Personality and Sexual Risk Taking: A Quantitative Review Rick H. Hoyle Michele C. Fejfar Joshua D. Miller University of Kentucky ABSTRACT Findings from a quantitative review of the empirical research literature on normal personality and sexual risk taking are reported. The review focuses on domains identified in major models of normal personality representing the psychobiological and taxonomic perspectives. Focal sexual risk-taking behaviors were number of partners, unprotected sex, and high-risk sexual encounters (e.g., sex with a stranger). A comprehensive search produced 53 studies relevant to the review. A striking feature of the results is the paucity of research on domains of normal personality and sexual risk taking for all domains other than sensation seeking, which accounted for 64% of the effect sizes. The preponderance of studies (81%) took the psychobiological perspective and were published since 1990 (75%). Among the substantive findings were effects for sensation seeking, impulsivity, and agreeableness on all sexual risk-taking behaviors considered. Additionally, there were effects on specific behaviors for neuroticism and conscientiousness. The implications of these findings for future research on normal personality and sexual risk taking are discussed. During the writing of this article, Rick Hoyle was supported, in part, by grants from the National Institute on Drug Abuse (DA-05312 and DA-09569) and the Center for Substance Abuse Prevention (SP-07967). Joshua Miller was supported by a fellowship from the Commonwealth of Kentucky Research Challenge Trust Fund. Correspondence concerning this manuscript should be addressed to Rick H. Hoyle, Department of Psychology, 106-C Kastle Hall, University of Kentucky, Lexington, KY 40506-0044. Electronic mail correspondence should be sent to rhoyle@pop.uky.edu. Journal of Personality 68:6, December 2000. Copyright © 2000 by Blackwell Publishers, 350 Main Street, Malden, MA 02148, USA, and 108 Cowley Road, Oxford, OX4 1JF, UK. 1204 Hoyle et al. The impact of risky sexual behavior is staggering. More than 12 million cases of sexually transmitted diseases (STDs) are reported every year in the United States (Centers for Disease Control and Prevention, 1997b), making STD the most common reportable disease in the United States (Centers for Disease Control and Prevention, 1998c). As of June 1998, more than 350,000 U.S. citizens were living with human immunodeficiency virus (HIV) infection or the acquired immunodeficiency syndrome (AIDS; Centers for Disease Control and Prevention, 1998a); most were infected through sexual transmission (Centers for Disease Control and Prevention, 1996; Kalichman, Greenberg, & Abel, 1997). And it is estimated that 48% of all pregnancies in the United States, more than three million per year, are unintended (Henshaw, 1998). At the personal level, these sex-related outcomes have life-altering health and economic consequences. At the societal level, they are a significant burden on the nation’s health care system, with HIV patients alone requiring more than two million days of care per year (National Center for Health Statistics, 1996). In the years since the outbreak of AIDS in the late 1970s, the volume of behavioral research on sexual risk taking has increased dramatically. A major focus of this research literature is the explanation of behaviors that contribute to the spread of HIV; however, the kind of sexual activity that can lead to HIV infection can also result in the contraction of other STDs and unintended pregnancy. A key concern of behavioral researchers is pinpointing the factors that underlie sexual behaviors that have a relatively high probability of resulting in such aversive and costly outcomes. Motivated by this concern, the purpose of this article is to document the contribution of empirical research inspired by major theories of normal personality to the understanding of sexual behaviors that can result in HIV infection, the acquisition of other STDs, and unintended pregnancy. After a brief overview of sexual risk-taking behavior, we develop predictions regarding sexual risk taking from several prominent models of normal personality. We then report the results of a meta-analysis of research on the association between higher-order dimensions of normal personality and sexual risk taking. We conclude with a discussion of the implications of the findings for models of sexual risk taking and interventions designed to discourage such behavior. Personality and Sexual Risk Taking 1205 Sexual Risk-Taking Behavior The most significant risks with which sexually active people must contend are HIV infection, acquisition of an STD (e.g., gonorrhea, chlamydia, syphilis), and unintended pregnancy. The correct and consistent use of condoms is a highly effective means of reducing the risk of sexual transmission of HIV and other STDs as well as unintended pregnancy. Limiting sexual activity to a single, uninfected partner is another highly effective means of managing the risks associated with sexual activity. Despite the efficacy of these widely publicized risk-reduction strategies, many sexually active people do not routinely take measures to lower the risk of infection and unintended pregnancy. Unprotected Sex Failure to correctly and consistently use condoms during sexual intercourse places sexually active people at substantial risk of infection or pregnancy. Although the vast majority of sexually active people are aware of the preventive efficacy of condoms, most do not use them on a consistent basis (Hays, Kegeles, & Coates, 1990; Hingson, Strunin, Berlin, & Heeren, 1990; Thurman & Franklin, 1990). For instance, Thurman and Franklin (1990) found that, although 97% of the college students they surveyed knew that condom use was an effective means of avoiding HIV infection and STDs, only about 40% translated this knowledge into action. A study of HIV-seropositive men and women found that two-thirds had been sexually active and 40% had engaged in unprotected sex during the 2 weeks immediately following notification that they were HIV infected (Cleary et al., 1991). Interventions that increase knowledge about AIDS and favorability of attitudes toward AIDS-preventive behavior typically do not produce commensurate increases in safer-sex behaviors such as condom use (Fisher & Misovich, 1990). Unprotected sex remains a prevalent risk behavior among sexually active people. Multiple Partners Along with abstinence and conscientious condom use, monogamy is a highly recommended and efficacious strategy for reducing sexual transmission of HIV and other STDs. Yet, the sexual activity of many people extends to multiple partners and relationships within which the level of 1206 Hoyle et al. commitment and sexual fidelity is low (Temple, Leigh, & Schafer, 1993). For instance, Arnett (1998) found that 25% of a sample of unmarried, sexually active people in their 20s had sex with two or more partners during the past year; 5% of the sample had sex with five or more partners during the same period. In a more heterogeneous sample, college students and community members reported between one and three sexual partners during the previous year, but students reported the desire for four partners and community members the desire for eight partners in the next year (Seto, Lalumière, & Quinsey, 1995). Despite warnings against sexual activity outside a mutually monogamous relationship (e.g., Centers for Disease Control and Prevention, 1997a), a subset of sexually active people seek out multiple partners. High-Risk Encounters In addition to unprotected sex and sex with multiple partners outside a committed relationship, certain situational factors increase the likelihood that HIV infection, an STD, or an unintended pregnancy will result from a sexual encounter. In a survey of a probability sample of U.S. men and women, 13% of the men and 8% of the women reported drinking during their most recent sexual experience (Temple et al., 1993). Those percentages climb to 20% and 25%, respectively, for their most recent sexual experience with a new partner. The use of alcohol and other substances prior to a sexual encounter significantly impairs perceptions of risk (Norris, Nurius, & Dimeff, 1996), even contributing to positive expectations regarding the outcomes of risky sexual behavior (Fromme, Katz, & D’Amico, 1997). Thus, the likelihood of unprotected sex or other risky behavior in a sexual encounter is elevated by the consumption of alcohol. Other situational factors that pose a risk of infection or pregnancy concern characteristics of the partners in a sexual encounter. Sex between strangers or individuals not in a committed relationship, or casual sex, poses a variety of risks, including HIV and STD infection as well as interpersonal violence. The risks associated with casual sex often are exacerbated by the use of alcohol. Temple et al. (1993) found that 70% of sexual experiences with a new partner outside a committed relationship were accompanied by alcohol use; such experiences in a committed relationship were accompanied by alcohol use only 30% of the time. Men who have sex with men and women who have sex with women also are at increased risk for HIV infection (Centers for Disease Control and Personality and Sexual Risk Taking 1207 Prevention, 1998b; Chu, Hammett, & Buehler, 1992). In each type of sexual encounter, the increased risk primarily stems from the reduced likelihood of condom use. As detailed in the next section, there is reason to believe that different aspects of personality underlie different risky sexual behaviors. Thus, in our meta-analysis of the research on personality and sexual risk taking, we consider separately the three categories of high-risk sexual behavior we have identified: multiple sexual partners, unprotected sex, and sexual encounters in situations that favor infection or unintended pregnancy. Personality Perspectives on Sexual Risk Taking Although the five-factor model is enjoying growing acceptance by personality researchers (Costa & McCrae, 1995; Goldberg, 1993; John, 1990), most research on personality and sexual risk taking either predates the dominance of the five-factor model or eschews that model for one of several competing models. Rather than endorsing a single model of personality, we consider the role of personality from the perspective of a number of major models. We restrict our focus to higher-level factors, or domains, as assessed by instruments designed in accord with the conceptualization of the model by its originator. For the purpose of reviewing and generating hypotheses from the models, we organize them according to their foundational assumption: biological underpinnings or empirically derived taxonomy.1 Psychobiological Perspectives At the domain level, Eysenck’s psychoticism-extraversion-neuroticism (PEN) model of personality (e.g., Eysenck, 1990; Eysenck & Eysenck, 1985) posits three biologically based superfactors. Psychoticism concerns the likelihood of a psychotic episode and, to a lesser extent, aggression; it is associated with level of testosterone. Extraversion is 1. We originally included the interpersonal circumplex model (Wiggins, 1979) in this section; however, we were unable to find any empirical work on the circumplex model of personality and sexual risk taking. As such, we do not include that model in our review. At the conceptual level, predictions for power/dominance would correspond to those for extraversion and love/warmth to those for agreeableness in the five-factor model. 1208 Hoyle et al. based on cortical arousal, with chronic over- and underarousal corresponding to introversion and extraversion, respectively. Finally, neuroticism is believed to be a function of thresholds of activation of the sympathetic nervous system, emotionally unstable people evincing a relatively low threshold of activation. In 1976, Eysenck published Sex and Personality, in which he attempted to use the PEN model to explain variability in sexual behaviors such as frequency of intercourse, preference for different partners, and anxiety regarding sexual relations. Although Eysenck’s analysis did not focus specifically on sexual risk taking, it is not difficult to develop hypotheses from the PEN model regarding such behaviors based on his analysis. Eysenck predicted that people high on psychoticism would be more inclined to participate in socially disapproved sex acts. His survey studies revealed greater promiscuity among respondents high in psychoticism. Thus, we predict a positive association between psychoticism and number of partners as well as high-risk sexual encounters; the PEN model does not suggest a definitive prediction regarding psychoticism and condom use. Eysenck posited that extraverts would be promiscuous, playful, and interested in variety, predictions that generally were supported by his data. We expect a positive association between extraversion and all high-risk sexual behaviors discussed earlier. In theory, neuroticism should be associated with fear and anxiety regarding sexual contact and, therefore, relatively low sexual involvement. This leads to the prediction that neuroticism, if associated with sexual risk taking at all, would be negatively correlated with number of partners and high-risk sexual encounters. The prediction regarding condom use is not clear from Eysenck’s analysis, but the expected lack of experience and disgust regarding certain aspects of sexual relations leads to the prediction that the higher a person is in neuroticism the more likely he or she is to engage in unprotected sex. There is reason to believe that any effect sizes involving PEN domains will be small; in two large-scale survey studies, Eysenck (1976) found correlations between the PEN domains and sexual behavior to be very low. Another biological perspective is the alternative five-factor model (Zuckerman, Kuhlman, Joireman, Teta, & Kraft, 1993), which emerged from factor analyses of personality measures used in psychobiological research (Zuckerman, Kuhlman, & Camac 1988). In the alternative five-factor model, neuroticism-anxiety corresponds to neuroticism and sociability corresponds to extraversion in the PEN model. Aggression- Personality and Sexual Risk Taking 1209 hostility concerns the tendency toward negative interpersonal behavior. Activity captures the need for a busy life that requires hard work and poses challenges. Finally, impulsive sensation seeking involves experience seeking without thinking. Although impulsive sensation seeking departs somewhat from the traditional notion of sensation seeking (Arnett, 1994; Zuckerman, 1979), predictions regarding its association with sexual risk taking should be the same. Pinkerton and Abramson (1992, 1995), in their decision-making model of risky sex, view risk-related dimensions of personality such as sensation seeking as a significant influence on the decision to enact a sexual behavior because of their effect on people’s tolerance of risk and the value they place on sexual activities that place them at risk (e.g., multiple partners, casual sex). Because high sensation seekers have a high tolerance for risk and place a high value on high-risk activities, sensation seeking should be positively correlated with all forms of sexual risk taking. Regarding the remaining domains in the alternative five-factor model, the predictions for neuroticism-anxiety and sociability would correspond to those for neuroticism and extraversion from the PEN model. There is, at present, no sound basis for venturing a prediction regarding the role of activity and aggression-hostility in sexual risk taking. A relatively new psychobiological perspective is Cloninger’s neuropsychopharmacological model of personality (Cloninger, Svrakic, & Przybeck, 1993). According to the model, the three fundamental traits of novelty seeking, harm avoidance, and reward dependence are related to levels of dopamine, serotonin, and norepinephrine, respectively. Conceptually, novelty seeking is highly similar to sensation seeking and, therefore, would be expected to correlate positively with sexual risk taking. Harm avoidance evinces the emotional instability characteristic of neuroticism in the PEN model, leading to the prediction of weak but negative correlations with most forms of sexual risk taking. The link between reward dependence, which concerns behavioral maintenance as a function of responses to reward and punishment regarding those behaviors, and sexual risk taking is not clear, although features of reward dependence such as attention to details and careful decision making would suggest a negative relationship with sexual risk taking, particularly unprotected sex. There is reason to believe that these three dimensions work interactively to influence risky behavior (e.g., Wills, Vaccaro, & 1210 Hoyle et al. McNamara, 1994); however, there have not been empirical tests of this hypothesis in the realm of sexual risk taking. A biologically based dimension of personality not represented in pure form at the domain level in any of the major models of personality is impulsivity, which refers to the tendency to act without attending to the consequences of one’s actions. Although impulsivity is coupled with sensation seeking in the alternative five-factor model and encompassed by psychoticism and extraversion in the PEN model, it has received sufficient attention in research on sexual risk taking to warrant consideration in pure form in our meta-analysis. We would expect impulsivity to be positively associated with all forms of sexual risk taking. Taxonomic Perspectives An alternative means of construing normal personality involves grouping traits according to higher-order influences that account for their empirical commonality. Such taxonomic models often emerge from factor analyses of responses to a large number of trait terms (e.g., Goldberg, 1992a) or questionnaire items (e.g., Church & Burke, 1994). Because such models are inherently atheoretical (McAdams, 1992; cf. McCrae & Costa, 1996), the confident derivation of predictions from such models is not possible. Yet, because such models include aspects of theory-based models such as the PEN model, we can in some cases develop predictions based on the representation of different aspects of theory-based models in domains of the empirically derived taxonomic models. Perhaps the most prominent of the taxonomic models is the five-factor model (Digman, 1990). The five-factor model, like all taxonomic models of personality, attempts to encompass all aspects of personality. Thus, it is perhaps not surprising that there is substantial overlap between the five-factor model and the psychobiological models described earlier. Indeed, at the conceptual level neuroticism and extraversion are highly similar to domains in the PEN and alternative five-factor models. Agreeableness is analogous to aggression-hostility in the alternative five-factor model and aspects of psychoticism in the PEN model. In line with our reasoning regarding these domains, we do not see a clear-cut prediction regarding the association between agreeableness and sexual risk taking, and extant research does not suggest an important role for agreeableness in sexual behavior (Costa, Fagan, Piedmont, Ponticas, & Wise, 1992). The domain of conscientiousness reflects the degree to which a person Personality and Sexual Risk Taking 1211 is well organized, disciplined, and deliberate. We would expect a negative association between conscientiousness and sexual risking, particularly unprotected sex, which involves some measure of unpreparedness and lack of deliberation. Openness to experience, which is unique to the five-factor model (and varies somewhat across versions of the model), concerns flexibility, curiosity, and open-mindedness. These latter two features of openness lead us to predict positive, though perhaps weak, correlations between openness and risky sexual behaviors such as sex with strangers and with different partners. A more parsimonious taxonomic model is Tellegen’s (1985) threefactor model. Facets of constraint include control, harm avoidance, and traditionalism. The control facet corresponds to conscientiousness from the five-factor model, leading us to predict that constraint, like conscientiousness, will correlate negatively with sexual risk-taking behavior. People high on positive emotionality are active and involved in life in ways that give rise to positive emotions. And negative emotionality in Tellegen’s model reflects the tendency to experience negative emotions as well as unpleasant interpersonal relations. Positive and negative emotionality combine aspects of the various models described thus far (Church, 1994), leaving their theoretical role in risky sexual behavior unclear. The Present Analysis The goal of the present study was to evaluate in a comprehensive manner the status of empirical research on the role of high-level domains of personality in sexual behaviors that contribute to HIV infection, transmission of STDs, and unintended pregnancies. To accomplish this, we gathered reports of empirical research relevant to this question, and organized the findings according to which risky sexual behaviors and which personality domains they involved. Then, by combining results across studies, we could evaluate the relative success of each model at accounting for variability in sexual risk taking. METHOD Selection of Studies We searched two comprehensive databases for articles describing empirical research on risky sexual behavior and at least one personality domain from the models described earlier. PubMed (http://www.ncbi.nlm.nih.gov/PubMed/) is 1212 Hoyle et al. a public access search service that provides access to MEDLINE and PreMEDLINE. PsycINFO (http://members.apa.org/welcome/) is an online search service available by subscription to members of the American Psychological Association. In each case we searched the entire database from the earliest entries to March of 1999. We crossed each of a series of personality terms with each of a series of terms for sexual risk taking. Personality terms used in the search were psychoticism, neuroticism, extraversion, positive emotionality, negative emotionality, constraint, neuroticism, emotional stability, extraversion, surgency, openness, intellect, agreeableness, conscientiousness, dominance, warmth, novelty seeking, harm avoidance, reward dependence, sensation seeking, and impulsivity. Terms for sexual risk taking were sexual behavior, sexual risk taking, HIV, AIDS, STD, unsafe sex, risky sex, unprotected sex, condom use, abstinence, and unintended pregnancy. These terms yielded 635 citations of potential relevance to our review. Examination of abstracts and, when necessary, text of the articles reduced this number to 41 citations of published articles that reported findings from 45 studies relevant to the analysis.2 An electronic mail query to subscribers to the Society for Personality and Social Psychology Listserv netted eight additional, unpublished studies, bringing the total to 53 studies from which effect sizes were extracted. Exclusion Criteria To be included in the analysis, each study identified by the search had to meet two criteria. The study had to include a standard measure of at least one domain-level factor from one of the personality models described earlier. Excluded were studies that involved ad hoc, abbreviated, or nonstandard measures of personality domains. For instance, a number of studies used only a single subscale or a small sample of items from the Sensation Seeking Scale. Second, we included only those effect sizes that reflected the association between personality and sexual risk-taking behavior. The plethora of studies that focused on attitudes toward sexual risk taking were not included in the analysis. Also excluded were studies that focused on sexual behavior that would not pose a direct risk for disease contraction or pregnancy (e.g., frequency of intercourse with a single partner, preference for particular positions during intercourse). 2. Of the 587 irrelevant citations, 369 (63%) resulted from inclusion of the term dominance, which, in our initial search, was included in order to locate studies on sexual risk taking that used the interpersonal circumplex. As noted earlier, no such studies were found. Most citations that included the term dominance referred to sexual behavior of nonhuman species. Personality and Sexual Risk Taking 1213 Coded Information In addition to an effect size, the primary information extracted from each article or manuscript was personality domain and type of sexual risk-taking behavior. Personality domain was coded as corresponding either to the PEN model (psychoticism, extraversion, neuroticism), the alternative five-factor model (neuroticism-anxiety, sociability, aggression-hostility, activity, impulsive sensation seeking), the neuropsychopharmacological model (novelty seeking, harm avoidance, reward dependence), the five-factor model (neuroticism, extraversion, agreeableness, conscientiousness, openness), or Tellegen’s model (constraint, positive emotionality, negative emotionality). Sexual risk taking was categorized either as sex with multiple partners, unprotected sex, or other high-risk sexual encounters. The latter included such behaviors as sex with a stranger and sexual activity accompanied by drug or alcohol use. Initially, studies were coded for a number of characteristics that might serve to moderate the effects of interest. These include personality measure used, year of publication, percentage females in the sample, type of design—cross-sectional or longitudinal, and population—college student, high-risk (e.g., men who have sex with men), or noncollege/typical risk. With the exception of sensation seeking, there were not enough effect sizes to permit moderator analyses. Thus, these characteristics served primarily as a basis for describing the literature from which effect sizes were drawn. Effect Size Calculation Pearson r was chosen as the index of effect size. Virtually all studies were correlational in nature and, therefore, required none of the typical translation of test statistics and p-values to rs. For each personality domain and category of sexual risk taking, Fisher z-transformed rs were combined to obtain a mean effect size. Means were transformed back to rs for presentation. RESULTS Table 1 includes a complete listing of studies that contributed effect sizes to the analysis. From each study, we extracted an effect size for each pairing of a personality domain and a sexual risk-taking behavior. For studies that included more than one sexual risk-taking behavior, we also computed a mean effect size for each personality domain across behaviors. Examination of the descriptive characteristics of the studies provides an informative view of the state of the literature on personality and sexual Table 1 Characteristics of Studies Included in the Meta-Analysis Study Arnett (1990) Arnett (1991) Arnett (1996) Sample 1 Sample 2 Arnett (1998) Ball & Schottenfeld (1997) Barnes et al. (1984) Beard et al. (1974) Benotsch et al. (1998) Black et al. (1997) Study 1 Study 2 Bogaert & Fisher (1995) Breakwell (1996) Caspi et al. (1995) Clift et al. (1993) Cohen & Fromme (1999) Cooper et al. (2000)b Fergusson & Lynskey (1996) Fontaine (1994) N a Model Domain Outcome(s) 145 64 Zuckerman Zuckerman SS SS unprot unprot, hrisk 133 346 140 67 307 308 64 Zuckerman Zuckerman Zuckerman Zuckerman Eysenck Eysenck Five Factor SS SS SS ISS,N-A,A-H P,E,N E,N E,N,A,C,O unprot, hrisk unprot, hrisk #part, unprot, hrisk #part, hrisk hrisk unprot #part, unprot, hrisk Zuckerman Zuckerman Zuckerman, Eysenck SS SS SS,P I PE,NE,Co I ISS E,N,SS,I NS P,N,E hrisk hrisk #part #part hrisk unprot, hrisk #part, unprot #part, unprot, hrisk hrisk unprot, hrisk 52 217 215 576 842 387 858 1496 953 74 Tellegen Zuckerman Eysenck, Zuckerman Cloninger Eysenck Hart (1973) Hartzler (1998) Horvath & Zuckerman (1993) Husted & Edwards (1976) Kalichman et al. (1997) Kalichman et al. (1996) Kalichman et al. (1994) Kalichman & Rompa (1995) Sample 1 Sample 2 Kalichman et al. (1997) Kraft & Rise (1994) McCown (1991) McCown (1993) Miller et al. (2000) Newcomb & McGee (1991) Schenk & Pfrang (1986) Schroth (1996) Seal & Agostinelli (1994) Seto et al. (1995) Sample 1 Sample 2 Sheer & Cline (1994) Sheer & Cline (1995) Stein et al. (1994) Temple et al. (1993) 206 522 447 20 223 99 106 296 158 193 1184 86 109 474 595 498 100 185 58 221 234 267 438 569 Eysenck Cloninger Zuckerman Zuckerman Zuckerman Zuckerman Zuckerman N,E NS,HA,RD SS,I SS SS SS SS hrisk unprot hrisk #part unprot #part, unprot #part, unprot Zuckerman Zuckerman Zuckerman Zuckerman Eysenck Eysenck Five Factor Zuckerman Zuckerman, Eysenck Zuckerman Tellegen SS SS SS SS P,N,E P,N,E E,N,A,C,O SS SS,E,N SS Co #part, unprot #part, unprot hrisk #part, unprot, hrisk hrisk hrisk #part hrisk hrisk #part, unprot hrisk Zuckerman Zuckerman Zuckerman Zuckerman Zuckerman Zuckerman SS SS SS SS SS SS,I #part, hrisk #part, hrisk #part, unprot #part, unprot hrisk unprot Study Testa & Livingston (1998) Testa et al. (1999) Trobst et al. (1999) Vollrath et al. (1999) White & Johnson (1988) Witte & Morrison (1995) Wright & Reise (1997) Wulfert et al. (1999) Zuckerman et al. (1972) Zuckerman et al. (1976) N a 48 59 406 683 1034 92 350 183 98 144 Table 1 (cont.) Model Zuckerman Zuckerman Five Factor Five Factor Zuckerman Zuckerman Five Factor Zuckerman Zuckerman Domain SS,I SS,I E,N,A,C,O E,N,A,C,O SS,I SS E,N,A,C,O I SS SS Outcome(s) #part, hrisk #part, hrisk #part, unprot hrisk unprot unprot, hrisk hrisk #part hrisk #part Note. SS = sensation seeking; ISS = impulsive sensation seeking; N-A = neuroticism-anxiety; H-A = hostility-aggression; E = extraversion; P = psychoticism; N = neuroticism; A = agreeableness; C = conscientiousness; O = openness; PE = positive emotionality; NE = negative emotionality; Co = constraint; I = Impulsivity; NS = novelty seeking; HA = harm avoidance; RD = reward dependence; #part = number of partners; unprot = unprotected sex; hrisk = other high risk sexual encounters. aWithin some studies that included multiple outcomes, Ns varied across outcomes. In those instances, the tabled N is a mean of the Ns for the individual outcomes. bEffect sizes used in our meta-analysis vary from those in the published report; the complete set of effect sizes is available from the authors on request. Personality and Sexual Risk Taking 1217 risk taking. Of the 53 studies identified, only five were published prior to 1984; a full 75% were published after 1990. The median percentage of females is 50; however, samples in 16 studies, or 30%, were all male and samples in six studies, or 11%, were all female. Eighty-one percent of the studies considered personality as prescribed by one of the psychobiological models; 64% focused exclusively on sensation seeking. All but one study used a cross-sectional design. In summary, the literature on personality and sexual risk taking is relatively new and dominated by one-shot surveys inspired by psychobiological models of personality. Psychobiological Perspectives Unweighted mean effect sizes for the PEN model appear in the first three lines of Table 2.3 Overall, there is evidence of a small effect for extraversion and minimal-to-no effect for psychoticism and neuroticism.4 With regard to particular types of sexual risk taking, there was some evidence of a moderate effect of psychoticism on number of partners and unprotected sex; however, these effects are based on single studies of relatively small samples (Bogaert & Fisher, 1995; Fontaine, 1994) and, therefore, should be viewed as tentative. Consistent with Eysenck’s (1976) reasoning, extraversion was associated with high-risk sexual encounters.5 As noted earlier, a preponderance of the research relevant to this review featured sensation seeking. As revealed in the second section of the upper panel of Table 2, sensation seeking was positively correlated with all categories of sexual risk taking. We found only one study that had considered other domains from the alternative five-factor model (Ball & Schottenfeld, 1997). Results from this study indicated that both aggression-hostility and neuroticism-anxiety correlate positively with sexual risk taking. Surprisingly, the effect size for aggression-hostility exceeds 3. Weighted means differed trivially from the unweighted means shown in Table 2. Weighted means are available by request from the first author. 4. The overall effect for psychoticism is based on five studies among which the finding of an r = .34 between psychoticism and unprotected sex by Fontaine (1994) is an extreme case. When that effect size is removed, the mean effect size drops to r = .04. 5. Recall that extraversion in the PEN model includes elements of impulsivity. Given the relatively weak effect for extraversion in the five-factor model, it seems likely that the effect for extraversion in the PEN model is an overestimate attributable to undercurrents of impulsivity. Table 2 Unweighted Mean Effect Size (r) and Number of Studies by Personality Domain and Outcome Outcome Personality Domain Number of partners Unprotected sex High-risk encounter Overall Psychobiological Perspectives PEN model psychoticism extraversion neuroticism Alternative five-factor model (impulsive) sensation seeking aggression-hostility neuroticism-anxiety .20 (1) (0) (0) .34 .08 –.05 (1) (2) (2) .04 .15 .03 (4) (6) (6) .07 .14 .03 (5) (7) (7) .25 .30 .27 (18) (1) (1) .13 (18) (0) (0) .21 .32 .24 (20) (1) (1) .19 .31 .25 (34) (1) (1) (0) (0) (0) .22 –.02 –.00 (1) (1) (1) .09 (1) (0) (0) .15 –.02 –.00 (2) (1) (1) .15 (4) .13 (3) .10 (4) .12 (8) .11 (3) .20 (2) .08 (4) .06 (5) Psychopharmacological model novelty seeking harm avoidance reward dependence Impulsivity Taxonomic Perspectives Five-factor model neuroticism extraversion agreeableness conscientiousness openness Tellegen positive emotionality negative emotionality constraint .01 –.16 –.08 –.06 (3) (3) (3) (3) –.09 –.23 –.26 –.01 (0) (0) (0) Note. Numbers in parentheses denote number of studies on which effect size is based. (2) (2) (2) (2) .04 –.21 –.11 .04 (4) (4) (4) (4) .06 –.20 –.12 .01 (5) (5) (5) (5) (0) (0) (0) .01 .11 –.23 (1) (1) (2) .01 .11 –.23 (1) (1) (2) 1220 Hoyle et al. that for sensation seeking; however, it is important to note that this effect size comes from a single study of a small, high-risk sample. Sensation seeking was the lone personality domain on which there were sufficient effect sizes to allow for moderator analyses. Eleven studies included both number of partners and unprotected sex as outcomes. A within-study comparison of effect sizes revealed a significantly stronger effect of sensation seeking on number of partners (mean r = .28) than on failure to use a condom (mean r = .14), F(1, 9) = 6.02, p < .05. Overall effect size for sensation seeking was unrelated to year of publication (r = .06) or percentage of females in the sample (mean r = –.09). A comparison of overall effect size across population revealed a stronger effect of sensation seeking on sexual risk taking among college students and high-risk populations (rs = .24 and .27, respectively) compared to the noncollege/typical risk population (r = .13).6 Research based on Cloninger’s psychopharmacological model was scarce, revealing only the expected positive effect size for novelty seeking. Impulsivity was positively correlated with all forms of sexual risktaking behavior. As is apparent from the pattern shown in Table 2, this effect was modest and varied trivially across type of sexual risk taking. Taxonomic Perspectives Surprisingly, relatively few studies have considered sexual risk taking in the context of the five-factor model. The pattern of effects produced by these studies across domains and type of sexual risk taking is shown in the bottom portion of Table 2. Looking first at the overall effect, only agreeableness and conscientiousness are related to sexual risk taking; as 6. More fine-grained, exploratory analyses suggested differential effectiveness of measures of sensation seeking for predicting different types of sexual risk taking. For instance, Form V of the Sensation Seeking Scale (SSS) outshone the impulsive sensation-seeking subscale from the Zuckerman-Kuhlman Personality Question (ZKPQ) for predicting number of partners (rs were .33 and .19, respectively); however, the ZKPQ appeared to be superior for predicting other high-risk sexual encounters (.27 vs. .19). Results of these exploratory analyses coupled with the addition of explicit impulsivity items to the ZKPQ subscale suggest caution when comparing or integrating results based on the different measures. Personality and Sexual Risk Taking 1221 typically conceptualized, both dimensions are negatively correlated with sexual risk taking. Moving to effect sizes for specific categories of sexual risking taking, it is apparent that agreeableness is negatively correlated with all three categories of sexual risk taking. As predicted, the strongest effect of conscientiousness is for failure to use a condom.7 Neuroticism is positively correlated with unprotected sex and, to a lesser extent, sex with multiple partners. We identified only two studies that investigated sexual risk taking from the perspective of Tellegen’s (1985) model. Results from the single study that included negative emotionality indicated a small effect for that domain. As expected, the effect for constraint was negative and stronger than for any other factor in the model. Positive emotionality, considered in single study, evinced no association with sexual risk taking. DISCUSSION Five substantive findings, four expected and one not, emerged from our quantitative review. First, it comes as no surprise that sensation seeking predicts all forms of sexual risk taking covered by our review. Although the recent reconceptualization of sensation seeking to include impulsivity (Zuckerman et al., 1993) may prove important for predicting particular risk-taking behaviors, findings from the lone published study that coupled impulsivity with sensation seeking do not suggest a shift in the strength of the effect on sexual risk taking (Ball & Schottenfeld, 1997). At least one study has considered mechanisms that might account for the association between sensation seeking and a host of risky behaviors (Horvath & Zuckerman, 1993). Surprisingly, differences in risk appraisal between high and low sensation seekers do not account for differences in risk-taking behaviors by high and low sensation seekers. Rather, after engaging in a high-risk activity, high sensation seekers evaluate the activity as less risky. This finding, coupled with the finding that high sensation seekers view novel activities as less risky than do their low sensation-seeking counterparts (Zuckerman, 1979) suggest a complex process by which risk appraisal and sensation seeking influence risky behavior (cf. Pinkerton & Abramson, 1992, 1995). A potentially profitable direction for future research on mediators of the sensation-seeking– 7. Because of the small number of studies, it was not possible to formally compare these effect sizes. 1222 Hoyle et al. risk-taking relationship is biological mechanisms such as neurotransmission (e.g., Bardo, Donohew, & Harrington, 1996). After sensation seeking, impulsivity was the most frequently studied personality domain in the literature on sexual risk taking. We found a consistent, though not strong, positive association between impulsivity and sexual risk taking. A drawback to continued research on impulsivity and problem behavior is the inconsistent placement of impulsivity in the major models of personality. Whereas the alternative five-factor model couples impulsivity with sensation seeking at the highest level of the personality hierarchy (Zuckerman et al., 1993), impulsivity is spread across extraversion and psychoticism in the PEN model (Eysenck & Eysenck, 1985) and encompassed nominally by neuroticism (impulsiveness facet) and conceptually by conscientiousness (deliberation facet) in the five-factor model (Costa & McCrae, 1992). Moreover, nontrivial differences in the conceptualization of impulsivity across these models poses problems for research aimed at pinpointing the processes by which impulsivity influences sexual risk taking. As impulsivity is featured most prominently and developed most fully in the alternative five-factor model, research focused on the mechanisms that underlie the effect of impulsivity on sexual risk-taking would be best informed by the alternative five-factor model. Conscientiousness, which shares features of impulsivity and sensation seeking (Zuckerman et al., 1993), was negatively associated with sexual risk taking, but the effect was primarily confined to unprotected sex. This pattern was predicted and is consistent with behavioral tendencies captured by conscientiousness such as preparedness, planfulness, and attention to detail. The strength and specificity of this effect coupled with the focus of HIV and STD prevention programs on condom use suggests a potentially important role for conscientiousness in the development of prevention programs that target sexually active people. Our results provide conflicting evidence regarding the role of neuroticism in sexual risk taking. Neuroticism as conceptualized in the PEN model evinced no association with sexual risk taking. In studies taking the perspective of the five-factor model, neuroticism was weakly associated with number of partners but moderately correlated with unprotected sex. The lone study that investigated sexual risk taking from the perspective of the alternative five-factor model indicates an effect for neuroticism similar in magnitude to that for sensation seeking (Ball & Schottenfeld, 1997); because this effect was for a small, high-risk sample, the generality of the effect is unclear. In the relatively small number of papers that Personality and Sexual Risk Taking 1223 address the effect of neuroticism on sexual risk taking, there is consensus that neuroticism probably is not systematically related to sexual risk taking. In fact, Zuckerman and Kuhlman (2000) argue that neuroticismanxiety in the alternative five-factor model is not likely to be related to any risk-taking behavior. As noted earlier, Eysenck (1976) argued that the anxiety and disgust associated with neuroticism suggest that people high in neuroticism would not engage in much sexual behavior at all. And neuroticism from the five-factor model is associated with lower sexual satisfaction, but, otherwise, is not a strong predictor of sexual behavior (Costa et al., 1992). In summary, although there is some evidence in the literature that neuroticism is predictive of sexual risk taking, it is not clear from the major models of personality that an effect would be expected and what mechanism would underlie an effect for neuroticism. An unexpected finding, and one that warrants attention in future research, is the negative association between agreeableness and sexual risk taking. This effect is better understood by considering the negative pole of the agreeableness dimension, antagonism, which in the alternative five-factor model is termed aggression-hostility. Antagonism is characterized by a lack of interest in and concern for others. The overall effect of antagonism on sexual risk taking is equivalent in strength to the effect for sensation seeking. Corroboration for this finding can be found in recent research by Zuckerman and Kuhlman (2000) on the risk-taking personality. Personality profiles on the domains of the alternative fivefactor model indicate elevation on impulsive sensation seeking and aggression- hostility for groups of people who routinely engage in high-risk behavior (e.g., prostitutes). It is not clear from the relatively small number of studies on antagonism and sexual risk taking to what mechanisms the effect might be attributed. One finding relevant to this question emerged from a recent study of the NEO-PI facets and sexual risk taking (Miller et al., 2000). A primary predictor of promiscuity was the straightforwardness facet from the agreeableness domain. The authors argue that one explanation for this effect could be the manipulative and deceptive interpersonal style characteristic of individuals low in straightforwardness. Future research on sexual risk taking would profit from a focus on the agreeableness-antagonism domain and causal mechanisms that are interpersonal in nature. 1224 Hoyle et al. The State of the Literature A set of concerns highlighted by our review reflect on the general state of the literature on personality and sexual risk taking. Most prominent among the concerns is the relative paucity of research examining sexual risk taking from the perspective of major models of normal personality. Despite promising early work on personality and sexual risk taking inspired by the PEN model (e.g., Hart, 1973) and the sensation seeking construct (e.g., Zuckerman, Tushup, & Finner, 1976), there has been relatively little work on sexual risk taking from the perspective of major models of personality. Although increased funding for research on HIV risk and prevention along with increased interest in models of personality is likely to spur new work on personality and sexual risk taking, our search did not indicate a significant stream of research in the pipeline. As we noted at the outset, the toll of irresponsible sexual behavior is profound and behavioral scientists should have much to say about the causes of such behavior. At present, personality processes are conspicuously absent from models of sexual risk taking, which are dominated by attitude and peer influence variables. Our findings suggest that personality influences a broad range of sexual risk-taking behaviors and, as such, the inclusion of personality in models of sexual risk taking is warranted on empirical, if not conceptual, grounds. Of further concern is that, among the relatively small number of studies that have investigated normal personality and sexual risk taking, the preponderance of investigations are inspired by psychobiological models; and all but a few of these focus on sensation seeking, which captures only a portion of one of five domains in the alternative five-factor model. Our findings for agreeableness-antagonism highlight the potential importance of a domain of personality that is not represented in most psychobiological models. Conscientiousness, though somewhat similar to low impulsive sensation seeking, is another relevant domain that is central to taxonomic models (e.g., constraint in Tellegen’s model) but underrepresented in psychobiological models. A focus on such factors broadens the search for causal mechanisms from biological explanations to cognitive and interpersonal processes. Such a shift in focus raises the likelihood that models of personality process could be integrated with models of sexual risk taking that feature attitudes (i.e., cognitive) and peer influence (i.e., interpersonal) variables. Personality and Sexual Risk Taking 1225 Given the relatively small number of studies identified by our review, it is perhaps not surprising that causal mechanisms have received very little attention in the empirical literature on personality and sexual risk taking. A strength of psychobiological models over taxonomic models is the explicit specification of mechanisms; however, the role of such mechanisms is virtually never tested in studies investigating the role of personality as prescribed by these models in sexual risk taking. Although there is room for more research to establish the basic link between personality and sexual risk taking, particularly for relatively new models of personality, there is a clear void in the literature that needs to be filled with research that empirically investigates intervening mechanisms and processes. Similarly, there has been little or no consideration of personality in moderator, or interactionist, models of sexual risk taking. Such research could be inspired by two perspectives on the role of personality in behavior. From the perspective of personality researchers, moderator models would include situational variables, other personality factors, or individual differences that limit or magnify the effects of personality on sexual risk taking. A compelling example of such a model is captured by the accentuation hypothesis, which holds that the effect of personality on behavior is strongest when situational cues are ambiguous or uncertain (Caspi & Moffitt, 1993). Another example is a rare test of the synergistic effect of personality on behavior by Wills et al. (1994), which showed that drug use is best predicted by a model in which domains from Cloninger’s neuropsychopharmacological model exert an interactive influence. An alternative perspective involves a primary focus on situational forces on behavior and asks whether personality modifies the effect of such forces (Goldberg, 1992b). In either case, the research moves beyond the simple question of whether personality is related to sexual risk taking to the more informative question of how personality works in conjunction with other variables to influence such behavior In summary, our findings indicate the need for more research on normal personality and sexual risk taking. There is a clear need for such research to move beyond psychobiological models to account for aspects of personality not featured in such models. 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