Sutarso et al.

: Sexual temptation Int J Adolesc Med Health 2016 1

The final version of this paper was published in:

Sutarso, T., Tang, T. L. P., Anerin, D. R., & McCartt, I. W. S., & Gibson, C. B. (2016). Sexual
temptation: substance abuse, no sex, safe sex, risky sex, and STDs. International Journal of
Adolescent Medicine and Health, First online December 23, 2016 DOI 10.1515/ijamh-2016-
0101

Sexual Temptation:
Substance Abuse, No Sex, Safe Sex, Risky Sex, and STDs
Toto Sutarso, Thomas Li-Ping Tang, Denny R. Anerin, Intan W. S. McCartt and Courtney
B. Gibson

ABSTRACT

Background: University students’ substance abuse and risky sex contribute to sexually

transmitted diseases (STDs).

Purpose: We develop and empirically test a formative theoretical model of sexual temptation

involving substance abuse (cigarettes, alcohol, and marijuana), safe sexual behavior (use of

condom/barrier for oral and vaginal intercourse), risky sexual behavior (unprotected sex and

multiple sexual partners), and sexually transmitted diseases (STDs: gonorrhea, HIV, and genital

herpes). We simultaneously explore these constructs, controlling membership in social groups

(fraternity/sorority, varsity athlete, and club sports) and perceived norm of substance abuse.

Methods: A total of 687 American university students completed the National College Health

Assessment. We use structural equation modeling (SEM) to test the goodness of fit between our

formative theoretical model and actual data.

Results: Results reveal the following discoveries: Membership in campus social groups is

positively associated with STDs, whereas perceived norm of peer substance abuse is negatively

related to STDs. Under the influence of substance abuse, we test three outcomes of sexual
Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 2

temptation as related to STDs. Those who have no sex do not contract STDs. For those who fall

into temptation, substance abuse is more strongly related to risky sex which leads to STDs than

safe sex which does not. Those engaging in risky sex have significantly higher cognitive

impairment than those practicing safe sex.

Conclusions: Substance abuse contributes to STDs through risky sex only. Those having risky

sex suffer higher cognitive impairment than those practicing safe sex. We provide novel

implications to policy makers, practitioners, and researchers.

Keywords: sexual behaviors; structural equation modeling; STDs; substance abuse.

Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 3

INTRODUCTION

Around the world, an estimated 357 million sexually transmitted infections (STIs) occur

every year. In the USA, 20 million new sexually transmitted infections (STIs) cost $16 billion in

health care (1). About 53% of 350,062 gonorrhea cases occur among student 15-24-year olds. In

2013, genital warts appeared in 400,000 cases. STIs have profound impacts on reproductive

health (2). Those with a recent STI are less likely to use condom.

The highest rate of occurrence for STDs is among the 15-24-year old, which includes

most college students who normally range between 18 and 24 years of age. Clearly, college

students have the highest rate of STDs occurrence (3). Among students, only 24.8% of men and

15.6% of women always used a condom during sexual intercourse (4). In a national sample, the

proportion of condom use during the past 10 vaginal sex acts was 45% for men and 38% for

women (5). When questioned about pregnancy prevention, those who reported using withdrawal

only (10.2%) engage in risky behaviors—having multiple sex partners and using alcohol and

marijuana before last sexual encounter (6).

Epidemiological studies suggest that substance abuse (cigarettes, alcohol, and illegal

drug) interferes with cognitive functions, correlates with risky sexual behavior, and predicts

inconsistent condom use, multiple sexual partners, and high rates of STDs (7-11). Both alcohol

use and substance abuse correlate with risky sexual behavior and predict inconsistent condom

use, high sexual sensation seeking, multiple sexual partners, and high rates of STDs. African

Americans’ alcohol, tobacco, marijuana use, and dating violence are the strongest predictors of

having unprotected sex, multiple sex partners, and contracting gonorrhea, genital HSV (herpes),

and HIV (12-15). People who engage in risky sexual behavior such as having unprotected sex

and multiple sex partners are more likely to be diagnosed with STIs and have an overall
Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 4

increased risks for contracting gonorrhea, genital HSV, and HIC. Whites/Caucasians are less

likely to use condoms, whereas blacks have more sex partners and higher rates of STIs (16). STIs

are associated with a negative stigma and are socially judged more harshly than comparable

health risks.

Theory of free will suggests that most people value self-control, follow rules, and make

intelligent and rational decisions (17). Self-control enables individuals to enact long-term

positive goals and refrain from short-term behaviors with undesirable consequences (18).

Psychologist Daniel Kahneman won the 2002 Sveriges Rikesbank Prize in Economic Sciences in

Memory of Alfred Nobel, i.e., the Nobel Prize. In his recent book, Kahneman (19) discussed

individuals’ decision making processes: System 1 and System 2 thinking. A happy mood loosens

the control of System 2 thinking—slow, logical, effortful, and cognitive thinking. However, an

angry, uncomfortable, and unhappy mood causes them to lose touch with System 1 thinking—

fast, automatic, and intuitive thinking. Intoxication, due to alcohol abuse, also loosens the control

of logical, effortful, and cognitive (System 2) thinking, which, in turn, leads to impulsive

behavior, cognitive impairment, and risky sexual practices (20-21). Using protective behavioral

strategies reduces negative alcohol-related consequences.

College is a time of alcohol use initiation and escalation because it is the most commonly

used substance by students (22). Clearly, substance abuse (smoking cigarettes, use of alcohol,

and use of marijuana) leads to impulsive behavior, “cognitive impairment, inconsistent condom

use, loss of self-control, and risky sexual practices. After substance abuse and intoxication, most

students may have difficulties to engage in logical, effortful, and cognitive (System 2) thinking

and exercise their strong self-control (19).

Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 5

Following social bonding theory (23), strong social bonds undermine delinquency. Since

most college students move away from home and their parents, those in their closest social

network exert the greatest influence (24). It should be noted, however, that parental attachment

prevents teenagers’ dishonesty; whereas peer attachment promotes dishonesty, supporting the

notion—“bad company corrupts good morals” (25-29). These principles are applicable to college

students regarding substance abuse, sexual behaviors, and STDs.

Affiliations with campus social groups and students’ observations of their peers do

strongly shape their views of the social norm regarding other college students’ substance abuse

on campus. Residence in a fraternity or sorority predicts binge drinking and decreased condom

use (30-31). Four out of five residents (81.1%) of fraternities or sororities were binge drinkers

(32). Drinking alcohol decreases condom use (33).

Among students, sports participants (varsity, club, and intramural athletes) were more

likely to engage in binge drinking and chewing tobacco, but less likely to be cigarette smokers or

marijuana users (34). Athletes, males, in particular, propagate attributes of strength, toughness,

and dominance, and are likely to demonstrate their masculinity by engaging in risky sexual

behavior and/or sexual violence (14, 35) which may lead to STDs. Perception of their campus

drinking norm is the strongest predictor of alcohol consumption (36). Others refrain from

drinking alcohol when they socialize (37). Although scholars and administrators have considered

substance abuse among college student an important concern, yet very limited research has

investigated students’ substance abuse and STDs, using National College Health Assessment

(38).

Based on suggestions in the literature (39-40), we develop a formative theoretical model

of sexual temptation—substance abuse, sexually transmitted diseases (STDs), and two

Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 6

mediators—safe sexual behavior and risky sexual behavior, forming a diamond (Figure 1). We

simultaneously examine a direct path (Path 1), a safe indirect path (Paths 2 and 3), and a risky

indirect path (Paths 4 and 5). We theorize: Under the influence of substance abuse, three

possible reactions of sexual temptation lead to different outcomes (STDs). First, some abstain, do

not fall into temptation, have no sex, and do not contract STDs (Figure 1, Path 1). Second, others

tolerate cognitive impairment, fall into temptation, exercise self-control, and deliberately engage

in safe sex—condom/barrier for oral and vaginal sexual intercourse (Path 2), and do not contract

STDs (Path 3). Third, many do fall into temptation (41), prey upon or fall victim to substance-

induced cognitive impairment, deliberately engage in risky sex—unprotected sex and multiple

sexual partners (Path 4), and contract STDs (Path 5). We control two peer effects: membership in

campus social organizations and perceived norm of peer substance abuse.

METHODS

Participants

With Institutional Review Board’s approval, 687 students completed National College

Health Assessment (NCHA) online. NCHA helps college health service providers collect data

about students’ health habits, behaviors, and perceptions (42). We collected data from a public

institution which is the flagship University of a State located in the southeastern US. It has many

older non-traditional students, online adult/working students, veterans, and extensive graduate

programs. Our sample had 93.4% undergraduate students and 63.8% female. Only 76.4% of our

sample fell within the typical 18-24 year-old age group. The mean (23.30), standard deviation

(7.03), and range (18-56) of our students’ age were slightly higher than the traditional

undergraduate students.
Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 7

Measures

For substance abuse, students reported their use of cigarettes, alcohol, and marijuana

within the last 30 days, using the following 8-point scale and anchors: never used (1), have used,

not last 30 days (2), 1-2 days (3), 3-5 days (4), 6-9 days (5), 10-19 days (6), 20-29 days (7), and

used daily (8). The Cronbach’s alpha (α) was .66. For cognitive impairment, as a consequence of

drinking, did students do something later regretted and forgot where/what they did: N/A, don’t

drink (1), no (2), yes (3) (α = .91)? Risky sexual behavior consists of two items: had unprotected

sex as a consequence of drinking (N/A, don’t drink (1), no (2), yes (3)) and the number of sexual

partners for the last 12 months (α = .51). Safe sexual behavior has two items: condom/barrier

during oral sex and vaginal intercourse (α = .71). Sexually transmitted diseases include

diagnosed/treated for gonorrhea, HIV, and genital herpes for the last 12 months (α = .74). We

control peer effects: membership in (1) fraternity or sorority; (2) last 12 months: varsity athlete

and (3) club sports (no (1), yes (2); α = .29) and perceived norm—estimated percentage of

student using cigarettes, alcohol, and marijuana for last 30 days (α = .79).

Analysis Strategy

In this study, we move beyond descriptive statistics. We use structural equation model

(SEM), adopt a formative theoretical model, and simultaneously investigate observable items

(actual items used in a survey), measurement errors, and relationships among latent constructs

(unobserved variables). In formative models, sub-constructs are distinguishable, independent,

and non-interchangeable perspectives, or formative indicators of the overall latent construct. The

direction of the relationship is from sub-constructs to the overall latent construct. In order to

achieve model identification, a formative construct (substance abuse) must emit paths to at least

two theoretically appropriate outcomes.

Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 8

Specifically, we frame smoking cigarettes, drinking alcohol, and smoking marijuana as

three independent antecedents of substance abuse not only in the context of two items of

cognitive impairment but also in the context of safe sexual behavior, risky sexual behavior, and

STDs—a total of five outcomes. We adopted the following criteria in evaluating the goodness of

fit between our SEM theoretical model and actual data: (1) Chi square and degrees of freedom

(χ2/df < 5), (2) incremental fit index (IFI > .90), (3) Tucker–Lewis Index (TLI > .90), (4)

comparative fit index (CFI > .90), and (5) root mean square error of approximation (RMSEA <

.10).

RESULTS

Step 1: Common Method Variance (CMV). Due to cross-sectional data, we adopted

Harman’s single-factor test, examined the unrotated factor solution involving all 18 items of

interests in an exploratory factor analysis (EFA), and identified 6 factors, with eigenvalue greater

than one (the amount of variance explained = 23.33%, 12.09%, 10.73%, 8.07%, 6.94%, and

5.86%, respectively; total variance explained = 67.03%). Since the amount of variance explained

by Factor 1 (23.33%) was significantly less than 50%, the CMV bias was not a concern in this

study (43).

Step 2: Descriptive Statistics and Correlations. Table 1 shows the mean, standard

deviation, and correlations of major variables. We tested the difference between two dependent

correlations with one variable in common. Since the correlation between risky sex and safe sex

was .323, individuals engaging in risky sex (.499) had a significantly higher level of cognitive

impairment (z = -4.217, p < .001) than those involving in safe sex (.208).

Step 3: SEM results. Figure 2 shows an excellent fit between our theoretical model of

sexual temptation and data (χ2 = 379.504, df = 119, p = 0.000, χ2/df = 3.189, IFI = 0.936, TLI
Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 9

=0.907, CFI = 0.936, SRMSR = 0.056). First, the control variables are connected to all

constructs of our theoretical model. Membership of campus social groups was positively related

to STDs (0.32, p = 0.049); perceived norm of peer abuse was negatively related to STDs (− 0.10,

p = 0.039). All significant paths are presented using bold arrows and results.

After controlling these variables, Path 1 was non-significant (-.38, p = .064). The indirect

path showed that Path 2 (.28) was significantly positive, but Path 3 (-.05) was not. Both our Path

4 (.90) and Path 5 (.46) were significant, suggesting a significant indirect path. Interestingly,

Path 4 (.90) was significantly stronger (z = -.5.721, p < .001) than Path 2 (.28), according to

pairwise parameter comparisons.

The formative model provides additional insights. First, alcohol (.64) and marijuana (.14)

abuse, unlike cigarette smoking (.01), significantly contributed to the latent construct of

substance abuse. This, in turn, was significantly related to two items of cognitive impairment:

getting drunk and forgot (.91) and did something regretted (.91). Pairwise parameter

comparisons suggested that alcohol (.64) contributed significantly more than marijuana (.14) to

the latent substance abuse construct and the difference was statistically significant (z = -8.510, p

< .001). Cigarette smoking was significantly related to alcohol (.42) and marijuana abuse (.38)

and the latter two (alcohol and marijuana) were also significantly correlated (.36). All

correlations were significantly less than .80, suggesting limited construct overlap among the

three types of substance abuse.

Table 2 lists all the standardized direct effect, indirect effect, and total effect for all

constructs. All the direct paths in Figure 2 can also be found in Table 2 (Path 1 = -.38/Figure 2

and -.378/Table 2, due to rounding). The meaning of the total effect of Path 4 is that when
Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 10

substance abuse goes up by 1 standard deviation, risky sex also goes up by .904 standard

deviation.

Membership and perceived norm of peer abuse were non-significantly related to

substance abuse, safe sex, and risky sex. Interestingly, the standardized total effects of

membership and perceived norm on STDs were 0.300 and -0.118, respectively (see Table 2).

There are two indirect paths. The standardized indirect effect from substance abuse to STDs

through safe sex practices was -.014 (.277 * (-.052)), whereas the indirect path through risky sex

practices was .411 (.904 * .455). To calculate the total indirect effect, we combined these two

parts ((-.014) + .411 = .397) together. The sum of the direct effect and the indirect effect was the

total effect ((-.378) + .397 = .019). In summary, when substance abuse increases by 1 standard

deviation, then, STDs (1) decreases by .378 standard deviation (not falling into temptation—no

sex), (2) goes down by .052 standard deviation through safe sexual behavior (falling into sexual

temptation—safe sex), (3) but goes up by .411 standard deviation through risky sexual behavior

(falling into sexual temptation—risky sex), and (4) increases by .019 standard deviation for the

whole overall model.

DISCUSSION

Theoretical contributions. Most researchers examine relationships among substance

abuse, sexual behaviors, and numerous outcome variables, such as STDs, separately, using only

descriptive statistics. We develop a formative theoretical model, coherently integrate these

constructs together, and explore relationships among constructs of substance abuse, sexual

behaviors, STDs, and two control variables: membership of campus groups and norms of

substance abuse. We simultaneously test the hypotheses of our SEM model involving the direct

path (no sex), the indirect high path (safe sex), and the indirect low path (risky sex) (Figure 1).
Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 11

To the best of our knowledge, no research has investigated these complex relationships among

latent constructs and controlled for measurement errors of observable items together.

We clearly demonstrate that under the influence of substance abuse (alcohol), university

students have three possible choices: engage in (1) no sex, (2) safe sex, or (3) risky sex.

Regarding consequences, interestingly, the first two do not lead to STDs, but only the third one

does. Those who fall prey to substance abuse experience cognitive impairment which leads them

to fall into temptation, and engage in much higher level of risky sex which leads to STDs than

safe sex which does not. Individuals in the former (risky sex) have significantly higher cognitive

impairment than the latter (safe sex).

Table 1’s correlations show that membership in social groups is associated with STDs,

cognitive impairment, risky sex, and peer abuse. Perceived norm of peer abuse is related to

substance abuse, cognitive impairment, safe sex, risky sex, and social group affiliation, but not

related to STDs. Contrarily, Figure 2’s SEM results suggest that membership in social groups is

significantly related to contracting STDs, supporting correlation data and images of social

organizations on campus. However, perceived social norm of peer substance abuse, based on

their cognitive and rational thinking, are not related to substance abuse, safe sex, and risky sex.

We suspect that rational cognitive awareness of social norm for peer abuse is strong

enough to persuade students not to engage in risky behaviors and avoid falling into temptation,

eliminating the risk of contracting STDs. Perceived cognition of social norm, however, is not

exactly the same as their actual behaviors—actual substance abuse (alcohol) and risky sex in the

heat of the moment (41) under cognitive impairment. Cognitive impairment in the actual context

plays a much more important role regarding safe and risky sexual behaviors than peer effects.
Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 12

Empirically, our sample was small and slightly older than typical college students.

Experiments replicate SEM results (39). It is not practical, however, to establish cause-and-effect

relationships for this study—from substance abuse to sexual behaviors to STDs. We provide a

solid model for future research.

Practical contributions. Students can definitely avoid contracting STDs. Following

theory of free will, individuals value self-control, follow rules, and make rational decisions (17).

High self-control adolescents adopt long-term positive goals, maintain physical and reproductive

health, achieve successful academic, career, family, and personal goals, and refrain from short-

term risky behaviors with undesirable consequences (18). Yet it is difficult for students to

exercise self-control. They are not only alone by themselves without parents and relatives but

also under the influence of students in their campus social community.

The creation of the family starts at the wedding (25). Parents offer the most basic

training of moral values—precepts of what is right and wrong (ethics)—at home. Adolescents

with strong self-control can lead them not to temptation of instant gratification (49-50). Bad

company corrupts good morals: parents prevent negative behaviors, but peers promotes them,

unfortunately. Resources to resist temptation are limited. Adolescents must follow a difficult and

narrow (high) path, not an easy and broad (low) path, seek inspiration from parents and moral

leaders, aspire to please them, face the light (not darkness), identify like-minded good-moral

company—friends and groups-organizations on campus for support, hold their arms up, never let

their guard down, and fight against sexual temptations.

Adolescents must be aware of the dangers of substance abuse, curb binge drinking, evade

cognitive impairment and the temptation, successfully create a positive Pygmalion Effect (44-49)

for themselves and peers, practice sexual abstinence and safe sex, and elude contracting STDs.
Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 13

Policymakers should use educational resources, target young adolescents early in their lives,

develop skills training programs for abstinence and setting healthy SMART (Specific,

Measureable, Ambitious, Realistic, and Time) goals, promote positive social norms for student

organizations, in particular, and population, in general, provide a conducive and safe campus

milieu, and promote self-control to prevent STDs. Future scholars may empirically explore

whether the affiliations to sport teams are related to increased rates of sexual violence

perpetration by males and victimization of females.

CONCLUSIONS

Substance abuse leads to cognitive impairment and three possible outcomes—no sex, safe

sex, and risky sex. Directly, for students who do not fall into temptation and do not have sex,

substance abuse is not related to STDs. For those who fall into temptation, substance abuse is

more significantly related to risky sex which leads to STDs than to safe sex which does not.

Those engaging in risky sex have higher cognitive impairment than those practicing safe sex.

Avoiding substance abuse (alcohol) and staying in a conducive campus environment may

substantially prevent STDs.

Compliance with Ethical Standards, Human and animal rights, and informed consent: All
procedures performed in studies involving human participants were in accordance with the
ethical standards of the institutional and/or national research committee and with the 1964
Helsinki Declaration, as revised in 2000. Informed consent was obtained from participants in this
study.
Funding: The authors received no funding.
Conflict of Interest: The authors declare that they have no conflict of interest.
Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 14

REFERENCES
1. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance

2014. Atlanta, GA: U.S. Department of Health and Human Services, 2015.

2. Wallace AR, Blood EA, Crosby RA, Shrier LA. Differences in correlates of condom use

between young adults and adults attending sexually transmitted infection clinics.

International Journal of STD & AIDS, 2015; 26(8):526-533.

3. Lau JS, Adams SH, Irwin CE, Ozer EM. Receipt of preventive health services in young

adults. Journal of Adolescent Health, 2013;52(1):42-49.

4. MacDonald NE, Wells GA, Fisher WA, et al. High-risk STD/HIV behavior among

college students. Journal of American Medical Association, 1990;263(23):3155-3159.

5. Reece M, Herbenick D, Schick V, et al. Condom use rates in a national probability

sample of males and females ages 14 to 94 in the United States. Journal of Sexual

Medicine, 2010;7(5)SI:266-276.

6. Liddon N, Olsen EO, Carter M, Hatfield-Timajchy K. Withdrawal as pregnancy

prevention and associated risk factors among US high school students: Findings from the

2011 National Youth Risk Behavior Survey. Contraception, 2016;93(2):126-132.

7. Chesson H, Harrison P, Kassler WJ. Sex under the influence: The effect of alcohol policy

on sexually transmitted disease rates in the United States. Journal of Law & Economics,

2000;43(1):215-238.

8. Huebner AJ, Howell LW. Examining the relationship between adolescent sexual risk-

taking and perceptions of monitoring, communication, and parenting styles. Journal of

Adolescent Health, 2003;33(2):71-78.

Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 15

9. Tolou-Shams M, Conrad S, Louis A, Suford SH, Brown LK. HIV testing among non-

incarcerated substance-abusing juvenile offenders. International Journal Adolescent

Medicine and Health 2015;27(4):467-469.

10. Guo J, Chung IJ, Hill KG, et al. Developmental relationships between adolescent

substance use and risky sexual behavior in young adulthood. Journal of Adolescent

Health, 2002;31(4):354-362.

11. Seth P, Sales JM, DiClemente RJ, et al. Longitudinal examination of alcohol use: A

predictor of risky sexual behavior and trichomonas vaginalis among African-American

female adolescents. Sexually Transmitted Diseases, 2011;38(2):96-101.

12. Valois RF, Oelmann JE, Waller J, Hussey JR. Relationship between number of sexual

intercourse partners and selected health risk behaviors among public high school

adolescents. Journal of Adolescent Health, 1999;25(5):328-335.

13. Swartzendruber A, Sales JM, Brown JL, et al. Comparison of substance use typologies as

predictors of sexual risk outcomes in African American adolescent females. Archives of

Sexual Behavior, 2016;45(1):63-72.

14. Reidy DE, Smith-Darden JP, Cortina KS, et al. Masculine discrepancy stress, teen dating

violence, and sexual violence perpetration among adolescent boys. Journal of Adolescent

Health, 2015;56:619-624.

15. Agardh A, Cantor-Graae E, Ostergren PO. Youth, sexual risk-taking behavior, and

mental health: A study of university students in Uganda. International Journal of

Behavioral Medicine, 2012;19(2):208-216.

Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 16

16. Buhi ER, Marhefka SL, Hoban MT. The state of the union: Sexual health disparities in a

national sample of US college students. Journal of American College Health,

2010;58(4):337-36.

17. Baumeister RF, Heatherton TF, Tice DM. Losing control: How and why people fail at

self-regulation. San Diego, CA: Academic Press, 1994.

18. Gino F, Schweitzer ME, Mead NL, Ariely D. Unable to resist temptation: How self-

control depletion promotes unethical behavior. Organizational Behavior and Human

Decision Processes, 2011;115(2): 191-203.

19. Kahneman D. Thinking, fast and slow. New York: Farrar, Straus and Giroux, 2011.

20. Gannon-Loew KE, Eickhoff JC, Moreno MA. The relationship between attitude, social

norms and alcohol use: A longitudinal analysis using Facebook. Journal of Adolescent

Health, 2016;58:S108-S109.

21. Quinn PD, Fromme K. Self-regulation as a protective factor against risky drinking and

sexual behavior. Psychology of Addictive Behaviors, 2010;24(3):376-385.

22. Moreno MA, Cox ED, Young HN, Haaland W. Underage college students’ alcohol

displays on Facebook and real-time alcohol behaviors. Journal of Adolescent Health,

2015; 56:646-651.

23. Hirschi, T. (1969). Causes of delinquency. Berkley, CA: University of California.

24. Gentina E, Tang TLP, Gu QX. Does bad company corrupt good morals? Social bonding

and academic cheating among French and Chinese teens. Journal of Business Ethics.

2015. doi:10.1007/s10551-015-2939-z

25. Gentina, E., Tang, T. L. P., & Gu, Q. X. Do parents and peers influence adolescents’

monetary intelligence, and consumer ethics? French and Chinese adolescents and
Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 17

behavioral economics. Journal of Business Ethics, 2016. DOI:10.1007/s10551-016-

3206-7

26. Gu QX, Tang TLP, Jiang W. Does moral leadership enhance employee creativity?

Employee identification with leader and leader-member exchange (LMX) in the Chinese

context. Journal of Business Ethics, 2015;126(3):513-529.

27. Tang TLP, & Liu H. Love of money and unethical behavior intention: Does an authentic

supervisor’s personal integrity and character (ASPIRE) make a difference? Journal of

Business Ethics, 2012;107(3): 295-312.

28. Ali MM, Dwyer DS. Estimating peer effects in sexual behavior among adolescents.

Journal of Adolescence, 2011;34(1):183-190.

29. Kramer ADI, Guillory JE, Hancock JT. Experimental evidence of massive-scale

emotional contagion through social networks. Proceedings of the National Academy of

Sciences of the United States of America, 2014;111(24):8788-8790.

30. Soule EK, Barnett TE, Moorhouse MD. Protective behavioral strategies and negative

alcohol-related consequences among US college fraternity and sorority members. Journal

of Substance Use, 2015;20(1):16-21.

31 Wechsler H, Dowdall GW, Maenner G, et al. Changes in binge drinking and related

problems among American college students between 1993 and 1997: Results of the

Harvard School of Public Health College Alcohol Study. Journal of American College

Health, 1998;47(2):57-68.

32. Wechsler H, Dowdall GW, Maenner G, Gledhill-Hoyt J, Lee H. Changes in binge

drinking and related problems among American college students between 1993 and 1997:
Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 18

Results of the Harvard School of Public Health College Alcohol Study. Journal of

American College Health, 1998;47(2):57-68.

33. LaBrie J, Earleywine M, Schiffman J, Pedersen E, Marriot C. Effects of alcohol,

expectancies, and partner type on condom use in college males: Event-level analyses.

Journal of Sex Research, 2005;42(3):259-266.

34. Primack BA, Fertman CI, Rice KR, et al. Waterpipe and cigarette smoking among

college athletes in the United States. Journal of Adolescent Health, 2010;46(1):45-51.

35. Reidy DE, Brookmeyer KA, Gentile B, Berke DS, Zeichner A. Gender role discrepancy

stress, high-risk sexual behavior, and sexually transmitted disease. Archives of Sexual

Behavior, 2016; 45(2):459-465.

36. Perkins HW, Haines MP, Rice R. Misperceiving the college drinking norm and related

problems: A nationwide study of exposure to prevention information, perceived norms,

and student alcohol misuse. Journal of Studies on Alcohol, 2005;66(4):470-478.

37. Haines MP, Barker G, Rice RM. The personal protective behaviors of college student

drinkers: Evidence of indigenous protective norms. Journal of American College Health,

2006;55(2):69-75.

38. Lindley LL, Barnett CL, Brandt HM, Hardin JW, Burcin M. STDs among sexually active

female college students: Does sexual orientation make a difference? Perspectives on

Sexual and Reproductive Health, 2008;40(4): 212-217.

39. Chen JQ, Tang TLP, Tang NY. Temptation, monetary intelligence (love of money), and

environmental context on unethical intentions and cheating. Journal of Business Ethics,

2014;123(2):197-219.
Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 19

40. Tang TLP, Sutarso T. Falling or not falling into temptation? Multiple faces of temptation,

monetary intelligence, and unethical intentions across gender. Journal of Business Ethics,

2013;116(3):529–552.

41. Ariely D, Loewenstein G. The heat of the moment: The effect of sexual arousal on sexual

decision making. Journal of Behavioral Decision Making, 2006;19(2):87-98.

42. Hoban, M. American College Health Association-National College Health Assessment

Spring 2008 Reference group data report (abridged). Journal of American College

Health, 2009;57(5):477-488.

43. Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP. Common method biases in

behavioral research: A critical review of the literature and recommended remedies.

Journal of Applied Psychology, 2003;88(5):879-903.

44. Covey J, Rosenthal-Stott HES, Howell SJ. A synthesis of meta-analytic evidence of

behavioral interventions to reduce HIV/STIs. Journal of Behavioral Medicine, 2016.

doi:10.1007/s10865-016-9714-1.

45. Hall KS, Sales JM, Komro KA, Santelli J. The state of sex education in the United States.

Journal of Adolescent Health, 2016;58 (6):596-597.

46. Lederman, RP, Chan WY, Roberts-Gray C. Parent-adolescent relationship education

(APRE): Program delivery to reduce risks for adolescent pregnancy and STDs.

Behavioral Medicine, 2008;33:137-143.

47. Durvasula R, Miller TR. Substance abuse treatment in persons with HIV/AIDS:

Challenges in managing triple diagnosis. Behavioral Medicine, 2014;40: 43-52.

48. Howard LW, Tang TLP, Austin MJ. Teaching critical thinking skills: Ability, motivation,

intervention, and the Pygmalion effect. Journal of Business Ethics, 2015;128:133-147.

Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 20

49. Muraven M, Baumeister, RF. Self-regulation and depletion of limited resources: Does

self-control resemble a muscle? Psychological Bulletin, 2000;126(2):247-259.

50. Tangney JP, Baumeister RF, Boone AL. High self-control predicts good adjustment, less

pathology, better grades, and interpersonal success. Journal of Personality, 2004;72(2):

271-324.
Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 21

Table 1 Mean, Standard Deviation, and Correlations of Major Variables

______________________________________________________________________________
Variable M SD 1 2 3 4 5 6 7 8 9
______________________________________________________________________________

1. Age 23.30 7.03

2. Sex (%M) .36 .48 -.01
3. Race (%W) .89 .31 .03 .04
4. Abuse 2.41 2.46 .07 .06 .13**
5. Impairment 1.91 .66 -.05 -.06 .10* .54**
6. STDs 1.00 .05 -.04 .03 -.01 .01 .05
7. Safe 3.01 1.50 .05 -.04 -.08* .20** .21** -.01
8. Risky 1.60 1.04 -.02 .05 -.00 .44** .50** .02 .32**
9. Norm 53.45 17.99 -.16** -.14** .05 .18** .19** -.02 .12** .17**
10. Member 1.06 .15 -.14** .03 .07 -.04 .14** .17** .02 .12** .08*

______________________________________________________________________________

Note. N = 687. Sex: Male = 1, Female = 0; Race: White = 1 Non-White = 0

Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 22

Table 2 Standardized Direct, Indirect, and Total Effect

______________________________________________________________________________

Substance Safe Risky

Variable Member Peer Abuse Sex Sex
______________________________________________________________________________

Direct Effect

Peer .099
Substance Abuse .129 .049
Safe Sex -.002 .091 .277
Risky Sex -.028 .008 .904
STDs .321 -.117 -.378 -.052 .455
______________________________________________________________________________

Indirect Effect

Peer .000
Substance Abuse .005
Safe Sex .046 .014
Risky Sex .112 .044
STDs -.022 .000 .397
______________________________________________________________________________

Total Effect

Peer .099
Substance Abuse .134 .049
Safe Sex .044 .104 .277
Risky Sex .094 .052 .904
STDs .300 -.118 .019 -.052 .455

______________________________________________________________________________
Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 23

Figure 1 Our theoretical Model

Sutarso et al.: Sexual temptation Int J Adolesc Med Health 2016 24

Figure 2 Results of Our Diamond Theory of Temptation With Two Control Variables