Health-Protective Sexual Communication Scale

Abstract

The Health Protective Sexual Communication Scale (HPSC) is a widely utilized self-report scale developed by Joseph A. Catania to measure the frequency and quality of communication regarding health-protective behaviors when interacting with a new sexual partner. The scale specifically focuses on discussions concerning safer sex practices, sexual histories, and contraceptive planning, distinguishing this critical communication from exchanges merely related to sexual pleasure or sexual enhancement.

The HPSC exists in two primary forms: an original brief version (3 items) and a revised, expanded version (10 items). The original brief scale utilized a 3-point rating system (1, happened with all partners; 2, happened with some partners; 3, didn’t happen). The expanded version employs a 4-point Likert-type rating scale (ranging from 1 = never to 4 = always). Both versions are designed for quick administration, typically requiring only 1–2 minutes to complete, and are available in both English and Spanish.

Keywords

Sexual Communication, Health Protective Behavior, Safer Sex, Condom Use, HIV Risk, STD Prevention, Sexual History, Self-report scale, Health Psychology, Psychosocial Correlates.

Authors

Joseph A. Catania.

Purpose

The primary purpose of the HPSC scale is to quantify an individual’s propensity to engage in sexually health-protective communication with a new sexual partner. This measurement is crucial for identifying individuals at higher risk for sexually transmitted diseases (STDs), including HIV, and for understanding the psychosocial determinants of responsible sexual behavior.

The scale was developed as an extension of earlier brief measures utilized in two national survey studies to assess communication ability regarding sexual history disclosure and condom use negotiation. Empirical findings consistently demonstrate a strong link between low HPSC scores and engagement in high-risk sexual behaviors, such as having multiple partners, inconsistent condom use, and alcohol consumption before sexual activity, making it a valuable predictive tool in sexual health research.

Construct

The HPSC measures the construct of Health Protective Sexual Communication, defined as verbal interactions specifically intended to minimize health risks associated with sexual encounters. This construct covers several critical behavioral domains:

• Negotiation of protective measures, particularly condom use.
• Disclosure and inquiry regarding past sexual behaviors and histories (e.g., number of partners, injection drug use history).
• Discussion of sexual health status, including prior STDs and the need for HIV testing.
• Communication regarding relationship boundaries and contraceptive planning.

Crucially, the scale is designed to isolate communication related to risk reduction and health outcomes, thus distinguishing it from general sexual communication aimed at intimacy or sexual pleasure. High scores reflect greater sexual assertiveness and engagement in proactive health measures.

Validity

The HPSC scale has demonstrated strong criterion validity through its consistent association with actual sexual risk behavior across varied populations. Findings from major cohort studies, such as the AIDS in Multi-Ethnic Neighborhoods (AMEN) study and the National AIDS Behavior Survey (NABS), support its utility.

A hierarchical multiple regression model examining adolescent females found that a greater willingness to request partners to use condoms, as indicated by HPSC scores, was associated with more frequent condom use. Furthermore, analyses revealed that respondents with higher expanded HPSC scores were significantly more likely to possess greater sexual and condom relations skills, to be sexually assertive, to have been tested for HIV, and to be committed to future condom use. Conversely, low HPSC scores were associated with increased susceptibility to STDs and a higher likelihood of using alcohol before sex.

In certain analyses, the HPSC scale was dichotomized, revealing that the relationship to condom use was strongest primarily for those respondents scoring in the upper one third of the scale. This suggests that only consistent, high-level health protective communication is a powerful determinant of safer sexual behavior.

Reliability

The internal consistency reliability of the HPSC scale has been extensively assessed across diverse demographic groups using Cronbach’s alpha. Reliability estimates generally ranged from good to excellent, supporting the scale’s stability across different contexts and populations.

• The original brief version showed good reliability (alpha = .67) in a sample of 114 adolescent females.
• In the AMEN cohort study of unmarried heterosexuals, the brief version demonstrated excellent reliability (alpha = .84).
• The expanded 10-item HPSC scale, analyzed using data from the NABS longitudinal study, also yielded excellent internal reliability (alpha = .85) across the combined sample segments.

While overall reliability is robust, specific demographic subgroups showed lower, though often acceptable, consistency. For example, the Hispanic national sample recorded an alpha of .60, and the male high-risk cities sample recorded an alpha of .64. Normative data detailing means, standard deviations, and reliabilities across ethnic groups, gender, and education levels derived from the NABS and AMEN studies are provided in the source material (Table 1).

Factor Analysis

A factor analysis was conducted on the expanded 10-item HPSC scale using data from the NABS longitudinal study. The analysis strongly supported the scale’s conceptualization as a predominantly unidimensional measure.

The analysis yielded a single large eigenvalue (4.3), which accounted for 37% of the total variance. A secondary eigenvalue (1.15) was also present, accounting for 6% of the variance, suggesting the potential existence of a minor secondary factor. This second factor appeared to consist mainly of items specifically related to condom use. Given the substantial variance accounted for by the first factor, researchers opted to score the HPSC as a single-factor scale, though they recommended further development work to expand the number of condom-specific items to better examine potential multi-factor structures.

Instrument

Test Type: Self-report scale or Interviewer-administered measure.

Format: Brief (3 items, 3-point scale) or Expanded (10 items, 4-point Likert-type rating scale).

Language Available: English, Spanish.

Population Group: Varied populations, including adolescents, heterosexual adults, and national probability samples representing White, Black, and Hispanic ethnic groups, as well as high HIV-risk groups.

Age Group: Typically ranges from 12 (adolescent samples) to 49 years (adult samples).

Population Details: The scale has been validated in contexts such as the NABS and AMEN cohort studies. Items 9 and 10 of the expanded scale are explicitly excluded when administering the measure to gay men and lesbians.

Test Methodology: Both the short and expanded forms take approximately 1–2 minutes to complete. The brief scale requires reverse scoring and summing; the expanded scale uses direct summing across items.

Keywords

Health Communication, Condom Negotiation, HIV Prevention, STD Risk, Psychosocial Correlates, Sexual Assertiveness, NABS, AMEN Study, Joseph Catania, Longitudinal Study.

Authors

Author ORCID Identifier: Not provided in source material.

Affiliation Email addresses: [email protected] (Correspondence email).

Correspondence Address: Joseph A. Catania, College of Health and Human Sciences, Oregon State University, 320B Waldo Hall, Corvallis, OR 97331.

Permissions & Fee and Test Year

The HPSC scale was primarily developed and utilized in major longitudinal studies, including the NABS (1990–1991) and AMEN studies (early 1990s). The source material indicates that portions of the NABS survey data collected for reliability and validity indexing are available upon request from the author.

Reference’s

• Catania, J. (1995). [NABS Survey Data]. Unpublished raw data.
• Catania J., Coates, T., Golden, E., Dolicini, M., Peterson, J., Kegeles, S., Siegel, D., & Fullilove, M. (1994). Correlates of condom use among Black, Hispanic, and White heterosexuals in San Francisco: The AMEN Longitudinal Survey. AIDS Education and Prevention, 6, 12–26.
• Catania, J., Coates, T., & Kegeles, S. (1994). A test of the AIDS risk reduction model: Psychosocial correlates of condom use in the AMEN cohort survey. Health Psychology, 13, 548–555.
• Catania, J., Coates, T., Kegeles, S., Thompson-Fullilove, M., Peterson, J., Marin, B., et al. (1992). Condom use in multi-ethnic neighborhoods of San Francisco: The population-based AMEN (AIDS in Multi- Ethnic Neighborhoods) Study. American Journal of Public Health, 82, 284–287.
• Catania, J., Coates, T. J., Stall, R., Turner, H., Peterson, J., Hearst, N., et al. (1992). Prevalence of AIDS-related risk factors and condom use in the United States. Science, 258, 1101–1106.
• Catania, J., Kegeles, S., & Coates, T. (1990). Towards an understanding of risk behavior: An AIDS risk reduction model (ARRM). Health Education Quarterly, 17, 53–72.
• Dolcini, M. M., Coates, T. J., Catania, J. A., Kegeles, S. M., & Hauck, W. W. (1995). Multiple sexual partners and their psychosocial correlates: The population-based AIDS in Multi Ethnic Neighborhoods (AMEN) Study. Health Psychology, 14, 1–10.

Items of the Health Protective Sexual Communication Scale

Instructions: Now I am going to read a list of things that people talk about before they have sex with each other for the first time. How often in the past 12 mos. have you . . . (read each).Would you say always, almost always, sometimes, or never?

1 = Never 2 = Sometimes 3 = Almost always 4 = Always 6 = Don’t know 7 = Declined to answer

1. Asked a new sex partner how (he/she) felt about using condoms before you had intercourse.

2. Asked a new sex partner about the number of past sex partners (he/she) had.

3. Told a new sex partner about the number of sex partners you have had.

4. Told a new sex partner that you won’t have sex unless a condom is used.

5. Discussed with a new sex partner the need for both of you to get tested for the AIDS virus before having sex.

6. Talked with a new sex partner about not having sex until you have known each other longer.

7. Asked a new sex partner if (he/she) has ever had some type of VD, like herpes, clap, syphilis, gonorrhea.

8. Asked a new sex partner if (he/she) ever shot drugs like heroin, cocaine, or speed.

9. Talked about whether you or a new sex partner ever had homosexual experiences.

10. Talked to a new sex partner about birth control before having sex for the first time.

Note: Items 1, 2, and 4 were used in the original short version. Items 9 and 10 are excluded for gay men and lesbians.