BACKGROUND: The purpose of this study was to explore the relationships between psychosocial stress, alcohol expectancy, drinking refusal self-efficacy, and drinking behaviors with problematic sexual behaviors in college students. METHODS: Participants were college students (129 males, 67 females) with a mean age of 22.6 years old. Data analysis was done with SPSS 13.0 for descriptive statistics and LISREL 8.53 program for path analysis. RESULTS: The path model showed a good fit to the empirical data (chi2=10.14, P=0.71, GFI=0.98, AGFI=0.94, CFI=0.96, RMSEA=0.07). Our analysis showed that psychosocial stress, drinking refusal self-efficacy, and alcohol expectancy had a significant direct effect on drinking behaviors and that drinking behaviors had a significant direct effect on problematic sexual behaviors. CONCLUSIONS: These findings suggest that alcohol prevention or education programs should emphasize stress management and refusal skills training to prevent college students from drinking behaviors and problematic sexual behaviors at the highest risk for various stressors and heavy drinking.