Motivations for Sexual Behavior and Intentions to Use Condoms: Development of the Regulatory Focus in Sexuality Scale

Development of a scale for attitude toward sexually transmitted infections based on the Health Belief Model

OBJECTIVES

Determination of the attitudes of individuals toward sexually transmitted infections (STIs) can also help identify barriers to health service-seeking behavior. Hence, this study aimed to develop a scale for determining the attitudes of individuals toward sexually transmitted diseases.

STUDY DESIGN

This was a methodological study. The Health Belief Model (HBM) framework was used to elucidate the perceptions and interpretations of illnesses among individuals. After reviewing the relevant literature, an item pool was created to include 4 dimensions (perceived susceptibility (A), perceived severity (B), perceived benefit (C), and perceived barriers and self-efficacy (D)) about sexually transmitted diseases from the perspective of HBM. Exploratory factor analysis was conducted to evaluate the construct validity of the scale. Moreover, confirmatory factor analysis was used to examine the suitability of the items in terms of factor structures.

RESULTS

The final version of the scale comprised 19 items and 4 subdimensions. The first subdimension of the scale accounted for 20.11% of the total variance, whereas the second, third, and fourth subdimensions accounted for 17.83%, 12.50%, and 8.75% of the total variance, respectively. Collectively, these four subdimensions accounted for 59.19% of the total variance. The Cronbach's alpha reliability coefficient of the scale was found to be 0.74.

CONCLUSIONS

Briefly, the present study led to the development of a novel assessment tool, Attitude Toward Sexually Transmitted Infections Scale. Higher scores on the scale indicated higher likelihood of taking action for a possible STI treatment according to the HBM approach.

Focusing on Safety or Pleasure Determine Condom Use Intentions Differently Depending on Condom Availability and STI Risk

Objective

Regulatory Focus Theory suggests that goal pursuit is driven by two separate and fundamental motives. Being more focused on prevention motivates people to enact safer behaviors and avoid negative outcomes (e.g., to prevent diseases), whereas being more focused on promotion motivates people to take risks and pursue pleasurable experiences (e.g., condomless sex).

Methods

A quasi-experimental study (N = 476) examined if differences in regulatory focus (i.e., prevention vs. promotion) determined condom use intentions with a prospective casual partner, depending on condom availability delay and STI risk cues.

Results

Participants focused on prevention (vs. promotion) were less likely to consider having condomless sex across condom availability delays conditions. However, STI risk cues changed condom use intentions. When STI risk was lower, condom use intentions decreased as condom availability delays increased (particularly for participants focused on promotion). When STI risk was higher, condom use intentions were stronger and consistent across condom availability delays (particularly for participants focused on prevention).

Conclusions

These findings highlight the importance of distinct sexual motives when examining sexual health practices.

Prevent2Protect Project: Regulatory Focus Differences in Sexual Health Knowledge and Practices

The way people perceive risks and make decisions about their health is regulated by two motivational systems-prevention of harm or promotion of pleasure. People more focused on prevention strive to avoid negative outcomes and enact more health-protective behaviors. In contrast, people more focused on promotion strive to attain positive outcomes and take more risks with their health. Building upon recent evidence extending this framework to sexual behaviors and health, we conducted a pre-registered online survey ( OSF ) with Portuguese and Spanish adults (N = 742; M_age = 31.42, SD = 9.16) to examine whether self-reported STI knowledge and sexual health practices differ based on predominant regulatory focus. This study was part of the Prevent2Protect project ( OSF ). Results showed that prevention-focused participants had heard about more STIs and retrieved more of their knowledge from scientific sources but had been tested for fewer STIs in the past. In contrast, promotion-focused participants indicated they had specific knowledge about more STIs, retrieved more of their knowledge from medical and peer sources, and had been tested for more STIs in the past. They also reported more frequent STI testing, using free testing facilities or asking their family practice doctor to get tested, more routine sexual health check-ups, and more use of other contraceptive methods, such as birth control pills. These results remained unchanged after controlling for demographic differences. Overall, our findings showed that different motives in sexuality shape sexual health knowledge and sexual health practices.

Condom Use Beliefs Differ According to Regulatory Focus: A Mixed-Methods Study in Portugal and Spain

Reports worldwide have been showing increasing rates of sexually transmitted infections (STIs) and condomless sex in recent years. Research has identified several individual and situational variables that can determine the decision to use condoms or forgo their use. We argue that such a decision can also be shaped by motives related to pleasure and safety (i.e., regulatory focus in sexuality). Using open ended questions, we asked 742 Portuguese and Spanish adults to indicate situations and reasons that could inform the decision making process with casual partners and the functions/attributes related to condoms. Using thematic analyses, we coded the drivers of condomless sex and condom use into themes and subthemes, and computed their frequencies. Using quantitative measures, we also asked participants to indicate their condom use expectancies and perceived barriers. Comparing participants according to regulatory focus revealed some differences. Pleasure promotion participants were more likely to consider that condom use decision making is driven by unexpectedness, pleasure, and intimacy pursuit, attached more pleasure reduction functions to condoms, expected more negative outcomes in condom use, and endorsed more sensation and partner barriers in condom use. In contrast, disease prevention participants were more likely to consider that condom use decision making is driven by adequate sexual education, responsibility, and behavioral control, and attached more health protective functions to condoms. These differences can inform the development of tailored intervention and awareness campaigns aimed at helping people to use condoms more consistently with casual partners and to avoid behaviors that put them at risk of STI transmission.

Relationship and Sexual Quality in the Wake of COVID-19: Effects of Individual Regulatory Focus and Shared Concerns over the Pandemic

Research has shown mixed findings regarding the effect of the COVID-19 pandemic on relationship and sexual quality and activity. We argue that some of these findings might be understood considering people's predisposition to maintain safety (i.e., prevention focus) or take risks (i.e., promotion focus), and sharing concerns with one's partner about the pandemic. A longitudinal study (N = 153) tested if regulatory focus before the pandemic (November 2019) was associated with relationship quality, sexual quality, and joint sexual activity later on (June 2020) and whether these effects were moderated by shared concerns over the pandemic. Results showed that participants more focused on prevention experienced higher relationship quality later on, but also less sexual quality and less frequent joint sexual activity, when they shared fewer (vs. more) concerns with their partner. In contrast, participants more focused on promotion experienced higher relationship quality later on when they shared more (vs. less) concerns with their partner. These results indicate how individuals' regulatory focus and shared concerns in times of crisis, such as the COVID-19 pandemic, can have downstream consequences on people's relational and sexual dynamics. We offer insights for mental health professionals to improve psychosocial health and well-being when people are faced with critical events.

Reliability and Validity of the Colombian Version of the Revised Sociosexual Orientation Inventory

Sociosexuality refers to an individual's disposition to have casual sex without establishing affective bonds and has been widely studied worldwide using the Revised Sociosexual Orientation Inventory (SOI-R; Penke & Asendorpf, 2008). Despite its many validations in different cultural contexts, no psychometric analyses of this instrument have been conducted in Spanish-speaking Latin American countries. To address this gap in the literature, we examined the psychometric properties of the SOI-R in Colombia. In a cross-sectional study with a large sample of participants (N = 812; 64% women), we conducted exploratory and confirmatory factor analyses to identify different factor structures and determine which had the best fit for our sample and examined the reliability of the scale. Results showed that a three-factor structure, with sociosexual behaviors, attitudes, and desire as first-order factors, and global sociosexuality as a second-order factor, had the best fit indexes. Each factor presented good reliability indexes. Replicating already established gender differences, we also found that men scored higher on each factor when compared to women. These findings show that the SOI-R is a reliable and valid instrument to assess sociosexuality in countries where sociosexuality research is underrepresented.

Security motives and negative affective experiences during the early months of the COVID-19 pandemic

OBJECTIVE

Self-regulation can help individuals cope during stressful events, but little is known about why and when this might occur. We examined if being more focused on prevention was linked to negative affective experiences during the COVID-19 pandemic. We also examined possible underlying mechanisms for this association, and whether social support buffered it.

DESIGN

Pre-registered longitudinal study, with surveys every 2 weeks over one month (N = 1269).

MAIN OUTCOME MEASURES

Regulatory focus and worry for health (T1), adherence to self-isolation and preventive health behaviours (T2), negative affective experiences, positive affect, frequency of online interactions, and perceived social support (T3).

RESULTS

Prevention focus was associated with health worries at baseline and linked to greater adherence to preventive health behaviours (T2). Only adherence to self-isolation was linked to more negative affective experiences (T3). Exploratory analyses showed that prevention focus was linked to more negative affective experiences (T3), but only for participants with fewer online interactions with their family and less perceived social support from family and friends.

CONCLUSIONS

Prevention motives in threatening times can be a double-edged sword, with benefits for health behaviours and consequences for negative affective experiences. Having a strong social network during these times can alleviate these consequences.

Having a prevention regulatory focus longitudinally predicted distress and health‐protective behaviours during the COVID‐19 pandemic

People focussed on prevention (vs. promotion) are motivated by safety and are less inclined to take risks. We tested if having a prevention (vs. promotion) focus before the COVID-19 pandemic outbreak predicted threat perceptions and health outcomes throughout the pandemic. Participants (N = 161) took part in a longitudinal study. Measures were assessed before the pandemic was declared (on November 2019, T1) and after a global pandemic was declared (on June 2020, T2). Participants who were more focussed on prevention prior to the onset of the pandemic (at T1) perceived greater risk and were more worried about contracting COVID-19, and engaged in more preventive behaviours during the pandemic (at T2). They also reported less anxiety and felt healthier later on (at T2). Exploratory analyses revealed that enacting preventive behaviours helped people cope with pandemic-related anxiety. Being motivated by security and enacting preventive behaviours seems to have helped people reduce anxiety over risk even during the pandemic.

Regulatory Focus and Sexual Health: Motives for Security and Pleasure in Sexuality are Associated with Distinct Protective Behaviors

We examined if motives for security (i.e., prevention focus) or pleasure (i.e., promotion focus) were uniquely associated with intentions to get tested for STIs and behavioral control over condom use, over and above variables already identified in theoretical models. We conducted an online survey with Portuguese adults (N = 836; M_age = 22.27, SD = 5.14). Overall, 99.4% of the participants knew at least one of eight STIs, but only 25.2% got tested in the last six months. Participants more focused on prevention had condomless sex less frequently, whereas participants more focused on promotion knew more STIs and got tested for more STIs. Furthermore, participants had stronger intentions to get tested for STIs if they got tested for more STIs in the past, were more concerned about STIs, perceived greater susceptibility to STI acquisition, and were more focused on promotion (but not prevention). Participants had greater behavioral control over condom use if they had condomless sex less often and were more focused on prevention (but not promotion). These findings suggest that promotion-focused people are more likely to consider the consequences of having condomless sex. In contrast, prevention-focused people are more likely to take control of their sexual health.

Is Regulatory Focus Related to Condom Use, STI/HIV Testing, and Sexual Satisfaction?

Regulatory focus theory contends that when making decisions people are either more inclined to focus on avoiding negative consequences (more prevention-focused) or achieving pleasurable outcomes (more promotion-focused). Some research suggests that regulatory focus is related to health behaviors, although this has not been thoroughly investigated in the sexual health domain. The purpose of this study was to examine the relationship between regulatory focus (prevention, promotion) and sexual health. In an online survey of 409 youth from the U.S. (ages = 18-25; M_age = 23.5; 57.2% women; 74.1% White, 13.4% Asian, 10.5% Black, 9.8% Hispanic), we examined the relationship between regulatory focus and three sexual health outcomes: condom use, STI/HIV testing, and sexual satisfaction. Of youth in our sample, 31.8% had a dominant prevention-focus, while 54.8% had a dominant promotion-focus. Compared to youth who were more promotion-focused, more prevention-focused youth used condoms more frequently but reported less sexual satisfaction. No differences were found in rates of STI/HIV testing. This study lays the groundwork to investigate the dynamic role that regulatory focus may play in contributing to youths' sexual health. More experimental and longitudinal studies are needed to confirm the causal nature of the association between regulatory focus and sexual health.

Emotional Suppression and Psychological Well-Being in Marriage: The Role of Regulatory Focus and Spousal Behavior

Emotional suppression has been considered a critical factor in determining one's mental health and psychological well-being in intimate relationships such as marriage. The present study aimed to delineate the nuanced association between emotional suppression and psychological well-being in marriage by considering two critical factors: (a) individual differences in motivational orientation and (b) the perceived level of a partner's emotional suppression. A set of two online survey studies were conducted on a large sample of married participants. The participants were asked to indicate (a) their own level of emotional suppression, (b) the perceived level of their spouse's emotional suppression, (c) relationship motivation, and (d) satisfaction with marital life. The results consistently indicated that for prevention-focused individuals being emotionally suppressive was associated with greater marital satisfaction, but only for those who perceived their spouses as also emotionally suppressive. Conversely, for promotion-focused individuals, being less emotionally suppressive was associated with greater marital satisfaction, but again, only for those who perceived their spouses as also being less emotionally suppressive. These findings provide insights into research on emotion regulation and self-regulatory strategies in influencing psychological well-being and mental health in an intimate relationship.

Cultural Variability in the Attribute Framing Effect

An intriguing phenomenon that arises from decision making is that the decision maker’s choice is often influenced by whether the option is presented in a positive or negative frame, even though the options are, de facto, identical to one another. Yet, the impact of such differential framing of equivalent information, referred to as the attribute framing effect, may not be the same for every culture; rather, some cultures may be more readily influenced by the differentially valenced frames than others (i.e., showing a greater difference in evaluation in a positive vs. negative frame). The present study investigates to what extent and why cultures may differ in their sensitivity to the attribute framing effect. Participants were recruited from South Korea and the United States, cultures characterized by their focus on prevention and promotion, respectively, to test for the cultural variability in the attribute framing effect. The results revealed that Korean participants were markedly more influenced by the valence of the frame than North American participants. Regulatory focus explained why Koreas showed a greater sensitivity toward the attribute framing effect than North Americans. Specifically, a greater prevention (vs. promotion) orientation of Korean participants led them to show a greater evaluation gap in the positive and negative frames. Implications for cultural significance on the attribute framing effect are discussed.

Predictors of Condomless Sex and Sexual Health Behaviors in a Sample of Portuguese Single Adults

INTRODUCTION

Several theoretical models and intervention programs overlook the importance of individual motivations for the decision to have condomless sex. For instance, people focused on promotion (ie, eager to pursue pleasure) report less intentions to use condoms, because they perceive a lower risk of acquiring sexually transmitted infections.

AIM

We aimed at understanding to what extent individual motivations are predictive of condomless sex behavior among single individuals.

METHODS

A sample of 415 Portuguese individuals (254 women) with ages ranging from 18-46 years (M = 23.30; SD = 5.28) were recruited to a cross-sectional study. All participants were neither dating nor in a romantic relationship at the time of the study. The link to an anonymous web survey was shared in social networking platforms.

MAIN OUTCOME MEASURE

The survey included self-reported demographic variables (eg, age and sex), recent condomless sex behavior, and previously validated measures assessing regulatory focus in sexuality, ability in sexual restraint, perceived control over condom use, perceived safety with sex partners, and salience of the condom use norm.

RESULTS

More than two-thirds of the sample had recently engaged in condomless sex. A logistic regression showed that condomless sex was more likely for participants predominantly focused on promotion in sexuality. It was also more likely among less educated participants, those with a lower ability to restrain their sexual behavior, those who perceive to have less control over condom use, those for whom the condom use norm was less salient, and those who perceived to be safer with their sex partners. No other results were significant.

CLINICAL IMPLICATIONS

Our results can be informative to sexual health care professionals when planning strategies to increase condom use awareness, by considering the role of specific individual motivations.

STRENGTHS & LIMITATIONS

This is the first study showing that individual motivations uniquely contribute to the decision to have condomless sex. This study has 2 main limitations that constraint the generalizability of the findings: (a) cross-sectional data prevents us from establishing causality, and (b) individual data does not account for dyadic processes in sexuality (eg, condom use negotiation).

CONCLUSION

Our findings showed that condomless sex results from an individual focus on seeking pleasure, a lack of control in sexual behavior, and a perception of sex partners as more trustworthy. Overall, these findings are likely to help researchers and health care professionals improving theoretical models predicting condom use and preventing the spread of sexually transmitted infections. Rodrigues DL, Lopes D, Pereira M, et al. Predictors of Condomless Sex and Sexual Health Behaviors in a Sample of Portuguese Single Adults. J Sex Med 2020;17:26-36.

Perceived sexual self-control and condom use with primary and casual sex partners: age and relationship agreement differences in a Portuguese sample

OBJECTIVE

Consistent condom use is still not ideal. Research showed that perceived sexual self-control is associated with greater likelihood of using condoms. However, this association seems to vary according to age and relationship agreement (i.e. non-consensual non-monogamy, NCNM vs. consensual non-monogamy, CNM).

DESIGN

Cross-sectional study with 307 heterosexual users of a dating web site for romantically involved individuals (81.8% men; M_age = 42.24, SD = 9.65, range: 23-76 years). All individuals were in a romantic relationship (M_length = 13.47 years, SD = 9.39).

MEASURES

Demographic information, perceived sexual self-control, condom use frequency (casual sex partners; primary partner in the last 3 months) and relationship agreement.

RESULTS

Independently of relationship agreement, perceived sexual self-control was positively associated with condom use frequency with casual sex partners among younger and middle age participants, but not older ones (>49 years). Regarding the primary partner, a similar pattern emerged for CNM participants. In contrast, no significant association between perceived sexual self-control and condom use frequency with the primary partner emerged for NCNM individuals, regardless of age.

CONCLUSION

Our findings can inform evidence-based strategies to promote consistent condom use as an effective behaviour to prevent sexually transmitted infections, especially among older and NCNM individuals.