself in these situations in
real life, but for the purposes o f this study, please pretend as if you are a participant, and
that these things are happening. We are interested in what you are thinking in these
situations, and to get that information, we need for you to make this situation as realistic
and vivid in your imagination as possible and to verbalize your thoughts and feelings as
fully as possible.
“Also, we would like to assure you that your name will not be connected to the taping we
do here, so your responses are anonymous.
“After answering any questions you may have, we will start with a practice tape to help you
get accustomed to the procedure. During this practice tape, the experimenter may give you
additional instructions. After the practice tape, you’ll have a chance to ask questions about
the procedure in case there is anything that is still unclear. Then we will play the actual
tape.”
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109
Segment 1
Narrator
Friend
Segment 2
Narrator
Segment 3
Narrator
Friend
Segment 4
ATSS Script
Femmle
- Party Intro
You’ve just arrived at a party with your
girlfriend. You see some familiar faces.
Your friend is scoping out the scene.
She nudges you to get your attention.
“Oh look, isn’t that that guy John from
your class. You’re right, he’s hot.”
- Talking at party
John notices you and comes right over.
You start talking about the test you just
took. Although you’ve exchanged a
few words with him in class before,
you’ve never really had a chance to talk.
He is so easy to talk to and he’s really
good looking. His attention is
completely focused on you. You can’t
help noticing the strong chemistry.
- Friend’s comments
Later on, after John has left with his
friends, your friend comes over with a
big knowing smile on her face.
“It looks like you and John really hit it
off. He couldn’t take his eyes off you.
You’re really lucky; he’s gorgeous...I
bet he can get any woman he wants.”
Dating background, begin daydreaming
Three w’ eeks have passed since the
party. You and John have gone out
together several times and things are
going great between the two of you.
Every time you see him your attraction
grows stronger. Tonight you have plans
to go out to a movie together. You’re in
your bedroom getting ready for the
evening and you begin to daydream
about what the evening will be like.
Male
You’ve just arrived at a party with a
friend. You see some familiar faces.
Your friend is scoping out the scene.
He nudges you to get your attention.
“Oh look, isn’t that that girl Julie from
your class. You’re right, she’s hot.”
Julie notices you and smiles. You walk
over and start talking with her about the
test you just took. Although you've
exchanged a few words w ith her in class
before, you’ve never really had a
chance to talk. She is easy to talk to
and she’s really good looking. Her
attention is completely focused on you.
You can’t help noticing the strong
chemistry.
Later on, after Julie has left with her
friends, your friend comes over with a
big knowing smile on his face.
“It looks like you and Julie really hit it
off. She couldn’t take her eyes off you.
You’re really lucky; she’s
gorgeous... You know a lot of guys are
after her.”
Three weeks have passed since the
party. You and Julie have gone out
together several times and things are
going great between the two of you.
Every time you see her your attraction
grows stronger. Tonight you have plans
to go out to a movie together. You’re in
your bedroom getting ready for the
evening and you begin to daydream
about what the evening will be like.
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110
Segment 5
Segment 6
Segment 7
Segment 8
Segment 9
Narrator
Female
Imagine kissing
As you look through your wardrobe for
something to wear, your mind continues
to wander. You picture the tw o of you
back at your place at the end of the
evening. You see yourselves on the
couch kissing each other.
Imagine making out
You pick up your comb to fix your hair,
and you continue imagining the
evening. You start picturing the two of
you in bed together, naked.
Imagine close to intercourse
As you go to look for your shoes, your
imagination continues. You imagine
the two of you making out and getting
very’ close to intercourse.
At the cafe
Suddenly you realize that it's time to
go. John arrives at your place to pick
you up, and he's looking more attractive
than ever. You go to the movies and
then afterwards you go to a cafe for a
late snack. You're having such a good
time with him and it’s getting late. The
way he looks and the way he acts are
very’ sexy to you.
Going home
You’ve left the cafe and he’s pulling up
in front of your place to drop you off.
You’re feeling so comfortable with him.
You don’t want the night to end. The
thought of inviting him in for a drink
crosses your mind.
Male
As you look through your wardrobe for
something to wear, your mind continues
to wander. You picture the two of you
back at her place at the end of the
evening. You see yourselves on the
couch kissing each other.
You pick up your comb to fix your hair,
and you continue imagining the
evening. You start picturing the two of
you in bed together, naked
As you go to look for your shoes, your
imagination continues. You imagine
the two of you making out and getting
very close to intercourse.
Suddenly you realize that it's time to
go. You arrive at Julie's place to pick
her up, and she's looking more
attractive than ever. You go to the
movies and then afterwards you go to a
cafe for a late snack. You’re having
such a good time with her and it's
getting late. The way she looks and the
way she acts are very sexy to you.
You’ve left the cafe and you’re pulling
up in front of her place to drop her off.
You’re feeling so comfortable with her.
You don’t want the night to end. You
wonder if she's going to invite you in
for a drink.
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Segment 10
Narrator
Segment 11
Narrator
Segment 12
Narrator
Segment 13
Narrator
Segment 14 -
Narrator
111
Female
In the apartment
You’re sitting together on the couch in
the living room. You’ve had a few
drinks and you’re laughing and sharing
stories. Even though you don’t know
him very well you’re having a great
time. You gradually move closer to
each other and begin to kiss.
On the couch
You and John have been kissing for
awhile. The way he touches you really
excites you. He whispers to you how
turned on he is. You wonder whether
it's time to suggest moving into the
bedroom.
In the bedroom
In the bedroom, he takes off his shirt
and starts removing your clothes. You
feel his skin against yours. He seems
to know exactly how to turn you on.
You can’t believe how sexy he is.
You’re feeling incredibly aroused.
On the bed
Both of you are naked in bed. John is
hot and aroused. You feel perfectly in
tune with him. You’re way beyond
kissing now.
Beyond kissing
He seems to know exactly how to
touch you. The foreplav has been
intense and exciting. And now you're
very' close to intercourse.
Male
You’re sitting together on the couch in
the living room. You’ve had a few
drinks and you’re laughing and sharing
stories. Even though you don’t know her
very' well you’re having a great time.
You gradually move closer to each other
and begin to kiss.
You and Julie have been kissing for
awhile. The way she touches you really
excites you. She whispers to you how -
turned on she is. You wonder whether
it’s time to suggest moving into the
bedroom.
In the bedroom, you take off your shirt
and start removing her clothes. You feel
her skin against yours. She seems to
know exactly how to turn you on. You
can't believe how sexy she is. You're
feeling incredibly aroused.
Both of you are naked in bed. Julie is
hot and aroused. You feel perfectly in
time with her. You’re way beyond
kissing now.
She seems to know exactly where to
touch you. The foreplay has been intense
and exciting. And now you ’re very close
to intercourse.
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112
Segment 15
Narrator
Segment 16
Narrator
Segment 17
Narrator
Segment 18
Narrator
The moment of truth
As you move closer to penetration,
your thoughts flash back to your
friend's comment that John could get
any woman he wants.
Condom reference
As you continue to move closer to
intercourse, it occurs to you that he’s
not wearing a condom.
Wrap up
This is the end of the simulation.
Please take the next 30 seconds to
describe how you imagine the situation
ending.
Thank you!
This is the end of the tape. The
experimenter will enter the room in a
few moments.
As you move closer to penetration, your
thoughts flash back to your friend's
comment that Julie could get any man
she wants.
As you continue to move closer to
intercourse, it occurs to you that you're
not wearing a condom.
This is the end of the simulation. Please
take the next 30 seconds to describe how
you imagine the situation ending.
This is the end of the tape. The
experimenter will enter the room in a
few moments.
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113
Coding Instructions
Attention
Code 'O ' if the subject does not mention these,' 1' if there is any mention of these. It is possible
for a single statement to fell into more than one category.
a. present positives: Anything statement regarding what's happening in the present moment (or
in the upcoming events of the evening) which expressed as positive or desirable.
Examples: This is great. Oh yeah. I'm so excited. We're kissing and touching each
other [if this is expressed with a positive tone].
b. present negatives: Same as'a'but mentioning negative aspects. Examples: This is not a
comfortable situation for me. He's not so attractive.
c. Future positives: Anything regarding future outcomes which seem positive. Examples: I
hope we go out again. I can't wait till next time. This relationship will last.
d. Future negatives: Anything regarding possible negative future outcomes. Examples: I don't
want to get pregnant. I don't know where she's been and what std's she might have.
e. How long partner known: Code this whenever a subject mentions how long they have known
each other or have been going out, whether it's stated positively or negatively.
Time Orientation
Rate the extent to which subject is focusing on present and future.
0=lo\v: use this when there is no mention of present/future circumstances
l= rmedium: use this when there is some mention, but with more cognitive rather than emotional
content: basically when the person is talking about it, but not really into it.
2=high: use this when the person mentions present/future in a more emphatic way, with some
emotional involvement— like they're kind of into what they're saying
'present' is for anything related to the current moment or the evening of the date
'future' is for anything that might happen after that evening
Ambivalence
Rate the extent to which someone seems ambivalent about whether they want to move closer are
back away in the scenario (approach/avoid).
0= none; no internal conflict evident
1= some conflict can be sensed
2= subject is clearly feeling conflicted about the situation, but not extremely so
3= subject is feeling very conflicted about which way to go; usually with some emotion
expressed
Strongest Intention/Probable Behavior
Here coder uses own judgement to infer what would be the subject's most likely behavior by the
end of segments 4-9, segments 10-14, and segments 15-17. Try' to pick just one category, unless
you really feel that more than one behavior could be equally likely. If there isn't strong evidence
for any particular category, check 'don't know'’. If there is a behavior that doesn't fall into any
category, check 'other' and write a note describing the behavior. Do not code segments 1 -3.
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114
APPENDIX C: Sample ATSS Transcripts
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115
A TSS Transcript, Female Subject #14
01
O h really, h e 's hot? I don’t think so. Y ou know hot guys usually are basically jerk s, well
at least th at's w hat I think. I d o n 't know ju st be careful around this party, y o u ’ve got a lot
o f people here that seem not so nice. I better be careful o f w hat I am drinking right now
too.
02 O K now , stop for a moment. This is a party, this guy is com ing on me and I think he
w ants som ething, yeah h e’s ju s t all attractive and I like him a lot now but he w o n ’t be
because if he’s nice why doesn’t he talk to m e in class huh? W hy does he talk to m e right
now? T his is really suspicious. Be careful, be careful.
03 See any w om an he wants. I am not any w om an because, no th a t's wrong. I have to play-
hard to get because he's not going to g et me, h e ’s not.
04
W ell it's really nice o f him to ask me to the m ovies, but I w onder why. W ell I guess this
stereotype o f m en being male chauvinistic pigs should change after all w e are friends and
I'v e talked to him and he seem s to be a really nice guy. O K I'll give him a shot and sec
you know w hat h e 's made up of. I w onder w hat to n ig h t’s going to be like?
05
O K now this is, O K this is going, this is totally going out o f m y mind. U hm this thing
h asn 't even happened yet, no stop I sh o u ld n 't think ab o u t it because w hat happens is you
know this scenario doesn't happen. Stop thinking about it. stop thinking ab o u t it in your
daydream . Y o u ’re, this is your fantasy, stop it right now.
06
O K it's not w orking. My fantasy is going bizurk on me. O K stop, oh but he is ju s t so
gorgeous I m ean he is just w hat I dream of. No, no, no, no this hasn’t even happened yet.
w ere ju s t going to the movies, w e're ju s t friends, w e ’re ju s t going to go out have a nice
tim e com e back and w e’ll ju st be friends. N othing is going to happen, stop your
fantasies.
07
O K there it's going to stop. O K go get m y shoes, I'm looking fo r shoes right now , yes
shoes. N ice shoes for tonight that goes w ith the outfit, not that, shoes. W e are ju st
friends, shoes, w-e are just friends, shoes, I am looking fo r shoes right now. Stop, d o n ’t
think ab o u t it, shoes.
08
Oh this night is turning out to be one o f the m ost best nights I ’ve had. H e’s so rom antic
and w hat w e’re doing movies and kissing, that m ust m ean it is ju s t right. N o, but oh gosh
I d o n ’t know w hat to do. I can ’t invite him over later on, it’s ju s t not right. It’s o u r first
date, an d ...
09
O K I can get aw ay with asking him. com ing in and g et a drink. It’s ju st a drink, harm less
little drink. No big deal. I have done this w ith friends before, w e ju st sit dow n and talk
and talk fo r the w hole night. Y eah it’s a good idea I can really g et to know him as a
person, not ju st another friend in the classroom . W e can reallv be good friends. Y eah I'll
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1 1 6
invite him and if anything goes wrong I'll just stop.
10
OK, OK this is not good. Oh but it feels so good. No I’m not going to let my hormones
get in the way, no this is not good. Oh, but he’s so romantic. OK I guess a kiss won't be
too bad, if he’s going to do anything more I can always tell him to stop. He seems like a
very' sensible person.
1 1 OK this is not good. My heart is telling me one thing, my body is telling me another. No,
no, no, no we just settled for kissing that’s it. I’m, it’s not the time yet. I barely knew
him. This is not good. Hello I am not easy', I barely knew him, I better tell him to stop.
12
Oh this feels so good. This feels so good. OK I guess, what is this about the kissing and
not know ing him too much thing. Oh well, never mind. Anybody who kisses me like this
they must have known me or. I've never had anybody kissing me like this before. This
feels so good.
1 3
OK. OK at least he’s not in yet. Well, is it too late to tell him to stop? No but this feels so
good. OK I guess I have protection. I guess it's all right. This feels so good. Oh yes. this
feels so good.
14
OK better put some protection on right now if I’m going all the way, yes I am going all
the way, I definitely want to go all the way. Protection time, better put a condom on him
and oh yeah, protection, focus, protection. Yes. right here. I need protection, yes oh this
feels so good. Protection, protection. OK it's on.
15
Oh my God. what am I doing? I have sworn to God. to myself that I would not be all of
these other women and now' I am doing the same thing. OK I better stop right now. stop.
I'm getting, oh this is getting embarrassing. I am letting my biological needs get ahead of
me. No. no, no I am intelligent, I am educated. I better tell him stop.
16
No. no, uh oh. This has been getting bad. Not only am I one of his women, but he’s not
wearing protection. This is not great. I, focus, focus, I have to get myself protected. Stop,
stop, I have to stop and at least get protection, stop. I have to stop.
17
I just see myself stopping him. He gets really angry, pushes me off the bed, and but thank
God that we didn’t do anything serious yet. Our friendship would definitely be ruined,
but at least I know what kind of person he is, and so... and I’m glad that I am not like
any other one of them.
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A TSS Transcript, Female Subject #25
01
I'm thinking about going to talk to him. I want to go, but then again I’m nervous because
he is very hot and I’m not sure what he’s going to say, but I won’t let my friend know
this. I’ll just smile and say yeah I know he’s hot and we should go talk to him.
02
I’m smiling because I’m glad he’s so approachable and even though I haven’t talked to
him before I can picture dancing with him and having drinks with him and I want to talk
to him about things that I think he would enjoy. And I smile at him a lot, and I like him.
03
I'm thinking about how jealous she must feel that he likes me and that uhm he noticed
me. and I’m glad inside that she notices that he was looking at me and not at her or
someone else. And I'm thinking about how' it would be if I actually got with him because
she is reinforcing the idea of it, so I’m thinking about hopefully talking to him and...
04
I'm looking at myself in the mirror and I'm thinking about what I should be wearing and
I stand there in my underwear and make sure that it matches. And I’m trying to picture
how I would look next to him with what I'm wearing at the moment and I try many
things on and I think uhm that I don't look good because nothing would be perfect
enough for him, but I think about how...
05
I can picture me in the couch with him and he's kissing me slowly and I’m enjoying it
and I can picture uhm us being alone in there and I can picture me asking him to go up to
my room and spending the night with me.
06
I picture him touching me. My waist, my breasts. I can picture him hugging me and I'm
kissing him, kissing his neck. And he's caressing me gently and I can feel the passion
and I feel energy from both of us and I feel nerv ous because this is the first time that this
has ever happened with him.
07
He is kissing me and I'm kissing him back and I want to have intercourse with him. but
I'm thinking I hope it doesn’t happen. It's too soon, but I wouldn’t regret it if it
happened, so I can picture it happening. And I feel nervous and anxious about it.
08
I’m thinking about the rest of the night, about when we leave the cafe, even though I’m
there with him I’m not really paying attention to what he’s saying because I’m thinking
about us being intimate and getting closer together. And just bv looking at him I can
picture it because he looks very’ , very’ fine and I wished the whole time that the night
would end just so that we would go back to my place...
09
It's almost time for him to leave, but I ask him inside for a drink and I’m thinking about
making him stay longer just saying OK you want a drink and then saying want to w atch
the T V or then saying want to hear the radio just anything that I could say' so that he
stays longer and I’m thinking about what his reaction is. I'm looking straight at his eyes,
trying to see what he's thinking also and...
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118
10
We're kissing and it's very, very slow. Uhm not French kissing just barely kissing and he
starts to move his hands up my body and I let him and I start taking off his shirt and I
start kissing his breasts and kissing his mouth and I tell him how much I really like him
and how cute I think he is and I’m thinking about...
1 1
I'm thinking about asking him to go to my bed, when I hear what he says, but I just keep
kissing him and I think that uhm maybe it’s not right for me to do that yet uhm because
it'll lead to sex positively, it will lead to sex. And I don’t know exactly if I'm ready, but
I’m thinking that I will enjoy it so much that I’ll take the risk of taking him up to my bed
and being with him.
12 I’m thinking I want this to happen, I want him. And I’m thinking how easy it is to do this
because I've been thinking about it for so long, for the whole day that I actually feel like
it's ail right since I’ve been thinking about it and I don’t feel bad about it. And I want to
be with him and I'm thinking about letting him know that I really, really want to be with
him.
13 I'm thinking about sexual intercourse. I can feel his body and his erection. And I'm
thinking about how good it feels and how I really, really want him to make love to me
and I'm not thinking about any consequences even though they come into my mind I just
push them away and just think about right now, about the moment.
14
We’re very close to intercourse and maybe I'm thinking that a month ago I would have
said no because I was a virgin, but now that I am not I think it's OK for me to do it with
him and I’m thinking about asking him if he has a condom because I don't know if I ever
saw one in his pocket or not and I’m thinking about asking him that right now.
1 5
Yeah I think about that and I feel special even though I know maybe I shouldn’t but I
feel special because he’s with me. And I think that he must really like me because he is
there in my bed. And even though he may have been with other women it doesn't matter
to me because now he's with me and not with other women.
16 I realize he is not wearing a condom so I’m thinking maybe I shouldn’t do this, maybe I
shouldn't do this. 1 know he has been with other women, he might have something, but at the
same time I'm scared to ask him or to tell him you know put on a condom and I don’t know
if he has one or not, but I’m thinking about grabbing one from my drawer that I know I have
some there so that’s probably what I would do.
17
I imagine us having sexual intercourse and not using protection just because I did not ask
him and he did not bring it up and because we were so close and I just decided to have
sex with him. And I imagine us having sex the whole night and he is very, very good.
But then I also imagine not seeing him ever again.
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A TSS Transcript, Male Subject #32
01 Yeah I know. Should I go talk to her? She looks so good in that outfit. Why don't you
come with me to go with her, I don’t want to go all by myself, I’ll look like a fool. Come
on, forget you I’ll go by myself then.
02
Wow I think she really likes me. Wondering if I should ask her out. Man she must be
really hot. I think I will ask her out. Keep talking to her and just, hopefully it will spark
some interest in a later conversation and then we go out and watch a movie or hang out
with her for...
03
Hell yeah, damn straight. You know I’m the bomb. Shoot every girl always wants me.
but yeah I think she really likes me. I think I'm going to ask her out. I hope things w ork
out. man if I can score with her shit. I’d be like satisfied for life.
04
Wonder what she’ll be wearing. Wonder what movie we are going to watch. Does she
get to pick it or do I get to pick? Hope it's not some dumb chick flick, but if it is. after
the movie go back to her place and get it on.
05
Damn she smells good. I wonder how far this is going to go. Is she prepared for this?
Wow. this just might go all the wav.
06
Damn she's hot (unintelligible). Just caressing her body, kissing her all over. She's so
fine.
07
Damn I'm wondering if she has a condom around. Oh well I'm not going to stop the
moment to go interrupt to go find one. That would suck . Damn she's hot.
08
I wonder if we’re going to go back to her place. I wouldn't mind spending the night over
at her house. I wonder what's on her mind, what is she thinking about right now. Does
she want, should I? I can't decide.
09
This is it, it’s going to happen tonight, or not? Should I wait for her to make the move, or
should I. I really don't want this night to end. There’s a big chance, oh she’s getting out
of the car.
10
Man she smells good. She’s so hot. I wonder if I should just start feeling her up.
11
Should I make the move? Should I just pick her up and take her to the bedroom or should
I just stay? Make love to her right there on the couch. Start like hinting, undressing her.
Wondering what would be better, the bedroom or the couch. Or does it matter, I wonder
where she prefers.
12
I've waited on doing this. I don’t even know this person, oh well who cares, she looks so
good, skin is so soft. She smells so good.
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13
Oh it feels good. She is so hot, trip me out. I think she feels the same way too. I think it's
about time I get down to business.
14
Wow she’s hot. She's really turning me on. Stop this foreplay and get down to the real
thing. Oh her skin is so soft, come on let's go do it right now.
15
Man I wonder if like Julie is a sex addict, a sex-aholic or something. If she like sleeps
with every guy she dates. Am I going to get like a disease or like AIDS? Oh who cares,
she is so hot. I'm a guy, all I care about is sex anyways, whatever.
16
I wonder if she has a condom handy, like, if she does you know she’s getting busy with
other guys she knows. But I don’t want to break this moment and ask for a condom or go
look for one. What are we going to do, if we don’t have, are we going to do it? I’m so
turned on right, now, shoot I don't really care. Forget about the condom.
17
We have sexual intercourse and then we after that's done we just like lay in bed and just
talk. Hey, just fall asleep in each other's arms, and wake up the next morning next to
each other. Get cleaned up and go off to do whatever is...
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ATSS Transcript, Male Subject #38
01 Having a class w ith her is actually a great way to meet someone. You sit next to them, you
get into study groups with them, you get to know them and if they’re hot you know you
start getting to know them and start finding out what they’re into w hat they’re not into,
actually have som e information to when you actually decide to ask them out you know you
are not ju st going in cold, you actually know what you’re talking about you know what
they like and hopefully something will happen.
02 Uh, in this situation I’d uh talk to her about the test and basically ask her how she's doing,
when that’s kind o f warn itself out say you know how you doing you know ju st socially or
whatever, and ju st kind o f like try to get a feel for her if uh I really had a feeling that
something might be there I would probably say hey here’s my num ber, hey you want to go
get lunch after class or something.
03 I am feeling really good right now, anytime a hot chick likes you , you ju st feci great. I
mean like a m illion bucks. Uh. but at the same time I'm a little apprehensive 'cause I still
have to make that first move actually turn it from hey w e're ju st classm ates to hey let's get
something going, uhm . you know a little awkward like how much do you want to give
away, how quick do you want to try this out...
04 Uhm, go to the m ovies, do the whole holding hands, put my arm around her. uhm after the
movie go ahead and take a drive, and uh talk about maybe going back to m y place, you
know get a cup o f coffee and go there and just kiss her and touch her and sec, and get a feel
for if she wants to go to the bedroom and do something.
05 I would stay on the couch, the big question is you know uh at what point do you actually
like lean over and allow her to lay down, and get on top o f her uhm, assum ing that that is
w hat she wants, but I mean I'm pretty sure she does so get on top o f the couch, m ake out
some more and then go up to the bedroom and uh see what happens from there.
06 Uh being a daydream you know the sex is great, uh we really connect you know, w e just, I
mean we both have the same motion caressing each other, and you know ju st, like it's
perfect, uh it's ju st a dream, in real life it’s probably not going to be like that you know,
might as well hope for the best...
07 Uhm, cloths are com ing off, slowly, w e are just kissing each other first on the m outh , then
the neck then going lower then basically ju st like massaging each others’ body and kissing
each other all over I mean just keep it real slow, real gentle until the cloths are o ff and then
get on top o f her and see what happens from there.
08 oh man. I would ju st be thinking here we are, drinking coffee, uh things are going o.k.. but
I mean I'm not getting any you know perfect signals what she’s intending so I want to you
know say hey it’s getting late are you tired, do you want to go back, you know w hat’s up,
what are you interested in, uhm you know ...
09 Ooh, this is like the moment, I mean you ju st sit there and just go shit is she going to say
something, you know w e hope we are and kind o f just smile you know you ju st say so you
know I’ll see you later or are you busy or hey by any chance do you have anything to
drink.
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10 Uh, with alcohol in my system I’d start to get a little more interested, I probably should at
this point I mean I’d really probably have to make a move, might not be the best time but
I'd have to do it, uh just you know' touch her on the outside of her clothes, you know-
leaning more over like looming over her to see if she lays down to the couch onto her back
that w ay I can get on top of her and we can make-out.
1 1 If she says, you know- she’s turned on then it’s a pretty' safe bet to uh kind of you know-
change the setting a bit, I’d say you know - maybe we should go to the bedroom you know
get up and help her up you know - help her with her feet and like I don’t know- pick her up
and like cany' her to the bedroom and onto the bed...
12 Uh. wow- things are going real good, uhm at this point basically I know something is
happening. I’d be really much more confident now than in any other point which is a nice
thing because confidence like is hard to come by sometimes with me, uhm but right here
I’d be like just ready to go, I mean she's interested I'm interested, the alcohol is helping me
get over any kind of guilt feelings or anything...
1 3 Uh, at this point we'd be like doing some foreplay- and you know licking her, her liking me
kissing all over the body, oral sex or whatever, you know if she is interested she might just
want to go straight into sex I mean basically start by you know starting at her neck and kiss
down and see how she reacts.
14 Uh y ou know-just ready to go I mean foreplay' is great and all but I kind of w ant to get to
actual sex, uhm so you know first we would be like you know going to mv pants getting a
condom out or asking if she has a condom, uhm and getting that on I mean you have to
really show your intent and hopefully she's still like totally interested in what you're going
for uhm you want to make sure it's safe you know we'll have a good time but at the same
time you don’t want to get her pregnant.
1 5 I kick ass I mean this girl's hot. all the guys want her and yet I have her, uhm that's a really
cool feeling, you know a lot of times you think oh you know she’s too good for me or oh
man she has to already have a boyfriend 'cause girls like that just aren’t single and yet here
I am with one uhm just a great feeling, I'm totally stoked. Wow, you know it's my turn in
the spot light I guess.
16 Got to get a condom on, I mean sex feels better without one, it’s totally true everyone
knows it, most times a girl prefers it without one also, but I mean it’s like the whole Rush-
Lactcr model, cost vs. Potential benefit and the girl getting pregnant or who knows, I mean
I guess I don’t know very, I don't know a whole lot about her she might have had a few
guy s or a few hundred guys. I’m trying to be safe.
17 Uh, I get the condom get it on or better yet have her put it on me, which I really like uhm
we have sex I mean I’m on top of her, we’re just rocking and then we roll over and she’s
on top of me and that way I can like as we go through it I mean I can watch her, watch as
she closes her eyes, being my little dream here you know she’s had an orgasm too and we
totally enjoy- this uhm...
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123
APPENDIX D: Questionnaires for Study 1
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124
Sexual Behavior Study
Instructions:
Please read each question carefully and answer as accurately and honestly as
possible. There are no “good” or “bad” answers. Also, the questions are
intended to be straightforward; they are not designed to trick or deceive you.
Some questions may appear redundant and you may feel like you re answering
the same things over and over again. However, they are all slightly different and
do generate important information for the study. So please take your time and
answer each question carefully.
Thank you for your time and effort.
Definitions of terms used:
sexual intercourse or intercourse - penetrative sexual intercourse (vaginal or
anal sex), with or without ejaculation.
STD - sexually transmitted disease (herpes, gonorrhea, etc.)
Abstaining from intercourse - engaging in any sexual activities other than vaginal
or anal intercourse
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1 2 5
General Questionnaire
(CFC Scale)
For each of the statements below, please indicate whether or not the statement is characteristic of you If
the statement is extremely uncharacteristic of you (not at all like you) please write a “ 1 ” to the left of the
question, if the statement is extremely characteristic of you (very much like you) please write a “5” next to
the question And, of course, use the numbers in the middle if you fall between the extremes Please keep
the following scale in mind as you rate each of the statements below
1 2 3 4 5
extremely somewhat uncertain somewhat extremely
uncharacteristic uncharacteristic characteristic characteristic
1 I consider how- things might be in the future, and try to influence those things with my day to day
behavior.
2 Often I engage in a particular behavior in order to achieve outcomes that may not result for many
years
3 I only act to satisfy- immediate concerns, figuring the future will take care of itself
4 Mv behavior is only influenced by the immediate (i.e., a matter of days or weeks) outcomes of my
actions
5 My convenience is a big factor m the decisions I make or the actions I take.
6 I am willing to sacrifice my immediate happiness or well-being in order to achieve future outcomes
~ i 1 think it is important to take warnings about negative outcomes seriously even if the negative
outcome will not occur for many years
8 I think it is more important to perform a behavior with important distant consequences than a
behavior with less-important immediate consequences.
9 I generally ignore warnings about possible future problems because I think the problems will be
resolved before they reach crisis level.
10. I think that sacrificing now is usually unnecessary since future outcomes can be dealt with at a
later time.
11 I only act to satisfy- immediate concerns, figuring that I will take care of future problems that may
occur at a later date.
12 Since my day to day work has specific outcomes, it is more important to me than behavior that
has distant outcomes.
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126
Personal Background
1 Age:______
2 Gender: Male Female
3 Year in school:
Freshman Junior__________________ Graduate
Sophomore Senior
4 Ethnicity (check all that apply):
African-American __ Mid-Eastern__________ __ Hispanic
Asian __ Caucasian_______________ Other:___________
5 Sexual preference— which do you prefer0
Exclusively female Primarily female
Exclusively male Primarily male
Both male and female, equally
6 Are you in a long-term monogamous relationship0
yes __no
Thu fo llo w in g questions a sk a bout the num ber o f tim es yo u ve done certain things o r the num ber o f
partners y o u Ve been with. W hile you are not expected to recall exact num bers, please do y o u r best to
approxim ate (For example, to estim ate the num ber o f tim es y o u 'v e h a d intercourse in the p a st year, you
m ay approxim ate that you h a d sex about twice a week fo r fiv e m onths with one partner, so 2 rimes per
v.eex x 25 weeks m akes 50 tim es /
7 Approximately how many different partners have you had some kind o f sexual involvement with (any
kind of physical, sexual contact)
in the past year0 ______ . . in the past 30 days0 _____
8 Approximately how many different partners have you had sexual intercourse with.
total? _________ in the past year0 . . .in the past 30 days0 ______
9 Approximately how many times have you had sexual intercourse...
..in the past year? _________ ..in the past 30 days0 ______
10 Approximately how many times did you have intercourse without a condom...
. .in the past year0 in the past 30 days? _____
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127
1 1 Sometimes people plan to use a condom but end up having sex without a condom anyway
• Approximately how many times did this happen to you. .
..in the past year? ... in the past 30 days0 _____
• In how many of these instances were you under the influence of alcohol/drugs
in the past year0 . in the past 30 days0 _____
12 Consider past sexual encounters in which you had some intention to use a condom. In these situations,
on average, how difficult was it for you to follow through and use a condom? (circle one)
1 2 3 4 5 X
no problem a little moderately very difficult extremely Doesn't
at all difficult difficult difficult Apply •
13 Consider past sexual encounters in which you were intending to make out without going as for as
intercourse In these situations, on average, how difficult was it for you to abstain from intercourse0
(circle one)
1 2 3 4 5 X
no problem a little moderately very difficult extremely Doesn't
at all difficult difficult difficult apply •
• Circle "doesn't apply” if you have never been in such a situation
4
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Think about times when you’ve been in this situation....
Y o u re making out. about to have intercourse... earlier yo u thought you should use a
condom, but new you 're feeling tem pted to go ahead without one.
How often does this happen to you when you’re making out? (check one)
□ every time or almost every time
□ very often
□ sometimes
□ once m a while
□ almost never
□ This has never happened to me
Many different thoughts may pass through your mind in this situation.
How much do you have each o f the following thoughts when you’re in this type o f situation'7
fN'ote: If you have never been in this situation, just try to imagine how you would be thinking ’
this situation.)
1 • Not at all
2 - A little/once in a while
3 - moderately/somewhat
4 - quite a bit/most o f the time
5 - A lot/all the time
1 I think about the risks o f unprotected sex
2 I think about how good it would be (in the moment) without a condom
3 I tell myseif that I must use a condom.
4 I think about how it would be w orse (in the moment) to use condom
5. I think about how using a condom is beneficial in the long run.
6 I tell myself that having sex without a condom won’t be too risky
7 I think about how' I’d regret it soon after if I had unprotected sex.
S I think about how I like taking risks
9 I don’t think about much o f anything.
Sometimes people will try to avoid thinking certain thoughts. How much does each
statement describe your typical thought process in this situation?
1. I try not to think about future consequences o f unprotected sex.
2 I try not to think about how good it would be to have unprotected sex
3 I try not to think about anything, I just block out all thoughts.
4 I try not to think about the things I dislike about condoms
5
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1 2 9
Imagine the next time you and another person are making out and you both want to have
sexual intercourse.
Think carefully about the details o f this situation. Think about when this will most likely occur, who you
will be with, and where you might be. Imagine what you 1 1 be thinking about, how you will feel, how
you may feel about your partner, etc.
1 Describe the details of this scenario as you think it will most likely happen You may want to mention
thoughts and feelings as well as circumstances o f the situation
2 During this situation, do you think you will (a) have intercourse using a condom, (b) have intercourse
without a condom, or (c) not have intercourse'’ Please describe your thoughts about this.
6
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130
Important
The remainder of this questionnaire will ask specific questions about your
thoughts regarding the encounter you iust described. When answering
these questions, please keep this scenario in mind.
Remember, these questions are not asking about your attitudes/thoughts
about sexual encounters in general, but rather you should think specifically
about the scenario you just described.
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131
Recall the scenario you just described...
1 When do you think this will next occur? (check one)
some time in the next week
some time in the next month, but more than a week from now
some time in the next year, but more than a month from now
more than a year from now
have no idea
2 What type of partner do you think you will be with?
long-term monogamous partner
monogamous, but without long-term commitment
someone you’re casually dating
someone you’re not dating who you just got together with (chance encounter)
have no idea
3 How likely is it that you will be under the influence of alcohol or drugs'7
no chance or extremely unlikely
somewhat unlikely
somewhat likely
very likely
have no idea
4 How much do you think your judgment will be affected by alcohol or drugs'7
very affected
somewhat affected
not at all affected
h3ve no idea
5 How sexually aroused do you expect you will be during this encounter'7
much less aroused than usual for you
somewhat less aroused than usual
about as aroused as usual
somewhat more aroused than usual
much more aroused than usual
have no idea
6 During this encounter, how likely is it that...
very som ew hat mavhe. som ew hat verv
unhkelv unlikelv mavbe not likelv likelv
it will be possible to use a 1
2
3 4 5
condom?
...a condom will be 1 2 3 4 5
available?
your partner will be I
2
3 4 5
willing to use a condom?
8
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Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
1. During this encounter, do you intend to.... (circle one)
yes,
no, definitely strongly somcwhnt somewh.it strongly definitely
intend not to intend not to intend not to neutral Intend to intend to intend to
have intercourse with a condom? 1 2 3 4 5 6 7
have intercourse without a condom? 1 2 3 4 5 6 7
abstain from intercourse ? 1 2 3 4 5 6 7
2. Which do you most intend to do? (check one)
have intercourse with a condom
have intercourse without a condom
abstain from intercourse
3 How difficult do you think it will be to follow through with the action you indicated above in question #2? (circle one)
no problem a little moderately very extremely
at all difficult difficult difficult difficult
1 2 3 4 5
9
K)
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4. If it is not possible to use a condom for some reason, do you intend to.. (circle one)
yes,
no, definitely strongly somewhat somewhat strongly definitely
_________________________________ Intend not to intend not to Intend not to ncnltal intend to Intend to Intend to
.have intercourse without a condom? 1 2 3 4 5 6 7
abstain from intercourse? 1 2 3 4 5 6 7
5. If it is not possible to use a condom, which do you most intend to do? (check one)
have intercourse without a condom
abstain from intercourse
6. Supposing that it wasn't possible to use a condom in this situation, how difficult do you think
It would be to follow through with the action you indicated above in question #5? (circle one)
no problem a little moderately very extremely
at nil difficult difficult difficult difficult
1 2 3 4 5
10 w
I,)
134
For the situation that you described, where you and another person are making
out and you both want to have sexual intercourse...
How important is each of the following things to you?
(circle a number)
IN T H IS S IT U A T IO N ,
H O W IM P O R T A N T T O Y O U IS ... not at all a little moderately
quite
a bit extrem ely
1. your physical stimulation 1 2 3 4 5
2. your partner's physical stimulation 1 2 3 4 5
3. m ood/atm osphere 1 2 3 4 5
4. spontaneity 1 2 3 4 5
S. continuity, not having interruptions 1 2 3 4 5
6. variety/creativity 1 2 3 4 5
7 relieving your sexual tension i 2 3 4 5
8. your partner relieving his/her sexual tension 1 2 3 4 5
9 feeling natural, skin-to-skin i 2 3 4 5
10. m essiness (not having a m ess to clean up) 1 2 3 4 5
11. passion i 2 3 4 5
12. intimacy 2 3 4 5
13. emotional attraction i 2 3 4 5
14.
emotional bonding i 2 3 4 5
15. loving each other 1 2 3 4 5
16. trusting each other ' 2 3 4 5
17 feeling good about yourself 2 3 4 5
18. feeling good about your partner 1 2 3 4 5
19. mutual enjoym ent 1 2 3 4 5
11
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IN THIS SITUATIO N,
H O W IM PO RTANT TO Y O U IS... not at ail a little moderately
quite
a bit extremely
20. feeling uninhibited i 2 3 4 5
21. staying monogamous 1 2 3 4 5
22. the excitement of taking risks 1 2 3 4 5
23. pleasing your partner 2 3 4 5
24. avoiding conflict with your partner i 2 3 4 5
25. your partner's opinion of you 1
2 3 4 5
26. not feeling embarrassed 1
2 3 4 S
27. man staying hard, erect 1
2 3 4 5
28. how long the man lasts 2 3 4 5
29. having enough lubrication 2 3 4 5
30. convenience 2 3 4 5
31. avoiding unpleasant tastes/smells 2 3 4 5
32. not getting HIV/AIDS 2 3 4 5
33. not giving your partner HIV/AIDS 2 3 5
34. not getting other STDs 2 3 4 5
35. not giving your partner other STDs 2 3 4 5
36. not getting pregnant (you or partner) 2 3 4 5
37 being worry-free, relaxed at the moment 2 3 4 5
38 being worry-free later 2 3 4 5
12
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Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Recall the scenario you described earlier.
Using a condom in this situation would b e....
(circlo one number on each line)
(
extremely
unfavorable
moderately
unfavorable
somewhat
unfavorable neutral
somewhat
favorable
moderately
favorable
extremely
favorable
favorable/unfavorable 1 2 3 4 5 6 7
extremely
useless
moderately
useless
somewhat
useless neutral
somewhat
useful
moderately
useful
extremely
useful
useful/useless 1 2 3 4 5 6 7
extremely
bad
moderately
bad
somewhat
bad neutral
somewhat
good
moderately
good
extremely
good
good/bad 1 2 3 4 5 6 7
extremely
dull
moderately
dull
somewhat
dull neutral
somewhat
exciting
moderately
exciting
extremely
exciting
exciting/dull 1 2 3 4 5 6 7
extremely
unpleasant
moderately
unpleasant
somewhat
unpleasant neutral
somewhat
pleasant
moderately
pleasant
extremely
pleasant
pleasant/unpleasant 1 2 3 4 5 6 7
13
Cs
137
Recall the specific scenario you described earlier...
In deciding whether or not to use a condom in this situation, which of the
following issues do you think about (even if only a little)?
(Check all that apply)
____ 1. your physical stimulation
____ 2. your partner's physical stimulation
____ 3. mood/atmosphere
____ 4. spontaneity
5.
continuity, not having interruptions
____ 6. variety/creativity
____ 7.
relieving your sexual tension
____ 8.
your partner relieving his/her sexual tension
9.
feeling natural, skin-to-skin
10.
messiness (not having a mess to clean up)
____ 11. passion
12. intimacy
____ 13. emotional attraction
____ 14. emotional bonding
____ 15. loving each other
____ 16. trusting each eth er
____ 17.
feeling good about yourself
18. feeling good about your partner
19. mutual enjoyment
20. feeling uninhibited
____ 21. ' staying monogamous
____ 22. the excitement of taking risks
____ 23. pleasing your partner
24.
avoiding conflict with your partner
____ 25. your partner’s opinion of you
____ 26. not feeling embarrassed
____ 27. man staying hard, erect
28. how long the man lasts
____ 29. having enough lubrication
____ 30. convenience
____ 31.
avoiding unpleasant tastes/smells
____ 32. not getting HIV/AIDS
33. not giving your partner HIV/AIDS
____ 34. not getting other STDs
____ 35. not giving your partner other STDs
____ 36. not getting pregnant (you or partner)
____ 37.
being worry-free, relaxed at the moment
____ 38. being worry-free later
14
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Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission.
For the situation you described earlier...
Indicate the effect of using a condom during intercourse on each of the following things?
T H E EFFECT O F A C O N D O M ON...
ex trem ely
u n p le a sa n t
m o d erately
u n p le a sa n t
so m ew h at
u n p le a sa n t n eutral
so m ew h at
p le a sa n t
m o d erately
p le a sa n t
ex trem ely
p le a sa n t
1. your physical stim ulation i ? 3 4 5 6 7
2. your p a rtn e r's physical stim ulation t
■ >
3 4 5 e 7
3. m o o d /a tm o sp h e re t 2 3 4 5 6 7
4. sp o n ta n eity t 2 3 4 5 6 7
5. continuity, not h av in g in terruptions t 2 3 4 5 6 7
6. am o u n t of variety /creativ ity l 2 3 4 5 6 7
7. re le a s e of se x u a l te n sio n (for you) 1 2 3 4 5 6 7
6. re le a s e of se x u a l te n sio n (for your parln cr) i 2 3 4 5 e 7
9. feeling n atu ral, sKin-to-skin i 2 3 4 5 6 7
10. m e s s in e s s (not h av in g a m e s s to c le a n up) t
2
3 4 5 e 7
11 p a ssio n i 2 3 4 r> 6 7
12. intim acy 1 2 3 4 5 6 7
13 em o tio n al attraction 1 2 3 4 5 6 7
14 em o tio n al bonding i
2
3 4 5 6 7
15. lo v e for e a c h o th er r 2 3 4 5 6 7
16. tru st of e a c h oth er i 2 3 4 5 6 7
17. how g o o d you feel ab o u t yourself t 2 3 4 5 6 7
18. how g o o d you feel ab o u t your p artn er r 2 3 4 5 6 7
19. m u tu al enjo y m en t i 2 3 4 5 6 7
if.
138
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THE EFFECT OF A CONDOM ON...
extremely
unpleasant
moderately
unpleasant
somewhat
unpleasant neutral
somewhat
pleasant
moderately
pleasant
extremely
pleasant
20. how uninhibited you (eel i ? 3 - i 5 6 7
21. whether you both stay monogamous i
2
3 4 5 6 7
22. the excitement of taking risks i 2 3 4 5 6 7
23. how much you please your partner t 2 3 < 1 5 6 7
24. amount of conflict with your partner i
- i
3 > 1 5 6 7
25. your partner's opinion of you i * . 3 4 5 6 7
26. embarrassment i 2 3 4 5 6 7
27. man staying hard, erect i
2
3 4 5 6 7
28. how long Ihe man lasts i 2 3 4 r > 6 7
29. having enough lubrication i 2 3 4 5 6 7
30. convenience i 2 3 4 5 6 7
31. tastes/smelts i 2 3 4 5 6 7
32. protecting you from H IV/AID S i 2 3 4 5 6 7
33. protecting your partner (rom HIV/AIDS i 2 3 4 S 6 7
34. protecting you (rom other STDs i 2 3 4 5 6 7
35. protecting your partner (rom other STDs t 2 3 4 5 6 7
36. preventing pregnancy t
2
3 4 5 0 7
37. how worry-free, relaxed you are at the lime i 2 3 4 5 6 7
38. tiow worried you feel later i
2
3 4 5 G 7
16
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Koep in mind the interaction you doscribed eariier.
Think about the person you will most likely be with.
Indicate the likelihood of each of the followina conseauences hanoenina durina this encounter
(Answer all items on this page)
I f you use a condom during intercourse,
no ct
very
•rnce unlikely
somewhat
unlikely
maybe,
maybe not
somewhat
likely
very
likely
certain to
happen
how likely is it that you will got HIV this next time? 2 3 4 5 6 7
how likely is it that you will glvo your partner HIV this next time? 2 3 A 5 6 7
how likely is it that you will get other STDs this next lime? 2 3 4 5 6 7
how likely is it that you will give your partner other STDs this next time? 2 3 4 5 6 7
how likely is it that you/your partner w ill get pregnant this next time? 2 3 4 5 6 7
I f you have intercourse without a condom,
how likely is it that you w ill gel HIV this next time? 2 3 4 5 6 7
how likely is it that you will give your partner HIV this noxt lime? 2 3 4 5 6 7
how likely is it that you w ill get other STDs this next time? 2 3 4 5 6 7
how likoly is it that you will give your partner other STDs this next time? 2 3 4 5 6 7
how likely is it that you/your partnor will get pregnant this next time? 2 3 4 5 6 7
I f you do not have intercourse,
how likely is it that you will get HIV this next time? 2 3 4 5 6 7
tiow likely is it ttiat yott will give your partner HIV this next time? 2 3 4 5 6 7
how likely is it that you w ill got other STDs this next time? 2 3 4 5 6 7
tiow likely is it that you will give your partner other STDs this next time? 2 3 4 5 0 7
trow likely Is it that you/your partner will get pregnant this next time? 2 3 4 5 6 7
17
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Regarding the scenario you described earlier...
Complete the following sentences about what other people think you ought to do.
(Write "N/A" next to those that are not applicable to you-tor example, on #3 if you don’ t have siblings.)
definitely
should not neutral
definitely
should
t. Your friends and peers think you......... use a condom. 1 2 3 4 5 6 7
2. Your parents think you use a condom. 1 2 3 4 5 6 7
3. Your brothers and sisters think you......... use a condom. 1 2 3 4 5 6 7
4 Medical professionals think you use a condom. 1 2 3 4 5 6 7
5. Previous sexual partners think you use a condom. t 2 3 4 5 6 7
6. Your current sexual partner thinks you.......... uso a condom. t 2 3 4 5 6 7
7. The general public thinks you . ... use a condom ! 2 3 4 5 6 7
8. People who are important to you ihlnk you..... use a condom I 2 3 4 5 8 7
How willing are you to do what the following people think you should do (regarding condom use)?
nol nt nil somewhat moderately extremely
willing willing willinu willing
1. Your Iriends and peers
2 Your parents
3. Your brothers and sisters
4 Medical professionals
5. Previous sexual parlnors
6. Your current sexual partner
7 The general public
8. People who are important to you, in general
18
141
1 4 2
Take-home Questionnaire
INSTRUCTIONS
Do not open this envelope right away. Please follow the instructions carefully...
Open this envelope within 24 hours after your next sexual encounter in which
(a) You have sexual intercourse, or
(b) You would have had intercourse, but you didn't because you couldn't use
a condom for some reason (you didn’t have one, partner didn't want to
use one. etc.).
If such an encounter does not occur within the next 30 days, open the envelope and
complete the questionnaire then. (It should take less than 1 hour to fill out.)
Seal the envelope and turn it in at SGM 718. (You may slide it under the door.) Write
your name and ID# on the sign-in sheet labeled "Experiment 98-51 a," which will be
taped to the door.
Note: You must return this by December 4th to get credit (2 hrs).
Date of first questionnaire:
If you participate in any other sex-related experiments between the date o f the first questionnaire
and the time you com plete the take-hom e questionnaire, indicate the experiments you did (check
all that apply)
□ =95-5lb Thoughts About Sex
u =9S-53: What were they thinking'7 Articulated thoughts sexual situation
o Other ______________________________
Note. We would prefer that you wait until after you complete the take home questionnaire before
you participate in other sex-related experiments Thank you!
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Sexual Behavior Study
Take-home Questionnaire
143
General instructions:
Please answer all questions as honestly and completely as possible.
Thank you for participating. Your time and effort are greatly appreciated.
Definitions of terms used:
sexual intercourse or intercourse - penetrative sexual intercourse (vaginal or
anal sex), with or without ejaculation, no matter how brief it was.
STD - sexually transmitted disease (herpes, gonorrhea, etc.)
Abstaining from intercourse - engaging in any sexual activities other than vaginal
or anal intercourse
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144
General Questionnaire
(CFC Scale)
For each of the statements below, please indicate whether or not the statement is characteristic o f you. If
the statement is extremely uncharacteristic of you (not at all like you) please write a “ 1” to the left of the
question; if the statement is extremely characteristic of you (very much like you) please write a “5" next to
the question. And, of course, use the numbers in the middle if you fall between the extremes Please keep
the following scale in mind as you rate each of the statements below.
1 2 3 4 5
extremely somewhat uncertain somewhat extremely
uncharacteristic uncharactenstic characteristic characteristic
1 I consider how things might be in the future, and try to influence those things with my day to day
behavior.
2 Often I engage in a particular behavior in order to achieve outcomes that may not result for many
years.
3 I only act to satisfy- immediate concerns, figuring the future will take care of itself
4. My behavior is only influenced by the immediate (i.e., a matter of days or weeks) outcomes of my
actions
5 My convenience is a big factor in the decisions I make or the actions I take
6 I am willing to sacrifice my immediate happiness or well-being in order to achieve future outcomes
7 I think it is important to take warnings about negative outcomes seriously even if the negative
outcome will not occur for many years
8 1 think it is more important to perform a behavior with important distant consequences than a
behavior with less-important immediate consequences.
9 I generally ignore warnings about possible future problems because I think the problems will be
resolved before they reach cnsis level
10 I think that sacrificing now is usually unnecessary since future outcomes can be dealt with at a
later tune.
1 1 I only act to satisfy immediate concerns, figuring that I will take care of future problems that may
occur at a later date
12. Smce my day to day work has specific outcomes, it is more important to me than behavior that
has distant outcomes.
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145
For the rem ainder of this questionnaire, you will b e ask ed questions about a previous sexual
encounter. A nsw er th e following questions to determ ine which encounter to refer to.
1. Since the time you filled out the first questionnaire, have you had the kind of sexual
encounter describ ed on the cover of th e envelope [you had intercourse, or you would
have had intercourse if you could h av e u sed a condom]? (c h e c k o n e)
□ yes
□ no
If you answered ' ‘yes’ ’ to this question, keep this sexual encounter in mind for the
remainder of the questionnaire and skip to the next page.
2. Think back to th e last time you had a “slip-up" w here you w ere going to u s e a condom
but ended up having intercourse without a condom . Do you rem em ber th e last time this
hap p en ed to you?
□ yes. rem em b er a t least som ew hat dearly
□ no. can hardly rem em ber or it h as never hap p en ed to me
If you answered “ yes" to this question, keep this sexual encounter in mind for the
remainder of the questionnaire and skip to the next page.
3. Think back to th e last time you had intercourse with a condom, but had to resist a
strong tem ptation to do it without a condom . Do you rem em ber the last time this
hap p en ed to you?
H yes. rem em ber at least som ew hat clearly
□ nc. can hardly rem em ber or it h as n ev er happened to me
If you answered “ yes" to this question, keep this sexual encounter in mind for the
remainder of the questionnaire and skip to the next cage.
4. Do you rem em ber the last time you had sexual intercourse?
□ yes. rem em ber at least som ew hat clearly
□ no. can hardly rem em ber or it has never hap p en ed to me
If you answered “ yes” to this question, keep this sexual encounter in mind for the
remainder of the questionnaire and skip to the next page.
5. If you answ ered “no" to all of the questions above, stop here. Thank you for
participating! P le ase turn this questionnaire in a s instructed on the envelope.
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146
R e c a ll th e d e ta ils o f th is en c o u n te r. T h e m o r e d e ta ils y o u c a n p ro v id e th e b etter.
Describe the circumstances of this situation. (Who were you with? When was it? etc.)
What happened before you started making out? What were your thoughts and feelings at this
time?
What happened during this encounter? What were your thoughts and feelings at this time?
What happened afterwards? What were your thoughts and feelings afterwards?
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147
What thoughts did you have regarding condom use before, during and after this encounter?
Did this incident occur some time after you filled out the initial questionnaire?
(c h e c k o n e)
□ yes 3 no
If you answered ‘yes.’
(a) Was it similar to the scenario you described in the first questionnaire?
yes. very similar
some things were different
no, very different
don't remember scenario from first questionnaire
(b) In what ways was it different, if at all?
(c) Did being involved in this study affect your behavior at all?
□ yes 3 no
If yes. in what way? Please be specific.
How well do you recall the details of this situation?
□ not very well 3 fairly well 3 very well
Today’s date: _________________________
Date of this encounter: _________________
5
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14S
What type of partner were you with?
long-term monogamous partner
monogamous, but without long-term commitment
someone you’re casually dating
someone you’re not dating, who you just got together with (chance encounter)
Were you under the influence of drugs or alcohol at all?
□ yes □ no If yes. what kind of_substance(s)?_______________
If yes, how much was your judgment affected?
very affected
somewhat affected
not at all affected
How sexually aroused were you during this encounter?
much less aroused than usual for you
somewhat less aroused than usual
about as aroused as usual
somewhat more aroused than usual
much more aroused than usual
Was it possible to use a condom during this encounter?
□ yes 3 no
If no, why not?
condom not available
partner unwilling to use it
other __________________________(please specify reason)
Did you have intercourse with a condom? □ yes □ no
Did y o u have intercourse without a condom? □ yes □ no
Did you abstain from intercourse? □ yes □ no
The following statements refer to what you were thinking while you were making out, as far as
choosing between using a condom, not using a condom, or abstaining from intercourse. How
true is each statement?
Regarding condom use (or abstaining)... not at all
true
somewhat
true
very
true
1 didn't think much about it. 1 did what 1 had decided to
do previously.
1 2 3
1 didn't think much about it 1 did what 1 always do. 1 2 3
1 didn't think about it at all. 1 just did what 1 felt like doing. 1 2 3
1 weighed the consequences then decided what to do. 1 2 3
1 struggled with myself over what 1 should do. 1 2 3
1 regretted what 1 ended up doing. 1 2 3
6
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission.
1. Some time before you started making out (prior to any sexual contact), did you intend to... (circle one)
no, definitely strongly somewhat somewhat strongly yes, definitely
_________________________________________intended not intended not intended not neutral intended to Intended to intended to
(a) have intercourse with a condom? 1 2 3 4 5 6 7
(b) have intercourse without a condom? 1 2 3 4 5 6 7
(c) abstain from intercourse? 1 2 3 4 5 6 7
2. At this time, which did you most intend to do? (check one)
have intercourse with a condom
have intercourse without a condom
abstain from intercourse
3. How difficult was it to follow through with the intention you indicated above in question #2? (circle one)
no problem a little moderately very extremely
at all difficult difficult difficult difficult
1 2 3 4 5
7
149
Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission.
When you first started making out, did you intend to. (circle one)
(to, definitely stio n g ly s o m e w h a t s o m e w h a t stio n g ly y e s, definitely
in te n d e d n o t in te n d e d not in te n d e d not n e u tia l in te n d e d to in te n d e d to in te n d e d to
(a) have intercourse with a condom? i 2 3 4 5 6 7
(b) have intercourse without a condom? i 2 3 4 5 6 7
(c) abstain from intercourse? i 2
At this time, which did you most intend to do? (check one)
___have intercourse with a condom
___have intercourse without a condom
___abstain from intercourse
3 4 5 6 7
While you were making out, just before you had intercourse (or when you were close to intercourse, if you didn't have
intercourse), did you intend to... (circle one)
n o , definitely stio n g ly s o m e w h a t so m e w h a t stro n g ly y e s , definitely
in te n d e d not in te n d e d not in te n d e d not n eu tra l in te n d e d to in te n d e d to in te n d e d to
(a) have intercourse with a condom? i 2 3 4 5 6 7
(b) have intercourse without a condom? i 2 3 4 5 6 7
(c) abstain from intercourse? i 2 3 4 5 6 7
7. At this time, which did you most intend to do? (check one)
have intercourse with a condom
have intercourse without a condom
abstain from intercourse
B
L / »
o
151
Important:
The remainder of this questionnaire will ask specific questions about your thoughts
during the encounter you iust described. Remember, these questions are not asking
about your attitudes/thoughts about sexual encounters in general, but rather you should
think specifically about this oast sexual encounter.
If you did have sexual intercourse during this encounter, focus on your thoughts that
were present shortly before you started having intercourse.
If you did not have intercourse, think back to the thoughts you had some time when you
were very close to having intercourse.
Answer the questions the way you think you would have if you’d been asked at that
time.
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152
Think back to what you were thinking and how your were feeling while you were making
out. (If you had intercourse, recall the time just before intercourse began.)
How important w as each of the following things to you?
(circle a number)
H O W IM PO RTANT TO YO U WAS... not at all a little moderately
quite
a bit extremely
1. your physical stimulation 1 2 3 4 5
2. your partners physical stimulation 2 3 4 5
3. mood/atmosphere 2 3 4 5
4.
spontaneity 2 3 4 5
5. continuity, not having interruptions 2 3 4 5
6. variety/creativity 2 3 4 5
7. relieving your sexual tension 2 3 4 5
8 your partner relieving his/her sexual tension i
2 3 4 5
9. feeling natural, skin-tc-skin
!
2 3
5
10. messiness (not having a mess to clean up) 1
2 3 4 5
11. passion 2 3 5
12. intimacy 1
2 3 4 5
13. emotional attraction 1 2 3 4 5
14
emotional bonding
t
2 3 4 5
15. loving each other :
2 3 4 5
16. trusting each other 1
2 3 4 5
17. feeling good about yourself 2 3 4 5
18 feeling good about your partner 1
2 3 4 5
19 mutual enjoyment i
2 3 4 5
10
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q u ite
H O W IM PO R TA N T TO YOU WAS... not at all a little moderately a Pit extremely
20. feeling uninhibited 1 2 3 4 5
21. staying monogamous 1 2 3 4 5
22. the excitement of taking risks 1 2 3 4 5
23. pleasing your partner 2 3 4 5
24. avoiding conflict with your partner 1 2 3 4 5
25. your partner's opinion of you i 2 3 4 5
26. not feeling embarrassed i 2 3 4 5
27. man staying hard, erect 2 3 4 5
28 how long the man would last i 2 3 4 5
29. having enough lubrication 2 3 4 5
30. convenience
t 2 3 4 5
31. avoiding unpleasant tastes/smells 1 2 3 4 5
32.
r e t getting HIV/AIDS 2 3 5
33. not giving your partner HIV/AIDS 1 2 3 4 5
34, not getting other STDs i 2 3 4 5
35. not giving your partner other STDs * 2 3 4 5
35. not getting pregnant (you or partner) 2 3 4 5
37. being worry-free, relaxed at the moment i 2 3 4 5
38 bemg worry-free later 2 3 4 5
11
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Think back to what you were thinking while you were making out (just before you started having
intercourse, if you did havo intercourse.) How would you have answered these questions at that time...
Using a condom during intercourse would be. .
(circle one num ber on each line)
extremely moderately somewhat somewhat moderately extremely
unfavorable unfavorable unfavorable neutral favorable favorable favorable
favorable/unfavorable 1 2 3 4 5 6 7
extremely
useless
moderately
useless
somewhat
useless neutral
somewhat
useful
moderately
useful
extremely
useful
useful/useless 1 2 3 4 5 6 7
extremely
bad
moderately
bad
somewhat
bad neutral
somewhat
good
moderately
good
extremely
good
good/bad 1 2 3 4 5 6 7
extremely
dull
moderately
dull
somewhat
dull neutral
somewhat
exciting
moderately
exciting
extremely
exciting
exciting/dull 1 2 3 4 5 6 7
extremely
unpleasant
inodorately
unpleasant
somewhat
unpleasant neutral
somewhat
pleasant
moderately
pleasant
extremely
pleasant
pleasant/unpleasant 1 2 3 4 5 6 7
12
155
While you were making out...
Did you co n sid er u sing a condom at all during this encounter? y es no
If you an sw ered 'no.' skip this section and turn to the next page.
W hich of th e following is s u e s (regarding co n d o m s) cro ssed your m ind while you w e re m aking out?
Check all that apply.
1. your physical stimulation
_ __ 2. your partner's physical stimulation
___ 3. mood/atmosphere
____ 4. spontaneity
____ 5. continuity, not having interruptions
____ 6. variety/creativity
____ 7. relieving your sexual tension
____ 8. your partner relieving his/her sexual tension
____ 9. feeling natural, skin-to-skin
____ 10. messiness (not having a mess to clean up)
11. passion
____ 12. intimacy
13. emotional attraction
14. emotional bonding
____ 15. loving each other
IS. trusting each ether
____ 17. feeling gooa about yourself
____ 18. feeling good about your partner
____ 19. mutual enjoyment
20. feeling uninhibited
21. staying monogamous
22. the excitement of taking risks
____ 23. pleasing your partner
24. avoiding conflict with your partner
25. your partner's opinion of you
26. not feeling embarrassed
____ 27. man staying hard, erect
____ 28. how long the man lasts
29. having enough lubrication
____ 30. convenience
31. avoiding unpleasant tastes/smells
____ 32. not getting HIV/AIDS
33. not giving your partner HIV/AIDS
34. not getting other STDs
35. not giving your partner other STDs
36. not getting pregnant (you or partner)
____ 37. being worry-free, relaxed at the moment
38. being worry-free later
13
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1 5 6
During this encounter, many thoughts may have passed through your mind.
How much did you have each of the following thoughts during this encounter?
(Read each statement carefully.)
1 - Not at all
2 - A little/once in a while
3 - moderately/somewhat
4 - quite a bit/most of the time
5 - A lot/all the time
1. I thought about the risks of unprotected sex.
2. I thought about how good it would be (in the moment) without a condom
3. I told myself that I must use a condom.
4. I thought about how it would be worse (in the moment) to use condom.
5. I thought about how using a condom would be beneficial in the long run.
6. I told myself that having sex without a condom won’t be too risky.
7. I thought about how I’d regret it soon after if I had unprotected sex.
8. I thought about how I like taking risks.
9. I didn't think about much of anything.
Sometimes people will try to avoid thinking certain thoughts. How much does
each statement describe your thoughts during this encounter? (Read each item
carefully.)
1. I tried not to think about future consequences of unprotected sex.
2. i tried not to think about how good it would be to have unprotected sex.
3. I tried not to think about anything; i just blocked out all thoughts.
4. I tried not to think about the things I dislike about condoms.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Recall what you were thinking and how you were feeling while you were making out (just before you started having
intercourse, if you did have intercourse.) How would you have answered theso questions at that time...
Whal would the effect of using a condom be for each of the following things this time?
THE EFFECT OF A CONDOM ON...
extremely
unpleasant
moderalely
unpleasant
somewhat
unpleasant neutral
somewhat
pleasant
moderately
pleasant
exlremely
pleasant
1 . your physical stimulation 1 2 3 4 5 6 7
2. your partner's physical stimulation 1 2 3 4 5 6 7
3. mood/atmosphere 1 2 3 4 5 6 7
4. spontaneity t 2 3 4 5 6 7
5. continuity, not having interruptions t 2 3 4 5 6 7
6 amount ol variety/creativity 1 2 3 4 5 6 7
7. release of sexual tension (for you) i 2 3 4 5 6 7
8. release of sexual tension (for your partner) 1 2 3 4 5 6 7
9. feeling natural, skin-lo-skin 1 2 3 4 5 6 7
10. messiness (not having a mess lo clean up) 1 2 3 4 5 6 7
1 1 passion i 2 3 4 5 6 7
12 intimacy 1 2 3 4 5 6 7
13. emotional attraction 1 2 3 4 5 6 7
14. emotional bonding t 2 3 4 5 6 7
15. love for each other 1 2 3 4 5 6 7
16. trust of each other t 2 3 4 5 6 7
17. how good you feel about yourself 1 2 3 4 5 6 7
18 how good you leel about your partner 1 2 3 4 5 6 7
15
157
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THE EFFECT OF A CONDOM ON...
extremely moderately somewhat somewhat moderately extremely
unpleasant unpleasant unpleasant neutral pleasant pleasant pleasant
19. mutual enjoyment
20. how uninhibited you feel
21. whether you both stay monogamous
22. the excitement o f 1 risks
23. how much you please your partner
24 amount of conflict with your partner
25 your partner's opinion of you
26. embarrassment
27. man staying hard, erect
28. how long the man w ill last
29. having enough lubrication
30. convenience
31 tastes/smells
32 protecting you from H IV /A ID S
33 protecting your partner (rom HIV/AID S
34. protecting you from other STDs
35. protecting your partner from other STDs
36. preventing pregnancy
37. how worry-free, relaxed you'll feel during intercom
38. how worried you'd feel later
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 2 3 5 6 7
1 6
1 5 8
34
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Think back to what was going through mind while you were making out (just before you started having intercourse,
if you did have intercourse.) How would you have answered these questions at that time?
Indicate the likelihood of each of the following consequences happening during this encounter.
Complete all three sections. (Circle a number)
If you use a condom during intercourse,
how likely is I I that you w ill gel HIV this lime?
how likely is il lhal you will give your partner HIV Ihis lime?
how likely Is it that you will get other STDs this time?
how likely is it that you w ill givo your partner olher STDs this time?
how likely is it that you/your pnrtnor w ill get pregnant this time?
If you have intercourse without a condom,
how likely is it that you will get HIV Ihis time?
how likely is il lhat you w ill givo your partner HIV Ihis lime?
how likely Is it that you will get other STDs this lime?
how likely is it lhat you will givo your partner other STDs this time?
how likely is it lhat you/your partner w ill gel pregnant this time?
If you do not have intercourse,
how likely is it that you w ill get HIV this time?
how likely is it that you w ill give your partner HIV Ihis lime?
tiow likely is it that you will get other STDs this lime?
how likely is il that you will give your partner other STDs this time?
how likely is it that you/your partner w ill get pregnant this time?
very somewhat maybe, somewhat very certain to
no chance unlikely unlikely maybe not likely likely happen
6 2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
6
6
6
6
6
6
6
6
6
0
6
6
6
6
1 7
v O
Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission.
Recall what you were thinking and how you were feeling while you were making out (just before you started having
intercourse, if you did have intercourse.) How would you have answered these questions at that time...
Complete the following sentences about what other people think you ought to do this tim e.
(Write "N/A" next to those that are not applicable to you-for example, on M 3 il you ilonl have siblings)
definitely
should not neutral
definitely
should
1. Your friends and peers think you......... use a condom. i 2 3 4 5 6 7
2. Your parents think you use a condom. 1 2 3 4 5 6 7
3 Your brothers and sisters think you......... use a condom. t 2 3 4 5 6 7
4 Medical professionals think you........ use a condom. t 2 3 4 5 6 7
5 Previous sexual partners think you uso a condom. i 2 3 4 5 6 7
6. Your current sexual padner thinks you.......... use a condom. i 2 3 4 5 6 7
7 The general public thinks you use a condom t 2 3 4 5 6 7
8 People who are important to you think you..... use a condom 1 2 3 4 5 6 7
How willing are you to do what the following people think you should do right now?
not at all somewhat moderately extremely
willing willing willing wilting
1 . Your friends and peers 1 2 3 4
2. Your parents t 2 3 4
3 Your brothers and sisters 1 2 3 4
4. Medical professionals 1 2 3 4
5. Previous sexual padncrs 1 2 3 4
6. Your current sexual partner 1 2 3 4
7. The general public 1 2 3 4
8 People who are important to you, in general 1 2 3 4
18
o \
©
161
APPENDIX E: Questionnaires for Study 2
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162
PART I: ATSS Follow-up Questionnaire
The following questions will ask you about the sexual scenario which you just listened to Please
answer them using the rating scale below. Feel free to write additional comments next to any o f
the questions or in the space at the bottom o f the page.
1 = not at all
2 = slightly
3 = moderately
4 = very
5 = extremely
1 How' realistic was the scenario to you9
2 With regard to the thoughts you verbalized in this imaginary' situation, how similar
were they to the thoughts you would have in an actual situation o f this kind?
3 How much did it feel like this imaginary situation w as really happening (like you were
really in the situation)9
4 When you w ere talking out loud, how much did you really let your thoughts go,
without censoring your thoughts9
5 When you w ere talking out loud, how much did you hold back from saying exactly
what was going through your mind9
6 How’ intense did your emotions actually get while you were hearing the scenario9
7 How much w ere you sexually aroused during the scenario9
A dditional Comments:
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163
Definitions of terms used in this questionnaire
sexual intercourse or intercourse - penetrative sexual intercourse (vaginal or anal sex), w ith or
without ejaculation, no matter how brief it was.
STD - sexually transmitted disease (herpes, gonorrhea, etc.)
Abstaining from intercourse • engaging in any sexual activities other than vaginal or anal
intercourse
Recall the taped scenario that you just heard. In the situation that you imagined...
Did you have intercourse with a condom? □ yes □ no
Did you have intercourse without a condom? 3 yes □ no
Did you abstain from intercourse? □ yes □ no
Important:
T h e r e m a in d e r o f this q u e s tio n n a ir e will a s k sp e cific q u e s tio n s a b o u t y o u r th o u g h ts during th e
s c e n a r io th a t y o u im a g in ed . R e m e m b e r , th e s e q u e s tio n s a re n o t a sk in g a b o u t y o u r
a ttitu d e s /th o u g h ts a b o u t s e x u a l e n c o u n te r s in g eneral, b u t ra th e r y o u s h o u ld th in k sp e cifica lly
a b o u t th is s im u la te d situ a tio n .
F o r t h e s e n e x t q u e s tio n s, reca ll w h a t y o u w e re thinking a s y o u e x p e r ie n c e d th e la te r p a rts o f
th e s c e n a r io (m a k in g c u t a t th e a p a r tm e n t a fte r returning fro m th e n ig h t out). T h in k b a c k to th e
th o u g h ts y o u w e r e h a vin g a r o u n d th e tim e w h e n y o u w e re v e ry c lo s e to in te rc o u rse . A n s w e r
th e q u e s tio n s th e w a y y o u th in k y o u w o u ld h a v e if y o u d b e e n a s k e d a t th a t tim e.______________
The following statements refer to what you were thinking while you were making out, as far as
choosing between using a condom, not using a condom, or abstaining from intercourse. How
true is each statement?
Regarding condom use (or abstaining)... not at all
true
somewhat
true
very
true
1 didn’t think much about it. 1 did what 1 had decided to
do previously.
1 2 3
1 didn't think much about it. 1 did what 1 always do. 1 2 3
1 didn't think about it at all. 1 just did what 1 felt like doing. 1 2 3
1 weighed the consequences then decided what to do. 1 2 3
1 struggled with myself over what 1 should do. 1 2 3
1 regretted what 1 ended up doing. 1 2 3
“ >
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
DURING THE SIMULATED ENCOUNTER...
1 . Some time before you started making out (prior to any sexual contact), did you intend to... (circle one)
no, definitely strongly so m e w h at so m e w h at strongly yes, definitely
___________________________________________________ Intended not intended not intended not neutral intended to intended to Intended to
(a) have intercourse with a condom? 1 2 3 4 5 6 7
(b) have intercourse without a condom? 1 2 3 4 5 6 7
(c) abstain from intercourse? 1 2 3 4 5 6 7
2. Some time before you started making out (prior to any sexual contact), which did you most intend to do? (check one)
have intercourse with a condom
have intercourse without a condom
abstain from intercourse
3. How difficult was it to follow through with the intention you indicated above in question #2? (circle one)
no problem a little moderately very extremely
at all difficult difficult difficult difficult
1 2 3 4 5
3
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission
4. When you first started making out, did you intend to... (circle one)
no, definitely
inten d ed not
slrongly som ew hat
intended not inten d ed not neutral
so m ew h at
Intended to
strongly
intended to
yes, definitely
Intended to
(a) have intercourse with a condom? 1 2 3 4 5 6 7
(b) have intercourse without a condom? 1 2 3 4 5 6 7
(c) abstain from intercourse? 1 2 3 4 5 6 7
When you first started making out, which did you most intend to do? (check one)
_ _ have intercourse with a condom
___have intercourse without a condom
_ _ abstain from intercourse
While you were making out, just before you had intercourse (or when you were close to intercourse, if you didn't have intercoursr
did you intend to...
(circle one)
no, definitely
Intended not
stiongly so m e w h at
intended not in ten d ed not neutral
so m e w h at
Intended to
strongly
inten d ed to
yes, definitely
in ten d ed to
(a) have intercourse with a condom? 1 2 3 4 5 6 7
(b) have intercourse without a condom? 1 2 3 4 5 6 7
(c) abstain from intercourse? 1 2 3 4 5 6 7
7 While you were making out, just before intercourse, which did you most intend to do? (check one)
have intercourse with a condom
have intercourse without a condom
abstain from intercourse
166
Think back to what you were thinking and how you were feeling while you were making
out and you were close to intercourse.
How important was each of the following things to you at that time?
(circle a number)
HOW IM PORTANT TO YOU WAS... not at all a little moderately
quite
a bit extremely
1. your physical stimulation 1 2 3 4 5
2. your partner's physical stimulation 1 2 3 4 5
3. mood/atmosphere 1 2 3 4 5
4. spontaneity i 2 3 4 5
5. continuity, not having interruptions i 2 3
4 5
6. variety/creativity t 2 3 4 5
7. relieving your sexual tension 1 2 3 4 5
8. your partner relieving his/her sexual tension i 2 3 4 5
9. feeling natural, skm-to-skin ' 2 3 4 5
10. messiness (not having a m ess to clean up) i 2 3 4 5
11. passion 1 2 3 4 5
12. intimacy i 2 3 4 5
13. emotional attraction 2 3 4 5
14. emotional bonding i 2 3 4 5
15. loving each other 2 3 4 5
16. trusting each other 1 2 3 4 5
17. feeling good about yourself 1 2 3 4 5
18. feeling good about your partner 1 2 3 4 5
19. mutual enjoyment 1 2 3 4 5
5
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167
H O W IM PORTANT TO YOU WAS... not at all a little moderately
quite
a bit extremely
20. feeling uninhibited 1 2 3 4 5
21. staying monogamous i 2 3 4 5
22. the excitement of taking risks 1 2 3 4 5
23. pleasing your partner i 2 3 4 5
24. avoiding conflict with your partner t 2 3 4 5
25. your partners opinion of you 1 2 3 4 5
26. not feeling em barrassed 1 2 3 4 5
27. man staying hard, erect 1 2 3 4 5
28. how long the man would last 1
2 3 4 5
29. having enough lubrication 1
2 3 4 5
30. convenience t
2 3 4 5
31. avoiding unpleasant tastes/smells 1 2 3 4 5
32. not getting HIV/AIDS
1
2 3 4 5
33. not giving your partner HIV/AIOS t 2 3 4 5
34 not getting other STDs 1 2 3 4 5
35. not giving your partner other STDs 2 3 4 5
36 not getting pregnant (you or partner) 1 2 3 4 5
37. being worry-free, relaxed at the moment t
2 3 4 5
38. being worry-free later t
2 3 4 5
6
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced w ith perm ission o f th e copyright owner. Further reproduction proh ib ited w ithout permission.
Think back to what you were thinking while you were making out, close to intercourse. How would you have
answered these quostions at that time...
Using a condom during intercourse would be...
(circle one number on each line)
extremely moderately somewhat somewhat moderately oxlremely
unfavorable unfavorable unfavorable neutral favorable favorable favorable
favorable/unfavorable 1 2 3 4 5 6 7
extremely
useless
moderately
useless
somowhal
useless neutral
somewhat
usoful
moderately
useful
extremely
useful
useful/useless 1 2 3 4 5 6 7
extremely
bad
moderately
bad
somewhat
bad neutral
somewhat
good
moderately
good
extremely
good
good/bad 1 2 3 4 5 6 7
extremely
dull
moderately
dull
somewhat
dull neutral
somewhat
exciting
moderately
exciting
extremely
exciting
exciling/dull t 2 3 4 5 6 7
extremely
unpleasant
moderately
unpleasant
somewhat
unpleasant neuhnl
somewhat
pleasant
moderately
pleasant
extremely
pleasant
pleasant/unpleasant 1 2 3 4 5 6 7
7
169
In this simulated experience, while you were making out...
Did you consider using a condom at all during this encounter? yes ____no
If you answered 'no,' skip this section and turn to the next page.
Which of the following issues (regarding condoms) crossed your mind while you were making out?
Check all that apply.
1. your physical stimulation
2. your partner's physical stimulation
3. mood/atmosphere
4. spontaneity
5. continuity, not having interruptions
6. variety/creativity
7. relieving your sexual tension
8. your partner relieving his/her sexual tension
9. feeling natural, skin-to-skin
10. m essiness (not having a m ess to clean up)
11. passion
12. intimacy
13. emotional attraction
14. emotional bonding
15. loving each other
16. trusting each other
17. feeling good about yourself
18. feeling good about your partner
19. mutual enjoyment
20. feeling uninhibited
21. staying monogamous
22. the excitement of taking nsks
23. pleasing your partner
24. avoiding conflict with your partner
25. your partner's opinion of you
25. not feeling em barrassed
27. man staying hard, erect
28. how long the man lasts
29. having enough lubrication
30. convenience
31. avoiding unpleasant tastes/sm ells
32. not getting HIV/AIDS
33. not giving your partner HIV/AIDS
34. not getting other STDs
35. not giving your partner other STDs
36. not getting pregnant (you or partner)
37. being worry-free, relaxed at the moment
38. being worry-free later
8
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170
During this simulated encounter, many thoughts may have passed through your
mind.
How much did you have each of the following thoughts during this encounter,
when you were close to intercourse? (Read each statement carefully.)
1 - Not at all
2 - A little/once in a while
3 - moderately/somewhat
4 - quite a bit/most of the time
5 - A lot/all the time
1. I thought about the risks of unprotected sex.
2. I thought about how good it would be (in the moment) without a condom
3. I told myself that I must use a condom.
4. I thought about how it would be worse (in the moment) to use condom.
5. I thought about how using a condom would be beneficial in the long run.
6. I told myself that having sex without a condom won’t be too risky.
7. I thought about how I’d regret it soon after if I had unprotected sex.
8. I thought about how I like taking risks.
9. I didn’t think about much of anything.
Sometimes people will try to avoid thinking certain thoughts. How much does
each statement describe your thoughts during this encounter? (Read each item
carefully.)
1. I tried not to think about future consequences of unprotected sex.
2. I tried not to think about how good it would be to have unprotected sex.
3. I tried not to think about anything; I just blocked out all thoughts.
4. I tried not to think about the things I dislike about condoms.
9
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Recall what you were thinking and how you were feeling while you were making out in this scenario. How would
you have answered these questions at that time...
Whal would the effect of using a condom be for each of the following things this time?
THE EFFECT OF A CONDOM ON...
extremely
unpleasant
moderately
unpleasant
somewhat
unpleasant
somewhat
neutral pleasant
moderately
pleasant
extremely
pleasant
t. your physical stimulation 1 2 3 4 5 6 7
2. your partner's physical stimulation 1 2 3 4 5 6 7
3 mood/atmosphere 1 2 3 4 5 6 7
4. spontaneity 1 2 3 4 5 6 7
5 continuity, not having Interruptions 1 2 3 4 5 6 7
6. amount of variety/creativity 1 2 3 4 5 6 7
7 release of sexual tension (for you) 1 2 3 4 5 6 7
a release of sexual tension (for your partner) 1 2 3 4 5 6 7
9. feeling natural, skin-to-skin 1 2 3 4 5 6 7
10. messiness (not having a mess to clean up) 1 2 3 4 5 6 7
11. passion 1 2 3 4 5 6 7
1 2 intimacy 1 2 3 4 5 6 7
13 emotional attraction 1 2 3 4 5 6 7
1 4. emotional bonding 1 2 3 4 5 6 7
1 5. love for each other 1 2 3 4 5 6 7
16. trust of each other t 2 3 4 5 6 7
17. how good you feel about yourself 1 2 3 4 5 6 7
18 how good you feel about your partner 1 2 3 4 5 6 7
10
Reproduced w ith permission o f th e copyright owner. Further reproduction prohibited without permission.
e x tr e m e ly m o d e r a te ly
THE EFFECT OF A CONDOM ON...________________ u n p le a s a n t u n p le a s a n t
19 m u tu a l e n jo y m e n t 1 2
20. M ow uninhibited you (eel 1 2
21. whether you both stay monogamous t 2
22. the excitement of taking risks 1 2
23. how much you pteaso your partner 1 2
24. amount of conflict with your parlner t 2
25. your palmer's opinion of you 1 2
26. embarrassment 1 2
27. man staying hard, erect 1 2
26 how long the innn will Inst 1 2
29 having enough lubrication t 2
30 convenience 1 2
31 lastes/smells 1 2
32 protecting you from HIV/AIDS t 2
33. protecting your parlner from HIV/AIDS 1 2
34. profecling you from other STDs 1 2
35 protecting your parlner from other STDs i 2
36. preventing pregnancy 1 2
37. how worry-free, relaxed you'll feel during intercom t 2
38. how worrlod you'd feel later 1 2
II
som ew hat som ew hat m oderately extrem ely
unpleasan l neutral pleasan l pleasant pleasant
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
3 5 6
i -j
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Think back to what was going through mind while you were making out. How would you have answered these
questions at that time?
Indicate the likelihood of each of the following consequences happening during this encounter.
Complete all three sections. (Circle a number)
It you use a condom during intercourse,
how likely is il that you will gel H IV this time?
how likely is I I that you will give your partner HIV this time?
how likely Is it that you will get other STDs this lime?
how likely is it that you will give your partner other STDs this lime?
how likely is il that you/your partner w ill get pregnant this time?
If you have intercourse without a condom,
how likoly is it that you will get H IV this lime?
how likely Is it that you will give your partner HIV this lime?
how likely Is I I Itml you w ill get other STDs this tiino?
how likely is il that you will give your partner other STDs this time?
how likely is il that you/your partner w ill get pregnant this lime?
If you do not have intercourse,
how likely is it that you will get H IV this time?
how likely is it that you will give your partner HIV this lime?
how likely is it that you will gel other STDs this lime?
how likely is it that you will give your partner other STDs this time?
how likely is it that you/your partner w ill get pregnant this lime?
very somewhat maybe, somewhat very certain to
no chance unlikely unlikely maybe not likely likely happen
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
5
5
5
5
5
5
5
5
5
5
5
5
5
5
5
6
6
6
a
6
6
6
6
6
6
6
6
6
6
6
1 2
173
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Recall what you were thinking and how you were feeling while you were making out in the sim ulated situation. How
would you have answ ered th ese q u estion s at that time...
Complete the following sentences about what other people think you ought to do this tim e
definitely
should not neutral
definitely
should
1 . Your friends and peers think you.........use a condom. 1 2 3 4 5 6 7
2. Your parents think you use a condom. 1 2 3 4 5 6 7
3 Your brothers and sisters think you.........use a condom. 1 2 3 4 5 6 7
4 Medical professionals think you........use a condom. 1 2 3 4 5 6 7
5. Previous sexual parlners think you , use a condom. 1 2 3 4 5 6 7
6. Your current sexual parlner thinks you......... use a condom. 1 2 3 4 5 6 7
7. Tho general public thinks you use a condom. 1 2 3 4 5 6 7
8. People who are important to you think you.....use a condom 1 2 3 4 5 6 7
How willing are you to do what the following people think you should do right now?
not A t nil somewhat moderately extremely
w illing w illing w illing w illing
1 . Your friends and peers
2. Your parents
3. Your brothers and sisters
4. Medical professionals
5. Previous sexual parlners
6 Your current sexual paitner
7. The general public
8. People who are impodant to you. In general
13
PART II: General Questionnaire
(CFC Scale)
For each of the statements below, please indicate whether or not the statement is characteristic o f you. If
the statement is extremely uncharacteristic o f you (not at all like you) please write a “ 1” to the left o f the
question, if the statement is extremely characteristic of you (very much like you) please write a “5" next to
the question. And, of course, use the numbers m the middle if you fall between the extremes Please keep
the following scale in mind as you rate each o f the statements below
1 2 3 4 5
extremely somewhat uncertain somewhat extremely
uncharacteristic uncharacteristic characteristic characteristic
1 I consider how things might be in the future, and try to influence those things with my day to day
behavior
2 Often I engage in a particular behavior in order to achieve outcomes that may not result for many
years
3 I only act to satisfy- immediate concerns, figuring the future will take care of itself.
4 My behavior is only influenced by the immediate (i.e., a matter of days or weeks) outcomes of my
actions
5 My convenience is a big factor in the decisions 1 make or the actions I take.
6 1 am willing to sacrifice my immediate happiness or well-being in order to achieve future outcomes.
7 I think it is important to take warnings about negative outcomes seriously even if the negative
outcome will not occur for many years
S I think r t is more important to perform a behavior with important distant consequences than a
behavior with less-important immediate consequences.
9 I generally ignore warnings about possible future problems because I think the problems will be
resolved before they reach crisis level
10 I think that sacrificing now is usually unnecessary since future outcomes can be dealt with at a
later tune
1 1 I only act to satisfy immediate concerns, figuring that I will take care o f future problems that may
occur at a later date.
12 Since my day to day work has specific outcomes, it is more important to me than behavior that
has distant outcomes.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
176
Personal Background
1 Age:______
2 Gender Male Female
3 Year in school:
Freshman Junior Graduate
Sophomore Senior
4 Ethnicity (check all that apply):
African-American___________ Mid-Eastem Hispanic
Asian Caucasian Other
5 Sexual preference— which do you prefer0
Exclusively female __ Primarily female
Exclusively male __ Primarily male
Both male and female, equally
6 .Are you in a long-term monogamous relationship0
y es__________________________ _ no
The following questions ask about the number or'tim es you ve done certain things or the num ber o f
partners you ve been with. While you are not expected to recall exact numbers, please do yo u r best to
approximate. (For example, to estimate the num ber o f times you ve had intercourse in the p ast year, you
may approximate that you ha d sex about twice a week fo r fiv e m onths with one partner, so 2 times per
week x 25 weeks makes 50 times )
7 Approximately how many different partners have you had some kind of sexual involvement wrth (any
kind of physical, sexual contact)
in the past year0 ___________ in the past 30 days0 _
8 Approximately how many different partners have you had sexual intercourse with ..
total0 ____ . in the past year0 ___________ in the past 30 days0____
9 Approximately how many times have you had sexual intercourse...
... in the past year? __________ ..in the past 30 days0 _
10 Approximately how many times did you have intercourse without a condom .
in the past year0 ...in the past 30 days0______
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
177
11 Sometimes people plan to use a condom but end up having sex without a condom anyway
• Approximately how many tunes did this happen to you...
...m the past year?____ ... in the past 30 days? ____
• In how many of these instances were you under the influence of alcohol/drugs
. in the past year'’ . .. in the past 30 days? _____
12. Consider past sexual encounters in which you had some intention to use a condom. In these situations,
on average, how difficult was it for you to follow through and use a condom? (circle one)
1 2 3 4 5 X
no problem a little moderately very difficult extremely Doesn’t
at all difficult difficult difficult Apply •
13 Consider past sexual encounters in which you were intending to make out without going as far as
intercourse In these situations, on average, how difficult was it for you to abstain from intercourse'1
(circle one)
1 2 3 4 5 X
no problem a little moderately very difficult extremely Doesn't
at all difficult difficult difficult apply •
* Circle ’ ’ doesn't apply" if you have never been in such a situation
14 Think back or.ce more to the scenario you heard on the tape. If you were actually in a
situation like this and you did choose to have intercourse, how important do you think it would be
to use a condom? (circle one)
1 2 3 4 5
not at all a little somewhat very extremely
important important important important important
15 If you were actually in a situation like this and you did choose to have intercourse, how likely
is it that you would use a condom"7 (circle one)
1 2 3 4 5 6 7
extremely very somewhat maybe, somewhat very likely extremely
unlikely unlikely unlikely maybe not likely likely
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
Think about times when you've been in this situation....
Y o u 're m aking out. about to haw intercourse... earlier you thought you should use a
condom, but now you 're feeling tempted to go ahead without one.
How often does this happen to you when you’re making out? (check one)
□ every time or almost every time
□ very often
□ sometimes
□ once in a while
□ almost never
□ This has never happened to me.
Many different thoughts may pass through your mind in this situation.
How much do you have each o f the following thoughts when you’re in this type o f situation'5
(Note If you have never been in this situation, just try to imagine how you would be thinking
this situation.)
1 - Not at all
2 - A little/once in a while
3 - moderately/somewhat
4 - quite a bit/most o f the time
5 - A lot/all the time
I I think about the risks o f unprotected sex
I think about how good it would be (in the moment) without a condom
3 I tell myseif that I must use a condom.
4 I think about how it would be worse (in the moment) to use condom
5. I think about how' using a condom is beneficial in the long run.
6 I tell myself that having sex without a condom won’t be too risky.
7. I think about how I’d regret it soon after if I had unprotected sex.
8 I think about how I like taking risks.
9 I don’t think about much o f anything
Sometimes people will try to avoid thinking certain thoughts. How much does each
statement describe your typical thought process in this situation?
1 I try not to think about future consequences o f unprotected sex.
2 I try not to think about how good it would be to have unprotected sex.
3 I try not to think about anything; I just block out all thoughts
4 I try not to think about the things I dislike about condoms.
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.
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Asset Metadata
Creator
Masson, Natalie
(author)
Core Title
Cognitive predictors of intention -behavior consistency in safer sex practices
Degree
Doctor of Philosophy
Degree Program
Clinical Psychology
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
OAI-PMH Harvest,psychology, behavioral,psychology, cognitive,psychology, social
Language
English
Contributor
Digitized by ProQuest
(provenance)
Advisor
Davison, Gerald (
committee chair
), [illegible] (
committee member
), Newcomb, Michael (
committee member
), Read, Steven (
committee member
)
Permanent Link (DOI)
https://doi.org/10.25549/usctheses-c17-579179
Unique identifier
UC11351333
Identifier
9987625.pdf (filename),usctheses-c17-579179 (legacy record id)
Legacy Identifier
9987625.pdf
Dmrecord
579179
Document Type
Dissertation
Rights
Masson, Natalie
Type
texts
Source
University of Southern California
(contributing entity),
University of Southern California Dissertations and Theses
(collection)
Access Conditions
The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...
Repository Name
University of Southern California Digital Library
Repository Location
USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA
Tags
psychology, behavioral
psychology, cognitive
psychology, social