Arch Sex Behav

DOI 10.1007/s10508-017-1054-x

ORIGINAL PAPER

Impulsivity Dimensions and Risky Sex Behaviors in an At-Risk

Young Adult Sample
Inga Curry1,2 · Jeremy W. Luk2,3 · Ryan S. Trim1,2 · Christian J. Hopfer4 ·
John K. Hewitt5 · Michael C. Stallings5 · Sandra A. Brown2 · Tamara L. Wall1,2

Received: 7 January 2017 / Revised: 28 July 2017 / Accepted: 1 August 2017

© Springer Science+Business Media, LLC 2017

Abstract Impulsivity is a personality-based risk factor that has of premeditation and negative urgency suggests that at-risk young
been well studied in relation to risky sexual behavior. Recent adults with both high negative urgency and lack of premeditation
conceptualizationsofimpulsivity haveproposedmultidimensional werethelikeliesttohavethemostsexualpartnersinthepast5years.
facets comprised of premeditation, perseverance, sensation seek- This study adds to the current understanding of the relationship
ing,negative urgency, and positive urgency (UPPS-P model). Prior between reward- and affect-driven facets of impulsivity and
studies have found that these facets are associated with risky sexual risky sexual behaviors and may lend utility to the development
behavior in adolescent and college student samples, but no prior of interventions for at-risk populations.
studies have evaluated them in clinical samples. The current study
examined how impulsivity-related traits related to two different Keywords Impulsivity · Risky sex · Clinical sample ·
risky sexual behaviors in a clinical sample of at-risk young adults UPPS-P
who had both conduct disorder and substance use disorder symp-
toms as adolescents (n = 529). Lack of premeditation was also
tested as a moderator of the relationship between facets of impul- Introduction
sivityandbothriskysexoutcomes.Resultsdemonstratedthatsen-
sation seeking, negative urgency, and positive urgency were corre- Risky sexual behavior contributes to significant disease burden
lated with risky sex behaviors. Additionally, multiple regression as well as unplanned pregnancy. Each year, there are approx-
analyses indicated that sensation seeking was uniquely associated imately 20 million new cases of sexually transmitted diseases
with the number of sexual partners in the past 5 years, whereas pos- (STDs) and nearly one-half of STD incidences occur among youth
itive urgency was uniquely associated with unprotected sex while aged 15–24 years of age (Centers for Disease Control and Preven-
under the influence. Finally, a significant interaction between lack tion,2015b).Inaddition,overone-fifthofnewHIVdiagnosesinthe
United States were among youth aged 13–24 years (Centers for
Disease Control and Prevention, 2015a). A study conducted in
& Tamara L. Wall 2008 estimated that in the U.S., direct medical services related to
[email protected] STDs cost $15.6 billion dollars each year (Owusu-Edusei et al.,
1
V.A. San Diego Healthcare System, La Jolla, San Diego, CA,
2013).
USA Riskysexual behaviors aremoreprevalent inadults witha his-
2
Department of Psychiatry, University of California, San Diego,
tory of externalizing behaviors. For example, young adults with a
3350 La Jolla Village Drive (116B), San Diego, CA 92161, USA history of childhood antisocial behavior are twice as likely to have
3
Health Behavior Branch, Division of Intramural Population
earlier (i.e., prior to age 16 years) and risker (e.g., more than three
Health Research, Eunice Kennedy Shriver National Institute of different partners in the past year, unprotected sex) sexual expe-
Child Health and Human Development, Bethesda, MD, USA riences compared to individuals with a history of relatively low
4
Department of Psychiatry, University of Colorado, Denver, antisocial behavior (Ramrakha et al., 2007). Males with a child-
Denver, CO, USA hood diagnosis ofoppositional defiant disorder (ODD) orconduct
5
Institute for Behavioral Genetics, University of Colorado, disorder (CD) are more likely to engage in casual sex, have mul-
Boulder, Boulder, CO, USA tiple sexual partners, and usecondoms infrequently (Flory, Molina,

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 Arch Sex Behav

Pelham, Gnagy, & Smith, 2006). Multiple studies have found that urgencyandsensationseekingaremoreconsistentlyrelatedtorisky
substance use behaviors are associated with more risky sexual sexual behaviors among college students (Deckman & DeWall,
behaviors during young adulthood (Cavazos-Rehg et al., 2007; 2011; Simons, Maisto, & Wray, 2010), whereas lack of persever-
Costa, Jessor, Donovan, & Fortenberry, 1995; Tubman, Windle, & ance may be associated with increases in risky sexual behavior dur-
Windle, 1996; Vasilenko, Kugler, Butera, & Lanza, 2015). The ing students’ first year in college (Zapolski, Cyders, & Smith, 2009).
robust associations between antisocial behavior, substance use, Althoughmanystudieshavetestedimpulsivityasamultifacted
and risky sex indicate that there may be underlying personality trait in relation to sexual behavior, all prior studies described pre-
traits influencing these problem behaviors. viously used non-clinical samples. It is important to study these
associations in clinical samples as findings from such studies can
Impulsivity and Risky Sex Behaviors be particularly helpful in informing prevention and intervention
efforts for at-risk populations. Prior research using the UPPS-P in
One personality trait commonly associated with risky sexual clinical samples have shown that negative urgency and sensation
behavior is impulsivity (Charnigo et al., 2013; Hoyle, Fejfar, seekingaremostconsistentlyassociatedwithexternalizingbehav-
& Miller, 2000). Impulsivity is associated with behaviors iors and psychopathology, including alcohol problems and anti-
such as sex while using drugs or with a partner using drugs social behaviors, disordered eating, and pathological gambling
(Charnigo et al., 2013), infrequent use of condoms (Cooper, (Anestis, Smith, Fink, & Joiner, 2009; Grall-Bronnec et al., 2012;
Agocha, & Sheldon, 2000; Dir, Coskunpinar, & Cyders, 2014), Whiteside, Lynam, Miller, & Reynolds, 2005). The current study
engagement in sex with strangers (Deckman & DeWall, 2011; extended these studies by examining whether these same facets
Derefinko et al., 2014), multiple sex partners (Derefinko et al., drove the association between impulsivity and sexual risk behaviors.
2014; Dir et al., 2014), and history of STDs (Dir et al., 2014;
Sales et al., 2012). Interactive Effects of Impulsivity Facets

Impulsivity as a Multidimensional Construct Impulse control is often referred to as the ability to think before act-
ing, planning ahead, and premeditation (Coutlee, Politzer, Hoyle,
A recent conceptualization of impulsivity has suggested four & Huettel, 2014; Whiteside & Lynam, 2001). Conversely, low
separate facets of impulsivity: urgency, perseverance, premed- impulse control is related to externalizing problems (Whiteside &
itation, and sensation seeking (UPPS; Whiteside & Lynam, Lynam, 2003). Given that sensation seeking and affective urgency
2001). A subsequent analysis found that urgency can be further are also related to externalizing psychopathology (Anestis et al.,
divided into positive and negative facets to reflect rash action in 2009; Whiteside et al., 2005), it is important to explore whether the
response to positive versus negative emotion, referred to as the co-occurrence of poor impulse control (i.e., lack of premeditation)
UPPS-P framework (Cyders & Smith, 2008; Lynam, Smith, and other facets of impulsivity have synergistic effects on external-
Whiteside, & Cyders, 2006). Collectively, this widely used izing behaviors, such as risky sex. Integrating evidence from neu-
UPPS-Pframework(Lynam,Smith,Cyders,Fischer,&Whiteside, rodevelopmental and personality literature, McCabe, Louie, and
2007) disaggregates trait impulsivity into five subscales indicative King (2015) proposed a “developmental asymmetry” hypothesis,
of unique aspects of impulsive behavior: (1) Lack of Premeditation which posits that young adults are at most likely to engage in risky
defined as the tendency to act without prior thought or planning; (2) behaviorswhenthey have astrong disposition toward reward-driven
Lack of Perseverance defined as a failure to tolerate boredom or to behavior(reflectedinsensationseeking)pairedwithanotyetfully
remainfocuseddespitedistraction;(3)SensationSeekingdefinedas developed capacity to control such behavior (reflected in lack of
the tendency to seek excitement and arousal; (4) Negative Urgency premeditation). They found lack of premeditation interacted with
defined as the tendency to act rashly when experiencing extreme sensation seeking in predicting drinking consequences, drug use,
negative affect; and (5) Positive Urgency defined as the tendency to and drug consequences for college students. Conversely, this inter-
act rashly when experiencing extreme positive affect (Lynam et al., actioneffectdidnotsignificantlyinfluenceantisocialbehaviors,the
2007). only outcome that was unrelated to substance use. Another study
exploring the developmental asymmetry hypothesis examined risky
Previous Research on the Association Between Impulsivity driving behaviors and found that lack of premeditation moderated
and Sexual Risk Behaviors and strengthened the positive association between sensation seek-
ing and driving under the influence (Luk et al., 2017). This implies
A meta-analysis of studies with adolescent samples revealed thatthesynergisticeffectsofsensationseekingandlackofpremedi-
significant, but small, effects of the four original UPPS impulsivity tationmaybespecifictosubstanceuserelatedoutcomes.Theafore-
traits with risky sexual behavior and no marked differences in the mentioned studies that examined the relationships between dif-
sizeofthefoureffects(Diretal.,2014).Incontrast,studieswithcol- ferent facets of impulsivity and risky sex did not test whether there
legestudentsamplesshowthattheimpulsivity-riskysexrelationmay were interactions between the facets in relation to sex behaviors.
be driven by specific impulsivity facets. Several studies found that Thus, another goal of this study was to determine if lack of

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premeditationenhancedtheassociationsbetweenotherimpulsivity were lack of premeditation (8 items; α = .80), lack of perse-

facets and risky sex in an at-risk sample. verance (6 items; α = .68), sensation seeking (7 items; α = .76),
negative urgency (7 items; α = .76), and positive urgency (7
Present Study items; α = .82). Sample items include: “I usually make up my
mind through careful reasoning” (lack of premeditation), “I tend
The goals of this study were to examine five dimensions of impul- to give up easily” (lack of perseverance), “I welcome new and
sivityasuniqueandinteractivepredictorsofriskysexbehaviors.Our exciting experiences and sensations, even if they are a little
hypotheses were: frightening and unconventional” (sensation seeking), “I often
make matters worse because I act without thinking when I am
1. Following previous studies utilizing clinical samples (Anestis
upset” (negative urgency), and “When I get really happy about
et al., 2009; Grall-Bronnecetal.,2012;Whitesideet al.,2005),
something, I tend to do things that can have bad consequences”
we hypothesized negative urgency and sensation seeking are
(positive urgency). For all items, response options ranged from
the most consistent correlates of risky sex behaviors.
1 (Strongly Disagree) to 4 (Strongly Agree).
2. Based on the developmental asymmetry model presented by
McCabe et al. (2015), we hypothesized that lack of premed-
Risky Sex Behaviors
itation moderated and enhanced associations of sensation seek-
ing and negative urgency for both risky sex outcomes.
Participants responded to two self-report items assessing num-
ber of sexual partners in the past 5 years and frequency of past-
year unprotected sex under the influence. The outcome of num-
Method
ber of partners was assessed using the item “In the past 5 years,
with how many people (different partners) have you had oral,
Participants
vaginal, or anal sex?” with response options: “none” (0), “one”
(1), “two” (2), “3–5” (3), “6–9” (4), “10–19” (5), and “20?” (6). The
We utilized cross-sectional data from a multisite longitudinal
frequency of past-year unprotected sex under the influence out-
research project on genetics of antisocial drug dependence
come was assessed using the item “In the past 12 months, I have
(Derringer et al., 2015; Melroy et al., 2014). Participants in Denver
had unprotectedsex(not used a condom) because I was drinking
and San Diego were identified via residential or outpatient treat-
or using drugs,” using response options: “none” (0), “1 time” (1),
ment programs, involvement with the criminal justice system or
“2 times” (2), “3–5 times” (3), “6–9 times” (4), “10–19 times” (5),
special schools for youth with behavioral problems, who were at
and “20?” (6). Due to a skip pattern in the survey, where only
high risk for having a substance use disorder and conduct disorder.
individuals who endorsed having sex with two or more different
At the time of recruitment participants were 13–19 years old and
sexual partners in the past 5 years were asked all the sexual risk
had to meet one or more lifetime substance dependence symptom
behavior questions, 14% of the sample had missing responses to
and at least one conduct disorder symptom. Given the large and
the unprotected sex under the influence item. Compared to par-
difficult-to-followsamplethatwasgeographicallydispersed,there
ticipants with data on past-year unprotected sex under the influ-
wasvariabilityintheamount oftimefromthebaselineinterview to
ence, those with missing data on this item were significantly older
follow-up(onaverage6.5yearsaftertheoriginalassessment).Over
(M age 23.2 vs. 22.6 years, t = 2.71, p \ .01). There were no
half (56%) of the participant follow-up data was collected 3 to
significant differences in risky sex behaviors across gender or
6 years after baseline, and 95% of the follow-up data was collected
race/ethnicity. Given that age differences in both impulsivity and
by year 9. Impulsivity and risky sex behavior measures were only
sexual behaviors have been reported previously (Herbenick et al.,
included in the follow-up assessment. Therefore, the current study
2010; Steinberg et al., 2008), and that our analyses showed that
focused only on this time point. The University of California, San
age differentiated between the analytic sample and those who had
Diego, and the University of Colorado, Denver institutional review
missing data, we had theoretical and statistical reasons to control
boards approved all subject recruitment and assessment procedures.
for age in our analyses of risky sex behavior outcomes.
Informed consent was obtained from all individual participants
included in the study.
Statistical Analyses

Measures Prior to the primary analyses, we evaluated whether there were

significantmulticollinearityissuesusingvarianceinflationfactors
Multidimensional Impulsivity (VIF), with a threshold VIF of 2 or above indicating the presence of
multicollinearity. Descriptive data were analyzed to determine
A 35-item, modified version of the UPPS-P scale (Lynam et al., the optimal model for each outcome. Due to the continuous and
2006; Whiteside & Lynam, 2001) was used to measure the five normallydistributednatureofthedata,weutilizedlinearregression
facets of impulsivity. The five facets of impulsivity measured forthesexualpartnersinthepast5yearsoutcomevariable.Descrip-

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Table 1 Sample characteristics (n = 529) Results

Mean (SD)
Descriptive Statistics
Age (in years) 22.7 (2.04)
% Male 73% Sample characteristics, mean scores of UPPS-P subscales, and
% Non-hispanic white 51% counts of riskysex behaviors are presented in Table 1. Bivariate
UPPS-P correlations of UPPS-P facets and risky sex behaviors are pre-
(Lack of) premeditation 1.86 (.51) sented in Table 2. Sensation seeking, negative urgency and pos-
(Lack of) perseverance 1.76 (.51) itive urgency were positively correlated with number of sexual
Sensation seeking 2.96 (.64) partners in the past 5 years and past-year unprotected sex while
Negative urgency 2.43 (.66) under the influence. Multicollinearity between facets of UPPS-
Positive urgency 2.20 (.66) P was not suspected given all VIF values were below 2.
Risky sex
Sexual partners in the past 5 yearsa 3.58 (1.60) Facets of Impulsivity and Risky Sexual Behaviors
Past-year unprotected sex under the influencea,b 1.44 (1.94)
a Linear regression estimates predicting the number of sexual part-
Reflects 0–6 scale described in the “Methods”section
ners in the past 5 years are presented in Table 3. Age, being male,
b
Reduced (n = 453) due to skip pattern
and sensation seeking were significant predictors, and there was a
significant interaction between lack of premeditation and nega-
tive analyses of past-year unprotectedsexunder theinfluence data tive urgency (see Fig. 1). The trimmed model revealed that being
revealed overdispersion, and thus, negative binomial regression male (b = .42, SE = .16, p = .01), lack of premeditation (b = .27,
was used to analyze this count data. Age, gender (females coded as SE = .14, p= .05), sensationseeking (b = .52,SE =.11, p\.001),
“0” and males coded as “1”), and race/ethnicity (non-Hispanic and negative urgency (b = .16, SE = .11, p = .13) were all sig-
White, coded as “1,” vs. all other racial/ethnic groups combined, nificantly predictive of a greater number of sexual partners in the
and coded as “0”) were significantly correlated with the number past 5 years, whereas being older was associated with fewer sex-
ofpartnersinthepast5years,andgenderwascorrelatedwithpast- ual partners in thepast 5 years (b= −.09, SE = .03, p = .01). These
year unprotected sex and was therefore included as covariates variables accounted for 10% of the variation in number of sexual
inouranalyses.Thestudyhypothesesweretestedinthreestepsusing partners in the past 5 years. Inclusion of the premeditation-negative
regression analyses. First, the effects of the impulsivity dimensions urgency interaction term explained an additional 1.1% of variation
and related covariates on each risky sex outcome were estimated in predicting the number of sexual partners. The interaction pre-
to test for unique main effects. Second, we tested our moderation sented in Fig. 1 demonstrates that the association between negative
hypotheses byincludinginteraction termsbetweenlack ofpremed- urgency and number of sexual partners in the past 5 years was
itationand the other four impulsivity dimensions. All indepen- strongerathigherlevelsoflackofpremeditation.Thisassociationis
dent variables were mean-centered prior to the moderation anal- statistically significant for individuals who had a score on lack of
yses to assist with interpretation of results. Third, we dropped all premeditationthatdoesnotfallinthe95%confidenceintervalband
nonsignificant predictors in the final trimmed model to ensure that around this linear association; thus, the association is significant for
the key findings were not attributable to potential suppression individuals who scored approximately 0 (which is the centered
effects. All analyses were conducted in SPSS 24.0. mean) or higher on lack of premeditation.

Table 2 Bivariate correlations among UPPS-P facets and risky sex behaviors
1. 2. 3. 4. 5. 6. 7.

1. (Lack of) Premeditation –

2. (Lack of) Perseverance .49** –
3. Sensation seeking −.09* −.19** –
4. Negative urgency .27** .33** .15* –
5. Positive urgency .16** .21** .33** .62** –
6. Sexual partners in the past 5 yearsa .07 .02 .25** .12* .16** –
7. Past-year unprotected sex under the influencea .07 .07 .17** .10* .21** .30** –
* p\.05; ** p\.01
a
Reflects 0–6 scale described in the “Methods” section

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Arch Sex Behav

Table 3 Hierarchical regression models for sexual partners in past 5 years (n = 529)
Model 1: main effects Model 2: premeditation as moderator Model 3: final trimmed model
b SE p value b SE p value b SE p value

Age −.09 .03 .004 −.10 .03 .002 −.09 .03 .01
Male gender .41 .16 .01 .41 .16 .01 .44 .16 .01
Non-hispanic white .18 .14 .21 .19 .14 .18 – – –
(Lack of) premeditation .24 .15 .12 −.14 .15 .36 .20 .14 .15
(Lack of) perseverance −.002 .16 .99 .06 .16 .71 – – –
Sensation seeking .47 .12 \.001 .45 .12 \.001 .51 .11 \.001
Negative urgency .13 .14 .35 .15 .14 .26 .21 .11 .05
Positive urgency .07 .14 .62 .10 .14 .47 – – –
L. premed 9 l. perseverance – – – −.26 .26 .32 – – –
L. premed 9 sensation seeking – – – −.23 .22 .30 – – –
L. premed 9 negative urgency – – – .44 .24 .05 .47 .18 .01
L. premed 9 positive urgency – – – .28 .26 .28 – – –
L. premed lack of premeditation, l. perseverance lack of perseverance

2.5

2
Number of Seuxal Partners
Negative Urgency on the

1.5
Adjusted Effect of

0.5

0
-1.2 -1 -0.8 -0.6 -0.4 -0.2 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2 2.2

-0.5 Lack of Premeditation(centered)

-1

Fig. 1 Interaction between lack of premeditation and negative urgency in number of sexual partners in the past 5 years that correspond to all observed
predicting number of sexual partners in the past 5 years. This figure illus- (mean-centered) values of lack of premeditation. The dashed, curved lines
trates the Johnson–Neyman plot of the Final Trimmed Model of the above and below the solid plot line represent 95% confidence bands around
negative urgency and lack of premeditation interaction. The straight, solid the adjusted effect of negative urgency on the number of sexual partners in
plot line represents values of the adjusted effect of negative urgency on the past 5 years

Negative binomial regressionresults for thefrequency ofpast- sions and lack of premeditation were significant. The final trimmed
year unprotected sex while under the influence outcome are pre- model revealed that males were 1.60 (95% CI, 1.16–2.21) times as
sented in Table 4. Being male, sensation seeking, and positive likelytohavehadunprotectedsexundertheinfluenceinthepastyear
urgency were associated with unprotected sex under the influence thanfemales. Additionally,forevery one-unit increaseonthepos-
inthepastyear.Noneoftheinteractionsbetweenimpulsivitydimen- itive urgency scale, participants were 1.38 (95% CI, 1.14–1.67)

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Table 4 Negative binomial regression models for unprotected sex under the influence in past year (n = 453)
Model 1: main effects Model 2: premeditation as moderator Model 3: final trimmed model
IRR 95% CI p value IRR 95% CI p value IRR 95% CI p value

Age .96 0.90–1.02 .15 .96 0.90–1.02 .15 – – –

Male gender 1.63 1.17–2.27 .004 1.63 1.17–2.27 .004 1.60 1.16–2.21 .004
Non-hispanic white .94 0.73–1.22 .65 .94 0.73–1.22 .66 – – –
(Lack of) premeditation 1.18 0.89–1.57 .25 0.97 0.21–4.37 .96 – – –
(Lack of) perseverance 1.07 0.80–1.44 .63 1.19 0.42–3.34 .74 – – –
Sensation seeking 1.29 1.03–1.61 .03 1.17 0.53–2.58 .69 1.22 0.99–1.52 .07
Negative urgency .95 0.74–1.22 .67 0.82 0.32–2.08 .67 – – –
Positive urgency 1.35 1.05–1.73 .02 1.44 0.55–3.77 .46 1.38 1.14–1.67 .001
L. premed 9 l. perseverance – – – 0.95 0.57–1.58 .84 – – –
L. premed 9 sensation seeking – – – 1.05 0.70–1.59 .81 – – –
L. premed 9 negative urgency – – – 1.08 0.67–1.76 .75 – – –
L. premed 9 positive urgency – – – 0.97 0.59–1.60 .90 – – –
L. Premed lack of premeditation, IRR incidence rate ratio, l. perseverance lack of perseverance

times as likely to engage in unprotected sex under the influence in tently found negative urgency and sensation seeking to be asso-
the past year (p = .001). ciated with problematic behaviors, such as disordered eating in
clinical samples (Anestis et al., 2009) and pathological gambling
(Grall-Bronnec et al., 2012).
Discussion Examiningthepast-yearunprotectedsexwhileundertheinflu-
ence outcome more closely revealed that it was uniquely asso-
This study examined unique and interactive associations between ciated with positive urgency. In addition, gender, a covariate, had
different facets of impulsivity and risky sexual behaviors in an at- a significant association, showing an increased risk among males
risk clinical sample of young adults with a history of conduct and for past-year engagement in unprotected sex while under the influ-
substance use problems. Our hypothesis that negative urgency ence. These findings were slightly different from previous research
and sensation seeking would be the best predictors of risky sex with a college sample, which found that positive urgency was pos-
behaviors was supported. We found that sensation seeking, neg- itively associated with unprotected sex among women but not men
ative urgency and positive urgency were all positively correlated (Simons et al., 2010). Our study’s findings were consistent with
with both number of partners in the past 5 years and unprotected Zapolski et al. (2009), who identified positive urgency as the
sex under the influence in the past year. Given that sensation seek- strongest predictor of risky sex, and suggested that an increase
ingand positiveurgencyaretheoreticallyconsidered to bereward- inpositiveaffectcouldimpaircognitiveabilitytoactonorrestrain
driven facets of impulsivity, and that negative and positive urgency fromsexualattractionbasedonlong-termpersonalandhealthcon-
are defined by rash responses to extreme affect, our current study sequences(e.g., wearing a condom to prevent STDsand unwanted
suggests that these three facets may be of particular importance pregnancies).
among at-risk young adults. Overall, these findings confirmed Finally, we tested the “developmental asymmetry” hypothesis
that trait impulsivity measures are capable of capturing signifi- (McCabe et al., 2015), which proposed that higher dispositions
cant individual differences in relation to risky sex behaviors toward reward-driven behavior paired with a not well-developed
among young adults with a history of substance use and exter- capacity to control such behavior would result in risky behaviors.
nalizing behaviors. The present study found a unique significant interaction between
Our analyses, which included covariates, facets of impulsivity, lack of premeditation and negative urgency, but only for the num-
aswellasinteractionsbetweenlackofpremeditation andtheother ber of sexual partners in the past 5 years outcome variable. At-risk
four facets of impulsivity revealed that sensation seeking was young adults with high negative urgency and lack of premedita-
associated with the number of sexual partners in the past 5 years. tion were most likely to have the most sexual partners in the past
These results were consistent with previous research, which found 5 years. McCabe et al. found that premeditation enhanced the
negative urgency and sensation seeking to have the strongest rela- associations between sensation seeking and multiple substance
tionships with risky sexual behavior (Deckman & DeWall, 2011). use behaviors but this interaction did not extend to predict anti-
Furthermore, our findings added to previous findings that consis- social behaviors. Our current findings were slightly different than

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those of McCabe et al. (2015) in that the premeditation by neg- (2015), furtherexpanding the research to include risky sex behav-
ative urgency interaction was only significant for sexual part- iors. These findings underscored the importance of personality
ners in the past 5 years, but not for past-year unprotected sex while factors as they relate to risky sex behaviors and the importance of
under the influence, which is conceptually more related to sub- incorporating such factors into prevention and intervention pro-
stance use. Clinically high-risk samples are particularly prone to grams specifically tailored for young adults with a history of exter-
experiencing poor emotional self-regulation (Gratz & Tull, 2010; nalizing psychopathology.
Leadbeater, Blatt, & Quinlan, 1995), and the experience of fre-
quent or acute negative affect increases chances of engaging in Acknowledgements This research was supported by National Institute of
Drug Abuse grants R01 DA035804 (PIs: Hopfer, Stallings, & Wall), R01
avoidant coping mechanisms (Westen, 1994), which have been DA021905 (PIs: Brown & Wall), R01 DA012845 (PI: Hewitt), P60
linked to engagement in risky sex behaviors (Folkman, Chesney, DA011015 (PI: Hewitt), R01 DA021913 (PI: Hopfer), R01 DA015522 (PI:
Pollack, & Phillips, 1992). When negative urgency is combined Hopfer), K24 DA032555 (PI: Hopfer), and National Institute on Alcohol
with lack of premeditation, or giving less careful thought to poten- Abuse and Alcoholism (NIAAA) grant T32 AA013525 (PI: Riley). Jeremy
Luk’s effort was also supported by the Intramural Research Program of the
tially more adaptive coping strategies, the combination of high Eunice Kennedy Shriver National Institute of Child Health and Human
levels of those impulsivity facets puts individuals at higher risk for Development. The content of this article is solely the responsibility of the
negative consequences related to having numerous sexual part- authors and does not necessarily represent the official views of the National
ners.Movingforward,exploringtheunderlyingfactorsofthisinter- Institutes of Health. The sponsoring agencies were not involved in the design,
analyses, ordevelopmentofthis article,or thedecisiontosubmit this paper for
action, such as identifying risky sex related cognitions and moti- publication.
vations (e.g., coping with negative affect), could inform prevention
and intervention efforts for at-risk young adults. Compliance with Ethical Standards
This study had several limitations. First, the UPPS-P impul-
sivity scale was only assessed at follow-up; as such, only cross- Conflict of interest The authors declare that they have no conflict of
interest.
sectional data were available for the present study, which limited
the ability to evaluate causal inference. Second, the measure- Ethical Statements All procedures performed in studies involving
ment of risky sex behaviors was based on two retrospective self- human participants were in accordance with the ethical standards of the
reported items, which are prone to self-report and recall biases. institutional and/or national research committee and with the 1964 Decla-
ration of Helsinki and its later amendments or comparable ethical standards.
Although utilizing single items to capture specific risky sex behav-
iors is a common practice (e.g., Derefinko et al., 2014; Simons Informed Consent Informed consent was collected from all partici-
et al., 2010), utilizing a scale that captures a full range of risky pants (and both assent from participants and consent from the par-
sex behavior might depict the relationship between facets of ent/guardian were collected during the baseline data collection in cases
when participants were adolescents).
impulsivity and sex more comprehensively. Lastly, because
of a skip pattern in our questionnaire, where only individuals
who endorsed having sex with two or more different sexual part-
ners in the past 5 years were asked about unprotected sex under the References
influence, 14% of the sample had missing data. As the present
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