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An evaluation of a brief HIV /AIDS prevention intervention using normative feedback to promote risk reduction among sexually active college students
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An evaluation of a brief HIV /AIDS prevention intervention using normative feedback to promote risk reduction among sexually active college students
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AN EVALUATION OF A BRIEF HIV/AIDS PREVENTION INTERVENTION
USING NORMATIVE FEEDBACK TO PROMOTE RISK REDUCTION
AMONG SEXUALLY ACTIVE COLLEGE STUDENTS
by
Robert Alan Chemoff
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree of
DOCTOR OF PHILOSOPHY
(Psychology)
August 2000
Copyright 2000 Robert Alan Chemoff
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UMI Number: 3018064
___ ®
UMI
UMI Microform 3018064
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.
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UNIVERSITY OF SOUTHERN CALIFORNIA
T H E GRADUATE SCHOOL
UNIVERSITY PARK
LOS ANGELES. CALIFORNIA 90007
This dissertation, written by
......................
*
under the direction of h./.§....... 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
DO CTO R OF PHILOSOPHY
Dean o f Graduate Studies
Date . 2 0 0 0 ..................
DISSERTATION COMMITTEE
......................
Chairperson
T5.93—
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ACKNOWLEDGMENTS
This research was supported by National Institute of Mental Health Grant R03-
MH58959-01. The author wishes to thank Gerald C. Davison, Beth Meyerowitz, Mitch
Earleywine, Shelley Duval, Michael Newcomb, Steven David, Elsa Busch, Laura Barde,
Krista Barbour, and Leilani Feliciano for their invaluable assistance.
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iii
TABLE OF CONTENTS
ACKNOWLEDGMENTS
PAGE
ii
TABLE OF CONTENTS iii
LIST OF TABLES V
LIST OF FIGURES vii
ABSTRACT viii
INTRODUCTION 1
Background
Intervention Components 7
Hypotheses and Dependent Measures 9
METHOD 12
Participants 12
Materials 14
Procedure 23
RESULTS 28
Preliminary Analyses 28
Changes in Reported Behavior 33
Changes in Intention 39
Correlations Between Intention and Behavior 41
ATSS: Changes in Cognition 42
DISCUSSION 51
Principal Findings 51
Theoretical Explanations and Implications 54
Practical Implications 59
Limitations 60
ATSS 61
REFERENCES 68
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IV
TABLE OF CONTENTS (CONT’D)
PAGE
APPENDICES
A PREINTERVENTION QUESTIONNAIRE 97
B POSTINTERVENTION QUESTIONNAIRE 118
C FOLLOW-UP QUESTIONNAIRE 121
D PREVALENCE ESTIMATION QUESTIONNAIRE 132
E WILLINGNESS-TO-CHANGE QUESTIONNAIRE 134
F ATSS INSTRUCTION TAPE 159
G ATSS DATING TAPE 161
H ATSS CODING MANUAL 165
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TABLE
1
2
3
4
5
6
7
8
9
10
11
LIST OF TABLES
Summary o f Participants’ Demographic Information (N=155)
Prevalence Over- and Underestimates o f HIV Risk Behaviors
Made by Participants in Intervention Condition (N=78)
Means and Standard Deviations for Willingness-to-Change
Questionnaire Completed by Participants in Intervention
Group (N=78)
Means and Standard Deviations for Measures o f Reported
Behavior (N=105)
Means and Standard Deviations for Significant Group X
Gender Interaction Effects on Behavior Using ANCOVA
(N=105)
Means and Standard Deviations for Significant Group X
Gender X Monogamy Interaction Effect on Behavior Using
ANCOVA (N=105)
Means and Standard Deviations for Significant Main Effects
of Monogamy Using ANCOVA (N=105)
Means and Standard Deviations for Measures of
Intention (N=T55)
Means and Standard Deviations for Significant Main Effect
of Group on Intention Using ANCOVA (N=155)
Means and Standard Deviations for Significant Group X
Gender Interaction Effects on Intention Using ANCOVA
(N=155)
Interrater Reliability for ATSS Codes
PAGE
77
78
79
80
81
82
83
84
85
86
87
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LIST OF TABLES (CONT’D)
PAGE
88
89
90
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TABLE
12 Means and Standard Deviations for ATSS Frequency
Codes, and Significant Time, Gender, and Gender X Time
Effects Using Repeated Measures ANOVA (N=155)
13 Means and Standard Deviations for ATSS c c First Mention”
Codes, and Significant Time, Gender, and Gender X Time
Effects Using Repeated Measures ANOVA (N=155)
14 Participants’ Assessment of ATSS Scenario (N=155)
LIST OF FIGURES
PAGE
91
92
93
94
95
96
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FIGURE
Group X Gender interaction for percentage o f
condom use (vaginal intercourse)
Group X Gender interaction for number of sexual
partners (vaginal intercourse)
Group X Gender interaction for number of sexual
partners (anal intercourse)
Group X Gender X Monogamy interaction for
number of sexual partners (vaginal intercourse)
Group X Gender interaction for intention to use
condoms more frequently
Group X Gender interaction for intention to discuss
safe sex more frequently
viii
ABSTRACT
This study evaluated the efficacy o f a 20 min, self-administered HIV/AIDS
intervention to promote risk reduction among sexually active college students over a 30-
day follow-up period. The intervention used normative feedback about the risky sexual
behavior of fellow college students to persuade participants that safe sex was the
prevailing social norm among their peer reference group. One hundred fifty-five male and
female college students were assigned to either an intervention or control group.
Participants in the control group read an AIDS information pamphlet. Compared to
controls, men in the intervention group reported significantly higher condom use at
follow-up, and expressed significantly stronger intentions to increase condom use. Men’s
intention to increase condom use was a moderate predictor o f actual condom use,
accounting for 39% o f the variance. Women in the intervention group reported
significantly fewer sexual partners at follow-up relative to controls. At postintervention,
participants in both groups expressed significantly stronger intentions to discuss safe sex
with their sexual partners more frequently, with men in the intervention group expressing
the strongest intention. At follow-up, participants in both groups reported significantly
fewer safe sex discussions compared to baseline. Neither condition decreased participants’
use o f alcohol, marijuana, or drugs with sexual intercourse. At pre- and postintervention,
participants heard an audiotaped imaginary sexual scenario in which they were asked to
verbalize their cognitions, following the Articulated Thoughts During Simulated Situation
paradigm (Davison et al., 1997). At postintervention, participants n both groups expressed
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ix
ABSTRACT (CONT’D)
significantly more thoughts about the imaginary dating partner’s past sexual history, and
about HIV/AIDS, compared to baseline. Men and women differed significantly in their
responses to the imaginary scenario.
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1
AN EVALUATION OF A BRIEF HIV/AIDS PREVENTION INTERVENTION
USING NORMATIVE FEEDBACK TO PROMOTE RISK REDUCTION
AMONG SEXUALLY ACTIVE COLLEGE STUDENTS
INTRODUCTION
Infection from HTV (human immunodeficiency virus), the virus that causes AIDS
(acquired immune deficiency syndrome), continues to pose a major worldwide health
threat (Centers for Disease Control, 1996). At present, the prospects for a cure or
preventive vaccine remain indefinite. Drug treatments that retard the proliferation of the
virus, such as protease inhibitors, have in recent years been successful at prolonging the
life spans of those infected. Since the appearance o f these treatments, deaths from AIDS
have declined dramatically (Kalichman, 1998).
Nevertheless, the treatments remain expensive, unavailable to many who need
them, and not always effective for everyone who uses them. They often have unpleasant
side effects that discourage consistent compliance with the required dosage, which in turn
increase the likelihood o f drug resistant strains developing (Kalichman, 1998). The first
line of defense against infection continues to be the avoidance o f unprotected sexual
intercourse through abstinence or the adoption and long-term maintenance of “safer”
sexual behaviors designed to prevent the transmission o f HTV (Auerbach, Wypijewska, &
Brodie, 1994).
The past decade has seen a proliferation in the development and empirical
evaluation of AIDS prevention interventions intended to facilitate the reduction of risky
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2
sexual behavior (Choi & Coates, 1994; Kelly & Murphy, 1992; Oakley, Fullerton, &
Holland, 1995). Many o f these interventions have taken an educational approach by
disseminating information on how HIV is transmitted and infection prevented (Kelly,
1995). Underlying these interventions is the assumption that when people understand the
consequences o f their risky behavior and know how to prevent infection, they will
naturally gravitate towards risk reduction (Rosenstock, Strecher, & Becker, 1994).
Other prevention programs have combined information dissemination with skills-
training (Kelly, 1995). Because information alone does not always lead inevitably to harm
reduction (Catania, Kegeles, & Coates, 1990; Helweg-Larsen & Collins, 1997), the
avoidance of unprotected intercourse and the practice o f safe sex precautions often require
the acquisition o f new sets o f skills, particularly in communication, negotiation, and
assertiveness. Many interventions have focused specifically on teaching these skills
through modeling, rehearsal, and corrective feedback (Kelly, 1995). Still other
interventions have adopted a community-focused approach in which “opinion leaders” are
recruited and trained to use their personal influence to persuade peer group members to
adopt safer sex practices (Kelly, 1995).
One of the populations for whom AIDS interventions have been developed and
tested has been college students. The high degree of sexual experimentation and partner
change that is characteristic o f young adults in their late teens and 20’s have made college
students potentially vulnerable to HTV infection. Some interventions with college students
have taken a purely educational approach to AIDS prevention (e.g., Abramson, Seler,
Berk, & Cloud, 1989; Goertzel & Bluebond-Langner, 1991; O’Leary, Jemmott, Goodhart,
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& Gebelt, 1996; Turner, Korpita, Mohn, & Hill, 1993; Turner et al., 1994). Other
interventions have emphasized training in communication, negotiation, and assertiveness
skills (Basen-Engquist, 1994; Bryan, Aiken, & West, 1996; Franzini, Sideman, Dexter, &
Elder, 1990; MacNair-Semands, Cody, & Simono, 1997; Reeder, Pryor, & Harsh, 1997;
Sanderson & Jemmott, 1996; Sikkema, Winett, & Lombard, 1995). At least one treatment
outcome study evaluated an intervention that adopted a community-oriented approach in
which student opinion leaders were recruited and trained to disseminate risk reduction
messages among fellow female college students (Kauth, Christoff, Sartor, & Sharp, 1993).
The present study evaluated an AIDS prevention intervention designed to increase
risk reduction among sexually active college students. Unlike other AIDS prevention
programs for college students, which typically disseminated only general information
about HTV transmission and prevention (e.g., Abramson et al., 1989; MacNair-Semands et
al., 1997; O ’Leary et al., 1996), in this study, specific information about the normative
sexual behavior of fellow college students was presented to participants and used as a
strategy for persuading them that safe sex practices were the dominant, prevalent social
norm among their peer reference group. This normative feedback, which was specifically
tailored to this particular audience, was intended to convince participants that risk
reduction was the typical and preferred approach to sexual situations.
Background
The use of normative information in an AIDS prevention program was founded on
the empirical finding that social factors are important determinants of risky sexual behavior
(DiClemente, 1993; DiClemente, 1992; Fisher & Misovich, 1990; Flora & Thoresen,
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4
1988). Humans, being the social animals that they are, tend to seek acceptance within the
social unit by behaving as others within the social unit do. Human sexual behavior is
subject to social pressures just as any other behavior is. Sexual behavior occurs within a
context of social relationships and is shaped and influenced to some degree by the values,
beliefs, norms, and standards o f the individual’s social network (Gagnon & Simon, 1973;
Laumann, Gagnon, Michael, & Michaels, 1994). In social networks where AIDS
preventive behaviors are the dominant norm, members o f the network are likely to feel
some degree of social pressure to conform to the majority standard o f behavior.
Conversely, where risky behavior is the accepted social norm, risky behavior is likely to be
maintained (Auerbach et al., 1994; Fisher & Misovich, 1990; Laumann et al., 1994).
Social norms supportive of AIDS risk behavior have been found to be associated with
risky sexual behavior among heterosexual college students (Catania et al., 1989; White,
Terry, & Hogg, 1994; Winslow, Franzini, & Hwang, 1992), secondary school students
(Biglan et al., 1990; Schaalma, Kok, & Peters, 1993; Walter et al., 1993), gay and bisexual
men (Heckman et al., 1995; Kelly et al., 1995), women (Stein, Newcomb, & Bentler,
1994), and minority runaway adolescents (Rotheram-Borus & Koopman, 1991).
The normative feedback strategy is an attempt to attack an underlying assumption
among risk-prone individuals, namely, that risky behavior represents the majority
normative standard of conduct among their peer reference group. Empirical evidence
suggests that risky individuals tend to overestimate the prevalence o f their particular risky
behavior. Sexually active adolescents, for example, tend to overestimate the prevalence of
sexual behavior among other adolescents (Gibbons, Helweg-Larsen, & Gerrard, 1995).
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Heavy-drinking college students tend to overestimate the prevalence of alcohol
consumption among the general population (Agostinelli, Brown, & Miller, 1995; Baer &
Carney, 1993; Baer, Stacy, & Larimer, 1991). Teenage smokers tend to overestimate the
prevalence of smoking among other teens (Botvin, 1986; Hansen & Graham, 1991). This
tendency to believe that “if I do it, then everyone else probably does it too” has been
called the false consensus effect (Gross & Miller, 1997; Ross, Greene, & House, 1977).
The false consensus effect helps maintain and perpetuate risky behavior by lulling
individuals into the false belief that their behavior is consistent with the dominant norm of
the majority.
The purpose o f normative feedback is to demonstrate to risky individuals that their
behavior is in fact an aberration from the dominant majority social norm. For some risk-
takers, the risky behavior will be maintained because they believe, falsely, that “everybody
does it” (i.e., the false consensus effect). When they realize that far fewer people engage in
the risky behavior than they previously assumed, at least some risk-takers will be bothered
enough by this realization to question the wisdom of their behavior and consider changing
it to be more consistent with prevailing normative standards (Agostinelli et al., 1995;
Gibbons et al, 1995; Baer & Carney, 1993; Baer et al., 1991). O f course, some risk-takers
will dismiss normative information as irrelevant to their lives, and may even take pride in
the fact that their behavior is different from the dominant social norm. However, empirical
studies suggest that subgroups o f risk-takers will be motivated to change their behavior
when confronted with normative information.
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6
Nonnative feedback was successfully used as a strategy for reducing heavy
drinking among college students (Agostinelli et al., 1995). Participants randomly assigned
to an intervention group were mailed personalized information about their drinking habits,
together with information about the normative drinking standards of the US population.
They were invited to compare their own drinking habits to the majority norms.
Participants randomly assigned to a no-feedback group received no information about
their drinking habits or the majority norms. At follow-up, participants in the intervention
group showed significantly greater reduction in weekly alcohol consumption and
intoxication levels relative to controls. When confronted with the fact that their drinking
habits were much higher than the national average, heavy drinking college students were
much more likely to cut back on their drinking.
Normative information was used in a prevention program to help junior high
school students reduce their rates of alcohol, marijuana, and tobacco use (Hansen &
Graham, 1991). Teen drinkers and smokers assumed that drinking and smoking were
widely prevalent behaviors among their age group. In fact, the teens had greatly
exaggerated the prevalence o f these behaviors among their peers. The intervention offered
normative education classes to correct the students’ erroneous perceptions about the
prevalence and acceptability o f alcohol, marijuana, and tobacco use among their
classmates. After learning that they had overestimated the prevalence of these behaviors,
teenagers who received corrective normative education significantly decreased their level
o f substance use relative to other teens who received no normative education.
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Normative feedback was also used in an intervention to motivate community
residents to participate in a curbside recycling program (Schultz, 1998). Households were
randomly assigned to one of several conditions, including a group feedback condition in
which residents received feedback about the neighborhood’s level o f participation in the
recycling program. Households receiving feedback that their neighbors were participating
in the recycling program were much more likely to participate in the recycling program
themselves.
Intervention Components
The intervention developed for this study was an attempt to apply the normative
feedback strategy to the problem o f risky sexual behavior. It was anticipated that
normative information would be as successful in helping college students reduce their risky
sexual behavior as it had been in helping college students and teenagers decrease their
rates of alcohol, marijuana, and tobacco use. To accomplish this objective, four basic
components were incorporated into the intervention.
The first component was a survey in which participants were asked to estimate
what they believed to be the prevalence of risky sexual behaviors among their fellow
college students. It was assumed that participants engaging in risky sexual behaviors, like
inconsistent condom use, would tend to overestimate the prevalence o f these behaviors
among other students like themselves.
In the second component o f the intervention, actual data on the prevalence of risky
sexual behaviors among sexually active USC students (Chemoff & Davison, 1999) were
presented to participants as a means o f counteracting the false consensus effect. The
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8
presentation o f accurate normative information was expected to demonstrate that safe sex
was actually the majority norm and that risky behavior was less prevalent than perhaps
assumed.
The intervention’s third component engaged participants in a series of exercises
designed to initiate reflection and self-evaluation about past behavior. Participants were
invited to compare their own behavior to that of the majority norms and asked whether
their behavior was risky in comparison to that of other college students, whether they
were concerned about their level of risk, and whether they would be open to the idea of
modifying their behavior over the next 30 days. Such motivational techniques were
intended to raise participants’ awareness o f the risks and consequences of their past
behavior in a nonconfrontational manner. Similar strategies have been used in other
interventions to promote the reduction of alcohol and substance use (Miller & Rollnick,
1991; Sobeli & Sobell, 1993).
The final component o f the intervention was a goal setting exercise designed to
facilitate commitment to short-term behavior change. Participants were presented with a
list of specific risk reduction goals and asked to commit themselves toward achieving as
many o f these goals over the next 30 days as they felt capable. Goal selection has been
shown to increase the likelihood of actual behavior change (Bandura, 1986; Gollwitzer,
1993; Gollwitzer, 1995; Gollwitzer & Moskowitz, 1995; Miller, 1986/1987). Sobell and
Sobell (1993) used goal selection as part o f their treatment protocol for reducing problem
drinking. In much the same way, goal selection was expected to facilitate AIDS risk
reduction.
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9
Guiding the development o f this intervention was the theory o f reasoned action
(Ajzen & Fishbein, 1980; Fishbein, Middlestadt, & Hitchcock, 1994), a model which
recognizes the linkage between social norms, intentions, and behaviors. The normative
information presented to participants in the intervention group was expected to play an
integral role in shaping and influencing their intentions to engage in risk reduction
behaviors, which in turn were expected to shape and influence their actual behavior.
Hypotheses and Dependent M easures
The intervention was evaluated in a between-subjects design in which participants
were assigned to a group that received either the intervention or a control condition
against which the intervention was compared. The control condition was a standard AIDS
information pamphlet that provided basic, general information about HTV and AIDS. The
intervention was expected to produce significantly greater cognitive and behavioral change
than the control condition.
The intervention’s effects were measured in three ways. First, in comparison to the
control condition, participants in the intervention group were expected to report stronger
intentions to engage in risk reducing behaviors after being exposed to the intervention.
Specifically, participants were predicted to report stronger intentions to (1) use condoms
more frequently, (2) have fewer sexual partners, (3) discuss safer sex more frequently, (4)
reduce alcohol consumption in connection with intercourse, and (5) reduce marijuana and
drug use in connection with intercourse.
Second, the intervention was expected to produce significantly greater increases in
risk reducing behaviors than the control condition over the 30-day follow-up period.
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10
Participants receiving the intervention were predicted to report (1) higher rates o f condom
use with vaginal and anal intercourse, (2) fewer numbers o f vaginal and anal intercourse
partners, (3) higher rates o f safe sex discussions with sexual partners, (4) lower rates of
alcohol consumption in conjunction with intercourse, and (5) lower rates of marijuana and
drug use with intercourse.
Third, the intervention was expected to produce greater changes in the area o f
cognition compared to the control condition. When presented with an analogue sexual
situation, which participants were asked to imagine themselves experiencing, participants
in the intervention group were expected to express greater caution and sensitivity towards
safe sex issues.
An assumption o f this study was that people’s thoughts are integrally related to
their behavior and are therefore important and worth assessing. Traditional methods o f
thought assessment would have participants responding to items on self-report
questionnaires or answering questions in a structured interview. The drawback o f these
methods is that they require participants to give global, retrospective answers to a
predetermined set of items.
After administering an AIDS risk reduction intervention, one would ideally want to
follow participants into their next sexual situation and tap into their thoughts to see first
hand whether the intervention had made an impact on their thinking. Because o f the
impracticality o f such in vivo thought-sampling, the next best alternative would be to put
participants into an imaginary, analogue sexual situation and ask them to verbalize their
thoughts aloud so as to capture the kind of in-the-moment thinking that they might have in
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11
an actual sexual situation. To this end, the Articulated Thoughts During Simulated
Situation paradigm (ATSS) was chosen as the method of cognitive assessment following
the administration of the intervention (Davison, Navarre, & Vogel, 1995; Davison,
Robins, & Johnson, 1983; Davison, Vogel, & Coffinan, 1997).
ATSS is a research technique that enables assessment of “on-line,” in-the-moment
cognitions in an audiotaped role-play situation. Participants listen to an imaginary situation
and pretend as if they are actually experiencing the scenario as it is happening. At various
points in the scenario, a tone is sounded, after which participants verbalize their thoughts
aloud in response to the segment they have just heard. The verbalized thoughts are tape-
recorded and transcribed for later content analysis. The unstructured response format
enables participants to verbalize an unlimited array of “on-line” thoughts rather than the
type o f global, retrospective thought sampling which typically occurs in studies that use
questionnaires or structured interviews. The immediate “on-the-spot” nature o f the
protocol also reduces the likelihood o f social desirability tainting participants’ responses
(Davison, Vogel, & Coffinan, 1997).
In the present study, participants listened to an audiotaped scenario in which they
imagined themselves meeting someone o f the opposite sex, dating, and becoming sexually
involved. Participants were asked to verbalize their thoughts aloud in response to the
scenario, and their verbalized thoughts were recorded, transcribed, coded, and analyzed to
see what effects the intervention may have had on their thinking. In comparison with the
control condition, the intervention was expected to elicit more thoughts indicating caution
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12
toward having intercourse with the imaginary dating partner, and increased thoughts about
condom use, pregnancy, STDs, AIDS, and the dating partner’s past sexual history.
METHOD
Participants
The sample consisted o f 155 college students at the University o f Southern
California in Los Angeles (77 men, 78 women). Participants ranged in age from 17 to 37
(M = 20.7, SD = 3.1). As shown in Table 1, they were racially and ethnically diverse, with
somewhat less than half (46.5%) describing themselves as White. The remainder described
themselves as Asian/Pacific Islander (14.8%), Latino/Hispanic (13.5%), African American
(5.2%), or “Other” (20%). Most participants placing themselves in the “Other” category
reported having mixed racial or ethnic backgrounds. About 7% of participants were
citizens from other countries. Most participants (95.5%) described themselves as never
having been married, although a small minority were married (1.9%) or living with
someone as if married (2.6%). Participants reported a diverse range of religious
backgrounds, as shown in Table 1. With regard to sexual orientation, the vast majority
described themselves as being attracted to persons of the opposite sex exclusively
(91.6%), engaging in sexual behavior with persons o f the opposite sex exclusively
(94.8%), and identifying themselves as heterosexual (96.1%). About 4% identified
themselves as bisexual, 5.2% reported engaging in sexual behavior with persons of both
sexes, and 8.4% reported having sexual attraction to persons of both sexes. There were no
participants identifying themselves as homosexual, or reporting exclusively same-sex
attraction or sexual behavior.
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13
Efforts were made to obtain a sample that was gender balanced and reasonably
representative o f the general student population. Thirty-one percent o f the sample (18
men, 30 women) were recruited through the USC Psychology Department Human Subject
Pool and received course credit for their participation. Sixty-nine percent o f participants
were recruited through advertisements that appeared in a free, widely distributed daily
campus newspaper (The Daily Trojan), or in fliers placed at different points around
campus. Participants recruited through advertising were paid $20.00 for their involvement.
To qualify for the study, participants had to have been sexually active with two or
more different sexual partners over the previous 12-month period. Persons with multiple
sexual partners were presumed to be at greater risk for HTV infection and therefore more
suitable for an AIDS risk reduction intervention.
At the point of recruitment, participants were told that they would be volunteering
for a study on “sex and dating.” They were told that they would be asked to disclose
personal information about their sexual behavior on written questionnaires. They were
also told that they would be listening to an audiotaped scenario in which they would be
asked to imagine themselves being on a date and becoming sexually involved with a
person of the opposite sex. During the scenario, they would be asked to verbalize their
thoughts and feelings into a tape recorder. Because o f the personal and sensitive nature of
the study, participants were assured that all information obtained from them would be
anonymous and confidential. To reduce the likelihood of recruiting volunteers who were
already biased in favor o f HTV preventive behavior, participants were not told that the
study was intended to promote HIV risk reduction.
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14
Materials
Preintervention Questionnaire. The purpose o f this self-administered, self-report
instrument (Appendix A) was to obtain baseline measures of participants’ intentions and
behaviors prior to their exposure to the intervention or control conditions. Many o f the
items contained in this questionnaire were based on items developed by Misovich, Fisher,
and Fisher (1997) and adapted by the author for this study. Twenty-seven items addressed
various sexual and HIV-related behaviors that occurred over the 30-day preintervention
period, including condom use with vaginal and anal intercourse, the number of vaginal and
anal intercourse partners, discussion of safe sex, alcohol use with sex, and marijuana or
drug use with sex. Most o f these behaviors were measured in three ways: percentage,
number, and a 5-point Likert scale ranging from never (1) to always (5). Another 27 items
asked participants to give retrospective reports o f the same behaviors over the 12-month
preintervention period. Sexual behavior reported over a 30-day period was expected to be
more accurate, if somewhat less representative, than behavior recalled over a 12-month
period (Catania, Gibson, Chitwood, & Coates, 1990; Kauth, St. Lawrence, & Kelly,
1991). For comparison purposes, participants were asked about both time periods.
The questionnaire contained 11 items pertaining to behavioral intentions.
Participants were presented with statements about their intentions to engage in HIV risk
reduction behaviors over the next 30 days and asked to rate each statement according to a
5-point Likert scale ranging from strongly disagree (0) to strongly agree (4). The
behaviors of interest were condom use, number o f partners, discussion of safe sex, alcohol
consumption with sex, and marijuana/drug use with sex. Each behavior had two
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corresponding intention items, one framed as an intention to make a complete change
(e.g., “I intend to use condoms at all times”) and the other framed as an intention to make
a partial change (e.g., “T intend to use condoms more frequently”)- The last item asked
participants whether they were satisfied with their current sexual behavior and had no
desire or intention o f modifying it.
In addition to the seven demographic items summarized in Table 1, the
questionnaire assessed participants’ level of HIV/AIDS knowledge. Participants read 14
statements addressing how HTV is transmitted (e.g., “The virus that causes AIDS is not
spread by sneezing or coughing”) and how HIV infection can be prevented (e.g., “You
really only need to use condoms during ‘one night stands’”). Participants were asked to
decide whether each statement was true or false. Participants were also asked whether
they had ever had a course or instruction on HIV/AIDS that included information on
transmission and prevention, and if so, when such course or instruction most recently
occurred.
A working assumption of this study, supported by numerous empirical studies
(e.g., Catania et al., 1990; DiClemente, 1993; Fisher & Fisher, 1993), was that participants
would be relatively knowledgeable about how HTV infection is transmitted and prevented.
Any lapses in participants’ safe sex behavior were presumed to be attributable to factors
other than ignorance o f how HTV infection is transmitted or prevented. To rule out
knowledge deficiencies as an explanatory factor for lapses in safe sex behavior, a baseline
measure of HTV knowledge had to be included in order to demonstrate that participants’
knowledge level was reasonably high.
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Postintervention Questionnaire. This instrument (Appendix B) measured
changes in participants’ behavioral intentions after their exposure to the intervention or
control condition. Participants were presented with the same 11 statements from the
Preintervention Questionnaire about their intentions to engage in HIV risk reduction over
the next 30 days. Participants were again asked to rate their agreement with each
statement on a 5-point Likert scale ranging from strongly disagree (0) to strongly agree
(4).
The Postintervention Questionnaire also contained seven items intended to
measure the ecological validity of the ATSS imaginary dating scenario. Participants were
asked whether they found the ATSS procedure realistic, and whether the thoughts and
feelings verbalized in response to the imaginary sexual situation were representative o f the
cognitions they might have in an actual, comparable situation. Participants responded to
these items on a 5-point Likert scale ranging from not at all (1) to extremely (5).
Follow-Up Questionnaire. This instrument (Appendix C) measured participants’
behavior over the 30-day follow-up period after their exposure to the intervention or
control condition. Participants were asked to record, on a daily basis, any occurrences o f
condom use with vaginal or anal intercourse, safe sex discussions, alcohol use with sex,
and marijuana/drug use with sex. At the end o f the 30-day follow-up period, participants
answered 27 questions about their behavior over the previous 30 days. These items were
identical to the 27 questions contained in the Preintervention Questionnaire regarding
behavior over the 30-day preintervention period.
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Prevalence Estimation Questionnaire (Intervention Group Only). Participants
in the intervention group were told that they would be shown the results o f a survey of
USC students regarding their sexual behaviors over a 12-month period. Before being
shown the results, participants were told that they would be asked to estimate the
prevalence of these behaviors among their fellow students. Participants were asked to
guess what percentage of USC students were sexually abstinent; had one sexual partner,
or multiple sexual partners; used condoms at all times, most of the time, or none of the
time; discussed safe sex before intercourse; consumed alcohol in conjunction with all or
most o f their sexual encounters; or used marijuana or drugs in conjunction with all or most
of their sexual encounters (Appendix D).
Willingness-To-Change Questionnaire (Intervention Group Only).
Participants in the intervention group were presented with data on the actual prevalence of
HIV risk behaviors among a sample o f 761 USC students over a 12-month period
(Chemoff & Davison, 1999). Textual and graphical data were presented as to the
prevalence o f abstinence, number o f intercourse partners, condom use, partner
communication about condom use, alcohol consumption with sex, and marijuana/drug use
with sex. For each behavior, participants were told what was normative for the “majority”
and “minority” o f USC students. For example, participants were told that a majority of
sexually active USC students (61%) reported using a condom all or most of the time,
whereas only a minority of students (16%) reported never using a condom. The purpose
of presenting the data in this way was to emphasize that safe sex behavior was normative
among most USC students, and that risky behavior was atypical.
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Following the presentation of data for each of these behaviors, participants were
presented with a series o f questions designed to engage them in thinking about their own
behavior in comparison with other students and reflecting on their own level of risk-
taking. First, participants were asked how “surprised” they were at learning the actual
prevalence of each behavior. They rated their level of surprise on an 11-point Likert scale
ranging from not at all (0) to extremely (10). Second, they were asked where their
behavior “fit in” in comparison with other USC students, selecting from a list of choices
that required them to consider whether their behavior was more like the “majority” of
students, or closer to that o f the “minority.”
For all behaviors except abstinence, participants were then asked a further set of
questions. They were asked to reflect on their own behavior and assess how “at risk” they
had been for STD or HTV infection in comparison with other USC students, rating their
risk level on an 11-point scale from not at all (0) to extremely (10). Next, on the same 11-
point scale, participants were asked to rate how “concerned” they were about their risk o f
infection from STDs or HTV, and how open they would be to modifying their behavior
over the next 30 days to reduce their risk of becoming infected. Participants were then
asked whether they would be willing to change the particular target behavior over the next
30 days. If they answered “yes,” they were asked to rate on the same 11-point Likert scale
how “important” it was for them to achieve the goal, and how “confident” they felt that
they would.
In the final task, participants were presented with a list o f 10 behavior change
goals and asked if they would be willing to commit to any of these changes over the next
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30 days. The goals were based on the 10 intention statements from the Preintervention and
Postintervention Questionnaires (e.g., ‘T d be willing to use a condom more frequently
during intercourse”). Participants were free to select as many behaviors to change over the
next 30 days as they wished. Participants also had the option o f selecting a statement that
said that they were currently satisfied with their sexual behavior and had no desire or
intention of changing it (Appendix E).
HlV/AIDS Information Pamphlet (Control Group Only). The control group
was presented with a pamphlet entitled How to Prevent AIDS and Other Sexually
Transmitted Diseases. Available to any student at the USC Student Health Center and
often disseminated at public lectures on the topic of HTV/AIDS prevention, the pamphlet
provided brief, basic information on such topics as risk factors for HIV infection; how to
prevent HTV transmission, including proper use of condoms; the importance of partner
communication about safe sex; HTV testing; common ADDS myths; and diagnoses and
treatments for other sexually transmitted diseases. The pamphlet was an example of the
most common HIV prevention intervention available to college students, namely, general
information about HTV transmission and prevention.
ATSS Instruction Tape. A standardized audiotape was presented to participants
instructing them on the details of the ATSS procedure (Appendix F). Participants were
told that they would be listening to an audiotape of a make-believe situation which they
would be asked to imagine themselves actually experiencing. The audiotape would consist
of 13 segments. They were told that after each segment, they would hear a tone, signaling
them to verbalize their thoughts and feelings about what they had just heard. Participants
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were instructed not to talk back to any o f the voices on the tape as if they were having a
conversation, but rather to focus attention on their own private thoughts and reactions
that they were having at the moment and to say them aloud. They were told that their
verbal responses would be tape recorded and later transcribed, but that the audiotapes and
transcriptions would remain anonymous and confidential. They were also informed that
the room in which they verbalized their responses was soundproof so that no one would
be able to hear what they were saying as they were speaking.
ATSS Practice Tape. Participants had an opportunity to listen to a Practice Tape
before hearing the actual stimulus tape. The Practice Tape was intended to enable
participants to practice verbalizing their thoughts aloud in response to an imaginary
situation, and to enable the experimenter to judge whether participants performed the
think-aloud procedure correctly. The Practice Tape was completely unrelated to the
content of this study. It consisted o f seven segments in which participants were asked to
imagine themselves at a party where two people were speaking about them in a
disparaging manner.
ATSS Dating Tape. The stimulus tape for this study was a narrative in which
participants were asked to imagine themselves meeting someone of the opposite sex at a
party, dating, and becoming sexually involved. The Dating Tape was divided into 13
segments, each lasting from five to 20 s. After each segment, a 30 s pause ensued,
allowing time for the participant to verbalize his or her thoughts and feelings in reaction to
the segment just heard. In each segment o f the Dating Tape, a narrator described the
events that participants were asked to imagine themselves experiencing. Two versions of
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the Dating Tape were used, one for male participants with a male narrator, and one for
female participants with a female narrator. Both versions were virtually identical except
for a few details and language differences (Appendix G.)
The Dating Tape’s storyline went as follows: In segment 1, participants learned
that they were attending a party where an attractive person of the opposite sex was also in
attendance. In segment 2, participants were told that they had engaged in conversation
with the attractive person and had noticed a “strong chemistry” developing. In the third
segment, participants heard a friend tell them that they were lucky that they had “hit it off’
so well with such an attractive person. In the female version of the Dating Tape,
participants heard their female friend say, ‘T bet he can get any woman he wants.” In the
male version, participants heard their male friend say, “You know a lot o f guys are after
her.” The inclusion o f this detail was intended to suggest that the attractive person at the
party was sexually experienced and potentially risky as a sexual partner.
In segment 4, participants were told that three weeks had passed and that they had
gone out several times with he attractive person. For the remainder o f the Dating Tape,
participants were asked to imagine that they were on another date that evening.
In segment 5, participants were told that they were having such a good time that
they “didn’t want the night to end,” and that they considered inviting the dating partner in
for a drink. Segments 6 and 7 asked participants to imagine themselves on the living room
couch with the dating partner, sitting close together, having a few drinks, laughing,
sharing stories, touching and kissing. In both versions o f the Dating Tape, the setting for
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these events was the woman’s apartment, in order to minimize any concerns about
physical safety.
Segments 8 through 10 described foreplay occurring in the bedroom. Participants
were told that the foreplay was intense and exciting. Segment 10 ended with the narrator
saying, “And now you’re very close to intercourse.”
In segment 11, participants were told that their thoughts flashed back to their
friend’s comment that the dating partner was good-looking enough to attract almost
anyone they wanted. In segment 12, participants were told that as they moved closer to
penetration, they realized that a condom was not being used— the first explicit reference to
a condom in the Dating Tape. In the final segment, participants were asked to describe
how they imagined the situation ending. At no time during the Dating Tape were any
explicit or implicit references made to safe sex, STDs, HTV/AIDS, pregnancy, diseases or
any other risks.
ATSS Coding M anual. All participants’ verbal responses to the ATSS Dating
Tape were audiotaped, transcribed, and coded for content analysis. The ATSS Coding
Manual (Appendix H) was designed to be a uniform, standardized set of written guidelines
according to which all ATSS transcripts would be coded. The Manual described each
coding category in detail and provided examples. The primary coding categories were as
follows:
1. Interest in sexual intercourse. Statements indicating express or implied
interest in having intercourse with the fictitious dating partner.
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2. Caution about or aversion to sexual intercourse. Statements indicating a
desire to stop intercourse, to slow down and proceed cautiously with intercourse, or to
use safe sex precautions.
3. Condom use. Statements indicating a recognition of the importance and
need for a condom to be used.
4. STDs, disease, or other risks. Statements indicating a concern about
STDs, disease, or other risks besides pregnancy or HIV/AIDS.
5. HIV/AIDS. Statements indicating a specific concern about HIV or
AIDS.
6. Pregnancy. Statements indicating a specific concern about pregnancy.
7. Sexual history. Statements indicating a concern about the fictitious
dating partner’s past sexual history.
8. Alcohol. Specific references to alcohol and the effect alcohol would have
on the participant’s thoughts, reactions, or behaviors in the imaginary situation.
Other secondary coding categories of interest wr ere included in the Manual. These
are described in more detail elsewhere in the Results section.
ATSS Coding Sheet. The codes for all transcripts of participants’ responses to
the ATSS Dating Tape were recorded on these sheets.
Procedure
Participants were assigned to the intervention or control group depending on the
order in which they appeared for the study. Assignment was performed separately for men
and women. The first female participant who appeared for the study was assigned to the
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intervention group, the second woman to the control group, the third to the intervention
group, and so forth in alternating order. The same procedure was followed for male
participants. Assignment was based on actual appearance at the experiment rather than the
order in which appointments for the experiment were scheduled, since a number of
participants who were scheduled to participate never actually appeared.
Participants first completed an informed consent. To increase the likelihood of
frank and honest responding, participants were told that their involvement was anonymous
and confidential, that the consent form was the only document on which they would be
placing their names, and that the consent form would be unconnected with any other
material completed for the study. Participants were informed that they would be asked a
number of personal, sensitive questions about their sexual behavior, and that if they felt
uncomfortable or embarrassed with any aspect of the study, they could leave at any time
without being penalized.
After completing the consent form, all participants heard the ATSS Instruction
Tape, followed by the ATSS Practice Tape. In the first segment of the Practice Tape, the
experimenter demonstrated the “think aloud” procedure for the participant. In the next
segment, participants were asked to demonstrate the “think aloud” procedure so that the
experimenter could judge whether they understood the task. This procedure was repeated
as many times as necessary until the participant could adequately perform the “think
aloud” task.
Before playing the ATSS Dating Tape, the experimenter reminded participants to
verbalize the thoughts and feelings that were on their minds as if the event were actually
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happening to them at the moment, rather than hypothesizing about what they would do if
they ever found themselves in a comparable situation. Participants were reminded not to
talk back to the speakers on the tape as if they were having a conversation. They were also
reminded that the room in which they were sitting was soundproof and that no one could
hear their responses as they were spoken. The experimenter then left the room, and the
ATSS Dating Tape was played for the first time.
When The Dating Tape was ended, participants completed the Preintervention
Questionnaire. To maximize privacy, participants completed this and all other
questionnaires alone in the soundproof room. The next step in the procedure depended on
whether the participant had been assigned to the intervention or control group.
Participants in the intervention group completed the Prevalence Estimation
Questionnaire. When finished, the questionnaire was taken from participants so that they
would not be able to change any o f their answers after seeing the data on actual
prevalence. Participants were then given the Willingness-To-Change Questionnaire to
complete. In the goal selection portion o f this questionnaire, participants wrote their
responses on original and carbon copies so that they would be able to take a copy home
with them. Participants completed the intervention condition within 15 to 20 min on
average.
Participants in the control group were asked to read the HIV/AIDS Information
Pamphlet. They were not allowed to take the pamphlet home with them. On average, the
control condition was completed within 10 to 15 min.
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All participants then heard the ATSS Dating Tape for a second time. They were
verbally reminded to follow the same procedure as before, “thinking aloud” during the
pauses. At the conclusion o f the Dating Tape, all participants completed the
Postintervention Questionnaire.
All participants were then presented with the Follow-Up Questionnaire and
verbally instructed on how to complete it. Over the next 30 days, participants were asked
to record in a daily log the target behaviors each day that they occurred. At the end o f the
30-day period, they were asked to answer 27 questions about their behavior over the 30-
day follow-up period. Participants in the intervention group were also given a carbon copy
of their completed goal statement and told that it was being given to them “as a reminder
of what goals they had selected.” To minimize attrition, participants were asked if they
would give their permission to receive a reminder phone call or e-mail about when the
questionnaire should be returned. All participants but one gave their permission. At the
end of the session conducted in the lab, participants were informed o f the availability of
on-campus student health and counseling services to address any health or psychological
issues that may have been elicited by the study.
Participants recruited from the Human Subject Pool received course credit for
their initial participation in the study, and additional course credit only if they returned the
Follow-Up Questionnaire 30 days later. Participants recruited through advertising were
paid $10.00 for their initial participation and an additional $10.00 if they returned the
Follow-Up Questionnaire.
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All audiotapes of participants’ responses to the ATSS Dating Tape were
transcribed verbatim. Nonverbal information (e.g., laughter, sighs, tone o f voice) was not
included in the transcripts. To control for coding bias, all transcripts were re-ordered and
re-numbered so that coders would be blind to whether the participant had been in the
intervention or control group, or whether the Dating Tape had been heard at pre- or
postintervention. Coders were not blind to gender, because gender was self-evident from
the content of the transcripts and could not be concealed.
Transcripts were coded by the author and three research assistants, all o f whom
coded according to the guidelines set forth in the ATSS Coding Manual. Coders initially
each coded the same 10 transcripts so that adequate interrater reliability could be
established. After corrections were made to the Coding Manual, an additional 20
transcripts were coded and checked for reliability. After some additional refinements to
the Coding Manual, all remaining transcripts were coded.
All coding was based exclusively on the written transcripts o f participants’ verbal
responses to the ATSS Dating Tape. Coders read one segment of a transcript at a time
and completed all codes on the ATSS Coding Sheet for that particular segment before
proceeding on to coding the next segment. Segments were coded for the presence or
absence of each code in each segment. If a codeable response occurred at least once in a
segment, it was coded as present.
When all 13 segments of each transcript were coded in this way, two additional
data were entered on the ATSS Coding Sheet. First, for each code, the number of
segments containing the codeable response in each transcript was calculated and entered
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as a “frequency” count, with a possible range of 0 to 13. Second, for each code, the
number o f the segment in which the codeable response first appeared in the transcript (if at
all) was entered as the “first mention” of the code, with a possible range of 1 to 13.
Segments were coded with the number 14 if no mention o f the coding category was made.
The author coded all 310 transcripts. The same 310 transcripts were divided up
equally among the three research assistants for coding. This resulted in two complete sets
o f codes which were used for determining interrater reliability. Additionally, from these
two data sets a single data set was created for testing hypotheses. Mean frequencies and
mean “first mentions” were calculated from the two sets of codes.
RESULTS
Preliminary Analyses
Group Equivalency at Baseline
The intervention and control groups were compared on baseline measures to test
whether the assignment procedure had been successful in creating two equivalent groups.
There were no significant differences between the two groups on any o f the demographic
variables listed in Table 1. There was only one significant difference in reported behavior
at baseline. More participants in the intervention group reported engaging in sexual
intercourse 30 days prior to the study than in the control group (45% vs. 37%), x2( l ,N =
155) = 5.6, p = .018. Because incidence of sexual intercourse by itself was not a variable
o f interest, this preintervention difference was not regarded as having significance for the
results of this study. Consequently, it was concluded that the assignment procedure had
been successful at creating two essentially equivalent groups.
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Male and female participants were compared on demographic and behavioral
measures to test for preintervention gender differences. In comparison to men,
significantly more women reported having sexual intercourse in the past 30 days (45.8%
vs. 36.8%), X 2(l, N = 155) = 7.78, p = .005, and being in a monogamous relationship in
the past 30 days (32.3% vs. 19.4%), %2( l, N = 155) = 10.89, p = .012. In comparison to
women, men reported a higher percentage rate o f condom use with vaginal intercourse in
the past 30 days (60.9% vs. 43.9%), t (126) = 2.19, p = .03. Men also reported keeping
condoms nearby more often in the past 30 days than women (37.4% vs. 28.4%), t (153) =
-3.07, p = .003. There were no significant gender differences on any of the demographic
variables shown in Table 1.
Participants describing themselves as “monogamous” were also compared against
their nonmonogamous counterparts on demographic and behavioral premeasures. At
baseline, participants with multiple sexual partners reported significantly higher rates of
condom use with vaginal intercourse (64.7% vs. 43%), t (126) = -2.79, p = .006, higher
rates o f alcohol use with sex (33.1% vs. 19.5%), t (125) = -2.5, p = .013, and higher rates
of marijuana/drug use with sex (11.5% vs. 4.7%), t (121) = -2.05, p = .015. Monogamous
participants reported significantly higher numbers o f safe sex discussions (4.25 vs. 2.28
times), t (126) = 2.47, p = .015. On demographic variables, monogamous participants
reported significantly higher family incomes than nonmonogamous participants, t (132) =
2.29, p = .023.
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Attrition
At the end of the 30-day follow-up period, 4.5% of the sample was lost to follow-
up (5 men, 2 women). Participants retained in the study were compared against
participants lost to follow-up to see if there were any differences on baseline measures.
There were no significant differences on any of the demographic variables listed in Table
1. On baseline measures o f behavior, participants lost to follow-up reported a significantly
higher percentage of marijuana/drug use with sex than the retained group (24% vs. 6.5%),
t (121) = -2.34, p = .021. There were no other differences between the two groups.
HIV/A IDS Knowledge: Baseline Measure
Participants answered a brief set of 14 true/false items to test their knowledge of
HTV transmission and prevention. As expected, participants’ level o f knowledge was high.
The mean correct score was 13.2, with a standard deviation o f 1.1. The percentage of
participants answering each item correctly ranged from 81.3% to 99.4%, with an average
of 94.4%. Nearly 94% o f participants reported having had a course of instruction that
included information on how HIV is transmitted and prevented.
The item answered incorrectly by the most number of participants was the
statement, “When you feel you have gotten to know someone very well, you no longer
need to practice safer sex with them.” Even this item was still answered correctly by
81.3% of the sample. The only item showing a gender difference was the statement, ‘I f
you know a person’s sexual history and lifestyle before you have sex with them, it is
unnecessary to use condoms,” which was answered incorrectly (i.e., true) by significantly
more men than women (5.8% vs. 1.3%), x2 (1, N = 155) = 4.89, p = .027. Based on these
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results, it was concluded that participants’ baseline knowledge level was sufficiently high
that lapses in safe sex behavior could not be attributable to knowledge deficiencies.
Results from Instruments Administered to Intervention Group
Prevalence Estimation Questionnaire. An assumption of this study was that
participants would overestimate the prevalence o f HTV risk behaviors and underestimate
the prevalence o f safe sex behaviors among their fellow college students. As predicted,
participants did both. They especially overestimated the prevalence o f alcohol, marijuana
and drug use with sex, as shown in Table 2. They also overestimated the percentage of
fellow students who reported having multiple sexual partners, or who reported never using
a condom. Participants underestimated the rate at which fellow students used condoms
and discussed safe sex with their partners. They were reasonably accurate in their
estimation o f sexual abstinence among USC students. There was only one significant
gender difference: men were somewhat more accurate than women in estimating the rate
of condom use among fellow students. About 55% o f men correctly estimated their fellow
students’ rate o f condom use, whereas only 42.4% o f women correctly estimated this
behavior, t (76) = 2.46, £ = .016.
Willtngness-To-Change Questionnaire. As shown in Table 3, participants were
“moderately surprised” when presented with data on the actual prevalence of HIV-related
behaviors. They expressed the most surprise that frequent alcohol consumption with sex
was lower than expected (20% vs. 56.8%). When asked to think about their own behavior
in comparison with other students, participants only perceived themselves as “somewhat at
risk” and only “somewhat concerned” about their risk of STD or HTV infection.
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Participants felt the most “at risk” and the most “concerned” about their number of
intercourse partners and rate o f condom use. Participants reported being “moderately open
to the idea” of modifying their behavior over the next 30 days, particularly their rate of
condom use and number o f partners. The majority o f participants in the intervention group
expressed willingness to change their behavior over the next 30 days. About 72% of
participants were willing to discuss safe sex with their partners more frequently. About
69% expressed willingness to use condoms more frequently, and 65.4% expressed
willingness to have fewer sexual partners.
There were three significant gender differences in the willingness o f participants to
change their behavior over the 30-day follow-up period. More men expressed willingness
to increase their rate o f condom use than women (41.6% vs. 27.3%), x2(l, N = 77) =
6.44, p=.011. More men were willing to increase their discussion o f safe sex than were
women (42.3% vs. 29.5%), x2(l> M = 78) = 6.33, £ = .012. More men were willing to
reduce their use o f marijuana or drugs with sex than were women (30% vs. 15.7%), % 2(1,
N = 70) = 3.86, £ = .0 5 .
The majority o f participants in the intervention group selected one or more
behavior change goals for the 30-day follow-up period. About 65% agreed to discuss safe
sex more frequently, 57.7% agreed to have fewer intercourse partners, 56.4% agreed to
use alcohol less frequently when having sex, and 53.8% agreed to use condoms more
frequently. About 36% said that they were satisfied with their current sexual behavior and
had no desire or intention of modifying it. The only gender difference in goal selection was
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that significantly more men than women selected the goal o f increased condom use
(33.3% vs. 20.5%), X2(l, N = 78) = 5.16, p = .023.
Data Screening Prior to Hypothesis Testing
The data were checked for violations of the assumptions of normality, linearity,
and homoscedasticity. Variables violating these assumptions (i.e., the behavioral
measures) were transformed using the formula Iogio(X+l), as recommended by Kirk
(1968) and Winer (1971). Other transformations, such as square root and inverse
transformations, were applied to minimize the effect of outliers and skewness. Hypotheses
were tested using transformed and untransformed variables, and the results compared. The
results using transformed variables were either the same or less powerful than those using
untransformed variables. Therefore, the untransformed data were used in the analyses
reported here.
Data were also checked for multicollinearity. Where multiple measures o f a single
variable were highly correlated (i.e., r > .7), the redundant measure was eliminated from
the analyses. For example, the 5-point Likert scales used in measuring behaviors were so
highly correlated with the percentage measures of behavior that only the latter were used
in the analyses.
Changes in Reported Behavior
Baseline Measures of Reported Behavior
Table 4 presents baseline behavioral data for the 30-day preintervention period.
The average rate o f reported condom use during this period was less than 50%. About
25.2% of the sample reported always using a condom with vaginal intercourse, 25.8%
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reported never using a condom, and 49% reported inconsistent condom use. For the 13
participants reporting anal intercourse, 23% reported always using a condom, 53.8%
reported never using a condom, and 23.2% reported inconsistent condom use. On
average, safe sex was reportedly discussed in less than 50% of the occasions in which
intercourse took place. Alcohol was reportedly consumed in conjunction with nearly 25%
of intercourse occasions. In comparison with monogamous participants, those having
multiple sexual partners over the 30-day preintervention period reported significantly
higher condom use (64.7% vs. 43%), t (126) = -2.79, £ = .006, but also significantly
higher rates o f alcohol consumption with sex (33.1% vs. 19.5%), t (125) = -2.52, £ =
.013, and higher rates o f marijuana/drug use with sex (11.5% vs. 4.7%), t (121) = -2.05, p
= .042.
Table 4 also presents participants’ reported behaviors for the 12-month
preintervention period. There were only two behaviors for which the 12-month and 30-day
base rates differed significantly. The reported rate o f condom use with vaginal intercourse
was significantly higher over the 12-month period (58% vs. 46.9%), t (127) = -3.8, £ <
.001, and the reported rate of marijuana/drug use with sex was also significantly higher
over the 12-month period (8.4% vs. 5.2%), t (118) = -2.15, £ = .034.
The average number o f vaginal intercourse partners reported by this group of
sexually active college students over the previous 12-month period was 3.2 partners, with
a standard deviation of 1.8. Men reported having more sexual partners than women (men:
M = 3.5, SD = 1.9; women: M = 2.8, SD = 1.5), and this difference was significant, t
(153) = 2.27, £ = .025. Participants’ reported age o f first intercourse was 16.5, with a
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standard deviation of 2.3. There was no significant difference between men and women as
to their age of first intercourse.
Significant Interactions and Main Effects
Separate multivariate analyses of covariance (MANCOVA) were performed for
each of the dependent variables listed in Table 4. Separate MANCOVAs were performed
instead of a single omnibus test because the dependent variables measured relatively
distinct behaviors rather than one construct (Chemoff & Davison, 1999). Analyses were
performed on the follow-up scores, with preintervention scores as covariates. Group
(intervention vs. control), gender, and monogamy were entered as factors. Participants
were categorized as “monogamous” if they were sexually active during the 60-day
preintervention to follow-up period with one and the same partner (n = 57). Participants
were categorized as “nonmonogamous” if they were sexually active during the 60-day
period with more than one partner, or uncertain as to whether their partner was
monogamous (n = 48).
MANCOVAs were significant for condom use with vaginal intercourse, Wilks’ X =
.4, F (2, 95) = 27.35, 2 < -001, number of sexual partners, Wilks’ X = .79, F (2, 89) =
14.06, £ < .001, discussion o f safe sex, Wilks’ X = .57, F (2, 89) = 14.06, £ < .001,
alcohol consumption with sex, Wilks’ X = .5, F (2, 94) = 19.18, £ < .001, and
marijuana/drug use with sex, Wilks’ X = .19, F (2, 87) = 55.91, £ < .001. SPSS was
unable to perform a MANCOVA for condom use with anal intercourse. Too few
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participants (n = 13) reported having anal intercourse over the 60-day period for there to
be sufficient degrees o f freedom.
Univariate ANCOVAs were performed for the five above-mentioned behaviors.
With each behavior having two dependent measures, a Bonferroni-adjusted alpha level
was set at .025 (.05/2). As shown in Table 5 and Figure 1, there was a significant 2
(Group) X 2 (Gender) interaction for percentage o f condom use with vaginal intercourse,
F (1, 96) = 4.3, £ = .003. Men in the intervention group significantly increased their
reported rate of condom use at follow-up from 64.3% to 76.7%— a 19.3% increase. Men
in the control group decreased their reported condom use from 48.5% to 38.6%— a 20.4%
decrease. For men in the intervention group, the magnitude of the increase from
preintervention to follow-up was low to moderate (d = .36) as measured by Cohen’s
measure of effect size (Cohen, 1988). However, the magnitude of the difference in
condom use at follow-up between men in the intervention group and men in the control
group was large (76.7% vs. 38.6%, d = 1.05). Although reported condom use was already
higher at baseline for men in the intervention group than for men in the control group, men
in the intervention group still increased their reported condom use at follow-up, while men
in the control group reportedly decreased their condom use, as shown in Figure 1. By
contrast, reported condom use for women in both groups remained about the same before
and after the intervention.
There was a significant 2 (Group) X 2 (Gender) interaction for the number o f
vaginal intercourse partners reported at follow-up, F (1, 96) = 20.6, p < .001. Table 5
shows that women in the intervention group reported significantly fewer sexual partners at
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follow-up than any other group. The effect size o f this decrease from preintervention to
follow-up was moderate (d = .57). As Figure 2 illustrates, women in both groups reported
an average of 1.2 partners at baseline. But at follow-up, women in the intervention group
reported significantly fewer partners on average than women in the control group (1.0 vs.
1.5). The effect size o f this difference was large (d = .74).
There was also a significant 2 (Group) X 2 (Gender) interaction for the reported
number of anal intercourse partners, F (1, 96) = 7.09, £ = .009, as shown in Table 5 and
Figure 3. At follow-up, women in the control group reported an increase in their average
number of partners, whereas women in the intervention group reported about the same
number. Conversely, men in the intervention group reported an increase in the reported
number o f partners, and men in the control group did not.
As shown in Table 6 and Figure 4, there was a 2 (Group) X 2 (Gender) X 2
(Monogamy) interaction for the reported number o f vaginal intercourse partners, F (1, 96)
= 20.6, £ < .001. Nonmonogamous women in the intervention group significantly
decreased their reported number o f partners at follow-up. The magnitude of this change
from preintervention to follow-up was large (d = 1.0). As illustrated in Figure 4,
nonmonogamous women in the intervention group decreased their reported number of
partners significantly more at follow-up than did nonmonogamous women in the control
group (1.1 vs. 2.2 partners), another difference whose effect size was large (d = 1.38).
Although there was no significant 3-way interaction for the reported number of anal
intercourse partners, there was a trend in the same direction, with nonmonogamous
women in the intervention group reportedly decreasing their number o f partners at follow-
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up, and all other nonmonogamous participants reporting an increase in partners, F (1, 96)
= 4.18, p = .044.
As shown in Table 7, there were two significant main effects o f monogamy
pertaining to substance use and sex. Monogamous participants reportedly reduced their
use of alcohol with sex by 6 % at follow-up, whereas nonmonogamous participants
reportedly reduced this behavior by only 1.8%, F (1, 95) = 6.4, £ = .013. Similarly,
reported marijuana/drug use with sex decreased 1.9% for monogamous participants and
increased 4.9% for nonmonogamous participants, F (1, 89) = 6.58, £ = .012. Although
significant, both effect sizes were small (d < .3).
There were no main effects of group or gender for any o f the behavioral dependent
measures, although a trend indicated an increase in reported condom use with vaginal sex
for the intervention group and a decrease in reported condom use with vaginal sex for the
control group, F (1, 96) = 4.24, £ = .042. There were also trends suggesting possible
Group by Gender interactions with regard to discussion o f safe sex. Participants in both
groups reported a decrease in their percentage o f safe sex discussions at follow-up, but the
decrease was lowest for men in the intervention group, F (1, 94) = 4.09, £ = .046.
Conversely, women in the intervention group reported the fewest number of safe sex
discussions with their partners at follow-up than any other group of participants, F (1, 90)
= 4.92, £=.029.
Repeated measures analysis of variance (ANO VA) was performed to detect
behavior changes from 30-day preintervention to 30-day follow-up for the entire sample,
regardless of group, gender, or monogamy. Reported discussion o f safer sex decreased
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significantly over time. At the 30-day follow-up, participants reported having smaller
percentages of safe sex discussions with their partners, F (1, 102) = 19.7, p < .001, as well
as fewer numbers o f such discussions, F (1, 98) = 11.9, £ < .001. In addition, the reported
number o f reported partners for anal intercourse increased significantly at follow-up, F (1,
104) = 6.5, p < .012. There were no other significant time effects.
Changes in Intention
Five of the original 11 items measuring intentions were selected to measure change
from preintervention to postintervention. Four of these items measured changes in the
intention to have (1) fewer sexual partners, (2) more frequent condom use, (3) more
frequent safe sex discussions, and (4) less frequent use of alcohol with sex. A fifth item
asked participants whether they were satisfied with their current sexual behavior and had
no intention of changing.
To ascertain whether the assignment procedure had produced equivalent groups
on these variables, preintervention measures of intention were compared for the
intervention and control groups. No significant differences were found. When
preintervention gender differences were examined, only one significant difference
emerged. At baseline, women were more likely than men to endorse the intention to have
fewer sexual partners over the next 30 days, t (151) = -3.51, p = .001.
Repeated measures ANOVA was performed to detect changes in intention from
preintervention to postintervention for the entire sample regardless of group, gender, or
monogamy, with a Bonferroni-adjusted alpha level at .02 (.10/5). Two significant changes
in intention occurred at postintervention. As shown in Table 8, the largest change was in
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the intention to discuss safe sex more frequently with sexual partners. At baseline,
participants were “neutral” towards increasing safe sex discussions. At postintervention,
participants on average “agreed” to increase this behavior over the next 30 days, F (1,
151) = 32.92, p < .001. However, the effect size of this change was low to moderate (d =
.38). The only other significant change was an increase in the intention to use alcohol less
frequently in connection with sexual intercourse, F (1, 150) = 12.66, £ < .001. Although
this change was significant, its effect size was modest (d = .21).
Significant Interactions and Main Effects
MANCOVA was performed on the postintervention scores for the five measures
of intention shown in Table 8, with preintervention scores used as covariates, and group,
gender, and monogamy entered as factors. The result was significant, Wilks’ X = . 10, F (5,
87) = 10.43, p < .001. When univariate ANCOVAs were performed for each dependent
measure separately, the results approached but failed to reach significance. The inclusion
of monogamy as an independent variable had the effect of reducing the number of
participants included in the analyses (n = 105) and was believed to have reduced power
substantially. To increase power by including all 155 participants in the analyses, only
group and gender were entered as factors. MANCOVA was again significant, Wilks’ X =
.07, F (5, 137) = 21.35, p < .001, and univariate ANCOVAs produced significant results.
As shown in Table 9, there was a significant main effect of group for the intention
to have more frequent discussion o f safe sex, F (1, 147) = 6.01, p = .015. At
postintervention, participants in both groups expressed the intention to increase their
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discussions of safe sex, but the effect size was greater for participants in the intervention
group (d = .52) than for those in the control group (d = . 14).
There were two significant 2 (Group) X 2 (Gender) interactions, as shown in Table
10. At postintervention, men in the intervention group endorsed the intention to increase
condom use more than any other group, F (1, 147) = 7.0, 2 = .009, although this pre- to
postintervention increase for men in the intervention group had a relatively small effect
size (d = .32). The difference between postintervention scores for men in the intervention
and control groups had a larger effect size (d = .56), suggesting that men in the
intervention group agreed to increase their condom use more than men in the control
group. Figure 5 illustrates these results.
At postintervention, men in the intervention group also intended to have more
discussions of safe sex with their partners, F (1, 147) = 5.72, p = .018. As illustrated in
Figure 6, the intention increased for men and women in both groups, but the pre- to
postintervention increase was greatest for men in the intervention group (d = .84), and the
difference in postintervention scores was greater for men in the intervention group than
for men in the control group (d = .58).
Correlations Between Intention and Behavior
Bivariate regressions were performed to test whether participants’ intentions to
change behavior at postintervention were correlated with actual behavior reported at
follow-up. The intention to increase condom use was moderately correlated with the
percentage of condom use reported at follow-up (r = .48), accounting for 23% of the
variance, R2 = .233, F (1, 111) = 33.64, p < .001. The correlation between intention and
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behavior was larger for men (r = .63), accounting for 39% of the variance in actual
condom use, R2 = .39, F (1, 50) = 32.56, g < .001. For women, the correlation was
smaller (r = .34), accounting for only 12% of the variance, R2 = .12, F (1, 59) = 7.75, g =
.007.
Participants’ reported intention to have fewer sexual partners was a poor predictor
o f their actual number o f partners reported at follow-up. There was a small but significant
correlation with intention (r = .30), accounting for only 9% of the variance, R2= .09, F (1,
141) = 13.71, £ < .001. The correlation was about the same for men (r = .29) as for
women (r = .27).
There was an even lower correlation between the intention to discuss safe sex with
one’s partner and the actual reported incidence of this behavior (r = .23), accounting for
only 5% o f the variance, R2 = .05, F (1, 110) = 5.86, g = .017. When men and women
were considered separately, the intention/behavior correlation was nonsignificant. There
were no correlations between the intention to decrease alcohol, marijuana or drug use with
sex and the actual reported incidence of these behaviors.
ATSS: Changes in Cognition
Interrater Reliability
ATSS coding was checked for interrater reliability. As shown in Table 11,
reliability was generally high. Intraclass correlation coefficients for frequency codes ranged
from .74 to .93, with a median o f .89. Coefficients for “first mention” codes ranged from
.64 to .94, with a median o f .84.
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Baseline Measures of Participants’ First Exposure to ATSS Dating Tape
In participants’ first hearing of the ATSS Dating Tape, the vast majority (98.1%)
expressed at least one thought indicating that they were cautious about engaging in
intercourse with the imaginary dating partner. Most (87.4%) did so before the segment in
which they were told that intercourse was going to proceed without a condom being used.
Over 92% o f the sample specifically articulated the thought that a condom had to be used
before intercourse could proceed. Two-thirds of the sample articulated this thought
without any prompting or priming, but 34.2% expressed this thought only after being told
that intercourse was about to proceed without a condom. Concern about the imaginary
dating partner’s sexual history was expressed by about 69% o f the sample. Concerns
about STDs, disease, and general “risk” were voiced by less than half of the sample
(47%). Fewer participants expressed concerns about pregnancy (30.3%), and even fewer
expressed concerns specifically about HTV or AIDS (12.3%). About 28% of the sample
said that they imagined themselves consuming enough alcohol in the make-believe
situation to affect their behavior or judgment.
The different categories of articulated thoughts were first mentioned at various
points in the scenario. In their first hearing o f the ATSS Dating Tape, it was fairly late in
the scenario (i.e., segments 8 through 10) before most participants expressed caution
towards having intercourse, or concerns about STDs, HTV/AIDS, pregnancy, and the past
sexual history o f the dating partner. On average, the first mention that a condom was
necessary was not made until segment 10, when participants were told that they were
“very close to intercourse.”
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A relative minority explicitly discounted any reasons for being overly concerned
about safe sex issues. Some participants saw a condom as completely unnecessary in the
situation (9.7%). Some specifically said that they were unconcerned about the dating
partner’s sexual history (6.1%), STDs and other diseases (2.9%), HTV (1.3%), or
pregnancy (.6%).
When participants were asked how they imagined the situation ending, most
(81.3%) imagined that intercourse would proceed only if a condom were used. About
23% said that it was too soon to have intercourse with the imaginary dating partner,
whether a condom were present or not. About 15% said that the absence o f a condom
would not deter them from having intercourse. Another 5.5% said that in the absence o f a
condom, they would probably engage in other forms o f sexual activity besides intercourse.
Significant Time and Gender Effects
Repeated measures ANTOVA was performed to detect any changes in cognition
from pre- to postintervention. Group and gender were entered as factors to detect any
between-subject effects. As shown in Table 12, there were main effects of Time for the
entire sample. The frequency of certain thoughts increased from pre- to postintervention,
regardless o f group or gender. At postintervention, there was an increase in the frequency
o f thoughts expressing caution about having sexual intercourse with the imaginary dating
partner, F (1, 151) = 6.44, p < .001, the need for using a condom, F (1, 151) = 6.44, p =
.012, concerns about STD’s and other diseases, F (1, 151) = 9.48, p = .002, concerns
about HTV and AIDS, F (1, 151) = 18.31, p < .001, and concerns about the past sexual
history o f the imaginary dating partner, F (1, 151) = 20.92, p < .001. In addition, at
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postintervention more participants imagined the scenario ending without sexual
intercourse occurring at all, F (1, 151) = 6.36, £ = .013. Most of these effects were
relatively small (i.e., d < .35). However, the increase in thoughts about HIV/AIDS was
moderate in effect size (d = .40), as was the increase in thoughts about the imaginary
dating partner’s past sexual history (d = .48).
There were significant gender differences at preintervention for the frequency of
articulated thoughts, as shown in Table 12. At participants’ first hearing o f the ATSS
Dating Tape, men expressed more interest in having intercourse with the imaginary dating
partner than women, F (1, 151) = 13.79, £ < .001, d = .70, whereas women expressed
more caution than men about having intercourse with the dating partner, F (1, 151) =
20.6, £ < .001, d = .80. The effect size of this difference was large. At preintervention,
women expressed more thoughts than men about the past sexual history o f the imaginary
dating partner, F (1, 151) = 6.42, £ = .012, d = .40. By a large magnitude, women were
more likely than men to express thoughts about having alcohol in the imaginary situation,
F (1, 151) = 7.86, £ = .006, d = .80. Also by a large magnitude, women were more likely
at preintervention to imagine the scenario ending without having intercourse with the
imaginary dating partner, F (1, 151) = 28.54, £ < .001, d = 1.0. To a much lesser degree,
men were more likely than women to imagine the scenario ending in unprotected
intercourse, F (1, 151) = 5.55. £ = .02, d = 29. There was a trend toward men imagining
the scenario ending in protected intercourse, F (1, 151) = 3.55, £ = .061.
There were only two significant Gender X Time effects at postintervention, as
shown in Table 12. Both o f these effects were small in size. After hearing the ATSS
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Dating Tape for the second time, men were more likely than women to express the need
for using a condom in the situation, F (1, 151) = 5.51, p = .02, d = .34, and men were
more likely to express concerns about pregnancy, F (1, 151) = 5.82, p = .017, d = .33. At
postintervention, there was a trend toward men imagining the scenario ending in protected
intercourse, F (1, 151) = 3.27, p = .073. Most of the gender differences that existed the
first time participants heard the ATSS Dating Tape disappeared when participants heard
the ATSS Dating Tape for the second time.
As shown in Table 13, there were main effects o f Time for the entire sample as to
when certain thoughts were first mentioned. Regardless o f group or gender, at
postintervention participants expressed caution about STD’s and other diseases at an
earlier point in the scenario, F (1, 151) = 7.05, p = .009, d = .38, as well as caution about
HTV and AIDS, F (1, 151) = 10.71, p = .001, d = .16. They also expressed concern about
the dating partner’s past sexual history earlier in the scenario, F (1, 151) = 6.35, p = .013,
d = .36. There was a trend toward expressing concern about having intercourse earlier in
the scenario, F (l, 151) = 3.25, p = .073.
There were significant gender differences as well. When participants heard the
ATSS Dating Tape the first time, men expressed interest in having intercourse at an earlier
point in the scenario than did women, F (1, 151) = 9.15, p = .003, d = .23, whereas
women expressed caution about having intercourse earlier in the scenario than did men, F
(1, 151) = 6.51, p = .012, d = .38. Women were earlier than men in first expressing
concern about the dating partner’s past sexual history, F (1, 151) = 5.65, p = .019, d =
.42. There was a trend toward women mentioning alcohol earlier in the scenario than men,
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F (1, 151) = 3.24, p = .074. However, at postintervention, when participants heard the
ATSS Dating Tape for the second time, all o f these gender differences disappeared.
There were no main effects of group and no interactions between group and
gender. Contrary to expectation, the intervention failed to increase the frequency of
articulated thoughts about caution or safer sex in comparison to the control condition. The
intervention also failed to make participants think about the need for a condom, the threat
o f disease or pregnancy, or the dating partner’s sexual history at any earlier point in the
Dating Tape. Both conditions had the same effect.
Correlations Between Imagined and Actual Behavior
Correlations were examined between participants’ imagined safe sex behavior in
the ATSS procedure and their actual safe sex behavior as reported in the study’s
measures. The correlations were limited to nonmonogamous participants, since it was
assumed that the actual sexual experiences of this subgroup were the most closely related
to the situation depicted in the ATSS Dating Tape. Perhaps not surprisingly, there were no
correlations between participants’ actual rate o f condom use and the way in which they
imagined the Dating Tape ending. The Dating Tape represented one particular sexual
situation which may or may not have been similar to participants’ actual sexual
experiences. Participants’ reports of their actual behavior represented multiple situations
occurring over a 30-day period, and may not necessarily have been similar to the
imaginary sexual situation.
Nevertheless, there were two comparisons between participants’ actual and
imagined behavior that were noteworthy. The percentage of nonmonogamous participants
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who imagined the Dating Tape ending in protected sex (81.3%) was comparable to the
percentage of participants reporting at least one instance of condom use over the 30-day
preintervention period (79.2%). On the other hand, there was a discrepancy between the
percentage of nonmonogamous participants who never used a condom at anytime over the
30-day preintervention period (20.8%) and those who imagined the Dating Tape ending in
unprotected intercourse (15%). Apparently more participants engaged in unprotected
intercourse in their actual lives than were willing to admit in the imaginary sexual
situation.
Gender Differences in Other Variables of Interest
The ATSS transcripts were coded for other variables of interest to detect possible
gender differences. Repeated measures ANOVA was performed on the frequency of
certain categories of thought at preintervention. Interrater reliabilities for these variables
were generally high. Intraclass correlation coefficients ranged from .48 to .87, with a
median of .83.
At preintervention, about 15% o f the sample expressed the belief that three weeks
of knowing the dating partner was an insufficient amount of time for becoming sexually
involved, and 14% expressed the belief that three weeks was an adequate amount o f time.
At postintervention, however, the number of participants expressing the view that three
weeks was an insufficient amount o f time doubled to 38.4%, with the mean frequency of
this thought increasing significantly, F (1, 151) = 44.82, £ < .001. There was a significant
gender difference in the expression o f the belief that three weeks was an insufficient
amount o f time for becoming sexually involved. Women expressed this belief with greater
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frequency than men, F (1, 151) = 24.46,2 < .001, and the effect size o f this difference was
large (d = .89). There was no gender difference among those who expressed the view that
three weeks was an adequate amount o f time for becoming sexually involved.
Women were significantly more likely to say that it was the man’s responsibility to
initiate condom use, than for men to say it was the woman’s responsibility, F (1, 151) =
38.64, 2 < .001. The difference between men and women on this dimension was large (d =
.71). Men were significantly more likely than women to say that initiating condom use was
their responsibility, F (1, 151) = 43.53, 2 < -001, and this effect was moderate (d = .67).
Men were significantly more likely than women to say that being the object o f the
dating partner’s affection made them feel “confident” or “proud,” F (1, 151) = 12.52, 2 =
.007, d = .73. Men were significantly more likely than women to interpret their success
with the dating partner as evidence o f their superiority to the other male “competition,” F
(1, 151) = 21.41, 2 = -001, d = 1.0. Men were significantly more likely than women to say
that they were “lucky” for finding such an attractive dating partner, F (1, 151) = 5.77, 2 =
.018, d = .40. Women were significantly more likely than men to react to the dating
partner’s attention with suspicion, to question the dating partner’s motives, or to wonder
aloud, “why me?”, F (1, 151) = 42.86, 2 < -001, d = .91.
Men were significantly more likely than women to express concern about
appearing too “forward” or “coming on too strong,” F (1, 151) = 39.73,2 < -001. The
effect size o f this gender difference was large (d = 1.14). Women, on the other hand, were
significantly more likely than men to express concern over appearing too “loose” or
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“easy”, F (1, 151) = 24.57, p < .001, and the effect size of this difference was moderate (d
= .50).
Other categories of articulated thoughts showed no significant gender differences.
Transcripts were coded for expressions o f two emotional states: happiness and anxiety.
Men and women were no different in their expression o f these emotional states in reacting
to the Dating Tape. About 41% of the sample articulated the thought that they could
imagine developing a serious relationship with the dating partner. Men and women were
equally likely to articulate this thought.
Ecological Validity of ATSS Dating Tape
An assumption of the ATSS procedure was that the thoughts expressed in the
simulated dating situation would be comparable to the thoughts actually experienced in a
real-life situation. Seven items in the Postintervention Questionnaire asked participants to
rate how similar they believed their reactions to the simulated dating situation would be to
their reactions in an actual, similar dating situation.
As shown in Table 14, participants largely agreed that the thoughts they verbalized
in the imaginary dating situation were similar to thoughts they would have in an actual and
comparable dating situation. They largely agreed that when speaking aloud, they did not
censor their thoughts and feelings. Participants moderately agreed that the Dating Tape
sounded realistic and was emotionally arousing. However, most agreed that it was only
slightly sexually arousing. These data provided at least some supportive evidence for the
ecological validity of the ATSS Dating Tape, in that the thoughts expressed in the
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imaginary dating situation were generally believed to be reasonably related to thoughts
that would probably be expressed in an actual, comparable situation.
DISCUSSION
This study evaluated the ability of a brief paper-and-pencil intervention to promote
HIV risk reduction among a gender-balanced, racially diverse, and predominantly
heterosexual sample of college students over a 30-day period. Following the example of
previous interventions that had used normative feedback successfully to discourage
behaviors harmful to health (e.g., Agostinelli et al., 1995; Hansen & Graham, 1991), the
intervention in this study used normative feedback to encourage participants to reduce
HTV risk behavior. In comparison to participants who merely read a standard AIDS
informational pamphlet, participants exposed to normative information about the
prevalence of safe sex practices among their fellow college students were significantly
more likely to report increases in safe sex behavior themselves.
Principal Findings
The intervention was more successful than the control condition at increasing
men’s rate of condom use. Men in the intervention group reported a significant though
moderate increase in condom use with vaginal intercourse (d = .36), from 64.3% at
baseline to 76.7% at follow-up. This 19.3% increase for men in the intervention group was
the largest increase in condom use of any subgroup of men or women in the study. Men in
the intervention group also reported a significantly higher level o f condom use at follow-
up than did men in the control group, for whom condom use actually decreased at follow-
up (76.7% vs. 38.6%).
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The intervention was also more successful than the control condition at affecting
women’s sexual behavior. Women in the intervention group reported a significant
reduction in their number of sexual partners. At baseline, women in both groups reported
an average o f 1.2 vaginal intercourse partners over the 30-day preintervention period. At
follow-up, women in the intervention group reported a significant decrease in their number
o f partners (M =1), whereas women in the control group reported an increase (M =1.5).
The magnitude o f this effect was large (d = .74).
Both the intervention and control conditions provided information about
HTV/AIDS and primed participants to think about implementing safe sex practices. But the
intervention appeared to offer additional “active ingredients” for promoting even greater
levels o f risk reduction. The intervention presented information specifically tailor-made for
participants, whereas the control condition presented only general information about
AIDS. The intervention engaged participants in an active process of reflection and
examination o f their past behavior. The control condition merely required participants to
be passive recipients of information. The intervention invited participants to commit to
explicit short-term behavior change goals, whereas the control condition required no
specific commitment to change.
The intervention also possessed several practical advantages that set it apart from
other AIDS prevention programs developed for college students. Previous interventions
typically required multiple hours o f education or skills-training over the course of several
days or weeks, presented in group workshops or seminar formats with trained AIDS
educators or peer leaders (e.g., Basen-Engquist, 1994; Bryan et al., 1996; Franzini et al.,
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53
1990; O’Leary et al., 1996; Reeder et al., 1997; Sikkema et al., 1995). This intervention
was presented in a single 15 to 20 min session and was still able to produce measurable
behavior change simply by having participants complete a few self-administered
questionnaires. Another advantage o f this study was that all participants were blind to the
fact that they were volunteering for an AIDS intervention. In other AIDS prevention
studies (e.g., Abramson et al., 1989; O’Leary et al., 1996; Sanderson & Jemmott, 1996;
Sikkema et al., 1995), participants would know that they were volunteering for an AIDS
prevention program, making it more likely that participants who volunteered were already
predisposed towards behavior change. This study produced behavior change among a
group of participants who were not necessarily interested at the outset in changing their
behavior. Therefore, stronger effects might be found with participants already motivated
to reduce their high-risk behaviors. Finally, the intervention evaluated in this study
contained only a few components, making it somewhat easier to infer what factors were
responsible for the observed effects. Most AIDS interventions contain so many
components (e.g., Bryan et al., 1996; MacNair-Semands et al., 1997; O’Leary et al., 1996;
Reeder et al., 1997; Sikkema et al., 1995) that it is impossible to know which components
are responsible for causing behavior change (Kalichman, Rompa, & Coley, 1996).
Despite the positive results achieved in this study, the intervention was only
partially successful. It failed to affect certain behaviors with certain subgroups, as
evidenced by the fact that it failed to increase condom use among women, or reduce the
number o f sexual partners reported by men. For other behaviors, the intervention had only
a marginal impact, or none at all.
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54
The intervention was completely unsuccessful at getting participants to discuss
safe sex more frequently with their sexual partners. Neither the intervention nor control
group participants reported any increase in this behavior. In fact, from preintervention to
follow-up, there was a significant decrease in the percentage (40.1% to 25.3%) and
number (3.6 to 2.3) o f occasions in which safe sex was discussed prior to intercourse. This
was true for both men and women.
The intervention also had little effect in discouraging students’ use o f alcohol,
marijuana, or drugs in connection with sexual intercourse. Among nonmonogamous
participants, alcohol consumption in connection with intercourse declined only slightly,
and marijuana and drug use with sex actually increased at follow-up.
In summary, the intervention was more successful than the control condition at
increasing the rate o f condom use among men, and decreasing the number o f sexual
partners reported by women. At the same time, the intervention was ineffective at
increasing safe sex discussions, and actually appeared to reduce their frequency over the
follow-up period. The intervention also failed to discourage the use of alcohol, marijuana,
and drugs with sex. For some participants, the use o f marijuana and drugs with sex
seemed to increase during follow-up.
Theoretical Explanations and Implications
If one of the aims o f the study was the development of an effective intervention to
reduce HTV risk behavior among college students, another of the study’s aims was to
explain the causal mechanism for the intervention’s effects. Arguably, the presentation of
accurate normative feedback corrected any erroneous perceptions that risky sexual
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55
behavior was the prevailing normative standard among fellow students, prompting at least
some participants to question their previous assumptions and reconsider the wisdom of
their past behavior. The self-evaluation and goal selection exercises arguably had the
further effect of encouraging participants to take a critical look at their past behavior and
consider committing themselves to short-term risk reduction goals.
The problem with this explanation is that it fails to account for all o f the results. It
may adequately explain men’s increase in condom use, and women’s decline in the number
o f sexual partners, but it does not explain why the intervention failed to increase
discussion o f safe sex. If normative feedback alone were sufficient to produce behavior
change, then alcohol, marijuana and drug use with sex should have declined dramatically,
because participants overestimated the prevalence of these behaviors more than any
others. Yet the intervention had little impact on these behaviors, and even increased some
of them.
The theory of reasoned action (Ajzen & Fishbein, 1980), which guided the
development of this intervention, was expected to explain the study’s results.
Unfortunately the theory could provide only a partial explanation at best. Some of the
evidence collected from the study suggested that information about social norms may have
played a role in shaping and influencing students’ intentions to engage in risk reducing
practices, and that their intentions may have been closely associated with their decisions to
engage in behavior consistent with their intentions. Other evidence from the study failed to
support such linkages between social norms, intentions, and behaviors.
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56
The theory o f reasoned action was perhaps best at explaining the increase in
condom use by men in the intervention group. Normative feedback about the prevalence
of condom use may have helped men in the intervention group realize that frequent
condom use was the normative standard of behavior among the majority of their fellow
college students. This information about the majority social norm may have been
instrumental in influencing men in the intervention group to express stronger intentions to
use condoms over the follow-up period. As evidence from the study shows, after being
presented with normative feedback, men in the intervention group reported greater
willingness to increase their condom use than women (41.6% vs. 27.3%), and were more
likely than women to select increased condom use as a behavior change goal (33.3% vs.
20.5%). Men in the intervention group expressed the strongest intention to increase their
condom use o f any subgroup in the study. In addition, men’s intention to use condoms
was strongly correlated with their rate o f actual condom use (r = .63) and accounted for
39% of the variance in this behavior.
The theory o f reasoned action was less helpful in explaining why women in the
intervention group reduced their number of sexual partners. Normative feedback appeared
to have little influence in affecting women’s intentions or behavior. At preintervention,
women in both groups already expressed the intention to have fewer sexual partners, and
women’s intention to have fewer partners remained about the same in both groups even at
postintervention. With this result, one would reasonably have expected women in both
groups to report fewer sexual partners at follow-up, but in fact women in the intervention
group were the only ones to report such reduction. Moreover, women’s intention to
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57
reduce their number o f partners was only modestly correlated with their actual behavior (r
= .3), accounting for 9% o f the variance in predicted behavior. Thus, normative feedback
did not appear to change or influence women’s intentions, and intention was only a
modest predictor o f partner number. For whatever the reasons that women in the
intervention group reduced their number of partners, the theory of reasoned action failed
to provide an adequate causal explanation.
Likewise, the theory of reasoned action failed to account for the study’s other
outcomes. At postintervention, participants in both groups expressed stronger intentions
to increase their frequency of safe sex discussions. Participants in the intervention group
expressed even stronger intentions than participants in the control group. Such definitive
intentions should have led to significant increases in safe sex discussions reported at
follow-up. In fact, the opposite occurred. Discussion o f safe sex declined during the
follow-up period. Intention was a poor predictor of this behavior.
At postintervention, participants in both groups also expressed stronger intentions
to reduce consumption o f alcohol in conjunction with sexual intercourse. The theory of
reasoned action would have predicted such increased intention to lead to actual behavior
change. However, alcohol consumption with sexual intercourse did not decline at follow-
up. Intention and behavior were completely uncorrelated on this measure.
Further research would be required to explain the exact mechanisms by which the
intervention caused the behavior changes that it did. Unfortunately, the data from this
study did not entirely explain why the intervention increased risk reduction for some
behaviors and not for others, and why it affected women differently than men.
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58
One is left to speculate on the reasons for these apparent inconsistencies. It may be
that the intervention was effective at changing only those behaviors over which
participants had the most unilateral control. Men arguably have the most control over
condom use because they are the ones who actually wear condoms. For this reason, men
may have been more open and willing to change this particular behavior. Women, on the
other hand, do not have direct control over condom use. Women do not “use” condoms in
the literal sense. At best, they persuade their male partners to use them. Women may have
more direct control over the decision of whether to have sex, with whom, and with how
many partners. For this reason, women may have been more amenable to reducing their
number of sexual partners as a risk reduction strategy. Thus, the intervention may have
motivated men and women to choose different risk reduction strategies depending upon
the behavior over which they had the most direct control— condom use in the case o f men,
partner choice in the case of women.
This may explain why the intervention failed to increase discussion of safe sex.
Sexual partners do not have unilateral control over this behavior. By its very nature,
discussion of safe sex requires the willing cooperation o f another person. It may entail
discussing awkward and potentially embarrassing questions with one’s partner, especially
if there has been a previous history of not practicing safer sex (Appleby, Miller, &
Rothspan, 1999). Discussion of these issues also requires a certain level of expertise in
communication and assertiveness skills, skills which this intervention did not teach as part
o f its protocol. The whole subject of safe sex may be so fraught with complications that
sexual partners may be easily dissuaded from bringing it up, despite the best o f intentions.
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59
Ironically, it may be easier for men to simply use a condom, or for women to simply
refrain from sex, than for men and women to talk about having safer sex.
The intervention’s failure to reduce the use o f alcohol and drugs with sex may have
been due to the perception among participants that these behaviors were not particularly
risky or out of the ordinary. Participants’ reported rates of alcohol, marijuana, and drug
use with sex appeared to be consistent with the majority norms o f fellow USC students.
When participants in the intervention group were presented with data showing that their
behavior was consistent with the majority norms, they may well have concluded that their
behavior required no alteration. Other evidence from the study indicated that participants’
alcohol and drug use with sex was uncorrelated with their use o f condoms. Contrary to
expectation, the use of alcohol and drugs with sex was not associated with lapses in
condom use. Participants may not have felt that their use of alcohol or drugs with sex was
a risky behavior that increased their likelihood o f STD or HIV infection. Further research
would obviously be necessary to furnish empirical support for all o f these speculations.
Practical Implications
The effects observed in this study suggest several practical implications for future
AIDS prevention interventions. Normative feedback, combined with self-evaluation and
goal selection exercises of the type featured in this intervention, represents an effective set
o f components for promoting risk reduction among college students. In particular, these
components have the potential for encouraging increases in condom use and decreases in
the number of sexual partners. The results o f the study suggest that even simple self
administered interventions as brief as 20 min can potentially lead to short-term changes in
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60
sexual behavior. The results also make clear that interventions have differential effects for
men and women, suggesting that traditional prevention strategies may not be equally
effective for everyone. The message to “always use a condom,” so prevalent in most
informational interventions, may be appropriate for men, but less helpful for women.
Merely admonishing women to “use” condoms may not help women increase their rate of
protected intercourse without special instruction on how to resist pressure to have
unprotected intercourse, or in how to persuade male sexual partners to use condoms.
Limitations
The limitations o f the study should be briefly mentioned. The intervention’s effects
were measured for a relatively brief period o f only 30 days. Because the intervention itself
was brief, its effects were likely to be short-lived as well. It has been observed that most
intervention effects for short-term AIDS prevention programs eventually decline with the
passage o f time (Kalichman, Carey, & Johnson, 1996). Nevertheless, this study
demonstrated that even a brief intervention can produce significant behavior changes with
moderate to large effect sizes.
The results o f this study are, of course, based on participants’ retrospective self-
reports o f their behaviors, with all the inherent problems o f social desirability and
inaccurate recall associated with self-reports. However, social desirability problems in
surveys o f sexual behavior tend to be more common among participants who are older and
less educated (Catania et al., 1990). The fact that the study’s participants were young and
college educated does not guarantee against social desirability problems, but their
likelihood is arguably lower. The problem o f inaccurate recall may have been somewhat
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diminished by the fact that participants kept a daily log of their behavior during the follow-
up period. The process of self-tracking may have facilitated accurate recall.
Other factors may have reduced the intervention’s potential effects. The sample
size was relatively small, especially for detecting behaviors with low base rates such as
condom use with anal intercourse and marijuana or drug use in conjunction with
intercourse. A segment o f the 105 participants who were sexually active during the
preintervention and follow-up periods (21.9%) reported 100% condom use, creating
something o f a ceiling effect for over a fifth o f the sample. Many o f the participants also
reported being in monogamous relationships, whose safe sex behavior is usually lower and
more resistant to change (Laumann et al., 1994). Future interventions would be advised to
treat monogamous and nonmonogamous participants separately.
ATSS
The ATSS procedure provided insight into the moment-to-moment thoughts and
feelings that young adults probably experience when they are engaged in a sexual
encounter with a relatively unfamiliar sexual partner. In the first administration o f the
ATSS Dating Tape, participants were blind to the fact that the focus o f the study was
AIDS prevention. They responded to the Dating Tape without any priming or prompting
about safe sex issues. Even without priming, the vast majority o f participants expressed
caution about becoming sexually involved with the imaginary dating partner and
recognized the need for a condom in the situation. Over 87% o f participants recognized
and articulated the need for exercising caution in the situation, even before hearing the
segment in which they were told that unprotected intercourse was about to occur. Prior to
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being told that intercourse was proceeding without a condom, nearly 66% o f participants
articulated the belief that a condom had to be used. Nearly 70% of participants expressed
concerns about the past sexual history o f the imaginary dating partner, and nearly 50%
expressed concerns about STDs. Approximately one-third o f participants expressed
concerns about pregnancy, and about 12% articulated concerns specifically about HTV or
AIDS. In imagining how the dating situation would end, over 80% o f participants said that
intercourse would proceed only if a condom were used. Nearly a quarter of participants
said that they were not ready to have intercourse with the imaginaiy dating partner,
whether or not a condom was present. Less than 6% o f participants considered the option
o f continuing to engage in alternative sexual activities besides intercourse.
Participants tended to articulate concerns about safe sex fairly late in the Dating
Tape. On average, they expressed concerns about STDs, AIDS and pregnancy well into
the foreplay stages of the imaginary scenario. Their first mention that a condom was
necessary tended to occur (on average) at the point in the scenario when participants were
told that intercourse was just about to happen.
A relative minority of participants expressed indifference towards safe sex issues.
Less than 10% of participants said that they saw no need for a condom. Less than 7% said
that they were unconcerned about the past sexual history o f the imaginaiy dating partner,
or about pregnancy, STDs, or AIDS. About 15% of participants imagined the situation
ending in unprotected intercourse.
Thus, the majority of participants articulated thoughts about caution and safer sex
in their first exposure to the ATSS Dating Tape, even without knowing that the study
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63
would be about AIDS prevention. However, they tended to articulate these concerns fairly
late in the Dating Tape. A relative minority of students appeared completely uninterested
in exercising caution in the situation and unconcerned about the possibility o f STDs,
AIDS, pregnancy, or other risks.
When participants heard the Dating Tape for the second time, they were already
primed to think about safe sex issues. As predicted, participants expressed greater concern
and caution on their second exposure to the Dating Tape. They articulated significantly
greater frequency of thoughts about the need to exercise caution, the importance of
condom use, and the threat o f STD’s and HIV/AIDS. In the second exposure to the
Dating Tape, participants articulated more concerns about the past sexual history of the
dating partner than they had in the first hearing. They were more likely to imagine the
scenario ending in no intercourse with the dating partner. They were also more likely to
express concerns about STD’s, HTV/AIDS, and the dating partner’s past sexual history at
an earlier point in the Dating Tape than they had when they heard the tape for the first
time.
Contrary to expectation, the intervention was not more effective at changing
participants’ cognitions than was the control condition. Both groups showed increased
expressions of caution about sex and concerns over disease and risk.
The ATSS procedure produced significant gender differences in the way that men
and women responded to the imaginary sexual situation. In their first hearing of the
scenario, women responded with greater caution. Women were more wary about having
intercourse with the dating partner and expressed their wariness earlier in the scenario than
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64
did men. Women were more likely to say that they were unwilling to have intercourse with
the dating partner, whether a condom were present or not. Women expressed more
concern about the dating partner’s past sexual history and expressed this concern earlier in
the scenario. They were more likely to voice suspicions about the dating partner’s
motives. Women were more likely than men to express interest in having alcohol in the
imaginary situation. Women were more likely than men to say that three weeks was not
enough time to become sexually involved, and they voiced concern about appearing too
“loose” and rushing into sex prematurely.
Compared to women, men expressed less caution about having intercourse. They
tended to express greater interest in having intercourse with the dating partner and
expressed this interest at an earlier point in the Dating Tape. Among the 15% o f
participants who imagined the scenario ending in unprotected intercourse, most were men.
Men were less concerned about the past sexual history of the dating partner, and less
suspicious of the dating partner’s motives. Men were more likely to react to the dating
partner’s attention with expressions o f pride or confidence, and to express the belief that
the}' had ‘heaten the competition” in gaining the attention o f such an attractive dating
partner. Men were less likely to say that three weeks was an insufficient amount o f time
for becoming sexually involved. The primary caution that men expressed was a concern
about appearing too forward or pushy with the dating partner.
In their second hearing of the scenario, many o f these gender differences
disappeared. Men expressed somewhat more concern about condom use and avoidance of
pregnancy, but for the most part, in their second exposure to the Dating Tape, men and
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65
women expressed equal caution about having intercourse with the imaginary partner and
equal concern over STD’s, HIV/AIDS, and the dating partner’s past sexual history. There
was no significant difference in the way that men and women imagined the scenario
ending. After the ATSS procedure was conducted for a second time, there were no longer
any gender differences in the time at which thoughts were first expressed. The reasons for
the diminution o f gender effects at postintervention are not entirely clear. It may be that
the priming effect o f having heard the Dating Tape the first time, together with the
exposure to the intervention and control conditions, put all participants in a more cautious
mindset, regardless o f gender.
The results o f the ATSS portion o f this study have implications for future AIDS
prevention interventions. If we are to assume that the cognitions expressed in the
imaginary dating scenario bear a close resemblance to thoughts and feelings experienced in
comparable real-life situations, then it is encouraging that so many participants articulated
the importance o f proceeding cautiously in a sexual encounter with a new and somewhat
unfamiliar partner. On the other hand, it is disconcerting that so many participants waited
until they were on the brink of having (imaginary) intercourse before they articulated
concerns about disease or pregnancy, and recognized the immediate need for a condom. It
is highly probable that many young adults are behaving the same way in actual sexual
encounters, namely, waiting until the last possible moment to bring up the condom issue
with their sexual partners. The awkwardness inherent in raising safe sex issues may be
enough to discourage their discussion. Men may worry that raising the condom issue too
prematurely will signal their interest in intercourse before their partner is also o f the same
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6 6
mind. Women may be concerned that raising the condom issue too early will signal to their
male partners that they are very sexually experienced, perhaps even promiscuous,
jeopardizing any prospects for a long-term relationship. (Both o f these concerns were
repeatedly voiced by participants in response to the ATSS Dating Tape.) This may help to
explain why some people approach a sexual situation fully intending to use a condom, but
find themselves swept along by the heat o f the moment and unable to raise the need for a
condom at the appropriate time.
Future interventions would be well-advised to focus more attention on this critical
issue of timing. Simply lecturing young people about the need to “talk to their partners”
about using a condom is not enough. Instruction and training are badly needed on when
and how to raise the issue.
The ATSS procedure also shed light on the fact that concerns about disease are
not necessarily salient in the minds o f many young people engaged in sexual encounters
with relatively unfamiliar sexual partners. About 50% of participants never articulated any
thoughts about STDs or HIV/AIDS in response to the Dating Tape. Many voiced
concerns about the dating partner’s past sexual history without necessarily connecting this
with disease. Among those who did express concerns about disease, the tendency was to
think about these issues relatively late into the foreplay stages o f the scenario. AIDS
prevention programs need to do a better job of priming young people to think about
disease and other risks. Sexually active young adults need to be taught that the early
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67
stages of sexual situations, well before intercourse, should serve as cues and reminders
that disease and pregnancy are imminent health risks for which the appropriate precautions
need to be taken.
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68
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Table 1
Summary of Participants' Demographic Information (N=155)
n M SD
Gender
Men
Women
77
78
49.7
50.3
Age
Racial Background
White 72
Asian/Pacific Islander 23
Latino/Hispanic 21
African American/Black 8
American Indian/Alaskan Native 0
Other 31
20.7 3.1
46.5
14.8
13.5
5.2
0.0
20.0
Religious Background
Catholic
Protestant
Atheist/Agnostic/None
Jewish
Islamic
Buddhist
Hindu
Other
58
31
26
12
4
3
3
17
37
20
16
7
2
1
1.9
10. 9
Citizenship
US
Non-US
144
11
92.
7.
Marital Status
Never Married
Living with someone
Married
Sexual Orientation
Sexual Attraction
Opposite sex only
Both sexes
Sexual Behavior
Opposite sex only
Both sexes
Sexual Identity
Heterosexual
Bisexual
148
4
142
13
147
8
149
6
95.
2 .
i
91.6
8.4
94.8
5.2
96.1
3.9
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78
Table 2
Prevalence Over- and Underestimates of HIV Risk Behaviors Made by
Participants in Intervention Condition (N=78)
Estimated
Prevalence
Actual
Prevalence3
Over(under)
Estimate
Behavior Mean % Mean %
Abstinence from all
sexual activity
18.9 20 (1.1)
One intercourse partner 37.7 31 6.7
Two or more
intercourse partners
45.1 36 9.1
Condoms used
all or most of the time
48.6 61 (12.4)
Condoms never used 25.6 16 9.6
Condom use
discussed with partner
40.0 60 (20.0)
Alcohol used in
conjunction with sex
all or most of the time
56.8 20 36.8
Marijuana/drugs used in
conjunction with sex
all or most of the time
33.3 8 25.3
5 Data reported in Chernoff and Davison (1999) .
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Table 3
Means and Standard Deviations for Willingness-to-Change Questionnaire Completed by
Participants in Intervention Group (N=78)
How
Surprised?
"Fit
in?"
How
At Risk?
How
Concerned?
How Open
To Change?
Willing To
1 Change?
Behavior
M(SD) % M(SD) M (SD) M(SD) Yes(%) No (%)
Abstinence 3.6(2.5) — — — — —
—
Number of intercourse
partners
5.0(2.3) 5.1 3.2(2.6) 3.9(2.9) 4.7(3.7) 65.4 34.6
Condom use 4.2(3.0) 52.6 2.8(2.5) 3.6(2.9) 5.3(3.7) 68.8 31.2
Discussion of condom
use with sexual
partner(s)
4.3(2.8) 39.7 2.6(2.2) 3.2(2.8) 5.0(3.3) 71.8 28.2
Alcohol and sex 6.6(2.2) 75.6 2.4(2.4) 2.9(2.2) 4.4(3.5) 59.7 40.3
Marijuana/drugs
and sex
4.2(3.2) 89.7 1.5(2.3) 1.6(2.5) 3.8(4.2) 45.7 54.3
Note. Ratings were made on an 11-point Likert scale: 0 = not at all, 1-3 = somewhat,
4-6 = moderately, 7-8 = very, and 9-10 = extremely.
"j
V O
80
Table 4
Means and Standard Deviations for Reported Behavior (N=105)
12 Mo. Pre 30 Day Pre 30 Day FU
Behavior
51
SD M (SD) M (SD)
Condom use (vaginal sex)
%
Number
58.0
36.0
(36.6)
(47.1)
46.9
4.8
(44.0)
(6.5)
47.1
5.6
(43.6)
(11.5)
Condom use (anal sex)
%
Number
48.4
3.0
(47.6)
(4.9)
38.8
1.0
(50.8)
(1.3)
60.0
3.0
(49.0)
(4.4)
Number of partners
Vaginal sex
Anal sex
3.1
.4
(1.7)
(.7)
1.3
.1
(.5)
(.3)
1.4
.3
(.8)
(.7)
Discussed safe sex
%
Number
43.7
28.0
(31.8)
(36.6)
40.1
3.6
(37.7)
(4.6)
25.3
2.3
(31.7)
(2.9)
Alcohol used in
conjunction with sex
%
Number
22.4
16.5
(24.0)
(23.9)
23.5
3.4
(29.4)
(10.2)
19.6
1.9
(27.9)
(2.8)
Marijuana/Drugs used in
conjunction with sex
%
Number
8.4
7.4
(16.9)
(24.1)
5.2
.8
(14.4)
(2.2)
6.5
.6
(19.8)
(1.9)
Mote. Pre = preintervention. FU = follow-up. All participants who were
sexually active during both the 30-day preintervention and 30-day
follow-up periods were included.
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Table 5
Means and Standard Deviations for Significant Group X Gender Interaction Effects on Behavior Using
ANCOVA (N=105)
Behavior
Intervention Group Control Group
F
2
1
Pre
M
(SD)
Men
= 23)
FU
M
(SD)
Women
(n = 33)
Pre
M
(SD)
FU
M
(SD)
Men
(n =
Pre
M
(SD)
23)
FU
M
(SD)
Women
(n = 26)
Pre
M
(SD)
FU
M
(SD)
% condom use 64.3 76.7 31.6 29.7 48.5 38.6 49.4 50.7 4.3 .003
(vaginal sex) (37.9 ) (31.1) (39.6) (40.4) (47.6) (41.8) (46.9) (46.5)
Number of partners 1.2 1.8 1.2 1.0 1.5 1.4 1.2 1.5 20.6 .001
(vaginal sex) (.4) (.9) (.5) (.2) (.7) (.6) (.4) (1.0)
Number of partners 0.1 0.5 0.1 0.1 0.1 0.1 0.1 0.4 7.09 .009
(anal sex) (.3) (1.0) (.3) (.3) (.3) (.3) (.3) (.8)
Note. Pre = 30 day preintervention. FU = 30 day follow-up. Bonferroni-adjusted a = .05/2 = .025.
o o
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Table 6
Means and Standard Deviations for Significant Group X Gender X Monogamy Interaction Effect on
Behavior Using ANCOVA (N=105)
Intervention Group Control Group
Nonmonogamous Nonmonogamous
Men Women Men Women
(n = 14) (n = 11)
(
n = 12) (n = 11)
Pre FU Pre FU Pre FU Pre FU
M M M M M M M M
(SD) (SD) (SD) (SD) (SD) (SD) (SD) (SD) F
E
Behavior
Number of partners 1.3 2.3 1.6 1.1 1.9 1.8 1.5 2.2 20.6 .001
(vaginal sex) (.5) (.8) (.7) (.3) (.7) (.6) (.5) (1.3)
Note. Pre = 30 day preintervention. FU = 30 day follow-up. Bonferroni-adjusted a = .05/2 = .025. For all
monogamous men and women in both groups, M - 1, SD = 0.
00
to
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Table 7
Means and Standard Deviations for Significant Main Effects of Monogamy Using ANCOVA (N=105)
Monogamous Nonmonogamous
Behavior
Pre FU
M (SD) M (SD)
Pre
M (SD)
FU
M (SD) F
E
% alcohol used in (n = 57) (n = 47) (n = 48)
conjunction with sex 17.7 (23.1) 11.7 (20.1) 30.7 (34.6) 28.9 (32.7) 6.4 .013
% marijuana/drugs used
in conjunction with sex
(n = 55)
3.0 (8.9) 1.1 (3.7)
(n = 45)
7.9 (18.8)
(n = 48)
12.8 (27.6)
6.58 .012
Note. Pre = 30 day preintervention. FU = 30 day follow-up. Bonferroni-adjusted a = .05/2 = .025.
84
Table 8
Means and Standard Deviations for Measures of Intention (N=155)
Intention
Pre
M(SD)
Post
M(SD)
To have fewer sexual
intercourse partners
2.23 (1.50) 2.16 (1.61)
To use condoms more
frequently
2.67 (1-34) 2.74 (1.42)
To discuss condom use/
safe sex more frequently
with sexual partner(s)
2.20 (1.29) 2.67 (1.22)
To use alcohol less
frequently in conjunction
with sex
2.02 (1.29) 2.30 (1.38)
No intention to modify
sexual behavior
2.71 (1.27) 2.58 (1-27)
Note. Intentions were measured on a 5-point Likert scale:
0 = strongly disagree, 1 = disagree, 2 = neutral, 3 = agree,
and 4 = strongly agree. Bonferroni-adjusted a. = .10/5 = .02.
d = Cohen's measure of effect size (Cohen, 1988).
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Table 9
Means and Standard Deviations for Significant Main Effect of Group on Intention Using ANCOVA (N=155)
Intervention Group Control Group
Intention
Pre
(n=78)
M (SD)
Post
(n=77)
M (SD)
Pre
(n=75)
M (SD)
Post
(n=76)
M (SD) F
E
To discuss condom use/
safe sex more fre
quently with partner
2.2 (1.2) 2.8 (1.1) 2.3 (1.4) 2.5 (1.4) 6.01 .015
Note. Pre = preintervention. Post = postintervention. Intentions were measured on a 5-point Likert
scale: 0 = strongly disagree, 1 = disagree, 2 = neutral, 3 = agree, and 4 = strongly agree.
Bonferroni-adjusted a = .10/5 = .02.
o o
to
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Table 10
Means and Standard Deviations for Significant Group X Gender Interaction Effects on Intention Using
ANCOVA (N=155)
Intervention Group______________ Control Group
Intention
Men
(n = 38
Pre
M
(SD)
)
Post
M
(SD)
Women
(n = 39)
Pre
M
(SD)
Post
M
(SD)
Men
(n = 37
Pre
M
(SD)
)
Post
M
(SD)
Women
(n = 38)
Pre
M
(SD)
Post
M
(SD) F
E
To use condoms 3.0 3.3 2.2 2.2 2.7 2.6 2.7 2.8 7.0 .009
more frequently (1.0) (.9) (1.5) (1.6) (1.5) (1.6) (1.3) (1.3)
To discuss condom 2.2 3.0 2.2 2.6 2.1 2.3 2.4 2.8 5.72 .018
use/safe sex more (1.0) (.9) (1.3) (1.2) (1.5) (1.5) (1.4) (1.2)
frequently with
partner
Note. Pre = preintervention. Post = postintervention. Intentions were measured on a 5-point Likert scale:
0 = strongly disagree, 1 = disagree, 2 = neutral, 3 = agree, and 4 = strongly agree.
Bonferroni-adjusted a = .10/5 = .02.
o o
O n
87
Table 11
Interrater Reliability for ATSS Codes
Intraclass Correlation Coefficients
Articulated Thoughts Frequency First Mention
Interest in intercourse .84 .64
Caution about intercourse .86 .76
Need for condom use .92 .81
Concern about disease/STDs .93 .86
Concern about HIV/AIDS .93 .94
Concern about pregnancy .93 .87
Concern about partner's .90 .74
sexual history
Alcohol reference .88 .87
Imagined ending (last segment)
No sex .74 —
Sex only with condom .79 —
Sex without condom .90 —
Sexual activitv besides .79
—
intercourse
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Table 12
Means and Standard Deviations for ATSS Frequency Codes, and Significant Time, Gender, and Gender X Time
Effects Using Repeated Measures ANOVA (N=155)
Time Effects Gender Effects Gender X Time Effects
Men Women Men Women
Pre Post Pre Pre Post Post
M(SD) M(SD) M(SD) M(SD) M(SD) M(SD)
Articulated Thoughts
Frequency
Interest in intercourse 4.9 (2.3) 4.6 (2.5) 5.6 (2.0) 4.1 (2.3)a 5.5 (2.2) 3.7 (2.5)
Caution about intercourse 4.0 (1.9) 4.6 (1.9)“ 3.3 (1.6) 4.7 (1.9)a 4.1 (1.7) 5.0 (2.0)
Need for condom use 2.6 (1.5) 3.0 (1.8)c 2.6 (1.6) 2.7 (1.5) 3.3
(1.9)
2.7 (1.6)
Concern about disease/STDs .6 (.9) .9 <1.0)b .6 (.8) .7 (.9) .7 (.9) 1.0
(1.1)
Concern about HIV/AIDS .1 (.4) .3 (•6)a .1 (.3) .2 (.4) .3 (.6) .4 (.7)
Concern about pregnancy .3 (.6) .3 (.6) .3 (.6) .3 (.6) .4 (.7) .2 (.5)
Concern about partner's 1.0 (1.0) 1.6 (1•5)a .8 (.9) 1.2
(l.l)c
1.3 (1.4) 1.8 (1.5)
sexual history
Alcohol .4 (.7) .4 (.8) .2 (.5) .6 (1.0)D .3 (.6) .4 (.9)
Imagined ending
No sex .2 (.3) .2 (• 4) .1 (.2) .3 (• 4) .1 (.3) .4 (.4)
Sex only with condom .8 (.4) .7 (.7) .8 (.4) .7 (.4) .8 (.4) .6 (.4)
Sex without condom .1 (.3) .1 (.3) .2 (.4) .1 (.3)° .2 (.4) .1 (.2)
Note. Pre = previntervention. Post = postintervention. Range for frequency = 0 to 13. Bonferroni-adjusted
a = .10/5 = .02. d = Cohen's measure of effect size (Cohen, 1988).
a £ < .001 l,£ < .01 c£ < .02
o o
oo
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Table 13
Means and Standard Deviations for ATSS "First Mention" Codes, and Significant Time, Gender, and
Gender X Time Effects Using Repeated Measures ANOVA (N=155)
Time Effects Gender Effects Gender X Time Effects
Men Women Men Women
Pre Post Pre Pre Post Post
M(SD) M(SD) • MOD) M (SD) M(SD) M(SD)
Articulated Thoughts
First Mention
Interest in intercourse 7.5 (2.4) 7.6 (3.0) 7.0 (2.2) 7.9 (2.5)b 6.9 (2.7) 8.3 (3.0)
Caution about intercourse 8.7 (2.5) 8.3 (2.1) 9.2 (2.6) 8.2 (2.3)c 8.6 (2.1) 8.1 (2.0)
Need for condom use 10.1 (2.1)i 10.1 (8.5) 10.2 (1.9) 10.7 (2.2) 9.4 (2.3) 10.9 (11.8)
Concern about STDs 11.9 (2.8)i 11.0 (3,5)b 12.0 (2.8) 11.8 (2.9) 11.0 (3.5) 11.0 (3.5)
Concern about HIV/AIDS 13.4 (1.7) 12.7 (2.7)* 13.5 (1.7) 13.4 (1.7) 12.6 (2.9) 12.8 (2.5)
Concern about pregnancy 12.5 (2.8) 12.9 (2.4) 12.8 (2.4) 12.2 (3.1) 12.9 (2.3) 13.0 (2.5)
Concern about partner's 9.4 (3.7) 8.3 (4.2)c 10.1 (3.2) 8.6 (4.0)c 8.5 (4.4) 8.0 (4.1)
sexual history
Alcohol 11.4 (4.4) 11.7 (4.2) 12.1 (4.1) 10.8 (4.6) 12.0 (4.1) 11.4 (4.2)
Note. Pre = previntervention. Post = postintervention. Range for frequency = 0 to 13. Bonferroni-adjusted
a = .10/5 = .02. d = Cohen's measure of effect size (Cohen, 1988).
< .001 < .01 c£ < .02
o o
v O
90
Table 14
Participants' Assessment of ATSS Scenario (N=155)
Questionnaire Item M Median SD
How similar were your thoughts to those
you would have in an actual situation?
3.9 4 .9
How much did you let your thoughts go
without censorship?
3.7 4 .8
How much did you hold back from saying
what was on your mind?
1.8 2 .9
How realistic was the scenario to you? 3.5 4 1.0
How much did it feel like the situation
was really happening?
3.1 3 1.1
How intense did your emotions get? 2.8 3 .9
How sexually aroused were you? 1.9 2 1.0
Note. Participants responded to each item according to the following
5-point Likert scale: 1 = not at all, 2 = slightly, 3 = moderately,
4 = very, and 5 = extremely.
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Men Women
N
C
C T
a
2
S i
3
■ o
c
o
o
ss
80
70
eo
50
40
30
20
10
0
FU Pre
■Intervention Group
-Control Group
80
g 70
| 60
50 (
2
S i
o
*
40
30'
20
10
0
Pre
i
FU
Time Time
Figure 1. Group X Gender interaction for percentage o f condom u se (vaginal intercourse),
Pre = preintervention. FU = follow-up.
Intervention Group
Control Group
v O
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Intervention Group
Control Group
Intervention Group
Control Group
Time
Figure 2. Group X Gender interaction for number o f sexual partners (vaginal intercourse).
Pre = preintervention. FU = follow-up.
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Men
0.5
0.45 < 0
5 0.4
2 0.35
| 0,3
5 0.25
iL
•8 0,2
S 0.15
| 0.1
| 0.05
Pre FU
■ Intervention Group
-Control Group
Time
Women
0.5
f 0.45
I, 0,4
2 0,35
| 0.3
5 0.25
0,15
0.1
0.06
Pre FU
■Intervention Group
■Control Group
Time
Figure 3. Group X Gender interaction for number o f sexual partners (anal intercourse).
Pre = preintervention. FU = follow-up.
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Men
- 2.4
1 0
f , 2.2
( 0
4 J
€
2.
* -
o
km
ii
E
3
Z
FU Pre
■ Intervention Group
■Control Group
Time
Women
2.4
2
2.2
S ’
£
o
I
z
Pre FU
Time
■Intervention Group
-Control Group
Figure 4. Group X Gender X M onogam y interaction for number o f sexual partners (vaginal intercourse), The figure depicts the
interaction effect for nonm onogam ous participants only. (For all m onogam ous participants, mean number o f partners = 1.)
Pre = preintervention. FU = follow-up.
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Men
3.4
3.2
S 2 .8
o 2.4
# 2.2
Pre FU
-Intervention Group
-Control Group
Time
3.4
3.2
1 2.8
O
S i 2.6
3
o 2.4
| 2.2
2
Pre
Women
-Intervention Group
-Control Group
i
FU
Time
Figure 5. Group X Gender interaction for intention to use condom s more frequently,
Pre = preintervention. FU = follow-up.
V O
Reproduced with permission o f th e copyright owner. Further reproduction prohibited without permission.
Men
£ 2.9
2 2.8
3 2,7
3 2.6
5 2.5
S 2.4
c
o 2,3
2.2 c
c
Pre FU
■Intervention Group
■ Control Group
Time
Women
£ 2.9
o
2
8
2.6
2.5
2,4
2.3
Q
0
c
1
Pre FU
■Intervention Group
■Control Group
Time
Figure 6. Group X Gender interaction for intention to discuss safe sex more frequently,
Pre = preintervention. FU = follow-up.
V O
O v
97
APPENDIX A
Pre
N o ._____________
[PREINTERVENTION QUESTIONNAIRE]
Instructions
This survey will be asking you some very private, personal questions. All of
your answers are strictly confidential and will be used only for statistical
reports. Your name and your ID number will not be requested at anytime, and
they should NOT be written or appear anywhere on this survey.
We need your frank and honest responses.
There are no right or wrong answers.
Please read all instructions and all questions carefully.
Thank you again for your cooperation in this project.
PLEASE TURN THE PAGE AND BEGIN.
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98
Please answer the following questions by circling the number corresponding to the
best answer.
1. What is your gender?
Male 1
Female 2
2. Are you a United States citizen?
Yes 1
No 2
If your answer to Question 2 is “No,” please specify your country of
origin:_____________________
3. What is your age? _________
4. Which of the following would best describe your racial background?
Circle all that apply.
American Indian or Alaskan Native 1
Asian or Pacific Islander 2
African-American or Black, not of Hispanic origin 3
Latino or Hispanic 4
White, not of Latino or Hispanic origin 5
Other (e.g., mixed racial background) 6
If your answer to Question 4 is “Other,” please specify how you would describe your
racial background:_______________________________
5. What is your current marital status?
Never married 1
Married 2
Living with someone as if married 3
Divorced 4
Widowed 5
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99
6. What is your religious background?
Protestant 1
Catholic 2
Jewish 3
Islamic 4
Buddhist 5
Other 6
If your answer to Question 6 is “Other,” what is your religious
background:_______________________________
7. To the best o f your knowledge, what is your family’s annual income?
Under $20,000 1
$20,000 - 40,000 2
$41,000 - $60,000 3
$61,000 - $80,000 4
$81,000 - $100,000 5
Over $100,000 6
PLEASE TURN THE PAGE AND CONTINUE
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1 0 0
Please answer each question below by circling “true” or “false.”
8. The virus that causes AIDS is not spread by sneezing or coughing.
True False
9. It is unsafe to use drinking fountains or public toilets that might have
been used by somebody who has the virus that causes AIDS.
True False
10. Some people have gotten the virus that causes AIDS from infected people’s sweat in
gymnasiums or health clubs.
True False
11. If you kiss someone who has the virus that causes AIDS, you will probably get the
disease.
True False
12. In order for a condom to effectively reduce one’s risk for the virus that causes AIDS,
it must be put on before any sexual intercourse takes place.
True False
13. Natural condoms made of animal products are as effective as latex condoms in
preventing the virus that causes AIDS.
True False
14. In order for the virus that causes AIDS to be transmitted from one person to another,
there must be direct contact between one person’s blood, vaginal secretions or semen, and
the other person’s blood.
True False
15. When properly used, latex condoms greatly reduce the chance that the virus that
causes AIDS will be transmitted through sexual intercourse.
True False
16. If you know a person’s sexual history and lifestyle before you have sex with them, it is
unnecessary to use condoms.
True False
17. The way a person behaves around you when you first meet them is probably a good
indicator of whether or not they are the type of person who may have been exposed to the
virus that causes AIDS.
True False
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1 0 1
18. You really only need to use condoms during “one night stands.”
True False
19. You can tell whether a potential sex partner is at risk for AIDS by how they dress and
how they look.
True False
20. When you feel you have gotten to know someone very well, you no longer need to
practice safer sex with them.
True False
21. As long as a person doesn’t belong to a “high risk” group such as gays or drug users,
you really don’t need to worry about getting the virus that causes AIDS from them.
True False
PLEASE TURN THE PAGE AND CONTINUE
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1 0 2
The following questions will ask you about your sexual behavior over the PAST 30
DAYS.
Please answer these questions by circling the number corresponding to the best
answer.
22. Have you had sexual intercourse (sex in which the penis is put into the vagina, or sex
where the penis is put into the rectum) at all during the past 30 days?
Yes, I have had sexual intercourse during the past 30 days. 1
No, I have NOT had sexual intercourse during the past 30 days. 2
23. Over the past 30 days, have you been in a close relationship involving sexual
intercourse in which you and your partner are both monogamous (i.e., neither of you has
sexual intercourse with other people)?
Circle one:
Yes (1) No (2) Uncertain (3) Not Applicable: (4)
I have not had sexual intercourse
during the past 30 days.
2 4 .1 have bought latex condoms during the past 30 days.
Circle one:
Often (1) A few times (2) Once (3) Never (4)
2 5 .1 kept latex condoms some place nearby where they were easily available during the
past 30 davs.
Circle one:
Always (1) Often (2) Sometimes (3) Rarely (4) Never (5)
26. How many different people have you had
vaginal intercourse (penis-in-vagina) with during the past 30 davs?
27. With how many o f these partners were condoms used ALL the time?
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103
28. How many of these partners had an AIDS blood test and you
knew they had not been exposed to the virus that causes AIDS?
29. When you had vaginal intercourse during the past 30 davs, what percentage of the
time were condoms used?
______ % Not Applicable:
I have not had
(enter % above) vaginal intercourse during the past 30 days.
30. When you had vaginal intercourse during the past 30 days, how often were condoms
used?
Circle one:
Never (1) Rarely (2) Sometimes (3) Often (4) Always (5)
Not Applicable: (6)
I have not had
vaginal intercourse
during the past 30 days.
31. When you had vaginal intercourse during the past 30 davs, how many times were
condoms used?
______ Not Applicable:
I have not had
(enter number above) vaginal intercourse
during the past 30 days.
32. How many times did you have vaginal intercourse during the past 30 davs?
______ Not Applicable:
I have not had
(enter number above) vaginal intercourse
during the past 30 days.
33. How many different people have you had
anal intercourse (penis-in-rectum) with during the past 30 davs?
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104
34. With how many o f these partners were condoms used ALL the tim e?
35. How many of these partners had an AIDS blood test and you
knew they had not been exposed to the virus that causes AIDS?
36. When you had anal intercourse during the past 30 davs. how often were condoms
used?
Circle one:
Never (1) Rarely (2) Sometimes (3) Often (4) Always (5)
Not Applicable: (6)
I have not had
anal intercourse
during the past 30 days.
37. When you had anal intercourse during the past 30 davs. what percentage of the time
were condoms used?
______ % Not Applicable:
I have not had
(enter % above) anal intercourse
during the past 30 days.
38. When you had anal intercourse during the past 30 davs. how many times were
condoms used?
Not Applicable:
1 have not had
(enter number above) anal intercourse
during the past 30 days.
39. How many times did you have anal intercourse during the past 30 davs?
Not Applicable:
I have not had
(enter number above) anal intercourse
during the past 30 days.
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105
40. When you had sexual intercourse (vaginal or anal) during the past 30 davs, how often
did you discuss condom use or safer sex with your sexual partner(s)?
Circle one:
Never (1) Rarely (2) Sometimes (3) Often (4) Always (5)
Not Applicable: (6)
I have not had
sexual intercourse during the past 30 days.
41. When you had sexual intercourse during the past 30 davs, what percentage of the
time did you discuss condom use or safer sex with your sexual partner(s)?
_______% Not Applicable:
I have not had
(enter % above) sexual intercourseduring the past 30 days.
42. When you had sexual intercourse during the past 30 davs, how many times did you
discuss condom use or safer sex with your sexual partner(s)?
_______ Not Applicable:
I have not had
(enter number above) sexual intercourse during the past 30 days.
43. How often have you consumed alcohol before or during sexual intercourse in the past
30 davs?
Never (1) Rarely (2) Sometimes (3) Often (4) Always (5)
Not Applicable: (6)
No intercourse in past 30 days.
44. What percentage of the time did you consume alcohol in conjunction with sexual
intercourse in the past 30 davs?
______ % Not Applicable:
I have not had
(enter % above) sexual intercourse during the past 30 days.
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106
45. How many times did you consume alcohol in conjunction with sexual intercourse in
the past 30 davs?
______ Not Applicable:
I have not had
(enter number above) sexual intercourse during the past 30 days.
46. How often have you used marijuana or drugs before or during sexual intercourse in
the past 30 davs?
Never (1) Rarely (2) Sometimes (3) Often (4) Always (5)
Not Applicable: (6)
No intercourse in past 30 days.
47. What percentage of the time did you use marijuana or drugs in conjunction with sexual
intercourse in the past 30 days?
______ % Not Applicable:
I have not had
(enter % above) sexual intercourse during the past 30 days.
48. How many times did you use marijuana or drugs in conjunction with sexual
intercourse in the past 30 davs?
______ Not Applicable:
I have not had
(enter number above) sexual intercourse during the past 30 days.
The following questions will ask you about the LAST OCCURRENCE of certain
behaviors (that is, the most recent occurrence of these behaviors regardless of how
long ago.)
Please answer these questions by circling the number corresponding to the best
answer.
49. The LAST TIM E you had vaginal intercourse, was a condom used?
Yes (1) No (2) Not Applicable: (3)
I have not had vaginal intercourse.
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107
50. The LAST TIME you had anal intercourse, was a condom used?
Yes (1) No (2) Not Applicable: (3)
I have not had anal intercourse.
51. The LAST TIME you had sexual intercourse, did you discuss condom use or safer
sex with your sexual partner(s)?
Yes (1) No (2) Not Applicable: (3)
I have not had sexual intercourse.
52. The LAST TIME you had sexual intercourse, did you consume alcohol before or
during intercourse?
Yes (1) No (2) Not Applicable: (3)
I have not had sexual intercourse.
53. The LAST TIME you had sexual intercourse, did you use marijuana or drugs before
or during intercourse?
Yes (1) No (2) Not Applicable: (3)
I have not had sexual intercourse.
The following questions will ask you about your sexual behavior over the PAST 12
MONTHS.
Please answer these questions by circling the number corresponding to the best
answer.
54. Have you had sexual intercourse (sex in which the penis is put into the vagina, or sex
where the penis is put into the rectum) at all during the past 12 months?
Yes, I have had sexual intercourse during the past 12 months. 1
No, I have NOT had sexual intercourse during the past 12 months. 2
55. Over the past 12 months, have you been in a close relationship involving sexual
intercourse in which you and your partner are both monogamous (neither of you has
sexual intercourse with other people)?
Circle one:
Yes (1) No (2) Uncertain (3) Not Applicable: (4)
1 have not had sexual intercourse
during the past 12 months.
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108
56.1 have bought latex condoms during the past 12 months.
Circle one:
Often (1) A few times (2) Once (3) Never (4)
5 7 .1 kept latex condoms some place nearby where they were easily available during the
past 12 months.
Circle one:
Always (1)
Never (5)
Often (2) Sometimes (3) Rarely (4)
58. How many different people have you had
vaginal intercourse (penis-in-vagina) with during the past 12 months?
59. With how many of these partners were condoms used ALL the time?
60. How many of these partners had an AIDS blood test and you
knew they had not been exposed to the virus that causes AIDS?
61. When you had vaginal intercourse during the past 12 months, how often were
condoms used?
Circle one:
Never (1) Rarely ( ! ) Sometimes (3) Often (4) Always (5)
Not Applicable: (6)
I have not had
vaginal intercourse
during the past 12 months.
62. When you had vaginal intercourse during the past 12 months, what percentage of the
time were condoms used?
% Not Applicable:
I have not had
vaginal intercourse during the past 12 months. (enter % above)
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109
63. When you had vaginal intercourse during the oast 12 months, how many times were
condoms used?
64. How many times did you have vaginal intercourse during the past 12 months?
65. How many different people have you had
anal intercourse (penis-in-rectum) with during the past 12 months?
66. With how many o f these partners were condoms used ALL the time?
67. How many of these partners had an ADDS blood test and you
knew they had not been exposed to the virus that causes AIDS?
68. When you had anal intercourse during the past 12 months, how often were condoms
used?
Circle one:
Never (1) Rarely (2) Sometimes (3) Often (4) Always (5)
Not Applicable: (6)
I have not had
anal intercourse
during the past 12 months.
69. When you had anal intercourse during the past 12 months, what percentage of the
time were condoms used?
(enter number above)
Not Applicable:
I have not had
vaginal intercourse during the past 12 months.
(enter number above)
Not Applicable:
I have not had
vaginal intercourse during the past 12 months.
% Not Applicable:
I have not had anal intercourse
during the past 12 months. (enter % above)
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110
70. When you had anal intercourse during the past 12 months, how many times were
condoms used?
___________________ Not Applicable:
I have not had
(enter number above) anal intercourse
during the past 12 months.
71. How many times did you have anal intercourse during the past 12 months?
___________________ Not Applicable:
I have not had
(enter number above) anal intercourse
during the past 12 months.
72. When you had sexual intercourse (vaginal or anal) during the past 12 months, how
often did you discuss condom use or safer sex with your sexual partner(s)?
Circle one:
Never (1) Rarely (2) Sometimes (3) Often (4) Always (5)
Not Applicable: (6)
I have not had
sexual intercourse
during the past 12
months.
73. When you had sexual intercourse during the past 12 months., what percentage of the
time did you discuss condom use or safer sex with your sexual partner(s)?
_______% Not Applicable:
I have not had
(enter % above) sexual intercourse
during the past 12
months.
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I l l
74. When you had sexual intercourse during the past 12 months, how many times did you
discuss condom use or safer sex with your sexual partner(s)?
_______ Not Applicable:
I have not had sexual intercourse
(enter number above) during the past 12 months.
75. How often have you consumed alcohol before or during sexual intercourse in the past
12 months?
Never (1) Rarely (2) Sometimes (3) Often (4) Always (5)
Not Applicable: (6)
No intercourse
in past 12 months.
76. What percentage o f the time did you consume alcohol in conjunction with sexual
intercourse in the past 12 months?
______ % Not Applicable:
I have not had
(enter % above) sexual intercourse
during the past 12
months.
77. How many times did you consume alcohol in conjunction with sexual intercourse in
the past 12 months?
_______ Not Applicable:
I have not had
(enter number above) sexual intercourse
during the past 12
months.
78. How often have you used marijuana or drugs before or during sexual intercourse in
the past 12 months?
Never (1) Rarely (2) Sometimes (3) Often (4) Always (5)
Not Applicable: (6)
No intercourse
in past 12 months.
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112
79. What percentage of the time did you use marijuana or drugs in conjunction with sexual
intercourse in the past 12 months?
%
(enter % above)
Not Applicable:
I have not had
sexual intercourse
during the past 12
months.
80. How many times did you use marijuana or drugs in conjunction with sexual
intercourse in the past 12 months?
(enter number above)
Not Applicable:
I have not had
sexual intercourse
during the past 12
months.
81.1 engage in sexual activity:
with men only. 1
with both men and women. 2
with women only. 3
I don’t engage in sexual activity. 4
8 2 .1 am sexually attracted to:
men only.
both men and women
women only.
8 3 .1 think o f myself as:
heterosexual. 1
homosexual. 2
bisexual. 3
84. How old were you the first time you engaged in sexual intercourse (sex in which the
penis is put into the vagina, or sex where the penis is put into the rectum)?
A ge______ Not applicable:
I have never engaged in
sexual intercourse in my life.
1
2
3
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113
85. Have you ever had any course or instruction that included information on HIV and
AIDS, including information on how HTV is transmitted and how to prevent infection?
Yes 1
No 2
When was the most recent occasion on which you had such a course or instruction?
INT.l
Please read each o f the following statements carefully. Circle the number that best
describes your reaction to each statement with regard to your behavior over the next 30
days. Use the following numerical scale:
4 = s tr o n g ly a g r e e
3 = a g r e e •
2 = n e u tr a l
1 = d is a g r e e
0 = s tr o n g ly d is a g r e e
OVER THE NEXT 30 DAYS:
1 .1 intend to have no sexual intercourse whatsoever. 4 3 2
2. I intend to have fewer sexual partners with whom 4 3 2
I have intercourse.
3. I intend to use condoms at all times during 4 3 2
sexual intercourse.
4 .1 intend to use condoms more frequently during 4 3 2
sexual intercourse than I have in the past.
5 .1 intend to talk with my sexual partner(s) about 4 3 2
condom use and safer sex before or during every
occurrence of sexual intercourse.
0
0
0
0
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114
6 .1 intend to talk with my sexual partner(s) about 4 3 2 1 0
condom use and safer sex more frequently than
I have in the past.
7 .1 intend to abstain from using alcohol altogether 4 3 2 1 0
when I have sex.
8 .1 intend to use alcohol less frequently 4 3 2 1 0
when I have sex.
9 .1 intend to abstain from using marijuana or drugs 4 3 2 1 0
altogether when I have sex.
10.1 intend to use marijuana or drugs less frequently 4 3 2 1 0
when I have sex.
11.1 am satisfied with my current sexual behavior, 4 3 2 1 0
and I have no desire or intention of modifying my
sexual behavior at this time.
LOT
Please indicate the extent to which you agree with each of the items below, using the
following response format:
4 = s tr o n g ly a g r e e
3 = a g r e e
2 = n e u tr a l
1 = d is a g r e e
0 = s tr o n g ly d is a g r e e
Circle the number that best describes your reaction to each statement. Try to be as
accurate and honest as you can throughout, and try not to let your answers to one
question influence your answers to other questions. There are no correct or incorrect
answers.
1. In uncertain times, I usually expect the best. 4 3 2 1 0
2. It’s easy for me to relax. 4 3 2 1 0
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3. If something can go wrong for me, it will. 4 3 2 0
4 .1 always look on the bright side of things. 4 3 2 0
5. I’m always optimistic about my future. 4 3 2 0
6 .1 enjoy my friends a lot. 4 3 2 0
7. It’s important for me to keep busy. 4 3 2 0
8 .1 hardly ever expect things to go my way. 4 J 2 0
9. Things never work out the way I want them to. 4 3 2 0
10.1 don’t get upset too easily. 4 3 2 0
11. I’m a believer in the idea that
“every cloud has a silver lining.” 4 3 2 0
12. I rarely count on good things happening to me. 4 2 0
HLOC
Please indicate the extent to which you agree with each of the items below, using the
following response format:
4 = s tr o n g ly a g r e e
3 = a g r e e
2 = n e u tr a l
1 = d is a g r e e
0 = s tr o n g ly d is a g r e e
Circle the number that best describes your reaction to each statement. Try to be as
accurate and honest as you can throughout, and try not to let your answers to one
question influence your answers to other questions. There are no correct or incorrect
answers.
1. If I become sick, I have the power to 4 3 2 1 0
make myself well again.
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2. Often I feel that no matter what I do,
if I am going to get AIDS, I will get AIDS.
3. If I see an excellent doctor regularly, 4 3 2
I am less likely to have health problems.
4. It seems that my avoidance of AIDS is 4 3 2
greatly influenced by accidental happenings.
5 .1 can only prevent HIV infection by 4 3 2
consulting AIDS prevention professionals.
6 .1 am directly responsible for avoiding 4 3 2
HIV infection.
7. Other people play a big part in whether 4 3 2
I get the AIDS virus.
8. If I get the AIDS virus, it’s my own fault. 4 3 2
9. When I am sick, I just have to let nature 4 3 2
run its course.
10. Health professionals keep me healthy. 4 3 2
11. When I stay healthy, I’m just plain lucky. 4 3 2
12. My physical well-being depends on how well 4 3 2
I take care of myself.
13. When I feel ill, I know it is because I have 4 3 2
not been taking care of myself properly.
14. The type of care I receive from other people 4 3 2
is what is responsible for how well I recover
from an illness.
15. Even when I take care of myself, it’s easy 4 3 2
to get sick.
16. If I get the AIDS virus, it’s a matter o f fate. 4 3 2
116
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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117
17.1 can pretty much avoid AIDS by taking 4 3 2 1 0
the necessary precautions.
18. Following safer sex guidelines to the letter 4 3 2 1 0
is the best way for me to avoid HTV infection.
THIS IS THE END OF THE SURVEY.
PLEASE LET THE EXPERIMENTER KNOW YOU HAVE FINISHED.
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118
APPENDIX B
N o .__________
[POSTINTERVENTION QUESTIONNAIRE]
The following questions will ask you about the sexual scenario which you just listened to.
Please answer them using the rating scale below.
1 = n o t a t a ll
2 = s lig h tly
3 = m o d e r a te ly
4 = v e r y
5 = e x tre m e ly
1. How realistic was the scenario to you?
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 of this kind?
3. How much did it feel like this imaginary situation was really happening (like you
were really in the situation)?
4. When you were talking out loud, how much did you really let your thoughts go,
without censoring your thoughts?
5. when you were talking out loud, how much did you hold back from saying
exactly what was going through your mind?
6. How intense did your emotions actually get while you were hearing the
scenario?
7. How much were you sexually aroused during the scenario?
PLEASE TURN THE PAGE AND CONTINUE.
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119
ESTT.2
Please read each of the following statements carefully. Circle the number that best
describes your reaction to each statement with regard to your behavior over the next 30
days. Use the following numerical scale:
4 = s tr o n g ly a g r e e
3 = a g r e e
2 = n e u tr a l
1 = d is a g r e e
0 = s tr o n g ly d is a g r e e
OVER THE NEXT 30 PAYS:
1 .1 intend to have no sexual intercourse whatsoever.
2 .1 intend to have fewer sexual partners with whom
I have intercourse.
4 3
0
0
3 .1 intend to use condoms at all times during
sexual intercourse.
4 3 0
4 .1 intend to use condoms more frequently during 4 3
sexual intercourse than I have in the past.
5 .1 intend to talk with my sexual partner(s) about 4 3
condom use and safer sex before or during every
occurrence o f sexual intercourse.
6 .1 intend to talk with my sexual partner(s) about 4 3
condom use and safer sex more frequently than
I have in the past.
7 .1 intend to abstain from using alcohol altogether 4 3
when I have sex.
0
0
0
0
8 .1 intend to use alcohol less frequently
when I have sex.
0
9 .1 intend to abstain from using marijuana or drugs
altogether when I have sex.
0
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120
10.1 intend to use marijuana or drugs less frequently 4 3 2 1 0
when I have sex.
1 1 .1 am satisfied with my current sexual behavior, 4 3 2 1 0
and I have no desire or intention of modifying my
sexual behavior at this time.
THIS IS THE END OF TUTS QUESTIONNAIRE.
PLEASE LET THE EXPERIMENTER KNOW YOU HAVE FINISHED.
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121
APPENDIX C
Post N o ._____________
[FOLLOW-UP QUESTIONNAIRE)
Instructions
This survey will be asking you some very private, personal questions. All of
your answers are strictly confidential and will be used only for statistical
reports. Your name and your E D number will not be requested at anytime, and
they should NOT be written or appear anywhere on this survey.
We need your frank and honest responses.
There are no right or wrong answers.
Please read all instructions and all questions carefully.
Thank you again for your cooperation in this project.
Please complete these forms in the following order:
1. Complete the Daily Log over the next 30 days (see instructions on the
next page).
2. Then complete the attached Behavior Questionnaire at the end of the
30 day period.
3. Then return the Daily Log and Behavior Questionnaire to SGM 718 in
the envelope provided.
PLEASE TURN THE PAGE AND BEGIN.
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122
DAILY LOG
Instructions
You will be monitoring and recording your behavior over the next 30 days, starting with
today. The sheet attached is a Daily Log to help you do this.
For each of the next 30 days, you will be keeping track of the following 8 questions:
1. Vaginal Sex: Did you have vaginal intercourse (sex where the penis is put into the
vagina)?
2. Condom Used: If so, was a latex condom used?
3. Anal Sex: Did you have anal intercourse (sex where the penis is put into the rectum)?
4. Condom Used: If so, was a latex condom used?
5. Discussed Safer Sex: Did you discuss condom use and/or safer sex with your sexual
partner before or during sexual intercourse with him or her?
6. Alcohol Used: Did you consume alcohol before or during sexual intercourse?
7. Marijuana or Drugs Used: Did you use marijuana or drugs before or during sexual
intercourse?
8. Different Partner: Did you have sexual intercourse with a different partner than the
person you had sexual intercourse with on the previous occasion?
For each of the next 30 days, if any of your answers to these 8 questions is “Yes,” please
indicate so in the appropriate space on the Daily Log. You may indicate this by a check
mark, the letter “X,” the letter “Y,” or the word “Yes.” You only need to mark the box if
vour answer to a particular question is “Yes.” You do NOT need to record anything if
vour answer to a particular question is “No.”
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DAIT,Y LOG
START DATE:__________________
PLEASE RETURN THIS SHEET TO SGM 718 AS SOON AS POSSIBLE AFTER
Day Vaginal Condom Anal Condom? Discussed Alcohol | Marij./Drugs
Sex? Used? Sex? Used? Safer Sex? Used? | Used?
Day 1
Day 2
Day 3
!
Day 4
t
Day 5
Day 6
Day 7
Day 8
Day 9
Day 10
Day 11
Day 12
Day 13
Day 14
Day 15
Day 16
Day 17
Day 18
Day 19
i
Day 20
I
Day 21
Day 22
Day 23
Day 24
Day 25
Day 26
Day 27
When you have reached Day 30, please complete the attached Behavior
Questionnaire.
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124
BEHAVIOR QUESTIONNAIRE
The following questions will ask you about your sexual behavior over the PAST 30
DAYS since vour participation in the first phase of this study. Please answer these
questions by circling the number corresponding to the best answer.
22. Have you had sexual intercourse (sex in which the penis is put into the vagina, or sex
where the penis is put into the rectum) at all during the past 30 days?
Yes, I have had sexual intercourse during the past 30 days. 1
No, I have NOT had sexual intercourse during the past 30 days. 2
23. Over the past 30 days, have you been in a close relationship involving sexual
intercourse in which you and your partner are both monogamous (i.e., neither of you has
sexual intercourse with other people)?
Circle one:
Yes (1) No (2) Uncertain (3) Not Applicable: (4)
I have not had sexual intercourse
during
the past 30 days.
24.1 have bought latex condoms during the past 30 days.
Circle one:
Often (1) A few times (2) Once (3) Never (4)
2 5 .1 kept latex condoms some place nearby where they were easily available during the
past 30 days.
Circle one:
Always (1) Often (2) Sometimes (3) Rarely (4) Never (5)
26. How many different people have you had
vaginal intercourse (penis-in-vagina) with during the past 30 days?
27. With how many o f these partners were condoms used ALL the time?
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125
28. How many of these partners had an AIDS blood test and you
knew they had not been exposed to the virus that causes AIDS?
29. When you had vaginal intercourse during the past 30 days, what percentage o f the
time were condoms used?
______ % Not Applicable:
I have not had vaginal intercourse
(enter % above) during the past 30 days.
30. When you had vaginal intercourse during the past 30 days, how often were condoms
used?
Circle one:
Never (1) Rarely (2) Sometimes (3) Often (4) Always (5)
Not Applicable: (6)
I have not had
vaginal intercourse
during the past 30
days.
31. When you had vaginal intercourse during the past 30 days, how many times were
condoms used?
______ Not Applicable:
I have not had
(enter number above) vaginal intercourse
during the past 30
days.
32. How many times did you have vaginal intercourse during the past 30 days?
______ Not Applicable:
I have not had
(enter number above) vaginal intercourse
during the past 30
days.
33. How many different people have you had
anal intercourse (penis-in-rectum) with during the past 30 days?
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126
34. With how many o f these partners were condoms used ALL, the tim e?
35. How many of these partners had an AIDS blood test and you
knew they had not been exposed to the virus that causes AIDS?
36. When you had anal intercourse during the past 30 days, how often were condoms
used?
Circle one:
Never (1) Rarely (2) Sometimes (3) Often (4) Always (5)
Not Applicable: (6)
I have not had
anal intercourse
during the past 30
days.
37. When you had anal intercourse during the past 30 days, what percentage o f the time
were condoms used?
38. When you had anal intercourse during the past 30 days, how many times were
condoms used?
(enter % above)
% Not Applicable:
I have not had
anal intercourse
during the past 30
days.
(enter number above)
Not Applicable:
I have not had
anal intercourse
during the past 30
days.
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127
39. How many times did you have anal intercourse during the past 30 days?
___________________ Not Applicable:
I have not had
(enter number above) anal intercourse
during the past 30
days.
40. When you had sexual intercourse (vaginal or anal) during the past 30 days, how often
did you discuss condom use or safer sex with your sexual partner(s)?
Circle one:
Never (1) Rarely (2) Sometimes (3) Often (4) Always (5)
Not Applicable: (6)
I have not had
sexual intercourse
during the past 30
days.
41. When you had sexual intercourse during the past 30 days, what percentage of the
time did you discuss condom use or safer sex with your sexual partner(s)?
______ % Not Applicable:
I have not had
(enter % above) sexual intercourse
during the past 30
days.
42. When you had anal intercourse during the past 30 days, how many times did you
discuss condom use or safer sex with your sexual partner(s)7
_______ Not Applicable:
I have not had
(enter number above) sexual intercourse
during the past 30
days.
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128
43. How often have you consumed alcohol before or during sexual intercourse in the past
30 days?
Never (1) Rarely (2) Sometimes (3) Often (4) Always (5)
Not Applicable: (6)
No intercourse
in past 30 days.
44. What percentage of the time did you consume alcohol in conjunction with sexual
intercourse in the past 30 days?
______ % Not Applicable:
I have not had
(enter % above) sexual intercourse
during the past 30 days.
45. How many times did you consume alcohol in conjunction with sexual intercourse in
the past 30 days?
_______ Not Applicable:
I have not had
(enter number above) sexual intercourse
during the past 30
days.
46. How often have you used marijuana or drugs before or during sexual intercourse in
the past 30 days?
Never (1) Rarely (2) Sometimes (3) Often (4) Always (5)
Not Applicable: (6)
No intercourse
in past 30 days.
47. What percentage of the time did you use marijuana or drugs in conjunction with sexual
intercourse in the past 30 days?
______ % Not Applicable:
I have not had
(enter % above) sexual intercourse
during the past 30
days.
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129
48. How many times did you use marijuana or drugs in conjunction with sexual
intercourse in the past 30 days?
______ Not Applicable:
I have not had
(enter number above) sexual intercourse
during the past 30
days.
The following questions will ask you about the LAST OCCURRENCE of certain
behaviors (that is, the most recent occurrence of these behaviors regardless of how
long ago.)
Please answer these questions by circling the number corresponding to the best
answer.
49. The LAST TIME you had vaginal intercourse, was a condom used?
Yes (1) No (2) Not Applicable: (3)
I have not had vaginal intercourse.
50. The LAST TIME you had anal intercourse, was a condom used?
Yes (1) No (2) Not Applicable: (3)
I have not had anal intercourse.
51. The LAST TIME you had sexual intercourse, did you discuss condom use or safer
sex with your sexual partner(s)?
Yes (1) No (2) Not Applicable: (3)
I have not had sexual intercourse.
52. The LAST TIME you had sexual intercourse, did you consume alcohol before or
during intercourse?
Yes (1) No (2) Not Applicable: (3)
I have not had sexual intercourse.
53. The LAST TIME you had sexual intercourse, did you use marijuana or drugs before
or during intercourse?
Yes (1) No (2) Not Applicable: (3)
I have not had sexual intercourse.
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130
ENT.3
Please read each of the following statements carefully. Circle the number that best
describes your reaction to each statement with regard to your behavior over the next 30
days. Use the following numerical scale:
4 = s tr o n g ly a g r e e
3 = a g r e e
2 = n e u tra l
1 = d is a g r e e
0 = s tr o n g ly d is a g r e e
OVER THE NEXT 30 DAYS:
1 .1 intend to have no sexual intercourse whatsoever. 4 3 2
2 . 1 intend to have fewer sexual partners with whom 4 3 2
I have intercourse.
0
0
3 . 1 intend to use condoms at all times during 4 3
sexual intercourse.
4. I intend to use condoms more frequently during 4 3
sexual intercourse than I have in the past.
5 .1 intend to talk with my sexual partner(s) about 4 3
condom use and safer sex before or during every
occurrence of sexual intercourse.
6 . 1 intend to talk with my sexual partner(s) about 4 3
condom use and safer sex more frequently than
I have in the past.
7 .1 intend to abstain from using alcohol altogether 4 3
when I have sex.
0
0
0
0
8 .1 intend to use alcohol less frequently
when I have sex.
4 3 0
9 .1 intend to abstain from using marijuana or drugs
altogether when I have sex.
4 3
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131
10. I intend to use marijuana or drugs less frequently 4 3 2 1 0
when. I have sex.
1 1 .1 am satisfied with my current sexual behavior, 4 3 2 1 0
and I have no desire or intention of modifying my
sexual behavior at this time.
THIS IS THE END OF THE QUESTIONNAIRE.
PLEASE PUT THE DAILY LOG AND BEHAVIOR QUESTIONNAIRE IN THE
ENVELOPE WE PROVIDED TO YOU AND RETURN THEM AS SOON AS
POSSIBLE TO SGM 718.
THANK YOU FOR YOUR PARTICIPATION IN THIS STUDY!
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132
APPENDIX D
No,
[PREVALENCE ESTIMATION QUESTIONNAIRE]
PART ONE
Have you ever wondered about the sexual behavior of your fellow USC undergraduates?
We have.
We conducted a survey last year of a large sample of USC students to ask them
about their sexual behavior. Before we share the results o f this survey with you, we’d like
to see what you currently assume about the sexual behavior of your fellow USC students.
Please answer these questions as best you can, and if you’re not sure, just guess.
1. What percentage o f USC students would you say were completely abstinent from all
sexual activity over the past 12 months?
%
2. What percentage o f USC students would you say had one sexual partner with whom
they had sexual intercourse over the past 12 months?
%
3. What percentage o f USC students would you say had two or more sexual partners with
whom they had sexual intercourse over the past 12 months?
%
4. Of the USC students who had vaginal intercourse over the past 12 months, what
percentage would you say used a condom all or most of the time?
%
5. Of the USC students who had vaginal intercourse over the past 12 months, what
percentage would you say never used a condom?
%
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■too
1JJ
6. O f the USC students who had vaginal intercourse over the past 12 months, what
percentage would you say talked to their sexual partner about using a condom before or
during intercourse?
%
7. What percentage o f USC students would you say consumed alcohol in conjunction with
all or most o f their sexual encounters over the past 12 months?
%
8. What percentage of USC students would you say used marijuana or other drugs in
conjunction with all or most o f their sexual encounters over the past 12 months?
%
9. What would you say is the average number o f sexual partners the typical USC student
has in a 12-month period?
For men: _______
For women: _______
For all students:
10. What would you say is the average age that the typical USC student had his or her
first experience with sexual intercourse?
For men: _______
For women: _______
For all students:
PLEASE STOP.
LET THE EXPERIMENTER KNOW YOU HAVE FINISHED.
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134
APPENDIX E
No._
[WILLINGNESS-TO-CHANGE QUESTIONNAIRE]
PART TWO
There is a lot o f concern these days about the AIDS epidemic. Sexually active adolescents
and young adults are believed to be especially vulnerable to the risks of contracting the
human immunodeficiency virus (HTV), the virus that causes ADDS. Currently there is no
known cure or vaccine for HTV or AIDS.
The drug treatments that do exist today for treating HTV infection have many side effects,
are very expensive and harsh on the body, and in many cases have only a limited effect or
no effect at all.
The most effective method o f preventing HTV infection remains abstinence from sexual
activity, or the use o f condoms during sexual intercourse.
Sexual intercourse with multiple partners, and without the use of condoms, increases the
likelihood of contracting a sexually transmitted disease, including HTV.
The use of alcohol, marijuana, or drugs in conjunction with sexual activity is believed to
increase this risk even more.
We’d like you to think for a few moments about your own sexual behavior, especially in
comparison to the sexual behavior of your fellow USC undergraduates.
PLEASE TURN THE PAGE AND CONTINUE.
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135
We asked a large group of USC undergraduates about their sexual behavior over the
preceding 12-month period. The group we surveyed was racially and ethnically diverse,
and included both men and women.
Here’s what they had to say:
ABSTINENCE
20% o f the students surveyed were completely abstinent from all sexual activity
over a 12-month period.
13% engaged in some form of sexual activity over a 12-month period, but did
NOT engage in any form of sexual intercourse.
So, a sizable number of USC students in the survey— about one third— were at
very low risk for HTV infection. They either abstained from any kind o f sexual activity
whatsoever, or they abstained from any form o f sexual intercourse.
PLEASE TURN THE PAGE AND CONTINUE.
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136
10. How surprised are you by this result? (Circle the number on the rating scale below
that best describes your level of surprise at this result.)
0 1 2 3 4 5 6 7 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
11. Where would you say your behavior “fits in,” in comparison with your USC peers?
(Check one below)
I was abstinent from all sexual activity during the past 12 months.
I was sexually active during the past 12 months, but my sexual activity did NOT
include sexual intercourse.
I was sexually active during the past 12 months, and my sexual activity DID include
sexual intercourse.
PLEASE TURN THE PAGE AND CONTINUE.
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137
NUMBER OF INTERCOURSE PARTNERS
8 40%
c
at
•a 30%
3
C O 20%
«• -
o
•
10%
a
a 0%
II
1 2 -3 4 -5 6 +
Number of Intercourse Partners
Over a 12-month period:
33% of the students surveyed had no partners with whom they had sexual
intercourse.
31% of the students surveyed had only 1 . partner with whom they had intercourse.
20% of the students reported having 2 or 3 different intercourse partners.
10% of the students reported having 4 or 5 different intercourse partners.
6 % of the students reported having 6 or more different intercourse partners.
So apparently, the majority o f USC students surveyed (64%) either had no
intercourse partners, or only one intercourse partner, over a 12-month period.
A minority o f USC students (36%) had multiple intercourse partners, and only a
very small minority had a significant number o f intercourse partners.
PLEASE TURN THE PAGE AND CONTINUE.
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138
12. How surprised are you by this result? (Circle the number on the rating scale below
that best describes your level of surprise at this result.)
| 1 1 1 1 1 1 1 1 1 1
0 1 2 3 4 5 6 7 89 10
Not at all Somewhat Moderately Very Extremely
surprised surprised surprised surprised surprised
13. Where would you say your behavior “fits in,” in comparison with your USC peers?
(Check one below)
Like the majority o f USC students, I either had no sexual intercourse during the past
12 months, or only had one partner with whom I had intercourse.
Like a minority of USC students, I had 2 or 3 partners with whom I had sexual
intercourse during the past 12 months.
Like a minority o f USC students, I had 4 or 5 partners with whom I had sexual
intercourse during the past 12 months.
Like a minority of USC students, I had 6 or more partners with whom I had sexual
intercourse during the past 12 months.
14. When you think about the number of partners with whom you have had sexual
intercourse over the past 12 months, especially in comparison with your USC peers, how
“at risk” would you say you have been for becoming infected with a sexually transmitted
disease, including HIV?
Circle the number on the rating scale below that best describes how “at risk”
you have been in comparison with your fellow USC students.
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
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139
15. When you think about your number of intercourse partners in comparison with your
fellow USC students, how concerned are you about your risk o f becoming infected with a
sexually transmitted disease, including HIV?
Circle the number on the rating scale below that best describes how
concerned you are about the number of sexual partners you have had.
0 1 2 3 4 5 6 7 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
16. How open would you be to the idea of modifying this behavior over the next 30
days (that is, reducing the number of people with whom you have sexual intercourse) in
order to reduce your risk of becoming infected with a sexually transmitted disease,
including HTV?
Circle the number on the rating scale below that best describes how open you
would be to the idea of reducing your number of intercourse partners over the next
30 days?
01 2 3 4 5 6 7 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
17. Would you be willing to have fewer sexual partners with whom you have intercourse
over the next 30 days? Yes No
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140
18. If you answered “yes” to question 17, how important would it be to you to achieve
this goal?
(Skip this question if you answered “No” to question 17.)
Circle the number on the rating scale below that best describes how
important it is to you that you achieve this goal.
0 1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
19. If you answered “yes” to question 17, how confident are you that you could achieve
this goal?
(Skip this question if you answered “No” to question 17.)
Circle the number on the rating scale below that best describes how
confident you feel that you could achieve this goal.
0 1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
PLEASE TURN THE PAGE AND CONTINUE.
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141
CONDOM USE
( 0
■£ 70%
S 60%
i n
i_ 30%
° 20%
g, 1 0%
A ll or Never
most
of the
Rate of Condom Use
Out of all the USC students surveyed who reported having vaginal
intercourse over a 12-month period:
61% used a condom all or most of the time.
Only a minority— 16%— never used a condom.
Apparently, a majority of sexually active USC students (61%) recognized the
importance of using a condom, and did so during sexual intercourse all or most of the
time.
Those who never used a condom were in the minority (16%).
PLEASE TURN THE PAGE AND CONTINUE.
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142
20. How surprised are you by this result? (Circle the number on the rating scale below
that best describes your level of surprise at this result.)
I------ 1 ------- 1-------1 -------j-------1 ------- 1------- 1 -------1-------1 --------1
01 2 3 4 5 67 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
21 . Compared to your USC peers, where would you say your behavior “fits in”?
That is, during the past 12 months, whenever you had sexual intercourse, how often did
you or your partner(s) used condoms?
(Check one below)
All or most of the time (like the majority of USC students).
Only some of the time (like a minority of USC students).
None of the time (like a minority o f USC students).
I never had sexual intercourse during the past 12 months.
22. When you think about your condom use over the past 12 months, especially in
comparison with your USC peers, how “at risk” would you say you have been for
becoming infected with a sexually transmitted disease, including HTV?
Circle the number on the rating scale below that best describes how “at risk’’
you have been in comparison with your fellow USC students.
I------- 1------- 1-------- ,-------1--------1--------1--------j--------1------- [-------- 1
01 2 3 4 5 67 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
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143
23. When you think about your condom use in comparison with that o f your fellow USC
students, how concerned are you about your risk o f becoming infected with a sexually
transmitted disease, including HTV?
Circle the number on the rating scale below that best describes how
concerned you are about your current rate of condom use.
0 1 2 3 4 5 67 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
24. How open would you be to the idea of modifying this behavior over the next 30
days (that is, increasing your condom use) in order to reduce your risk o f becoming
infected with a sexually transmitted disease, including HTV?
Circle the number on the rating scale below that best describes how open you
would be to the idea of increasing your condom use over the next 30 days?
0 1 2 3 4 5 6 7 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
25. Would you be willing to increase your condom use over the next 30 days?
Yes No
26. If you answered “yes” to question 25, how important would it be to you to achieve
this goal?
(Skip this question if you answered “No” to question 25.)
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144
Circle the number on the rating scale below that best describes how
important it is to you that you achieve this goal.
I------ 1------- 1 -------1 ------- 1 ------- 1 ------- 1 ------- 1 ------- 1 -------1 --------1
0 1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
27. If you answered “yes” to question 25, how confident are you that you could achieve
this goal?
(Skip this question if you answered £ C No” to question 25.)
Circle the number on the rating scale below that best describes how
confident you feel that you could achieve this goal.
-I 1 -------1--------1--------1--------I
0 1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
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145
PARTNER COMMUNICATION ABOUT CONDOM USE
C O 40%
All or Never
Rate o f Partner Communication
About Condom Use
Out of all of the USC students surveyed who reported being sexually active over a
12-month period:
60% reported talking to their sexual partner about condom use before or during
intercourse all or most o f the time.
Only a minority— 15%— reported that they never talked about condom use before
or during intercourse.
Apparently, a majority of sexually active USC students recognized the importance
of talking with their sexual partners about condom use before or during intercourse, and a
majority of them (60%) did so all or most of the time.
Only a minority did not seem to see the importance of talking about condom use
with their sexual partners.
PLEASE TURN THE PAGE AND CONTINUE.
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146
28. How surprised are you by this result? (Circle the number on the rating scale below
that best describes your level of surprise at this result.)
0 1 2 3 4 5 67 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
29. Compared to your USC peers, where would you say your behavior “fits in”?
That is, during the past 12 months, whenever you had sexual intercourse, how often did
you talk with your sexual partner(s) about condom use:
(Check one below)
All or most of the time (like the majority of USC students).
Only some of the time (like a minority of USC students).
None of the time (like a minority o f USC students).
I never had sexual intercourse during the past 12 months.
30. When you think about how often you talked with your sexual partner(s) about condom
use over the past 12 months, especially in comparison with your USC peers, how “at
risk” would you say you have been for becoming infected with a sexually transmitted
disease, including HIV?
Circle the number on the rating scale below that best describes how “at risk”
you have been in comparison with your fellow USC students.
0 1 2 3 4 5 67 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
PLEASE TURN THE PAGE AND CONTINUE.
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147
31. When you think about how often you talked with your sexual partner(s) about condom
use in comparison with your fellow USC students, how concerned are you about your
risk o f becoming infected with a sexually transmitted disease, including HTV?
Circle the number on the rating scale below that best describes how
concerned you are about the risk level of your current sexual behavior.
0 1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
32. How open would you be to the idea o f modifying this behavior over the next 30
days (that is, talking more often with your sexual partner(s) about condom use) in order
to reduce your risk of becoming infected with a sexually transmitted disease, including
HIV?
Circle the number on the rating scale below that best describes how open you
would be to the idea of talking more often with your partners) about condom use
over the next 30 days?
0 1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
33. Would you be willing to talk more often with your sexual partner(s) about condom use
over the next 30 days? Yes No
34. If you answered “yes” to question 33, how important would it be to you to achieve
this goal?
(Skip this question if you answered “No” to question 33.)
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148
Circle the number on the rating scale below that best describes how
important it is to you that you achieve this goal.
I-------1 --------1--------[--------1--------1--------1------- 1 -------- 1------- j---------1
0 1 2 3 4 5 67 89 10
Not at all Somewhat Moderately Very Extremely
surprised surprised surprised surprised surprised
35. If you answered “yes” to question 33, how confident would you feel that you could
achieve this goal?
(Skip this question if you answered “No” to question 33.)
Circle the number on the rating scale below that best describes how
confident you feel that you could achieve this goal.
I-
0 1 2 3 4 5 67 89 10
Not at all Somewhat Moderately Very Extremely
surprised surprised surprised surprised surprised
PLEASE TURN THE PAGE AND CONTINUE.
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149
ALCOHOL CONSUMPTION AND SEX
70% -
3 60% --
2 50% --
° 40% --
O) 30% --
■3 2 0% --
g 1 0% --
a
c
o
«
o >
5 o%
0.
Occasionally
or never
All or most
of the time
Alcohol Consumption and Sex
Out of all the USC students surveyed who reported being sexually active over a
12-month period:
80% said they never consumed alcohol in connection with sex, or did so only
occasionally.
Only 20% said they consumed alcohol in conjunction with all or most o f their
sexual encounters.
Apparently, the majority (80%) of sexually active USC students never or only
occasionally consumed alcohol in connection with sex.
Only a minority (20%) consumed alcohol in connection with all or most of their
sexual encounters.
PLEASE TURN THE PAGE AND CONTINUE.
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150
36. How surprised are you by this result? (Circle the number on the rating scale below
that best describes your level of surprise at this result.)
o 2 3 4 5 6 7 8 9 10
Not at all
surprised.
Somewhat Moderately
surprised. surprised.
Very
surprised.
Extremely
surprised.
37. Compared to your USC peers, where does your behavior “fit in”? That is, during
the past 12 months, how often did you consume alcohol before or during any sexual
encounter?
(Check one below)
None of the time, or only occasionally (like the majority of USC students).
Most of the time (like a minority of USC students).
All of the time (like a minority of USC students).
I had no sexual encounters during the past 12 months.
38. When you think about your alcohol use with sex over the past 12 months, especially in
comparison with your USC peers, how “at risk” would you say you have been for
becoming infected with a sexually transmitted disease, including HTV?
Circle the number on the rating scale below that best describes how “at risk”
you have been in comparison with your fellow USC students.
0 1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
PLEASE TURN THE PAGE AND CONTINUE.
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151
39. When you think about your alcohol use with sex in comparison with your fellow USC
students, how concerned are you about your risk o f becoming infected with a sexually
transmitted disease, including HTV?
Circle the number on the rating scale below that best describes how
concerned you are about the risk level of your current use of alcohol with sex.
0 1 2 3 4 5 67 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
40. How open would you be to the idea of modifying this behavior over the next 30
days (that is, reducing your use o f alcohol with sex) in order to reduce your risk of
becoming infected with a sexually transmitted disease, including HIV?
Circle the number on the rating scale below that best describes how open you
would be to the idea of reducing your consumption of alcohol with sex over the next
30 days?
0 1 2 3 4 5 67 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
41. Would you be willing to reduce your alcohol use with sex over the next 30 days?
Yes No
42. If you answered “yes” to question 41, how important would it be to you to achieve
this goal?
(Skip this question if you answered “No” to question 41.)
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152
Circle the number on the rating scale below that best describes how
important it is to you that you achieve this goal.
I------1 -------1------- 1------- 1 ------ 1 ------- 1 -------1 ------- 1 -------1------- 1
0 1 2 3 4 5 67 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
43. If you answered “yes” to question 41, how confident are you that you could achieve
this goal?
(Skip this question if you answered “No” to question 41.)
Circle the number on the rating scale below that best describes how
confident you feel that you could achieve this goal.
I------- 1--------1------- 1--------1 --------1--------1-------- 1 .
0 1 2 3 4 5 67 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
PLEASE TURN THE PAGE AND CONTINUE.
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153
MARIJUANA. DRUG USE. AND SEX
(A
«
■ o
CO
o
«
a
$
e
«
u
«
a
100%
80% --
60% --
40% - -
20% --
Occasionally
or never
All or most
of the time
Marijuana, Drug Use, and Sax
Out of all of the USC students surveyed who reported being sexually active over a 12-
month period:
92% said they never used marijuana or drugs in connection with sex, or did so
only occasionally
Only 8% said they used marijuana or drugs in conjunction all or most o f their
sexual encounters.
Apparently, the majority (92%) of sexually active USC students never or only
occasionally used marijuana or drugs in connection with sex.
Only a very small minority (8%) used marijuana or drugs in connection with all or
most of their sexual encounters.
PLEASE TURN THE PAGE AND CONTINUE.
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154
44. How surprised are you by this result? (Circle the number on the rating scale below
that best describes your level of surprise at this result.)
o l 2 3 4 6 7 8 9 10
Not at all
surprised.
Somewhat Moderately
surprised. surprised.
Very
surprised.
Extremely
surprised.
45. Compared to your USC peers, where would you say your behavior “fits in?”
That is, during the past 12 months, whenever you had sexual intercourse, how often did
you use marijuana or drugs before or during any sexual encounter?
(Check one below)
None of the time, or only occasionally (like a majority o f USC students).
Most of the time (like a minority o f USC students).
All of the time (like a minority o f USC students).
I never had any sexual encounters during the past 12 months.
46. When you think about your marijuana or drug use with sex over the past 12 months,
especially in comparison with your USC peers, how “at risk” would you say you have
been for becoming infected with a sexually transmitted disease, including HTV?
Circle the number on the rating scale below that best describes how “at risk”
you have been in comparison with your fellow USC students.
0 1 2 3 4 5 67 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
PLEASE TURN THE PAGE AND CONTINUE.
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155
47. When you think about your marijuana or drug use with sex in comparison with your
fellow USC students, how concerned are you about your risk o f becoming infected with a
sexually transmitted disease, including HTV?
Circle the number on the rating scale below that best describes how
concerned you are about the risk level of your use of marijuana or drugs with sex.
0 1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
48. How open would you be to the idea o f modifying this behavior over the next 30
days (that is, reducing your use o f marijuana or drugs with sex) in order to reduce your
risk of becoming infected with a sexually transmitted disease, including HTV?
Circle the number on the rating scale below that best describes how open you
would be to the reducing your use of marijuana or drugs with sex over the next 30
days?
0 1 2 3 4 5 6 7 8 9 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
49. Would you be willing to reduce your marijuana or drug use with sex over the next 30
days? Yes No
50. If you answered “yes” to question 49, how important would it be to you to achieve
this goal?
(Skip this question if you answered tc No” to question 49.)
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156
Circle the number on the rating scale below that best describes how
important it is to you that you achieve this goal.
I-------1--------1--------1 ------- 1--------1--------1------- 1--------[------- 1---------1
01 2 3 4 5 6 7 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
51. If you answered “yes” to question 49, how confident are you that you could achieve
this goal?
(Skip this question if you answered “No” to question 49.)
Circle the number on the rating scale below that best describes how
confident you feel that you could achieve this goal.
I------ 1 -------1 ------- 1 -------1-------1 -------1 -------1 -------1 -------1 --------1
01 2 3 4 5 6 7 89 10
Not at all Somewhat Moderately Very Extremely
surprised. surprised. surprised. surprised. surprised.
PLEASE TURN THE PAGE AND CONTINUE.
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157
To sum up: In a 12-month period, the majority of USC students said they:
1. Had no more than 1 intercourse partner.
2. Used a condom during sexual intercourse.
3. Communicated with their sexual partner(s) about condom use or safer sex.
4. Only occasionally used alcohol with sex.
5. Rarely used marijuana or drugs with sex.
Only a minority of USC students said they:
1. Had multiple intercourse partners.
2. Failed to use a condom during sexual intercourse.
3. Failed to communicate with their sexual partner(s) about condom use or safer sex.
4. Frequently used alcohol with sex.
5. Frequently used marijuana or drugs with sex.
PLEASE TURN THE PAGE AND CONTINUE.
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158
GOAL STATEMENT
OVER I HE NEXT 30 DAYS, what specific behaviors would you be willing to modify in
order to protect your health (including reducing your risk of contracting a sexually
transmitted disease, such as HTV?)
Read each choice carefully. Check all that apply.
OVER THE NEXT 30 DAYS:
1. I’d be willing to have no sexual intercourse whatsoever.
2. I’d be willing to have fewer sexual partners with whom I have intercourse.
3. I’d be willing to use a condom at all times during sexual intercourse.
4. I’d be willing to use a condom more frequently during sexual intercourse than I
have in the past.
5. I’d be willing to talk with my sexual partner(s) about condom use and safer sex
before or during every occurrence of sexual intercourse.
6. I’d be willing to talk with my sexual partner(s) about condom use and safer sex
more frequently than I have in the past.
7. I’d be willing to abstain from using alcohol altogether when I have sex.
8. I’d be willing to use alcohol less frequently when I have sex.
9. I’d be willing to abstain from using marijuana or drugs altogether when I have sex.
10. I’d be willing to use marijuana or drugs less frequently when I have sex.
11.1 am satisfied with my current sexual behavior, and I have no desire or intention of
modifying my sexual behavior at this time.
THIS IS THE END OF THIS FORM.
PLEASE LET THE EXPERIMENTER KNOW YOU HAVE FINISHED.
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159
a p p e n d i x : f
ATSS INSTRUCTION TAPE
‘Thank you again for participating in this study. We are interested in the kinds o f thoughts
people have when they are in certain situations. When people go about their daily affairs,
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 something which is happening.
“We are going to ask you to listen to a make-believe situation and imagine that you are in
it. The situation you’ll be listening to is a make-believe story of your getting to know a
fellow student o f the opposite sex at a party, dating the individual, and eventually getting
sexually involved.
“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. The
microphones here will pick up what you say, and we’ll be tape-recording your thoughts.
“While the story you will hear is designed to be realistic, and while we are asking you to
imagine as hard as you can that it is actually happening to you, it is important for you to
remember that it is make-believe. You personally might not necessarily participate in some
of the things described on the audiotape, but for the purposes of this study, we would
greatly appreciate your pretending as if you are a participant, and these things are
happening. What we are interested in is what you think about the events to be described to
you, and to get that information, we need for you to make this pretend situation as
realistic and vivid in your imagination as possible and to verbalize your thoughts and
feelings as fully as possible.
“The tape you’ll be listening to is divided into 12 segments. At the end of each segment,
there will be a tone such as this [SOUND OF TONE] followed by a pause o f thirty
seconds. During these 30 seconds, we would like you to say out loud whatever is going
through your mind. Say as much as you can until you hear another tone. In fact, try to talk
out loud about your thoughts and feelings throughout this 30-second period, until you
hear another tone that will signal that the story is about to continue.
“Of course, there are no right or wrong answers, so please just say whatever comes to
mind without judging whether it seems appropriate or not. The more you can tell us, the
better. Try to imagine as clearly as you can that it is really you in the situation right now.
“Please note that your task is not to speak back to any one of 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 loud.
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160
“Let me mention that your name will not be connected to the taping we do here, so your
thoughts will be kept confidential.
“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, just to help you understand the procedure. 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.
“Remember, at the end of each segment say out loud as frankly and completely as you can
whatever you are thinking and feeling. The experimenter will now see if you have any
questions before the practice tape is played.”
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161
Segment 1
Narrator
Friend
Segment 2
Narrator
Segment 3
Narrator
Friend
APPENDIX G
ATSS DATING TAPE
Female
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.”
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.”
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.
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 with 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.
Friend’s comments
Later on, after John has left with his
friends, your friend comes over with
a big knowing smile on her face.
‘I t 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.”
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 o f guys
are after her.”
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162
Segment 4
Narrator
Segment 5
Narrator
Segment 6
Narrator
Female
Dating background
Three weeks have passed. You and
John have gone out several times,
and every time you see him your
attraction grows stronger. Tonight
you’ve been to a movie and you’re at
a cafe having 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 o f 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.
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.
Male
Three weeks have passed. You and
Julie have gone out several times,
and every time you see her your
attraction grows stronger. Tonight
you’ve been to a movie and you’re at
a cafe having 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 o f 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.
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.
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163
Female Male
Segment 7 - 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.
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.
Segment 8 - In the bedroom
Narrator 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.
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.
Segment 9 - On the bed
Narrator Both o f you are naked in bed. John
is hot and aroused. You feel
perfectly in tune with him. You’re
way beyond kissing now.
Both of you are naked in bed. Julie is
hot and aroused. You feel perfectly
in tune with her. You’re way beyond
kissing now.
Segment 10 - Beyond kissing
Narrator He seems to know exactly how to
touch you. The foreplay has been
intense and exciting. And now
you’re very close to intercourse.
She seems to know exactly where to
touch you. The foreplay has been
intense and exciting. And now you’re
very close to intercourse.
Segment 11 - The moment of truth
Narrator As you move closer to penetration,
your thoughts flash back to your
friend’s comment that John could
get any woman he wants.
As you move closer to penetration,
your thoughts flash back to your
friend’s comment that Julie could get
any man she wants.
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164
Segment
Narrator
Segment
Narrator
Segment
Narrator
Female
- Condom reference
As you continue to move closer to
penetration, it occurs to you that
he’s not wearing a condom.
- Wrap up
This is the end o f the simulation.
Please take the next 30 seconds to
describe how you imagine the
situation ending.
- Thank you!
This is the end o f the tape. The
experimenter will enter the room in
a few moments.
Male
As you continue to move closer to
penetration, 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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165
APPENDIX H
ATSS CODING MANUAL
General Strategies:
1. There are 13 segments in each transcript. Read one segment at a time. Then complete
all codes for that segment before moving onto the next segment.
2. The codes are designed to be categorical rather than continuous. In other words, for
each code, it’s either absent or present.
a. A “0” always means the code is absent from the entire segment.
b. A “ 1” or “2” always means that a very specific type of statement is clearly
present somewhere in the segment at least once.
c. A “3” always means that there is a mixture in the segment o f “ 1” and “2” type
statements, regardless o f the relative proportion o f each type of statement.
3. The general rule in coding should be that the statement must clearly be there in order to
be coded as present. Don’t “mind read” the subject, or speculate too much on what the
subject probably meant. Inference should be kept to a minimum. Ask yourself: is there
clear evidence that the statement is there? If yes, you can code it as present. If not, err on
the side of caution and conservatism, and code it as absent. In general, we are coding
articulated thoughts, not unarticulated thoughts.
4. Be sure to have a copy of the ATSS script close at hand so that you know which
segment the subject is responding to. This will help in deciding whether a code is present
or not. For example, suppose a subject says, “Sure, why not?” If this statement is in
response to the segment that says “You gradually move closer together and begin to kiss,”
then you’ll know that “Sure why not?” is a statement indicating interest in becoming
sexually involved. Context is very important in coding these transcripts.
5. As you read the transcripts, circle or underline keys words and phrases that are code
relevant. This will make it easier when you go to enter codes.
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166
Code A.I.a. and b.; General Sexual Interest
This code measures the degree to which the subject wants to become “sexually
involved” with the dating partner (John or Julie). “Sexually involved” means any form o f
physical intimate contact, ranging from kissing and foreplay, to oral sex and intercourse.
The code is divided into 2 parts: (a) interest in sexual involvement, and (b)
aversion to sexual involvement.
a. Interest in sexual involvement means the speaker wants to go forward and
start to become physically involved with John or Julie in some way, anywhere from
kissing to intercourse. The statement must be one which indicates the speaker wants
to move beyond mere attraction and is interested in actual behavior. Statements
showing that the speaker is simply attracted to John or Julie don’t count unless they
indicate an intention to engage in behavior, or a desire that the other person engage in
behavior.
Examples:
Yeah, it’s time to start having sex.
I guess at this point we’re making out on the couch, maybe some oral sex.
We can keep touching and feeling each other, just continue the foreplay.
She’s hot. I love kissing her.
These statements can also indicate that the speaker wants the other person to engage in
sexual behavior.
Examples:
It would be great if he started kissing me.
I’d love it if she wanted me to spend the night.
These statements can be explicit references to sexual behaviors, such as kissing, foreplay,
oral sex, or intercourse. Or they can be more indirect, colloquial expressions, so long as
it is clear from the context that the speaker has an interest in sexual involvement.
Examples:
Yes, I think it is time to move into the bedroom.
It would be great if we spent the night together.
Sure, let’s fool around.
I’d like to do her.
I’d really like to hook up with him.
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167
Remember that segments 6 through 13 of the ATSS scenario have the narrator telling the
subject that he or she is engaging in sexual behavior. Since subjects are responding to the
suggestion that they are engaging in sexual behavior, it’s important to look carefully at the
context o f what they are saying. Therefore, an otherwise innocuous statement like “Yeah,
that’s great” in response to segment 9, will qualify as a statement indicating interest in
sexual involvement.
Finally, statements about taking safe sex precautions, such as condom use, should be
coded as showing interest in becoming sexually involved. The idea is that a subject
who expresses interest in safe sex precautions wouldn’t do so unless he or she were
thinking about getting sexually involved. Even if a segment only has references to safe sex
(e.g., condom use) and no references to sexual behavior per se, it should still be coded as
showing interest in sexual involvement.
So, to summarize, statements should be coded as indicating an interest in sexual
involvement if they:
(1) show that the speaker wants to engage in some form of intimate, physical sexual
behavior, ranging anywhere from kissing to intercourse;
(2) show that the speaker wants the dating partner (John or Julie) to engage in some form
of sexual behavior;
(3) indirectly show an interest in sexual involvement through the use of widely understood
colloquial expressions (e.g., go to bed with, spend the night with, fool around, etc.)
(4) show an interest in sexual involvement through their context (i.e., by being positive
responses to segments 6 through 13, which suggest sexual involvement)
(5) show an interest in taking safe sex precautions such as condom use, thus indirectly
indicating an interest in sexual involvement.
This should be coded 0 or 1 as follows:
0 = Completely absent from segment.
1 = Presence of at least one statement indicating interest in sexual involvement.
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168
b. Statements may also indicate caution about or aversion to sexual involvement.
Examples:
There is no way we’re gonna have sex tonight.
I shouldn’t be having sex with him yet. I barely know him.
It’s just too soon for me to be moving so fast and getting this intimate.
These statements can indicate that the speaker wants to stop the behavior altogether, or
wants the dating partner to stop the behavior.
Examples:
We’ve gotta stop now. Can’t go any further.
I don’t go to bed with guys this soon. He has to leave.
I hope she doesn’t want to have sex tonight.
These statements can also indicate that the speaker wants to slow down and proceed
more cautiously, without stopping altogether. These are statements that show the
speaker is having second thoughts about becoming sexually involved.
Examples:
This is moving way too fast. I wanna slow the action down.
I don’t know him that well. Gotta be careful about this. Don’t wanna do
something stupid.
Well I’ll have a drink with him, but nothing more than that.
This seems a little risky. I don’t know her that well.
I hope he doesn’t want to do more than this.
Statements about taking safe sex precautions should be coded under this code. In fact,
when a subject talks about safe sex precautions (e.g., condom use), it should be coded as
BOTH interest in sexual involvement AND caution about sexual involvement.
To summarize, statements should be coded as indicating caution about or aversion to
sexual involvement if they:
(1) show a desire to stop sexual behavior;
(2) show a desire to slow down and proceed cautiously with sexual behavior;
(3) show a desire to use safe sex precautions (e.g., condoms).
This should be coded 0 or 1 as follows:
0 = Completely absent from segment.
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1 = Presence o f at least one statement indicating caution about or aversion to
sexual involvement.
Code A.2.a. and b.: Interest in Sexual Intercourse
This code measures the degree to which the subject wants to engage in sexual
intercourse with the dating partner (John or Julie). “Sexual intercourse” specifically
means penile/vaginal or penile/anal penetration. It is NOT necessary that the subject use
the word “intercourse.”
This code is very similar to code A. 1. (interest in sexual involvement), except that
it relates specifically to sexual intercourse, as opposed to simply interest in any kind of
sexual involvement.
Like code A. 1., this code will be divided into (a) interest in sexual intercourse,
and (b) caution about or aversion to sexual intercourse.
a. Interest in sexual intercourse.
Examples:
At this point I’m definitely thinking about having sex.
I’m really hoping we’ll go all the way.
I’m thinking, let’s do this, just put it in her.
Follow the same guidelines here as in code A. 1. Statements should be seen as indicating an
interest in sexual intercourse if they fall into these categories:
(1) They show that the speaker wants to engage in intercourse through the use of such
explicit words or phrases as “intercourse” or “have sex.”
Example: I’m hoping we’ll have intercourse.
(2) They show that the speaker wants the dating partner (John or Julie) to initiate
intercourse.
Example: I hope Julie will want to have sex with me.
(3) They indicate an interest in intercourse through the use of widely understood
colloquial expressions.
Example: I’m hoping we can sleep together tonight.
I’m thinking it would be nice to spend the night with her.
I wonder if we’ll end o f going to bed.
Let’s go all the wav.
Let’s iust do it.
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(NOTE: We’ve agreed that simply referring to “moving into the
bedroom” is NOT sufficiently clear to show an interest in intercourse per se
(although it probably does show general sexual interest under code A.I.]
(4) They show an interest in sexual intercourse through their context (i.e., by being
positive responses to segments 10 through 13, which specifically refer to intercourse).
(5) They show an interest in taking safe sex precautions such as condom use, thus
indirectly indicating an interest in sexual intercourse. That is, we will agree that thinking
about condom use implies that the speaker is interested in intercourse.
This should be coded 0 or 1 as follows:
0 = Completely absent from segment.
1 = Presence o f at least one statement indicating interest in intercourse.
(b) Caution about or aversion to sexual intercourse:
Examples:
There’s no way we’re going all the way tonight.
I’m not going to let him have intercourse with me.
If she wants to go to bed with me, well, I’m not really ready yet.
Again, follow the same guidelines as in code A. 1. Statements should be seen as indicating
caution about or aversion to sexual intercourse if they fall into these categories:
(1) They show a desire to stop or desist from intercourse.
Example: It’s way too soon for me to have sex with him. He has to leave.
(2) They show a desire to slow down and proceed cautiously with intercourse.
Example: I don’t know if I should be going to bed with her.
I hope he doesn’t want me to spend the night.
I don’t mind fooling around a little, but I don’t plan on sleeping
with her tonight.
(3) They show a desire to use safe sex precautions (e.g.. condomsY
NOTE: References to condom use should be coded as showing BOTH
an interest in AND caution about intercourse.
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This should be coded 0 or 1 as follows:
0 = Completely absent from segment.
1 = Presence o f at least one statement indicating caution about or aversion to
sexual intercourse.
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Code A.3.: Is 3 Weeks Enough Time to Become Intimate with John or Julie?
This code measures whether the subject believes that 3 weeks is a long enough
period of time to become sexually involved with the dating partner (John or Julie).
(a) Look for statements indicating that the subject believes 3 weeks IS a long
enough period of time to become sexually involved.
Examples:
Three weeks is definitely long enough to get to know someone.
We’ve probably already had sex.
We’ve been going together a pretty long time.
This can also include statements indicating that the speaker knows John or Julie well
enough to proceed further.
Example: I know him pretty well at this point.
(b) Also look for statements indicating just the opposite, that the speaker believes 3 weeks
is NOT a long enough period of time to become sexually involved.
Examples:
I barely know him. Three weeks is not enough time for me to have sex with
him.
There’s no way I’m going to bed with someone I’ve only known for 3
weeks.
I haven’t known him long enough to get this intimate this fast.
This can include statements indicating that the speaker does NOT know John or Julie well
enough to proceed further.
Example: I really don’t know him very well.
This should be coded 0, 1, 2, or 3 as follows:
0 = Completely absent from segment.
1 = Presence o f at least one statement indicating that 3 weeks IS long enough.
2 = Presence o f at least one statement indicating that 3 weeks is NOT long
enough.
3 = Presence o f 1 and 2 in same segment (a mixture).
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Code A.4.: Letting Go. Getting Caught Up in the Moment
This code measures whether the speaker articulates thoughts about being caught
up in the spontaneity o f the moment.
This can be expressed in a number of ways.
(1) Explicit statements of being caught up in the moment.
Examples: This is where I just get caught up in the moment.
At times like this I just feel like letting myself go.
I’m just going with the flow at this point.
(2) Statements that indicate the speaker is reiving on feelings more than rational
thinking.
Examples: This is where my emotions just take over.
I’m not really thinking anymore.
(3) Statements that indicate the speaker can’t stop the behavior.
Examples: Once I get aroused, there’s no turning back.
I don’t think I can resist anymore.
The devil just got in me.
This should be coded 0 or 1 as follows:
0 = Completely absent from segment.
1 = Presence o f statement indicating subject’s getting caught up in the moment.
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Code B.5.: Interest in Practicing Safe Sex ('Condom Use)
This code measures whether or not the subject is interested in engaging in condom
use and safe sex. The subject does not necessarily have to use the words “safe sex” or
“condom.” Colloquial expressions such as “protection,” “safety,” “rubber,” “glove,” or
“cover” are also sufficient for this code.
Look for statements that indicate the subject wants to take precautions and
practice safe sex (e.g.. use condoms).
Examples:
At this point I’m thinking where’s the condom?
There is just no way we’re going any further without some protection.
No glove, no love.
I wanna be sure to take the necessary precautions.
The speaker doesn’t have to mention condoms for this code to apply. As long as he
or she is thinking about taking some precautions and practicing some form of safe
sex, this code will apply.
Also look for statements that indicate the subject is averse to practicing safe sex.
Examples:
I hate condoms. I’d rather not be bothered.
Even if I don’t have a condom, I’m still going for it.
This should be coded 0, 1, 2, or 3 as follows:
0 = Completely absent from segment.
1 = Presence of statement indicating an interest in practicing safe sex fe.g..
condom usel.
2 = Presence of statement indicating an aversion to practicing safe sex (e.g.,
condom usel.
3 = Presence o f 1 and 2 in same segment (a mixture).
NOTE: For this code in particular, be sure to pay close attention to PRONOUNS.
Sometimes references to condoms can be subtle, as in the statements “I better get it”
or “I need to put one on.”
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Code B.6.: Who Initiates Safe Sex (Condom Use)?
This code measures whether the subject takes the initiative in using a condom and
practicing safe sex, or whether the subject expects the dating partner (John or Julie) to
take the initiative in insisting upon condom use and safe sex.
Look for statements indicating that the subject sees him or herself as having
some responsibility for initiating or insisting upon condom use and safe sex.
For males, this will usually mean that the subject talks about (1) how he has to get
or put on a condom, or (2) how he needs to insist to Julie that a condom must be used.
Examples:
Before we go any further, I have to get a condom out so I’m ready.
I’ve gotta tell her we need to use a condom.
I wanna take some precautions.
Because men, not women, actually wear condoms, a female subject will show that
she sees herself as being responsible for using a condom (1) by telling John that a condom
must be used, or (2) by giving one to him.
Examples:
Can’t go on without a condom. I’m gonna tell him he’s got to use a
condom.
I’m gonna suggest using a condom and be sure that I give one to him.
Also, look for statements indicating that the subject does NOT see him or herself
as having responsibility for initiating or insisting upon condom use and safe sex, but
instead expects the other person to take the initiative.
Examples:
I hope he has a condom and puts it on.
She better have a condom, otherwise we won’t be able to continue.
If she asks me to wear one, I’ll put one on. Otherwise, I won’t bother.
I’ll ask her if she has one in her bedroom.
This should be coded 0, 1, 2, or 3 as follows:
0 = Completely absent from segment.
1 = Presence o f statement indicating willingness to insist on condom use and safe
sex.
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2 = Presence o f statement indicating expectation that other person has to bring up
condom use and safe sex.
3 = Presence o f 1 and 2 in same segment (a mixture).
NOTE: A segment should be coded with the number 3 if:
(1) the speaker sees both parties as clearly having responsibility for
taking safe sex precautions
Example: We need to get a condom.
OR
(2) the speaker is unclear and ambiguous about specifically who is
responsible
Example: Has to be a condom involved.
Can’t do this without protection.
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Code B.7.: Concern with Dating Partner’s Negative Reaction to Safe Sex Suggestion
This code measures how concerned the subject is about John or Julie reacting
negatively to the suggestion that safe sex must be practiced (e.g., that a condom must be
used). In other words, this code measures how worried the subject is about the negative
consequences of bringing up safe sex, and whether the dating partner will be turned off by
the suggestion, for example, that a condom must be used. The focus of the statement is on
the partner's expected reaction to the safe sex suggestion.
Look for statements indicating that the subject is concerned th at John or Julie
will react negatively to the safe sex suggestion.
Examples:
I hope he doesn’t get upset if I insist on a condom.
Hopefully, that won’t ruin the mood.
This will include statements indicating that the subject is concerned about a
negative reaction to the suggestion that further sexual activity must be curtailed or
stopped.
Examples:
I wanna stop, but I’m afraid that if I tell him, he won’t want to see me
again.
I’ve gotta tell her I can’t do this, but what if she gets mad at me?
Look for statements indicating that the subject is NOT concerned and does not
care w hether John or Julie reacts negatively to the safe sex suggestion.
Examples:
I’m gonna say we have to use a condom, even if he doesn’t really want to.
No condom no sex. I don’t care if that upsets her. I’m not gonna take any
chances.
We’ve gotta stop. He has to get out o f my bed. If he doesn’t like it, tough.
This should be coded 0, 1, 2, or 3 as follows:
0 = Completely absent from segment.
1 = Presence o f statement indicating subject is concerned with John or Julie’s
negative reaction
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2 = Presence of statement indicating subject is NOT concerned with John or Julie’s
negative reaction
3 = Presence of 1 and 2 in same segment (a mixture).
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Code B.8.: Concern With Disease or STDs
This code measures whether or not the subject is concerned about “disease” or
“STDs.” This does NOT include statements about HTV or AIDS. These statements will be
coded separately under their own category (Code B.9.).
Look for statements that indicate the subject is concerned about disease or
STDs.
Examples:
Gotta be thinking about what kind o f diseases he may have.
I’m wondering at this point whether she’s ever had an STD.
NOTE: Some subjects make vague statements about whether John or Julie is
“clean” or “dirty,” or whether sex with John or Julie is “risky” or whether
“something could happen.” If there are no other statements to clarify what the
speaker means by these statements, treat them as if they are statements showing
concern about disease.
Examples:
I don’t know. She could be dirty.
I should be careful. It’s risky.
I’m not sure I should sleep with him. Something could happen.
Also look for statements that indicate the subject is NOT concerned about
disease or STDs.
Examples:
I’m not gonna think about diseases, cause it’ll ruin the moment.
Lots o f people get STDs. It’s nothing to get too worried about.
He looks clean. I’m sure there’s no danger.
You only live once. I’m not gonna worry about the risks.
This should be coded 0, 1, 2, or 3 as follows:
0 = Completely absent from segment.
1 = Presence o f statement indicating concern about STDs/disease/risk.
2 = Presence o f statement indicating lack o f concern about STDs/disease/risk.
3 = Presence o f 1 and 2 in same segment (a mixture).
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Code B.9.: Concern With HTV/AIDS
This code measures whether or not the subject expresses concern over HTV or
AIDS. For this code, the acronyms £ e HIV” or “AIDS,” or the actual names for which these
stand, must be used.
Look for statements that indicate the subject is concerned about HIV or AIDS.
Examples:
Now I’m starting to think about whether she might have HIV.
I’ve got to stop. This is risky. He might have AIDS for all I know.
Also look for statements that indicate the subject is NOT concerned about HTV
or AIDS.
Examples:
I’m not gonna think about AIDS.
I’m sure she doesn’t have HTV.
This should be coded 0, 1, 2, or 3 as follows:
0 = Completely absent from segment.
1 = Presence o f statement indicating concern about HTV or AIDS
2 = Presence of statement indicating lack o f concern about HTV or AIDS.
3 = Presence o f 1 and 2 in same segment (a mixture).
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Code B.10.: Pregnancy Concerns
This code measures whether or not the subject is concerned about pregnancy.
Look for statements that indicate the subject is concerned about pregnancy:
Examples:
Wanna be sure I’m careful. Don’t wanna get pregnant.
I’ve gotta be responsible in this situation. Can’t afford to get pregnant.
NOTE: Sometimes subjects verbalize concerns about pregnancy indirectly,
such as references to birth control (e.g„ being on the pill). Be on the look out for
statements of this kind.
Examples:
I’m on the pill, but something could still happen.
I need to think before I rush into this. Am I on birth control?
Also look for statements that indicate the subject is NOT concerned about
pregnancy.
Examples:
I’m not gonna worry about whether she gets pregnant. It probably won’t
happen.
Why not have sex with him? I’m on the pill.
This should be coded 0, 1, 2, or 3 as follows:
0 = Completely absent from segment.
1 = Presence of statement indicating concern about pregnancy.
2 = Presence of statement indicating lack o f concern about pregnancy.
3 = Presence of 1 and 2 in same segment (a mixture).
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Code B .ll.: Interest in Knowing about Dating Partner’s Sexual History
This code measures whether the subject is thinking about or is concerned with
John’s or Julie’s dating history, particularly the number o f sexual partners they have been
with previously.
Look for statements indicating that the subject is concerned about how many
people John or Julie has been with. Sometimes these statements can be fairly subtle.
Examples:
I wonder how many women he’s slept with.
She probably has slept around a lot.
I don’t know where he’s been.
She seems to have a lot of experience with this kind of thing.
I wonder if I’m the only girl he’s been with.
Am I the only one he’s done this with?
Also look for statements indicating that the subject is NOT concerned about how
many people John or Julie has been with.
Examples:
I don’t care if she has been with a lot of guys. Actually, that’ll mean she’s
got a lot of experience.
I don’t really wanna think about how many girls he’s been with.
He probably can get any girl he wants, but I don’t care. He’s got me.
This should be coded 0, 1, 2, or 3 as follows:
0 = Completely absent from segment.
1 = Presence o f statement indicating concern about dating partner’s sexual history.
2 = Presence o f statement indicating lack o f concern about dating partner’s sexual
history.
3 = Presence o f 1 and 2 in same segment (a mixture).
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Code B.12.: Alcohol
This code measures how much alcohol is a factor in the subject’s reaction to the
scenario.
Look for statements indicating that the subject is fa) thinking about alcohol, and
(b) sees some connection between the alcohol and his or her thoughts, reactions, or
behaviors in the situation.
Examples:
He looks better, now that I’m drunk.
Having a few drinks can make things seem a lot nicer than they actually
are.
If I’m this carried away, it’s probably the alcohol talking.
Mere references to having a drink are NOT sufficient for getting this code. If
a subject says “let’s go get a drink,” o r‘T want her to invite me in for a drink,” that would
not be sufficient for this code. The subject is merely stating that he or she is drinking, or
that he/she has an intention to drink. To get this code, the subject must say something
about the effect or impact that the alcohol is having in terms of his/her thoughts,
reactions, or behaviors in the situation.
This should be coded 0 or 1 as follows:
0 = Completely absent from segment.
1 = Presence o f statement indicating that alcohol is having an effect or impact on
the subject’s thoughts, reactions, or behaviors.
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Code C.13.: Casual Sex vs. Serious Relationship
This code measures whether the subject sees this relationship as casual, short-term,
and purely sexual in nature, or as developing into a more serious, enduring, and long-term
relationship.
Look for statements indicating that the subject sees this as merely a casual, short
term. sexual relationship.
Examples:
We’ll just probably have sex. I don’t see this as anything more than that.
We’ll have sex tonight, and then who knows where it’ll go from here?
Also look for statements indicating that the subject sees this as developing into a
more serious relationship.
Examples:
I really hope he likes me and this isn’t just a one-night stand.
I’m hoping this will develop into something more.
Will this develop into a potential relationship?
This is the girl for the rest of my life.
NOTE: We’ll assume that use of the word “relationship” by itself is intended
to imply that the subject is thinking about a longer-term relationship, UNLESS the
context or other statements by the subject suggest otherwise.
This should be coded 0, 1, 2, or 3 as follows:
0 = Completely absent from segment.
1 = Presence of statement indicating subject’s interest in a casual sexual
relationship.
2 = Presence of statement indicating subject’s interest in a more serious
relationship.
3 = Presence of 1 and 2 in same segment (a mixture).
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Code C.14.: Predatory vs. Sluttv
This code measures whether the subject is concerned about appearing too eager to
be rushing into sex. Specifically, we’re looking for two types o f statements: (1) those that
indicate the speaker is concerned about appearing too predatory (i.e., forcing themselves
onto the other person, rushing into sex too quickly, pushing too hard for sex, etc.); and (2)
those that indicate the speaker is concerned about appearing too “loose” or “sluttv” (i.e.,
willing to submit to sexual advances too easily or willingly).
Look for statements indicating that the subject is concerned about appearing too
predatory.
Examples:
I don’t want to look as if I’m forcing her into having sex with me.
I don’t wanna push her into anything too fast.
I want her to feel comfortable, not like we’re rushing into anything.
Also, look for statements indicating that the subject is concerned about appearing
too loose or sluttv.
Examples:
I wonder if he’ll respect me for going to bed with him so soon.
Will he think I’m a slut?
This should be coded 0, 1, 2, or 3 as follows:
0 = Completely absent from segment.
1 = Presence o f statement indicating subject’s concern about appearing too
predatory.
2 = Presence o f statement indicating subject’s concern about appearing too loose
or sluttv.
3 = Presence o f 1 and 2 in same segment (a mixture).
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Code C.15.; Emotional State
This code measures whether the subject describes his or her emotional state in
each segment. Specifically, we are interested in two particular emotional states: (1) happy.
or (2) anxious.
NOTE; To get this code, the statement must be a description of one’s
feelings. That is, the subject must explicitly articulate how he or she is feeling. If you
read a segment, and the subject sounds happy or anxious, but does not expressly
articulate these feelings, then the segment will NOT get this code.
Look for statements indicating that the subject is happy in the situation. Key
words to look for which qualify for this code are: happy, excited, glad, good,
comfortable (or their equivalents).
Examples:
Fm feeling really great at this point. Very excited to be with her.
Everything’s going just the way I want it to. I couldn’t be happier.
I’m feeling very comfortable in this situation. Glad to be here.
Also look for statements indicating that the subject is nervous and anxious in the
situation. Key words to look for are: nervous, anxious, scared, uncomfortable,
concerned, fearful, worried (or their equivalents).
Examples:
This is the point where I always feel kinda uncomfortable, not sure if she
wants it.
Fm feeling really nervous again. Does he really wanna be with me?
Fm feeling pretty scared at this point. Concerned about getting a disease.
NOTE: Other negative emotional states, such as jealousy or anger, should
NOT be coded under this code. This is limited to anxiety.
This should be coded 0, 1, 2, or 3 as follows:
0 = Completely absent from segment.
1 = Presence o f statement where the subject describes feeling good and happy.
2 = Presence o f statement where the subject describes feeling nervous and anxious.
3 = Presence o f 1 and 2 in same segment (a mixture).
Example: Fm feeling good, but I also feel kind of uncomfortable.
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Code C.16.a. through d.: Reaction to Partner
These codes measure 4 different ways that subjects might react to the attention and
attraction they receive from John or Julie.
a. Look for statements indicating that the subject feels confident or proud that they
are the object of John’s/Julie’s attraction.
Examples:
I’m feeling really confident, seeing as how such a beautiful girl has chosen
me.
I’m feeling really proud of myself that I’m with such a great looking guy.
This is a real ego booster, getting so much attention from her.
Good for me. I’m the man.
NOTE; To get this code, the speaker must in some way expressly articulate
that he or she is confident or proud, or use some other equivalent descriptor. Do not
read between the lines and infer that a speaker feels confident or proud, UNLESS he
or she explicitly states that this is what they are thinking. Simply sounding confident
is not enough for this code. The speaker must articulate this.
This should be coded 0 or 1 as follows:
0 = Completely absent from segment.
1 = Presence of statement indicating the subject feels confident or proud.
b. Look for statements indicating that the subject feels lucky or fortunate that they
are the object of John’s/Julie’s attraction.
Examples:
I feel real lucky that I’m the one she’s chosen out o f all these other guys.
NOTE: Same instruction. Look for express articulations. Don’t “mind read”
or “read between the lines.”
This should be coded 0 or 1 as follows:
0 = Completely absent from segment.
1 = Presence of statement indicating the subject feels lucky or fortunate.
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c. Look for statements indicating that, in being the object of John’s or Julie’s
attraction, the subject believes he or she has “beaten the competition” (i.e., that they
are better than their peers, that they are superior, or other such equivalent thoughts).
Examples:
I’m feeling good that I beat out the other guys, and that she chose me.
I guess he’s got good taste. He knows a good thing when he sees it.
MOTE: Same instruction. Look for express articulations. Don’t “mind read”
or “read between the lines.”
This should be coded 0 or 1 as follows:
0 = Completely absent from segment.
1 = Presence o f statement indicating subject’s belief that he or she has “beaten the
competition.”
d. Finally, look for statements indicating that the subject is questioning or wondering
about John’s or Julie’s motives in giving them so much attention.
This could mean that the subject expresses suspicion about John’s or Julie’s
motives.
Examples:
What’s his agenda? What does he want from me?
I wonder what her intentions are.
This could also mean that the subject questions why John or Julie is singling them
out.
Example:
Why did he pick me over all the other girls?
NOTE: Same instruction. Look for express articulations. Don’t “mind read”
or “read between the lines.”
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189
This should be coded 0 or 1 as follows:
0 = Completely absent from segment.
1 = Presence of statement indicating that subject questions John’s/Julie’s motives.
C.17.a. through d.: Imagining How the Scenario Ends (Segment 13 only)
This code relates to segment 13 only— the segment where subjects are asked to
imagine how they see the scenario ending. You are coding whether the subject states any
of 4 possible endings:
a. M o sex at all — The subject imagines that any sexual activity stops altogether, with or
without a condom. In some cases, the subject may say that they never even got to the
point o f engaging in any sexual activity.
b. Intercourse, but only with a condom — The subject imagines that intercourse takes
place, provided a condom is used. The subject may also say that if no condom is used,
there will be no intercourse. (This is different from a. above, in that in a. above, there is no
sex at all, with or without a condom. Here, intercourse is conditional upon having a
condom, and is discontinued only in the event there is no condom.)
c. Intercourse, with or without a condom — The subject imagines that intercourse takes
place whether there is a condom or not. In some cases, a subject may specifically say that
intercourse takes place without a condom.
d. Sexual activity without intercourse — The subject imagines that they engage in sexual
activity other than intercourse (e.g., oral sex, masturbation, more foreplay, etc.)
These categories are not necessarily mutually exclusive. A subject may express his or
her thoughts in such a way that several of these will appear in the same segment.
Code all those that seem to be present. (Also, it may be that none of them are
present.)
Each o f these should be coded separately as follows:
0 = Completely absent.
1 = Presence of statement indicating a, b, c, or d above.
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Asset Metadata
Creator
Chernoff, Robert Alan
(author)
Core Title
An evaluation of a brief HIV /AIDS prevention intervention using normative feedback to promote risk reduction among sexually active college students
School
Graduate School
Degree
Doctor of Philosophy
Degree Program
Psychology
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
health sciences, public health,OAI-PMH Harvest,Psychology, clinical,psychology, social
Language
English
Contributor
Digitized by ProQuest
(provenance)
Advisor
Davison, Gerald C. (
committee chair
), Duval, Shelley (
committee member
), Earleywine, Mitchell (
committee member
), Meyerowitz, Beth E. (
committee member
), Newcomb, Michael (
committee member
)
Permanent Link (DOI)
https://doi.org/10.25549/usctheses-c16-74097
Unique identifier
UC11328286
Identifier
3018064.pdf (filename),usctheses-c16-74097 (legacy record id)
Legacy Identifier
3018064.pdf
Dmrecord
74097
Document Type
Dissertation
Rights
Chernoff, Robert Alan
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
health sciences, public health
psychology, social