The Experience of Regretted Sex Among Undergraduate College

The Pennsylvania State University

The Graduate School

College of Health and Human Development

AN EXAMINATION OF THE EXPERIENCE OF AND THE REASONS FOR

REGRETTED SEX AMONG UNDERGRADUATE COLLEGE STUDENTS

A Dissertation in

Biobehavioral Health

Clinton Colaco

 2016 Clinton Colaco

Submitted in Partial Fulfillment of the Requirements for the Degree of

Doctor of Philosophy

August 2016

The dissertation of Clinton Colaco was reviewed and approved* by the following:

Patricia Barthalow Koch Professor of Biobehavioral Health Dissertation Advisor Chair of Committee

Linda Wray Professor of Biobehavioral Health

Lori Francis Associate Professor of Biobehavioral Health

Edgar Yoder Professor of Agricultural and Extension Education

Robert Turrisi Professor of Biobehavioral Health Professor-in-Charge of the Graduate Program

*Signatures are on file in the Graduate School

iii

ABSTRACT

Surveys of college campuses have found that at least 70% of young adults engage in sexual activities. Although exploration, freedom, and self-discovery in the sexual context are common when entering college, they do not come without the potential for serious physical, emotional and social consequences that may result in regretting those sexual activities. In fact, regretted sexual experiences are beginning to be recognized as significant and fairly common in the lives of college students. Research regarding the sexual regret experienced by adolescents and college students is limited and has only been addressed in a few studies to date. Given the incidence of and consequences from regretted sex, researchers have argued for

more in-depth study of this phenomenon. Therefore, the purpose of the current study was to

examine the relationships among the experience of regretted sex, the reasons for regretted sex,

and the factors associated with sexual regret. In the first of a three-part study, a convenience sample of 435 undergraduate students completed a survey about regretted sex, which resulted in the development of the 11-item Experience of Regretted Sex Scale (ERSS) as a reliable and valid measure of the experience of sexual regret. In study 2, the 36-item Reasons for

Regretted Sex Scale (RRSS) was created and its psychometric properties were tested. Five categories of reasons for regretting sex were identified as significant factors: casual/drunken sex, negative sexual experiences, bad sex, relationship issues, and partner issues. The RRSS and each associated factor provided evidence of good psychometric properties. In Study 3, we explored behavioral and demographic variables that may predict a person’s engagement in regretful sexual behaviors. Consistent with prior research, the behavioral variable— number of lifetime sexual partners—was significantly associated with each category of regret on the RRSS. We hope that the utilization of the ERSS and RRSS will lead to more consistent and reliable research in the area of sexual regret in young adults.

TABLE OF CONTENTS Chapter 1 ...... 1

Introduction ...... 1

Purpose ...... 6

Specific Aims and Research Questions ...... 7

Limitations ...... 8

Definitions...... 8

Organization of the Dissertation ...... 10

Chapter 2 ...... 11

Literature Review ...... 11

The Developmental Period of Emerging Adulthood – Biobehavioral Changes ...... 11

Sexual Activity Among College Students ...... 13

Hooking Up ...... 14

Summary and Critique ...... 24

Risky Sexual Experiences ...... 25

Unwanted Sexual Experiences ...... 26

Summary and Critique ...... 31

Alcohol and Sexual Activity ...... 33

Relationship Between Alcohol and Risky Sex ...... 37

Summary and Critique ...... 45

Relationship Between Alcohol and Unwanted Sex ...... 47

Summary and Critique ...... 50

Research on Regretted Sex ...... 51

Feelings Associated with Regretted Sex ...... 58

Regrets Related to Casual Sex and Hooking Up ...... 59

Regrets Related to Drunken Sex ...... 64

Methodological Issues with Research on Regretted Sex ...... 66

Issues with Definitions ...... 67

Issues with Sampling ...... 67

Issues with Measurement ...... 68

Issues with the Analysis of Data ...... 70

Chapter 3 ...... 73

Development and Validation of the Experience of Regretted Sex Scale: Findings From

Undergraduate College Students ...... 73

Methods...... 82

Results ...... 88

Results for research question 1: To what degree do undergraduate college students

experience regretted sex? ...... 94

Results for research question 2: What demographic (age, gender, race/ethnicity,

sexual orientation) and behavioral (relationship status, number of lifetime sexual

partners) characteristics of students are significantly associated with regretted sexual

experiences? ...... 96

Discussion ...... 98

Chapter 4 ...... 101

Study 2 - Development and Validation of the Reasons for Regretted Sex Scale ...... 101

Methods...... 108

Results ...... 114

Discussion ...... 135

Limitations ...... 139

Strengths ...... 140

Future Research ...... 140

Chapter 5 ...... 142

Study 3 – The Who and What of Regretted Sex Among Undergraduate College

Students ...... 142

Study Purpose and Research Questions ...... 149

Methods...... 149

Results ...... 153

Discussion ...... 176

Limitations ...... 183

Future Research ...... 183

Chapter 6 ...... 185

Conclusions and Recommendations ...... 185

Chapter overview ...... 185

Purpose ...... 185

Specific aims, research questions, procedures and analytic plans ...... 185

Summary of the Findings by Study...... 190

Contributions to the Field ...... 198

Recommendations for Future Research ...... 204

vii

References ...... 206

Appendix A ...... 227

Appendix B ...... 230

Appendix C ...... 245

viii

LIST OF FIGURES

Figure 1: The relationship between reasons for sexual regret and feelings of regret .. .70

Figure 2: Confirmatory factor analysis (n=364) ...... 91

LIST OF TABLES

Table 1: Behavioral and demographic characteristics of the sample (n=435) ...... 84

Table 2: Principal components analysis of the Experience of Regretted Sex Scale

(n=364) ...... 89

Table 3: Summary of exploratory factor analysis results (n=364) ...... 90

Table 4: Confirmatory factor analysis: Two factor solution (n=364) ...... 92

Table 5: Item total correlation (n=367) ...... 93

Table 6: ERSS scores (n=229) ...... 95

Table 7: ERSS scores: Females (n=168) ...... 95

Table 8: ERSS scores: Males (n=56) ...... 95

Table 9: Binary logistic regression results for the experience of regretted sex

(n=258) ...... 97

Table 10: Behavioral and demographic characteristics of the sample (n=435) ...... 112

Table 11: Exploratory factor analysis: Rotated 16-factor solution for the RRSS

(n=396) ...... 115

Table 12: Items excluded for low factor loading/loadings on multiple factors ...... 119

Table 13: Items with low item total correlations (<45) ...... 120

Table 14: Exploratory factor analysis on 36 items: Rotated five-factor solution

(n=396) ...... 121

Table 15: Factors and corresponding items on the Reasons for Regretted Sex

Scale ...... 124

Table 16: Confirmatory factor analysis for the RRSS: Factor loadings on

respective factors (n=396) ...... 126

Table 17: Confirmatory factor analysis for the RRSS: Correlations between

factors on the RRSS (n=396) ...... 127

Table 18: Correlations between the ERSS and the RRSS ...... 128

Table 19: Correlations between ERSS and individual factors on the RRSS ...... 128

Table 20: Item total statistics for factors 1-5 on the RRSS (n=396) ...... 130

Table 21: Reliability of the RRSS: Factor and corresponding Cronbach's alpha ...... 131

Table 22: Binary logistic regression testing the association of behavioral /

demographic variables and each factor on the RRSS with the ERSS as the

dependent variable block (n=367) ...... 134

Table 23: Behavioral and demographic characteristics of the sample (n=435) ...... 151

Table 24: Frequencies for RRSS items for all respondents (n=365) ...... 155

Table 25: Frequencies for RRSS items for women (n=271) ...... 156

Table 26: Frequencies for RRSS items for men (n=91) ...... 157

Table 27: Binary logistic regression testing the association of behavioral and

demographic variables with factor 1 (casual/drunken sex) Block 1 (n=367) ...... 160

Table 28: Binary logistic regression testing the association of behavioral and

demographic variables with factor 1 (casual/drunken sex) Block 2 (n=367) ...... 161

Table 29: Binary logistic regression testing the association of behavioral and

demographic variables with Factor 2 (negative feelings) Block 1 (n=367) ...... 163

Table 30: Binary logistic regression testing the association of behavioral and

demographic variables with Factor 2 (negative feelings) Block 2 (n=367) ...... 164

Table 31: Binary logistic regression testing the association of behavioral and

demographic variables with Factor 3 (bad sex) Block 1 (n=367) ...... 167

Table 32: Binary logistic regression testing the association of behavioral and

demographic variables with Factor 3 (bad sex) Block 2 (n=367) ...... 168

Table 33: Binary logistic regression testing the association of behavioral and

demographic variables with Factor 4 (relationship issues) Block 1 (n=367) ..... 170

Table 34: Binary logistic regression testing the association of behavioral and

demographic variables with Factor 4 (relationship issues) Block 2 (n=367) ..... 171

Table 35: Binary logistic regression testing the association of behavioral and

demographic variables with Factor 5 (partner issues) Block 1 (n=367) ...... 174

Table 36: Binary logistic regression testing the association of behavioral and

demographic variables with Factor 5 (partner issues) Block 2 (n=367) ...... 175

Table 37: Summary of the RRSS factors and significantly-related variables ...... 182

Table 38: Summary of the variables and significantly-related RRSS factors ...... 182

xii

ACKNOWLEDGEMENTS

I would like to acknowledge and give special thanks to the people who have

helped me complete one of the most rewarding academic experiences of my life.

I want to begin by thanking my academic advisor and committee chair, Dr.

Patricia Koch, for her invaluable guidance, unwavering support, and encouragement. I

cannot express in words how much I appreciate the dedication, effort and affection she

afforded me throughout this whole journey. I was able to accomplish many professional

and personal goals along the journey due to her patient mentorship, none of which would

have been possible with Dr. Koch.

I want to thank Dr. Linda Wray who has supported me through my graduate

journey, and whom I regard as a friend, philosopher and guide. I would also like to thank

Dr. Lori Francis and Dr. Ed Yoder for their advice, wealth of knowledge, and guidance

throughout my doctoral studies.

I would like to acknowledge my parents for valuing education above all else and supporting me in all my endeavors.

Chapter 1

Introduction

Surveys of college campuses have found that at least 70% of young adults are engaging in sexual activities (American College Health Association, 2014). This sexual experimentation may be because college years are seen as a time for exploration, freedom, and self-discovery (Cooper, 2002). The transition from high school to college offers adolescents more freedom that may result in increased risky sexual behaviors

(Vail-Smith, Maguire, Brinkley & Burke, 2010). According to the National College

Health Assessment which included data from one hundred and forty post-secondary institutions (ACHA 2014), 66.8% of college students reported having one or more sexual partners within the last 12 months. In fact, 42.1 % of college students reported engaging in oral sex, 46.5% reported engaging in vaginal sex while 5% reported engaging in anal sex within the past 30 days. Thus, college students are an at-risk population for negative sexual experiences based on the high incidence and prevalence of sexual behaviors on college campuses (Fisher, Cullen, & Turner, 2000).

When adolescents enter college they have an increased opportunity to partake in risky sexual behavior (Turchik & Garske, 2009). These constitute behaviors that involve the possibility of an adverse outcome, such as contracting a sexually transmitted infection or unwanted pregnancy (Marcus, Fulton & Turchik, 2011). Risky sexual behaviors are a serious problem on college campuses in the United States (Pluhar, Fongillo,Stycos, &

Dempster-McClain, 2003) and sexual regret may be experienced by some students after a risky sexual experience. The consequences of the negative outcomes associated with sexual risk taking often have long-term detrimental effects. These outcomes can include

damage to romantic relationships, family conflicts, financial concerns, damage to social

reputations, legal disputes, and more (Turchik & Garske, 2009). Two negative outcomes

which have long-lasting consequences include unintended pregnancies and the

contraction of sexually transmitted infections (STIs), including the Human

Immunodeficiency Virus (HIV)/ Acquired Immune Deficiency Syndrome (AIDS)

(Pluhar, Frongillo, Stycos, & Dempster-McClain (2003).

However, regretted sexual experiences are beginning to be recognized as

significant and fairly common experiences in the lives of college students (Oswalt,

Cameron & Koob, 2005), although they have only been addressed in a few studies to

date. Zeelenberg (1999) defines regret as a negative emotion that one feels when

remembering the past and imagining that the present would be different if one had

behaved differently. It is an emotion often experienced when individuals feel they have

caused harm to themselves or to others (Zeelenberg & Breugelmans, 2008). Regretted sex

has been conceptualized as regret that an individual experiences when he or she reflects

on past sexual experiences (Oswalt et al., 2005).

An estimated three-quarters (71%) of students regret their decision to engage in sexual activity at least once during their undergraduate education (Oswalt et al., 2005).

The three most common reasons for this were: participants’ actions were inconsistent with their personal values (32%), participants’ decisions were influence by alcohol

(28%), and participants failed to use condoms (25%). Regret about romantic relationships is especially common in younger adults since college environments are known for facilitating sexual permissiveness (Chng & Moore, 1994; Paul, McManus, & Hayes,

2000).

Regret pertaining to sexual experiences may have long-term psychological

consequences as well. Regret in general has been associated with emotions such as anger,

shame, and embarrassment (Seaman, 2005) and even depression or other psychological

disorders (Grello, Welsh & Harper, 2006). Further, perceived consequences of regrets

have been shown to be related to lower self-rated life satisfaction and increased physical ailments (Jokisaari, 2003). Given the consequences of regretted sexual experiences and the frequent occurrence of regretted sex in the college student population, further

examination of regretted sex is warranted.

In addition to the frequency of sexual behaviors engaged in on college campuses, the context in which various behaviors can contribute to regretted sex. For instance, casual sex is common on college campuses. Nationally representative studies reveal that

70-85% of sexually experienced adolescents age 12-21 reported engaging in intercourse

with a casual sexual partner during the previous year (Grello, Welsh, Harper, & Dickson,

2003). Casual sexual relationships or encounters are referred to by a variety of terms in

the research literature, including "chance encounters", "hook ups", "sociosexuality",

"anonymous sex", and "casual sex" (Paul, McManus, & Hayes, 2000). In the media, such

encounters have been referred as "meaningless sex", "friends with benefits," and "booty

call" (Grello et al., 2006). Casual sexual relationships can be sexual encounters with

strangers or sex with a friend. They can be short or long in duration. These encounters are

often superficial, based on sexual desire or physical attraction, spontaneous, impulsive,

and frequently involve drugs or alcohol (Grello et al., 2006). Students are increasingly

engaging in casual sexual encounters known as “hooking up” (Flack et al., 2007).

Hooking up is defined as a single, casual encounter, sometimes involving sexual

intercourse but with no expectation of future commitment (Daubman & Schatten, 2005).

This sexual practice explicitly permits a sexual interaction without romance,

commitment, or even affection (Glenn & Marquardt, 2001).

Hook ups are considered a common sexual experience in college life (Grello,

Welsh, & Harper, 2006; Paul & Hayes, 2002). Paul and Hayes (2002) found that 78% of

college students had engaged in a hook up and 30% of college students had engaged in a

hook up involving intercourse. The combination of mismatched expectations and the lack

of communication about the meaning of the encounter results in adverse outcomes for

some students who engage in hook ups (Owen, Rhoades, Stanley & Fincham, 2010).

Because hooking up and casual sex are becoming more prevalent among the

college population, the likelihood of regretted sex has significantly increased, as

indicated in several studies (Bogle, 2007; Eshbaugh & Gute, 2008; Oswalt et al., 2005).

Fisher, Worth, Garcia, and Meredith (2012) explored the prevalence of regret following

uncommitted sexual encounters and found that the majority of participants self-reported

that they had experienced feelings of regret after an uncommitted sexual encounter.

Women reported feeling significantly more regret than men. Galperin and colleagues

(2013) also examined gender differences in sexual regret. They found that while both genders reported similar rates of casual sexual encounters, women tended to report more frequent and intense regrets afterwards.

The likelihood of experiencing regretted sex may also depend on the individual's sexual values. In their study on sexual regret, Oswalt et al. (2005) found that the most common reason for regretting sex was that “participants’ decisions were inconsistent with their morals and values. If students make sexual decisions contradicting their value set,

these values may be the cause of sexual regret after a sexual experience (Oswalt et al.,

2005). Sexual guilt, defined as “guilt about moral conduct in sexual situations” (Young,

Hubbard, & Fox, 1992), is thought to influence sexual behavior. Further, morals and values in the domain of sexuality are often driven by religiosity. In examining the relationship between sexual regret and casual sex, Eshbaugh and Gute (2008) found that religious participants were more likely to report regret than non-religious participants.

In addition, regretted sexual experiences often occur in the context of excessive alcohol consumption (Oswalt et al., 2005; Esbaugh & Gute, 2008; Caron &

Moskey,2002). Cooper (2002) states that drinking is found to be strongly related to the decision to have sex and to engaging in indiscriminate forms of risky sex (e.g., having multiple or casual sex partners). Numerous studies find an association between drinking and risky sexual experiences (LaBrie, Kenney, Migliuri & Lac, 2011). Caldeira, Arria,

Zarate, Vincent, Wish & O'Grady, 2009; Ebel-Lam, MacDonald, Zanna & Fong, 2009;

Wells, Kelly, Golub, Grov & Parsons, 2010). Excessive alcohol consumption is a significant feature on U.S. college campuses (Hingson, Heeren, Winter, & Wechsler,

2005; Hingson, Zha, & Weitzman, 2009; O’Malley & Johnson, 2002). An estimated

400,000 students between the ages of 18 and 24 have had unprotected sex, and more than

100,000 students between the ages of 18 and 24 report having been too intoxicated to know if they consented to having sex (Hingson et al.,2002). Heavy episodic drinking are significant and co-occurring problems on college campuses (Grucza, Norberg, & Bierut,

2009).

Further, alcohol is consistently associated with sexual assault (Abbey et al., 2004;

Testa & Livingston, 2009). Approximately 50% of sexual assaults involve alcohol

consumption by the victim, the perpetrator or both (Abbey et al., 2004). Hingson, Zha

and Weitzman (2009) a meta-analysis, integrating data from 1998-2005, to assess the

magnitude of and trends in alcohol-related morbidity and mortality among U.S college

students ages 18-24. They estimated that greater than 97,000 students between the ages of

18 and 24 were victims of alcohol-related sexual assault or date rape each year. Krebs,

Lindquist, Warner, Fisher and Martin (2009) collected data on sexual assault victimization from a random sample of 5,446 undergraduate women and found that almost 20% of undergraduate women experienced some type of completed sexual assault since entering college. Most sexual assaults occurred after women voluntarily consumed alcohol, whereas few occurred after women had been given a drug without their knowledge or consent.

In summary, there is a paucity of research on regretted sexual experiences. The

predictors of sexual regret have not been adequately outlined by previous studies.

Additionally, to the best of our knowledge, no researcher has explored the relationship

between reasons for sexual regret and the intensity of the experience of sexual regret.

Purpose

Given the incidence of and consequences from regretted sex, researchers have

argued for more in-depth study of this phenomenon (Oswalt et al., 2005; Eshbaugh &

Gute, 2008). Therefore the purpose of the current study was to examine the relationships

among the experience of regretted sex, the reasons for regretted sex, and behavioral and

demographic variables that may be associated with regretted sex. In order to achieve this

purpose, psychometrically-sound measurement instruments needed to be designed. It is

important to note that measuring the reasons for regretted sex is not the same as

measuring the experience of regretted sex itself. Reasons are better viewed as causes or

predictors of regretted sex rather than as regretted sex itself.

Specific Aims and Research Questions

Thus the specific aims of this current research, with their corresponding research

questions, included:

Specific Aim 1: Develop a psychometrically-sound measure of the experience

of regretting sex.

• Research Question 1.1: To what degree do undergraduate college students

experience regretted sex?

• Research Question 1.2: What demographic (age, gender, race/ethnicity, sexual

orientation) and behavioral (relationship status, number of lifetime sexual

partners) characteristics of students are significantly associated with regretted

sexual experiences?

Specific Aim 2: Develop a psychometrically-sound measure of the reasons for

regretting sex.

• Research Question 2.1: Which categories of regretted sex are associated with a

higher degree of regretted sex?

Specific Aim 3: Examine the who and what of regretted sex among undergraduate college students in more depth than has previously been undertaken.

• Research Question 3.1: What are the reasons that undergraduate college

students cite most frequently for regretting sex?

• Research Question 3.2: What are the demographic characteristics (age, gender,

race/ethnicity, class standing, and sexual orientation) and behavioral

characteristics (relationship status, number of lifetime sexual partners) of those

undergraduate students who are most likely to experience different reasons for

regretted sex?

Limitations

Following are some limitations of this research study:

1. The population of interest for the current study was college students (male and

female) in the United States. However, our student sample was drawn from a

purposive sample of a fairly homogeneous student body attending one

university. The majority of the students was heterosexual and Caucasian. Since

our sample is not representative of the entire population of college students in

the U.S, the generalizability of the present study is limited. Specifically, the

results may not be generalizable to other groups of college students with

different demographic compositions.

2. The current study relied on the use of a self-report survey. Self-report

questionnaires are an efficient, practical and inexpensive method of collecting

large volumes of data. However, this method of data collection can be subject

to participation bias, subjective interpretations of the questions, and memory

distortion.

Definitions

The following definitions are key to understanding this research study:

Anticipated regret: Anticipated regret involves the negative feelings and self-

recriminations an individual may feel before any negative consequences actually occur

from a behavior (Bell, 1982).

Casual Sex: Casual sex refers to sexual relationships in which the partners do not

define the relationship as romantic or their partner as a boyfriend or girlfriend (Grello,

Welsh & Harper, 2006).

Hook up/Hooking up: A physical and/or sexual behavior that explicitly permits a

sexual interaction without romance, commitment, or affection (Glenn & Marquardt,

2001). "Hookups," are sexual interactions between partners who do not expect a romantic

commitment (Fielder & Carey, 2010). Such physical encounters are not necessarily

precursors to a relationship, and there are no guarantees anything will evolve past

physical or sexual interactions (Bogle, 2007).

Regret. Regret is a negative cognitive emotion experienced when an individual remembers a past event and realizes or imagines that the present would be different had one acted differently (Zeelenberg, 1999).

Regretted sex. Regretted sex is a negative cognitive emotion experienced when an individual remembers a past sexual experience and wishes that it had not happened or that it had been different (Colaco, 2009).

Risky sex. Risky sexual behaviors are behaviors that involve the possibility of an adverse outcome, such as contracting a sexually transmitted infection or unwanted pregnancy (Marcus, Fulton & Turchik, 2011).

Unwanted sex. Unwanted sex is defined as a general concept that includes sexual assault or rape, but may also incorporate any behavior involving sexual contact experienced as harmful or regretful during or following the incident (Flack et al., 2007).

Organization of the Dissertation

As presented earlier, the purpose of the present study is to examine the relationships among the experience of regretted sex, the reasons for regretted sex, and behavioral and demographic variables that may be associated with regretted sexual experiences among a sample of undergraduate college students. Chapter 1 of this dissertation includes a short overview of important areas related to this research, the purpose of the study, specific research aims and their corresponding research questions, the limitations of the study, and a list of definitions of important terms. Chapter 2 provides a comprehensive review of the literature. Chapter 3 contains the article that addresses the first specific aim of this study entitled, Development and Validation of The

Experience of Regretted Sex Scale: Findings from Undergraduate College Students, which will be submitted to a scientific journal. Chapter 4 contains the article that addresses the second specific aim of this study entitled, Development and Validation of

The Reasons for Regretted Sex Scale: Findings from Undergraduate College Students, which will be submitted to another scientific journal. Chapter 5 contains the article the address the third aim of the study entitled, An examination of the who and what of regretted sex among undergraduate college students, which will be submitted to another scientific journal. Finally, an overview of the entire study and recommendations for further study are addressed in Chapter 6.

Chapter 2

Literature Review

The purpose of the current study was to examine the relationships among the

experience of regretted sex, the reasons for regretted sex, and behavioral and

demographic variables that may be associated with regretted sex. In order to achieve this

purpose, psychometrically-sound measurement instruments needed to be designed.

In this chapter, we will review the scientific literature relevant to the purpose of

this study. This review begins with an overview of the biobehavioral changes that are

noted to occur in the lives of college students as they journey through emerging

adulthood. This is followed by an update on college students’ sexual activity, including

hooking up and risky and unwanted sexual experiences. The relationship between alcohol

consumption and these experiences will then be explored. The review will then focus on

the research regarding regretted sex. The chapter will conclude with an overview of the

methodological issues involved with this type of research.

The Developmental Period of Emerging Adulthood – Biobehavioral Changes

According to Arnett (2005), emerging adulthood is a period in the life-span from

the age of 18 to 25, when individuals have the opportunity to focus on the exploration of

life’s options in areas of relationships, careers, and ideology. Emerging adulthood

encompasses five defining dimensions: (a) age of feeling in-between, (b) period of identity exploration, (c) time of self-focus, (d) age of possibilities, and (e) age of instability. This is considered to be a period of intense self-exploration, involving experimentation, transitions, and expansion of an individual’s self (Arnett, 2000). In the

United States, this phase of life coincides with undergraduate college life. It is normative

for emerging adults to increase the prevalence and exploration of sexual behaviors in response to increased freedom such as being out of the parental homes or being in a college environment (Turchik, Probst, Irvin, Chau, & Gidycz, 2009). Lefkowitz, Gillen,

Shearer and Boone (2004) also found that college students perceived engaging in sex as normative and that their sexual beliefs became more lenient after entering college. Due to their optimistic bias, emerging adults may underestimate their personal risk of contracting human immunodeficiency virus (HIV) or a sexually transmitted infection

(STI), in relation to their peers (Chapin, 2001; Patel, Yoskowitz, & Kaufman, 2006;

Patel, Yoskowitz, Kaufman, & Shortliffe, 2008). In fact, research has shown that emerging adults tend to perceive STI s and HIV/Acquired Immune Deficiency Syndrome

(AIDs) as an unlikely outcome of engaging in unprotected vaginal/anal sex (Adefuye,

Abiona, Balogun & Lukobo-Durrell, 2009; Cohen & Bruce, 1997). Additionally, studies indicate that emerging adults tend to underestimate the possibility of “hooking-up” with a partner who has HIV or an STI (Patel et al., 2008). Impulsivity and sensation-seeking behaviors increase during emerging adulthood and are associated with higher levels of sexual risk-taking behavior (Winters, Botzet, Fahnhorst, Baumel, & Lee, 2009; Cyders et al., 2010; Fulton, Marcus, & Payne, 2010). Further, early within emerging adulthood, intense positive mood states are often experienced which can decrease individuals’ ability to focus on long-term consequences (Cyders et al., 2010). Emerging adults may be more susceptible to the influence of personality traits and mood states on sexual risk-taking behaviors because the subcortical limbic system, that influences reasoning and judgment, is still developing during this life-stage (Casey, Jones, & Somerville, 2011). In sum, the

biopsychosocial changes occurring during the phase of emerging adulthood significantly

influence sexual behaviors and decision-making.

Sexual Activity Among College Students

Sexual activity is a common occurrence on college campuses. One hundred forty-

eight post-secondary institutions self-selected to participate in the spring 2015 National

College Health Assessment (NCHA) conducted by the American College Health

Association, and 116,432 surveys were completed by students on these campuses. Only institutions located in the United States that surveyed all students or used a random sampling technique were included, yielding a final data set consisting of 93,034 students attending 108 schools. According to NCHA data, almost 44.2% of students (44.8% male,

44% female) reported engaging in oral sex in the past 30 days. An estimated 48.1% of students (44.4% male and 50% female) reported engaging in vaginal sex, while 5.5%

(7.8% males and 4.3% females) reported engaging in anal sex in the past 30 days.

Although the NCHA data cannot be said to be generalizable to all the college and university students in the United States, it serves as a reference group for the purpose of comparison.

An increasing number of college students engage in multiple serial relational and extra-relational (at the same time) sexual experiences (Bogle, 2008). However, dating behavior is no longer the core of campus relations and single students rarely meet others through traditional dating. Although students understand the concept of formal dating, they do not often engage in this behavior (Bogle, 2008). A vast majority of today’s young adults, from a wide range of college student populations, report some personal “casual” sexual experience. Casual sex is a term used to refer to sexual relationships in an

uncommitted partnership (Paul, McManus & Hayes, 2000). These encounters are often based on sexual desire or physical attraction, are often spontaneous and impulsive, and frequently involve drugs or alcohol. Casual sexual relationships can be sexual experiences with strangers or friends and can be brief or long in duration. In research these relations have been referred to as "chance encounters,” "one-night stands,” "hook ups,” "socio-sexuality,” "anonymous sex,” and "casual sex.” In the popular press, it has been referred to as "meaningless sex", "friends with benefits," and "booty call"(Grello,

Welsh & Harper, 2006). A recent review found that lifetime prevalence rates of casual sex among college samples typically range from 60–80% (Garcia, Reber, Massey &

Merriwether, 2012). Lewis, Granato, Blayney, Lostutter and Kilmer (2012) studied hooking-up behaviors and emotional reactions among U.S college students. A random sample of 3,224 undergraduate students (ages 18-24) was invited to participate in a web- based screening survey for a larger study on sexual behavior and alcohol use. A total of

1,468 students participated in the larger study, while 1,388 fully completed the survey.

The sample included 56.4% women and 43.6% men. Ethnicity of the sample was 61.0%

Caucasian, 23.2% Asian, 9.4% multiracial, 6.4% other and 5.6 % Hispanic. The mean age for participants was 19.9 years. The researchers believed that this sample was nationally representative of college students. The majority of students (63.1%) reported not currently being in a monogamous relationship and 94.4% identified as heterosexual.

The researchers found that 83% of students reported that they had ever hooked up.

Hooking Up

Specifically, the casual sexual behavior termed as the “hook up” is at the center of heterosexual relationships on campus (Bogle, 2008; Garcia, Reiber, Massey, &

Meriwether, 2012; Stinson, 2010). A hook up broadly refers to an uncommitted sexual

encounter but there is no universally accepted definition. Lambert, Kahn and Apple

(2003) define "hooking up" as a behavior when two people agree to engage in sexual

behavior for which there is no future commitment. Glenn and Marquardt (2001) define a

hook-up as “sex without commitment” in which a heterosexual pair gets together for sex

without any expectations for the future. Paul and colleagues (2000) have defined a hook- up as a “sexual encounter which may or may not include sexual intercourse, usually occurring on only one occasion between two people who are strangers or brief acquaintances” (page 79). Broadly, hook-ups are characterized by the absence of traditional romantic relationships, lack of a priori agreements regarding the type of sexual experience to occur, and no promise of subsequent intimacy or relationship (Stinson,

2010; Bogle, 2008). In addition, a hook up can involve a wide variety of sexual behaviors ranging from heavy kissing, petting, oral sex, anal sex, mutual masturbation, and vaginal intercourse (Garcia & Reiber, 2008).

Scholars consistently demonstrate that “hooking up” is becoming increasingly

prevalent and normative on college campuses across the United States. In a study of

4,000 undergraduates from five U.S. universities across the country, England, Shafer, and

Fogarty (2007) reported that roughly 75 percent of students “hook up” at least once

during their college career, and 28 percent “hook up” 10 or more times. Heldman and

Wade (2010) cite a variety of reasons to explain this sexual paradigm shift from dating to

hooking up, including easing of college and university policies, the gender distribution of

students, increased alcohol use, greater access to and consumption of pornography,

increased sexual content of non-pornographic media, rising self-objectification and

narcissism, relaxed norms for marriage, and low perceptions of sexual risk. In examining social and psychological causes for hooking up, Stinson (2010) highlights the role of the shift in intimacy over the past century, social norms enforced by popular culture and peer groups, individual psychological characteristics, and the developmental transition period between adolescence and adulthood, known as emerging adulthood which is characterized by sexual experimentation.

Prevalence rates of hooking up in the United States range from 53% to 81% of the student population depending on the college campus surveyed (Grello et al., 2006; Flack et al., 2007; Paul & Hayes, 2000; Penhollow, Young, & Bailey, 2007; Reiber & Garcia,

2010). This behavior typically occurs with someone who is known and happens at parties, dorms, fraternity houses, bars and clubs which are all venues where alcohol is readily available (Paul & Hayes, 2002; Paul et al., 2000; Stinson, 2010).

England, Fitzgibbons Shafer and Fogarty (2007) surveyed more than 14,000 students from 19 universities and colleges nation-wide about their hook up, dating, and relationship experiences. They found that 72% of both men and women reported at least one hook up by their senior year in college. Of these, roughly 40 % engaged in three or fewer hook ups, 40 % between four and nine hook ups, and 20 % engaged in ten or more hook ups. Fielder and Carey (2010) examined the prevalence and characteristics of sexual hook ups among first-semester female college students at a private research university in the northeastern United States. Hook ups involving oral, vaginal, or anal sex were reported by 51% before college, 36% during their first semester, and 60% by the end of their first semester. They found that hook ups were more likely to involve friends or

acquaintances rather than strangers and that alcohol use preceded 64% of the hook ups.

Condoms were used only during 69% of vaginal sexual hook ups.

Most research studies on hooking up, which have compared men and women,

have had inconsistent findings. Some studies show that men hook up more often than

women (Manning, Longmore & Giordano, 2005; Paul & Hays, 2000; Penhollow et al.,

2007), whereas others failed to replicate this ﬁnding (Owen, Stanley & Fincham, 2010).

For example, Owen, et al. (2010) examined the demographic and psychosocial correlates

of hooking up in a convenience sample of 832 college students at a large southeastern

university in the U.S. In this study, a total of 578 participants were female, 247 were

male, and 7 did not indicate their sex. The sample was, on average, 20 years old (age

range, 17–54). The majority of the students were juniors (39.4%) followed by

sophomores (34.1%), freshman (19.5%), and seniors (5.4%); less than1% did not indicate

their grade level. Participants were 62.5% Caucasian, 11.1% Asian American, 9.8%

African American, 7.1% Hispanic, and 6.3% Multi-ethnic; 3.3% did not indicate race or ethnicity. A majority (93.4%) indicated that they were heterosexual, 2.4% identified as bisexual, 3.2% as gay or lesbian, and 1.0% did not respond. They found that similar proportions of men and women had hooked up but students of color were less likely to hook up than Caucasian students. More alcohol use, more favorable attitudes toward hooking up, and higher parental income were associated with a higher likelihood of having hooked up at least once in the past year.

Bradshaw, Kahn and Saville (2010) examined the relative benefits and costs associated with dating and hooking up among college students. Their convenience sample included 221 undergraduate students (71 men, 150 women) from a southern, public

university. Most participants were first year students (81.4%), white (89.1%), and

heterosexual (96.4%), with an average age of 18.72 years. A majority (115) of

participants reported being single, 29 were in a relationship of 6 months or less, 76 were

in a relationship of 7 months or more, and 1 was engaged. The researchers found that in

most situations women more than men preferred dating and men more than women

preferred hooking up. However, both men and women perceived similar benefits and

risks to dating and hooking up. Benefits of traditional dating included: having a partner

who is a friend, being loved, having a more productive relationship, being able to share

something you enjoy with another person, and physical intimacy. Risks associated with

traditional dating included: the potential of getting hurt, risk of a broken heart, losing a

friend if you cross the line, being more interested than your partner, risk of rejection and

loss of independence. Benefits of hooking up included: lack of expectation for

commitment (no strings attached), the experience being fun and exciting, feeling of being

wanted/desired and sexual gratification. Perceived risks of hooking up behaviors

included: contracting a sexually transmitted infection, unintended pregnancy, not

knowing the sexual history of your partner, risk of getting emotionally attached, and

wanting a relationship after the hook up when the other partner felt otherwise. The

sample in this study were predominantly white, heterosexual, first-year college students

and so the results may not be applicable to students across the college years or to noncollege students of the same age, of other racial and ethnic groups, and with other sexual orientations.

In another study, Olmstead, Pasley and Fincham (2013) examined the individual, social, relational, and family background correlates of hooking up, in general, and

penetrative hook ups, in particular, in a sample of undergraduate men enrolled at a large southeastern university. The final sample of 158 men had a mean age of 18.09 years.

Most (72.2%) reported their race as White, followed by Latino (12.7%), African

American (7.0%), Asian American (4.4%), and Other (3.8%). Most (94.3%) identified as heterosexual, followed by homosexual (3.8%), bisexual (0.6%), and 1.3% did not specify.

The researchers found that men were more likely to hook up if they had an extraverted personality, were consuming more alcohol, and had previous hook up experience. They were less likely to hook up if they were more thoughtful about their relationship decisions and if they were in a stable, committed romantic relationship. Men also were more likely to engage in penetrative hook ups only if they held more permissive attitudes towards sex and if they had previous penetrative hook up experience. Although this study provides insights into the correlates of hooking-up behaviors, results are not generalizable to all college men as study participants were recruited from a course on marriage and family relationships at one university.

Lambert, Kahn and Apple (2003) examined the extent to which pluralistic ignorance affects hooking up in a convenience sample of 175 female and 152 male undergraduate students from a mid-sized residential southeastern public university.

Pluralistic ignorance refers to a phenomenon in which individuals assume that their own private attitudes are more conservative than are those of others, even though their public behavior is identical (Miller and Mcfarland, 1991). They investigated participants’ comfort and their perceived peers ' comfort in engaging in a variety of sexual behaviors while hooking up. Analyses concerning pluralistic ignorance and comfort with hooking up were based on the data from 136 women (77.7% of female participants) and 128 men

(84.2% of male participants) who indicated that they had hooked up. They found that men expressed more comfort than did women in engaging in hook-up behaviors and both genders overestimated the other gender's comfort with hooking-up behaviors.

In a related study, Chia and Gunther (2006) found that students believed that their peers were significantly more sexually permissive than was actually the case. The convenience sample was composed of 312 college students, ages 18 to 25, at the

University of Wisconsin-Madison. About 73% of the respondents were female, and the majority were White (90%), whereas 1% were African American, 2% Latino, 5.2% Asian

American, and 0.3% others. The authors concluded that students formed such erroneous impressions of peers based in part on their perceptions of media influence on peers.

Students are unaware that their perceptions of media influence on others may be erroneous and consequently infer peer norms according to those perceptions. The more susceptible they believe their peers are to media influence, the more likely they are to believe that their peers are sexually active. Hence, they misjudge peer norms and overestimate their peers’ comfort with sexual behaviors. The researchers also found that male students who believed their peers to be more sexually permissive were more likely to engage in premarital and casual sex, whereas female students showed no such susceptibility. The authors offer two possible explanations for this sex difference. First, sex-related norms are likely to be more important for college men than for college women because men are more likely to share information about their sexual experiences freely as compared to women. Second, men and women may perceive similar amounts of peer pressure to be sexually active, but identification with peer groups is likely to be

more critical for college men than for college women (Prentice & Miller, 1993). As a

result, men are more responsive to the pressures of conformity.

Penhollow, Young and Bailey (2007) examined the relationship between

religiosity (religious feelings and attendance at religious services) and hooking up

behavior in 459 college students (35% male and 65% female) enrolled at a public four- year university located in the southeastern United States. The majority of the participants were white (88%), which was representative of the overall college population at this school. The researchers found that religious attendance and religious belief played a significant role in distinguishing between those who have and have not participated in hooking up behaviors. The generalizability of this study is limited as participants consisted of a convenience sample of single undergraduate college students at one university. Similarly, Burdette, Ellison, Hill and Glenn (2009) examined the impact of both individual and institutional religious involvement on "hooking up" in a national sample of 1,000 college women. They found that religious involvement reduced the odds of hooking up at college, and this pattern was driven by religious service attendance rather than religious affiliation or subjective religiosity.

Personality has the potential to influence a variety of sexual behaviors, including hooking-up behaviors. Paul, McManus and Hayes (2000) examined the relative importance of a variety of social and psychological predictors in understanding differences among undergraduate students who had never hooked up, those who had hooked up without sexual intercourse, and those who had hooked up with sexual intercourse. Participants were a random sample of 555 undergraduate students at a state college in the northeastern United States. The sample was comprised of 37.5% males and

62.5% females, ranging in age from 17 to 26 (modal ages were 20 and 21). Juniors (35%)

and seniors (39%) were overrepresented in the sample. Participants were 86% White/non-

Hispanic, 6% African American, 4% Hispanic, and 3% Asian students. A majority 98%

of the sample was heterosexual. The researchers found that those who had penetrative

hook ups reported greater impulsivity, less harm avoidance, poorer ability to seek out

affection and support, were more likely to have an erotic rather than a companionate love

style, and had more fears of intimacy due to the potential loss of individuality. This study

focused on traditional-aged college students and so the generalizability is limited.

Gute and Eshbaugh (2008) also examined personality traits as predictors of hooking up among undergraduate college students. Participants included 193 female and

54 male students in a human sexuality course at a medium-sized Midwestern university.

The mean age was 19.42 years. Approximately 77% of participants were 21 years old or

younger. Over 95% identified as Caucasian or White, with the remainder identifying as

Latino, African-American, and Asian. The overwhelming majority of participants were

heterosexual; three women identified themselves as bisexual, and one individual

identified himself as homosexual. Seventy-nine percent of participants were from cities

or towns with populations of fewer than 750,000 people. The researchers found that

greater extraversion and neuroticism increased the likelihood of engaging in non-

committed sexual behavior, but openness, conscientiousness, and agreeableness protected

individuals from these behaviors. Personality characteristics were predictive of hook-up

behaviors even after controlling for alcohol use. Generalizability of the findings is limited

as the data were collected from a medium-sized, Midwestern university from one course focused on human sexuality. Further, the proportion of male participants in this study was

low; over three-fourths of participants were women. The sample was also limited in terms of racial diversity and diversity of sexual orientation.

Owen and Fincham (2011) examined young adults’ engagement in, and reactions to, a “friends with benefits” relationship in the past year based on gender, psychological distress, alcohol use, and relationship attitudes. Their sample consisted of 889 participants drawn from a university course on families and so unlikely to be representative of the entire college population. The sample included 341 men and 548 women with a median age of 19 (range, 17–25) at a large southeastern university in the

United States. The majority of the participants identified as Caucasian (70.5%), 14.6% identified as African American, 11.8% identified as Latino, 2.7% identified as Asian

American, and 0.3% identified as Native American. The researchers found that college students who reported greater relationship thoughtfulness and planning with regards to important relationship decisions were less likely to engage in hook-up behavior.

However, this relationship was no longer significant after including additional variables such as depression, alcohol use and loneliness. Similarly in their study of undergraduate men enrolled at a large southeastern university, Olmstead and Fincham (2012) found that men were less likely to hook up if they were more thoughtful about their relationship decisions and if they were in a stable, committed romantic relationship.

Finally, research provides evidence that physical attractiveness is related to involvement in casual sexual relationships. Weeden and Sabini (2007) found that being physically attractive may create opportunities for casual involvement. Their sample was drawn from undergraduates (218 men and 238 women) at an elite, private university in the northeastern U.S, and therefore unlikely to be representative of the general college

student population. A majority (71%) were of non-Hispanic European descent, 15% were of Asian descent, 3% were of African descent and 11% identified as “other.” Almost

28% of participants were in a serious romantic relationship. The researchers found that measured attractiveness correlated moderately with sexual behaviors but not with socio- sexuality or sexual moral attitudes. Thus, higher levels of observable attractiveness may serve to increase opportunities for sex with multiple desirable partners without affecting interests in or moral acceptance of casual sex.

Summary and Critique

Hook ups or uncommitted sexual encounters are becoming progressively more prevalent in popular culture, reflecting both evolving sexual preferences and changing social and sexual culture. Hook-up activities may include a wide range of sexual behaviors, such as kissing, oral sex, and penetrative intercourse. These encounters often occur without any promise of, or desire for, a more traditional romantic relationship. A vast majority of today’s young adults, from a wide range of college student populations studied so far, report some personal casual sexual experience. Among college students, hook ups have been reported in a variety of college settings. The negative consequences of hook ups can include emotional and psychological injury, sexual violence, sexually transmitted infections, and unintended pregnancy. In addition to sexual risk-taking, another issue of concern involving hook ups is the high co-morbidity with substance use.

Although alcohol and drugs are likely a strong factor, it is still largely unclear what role individual differences play in shaping decisions to engage in hookups. The divergence between behaviors and desires, particularly with respect to social–sexual relationships, has dramatic implications for physical and mental health. Not all hook-up encounters are

necessarily wanted or consensual. In fact, individuals occasionally consent to engage in a

sexual act but do not necessarily want sex. A number of studies have included measures

of regret with respect to hook ups and these studies have documented the negative

feelings men and women may feel after hooking up. Understanding hook ups during the

critical stage of late adolescent development and young adulthood is important for

promoting healthy decision-making among emerging adults. However, although hooking

up behaviors are being extensively studied, that several deficits in our knowledge

continue to impede the understanding of hookup behavior. First, operational definitions

of hook ups differ among researchers making comparisons across studies difficult.

Second, recall bias may affect individuals’ reports of previous romantic and sexual

engagements and so much of the research asking participants about previous hook-up relationships may be biased due to recall. Third, most research to date focuses on heterosexual hook ups among emerging adults while hooking up behaviors among sexual minorities have not been adequately studied.

Risky Sexual Experiences

While not the focus of this current research, it is still important to note that risky

sexual behaviors are fairly common on college campuses (Trepka, Kim, Pekovic, Zamor,

Velez, & Gabaroni, 2008; Teague, 2009; Gil, 2005). Despite many public health efforts,

numerous college students continue to engage in risky sexual behaviors, such as

participating in sexual behaviors with numerous partners, failing to discuss safer sex

options with partners prior to sexual activity, failing to use condoms consistently and

properly during sexual intercourse, and using alcohol and drugs prior to sexual activity

(Baldwin & Baldwin, 2000; Flannery et al. 2003; Gullette & Lyons 2006).

The National College Health Assessment (NCHA 2015) of 93,034 students at 108 schools revealed that only 50.2% of students who engaged in vaginal sex used a condom or other protective barrier within the last 30 days. Only 5.1% of students surveyed used a condom or other protective barrier for oral sex, whereas 29.3% used protection during anal sex. Only 54.4% of students reported the use of another type of contraceptive by themselves or their partners the last time they had sexual intercourse, while 45.6% reported that they did not. An estimated 16.3% of college students engaging in vaginal sex reported using (or reported their partner used) emergency contraception ("morning after pill") within the last 12 months. Despite public health awareness, 1.4 % of college students who had vaginal intercourse within the last 12 months reported experiencing an unintentional pregnancy or got someone pregnant. As can be seen from this national survey, risky sexual behaviors remain a serious problem on college campuses and may even be on the increase (Turchik & Garske, 2008). [Note: drinking alcohol and engaging in sexual activity will be discussed in a separate section].

Unwanted Sexual Experiences

While not the focus of this current study, unwanted sexual experiences may overlap with regretted sex. Partnered sexual activity is typically looked at in dichotomous terms as consensual or non-consensual with the assumption that a consensual sexual encounter is a wanted one (Peterson & Muehlenhard, 2007). However, a growing body of literature suggests that acquiescing to a partner’s sexual overtures does not necessarily indicate interest or desire. A closer examination of unwanted sex has revealed the ambiguity and complexity of consent and wantedness (Muehlenhard & Peterson, 2005).

Recent research by Peterson and Muehlenhard (2007) indicates that wantedness is a

continuous and multidimensional construct. An individual may want a sexual interaction for a variety of reasons and simultaneously not want it for others. Sex can be unwanted and consensual (giving into a partner to bring more intimacy and emotional connection to the relationship). Sex can be wanted and nonconsensual (e.g. wanting sex in the beginning but then passing out from alcohol consumption, thus being unable to consent to further sexual activity). Hence, research indicates that the term unwanted should not be used synonymously with nonconsensual sex but rather be considered as two distinct, but sometimes overlapping phenomena.

There is extensive variation in the definition of unwanted sex. Flack and colleagues (2007) define unwanted sexual behavior as a general concept than includes sexual assault or rape but that may also incorporate any behavior involving sexual contact experienced as harmful or regretful during or following the incident. Thus, in addition to unwanted sexual intercourse involving vaginal, anal, or genital-oral contact, non- penetrating behavior, such as fondling, is also included in this construct. Stated differently, unwanted sexual experiences comprise any of a variety of behaviors that can be consensual or nonconsensual, which may include experiences referred to as regretted sex, aggressive sex, incapacitated sex, sexual assault and rape (Banyard, Ward, Cohn,

Plante, Moorhead & Walsh, 2007).

Unwanted sexual behavior, including assault and rape, remains an all too common experience among college students (U.S. Department of Justice, 2000). Research suggests that almost half (between 44% and 47%) of all sexually active American undergraduates have consented to unwanted coitus (O’Sullivan & Allgeier, 1998; Sprecher, Hatfield,

Cortese, Potapova, & Levitskaya, 1994). In a representative sample of 178 students (107

women and 71 men) at a small liberal arts university, Flack and colleagues (2007) found

that 44% of their female college sample experienced unwanted sex. Studies have found

that between 15-25 percent of male college students initiate an unwanted sexual

experience (Malamuth, Sockloskie, Koss, & Tanaka, 1991). In their study of unwanted

sex in male students, Muehlenhard and Cook (1988) found that when sexual activity was

inclusive of kissing, petting, and intercourse, women were more likely than men to report

high rates of consenting to unwanted sex. However, when sexual activity was limited to

intercourse only, men reported higher rates of consenting to unwanted sex than women.

In sum, the literature suggests that consensual unwanted sex occurs across genders, on

several occasions and across multiple partners.

Research has identified several reasons for engaging in unwanted sexual behavior.

Flack and colleagues (2007) studied unwanted sexual experiences in the collegiate hooking-up culture in a representative sample of 178 students at a small liberal arts

university. Their study indicated that 23% of women and 7% of men reported

experiencing an unwanted sexual encounter. Seventy-eight percent of all unwanted sex

(vaginal, anal, and oral) took place during a hook up. They also found that judgment

impaired by alcohol and drugs was the most frequently cited reason for unwanted sex

(62.2%). Other frequently reported reasons were: happened before I could stop it

(37.8%), taken advantage of because I was wasted (32.4%), thought I wanted it at the

time (32.4%), and easier to go along with it than cause trouble (24.3%). Students at this

campus were predominantly Caucasian and from upper middle-class backgrounds. The

vast majority of the sample identified as heterosexual (97.8%), with three students (1.7%)

identifying as bisexual and one student (0.6%) identifying as homosexual. Thus, the

study findings cannot be generalized to students of color, those of bisexual or homosexual orientation, students hailing from lower socioeconomic backgrounds, students enrolled in large public colleges or those in urban settings.

Among college students, commonly reported reasons for consenting to unwanted sex were related to partner and relationship promotion. Specifically, men and women identified satisfying a partner’s need, avoiding relationship tension, not wanting to make the partner feel rejected, and promoting intimacy in the relationship as reasons for engaging in unwanted sexual activity with a dating partner (Impett & Peplau, 2002;

Muehlenhard & Cook, 1988; O’Sullivan & Allgeier, 1998). Women also identified physical or verbal coercion, and a feeling of obligation to have sex with their partner, whereas men admitted engaging in unwanted sexual activity because there was nothing else to do (Muehlenhard & Cook, 1988). Less frequently reported reasons for consensual unwanted sex among college women included worry about threats to end the relationship, worry that the partner would not be interested anymore, and the desire to gain sexual experience (Impett & Peplau, 2002). Some of the reasons given for engaging in unwanted sex appear to be products of gender norms and scripts. For instance, studies have shown that many young women consent to or want sexual contact due to the following: the wish to maintain a relationship (Impett & Peplau, 2002), feeling that a male partner was aroused to a point of no return (Shotland & Hunter, 1995), partner pressure ranging from

‘‘sweet-talking’’ to explicit threats (Gavey, 1992; Livingston, Buddie, Testa, & VanZile-

Tamsen, 2004), fear of negative partner response to women’s initiation of behaviors such as condom use (Sione´an et al., 2002), and self-protection against violence (Basile, 1999).

Muehlenhard & Cook (1988) studied men’s experience with unwanted sexual activity in a convenience sample of 507 male and 486 female college students (mean ages were 20 for men and 19.3 for women) enrolled in an introductory psychology class at

Texas A & M university. For men and women respectively, 41.9% and 65.8% were freshmen, 29.5% and 23.4% were sophomores, 21% and 7.6% were juniors, and 7.6% and 3.2% were seniors. Regarding race/ethnicity, 88.6% and 90.4% were white, 7% and

4.9% were Hispanic, 2 % and 2.1 % were black, 1.2% and 1.3% were oriental, and 1.2% and 1.3% were other. A majority (96.8%) of men and (97.9%) of women were heterosexual, 1.0% of men and 1.7% of women were homosexual, 2.2% of men and 0.4% of women were bisexual. Thirteen general reasons emerged for engaging in unwanted sexual behaviors. These included: enticement, physical coercion, intoxication, altruism

(to not make the partner feel rejected), inexperience, peer pressure, fear of termination of relationship, wanting popularity, partner’s verbal coercion, sex-role concerns, reluctance, partner’s threat of self-harm, and family pressure. Further, they found that men and women who engaged in unwanted sex tended to believe that women’s resistance to sex is often only token, done so that women can have sex without appearing to be promiscuous.

Although the literature on the direct effects of consensual unwanted sex is scarce, the existing data suggest that an inability to negotiate sexual practices may result in negative consequences such as psychological distress. Among college students who reported engaging in unwanted sex, the most frequently reported negative outcome was emotional discomfort, including disappointment in oneself or discomfort about engaging in meaningless sex (O’Sullivan & Allgeier, 1998). Similar negative outcomes have been reported in the research on consent to coercion. Sexual pressure in a relationship has been

associated with negative feelings among college women who were pressured by their

dating partner (O’Sullivan & Allgeier, 1998). Similarly, college men reported anecdotal

reactions of shame and sadness in response to unwanted sex (Larimer, Lydum, Anderson

&Turner, 1996). Among college-aged men, rates of depressive symptoms, were higher in

those who had engaged in unwanted sexual intercourse with a female partner (Larimer et al., 1999).

The impact of non-consensual unwanted sexual experiences is more extensively studied. Rape victims are at an increased risk for various mental disorders, including depression and suicidal ideation/attempts (Broman-Fulks et al., 2007; Tjaden &

Thoennes, 2006). Some rape victims have reported experiencing acute symptoms (e.g., nausea, diarrhea, dizziness, numbness, fatigue, headaches, and back/joint/abdominal pain), chronic diseases (e.g., hypertension, diabetes, allergy, dermatitis) and somatic symptoms affecting their reproductive organs and sexual well-being (e.g., premenstrual

distress, sexual anhedonia and anorgasmia) at an increased rate compared to females who

had not experienced rape (Walker, Gelfand, Katon, Koss, Von Korff, Bernstein, &

Russo,1999). Overall, unwanted sexual experiences, whether consensual or non-

consensual, can have a long lasting negative impact on physical health and psychological

well-being (Tjaden & Thoennes, 2006).

Summary and Critique

Consensual unwanted sex is the act of acquiescing to sexual advances when there

is no desire to engage in sexual activity. While previous research has extensively

investigated sexual experiences involving rape, less is known about consensual,

unwanted sexual activity. Few studies to date have investigated the correlates of

unwanted yet consensual sexual behavior. Although this behavior has received relatively

little attention, previous research has reported a high prevalence of unwanted sex in the

college student population. The increased prevalence of hooking up on college campuses

may be the single most important factor in the currently high incidence of unwanted sex

among women. Many studies also indicate a gender difference in consensual unwanted

sex with women typically reporting higher rates than men; however some studies have

only included women participants. Individuals who decide to engage in unwanted sexual

activity may be more likely to repeat this behavior within a relationship and across

partners. Although literature on the direct effects of consensual unwanted sex is scarce,

the existing data suggest that an inability to negotiate sexual practices may result in

negative consequences such as psychological distress.

There are a number of factors that make a review of the literature on unwanted

sexual experiences challenging. Previous research in the area of consensual unwanted

sex has employed various measurement procedures including variations of self-report

methods. Studies have varied in types of sexual behaviors examined, style of questions

assessing behavior, and time frame of reference. While some studies have inquired

exclusively about unwanted sexual intercourse, others have included a range of sexual

behaviors from kissing and petting to sexual intercourse. Still other studies examining

unwanted sexual behaviors did not specify the type of sexual behavior under

investigation. Failure to define the construct clearly allows for variation in participants’

perception and possible inaccurate and incomparable reporting.

Previous studies examining the construct of unwanted sex have not employed a standardized, reliable method of measuring this behavior. Consensual unwanted sex has

typically been measured by one or two questions that asked if participants had engaged or

would engage in unwanted sexual behaviors. Within these studies, questions have varied

in terms of contexts, relationship types, and response choices. Some questions have asked

participants to estimate their likely behavior in a hypothetical situation, while others have

asked for reports on actual experiences. Some studies have assessed current behavior

with a current partner while others have assessed lifetime behavior. Response choices to

these questions have included categories, frequencies, likelihood and open-ended

responses. These variations make it difficult to compare studies and draw conclusions

about unwanted sexual behaviors in that participants across studies may be reporting on

different behaviors within varying contexts. Further, most previous research on unwanted

sex has been conducted primarily with Caucasian heterosexual women. There is a dearth

of research on unwanted sexual experiences among men, racial/ethnic minorities and

those with homosexual and bisexual orientations.

Alcohol and Sexual Activity

Scholars have identified a prominent culture of drinking alcohol on college

campus in the United States (Vander Ven & Beck, 2009). The highest rates of problems

with alcohol use typically occur among young adults, with the majority of problems occurring between the ages of 18-24 (Grant, Dawson, Stinson, Chou, Dufour, &

Pickering, 2004; Schulenberg & Maggs, 2001). More than half of full-time college students in the United States are current drinkers (59% drank alcohol during the past month), and 39% are characterized as “binge” drinkers, having more than 5 or 4 drinks in a row on 1 occasion during the past month, for males and females, respectively

(Substance Abuse and Mental Health Services Administration, 2014). Moreover, college

students tend to drink more than their non-college peers (Johnston & White, 2003;

Wechsler et al., 2002), usually in the form of weekend-binge drinking (Schulenberg &

Maggs, 2001). Four in five college students drink alcohol, and two in five college students report heavy episodic, or binge, drinking (Wechsler et al., 2002).

Two established theories depict alcohol as a cause of disinhibited social/sexual behaviors: alcohol myopia and expectancy theories. Alcohol myopia theory (Steele &

Josephs, 1990) posits that disinhibited behavior results from an interaction of diminished cognitive capabilities and the specific cues that influence behavior in a given situation.

According to this theory, alcohol use may lead to sexual activity directly through disinhibition (Kaly, Heesacker, & Frost, 2002; MacDonald, MacDonald, Zanna, & Fong,

2000; Steele & Josephs, 1990). Myopia theory states that the acute disinhibitory effects of alcohol reduce the ability to process complex information such as long-term goals, thus allowing immediate and salient goals, such as sexual arousal, to influence behavior more strongly (Cooper, 2002; Dermen & Cooper, 2000; Steele & Josephs, 1990).

Leeman, Toll & Volpicelli (2007) describe three types of disinhibiting effects of alcohol, including engaging in casual consensual sex with someone you are not dating, engaging in consensual sexual acts that you would be less likely to take part in when not drinking, and hooking up with someone who you are not dating.

To test alcohol myopia theory, Ebel-Lam MacDonald, Zanna and Fong (2009) performed an experimental investigation of the interactive effects of alcohol and sexual arousal on intentions to have unprotected sex. Their sample consisted of 79 male undergraduate students who were recruited from two Canadian universities, and was not representative of the general college student population. They presented male participants

with a video vignette in which two undergraduates decide whether to have unprotected

sexual intercourse. Participants were asked what they would do if they were in a similar

situation. They found that among sober participants, those assigned to a sexually arousing

or neutral condition did not differ in their intentions to engage in unprotected sexual

intercourse. Among intoxicated participants, however, those assigned to the sexually

arousing condition reported that they were more likely to have unprotected sex than did

those assigned to the sober condition. These findings supported the theory (Steele &

Josephs, 1990) and were consistent with prior non-experimental work (MacDonald,

MacDonald, Zanna, & Fong, 2000). Similarly, Patrick and Maggs (2009) found that

individuals were more likely to engage in oral sex due to the disinhibitory effects of

alcohol, while penetrative sex was more often determined by other factors including the

strength of the interpersonal relationship.

While alcohol myopia theory emphasizes pharmacological mechanisms,

expectancy theory emphasizes psychological ones. According to expectancy theory, an

individual’s behavior after drinking is driven by pre-existing beliefs about alcohol’s effects on behavior, much like a self-fulfilling prophecy (Cooper, 2002; Dermen &

Cooper, 2000). Conversely, the desire to engage in sexual behavior may lead to heavier drinking because of the belief that alcohol favorably influences sexuality. Based on alcohol expectancy theory, some college students use alcohol with the expectation that alcohol facilitates sexual drive and sexual affect and decreases sexual inhibitions

(Kotchick, Shaffer, Forehand, & Miller, 2001). In fact, survey research has found relatively strong correlations between expectancies and alcohol use (Brown, 1985; Leigh

& Stacy, 1993; Southwick, Steele, Marlatt, & Lindell, 1981). Several studies have

documented a positive relationship between endorsement of alcohol expectancies regarding sex and engagement in risky sexual behavior (Fromme, Katz, & Rivet, 1997;

LaBrie, Schiffman, & Earleywine, 2002; Patrick & Maggs, 2009; LaBrie, Earleywine,

Schiffman, Pedersen & Marriot 2005; O'Hare, 2005).

A reverse causal explanation posits that the intention or desire to engage in risky sex causes one to drink when sexual opportunity presents itself. Hence, in some cases, the intention to engage in sexual behaviors may precede and facilitate drinking rather than the reverse. Lindgren, Pantalone, Lewis & George (2009) used focus groups to investigate 14 male and 15 female undergraduates’ conceptualizations of the relations between alcohol and consensual sex. They were recruited from the Psychology

Department subject pool at a large, public university in the Pacific Northwestern

U.S. Seventy-six percent of the participants were in the first year of college at a large, public university in the Pacific Northwest. The majority (73%) were Caucasian while the remaining 27% identified as Asian (four students), biracial (3 students), or African

American (1 student). All participants self-identified as heterosexual. The researchers concluded that college students drank, or went to settings in which drinking occurred, in order to find a sexual partner. The effects of alcohol lowered the priority given to personal morals or values while reducing inhibitions on sexual arousal. For men, drinking resulted in decreased inhibitions and increased the likelihood that they would make more direct sexual comments to women. Men also expressed mostly positive feelings about the ways in which alcohol affected their dating and sex lives. They enjoyed the freedom that came with the decreased inhibitions associated with alcohol and appreciated the benefits of pursuing women more directly due to the effects of alcohol. For women, alcohol

effects provided an excuse for desiring more aggressive sexual activity. Similarly,

Vander Ven and Beck (2009) examined the relationship between alcohol intoxication and sex by investigating the ways in which college students use alcohol as a tool to facilitate, explain, and justify sexual encounters and casual coupling (e.g., kissing, ‘‘making out,’’

petting, touching). They administered 469 surveys and conducted 32 individual

interviews across three American universities, including a small private college in the

Northern Central region of the United States, a commuter-based state school in the

Southeast, and a large state school in the Midwest. Interviews were arranged through

snowball sampling of university students. The sample had a mean age of 20 years and

56% of the respondents were female. The sample contained 35% freshmen, 25%

sophomores, 22% juniors, and 18% seniors. The researchers believed that the sample

respondents represented a relatively privileged population. They found that college

students use alcohol as a tool to facilitate, explain, and justify sexual encounters and

casual coupling (kissing, making out, petting, touching). Their findings suggest that

college drinkers view alcohol as a disinhibiting force that elevates the potential for

sexuality and that alcohol intoxication is also used as a resource to justify casual coupling

events, before and after the fact. Therefore, it seems clear that alcohol consumption

increases opportunities for engaging in sexual behaviors. In the following sections, the

relationships between alcohol and risky sex, as well as unwanted sex, will be examined.

Relationship Between Alcohol and Risky Sex

In a review by Cooper (2002), global and situational alcohol use were generally

connected to having a greater number of sexual partners, less condom use, and more

frequent instances of unprotected sex with multiple partners. At the global level, evidence

suggests that heavier drinking is associated with increased sexual risk taking (Halpern-

Felsher, Millstein, & Ellen, 1996), a finding that has been established in a large number

of studies with a variety of populations (Cooper, 2008; Graves, 1995; Hingson, Strunin,

Berlin, & Heeren, 1990; Wechsler, Davenport, Dowdall, Moeykens, & Castillo, 1994).

However, global association studies cannot prove causality due to the correlational nature of their designs. In other words, they fail to examine the actual co-occurrence of alcohol

use with risky sex (Leigh & Stall, 1993).

Other studies have examined the relationship between alcohol and risky sex at the

situational level by asking respondents to estimate the frequency of drinking prior to

intercourse and the frequency of having unprotected sex within a specified period of time.

Some of these studies have supported an association between drinking and risky sex

(Halpern-Felsher, Millstein and Ellen, 1996). Several of these studies (Cooper, Pierce, &

Huselid, 1994; Corbin & Fromme, 2002; Dermen & Cooper, 2000; Dermen, Cooper, &

Agocha, 1998; Koch, Palmer, Vicary, & Wood, 1999) have found evidence suggesting

that alcohol use led to, at best, a moderate increase in risky sexual behaviors (i.e., no

condom use or HIV discussion, unknown partner). However, other event-level studies that link alcohol use to sexual activity for specific encounters show no difference in condom use for drinking versus non-drinking encounters (Vélez-Blasini, 2008; Brown &

Vanable; 2007).

In addition, researchers have examined the relationship between alcohol and risky

sex using daily activity logs for periods of time ranging from a few weeks to up to 3

months (Fortenberry, Costa, Jessor & Donovan, 1997; Harvey & Beckman, 1986; Leigh,

1993; Morrison, Gillmore, Hoppe, Gaylord, & Leigh, 2003). Contrary to the evidence in

other types of studies, in none of these studies was alcohol use related to an increase of

risky sexual behavior.

Several studies also have explored the relationship between alcohol and risky sex using experimental designs. For instance, MacDonald, Zanna, and Fong (1996) developed a video clip of an attractive male and female couple drinking alcohol and having fun in a university campus bar. The video clip showed them passionately kissing and consensually finding themselves in her apartment where they were faced with the dilemma of a mutual desire to have sex without access to a condom. The video clip was

presented to 24 sober and 30 intoxicated college males at the University of Waterloo,

who were asked to rate their intentions of having sex with the woman in the video, and

provide justifications for these intentions. Consistent with predictions of the alcohol

myopia model, compared with sober men, intoxicated subjects directed more attention to

the salient sexually arousing cues in the video clip than those signaling the dangers of

unprotected sex as evidenced by their greater intentions to have sex and providing more

justifications to do so. Although such experiments have provided evidence of a causal

role for alcohol consumption on sexual risk taking, the ecological validity of this type of

research has been questioned.

In order to better understand the relationship between alcohol and sexual

behavior, the role of third variables has often been cited (Cooper, 2006; Patrick & Maggs,

2009; Weinhardt & Carey, 2000). Third variables are features of the individual or life

situation that explain the co-variation between drinking alcohol and engaging in sexual

behavior. Researchers have assembled a body of direct evidence showing that co-

variation between the two behaviors can often be explained by third variables, and

indirect evidence showing that involvement in both behaviors is linked to the same putative causal factors. Many studies support the contention that the association between drinking and risky sex is at least partly due to the influence of underlying common causes. A review of well-studied key variables is presented below.

Cooper, Wood, Orcutt, and Albino (2003) used longitudinal data from a representative sample of 1,978 black and white adolescents to examine the role of personality in multiple risk or problem behaviors. Participants for this study included a random sample of adolescents aged 13 to 19 years, residing in Buffalo, New York. They found that traits such as avoidance coping, thrill seeking and impulsivity appear to be important common factors that partially account for the link between drinking and risky sex. The researchers believe that personality and behavioral dimensions (socio-sexuality, impulsivity, sensation seeking, sociability, and usual drinking) provided a better explanation for sexual risk taking than acute alcohol effects. Similarly, an individual might also drink and have risky sex as part of a lifestyle, such as being single or living in a fraternity house, where both behaviors are tacitly or openly encouraged.

Consistent with the third variable explanation, perceptions of peer norms related to drinking and sex are among the most robust predictors of involvement in both behaviors among youth. Klein, Geaghan and MacDonald (2007) studied how risk perceptions regarding unplanned sexual activity following alcohol use are prospectively related to subsequent alcohol consumption in a random sample of 380 freshmen students at Colby college, a liberal arts college in the northeastern United States. They found that risk perceptions regarding sexual activity may play a role in college students' alcohol use.

Martens et al., (2006) compared perceptions of peer norms in the areas of alcohol use,

drug use, and sexual behavior with actual behavior and determined if a relationship existed between a student’s perceptions of normative behavior and a student’s actual behavior. Participants were 833 college students at a large, public university in the

Northeast. The researchers found that students overestimated alcohol use, drug use, and sexual behavior among their peers. Furthermore, they found a positive relationship between actual behavior and perceived peer norms.

Bon, Hittner and Lawandales (2001) studied normative perceptions in relation to substance use and HIV-risk behaviors of college students. Their convenience sample included 410 college students (136 men and 258 women; 16 did not report gender) who were surveyed in their classes at a medium-sized public university in the southeastern

United States during the fall of 1997. The vast majority of the sample was White

(86.4%), with a remaining racial breakdown of Black (7.2%), Hispanic (1.2%), Asian or

Pacific Islander (1.2%), American Indian or Alaskan Native (1.2%), and other (2.5%).

Most students were single, but 4.4% were married, and the majority (96.1%) was full- time students. The researchers found that HIV-risk behavior when drunk or high was predicted by personal substance use as well as by number of recent partners and normative perceptions of peer sexual behavior.

Relationship and contextual characteristics may influence the association between drinking and sexual behavior as well. Goldstein, Barnett, Pedlow and Murphy (2007) examined drinking in conjunction with sexual experiences among 225 at-risk college student drinkers attending a private university in the Northeast. Participants completed a baseline assessment as part of a clinical trial of a brief intervention for students required to attend a session of alcohol education following medical evaluation for intoxication or a

disciplinary hearing for an alcohol-related violation. Of the eligible 221 participants,

51.1% were women and 48.9% were men. The average age of participants was 18.8

years, and the majority were freshmen (67.9%). For race and ethnicity, the majority of

participants endorsed white (73.8%); the remaining endorsed Hispanic (12.2%), Asian

(12.7%), black (3.6%), American Indian (2.3%), and “other” (9.0%). Results of the study

indicated that college students are more likely to drink in conjunction with new and less-

committed sexual partnerships. Alcohol use was also associated with fewer discussions of

topics pertinent to safer-sexual practices. The researchers found that there was a tendency

for drinking in conjunction with a new vaginal sexual experience and this was associated

with a lower likelihood of contraceptive use.

Similarly, Brown and Vanable (2007) attempted to characterize partner type differences in the association between alcohol use and unprotected sex in a convenience sample of young adults recruited at a large university in the northeastern United States.

A total of 547 participants provided completed surveys. The sample was restricted to 330 participants who reported having vaginal sex during their most recent sexual encounter.

Among these respondents, 67% were female, with a median age of 19 years. Participants self-identified as Caucasian (82%), Asian/Pacific Islander (4%), African-American (6%),

Latino (4%), and “Other” (4%). Responding to a behavioral measure of sexual orientation, the majority of participants indicated that they were attracted only to the opposite sex (90%). Among the sample, 3% reported a lifetime history of one or more sexually transmitted disease. The researchers found that for sexual encounters involving a non-steady partner, alcohol consumption was associated with an increase in unprotected

vaginal sex, whereas rates of unprotected vaginal sex did not vary by drinking status for

encounters involving a steady partner

Scott-Sheldon, Carey and Carey (2010) used multiple event-level methodology to

examine the relation between risky sexual behavior and alcohol use among sexually

active, heavy drinking college students. The convenience sample consisted of 221

undergraduates (67% female, 87% White, mean age 19 years, 55% freshman, 21% Greek

members/pledges) attending Syracuse University. Participants were included if they

reported greater than one episode of heavy episodic drinking in the preceding month,

sexual activity during the past ninety days and were between 18 to 25 years of

age. Results from this study provide evidence of a relationship between unprotected

vaginal and anal sex concurrent with heavy alcohol consumption but this relationship

varied by gender and partner type (steady vs. casual). Within-subjects analyses, restricted

to those who reported both heavy alcohol consumption concurrent with sex and sex when

no alcohol consumption occurred, revealed an association between less condom use and

heavy alcohol consumption with steady but not casual sexual partners. However,

multilevel regression analysis revealed a more complex pattern. Consistent with the

within-subjects analyses, condom use was unrelated to alcohol consumption for both men

and women. Among women, but not men, less condom use was associated with steady

versus casual sexual partners, but partner type interacted with alcohol consumption such

that less condom use occurred when heavy drinking preceded sex with steady partners. In

this study, the sample consisted of sexually-active heavy drinking college students attending a university in upstate New York, and may not be representative of the overall population of heavy-drinking individuals.

Koch, Porter and Colaco (2007) examined the relationship between alcohol consumption, communication and use of protection among 359 undergraduate students at

Penn State University. These students were recruited from general education courses and so the researchers believed that they were representative of the university. The respondents ranged in age from eighteen to thirty five years of age with a mean age of

20.9; 97% were between the ages of eighteen and twenty-three. Most (84.7%) identified themselves as White. The majority of participants (60.8%) were upperclassmen and most

(76.3%) identified themselves as not being a member of a social sorority/fraternity or a member of a sports team. Almost two-thirds (63.5%) of the respondents lived-off campus while 27.6% resided in a dormitory. Almost all of the respondents had consumed alcohol

(91.4%) and engaged in sexual intercourse (87.5%) in the previous two months. The researchers used structural equation modeling to examine the mechanisms through which being drunk or wasted influenced the likelihood of using protection during sexual intercourse. They found that discussion of feelings significantly predicted the actual use of protection during sexual intercourse. The variable “discussion of protection” was found to mediate the relationship between discussion of emotional commitment and actual use of protection. When controlling for the nature of the relationship status, being drunk or wasted was significantly and negatively associated with discussion of feelings or emotional commitment. These findings imply that while being drunk or wasted may not be a significant predictor of condom use, at these levels of inebriation the ability to discuss sexual topics is impaired, and this in turn negatively impacts condom use.

Summary and Critique

The existing literature suggests that the relationship between alcohol use and risky sex is complex. It cannot be explained by a single mechanism but instead reflects multiple underlying causal and non-causal processes. Furthermore, even the causal portion of this relationship is often an interaction effect rather than a main effect (Cooper,

2006). Broadly, three methodological approaches have been used to examine the relationship namely global correlation studies, situational covariation studies and event analyses. In global correlational studies, participants’ general patterns of alcohol use are examined in relationship to their general patterns of sexual behavior. Global correlation studies have shown that adolescents who use alcohol are more likely to be sexually active than non-drinkers, and may also engage in more risky sexual practices. These studies have also found that adolescents and adults who drink heavily are more likely to engage in unprotected sexual intercourse. These studies, examining the overall relationship between drinking status and sexual behaviors, are limited to describing patterns of general covariation. They do not provide information about the degree to which alcohol use and sexual behavior co-occur on the same occasion, and therefore cannot inform us about potential causal effects of alcohol and sexual behavior.

A number of studies have attempted to determine whether alcohol is being consumed proximal to the act of sexual intercourse by examining patterns of risky sexual behavior among individuals who use or do not use alcohol in conjunction with sex. In general, these studies correlate the frequency of unprotected sex over a period of intercourse over a specified time period with the frequency of alcohol used proximal to sexual intercourse for the same time period. Many but not all studies find that individuals

who use alcohol during sex are more likely to engage in high risk sexual behavior. These

studies are relatively more informative than global correlation studies, as they examine

effects from using alcohol during sexual events. However, they still do not address the

important temporal relationship between alcohol use and risky sexual behavior. These

studies still fail to describe what happened on an event-by-event basis, and thus do not determine whether the occasions characterized by unprotected intercourse were the same occasions during which alcohol was consumed. Furthermore, global and correlational studies fail to address the temporal association between alcohol use and risky sexual behavior. It is plausible that both behaviors are caused by a third factor, and that any observed relationship between the two factors is a spurious one (Cooper, 2006).

The most rigorous studies investigating the evidence between alcohol and risky sexual behavior have employed event analysis. These studies assure focus on the concurrence between alcohol use and sexual behaviors by inquiring about a specific, discrete sexual event, such as the most recent time had sexual intercourse or the first sexual event ever (Weinhardt and Carey, 2000). The most useful of these studies compare at least two discrete events for each subject. In these studies, subjects provide information on events which did and did not involve alcohol use. This within-subjects design controls for the effects of dispositional factors because subjects essentially serve as their own controls. Furthermore, by examining two events for the same individual and by using within-subjects design, it is possible to control for other factors that may confound the alcohol-risky sex relationship. In contrast, studies which inquire about a single sexual event are unable to assess the contribution of these potential third variables.

Despite the rigor of such analyses, these studies still suffer from several methodologic

limitations. First, they are limited by recall bias resulting from their use of retrospective

data. Second, studies comparing more than one sexual event may be confounding the

developmental level within subjects across the time of events being compared. Third,

although many studies using event analysis inquire about more than one type of sexual

relationship for a given subject, most studies fail to examine both sexual events where the

subject has versus has not been drinking (Halpern-Felsher, Millstein & Ellen, 1996).

Therefore, these studies cannot offer information on whether an adolescent is more likely

to engage in sexual activity while under the influence of alcohol than when not drinking.

Similarly, these studies cannot determine the level of alcohol consumption necessary to

influence sexual behavior. Lastly, event analysis can be problematic if they compare

subjects across different types of relationships. A few studies have employed

experimental designs to assess the relationship between alcohol and sexual risk taking.

Although these studies provide insight into the relationship between these two variables, their ecological validity is questionable (MacDonald, Zanna and Fong, 1996).

Relationship Between Alcohol and Unwanted Sex

Alcohol use is also a risk factor for both hooking up and unwanted sexual

experiences (Fielder & Carey, 2010; Testa, Hoffman, & Livingston, 2010). Unwanted

sexual experiences encompass a variety of behaviors that can be consensual or

nonconsensual and can include experiences referred to as regretted sex, aggressive sex,

incapacitated sex, sexual assault and rape. In their study of unwanted sexual experiences

in a representative sample of 178 students at a small liberal arts university, Flack and

colleagues (2007) found that “judgment impaired by alcohol and drugs” was the most

frequently cited reason for unwanted sex (62.2%). These researchers found that one third

of female college students experienced some form of unwanted sex usually under the influence of alcohol. Of this group, 78% of the unwanted sexual encounters took place during a hook-up.

Numerous studies have implicated alcohol as a cause or contributor to sexual assault (Abbey, 2004). For instance, For example, in a representative sample of 814 men at a large urban university, Abbey and colleagues (1998) found that 47% of the college men in their sample who acknowledged committing sexual assault were drinking alcohol at the time of the assault. Similarly, about half of all sexual assault victims report that they were drinking alcohol at the time of the assault (Abbey, 2004). Muehlenhard and

Linton (1987) examined the incidence of and the risk factors for date rape and other

forms of male-against-female sexual aggression in dating situations in a sample of 341

women and 294 men. They compared levels of alcohol consumption on dates during

which sexual aggression occurred to those dates during which sexual aggression did not

occur. These investigators found that heavy alcohol use by both the perpetrator and

victim was more likely on dates in which sexual aggression occurred. In their study of

179 freshmen College women, Parks and colleagues (2008) assessed the temporal relationship between alcohol consumption and verbal, physical, and sexual aggression.

They found that the odds of experiencing verbal, sexual and physical aggression were significantly higher on heavy drinking days, compared to non-drinking days.

College student’s beliefs regarding sexual behaviors and alcohol can contribute to unwanted sexual behaviors. Men may target women who are drinking as they perceive these women to be sexually available or acceptable targets for sexual aggression, assault and rape (Palmer, McMahon, Rounsaville, & Ball, 2010). Men may also encourage

women to drink in order to facilitate an encounter or to take advantage of them especially

in settings such as parties and bars (Norris et al., 1996). Further, some college males

report purposefully getting drunk on a date in order to justify sexually aggressive

behavior.

Research has indicated that transitioning into college along with alcohol use may

place women at an increased risk for unwanted sexual experiences (Krebs et al., 2009).

Ostrander and Schwartz (1994) refer to the first six to eight weeks of freshman year as

the “red zone” as it represents a time of new found freedom and experimentation with the

co-occurring behaviors of alcohol consumption and risky sex. Flack and colleagues

(2008) tested the notion of the red zone in a survey study of a representative sample of

207 first-and second-year students (121 women, 84 men) at a small, liberal arts

university. They found that 44% of female college students in their sample experienced

unwanted sex during this time. Of those who experienced unwanted sex, 71% of the

incidents involved alcohol, 40% involved partners well-known to the women, and 98%

involved partners who were fellow students. Further, the sexual assault research that

suggests the greatest likelihood for rape and sexual assault to occur among women in

college is during their freshman year (Flack et al., 2008) when they appear to be drinking

increased amounts of alcohol (McCabe et al., 2006).

College-age males engage in heavy episodic drinking with greater frequency than

their female counterparts (Johnston et al., 2007). Despite lower rates of heavy drinking,

women are particularly vulnerable to the negative consequences in a college co- educational setting. It is estimated that alcohol is involved in at least half of all cases of heterosexual assault among college students (Abbey, 2002; Mohler-Kuo et al., 2004) and

the likelihood of sexual assault increases nine-fold on days in which college women

engage in heavy alcohol consumption (Parks & Fals-Stewart, 2004). Among college students, the majority of sexual assaults occur within heterosexual relationships in which both people are acquainted and a male student perpetrates the assault; usually alcohol has been consumed by one or both people (Abbey, 2004).

Summary and Critique

Previous research has demonstrated a strong association between alcohol use and

unwanted sexual experiences on college campuses. Studies indicate that the use of

alcohol and drugs especially in the context of hook-ups is associated with unwanted

sexual experiences. In fact, heavy use of alcohol by the perpetrator and the victim has

been associated with reports of sexual aggression. Studies have also indicated that men

target women who are drinking as they perceive them to be easy targets. Further, some

studies indicate that men encourage women to get drunk and purposefully get drunk in

order to justify sexually aggressive behavior. The first six to eight weeks of freshman

year, known as the “red zone”, has been associated with increased incidence of unwanted

sexual experiences. Of note, unwanted sexual experiences occur when students who are

acquainted with each other, have been drinking. Research studies on unwanted sex suffer

from certain limitations. They differ in the way that they define the construct of

unwanted sex. They also vary in their definitions of the types of unwanted sexual

contact. Further, most studies rely on self-reports which although reasonably valid and reliable, may vary as individuals re-evaluate experiences across time. Lastly, studied populations include Caucasian and heterosexual individuals, while there is a dearth of research on racial/ethnic minorities and sexual minorities.

Research on Regretted Sex

Regret is a negative emotion and is often accompanied by self-blame (Gilovich &

Medvec, 1995; Connolly & Zeelenberg, 2002). The psychological literature defines regret

as a negative cognitive emotion that can only be experienced when an individual

remembers a past event and realizes or imagines that the present would be different had

one acted differently (Zeelenberg, 1999). According to Landman (1993), “regret is a

more or less painful cognitive and emotional state of feeling sorry for misfortunes,

limitations, losses, transgressions, shortcomings, or mistakes. It is an experience of felt-

reason or reasoned-emotion. The regretted matters may be sins of commission as well as

sins of omission; they may range from the voluntary to the uncontrollable and accidental;

they may be actually executed deeds or entirely mental ones committed by oneself or by

another person or group; they may be moral or legal transgressions or morally and legally

neutral…. (p. 36)”. In general, regrets can be ones of commission or omission. Regrets of

commission involve an individual doing something and wishing later that he or she had

not done that action, whereas regrets of omission occur when an individual fails to do

something and later wishes that he or she had done that action. Regret is widely studied

because of its impact on emotional well-being, decision-making, behavior regulation, and mental health (Roese & Summerville, 2005; Zeelenberg, 1999).

Romantic and sexual experiences provide some of people’s most common and poignant experiences of regret (Morrison & Roese, 2011; Roese & Summerville, 2005;

Roese et al., 2006). However, there is a paucity of research on regretted sexual experiences (Oswalt, Cameron and Koob, 2005). Conceptually, regretted sexual experiences are considered to be “regrets of action” in which regret is related to a

behavior the individual feels he or she should not have done and resulted in an undesired outcome (Orchowski, Mastroleo, & Borsari, 2012; Gilovich & Medvec,

1995; Zeelenberg, van den Bos, van Dijk, & Pieters, 2002). This is in contrast to overall sexual regrets that could be regrets of action or inaction.

While there is a significant body of research on the topic of sexual activity among college students, including risky and unwanted sex, there has been much less research examining the issue of students regretting the sexual experience. In fact, regretted sexual experiences in the college student population have only been formally addressed in a few research studies to date. Summaries of the studies are discussed below in chronological order to highlight the evolution of the concept of regretted sex. Since this section of the literature review focuses on the primary topic of the current research, regretted sex, each study will be critiqued in more detail than the studies reviewed in previous sections.

Caron and Moskey (2002) conducted the first documented exploratory study to examine regretted sexual experiences in a convenience sample of 392 college students attending a large public university in the northeastern United States. Participants who were enrolled in a large undergraduate course in human sexuality were asked to submit a story about a regrettable sexual experience (e.g. “sex in which the person feels regret later for something he/she agreed to participate in”, p. 48) experienced by themselves or somebody they knew. The sample of students submitting stories was comprised predominantly of females (73%) and the respondents were overwhelmingly heterosexual

(99%). Responses were analyzed for common themes. Six major categories of sexual regret emerged among the 392 stories that were collected: it was a disappointing first time

(25%), it was unprotected sex (22%), I was cheating on my partner (17%), I was drunk

(16%), it resulted in ruined friendship (11%), and other reasons for regretting sex (25%).

Some other reasons included being caught (by priest, police, parent), being videotaped or

watched, it was based on revenge or to get back at someone else, feeling used or using

someone else, feeling it was against his/her religion, and because the person was ugly, fat

or smelled badly. Although the study provided insight into an unstudied phenomenon,

there were limitations. First, the sample was not randomly selected and came from a

sexuality class raising the possibility of bias occurring due to self-selection. Second, the sample was small and males were underrepresented. These two factors limit the generalizability of the results.

This initial study was followed by one conducted by Oswalt, Cameron, and Koob

(2005) who examined sexual regret experienced by 248 female and 98 male college students attending a peer-facilitated sexual health program at a university in the southern region of the United States. The average age of participants in this convenience sample was 19 years. The majority of participants were Caucasian (68.1%) with approximately a quarter of the sample was African American (26.9%). For this study, regret was defined as “a negative cognitive emotion that can only be experienced when as individual remembers a past event and realizes or imagines that the present would be different had one acted differently” (p. 663). As part of a broader survey, entitled “Peer Sexuality

Education Program Pretest,” one question was asked regarding regretted sex: “Have you every regretted your decision to engage in sexual activity?” The results indicated that

65.5% of participants had engaged in vaginal sex, 68.4% in oral sex, and 9.2% in anal sex. The number of partners for vaginal/oral/anal sex ranged from zero to fifty. Of the students who had engaged in sexual activity, 75% reported some level of regret about a

sexual experience. Twenty-eight percent rarely (28%) regretted their sexual decisions,

36.8% sometimes regretted their decisions, 7.3% experienced sexual regret often, and

2.7% always regretted their sexual experiences. The most common reason for regret

(36.8%) was because the decision to engage in the sexual activity disagreed with the student’s morals and values. Regret due to the influence of alcohol on his/her decision was another common explanation (31.6%). Other reasons included: participants’ partners did not want the same thing the participants did, participants did not use condoms or were pressured by the partner, and participants had wanted to wait until marriage. Interestingly sexual regret secondary to unintentional pregnancy and acquiring a sexually transmitted infection were not commonly reported. Multivariate analyses revealed a strong relationship between a higher number of sexual partners and the frequency of experiencing sexual regret. The only significant gender difference found was that women reported regret after being pressured by a partner more than men did.

Similar to the limitations of the first study, this sample was not random and participants were recruited to attend a peer-lead sexual health program through advertisements in a residence hall. Further, the location of the university limits generalizability of the findings since the rates of sexually transmitted infections in the southeastern United States are higher, gender roles are more stereotyped and religious influences are stronger than in other parts of the country (Oswalt et al., 2005). Other limitations pertain to instrument weakness and issues related to self-report. Only one question addressed regretted sex: “Have you ever regretted your decision to engage in sexual activity?” In addition, the Likert-type response choices also limited information learned. An individual who has only one sexual experience and regrets it would have

responded “always” on the current item. However, a person who has extensive sexual

experiences and has only one regretted experience would mark “rarely.” Asking what

proportion of decisions participants regretted would provide a more accurate frequency of

regretted sexual decisions. Identifying multiple reasons for regretting sex and then

examining the factor structure for these reasons would have also strengthened the study.

Thomas (2010) examined the relationship between sexual regret and cognitive dissonance in a convenience sample of 134 male and 158 female college students attending a mid-sized university in the western United States. Cognitive dissonance is said to occur when an individual must choose between attitudes and behaviors that are contradictory and then tries to justify the choice (Festinger, 1957). Of the participants who reported engaging in sex, 68% (66% male, 70% female) indicated experiencing some level of regret after at least one sexual encounter. In response to the question,

“Have you ever regretted a decision to engage in sexual activity?”, 36% (35% males,

31% females) answered “rarely” and 35% (28% males, 31% females) answered

“sometimes.” The most common explanation for regret was “alcohol influenced my decision” (25%; 26% males, 23% females). Other common responses were “having sex disagreed with morals and values” (11%; 9% males, 13% females), “I felt pressure from partner” (10%; 5% males, 15% females), and “I did not want same thing as partner” (9%;

12% males, 6% females). Multivariate analyses revealed that for both males and females, dissonance was a significant predictor of sexual regret. For females, sexual attitudes also significantly predicted sexual regret. The researcher admits that the potential for selection bias may have existed due to the absence of random sampling, such that those experiencing the greatest amount of dissonance may not have participated in the study for

fear of experiencing psychological discomfort. Since Caucasians and heterosexuals were

over-represented in the sample, generalizations cannot be made to ethnic or sexual

minorities.

Roese and colleagues (2006) conducted a three-part study to examine gender differences in regret among 486 (317 women, 169 men) attending the University of

Illinois. The focal question was whether sexually-oriented regrets were more sharply sex differentiated than nonsexual regrets. The researchers presented the students with 18 regret statements obtained from their previous research. Three of these regrets dealt with missed opportunities for having sex and three others dealt with regrets over having sex with someone. Respondents rated their frequency of regret and intensity of regret for each

item using a 7-point scale, although the scale was not described and definitions of

frequency and intensity were not provided in the article. The researchers found that

degree of regret experienced by men and women in romantic and sexual domains differed

according to whether the regret was one of action (regret over having engaged in a

relationship or sexual encounter) or inaction (regret over having passed up an opportunity

to engage in a relationship or sexual encounter), with men tending to regret inaction more

than women. This research constitutes the first clear demonstration of sex differences in

regret. The researchers do not comment upon the demographics of the men and women

in the study thus limiting the generalizability of the results. In addition, it is difficult to

critique the measurement instrument since it was not described in detail.

Galperin and colleagues (2013) also examined sex differences in sexual regret in a three- part study. In the first part of the study, the researchers measured the intensity of male and female college students’ anticipated regret in response to detailed vignettes

describing sexual and romantic actions and inactions. They found that men anticipated more intense regret for casual sex inactions whereas women anticipated more intense regret for casual sex actions, even when these actions and inactions were identical for women and men. However, there was no difference between men and women in the context of romantic opportunities. In the second part of the study, participants were presented with a checklist of regrets and were asked to indicate which regrets they had experienced. The researchers found that women reported more action regrets than did men, and men reported more inaction regrets than did women. Action regrets in the context of uncommitted sex dominated women’s top five lists. These included having a one-night stand, having sex with a stranger, and having sex with someone who falsely promised commitment. Women’s top regrets also included having sex with a physically unattractive partner and women (17 %) were more likely than men (10 %) to list this as one of their strongest regrets. Men’s top five list largely consisted of regrets including missing casual sex opportunities, not having sex early enough in a relationship, staying in a bad relationship and missing sexual opportunities as a result, and expending effort in pursuing someone whom they thought would have sex with them but did not.

The third part of the study employed a regret intensity measure and expanded the investigation to a large online sample of 24,230 U.S. adults ages 18-65 on craigslist.org.

Participants were asked: ‘‘Think about the last time you had each of the experiences listed below. How do you feel about your action or decision?’’ The experiences were ‘‘I had casual sex with someone’’ and ‘‘I passed up a chance to have casual sex with someone.’’ The response options ranged from 0 to 3 where 0 indicated satisfaction with the decision and 3 indicated much regret. The researchers found that men and women

reported similar rates (56 %) of having engaged in casual sex. Men (66 %) were somewhat more likely to report regret about passing up a casual sex opportunity than were women (59 %). Overall, across sexual orientation groups, more women (46 %) than men (23 %) regretted their most recent experience of casual sex and fewer women (16 %) than men (43 %) regretted their most recent experience of passing up casual sex. This study did have certain limitations. First, the first part of the study relied on participants’ reports of their current regrets in response to specific prompts, which could differ from how people felt just after a decision occurred or may bring to mind regrets that would not otherwise become activated in their lives. Second, in the second and third part of the study, the researchers relied on volunteers who completed internet surveys, which offer few controls over the testing conditions. For instance, it is difficult for researchers to control the order in which participants complete online surveys (Nosek et al., 2002). This is especially the case when questionnaire items are presented on the same page, thereby allowing participants to scroll down the screen and answer questions in the order they desire.

Feelings Associated with Regretted Sex

College students can experience a variety of negative emotions due to regretted sex. These include psychological distress, guilt, shame, poor self-esteem, anxiety and depression. Feelings of regret following casual sexual encounters have been repeatedly reported. For example, in an examination of the predictors and consequences of sexual hook ups among college students, Fielder and Carey (2010) found that penetrative hook ups correlated positively with psychological distress for females, but inversely for males.

Similarly, Paul and Hayes (2002) examined the phenomenology of hook ups in male and

female college students at a mid-sized primarily residential public college in the

northeastern United States. They found that the most common feelings after an

uncommitted brief sexual interaction were ‘regret and disappointment’ (35%). They

stated that, for women, ‘‘not knowing their partner and the lack of further contact with

the partner seemed to compound their regret and anger at themselves” (p. 655). Common

negative experiences for males were the partner was insufficiently attractive and/or was

too promiscuous. Common themes for females were shame, regret, self-blame, and pressure to perform unwanted sexual acts (Paul & Hayes, 2002).

Similarly, in a national sample of 1,000 unmarried heterosexual undergraduate

women at four-year colleges and universities, Glenn and Marquardt (2001) found that many women felt hurt and confused about their future relations with their partners after hooking up. In their examination of the psychological consequences of casual sexual behaviors in undergraduate students at a large public university in the southeastern

United States, Welsh, Grello and Harper (2006) found that those who had feelings of regret about a casual sex encounter had more symptoms of depression than those who did not have regrets. Overall, in their study of hook ups in male and female undergraduate students at a state college in the northeastern United States, Paul, McManus and Hayes

(2000) indicated that both men and women who had ever engaged in an uncommitted, brief sexual activity at any point in their life had lower self-esteem than individuals who had not.

Regrets Related to Casual Sex and Hooking Up

As described previously, sexual encounters that last only one night with a brief acquaintance, such as hook ups, are common among college students (Armstrong,

Hamilton, & England, 2010; Paul, McManus, & Hayes, 2000). However, such

experiences are frequently associated with disappointment and regret (Paul & Hayes,

2002). In fact, the decision to hook up is not trivial as such encounters have been linked

to a variety of positive and negative psychological and physical consequences. While

some students express unequivocal enjoyment of the hook-up culture (Armstrong &

Hamilton 2009), a majority report emotional distress to varying degrees. For these

students, a “no strings attached” encounter that is unlikely to lead to emotional

connection can leave them feeling lonely and isolated (Paul 2006; Wade & Heldman

2010). The frequent incongruence between what students want and what they get is one

reason for the hook-up culture’s emotional toll (Freitas, 2008; Garcia & Reiber 2008;

Paul 2006; Paul & Hayes 2002). In addition to potential negative psychological

consequences, the hook-up culture carries a higher risk of contracting an STI than dating

culture because the former entails more sexual activity with “strangers” and sexual

contact with more partners. The hook-up culture also involves more unplanned sexual encounters that are less likely to involve STI protection than planned sex (MacDonald &

Hynie 2008).

A number of studies have included measures of regret with respect to hook ups and these studies have documented the negative feelings men and women may feel after hooking up (Garcia, et al., 2012). Eshbaugh and Gute (2008) explored predictors of sexual regret among 152 female students in a human sexuality course at a midsized midwestern university who had engaged in hook ups. The participants were overwhelmingly heterosexual (97%) and white (96%). They defined hooking up as any of the following four actions: engaging in intercourse with someone once and only once,

engaging in intercourse with someone known for less than 24 hours, performing oral sex

on someone known for less than 24 hours, and receiving oral sex from someone known

for less than 24 hours. Almost two-thirds of the students (61 percent) had a few regrets,

13 percent had some regrets, and 3 percent had many regrets. Only 23 percent had no

regrets. Participants who indicated strong religious beliefs were less likely to indicate a

high level of regret. When the researchers accounted for age, religiosity, and other

sexual-behavior variables, they found that engaging in penetrative intercourse with someone once and only once and engaging in intercourse with someone known for less than 24 hours significantly predicted sexual regret. Receiving oral sex from someone known for less than 24 hours approached significance for predicting regretted sex. The authors acknowledged that their research had several limitations. First, only women who had engaged in sexual intercourse were included in the study, yet it is likely that some of the excluded women had engaged in non-coital hook ups and may still have experienced sexual regret. Second, because men were not included in the sample, the authors were unable to examine the possibility of a gender differences.

Lewis, Granato, Blayney, Lostutter and Kilmer (2012) studied predictors of hooking up and emotional reactions in a representative sample of 1,468 undergraduate students at a large university in the Pacific Northwest region of the United States. Eight hundred and twenty-four students (56.1%) who reported ever hooking-up were included in the final analyses. Ethnicity of the sample was 61.0% Caucasian, 23.2% Asian, 9.4% multi-racial, and 6.4% other. A small proportion of the sample identified as Hispanic

(5.6%). The mean age for participants was 19.9 years (SD = 1.52). The majority of students (63.1%) reported not currently being in a monogamous relationship and 94.4%

identified as heterosexual. Overall, students reported having experienced a number of

emotional, social, or physical consequences as a result of their most recent hook up.

Findings from this study showed that over half (53.3%) of students reported having sex during their most recent hook up; however, only 46.6% of these students reported using a condom. As a result of their most recent hook up, .2% of students reported an unwanted pregnancy and .9% of students reported contracting a sexually transmitted infection. A concerning 7.6% of students indicated that their most recent hook up was an experience they did not want to have or were unable to give consent to. Students also experienced emotional consequences as a result of their most recent hookup, with 20.8% of students reporting experiencing a loss of respect, 27.1% indicating feeling embarrassed, and

24.7% reporting emotional difficulties. Finally, students reported their most recent hook up as a cause of problems with a steady partner with 10.0% of students reporting difficulties in a relationship with a steady partner and 2.5% of students reporting breaking up with a steady partner.

Fisher, Worth, Garcia and Meredith (2012) explored the prevalence of regret, defined by the researchers as a negative emotion often accompanied by self-blame, following uncommitted sexual encounters among 138 female and 62 male Canadian university students, who were approximately 21 years of age. The researchers believed that a positive sexual experience (good pleasurable sex) may mitigate predispositions for regret. Conversely, a poor quality sexual experience (bad unfulfilling sex) may intensify negative feelings. The majority of males (72%) and females (78%) in the study reported that they had experienced feelings of regret after an uncommitted sexual encounter. The researchers found that women reported feeling significantly more regret than men did.

However, men’s regret was more closely associated with the physical attributes of their

partners than were women’s regrets. Regret was also influenced by the quality of the sex

in that high-quality sex rarely led to regret, while the reverse was true for poor-quality sex. Intoxication by alcohol and/or drugs was often listed as a source of regret by both men and women.

Glenn and Marquardt (2001) examined feelings after hooking up in a nationally representative random sample of 1,000 unmarried heterosexual undergraduate women at four-year colleges and universities. Most women felt awkward (64%) or confused (57%) because they weren’t sure if the encounter would lead to a relationship. They worried about the possibility of running into their hook-up partner on campus and having to pretend an intimate encounter had not occurred between them. In addition, 44% reported feeling disappointed and some felt empty (27%) or exploited (23%) after the encounter.

Campbell (2008) studied affective reactions in a random sample of 1,743 heterosexual British individuals (998 men and 745 women) in the community who had experienced a one-night stand. Approximately 59% of the sample had experienced a one- night stand. This study found that men had stronger feelings of being "sorry because they felt they used another person," whereas women had stronger feelings of "regret because they felt used." Nearly one in four (23%) of men and over half (58%) of women indicated some regret and said they would not repeat the experience. Among the men, the prevailing emotion was one of isolation and loneliness. A number of women expressed distress at their partners’ behavior following the event. They felt the men had subsequently behaved disrespectfully and dismissively toward them. While not wanting a longer relationship, many women felt a strong sense of rejection. The tone of women’s

negative comments was consistently about a loss of self-worth after the experience. A

number of women expressed disappointment with the quality of the sexual encounter and

a sense that the experience as a whole did not live up to their expectations.

Regrets Related to Drunken Sex

Research has found alcohol to be frequently correlated with regretted sex. In a

random sample of 2548 undergraduates ages 17 to 24 from six university campuses in

New Zealand, Kypri and colleagues (2009) found that over a relatively short four-week

period, 9% of undergraduates reported regretting a sexual experience that occurred after

consuming alcohol. Similarly, in a purposive sample of 303 (66% women) college

students recruited from introductory psychology courses at a large, public, northwestern

university, 21% of college students reported an alcohol-related regretted sexual experiences in the past year (Mallett, Lee, Neighbors, Larimer, & Turrisi, 2006).

As noted previously, Caron and Moskey (2002) found that 16% of participants regretted a sexual experience because they had been intoxicated, whereas nearly half

(49%) of all regrettable sex encounters involved alcohol use. These findings have been replicated in other studies. For example, approximately one-third of undergraduate participants at a mid-sized public university, attribute an ‘unintentional’ (i.e., due to drugs and/or alcohol) motivation for a hook up (Garcia & Reiber 2008). In their study examining feelings of regret following uncommitted sexual encounters, Fisher and colleagues (2012) also found that 56% of men and 55% of women agreed that intoxication by alcohol and/or drugs caused them to feel regret following an uncommitted sexual experience. The majority of men (93%) and women (81%) reported being under the influence of alcohol during at least one uncommitted sexual encounter. Both men and women reported the

degree of their intoxication as having moderately influenced their decision to engage in

their most recent uncommitted sexual encounter.

Mallett and colleagues (2006) examined self-reported past drinking behavior and

resulting consequences among 303 (66% women) college students recruited from

introductory psychology courses at a large, public northwestern university. Participants’

average age was 18.7 years. Ninety percent of participants reported lifetime use of

alcohol. Sixty-three percent of participants reported consuming one or more drinks on a

typical weekend evening during the past month and 29% of the sample reported

consuming four or more drinks on a typical weekend evening. When asked about

consequences experienced during the past year, 21% reported a regretted sexual

experience, and 31% of participants stated they had blacked out as a result of drinking.

In another study, Mallett and colleagues (2008) assessed college students’

perceptions of alcohol-related consequences they experienced during the past year.

Participants were 341 freshman students from a large, public university in the northeast.

Respondents completed measures on alcohol consumption, alcohol-related consequences,

and how they experienced endorsed alcohol-related consequences. The mean age of the participants was 18.5 years, with 55.1% identifying as female. The researchers reported that college students’ positive valuations of regretting sexual experiences were associated with higher weekly alcohol consumption. One potential reason for these findings is that individuals may believe that experiencing certain consequences (e.g. hangovers) are part of the overall drinking experience and balance these negative consequences with the positive consequences they experience.

Orchowski, Mastroleo and Borsari (2012) examined correlates of regretted sexual experiences involving alcohol use among high-risk college student samples. The total sample included 937 participants. Respondents were mainly Caucasian, between 18 to 19 years of age, and living in residence halls. They found that alcohol-related regretted sex was a common occurrence, with approximately 25% of the students reporting at least one occurrence in the past month. Several variables were significantly and positively associated with alcohol-related regretted sex; namely other problem drinking behaviors as well as alcohol expectancies regarding sexuality, including liquid courage, risk-taking and aggressiveness. Regretted alcohol-related sexual experiences were also positively associated with peer alcohol use, personal alcohol use, and alcohol expectancies regarding sociability. The belief that alcohol use would result in “liquid courage” was associated with alcohol-related regretted sex among college students, even after accounting for greater alcohol use and problem alcohol use behaviors,. This suggests that alcohol may facilitate sexual risk taking by providing individuals with “liquid courage” that allays fear associated with engagement in inappropriate or risky behavior. Now that the methodologies used and findings from the body of literature on regretted sex has been presented, the final section will examine the methodological issues found in this research.

Methodological Issues with Research on Regretted Sex

Throughout this review of previous research conducted on regretted sex, many methodological issues are apparent and will be discussed below.

Issues with Definitions

Due to a lack of a universally accepted definition for regretted sex, researchers have defined the construct somewhat differently in the various research studies. For example, Oswalt et al. (2005) and Esbaugh and Gates (2008) extrapolated the definition of regret from the psychological literature to the domain of sexual experiences. The psychological literature defines regret as a negative cognitive emotion that can only be experienced when an individual remembers a past event and realizes or imagines that the present would be different had one acted differently. In their examination of regrets pertaining to close romantic relationships, Roese and colleagues (2006) defined regret as the negative emotion that springs from counterfactual musings, particularly those counterfactuals that are upward (focusing on how things could have been better) and centered on personal action. Most recently, Galperin and colleagues (2013) identified two categories of sexual regrets: 1) poorly chosen sexual actions that are later regretted

(regrets of commission or regretted sex), and 2) sexual inactions that someone later wishes he/she had done (regrets of omission). Acceptance of a universally definition would make the study of sexual regret more cohesive.

In addition, other constructs and terms (e.g. unwanted sex) are often misused interchangeably with the construct and term of regretted sex (Mallet et al., 2006; Mallett et. al., 2008). Clearer and distinct definitions of constructs/terms are essential to ensuring the validity of research in this area.

Issues with Sampling

To date, most of the research on regretted sex has been conducted with convenience samples of undergraduate students, most likely because they are easily

accessible for academic researchers. Further, most of these samples are relatively

homogenous consisting of self-selected groups which are not representative of all college

students. They often lack diversity in terms of race, ethnicity and sexual orientation. All

of these sampling issues limit the generalizability of the research findings to all

undergraduate students attending colleges and universities in the United States

(Campbell, 2008). For instance, results of most studies can reasonably be expected

generalize to Caucasian, heterosexual undergraduate students but they should not be

assumed to characterize students of color, those with homosexual or bisexual

orientations, or those who come from different socioeconomic backgrounds.

Issues with Measurement

Most research concerning sexual regret relies on self-report measures. Self-report measures have several advantages in sexuality research. Self completion questionnaires reduce the need for respondents to disclose sensitive behaviors to the interviewer and may result in more valid reports than interviews (Catania et al., 1995). Johnson and colleagues (1994) reported increased disclosure of censured behaviors (for example, homosexual experience) in self completion compared with face to face questioning. As with most behaviors, the accuracy with which people can recall sexual behaviors is influenced by such factors as the length of the recall period and the vividness of the events (Catania et al., 1993). Even among respondents who attempt to accurately report their past behaviors, problems with recall can distort the reported incidence and frequency of specific behaviors (James, Bignell, & Gillies, 1991). Social desirability and the need to present oneself in a positive light are limitations associated with self-report of sexual behavior (Brener, Billy, & Grady, 2003).

An ideal measure of regretted sex would be able to assess the frequency of regretted sexual experiences, as well as to capture the intensity of feelings of regret associated with each experience. “Reasons for regretted sex” are better viewed as causes or predictors of regretted sex rather than as regretted sex itself.

Previous researchers have often used one Likert-type item to assess the frequency or intensity of regretted sexual experiences. For instance, in the Oswalt (2005) study, participants were asked to respond to the question “Have you ever regretted your decision to engage in sexual activity?” They provided their answer based upon a 5-point Likert- type response, in which “1” indicated “never” and “5” indicated “always”. However, frequency-based differences in some regrets could be either masked or enhanced by differences in the base rates of opportunity for the relevant sexual experiences (Galperin et al., 2013). For instance, an individual who has only one sexual experience and regrets it would have responded “always” on the current item. However, a person who has extensive sexual experiences and has only one regretted experience would endorse

“rarely.”

In addition to measuring frequency, it is also important to measure intensity of the feeling of regrets. For example, Galperin and colleagues (2013) measured the intensity of sexual regret using a 9-point scale in which “1” indicated “no regret at all”, “5” indicated

“moderate regret” and “9” indicated “extreme regret”. However, this method relies on the implicit assumption that participants can easily associate their feelings with a verbal label. It may be erroneous to assume that people automatically apply the meaning of terms like “regret” to the complexity of their experienced emotions (Ferrante & Marcatto,

2008). The more psychometrically-sound approach to measuring a latent construct is to

ask a number of similar questions that are intended to assess that construct (Netemeyer,

Bearden, & Sharma, 2003). To the best of our knowledge, to date no one has employed

this approach in the context of measuring sexual regret.

Issues with the Analysis of Data

A comprehensive measurement of sexual regret would enable researchers to do

the following: 1) Capture intensity of feelings. 2) measure reasons for sexual regret, and

3) assess average regret associated with each reason. In such a measure, survey

participants would indicate both the frequency of feeling each reason for sexual regret

and the intensity of the regret they normally feel for that reason. However, it is unclear

how a single score could be generated from such a measure. Reasons for sexual regret are

better viewed as causes or predictors of sexual regret rather than as sexual regret itself.

Therefore, it is important to consider whether combining the scores on both measures

(intensity and frequency) into a single score can be justified. Stated differently, how often

someone feels regret for each of these reasons does not necessarily correspond directly to

how often they feel sexual regret. A visual depiction of how several broad categories of

reasons for regret (e.g., relationship, moral and health reasons) may relate to sexual regret

is given in Figure 1.

Relationship Reasons

Moral Reasons Sexual Regret

Health Reasons

Figure 1: The relationship between reasons for sexual regret and feelings of regret

Because neither sexual regret nor the categories of reasons for regret can be observed directly, these factors are considered to be latent. By convention, latent factors are represented as circles or ellipses. Note the direction of the arrows in Figure 1: The reasons lead to sexual regret rather than regret leading to the reasons. Therefore, the direction of this relationship underscores the need to consider reasons for regret and intensity of regret separately.

Furthermore, because there are several different categories of reasons that people are likely to endorse (given by the three ellipses on the left), reasons for regret can be considered multi-dimensional. If we attempt to create a single scale from these responses, we will violate the assumption that a scale measures a single unidimensional construct.

Analyzing a multi-dimensional scale as if it were unidimensional, such as taking the average frequency of regret across all of the reasons, presents problems for interpretation

(Netemeyer et al., 2003). For example, if a single “reasons for sexual regret” score correlates with a measure of sexual regret, it will be unclear what is driving the correlation; the correlation could reflect that people with moral reasons feel intense sexual regret, that people with relationship reasons feel intense regret, or that people who have either reason experience moderate regret. Hence, generating a single score from frequency and intensity data is problematic. Further, since reasons for sexual regret are better viewed as causing sexual regret and is likely to be a multi-dimensional construct, scoring such an instrument is also challenging.

A psychometric instrument which measures reasons for sexual regret will measure the explanations college students provide for regretting sex. Such an instrument will help

to identify students who are at high risk for engaging in sexual behaviors that result in

feelings of regret.

To conclude, regretting sex is becoming a more common experience for college

students and is particularly associated with consuming alcohol and being involved in

casual sex and hooking up. Regret pertaining to sexual experiences may have long-term

psychological consequences. Regret in general has been associated with emotions such as

anger, shame, and embarrassment (Seaman, 2005) and even depression or other

psychological disorders (Grello et al., 2006). Further, perceived consequences of regrets

have been shown to be related to lower self-rated life satisfaction and increased physical ailments (Jokisaari, 2003).

In summary, regretted sex is currently understudied and the studies that have been conducted are fraught with limitations. Research that is more methodologically sound needs to be conducted.

Chapter 3

Development and Validation of the Experience of Regretted Sex Scale: Findings

From Undergraduate College Students

Surveys of numerous college campuses across the United States have found that at least 70% of undergraduate students are engaging in sexual activities (American

College Health Association, 2007). The majority of these young adults report engaging in casual sexual experiences without any commitment, experiences currently known as hook ups (Bogle, 2008; Daubman & Schatten, 2005; England, Shafer, & Fogarty, 2007; Fielder

& Carey, 2010; Fisher, Worth, Garcia, & Meredith, 2012; Flack et al., 2007; Garcia &

Reiber, 2008; Grello, Walsh, & Harper, 2006; Gute & Eshbaugh, 2008; Heldman &

Wade, 2010; Lambert, Kahn, & Apple, 2003; Paul & Hayes, 2002; Paul, McManus, &

Hayes, 2000). The prevalence rates of hooking up in these studies range from 53%-85%, making this experience normative on college campuses (Glenn & Marquardt, 2001;

Grello, Welsh, Harper, & Dickson, 2003; Grello et al., 2006; Flack et al., 2007; Paul and

Hayes, 2000; Penhollow, Young, & Bailey, 2007; Reiber & Garcia, 2010). According to

National College Health Assessment data from one hundred and forty post-secondary institutions, 67% of college students reported having one or more sexual partners within the last 12 months; and 42% of college students reported engaging in oral sex, 47% reported engaging in vaginal sex, and 5% reported engaging in anal sex within the past 30 days (American College Health Association, 2014).

In addition to sexual activity, there is a prominent culture of drinking alcohol on college campuses (Grant, et al., 2004; Hingson, Heeren, Winter, & Wechsler, 2005;

Hingson, Zha, & Weitzman, 2009; O’Malley & Johnson, 2002; National College Health

Assessment, 2011; Schulenberg & Maggs, 2001; Ven & Beck, 2009). Data from several

national surveys indicate that about four in five college students drink and that about half

of college student drinkers engage in heavy episodic consumption. Approximately two of

five college students—more than 40 percent—have engaged in binge drinking (five or

more drinks in a row for males; four or more drinks in a row for females) at least once

during the past 2 weeks (NIAAA, 2005). College students often use alcohol as a tool to

facilitate (“liquid courage”), explain, and justify their sexual encounters, perhaps

especially hooking up (England, Fitzgibbons, Shafer & Fogarty, 2007; Ven & Beck,

2009).

Thus, the high prevalence of sexual activity on college campuses in the context of high levels of drinking place college students at a high risk for negative sexual experiences (Cooper, 2002; Fisher, Cullen, & Turner, 2000; Mallett, Bachrach, & Turrisi,

2008). The Harvard School of Public Health College Alcohol Survey (CAS) obtained

data from 12,317 full-time undergraduate college students, ages 18-24 and from 40 states

across the United States. In the CAS, 8.4% (nearly 400,000) full-time students nationwide reported having unprotected sex because of drinking alcohol. Over 70,000 were victims of a sexual assault or date rape, a problem reported by 1.5% of respondents

(Hingson, 2002). Some of the most common negative sexual experiences occurring in this environment are sexual encounters that the students later regret having occurred

(Caron & Moskey, 2002; Esbaugh & Gute, 2008; Oswalt et al., 2005; Taylor, 2010). It has been noted that romantic and sexual experiences provide some of people’s most poignant experiences of regret, especially in college-age adults (Chng & Moore, 1994;

Morrison & Roese, 2011; Paul, McManus, & Hayes, 2000; Roese & Summerville, 2005;

Roese et al., 2006). More specifically, college students identify one of the negative

consequences when drinking alcohol as engaging in a regretted sexual experience

(Mallatt, Bachrach, & Turrisi, 2008; Mallett, et al., 2006).

In general, regret has been defined as a negative emotion that one feels when

remembering the past and imagining that the present would be different if one had

behaved differently (Zeelenberg, 1999). It is an emotion often experienced when

individuals feel they have caused harm to themselves or to others (Zeelenberg &

Breugelmans, 2008). Landman (1993) describes regrets as “sins of commission” as well

as “sins of omission.” Regret is widely studied because of its impact on emotional well- being, decision making, behavior regulation, and mental health (Roese & Summerville,

2005; Zeelenberg, 1999). More specifically, regretted sex among college students has been associated with various forms of psychological distress, including poor self-esteem, anxiety and depression, as well as negative feelings, such as disappointment, hurt, confusion, anger, self-blame, guilt, or shame (Armstrong & Hamilton, 2009; Fielder &

Carey, 2010; Glenn & Marquardt, 2001; Lewis, et al., 2012; Owen, Rhoades, Stanley and

Fincham, 2010; Paul, 2006; Paul & Hayes, 2002; Paul, McManus, & Hayes, 2000; Wade

& Heldman; 2010; Welsh, Grello, & Harper, 2006).

Although it may be painful, regret is thought to be functional as well because it helps individuals make better decisions. Experienced regret (or retrospective regret) may help individuals to prevent similar mistakes in the future (Saffrey, Summerville & Roese,

2008). Thus, being able to look back on and evaluate past choices allows individuals to modify future behavior and presumably make better decisions. Behavior that involves

1making a different decision when faced with the same or a similar choice is termed adaptive choice switching. O’Connor, McCormack and Feeney (2014) hypothesized two mechanisms that might explain choice switching behavior. The first represents the direct effect of experienced regret that consists of remembering that a particular option yielded a poor result in the past. This leads to avoiding this option when faced with the same choice again. According to the alternative explanation, the effect of experienced regret on subsequent choices is mediated by anticipated regret. Anticipated regret can be defined as a cognitively-based anticipated emotion that people trigger when considering whether future outcomes would have been better if a different decision had been made (Mellers and McGraw, 2001). When future regret is brought to the attention of the decision maker, this feeling might bear weight on the decisional process and may result in regret aversion

(Connolly & Zeelenberg, 2002). Stated simply, people consider the possibility of future regret before making their decisions.

Although there is a significant body of research on the topics of sexual activity and drinking in college students, there has been much less research examining the experience of regretted sex in this group. Oswalt, Cameron, and Koob (2005) examined sexual regret in 346 college students at a southern university; the students were predominantly female (72%) and Caucasian (68%). The researchers defined sexual regret as “a negative cognitive emotion that can only be experienced when an individual remembers a past event and realizes or imagines that the present would be different had

1 (Note: The term “regretted sex” describes sexual experiences that have happened that are later regretted, considered regrets of “action”. This is part of the broader scope of “sexual regrets” that also includes regretting not having a sexual experience, considered regrets of “inaction”.)

one acted differently” (p. 663). As part of a broader survey, entitled “Peer Sexuality

Education Program Pretest,” students were asked one question about regretted sex: “Have

you ever regretted your decision to engage in sexual activity?” Of the 270 students who

had sexual experience, only 25.2% had no sexual regrets, whereas 28.0% rarely regretted

their sexual decisions, 36.8% sometimes regretted their decisions, 7.3% experienced

sexual regret often, and 2.7% always regretted their sexual experiences. The only

significant gender difference found was that women reported regret after being pressured

by a partner more than men did.

Roese and colleagues (2006) conducted a three-part study to examine gender

differences in regret in different types of interpersonal relationships. Here, regret was

defined as: “the negative emotion that springs from counterfactual musings, particularly

those counterfactuals that are upward (i.e. focusing on how things could have been better)

and centered on personal action” (p. 771). The focal question of part three of the study

was whether sexually-oriented regrets were more sharply gender differentiated than nonsexual regrets. The researchers surveyed 486 college students (317 females, 169 males) at a large midwestern university and presented them with 18 regrets obtained from their previous research. Three of these regrets dealt with missed opportunities for having sex and three others dealt with regrets over having sex with someone. Respondents rated their frequency and intensity of regret for each item using a 7-point scale; further details about the scales and definitions of frequency and intensity were not provided in the paper. It was stated that since frequency and intensity were so highly correlated that these scores were averaged into one summary regret score per item. Thus, researchers found that the sexual regret experienced by men and women significantly differed according to

whether the regret was one of action (regret over having engaged in a sexual encounter) or inaction (regret over having passed up an opportunity to engage in a sexual encounter).

Men regretted inaction more than women. Sexual regrets were found to be more sharply differentiated for men and women than regrets over relationships with family or friends.

Eshbaugh and Gute (2008) explored predictors of sexual regret in 152 women students in a human sexuality course at a mid-sized Midwestern university who had engaged in hook ups. They defined hooking up as any of the following four actions: engaging in intercourse with someone once and only once, engaging in intercourse with someone known for less than 24 hours, performing oral sex on someone known for less than 24 hours, and receiving oral sex from someone known for less than 24 hours. A total of 55 participants (36.2 %) reported having had intercourse with someone once and only once. Forty-four participants (28.9%) reported engaging in intercourse with someone known for less than 24 hours. Nineteen participants (12.5%) reported having performed oral sex on someone known for less than 24 hours. Fourteen participants (9.2%) reported having received oral sex from someone known for less than 24 hours. The participants were overwhelmingly heterosexual (97%) and white (96%). Participants were asked to indicate their overall sexual regret on a scale of 1 (no regrets) to 4 (many regrets).

Almost two-thirds of the students (61%) had a few regrets, 13% had some regrets, and

3% had many regrets; only 23% had no regrets. When the researchers accounted for age, religiosity, and other sexual-behavior variables, they found that engaging in penetrative intercourse with someone once and only once and engaging in intercourse with someone known for less than 24 hours significantly predicted sexual regret. Receiving oral sex from someone known for less than 24 hours approached significance for predicting

regretted sex. Since men were not included in the sample, the authors were unable to

examine the possibility of a gender-based difference.

Thomas (2010) examined the relationship between sexual regret and cognitive

dissonance in 134 male and 158 female college students attending a mid-sized university

in the western United States. According to cognitive dissonance theory, if individuals

have inconsistent cognitions after they make a decision to behave in a particular way,

they will experience psychological discomfort, or dissonance. This discomfort may cause

individuals to reflect on alternative behavioral choices, and, as such, lead to regret of the

specific behavioral choice (O’Keefe, 2002). In response to the question, “Have you ever

regretted a decision to engage in sexual activity?”, 36% (35% males, 31% females)

answered “rarely” and 35% (28% males, 31% females) answered “sometimes.”

Multivariate analyses revealed that, for both males and females, cognitive dissonance was

a significant predictor of sexual regret. For females, liberal sexual attitudes also

significantly predicted sexual regret.

These studies on sexual regrets/regretted sex in college students have many

methodological weaknesses. Foremost among these is the issue of internal validity due to

two major factors: lack of an empirically-based definition of regretted sex and lack of a psychometrically-sound measure of regretted sex. In order to address the issue of the construct validity of the term “regretted sex,” the researchers of the current study asked

college students to define the experience for themselves. This was done in a previous

research study of 169 undergraduate college students (119 females, 50 males), ages 18-

22, attending general education courses at a large northeastern land-grant university

(Woehling, Colaco & Koch, 2008). Volunteers were asked to complete surveys with nine

open-ended questions regarding one of the following negative sexual experiences:

regretted sex, unwanted sex, aggressive sex, incapacitated sex, or sexual victimization.

From the 34 students who randomly responded to the survey on regretted sex, content data analysis revealed that the majority of students (76.7% females; 53.8% males) defined regretted sex as, “a sexual experience you wish you had not done.” The remaining responses still echoed this theme, although in more specific terms, including:

“sex with a partner that you don’t know,” “negative or unsatisfying sexual experiences,”

“sex while consuming alcohol,” “not using protection”, or “sex that ruined a friendship.”

Almost three-quarters (72.0%) of the females and two-thirds (66.7%) of the males reported that they themselves or someone that they knew had experienced regretted sex.

From this study, a valid definition of regretted sex emerged as: a negative cognitive emotion experienced when an individual remembers a past sexual experience and wishes that it had not happened or that it had been different. This is the definition that will be used in the current study.

Another major weakness in the previous studies was a lack of the use of a methodologically-sound research instrument. Most studies relied on asking one question about regretted sex. The more psychometrically-sound approach to measuring a latent construct, like regretted sex, is to ask a number of similar questions that are intended to assess that construct (Netemeyer, Bearden, & Sharma, 2003). Further, questions within and between studies were often confounded with some questions asking about frequency of regretted sex, while other questions asked about level of, or reasons for regretted sex.

Frequency questions can be problematic since responses can be either masked or enhanced by the base rates of opportunity for the relevant sexual experiences (Galperin et

al., 2013). For instance, an individual who has only one sexual experience and regrets it

might respond “always” on a Likert scale, whereas a person who has extensive sexual

experiences and has many regretted experiences might endorse “rarely.” In addition,

reasons for regretted sex are better viewed as causes or predictors of the negative sexual

experience rather than as regretted sex itself. Further, it is unclear how a single score

could be generated measuring frequency, level, and reasons for sexual experiences.

Creating a single scale from these differing types of responses violates the assumption

that a scale should measure a single unidimensional construct (Netemeyer et al., 2003).

Analyzing a multi-dimensional scale as if it were unidimensional, by taking the average

frequency of regret across all of the reasons, presents interpretation problems.

To summarize, regretted sex is becoming a more common experience for college

students and is particularly associated with consuming alcohol and being involved with

casual sexual experiences. However, this phenomenon is currently understudied, and the

few studies that have been conducted are fraught with limitations. Thus, researchers have

recommended more in-depth, methodologically-sound research of this phenomenon

(Oswalt et al., 2005; Eshbaugh & Gute, 2008). Therefore, the purpose of the current

study was to develop a psychometrically-sound measure of the experience of regretted sex. Using this newly-developed research instrument, the following two research questions were examined.

Research Question 1: To what degree do undergraduate college students experience regretted sex?

Research Question 2: What demographic (age, gender, race/ethnicity, sexual

orientation) and behavioral (relationship status, number of lifetime sexual partners)

characteristics of students are significantly associated with regretted sexual experiences?

Methods

The methods for this research study were approved by the Institutional Review

Board of the university. Regarding the use of self-administered questionnaires (SAQs) in

research on sexuality, the following recommendations from Weinhardt and colleagues

(1998) were followed in the design of the ERSS and the data collection in order to ensure

a high degree of validity and reliability: (1) use a psychometrically-evaluated measure that is appropriate for the purpose of the assessment; (2) use formative methods to adapt the assessment to the target group of participants; and (3) establish trust with the respondents and be sensitive to the contextual issues involved with data collection. The following section describes the recruitment of participants, the development and pilot testing of the instrument.

Participants and procedure. The respondents were undergraduate students in general education classes participating for course credit at a large northeastern land-grant university. Since these students were in required general education classes, they were assumed to represent the diversity of student backgrounds and majors offered at the university. A total of 435 students (25% males, 73% females, 0.004% transgender) completed the survey. (Note that due to the low number of transgender students, they were dropped from subsequent multivariate analyses.) The response rate was 62%.

Compared to the overall undergraduate student body, females were over-represented by two times and males were under-represented by one-half. However, the over-

representation of females is a common phenomenon in social science research in which females are much more likely to volunteer than males (De Vaus, 2003). The behavioral and demographic characteristics of the sample are summarized in Table 1. Nearly all

(97%) of the students were ages18-23 years, with almost two-thirds upperclassmen. More than two-thirds (72.9%) identified themselves as White. Compared to the race/ethnicity of the entire undergraduate student population at the university, the sample was representative of White and Asian students attending the university, whereas Black students were over-represented and Latino students were under-represented. The majority of participants (95.4%) identified themselves as heterosexually-oriented. Most participants (91.3%) had engaged in sexual intercourse (vaginal, oral, or anal), and greater than 82% of participants had more than one sexual partner in their lifetime. Most participants (84.4%) identified themselves as single, whereas the rest were involved in on-going committed relationships. Most participants (91%) reported engaging in sexual intercourse. Only those participants who had engaged in any type of sexual intercourse were included in the multivariate analyses (n=396). Thus, the total number of participants exceeded the sample size requirement of 300 for the factor analyses that were conducted

(Tabachnik & Fidell, 2012). The behavioral and demographic characteristics of the sample are summarized in Table 1.

Table 1: Behavioral and demographic characteristics of the sample (n=435)

Variable N % Age <18 1 0.2 18-20 160 37.0 21-23 260 60.2 24-29 9 2.1 30+ 1 0.2 Missing 1 0.2 Gender Female 317 72.9 Male 112 25.7 Transgender 3 0.7 Missing 3 0.7 Orientation Heterosexual 411 95.4 Bisexual 9 2.1 Homosexual 9 2.1 Missing 2 0.4 Class Freshmen 8 1.9 Sophomores 76 17.6 Juniors 181 41.9 Seniors 166 38.4 Missing 1 0.2 Relationship status Single 367 84.4 Ongoing committed 59 13.6 Missing 9 2.0 Lifetime Number of Partners 1 78 17.9 2-4 165 37.9 5-10 113 26.0 11-20 32 7.4 21+ 16 3.7 Missing 31 7.1 Race/ethnicity White 317 72.9 Black 50 11.5 Asian 29 6.7 Latino 18 4.1 Other 15 3.4 Missing 1 0.2

Each student attending the classes received a written description of the study, a

consent form, a copy of the survey, a computerized answer form, an information sheet

listing campus resources for the topic being addressed, and an envelope in which to

return the answer form at the next class session. Participants were instructed to complete

the survey privately in a comfortable area, such as where they lived, and not to write their

names on the answer form. The Experience of Regretted Sex Scale (ERSS) was part of a

larger survey entitled the Regretted Sex Survey. The entire survey took approximately 30

minutes to complete, although the 11items on the ERSS took less than 10 minutes to

complete.

Measures. The Experience of Regretted Sex Scale was developed for this study.

Convergent validity was established with the Decision Regret Scale. Both of these scales

were included in a broader survey, the Regretted Sex Survey, along with six demographic

questions asked about age, sex, race/ethnicity, class ranking, sexual orientation, and

relationship status. Class ranking categories included freshman, sophomore, junior, senior and graduate student. Age was categorized as less than 18, 18-20, 21-23, 24-29 and above 30. Gender categories included female, male and transgender. Categories for race/ethnicity included white, black, Asian, Latino and other. Relationship status was characterized as currently single and currently married/life partner. Orientation categories

included heterosexual, bisexual and homosexual. An additional two questions were asked

to determine if the respondent had ever engaged in sexual intercourse (vaginal, oral, or

anal) and with how many lifetime partners (1, 2-4, 5-10, 11-20, 21+).

The Experience of Regretted Sex Scale (ERSS): The accepted approach to

measuring a latent construct, like regretted sex, is to ask a number of similar questions

that are intended to assess that construct (Netemeyer et al., 2003). Generally, this is done by asking questions that address the definition of or feelings associated with the construct. Following this guideline, the initial items for the ERSS were generated by the researchers using two sources: (1) the literature on general regret and regretted sex, and

(2) models of previous instruments that measured other types of regret, mainly the

Decision Regret Scale (DRS) which measures regrets regarding health decisions

(Brehaut, 2003). Colaco’s (2016) definition of regretted sex was employed: A negative cognitive emotion experienced when an individual remembers a past sexual experience and wishes that it had been different or had not happened. Using this definition, 21 items intended to assess the construct were generated and included in the Regretted Sex Survey distributed to the sample of undergraduate college students previously described.

Respondents to the ERSS were given the directions to choose the response that “most closely resembles how true each statement is about your feelings over the past 12 months.” The format of the items was modeled after the Decision Regret Scale (DRS)

(Brehaut, 2003). The response choices were: completely not true (1), generally not true

(2), neutral (3), generally true (4), and completely true (5). (See Appendix 3).

Decision Regret Scale (DRS). In order to establish convergent validity, respondents were also given the adapted Decision Regret Scale (DRS) (Brehaut, 2003).

The DRS is a five-item paper and pencil self-report measure that asks subjects to reflect on a particular decision and then rate each item on a Likert scale from 1 (strongly agree) to 5 (strongly disagree). This scale was chosen because it was concise and had established reliability and validity that was determined in the context of four studies using different samples related to decisions for different types of healthcare treatment

(hormone replacement therapy, breast cancer adjuvant therapy, breast cancer surgery, and

prostate cancer treatment decision). The scale showed good internal consistency

(Cronbach’s α = 0.81 to 0.92) and correlated strongly with decision satisfaction (r = –

0.40 to –0.60), decisional conflict (r = 0.31 to 0.52), and overall rated quality of life (r = –

0.25 to – 0.27).

Analytic Strategy. Principal components analysis was conducted to determine if

the ERSS was unidimensional for the construct of the experience of regretted sex or if the

items represented subscales (Field, 2013). Confirmatory factor analysis (CFA) using

structural equation modeling was then employed to ensure the construct of the chosen

items was unidimensional (Tabachnick and Fidell, 2012). Next, the internal consistency

reliability of the scale was estimated using the Cronbach’s alpha statistic (Netemeyer et

al., 2003). Convergent validity was assessed by examining the correlation between the

summated scale score for the ERSS (obtained by averaging each person’s scores on the

regretted sex items) and the scale score for the Decision Regret Scale (DRS).

Next, we proceeded to determine the prevalence of regretted sex in college students

of various demographic and behavioral backgrounds. The average scores for respondents to the ERSS scale were analyzed. Any participant who achieved a score above zero on the

ERSS was considered to have experienced regretted sex and, thus, the prevalence of regretted sexual experiences could be calculated from the sample. The behavioral and demographic variables of interest included the nominal variables of class ranking, age, gender, race/ethnicity, relationship status, prior sexual intercourse, sexual orientation, and lifetime number of sexual partners (ordinal variable). The relationship between the

predictor variables (nominal and ordinal) and the dependent variable (composite score on

the ERRS) was assessed using logistic regression analysis (Tabachnick & Fidell, 2012)

Results

The researchers developed 21 items that were believed to represent the construct

of the experience of regretted sex. To establish the psychometric properties of the

Experience of Regretted Sex Scale, an exploratory factor analysis, using principal

components analysis, was conducted to determine the underlying factor structure. Next, a

confirmatory factor analysis (CFA) using structural equation modeling was performed.

Principal components analysis. In principal component analysis, one of the most commonly used criteria for solving the number of components issue is the eigenvalue-one criterion, also known as the Kaiser criterion (Kaiser, 1960). Any component with an eigenvalue greater than 1.00 is retained and interpreted. Using this criterion, the principal components analysis (PCA) revealed 3 components with eigenvalues greater than one among the 21 items on the initial Experience of Regretted Sex Scale. (See Table 2). The

16 items in these three factors explained 69% of the variance in regretted sex.

Table 2: Principal components analysis of the Experience of Regretted Sex Scale (n=364)

Total Variance Explained Extraction Sums of Squared Rotation Sums of Squared Initial Eigenvalues Loadings Loadings % of Cumulative % of Cumulative % of Cumulative Component Total Variance % Total Variance % Total Variance % 1 8.138 50.863 50.863 8.138 50.863 50.863 3.866 24.164 24.164 2 1.783 11.141 62.004 1.783 11.141 62.004 3.616 22.599 46.762 3 1.022 6.386 68.390 1.022 6.386 68.390 3.460 21.627 68.390 4 .746 4.660 73.050 5 .644 4.023 77.073 6 .530 3.315 80.388 7 .466 2.912 83.300 8 .434 2.710 86.010 9 .417 2.607 88.617 10 .376 2.352 90.969 11 .325 2.034 93.003 12 .288 1.801 94.804 13 .250 1.561 96.365 14 .237 1.480 97.845 15 .202 1.260 99.105 16 .143 .895 100.000

Using the identified loading patterns, the three-factor EFA varimax rotated solution for the 16 retained items is presented in Table 3. Items in factor 1 describe bad feelings experienced after engaging in sex. Items in factor 2 describe positive reactions to having engaged in sex. Items in factor 3 describe bad feelings about sexual partners.

Table 3: Summary of exploratory factor analysis results (n=364)

Factor loadings Factor Factor Factor 1 2 3 After having sex, wish I had not done .841 -.230 .251 what I did Next day after having sex, I wish I hadn’t .805 -.252 .316 done it After having sex, I look back and wish I .797 -.265 .342 made different decisions I feel guilty after having sex .762 -.259 .197 I get myself in situations I feel bad about .600 -.160 .467 I am pleased with whom I’ve done it with -.138 .828 -.211 I have been pleased with my relationships -.180 .794 -.268 I Am happy with sex partners -.203 .790 -.278 I feel good about decisions I’ve made -.307 .746 -.119 about sex I am happy with my sex life -.143 .670 -.073 It bothers me that I don’t know partners .200 -.115 .740 Next day, I can’t believe who I was with .138 -.276 .721 I am not happy with partners .411 -.224 .696 I disappoint myself with decisions .429 -.272 .672 I make poor partner choices .326 -.416 .640 I wish it hadn’t happened .458 -.038 .546 Note: Factor 1: Bad feelings afterwards, Factor 2: Positive reactions, Factor 3:Bad feelings about sexual partners Confirmatory factor analysis. Next, a confirmatory factor analysis (CFA) using structural equation modeling was performed. Confirmatory factor analysis is ideal for the final verification of the unidimensionality of a scale (Tabachnick & Fidell, 2012). The unidimensionality of a scale is essential because a composite score is normally calculated on the basis of the respondents' scores on all items of a scale as an un-weighted sum. In addition, the items of a scale should measure the construct evenly. That is, all items should have a similarly strong association with the latent construct, as reflected in the factor loadings.

CFA of the three-factor solution resulted in good model fit (X2[101] = 241.413, p < .001,

CFI = .962, TLI = .955, RMSEA = .062[.052-.072]). Factor 1 (Bad feelings afterwards) was highly correlated with Factor 3 (Bad feelings towards partners) (r = .818). The factor loadings for most items on all three factors were greater than 0.6, except for one item on factor 3 (γ= .517).

However, factors 1 and 3 were more conceptually valid for the construct of regretted sexual experiences than was factor 2. Hence, an eleven-item scale was proposed by removing the items from factor 2. This model provided a better fit to the data (X2[43]=114.817, p < .001, CFI =

0.972, TLI = .964, RMSEA = .068). Additionally, all factor loadings exceeded .6. (See Table 4).

Figure 2: Confirmatory factor analysis (n=364)

Table 4: Confirmatory factor analysis: Two factor solution (n=364)

Estimate S.E Est/S.E P

ERSS Factor 1

After I wish I had not had sex with him or her 0.867 0.015 56.453 0.000

Wish I had made different decisions 0.904 0.012 73.343 0.000

I wish I had not done what I did 0.894 0.013 67.974 0.000

I feel guilty after having sex 0.746 0.025 29.532 0.000

I get myself into situations I feel badly about 0.707 0.028 24.987 0.000

ERSS Factor 2

I make poor choices about sexual partners 0.763 0.025 30.078 0.000

I’ve had one/more sexual experiences that I wish had not 0.612 0.036 17.101 0.000 happened

I haven’t known sexual partners very well 0.643 0.034 18.895 0.000

I can’t believe who I’ve slept with 0.660 0.033 20.148 0.000

I disappoint myself with the sexual choices 0.847 0.019 44.973 0.000

I am not happy with the sexual partners I have been involved with 0.829 0.020 41.044 0.000

ERSS Factor 2 with

ERSS Factor 1 0.818 0.023 35.259 0.000

Reliability. A reliability analysis on the 11- item scale was performed

(Cronbach’s alpha = .925), indicating excellent internal reliability. Item-total statistics were calculated for each individual item as well to determine item-total correlations

(Tabachnick & Fidell, 2012). All items had item-total correlations exceeding .5 indicating that each item correlates very well with the scale overall. (See Table 5 for correlations).

Reliability estimates were also calculated for each factor using Cronbach’s alpha. The five items for Factor 1 exhibited excellent reliability (α= .911) and high item-total

correlations (.667-.841). Factor 2 also had good reliability (α= .863) with medium to high item-total correlations (.561-.760).

Validity: In order to determine convergent validity, composite scores for the 11- item ERSS and the adapted Decision Regret Scale (DRS) were calculated independently.

These two scale scores were highly correlated ( r = -.784, p < .01) supporting convergent validity. Each factor was also compared to the Decision Regret Scale. Factor 1 (r = -.710, p <.001) and Factor 2 (r = -.740, p < .001) and both correlated highly with the DRS as well.

Table 5: Item total correlation (n=367)

Scale Mean if Item Scale Variance Corrected Item-Total Squared Multiple Cronbach's Alpha if

Deleted if Item Deleted Correlation Correlation Item Deleted After having sex, I wish I hadn't done it 11.1503 76.174 .753 .710 .916 After having sex, I look back and wish I 10.9133 73.708 .804 .759 .913 made different decisions Next day wish I hadn't done it 11.0694 74.442 .784 .755 .914 I feel guilty after having sex 11.2110 77.089 .672 .536 .919 I get myself in situations I feel bad about 11.0231 74.649 .711 .517 .917 I make poor partner choices 11.0000 75.125 .727 .566 .916 I Wish one or more sexual experiences 10.1069 71.806 .604 .397 .926 hadn't happened Bothers me I don't know my sexual 11.1156 76.589 .590 .395 .923 partners very well Next day I can't believe who it was with 11.4075 78.138 .589 .430 .922 I disappoint myself with the sexual 11.1301 73.429 .774 .656 .914 choices I make I am not happy with the sexual partners I 11.0578 73.626 .758 .637 .915 have been involved with

Results for research question 1: To what degree do undergraduate college students experience regretted sex?

The newly-developed 11- item ERRS scale was used to determine the degree to which the undergraduate students in the sample, who had engaged in intercourse, had experienced regretted sex. A total of 41 participants (11.2% of the sample) had an average score of 0 on the 11-item ERRS indicating that they did not experience any regret pertaining to their past sexual experiences. However, a majority of the participants

(n= 136, 59.4%) had average scores ranging from greater than 0 to 2 indicating that they had experienced some degree of regretted sex in the past. In comparison, 52 participants

(22.7%) achieved average scores between 2.00 and 3.99, indicating that they had experienced a high degree of regretted sex in the past. No participant scored 4 on the

ERSS. (See Table 6). The breakdown of scores according to gender are presented in

Tables 7 and 8.

Table 6: ERSS scores (n=229)

Score Participants Percentage 0 41 17.4 >0 to 2 136 59.4 >2 but <4 52 22.7 4 0 0 Note: 0=Completely not true, 1=Generally not true, 2=Neutral, 3=Generally true, 4=Completely true

Table 7: ERSS scores: Females (n=168)

Score Number Percentage 0 28 16.7 >0 to 2 100 59.5 >2 but <4 40 23.8 4 0 0 Note: 0=Completely not true, 1=Generally not true, 2=Neutral, 3=Generally true, 4=Completely true

Table 8: ERSS scores: Males (n=56)

Score Number Percentage 0 12 21.4 >0 to 2 33 58.9 >2 but <4 11 19.6 4 0 0 Note: 0=Completely not true, 1=Generally not true, 2=Neutral, 3=Generally true, 4=Completely true

Results for research question 2: What demographic (age, gender, race/ethnicity,

sexual orientation) and behavioral (relationship status, number of lifetime sexual

partners) characteristics of students are significantly associated with regretted

sexual experiences?

Binary hierarchical logistic regression was used to examine the relative

contribution of five demographic factors and two behavioral factors to the frequency of

regretted sex participants reported on the Experience of Regretted Sex Scale (ERSS).

The ERSS scale score was grouped into two categories: 0=lower frequency of regretted

sex and 1= higher frequency of regretted sex. Lower frequency on the ERSS was defined

as those reporting values in the lower quartile; whereas, higher frequency was defined as

those above the 25th percentile (quartile).

Logistic regression results are summarized in Table 9. The first model includes the five demographic factors, and as a block the demographic factors were not statistically significant (Chi square = 9.82; df =11; p =.55). The second model involved adding the two behavioral factors (number of lifetime sexual partners and current relationship status). The addition of the two behavioral factors resulted in the logistic regression model being statistically significant (Chi square = 51.73; df = 16; p < .01) in addition to the block for model two being significant (Chi square = 42.41; df =5; p<.01).

The results indicate that the behavioral factor, number of lifetime sexual partners, was the most influential factor in explaining differences in level of regretted sex measured on the Experience of Regretted Sex Scale (ERSS). The odds ratio of 2.15 indicates that participants reporting 2-4 partners were slightly more than 2 times more likely to report higher levels of regretted sex than those reporting 1 partner. Similar

trends existed for those reporting 5-10 partners (odds ratio = 3.62), 11-20 partners (odds ratio =

20.55) and 21 or more partners (odds ratio = 12.09) when compared with those reporting one partner. Also in the final model, participants 21 - 23 years of age were 2.45 times more likely to report higher levels of regretted sex as compared to participants less than 21 years of age.

Table 9: Binary logistic regression results for the experience of regretted sex (n=258)

Model 1 Model 2

Variable B / SE B Exp p B / SE B Exp p B B Constant .29 /1.13 .75 .80 -2.39 / 1.42 .09 .09 Gender (Ref = Female) Male .30 / .27 .74 .28 -.49 / .30 .61 .10 Race (Ref = White) Black .33 / .38 1.37 .40 .26 / .42 1.30 .53 Asian .33 / .50 1.39 .51 .99 / .60 2.68 .10 Latino -.64 /.62 .30 .53 -.27 /.66 .77 .69 Other .40/.61 1.49 .52 .73 / .65 2.08 .26

Age (Ref= ≤ 20 yrs.) 21-23 yrs. .71 / .32 2.03 .03 .90 / .36 2.45 .01 24-29 yrs. .05 / .83 1.05 .96 -.70 / 1.02 .49 .49 Current Rank in College (Ref = Freshmen) Sophomore Junior .43 / .98 1.54 .66 1.12 / 1.23 3.08 .36 Senior .11 / .97 1.12 .91 .63 / 1.21 1.87 .61 -.13 / 99 .89 .88 .15 / 1.23 1.16 .90 Sexual orientation (Ref = heterosexual) Bisexual or Homosexual -.30 /.59 .74 .61 .27 / .64 1.31 .67 Number Partners (Ref=1 partner) 2-4 partners .76/ .39 2.15 .05 5 – 10 partners 1.29 / .40 3.62 <.01 11-20 partners 3.02 / .64 20.55 <.01 21 or more partners 2.49 / .81 12.09 <.01 Relationship Status (Ref = Single) Married/Life Partner -.59 / .39 .56 .13 Model Summary 2 LL 450.95 397.70 Model Chi square/df/p 9.82/11/.55 51.73/15/<.01 Block Chi Square/df/p 9.82/11/.55 42.41/5/<.01 Nagelkerke R Square .04 .20 Hosmer Lemeshaw p .96 .33 Classification Accuracy % 56.76% 66.77% Note: The dependent variable experience of regretted sex is coded 0 = lower incidence of regretted sex and 1 = higher incidence of regretted sex.

Discussion

The analyses of the finalized 11-item Experience of Regretted Sex Scale (ERSS),

developed for use in this study, demonstrated that it is a reliable and valid measure of the

experience of regretted sex in at least one sample of undergraduate college students in a

large northeastern university. Previous studies on regretted sex have measured either the

frequency of regretted sex, the intensity of regretted sex, or the reasons for regretting sex,

often using only one item (Caron & Moskey, 2002; Esbaugh & Gute, 2008; Fisher,

Worth, Garcia & Meredith, 2012 Oswalt, Cameron, & Koob, 2005; Thomas, 2010). The

ERSS represents a more psychometrically-based approach to measuring the latent construct of regretted sex as it includes 11 validated items (Netemeyer, Bearden, &

Sharma, 2003). Specifically, the ERSS demonstrated convergent validity as evidenced by a high correlation with the adapted Decision Regret Scale (r=.784). Further, the ERRS demonstrated excellent internal consistency reliability with a sample of undergraduate college students (Cronbach’s alpha =0.925).

Results from analyses with the ERSS data for a sample of undergraduate college students indicated that a majority (88.8%) of respondents (89.7% of females and 85.7% of males) experienced some degree of regret pertaining to past sexual experiences. These results are somewhat higher than findings in previous studies of undergraduates at other universities throughout the U.S., which ranged from 68%-77% (Esbaugh & Gute, 2008;

Oswalt et al., 2005; Thomas, 2010; Worth, Garcia, & Meredith, 2012). It may be that the prevalence of regretted sex was higher in the present study than in previous studies due to the improved measurement (multiple indicators) of the concept through the development and validation of the Experience of Regretted Sex Scale.

Hierarchical binary logistic regression analyses showed that the majority of

demographic variables were not significant predictors of regret pertaining to past sexual

experiences. For the ERSS as the dependent variable, the behavioral variable, number of

lifetime sexual partners, emerged as a significant predictor of sexual regret. This finding

is consistent with that reported by Oswalt and colleagues (2005) who found that the

number of partners was the only significant predictor of regret in their study as well. Age

(above 21 years) was also a significant predictor in the present study. This could be that

older students have had more time to involved in sexual activity and/or that they have

more opportunity to drink alcohol before engaging in sex.

The current study has several limitations that must be considered in the

interpretation of the results. The findings were from one sample of undergraduate college

students at a large, northeastern, land-grant university. Although the sample was drawn from required general education courses representing the diverse backgrounds and majors of the students at this university, the demographics from this university’s student body may be different from that of other universities nationally. Thus, the generalizability of the results, particularly to students in typically underrepresented groups based on their race/ethnicity and sexual orientation, may be limited. Although comparison of study participants and non-participants, based on their gender and race/ethnicity, did not find significant differences, between these groups, there may have been differences in other demographic and/or behavioral differences that were not measured. In addition, the data collection method employed involved a self-administered questionnaire (SAQ) from students who volunteered to be part of the study. Inaccurate self-reporting can be caused

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by recall bias, social desirability bias and errors in self-observation (Weinhardt et al.,

1998).

It is hoped that the ERSS will be used with samples of university students at a variety of institutions of higher education (e.g., community colleges, religiously-oriented schools, private and public schools) at differing geographic locations throughout the

United States and in other countries in order to assess how various demographic, contextual, and cultural factors may affect the experience of regretted sex. The ERSS could also be used in studies of other groups, including adolescent and adult samples in various settings. Findings from the ERSS could be useful in educational and clinical settings. Based on theories of experienced and anticipatory regret, individuals could be encouraged to explore patterns of regretted sex in certain groups (e.g. first-year college students, students who engage in hook ups, students who binge drink) or examine their own patterns in order to make plans to improve the outcomes of their sexual interactions.

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Chapter 4

Study 2 - Development and Validation of the Reasons for Regretted Sex Scale

Engaging in sexual activity is a normative experience on college campuses, with an average of almost 70% of undergraduate students at one hundred and forty post- secondary institutions in the United States reporting having had one or more sexual partners in the past year (American College Health Association, 2014). A majority of these sexually-active young adults (53%-85% depending on the campus) report they engage in casual sex, also known as hooking up (Glenn & Marquardt, 2001; Grello,

Welsh, Harper, & Dickson, 2003; Grello et al., 2006; Flack et al., 2007; Paul & Hayes,

2000; Penhollow, Young, & Bailey, 2007; Reiber & Garcia, 2010). In addition to the prevalence of sexual activity, there is a prominent culture of drinking alcohol on college campuses (Grant, et al., 2004; Hingson, Heeren, Winter, & Wechsler, 2005; Hingson,

Zha, & Weitzman, 2009; O’Malley & Johnson, 2002; National College Health

Association, 2011; Schulenberg & Maggs, 2001; Ven & Beck, 2009). Studies show that approximately four in five college students drink alcohol, and at least two in five of them report heavy episodic, or binge, drinking (five or more drinks in a row for males, four or more drinks in a row for females) (Grucza, Norberg, & Bierut, 2009; Wechsler et al.,

2002).

The high prevalence of sexual activity on college campuses in the context of heavy drinking places college students at a high risk for negative sexual experiences

(Cooper, 2002; Fisher, Cullen, & Turner, 2000; Mallett, Bachrach, & Turrisi, 2008). One of the most common negative sexual experiences reported by college students is regretted sex (Caron & Moskey, 2002; Colaco, 2016b; Esbaugh & Gute, 2008; Oswalt et al., 2005;

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Taylor, 2010). The prevalence of sexual regret/regretted sex in college students who have

engaged in sexual activity has been reported to be between 69% and 89% (Colaco,

2016b, Esbaugh & Gute, 2008; Oswalt, Cameron, & Koob, 2005; Roese et al., 2006;

Thomas 2010). The experience of regretted sex in college students has been associated

with psychological distress, including poor self-esteem, anxiety and depression, and negative feelings, including disappointment, hurt, confusion, anger, self-blame, guilt, and

shame (Armstrong & Hamilton, 2009; Fielder & Carey, 2010; Glenn & Marquardt, 2001;

Lewis, et al., 2012; Owen, Rhoades, Stanley & Fincham, 2010; Paul, 2006; Paul &

Hayes, 2002; Paul, McManus, & Hayes, 2000; Wade & Heldman; 2010; Welsh, Grello,

& Harper, 2006).

Although it may be psychologically painful, regret can be functional if it helps

individuals make better decisions in the future (Saffrey, Summerville & Roese,

2008). Behavior that involves making a different decision when faced with the same or a similar choice is termed as adaptive choice switching. The effect of experienced regret on subsequent choices is often mediated by anticipated regret. Anticipated regret is defined as a cognitively-based anticipated emotion that people trigger when considering whether future outcomes would have been better if a different decision had been made (Mellers &

McGraw, 2001). When future regret is brought to the attention of the decision maker, this feeling might bear weight on the decisional process and may result in subsequent regret aversion (Connolly & Zeelenberg, 2002). Stated simply, people may consider the possibility of future regret before making their decisions.

Since regretted sex has been shown to have negative consequences but may also

motivate better sexual decision making in the future, it is important to determine the

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reasons for regretting sex and not just the prevalence of this experience, particularly in college students for which this experience is so common. Caron and Moskey (2002) conducted the first documented exploratory study to examine regretted sexual experiences in a convenience sample of 392 college students (73% female, 99% heterosexual) enrolled in an undergraduate course in human sexuality at a large public university in the northeastern United States. Participants were asked to submit a story about a regrettable sexual experience (e.g., “sex in which the person feels regret later for something he/she agreed to participate in,” p. 48) that happened to themselves or somebody they knew. Six major categories of sexual regret emerged among the 392 stories that were collected: It was a disappointing first time (25%), it was unprotected sex (22%), I was cheating on my partner (17%), I was drunk (16%), it resulted in a ruined friendship

(11%), or other reasons (25%).

This initial study was followed by one conducted by Oswalt, Cameron, and Koob

(2005) who examined the sexual regret experienced by 346 undergraduates (71% females) attending a peer-facilitated sexual health program at a university in the southern region of the United States. The majority of participants in this convenience sample were

Caucasian (68.1%) with an average age of 19. As part of a broader survey, entitled “Peer

Sexuality Education Program Pretest,” one question was asked regarding regretted sex:

“Have you every regretted your decision to engage in sexual activity?” The majority

(71.9%, n = 194) of sexually active participants in the sample reported regretting their decision to engage in sexual activity at least once. They were provided with a list of eight possible reasons for regretting sex that emerged from focused discussions with students. The most common reason for regret was that the decision to engage in the

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sexual activity was in conflict with the student’s morals and values (36.8%). Regret due to the influence of alcohol on his/her decision was another common explanation (31.6%).

Other notable reasons included: Partners did not want the same thing the participants did

(28.2%), did not use condoms (25.4%), felt pressured by the partner (22.9%), and had wanted to wait until marriage (15.3%). Interestingly, sexual regret secondary to unintentional pregnancy or acquiring a sexually transmitted infection were not commonly reported (4.3% and 2.9%, respectively). Multivariate analyses revealed a strong relationship between a higher number of sexual partners and the frequency of experiencing sexual regret. The only significant gender difference found was that women reported regret after being pressured by a partner to have sex more than men did.

Thomas (2010) also used Oswalt and colleagues’ (2005) two questions about sexual regrets in her study on cognitive dissonance and sexual regret in college students.

She found that having sex that conflicted with morals and values was reported by 11% of her convenience sample of 292 (158 female, largely Caucasian and heterosexual) undergraduate students attending a mid-sized university in the western United States.

Other common reasons for regretted sex were: Alcohol influenced my decision (25%), I felt pressure from partner (10%), and I did not want the same thing as partner (9%).

Multivariate analyses revealed that, for both males and females, cognitive dissonance was a significant predictor of sexual regret, and sexual attitudes predicted sexual regret among female students only.

Fisher, Worth, Garcia, and Meredith (2012) studied regretted sex specifically following uncommitted sexual encounters (USE) in a convenience sample of 200 (69% female) Canadian university students. Participants reported whether they had ever

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experienced sexual regret following an uncommitted sexual encounter. They were

provided 10 options, including both physical and emotional reasons, based on a small

survey given previously to students at the university. The researchers found that women

reported feeling significantly more regret than men did. In fact, when asked to report how

often they experienced feelings of regret, women (M = 2.88, SD = 1.29) reported

experiencing more frequent regret than men (M= 2.42, SD= 1.05) on the 5-point scale

ranging from never to always (t[133]= 2.05, p= .04, Cohen’s d = 0.39). The researchers

found that although men did select more physical reasons for regret than women,

attribution to individual sources did not vary much by sex. However, men did report

regret significantly more frequently than women for a lack of physical attraction. Regret

was also influenced by the quality of the sex in that high-quality sex rarely led to regret,

while the reverse was true for poor-quality sex. Intoxication by alcohol and/or drugs during a USE was often listed as a source of regret by both men and women.

Being intoxicated/drunk is a common theme throughout the studies on regretted sex in college students (Kypri et al., 2010; Mallett et al., 2006; Orchowski, Mastroleo &

Borsari, 2012). In fact, in a study of 341 first-year students (55% female, 86% White) from a large northeastern land-grant university, Mallett and colleagues (2008) found that although 83.8% of the sample felt that regretting sex was a negative consequence of drinking, the students with higher weekly alcohol consumption were more likely to rate regretted sex as a neutral or positive outcome of drinking. The researchers contend that one potential explanation for these findings is that individuals believe experiencing certain negative consequences are part of the overall drinking experience and balance

these negative consequences with the positive consequences they experience.

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Despite the potentially important findings from studies on the reasons for regretted sex in college students, most have methodological weaknesses. Foremost among these is the issue of internal validity due to two major factors: lack of an empirically-based definition of regretted sex and lack of a psychometrically-sound measure of the reasons for regretted sex. In order to address the issue of the construct validity of the term “regretted sex,” the researchers of the current study believed it would be important to have college students define the experience as a basis for creating a more valid definition of the construct. To achieve this aim, Woehling, Colaco and Koch

(2008) conducted a research study of 169 undergraduate college students (70% females) ages 18-22 who attended general education courses at a large northeastern land-grant university Volunteers were asked to complete surveys with nine open-ended questions regarding one of the following negative sexual experiences: regretted sex, unwanted sex, aggressive sex, incapacitated sex, or sexual victimization. From the 34 students who randomly responded to the survey on regretted sex, content data analysis revealed that the majority of students (76.7% females; 53.8% males) defined regretted sex as “a sexual experience you wish you had not done.” The remaining responses still echoed this theme, although in more specific terms, including: “sex with a partner that you don’t know,” “negative or unsatisfying sexual experiences,” “sex while consuming alcohol,”

“not using protection,” or “sex that ruined a friendship.” Almost three-quarters (72.0%) of the females and two-thirds (66.7%) of the males reported that they themselves or someone that they knew had experienced regretted sex. From this study, a valid definition of regretted sex emerged as: a negative cognitive emotion experienced when an

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individual remembers a past sexual experience and wishes that it had not happened or that it had been different. This is the definition that was used in the current study.

The second major weakness in the previous studies was a lack of the use of a methodologically-sound research instrument. Most of the studies relied on asking only one or two questions about regretted sex and/or providing a list of a few reasons for regretting sex, which have not been validated in the college student population. A systematic process to develop a valid list of reasons for regretted sex, which would consist of a number of different but related factors, is needed. The psychometrically- sound approach to measuring a latent construct, like regretted sex, is to ask a number of similar questions that are intended to assess that construct (Netemeyer, Bearden, &

Sharma, 2003).

To summarize, regretted sex is increasingly a common experience for college students and is particularly associated with consuming alcohol and engaging in casual sexual experiences. Yet, although the experience often has many negative outcomes, this phenomenon is currently understudied and the few studies that have been conducted are fraught with limitations. Thus, researchers have argued for more in-depth, methodologically-sound research of this phenomenon (Oswalt et al., 2005; Eshbaugh &

Gute, 2008). The purpose of the current study was to address that gap by developing a psychometrically-sound measure of the reasons for regretted sex. Using this newly- developed research instrument, the following research question was examined: Which categories of reasons for regretted sex are associated with a higher level of regretted sex among undergraduate college students?

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Methods

In order to answer the research question of this study, the development of the psychometrically-sound measure of the reasons for regretting sex was achieved in two

stages. Stage one involved the initial generation of items regarding the reasons that undergraduate students may regret sex. These items were then reviewed by an expert panel for aggregation and the removal of redundancies. In stage two, the shortened list of items, identified as the Reasons for Regretted Sex Scale (RRSS), was included in a broader

Regretted Sex Survey for testing of its psychometric properties with a sample of undergraduate students. Details about the methods used in the development and testing of the RRSS at each stage, as well as the analyses for the corollary research question, are provided below. All methods were approved by the Institutional Review Board of the university.

Stage 1: Participants, procedures, and measures used for item generation. At a large northeastern land-grant university, 256 undergraduate students (67% females) in two large general education courses were recruited to individually list up to 10 reasons college students might regret a sexual experience. Since general education courses are required to be taken by every student, they are comprised of students of differing majors and backgrounds representing the entire student body at the university. During the last 15 minutes of one of their classes, the study was described and consent forms were distributed. On a separate form, students who consented to participate were asked to list up to 10 reasons why a college student might regret a sexual experience. The only identifier on this form was a question eliciting the sex of the respondent. Thus, responses were anonymous. The response rate for participation in this study was 88%.

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When the responses were entered into an excel spreadsheet, the result was the creation of a master list of 432 reasons why college students may regret sex. (See

Appendix B for the master list). Using Neuendorf’s (2005) process for content analysis, the researchers took the initial step of identifying general categories. Each item was then placed into one of these categories. One hundred percent agreement was reached for the classification of each reason. The initial categories, accompanied by item examples, are presented below.

Relationship Issues (87 items): “It was a hook up,” “I cheated on someone,” “It hurt the relationship.”

Regrets related to the Physical Sex (86 items): “I performed poorly,” “I was not aroused (turned on),” “I faked an orgasm.”

Personal Issues/Negative Feelings (60 items): “I was not ready to have sex with this person,” “I felt used,” “I got a bad reputation from what I did.”

Regrets towards the Sexual Partner (51 items): “My partner was unattractive,” “I had sex with someone who was off-limits,” I slept with a jerk.”

Context of the Sexual Experience (39 items): “There was no privacy,” “We were caught having sex,” “I (or my partner) became ill during sex.”

Reasons for Having Sex (38 items): “I had sex for the wrong reason,” “I had sex to make myself feel better, but I didn’t,” “I felt pressured by my friends/peers.”

Regrets related to Drinking/Drugs (24 items): “I was drunk so I engaged in sex with someone I was not attracted to,” “I was drunk so I engaged in sexual acts that I wouldn’t do when I was sober,” “When I woke up, I couldn’t remember where I was or how I got there.”

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Regrets related to Consent (24 items): “My partner forced me,” “My partner took

advantage of me,” “My partner did not want to have sex.”

Regrets related to Health and Other Issues (23 items): “I had unprotected sex,” “I

experienced genital pain,” “I contracted an STI.”

Once the items on this master list were categorized, an expert panel of 8 specially-

trained peer sexuality educators examined the items in each category and identified items

that were redundant or closely related. For example, there were multiple specific items

related to the topic of “cheating” (i.e., “I had sex with someone I knew was cheating on

someone else”, “My partner slept with one of my friends”). These specific “cheating”

items were subsumed under a more generally-worded item, “By having sex, my partner

or I cheated on someone else.” The process of condensing similar items under broader

categories progressed under the direction of the researchers until 100% agreement on all

items was reached. A total of sixty-nine items were maintained as they were believed to represent a broad spectrum of reasons for regretted sexual experiences as identified by undergraduate college students.

Stage 2: Participants, procedure, and measures for testing the Reasons for

Regretted Sex Scale (RRSS) and the research question. The respondents were

undergraduate students in general education classes participating for course credit at a

large northeastern land-grant university. Since these students were in required general

education classes, they were assumed to represent the diversity of student backgrounds

and majors offered at the university. A total of 435 students (25% men, 73% women,

0.004% transgender) completed the survey. (Note that due to the low number of

transgender students, they were dropped from subsequent multivariate analyses.) The

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response rate was 62%. Compared to the overall undergraduate student body, females

were over-represented by two times and males were under-represented by one-half.

However, the over-representation of females is a common phenomenon in social science

research in which females are much more likely to volunteer than males (De Vaus, 2003).

The behavioral and demographic characteristics of the sample are summarized in Table 1.

Nearly all (97%) of the students were ages18-23 years, with almost two-thirds upperclassmen. More than two-thirds (72.9%) identified themselves as White. Compared to the race/ethnicity of the entire undergraduate student population at the university, the sample was representative of White and Asian students attending the university, whereas

Black students were over-represented and Latino students were under-represented. The

majority of participants (95.4%) identified themselves as heterosexually-oriented. Most participants (91.3%) had engaged in sexual intercourse (vaginal, oral, or anal), and greater than 82% of participants had more than one sexual partner in their lifetime. Most participants (84.4%) identified themselves as single, whereas the rest were involved in on-going committed relationships. Most participants (91%) reported engaging in sexual intercourse. Only those participants who had engaged in any type of sexual intercourse were included in the multivariate analyses (n=396). Thus, the total number of participants exceeded the sample size requirement of 300 for the factor analyses that were conducted

(Tabachnik & Fidell, 2012). The behavioral and demographic characteristics of the sample are summarized in Table 10.

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Table 10: Behavioral and demographic characteristics of the sample (n=435)

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Each student received a written description of the study, a consent form, a copy of

the survey, a computerized answer form, an information sheet listing campus resources

for the topic being addressed, and an envelope in which to return the answer form to the

next class session. Participants were instructed to complete the survey privately in a

comfortable area, such as where they lived, and not to write their names on the answer

form.

The Reasons for Regretted Sex Scale (RRSS), consisting of 69 items, was part of

a larger survey entitled the Regretted Sex Survey. In addition to the RRSS, the survey

contained seven background questions assessing the demographic characteristics (age,

gender, race/ethnicity, class standing, and sexual orientation) and behavioral characteristics

(relationship status, number of lifetime sexual partners). Finally, the survey contained the

Experiences of Regretted Sex Scale (ERSS), a measure of the degree to which someone

experiences regretted sex (Colaco, 2016a). The 11-item version of this scale

demonstrated construct and convergent validity, as well as high reliability (Cronbach’s

alpha = .925) with a sample of 429 undergraduate college students. The ERSS was used

to help answer the research question.

The directions for the RRSS said: “People regret having sex for many different

reasons. Following is a list of many different sexual situations that people may or may

not regret. Using the following scale, indicate how frequently each of the following

reasons has led you to regret having sex in the past.” The response choices were: Never

(1), Less than half of my sexual experiences (2), About half of my sexual experiences (3),

More than half of my sexual experiences (4), and All of my sexual experiences (5). There

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was also a choice for Never having been in this situation (0). The entire survey took

approximately 30 minutes to complete, including 15 minutes for the 69 items on the

RRSS.

Analytic Plan

Exploratory factor analysis (EFA) was used to examine the underlying factor

structure of the RRSS and identify the unidimensional sub-scales within this measure

(Field, 2013). Further correlational analyses and confirmatory factor analysis were conducted to verify the underlying factor structure (Tabachnick and Fidell, 2012). To establish convergent validity, the correlation between the Reasons for Regretted Sex

Scale and the Experience of Regretted Sex Scale was examined. Internal consistency reliability for each of the subscales and that of the entire measure was estimated using the

Cronbach’s alpha statistic. In order to examine the research question, logistic regression analysis was employed to estimate the influence of each of the subscales of the RRSS, as well as demographic and behavioral variables, on the ERSS. This enabled us to determine which factors on the RRSS explained most of the variance on the ERSS.

Results

The results of the psychometric testing of the Reasons for Regretted Sex Scale are presented first. The results from the testing of the question follow.

Psychometric testing of the Reasons for Regretted Sex Scale. Principal components analysis (PCA) using SPSS version 23 was conducted. A total of 16 components exceeded an eignenvalue of 1.0, explaining 70.94 percent of the total variance. The KMO

Measure of sampling accuracy was .914, and the Bartlett’s Test of Sphericity was significant

(X2[2415] = 11584.294, p < .001). A table representing the 16 factor solution obtained using

varimax rotation is presented below (Table 11).

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Table 11: Exploratory factor analysis: Rotated 16-factor solution for the RRSS (n=396)

Component Item # & statement 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 61 I was drunk/high .813 .353 22 It was a hook-up .764 48 Because I was drunk/high, I ended up with someone that I .758 wouldn’t be with if I was sober 62 My partner was drunk/high .756 30 We didn’t love each other .693 68 Because I was drunk/high, I did things that I wouldn’t have .620 .398 done if I was sober 38 I could not remember the .573 .332 sexual experience very well 9 I had sex with someone that I .521 really didn’t want to be with 36 There was a lack of .520 emotional connection 12 The experience was not .519 .455 meaningful 50 It happened on the spur of .484 moment 24 My partner was a player/slut .481 .333 52 It went too far .721 54 I felt conflicted about what I .703 did 51 I felt guilty .701 71 I was not comfortable with .609 .389 the experience 58 I was embarrassed by what .555 happened 42 I was concerned about others .500 .335 finding out 20 I didn’t really want to have .491 .425 sex in the first place 77 I felt pressured .491 .436

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13 I had sex for the wrong .360 .464 .405 reason 25 I felt cheap .455 .320 .359 39 I had sex to make myself feel .393 .374 .327 .354 better but I didn’t 34 It complicated relationship .392 .334 11 I felt used .382 .340 .338 43 It was physically unsatisfying .809 37 The sex was not as good as I .788 expected 59 The sex was bad .773 45 My partner not a good lover .766 69 It was no fun .599 63 It was emotional unsatisfying .354 .331 .543 .321 70 There was a lack of affection .431 .481 53 I wasn’t turned on .340 .477 28 I got emotionally hurt .370 .427 .411 17 I mistakenly thought my partner was into me as much as I .720 was into him/her 16 I found out my partner was .693 dishonest with me 18 I realized I didn’t know the .620 person as well as I thought 65 We expected different levels .603 of commitment afterwards 32 I had sex to make my partner care about me more but she/he .544 .440 didn’t 26 It ruined a friendship I had .531 with my partner 23 There was poor .327 .328 .463 .352 communication 14 I Thought that having sex would help relationship but it .442 .416 didn’t 60 The sex meant something .362 .441 different to the two of us 21 My partner dumped me .428 .345 78 I slept with a jerk .343 .369

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15 My partner was unattractive .736 33 My partner was more into me .610 .328 than I was into him/her 47 There was no chemistry .350 .599 55 I didn’t know my partner .527 56 I was out of control .366 .438 .419 29 It was awkward afterward .402 .419 31 My partner harassed me after .744 66 My partner demeaned me .648 35 We hurt someone else by .709 having sex together 73 I had sex with someone who .653 was off limits 67 My partner or I cheated on .522 -.332 someone 57 My Partner did not seem into .697 it 44 I was not a good lover .644 10 I got a bad reputation from .639 what I did 72 When others found out they .354 .402 criticized what I had done 74 I lost my virginity at wrong .321 .611 time or with wrong person 75 I was not ready to have sex .498 .559 with this person 76 The experience resulted in .443 .411 concern over pregnancy 49 The experience resulted in concern over a sexually .543 transmitted disease 27 My Partner was emotionally .536 hurt 46 It was physically painful .741 40 I did sexual things I really .321 .345 .462 wasn’t into 19 My partner said negative .706 things to others after 64 We had unprotected sex .772 41 There wasn’t any privacy .757

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Stevens (1992: in Field 2000, page :441) recommends interpreting only factor loadings with an absolute value greater than 0.4. Thus, twelve items were excluded from further analyses either due to low factor loadings or because they loaded to a substantial degree on more than one factor after factor rotation (Table 12). Additionally, 19 more items had low item-total correlations (< .45) and were excluded (Table 13). This is because an item with low item-total correlations does not produce responses that are consistent with the other items, and is thus an unreliable indicator of the underlying concept (Stommel and Wills, 2004). A second factor analysis was conducted in SPSS on the remaining 36 items. The principal components analysis resulted in 5 factors

(eigenvalues > 1) that explained 62.3% of the total variance. The five factor solution, using varimax rotation, is depicted in Table 14.

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Table 12: Items excluded for low factor loading/loadings on multiple factors

Item Statement

Item 39 I had sex to make myself feel better but it didn’t.

Item 34 It complicated the relationship.

Item 11 I felt used.

Item 28 I got emotionally hurt.

Item 14 I thought that having sex would help the relationship but it didn’t.

Item 60 The sex meant something different to the two of us.

Item 21 My partner dumped me afterwards.

Item 78 I slept with a jerk.

Item 56 I was out of control

Item 29 It was awkward afterwards

Item 72 When others found out they criticized what I had done

Item 76 The experience resulted in concern over pregnancy

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Table 13: Items with low item total correlations (<45)

Item No Statement

Item 10 I got a bad reputation from what I did

Item 19 My partner told others negative things about me or the sexual experience

Item 21 My partner dumped me afterwards

Item 22 It was a hook-up

Item 27 My partner was hurt emotionally

Item 31 My partner harassed me afterwards

Item 32 I had sex to make my partner care about me more afterwards but he didn’t

Item 35 We hurt someone else by having sex

Item 38 I could not remember the sexual experience very well

Item 41 There wasn’t any privacy

Item 44 I was not a good lover

Item 46 It was a physically painful experience

Item 49 The experience resulted in concerns over a sexually transmitted disease

Item 57 My partner did not seem into it

Item 64 We had unprotected sex

Item 65 We expected different levels of commitment afterwards

Item 66 My partner demeaned me

Item 67 By having sex, my partner or I cheated on someone else

Item 73 I had sex with someone who was off limits

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Table 14: Exploratory factor analysis on 36 items: Rotated five-factor solution (n=396)

Item # and statement 1 2 3 4 5 61 I was drunk/high .796 62 Partner was drunk/high .765 48 Because I was drunk/high, I ended up with someone .744 that I wouldn’t be with if I was sober 30 We didn’t love each .691 .352 other 68 Because I was drunk/high, I .658 .320 did things that I wouldn’t have done if I was sober 36 There was a lack of .572 .381 emotional connection 12 The experience was not .566 .403 .321 meaningful 9 I had sex with someone that I really didn’t want to .535 be with 50 It happened on the spur .462 .341 .334 of moment 51 I felt guilty .767 54 I felt conflicted about .724 what I did 52 It went too far .324 .719 75 I was not ready to have .649 sex with this person 58 I was embarrassed by .646 what happened 71 I was not comfortable .638 .408 with the experience 42 I was concerned about .619 others finding out

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77 I felt pressured .556 .387 25 I felt cheap .540 43 It was physically .818 unsatisfying 37 The sex was not as good .787 as I had expected 59 The sex was bad .772 45 My partner was not a .761 good lover 69 It was no fun .606 53 I wasn’t turned on .339 .502 .380 63 It was emotionally .411 .463 .345 unsatisfying 70 There was a lack of .456 .462 affection 16 My partner was not .748 honest with me 17 I mistakenly thought my .723 partner was into me as much as I was into him/her 26 It ruined a friendship I .614 had with my partner 23 There was poor .329 .600 communication 18 I realized I didn’t really know the person as well as .596 I thought 24 My partner was a .501 .509 player/slut 15 My partner was .706 unattractive 55 I didn’t know my .677 partner 47 There was no chemistry .355 .622 33 My partner more into .583 me than I was into him/her

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Based on the principal components analysis, the identified factors were categorized into the following groups, as presented in Table 15:

Casual/Drunken Sex: 9 items representing regrets based on being drunk or high and/or regrets due to the casual nature of the experience.

Negative Feelings: 9 items representing negative feelings experienced during or after the sexual interaction.

Bad Sex: 8 items representing aspects of the physical sexual interaction being negative or “bad.”

Relationship Issues: 5 items representing issues in the relationship with the sexual partner.

Partner Issues: 4 items representing issues with the partner himself or herself

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Table 15: Factors and corresponding items on the Reasons for Regretted Sex Scale

Factor Item # and statement Casual/Drunken Sex 61 I was drunk/high 62 My partner was drunk/high 48 Because I was drunk/high, I ended up with someone I wouldn’t be with if I were sober 30 We didn’t love each other 68 Because I was drunk/high, I did things I wouldn’t have done if I were sober item 36 There was a lack of an emotional connection 12 The experience was not meaningful 9 I had sex with someone that I really didn’t want to be with 50 It happened on the spur of the moment item Negative Feelings 51 I felt guilty 54 I felt conflicted about what I did 52 It went too far 75 I was not ready to have sex with this person 58 I was embarrassed by what happened 71 I was not comfortable with the experience 42 I was concerned about others finding out 77 I felt pressured 25 I felt cheap Bad Sex 43 It was physically unsatisfying 37 The sex was not as good as I had expected 59 The sex was bad 45 My partner was not a good lover 69 It was no fun 53 I wasn’t turned on 63 It was emotionally unsatisfying 70 There was a lack of affection Relationship Issues 17 I mistakenly thought that my partner was into me as much as I was into him/her 16 I found out that my partner was not honest with me 26 It ruined a friendship that I had with my partner 23 There was poor communication 18 I realized I did not really know the person as well as I thought 24 My partner was a player/slut Partner Issues 15 My partner was unattractive 55 I didn’t know my partner 47 There was no chemistry 33 My partner was more into me than I was into him/her

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Next a confirmatory factor analysis (CFA) was employed. The five factor model

using the above 36 items fit the data reasonably well, as explained below (X2[584] =

1842.037, p < .001, CFI/TLI >.82, RMSEA = .077). The goodness of fit of the model was determined using the Chi-square statistic. For the model, the p-value was 0.00 (i.e., smaller than 0.05), indicating that the model does not provide an acceptable fit to the data. However, χ2 is sensitive to sample size, and is not always the best measure of fit.

For large sample sizes, such as our sample with over 400 students, even small differences between the model and data can lead to a significant χ2 (Tabachnick & Fidell, 2012).

Many researchers disregard this index if both the sample size exceeds 200 or so, and

other indices indicate the model is acceptable The root mean square error of

approximation (RMSEA) indicates the discrepancy between the fit of hypothesized

model and the fit of a perfect (or saturated) model (Byrne, 2001); values below .06

indicate good fit and values above 0.1 indicate poor fit (Tabachnick & Fidell, 2012).

Here, RMSEA was .07, indicating that the model fits the data reasonably well. The

Comparative Fit Index (CFI) represents the extent to which the model of interest is better

than is the independence model. Values that approach 1 indicate acceptable fit. Similarly,

for the Tucker Lewis Index (TLI), acceptable fit is judged to be close to 1 (Byrne, 2001).

The CFI and TLI were 0.83 and 0.82 respectively indicating reasonable fit. All of the loadings for each item onto their respective factors exceeded .57, with most exceeding .60.

According to Hair and colleagues (2010), standardized loading estimates should have a regression weight of 0.5 or higher. High loadings on a factor indicate that they converge on a latent construct. The loadings for each item on their respective factors are represented in

Table 16. All five factors were correlated highly with each other (rs = .638 - .782).

Correlations between factors are represented in Table 17.

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Table 16: Confirmatory factor analysis for the RRSS: Factor loadings (n=396)

Estimate S.E. Est./S.E. P-Value

RRSS: Casual/Drunken Sex V61 I was drunk/high 0.777 0.025 30.762 0.000 V62 My partner was drunk/high 0.746 0.027 27.234 0.000 V48 Because I was drunk/high, I ended up with 0.736 0.028 26.653 0.000 someone that I wouldn’t be with if I were sober V30 We didn’t love each other 0.696 0.030 23.040 0.000 V68 Because I was drunk/high, I did things I 0.718 0.029 24.693 0.000 wouldn’t have done if I were sober V36 There was no emotional connection 0.736 0.027 26.894 0.000 V12 The experience was not meaningful 0.780 0.024 32.745 0.000 V9 I had sex with someone that I didn’t want 0.599 0.036 16.578 0.000 to be with V50 It happened on the spur of the moment 0.620 0.035 17.596 0.000

RRSS: Negative Feelings V51 I felt guilty 0.818 0.020 40.526 0.000 V54 I felt conflicted 0.780 0.023 33.303 0.000 V52 It went too far 0.790 0.022 35.148 0.000 V75 I was not ready to have sex with this 0.692 0.030 22.881 0.000 person V58 I was embarrassed 0.765 0.024 31.278 0.000 V71 I was not comfortable with the experience 0.748 0.026 28.983 0.000 V42 I was concerned about others finding out 0.576 0.038 15.304 0.000 V77 I felt pressured 0.644 0.033 19.427 0.000 V25 I felt cheap 0.698 0.030 23.567 0.000

RRSS: Bad Sex V43 It was physically unsatisfying 0.777 0.024 32.918 0.000 V37 The sex was not as good as I expected 0.780 0.023 33.420 0.000 V59 The sex was bad 0.814 0.020 39.814 0.000 V45 My partner not a good lover 0.830 0.019 43.369 0.000 V69 It was no fun 0.676 0.031 21.759 0.000 V53 I was not turned on 0.720 0.028 25.775 0.000 V63 It was emotionally unsatisfying 0.746 0.026 28.685 0.000 V70 There was lack of affection 0.690 0.030 22.758 0.000

RRSS: Relationship Issues V16 My partner not honest with me 0.621 0.039 15.934 0.000 V17 My partner was not into me 0.707 0.033 21.556 0.000 V26 It ruined a friendship 0.571 0.041 13.931 0.000 V23 There was poor communication 0.674 0.035 19.378 0.000 V18 I realized I did not really know the person 0.695 0.033 20.821 0.000 as well as I thought V24 My partner was a player/slut 0.577 0.041 13.979 0.000

RRSS: Partner Issues V15 My partner was unattractive 0.689 0.035 19.960 0.000 V55 I didn’t know my partner 0.601 0.040 14.892 0.000 V47 There was no chemistry 0.743 0.031 24.231 0.000 V33 My partner was more into me than I was 0.652 0.036 18.119 0.000 into him/her

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Table 17: Confirmatory factor analysis for the RRSS: Correlations between factors on the RRSS (n=396)

Estimate S.E. Est. S.E. P-Value

RRSS Factor 2 RRSS Factor 1 0.638 0.037 17.234 0.000

RRSS Factor 3 RRSS Factor 1 0.714 0.032 22.470 0.000 RRSS Factor 2 0.767 0.027 28.411 0.000

RRSS Factor 4 RRSS Factor 1 0.648 0.041 15.631 0.000 RRSS Factor 2 0.691 0.037 18.828 0.000 RRSS Factor 3 0.593 0.043 13.730 0.000

RRSS Factor 5 RRSS Factor 1 0.782 0.033 23.355 0.000 RRSS Factor 2 0.706 0.038 18.629 0.000 RRSS Factor 3 0.736 0.036 20.380 0.000 RRSS Factor 4 0.727 0.041 17.786 0.000

Convergent validity: Convergent validity was evaluated by testing the

relationship between the degree of the experience of regretted sex and the reasons for regretting sex. A total score for the 36 items of the RRSS for each participant was calculated using SPSS. These scores were then correlated with participants’ total scores on the 11-item ERSS. The RRSS exhibited good convergent validity with the ERSS (r =

.776, p < .001). This indicates that the RRSS was highly and significantly correlated with

another measure of the construct, which is necessary in establishing convergent validity

(Cohen, 1998). Table 18 depicts the correlational analysis between the ERSS and the

RRSS. Additionally, each subscale of the RRSS exhibited moderate to high correlations

with the ERSS (rs .523 - .790, ps< .001). Correlations between the ERSS and individual

factors on the RRSS are represented in Table 19.

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Table 18: Correlations between the ERSS and the RRSS

RSS ESRS11

RRSS Pearson ** 1 .776 Correlation Sig. (2-tailed) .000 N 282 270

ERSS Pearson ** .776 1 Correlation Sig. (2-tailed) .000 N 270 346 **. Correlation is significant at the 0.01 level (2- tailed).

Table 19: Correlations between ERSS and individual factors on the RRSS

Correlations between ERSS and RRSS RSSFa2 RSSFa1 RSSFa3 RSSFa4 RSSFa5 ESRS11 ** ** ** ** ** RSSFa2 Pearson Correlation 1 .560 .705 .603 .610 .790 Sig. (2-tailed) .000 .000 .000 .000 .000 N 324 304 319 308 310 310 ** ** ** ** ** RSSFa1 Pearson Correlation .560 1 .677 .547 .664 .630 Sig. (2-tailed) .000 .000 .000 .000 .000 N 304 320 312 300 310 306 ** ** ** ** ** RSSFa3 Pearson Correlation .705 .677 1 .532 .652 .649 Sig. (2-tailed) .000 .000 .000 .000 .000 N 319 312 338 312 319 323 ** ** ** ** ** RSSFa4 Pearson Correlation .603 .547 .532 1 .564 .523 Sig. (2-tailed) .000 .000 .000 .000 .000 N 308 300 312 325 307 308 ** ** ** ** ** RSSFa5 Pearson Correlation .610 .664 .652 .564 1 .558 Sig. (2-tailed) .000 .000 .000 .000 .000 N 310 310 319 307 329 314 ** ** ** ** ** ESRS11 Pearson Correlation .790 .630 .649 .523 .558 1 Sig. (2-tailed) .000 .000 .000 .000 .000 N 310 306 323 308 314 346 **. Correlation is significant at the 0.01 level (2-tailed).

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Reliability. Item-total statistics were calculated for each individual item on all five factors. Item-total correlations are the correlations between each item and the total score on the scale. In a reliable scale, all items should correlate with the total. Items that have high (>.4) corrected item-total correlations are deemed excellent items (Field, 2013).

Table 20 represents Item-total statistics for each factor of the RRSS. A reliability analysis of the finalized 36-item scale was conducted in SPSS. Although there are no concrete rules about what value of α constitutes acceptable reliability, it is generally recommended that the value exceed .80 (Netemeyer et al., 2003). Cronbach’s alpha value was calculated at .959, indicating excellent internal reliability for the finalized RRSS.

Cronbach’s alpha for Factor 1, Factor 2, and Factor 3 were all very high (α=.902, α=.906, and α=.918, respectively). The reliability for Factor 4 was lower than the other three factors, but was still high (α=.819), whereas Factor 5 had the lowest reliability of all, but was still above acceptable range (α=.762). Nunnaly (1978) has indicated 0.7 to be an acceptable reliability coefficient, but lower thresholds are sometimes used in the literature.

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Table 20: Item total statistics for factors 1-5 on the RRSS (n=396)

Item-Total Statistics Factor Corrected Squared Cronbach's Factor Mean if Variance if Item-Total Multiple Alpha if Item Item Deleted Item Deleted Correlation Correlation Deleted Factor 1: Casual/Drunken Sex V61 I was drunk or high 8.8063 35.511 .746 .766 .885 V62 Partner drunk or high 8.7875 36.055 .719 .734 .887 V48 Because I was drunk/high, I ended up with someone that I 9.3250 37.267 .690 .536 .890 wouldn’t be with if I were sober V30 We didn't love each 8.4563 33.766 .680 .554 .892 other V68 Because I was drunk/high, I did things I 9.2219 36.932 .651 .524 .892 wouldn’t have done if I were sober V36 There was no 8.8438 35.499 .712 .591 .887 emotional connection V12 The experience was 8.7531 34.745 .731 .575 .886 not meaningful V9 I had sex with someone that I didn’t want 9.2563 38.555 .554 .348 .899 to be with V50 It happened on the 8.9750 37.573 .585 .365 .897 spur of the moment Factor 2: Negative feelings V51 I felt guilty 6.1481 31.687 .784 .643 .887 V54 I felt conflicted 5.9938 31.659 .743 .582 .890 V52 It went too far 6.2438 32.439 .739 .579 .891 V75 I was not ready to 6.2623 32.107 .672 .488 .896 have sex with this person V58 I was embarrassed 6.3148 33.529 .718 .532 .893 V71 I was not comfortable 6.2315 33.089 .727 .548 .892 V42 I was concerned 6.0093 33.669 .517 .305 .909 about others finding out V77 I felt pressured 6.3056 34.108 .641 .447 .898 V25 I felt cheap 6.4414 34.105 .630 .444 .899 Factor 3: Bad sex V43 It was physically 6.3254 24.867 .757 .624 .905 unsatisfying V37 It was not as good as 6.1775 24.793 .762 .643 .904 I expected. V59 The sex was bad 6.4704 25.852 .784 .655 .903 V45 partner wasn't good 6.3964 25.047 .809 .673 .901 V69 It was not fun 6.6982 26.953 .676 .488 .911

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V53 I was not turned on 6.6331 26.447 .682 .499 .911 V63 It was emotionally 6.2308 24.914 .707 .536 .910 unsatisfying V70 There was no 6.4911 26.239 .664 .501 .912 affection Factor 4: Relationship issues V16 My partner was not 3.7231 9.991 .601 .391 .786 honest with me V17 My partner was not 3.7323 9.758 .653 .431 .774 into me V26 It ruined a friendship 3.9538 11.229 .508 .282 .805 V23 There was poor 3.5600 9.661 .619 .415 .783 communication V18 I didn’t know my 3.6831 10.229 .608 .385 .785 partner well V24 My partner was a 3.7323 10.925 .515 .299 .804 player/slut Factor 5: Partner issues V15 My partner was 2.2249 4.577 .619 .390 .682 unattractive V55 I realized I did not really know the person as 2.1884 4.647 .486 .248 .745 well as I thought V47 There was no 1.9240 4.144 .621 .393 .672 chemistry V33 My partner was more 1.7964 4.175 .537 .307 .723 into me than I was

Table 21: Reliability of the RRSS: Factor and corresponding Cronbach's alpha (n=396)

Cronbach’s alpha

RRSS (36 items) 0.970

Factor 1 0.902

Factor 2 0.906

Factor 3 0.918

Factor 4 0.819

Factor 5 0.762

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Research Question: Which categories of reasons for regretted sex are

associated with a higher level of regretted sex among undergraduate college

students? Binary logistic regression was used to examine the relative contribution of

each of the 5 factors of the RRSS to the intensity of regretted sex participants reported on

the Experience of Regretted Sex Scale (ERSS). Logistic regression is used to explain the

relationship between one dependent binary variable and one or more categorical or

continuous independent variables (Field, 2013). The ERSS scale score was grouped into

two categories (0=lower level of regretted sex and 1= higher level of regretted sex).

Lower level on the ERSS was defined as those reporting values in the lower quartile;

whereas, higher level was defined as those above the 25th percentile (quartile). This demarcation was chosen in order to ensure that the reference group was very low on the respective variable (Rucker, McShane & Preacher, 2015).

Logistic regression results are summarized in Table 22. The model included five demographic variables (age, gender, race/ethnicity, class standing, and sexual orientation), two behavioral variables (current relationship status, number of lifetime sexual partners), and the 5 factors of the RRSS. The logistic regression model was significant (Chi square = 172.456; df = 22; p = .000). The results indicate that Factor 1

(Casual/Drunken Sex) and Factor 2 (Negative Feelings) were the only two factors that significantly explained differences in the level of regretted sex as measured by the

Experience of Regretted Sex Scale (ERSS). None of the demographic or behavioral variables significantly contributed to the explanation of differences in the level of regretted sex, although having 5-10 lifetime sexual partners approached significance.

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Fit statistics indicate the model fit the data well. The logistic regression model was statistically significant (Chi square = 98.49, p=.00).The model explained 40 %

(Nagelkerke R2=.40) of the variance in the dependent variable. The classification accuracy was acceptable and the model and correctly classified the outcome for 81.11 % of cases.

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Table 22: Binary logistic regression testing the association of behavioral / demographic variables and each factor on the RRSS with the ERSS as the dependent variable block (n=367)

Binary logistic regression for the ERSS 95% C.I. for EXP(B) B S.E. Wald df Sig. Exp(B) Lower Upper Status (Ref=single) -.611 .625 .957 1 .328 .543 .159 1.847 Ongoing committed Gender (Ref = Female) .036 .484 .006 1 .940 1.037 .402 2.677 Male Race (Base = White) .934 .664 1.979 1 .160 2.546 .692 9.360 Black Asian -1.508 1.147 1.730 1 .188 .221 .023 2.094 Latino 1.145 1.066 1.155 1 .282 3.144 .389 25.378 Other Race -1.262 1.663 .576 1 .448 .283 .011 7.363 Age (Ref= ≤ 20 yrs.) 1.346 1.504 .801 1 .371 3.843 .202 73.299 F18to20 F21to23 1.489 1.448 1.057 1 .304 4.432 .259 75.716 Rank (Ref=freshmen) -1.484 1.306 1.290 1 .256 .227 .018 2.934 Sophomores Juniors -1.479 1.293 1.307 1 .253 .228 .018 2.877 Seniors -1.770 1.351 1.717 1 .190 .170 .012 2.404 Orientation (Ref=hetero) .196 1.308 .023 1 .881 1.217 .094 15.814 Bisexual Homosexual -1.601 1.370 1.366 1 .242 .202 .014 2.956 Partners (Ref=1) -.903 .629 2.061 1 .151 .405 .118 1.391 2-4 5-10 -1.361 .730 3.476 1 .062 .256 .061 1.072 11-20 -.431 .957 .203 1 .652 .650 .100 4.240 21+ .618 1.222 .256 1 .613 1.855 .169 20.350 RRSS Factor 1 .100 .053 3.576 1 .059 1.105 .996 1.225 RRSS Factor 2 .391 .067 33.652 1 .000 1.478 1.295 1.687 RRSS Factor 3 -.001 .056 .000 1 .983 .999 .894 1.116 RRSS Factor 4 .054 .069 .610 1 .435 1.056 .922 1.209 RRSS Factor 5 -.008 .124 .005 1 .945 .992 .778 1.263 Constant -2.918 2.024 2.079 1 .149 .054 Model Summary 2 LL 204.845 Model Chi square/df/p 172.456/22/.00 Nagelkerke R Square .623 Hosmer Lemeshaw p .740 Classification Accuracy % 83.8%

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Discussion

After running both principal components and confirmatory factor analyses to

determine the number of factors that comprise the reasons for regretting sex for

undergraduate college students, a five-factor solution was accepted as the best fit for the

data. The resulting 36–item scale, named the Reasons for Regretted Sex Scale (RRSS),

has five factors that include: Casual/Drunken Sex (9 items), Negative Feelings (9 items),

Bad Sex (8 items), Relationship Issues (6 items), and Partner Issues (4 items). The

validity of the entire RRSS and the five factors was supported by good convergent

validity with the Experience of Regretted Sex Scale (Colaco, 2016). In addition, the

RRSS has excellent internal reliability (α = .95), as do all of the five factors (ranging

from α = .76-.92)

Regarding the Casual/Drunken Sex factor, being drunk is a common theme

throughout studies on regretted sex in college students (Kypri et al., 2010; Mallett et al.,

2006; Mallett et al, 2008; Orchowski, Mastroleo & Borsari, 2012). More specifically,

Fisher and colleagues (2012) found that over one-half of the college men and women in

their sample stated that intoxication by alcohol and/or drugs caused them to feel regret

following an uncommitted sexual encounter. Additionally, about one-third of the college students in Oswalt, Cameron, and Koob’s (2005) sample identified the influence of alcohol on his/her decision making as a common reason for regretting sex, as did one- quarter of the students in Thomas’s (2010) study. “I was drunk” also emerged as a category when the 392 stories on regretted sex were analyzed in Caron and Moskey’s

(2002) study of 392 college students. In the current study, nearly three-quarters of the respondents (77%) reported that being drunk/high and/or their partner being drunk/high

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caused them to regret sex. Clearly, this is a major reason for regretting sex. Nearly as

many people in the current study (70%) identified that “lack of an emotional connection”

caused them to regret sex at some time. Since the majority of sexually-active college

students (53%-85%, depending on the campus) report engaging in casual sex (Glenn &

Marquardt, 2001; Grello, Welsh, Harper, & Dickson, 2003; Grello et al., 2006; Flack et

al., 2007; Paul & Hayes, 2000; Penhollow, Young, & Bailey, 2007; Reiber & Garcia,

2010), this finding may not be too surprising.

Negative feelings—including embarrassment, discomfort, conflict, guilt, and

“feeling cheap”—also emerged as a factor for sexual regret in our analysis. Such feelings

have been associated with regretted sex in other studies as well (Armstrong & Hamilton,

2009; Fielder & Carey, 2010; Glenn & Marquardt, 2001; Lewis, et al., 2012; Owen,

Rhoades, Stanley & Fincham, 2010; Paul, 2006; Paul & Hayes, 2002; Paul, McManus, &

Hayes, 2000; Wade & Heldman; 2010; Welsh, Grello, & Harper, 2006). Paul and Hayes

(2002) found that when they asked their sample of college students to list their feelings

after a typical hook up, the most frequent response was “regretful or disappointed”

(35%). An estimated 60% of the students in the current study reported that they had felt

uncomfortable with a sexual experience which led them to regret it later. This higher

percentage than what was found in previous studies may reflect the broader nature of this

question as compared to questions used in previous studies.

The third factor on the RRSS consisted of reasons pertaining to “Bad Sex”, including the experience of being physically and/or emotionally unsatisfying, no fun, or not being as good as expected. About two-thirds of the students (67% females; 62%

males) in the present study had regretted an experience because the sex was “bad.” When

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Fisher and colleagues (2012) investigated whether the pleasurable quality of the sexual activity (i.e., good sex versus bad sex) influenced whether an individual experienced regretted sex, they found that the quality of sex influenced feelings of regret for approximately one-third of the women and one-half of the men in their sample. High- quality sex seemed to relieve negative feelings associated with uncommitted sexual encounters, whereas poor-quality sex increased resentment and a feeling of wasting one’s time and effort. The researchers observed that quality of the sex and feelings after the encounter showed noticeable trends, such that good sex resulted in positive emotions

(e.g., feeling satisfied or happy), while bad sex was associated with negative emotions

(e.g., disappointment or embarrassment).

Relationship Issues emerged as the fourth factor for regretted sex. Previously,

Oswalt and colleagues (2005) found that students regretted sex when they came to the realization they did not want the same thing as their partner (28%). Similarly, Caron and

Moskey (2002) found that students often regretted sex when they were cheating on their partner (17%) and when the sexual experience resulted in a ruined friendship with the partner (11%). In the current study, 45% of the respondents reported that they had regretted sex since it had ruined a friendship. The percentage may be higher than in the previous studies that were conducted more than a decade ago since the practice of having

“friends with benefits” sex seems to have become more common and accepted

(Lehmiller, Vanderdrift, & Kelly, 2011; Mongeau, Knight, Williams, Eden, & Shaw,

2013; Vanderdrift, Lehmiller, & Kelly, 2012).

Factor 5 included partner-focused reasons for regretting sex. Prior research has demonstrated that partner issues are important causes of regretted sex. For instance,

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Galperin and colleagues (2012) found that women’s top regrets included having sex with a physically unattractive partner and having sex with someone who they thought would enter into a relationship with them but did not. Both Oswalt and colleagues (2005) and

Thomas (2010) also found that one of the reasons that students in their samples regretted sex was that their partners did not want the same thing as they did. In the current study, over one-third of the respondents regretted sex because their “partner was unattractive,” whereas over one-half didn’t feel any “chemistry” with their partners.

To summarize, all 5 factors of The Reasons for Regretted Sex Scale are supported by prior research findings. The higher percentages of regretted sex due to various reasons, as compared to findings in previous research, may be due to the use of a more valid and reliable research instrument than the typical one or two questions that were asked in these previous studies.

What is as notable as the items that were found through psychometric testing to be a good fit for the RRSS are those that were not supported as part of the scale. For example, hooking up as a reason for regretting sex was not one of the items supported through psychometric testing. This could be because hooking up has become such a common and accepted experience in college students (Glenn & Marquardt, 2001; Grello,

Welsh, Harper, & Dickson, 2003; Grello et al., 2006; Flack et al., 2007; Paul & Hayes,

2000; Penhollow, Young, & Bailey, 2007; Reiber & Garcia, 2010) that hooking up, in and of itself, is not regretful. However, more specific things that can happen during a hook up may cause regret (e.g., “it went too far,” “concerned others would find out,” “sex was bad,” “partner was unattractive”). Other items that reflected the partner’s reaction

(e.g., “partner was emotionally hurt,” “partner was not into it”) may not have made the

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final cut for scale items since it is more difficult to know about a partner’s reactions than your own reactions. Finally, items regarding “unprotected sex,” “pregnancy concern,” and “sexually transmitted infection concern” did not fit the final model either. Perhaps this may be due to young people thinking of “risky sex” differently than “regretted sex.”

Limitations

The current study has several limitations that must be considered in the interpretation of the results. The findings were from one sample of undergraduate college students at a large, northeastern, land-grant university. Although the sample was drawn from required general education courses representing the diverse backgrounds and majors of the students at this university, the demographics from this university’s student body may be different from that of other universities nationally. Thus, the generalizability of the results, particularly to students in typically underrepresented groups based on their race/ethnicity and sexual orientation, may be limited. Although comparison of study participants and non-participants, based on their gender and race/ethnicity, did not find significant differences between these groups, there may have been differences in other demographic and/or behavioral variables that were not measured. It has been found college students who volunteer for sexuality research, in comparison to non-volunteers, tend to be more sexually experienced, hold less traditional sexual attitudes, score higher on measures of sexual esteem and sexual sensation seeking, and indicate greater tendencies toward interpersonal exploitation and self‐monitoring of expressive behavior

(Wiederman, 1999). In addition, the data collection method employed involved a self- administered questionnaire (SAQ). Inaccurate self-reporting can result from recall bias and social desirability bias (Weinhardt et al., 1998). Social desirability refers to the

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phenomenon where socially desirable behaviors are likely to be exaggerated, and behaviors that are perceived as socially disapproved are likely to be underreported. Even among participants who attempt to accurately report their past behaviors, problems with recall can distort the reported incidence and frequency of specific behaviors.

Strengths

This study had several strengths. First, we were able to clarify the construct of sexual regret and distinguish between the experience of sexual regret from the reasons offered for regretting sex. Reasons for regretting sex are better looked upon as predictors of sexual regret. Another important contribution of the research project has been the identification of categories of reasons for regretted sex that students most commonly report: Casual/drunken sex, negative feelings, bad sex, relationship issues and partner issues. These reasons were obtained from a sample of undergraduate college students and reflect their experiences accurately. Third, we also developed the Reasons for Regretted

Sex Scale, a psychometrically-sound instrument designed to measure reasons for regretted sex that can be utilized in basic, applied, or clinical research. Previously, no such instrument existed.

Future Research

It is hoped that the Reasons for Regretted Sex Scale will be used with other samples of university students at a variety of institutions of higher education (e.g., community colleges, religiously-oriented schools, private and public schools) at differing geographic locations throughout the United States and in other countries in order to assess how various demographic, contextual, and cultural factors may affect the reasons why college students regret sex. The RRSS could also be used in studies of other groups,

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including adolescent, emerging adult, and older adult samples in other settings. Findings from the RRSS could be useful in educational and clinical situations. Based on theories of experienced and anticipatory regret (Connolly & Zeelenberg, 2002; Mellers &

McGraw, 2001; Saffrey, Summerville, & Roese, 2008), individuals could be encouraged to explore the reasons for regretted sex in certain groups (e.g. first-year college students, students who engage in hook ups, students who binge drink) or examine their own reasons in order to make plans to improve the outcomes of their sexual interactions.

The Reasons for Regretted Scale could be used to explore whether differences pertaining to regret exist among sub-groups of students. For instance, differences in sexual regret according to gender, race/ethnicity and class ranking must be explored.

Researchers are also encouraged to further explore mediator and moderator relationships between the variables, which were not explored in this study. For instance, we did not study variables such as religiosity and fraternity/sorority membership, which may be important factors in the study of sexual regret.

Surprisingly, our research found that undergraduate college students perceive risky sex and regretted sex differently. The relationship between regretted sex and risky sex should be explored to determine how these two phenomena relate to one another.

This is important in order to help college students decrease the risk of both.

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Chapter 5

Study 3 – The Who and What of Regretted Sex Among Undergraduate College

Students

Sexual experiences are common among young adults, with approximately 80% of

unmarried young adults and college students engaging in sexual activities (Mosher,

Chandra, & Jones, 2005). College years are a time for exploration, freedom, and self-

discovery, which can be associated with a carefree lifestyle and unhealthy decisions.

College students are a population at risk for negative sexual experiences based on the

incidence and prevalence of sexual behaviors on college campuses (Fisher, Cullen, &

Turner, 2000). In addition, casual sex, or sexual behavior occurring outside of long-term

romantic relationships, has gained substantial cultural prominence among young people

over the last two decades (Garcia, Reiber, Massey, & Merriwether, 2012). An estimated

80% of college students report some casual sex experience (Garcia & Reiber, 2008; Gute

& Eshbaugh, 2008; Paul, McManus, & Hayes, 2000), and some researchers have argued

that hooking up is replacing dating as the primary context for establishing and

maintaining intimate relationships on campuses (Bogle, 2008).

In this context, alcohol use and abuse among college students are great concerns

of college administrators, faculty, and health professionals. According to the National

Institute on Alcohol Abuse and Alcoholism (NIAAA,2015), about four out of five college

students drink alcohol and about one-half of college students who drink also consume alcohol through binge drinking. The National Institute on Alcohol Abuse and

Alcoholism defines binge drinking as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above. This typically happens

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when men consume 5 or more drinks, and when women consume 4 or more drinks, in

about 2 hours (NIAAA, 2004). Thus, the high prevalence of sexual activity on college

campuses in the context of heavy drinking places college students at a high risk for

negative sexual experiences (Cooper, 2002; Fisher, Cullen, & Turner, 2000; Mallett,

Bachrach, & Turrisi, 2008). According to the NIAAA, for example, more than 97,000

students between the ages of 18 and 24 are victims of alcohol-related sexual assault or date rape. Research has indicated that between 30% and 79% of both perpetrators and victims had been drinking before the sexual assault occurred (Abbey, Zawacki, Buck,

Clinton, & McAuslan, 2001). It is estimated that approximately one in six women will be sexually assaulted in their lifetimes, and college women are thought to be four times more likely to be sexually assaulted than women in general (Rape, Abuse and Incest

National Network, 2009).

One of the most common negative sexual experiences reported by college students is regretted sex (Caron & Moskey, 2002; Colaco, 2016 a & b; Esbaugh & Gute,

2008; Oswalt, Cameron and Koob, 2005; Taylor, 2010). Regretted sex is defined as a negative cognitive emotion experienced when an individual remembers a past sexual experience and wishes that it had not happened or that it had been different (Woehling,

Colaco & Koch, 2008). The prevalence of regretted sex among college students who have engaged in sexual activity has been reported to be between 69% and 89% (Colaco, 2016a

& b; Esbaugh & Gute, 2008; Oswalt et al., 2005; Roese et al., 2006; Thomas, 2010). The experience of regretted sex in college students has been associated with psychological distress, including poor self-esteem, anxiety and depression, as well as negative feelings, including disappointment, hurt, confusion, anger, self-blame, guilt, and shame

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(Armstrong & Hamilton, 2009; Fielder & Carey, 2010; Glenn & Marquardt, 2001; Lewis, et al., 2012; Owen, Rhoades, Stanley & Fincham, 2010; Paul, 2006; Paul & Hayes, 2002;

Paul, McManus, & Hayes, 2000; Wade & Heldman; 2010; Welsh, Grello, & Harper,

2006).

Yet, few studies have studied the reasons that college students offer for regretting sex. Caron and Moskey (2002) conducted the first documented exploratory study to examine regretted sexual experiences in a convenience sample of 392 college students

(73% female, 99% heterosexual) enrolled in an undergraduate course in human sexuality at a large public university in the northeastern United States. Participants were asked to submit a story about a regrettable sexual experience (e.g. “sex in which the person feels regret later for something he/she agreed to participate in”, p. 48) that happened to themselves or somebody they knew. Six major categories of sexual regret emerged among the 392 stories that were collected: It was a disappointing first time (25%), it was unprotected sex (22%), I was cheating on my partner (17%), I was drunk (16%), it resulted in a ruined friendship (11%), and other reasons (25%). Of note, nearly one in five endorsed sexual regret from engaging in a ‘one-night stand’ (17%).

Oswalt et al., (2005) examined the sexual regret experienced by 346 undergraduates (71 % women) attending a peer-facilitated sexual health program at a university in the southern region of the United States. The majority of participants in this convenience sample were Caucasian (68.1%) with an average age of 19. They found that

72% of sexually active university students regretted at least one sexual encounter. The three most common reasons closely reflect those of Caron and Moskey (2002):

Participants’ actions were inconsistent with their personal values (32%), participants’

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decisions were influenced by alcohol (28%) and participants failed to use condoms

(25%). Other notable reasons included: Partners did not want the same thing the

participants did (28.2%), felt pressured by the partner (22.9%), and had wanted to wait

until marriage (15.3%). Interestingly regretted sex secondary to unintentional pregnancy

and acquiring a sexually transmitted infection were not commonly reported (4.3% and

2.9%, respectively). Multivariate analyses revealed a strong relationship between a higher number of sexual partners and a greater frequency of experiencing sexual regret. The only significant gender difference found was that women reported regret after being pressured by a partner to have sex more than men did.

Eshbaugh and Gute (2008) explored the predictors of regretted sex among college women who had engaged in hook ups. Hook-ups were defined as any of the following four actions: engaging in intercourse with someone once and only once, engaging in intercourse with someone known for less than 24 hours, performing oral sex on someone known for less than 24 hours, and receiving oral sex from someone known for less than

24 hours. Participants included 152 female students in a human sexuality course at a midsized mid-western U.S. university who completed a sexual history questionnaire, and were overwhelmingly heterosexual (97%) and white (96%). An estimated 74% had either a few or some regrets from uncommitted sex, 61% had a few regrets, 23% had no regrets, 13% had some regrets and 3% had many regrets. The results of their study confirmed that hooking up was a predictor of sexual regret among women. The results also indicated that engaging in sexual intercourse once and only once and engaging in intercourse with someone known for less than 24 hours were the best predictors of

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regretted sex. Further, religious participants were more likely to report regret than non- religious participants.

Thomas (2010) examined the relationship between regretted sex and cognitive dissonance, a psychological phenomenon which is said to occur when an individual must choose between attitudes and behaviors that are contradictory. Results of this study indicated that having sex that conflicted with morals and values was reported by 11% of her convenience sample of 292 (54% female, largely Caucasian and heterosexual) undergraduate students attending a mid-sized university in the western United States.

Other common reasons for regretted sex were: “Alcohol influenced my decision” (25%),

“I felt pressure from partner” (10%), and “I did not want the same thing as partner (9%).

Multivariate analyses revealed that, for both males and females, cognitive dissonance was a significant predictor of regretted sex and conservative sexual attitudes predicted regretted sex among female students only.

Fisher, Worth, Garcia, and Meredith (2012) studied regretted sex specifically following uncommitted sexual relationships in a convenience sample of 200 (69% female) Canadian university students. Participants reported whether they had ever experienced regretted sex following an uncommitted sexual encounter (USE). They were provided 10 options, including both physical and emotional reasons, based on a small survey given previously to students at the university. The researchers found that the majority of both men and women reported at least some previous experience of regret following a USE. This result indicates that although USEs may be fairly normative in terms of occurrence, there are also substantial negative feelings afterwards for both men and women. Their findings suggest that men and women regret USEs for a variety of

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reasons, and although men did select more physical reasons for regret than women,

attribution to individual sources did not vary much by sex. However, men did report

regret significantly more frequently than women for a lack of physical attraction

(physical source). Further, nearly one-third of women and one-half of men reported that

the quality of sex in a USE influenced a regret. Intoxication by alcohol and/or drugs

during a USE was often listed as a source of regret by both men and women as well.

Being intoxicated/drunk is a common theme throughout the studies on regretted

sex among college students (Kypri et al., 2010; Mallett et al., 2006; Orchowski,

Mastroleo & Borsari, 2012). In fact, in a study of 341 first-year students (55% female,

86% White) from a large northeastern land-grant university, Mallett and colleagues

(2008) found that, while 83.8% of the sample felt that regretting sex was a negative

consequence of drinking, the students with higher weekly alcohol consumption were

more likely to rate regretted sex as a neutral or positive outcome of drinking.

To summarize, regretted sex is becoming a common experience for college

students, is particularly associated with consuming alcohol and engaging in casual sexual experiences, and results in many negative outcomes. However, this phenomenon is currently understudied, and the few studies that have been conducted are fraught with limitations. Thus, researchers have argued for more in-depth, methodologically-sound

research of this phenomenon (Oswalt et al., 2005; Eshbaugh & Gute, 2008).

Foremost among the weaknesses in the research on regretted sex is the issue of

internal validity due to two major factors: lack of an empirically-based definition of

regretted sex and lack of a psychometrically-sound measure of the experience of sexual

regret and the reasons for regretted sex. In order to address the issue of the construct

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validity of the term “regretted sex”, the current researchers employed the definition developed by Woehling (2009). In this qualitative study of 169 undergraduate college students (119 females), ages 18-22, who attended general education courses at a large northeastern land-grant university, content data analysis revealed that the majority of students (76.7% females; 53.8% males) defined regretted sex as, “a sexual experience you wish you had not done.” From this analysis, a valid definition of regretted sex emerged as: a negative cognitive emotion experienced when an individual remembers a past sexual experience and wishes that it had not happened or that it had been different.

This is the definition that was used in the current study.

Another major weakness in the previous studies was a lack of the use of a methodologically-sound research instrument. Most of the studies relied on asking only one or two questions about regretted sex and/or providing a list of a few unvalidated reasons. To address this problem, we employed the “Reasons for Regretted Sex Scale’

(RRSS) (Colaco, 20016b). This 36–item scale has five factors, established through both exploratory and confirmatory factor analysis, that include: Casual/Drunken Sex (9 items),

Negative Feelings (9 items), Bad Sex (8 items), Relationship Issues (6 items), and Partner

Issues (4 items). The validity of the entire RRSS and its five factors was supported by good convergent validity with the Experience of Regretted Sex Scale (Colaco, 2016a). In addition, the RRSS has excellent internal reliability (α = .95), as do all of the five factors

(ranging from α = .76-.92).

Finally, the previous research on regretted sex is also lacking in any examination of who might experience different types of sexual regrets. Those limitations lead to the development of the current research study.

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Study Purpose and Research Questions

The purpose of the current study was to examine the who and what of regretted

sex among undergraduate college students in more depth than has previously been

undertaken. The following two key research questions were posited.

Research Question 1: What are the reasons that undergraduate college students

cite most frequently for regretted sex?

Research question 2: What are the demographic (age, gender, race/ethnicity,

sexual orientation) and behavioral (relationship status, number of lifetime sexual

partners) characteristics of undergraduate college students who are most likely to

experience certain types of reasons for regretted sex?

Methods

Description of the participants, procedure, measures, and analytic plan follow. All

methods were approved by the Institutional Review Board of the university.

Participants and procedure. The respondents were undergraduate students in

general education classes participating for course credit at a large northeastern land-grant university. Since these students were in required general education classes, they were assumed to represent the diversity of student backgrounds and majors offered at the university. A total of 435 students (25% males, 73% females, 0.004% transgender) completed the survey. (Note that due to the low number of transgender students, they were dropped from subsequent multivariate analyses.) The response rate was 62%.

Compared to the overall undergraduate student body, females were over-represented by two times and males were under-represented by one-half. However, the over- representation of females is a common phenomenon in social science research in which

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females are much more likely to volunteer than males (De Vaus, 2003). The behavioral and demographic characteristics of the sample are summarized in Table 1. Nearly all

(Tabachnik & Fidell, 2012). The behavioral and demographic characteristics of the sample are summarized in Table 23.

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Table 23: Behavioral and demographic characteristics of the sample (n=435)

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Each student received a written description of the study, a consent form, a copy of

the survey, a computerized answer form, an information sheet listing campus resources

for the topic being addressed, and an envelope in which to return the answer form to the

next class session. Participants were instructed to complete the survey privately in a

comfortable area, such as where they lived, and not to write their names on the answer

form.

Measures. The Reasons for Regretted Sex Scale (RRSS), consisting of 36 items, was part of a larger survey entitled the Regretted Sex Survey. The RRSS was composed of 5 factors: Casual/Drunken Sex (9 items), Negative Feelings (9 items), Bad Sex (8 items), Relationship Issues (6 items), Partner Issues (4 items). The entire RRSS and its factors demonstrated excellent psychometric properties (Colaco, 2016b). In addition to the RRSS, the survey contained seven background questions assessing the demographic characteristics (age, gender, race/ethnicity, class standing, and sexual orientation) and behavioral characteristics (relationship status, number of lifetime sexual partners). The directions for the RRSS said: “People regret having sex for many different reasons.

Following is a list of many different sexual situations that people may or may not regret.

Using the following scale, indicate how frequently each of the following reasons has led you to regret having sex in the past. The response choices were: “Never” (1), “Less than half of my sexual experiences” (2), “About half of my sexual experiences” (3), “More than half of my sexual experiences” (4), and “All of my sexual experiences” (5). There was also a choice for “Never having been in this situation” (0). The entire survey took approximately 30 minutes to complete, including 15 minutes for the 36 items on the

RRSS.

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Analytic Plan

The first research question explored the reasons that undergraduate college

students cite most frequently for regretted sex. Hence, the percentage of respondent who

reported each of the possible response from the RRSS was calculated for the entire

sample as well as by gender.

The second research question explored the demographic (age, gender,

race/ethnicity, sexual orientation) and behavioral (relationship status, number of lifetime

sexual partners) characteristics of undergraduate college students who were most likely to

experience certain reasons for regretted sex. To answer this question, binary logistic

regression analyses were performed in order to assess the relationship between the

behavioral and demographic variables and each of the five factors on the RRSS scale.

These independent variables included age, class rank, gender, race/ethnicity, sexual

orientation, number of lifetime partners, and relationship status. Logistic regression is

used to explain the relationship between one dependent binary variable and one or more

categorical or continuous independent variables (Field, 2013).

Results

Research question 1: What are the reasons that undergraduate college students cite

most frequently for regretted sex? Table 2 presents the percentage of all respondents who indicated that one of the reasons listed in the RRSS led them to regret sex in the past. Table 3 represents the percentage of female respondents who indicated that one of the RRSS reasons led them to regret sex in the past; and Table 4 represents the percentage of male respondents who indicated that one of the RRSS reasons led them to regret sex in the past.

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As shown in Table 24, the following are the items that over 70% of the entire sample gave for ever regretting sex in the past:

• Factor 1: “Partner was drunk/high” (77.7%)

• Factor 1: “I was drunk/high” (76.6%)

• Factor 1: “We did not love each other” (74.4%)

• Factor 1: “Lack of emotional connection” (73.6%),

• Factor 3: “Sex was not as good as expected” (73.3%)

• Factor 1: “Experience was not meaningful” (72.2%)

• Factor 1: “It happened on the spur of the moment” (71.4%)

• Factor 3: “It was emotionally unsatisfying” (71.4%)

The Reasons for Regretted Sex Scale (RRSS) consisted of 5 factors identified though factor analysis namely Casual/Drunken Sex, Negative feelings, Bad Sex,

Relationship issues and Partner issues. It is interesting to note that six of the items that over 70% of the entire sample gave for ever regretting sex in the past, are from the

“Drunken/Casual Sex” factor, whereas the other two are from the “Bad Sex” factor representing both the physical and emotional aspects of bad sex. In addition, one item,

“We did not love each other” is noticeable in that 25.3% of the sample reported regretting sex for this reason in more than half of their sexual experiences. A review of tables 25 and 26, indicates that both men and women endorsed the reasons noted in almost equally high measure. However, the reason “sex was not as good as I expected” was reported more frequently by women than men (74.8% versus 65.6%).

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Table 24: Frequencies for RRSS items for all respondents (n=365)

RRSS Items (36 total) Never (%) ≤0.5 (%) >0.5 (%) 9 I had sex with someone that I really didn’t want to 46 48 6 be with 12 The Experience was not meaningful 27.8 56.4 14.2 15 My Partner was unattractive 61.3 32.7 2.7 16 I found out that my partner was not honest with me 45.2 44.4 4.9 17 I mistakenly thought that my partner was into me as 45.8 46 4.1 much as I was into him/her 18 I did not know the person as well 39.5 53.1 3.8 23 There was poor communication 37.3 52.3 6.8 25 I felt cheap 58.6 32.4 4.1 26 It ruined a friendship that I had with my partner 54.8 39.2 1.6 30 We didn’t love each other 25.6 46 25.3 33 My partner was more into me than I was into 37.1 52.3 7.6 him/her 36 There was lack of an emotional connection 26.4 59.1 11.4 24 My partner was a player/slut 40.3 51.8 3.5 42 I was concerned about others finding out 35.7 52 9.3 47 There was no chemistry 43.3 48.8 4.9 48 Because I was drunk/high, I ended up with someone 45 42.8 4.4 that I wouldn’t be with if I were sober 37 The sex was not as good as expected 26.7 61.9 8.7 43 It was physically unsatisfying 33.2 56.4 7.9 45 My partner was not a good lover 33.2 57.2 6.5 53 I wasn’t turned on 44.1 48.2 4.4 55 I didn’t know my partner 59.9 27 4.4 59 The sex was bad 33.8 59.9 4.4 50 It happened on the spur of the moment 28.6 59.4 7.9 51 I felt guilty 41.1 49.3 7.1 52 It went too far 46.6 44.7 4.9 54 I felt conflicted about what I did 33 56.1 9.3 61 I was drunk/high 23.4 59.7 11.4 62 My partner was drunk/high 22.3 62.7 10.6 63 It was emotionally unsatisfying 28.6 58.3 10.1 58 I was embarrassed by what happened 46 45.5 4.1 68 Because I was drunk/high, I did things I wouldn’t 42 44.1 6.8 have done if I were sober 69 It was no fun 48 45 3 70 There was lack of affection 37.9 52.6 5.7 71 I was not comfortable with the experience 40.1 51.8 4.4 75 I was not ready to have sex with this person 51.2 37.1 6.8 77 I felt pressured 47 46 3.3

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Table 25: Frequencies for RRSS items for women (n=271)

RRSS Items (36 total) Female Never (%) ≤0.5 (%) >0.5 (%) 9 I had sex with someone that I really didn’t want to 47.6 48 4.4 be with 12 The Experience was not meaningful 28.1 58.1 13.9 15 My Partner was unattractive 66.8 30.9 2.3 16 I found out that my partner was not honest with me 48.8 46.5 4.7 17 I mistakenly thought that my partner was into me as 46.5 51.2 2.3 much as I was into him/her 18 I did not know the person as well 41.4 55.6 3.1 23 There was poor communication 41.2 53.4 5.3 25 I felt cheap 60.3 35.8 3.9 26 It ruined a friendship that I had with my partner 59.6 39.2 1.2 30 We didn’t love each other 28 47.9 24.1 33 My partner was more into me than I was into 40.5 53.8 5.7 him/her 36 There was lack of an emotional connection 27.4 63.1 9.5 24 My partner was a player/slut 46.3 50.6 3.1 42 I was concerned about others finding out 36 54 10 47 There was no chemistry 46 50.6 3.4 48 Because I was drunk/high, I ended up with someone 52.8 43.5 3.7 that I wouldn’t be with if I were sober 37 The sex was not as good as expected 25.2 64.9 9.9 43 It was physically unsatisfying 31.2 59.7 9.1 45 My partner was not a good lover 34 59.2 6.9 53 I wasn’t turned on 42.7 53.8 3.4 55 I didn’t know my partner 70.2 25.7 4.1 59 The sex was bad 33 63.3 3.8 50 It happened on the spur of the moment 28.8 64.2 6.9 51 I felt guilty 38.6 53.4 8 52 It went too far 45.2 49.8 5 54 I felt conflicted about what I did 30.5 60.2 9.4 61 I was drunk/high 25.9 62 12.2 62 My partner was drunk/high 23.8 63.7 12.5 63 It was emotionally unsatisfying 28.7 61.3 10 58 I was embarrassed by what happened 49 46.3 4.7 68 Because I was drunk/high, I did things I wouldn’t 47.2 45.2 7.6 have done if I were sober 69 It was no fun 47.7 50.4 1.9 70 There was lack of affection 39 55.2 5.8 71 I was not comfortable with the experience 39.4 56.8 3.9 75 I was not ready to have sex with this person 51.8 40.5 7.8 77 I felt pressured 47.1 49.4 3.5

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Table 26: Frequencies for RRSS items for men (n=91)

RRSS Items (36 total) Male Never (%) ≤0.5 (%) >0.5 (%) 9 I had sex with someone that I really didn’t want to 40.7 49.5 9.9 be with 12 The Experience was not meaningful 29.2 55.1 15.7 15 My Partner was unattractive 54.9 41.8 3.3 16 I found out that my partner was not honest with me 45.3 48.8 5.8 17 I mistakenly thought that my partner was into me as 51.7 40.4 7.9 much as I was into him/her 18 I did not know the person as well 40.9 53.4 5.7 23 There was poor communication 32.2 56.3 11.5 25 I felt cheap 66.7 29.9 3.4 26 It ruined a friendship that I had with my partner 50.5 47.3 2.2 30 We didn’t love each other 21.1 46.7 32.2 33 My partner was more into me than I was into 30.7 54.5 14.8 him/her 36 There was lack of an emotional connection 26.1 55.7 18.2 24 My partner was a player/slut 30 65.6 4.4 42 I was concerned about others finding out 40 53.3 6.7 47 There was no chemistry 42.2 48.9 8.9 48 Because I was drunk/high, I ended up with someone 36.4 56.8 6.8 that I wouldn’t be with if I were sober 37 The sex was not as good as expected 34.4 60 5.6 43 It was physically unsatisfying 42.9 52.7 4.4 45 My partner was not a good lover 36 57.3 6.7 53 I wasn’t turned on 55.7 36.4 8 55 I didn’t know my partner 53.5 39.5 7 59 The sex was bad 38.5 56 5.5 50 It happened on the spur of the moment 31.8 55.7 12.5 51 I felt guilty 52.8 42.7 4.5 52 It went too far 58.4 38.2 3.4 54 I felt conflicted about what I did 43.3 47.8 8.9 61 I was drunk/high 21.6 68.2 10.2 62 My partner was drunk/high 22.2 70 7.8 63 It was emotionally unsatisfying 32.2 56.7 11.1 58 I was embarrassed by what happened 47.2 50.6 2.2 68 Because I was drunk/high, I did things I wouldn’t 40.2 54 5.7 have done if I were sober 69 It was no fun 55.1 39.3 5.6 70 There was lack of affection 39.3 55.1 5.6 71 I was not comfortable with the experience 49.4 46.1 4.5 75 I was not ready to have sex with this person 61.4 33 5.7 77 I felt pressured 53.3 43.3 3.3

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Research question 2: What are the demographic (age, gender, race/ethnicity,

sexual orientation) and behavioral (relationship status, number of lifetime sexual

partners) characteristics of undergraduate college students who are most likely to

experience certain types of reasons for regretted sex? Binary logistic regression

analyses were performed in order to assess the relationship between the behavioral and

demographic variables and each of the 5 factors on the RRSS scale. These independent

variables included age, class rank, gender, race/ethnicity, sexual orientation, number of lifetime partners, and relationship status.

Factor 1: Drunken/Casual Sex. Binary hierarchical logistic regression was used

to examine the relative contribution of five demographic factors and two behavioral

factors to frequency of regret related to Factor 1 (Casual/Drunken Sex) of the RRSS. The

inclusion of age in the analysis led to large standard error terms and unusually high

exponential B values. Hence, age was dropped from the analysis. The factor score was

grouped into two categories (0=lower score and 1= higher score). Lower score on Factor

1 was defined as those reporting values in the lower quartile; whereas, higher score was

defined as those above the 25th percentile (quartile). This demarcation was chosen in order to ensure that the reference group was very low on the respective variable (Rucker,

McShane & Preacher, 2015). Logistic regression results are summarized in Table 5 and

Table 27. The first model included the four demographic factors (gender, race,

orientation and rank); as a block, the demographic factors were not statistically

significant (Chi square = 10.17; df =9; p =.34). When the two behavioral factors, number

of partners and current relationship status were added, however, significance was

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achieved for both the logistic regression model (Chi square = 98.49; df =13.0; p= .00)

and the block of behavioral factors (Chi square = 88.32; df =4.00; p=.00).

The results indicate that one of the behavioral factors—number of lifetime sexual

partners—is the most influential factor in explaining differences in the frequency of regret over engaging in Drunken/Casual Sex (Wald= 46.45; p=.00). The odds ratio of

3.67 for participants reporting 2-4 partners indicates that they were slightly more than

three and one-half times more likely to report regretting sex for these reasons than those

having only 1 partner. Similar trends existed for those reporting 5-10 partners (odds ratio

= 43.90), 11-21 plus partners (odds ratio = 112.09) when compared with those reporting

one partner. Relationship status also was a significant factor in explaining differences in

the frequency of regret over engaging in Drunken/Casual Sex. The odds ratio was .38 for

those participants in ongoing committed relationships as compared to those in casual

relationships, meaning that college students in committed relationships were less likely

to report regretting sex.

Fit statistics indicate the model fit the data well. The logistic regression model

was statistically significant (Chi square = 172.456, p=.00). The model explained 62 %

(Nagelkerke R2=.62) of the variance in the dependent variable. The classification

accuracy was acceptable and the model and correctly classified the outcome for 83.8 %

of cases.

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Table 27: Binary logistic regression testing the association of behavioral and demographic variables with factor 1 (casual/drunken sex) Block 1 (n=367)

Binary Logistic regression for factor 1 (casual/drunken sex) Block 1 95% C.I. for EXP(B) Beta S.E. Wald df Sig. Exp(B) Lower Upper Gender (Ref = Female) .29 .34 .73 1.00 .39 1.34 .69 2.59 Male Race/ethnicity (Ref=White) 5.14 4.00 .27 Black -.46 .40 1.34 1.00 .25 .63 .29 1.38 Asian -1.12 .60 3.54 1.00 .06 .33 .10 1.05 Latino .11 .81 .02 1.00 .89 1.12 .23 5.49 Other -.71 .78 .84 1.00 .36 .49 .11 2.24 Sexual orientation (Ref=heterosexual) -.52 .81 .40 1.00 .52 .60 .12 2.94 Bisexual or homosexual Partners (Ref= 1 partner) 3.54 3.00 .32 2-4 partners .60 .90 .45 1.00 .50 1.83 .31 10.72 5-10 partners .91 .87 1.10 1.00 .29 2.49 .45 13.75 11-21+ partners 1.18 .88 1.81 1.00 .18 3.27 .58 18.36 Constant .72 1.20 .36 1.00 .55 2.05 Model Summary 2 LL 337.82 Model Chi square/df/p 10.17/9.00/.34 Block Chi Square/df/p 10.17/9.00/.34 Nagelkerke R Square .05 Hosmer Lemeshaw p .85 Classification Accuracy % 75.24

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Table 28: Binary logistic regression testing the association of behavioral and demographic variables with factor 1 (casual/drunken sex) Block 2 (n=367)

Binary logistic regression for Factor 1 (Casual/drunken sex) – Block 2 95% C.I. for EXP(B) Beta S.E. Wald df Sig. Exp(B) Lower Upper Gender (Ref = Female) -.24 .40 .37 1.00 .54 .78 .36 1.71 Male Race/ethnicity (Ref=White) 3.91 4.00 .42 Black -.73 .51 2.09 1.00 .15 .48 .18 1.30 Asian -.18 .75 .06 1.00 .81 .84 .19 3.64 Latino .78 .96 .67 1.00 .41 2.18 .33 14.28 Other -1.04 1.03 1.02 1.00 .31 .35 .05 2.66 Sexual orientation (Ref=heterosexual) .56 .92 .37 1.00 .54 1.75 .29 10.57 Bisexual or homosexual Current rank in college 2.75 3.00 .43 (Ref=freshman) Sophomore 1.51 1.29 1.37 1.00 .24 4.51 .36 56.26 Junior 1.88 1.26 2.24 1.00 .13 6.57 .56 77.44 Senior 1.68 1.26 1.77 1.00 .18 5.37 .45 63.56 Partners (Ref= 1 partner) 46.45 3.00 .00 2-4 partners 1.30 .40 10.39 1.00 .00 3.67 1.66 8.09 5-10 partners 3.78 .60 39.20 1.00 .00 43.90 13.44 143.42 11-21 + partners 4.72 1.16 16.58 1.00 .00 112.09 11.56 1086.44 Relationship status (base=single) -.96 .46 4.28 1.00 .04 .38 .16 .95 Ongoing committed Constant -2.64 1.63 2.63 1.00 .10 .07 Model Summary 2 LL 249.50 Model Chi square/df/p 98.49/13/.00 Block Chi Square/df/p 88.32/4/.00 Nagelkerke R Square .40 Hosmer Lemeshaw p .21 Classification Accuracy % 81.11

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Factor 2: Negative Feelings. Binary hierarchical logistic regression was used to examine the relative contribution of five demographic factors and two behavioral factors to frequency of regret pertaining to Factor 2 (Negative Feelings) of the RRSS. The inclusion of age in the analysis led to large standard error terms and unusually high exponential B values. Hence, age was dropped from the analysis. The factor score was grouped into two categories (0=lower score and 1= higher score). Lower frequency on

Factor 2 was defined as those reporting values in the lowest quartile; whereas, higher frequency was defined as those above the 25th percentile (quartile). This demarcation was

chosen in order to ensure that the reference group was very low on the respective variable

(Rucker, McShane & Preacher, 2015).

Logistic regression results are summarized in Table 29 and Table 30. The first

model included the four demographic factors (gender, race, orientation, and class rank)

and, as a block, the demographic factors were not statistically significant (Chi square

=9.60; df =9.00; p =.38). When the two behavioral factors, number of lifetime sexual

partners and current relationship status were added, however, significance was achieved

for both the logistic regression model (Chi square = 48.95; df =13.00 ; p=.00) and the

block of behavioral factors (Chi square =3.9.35; df =4.00; p=.00).

The results indicate that the behavioral factor—number of lifetime sexual

partners—is the most influential factor in explaining differences in the frequency of regretted sex due to negative feelings (Wald=26.09; p=.00). The odds ratio of 2.48 indicates that participants reporting 2-4 partners were slightly less than two and one-half times more likely to report regretting sex due to negative feelings more often than those having only one partner. Similar trends existed for those reporting 5-10 partners (odds

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ratio= 7.05) and 11-21 plus partners (odds ratio = 15.68) when compared with those

having one partner. In the final model, male participants were less likely to report

regretting sex due to negative feelings more often than female participants (OR = 0.43).

The logistic regression model was statistically significant (Chi square = 48.95, p=.00).

The model explained 21 % (Nagelkerke R2=.21) of the variance in the dependent

variable. The classification accuracy was acceptable and the model correctly classified

the outcome for 78.46 % of cases.

Table 29: Binary logistic regression testing the association of behavioral and demographic variables with Factor 2 (negative feelings) Block 1 (n=367)

Binary logistic regression for Factor 2 (negative feelings) Block 1 95% C.I.for EXP(B) Beta S.E. Wald df Sig. Exp(B) Lower Upper Gender (Ref=females) -.59 .30 3.91 1.00 .05 .56 .31 .99 Male Race (Ref=white) 4.86 4.00 .30 Black -.66 .39 2.92 1.00 .09 .52 .24 1.10 Asian -.50 .59 .70 1.00 .40 .61 .19 1.94 Latino -.20 .72 .07 1.00 .79 .82 .20 3.35 Other 1.21 1.09 1.23 1.00 .27 3.37 .39 28.68 Orientation (Ref= heterosexual) -.80 .81 .96 1.00 .33 .45 .09 2.22 Bisexual of homosexual .57 3.00 .90 Partners (Ref= 1 partner) .55 .95 .34 1.00 .56 1.74 .27 11.16 2-4 partners .47 .92 .27 1.00 .61 1.60 .27 9.65 5-10 partners .35 .92 .14 1.00 .71 1.41 .23 8.55 11-21+ partners 1.59 1.22 1.70 1.00 .19 4.92 Model Summary 2 LL 351.25 Model Chi square/df/p 9.60/9.00/.38 Block Chi Square/df/p 9.60/9.00/.38 Nagelkerke R Square .04 Hosmer Lemeshaw p .37 Classification Accuracy %. 73.63

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Table 30: Binary logistic regression testing the association of behavioral and demographic variables with Factor 2 (negative feelings) Block 2 (n=367)

Binary logistic regression for Factor 2 (negative feelings) – Block 2 95% C.I.for EXP(B) Beta S.E. Wald df Sig. Exp(B) Lower Upper Gender (Ref = Female) -.84 .32 6.73 1.00 .01 .43 .23 .81 Male Race/ethnicity (Ref=white) 5.34 4.00 .25 Black -.75 .43 3.01 1.00 .08 .47 .20 1.10 Asian .42 .66 .40 1.00 .53 1.52 .41 5.60 Latino .07 .80 .01 1.00 .93 1.07 .22 5.08 Other 1.35 1.11 1.46 1.00 .23 3.84 .43 33.94 Sexual orientation (Ref=heterosexual) -.17 .86 .04 1.00 .85 .85 .16 4.53 Bisexual or homosexual Current rank in college 3.32 3.00 .35 (Ref=freshman) Sophomore .87 1.05 .69 1.00 .41 2.40 .30 18.91 Junior .66 1.02 .42 1.00 .52 1.93 .26 14.20 Senior .22 1.02 .05 1.00 .83 1.24 .17 9.23 Partners (Ref= 1 partner) 26.09 3.00 .00 2-4 partners .91 .38 5.67 1.00 .02 2.48 1.17 5.23 5-10 partners 1.95 .44 19.30 1.00 .00 7.05 2.95 16.86 11-21 + partners 2.75 .71 14.92 1.00 .00 15.68 3.88 63.39 Relationship status (Ref=single) -.70 .40 3.11 1.00 .08 .50 .23 1.08 Ongoing committed Constant -.13 1.35 .01 1.00 .92 .88 Model Summary 2 LL 311.89 Model Chi square/df/p 48.95/13/.00 Block Chi Square/df/p 39.35/4/.00 Nagelkerke R Square .21 Hosmer Lemeshaw p .03 Classification Accuracy %. 78.46

Factor 3: Bad Sex. Binary hierarchical logistic regression was used to examine the relative contribution of five demographic factors and two behavioral factors to the frequency of sexual regret pertaining to Factor 3 (Bad Sex) of the RRSS. The factor

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score was grouped into two categories (0=lower score and 1= higher score). Lower

frequency on Factor 3 was defined as those reporting values in the lower quartile;

whereas, higher frequency was defined as those above the 25th percentile (quartile). This

demarcation was chosen in order to ensure that the reference group was very low on the

respective variable (Rucker, McShane & Preacher, 2015). The behavioral variable

number of lifetime sexual partners was re-coded as follows: 0=1 partner, 1= 2 or more

partners. This was done as there were very few cases for some levels of this variable

when cross tabbed with the dummy coded dependent variable.

Logistic regression results are summarized in Table 31 and Table 32. The first

model included the five demographic factors (age, gender, race/ethnicity, orientation, and

class rank) and, as a block, the demographic factors were not statistically significant (Chi

square =15.07; df =11.00; p =.18). When the two behavioral factors, number of lifetime

sexual partners and current relationship status were added, however, the logistic

regression model (Chi square = 48.95; df =13.00; p=.00) and the block of behavioral

factors (Chi square =76.05; df =2.00; p=.00).

The results indicate that the behavioral factor—number of lifetime sexual

partners—is the most influential factor in explaining differences in the frequency of regretted sex due to bad sex (Wald=45.47; p=.00). The results indicate that Latino participants were approximately 16.5 times more likely to report regretting sex because the sex was bad more often than White participants were. In the final model, participants in ongoing committed relationships were less likely to report regretting sex due to bad

sex more often than single participants (odds ratio 0.41). Participants having 2 or more

partners were 4.36 times more likely to report regretting sex on because it was “bad” as

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compared to participants having one partner. Finally, participants ages 21-23 were less likely to report regretting sex because it was “bad” more often than participants ages 18-

20 years (odds ratio 0.34).

The logistic regression model was statistically significant, Chi square = 91.12, p=.00. The model explained 35 % (Nagelkerke R2=.35) of the variance in the dependent variable. The classification accuracy was acceptable and the model correctly classified the outcome for 77.16 % of cases.

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Table 31: Binary logistic regression testing the association of behavioral and demographic variables with Factor 3 (bad sex) Block 1 (n=367)

Binary logistic regression for Factor 3 (bad sex) Block 1 95% C.I.for EXP(B) Beta S.E. Wald df Sig. Exp(B) Lower Upper Gender (Ref=females) -.08 .30 .07 1.00 .79 .92 .51 1.67 Males Race (Ref=whites) 8.13 4.00 .09 Black .03 .41 .01 1.00 .94 1.03 .46 2.31 Asian -1.17 .56 4.36 1.00 .04 .31 .10 .93 Latino 1.73 1.05 2.72 1.00 .10 5.67 .72 44.53 Other .68 .82 .68 1.00 .41 1.97 .39 9.81 Age (Ref 18-20) 4.29 2.00 .12 21-23 yrs. -.71 .38 3.51 1.00 .06 .49 .23 1.03 24-29 yrs. .34 1.21 .08 1.00 .78 1.41 .13 15.27 Orientation (Ref= females) -.92 .81 1.31 1.00 .25 .40 .08 1.93 Males Rank (Ref= freshmen) 1.56 3.00 .67 Sophomore -.05 .95 .00 1.00 .96 .95 .15 6.12 Junior .37 .94 .16 1.00 .69 1.45 .23 9.11 Senior .57 .97 .34 1.00 .56 1.77 .26 11.85 Constant 1.86 1.23 2.28 1.00 .13 6.45 Model Summary 2 LL 375.20 Model Chi square/df/p 15.07/11.00/.18 Block Chi Square/df/p 15.07/11.00/.18 Nagelkerke R Square .06 Hosmer Lemeshaw p .96 Classification Accuracy % 70.68

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Table 32: Binary logistic regression testing the association of behavioral and demographic variables with Factor 3 (bad sex) Block 2 (n=367)

Binary logistic regression for Factor 3 (bad sex) –Block 2 95% C.I.for EXP(B) Beta S.E. Wald df Sig. Exp(B) Lower Upper Gender (Base = Female) -.44 .34 1.63 1.00 .20 .65 .33 1.26 Male Race (Ref= White) 6.93 4.00 .14 Black -.01 .49 .00 1.00 .98 .99 .38 2.57 Asian -.14 .65 .04 1.00 .83 .87 .25 3.10 Latino 2.79 1.17 5.66 1.00 .02 16.35 1.64 163.19 Other 1.04 .92 1.26 1.00 .26 2.82 .46 17.22 Age (Ref 18-20) 5.85 2.00 .05 21-23 yrs. -1.09 .45 5.84 1.00 .02 .34 .14 .81 24-29 yrs. -1.02 1.35 .58 1.00 .45 .36 .03 5.03 Orientation (Ref =heterosexual) -.16 .88 .03 1.00 .85 .85 .15 4.74 Bisexual or Homosexual Rank (Ref=freshmen) 1.14 3.00 .77 Sophomore .35 1.21 .09 1.00 .77 1.42 .13 15.37 Junior .80 1.21 .43 1.00 .51 2.22 .21 23.94 Senior .66 1.25 .28 1.00 .60 1.94 .17 22.63 Number Partners (Ref= 1 partner) 1.47 .22 45.47 1.00 .00 4.36 2.84 6.69 2 or more partners Relationship Status (Ref= Single) -.90 .40 4.99 1.00 .03 .41 .19 .90 Married Constant -.49 1.49 .11 1.00 .74 .61 Model Summary 2 LL 299.15 Model Chi square/df/p 91.12/13/.00 Block Chi Square/df/p 76.05/2/.00 Nagelkerke R Square .35 Hosmer Lemeshaw p .79 Classification Accuracy % 77.16

Factor 4: Relationship Issues. Binary hierarchical logistic regression was used to examine the relative contribution of five demographic factors and two behavioral factors to frequency of regretted sex pertaining to Factor 4 (Relationship Issues) of the

RRSS. The inclusion of age in the analysis led to large standard error terms and unusually

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high exponential B values. Hence, age was dropped from the analysis. The factor score

was grouped into two categories (0=lower score and 1= higher score). Lower frequency

on Factor 4 was defined as those reporting values in the lower quartile; whereas, higher

frequency was defined as those above the 25th percentile (quartile). This demarcation was

chosen in order to ensure that the reference group was very low on the respective variable

(Rucker, McShane & Preacher, 2015). The variable, number of lifetime partners, was re- coded in the following way: 0 = 1 Partner, 1 - 2-4 partners, 2 = 5- 10 partners, 3 = 11 or more partners.

Logistic regression results are summarized in Table 33 and Table 34. The first model included the four demographic factors (gender, race/ethnicity, sexual orientation, and class rank) and, as a block, the demographic factors were not statistically significant

(Chi square =16.27; df =9.00; p =.06). When the two behavioral factors, number of lifetime sexual partners and current relationship status, were added, however, significance was achieved for both the logistic regression (Chi square = 76.91; df

=13.00; p=.00) and the block of behavioral factors (Chi square =60.64; df =4.00; p=.00).

The results indicate that the behavioral factor, number of lifetime sexual partners, is the most influential factor in explaining differences in how often regretted sex occurs due to relationship issues, as measured on the Factor 4 of the RRSS (Wald=41.09; p=.00). The odds ratio of 6.86 indicates that participants reporting 2-4 partners were approximately 7 times more likely to report regretting sex due to relationship issues than those reporting only having one lifetime sexual partner. Similar trends existed for those reporting 5-10 partners (odds ratio = 13.77), 11-21 plus partners (odds ratio = 61.13) when compared with those reporting one partner.

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The logistic regression model was statistically significant, Chi square = 76.91, p=.00. The model explained 30 % (Nagelkerke R2=.30) of the variance in the dependent variable. Classification accuracy was acceptable and the model correctly classified the outcome for 71.79 % of cases.

Table 33: Binary logistic regression testing the association of behavioral and demographic variables with Factor 4 (relationship issues) Block 1 (n=367)

Binary logistic regression for Factor 4 (relationship issues) Block 1 95% C.I.for EXP(B) Beta S.E. Wald df Sig. Exp(B) Lower Upper Gender (Ref=female) .00 .29 .00 1.00 1.00 1.00 .56 1.77 Male Race (Ref=white) 3.81 4.00 .43 Black -.48 .37 1.70 1.00 .19 .62 .30 1.27 Asian -.31 .56 .32 1.00 .57 .73 .25 2.18 Latino .19 .71 .08 1.00 .78 1.21 .30 4.88 Other .99 .80 1.51 1.00 .22 2.69 .56 12.95 Orientation (Ref= heterosexual) -2.07 1.07 3.75 1.00 .05 .13 .02 1.02 Bisexual or homosexual Current Rank in college 6.13 3.00 .11 (Ref=freshmen) Sophomore -.03 .85 .00 1.00 .97 .97 .18 5.16 Junior .59 .83 .50 1.00 .48 1.80 .35 9.12 Senior .77 .83 .87 1.00 .35 2.17 .43 11.05 Constant 2.08 1.28 2.64 1.00 .10 8.04 Model Summary 2 LL 393.36 Model Chi square/df/p 16.27/9.00/.06 Block Chi Square/df/p 16.27/9.00/.06 Nagelkerke R Square .07 Hosmer Lemeshaw p .67 Classification Accuracy % 64.10

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Table 34: Binary logistic regression testing the association of behavioral and demographic variables with Factor 4 (relationship issues) Block 2 (n=367)

Binary logistic regression for Factor 4 (relationship issues) – Block 2 95% C.I.for EXP(B) Beta S.E. Wald df Sig. Exp(B) Lower Upper Gender (Ref = Female) -.25 .33 .57 1.00 .45 .78 .41 1.49 Male Race (Ref = White) 7.48 4.00 .11 Black -.67 .41 2.65 1.00 .10 .51 .23 1.15 Asian .66 .67 .96 1.00 .33 1.93 .52 7.16 Latino .32 .78 .17 1.00 .68 1.37 .30 6.29 Other 1.67 .92 3.27 1.00 .07 5.29 .87 32.24 Sexual orientation (Ref = heterosexual) -1.57 1.11 2.02 1.00 .16 .21 .02 1.82 Bisexual or Homosexual Current Rank in College (Ref = 2.86 3.00 .41 Freshmen) Sophomore .16 1.04 .02 1.00 .88 1.17 .15 9.08 Junior .75 1.02 .55 1.00 .46 2.13 .29 15.63 Senior .58 1.02 .32 1.00 .57 1.79 .24 13.13 Number Partners (Ref=1 partner) 41.09 3.00 .00 2-4 partners 1.93 .45 18.31 1.00 .00 6.86 2.84 16.56 5-10 partners 2.62 .48 30.10 1.00 .00 13.77 5.40 35.14 11 or more partners 4.11 .74 30.56 1.00 .00 61.13 14.22 262.79 Relationship Status (Ref = Single) -.07 .40 .03 1.00 .86 .93 .42 2.05 Ongoing committed Constant -.45 1.43 .10 1.00 .76 .64 Model Summary 2 LL 332.71 Model Chi square/df/p 76.91/13/.00 Block Chi Square/df/p 60.64/4/.00 Nagelkerke R Square .30 Hosmer Lemeshaw p .22 Classification Accuracy % 71.79

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Factor 5: Partner Issues. Binary hierarchical logistic regression was used to examine the relative contribution of five demographic factors and two behavioral factors to frequency of regretted sex due to Factor 5 (Partner Issues) of the RRSS. The factor score was grouped into two categories (0=lower score and 1= higher score). Lower frequency on Factor 5 was defined as those reporting values in the lower quartile; whereas, higher frequency was defined as those above the 25th percentile (quartile). This demarcation was chosen in order to ensure that the reference group was very low on the respective variable (Rucker, McShane & Preacher, 2015). The behavioral variable number of lifetime partners was re-coded as follows: 0=1 partner, 1= 2 or more partners.

This was done as there were very few cases for some levels of this variable when cross tabbed with the dummy coded dependent variable.

Logistic regression results are summarized in Table 35 and Table 36. The first model included the five demographic factors (age, gender, race/ethnicity, sexual orientation, and class rank) and, as a block, the demographic factors were statistically significant (Chi square =20.85; df =11.00; p =.03). When the two behavioral factors, number of lifetime sexual partners and current relationship status, were added however, significance was achieved for both the logistic regression model (Chi square = 89.13; df

=13.00; p=.00) and the block of behavioral factors (Chi square =68.28; df =2.00; p=.00).

The results indicate that the behavioral factor, number of lifetime sexual partners, is the most influential factor in explaining differences in frequency of regretting sex due to partner issues, as measured on the Factor 5 of the RRSS (Wald=44.43; p=.00). The odds ratio of 3.56 for participants reporting 2 or more partners indicates that these participants were slightly more than three and one-half times more likely to report

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regretting sex due to partner issues than those having had only one partner. In the final

model, participants in ongoing committed relationships were less likely to report

regretting sex due to partner issues compared to single participants (odds ratio 0.46).

Participants ages 21-23 were less likely to report regretting sex due to partner issues than participants ages 18-20 years (odds ratio 0.37). Participants ages 24-29 were less likely to report regretting sex due to partner issues than participants ages 18-20 years (odds ratio

0.12).

The logistic regression model was statistically significant (Chi square = 89.13, p=.00). The model explained 33 % (Nagelkerke R2=.33) of the variance in the dependent

variable. Classification accuracy was acceptable and the model correctly classified the

outcome variable for 72.29 % of cases.

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Table 35: Binary logistic regression testing the association of behavioral and demographic variables with Factor 5 (partner issues) Block 1 (n=367)

Binary logistic regression for Factor 5 (partner issues) 95% C.I.for EXP(B) Beta S.E. Wald df Sig. Exp(B) Lower Upper Gender (Ref=female) .06 .29 .04 1.00 .84 1.06 .60 1.88 Males Race (Ref=white) 5.64 4.00 .23 Black .13 .39 .11 1.00 .74 1.14 .53 2.43 Asian -1.15 .57 4.07 1.00 .04 .32 .10 .97 Latino .26 .73 .13 1.00 .72 1.30 .31 5.49 Others .84 .84 1.02 1.00 .31 2.33 .45 12.03 Age (Ref 18-20 yrs.) 3.96 2.00 .14 21-23 yrs. -.69 .35 3.93 1.00 .05 .50 .26 .99 24-29 yrs. -.77 .94 .67 1.00 .41 .46 .07 2.92 Orientation (Ref=heterosexual) -2.14 1.07 4.03 1.00 .04 .12 .01 .95 Bisexual or homosexual Current rank in college 8.31 3.00 .04 (Ref=freshmen) Sophomore -.91 .94 .94 1.00 .33 .40 .06 2.55 Junior -.09 .93 .01 1.00 .92 .91 .15 5.66 Senior .42 .97 .19 1.00 .66 1.52 .23 10.15 Constant 3.00 1.41 4.51 1.00 .03 20.16 Model Summary 2 LL 400.47 Model Chi square/df/p 20.85/11.00/.03 Block Chi Square/df/p 20.85/11.00/.03 Nagelkerke R Square .09 Hosmer Lemeshaw p .91 Classification Accuracy % 63.06

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Table 36: Binary logistic regression testing the association of behavioral and demographic variables with Factor 5 (partner issues) Block 2 (n=367)

Binary logistic regression for Factor 5 (partner issues) – Block 2 95% C.I.for EXP(B) Beta S.E. Wald df Sig. Exp(B) Lower Upper Gender (Ref=female) -.12 .33 .13 1.00 .72 .89 .47 1.69 Male Race (ref=White) 3.47 4.00 .48 Black .22 .45 .23 1.00 .63 1.24 .52 2.98 Asian -.27 .63 .18 1.00 .67 .76 .22 2.65 Latino .87 .82 1.12 1.00 .29 2.39 .48 11.94 Others 1.41 .98 2.05 1.00 .15 4.10 .60 28.16 Age (Ref 18-20 yrs.) 7.70 2.00 .02 21-23 yrs. -1.00 .40 6.12 1.00 .01 .37 .17 .81 24-29 yrs. -2.16 1.01 4.56 1.00 .03 .12 .02 .84 Orientation (Ref=heterosexual) -1.52 1.10 1.90 1.00 .17 .22 .03 1.89 Bisexual or homosexual Rank (ref= freshmen) 6.46 3.00 .09 Sophomores -.91 1.18 .59 1.00 .44 .40 .04 4.11 Juniors .11 1.18 .01 1.00 .92 1.12 .11 11.38 Seniors .38 1.22 .10 1.00 .75 1.47 .13 16.05 Number Partners (Ref=1 partner) 1.27 .19 44.43 1.00 .00 3.56 2.45 5.17 2 or more partners Relationship Status (Ref = Single) -.77 .40 3.72 1.00 .05 .46 .21 1.01 Married Constant .95 1.61 .35 1.00 .55 2.59 Model Summary 2 LL 332.19 Model Chi square/df/p 89.13/13/.00 Block Chi Square/df/p 68.28/2/.00 Nagelkerke R Square .33 Hosmer Lemeshaw p .51 Classification Accuracy % 72.29

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Discussion

The current study supports previous research finding that a sizable majority (69%-

89%) of undergraduate college students report sexual experiences that they later regret

(Colaco, 2016a; Esbaugh & Gute, 2008; Oswalt, Cameron, & Koob, 2005; Roese et al.,

2006; Thomas, 2010; Woehling, 2009). Further, it supports findings from previous

research that being drunk is one of the most common reasons given for regretting sex

(Caron & Moskey, 2002; Kypri et al., 2010; Mallet et al., 2008;Orchowski; Mastroleo &

Borsari, 2012; Oswalt, Cameron, & Koob, 2005; Thomas, 2010). More specifically,

Fisher and colleagues (2012) found that over one-half of the college men and women in

their sample stated that intoxication by alcohol and/or drugs caused them to feel regret

(2002) study of 392 college students. In the current study, over three-quarters of the respondents reported that being drunk/high and/or their partner being drunk/high caused them to regret sex. Clearly this is a major reason that students give for regretting sex.

Taking part in casual sex, which is not meaningful, has also been found in other studies, as well as the current one, to be a major reason given for regretting sex (Fisher, Worth,

Garcia, & Meredith, 2012; Grello, Welsh, & Harper, 2006; Paul & Hayes, 2002). In fact, one-quarter (25.3%) of the college students in the current study reported “We did not

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love each other” was the reason that they regretted sex in more than one-half of their sexual experiences.

The current study, however, extends the previous research linking regretted sex to drunken and casual sex by establishing that the number of lifetime sexual partners is significant in explaining regrets based on being drunk and/or having casual sex. The odds that someone will regret sex for these reasons significant increase as one has more sexual partners: 3.67 times for 2-4 partners, 43.90 times for 5-10 partners, to 112.09 times for more 11-21 partners. Further, college students who were in casual relationships were twice as likely to report regretting sex due to alcohol intoxication and/or issues surrounding casual relationships than those in ongoing committed relationships. This is not surprising since the risk for regretted sex increases as one is involved with more sexual opportunities, particularly when the sexual relationship is casual and involves being intoxicated. (See Table 15 for other significant reasons for regretting sex).

Negative feelings, including embarrassment, discomfort, conflict, guilt, and

“feeling cheap,” emerged as a major reason for regretting sex in this study. Such feelings have been associated with regretted sex in other studies as well (Armstrong & Hamilton,

2009; Fielder & Carey, 2010; Glenn & Marquardt, 2001; Lewis, et al., 2012; Owen,

Rhoades, Stanley & Fincham, 2010; Paul, 2006; Paul & Hayes, 2002; Paul, McManus, &

Hayes, 2000; Wade & Heldman; 2010; Welsh, Grello, & Harper, 2006). Paul and Hayes

(2002) found that when they asked their sample of college students to list their feelings after a typical hook up, the most frequent response was “regretful or disappointed”

(35%). However, gender difference was not investigated in most previous studies, except for Fisher et al. (2012) who found that women reported feeling significantly more regret

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than men. However, gender was found to be a major variable associated with the

likelihood of reporting regretting sex in this current study, with women being

significantly more likely to report regretting sex due to a variety of negative feelings.

This is evident in the percentages of females versus males (respectively) who report

regretting sex for these reasons: Feeling conflicted (69.6% vs. 56.7%), concern over others finding out (64.0% vs. 60.0%), not comfortable (60.6% vs. 590.6%), feeling guilty

(54.2% vs. 47.2%), feeling pressured (52.9% vs. 46.7%), embarrassed (51.0% vs.

52.8 %), and feeling “cheap” (39.7% vs. 33.3

The third factor on the RRSS consisted of reasons pertaining to “Bad Sex,” including the experience being physically and/or emotionally unsatisfying, no fun, or not being as good as expected. About two-thirds of the students (67% females, 62% males) in

the present study had regretted an experience because the sex was “bad.” When Fisher

and colleagues (2012) investigated whether the pleasurable quality of the sexual activity

(i.e. good sex versus bad sex) influenced whether an individual experienced regretted sex,

they found that the quality of sex influenced feelings of regret for approximately one-

third of the women and one-half of the men in their sample. High-quality sex seemed to

relieve negative feelings associated with uncommitted sexual encounters, whereas poor-

quality sex increased resentment and a feeling of wasting one’s time and effort. The

researchers observed that quality of the sex and feelings after the encounter showed

noticeable trends, such that good sex resulted in positive emotions (e.g. feeling satisfied

or happy), while bad sex was associated with negative emotions (e.g. disappointment or

embarrassment). The current study extended previous research by investigating specific

variables that may be associated with regretting sex because it was “bad.” College

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students in casual relationships were more than twice as likely to give this as a reason for regretting sex than those in ongoing committed relationships. This is understandable from the perspective of persons who are in ongoing committed relationships may have better communications regarding their expectations and what does and does not feel “good” to them than partners who do not know each other well. Further, students who were under

21 years of age were more than three times as likely to report “bad” sex as a reason for regretting sex than their older student counterparts. This finding should be further examined to see if younger students are less likely to have formed ongoing committed relationships in which the sexual interaction may be more communicative and cooperative. Finally, a surprising finding was that Latino students were over 16 times more likely to report regret over “bad” sex than were White students. There seem to be some important cultural issues that warrant further investigation.

Relationship Issues was another major factor for which the college students reported regretting sex. Previously, Oswalt and colleagues (2005) found that students regretted sex when they came to the realization they did not want the same thing as their partner (28%). In comparison, in the current study 54.2% of the sample of college students reported regretting sex because they thought the “partner was in to me” but wasn’t. Similarly, Caron and Moskey (2002) found that students often regretted sex when they were cheating on their partner (17%) and when the sexual experience resulted in a ruined friendship (11%). In the current study, 54.8% of the college sample reported regretting sex because their partner was not honest and 45.0% of the respondents reported that they had regretted sex since it had ruined a friendship. The percentages may be higher than in the previous studies that were conducted more than a decade ago since the

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practice of having “friends with benefits” sex seems to have become more common and

accepted (Lehmiller, Vanderdrift, & Kelly, 2011; Mongeau, Knight, Williams, Eden, &

Shaw, 2013; Vanderdrift, Lehmiller, & Kelly, 2012). However, the current study extends previous work by documenting a relationship between the number of lifetime sexual partners and regretting sex due to relationship issues. Again, this may simply be the result of exposure to more relationships in which negative issues may occur.

The final major category (Factor 5) included partner-focused reasons for

regretting sex. Prior research has demonstrated that partner issues are important causes of

regretted sex. For instance, Galperin and colleagues (2012) found that women’s top

regrets included having sex with a physically unattractive partner and having sex with

someone who they thought would enter into a relationship with them but did not. Both

Oswalt and colleagues (2005) and Thomas (2010) also found that one of the reasons that

students in their samples regretted sex was that their partners did not want the same thing

as they did. In the current study, 33.2% of the females and 44.1% of the males regretted

sex because their “partner was unattractive.” Further, the current study extends the

understanding of who might be most likely to regret sex for partner-related reasons.

Younger students, under the age of 21, were much more likely to regret sex for partner- related reasons, than older students. Further students who had two or more lifetime sexual partners were over three and one-half times more likely to regret sex, compared to students who report only one partner, based on issues surrounding those partners. Again, this may result from exposure to more partners increasing the likelihood of negative issues arising from various partners.

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To summarize, the relationships among the demographic and behavioral variables and the factors for reasons for regretting sex are presented in two different ways in Tables

37 and 38. Table 37 presents each factor and the variables that are significantly related to increasing the likelihood that the college students sampled in this research reported for regretting sex. These relationships were described in the preceding text. Table 38 presents this information in a different way by listing the variables and showing the factors for regretting sex to which they are significantly related. It is interesting to note that number of lifetime sexual partners and being in a casual sexual relationship were each significantly related to 3 of the 5 factors for reasons for regretting sex, as measured on the

“Reasons for Regretted Sex Scale.” Age was related to two factors, and gender and race/ethnicity were each related to one factor. Sexual orientation was not found to be related to any of the factors, however this may be due to the lack of diversity in orientation within the sample.

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Table 37: Summary of the RRSS factors and significantly-related variables

RRSS Factor Behavioral/demographic variable

Factor 1: Casual/drunken sex Number of lifetime partners

Relationship status (casual relationships)

Factor 2: Negative feelings Number of lifetime partners

Gender (Women)

Factor 3: Bad sex Number of lifetime partners

Race/ethnicity (Latinos)

Relationship status(Casual relationships)

Age (18-20 years)

Factor 4: Relationship issues Number of lifetime partners

Factor 5: Partner issues Number of lifetime partners

Relationship status(Casual relationships)

Age (18-20 years)

Table 38: Summary of the variables and significantly-related RRSS factors

Behavioral/demographic variable RRSS Factor

Age Factor 3: Bad sex

Factor 5: Partner Issues

Gender Factor 2: Negative feelings

Class ranking -

Orientation -

Number of lifetime partners Factor 1: Casual/Drunken sex

Factor 2: Negative feelings

Factor 3: Bad sex

Factor 4: Relationship issues

Factor 5: Partner issues

Relationship status Factor 1: Casual/Drunken sex

Factor 3: Bad sex

Factor 5: Partner issues

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Limitations

The current study has several limitations that must be considered in the

interpretation of the results. The findings were from one sample of undergraduate college

participants and non-participants, based on their gender and race/ethnicity, did not find

significant differences between these groups, there may have been differences in other

demographic and/or behavioral variables that were not measured. It has been found

college students who volunteer for sexuality research, in comparison to non-volunteers,

tend to be more sexually experienced, hold less traditional sexual attitudes, score higher

on measures of sexual esteem and sexual sensation seeking, and indicate greater

tendencies toward interpersonal exploitation and self-monitoring of expressive behavior

(Wiederman, 1999). In addition, the data collection method employed involved a self-

administered questionnaire (SAQ). Inaccurate self-reporting can result from recall bias,

social desirability bias, and errors in self-observation (Weinhardt et al., 1998).

Future Research

While the current study has pushed the boundaries of understanding as to what

exactly undergraduate college students may regret about their sexual experiences and

who might be more at risk for experiencing regretted sex, there is still much to be studied.

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First, these results need to be confirmed with diverse samples of undergraduate college

students at other colleges and universities, particularly recruiting students in

underrepresented racial/ethnic groups and students with diverse gender identities and

sexual orientations. In addition, findings from the current study suggest other variables

that should be included in further research. For example, since alcohol consumption is a

major factor in regretting sex, future research should investigate patterns of drinking

among the respondents to see if certain patterns are associated with different reasons for

regretting sex. Further, more details regarding the types and durations of sexual

relationships and partner characteristics should be examined in relationship to regretting

sex. Personal outcomes of regretting sex, such as low self-esteem and depression, as well as academic consequences should be studied in more detail as well.

As to the practical applications of this research, based on theories of experienced and anticipatory regret (Connolly & Zeelenberg, 2002; Mellers & McGraw, 2001;

Saffrey, Summerville, & Roese, 2008), individuals could be encouraged to explore the reasons for regretted sex in certain groups (e.g. first-year college students, students who engage in hook ups, students who binge drink) or examine their own reasons in order to make plans to improve the outcomes of their sexual interactions.

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Chapter 6

Conclusions and Recommendations

Chapter overview

This final chapter will provide a brief overview of the purpose of the dissertational research which involved an in-depth examination of sexual regret in the undergraduate college student population. The specific aims and the procedures employed in the three articles that related to the development of the Experience of

Regretted Sex Scale and the Reasons for Regretted Sex Scale and the relationship between the correlates of regretted sex in the undergraduate college student population, are then presented. The main findings from these three studies are reviewed for each study and then are integrated with the existing literature to provide a broader understanding of the factors contributing to sexual regret. In conclusion, future research directions that will build upon the findings of this dissertation are discussed.

Purpose

The purpose of the current dissertation study was to examine the relationships among the experience of regretted sex, the reasons for regretted sex, and behavioral and demographic variables that may be associated with regretted sex in an undergraduate college student population.

Specific aims, research questions, procedures and analytic plans

The specific aims of this current research, their corresponding research questions, and the study procedures were addressed in the three separate research articles (Chapters 3-

5). For reference, they are presented again below and the procedures for each study summarized:

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Article 1: Development and Validation of The Experience of Regretted Sex

Scale: Findings From Undergraduate College Students

Specific Aim 1: Develop a psychometrically-sound measure of the experience of

regretting sex.

Research Question 1.1: To what degree do undergraduate college students

experience regretted sex?

Research Question 1.2: What demographic (age, gender, race/ethnicity, sexual

orientation) and behavioral (relationship status, number of lifetime sexual partners)

characteristics of students are significantly associated with regretted sexual experiences?

Procedures. We developed and validated a psychometric instrument designed to measure the degree to which undergraduate college students regret their past sexual experiences, using Colaco’s (2016) definition of regretted sex: A negative cognitive emotion experienced when an individual remembers a past sexual experience and wishes that it had been different or had not happened. Using this definition, 21 items intended to assess the construct were generated and used for the development of the Experience of

Regretted Sex Scale (ERSS). These items were included in a larger survey titled the

Regretted Sex Survey, along with six demographic and behavioral questions (age, sex, race/ethnicity, class ranking, sexual orientation, and relationship status). The regretted sex survey was completed by a sample of 435 undergraduate students (112 males, 317 females, 2 transgender) in general education classes at a large land-grant university in the

northeastern United States.

Analytic Strategy. Principal components analysis was conducted to determine if

the ERSS was unidimensional for the construct of the experience of regretted sex or if the

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items represented subscales (Field, 2013). Confirmatory factor analysis (CFA) using

structural equation modeling was then employed to ensure the construct of the chosen

items was unidimensional (Tabachnick and Fidell, 2012). Next, the internal consistency

reliability of the scale was estimated using the Cronbach’s alpha statistic (Netemeyer et

al., 2003). Convergent validity was assessed by examining the correlation between the

summated scale score for the ERSS (obtained by averaging each person’s scores on the

regretted sex items) and the scale score for the adapted Decision Regret Scale (DRS).

Next, we proceeded to determine the prevalence of regretted sex in college students of various demographic and behavioral backgrounds. The average scores for respondents to the ERSS scale were analyzed. Any participant who achieved a score above zero on the

Article 2: Development and Validation of The Reasons for Regretted Sex Scale

Specific Aim 2: Develop a psychometrically-sound measure of the reasons for regretting sex.

Research Question 2.1: Which categories of regretted sex are associated with a higher degree of regretted sex?

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Procedures. We developed and validated a psychometrically sound instrument designed to measure the reasons that undergraduate college students endorse for regretting sex in two stages. Stage one involved generating items regarding the reasons that

256 undergraduate students at a large northeastern land-grant university may regret sex, reviewing those items by an expert panel for aggregation and the removal of redundancies, and entering them into an Excel spreadsheet file. The result was a master list of 432 reasons why college students may regret sex (Appendix A). Using Neuendorf’s (2005) process for content analysis, the researchers took the initial step of identifying general categories. Each item was then placed into one of these categories. One hundred percent agreement was reached for the classification of each item. Once the items on this master list were categorized, an expert panel of 8 specially-trained peer sexuality educators

examined the items in each category and identified items that were redundant or closely

related. The process of condensing similar items under broader categories progressed

under the direction of the researchers until 100% agreement on all items was reached. A

total of sixty-nine items were maintained as they were believed to represent a broad

spectrum of reasons for regretted sexual experiences as identified by undergraduate

college students. In stage two, the shortened list of items, identified as the Reasons for

Regretted Sex Scale (RRSS), consisting of 69 items, was included in a broader Regretted

Sex Survey (described earlier) for testing of its psychometric properties with a sample of

undergraduate students. This was the same sample used to develop the ERSS.

Analytic Strategies. Exploratory factor analysis (EFA) was used to examine the underlying factor structure of the RRSS and identify the unidimensional sub-scales within this measure (Field, 2013). Further correlational analyses and confirmatory factor

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analysis were conducted to verify the underlying factor structure (Tabachnick & Fidell,

2011). To establish convergent validity, the correlation between the Reasons for

Regretted Sex Scale and the Experience of Regretted Sex Scale was examined. Internal

consistency reliability for each of the subscales and that of the entire measure was

estimated using the Cronbach’s alpha statistic. In order to examine the research question,

logistic regression analysis was employed to estimate the influence of each of the

subscales of the RRSS, as well as demographic and behavioral variables, on the ERSS.

This enabled us to determine which factors on the RRSS explained most of the variance

on the ERSS.

Article 3: The Who and What of Regretted Sex Among Undergraduate College

Students

Specific Aim 3: Examine the who and what of regretted sex among

undergraduate college students in more depth than has previously been undertaken.

• Research Question 3.1: What are the reasons that undergraduate college

students cite most frequently for regretting sex?

• Research Question 3.2: What are the demographic characteristics (age, gender,

race/ethnicity, class standing, and sexual orientation) and behavioral

characteristics (relationship status, number of lifetime sexual partners) of those

undergraduate students who are most likely to experience different reasons for

regretted sex?

Procedures. We explored the relationships between the ERSS and the RRSS with the same participants from Study 1 and Study 2. The resulting multivariate analyses

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included behavioral and demographic variables, as well as the 11- item ERSS and the 36- item RRSS.

Analytic Strategies. The first research question explored the reasons that undergraduate college students cite most frequently for regretted sex. Hence, for each reason on the RRSS, the percentage of respondents who reported the following was noted: Never, less than or half of previous sexual experiences, greater than half of previous experiences. Calculations were performed for the entire sample and then broken down according to gender.

The second research question explored the demographic (age, gender, race/ethnicity, sexual orientation) and behavioral (relationship status, number of lifetime sexual partners) characteristics of undergraduate college students who are most likely to experience certain types of reasons for regretted sex. To answer this question, a series of binary logistic regression analyses were performed in order to assess the relationship between the behavioral and demographic variables and each of the 5 factors on the RRSS scale. These independent variables included age, class rank, gender, race/ethnicity, sexual orientation, number of lifetime partners, and relationship status.

Summary of the Findings by Study

Study 1: Development and Validation of The Experience of Regretted Sex Scale:

Findings From Undergraduate College Students

The Experience of Regretted Sex Scale (ERSS) was developed and validated,

using exploratory factor analysis followed by confirmatory factor analysis to identify an

11-item scale that accurately represented the construct of the experience of sexual regret.

Principal components analysis (PCA) revealed 3 components among the 21 items on the

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initial Experience of Regretted Sex Scale. The 16 items in these three factors explained

69% of the variance in regretted sex. Items in factor 1 described bad feelings experienced after engaging in sex. Items in factor 2 described positive reactions to having engaged in sex. Items in factor 3 described bad feelings about sexual partners. Next, a confirmatory factor analysis (CFA) using structural equation modeling was performed.

CFA of the three-factor solution resulted in good model fit. However, factors 1 and 3 were more conceptually valid for the construct of regretted sexual experiences than was factor 2. Hence, an eleven-item scale was proposed by removing the items from factor 2.

This model provided a better fit to the data. The eleven items included: After I wish I had not had sex with him or her, Wish I had made different decisions, I wish I had not done what I did, I feel guilty after having sex, I get myself into situations I feel badly about, I make poor choices about sexual partners, One or more sexual experiences that I wish had not happened, I haven’t known sexual partners very well, I can’t believe who

I’ve slept with, I disappoint myself with the sexual choices, I disappoint myself with the sexual choices, I am not happy with my sexual partners. Participants were asked to choose the option that most closely resembled their feelings about their past sexual experiences. The response choices were: completely not true (scored as 0), generally not true (scored as 1), neutral (scored as 2), generally true (scored as 3), and completely true

(scored as 4). A participant’s score is calculated by calculating an average score across the 11 items. Thus, a participant’s score could range from 0 to 4 with 0 indicating no regret pertaining to past sexual experiences while 4 indicated a high degree of regret pertaining to past sexual experiences. The ERSS as an 11-item version was found to be a reliable and valid measure of the experience of regretted sex. The ERSS demonstrated

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excellent internal consistency reliability (Cronbach’s alpha 0.925). In order to determine

convergent validity, composite scores for the 16-item ESRS and the Adaptation of the

decision regret scale were calculated in SPSS. Then, these two scale scores were

correlated to calculate a measure of validity. Results indicated that the two scales are

highly correlated, r = -.857, p < .01.

Survey, 397 participants (92%) had engaged in sexual intercourse. This subset was comprised of 297 women (74.8%), 99 men (24.9%) and one transgendered participant

(0.3%). An estimated 148 participants (37.3%) were in the age group 18-20 years, 241

participants (60.7%) were in the age group 21-23 years, while 8 (2%) participants were in

the age group 24-29 years. The majority of participants (379, 95.7%) identified as

heterosexual while 17 participants (4.3%) identified as either homosexual or bisexual.

The majority were white (229, 75.7%), 42 (10.6%) participants were black, 22 (5.6%)

participants were Asian, 18 (4.6%) participants were Latino while 14 (3.5%) participants

identified as other. This sub-sample consisted of 7 freshmen (1.8%), 67sophomores

(18.6%), 166 juniors (41.8%), 156 seniors (38.9%) and one graduate student (0.3%). A

total of 75 (18.9%) participants reported one lifetime partner, 164 (41.3%) reported 2-4

lifetime partners, 110 (27.7%) reported 5-10 lifetime partners, 32 (8.1%) reported 11-20

lifetime partners, while 16 (4%) reported greater than 21 lifetime partners. The majority

of 336 participants (85.7%) were single while 56 participants (14.3%) reported being in

ongoing committed relationships. A total of 41 participants (11.2% of the sample) had an

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average score of 0 on the 11-item ERRS indicating that they did not experience any regret pertaining to their past sexual experiences. However, a majority of the participants

(n= 136, 59.4%) had mean scores ranging from greater than 0 to 2 indicating that they had experienced some degree of regretted sex in the past. In comparison, 52 participants

(22.7%) achieved average scores between 2.00 and 3.99, indicating that they had experienced a high degree of regretted sex in the past. No participant scored 4 on the

ERSS indicating that no participant regretted every past sexual experience.

Binary hierarchical logistic regression was used to examine the relative contribution of five demographic factors (age, gender, sexual orientation, race and class ranking) and two behavioral factors (number of lifetime sexual partners, relationship status) to the degree of regretted sex participants reported on the ERSS. The results indicated that the behavioral factor, number of lifetime sexual partners, was the most influential factor in explaining differences in level of regretted sex measured on the

Experience of Regretted Sex Scale (ERSS). The odds ratio of 2.15 indicated that participants reporting 2-4 partners were slightly more than 2 times more likely to report higher levels of regretted sex than those reporting 1 partner. Similar trends existed for those reporting 5-10 partners (odds ratio = 3.62), 11-20 partners (odds ratio = 20.55) and

21 or more partners (odds ratio = 12.09) when compared with those reporting one partner.

Also in the final model, participants 21 - 23 years of age were 2.45 times more likely to report higher levels of regretted sex as compared to participants less than 21 years of age

Study 2: Development and Validation of The Reasons for Regretted Sex Scale

The Reasons for regretted sex scale (RRSS) was developed and validated in the second study. A total of 69 reasons were generated in stage 1 of study 2. Principal

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components analysis identified a 16 factor solution. Twelve items were excluded from further analyses either due to low factor loadings or because they loaded to a substantial degree on more than one factor after factor rotation. Additionally, 19 more items had low item-total correlations (< .45) and were excluded. A second factor analysis was conducted in SPSS on the remaining 36 items. The principal components analysis resulted in 5 factors that explained 62.3% of the total variance. Based on the principal components analysis, the identified factors were categorized into the following groups: 1.

Casual/Drunken Sex: 9 items representing regrets based on being drunk or high and/or regrets due to the casual nature of the experience. 2. Negative Feelings: 9 items representing negative feelings experienced during or after the sexual interaction. 3. Bad

Sex: 8 items representing aspects of the physical sexual interaction being negative or

“bad.” 4. Relationship Issues: 5 items representing issues in the relationship with the sexual partner. 5. Partner Issues: 4 items representing issues with the partner himself or herself. Next a confirmatory factor analysis (CFA) was employed. The five factor model using the 36 items fit the data reasonably well Good convergent validity was found between the 36 item RRSS with the 11 item ERSS, further strengthening the psychometric properties of both instruments (r = .776, p < .001). Additionally, each subscale exhibited moderate to high correlations with the ERSS (rs .515 to .790, ps<

.001). The correlation co-efficient between scores on the ERSS and Factor 1 on the RRSS was 0.630. The correlation co-efficient between scores on the ERSS and Factor 2 on the

RRSS was 0.790. The correlation co-efficient between scores on the ERSS and Factor 3 on the RRSS was 0.523. The correlation co-efficient between scores on the ERSS and

Factor 4 on the RRSS was 0.649. The correlation co-efficient between scores on the

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ERSS and Factor 5 on the RRSS was 0.558. In addition, the RRSS was found to have

excellent internal reliability (α = .95), as did all of the five factors (ranging from α = .76

to .92) Cronbach’s alpha for Factor 1, Factor 2, and Factor 3 were all very high (α=.902,

α=.906, and α=.918, respectively). The reliability for Factor 4 was lower than the other

three factors, but was still high (α=.819), whereas Factor 5 had the lowest reliability of

all, but was still above acceptable range (α=.762).

Binary logistic regression was used to examine the relative contribution of each of the 5 factors of the RRSS to the degree of regretted sex participants reported on the

ERSS. The independent variables in the model included five demographic variables (age,

gender, race/ethnicity, class standing, and sexual orientation) and two behavioral

variables (current relationship status, number of lifetime sexual partners). The results

indicated that Factor 1 (Casual/Drunken Sex) and Factor 2 (Negative Feelings) were the

only two factors that significantly explained differences in the level of regretted sex as

measured by the ERSS. None of the demographic or behavioral variables significantly

contributed to the explanation of differences in the level of regretted sex, although having

5-10 lifetime sexual partners approached statistical significance.

Study 3: The Who and What of Regretted Sex Among Undergraduate College

Students

Using the Reasons for Regretted Sex Scale (RRSS), we examined the reasons that

undergraduate college students cited most frequently for regretting sex The following

were the items that over 70% of the entire sample gave for ever regretting sex in the past:

Factor 1: “Partner was drunk/high” (77.7%), Factor 1: “I was drunk/high” (76.6%),

Factor 1: “We did not love each other” (74.4%), Factor 1: “Lack of emotional

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connection” (73.6%), Factor 3: “Sex was not as good as expected” (73.3%), Factor 1:

“Experience was not meaningful” (72.2%), Factor 1: “It happened on the spur of the moment” (71.4%), Factor 3: “It was emotionally unsatisfying” (71.4%). Interestingly, six of these items were from the Drunken/Casual Sex factor, whereas the other two were from the “Bad Sex” factor representing both the physical and emotional aspects of bad sex. In addition, one item, “We did not love each other” is noticeable in that 25.3% of the sample reported regretting sex for this reason in more than half of their sexual experiences. These findings were similar for both men and women.

A series of binary logistic regression analyses were performed in order to assess the relationship between the behavioral (age, gender, race/ethnicity and orientation) and demographic variables (relationship status and number of lifetime sexual partners) and each of the 5 factors on the RRSS scale to see which variables would significantly predict the likelihood for reporting certain types of reasons for regretted sex.

The results of the first regression model indicated that the behavioral factor, number of lifetime sexual partners, is the most influential factor in explaining differences in the frequency of regret over engaging in Drunken/Casual Sex. The odds ratio was 3.67 for participants reporting 2-4 partners indicated that they were slightly more than three and one-half times more likely to report regretting sex for these reasons than those having only 1 partner. Similar trends existed for those reporting 5-10 partners (odds ratio =

43.90), 11-21 plus partners (odds ratio = 112.09) when compared with those reporting one partner. Relationship status also was a significant factor in explaining differences in the frequency of regret over engaging in Drunken/Casual Sex. The odds ratio was .38 for those participants in ongoing committed relationships as compared to those in casual

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relationships, meaning that the college students in casual relationships were more likely

to report a higher frequency of regretting sex for Drunken/Casual Sex reasons.

The results of the second regression model indicated that the behavioral factor,

number of lifetime sexual partners, is the most influential factor in explaining differences

in the frequency of regretted sex due to negative feelings. The odds ratio of 2.48

indicated that participants reporting 2-4 partners were slightly less than two and one-half

times more likely to report regretting sex due to negative feelings more often than those

having only one partner. Similar trends existed for those reporting 5-10 partners (odds ratio= 7.05) and 11-21 plus partners (odds ratio = 15.68) when compared with those having one partner. In the final model, male participants were 0.43 times less likely to report regretting sex due to negative feelings more often than female participants.

The results of the third regression model indicated that Latino participants were approximately 16.5 times more likely to report regretting sex because the sex was bad more often than White participants were. Participants in ongoing committed relationships were less likely to report regretting sex due to bad sex more often than single participants (odds ratio 0.41). Participants having 2 or more partners were 4.36 times more likely to report regretting sex on because it was “bad” as compared to participants having one partner. Finally, participants ages 21-23 were less likely to report regretting sex because it was “bad” compared to participants ages 18-20 years (odds ratio

0.34).

The results of the fourth regression model indicated that the behavioral factor, number of lifetime sexual partners, is the most influential factor in explaining differences in how often regretted sex occurs due to relationship issues, as measured on the Factor 4

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of the RRSS. The odds ratio of 6.86 indicated that participants reporting 2-4 partners were approximately 7 times more likely to report regretting sex due to relationship issues than those reporting only having one lifetime sexual partner. Similar trends existed for those reporting 5-10 partners (odds ratio = 13.77), 11-21 plus partners (odds ratio =

61.13) when compared with those reporting one partner.

The results of the fifth regression model indicated that the behavioral factor, number of lifetime sexual partners, is the most influential factor in explaining differences in frequency of regretting sex due to partner issues, as measured on the Factor 5 of the

RRSS. The odds ratio of 3.56 for participants reporting 2 or more partners indicates that these participants were slightly more than three and one-half times more likely to report regretting sex due to partner issues than those having had only one partner. Participants in ongoing committed relationships were less likely to report regretting sex due to partner issues compared to single participants (odds ratio = 0.46). Participants ages 21-23 were less likely to report regretting sex due to partner issues than participants ages 18-20 years

(odds ratio=0.37). Participants ages 24-29 were less likely to report regretting sex due to partner issues than participants ages 18-20 years (odds ratio=0.12).

Contributions to the Field

This dissertation involved an in-depth examination of the construct of regretted sex in a sample of undergraduate men and women at a large, land-grant university in the

Northeastern United States. In study 1, we developed a psychometrically valid measure

of the degree to which undergraduate college students regret their past sexual

experiences. This is the first measure of its kind to the best of our knowledge. However,

reasons for sexual regret are better viewed as causes or predictors of sexual regret rather

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than as sexual regret itself therefore must be measured separately. Hence, in study 2, we developed a psychometrically valid measure of the reasons that undergraduate college students offer for regretting sex. The two research instruments developed and validated in

Study 1 & 2 measure differing but complementary aspects of the construct of regretted sex. However, both the aspects of sexual regret measured provide unique and important information. In study 3, we employed the RRSS to examine how specific demographic and behavioral variables are associated with particular categories of regret. Our findings have important implications for expanding the current literature on factors influencing sexual regret, and the results provide insight into the regretted sexual experiences of undergraduate college students.

There is great deal of research on the issues of non-consensual sex (Banyard et al.,

2007; Fisher, Cullen & Turner, 2000). However, to date, there has been very little research on consensual sex in which one or both of the partners later regretted the sexual experience. It is important to study regret related to past sexual behavior as regret has been found to be related to long-terms negative physical and emotional consequences

(Seaman, 2005; Grello, Welsh & Harper, 2006; Jokisaari, 2003).

We have addressed gaps in the literature in the following ways. First, we employed a definition of sexual regret that was validated through research with college students so that it more accurately represented their perceptions of the construct. Sexual regret was defined as a negative cognitive emotion experienced when an individual remembers a past sexual experience and wishes that it had not happened or that it had been different (Woehling, Colaco & Koch, 2008). Previous research used definitions, if any, that were unclear and inconsistent.

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Second, our research resulted in the development of the Experience of Regretted

Sex Scale (ERSS) that established its validity and reliability in measuring the experience

of regretted sex. The previous lack of a psychometrically-sound standard measure of

sexual regret made it difficult to determine the reliability and validity of study results,

compare results across studies, and assess change as the result of prevention and

intervention programs. The newly-developed Experience of Regretted Sex Scale has addressed this critical need.

Third, we developed the Reasons for Regretted Sex Scale, a psychometrically-

sound instrument designed to measure reasons for regretted sex that can be utilized in

basic, applied, or clinical research. Previously, no such instrument existed. There are a

number of ways in which an individual’s reasons for regretting sexual experiences can be

used to prevent future harmful behavior. First, identifying explanations for the cause of

the problem is one way for the individual to begin to take control of the experience

(Addis, Truax & Jacobson, 1995). Second, different explanations for problems suggest

different approaches for intervention. Finally, different individuals may have different

personal meanings associated with alternative explanations for their problems. It is

reasonable to suggest that gaining an understanding of one’s reasons for sexual regret can

be an important determinant of behavioral change (Richard, Pligt & Vries, 1996;

Zeelenberg, 1999).

Finally, our research presents estimates of the prevalence of sexual regret, the

most common reasons that students offer for regretting sex, and the major predictors of

sexual regret. First, our research confirms that regretted sex is a very common experience

on college campuses. In fact, results from analyses with the ERSS data for our sample of

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undergraduate college students indicated that a majority (88.8%) of respondents (89.7%

of females and 85.7% of men) experienced some degree of regret pertaining to past

sexual experiences. This underlines the need for educators to incorporate the topic of

regretted sex into their sexuality and health curricula as the phenomenon of regret is

equally as important as pregnancy and sexually transmitted infections (STIs), which are

often the usual focus of sexuality education (Kirby, Laris & Rolleri, 2007). However, the

reality is that many students will not experience an unintended pregnancy or an STI, but

the majority experience sexual regret for a variety of other reasons, as documented in this

current research. There is the need to design educational programs that include safer sex

practices but also focus on the context of sex in which intentions are clearly stated and

partners are respectful participants (Caron & Moskey, 2002).

Another important contribution of the research project has been the identification of categories of reasons for regretted sex that students most commonly report:

Casual/drunken sex, negative feelings, bad sex, relationship issues and partner issues.

Our research has also highlighted the strong relationship between a higher number of lifetime sexual partners and many of the categories of regretted sex, indicating that this variable is a critical education intervention point. Decreasing one’s total number of sexual partners is likely to affect the regret that an individual experiences about their sexual decisions (Oswalt et al., 2005). Educators can use this information help students reflect on their own experiences and to encourage a more in-depth sexual decision making process. By having conversations with students about the occurrence and causes of regretted sex, educators and counselors can encourage students to change behaviors to decrease regretful situations and promote more sober and thoughtful decision making.

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Our research draws on the construct of regret including both experienced regret

and anticipated regret. Research suggests that both experienced (regret that a person

actually feels after a decision) or anticipated regret (regret that a person expects to

experience as a result of a decision), can affect decision making (Guthrie, 1999;

Zeelenberg, 1999; Zeelenberg & Beattie, 1997). Anticipated regret has been studied in

the context of unsafe sex and empirical evidence consistently demonstrates that

anticipated regret significantly predicts and even influences sexual behaviors and

intentions (Koch, 2014). Studies suggest that anticipated regret may be a particularly

effective intervention target as interventions that target anticipated regret may not only

have the advantage of being simple yet effective, but are also more effective than fear

appeals in effecting positive change in health and safety. Interventions that increase

awareness of potential negative emotional consequences of certain behaviors and

highlight the role of precautionary measures, may bring about positive changes in health

and safety-related behaviors (Richard, van der Plight & de Vries, 1995). Messages that

heighten anticipated regret involve both cognitive and affective factors and therefore may

be particularly persuasive (Connolly & Reb, 2005). Our research provides educators with

a basis for discussing the role of regret in programs aimed at preventing regretful sexual behaviors and helping students make sexual decisions that are consensual and desired.

Limitations

The current research has several limitations that must be considered in the

interpretation of the results. First, the findings were from one sample of undergraduate

college students at a large, northeastern, land-grant university. Although the sample was drawn from required general education courses representing the diverse backgrounds and

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majors of the students at this university, the majority of the students were Caucasian and

heterosexually-oriented. Therefore, the demographics from this university’s student body

may be different from that of other universities nationally. Thus, the generalizability of

the results, particularly to students in typically underrepresented groups based on their

race/ethnicity and sexual orientation, may be limited.

In addition, although comparison of study participants and non-participants, based

on their gender and race/ethnicity, did not find significant differences between these

groups, there may have been differences in other demographic and/or behavioral

variables that were not measured. It has been found that college students who volunteer

for sexuality research, in comparison to non-volunteers, tend to be more sexually

experienced, hold less traditional sexual attitudes, score higher on measures of sexual

esteem and sexual sensation seeking, and indicate greater tendencies toward interpersonal

exploitation and self-monitoring of expressive behavior (Wiederman, 1999). Therefore,

the participants in this research project may have reflected the biases that have been

found in other studies of sexual behavior.

Finally, the current research relied on the use of a self-report survey as the data collection method. Self-report questionnaires are an efficient, practical, and inexpensive method of collecting large volumes of data. However, this method of data collection can be subject to participation bias (as addressed above), subjective interpretations of the questions, and memory distortion (Fenton, Johnson, McManus & Erens, 2001).

Subjective interpretations of the questions occur when participants ascribe different meanings to terms used in surveys. Lastly, even among respondents who attempt to

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“accurately” report their past behaviors, problems with recall can distort the reported

incidence and frequency of specific behaviors (Fenton et al., 2001).

Recommendations for Future Research

The current study involved the development and validation of two new measures,

the Experience of Regretted Sex Scale (ERSS) and the Reasons for Sexual Regret Scale

(RRSS), designed to assess the experience of and reasons for regretted sexual behavior.

Future research should be conducted to further confirm the factor structure and

psychometric properties of these measures as they are used with diverse samples,

particularly college students from under-represented race/ethnicities and sexual minority groups of diverse identities and orientations.

This study also explored the association of behavioral and demographic variables

with regretted sexual experiences. Researchers are also encouraged to further explore

mediator and moderator relationships between the variables, which were not explored in this study. For instance, we did not study variables such as religiosity and fraternity/sorority membership, which may be important factors in the study of sexual regret.

The relationships among alcohol consumption, relationship issues (including casual sex), partner characteristics/issues, and regretted sex should also be studied in more detail. For example: 1) Are there particular types of casual sexual experiences that are regretted more than others, 2) What patterns of drinking are most associated with regretted sex, and 3) Are there particular partner characteristics that are more likely to result in regretted sex?

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Until now, there was no standard measure of regretted sex used in research with college students and the limited measures that were used lacked adequate psychometric properties. The utilization of the instruments developed and validated in this study could lead to more consistent and reliable research in the area of regretted sex. It is also hoped that the ERSS and the RRSS will be used to inform effective prevention and intervention programs to prevent and reduce regretted sex among college students.

206

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Appendix A

Brief summary of the procedures employed

Specific Aims Procedures

Study 1: Develop a - Item generation by researchers using two sources: psychometrically-sound measure (1) the literature on general regret and regretted sex, of the experience of regretted sex. and (2) models of previous instruments that

measured other types of regret, mainly the Decision

Regret Scale (DRS) which measures regrets

regarding health decisions (21 items were

developed)

- Testing of the pencil and paper version Experience

of Sexual Regret Scale in a sample of 435 students

(112 males, 317 females, 2 transgender) enrolled in

general education classes at a large land-grant

institution in the Northeastern United States

-Exploratory and confirmatory factor analysis used

to develop a unidimensional 11-item scale

- Testing of convergent validity by correlating scores

with the modified decision regret scale

- Estimation of the reliability by calculating

Cronbach’s alpha

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- Calculation of the prevalence of sexual regret

- Calculation of the percentage of students endorsing

varying degrees of sexual regret

- Examination of the contribution of five

demographic factors and two behavioral factors to

the frequency of regretted sex participants reported

on ERSS using binary logistic regression

Study 2: Develop a -Generation of 432 reasons by 256 undergraduate psychometrically-sound measure students (174 females) in two large general of the reasons for regretting sex. education courses at a large land-grant institution in

the Northeastern United States

- Review of items by an expert panel and reduction

in the number of items from 432 to 69 using content

analysis

- Testing of the pencil and paper version of the

Reasons for Sexual regret scale in a sample of 435

students (112 males, 317 females, 2 transgender)

enrolled in general education classes at a large land-

grant institution in the Northeastern United States

- Identification of a 36 item scale with 5 factors

using exploratory and confirmatory factor analysis

- Establishment of convergent validity with the

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ERSS

- Calculation of the reliability of the entire scale and

the individual subscales

- Examination of the relative contribution of each of

the 5 factors of the RRSS to the intensity of

regretted sex participants reported on the ERSS

using binary logistic regression

Study 3: Examine the who and - Testing of the Experience of regretted sex scale what of regretted sex among and the Reasons for regretted sex scale to explore undergraduate college students in relationships between the degree of sexual regret more depth than has previously experienced and the reasons for sexual regret in the been undertaken. same sample as the ERSS

- Calculation of the percentage of people endorsing

each factor on the RRSS

-Examination of the relative contribution of each of

demographic and behavioral variables on each of

the 5 factors of the RRSS using binary logistic

regression

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Appendix B

Master list of reasons for regretting sex

Regrets Related to the Reasons I had Sex:

1. I had sex even though I knew I was being used. 2. I had sex in order to become cooler. 3. I had sex knowing that my partner and I were no longer compatible. 4. I had sex because it was expected of me. 5. I had sex because I’d feel guilty if I didn’t. 6. I had sex to get even. 7. I had sex to prove a point. 8. I had sex because I got my partner exited and did not want to leave him/her hanging. 9. I had sex with someone else after a fight with my significant other. 10. It was make-up sex. 11. It was sex to try to solve a relationship issue 12. I had sex to try to build /save the relationship. 13. I had sex so that I could tell my friends/peers. 14. I had sex because I thought that no relationship exists without sex. 15. It was break-up sex. 16. I had sex for no reason 17. I had sex in order to fit in. 18. I was down and needed a boost. 19. I had sex on a dare. 20. I had sex to try to bury a problem. 21. I had sex because everybody was doing it. 22. I had sex to know what it feels like. 23. I had sex to make my partner like me. 24. I had sex to try to feel fulfilled. 25. I felt pressured by my friends/peers. 26. I had sex because I was lonely.

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27. I had sex because I was bored 28. I had low self-esteem. 29. I did it to make someone jealous. 30. My partner did it to make someone jealous. 31. I felt pressured by my partner. 32. I pressured my partner. 33. I had sex with a popular person just because they were popular. 34. I had sex so my partner wouldn’t dump me. 35. I had sex because I was worried what my partner would think if I said “no”. 36. I got talked into having sex when I didn’t want to. 37. I had sex to keep my partner interested/invested. 38. I was verbally pressured/persuaded/coerced into having sex. 39. I had sex to get a promotion. 40. I verbally pressured/persuaded/coerced my partner into having sex. 41. I was deceived into having sex. 42. I did not want to have sex in the first place. 43. I did it because I felt desperate. 44. I did it to please my partner. 45. I had sex to get a good grade.

Regrets Related to My Partner:

1. My partner was immature. 2. My partner was unattractive. 3. I lost my virginity with the wrong person. 4. My partner did not listen to me during sex. 5. It was not with the right partner. 6. I had sex with someone I knew was cheating on someone else. 7. My partner took advantage of me. 8. I found out my partner was cheating on me. 9. I was not in a relationship with my partner. 10. I was not sexually attracted to my partner.

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11. My partner was not sexually attracted to me. 12. My partner was aggressive. 13. My partner lied about his/her age. 14. My partner was a virgin and I didn’t know. 15. I had sex with someone I did not respect. 16. I had sex with someone I did not want a relationship with. 17. My partner was promiscuous/slutty. 18. My partner did not respect my boundaries. 19. My partner was not compatible with me. 20. My partner did not give consent. 21. My partner had feelings for someone else. 22. It was a hookup with a friend’s significant other. 23. I had sex with a married man or woman. 24. I had sex with someone I cared about but did not have feelings for me. 25. I had sex with someone who had feelings for me but I didn’t have feelings for him/her. 26. I mistakenly thought that my partner was into me as much as I was into her/him. 27. Someone I was close to liked or was involved with this partner. 28. My partner slept with one of my friends. 29. I realized I did not really know the person as well as I thought. 30. It was a hook-up with my ex. 31. I hooked-up with someone I work with (e.g. coworker/employee). 32. My partner was a stalker. 33. I slept with a jerk. 34. I did not trust my partner. 35. I slept with someone I really did not want to associate with. 36. My partner did not love me. 37. I had sex with someone with whom I should not have been sexually involved. 38. I was not comfortable with my partner. 39. I engaged in a heterosexual encounter even though I consider myself to be homosexual.

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40. I engaged in a homosexual encounter even though I consider myself to be heterosexual. 41. My partner had no feelings for me. 42. It was a hookup with a friend’s relative (e.g. brother/sister). 43. My partner cared for someone else. 44. My partner did not want to have sex. 45. My partner told his/her friends negative things about the experience. 46. My partner forced me. 47. There was no chemistry. 48. I was deceived by my partner’s gender. 49. My partner was in love with someone else. 50. I had sex with someone who I knew was off limits. 51. My partner later told me that he/she did not consent.

Regrets Related to Personal Issues:

1. I was too young. 2. It was a rash decision 3. I gave in too fast. 4. I was not ready. 5. We did not talk it through enough. 6. I was emotionally immature. 7. I gave my virginity away too easily. 8. I felt guilty while having sex. 9. I acted on an impulse without considering consequences. 10. I did not have enough information. 11. I went too far. 12. It happened on the spur of the moment. 13. I was not responsible enough to say “no”. 14. I was tired while having sex. 15. I lost my virginity in a random sexual encounter. 16. I felt anxious while having sex.

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17. I had a religious conflict regarding the sex. 18. I was stressed while having sex. 19. I had sex out of compulsiveness 20. I was unassertive and did not take charge of my sexual health. 21. I should have asked my partner before having sex if it was ok. 22. I was too submissive. 23. I had a moral conflict regarding the sex. 24. I felt like events were out of control. 25. I was saving myself for marriage 26. I took advantage of someone. 27. I did not know what a positive sexual experience was like. 28. It went against social expectations. 29. I wish I would have saved sex for someone special 30. It went against something I believe in. 31. My self-esteem was hurt. 32. It was premarital sex. 33. I tried something my partner was not comfortable with. 34. My partner tried something I was not comfortable with. 35. I felt promiscuous/slutty 36. My partner made me feel self-conscious during sex 37. I had a cultural conflict regarding the sex. 38. I felt guilty about cheating. 39. I cared for someone else. 40. I was uncomfortable/self-conscious about my body image. 41. I had feelings for someone else. 42. I was not comfortable during the sexual experience. 43. I was troubled by my own insecurities 44. My partner and I were not familiar with each other. 45. I was not comfortable enough to tell my partner what feels good & what does not 46. There was no respect for me during sex.

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47. I did not give consent. 48. I was in love with someone else. 49. I did not respect my partner’s boundaries. 50. I was uncomfortable performing certain sexual acts. 51. I was not in control of what I was doing during the sexual experience. 52. I did not know my partner’s first name or last name. 53. I had sex with multiple partners consecutively during the same night. 54. I had no feelings for my partner. 55. I got involved with kinky sex. 56. I had sex with multiple partners at the same time (e.g. threesome, group sex). 57. I forced my partner. 58. I engaged in degrading acts. 59. I had sex on the first date. 60. I tried to have more than one fling at a time. 61. I had sex even though I was not in the mood. 62. I was cheating on someone else. 63. I did not love my partner. 64. I felt ashamed. 65. I’m not special for someone else (e.g. husband/wife) anymore. 66. I felt guilty about engaging in sex. 67. I was embarrassed. 68. It hurt my pride. 69. Since I lost my virginity, other encounters have not mattered as much. Regrets Related to Context

1. There was no privacy. 2. It was a sexual experience in a fraternity. 3. We were in a bad location. 4. It disturbed roommates. 5. We were in a public area. 6. We were interrupted during sex. 7. My partner changed his/her mind midway during sex.

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8. My partner began crying during/after sex. 9. I cried during/after sex. 10. I was injured during sex. 11. My partner was injured during sex 12. My partner said something insensitive during sex. 13. We had sex during my/her period. 14. Concern over disturbing others nearby. 15. The mood was interrupted. 16. An embarrassing event happened during sex. 17. Half-way through I realized it was not what I expected. 18. I became ill during sex (e.g. asthma attack, upset stomach etc). 19. My partner became ill during sex (e.g. asthma attack, upset stomach, etc.). 20. My friends would/did disapprove. 21. My partner said things I didn’t want to hear. 22. We had an argument during sex 23. I passed gas during sex 24. My partner passed gas during sex 25. We were caught by the police. 26. I felt stigmatized for having random sex. 27. My partner bragged about the experience to his/her friends. 28. We watched pornography during sex. 29. My partner told his/her friends negative things about the experience. 30. My partner made fun of me afterwards. 31. My partner took pictures/videotaped the sexual encounter. 32. I became the victim of gossip or rumors. 33. I was paranoid about the way people looked at me afterward. 34. I got a bad reputation. 35. My parents/family would/did disapprove. 36. I worried about getting caught having sex.

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Regrets Related to Relationship Issues:

70. It was too soon in the relationship/we moved too fast. 71. It ruined a friendship with my partner. 72. I had sex with my roommates/friend’s boyfriend/girlfriend. 73. I had sex with my roommates/friend’s ex-boyfriend/-girlfriend. 74. I had sex with someone whom I later realized was related to my ex- boyfriend/girlfriend. 75. My girlfriend/boyfriend found out that I had sex with someone else. 76. My sexual experience created friction with someone not in the relationship. 77. It ruined my friendship with my partner’s significant other. 78. It ruined a friendship I had with someone else. 79. It emotionally hurt someone else. 80. I was emotionally hurt. 81. My partner was emotionally hurt. 82. It was the wrong time in the relationship. 83. I did not speak to my partner afterwards. 84. I did not hear from my partner afterwards. 85. I had no relationship with my partner after the experience. 86. It created stress on the relationship. 87. My partner wanted sex from then on and the relationship became just physical. 88. It complicated the relationship. 89. My partner’s attitude changed after sex. 90. There was awkwardness when I saw the person later. 91. I was put off because of the bad sex. 92. My partner lost interest after sex. 93. I forgot the name of the person I had sex with. 94. My partner went home and did not spend the night. 95. My partner hung around and refused to leave after sex. 96. I received unwanted calls from my partner following sex. 97. My partner developed a crush on me when I didn’t want him/her to. 98. There was awkwardness afterwards.

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99. I found out that my partner was having sex to please me. 100. I found out that my partner regretted the experience. 101. We fought after the experience. 102. My partner was arrogant after the experience. 103. My partner made me feel badly about the experience. 104. My partner dumped me after sex 105. I was heartbroken after the experience. 106. My partner ignored me after we had sex. 107. I had to marry my partner because we had sex. 108. I later realized that sex was better with someone special. 109. I wanted more than just sex but my partner didn’t. 110. I was told that the experience was a mistake. 111. I was told that I was doing something wrong sexually. 112. It made it more difficult to break up. 113. My partner didn’t feel comfortable afterwards. 114. I wanted monogamy after sex, but my partner did not want to be monogamous. 115. My partner wanted monogamy after sex, but I did not want to be monogamous. 116. I had sex just because I was horny. 117. We only hung out when having sex. 118. We fought when not having sex. 119. I felt used. 120. I felt depressed afterwards. 121. It created bad memories. 122. I disliked my partner. 123. We only got together for sex. 124. I realized that I didn’t care for my partner. 125. It made me more emotionally vulnerable. 126. I felt guilty for dumping my partner afterwards. 127. I felt obligated to my partner after having sex.

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128. I felt humiliated. 129. It caused me to feel unwanted emotions. 130. I wanted to avoid my partner afterwards. 131. My partner wanted to avoid me afterwards. 132. I found out unflattering things about my partner later on. 133. It gave false hope for a relationship in the future. 134. It changed our friends-with-benefits relationship. 135. I only expected a one-night stand but my partner expected more. 136. My partner only expected a one-night stand but I expected more. 137. The sex meant something different to the two of us. 138. We expected different levels of commitment afterwards. 139. I thought that sex would bring us closer and it didn’t 140. I was told I performed poorly. 141. I felt no attraction to my partner after sex. 142. I left and didn’t spend the night. 143. My partner left and didn’t spend the night. 144. My partner refused to leave after sex. 145. My partner wanted me to leave after the sex. 146. My partner didn’t get in touch with me afterwards. 147. My partner did not look like I remembered when I saw him/her later. 148. After this experience, sex lost its novelty. 149. I no longer felt any modesty about having sex after this experience. 150. I thought sex would bring us closer together but it didn’t. 151. It left me unsure about the relationship. 152. My boyfriend/girlfriend found out about my sexual past.

Regrets Related to the Sex:

1. I was physically unsatisfied. 2. My partner was physically unsatisfied. 3. It was a disappointing experience. 4. It was an awkward experience.

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5. My partner was inexperienced. 6. There was too much difference in our experience levels. 7. I did not have an orgasm. 8. My partner did not have an orgasm. 9. There was lack of physical stimulation. 10. We weren’t too much into it; we just laid there. 11. My partner performed oral sex poorly. 12. My partner did not have good hygiene 13. My partner was physically unattractive with clothes off. 14. There was no communication. 15. My partner did not hold me during sex. 16. There was no foreplay. 17. I had to do all the work. 18. My partner was not affectionate. 19. My partner was not responding. 20. My partner did not put effort into it 21. I was rushed through the experience 22. It was dull, routine sex. 23. I was unable to achieve/sustain an erection. 24. My partner ejaculated too quickly. 25. I did not ejaculate. 26. My partner did not ejaculate. 27. My partner was unable to maintain stamina. 28. My partner was a virgin without any experience. 29. The sex took too long. 30. My partner was inattentive. 31. It was a physically painful experience. 32. I don’t think my partner’s needs were fulfilled. 33. I thought it was special but my partner didn’t think so. 34. My partner was just going through the motions. 35. It was not emotionally fulfilling.

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36. My partner had no idea about what he/she was doing. 37. My partner expected more than I was willing to give. 38. I didn’t like his/her sex moves 39. The experience was not meaningful. 40. It was not romantic. 41. The experience fell short of my expectations. 42. The experience fell short of my partner’s expectations. 43. Since I didn’t know the person, I didn’t know what she/he wanted or needed. 44. It was not physically fulfilling. 45. I felt that I let my partner down. 46. I did not experience any pleasure. 47. My partner was not in tune with what pleases me 48. My partner was selfish in fulfilling his/her own needs without caring about mine. 49. I was not a good lover. 50. My partner was not a good lover. 51. My partner did not respect me. 52. My partner’s penis was too small. 53. My partner’s penis was too big. 54. My partner’s vagina was too tight. 55. My partner’s vagina was too loose. 56. My partner experienced more pleasure than I did. 57. I performed poorly. 58. My partner performed poorly. 59. It was no fun. 60. Sex did not feel good 61. I did not lay down ground rules / establish what I wanted beforehand. 62. I felt pressured to perform to a standard. 63. It was too quick. 64. I was not aroused (turned on). 65. My partner refused to experiment. 66. I performed a sexual act incorrectly.

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67. My partner performed a sexual act incorrectly. 68. I faked an orgasm. 69. I think my partner faked an orgasm. 70. I couldn’t wait until it is over. 71. I got tired or fell asleep during sex. 72. My partner got tired or fell asleep during sex. 73. I forgot my partner’s name or called him/her the wrong name during sex. 74. My partner forgot my name or called me the wrong name during sex. 75. I did not assert my needs or expectations. 76. I was not comfortable with my partner’s body. 77. I did not enjoy it. 78. I was drunk. 79. My partner was drunk. 80. I was high on drugs. 81. My partner was high on drugs. 82. I could not remember the experience. 83. My partner did not remember the experience. 84. I woke up with a stranger. 85. I passed out. 86. My partner passed out. 87. I was drunk so I slept with a sub-standard person. 88. I know I had sex but I forgot who it was with. 89. I lost my virginity when I was drunk/high 90. It was awkward the next morning after drunken sex. 91. I was drunk and did not wear protection. 92. I was drunk so I engaged in sex with someone I was not attracted to. 93. I was drunk so I engaged in sexual acts that I wouldn’t do when I was sober. 94. I was told the next day that I slept with a stranger. 95. I was taken advantage of since I was drunk. 96. I took advantage of someone while he/she was drunk. 97. When I woke up, I didn’t know where I was or how I got there.

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98. I threw up. 99. My partner threw up. 100. After the sexual encounter, I was unsure about what exactly I had done. 101. I couldn’t remember what happened. 102. I couldn’t remember if we used protection against STIs. 103. I couldn’t remember if we used contraception. 104. I mistook the identity of my partner because I was drunk. 105. I was taken advantage of when I was drunk/high. 106. I took advantage of a drunken/high person. 107. Someone drugged me to have sex. 108. I had unprotected sex. 109. My clothes were soiled/torn. 110. My partner didn’t care about pregnancy prevention 111. My partner had sores around his/her genitals. 112. I had a strange/foul taste in the mouth after oral sex. 113. It was a messy experience. 114. My partner had HIV 115. I contracted HIV. 116. An unplanned pregnancy resulted. 117. My genitals were sore. 118. My partner had a sexually transmitted infection (STI). 119. I contracted an STI. 120. I did not have a condom. 121. We did not use any protection against STIs. 122. We did not use any contraception. 123. I hurt my penis (e.g. fractured). 124. The condom slipped or broke. 125. It increased my number of sexual partners. 126. My partner didn’t care about protection against STIs. 127. It made me late for something. 128. My school work suffered.

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129. It was incest. 130. The contraception failed. 131. The experience ended up with an abortion. 132. I was sexually abused. 133. I sexually abused someone. 134. My partner did not disclose or lied about his/her STI history. 135. I did not disclose or lied about my STI history 136. I was raped. 137. I raped someone. 138. I had unprotected sex with a stranger.

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Appendix C

SEXUAL REGRET SURVEY Please answer the following questions as accurately and honestly as you can by marking your responses on the scantron sheets that have been provided.

Background Information 1. What is your class ranking? Freshman Sophomore Junior Senior (+) Grad Student A B C D E 2. What is your age? Less than 18 18-20 21-23 24- 29 30+ A B C D E 3. What is your gender? Female Male Transgender A B C 4. What is your race/ethnicity? White Black Asian Latino Other A B C D E 5. What is your relationship status? Currently Single Currently Married/Life Partner A B 6. Have you ever engaged in sexual intercourse (vaginal-penile, oral, or anal)? Yes No A B (If “No”, skip to Question #8) 7. With how many different partners have you had intercourse with in your lifetime? 1 2-4 5-10 11-20 21+ A B C D E 8. How would you identify your sexual orientation? Heterosexual Bisexual Homosexual A B C

Sexual Regret - Directions People regret having sex for many different reasons. Following is a list of many different sexual situations that people may or may not regret. Using the following scale, indicate how frequently each of the following reasons have led you to regret having sex in the past. A. Never B. Less than half of my sexual experiences C. About half of my sexual experiences D. More than half of my sexual experiences E. All of my sexual experiences

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If you have never been in this situation, mark the last circle (J) for that item and go to the next one. J. Never been in this situation. Please take your time and give your most accurate answer to each of the different situations.

Sexual Regret - Items 9. I had sex with someone that I really didn’t want to be with.

10. I got a bad reputation from what I did.

11. I felt used.

12. The experience was not meaningful.

13. I had sex for the wrong reason.

14. I thought that having sex would help the relationship but it didn’t.

15. My partner was unattractive.

16. I found out that my partner was not honest with me.

17. I mistakenly thought that my partner was into me as much as I was into

him/her.

18. I realized I did not really know the person as well as I thought.

19. My partner told others negative things about me or the sexual experience.

20. I didn’t really want to have sex in the first place.

21. My partner dumped me afterwards.

A. Never J. Never been in this situation situation B. Less than half of my sexual experiences C. About half of my sexual experiences D. More than half of my sexual experiences E. All of my sexual experiences

More items: 22. It was a hook-up.

23. There was poor communication.

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24. My partner was a player/slut.

25. I felt cheap.

26. It ruined a friendship that I had with my partner.

27. My partner was hurt emotionally.

28. I got emotionally hurt.

29. It was awkward afterward.

30. We didn’t love each other.

31. My partner harassed me afterwards.

32. I had sex to make my partner care about me more but she/he didn’t.

33. My partner was more into me than I was into him/her.

34. It complicated the relationship.

35. We hurt someone else by having sex together.

36. There was a lack of an emotional connection.

37. The sex was not as good as I had expected.

38. I could not remember the sexual experience very well.

39. I had sex to make myself feel better but I didn’t.

40. I did some sexual things that I really wasn’t in to.

41. There wasn’t any privacy.

Take a deep breath before you consider the next sexual situations! A. Never J. Never been in this situation B. Less than half of my sexual experiences C. About half of my sexual experiences D. More than half of my sexual experiences E. All of my sexual experiences

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Some different items: 42. I was concerned about others finding out.

43. It was physically unsatisfying.

44. I was not a good lover.

45. My partner was not a good lover.

46. It was a physically painful experience.

47. There was no chemistry.

48. Because I was drunk/high, I ended up with someone that I wouldn’t be

with if I were sober.

49. The experience resulted in concern over a sexually transmitted disease.

50. It happened on the spur of the moment.

51. I felt guilty.

52. It went too far.

53. I wasn’t turned on.

54. I felt conflicted about what I did.

55. I didn’t know my partner.

56. I was out of control.

57. My partner did not seem into it.

58. I was embarrassed by what happened.

59. The sex was bad.

Remember to use this scale: A. Never J. Never been in this situation B. Less than half of my sexual experiences C. About half of my sexual experiences

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D. More than half of my sexual experiences E. All of my sexual experiences

The last set of sexual situations! 60. The sex meant something different to the two of us.

61. I was drunk/high.

62. My partner was drunk/high.

63. It was emotionally unsatisfying.

64. We had unprotected sex.

65. We expected different levels of commitment afterwards.

66. My partner demeaned me.

67. By having sex, my partner or I cheated on someone else.

68. Because I was drunk/high, I did things that I wouldn’t have done if I were

sober.

69. It was no fun.

70. There was a lack of affection.

71. I was not comfortable with the experience.

72. When others found out, they criticized what I had done.

73. I had sex with someone who was off-limits.

74. I lost my virginity at the wrong time or with the wrong person.

75. I was not ready to have sex with this person.

76. The experience resulted in concern over pregnancy.

77. I felt pressured.

78. I slept with a jerk.

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Feelings Towards Sexual Experiences

Read each statement below concerning how you feel overall about your sexual experiences. Mark the choice that most closely resembles how true each statement represents your feelings about your past sexual experiences. For these items, use the following response choices A Completely not true B. Generally not true C. Neutral (neither true nor not true) D. Generally true E. Completely true

79. When I have sex with someone, afterwards I wish that I had not had sex with him or her. 80. After having sex, I look back and wish I had made different decisions. 81. The next day after having sex, I wish I had not done what I did. 82. I am happy with my sex life. 83. I feel guilty after having sex. 84. I regret the choices that were made. 85. I feel good about the decisions I’ve made about sex. 86. I get myself into situations that I feel badly about later. 87. I am pleased about who I’ve had sex with. 88. I make poor choices about sexual partners. 89. I’ve made the right decisions. 90. I am happy with the sexual partner(s) I have been involved with. 91. I’ve had one or more sexual experiences that I wish had not happened. 92. I would make the same choices if I had to do it over again. For these items, continue to use the following response choices A Completely not true B. Generally not true C. Neutral (neither true nor not true) D. Generally true E. Completely true

93. The decisions were wise ones. 94. It bothers me that I really haven’t known my sexual partners very well. 95. I have been pleased with my sexual relationship(s).

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96. Sometime when I wake up the next day, I can’t believe who I’ve slept with. 97. I disappoint myself with the sexual choices I make. 98. The choices did me a lot of harm. 99. I am not happy with the sexual partner(s) I have been involved with.

THANKS! THIS WAS THE LAST QUESTION.

C.Colaco VITAE EDUCATION

2016 Ph.D. Biobehavioral Health, The Pennsylvania State University, University Park, PA 2003 Bachelor of Medicine, Bachelor of Surgery, The University of Bombay

SELECTED PUBLICATIONS

Koch, P. B., Colaco, C.G., & Porter, A.W. (2010). Sexual Health Practices Self-Efficacy Scale. In In T. D. Fisher, C. M. Davis, W. L. Yarber, & S. L. Davis (Eds.). (Ed.), The Handbook of Sexually-Related Measures (3rd edition) (pp. 400). New York, NY. Routledge; 3 edition (August 14, 2010). Koch, P. B., Porter, A. W., & Colaco, C. G. (2010). STI Education Efficacy Scale. In T. D. Fisher, C. M. Davis, W. L. Yarber, & S. L. Davis (Eds.). (Ed.), The Handbook of Sexually-Related Measures (3rd edition) (pp. 400). NY, NY. Routledge; 3 edition (August 14, 2010).

SELECTED PRESENTATIONS

Koch, P.B., Colaco, C.G. & Robbins, S.C. (2012, November). Older Women’s Sexuality: What’s Health Got To Do With It? Poster presented at: First National Sexual & Reproductive Health Conference; Melbourne, Australia.

Koch, P. B., & Colaco, C.G. (2009, November). How do I regret sex? Let me count the ways. Oral Presentation presented at: The Society for the Scientific study of sexuality; Puerta Vallarta, Mexico.

Koch, P. B., Woehling, K., & Colaco, C.G. (2008, November). Concept mapping of negative sexual experiences. Oral Presentation presented at: The Society for the Scientific Study of Sexuality; San Juan, PR.

Colaco, C.G., Porter, A.W., & Koch, P. B. (2007, November). When college students have sex after drinking: Factors mediating condom use. Oral Presentation presented at: The Society for the Scientific study of Sexuality; Indianapolis, IN.

Koch, P. B., & Colaco, C.G. (2006, May). Using sexuality and alcohol logs in sexual health prevention research. Poster presented at: The Society for Prevention Research; San Antonio, TX.

FELLOWSHIPS AND AWARDS

2012 Diplomate of the American Board of Internal Medicine 2007 “Emerging Professional Award” For Commitment to and Accomplishments in Publishing, Presenting, and/or Practice in the Fields of Sexuality Education, Counseling, Therapy, Health-Care, or Research 2007 David McWhirter/Andrew Mattison Outstanding Graduate Paper Award 2005 Fund for Excellence in Graduate Recruitment Award, Pennsylvania State University