Date of Degree


Document Type


Degree Name





Sarit A. Golub


Jeffrey T. Parsons

Subject Categories

Public Health Education and Promotion | Quantitative Psychology | Social Psychology


arousal, condom use, dual process model, gay and bisexual men, rejection sensitivity, sexual risk


Dual process theories of decision making acknowledge the functioning of two distinct yet simultaneous processes termed System 1 and System 2. While System 1 relies more heavily on automatic and affective processing, System 2 relies more heavily on effortful and cognitive processing. Over the past several decades, many lines of research have shown the importance of System 1 in decision making and several prominent social psychological theories of interpersonal behavior, such as rejection sensitivity, rely on this dual distinction between affective and cognitive processing. Despite the prominence of dual process theories in many areas of psychology, the role of System 1 has been largely absent from psychological inquiries into sexual decision making. As such, the aims of this dissertation were to: (1) investigate a dual process model of sexual decision making by incorporating the role of anxious and sexual arousal into a model with known System 2 predictors of sexual behavior; and (2) examine whether rejection sensitivity as a dispositional trait can be applied to condom use as a behavior and whether it acts upon condom use via interactions within the dual process framework investigated within the first aim.

To achieve these aims, data were collected as part of a larger, longitudinal study of highly sexually active gay and bisexual men in New York City. As part of the project, men completed a one-hour survey from home (i.e., computer-assisted survey interviewing or CASI) as part of their 12-month longitudinal follow-up appointment and subsequently completed a 30-day online daily diary of their affect and sexual behavior. Using multilevel modeling, I tested a series of hypotheses regarding the role of anxious arousal (within-person), sexual arousal (within-person), perceived behavioral control (within-person), safer sex self-efficacy (between-person), and condom-related rejection sensitivity (between-person) on daily engagement in unprotected anal intercourse (UAI) with casual male partners.

Across models, results supported several of the hypotheses from the first aim. Although anxious arousal was not found to be associated with engagement in UAI, sexual arousal was significantly positively associated with UAI, as hypothesized. Similarly, perceived behavioral control and safer sex self-efficacy were both shown to be negatively associated with engaging in UAI. Results did not support the hypothesis that System 1 (i.e., sexual arousal) and System 2 (i.e., behavioral control) processing interact in their influence on UAI, but rather that System 1 biases System 2 processing as demonstrated through a mediational analysis. Building upon these analyses, several of the hypotheses from the second aim were also confirmed. Condom-related rejection sensitivity was found to be significantly and positively associated with engaging in UAI as well as with higher levels of anxious arousal on a given day. Examining potential mechanisms of the association between rejection sensitivity and UAI, results revealed significant interactions between rejection sensitivity and self-efficacy as well as rejection sensitivity and sexual arousal. Taken together, findings suggest that rejection sensitivity may ameliorate the protective effect of self-efficacy on UAI and heighten the risk for UAI influenced by sexual arousal. The theoretical and public health implications of the findings and directions for future research are discussed.