Worry About Sexual Outcomes Scale

Abstract

The Worry About Sexual Outcomes Scale (WASO) is a brief, 10-item psychological measure developed to quantify the level of worry experienced by adolescents regarding the potential negative consequences of risky sexual behavior. These key outcomes assessed include the risk of unintended pregnancy and Sexually Transmitted Infections (STIs/HIV infection). Developed as part of an NIMH-funded intervention grant (Sales et al., 2008), the scale was initially created from 18 items based on empirical literature and focus group verification among African American adolescent females.

The final instrument is structured into two primary subscales: the 8-item STI/HIV Worry subscale and the 2-item Pregnancy Worry subscale. The WASO is self-administered, typically takes less than five minutes to complete, and is suitable for low-literate populations, making it highly effective for pre- and post-intervention assessment in sexual health education programs.

Keywords

Worry About Sexual Outcomes Scale, WASO, adolescents, risky sexual behavior, STI worry, HIV worry, unintended pregnancy, sexual health, psychological assessment.

Authors

Jessica McDermott Sales (Emory University), Robin R. Milhausen (University of Guelph), Josh Spitalnick (Emory University), Ralph J. DiClemente (Emory University).

Purpose

The fundamental purpose of the WASO scale is to comprehensively assess the frequency of worry among adolescents concerning the critical adverse outcomes associated with unprotected or risky sexual activity. This measure helps researchers and practitioners understand the extent to which potential health threats—specifically STIs/HIV and pregnancy—serve as psychological factors influencing sexual decision-making and preventative behaviors.

The instrument is designed for practical use in sexual health education interventions. Its concise, self-administered format provides a quick and reliable mechanism to evaluate the efficacy of interventions by measuring changes in worry levels both before and after program implementation (Sales et al., 2008).

Construct

The WASO scale measures the psychological construct of anxiety or worry specific to sexual health outcomes, rooted in the context of engaging in risky sexual behavior. The scale development process identified three central, empirically supported domains of worry pertaining to sexual outcomes: pregnancy, Sexually Transmitted Infections (STIs), and Human Immunodeficiency Virus (HIV).

The final 10-item instrument adheres to a two-factor structure: the 8-item STI/HIV Worry subscale, which captures anxiety related to infection, transmission, and partner status; and the 2-item Pregnancy Worry subscale, which focuses exclusively on the fear of conception. Higher scores on the scale indicate more frequent worrying about these negative health outcomes.

Validity

The validation study (Sales et al., 2008) established the construct validity of the WASO by correlating its scores with several theoretically related psychological and behavioral measures. The frequency of worry about sexual outcomes (WASO total score) was found to be negatively associated with positive protective factors, including sexual communication self-efficacy, frequency of sexual communication with a partner (Milhausen et al., 2007), attitudes about condom use (St. Lawrence et al., 1994), and social support (Zimet et al., 1988).

Conversely, the scale demonstrated positive associations with known risk factors such as barriers to condom use (St. Lawrence et al., 1999), condom negotiation difficulty, external locus of control, and depression (Melchior et al., 1993). Both the total scale and the STI/HIV Worry subscale mirrored these findings. The Pregnancy Worry subscale specifically correlated positively with barriers to condom use, external locus of control, and depression, and was also positively correlated with the frequency of vaginal intercourse.

In terms of behavioral outcomes, the WASO and both subscales were negatively correlated with measures of condom use (e.g., condom use at last vaginal sex and over the previous six months with steady partners). These correlations were all statistically significant, indicating that increased worry is associated with increased engagement in risky sexual behaviors or decreased preventative behaviors, with effect sizes ranging from small to moderate (Cohen, 1988).

Reliability

The measurement stability (test-retest reliability) of the WASO scale was assessed using Pearson correlation coefficients across longitudinal follow-up periods of six and twelve months, which is recommended to mirror the duration of typical intervention studies (Gliner et al., 2001). The results confirmed acceptable stability over time.

Baseline scores for the full 10-item WASO scale were significantly correlated with scores measured at the 6-month follow-up (r = .38, p < .01) and the 12-month follow-up (r = .27, p < .01). Furthermore, scores obtained at 6 months were significantly correlated with scores at 12 months (r = .44, p < .01). During the initial item refinement, internal consistency was rigorously maintained, with items deleted if they decreased the overall scale’s Cronbach’s alpha below .90.

Factor Analysis

The development of the WASO resulted in a validated two-factor structure. While the specific methodology of the factor analysis is not detailed in the source, the item reduction process was guided by psychometric criteria, including inter-item correlations and the maximization of the scale’s internal consistency (Cronbach’s alpha).

The resulting factors are: 1) the STI/HIV Worry subscale, comprising 8 items focused on infectious outcomes, and 2) the Pregnancy Worry subscale, containing 2 items focused on reproductive outcomes. This structure suggests that worry regarding these two primary categories of negative sexual outcomes operates along distinct, measurable dimensions.

Instrument

Test Type: Self-administered behavioral scale, psychological assessment instrument.

Format: 10 items utilizing a 4-point Likert-type scale.

Language Available: English (Original development language).

Population Group: Individuals engaging in or at risk for risky sexual behavior. Although validated primarily with African American adolescent females, the items are broadly applicable across genders and ethnic groups.

Age Group: Adolescents (14–18 years in the initial validation sample), but applicable to older age groups.

Population Details: Suitable for low-literate samples, requiring approximately a fourth-grade reading level. The validation sample mean score for the total scale was 16.81 (SD = 6.43).

Test Methodology: Respondents answer based on the single stem, “In the past 6 months, how often did you worry that . . .”. Responses are coded 1 (Never), 2 (Sometimes), 3 (Often), and 4 (Always). The scale typically takes less than 5 minutes to complete. Scores range from 10 to 40 for the total scale; 8 to 32 for the STI/HIV Worry subscale; and 2 to 8 for the Pregnancy Worry subscale.

Keywords

Sexual anxiety, psychometrics, intervention evaluation, STI prevention, HIV prevention, unintended pregnancy, Likert scale, external locus of control, psychometric validation.

Authors

Author ORCID Identifier: Not provided in source content.

Affiliation Email addresses: [email protected] (for Jessica McDermott Sales).

Correspondence Address: Jessica McDermott Sales, Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, 1520 Clifton Rd., NE, Room 266, Atlanta, GA 30322.

Permissions & Fee and Test Year

Test Year: 2008 (Validation study published).

Permissions: The authors encourage researchers to utilize the WASO scale in their studies and appreciate receiving information regarding the results obtained with this measure. Specific fee or licensing information is not detailed in the source text, but the authors provide a correspondence email for direct inquiries.

Reference’s

• Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
• Gliner, J. A., Morgan, G. A., & Harmon, J. J. (2001). Measurement reliability. Journal of the American Academy of Child and Adolescent Psychiatry, 4, 486–488.
• Melchior, L., Huba, G., Brown, V., & Reback, C. (1993). A short depression index for women. Educational and Psychological Measurement, 53, 1117–1125.
• Milhausen, R. R., Sales, J. M., Wingood, G. M., DiClemente, R. J., Salazar, L. F., & Crosby, R. A. (2007). Validation of a partner communication scale for use in HIV/AIDS prevention interventions. Journal of HIV/AIDS Prevention in Children and Youth, 8, 11–33.
• Sales, J. M., Spitalnick, J., Milhausen, R. R., Wingood, G. M., DiClemente, R. J., Salazar, L. F., et al. (2008). Validation of the worry about sexual outcomes scale for use in STI/HIV prevention interventions for adolescent females. Health Education Research, 24, 140–152.
• St. Lawrence, J., Chapdelaine, A., Devieux, J., O’Bannon, R., Brasfield, T., & Eldridge, G. (1999). Measuring perceived barriers to condom use: Psychometric evaluation of the Condom Barriers Scale. Assessment, 6, 391–404.
• St. Lawrence, J., Reitman, D., Jefferson, K., Alleyne, E., Bradsfield, T. L., & Shirley, A. (1994). Factor structure and validation of an adolescent version of the condom attitude scale: An instrument for measuring adolescents’ attitudes toward condoms. Psychological Assessment, 6, 352–359.
• Zimet, G., Dahlem, N. V., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52, 30–41.

Items of the Worry About Sexual Outcomes Scale