1. Brooke Gomez, Eliot Lopez M.S., Chwee-Lye Chng Ph.D. & Mark Vosvick Ph.D. Center for Psychosocial Health Research

2. College life is stressful. Young college students must adapt to a host of behavioral, academic and social challenges that often lead to low self esteem, loneliness, guilt and risky sexual behaviors (Elkins, D. Forrester, S. & Noël-Elkins, A. 2011). The stressful environment of college life can undermine self-esteem in students, particularly those without strong coping skills. Students may turn to risky sexual and drug behaviors to escape from the pain of low self-esteem (McNair, Carter & Williams, 1998). Center for Psychosocial Health Research

3. Loneliness, a common emotion among students experiencing stress, contributes to risky sex (Johnson, E. 2007). Torres and Gore- Felton (2007) postulate that risky sex is used as a means to cope with the anxiety created by loneliness. Students who engage in sexual behaviors on college campuses in response to loneliness sometimes do so in violation of personal moral codes, resulting in sex guilt. Mosher and Cross (1971) found that college students who report high levels of sex guilt were less sexually experienced than those not as guilty. To date, research reveals that sex guilt and risky sex are negatively correlated (Stuewig et al., 2009). Center for Psychosocial Health Research

4. Stress Challenge Threat Primary Appraisal Positive Stress Secondary Appraisal Negative Stress; Increased Risk Positive Stress Reappraisal Transactional Model of Stress and Coping (Lazarus and Folkman, 1984)

5. Stress is positively associated with sexual risk. Self-esteem is negatively associated with sexual risk. Loneliness is positively associated with sexual risk. Sex guilt is negatively associated with sexual risk. Stress, self-esteem, loneliness and sex guilt make up a significant proportion of the variance in sexual risk. Center for Psychosocial Health Research

6. Participants were recruited through the use of flyers at the University of North Texas. Students received extra credit for their psychology classes as an incentive. Participants were required to be at least 18 years of age and fluent in English. IRB approval was obtained and participants signed informed consent. Center for Psychosocial Health Research

7. N= 504 VariableN%M(SD)Range Female38376% African American10420.6% European American 28957.3% Latino/a479.3% Other6412.8% Age (years)21.1(4.93)18-56 Education (years)13.9(1.75)11-22

8. Participants filled out electronic, self-report surveys. We used univariate analysis, bivariate analysis and a hierarchical linear regression analysis to analyze our data. Center for Psychosocial Health Research

9. Perceived Stress Scale (Cohen, Kamarck & Mermelstein, 1983; α=.84) 10 item measure on a 5 point likert-type scale from 0 (Never) to 4 (Very Often) Higher scores indicate higher stress Item examples include “In the last month, how often have you been able to control irritations in your life?” and “In the past month how often have you felt nervous and ‘stressed?’” Demonstrates concurrent and predictive validity (Cohen, Kamarck & Mermelstein, 1983) Center for Psychosocial Health Research

10. Rosenberg Self-Esteem Scale (Rosenberg, Schooler, & Schoenbach, 1989; α=.92) 11 item measure on a 4 point likert-type scale from 1 (strong agree) to 4 (strongly disagree) Higher scores indicate higher self-esteem Item examples include “I am able to do things as well as other people” and “I take a positive attitude toward myself” Demonstrates concurrent, predictive and construct validity Center for Psychosocial Health Research

11. UCLA Loneliness Scale (Russell, 1996; α=.91) 10 item measure on a 4 point likert-type scale from 1 (I often feel this way) to 4 (I never feel this way) Higher scores indicate higher loneliness Item examples include “How often do you feel you cannot tolerate being so alone?” and “How often do you feel completely alone?” Demonstrates construct validity Center for Psychosocial Health Research

12. Revised Mosher Guilt Inventory (Mosher, 1998; α=.90 ) Sex guilt subscale:.88 114 items, measured on 7 point likert type scale from 0 (Not at all true of/for me) to 6 (Extremely true of/for me) Higher scores indicate higher guilt Item examples include “Sex relations before marriage are wrong and immoral” and “Masturbation should not be practiced” Demonstrates construct validity Center for Psychosocial Health Research

13. Sexual Risk Questionnaire (Kalichman et. al, 2000) 37 item inventory Higher scores indicate higher sexual risk Measured by selecting either “yes” or “no” Center for Psychosocial Health Research

14. Mean(SD) Possible Range Actual Range Calculated α Stress 19.3(6.19) 0-404-36.85 Self-esteem 18.1(5.33) 10-4010-33.89 Loneliness 27.2(6.60) 0-4010-40.91 Sex guilt 99.0(45.33) 0-26319-263. 95 Sexual Risk 7.6(5.19) 0-370-25- Univariate

15. Bivariate p<.05*, p<.001** Center for Psychosocial Health Research 1.2.3.4.5.6.7.8. 1. Age- 2.Gender.08- 3.Education.30*.13- 4. Ethnicity.11.15 -.06- 5. Stress -.25**.16* -.12** -.03- 6. Self-esteem -.15.04 -.21**.03.03**- 7. Loneliness.05.06 -.07 -.16* -.21**.40**- 8. Sex Guilt -.09.18* -.04 -.06.14.18.16*- 9. Sexual Risk.21** -.07.11.06 -.18*-.18.25**-.53**

16. Hierarchical Regression Analysis Outcome variable: Negative Self-Image Stigma Center for Psychosocial Health Research IV β tpTolVIF Sex guilt-.45-7.37<.001.901.1 Self-esteem.02.40-.901.1 Loneliness-.44-11.26<.001.911.1 Stress.101.93<.05.911.1 Adj. r² =.23, (F (5, 498) = 31.1, p<.001

17. Our findings suggest that stress, loneliness and sex guilt are important factors which should be evaluated in college students, especially to reduce risky sexual behaviors. Clinicians should incorporate cognitive behavioral therapy to reduce stress and loneliness, and assess positive ways of coping with sex guilt. Center for Psychosocial Health Research

18. Some responses may be influenced by self report bias. Limited generalizability due to sample’s demographics (ethnicity, locations, etc.). Due to cross sectional correlational design, causation cannot be inferred. Center for Psychosocial Health Research

19. We would like to thank the Center for Psychosocial Health Research’s members and faculty and the students of the University of North Texas. Center for Psychosocial Health Research

21. McNair, L., Carter, J. & Williams., M. (2008). Self-esteem, gender and alcohol use: Relationships with HIV risk perception and behaviors in college students. Journal of Sex & Marital Therapy (Vol. 24). Mosher, D. L., & Cross, H. J. (1971). Sex guilt and premarital sexual experiences of college students. Journal Of Consulting And Clinical Psychology, 36(1), 27-32. doi:10.1037/h0030454 Torres, H. L., & Gore-Felton, C. (2007). Compulsivity, substance use, and loneliness: The loneliness and sexual risk model (LSRM). Sexual Addiction & Compulsivity, 14(1), 63-75. Center for Psychosocial Health Research