Sexual Activity Survey

Adolescent Sex 1

Running Head: ADOLESCENT SEXUAL ACTIVITIES

An Analysis of Adolescent Sexual Activities

In the Transition from High School to University

Eun-Jin Kim Han, Sarah Blom, and Ronald G. Hanson

Michigan State University

CEP 822 Final Project 2

A. Abstract

With the transition to college, high school students face many new situations and challenges.

One of these is the potential for increased sexual activity. This study will examine the experiences of students as they transition from high school to college to determine if there is an increase in sexual activity among students as they transition from high school to college/university. A sexual activity survey questionnaire will be used at the start of the first year of college and again at the conclusion of the first year of college to collect data from students on their sexual experiences and attitudes. The sample will be comprised of one hundred fifty senior high school students who have enrolled in Michigan State University in East Lansing

Michigan. It is hypothesized that students who are transitioning from their last year of high school through their first year of college will experience an increase in heterosexual sexual activity. This study will demonstrate the importance of understanding the change in sexual behaviors that occur as high school students transition to college and the necessity to address sexual issues as part of the curriculum during the freshman year of college. 3

Problem Statement

As adolescents transition from the high school environment to the college or university environment, they are faced with many choices and decisions. Some of these decision-makings they have already experienced; other decisions will be first time decisions and choices. A major area of their lives that they will have to face is that of sexual activities. Current statistics from the Youth Risk Behavior Survey – United States, 2003, state that 46.7% of 9th to 12th graders in

America had experienced sexual intercourse during their life. For 12th graders, the group that will be transitioning into college, 61.6% had had sexual intercourse, 20.3% had four or more sex partners, and 48.9% of 12th graders were currently, during the survey, sexually active; 57.4% used a condom at last intercourse. With the transition to the university, it is important to see if adjusting to life in the university setting makes a difference in the attitudes and behaviors of adolescents toward sexuality. If there is a marked increase in sexual behaviors, then it is important that adolescents be provided with information during this time period to guide their decision-makings and activities, so that they can make not only informed decisions, but also decisions that will be crucial to their future health and well-being, such as the decisions of avoiding an unwanted pregnancy, avoiding a sexually-transmitted disease or HIV/AIDS, or learning how to best navigate the intimacies of a relationship.

The purpose of this proposal is to examine the sexual activities of adolescents as they transition from high school to college or university settings: This research study includes two parts: first getting a baseline survey of current and past sexual activities of the freshmen as they begin their freshmen year in college or university, and then survey those freshmen again at the conclusion of their freshmen year to determine if their year in college led to an increase in sexual activity. If these two surveys demonstrate an increase in sexual activities, then the results 4 obtained can then be used in developing and implementing an intervention program for all freshmen students. It is expected that this intervention program will take into account the types of experiences that they may encounter in the college or university setting.

The sexual activity questionnaire (see Appendix A) was developed to examine the experiences of students as they transition from high school to college to find out whether or not there is an increase in sexual activity during the transition from high to college. The questionnaire was also designed to personalize the sexual risks and responsibilities of college freshmen and to identify sexual behaviors and attitudes among this student population. The survey is patterned after the Sexual Activity Survey conducted by Flannery and Ellingson

(2003). Content included sexual risk, students’ attitudes on sexual activity, and sexual self- efficacy items.

Literature Review

College freshmen represent a special population of interest as young adolescents move from a protected parental atmosphere to a more open unrestricted environment with exposure to influences and opportunities that they have not previously had, or not had to the same degree.

More access to alcohol and drugs, greater opportunities for sex and sexual experimentation and risk-taking, are just a few of the situations that youth can be faced with, and the necessity to make decisions with regard to them. A review of the literature found no studies that specifically examined this transition period from high school to college and its effects on adolescent sexuality. 5

Variables Affecting

Environment Sexual Activity & Peers

Experimenta- Values & tion Attitudes

Sexual Activity

Alcohol Education & Drugs

Consent

Most studies focused on a particular aspect of teen sexuality, such as religiosity (Zaleski,

Schiaffino & Kathreen, 2000; Beckwith & Morrow, 2005), use of alcohol (Ramrakha et al.,

2000; Weinhardt & Carey, 2001; Goldman et al., 1999; Monahan, Murphy & Miller, 1999), use of contraceptive devices (Siegel et al., 1999; McDonald, McDonald, et al., 2000), various sexual risk behaviors and sexual activities (Ramrakha et al., 2000; Reinisch et al., 1995; Siegel et al.,

1999; Weinhartdt & Carey, 2001), influences on sexual activity (Maticka-Tyndale et al., 1998;

Dworkin, 2005; Kalmuss et al.), norms and attitudes of youth (Lance, 2004; McAnulty &

Burnette, 2003; Knox & Zusman, 2001), and a variety of other factors. It therefore seems then that this research can provide an important new perspective on how college life affects adolescent sexuality. 6

Adolescents transitioning from high school to college experience great developmental change. First-year college students navigate a newfound independence in relation to their environment, as well as personal exploration opportunities involving values, education, sexuality, and numerous risk behaviors associated with each.

For “emerging adults”, considered approximately ages 18 to 25, this developmental period often involves the transition to a university (Lefkowitz, 2005). A university environment provides an exposure to new relationships, differing opinions, and the opportunity to question one’s own ideals. As described by Zalenski and Schiaffino, “the transition to college introduces issues regarding identity and identity exploration, leading the adolescent to experiment with possible adult roles, including sexual behavior,” (2000, pg. 226).

Navigating the many variables that impact sexual activity among college students is a rite of passage for most emerging adults. To specifically investigate how these variables influence adolescents transitioning from high school into college, it is necessary to first examine their sexual behavior prior to the university experience.

According to Centers for Disease Control and Prevention, almost one-half of U.S. high school students have had sexual intercourse in their lifetime (2002b). Regarding gender, several studies have reported that men initiate intercourse at an earlier age than women (Ompad et al.,

2006). This statement is supported by the National Longitudinal Study of Youth, which reported that the median age of first sex was younger for boys as compared to girls (15.9 and 16.1 years respectively) (Mott et al., 1996). Thus, the average college freshman has experienced some level of sexual activity upon entering their first year of school.

Given these statistics, how does an individual’s sexual activity change with the transition to a college environment? Balancing values and relationships in a transforming environment 7 filled with autonomy and risky behavior can be challenging for most first-year college students.

According to previously published literature, there are many variables that impact the sexual behavior of college freshman.

Values

One of the primary foundations for an individual’s value system is religious belief. Prior to reaching college, most emerging adult’s religious activity and beliefs are controlled by their parent or guardian. Upon reaching college, a freshman must now attempt to remain steadfast in their religious values in an environment that encourages new experiences and questioning previous ideals. Religious beliefs have an impact on a college student’s sexual activity.

Sexually active students have lower levels of religiosity (Zalenski and Schiaffino, 2000).

Students who place great importance on adhering to the beliefs of their particular religion are less likely to engage in sexual activity. Religion and values impact not only levels of sexual activity, but also the behaviors associated with those activities.

Zalenski and Schiaffino further this discussion by noting that religiosity may be a protective factor for sexual risk-taking, but also may be a contributing factor for unsafe sex

(2000). Because certain religions prohibit the use of contraception, unprotected sexual activity increases pregnancy and sexually transmitted diseases. In fact, 22% of females and 33% of males use no contraception for their first ever-sexual activity (Siegel et al., 1999). The value system is important to not only sexual activity levels, but also the risk behaviors associated with sexual activity. 8

Environment

Another key variable in the sexual activity levels of first-year college students is the environment itself. Students within a university find themselves without parental supervision as they attempt to navigate surroundings littered with risk behavior and peer pressure.

Eva Lefkowitz studied environment and the changes in college student attitude and sexual behavior, based on their surroundings. She found that students who are concerned with environmental changes tend to be more recent university students; students who are more concerned with attitude and behavior changes are more likely to have been at the university longer (Lefkowitz, 2005). Students new to college were most concerned with their new environment, whereas students who have been in the college atmosphere longer became more concerned with how attitudes and behaviors were changing as a result of the environment.

A seeming rite of passage for the college-aged student is the spring break vacation with friends. This excursion creates a particularly risky and experimental environment for college students with regard to sexual activity. In a survey of college students on spring break, it was determined that sexual activities were guided by intentions and expectations, as well as peer influences. In fact, peers provided a greater influence on women than men relative to sexual activity on spring break (Maticka-Tyndale et al., 1998). Peer expectations and influence seem to be a major factor in the sexual activities that occur among the college-aged students while on spring break.

The university environment encourages students to reflect upon themselves, their behavior, and examine the principles that will guide their lives. The environment is ripe for experimentation, and it is a necessary passage for college students. According to Dworkin, the 9 college atmosphere promotes experimentation, and in certain situations, how experimentation is developmentally appropriate for students (2005).

Experimentation

Experimentation is related to decisions students make, and it gives them an opportunity to test their limits and try new things and new experiences, or to question things such as religion or personal ideals. The college environment provides a culture more conducive to experimentation with its vast array of people, new ideas, and opportunities to experiment.

According to Dworkin, the period of college exploration is typified by Erickson’s

“moratorium” period – a time of transition as people seek their societal niche. These students listed two major transitions as accounting for their high rate of experimenting; (1) the transition from high school, and (2) the transition to having a greater level of independence (Dworkin,

2005). For these students, their period of “moratorium” is an important phase as they attempt to figure out who they are, and doing this through experimentation. The transition period is a necessary and important part of their development into adulthood, and experimentation is a key part of that phase.

Sex Education

Institutions of higher education and of secondary education in the United States realize that some sort of sex education must be present. According to the research conducted by Fields

(2002), typical educational efforts in sex education for students range from condom distribution and information on birth control to the prevention of sexually transmitted diseases and workshops on appropriate relationship behavior and protection against sexual assault. In order to ensure the well being of entire campus community, the above services are essential. Most of all, students who choose to be sexually active encounter the challenge of protecting themselves from 10 unwanted pregnancy and sexually transmitted diseases (STD). As various researches on sexual activities of university students have shown, differential socialization has lead to gender differences in sexual attitudes, behaviors and information.

Despite differences between men and women in these areas, there needs to be a change in the same direction for both genders: sexual responsibility (ibid). As Fields (2001) specifically pointed out, teaching students appropriate sexual behavior is not an easy task and this kind of work is best done early in a student's life by their parents. However, there are not many students who have had the benefit of their parental guidance when it comes to sex education. Parental guidance is one of the most influential factors in sex education: teenagers who perceive that their mother disapproves of their having sex or who talked with their mother about condom use before first intercourse are less likely than others to become sexually active or to fail to use condoms

(Kalmuss et al., 2003).

According to Kalmuss et al., sex education programs should begin earlier and target younger adolescents to prevent sexual risks. Kalmuss et al. suggested that primary health care providers should be screening and counseling youth regarding puberty, sex and sexual risk behaviors at younger ages than they currently do because adolescents who experience early puberty are at increased risk for early sexual activity (2003).

Alcohol and Drugs

Being that college is an environment of experimentation, increased alcohol and drugs use become two significant risk behaviors students engage in. Substance abuse is a contributing factor to risky behavior with adolescents as well as adults, and often, this behavior leads to increased sexual activity. Adolescents with substance disorders were 2.1 times more likely to 11 have initiated sexual intercourse before age 16 as compared to non-substance using adolescents

(Ramrakha et al., 2000).

“A large number of global association studies suggest a direct correlation between patterns of alcohol use and risky sexual behavior; that is, individuals who report heavier and more frequent alcohol use tend to report more unsafe sex,” (Weinhardt & Carey, 2001, as cited in Maisto et al., 2004, pg. 571). Alcohol dims some of the inhibitions individuals place on themselves due to value systems, and thus, contributes to an increased frequency of unprotected sex.

Not only does alcohol contribute to increased sexual activity in emerging adults, but also it facilitates the belief that alcohol will create better sexual experiences. Beliefs (expectancies) that alcohol enhances sexual experiences may lead to the initiation or continuation of alcohol use in contexts where a sexual encounter is anticipated (Goldman et al., 1999). Similarly, in a study where young adult men were given either alcohol or a placebo, the individuals who believed they drank alcohol reported more confidence than individuals who believed they had not consumed alcohol (Monahan, Murphy, & Miller, 1999). In college-aged students, alcohol is not only used to elevate sexual activity, but also to provide a perceived boost of confidence.

Alcohol abuse and increased sexual activity leads to an increased possibility of having unprotected sex. In addition to risky sexual activity, alcohol impairs one’s ability to negotiate sexual encounters with prospective partners. “Alcohol intoxication is positively associated with perceived likelihood of having sex without a condom and impairs condom use negation skills,”

(McDonald, McDonald, et al., 2000; Gordon et al., 1997, as cited in Maisto et al., 2004). The administration of alcohol caused greater intentions to engage in unprotected sex and impairment of skills in negotiating safer sex. 12

Consent

Impairing negotiation skills within a sexual context leads to mixed signals regarding sex and consent between partners. Communication problems in our society are prevalent, with men and women interpreting behavior differently and coming to alternate conclusions about the same behaviors.

A highly publicized Antioch University policy on sexual behavior states that “consent’ shall be defined as follows: the act of willingly and verbally agreeing to engage in specific sexual contact or conduct,” (Hall, 1998). There is a stereotype that exists that indicates that women say “no” to sex when they really mean “yes” (token resistance). In an attempt to investigate whether token resistance behavior actually happens, Muehlenhard and Hollabaugh

(1988) studied college women. Of 610 participants, 39.3% reported they had said no to sexual intercourse when they meant yes, at least once. The results from this experiment indicate that much of the sexual activity of college students proceeds without much verbal permission granting, and there is a high reliance on nonverbal permission. Muehlenhard further summarizes studies that show men are more likely than women to interpret specific behaviors as indicators of interest in sex.

All of these factors, given the highly charged sexual atmosphere for college-aged students, can lead to misinterpretations of consent and intent, and create unhealthy and unsafe sexual environments for emerging adults.

Attitudes and Behaviors related to Sexual Activity

A variety of studies have been conducted to indicate the differences in the sexual attitudes and behaviors of female and male university students. Of those, Lance (2004) examined the contemporary sexual attitudes and perceived sexuality information of university students, 13 focusing on the attitudes of college students toward contraceptive in consideration of gender differences. According to him, there is a “contraceptive gap” among young people: there is a time lapse between the onset of sexual activity and the use of contraceptives while a large majority of young males and females become sexually active. As a result of this lack of sexual responsibility among teenagers, there have been over a million teenage pregnancies each year in the U.S.

As Lance pointed out, university men's and women's attitudes towards sex seem to have coincided over the years; nevertheless, differences still exist. In the past men generally held more positive attitudes towards sex than women, feeling less guilt for sexual behavior, feeling that sex is a natural social evolution of relationships, resulting in a more open attitude regarding sex.

Therefore, men participated in wider sexual behaviors than women as a result of positive attitudes about sex. Gender role socialization and expectation seems to be key factors in gender differences in sexual attitudes and behaviors of university students as well.

It is generally assumed that men are more sexual than women; that men have stronger and more readily stimulated sexual appetites and that they find sex more pleasurable than women in modern American culture (ibid). According to McAunlty and Burnette (2003), different factors play a part in the involvement in sexual intercourse. In addition, perceived peer norms are involved in the timing of sexual intercourse as well. That means if teens have friends who are involved in sexual activities, they tend to be more inclined to start sexual activities themselves.

The research regarding the impacts of religiosity and spirituality on the sexual attitudes of college students conducted by Beckwith and Morrow (2005) has shown that religiosity and spirituality were significantly negatively correlated with conservative attitudes about sex.

Religiosity and spirituality were significantly positively related. Beckwith and Morrow 14 hypothesized that religiosity would be related with more conservative sexual attitudes and that students who possessed qualities that defined them as spiritual would also demonstrate more conservative attitudes about sex. As assumed, the result of the study showed that religiosity was significantly related to permissiveness, sexual practices, and the instrumentality sexual attitude factor; religiosity was not related to communion in the relationship. Therefore, according to the research, the more religious a person tends to be, the more likely he or she will also hold conservative attitudes about sex.

Knox and Zusman (2001) also attempt to identify the social correlates of sexual values among a sample of university students. In their study, six hundred and twenty never-married undergraduates at a large southeast university identified the sexual values that guide their behaviors in sexual decision making. Each student completed a questionnaire that evaluated his or her sexual value system as one of absolutism, relativism, or hedonism. Analysis was run by sex, race, age, relationship status, and a series of Likert-scored questions related to students’ attitudes on sexual value. Both men and women were more relativistic than absolutist or hedonistic. However, male students were six times more hedonistic than were female students.

Other factors significantly associated with hedonism included being over age 20, uninvolved in a relationship, being open to living together, and a belief that divorce was justifiable. Overall, this research has shown that university students today are predominantly relativistic in their sexual beliefs. Whether or not they have intercourse is a decision that can only be made in reference to the context of the relationship with the partner.

According to Knox, Cooper, and Zusman (2001), traditionally, women have been socialized to be more concerned about relationship context--commitment and security--as a condition for sexual expression than men. They also claimed that men have traditionally been 15 more sexually aggressive and pleasure focused independent of the relationship context than women.

Association of Sexual Activity with Academic Achievement

Schvaneveldt, Miller, Berry and Lee (2001) found that there is a negative correlation between the age of one’s first sexual intercourse and one’s academic performance based on their longitudinal study. They tried to address two main questions in their research: First, do adolescents' previously measured academic values and achievement predict their age at first sexual intercourse? Second, does the onset of sexual activity predict later measured academic values and achievement? They hypothesized that people who are sexually active will perform differently academically than those who are not sexually active. It was further hypothesized that students who are sexually active and in relationships will perform differently than students who are sexually active and not in relationships. Research has been done on the age at which one has sexual activity as well. The younger the age at which one has sexual intercourse is negatively correlated with lowered academic performance and goals (Schvaneveldt et al., 2001).

Quatman et al. (2001) also found a negative correlation between dating frequency and academic achievement in high school students. Furthermore, Quatman et al. also pointed out that dating frequency and academic motivation to be negatively correlated as well. Therefore, based on the study conducted by Quatman et al., we can see that there is an interaction between dating and grade point average.

According to various studies on the relationship between academic achievement and sexual activity, adolescents with higher educational achievement and goals are more likely to delay sexual activity than those with lower educational achievement and goals since having sexual intercourse at an early age could lower educational interest, goals, and achievement. 16

Method

Participants

The subjects of this study are 150 (75 males and 75 females) 17-19 year-old freshman students of Michigan State University in East Lansing, Michigan. Students are of varied ethnicities and socioeconomic status and will be full-time university students. All subjects will have graduated from public high schools in the spring of 2006, and entered university in the fall of 2006.

Instrumentation

The instrumentation for this research is a survey questionnaire. Participants will be informed that they will be completing two pencil and paper surveys during their freshman year, once within the first four weeks of school (T1), and the second (T2) in the final four weeks of the freshman year. Participants will be paid $15 to complete the first survey and $25 to complete the second survey. The increased incentive is offered as a means of avoiding mortality during the year.

The instrument that will be used will be a modified version of the Sexual Activity Survey by Diana Flannery and Lyndall Ellingson. The questionnaire was designed to look at sexual behaviors and attitudes of college freshmen in regards to sexual risk factors and risk prevention measures, sexual practices, sexual orientation, sex drive and body image.

A sample questionnaire is provided in Attachment A.

Piloting

University professors familiar with the survey questionnaire process will review the questionnaires and the process in order to reveal any potential problems or weaknesses either in instrument design or in the procedures employed. . Additionally, a group of twenty-five students 17 will pilot the process to make sure that the process works smoothly and that the results can be appropriately tabulated.

Procedure

Data will be collected via the questionnaire that is completed at the beginning of the freshman year and again at the completion of the freshman year. The participants will be randomly selected from a pool of applicants who will have responded to an invitation to participate as part of their freshmen orientation packet. All incoming freshmen will be invited by means of a letter along with a coded card in their orientation packet. Students will be informed that the survey has to do with sexuality, but not of the specific purpose in order to prevent any possible bias. Those who choose to participate will turn in one-half of the card and retain the other half, both of which will be coded, with an M or an F for male or female, followed by a unique identifier number. From those cards an equal number of males and females will be selected, and those who are chosen to participate will respond with their card to participate and to receive their incentive. Among those who volunteer, 150 students will be randomly selected to participate. All students volunteering will be categorized by gender only, and an equal number of subjects will be randomly selected for each gender, 75 males and 75 females.

Participants will also sign a university participation form. The results of this study will only generalize to the population of students who might typically attend this university having come from public high schools.

Research staff will oversee the administering of the survey, and will also assist by answering any questions. The surveys will be administered in a large classroom configured so that students are not able to see the answers of other students. 18

Completed surveys will be placed in an individual envelope that each student has and then collected from the students. Each survey will have a bar coded identifier number on it. It is estimated that each survey will take approximately 30 minutes to complete.

Analysis

Responses to individual questions by each student will be recorded by a trained coder and entered into a computer database. Questionable markings on the survey response form will be discussed with the principal researcher. Computer generated reports, bar graphs, pie graphs, and other formats will be used to display the resultant data. Observed trends will be communicated via a report that will summarize the findings of the surveys. Nonparametric techniques would be most appropriate for this study in that few if any assumptions are made about the sample. Chi-

Square would be the inferential statistical technique most appropriate for this study. Logistic regression would also be used in the analysis of the data.

Data obtained from the survey will be separated into categories by gender and sexual experience. Data analysis involves using the parametric techniques T-test to compare the two sets of data. For the survey from the beginning of the freshman year in college, we can obtain the mean and standard deviation for sexual activities of the participating students. We would do the same thing for the survey taken at the completion of the freshman year. By using the t-test we can discover if there are statistically significant differences between the two data sets. We will be able to demonstrate that there was an increase in sexual activity if the mean from the second survey is higher than the first.

The questionnaire that is being used has face validity. Additionally, the validity of the instrument would be determined through content-related evidences of validity. To accomplish this, a minimum of three qualified university researchers in the human sciences field (sociology, 19 ethnology, human ecology, psychology) would be selected to review and critique the instrument.

They will provide their responses based on whether or not they feel the instrument measures what it is intended to measure based on the characteristics of the sample.

Reliability of the instrument will be determined using the split-half reliability Spearman-

Brown Prophecy Formula. Definitions of specific terms are provided to make sure respondents understand what they are replying to.

Potential limitations

The sample was restricted to adolescents who were public high school students and who participated in the freshmen orientation. Students from parochial or private high schools were not included thus the sample is not reflective of the general population of freshmen college students. Students who decided to participate may have done so for monetary reasons only, and thus students who had no need for financial remuneration would not have participated, thus the participants may be reflective of a certain socioeconomic status.

Due to the fact that participants in this survey are not totally random, we are forced to include in the survey only those who have elected to participate. In so doing we run the potential for subject bias from the standpoint that those who participate in the survey may be sexually experienced versus those who are not sexually experienced and may not choose to participate in the survey.

Definitions

Sexual intercourse is defined as the penis in the vagina.

Anal intercourse is defined as the penis in the rectum.

One night stand is defined as a one-time sexual encounter with a member of the opposite sex with no intention of forming a relationship. 20

Oral-genital sexual play is described as mouth-penis or mouth-vagina play. 21

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APPENDIX A

SEXUAL ACTIVITY SURVEY

PLEASE DO NOT PUT YOUR NAME ON THE QUESTIONNAIRE. Your honesty in responding to the statements is very important. Be sure to answer every question, even if it does not apply.

1. What is your sex? A. Female B. Male

2. What is your age? ______1 3. Have you ever had sexual intercourse? A. Yes B. No

4. How old were you when you had sexual intercourse for the first time? A. I have never had sexual intercourse B. ______years of age

5. During your life, with how many people have you had sexual intercourse? A. I have never had sexual intercourse B. ______number of partners

6. During the past 9 months, with how many people did you have sexual intercourse? A. I have never had sexual intercourse B. I have had sexual intercourse, but not during the past 9 months C. 1 person D. 2 people E. 3 people F. 4 people G. 5 people H. 6 or more people

7. Did you drink alcohol or use drugs before you had sexual intercourse the last time? A. I have never had sexual intercourse B. Yes C. No

8. The last time you had sexual intercourse did you or your partner use a condom? A. I have never had sexual intercourse B. Yes C. No 25

9. The last time you had sexual intercourse, what one method did you or your partner use to prevent pregnancy? (Select only one response.) A. I have never had sexual intercourse B. No method was used to prevent pregnancy C. Birth control pills D. Condoms E. Depo-Provera (injectable birth control) F. Withdrawal G. Some other method H. Not sure

10. How many times have you been pregnant or gotten someone pregnant? A. 0 times B. 1 time C. 2 or more times D. Not sure

11. Regarding your sexual orientation, you are primarily? A. Heterosexual B. Gay/lesbian C. Bisexual D. Don’t know

12. Have you ever engaged in sexual play with someone of the same sex? A. Yes B. No

13. Which of the following best describes your oral-genital sexual play? A. Does not apply B. Received and given equally C. I usually give more than I receive D. I usually receive more than I give

14. How often have you had sexual intercourse on a "one night stand" over the last 9 months? A. Never B. Once C. Two to Three times D. Four or more times

15. Have you ever engaged in anal intercourse? A. Yes B. No 1 16. If you answered yes to anal intercourse was a condom used? A. I have never engaged in anal intercourse B. Always C. Sometimes D. Never 26

17. How would you describe your sex drive? A. Very strong B. Somewhat strong C. Not very strong D. No sex drive

18. Are you happy with the way your body looks? A. All of the time B. Most of the time C. Sometimes D. Rarely E. Never

19. Have you ever experienced forced sexual intercourse? A. Yes B. No

20. Have you ever forced someone to engage in sexual intercourse with you? A. Yes B. No

Footnote: Permission to use Sexual Activity Survey was received from Diana Flannery.