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The Influence of Attributional Style on Substance Abuse and Risky Sexual Behavior among College Students

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Title: The Influence of Attributional Style on Substance Abuse and Risky Sexual Behavior among College Students
Language: English
Authors: Burnett, Audrey J., Sabato, Todd M., Walter, Katherine Ott, Kerr, Dianne L., Wagner, Laurie, Smith, Amy
Source: College Student Journal. Mar 2013 47(1):122-136.
Availability: Project Innovation, Inc. P.O. Box 8508 Spring Hill Station, Mobile, AL 36689-0508. Tel: 251-343-1878; Fax: 251-343-1878; Web site: http://www.projectinnovation.biz/csj.html
Peer Reviewed: Y
Page Count: 15
Publication Date: 2013
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Sexuality, College Students, Sexually Transmitted Diseases, Acquired Immunodeficiency Syndrome (AIDS), Pregnancy, Student Surveys, Gender Differences, Health Behavior, Drinking, Drug Abuse, Attribution Theory, At Risk Persons, Health Promotion, Questionnaires, Likert Scales, Student Characteristics, Racial Differences, Knowledge Level, Misconceptions
Geographic Terms: Virginia
Assessment and Survey Identifiers: Attribution Style Questionnaire, Center for Epidemiologic Studies Depression Scale
ISSN: 0146-3934
Abstract: HIV, AIDS, STIs, and unwanted pregnancy continue to impact young adults in the U.S. at a disproportionate rate, particularly during the college years. Attributional style (i.e., locus of control) influences one's HIV risk. Internal locus of control indicates a lower risk of HIV infection, whereas an external locus of control signals an increased risk of HIV. A sample of 1,874 university students aged 16-54 years were surveyed to determine if sexually active males versus females with external, unstable, and specific causal attribution (i.e., external locus of control) engaged in safer sexual practices (e.g., condom use) and lesser alcohol and legal/illicit drug use. Results indicated that male students with an external attributional style engaged in a greater number of unsafe sexual behaviors (e.g., multiple partners) and higher amounts of alcohol and drug use than female students. Additionally, for both males and females, an internal attributional style was associated with greater drug use and a greater likelihood to engage in HIV-related risk behavior. Comprehensive sexual health and substance use education targeting college students should consider attributional style in relation to health promoting and protective behaviors.
Abstractor: As Provided
Number of References: 66
Entry Date: 2014
Access URL: https://www.projectinnovation.biz/csj_2006.html
Accession Number: EJ1022084
Database: ERIC
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  Value: <anid>AN0092757391;cgl01mar.13;2013Dec13.10:20;v2.2.460</anid> <title id="AN0092757391-1">THE INFLUENCE OF ATTRIBUTIONAL STYLE ON SUBSTANCE USE AND RISKY SEXUAL BEHAVIOR AMONG COLLEGE STUDENTS </title> <p>HIV, AIDS, STIs, and unwanted pregnancy continue to impact young adults in the U.S. at a disproportionate rate, particularly during the college years. Attributional style (i.e., locus of control) influences one's HIV risk. Internal locus of control indicates a lower risk of HIV infection, whereas an external locus of control signals an increased risk of HIV. A sample of 1,874 university students aged 16-54 years were surveyed to determine if sexually active males versus females with external, unstable, and specific causal attribution (i.e., external locus of control) engaged in safer sexual practices (e.g., condom use) and lesser alcohol and legal/illicit drug use. Results indicated that male students with an external attributional style engaged in a greater number of unsafe sexual behaviors (e.g., multiple partners) and higher amounts of alcohol and drug use than female students. Additionally, for both males and females, an internal attributional style was associated with greater drug use and a greater likelihood to engage in HIV-related risk behavior. Comprehensive sexual health and substance use education targeting college students should consider attributional style in relation to health promoting and protective behaviors.</p> <p>Keywords: college; attributional style; substance use; health risk behaviors; HIV; STIs</p> <hd id="AN0092757391-2">Introduction</hd> <p>Viruses differ from infectious agents, such as bacteria, in their unrelenting need to infect and multiply within their host. The body's immune system serves as a protective means from infectious agents, including viruses, bacteria, and fungi. However, the goal of the human immunodeficiency virus (HIV) is to attack and destroy the host's CD4 or immune cells (TeachAIDS, 2010). Unlike other worldly viruses, HIV is an incurable disease that targets specific immune system cells, eventually destroying these cells and rendering the body incapable of warding off secondary infections. HIV is easily transmittable and can infect anyone, as the virus does not discriminate based upon gender, sexual orientation/preference, race, socioeconomic status, or religion (International Olympic Committee, n.d.; News Medical, 2011; United Nations Population Fund, 2008).</p> <p>An estimated 1.2 million Americans are HIV-positive, one in five who do not know their HIV status, and approximately 50,000 new cases of HIV are reported each year. Currently, young adults are becoming infected with HIV at increasing rates each year. When it comes to the issue of HIV, not every university student is aware of the risks or means of transmission. More specifically, in 2009, adolescents and young adults between the ages of 13 and 29 were tested for and constituted 39% of new HIV infections. Those aged 20 to 24 years old accounted for the highest rate of newly HIV infected individuals (Centers for Disease Control and Prevention [CDC], 2011), supporting the hypothesis that those with the highest rate of new HIV diagnoses are college-aged students (Mecoli, 2011; Pablo, 2012). These recent statistics highlight the fact that this newly HIV-infected demographic was more than likely to have been infected during their college years. College students are developing personal values, principles, independent thinking styles, and identity throughout their four years attending a university and are often not concerned with the possibility of becoming infected with an incurable disease. In addition, students have been known to be promiscuous and experimental via engaging in risky sexual behaviors or experimenting with drugs, which is further perpetuated by their invincible mentality. According to the American College Health Association's (ACHA) (2011) National College Health Assessment, 8.3% of the sample reported four or more sexual partners within the past 12 months, and 27.2% reported using drugs within the last 30 days (e.g., smokeless tobacco, marijuana, or illicit drugs such as cocaine, methamphetamine, sedatives, hallucinogens, MDMA). Furthermore, increases in risky sexual behavior are common among first-year students between their first and second semesters (Vail-Smith, Maguire, Brinkley & Burke, 2010).</p> <p>Locus of control is defined as one's perceived control over his or her own actions. Therefore, internal factors, chance, or individuals outside the person serve to influence one's health behaviors. Internal locus of control is measured by an individual's accountability for his/her own actions, while external locus of control exists when an individual perceives behavior as being controlled solely by outside sources (e.g., chance, peers, healthcare providers, influential others) (Brincks, Feaster, Burns & Mitrani, 2010; Wallston, Wallston & DeVellis, 1978). University students who possess a greater internal locus of control are typically more aware of the dangers of HIV infection and feel more in control and proactive when it comes to preventing infection (Gwandure, 2008). Alternatively, students possessing an external locus of control are not concerned about becoming infected and/or are unaware of the risk of HIV infection. Furthermore, a greater percentage of young adults are not alarmed about becoming infected with HIV and are not taking preventive measures to protect themselves and others from HIV and other sexually transmitted infections (STIs) (CDC, 2011). Moreover, over 56,000 Americans become infected with HIV yearly, one-third of whom are 13 to 29 years of age. Hence, at least two teenagers and young adults are infected with HIV upon the hour every day. Nevertheless, many young adults still do not think they are at risk for HIV (Advocates for Youth, 2008; American Foundation for AIDS Research, 2010; National Institute of Allergy and Infectious Diseases, 2008). This apathetic attitude can increase the spread of HIV infection and cause new infection rates to increase rapidly, particularly among college-aged students (Kaiser Family Foundation, 2000; O'Sullivan, Udell, & Patel, 2006; Weatherspoon, Glickand, & Dain, 2009).</p> <hd id="AN0092757391-3">Literature Review</hd> <p>Attribution of Causality and Sexual Risk Behavior</p> <p>Internal versus external locus of control. The attribution of causality highlights the need for people to understand the origin of and explain their daily experiences and events (Camargo & Bousfield, 2009). Locus of control, or health locus of control (HLOC), to which it is often referred in the health literature (Brincks et al., 2010; Burns & Dillon, 2005; Wallston, Wallston & DeVellis, 1978), is a component of the attribution of causality and has been continuously referenced in previous research on HIV. More specifically, HLOC is traditionally defined as one's belief that his/her health is controlled by one's behavior (i.e., internal locus of control or personal causality), as opposed to fate, luck, friends, family, or health care providers (i.e., external locus of control or impersonal causality; Camargo & Bousfield, 2009; Ruffin, Ironson, Fletcher, Balbin & Schneiderman, 2011). Numerous studies have highlighted the influence of locus of control on health behaviors, including negotiating risk of STIs and HIV (Gwandure & Mayeskiso, 2010; Loue, Cooper, Traore & Fieldler, 2004; Steptoe & Wardle, 2001). Sales and colleagues (2009) measured female African American adolescents' degree of worry regarding risky sexual behavior (i.e., STIs), as correlated with locus of control (e.g. 'My boyfriend controls whether or not we have sex.'). Worry was positively correlated with perceived barriers to condom use, condom negotiation, external locus of control, and depression. Interestingly, those who worried about unintended pregnancy, or contracting HIV or other STIs, engaged in fewer safe sex behaviors (e.g., consistent condom use) (Sales et al., 2009).</p> <p>Internally-locused individuals tend to hold themselves responsible and capable of influencing their health status and mortality, while those with an external locus of control or impersonal attributional style believe that their health outcomes are governed by "powerful others, and chance" (Steptoe & Wardle, 2001, para. 3). Steptoe & Wardle (2001) found that among university students, those with greater internal loci were up to 70% more likely to carry out healthy behaviors (e.g., exercise, avoiding fatty foods, brushing teeth) than those with some of the lowest internal loci scores. If some university students cannot be easily convinced to brush their teeth or exercise regularly, the issue of teaching them to practice condom negotiation and regular HIV testing for themselves and their partners--behaviors requiring much more personal initiative--becomes even more important.</p> <p>External attributional style/locus of control and sexual risk perception. The notion that health outcomes are left to chance leads to the related issue of whether these individuals perceive themselves as at-risk for HIV infection. Klein, Elifson, and Sterk (2003) reported a greater perception of risk is due to the presence of greater HIV risk factors. However, those possessing minimal perceptions to no risk for HIV were still engaging in risk behaviors. More specifically, 50% reported unprotected sex, more than one out of five engaged in sexual acts while high and 16% reported illegal drug use (e.g., crack cocaine).</p> <p>Conversely, not all of those who engage in risky behaviors exhibit denial of their risk. In a study of college students, Ben-Zur (2003) found positive associations between the perception of peer and personal sexual risk behaviors. Additionally, denying of HIV/ AIDS risk was highly correlated with greater peer and personal risk behaviors. Similarly, Siegel, Klein, and Roghmann (1999) found varying degrees of sexual behavior among college seniors versus freshmen in terms of frequency of sex, condom use, HIV testing, and inter-partner trust. O'Hea and colleagues (2009) also proposed that people will be less likely to engage in health-protecting behaviors if they believe an external being or force will cause their HIV infection. Additionally, Oswald, Walker, Krajewski, and Reilly (1994) suggested that an external HLOC determines one's substance use, potentially increasing one's HIV risk.</p> <p>Regarding sexual risk behavior, Downing-Matibag and Geisinger (2009) reported that situational characteristics, such as spontaneity tends to influence students' sexual self-efficacy, making them more prone to sexual risk-taking. Hence, there is a vast disconnect between sexual risk prevention services and education that college students are receiving on-campus and their self-efficacy regarding risk behaviors (Burns & Dillon, 2005). Internal locus of control signals a lower HIV risk, whereas an external locus of control points to a higher HIV infection risk. The variables and dimensions of the locus of control-based model utimately impacts students' attitudes towards HIV and their locus of control status.</p> <p>The purpose of the current study was to better understand sexually active university students' HIV-risk behavior and determine whether a set of predictors (i.e., attributional style and substance use) reliably distinguish between individuals who engage and those who do not engage in HIV risk behaviors. University students aged 16-54 years were surveyed to address the following research questions:</p> <olist> <item> Are sexually active male versus female students with external, unstable, and specific causal attribution engaging in safer sexual practices (e.g., condom use)?</item> <item> Are sexually active male versus female students with external, unstable, and specific causal attribution engaging in lesser alcohol and legal/illicit substance use?</item> </olist> <hd id="AN0092757391-4">Methods</hd> <p>Participants</p> <p>The sample consisted of 1,874 university students enrolled in personal wellness, personal health, and drug education courses across three separate university campuses. Participants' average age was 19.6 (SD = 2.07; range = 16 - 54) and 82% identified as Caucasian. In addition, 70.3% identified as female and 29.4% as male. A total of 67.18% of participants reported sexual activity in the three months prior to the study (SD = 2.33) (see Table 1).</p> <p>Measures</p> <p>In addition to basic demographic information, the questionnaire packet consisted of seven scales measuring different aspects of sexual risk behavior. The scales are discussed in detail below, including their respective validity and reliability information.</p> <p>a) A demographic forced-choice questionnaire was included to solicit information on age, race, gender identity, sexual preference, educational level, history of counseling and type, and history of HIV testing in the past twelve months.</p> <p>b) To assess locus of control in a sexual context, the Dyadic Sexual Regulation Scale (DSR) was used, which is an 11-item Likert type scale that includes seven points (1 = strongly disagree, 7 = strongly agree). The scale items originated from open ended interviews regarding sexual attitudes with heterosexual and homosexual couples and have been shown to have excellent reliability and validity (Catania, McDermott, & Wood, 1984). More specifically, the DSR measures the degree to which an individual perceives sexual activity as being regulated via internal or external locus of control, including behaviors that: (a) influence the acquisition and termination of sexual rewards, (b) effect events between these latter two points, and (c) prevent or avoid aversive sexual encounters. The scale also includes items that measure control flexibility, which refers to an individual's ability to resign or accept control, contingent upon the variety of social/sexual interactions (Fisher, Davis, Yarber, & Davis, 2010). Summary scores range from 11 to 77, with higher scores indicating a greater external locus of control. This instrument has been found to be both valid and reliable for use among college students (Beere, 1990). The reliability coefficient in the present study was 0.76.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/cgl/01mar13/126n1.jpg?ephost1=dGJyMNHX8kSepq84v%2bvlOLCmsE6epq5Srqa4SK6WxWXS" alt="126n1.jpg" title="TABLE: Table 1. Socio-demographic characteristics of student respondents (N=1,874)" /> </p> <hd id="AN0092757391-6">Table 1. Socio-demographic characteristics of student respondents (N=1,874)</hd> <p>Gender Males (n = 552) Females (n = 1,322) n (%) n (%) Race/Ethnicity Caucasian 434 (78.6) 1,105 (83.6) African American 31 (5.6) 78 (5.9) Asian/Pacific Islander 50 (9.1) 70 (5.3) Other 37 (6.7) 69 (5.2) Sexually Active in Last 3 Months Yes 370 (69.8) 889 (68.9) No 160 (30.2) 401 (31.1)</p> <p>c) The original Brief HIV Knowledge Questionnaire (HIV-KQ-45) was a 45-item instrument, which typically serves as a burden to respondents with limited knowledge or time. Therefore, an 18 true-false item self-administered set of statements (HIV-KQ-18) was selected from the original 45-item pool to provide a brief and reliable means to assess HIV knowledge among high-risk populations. The instrument addresses information relevant for awareness of sexual risk behavior, informed decisions, and behavior change, as well as misconceptions about the risk associated with close contact with persons suspected or known to be infected with HIV (e.g., "A person can get HIV by sharing a glass of water with someone who has HIV"). Furthermore, The HIV-KQ-18 has yielded an internal consistency across samples (α=.75-.89) (Carey & Schroder, 2002). Summary scores were obtained by summing the number of items correctly answered, with higher scores indicating greater HIV knowledge. In the present study, internal consistency was measured at .78.</p> <p>d) HIV-related sexual risk behavior was assessed by the University of California San Francisco (UCSF) Center for AIDS Prevention Studies Sexual Behaviors Questionnaire (Chesney, Folkman, & Chambers, 1996). The UCSF is a 20-item scale that asks participants to report the number of persons they had engaged in sexual activity with during the preceding three months. In addition, participants were asked to respond to dichotomous (yes/ no) items related to condom usage, and insertive and receptive anal, oral, and vaginal intercourse (e.g., 'During the past 3 months, have you had receptive oral sex without a condom?") Summary scores were calculated based upon responses to all items involving unprotected oral, anal, and vaginal sex. Scores could range from 0 to 22, with higher scores indicating greater participation in HIV-related sexual risk.</p> <p>e) The Attributional Style Questionnaire (ASQ) is a 7-point self-report instrument that provides scores for explanatory style for both good and bad events addressing three attributional element combinations: Internal versus external, that is, caused by something about the person as opposed to a force external to the person; stable versus unstable, or if uncontrollable events are caused by long-term versus temporary factors; and global (i.e., limited in its influence or widespread) versus specific, which refers to causes stemming from the situation itself, as opposed to causes external to the situation (Fernandez-Ballesteros, 2002).</p> <p>The ASQ describes 12 hypothetical positive (e.g., "you meet a friend who compliments you on your appearance") and negative ("you go out on a date and it goes badly") events and asks participants to generate their own cause for each event and then rate the cause along a 7-point continuum for each of the three causal dimensions. Scores are computed for each dimension with positive and negative events. The ASQ is regarded as a predictor of depression, physical health, and achievement in various domains (e.g., academics, work, and sports) (Fernandez-Ballesteros, 2002; Peterson, Semmel, von Baeyer, Abramson, Metalsky, & Seligman, 1982).</p> <p>The internal consistency for the ASQ typically falls between adequate to low, particularly for the locus of control measure. Therefore, given that the three dimensions highly correlate with one another, a commonly practiced solution is to combine the three dimensions as one index to increase reliability. However, the interpretation of the results must be approached carefully, as there are specific predictions for each dimension and a composite score may pose a threat to model validity. The Expanded Attributional Style Questionnaire (EASQ) follows a similar format as the ASQ, but addresses the low reliability issue by including more situations. Nevertheless, reliability remains modest (Fernandez-Ballesteros, 2002), with Cronbach's alpha ranging from .44 to .69 has been reported (Peterson et al., 1982). Each of the three attributional elements (internality, stability, and globality) were measured in the event, producing a total of 12 items. Summary scores range from 0 to 84, with higher scores indicating greater degrees of internal, stable, and global attribution. Previous research among college students has shown the instrument to be highly reliable (Lo, Ho, & Hollon, 2010). Reliability of the instrument in the present study was 0.83.</p> <p>f) The Center for Epidemiologic Studies Depression Scale (CES-D) Short Version is an 8-item measure representing the major components of depressive symptomatology within the past week, identified in clinical literature among community populations, specifically, the frequency of depressed affect, feelings of guilt and worthlessness, feelings of helplessness and hopelessness, psychomotor retardation, loss of appetite, and sleep disturbance, with responses ranging from "rarely or none of the time" to "most or all of the time" (Santor & Coyne, 1997). The CES-D shows exceptional internal consistency (α>0.85) and test-retest correlation (r >0.5). Internal consistency using coefficient alpha is estimated to be .85 for the general population and .90 in patient samples (Fisher, 2009; Radloff, 1977). Most estimates of test-retest reliability from 2 weeks to 12 months fall in the moderate range (.45-.70). Nevertheless, test-retest estimates are consistent with the CES-D's design, as current affective symptoms are expected to fluctuate between test administrations (Naughton & Wiklund, 1993; Radloff, 1977). Previous studies among college students have found this scale to be both valid and reliable, with alpha coefficients as high as 0.86 (Zawawi & Hamaideh, 2009). Summary scores range from 0 to 24, with higher scores indicating a greater degree of depressive symptomatology.</p> <p>g) The Brief Michigan Alcoholism Screening Test (bMAST) is a 10-item scale that provides a reliable measure for identifying the existence of alcoholic tendencies.</p> <p>The 10-item bMAST was adapted from the original 25-item MAST (Selzer, 1971). Responses are "yes" or "no" to each of the questions, and the scoring method typically uses weighted scores, with higher weights assigned to items pertaining to prior alcohol-related treatment experiences and help-seeking behaviors. Items 3, 8, and 9 scoring either 0 or 5, and the remaining items scoring either 0 or 2, and the total score range is 0-29, which is obtained by adding the weighted scores from all items. Aggregate scores, generated by summing the weighted scores to each item, can range from 0 to 29, with higher scores indicating greater behavioral risks for alcoholism (Conner, Grier, Feeney & Young, 2007). Gibbs (1983) indicated that the long version of the MAST possesses good internal-consistency reliability, as indicated by Cronbach's alpha coefficients of .83 and .93. Furthermore, due to the fact that reliability tends to be lower for the shorter versions (Gibbs, 1983), the validity and reliability of the bMAST is traditionally reported from the longer versions of the MAST (Connors & Volk, 2003; Dawn, Loxton, Hides, Kavanagh, & Mattick, 2002). Nevertheless, the instrument has been found to be very reliable (α=.95-.99, .81 in the present study) (Pokorney, Miller & Kaplan, 1972; Selzer, 1971).</p> <p>h) The Drug Abuse Screening Test (DAST) is a 20-item scale that addresses various consequences that are combined in a total DAST score to yield a quantitative index of past and current problems related to legal and illicit drug use, abuse, and misuse (Skinner, 1982). The internal consistency has been found to be high (.92), and a factor analysis has revealed that the instrument measures a unidimensional construct. Higher scores indicate greater drug-use related consequences (McCann, Simpson, Ries, & Roy-Byrne, 2000). The DAST total score, computed by summing all items in the direction of increased drug use problems, can range from 0 to 20. The instrument has proven to be highly reliable, with alpha scores ranging from .86 to .95 (Skinner, 1982). Reliability of the instrument in the present study was .78.</p> <p>Procedure</p> <p>This study was approved by the Institutional Review Board at James Madison University. Students enrolled in the courses were asked to participate in a survey of behaviors and personal characteristics. Students who expressed an interest in participating in the study were provided with a copy of the detailed cover letter, as well as a copy of the questionnaire packet. Instructions were that participants complete the questionnaire packet prior to the next class session (i.e., one-week timeframe for completion).</p> <p>Upon completion of the questionnaires, students were asked to separate the questionnaires from the cover letter, and return them to the Principal Investigator via a locked drop box, which assisted in maintaining participant anonymity. The risks of participating in this study were minimal. While completing the questionnaires, respondents may have felt some level of discomfort, as one survey asked detailed questions about sexual experiences, while others asked about feelings and attitudes about one's self, his/her sexual orientation, drug use, and the AIDS epidemic. Participation in this study was strictly voluntary; therefore, respondents had the right to refuse to participate, answer any question(s), or discontinue participation all together.</p> <p>All information provided by the respondents was kept confidential, and their names were not associated with any completed questionnaires. Completed questionnaires were immediately separated from informed consent forms to further protect participant privacy. Identification numbers, rather than names, were used to code questionnaires and other information that was obtained. All responses to questionnaires were kept in a locked office to which only the research team had access. Prior to receiving informed consent, participants were instructed that information obtained in the research may be used to support additional research funding and/or may be reported in group form in professional publications.</p> <p>After entry into IBM SPSS v. 20, all data were screened to identify missing information and outliers. Frequency counts were generated for each scale to examine missing data. None of the scales had greater than 4% missing data. A series of two-tailed t-tests revealed no significant univariate outliers. Data screening using Mahalanobis distance further detected no multivariate outliers.</p> <hd id="AN0092757391-7">Results</hd> <p>A split file methodology was utilized prior to any analyses to examine differences between males and females (Table 2). Among males and females who were sexually active in the previous three months (67.18%), women engaged in fewer sexual risks (t = 7.58; p < .000).</p> <p>Attributional Style & Sexual Practices</p> <p>Based on the University of California -- San Francisco (UCSF) Center for AIDS Prevention Studies Sexual Behaviors Questionnaire, results of an independent samples t-test indicated that, among both sexually active males and females, those with external, unstable, and specific causal attribution engaged in safer sexual practice, compared to students exhibiting internal, stable, and global attribution (M = 2.75 and 2.81, respectively). While these results were not statistically significant, compared to their female counterparts males are more likely to engage in risky sexual behavior (e.g., multiple partners) (see Table 3).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/cgl/01mar13/130n1.jpg?ephost1=dGJyMNHX8kSepq84v%2bvlOLCmsE6epq5Srqa4SK6WxWXS" alt="130n1.jpg" title="TABLE: Table 2. Personal and Behavioral HIV Risk Means for Males and Females" /> </p> <hd id="AN0092757391-9">Table 2. Personal and Behavioral HIV Risk Means for Males and Females</hd> <p>Gender Males Females t df Dyadic Sexual Regulation 29.6 (3.9) 29.5 (4.4) .54 1,838 Depression 4.1 (4.0) 5.3 (4.6) -5.35* 1,851 Attributional Style 54.4 (7.7) 54.6 (7.1) -.52 1,783 Drug Abuse 2.1 (2.8) 1.1 (1.7) 8.98** 1,824 Alcohol Use/Abuse 2.8 (3.7) 2.3 (2.5) 3.39** 1,851 HIV Knowledge 13.4 (3.5) 13.4 (3.5) -.19 1,840 Sexual Risk 2.6 (2.6) 1.7 (1.9) 7.58** 1,631</p> <p>Attributional Style, Substance Use, and High-Risk Sexual Behavior</p> <p>Relationships were examined between the following variables based on correlations: (<reflink idref="bib1" id="ref1">1</reflink>) Internality/externality as measured by the DSR and UCSF; (<reflink idref="bib2" id="ref2">2</reflink>) Alcohol and drug use as measured by the BMAST and DAST, respectively; and (<reflink idref="bib3" id="ref3">3</reflink>) high-risk sexual activity served as the dependent variable. Externally locused males experienced higher rates of risky sexual behavior (r = -.178; p<.001) and higher amounts of alcohol and drug use (r = .120; p<0.03). Furthermore, for both males and females, higher levels of internal control over sexual regulation was associated with greater drug use and/or abuse, and a greater likelihood to engage in HIV-related risk behavior (p<.005) (see Table 4).</p> <hd id="AN0092757391-10">Discussion</hd> <p>Compared to their older counterparts, young adults generally have more sex partners and, therefore, experience a higher risk of HIV/STIs (Bajos, Guillaume, & Kontula, 2003). According to the American College Health Association (ACHA) (2011), 8.3% reported having four or more sexual partners within the last 12 months, with 50.7% reporting using a condom or other protective barrier during vaginal intercourse within the last month (5.3% for oral sex; 27.4% for anal intercourse), and 60.4% reporting the use of birth control pills during their last vaginal intercourse. However, sexual behaviors, such as consistent condom or contraceptive use, may fluctuate for an individual depending on one's age, risk perception, beliefs about STIs, and life experiences (Brewer, Weinstein, Cuite, Herrington, 2004; Pavlich, Antil, Kerr, & Thompson, 2007). Despite their higher education levels and high levels of HIV/STI knowledge, many college-aged men and women continue to engage in high-risk sexual behaviors (Lewis, Miguez-Burbano, & Malow, 2009). The aim of this article was to assess the degree to which one's causal attribution and substance use influences his/her sexual practices.</p> <p>In concordance with previous literature (e.g., Sabato, 2007), the above results suggest that students with reportedly higher substance use engage in more risky sexual behaviors (e.g., multiple partners). Furthermore, the present study's findings confirm previous findings that substance use (i.e., legal and illicit) and binge-drinking behavior are the most frequently cited reasons for engaging in high-risk sexual behavior, particularly among males (ACHA, 2012; Indiana Prevention Resource Center, 2012; Ragsdale, Porter, Zamboanga, St. Lawrence, Read-Wahidi & White, 2011). Additionally, prescription drug use also has an impact on high-risk sexual behavior. The illicit use of prescription drugs has increased among young adults to facilitate unwanted sexual contact (e.g., opiates and benzodiazepines) (Apodaca1 & Moser, 2011). Benotsch, Koester, Luckman, Martin, & Cejka (2011) found that young adults who used prescription medications recreationally engaged in higher rates of sexual risk behavior (e.g., multiple sex partners, more unprotected sex), and hence, had a higher propensity to contracting STIs.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/cgl/01mar13/131n1.jpg?ephost1=dGJyMNHX8kSepq84v%2bvlOLCmsE6epq5Srqa4SK6WxWXS" alt="131n1.jpg" title="TABLE: Table 3. Comparison of Attributional Style by Gender" /> </p> <hd id="AN0092757391-12">Table 3. Comparison of Attributional Style by Gender</hd> <p>Gender Males t df Females t df Sexually Active in the Past Three Months Yes No Yes No Internal Attributional Style 3.63 .080 1.71 95 2.33 .112 3.87 207 (2.6) (.40) (2.1) (.73) External Attributional Style .072 .486 361 2.48 8.00 910 (.62) (1.8) Note. * = p<.005, ** = p<.05. Standard Deviations appear in parentheses below means.</p> <p>The findings from this study highlight priority needs in education and prevention efforts implemented on university campuses aimed at preventing the perpetuation of STI/ HIV infection. The fact that more than 41.6% of sexually active persons practiced receptive oral sex with men without a condom and without ejaculation, and 84.1% of students who indicated that they currently had a partner at the time of data collection was unaware of their partner's HIV status, warrants the need for greater sex education programs on college campuses. Behavioral-based programming incorporating risk perceptions has been found effective among college students, who are increasingly participating in risky sexual practices, particularly females (Bontempi, Mugno, Bulmer, Danvers, & Vancour, 2009). Therefore, the use of peer-led student speakers who are HIV-positive (Adamchak, 2009) and gender-specific education programming, the invitation of local or national celebrity-status speakers on the topic of risk behaviors and living with HIV/STI's may serve as effective means to address risky sexual practices on college campuses (Hoban, Ottenritter, Gascoigne, & Kerr; Rotheram-Borus, O'Keefe, Kracker, & Foo, 2000; World Bank, 2004).</p> <p>More than 44% of college students have reported inconsistent use of condoms for a variety of reasons (e.g., cost, availability, discomfort), which increases these students' risk for unintended pregnancy and STIs (Palmer, n.d.). Moore, Smith, and Folsom (2012) found that person-led and discussion-based learning, such as viewing pictures of sexually transmitted infections, and hearing real-life experiences about the consequences of unsafe sex, resulted in higher knowledge gains and was preferred by students. College sexual health information and education programming should be provided during first-year student orientation and throughout one's college career. Additionally, sexual health education and counseling should be comprehensive, address students' concerns and questions regarding contraception and STIs, and be provided in a personalized, straightforward, entertaining, and comfortable atmosphere. A follow-up component should also be included to gauge the effectiveness of college sexual health education and counseling and target areas for improvement (Palmer, n.d.). Furthermore, sexual health education programming should address the interaction between drug and substance use and decision-making among both heterosexual and sexual minority students (Levy, Sherritt, Gabrielli, Shrier, & Knight, 2009; Woodford, Krentzman, & Gattis, 2012), as well as the non-medical use and influence of prescription medications (Benotscha, Koesterb, Luckmanc, Martina, & Cejka, 2011; Teter, McCabe, LaGrange, Cranford, & Boyd, 2006).</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/cgl/01mar13/132n1.jpg?ephost1=dGJyMNHX8kSepq84v%2bvlOLCmsE6epq5Srqa4SK6WxWXS" alt="132n1.jpg" title="TABLE: Table 4. Correlations among Attributional Style, Substance Use, and High-Risk Sexual Behavior (n = 1,874)" /> </p> <hd id="AN0092757391-14">Table 4. Correlations among Attributional Style, Substance Use, and High-Risk Sexual Behavior (n = 1,874)</hd> <p>Measure Attributional Styles Alcohol Use Drug Use Sexual Behavior Male --- .277** .120* -.178** Female .144** .128** --- -.154** * p < .05; **p < .01</p> <p>Limitations</p> <p>While the present study incorporated findings from three individual university campuses, several limitations should be highlighted. First, the data for this study was collected from three convenience samples of college students in the Northern and Southwestern regions of Virginia and Northeastern Ohio. Therefore, generalizations to other regions of the US and populations may not be possible. Second, the sample was not very diverse in terms of ethnicity, culture, or sexual orientation/preference. Therefore, studies involving a more diverse sample are warranted to corroborate and extend applicability. Third, the data was based on self-reports, which may have limited the truthfulness of the responses, as students may have over- or under-reported risk behaviors, such as frequency of sex, actual use of protection, and number of sex partners. Finally, the survey packet distributed to students was rather lengthy, which may have skewed student responses, particularly if they hurriedly completed the various questionnaires and scales. In spite of its limitations, the current study highlights the numerous sexual risk behaviors associated with college students and confirms previous studies' findings concerning the influence of attributional style and sexual risk behaviors.</p> <p>Recommendations for Future Research</p> <p>Additional psychosocial factors, such as condom self-efficacy and assertiveness in relation to condom negotiation, as influenced by attributional style, warrant further investigation, particularly among sexually inexperienced college students (Lee, 2010). Wright (2008) found that African American college women's sense of self-efficacy and condom negotiation largely influenced their condom use behavior. Similarly, O'Leary, Jemmott, and Jemmott (2008) reported that condom use self-efficacy was the most significant mediator in risky sexual behavior compared to other mediators, such as condom use knowledge, and self-efficacy. Furthermore, the aforementioned studies highlight the importance of simultaneously addressing the influence of cultural health beliefs with regard to condom use self-efficacy, assertiveness, and negotiation (Wingood et al., 2011).</p> <p>Theory-based (e.g., theory of planned behavior), skill-building sex education programs on college campuses should incorporate interactive condom use negotiation in an effort to promote consistent condom use, increase sexual self-efficacy, limit sexually impulse decisions and address HIV/STI and pregnancy-related perceptions and risk behaviors (Lee, 2010; O'Leary, Jemmott, & Jemmott, 2008; Turchik & Gidycz, 2012). Taken together, these findings suggest a dire need for continuous development of sexual risk reduction and HIV/AIDS preventive-education programs aimed toward college students (Wright, 2008), including first-year students (Walsh, Filder, Carey, & Carey, 2012) and men who have sex with men (MSM) (Teng & Mak, 2011), particularly among culturally diverse student populations (Gilliam, Neustadt, Whitaker, & Kozloski, 2011; O'Leary, Jemmott, & Jemmott, 2008).</p> <p>Future research should also incorporate integrated psychosocial models (e.g., information-motivation-behavioral skills model) to examine health protective behaviors such as consistent condom use (Reid & Alken, 2011), as well as assertiveness and condom negotiation (Gil-Rivas, 2012). Furthermore, future studies should examine psychopathic personality traits in relation to risky behaviors and sexual sensation-seeking among college students, including parental influence (Fulton, Marcus, & Payne, 2010).</p> <hd id="AN0092757391-15">Conclusion</hd> <p>The influence of psychosocial factors such as attributional style on college students' decision-making regarding risky sexual behavior should not be underestimated. One's attributional style (i.e., internal versus external locus of control) and simultaneous legal or illicit substance use can lead to a long-term pattern of risky sexual behavior, leaving students highly susceptible for STIs and unwanted pregnancy. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: The Influence of Attributional Style on Substance Abuse and Risky Sexual Behavior among College Students
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Burnett%2C+Audrey+J%2E%22">Burnett, Audrey J.</searchLink><br /><searchLink fieldCode="AR" term="%22Sabato%2C+Todd+M%2E%22">Sabato, Todd M.</searchLink><br /><searchLink fieldCode="AR" term="%22Walter%2C+Katherine+Ott%22">Walter, Katherine Ott</searchLink><br /><searchLink fieldCode="AR" term="%22Kerr%2C+Dianne+L%2E%22">Kerr, Dianne L.</searchLink><br /><searchLink fieldCode="AR" term="%22Wagner%2C+Laurie%22">Wagner, Laurie</searchLink><br /><searchLink fieldCode="AR" term="%22Smith%2C+Amy%22">Smith, Amy</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22College+Student+Journal%22"><i>College Student Journal</i></searchLink>. Mar 2013 47(1):122-136.
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  Data: Project Innovation, Inc. P.O. Box 8508 Spring Hill Station, Mobile, AL 36689-0508. Tel: 251-343-1878; Fax: 251-343-1878; Web site: http://www.projectinnovation.biz/csj.html
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 15
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2013
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Sexuality%22">Sexuality</searchLink><br /><searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Sexually+Transmitted+Diseases%22">Sexually Transmitted Diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Acquired+Immunodeficiency+Syndrome+%28AIDS%29%22">Acquired Immunodeficiency Syndrome (AIDS)</searchLink><br /><searchLink fieldCode="DE" term="%22Pregnancy%22">Pregnancy</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Surveys%22">Student Surveys</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Behavior%22">Health Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Drinking%22">Drinking</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+Abuse%22">Drug Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Attribution+Theory%22">Attribution Theory</searchLink><br /><searchLink fieldCode="DE" term="%22At+Risk+Persons%22">At Risk Persons</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Promotion%22">Health Promotion</searchLink><br /><searchLink fieldCode="DE" term="%22Questionnaires%22">Questionnaires</searchLink><br /><searchLink fieldCode="DE" term="%22Likert+Scales%22">Likert Scales</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Characteristics%22">Student Characteristics</searchLink><br /><searchLink fieldCode="DE" term="%22Racial+Differences%22">Racial Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Knowledge+Level%22">Knowledge Level</searchLink><br /><searchLink fieldCode="DE" term="%22Misconceptions%22">Misconceptions</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Virginia%22">Virginia</searchLink>
– Name: SubjectThesaurus
  Label: Assessment and Survey Identifiers
  Group: Su
  Data: <searchLink fieldCode="SU" term="%22Attribution+Style+Questionnaire%22">Attribution Style Questionnaire</searchLink><br /><searchLink fieldCode="SU" term="%22Center+for+Epidemiologic+Studies+Depression+Scale%22">Center for Epidemiologic Studies Depression Scale</searchLink>
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0146-3934
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: HIV, AIDS, STIs, and unwanted pregnancy continue to impact young adults in the U.S. at a disproportionate rate, particularly during the college years. Attributional style (i.e., locus of control) influences one's HIV risk. Internal locus of control indicates a lower risk of HIV infection, whereas an external locus of control signals an increased risk of HIV. A sample of 1,874 university students aged 16-54 years were surveyed to determine if sexually active males versus females with external, unstable, and specific causal attribution (i.e., external locus of control) engaged in safer sexual practices (e.g., condom use) and lesser alcohol and legal/illicit drug use. Results indicated that male students with an external attributional style engaged in a greater number of unsafe sexual behaviors (e.g., multiple partners) and higher amounts of alcohol and drug use than female students. Additionally, for both males and females, an internal attributional style was associated with greater drug use and a greater likelihood to engage in HIV-related risk behavior. Comprehensive sexual health and substance use education targeting college students should consider attributional style in relation to health promoting and protective behaviors.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: Ref
  Label: Number of References
  Group: RefInfo
  Data: 66
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2014
– Name: URL
  Label: Access URL
  Group: URL
  Data: <link linkTarget="URL" linkTerm="https://www.projectinnovation.biz/csj_2006.html" linkWindow="_blank">http://www.projectinnovation.biz/csj_2006.html</link>
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1022084
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1022084
RecordInfo BibRecord:
  BibEntity:
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 15
        StartPage: 122
    Subjects:
      – SubjectFull: Sexuality
        Type: general
      – SubjectFull: College Students
        Type: general
      – SubjectFull: Sexually Transmitted Diseases
        Type: general
      – SubjectFull: Acquired Immunodeficiency Syndrome (AIDS)
        Type: general
      – SubjectFull: Pregnancy
        Type: general
      – SubjectFull: Student Surveys
        Type: general
      – SubjectFull: Gender Differences
        Type: general
      – SubjectFull: Health Behavior
        Type: general
      – SubjectFull: Drinking
        Type: general
      – SubjectFull: Drug Abuse
        Type: general
      – SubjectFull: Attribution Theory
        Type: general
      – SubjectFull: At Risk Persons
        Type: general
      – SubjectFull: Health Promotion
        Type: general
      – SubjectFull: Questionnaires
        Type: general
      – SubjectFull: Likert Scales
        Type: general
      – SubjectFull: Student Characteristics
        Type: general
      – SubjectFull: Racial Differences
        Type: general
      – SubjectFull: Knowledge Level
        Type: general
      – SubjectFull: Misconceptions
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      – SubjectFull: Virginia
        Type: general
      – SubjectFull: Attribution Style Questionnaire
        Type: general
      – SubjectFull: Center for Epidemiologic Studies Depression Scale
        Type: general
    Titles:
      – TitleFull: The Influence of Attributional Style on Substance Abuse and Risky Sexual Behavior among College Students
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      – PersonEntity:
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            NameFull: Burnett, Audrey J.
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            NameFull: Sabato, Todd M.
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            NameFull: Walter, Katherine Ott
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            NameFull: Kerr, Dianne L.
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            NameFull: Wagner, Laurie
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