A meta-analytic review of the relationship between adolescent risky sexual behavior and impulsivity across gender, age, and race

doi:10.1016/j.cpr.2014.08.004

Clinical Psychology Review

Volume 34, Issue 7, November 2014, Pages 551-562

https://doi.org/10.1016/j.cpr.2014.08.004 Get rights and content

Highlights

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Meta-analysis on relationship between impulsivity and risky sex among adolescents.
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The relationship between impulsivity and adolescent risky sex is significant and small.
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Effects are similar across unique risky sexual behaviors and impulsivity traits.
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Gender was a significant moderator in the impulsivity–risky sex relationship.
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Samples with more females showed stronger effects for impulsivity and risky sex.

Abstract

Background

Impulsivity is frequently included as a risk factor in models of adolescent sexual risk-taking; however, findings on the magnitude of association between impulsivity and risky sexual behavior are variable across studies. The aims of the current meta-analysis were to examine (1) how specific impulsivity traits relate to specific risky sexual behaviors in adolescents, and (2) how the impulsivity–risky sex relationship might differ across gender, age, and race.

Method

Eighty-one studies were meta-analyzed using a random effects model to examine the overall impulsivity–risky sex relationship and relationships among specific impulsivity traits and risky sexual behaviors.

Results

Overall, results revealed a significant, yet small, association between impulsivity and adolescent risky sexual behavior (r = 0.19, p < 0.001) that did not differ across impulsivity trait. A pattern of stronger effects was associated with risky sexual behaviors as compared to negative outcomes related to these behaviors. Gender moderated the overall relationship (β = 0.22, p = 0.04), such that effect sizes were significantly larger in samples with more females. Age, race, study design, and sample type did not moderate the relationship, although there was a pattern suggesting smaller effects for adolescents in juvenile detention settings.

Conclusions

Adolescent samples with more females showed a larger impulsivity–risky sex relationship, suggesting that impulsivity may be a more important risk factor for risky sex among adolescent females. Research and treatment should consider gender differences when investigating the role of impulsivity in adolescent sexual risk-taking.

Section snippets

Impulsivity as a risk factor for risky sexual behavior

Impulsivity is a prominent personality-based risk factor that is consistently included in models of risky sexual behavior for both adults (Deckman and DeWall, 2011, Hoyle et al., 2000, Miller et al., 2004) and adolescents (e.g., Broaddus and Bryan, 2008, DiClemente et al., 2008, DiClemente et al., 2010, Kahn et al., 2002, Khurana et al., 2012, Zimmerman, 2010). Impulsivity likely influences risky sexual behaviors among adolescents because (1) adolescence often marks the initiation of sexual

Disaggregation of risky sexual behavior

Conceptualizations of risky sexual behavior subsume a number of different sexual activities, including unprotected sex, sex with an uncommitted partner, multiple sexual partners, sex while intoxicated or high, and other sexual activities with increased risk of STD or unplanned pregnancy (e.g., Beadnell et al., 2007, Fortunato et al., 2010, Hoyle et al., 2000). This broadly heterogeneous conceptualization has led to inconsistency in the measurement of risky sexual behavior. For example, while

Gender

Evidence for different effects of impulsivity on risky sexual behavior across adolescent males and females is inconsistent (e.g., Crockett et al., 2006, Cyders, 2013, Kraft and Rise, 1994); however, there is substantial evidence that adolescent males and females have varying (1) impulsivity trait levels (e.g., d'Acremont & Van der Linden, 2005) and (2) patterns of risky sexual behavior (Kotchick et al., 2001, Leigh et al., 1994, Seidman and Reider, 1994). Adolescent males often show more

The current study

This is the first empirical review to examine the relationship between specific facets of impulsivity and risky sexual behaviors among adolescents, and how this relationship might vary across gender, age, and race. Understanding how risk patterns might differ across sample characteristics will foster the development of targeted and more effective intervention and prevention strategies in this high-risk group. We hypothesized that the relationship would differ across impulsivity facet and sexual

Selection of studies

Relevant studies were identified via literature searches, using Medline, PsychInfo, PsychArticles, Web of Science, EMBase, and PubMed (published before November 2013), as well as reference section reviews, forward searches, and email alerts. Searches were performed based on all keyword combinations of terms for impulsivity and sexual behavior (see Appendix A), as used in previous reviews (e.g., Coskunpinar et al., 2013, Hoyle et al., 2000).

Studies were included if they used both self-report

Sample

The final study sample consisted of 81 studies (75 peer-reviewed journal articles and six dissertation manuscripts) and 98 independent samples (some studies reported separate effects for multiple independent samples). The mean size of the samples was 548.72 (SD = 852.18; range 19–6,663; n = 98 distinct samples), and mean sample age was 16.25 (SD = 1.78; range 11–19.9; 53.5% of samples represented middle adolescents aged 14–16). On average, samples were 53.06% female (SD = 35.87; range 0–100) and 44.36%

Discussion

This review sought to examine the relationship between specific impulsivity traits and risky sexual behaviors among adolescents and how it might vary based on gender, age, and race. Overall, results from the meta-analysis revealed a significant, yet small, association between impulsivity and risky sexual behavior among adolescents that was similar across impulsivity trait, but did show some variability across risky behavior conceptualization, with stronger effects for risky sexual behaviors,

Limitations

First, the file drawer problem applies to the current study, such that there may be inflated effect sizes due to publication bias (Rosenthal, 1979); however, fail-safe N analyses suggest robust effects even with the addition of null results. The findings are also limited by the nature of the studies assessed: Variance across studies related to methodology, sample characteristics, and measurement may have obscured results, and although many of these factors were examined as potential moderators,

Conclusions

This review was the first to aggregate existing data on impulsivity and risky sexual behavior across the adolescent literature. Moreover, this was the first study to examine discrete relationships between unidimensional impulsivity traits and specific risky sexual behaviors among adolescents, and how these relationships may vary depending on age, gender, and race. Results from a review of 81 studies suggest that the relationship between impulsivity and adolescent risky sexual behavior is small,

Role of funding sources

There was no funding source for this study. No funding source was connected to the study design, collection, analysis or interpretation of the data, writing of the manuscript, or the decision to submit the paper for publication.

Contributors

Dir and Cyders designed the study. Dir and Coskunpinar conducted literature searches and coded the studies for the meta-analysis. Dir conducted statistical analysis and wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

Conflict of interest

The authors declare that there are no conflicts of interest.

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A meta-analytic review of the relationship between adolescent risky sexual behavior and impulsivity across gender, age, and race

Highlights

Abstract

Background

Method

Results

Conclusions

Section snippets

Impulsivity as a risk factor for risky sexual behavior

Disaggregation of risky sexual behavior

Gender

The current study

Selection of studies

Sample

Discussion

Limitations

Conclusions

Role of funding sources

Contributors

Conflict of interest

Journal of Pediatric Health Care

Neuroscience & Biobehavioral Reviews

Journal of Adolescent Health

Journal of Adolescent Health

Journal of Adolescent Health

Journal of Research in Personality

Personality and Individual Differences

Addictive Behaviors

Computers in Human Behavior

Personality and Individual Differences

Personality and Individual Differences

Personality and Individual Differences

Pediatric Clinics of North America

Personality and Individual Differences

Personality and Individual Differences

Journal of Adolescent Health

Clinical Psychology Review

Clinical Psychology Review

Journal of Adolescent Health

Journal of Adolescent Health

Personality and Individual Differences

Journal of Adolescence

Personality and Individual Differences

Alcohol's role in sexual violence perpetration: Theoretical explanations, existing evidence and future directions

Drug and Alcohol Review

Sex and punishment: An examination of sexual consequences and the sexual double standard in teen programming

Sex Roles

Smoking, drinking and drug use in young adulthood: The impacts of new freedoms and new responsibilities

What predicts sex partners' age differences among African American youth? A longitudinal study from adolescence to young adulthood

Journal of Sex Research

Intrapersonal and interpersonal factors influencing adolescents' decisions about having sex: A test of sufficiency of the theory of planned behavior

Journal of Applied Social Psychology

The National Longitudinal Study of Adolescent Health: Research design

Social and psychological factors associated with AIDS risk behaviors among low-income, urban, African American adolescents

Journal of Research on Adolescence

Decision-making in the adolescent brain

Nature Neuroscience

The normative development of child and adolescent problem behavior

Journal of Abnormal Psychology

Introduction to meta-analysis

Adolescents' reported consequences of having oral sex versus vaginal sex

Pediatrics

Risk estimation and sexual behaviour: A longitudinal study of 16–21-year-olds

Journal of Health Psychology

Consistent condom use among juvenile detainees: The role of individual differences, social bonding, and health beliefs

AIDS and Behavior

Marijuana use and risky sexual behavior among high-risk adolescents: Trajectories, risk factors, and event-level relationships

Developmental Psychology

Adolescent girls' alcohol use as a risk factor for relationship violence

Journal of Research on Adolescence

HIV/AIDS surveillance—June 2002

Youth risk behavior surveillance—United States, 2003

Center for Disease Control and Prevention: Morbidity and Mortality Weekly Report

Sexually transmitted disease surveillance, 2007

Division of STD prevention

Watching sex on television predicts adolescent initiation of sexual behavior

Pediatrics

Alcohol use and risky sexual behavior among college students and youth: Evaluating the evidence

Journal of Studies on Alcohol and Drugs

A motivational perspective on risky behaviors: The role of personality and affect regulatory processes