Abstract
Sexual decision-making in young adults continues to present challenges for public health and social science researchers more than three decades after the first HIV epidemic. The objective of this chapter is to identify relevant social and cognitive factors that may influence decision-making about risky sexual behavior in young adults. More specifically, the chapter focuses on our research on sexual decision-making among heterosexual urban college students in a high-risk HIV/AIDS community. Participants completed two weeks of daily sexual encounter diaries, followed by in-depth interviews. Both quantitative and qualitative methods were used to analyze the data. Results showed that participants’ decisions about the use of condoms varied by particular social factors, such as partner influence and condom use attitudes; and cognitive factors, such as perceptions of relationship status and HIV/STD risk assessment. Participants’ justification of their behavior differentiated higher- from lower- risk individuals. The findings suggest that in order to intervene effectively with higher-risk individuals, it is important to understand the nature of the evidence used to make decisions and the conditions under which these decisions change. Risky decision-making in the context of education, the role of technology, and adequate interventions are discussed.
Keywords
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Adimora AA, Schoenbach VJ, Bonas DM, Martinson FE, Donaldson KH, Stancil TR. Concurrent sexual partnerships among women in the United States. Epidemiology. 2002;13(3):320–7.
Ajzen I, Fishbein M. Understanding attitudes and predicting social behavior. Englewood Cliffs: Prentice-Hall; 1980.
Alexander B. Is monogamy dead? A look at the influence of ‘non-connected sex,’ Clinton and Kobe [Internet]. MSNBC; 2005. [cited 2006 Feb 10]. http://www.msnbc.msn.com/id/9117931
Alexander KA, Jemmott LS, Teitelman AM, D’Antonio P. Addressing sexual health behaviour during emerging adulthood: a critical review of the literature. J Clin Nursing. 2015;24(1–2):4–18.
Ali MM, Cleland J, Shah IH. Condom use within marriage: a neglected HIV intervention. Bull World Health Organ. 2004;82(3):180–6.
Amaro H. Love, sex, and power: considering women’s realities in HIV prevention. Am Psychol. 1995;50(6):437.
Amaro H, Raj A. On the margin: power and women’s HIV risk reduction strategies. Sex Roles. 2000;42(7–8):723–49.
Anaebere AK, Maliski S, Nyamathi A, Koniak-Griffin D, Hudson A, Ford C. “Getting to Know”: exploring how urban African American women conceptualize safer and risky sexual behaviors. Sexuality Culture. 2013;17(1):113–31.
Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice-Hall; 1986.
Bandura A. Social cognitive theory. In: Vasta R, editor. Six theories of child development: revised formulations and current issues. Philadelphia: Jessica Kingsley; 1992. p. 1–60.
Barman-Adhikari A, Rice E, Bender K, Lengnick-Hall R, Yoshioka-Maxwell A, Rhoades H. Social networking technology use and engagement in HIV-related risk and protective behaviors among homeless youth. J Health Commun. 2016;21(7):809–17.
Bauman LJ, Berman R. Adolescent relationships and condom use: trust, love and commitment. AIDS Behav. 2005;9(2):211–22.
Bechtel W, Abrahamsen A, Graham G. The life of cognitive science. In: Bechtel W, Graham G, et al., editors. A companion to cognitive science. Malden: Blackwell; 1998. p. 2–104.
Blackstock OJ, Patel VV, Cunningham CO. Use of technology for HIV prevention among adolescent and adult women in the United States. Curr HIV/AIDS Rep. 2015;12(4):489–99.
Burnett AJ, Sabato TM, Wagner L, Smith A. The influence of attributional style on substance use and risky sexual behavior among college students. College Student J. 2013;47(1):325–34.
CDC (US). HIV surveillance report: diagnoses of HIV infection and AIDS in the United States and dependent areas [Internet]. Atlanta (GA); Centers for Disease Control and Prevention; 2010. [cited 2013 Jan 23]. http://www.cdc.gov/hiv/surveillance/resources/reports/2010report/index.htm
CDC (US). Youth behavior risk surveillance—United States, 2013 [Internet]. Atlanta (GA); Centers for Disease Control and Prevention; Jun 2014. [cited 2016 Aug 20]. http://www.cdc.gov/mmwr/pdf/ss/ss6304.pdf
CDC (US). HIV among hispanics/latinos [Internet]. Atlanta (GA); Centers for Disease Control and Prevention; 2015. [cited 2016 Aug 20]. http://www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/
CDC (US). HIV Among African Americans [Internet]. Atlanta (GA); Centers for Disease Control and Prevention; 2016a. [cited 2016 Aug 20]. http://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html
CDC (US). HIV Among Women [Internet]. Atlanta (GA); Centers for Disease Control and Prevention; 2016b. [cited 2016 Aug 20]. http://www.cdc.gov/hiv/group/gender/women/index.html
CDC (US). HIV Among Youth [Internet]. Atlanta (GA); Centers for Disease Control and Prevention; 2016c. [cited 2016 Aug 20]. http://www.cdc.gov/hiv/group/age/youth/index.html
Centers for Disease Control and Prevention (CDC) (US). Compendium of evidence-based HIV behavioral interventions: risk reduction chapter [Internet]. Atlanta (GA); Centers for Disease Control and Prevention; 2012. [cited 2012 Nov 2]. http://www.cdc.gov/hiv/topics/research/prs/rr_chapter.htm
Centers for Disease Control and Prevention (CDC)(US) HIV in the United States: at a glance [Internet]. Atlanta (GA); Centers for Disease Control and Prevention; 2016. [cited 2016 Aug 20]. http://www.cdc.gov/hiv/statistics/overview/ataglance.html
Charnigo R, Noar SM, Garnett C, Crosby R, Palmgreen P, Zimmerman RS. Sensation seeking and impulsivity: combined associations with risky sexual behavior in a large sample of young adults. J Sex Res. 2013;50(5):480–8.
Conley TD, Rabinowitz JL. Scripts, close relationships, and symbolic meanings of contraceptives. Pers Relat. 2004;11(4):539–58.
Davis KC, Danube CL, Neilson EC, Stappenbeck CA, Norris J, George WH, Kajumulo KF. Distal and proximal influences on men’s intentions to resist condoms: alcohol, sexual aggression history, impulsivity, and social-cognitive factors. AIDS Behav. 2016;20(1):147–57.
DiClemente RJ, Crittenden CP, Rose E, Sales JM, Wingood GM, Crosby RA, Salazar LF. Psychosocial predictors of HIV-associated sexual behaviors and the efficacy of prevention interventions in adolescents at-risk for HIV infection: what works and what doesn’t work? Psychosom Med. 2008;70(5):598–605.
Dir AL, Coskunpinar A, Cyders MA. A meta-analytic review of the relationship between adolescent risky sexual behavior and impulsivity across gender, age, and race. Clin Psychol Rev. 2014;34(7):551–62.
Dittus PJ, Jaccard J. Adolescents’ perceptions of maternal disapproval of sex: relationship to sexual outcomes. J Adolesc Health. 2000;26(4):268–78.
Dittus PJ, Michael SL, Becasen JS, Gloppen KM, McCarthy K, Guilamo-Ramos V. Parental monitoring and its associations with adolescent sexual risk behavior: a meta-analysis. Pediatrics. 2015;136(6):e1587–99.
Dolcini MM, Catania JA. Psychosocial profiles of women with risky sexual partners: the national AIDS behavioral surveys (NABS). AIDS Behav. 2000;4(3):297–308.
Eder F. Sex, popular beliefs and culture. In: Hekma G, editor. A cultural history of sexuality in the modern age. London: Berg; 2011.
El Bcheraoui C, Sutton MY, Hardnett FP, Jones SB. Patterns of condom use among students at historically Black colleges and universities: implications for HIV prevention efforts among college-age young adults. AIDS Care. 2013;25(2):186–93.
Ericsson KA, Simon HA. Protocol analysis: verbal reports as data. Cambridge: MIT Press; 1993.
Ewing SWF, Bryan AD. A question of love and trust? The role of relationship factors in adolescent sexual decision making. J Develop Behav Pediatr. 2015;36(8):628–34.
Flood M. Lust, trust and latex: why young heterosexual men do not use condoms. Culture, Health Sexuality. 2003;5(4):353–69.
Friedman SR, Flom PL, Kottiri BJ, Neaigus A, Sandoval M, Curtis R, Jarlais DD, Zenilman JM. Consistent condom use in the heterosexual relationships of young adults who live in a high-HIV-risk neighbourhood and do not use “hard drugs”. AIDS Care. 2001;13(3):285–96.
Gaither GA, Sellbom M. The sexual sensation seeking scale: reliablity and validity within a heterosexual college student sample. J Personality Assess. 2003;81(2):157–67.
Harlow LL, Prochaska JO, Redding CA, Rossi JS, Velicer WF, Snow MG, Schnell D, Galavotti C, O’reilly K, Rhodes F. Stages of condom use in a high HIV-risk sample. Psychol Health. 1999;14(1):143–57.
Harman JJ, O’Grady MA, Wilson K. What you think you know can hurt you: perceptual biases about HIV risk in intimate relationships. AIDS Behav. 2009;13(2):246–57.
Hock-Long L, Henry-Moss D, Carter M, Hatfield-Timajchy K, Erickson PI, Cassidy A, Macauda M, Singer M, Chittams J. Condom use with serious and casual heterosexual partners: findings from a community venue-based survey of young adults. AIDS Behav. 2013;17(3):900–13.
Howard MM, Fortenberry JD, Blythe MJ, Zimet GD, Orr DP. Patterns of sexual partnerships among adolescent females. J Adolesc Health. 1999;24(5):300–3.
Hoyle RH, Fejfar MC, Miller JD. Personality and sexual risk taking: a quantitative review. J Pers. 2000;68(6):1203–31.
Iles I, Boekeloo B, Seate AA, Quinton S. The impact of spirituality and religiosity on unprotected sex for adult women. Am J Health Behav. 2016;40(2):240–7.
Impett EA, Peplau LA. Sexual compliance: gender, motivational, and relationship perspectives. J Sex Res. 2003;40:87–100.
Jones JW. Personality and epistemology: cognitive social learning theory as a philosophy of science. Zygon. 1989;24(1):23–38.
Kalichman SC, Rompa D. Sexual sensation seeking and sexual compulsivity scales: validity, and predicting HIV risk behavior. J Personality Assess. 1995;65(3):586–601.
Karney BR, Hops H, Redding CA, Reis HT, Rothman AJ, Simpson JA. A framework for incorporating dyads in models of HIV-prevention. AIDS Behav. 2010;14(2):189–203.
Kershaw T, Arnold A, Gordon D, Magriples U, Niccolai L. In the heart or in the head: relationship and cognitive influences on sexual risk among young couples. AIDS Behav. 2012;16(6):1522–31.
Koopman C, Ried H. Assessment of knowledge and beliefs about HIV/AIDS among adolescents. In: Davis CM, Yarber WL, Bauserman R, Schreer G, Davis SL, editors. Handbook of sexuality-related measures. Thousand Oaks: Sage; 1998. p. 321–4.
Kotchick BA, Shaffer A, Miller KS, Forehand R. Adolescent sexual risk behavior: a multi-system perspective. Clinical Psychol Rev. 2001;21(4):493–519.
Ku L, Sonenstein FL, Pleck JH. The dynamics of young men’s condom use during and across relationships. Fam Plann Perspect. 1994;26(6):246–51.
Lam CB, Lefkowitz ES. Risky sexual behaviors in emerging adults: longitudinal changes and within-person variations. Archiv Sexual Behav. 2013;42(4):523–32.
Lee TR, Mancini JA. Locus of control and premarital sexual behaviors. Psychological Reports. 1981.
LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, Nwoko N, Hightow-Weidman LB. Epic allies: development of a gaming app to improve antiretroviral therapy adherence among young HIV-positive men who have sex with men. JMIR Serious Games. 2016;4(1):e6.
Lewis MA, Lee CM, Patrick ME, Fossos N. Gender-specific normative misperceptions of risky sexual behavior and alcohol-related risky sexual behavior. Sex Roles. 2007;57(1–2):81–90.
Manlove J, Ryan S, Franzetta K. Contraceptive use patterns across teens’ sexual relationships: the role of relationships, partners, and sexual histories. Demography. 2007;44(3):603–21.
Marston C, King E, Ingham R. Young people and condom use: findings from qualitative research. In: Ingham R, Aggleton P, editors. Promoting young people’s sexual health: international perspectives. London: Routledge; 2006. p. 27–40.
Masaro CL, Dahinten VS, Johnson J, Ogilvie G, Patrick DM. Perceptions of sexual partner safety. Sex Transm Dis. 2008;35(6):566–71.
Maxwell C, Boyle M. Risky heterosexual practices amongst women over 30: gender, power and long term relationships. AIDS Care. 1995;7(3):277–94.
McCoul MD, Haslam N. Predicting high risk sexual behaviour in heterosexual and homosexual men: the roles of impulsivity and sensation seeking. Personal Individ Differ. 2001;31(8):1303–10.
Miller L, Gur M. Religiousness and sexual responsibility in adolescent girls. J Adolesc Health. 2002;31(5):401–6.
Misovich SJ, Fisher JD, Fisher WA. Close relationships and elevated HIV risk behavior: evidence and possible underlying psychological processes. Rev Gen Psychol. 1997;1(1):72.
Mitchell JW. The use of technology to advance HIV prevention for couples. Curr HIV/AIDS Rep. 2015;12(4):516–22.
Moatti JP, Hausser D, Agrafiotis D. Understanding HIV risk related behaviour: a critical overview of current models. In: Van Campenhoudt L, Cohen M, Guizzardi G, Hauser D, editors. Sexual interactions and HIV risk: new conceptual perspectives in European research. London: Taylor & Francis; 1997. p. 100–26.
Moore EW. Assessing God locus of control as a factor in college students’ alcohol use and sexual behavior. J Am College Health. 2014;62(8):578–87.
Moore SM, Rosenthal DA. Contemporary youths’ negotiations of romance, love, sex, and sexual disease. In: de Munck VC, editor. Romantic love and sexual behavior: perspectives from the social sciences. Westport: Praeger; 1998. p. 233–47.
Morrison-Beedy D, Carey MP, Lewis BP. Modeling condom-use stage of change in low-income, single, urban women. Res Nurs Health. 2002;25(2):122–34.
Muessig KE, Pike EC, LeGrand S, Hightow-Weidman LB. Mobile phone applications for the care and prevention of HIV and other sexually transmitted diseases: a review. J Med Internet Res. 2013;15(1):e1.
Nappi CM, Thakral C, Kapungu C, Donenberg GR, DiClemente R, Brown L, Project STYLE Study Group. Parental monitoring as a moderator of the effect of family sexual communication on sexual risk behavior among adolescents in psychiatric care. AIDS Behav. 2009;13(5):1012–20.
Netting NS, Burnett ML. Twenty years of student sexual behavior: subcultural adaptations to a changing health environment. Adolescence. 2004;39(153):19.
Newman PA, Zimmerman MA. Gender differences in HIV-related sexual risk behavior among urban African American youth: a multivariate approach. AIDS Educ Prev. 2000;12(4):308.
O’Sullivan LF, Udell W, Patel VL. Young urban adults’ heterosexual risk encounters and perceived risk and safety: a structured diary study. J Sex Res. 2006;43(4):343–51.
Patel VL, Arocha JF. Cognitive and social science foundation for medical education and training in the information age. Clin Invest Med. 2000;23(4):248–80.
Patel VL, Kaufman DR, Arocha JF. Emerging paradigms of cognition in medical decision-making. J Biomed Inform. 2002;35(1):52–75.
Patel VL, Gutnik LA, Yoskowitz NA, O’sullivan LF, Kaufman DR. Patterns of reasoning and decision making about condom use by urban college students. AIDS Care. 2006;18(8):918–30.
Patel VL, Yoskowitz NA, Kaufman DR. Comprehension of sexual situations and its relationship to risky decisions by young adults. AIDS Care. 2007;19(7):916–22.
Pinkerton SD, Abramson PR. Is risky sex rational? J Sex Res. 1992;29:561–8.
Powell A. Sex, power and consent: youth culture and the unwritten rules. Cambridge: Cambridge University Press; 2010.
Raffaelli M, Crockett LJ. Sexual risk taking in adolescence: the role of self-regulation and attraction to risk. Dev Psychol. 2003;39(6):1036.
Regnerus M, Uecker J. Premarital sex in America: how young Americans meet, mate, and think about marrying. Oxford: Oxford University Press; 2011.
Rolison MR, Scherman A. College student risk-taking from three perspectives. Adolescence. 2003;38(152):689.
Santelli JS, Brener ND, Lowry R, Bhatt A, Zabin LS. Multiple sexual partners among US adolescents and young adults. Fam Plan Perspect. 1998;30(6):271–5.
Santelli JS, Lindberg LD, Abma J, McNeely CS, Resnick M. Adolescent sexual behavior: estimates and trends from four nationally representative surveys. Fam Plann Perspect. 2000;32(4):156–94.
Sheeran P, Abraham C, Orbell S. Psychosocial correlates of heterosexual condom use: a meta-analysis. Psychol Bull. 1999;125(1):90.
Sivaramakrishnan M, Patel VL. Models of health beliefs in South India: impact on managing childhood nutritional illnesses. In: Patel VL, Arocha JF, Ancker JS, editors. Cognitive informatics in health and biomedicine: understanding and modeling health behaviors. London: Springer; 2017.
Sobo EJ. Inner-city women and AIDS: the psycho-social benefits of unsafe sex. Cult Med Psychiatry. 1993;17(4):455–85.
Soet JE, Dudley WN, Dilorio C. The effects of ethnicity and perceived power on women’s sexual behavior. Psychol Women Quart. 1999;23(4):707–23.
Sparling S, Cramer K. Choosing the danger we think we know: men and women’s faulty perceptions of sexually transmitted infection risk with familiar and unfamiliar new partners. Canad J Hum Sexuality. 2015;24(3):237–42.
Sprecher S, Sullivan Q, Hatfield E. Mate selection preferences: gender differences examined in a national sample. J Personality Soc Psychol. 1994;66(6):1074.
Stoner BP, Whittington WL, Aral SO, Hughes JP, Handsfield HH, Holmes KK. Avoiding risky sex partners: perception of partners’ risks vs. partners’ self reported risks. Sex Transm Infect. 2003;79(3):197–201.
Susser I, Stein Z. Culture, sexuality, and women’s agency in the prevention of HIV/AIDS in Southern Africa. Am J Public Health. 2000;90:1042–8.
Terry K. Number of health apps soars, but does not always follow [Internet]. New York: Medscape; 2015. [cited 2016 Aug 20]. http://www.medscape.com/viewarticle/851226
Werner-Wilson RJ. Gender differences in adolescent sexual attitudes: the influence of individual and family factors. Adolescence. 1998;33(131):519.
Werner-Wilson RJ, Vosburg J. How do contextual factors and gender differences influence college students’ safer sex practices? J HIV/AIDS Prev Educ Adolesc Child. 1998;2(2):33–49.
Whitaker DJ, Miller KS. Parent-adolescent discussions about sex and condoms impact on peer influences of sexual risk behavior. J Adolesc Res. 2000;15(2):251–73.
Widman L, Nesi J, Choukas-Bradley S, Prinstein MJ. Safe sext: adolescents’ use of technology to communicate about sexual health with dating partners. J Adolesc Health. 2014;54(5):612–4.
Acknowledgements
The research presented in this chapter was supported by NIMH Grant R01 MH65851 to Vimla L. Patel. Support of writing this manuscript was provided in part by James S. McDonnell Foundation (JSMF 220020152).
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Yoskowitz, N.A., Kaufman, D.R., Denton, C.A., Patel, V.L. (2017). The Slippery Slope of Sexual Decision-Making in Young Adults: The Role of Social and Cognitive Factors. In: Patel, V., Arocha, J., Ancker, J. (eds) Cognitive Informatics in Health and Biomedicine. Health Informatics. Springer, Cham. https://doi.org/10.1007/978-3-319-51732-2_8
Download citation
DOI: https://doi.org/10.1007/978-3-319-51732-2_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-51731-5
Online ISBN: 978-3-319-51732-2
eBook Packages: MedicineMedicine (R0)