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TPJXXX10.1177/0032885514563271The Prison JournalCarcedo et al.

The Prison Journal
2015, Vol. 95(1) 43­–65
The Relationship © 2014 SAGE Publications
Reprints and permissions:
Between Sexual
DOI: 10.1177/0032885514563271
Satisfaction and

Psychological Health
of Prison Inmates: The
Moderating Effects of
Sexual Abstinence and

Rodrigo J. Carcedo1, Daniel Perlman2,
Félix López1, M. Begoña Orgaz1,
and Noelia Fernández-Rouco1,3

Research has found a relationship between sexual satisfaction and
psychological health in prisoners, although few studies have focused on
possible moderators of this relationship. The main foci of this study of
a sample of prison inmates were as follows: (a) the association between
sexual satisfaction and psychological health and (b) the moderating effects
of heterosexual activity level (abstinent vs. non-abstinent) and gender on
the relationship between these two variables. In-person interviews were
conducted with 82 males and 91 females who lived in separate modules in
Spain’s Topas Penitentiary. Sexual satisfaction was a significant predictor of
psychological health only for members of the sexually abstinent group. These

1University of Salamanca, Salamanca, Spain
2University of North Carolina, Greensboro, NC, USA
3University of Cantabria, Santander, Spain

Corresponding Author:
Rodrigo J. Carcedo, Department of Developmental and Educational Psychology, University of
Salamanca, Facultad de Psicología, Avda. de la Merced, 109-131 37005 Salamanca, Spain.

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44 The Prison Journal 95(1)

findings point to the positive effect of sexual satisfaction on psychological
health, especially for the inmates in a less favorable sexual situation (i.e.,
sexual abstinence).

sexual abstinence, sexual satisfaction, psychological health, prison inmates

The research to be reported in this article focused on (a) the differences in
sexual satisfaction as a function of gender and the level of sexual activity
(being sexually abstinent or not), (b) the relationship between sexual satis-
faction and psychological health, and (c) the moderating effect of gender
and level of sexual activity on this relationship. Many authors have noted
that inmates suffer due to heterosexual sexual relationship deprivation in
prison (Lacombe, 1997; Levenson, 1983; Maeve, 1999; Neuman, 1982;
Sánchez, 1995). However, none of the authors has empirically tested
whether these inmates showed less sexual satisfaction than the inmates
who have had sex. The role of gender in this relationship is also unknown.
In addition, some prison studies have found a relationship between sexual
satisfaction and psychological health (Carcedo, López, Orgaz, Toth, &
Fernández-Rouco, 2008), but there are no studies of whether this associa-
tion is moderated by other variables such as gender and the level of sexual

Gender, Sexual Abstinence, and Sexual Satisfaction
Female inmates have been found to show higher levels of sexual satisfaction
than males (Carcedo et al., 2008). However, after controlling for age, nation-
ality, total time in prison, actual sentence time served, and estimated time to
parole and partner status, this difference was not statistically significant
(Carcedo et al., 2011).
Several authors have reported negative feelings toward abstinence by both
male and female inmates (i.e., Lacombe, 1997; Maeve, 1999; Neuman, 1982;
Sánchez, 1995). However, only one study of prison inmates has empirically
investigated the differences in the sexual satisfaction of heterosexually absti-
nent and heterosexually active inmates, finding much lower levels of sexual
satisfaction in the sexually abstinent group (Carcedo, 2005). Gender was not
taken into account in that study, although this is an important variable to con-
sider. In the present study, sexual abstinence and gender effects will be exam-
ined together with respect to inmates’ sexual satisfaction.

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2005. 2012).2% more of the variance was explained for females than males. 2008. However. & Orgaz. 2004. 1982). this variable has been associated with psychological health and happiness in both genders. Downloaded from tpj. In a study of 118 male and 70 female prison inmates. 2008. 2002). 2012) and non-prison studies (Fegg et al. 2005. Neuman. 1999. the possibility that gender moderates the relationship between sexual satisfac- tion and psychological health warrants consideration. 1995). Sánchez. but the relationship between sexual variables and psychological measures has been slightly stronger among women than among men (Laumann et al. Notwithstanding. Arrigo. 1983. Linville (1981) found that approximately three quarters of a sample of 100 males in a minimum-security prison reported emotional problems because of sexual deprivation. 1977. Taleporos & McCabe. & Yang. Wang. Taleporos & McCabe. 2011.. 2002). One of the possible causes of this risk is that inmates encounter difficulties in having a satisfactory sex life (Carcedo. although 6. Villa. 45 Sexual Satisfaction and Psychological Health Prison inmates have been identified as an at-risk population for poor psycho- logical health because of the distress associated with incarceration (Toch. 2003. Linville. 1981. Neuman. 2006. 1988). Carcedo et al. Carcedo. Carcedo et al.. Moreira. 1997. Zamble & Porporino. Levenson. (2008) found that sexual satisfaction signifi- cantly explained the psychological health for both genders.Carcedo et al. Lau. Lacombe. Higher levels of sexual satisfaction were asso- ciated with higher levels of psychological health and other well-being related measures. female inmates (Pardue. This will also be examined in the present study. In addition. Perlman. 2015 . Levenson. Cheng. Carcedo et al. & Glasser. 2005.sagepub. Maeve. Thus.. it is unknown if the relationship between sexual satisfaction and psychological health is dif- ferent for male and female inmates. 1983. 1997. 1982). the possible moderator effect of gender was not tested. & Murphy. Ló at UQ Library on March 13.. In non-prison popu- lation studies that have strictly measured sexual satisfaction or sexual well- being. Moderating Effect of Gender and Sexual Abstinence on the Relationship Between Sexual Satisfaction and Psychological Health The suffering and the deterioration of psychological health due to the lack of sexual satisfaction have been suggested regarding male inmates (Lacombe. and both gen- ders (Carcedo et al.. sexual satisfaction and psychological health and other well-being-related measures have been shown to be significantly related in prison settings (Carcedo. Nicolosi.

p. 1983. reactance is likely to be high among inmates whose access to heterosexual activity is thwarted by their circumstances. 1981). amputations (Walters & Williamson. any form of depriva- tion may increase the desire for the deprived object (Brehm & Brehm. Maeve. these authors were implicitly confounding sexual satis- faction with sexual abstinence. or eliminated. Sánchez. Notwithstanding. 1997. 2005. If their freedom is reduced. most authors (Lacombe. the moderating effect of being sexu- ally abstinent versus active in the relationship between sexual satisfaction and psychological health will be tested in this research. Neuman. individuals will become “motivationally aroused” to regain this freedom (Brehm. the relationship between inmates’ sexual satisfaction and psychological health may be different for sexual abstainers versus sexu- ally active individuals. 1966. 1999. Poorer mental health has been Downloaded from tpj. 2015 . 9)... such reactance may intensify the association between their sexual satisfaction and psychological at UQ Library on March 13. Ventegodt.46 The Prison Journal 95(1) In arguing that a lack of sexual satisfaction can negatively impact prison inmates’ psychological health. an inmate may have been sexually active. a set of socio-demographic and punishment-related variables have been found to be important. amplifying its relevance for individuals’ psychological health. Levenson. Thus.” (p. Whereas sexual satisfaction reflects an evalu- ation of one’s current sexual life. Thus. yet have low sexual satisfaction. These different concepts may delineate different situations: An inmate may have been sexually absti- nent during the last 6 months. 1998). physical disabilities (Taleporos & McCabe. psychological reactance is a “motivational state directed toward the re-establishment of free behaviors that have been eliminated or threatened with elimination. 2). Therefore. 2003). 1998). According to reactance theory (RT. For example. 1982. sexual abstinence refers to the complete lack of sexual relationships during a period of time. and having had germ-cell tumor therapy (Fegg et al. With reference to this research. No prison study has investigated this moderating effect. The major premise of RT is that individuals wish to operate with a freedom to choose behaviors to satisfy their needs—in this case sexual needs. 2002). In addition. Brehm. 1966). Control Variables Other variables have been demonstrated to be related to inmates’ psychologi- cal health. By contrast. threatened.sagepub. non-prison studies have found a stronger relation- ship between sexual satisfaction and general well-being for those who have been sexually deprived due to the presence of sexual dysfunctions (Lau et al. We believe that in enhancing the value of sex. 1995) were referring mainly to inmates who have not had heterosexual sexual relationships during their incarceration. yet show reasonable high sexual satisfaction.

part- ner status. actual sentence time served. estimated time to parole. these variables were also included in analyzing the effect of sexual abstinence on sexual satisfaction because of their potential association with inmates’ sexual satisfaction. 2006). Caucasian (Lindquist. These included sexual satisfaction (the main predictor variable). partner status. estimated time to parole. and estimated time to parole as control variables when predicting psychological health. Due to these findings.sagepub. Taking these results into consideration. and frequency of masturbation? (c) Will gender and/or sexual abstinence play a moderating role in the relationship between sexual satisfaction and psychological health? More specifically. the authors include age.Carcedo et al. Das. & Laumann. Langstrom & Hanson. social loneliness. social loneliness and frequency of Downloaded from tpj. 2000). masturbation has been found to be related to sexual satisfac- tion and well-being-related measures in non-prison studies (Das. at UQ Library on March 13. partner status. and frequency of masturbation? (b) Will sexual satisfaction be associated with inmates’ psychological health after controlling for age. actual sentence time served. In addition.. and social loneli- ness has been shown to be an important predictor of prisoners’ psychological health (Carcedo et al. Although the relationship between these variables and sexual satisfaction has not been investigated in prison research. ethnic group-nationality. married (Lindquist. 2009. total time in prison. actual sentence time served. Lindquist & Lindquist. In sum. 2015 . we also included the frequency of masturbation as a possible predictor of sexual sat- isfaction and psychological health. Parish. eth- nic group-nationality. total time in prison. will sexual satisfaction explain more variance in the psychological health among inmates in the “worse-off” heterosexually abstinent group than among inmates in the heterosexually active group? Will sexual satisfaction explain more variance in the psychological health of females than of males? Method Design The data for this study were collected in two sessions. and who have longer sen- tences and a longer expected time prior to their release (James & Glaze. 2007. total time in prison. 47 exhibited by inmates who are younger. and social loneliness as a possible predic- tor of psychological health. The primary variables of our study were all evaluated in the first session. we set out to examine the following research questions in this study: (a) Will gender and sexual abstinence be associated with inmates’ sexual satisfaction after controlling for age. 2008). 1997). 2006). ethnic group-nationality.

98 months. While 35. 173 medium-security prison inmates (91 men and 82 women) from a prison in the northwestern region of Spain provided data for this study during 2008.96% were foreigners (n = 102).18% reported having had sexual relationships in other areas inside the prison where men and women share different activities ( at UQ Library on March 13.g. the gym. and estimated time to parole were 51. 74.24% (n = 80.. Their average age was 35. The outcome variable (psycho- logical health) was evaluated in the second session. the socio-cultural module. the moder- ating variables (heterosexual activity level and gender).04% (n = 71) were Spanish. 2015 . 64.sagepub. Inmates reported that all their sexual relationships had been heterosexual and had included vaginal coitus at least once in the last 6 months. The mean of total time in prison for all offenses. respectively. of the heterosexually active group. actual sentence time served for their current offense. After stratifying by gender. total time in prison. Participants In total.72% reported having had sexual relation- ships in the conjugal visits rooms inside the prison.. 80% of the participants were randomly selected. The heterosexual activity status of participants (i. Regarding nationality. at their workplace in prison. whereas 58. 29 men and 64 women) had had sexual relationships in the last 6 months.59% reported having maintained sexual relationships during their furloughs outside the prison. Depending on the inmates’ schedules. 1961). Participants were selected to have an equal number of men and women. Participants were excluded under the following conditions: (a) they Downloaded from tpj. abstinent vs. and 53. nationality. All these sexual behaviors were con- sensual except for the case of one female and one male inmate who had also had consensual sexual relationships. 53 men and 27 women) of the inmates had been sexually abstinent for at least 6 months. etc.61. It was checked in the sec- ond session to verify that the situation of the inmates had not changed between sessions.76% (n = 93.26% (n = 61) had no romantic partner. while 20% were selected under a “snowball” sampling scheme (Goodman. and the control vari- ables (age.). 41. There was no participant change. With respect to the characteristics of the sample regarding sexual behav- ior. and 24. with a range from 20 to 62. 42. actual sentence time served. none reported having had homo- sexual contacts during the 6 months prior to data collection. and anticipated time to parole). Finally.e. partner status. het- erosexually active) was obtained in both sessions. 46.35.10 years. and 24.74% (n = 112) had a partner. 6. Although some of the inmates reported having had homosexual contacts in prison.48 The Prison Journal 95(1) masturbation (other relevant interpersonal and sexual predictors). the second session was conducted approximately a week later.

49 had been in prison for less than 6 months. They also were asked to participate and were informed about the possibility of leaving the study whenever they wished to do so. Procedure This study is part of a larger project that involved two interview at UQ Library on March 13. an “interrogation effect”). No names were attached to the interviews and an informed consent statement was signed by the inmate and the inter- viewer. the interviewer spent a significant amount of time gaining each inmate’s trust. (c) they did not speak Spanish or English. which meant that any information given during the interview would not be divulged and their names would not appear in any printed reports. In addition. The time needed to complete questionnaires was kept short (approximately 30 min) to avoid participants either getting tired or experiencing an invasive sense of being questioned (i. Due to an interviewer error or that the inmate refused to answer.. in the inmate’s module. All of the participants considered the interview as a generally positive experience.. depending on the inmate’s responsiveness. the time considered necessary to adapt to prison life and develop new relationships inside the facility.. participants were informed about the confiden- tiality and anonymity of their answers.Carcedo et al. it usually lasted around 30 min. Usually. the second session was conducted. Both kinds of measures were mixed in the two sessions.g. psychotic and mood disorders). the trust-building phase took around 20 min. but they were included in the analyses using the mean of the other items in the scale that had been answered. a period when inmates are usually focused on being released more than their life in prison.g. Approximately a week later. The first session lasted between 60 and 90 min.e. participants were invited to read and sign the consent form. Both sessions consisted of interview questions formulated specifically for this project and standardized questionnaires.sagepub. Before the start of the interview. in some cases it took up to 2 hr. The first author conducted in-person interviews with each participant in a private room. (d) they had been diagnosed with a serious mental disorder (e. However. 23 participants skipped a single item from one or more scales. 2015 . especially because it gave them an oppor- tunity to express their personal worries and feelings. Before beginning the interview itself. under the influence of drugs or expressing high levels of anxiety or distrust toward the interviewer). Only eight potential participants declined or stated that they were not interested in being interviewed. or (e) they were not in optimal condition to be interviewed (e. separated from the rest of the inmates. (b) the estimated time to parole was less than a month. Downloaded from tpj.

Downloaded from tpj.96. In the last 6 months. 2 (less than once per month). A total of five items were scored on 5-point Likert-type scales that ranged from 1 (not at all character- istic of me) to 5 (very characteristic of me). always). Outcome variable: Psychological health. Moderating variables: Heterosexual activity level (abstinence) and gender.81. The following question was used to measure masturbation: “Masturbation is a normal and very common human behavior. 1998) was used. The total score was obtained by adding the individual scores and dividing them by the number of items answered. how often did you masturbate?” The possible answers ranged from 1 (never). the five-item social loneliness sub- scale of the short version of the Social and Emotional Loneliness Scale for Adults (SELSA-S. Items were answered on a 7-point Likert-type scale that ranged from 1 (strongly disagree) to 7 (strongly agree). Brannen. The Psychological Health State score was obtained by summing the individual scores and dividing them by the number of items answered. the short. Snell.72. Gender was recorded as 0 for females and 1 for males. 5 (once per day). Coefficient alpha for this subscale was . 2004) was used. Spanish version of the Psychological Health subscale of the World Health Quality of Life scale (WHOQOL-BREF.sagepub. 4 (once or twice per week). to 6 (more than once per day). Possible scores range from 1 to 5 (high sexual satisfac- tion). DiTommaso. never) to 5 (extremely-completely. 1995) was used. Alpha was . and 1 for the inmates who had had at least one sexual relationship in the last 6 months. 3 (once or twice per month). Coefficient alpha for this subscale was . Six items were scored on a 5-point Likert-type scale that at UQ Library on March 13. the Sexual Satisfaction subscale of the Multidimensional Sexual Self-Concept Questionnaire (MSSCQ. Possible score range from 1 to 5 (positive health). The total sexual satisfaction score was obtained by summing the scored items and dividing them by the number of items answered. 2015 . with differ- ent labels.  To measure loneliness. very satisfied. Absti- nence was recorded as 0 for the inmates who had not experienced any sexual relationships in the past 6 months.  To assess this dimension. very dissatisfied. Other interpersonal and sexual predictor variables: Social loneliness and frequency of masturbation. Pos- sible scores range from 1 to 7 (high loneliness). & Best. Lucas. from 1 (not at all.  To measure this construct.50 The Prison Journal 95(1) Measures Primary predictor variable: Sexual satisfaction.

thus they were likely to expect parole around this time. The esti- mated time to parole was the amount of time remaining before each inmate’s expected parole date.sagepub. Nachtsheim.e. It also was obtained from inmate penitentiary records and listed in months. This item denotes the time spent in prison since the last entry (i..Carcedo et al. sexual activ- ity level is significantly associated with gender. 1974. Nationality. the individual and combined effects of sexual activity level. we used the model com- parisons strategy recommended by Neter..  Nationality was split into Spaniards (0) versus foreigners (1). After discussions with the legal advisors from Topas Penitentiary. Because of the presence of non-orthogonality in the design (i. 2015 . This variable was also recorded in months. Analysis Strategy The primary research issue addressed by this project is how the sexual satis- faction of heterosexually abstinent (male and female) and heterosexually active (male and female) inmates is related to their psychological health.  This variable was obtained from the sum of all time spent in a prison for previous and current offenses. Clearly. see Table 1). beginning with the test of the higher order interaction (third order: Sexual Downloaded from tpj. Maxwell & Delaney. It was collected by review- ing inmates’ penitentiary records and recorded in months. Following Neter et al.e. Total time in prison. gender. we chose to take three quarters of participants’ actual sentences as the expected time when inmates would be paroled due to the fact that it was the modal parole time. In particular. Kutner. Cramer & Appelbaum. a logical sequence of model comparisons is undertaken. 51 Control variables Age. actual time to parole varies. Actual sentence time served. and Wasserman (1996) who applied previous authors’ recommendations on ANOVA designs (Appelbaum & Cramer. This fact was familiar to the inmates. and sexual satisfaction on psychological health were assessed. Estimated time to parole. during the current prison term).  This item was rated as 0 for inmates without a partner and 1 for inmates in a romantic relationship. depending on inmates’ characteristics and behavior.’s recommendations. 1990) to regression designs. Partner status.  Inmates were asked to state their ages. and this variable was con- firmed using inmate penitentiary records to ensure accuracy. at UQ Library on March 13.

Actual sentence served 44.96 (33. Sexual satisfaction × Gender. 1996).44 (0. Chi-squares were performed using the exact test.03 (1. 2015 .35 (32.08) 44.37% *** 10. In all the analyses reported here. Frequency of masturbation 2. total time in prison.25) 41. and finally a test of each interaction in the absence of the other (ignoring tests).001. allowing valid conclusions to be drawn even in the presence of highly non-orthogonal regression models (Neter et al.44% 60. ***p < . 2009). Time to parole 25.67) ** Note. actual sentence time served. **p < .com at UQ Library on March 13. Sexual satisfaction 1. Social loneliness 3. Asymptotic likelihood ratio chi- squares yielded the same significant differences.05. Only the minimum number of tests nec- essary to logically determine a final statistical model is performed.51) 24.06 (47. national- ity.89% ***   4.40)     9. participant age.32 (0.78) 3.18)     2. These effects are also called “main effects” in ANOVA designs (see Hayes & Matthes. *p < .34) *** 11. Nationality (Spanish) 39. and. satisfaction × Sexual activity level × Gender).84 (1.38 (1.56%     3.78 (57. Total time in prison 58.52 The Prison Journal 95(1) Table 1.sagepub.81 (7. At the end of this procedure. a test of each main effect in the absence of the other main effects (ignoring tests) is performed.80) 3. the so-called conditional effects are tested. partner status.65 (0.05)     6.69 (1.37 (16.37) 34.  Descriptive Statistics of Major Variables for Sexual-Abstinent and Non- Sexual-Abstinent Groups.68 (21.78) 3.01.86 (1. Partner status (with partner) 24. finally. Gender (males) 64. estimated time to parole. a test of each main effect in the presence of the other main effects is performed (eliminating tests). Akin to the proce- dure used with second-order interactions.42) 2. Psychological health 3. Sexually abstinent Sexually active (n = 80) (n = 93)   M (SD) M (SD)   Variables % % p   1.60) **   8.44 (8. and frequency of masturbation were controlled because Downloaded from tpj. Age 35.63% 35..24)     7.11% 75.06)     5. and Sexual activity level × Gender) in the pres- ence of the others (eliminating tests). at this stage. social loneliness. proceeding to a test of lower order interactions (second order: Sexual satisfaction × Sexual activity level.

2006. Under these cir- cumstances. 2015 .. & Aiken. yielding p values and conclusions that remain valid under the conditions observed. t tests for independent samples and chi-square tests (exact test) were conducted. 2000. West. James & Glaze. pp. actual sentence time served. two categories: 0 for “sexual-abstinent. 9-39). social loneliness.e. Das. 1997). Results Descriptive statistics were calculated and are displayed in Table 1 separately by heterosexually abstinent and heterosexually active inmates. proceeding to a test of each main effect in the pres- ence of the other (eliminating tests). total time in prison.sagepub. 2003) was utilized. 2002.. who has been incarcerated for an “average” 42 months during the current stay. 1991. all tests of categorical association were con- ducted under a permutation-based exact test statistical modeling framework (Mehta & Patel. who has served an “average” 51 months of total time in prison. Thus. Das et al. the logical sequence of model comparisons starts with the test of interaction (Sexual activity level × Gender). estimated time to parole. asymptotic likelihood ratio tests of categorical association are likely to be inaccurate. Cohen. participant age. Lindquist & Lindquist. and sexual satisfaction were centered before entry into the at UQ Library on March 13.2) developed by Hayes and Matthes (2009) were used for probing and plotting the interactions. and who has an “average” esti- mated 25 months remaining until parole). SPSS 17.0 was used for data analysis. Also. Downloaded from tpj.” and 1 for “non-sexual-abstinent”) and then estimates the effect of the focal predictor at those values. The pick-a-point approach (Aiken & West. 2007.. heterosexually abstinent and heterosexually active inmates are differently distributed within gender categories. Cohen. This program and the MODPROBE script (Version 1. 2006. To examine whether there are mean differences based on sexual activity status for the study variables. Langstrom & Hanson. 2009. This proce- dure selects representative values of the moderator variable (in this case. To study how sexual abstinence and gender were related to sexual satisfac- tion. 53 previous research has linked them to prisoner and non-prison psychological health (Carcedo et al. the same analytic approach was utilized. 2008. Lindquist. As shown in Table 1. one of an “average” age of 35 years. and sexual- abstinent group are referenced to an “average” Spaniard prison inmate with- out a partner (i. the parameter estimates associated with sexual satisfaction. gender. frequency of masturbation. and finally a test of each main effect in the absence of the other (ignoring tests). In this case. Thus.Carcedo et al.

nationality. heterosex- ual activity level. Bonferroni post hoc comparisons were used to analyze the differences between the heterosexually abstinent and heterosexually active groups. actual sentence time served. SE = . the three 2-way inter- actions (Sexual satisfaction × Heterosexual activity level. and we con- tinued studying the model with the three second-order possible interactions. actual sentence time served. and estimated time to parole. After accounting for the control variables. Sexual satisfaction × Gender. p < . Table 2 builds different sequences of hierarchical regression analyses. SE = . In short. was significantly associ- ated with sexual satisfaction (B = −1. Model 1 only includes the con- trol variables. neither gender nor the control variables were significantly associated with sexual satisfaction. Nor were any signifi- cant interaction effects between gender and level of sexual activity found for sexual satisfaction.805. As was expected. nationality.. Sexual activity level. at UQ Library on March 13. total time in prison. however. using estimated marginal means. also called least-squares means. and gender were added in the third step. The third-order level interaction was not significant.457. Model 2 adds interpersonal and sexual variables. the heterosexually abstinent inmates (M = 1. The Type III Sums of Squares and a simultaneous entry of the variables in different steps were utilized. conditional effects of sexual satisfaction. 1996). Model 3 adds the conditional effects and interactions of the variables on which this study is Downloaded from tpj.54 The Prison Journal 95(1) Sexual Activity and Gender Differences on Sexual Satisfaction An ANCOVA was performed to analyze the main and interaction effects of sexual activity and gender on sexual satisfaction after controlling for age. and Heterosexual activity level × Gender) were added in the fourth step. and the 3-way interaction (Sexual satisfaction × Heterosexual activity level × Gender) was included in the fifth step.136). Moderating Effect of Sexual Activity and Gender on the Relationship Between Sexual Satisfaction and Psychological Health Regarding the interaction effect of Sexual satisfaction × Heterosexual activity level and Sexual satisfaction × Gender on psychological health.511.316. Socio-demographic and penitentiary control variables (age. R2 = . total time in prison. partner status.sagepub. 2015 . SE = . this interaction was dropped from the final model. a series of hier- archical linear regression analyses were performed. We used the analysis strategy described above (Neter et al. once the three-way interaction was dropped.001). interper- sonal and sexual variables (social loneliness and frequency of masturbation) were included in the second step. and time to parole) were included in the first step.228.148) reported much lower levels of sexual satisfac- tion than the heterosexually active ones (M = 3.

006    Nationality 0.000 0.001.179 0. sexual satisfaction. Models 3 and 4 showed that nationality.002     Time to parole −0.399*** 0.030 −0. and being higher in sexual satisfac- tion were associated with higher psychological health (see Table 2).261* 0. Finally.054 at UQ Library on March 13.360 .103 0.116 0.089 Step 4: Interaction model   Gender × Sexual activity level 0. Being a foreign inmate.468* 0.499 0.150*** 0.351*** 0. In Model 1.003 −0. Downloaded from tpj.001 0.267 0.101 activity level R2 .  Predictors of the Prison Inmates’ Psychological Health.158*** 0.110 −0.002     Actual sentence served 0.029 −0.009** 0.002 0. 55 Table 2.344 Note.360*** 0.002 0.027. focused.003 0.231   Sexual satisfaction 0. **p < .000 0.103 −0.023 0. ***p < .006* 0.007 0.269 . and social loneliness.002 0. the significant variables that entered in the model were nationality. and the interaction between sexual sat- isfaction and heterosexual activity level were significant.128     Total time in prison 0.117 0.000 0. In this last model.01. and the interac- tion between sexual satisfaction and heterosexual activity level were esti- mated.126 .422*** 0.007 0.003 0.014 0.002 0.167 0. *p < .009). 2015 .Carcedo et al.003 0.266** 0. being lower in social loneliness. social loneliness.002 0.sagepub.265     Gender × Sexual satisfaction −0. having a shorter estimated time to parole. social loneliness.037 0.002 0. The same interaction effect was found when selected only the participants who did not miss any item from the scales (n = 150). estimated time to parole (not in Model 4).107 0.05.003 −0.028   Frequency of masturbation 0.030 −0.040 0. Psychological health   Model 1 Model 2 Model 3 Model 4   B SE B SE B SE B SE Step 1: Control variables (socio-demographics and penitentiary)  Age −0. Model 4 includes only the variables and the interaction that proved to be significant in Model 3.205 0.007* 0. the parameters of nationality.102 0. sexual satisfaction.487*** 0. p = . heterosexual activity level (in this case because it is necessary for the interaction term).004 0.170*** 0.002 Step 2: Interpersonal and sexual variables   Social loneliness −0. The contribution of explained variance by the interaction term to the Model 4 was significant (R2 = .440*** 0. In Model 2.086     Sexual satisfaction × Sexual −0.204     Sexual activity level 0.096   Partner status 0.007 0.039   Step 3: Conditional effects  Gender 0. estimated time to parole. only nationality and estimated time to parole showed to be significant.

This result contra- dicts our first two studies (Carcedo.56 The Prison Journal 95(1) Table 3.011. the greater their psychological health.089 was found among the non-sexual-abstinent group (see Table 3). 2015 . but non-significant trend (p = . **p < . 2005. The more sexually satisfied inmates were. ***p < .048 1. 2008) but supports Downloaded from tpj. The level of sexual satisfaction predicted psychological health among the sexually abstinent inmates.  The moderating impact of sexual abstinence on the relationship between sexual satisfaction and psychological health.001.956*** [0.sagepub. 0. The resulting interaction plot can be seen in Figure 1.176.351 0.179] *p < . Discussion This study found two main results: (a) Sexual satisfaction was lower for sexually abstinent inmates in comparison to inmates who have had heterosexual sexual relationships in the last 6 months.084 0. Psychological health   B SE t 95% CI Sexual activity level   Sexual-abstinent (0) 0. no differences in sexual satisfac- tion scores were found between male and female inmates. Psychological health 5 Sexual abstinence 4 3 Non-sexual abstinence 2 1 1 2 3 4 5 Sexual Satisfaction Figure 1. 0. Carcedo et al.526]   Non-sexual-abstinent (1) at UQ Library on March 13. and (b) sexual satisfaction was a significant predictor of psychological health but only for the sexually abstinent group.753 [−0.. Gender and Sexual Activity Level Differences in Sexual Satisfaction After accounting for the control variables. A similar.  Conditional Effects of Sexual Satisfaction at Two Sexual Activity Levels on Psychological Health.

. 2004. higher levels of sexual satisfaction were associated with higher levels of psychological health and other well-being-related measures. In other words. Taleporos & McCabe. the heterosexually abstinent prison inmates showed lower sexual satisfaction than the heterosexually active group. 1981). 2008). Schkade.. 2008.. Nicolosi et al. Carcedo et al. Sexual Satisfaction and Psychological Health Independent of gender and sexual activity level. one might question the impor- tance of sex. 2011) in which a set of control variables were included. other authors’ statements about prison inmates (Lacombe. the relationship between sexual satisfaction and psychological health is significant for the group whom Downloaded from tpj. 2002). at UQ Library on March 13. no interaction effect of gen- der by heterosexual activity level was found. 1983. monotonic. For all of them. This makes clear that when control variables are included. The Moderating Effects of Sexual Activity Level on the Relationship Between Sexual Satisfaction and Psychological Health Sexual satisfaction was a significant predictor of psychological health but only for the sexually abstinent group.. Levenson. higher levels of sexual satis- faction were associated with higher levels of psychological health.. The 2007 Durex Global Sexual Well-Being Survey showed that the typical adult around the world only has sex once a week with foreplay and intercourse averaging a mere 36 min (Durex®. having a sexual rela- tionship is important for inmates’ psychological health. 2009). Carcedo et al. Carcedo et al. and large. 411). This result is consistent with other prison studies (Carcedo. In sum. Krueger. Schwarz. independent of the inmate being a male or a female. 2015 . Linville. 2003. 57 the findings of a more recent work (Carcedo et al. In addition. no control variables were included in the other two previous studies that showed women to have a higher level of sexual satisfaction than men (Carcedo. 1981.. Despite this. In the present study. gender is no longer significant for inmates’ sexual satisfaction. 2005. Wylie.Carcedo et al. Linville. Blanchflower and Oswald (2004) add to this that the “effect of sex on happi- ness is statistically well determined. 1997. However. and Stone (2004) found that “intimate relations” are the most positively evaluated of all daily activities.” especially for individuals under age 40 (p. 1982). 2005. This result is akin to Carcedo’s (2005) findings. 2005. Lau et al. Of all the things that influence well-being.. Neuman. 2007.sagepub. and non-prison studies (Fegg et al. 2012.

The authors of these early studies discussed the possible negative consequences of sexual abstinence for inmates’ health (Levenson. these authors presumably were referring to inmates who had not had sex for a long time. We suspect that what inmates discuss reflects the importance they attribute to things.. RT can explain why higher levels of sexual satisfaction were associated with higher levels of psy- chological health.sagepub. flow- ing from these ideas and supporting our results. amputations (Walters & Williamson. However. although only for the inmates belonging to the sexually abstinent group. This sexual deprivation could increase the desire for having sexual rela- tionships. The interviewers’ observations and the data gathered from this and another of our previous studies (Carcedo.58 The Prison Journal 95(1) we believe were experiencing greater reactance due to their lack of choice in their sexual behaviors. Thus. Neuman. 1981. The stronger relationship between sexual satisfaction and psychological well-being among the sexually abstinent group also complements themes in the early prison literature. 2002).com at UQ Library on March 13. this result needs to be further investigated not only in prison inmates but also in other populations with sexual problems in relation with other individuals without these issues. 2005) have relevance for understanding the obtained interaction. 1983. thus intensifying the impact of sexual satisfaction on psychological health. 2015 . The scarcity of empirical evidence regarding the heterosexual desires and behaviors of inmates makes it espe- cially important to focus on such populations in future studies. Inmates who have not had sex for a long time made more references to terms and adjectives related to sexual well-being and expressed more anger (a concept-related to reactance) than did the inmates who have had sex in the last 6 months. 1981) and other results found in non-prison populations whose freedom to choose has been reduced or eliminated due to constraining situa- tions such as the presence of sexual dysfunctions (Lau et al. 1998). not for inmates with greater access to and involvement in heterosexual activity. Linville. Notwithstanding. we believe that those who are sexually abstinent due to the conditions of prison life see sex as more crucial to their well-being than do non-sexual-abstinent inmates. 1982. 2005. Downloaded from tpj. Sánchez. 1998). 2003). As conju- gal visits within prisons were even rarer than they are today. This is the first time that this result has been encoun- tered in prison inmates. 1981) posits. The present findings imply that it is for such sexually deprived inmates that the negative mental health consequences are most pronounced. sexual satisfaction may be more central for the psychological health of sexually abstinent inmates. Ventegodt. Thus. that is. this finding is consistent with RT (Brehm & Brehm.. physical disabilities (Taleporos & McCabe. 1995). as RT (Brehm & Brehm. and having endured germ-cell tumor therapy (Fegg et al.

The Moderating Effect of Gender on the Relationship Between Sexual Satisfaction and Psychological Health. However. the conditional effect of Downloaded from tpj. Taleporos & McCabe. and (b) that sexual needs are highly important prior to the transition but decline in importance after the transition. Some heterosexually abstinent participants in this study reported relatively higher levels of sexual satisfaction and psychological health. Second. consistent with the only prison study of which we are aware that has dealt with this relationship (Carcedo et al. To fully under- stand this. however. 59 Future research pertaining to the sexual activity by sexual satisfaction interac- tion might go in several directions. it would be valu- able to isolate a group of inmates who have not had sexual relationships for a long time. in cross-sectional studies. For instance. If our analysis is correct. In this sense. sexual deprivation may not be consid- ered and experienced by these individuals as necessarily negative.. Third. 2002). and Control Variables The moderating effect of gender on the relationship between sexual satisfac- tion and psychological health was not found.Carcedo et al. First. Consider those starting in the sexual-abstinent group: It would be valu- able to demonstrate on a within-subject bases (a) that prior to the transition sexual satisfaction is associated with psychological health but this association is non- significant afterward.’s study did not statistically test whether that difference was significant. although the percentage of explained variance was slightly higher for at UQ Library on March 13. 2015 . In that particular study. it would be beneficial to study why some inmates adjust better than others to sexual deprivation. A final area for future research might be efforts to apply RT to other deprivations of prison life. 2006.. An association between being more sexually satisfied and having greater psy- chological health was obtained. Carcedo et al. there should still be a strong sexual satisfaction/ psychological health association for this unique population. individuals who have had fairly nega- tive sexual experiences in the past might not have been very interested in sex.sagepub. sexual satisfaction predicted psychologi- cal health for both genders. 2008). longitudinal studies of the inmates going from the sexually abstinent group to the sexually active group (or vice versa) are war- ranted. or some people may be generally more positive in their outlook such that they judge both their sexual situation and their well- being through positive lens. contradicting previous non- prison studies (Laumann et al. or individuals for whom sexual abstinence is a positive value might interpret this situation in a more positive way. it would be profitable to demonstrate that reactance is greater in populations such as inmates whose members are prevented from having sex and that in sexually constrained subgroups these reactance processes mediate between sexual satisfaction and psychological health.

Even more caution is needed in making generalizations to the non- prison population. Limitations of the Present Study Although we think that the sample size is quite large for an interview study focused on an uncommon topic in prison and sexuality research. in light of the uneven ratio of women to men within the two sexual activity groups. This result is also consistent with previous RT at UQ Library on March 13. these results have practical implications. More research is needed in this regard. 1981). 2015 . especially interaction effects. Thus caution is needed in generalizing these results to the whole prison popu- lation. in the same issue. In a recent issue of the Journal of Sex & Marital Therapy. Balon (2008) stated that psychological health may lead to sexual satisfaction or sexual satisfaction and psychological health may have a circu- lar relationship.60 The Prison Journal 95(1) sexual satisfaction in the current investigation supports and refines Carcedo et al. Finally. despite the interviewer stressing the confidentiality and anonym- ity of the study. Implications and Conclusions Finally. In this sense. Future research- ers might employ more subtle ways of seeking information about homosex- ual acts to determine if their true rate is higher in Spanish prisons than was reported to the current research team. we used the model comparisons framework articulated by Appelbaum and Cramer (1974) and Maxwell and Delaney (1990) to deal with non-orthogonality. psychological reactance is not gender- specific (Brehm & Brehm. Still future research is needed to check if similar results are found using com- pletely balanced or orthogonal designs. In addition. because research in psychological reac- tance has detected gender differences only in an insignificant portion of the reactance literature. Allowing inmates to have romantic and sexual relationships with other inmates in prison appears to be Downloaded from tpj. the statisti- cal power for detecting effects. homosexual contacts might have been underreported by the inmates. since a group of control variables were analyzed simultaneously with sexual satisfaction to predict psychological health.’s work. Rosen and Bachmann (2008) used empirical evidence and the perspective of a positive psychology to argue for a directional relationship from sexual satisfaction to well-being. is still low. However. In evaluating that possibility it is important to keep in mind that all the inmates indicated they felt very comfortable during the interview and they disclosed other sensitive information about themselves. Another limitation of this study is that causation is difficult to infer due to the correlational design.

the fact is that sexual satisfaction seems to be associated with psychological health. Culture and Sports of Spain which provided two grants. Thus. For example.” and misconceptions are likely to proliferate. and fears have always surrounded this topic. tests inmates for STDs and HIV. and takes into consideration the inmates’ criminal records. Therefore. Rather than be guided by our own (mis)conceptions. and another through the “José Castillejo” pro- gram to support the stay of the first author in the Department of Human Development and Family Studies at the University of North Carolina at Greensboro. Correctional systems focused on punishing inmates have adopted an easy solution: deprivation.g. the implication for prison policies appears clear: Sexual activity enhances psychological health and. 2007). as well as now. and sexual-partner violence) also have to be developed. The first author Downloaded from tpj. SA007B08).. especially for those who have not had sex for a long time. one to carry out this study (ref. unwanted pregnancies. at UQ Library on March 13. & Goggin. 1996). If we add “prison. Acknowledgments The authors are very grateful to the regional education authority of Castilla y León and the Ministry of Education. & Van Voorhis. false beliefs. supervises their relationships to prevent any possible sort of violence. 61 a valuable option for them.” the resultant equation is even more “scary. Salisbury. Myths. For inmates who have no partner. especially for those without a partner. among those without a partner. conjugal visits are not a viable solution. we would point out that housing men and women in the same prison can be beneficial. the prison gives condoms to inmates every month. STDs.sagepub. The former effect appears more powerful than the latter. It may also benefit prisons: Inmates scoring higher on psychological health have lower levels of misconduct at prison (Wright. Prison systems con- cerned with inmates’ needs have offered some alternatives to sexual depriva- tion such as conjugal visits. particularly if they are allowed to start romantic relationships and maintain sexual relationships. let us be guided by tested knowledge. Little. Systems such as the one we studied that allow inmates to form relationships are needed. however. in the prison where this study was conducted. a psychological health-related concept. We advocate for more research in this area. Furthermore. having this as a prison policy may be beneficial for inmates’ sexual satisfac- tion and psychological health. have been significantly associated with lower recidivism rate after inmates are released (Gendreau. Nevertheless. being satisfied with one’s sexual situation enhances psychological health. education and policies to control sexual risks (e. sexuality has all too often been left in the shadows rather than illuminated. Independent of the prison system and the cultural view of sexuality. but if the present results are supported in the future.Carcedo et al. lower levels of per- sonal distress. offers some sexual education courses. 2015 .

.. (2004). & Cramer. L. K. at UQ Library on March 13. (1974). Blanchflower. Orgaz. Carcedo. R. & Fernández-Rouco.. 393-415. 34. 187-198. (1966). 641-657.. New York. & West. F. R. & Oswald. (2011). M. (1991).. authorship. CA: Sage. B. A. authorship.sagepub. Multiple regression: Testing and interpreting interactions. emocionales y sexuales. 335-343. F. Finally. and/or publication of this article: The authors received financial support for the research from the regional education authority of Castilla y León (Junta de Castilla y León. Estudio en un centro penitenciario [Social.. 81.. S. 52. R.. In pursuit of (sexual) happiness and well-being: A response. J. A theory of psychological reactance. Carcedo. E. Heterosexual romantic relationships inside of prison: Partner status as predictor of loneliness. Orgaz. D. López. NY: Academic Press. R. M. The Spanish Journal of Psychology. emotional. Psychological reactance: A theory of freedom and control. Thousand Oaks. New York. 298-301. Funding The author(s) disclosed receipt of the following financial support for the research. 2015 . 106.62 The Prison Journal 95(1) is also grateful to this department for their support and help with this project. Carcedo. Some problems in the nonorthogonal analysis of variance. & Orgaz. he wants to thank Ioana Scripa for her help in preparing the manuscript. J.. N. B. W. J. R. Downloaded from tpj. S. Spain: Servicio de Publicaciones de la Universidad de Salamanca. sexual satisfaction. and/or publication of this article. interpersonal needs. (2008). B. M. J.. W. J. & Faldowski. D. Balon.. Toth. Necesidades sociales. sex and happiness: An empirical study. Salamanca. López. Carcedo. M. 15. F. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research. Perlman. S. J.. Heterosexual roman- tic relationships. & Brehm. G. (2005). (2012). Fernández-Rouco. N. Journal of Sex & Marital Therapy. I. Perlman.. Appelbaum. Culture and Sports of Spain to support his stay in the Department of Human Development and Family Studies at the University of North Carolina at Greensboro. and sexual needs: Study in a peni- tentiary]. Men and women in the same prison: Interpersonal needs and psychological health of prison inmates. (1981). International Journal of Offender Therapy and Comparative Criminology.. Money. Brehm. References Aiken. and quality of life. The first author also received a grant from the Ministry of Educación. López.. (2008). S. D. SA007B08). and quality of life in prison. R. Scandinavian Journal of Economics. M.. Brehm. NY: Academic Press. Psychological Bulletin.

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He has also served as president of four professional associations. her most recent publi- cations have appeared in The International Journal of Offender Therapy & Comparative Criminology. P. University of Cantabria. J.Carcedo et al. adolescence. Coping. and socially excluded populations. Félix López is professor in the Department of Developmental and Educational Psychology. He is co-author of a textbook. M. and prison inmate populations. 23. Behavioral Psychology. University of Salamanca. and co-editor of the Cambridge Handbook of Personal Relationships. J. (2009). E. Begoña Orgaz is an associate professor in the Department of Methodology of Behavioral Sciences. Carcedo is an associate professor in the Department of Developmental and Educational Psychology. & Van Voorhis. E. A global survey of sexual behaviours. University of Salamanca. K. The Spanish Journal of Psychology. He has also published his work in prestigious journals such as Criminal Justice and Behavior. He has recently published in The International Journal of Offender Therapy & Comparative Criminology.” Her most recent pub- lications are a book and an article in The International Journal of Offender Therapy and Comparative Criminology. Archives of Sexual Behavior. Predicting the prison misconducts of women offenders: The importance of gender-responsive at UQ Library on March 13. his research interests are sexuality and interpersonal relationships needs theory. Psicothema. M. behaviour and adaptation in prisons. (2007). University of North Carolina at Greensboro. Downloaded from tpj.sagepub. & Porporino. Author Biographies Rodrigo J. 3(2). The Spanish Journal of Psychology. Behavioral Psychology. Noelia Fernández-Rouco is an assistant professor in the Department of Education. homosexual. Her research interests include well-being in transsexual. 39-49. Salisbury.. Adicciones. Wylie. F. 310-340. and Infancia y Aprendizaje. and “needs theory. Society and Learning. Zamble. University of Salamanca. 65 Wright. Personality and Social Psychology Bulletin. Journal of Social Issues. A data analyst. A senior scientist.. BMC Pediatrics Journal. New York: Springer-Verlag. His research has been published in The International Journal of Offender Therapy & Comparative Criminology. 2015 .. and Computers in Human Behavior. and Sex Education: Sexuality. Daniel Perlman is a professor of human development & family studies. His research focuses on inter- personal and sexual needs related to prisoners and other socially excluded popula- tions. E. Intimate Relationships. Journal of Family & Reproductive Health. Journal of Contemporary Criminal Justice. (1988). infancy. and Journal of Social and Personal Relationships.