Risk Behavior Assessment

Abstract

The Risk Behavior Assessment (RBA) is a comprehensive, interviewer-administered instrument developed by the Community Research Branch of the National Institute on Drug Abuse (NIDA) in collaboration with principal investigators from the NIDA Cooperative Agreement (CA). Its primary function is to systematically document specific behaviors that place individuals at high risk for infection with the Human Immunodeficiency Virus (HIV).

The RBA underwent two revisions to establish its final version, which is divided into 11 sections covering a wide range of topics: preliminary data, demographics, extensive historical and recent drug use (including injection practices), drug treatment history, detailed sexual risk behaviors (with specific subsections for diverse partner combinations), sex trading, health status, arrest/incarceration, economic factors, and interviewer impressions. The RBA system also includes the companion instrument, the Risk Behavior Follow-up Assessment (RBFA), available in 3-month and 6-month versions, designed specifically to measure intervention effects within NIDA’s community-based outreach research programs.

Keywords

Risk Behavior Assessment, RBA, HIV risk, drug abuse, sexual risk, NIDA, self-report, substance use, injection drug use, public health

Authors

DENNIS G. FISHER, LUCY E. NAPPER, GRACE L. REYNOLDS, MARK E. JOHNSON

Purpose

The core purpose of the Risk Behavior Assessment (RBA) is to provide standardized, detailed documentation of specific behaviors that elevate an individual’s risk profile concerning sexually transmitted infections (STIs) and blood-borne pathogens, particularly HIV.

The instrument was strategically created to serve as a baseline and outcome measure for intervention studies. By utilizing the RBA and its follow-up component (RBFA), researchers involved in the National Institute on Drug Abuse (NIDA) Cooperative Agreement were able to quantify the effectiveness of community-based outreach programs aimed at reducing high-risk activities among vulnerable populations.

Construct

The RBA measures the overarching construct of HIV risk behavior, which is operationalized through various domains of self-reported activities occurring within specified time frames (e.g., the last 30 days or 48 hours). The scale assesses both injection drug use risk and sexual risk behavior.

Specific sub-constructs measured include: the frequency and type of illicit drug use; injection practices (e.g., needle sharing); history of drug treatment; detailed sexual practices (vaginal, oral, and anal sex); frequency of condom use; number and type of sexual partners (e.g., partners who inject drugs, partners for sex trading); and contextual factors such as homelessness, incarceration, and co-occurring infectious diseases (e.g., hepatitis, syphilis).

Validity

Validity studies, including those utilizing a 48-hour test-retest interval, demonstrated acceptable validity for most RBA items. A key method for establishing criterion validity for drug use variables was the comparison of self-reported recent drug use against objective confirmation via urine test results (Dowling-Guyer et al., 1994; Weatherby et al., 1994).

Further analyses have consistently supported the validity of specific RBA items across a variety of domains. This includes the accuracy of self-report concerning infection status for hepatitis, gonorrhea, and syphilis, as well as the sensitivity and specificity of self-reported HIV testing and infection results (Fisher et al., 1999; Fisher et al., 2007; Schlicting et al., 2003).

Reliability

The reliability of the RBA was primarily evaluated using 48-hour test-retest reliability. Initial studies indicated that most questions showed acceptable reliability, though revisions were necessary to improve the reliability of items related to needle sharing (Needle et al., 1995).

For the RBA sexual risk items, the 48-hour test-retest reliability coefficients exhibited a broad range, reflecting the complexity of measuring varied sexual behaviors. Coefficients ranged from a low of .07 (for male reporting of oral sex with a barrier) to a high of .92 (for the number of different sex partners in the last 30 days). A substantial number of key sexual risk behavior items demonstrated strong reliability, with four items exceeding .80 and another four exceeding .70. The companion RBFA instrument also demonstrated high reliability for sexual risk questions, with coefficients ranging from .57 to .87 (Johnson et al., 2000).

Factor Analysis

The RBA is structured as a detailed, multi-topic behavioral inventory rather than a psychometric scale designed for internal consistency or factor structure analysis. Therefore, traditional factor analysis procedures focusing on latent traits are not the primary method of validation for this instrument. Instead, reliability and validity research focuses on the test-retest consistency and criterion validity of individual behavioral items or defined sets of items (e.g., sexual risk cluster, drug use cluster).

Instrument

Test Type: Self-report behavioral assessment interview

Format: Structured, interviewer-administered questionnaire using specific numeric codes for responses. Extensive skip patterns are used to streamline the interview based on the respondent’s history. Administration time ranges from 18 to 60 minutes.

Language Available: English

Population Group: Individuals engaged in high-risk behaviors, particularly drug users and those at risk for HIV/AIDS infection.

Age Group: Adult (Implied)

Population Details: Out-of-treatment drug users, injection drug users, crack cocaine users, and individuals recruited via street outreach in community-based intervention research settings.

Test Methodology: Interviewer-administered, utilizing coded responses (single-, double-, triple-, or quadruple-digit answers). Responses include numeric counts, yes/no, categorical options, and coded responses for Don’t Know/Unsure (77/777), Refused (88/888), and Skip (999).

Keywords

RBA, RBFA, intervention research, HIV/AIDS prevention, drug treatment history, injection practices, statistical software, SAS, SPSS, test-retest reliability

Authors

Author ORCID Identifier: Not specified in source content.

Affiliation Email addresses: [email protected] (Dennis G. Fisher)

Correspondence Address: Dennis G. Fisher, Center for Behavioral Research and Services, 1090 Atlantic Ave., Long Beach, CA 90813

Permissions & Fee and Test Year

The annotated versions of all Cooperative Agreement instruments, including the RBA, are in the public domain. The RBA system was originally developed and implemented in the context of NIDA CA research programs, predominantly in the mid-1990s. A data entry package, NOVA-DE, is available to process the raw ASCII file output, which is compatible with statistical software packages like SPSS and SAS.

The original PDF of the Cooperative Agreement instruments can be downloaded here: http://www.icpsr.umich.edu/SAMHDA/survey-inst/CAA_1.pdf.

Reference’s

• Dowling-Guyer, S., Johnson, M. E., Fisher, D. G., & Needle, R. (1994). Reliability of drug users’ self-reported HIV risk behaviors and validity of self-reported recent drug use. Assessment, 1, 383–392.

• Edwards, J. W., Fisher, D. G., Johnson, M. E., Reynolds, G. L., & Redpath, D. P. (2007). Test-retest reliability of self-reported drug treatment variables. Journal of Substance Abuse Treatment, 33, 7–11.

• Fisher, D. G., Kuhrt-Hunstiger, T. I., Orr, S. M., & Davis, D. C. (1999). Hepatitis B validity of drug users’ self-report. Psychology of Addictive Behaviors, 13, 33–38.

• Fisher, D. G., Reynolds, G. L., Creekmur, B., Johnson, M. E., & Deaugustine, N. (2007). Reliability and criterion-related validity of self-report of syphilis. Sexually Transmitted Diseases, 34, 389–391.

• Fisher, D. G., Reynolds, G. L., Jaffe, A., & Johnson, M. E. (2007). Reliability, sensitivity and specificity of self-report of HIV test results. AIDS Care, 19, 692–696.

• Johnson, M. E., Fisher, D. G., Montoya, I., Booth, R., Rhodes, F., Andersen, M., et al. (2000). Reliability and validity of not-in-treatment drug users’ follow-up self-reports. AIDS and Behavior, 4, 373–380.

• Johnson, M. E., Fisher, D. G., & Reynolds, G. L. (1999). Reliability of drug users’ self-report of economic variables. Addiction Research, 7, 227–238.

• Johnson, M. E., Pratt, D. K., Neal, D. B., & Fisher, D. G. (in press). Drug users’ test-retest reliability of self-reported alcohol use on the Risk Behavior Assessment. Substance Use and Misuse.

• Klahn, J. A., Fisher, D. G., Wood, M. M., Reynolds, G. L., & Johnson, M. E. (2004). Homelessness among out-of-treatment drug users in Long Beach, CA. Journal of Social Distress and the Homeless, 13, 345–368.

• Napper, L. E., Fisher, D. G., Johnson, M. E., & Wood, M. M. (2008, October 25–29). Reliability and validity of drug users’ self-reports of amphetamine use. Paper presented at the 136th Annual Meeting and Exposition of the American Public Health Association, San Diego, CA.

• Needle, R., Fisher, D. G., Weatherby, N., Chitwood, D., Brown, B., Cesari, H., et al. (1995). Reliability of self-reported HIV risk behaviors of drug users. Psychology of Addictive Behaviors, 9, 242–250.

• Paschane, D. M., Fisher, D. G., Cagle, H. H., & Fenaughty, A. M. (1998). Gonorrhea among drug users: An Alaskan versus a national sample. American Journal of Drug and Alcohol Abuse, 24, 285–297.

• Schlicting, E. G., Johnson, M. E., Brems, C., Wells, R. S., Fisher, D. G., & Reynolds, G. L. (2003). Validity of injecting drug users’ self report of hepatitis A, B, and C. Clinical Laboratory Science, 16, 99–106.

• Weatherby, N. L., Needle, R., Cesari, H., & Booth, R. E. (1994). Validity of self-reported drug use among injection drug users and crack cocaine users recruited through street outreach. Evaluation and Program Planning, 17, 347–355.

Items of the Risk Behavior Assessment

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Now, we are going to talk about your sexual practices, including each of the times you have had vaginal, oral, and anal sex. We are also talking about all types of partners: regular partners, partners for money, drugs, or whatever.

Q25. How many days in the last 30 days have you had sex (vaginal, oral, and/or anal)?

DK/Unsure Refused

Days      77 88

Q26. During the last 30 days, how many different people have you had vaginal, oral, and/or anal sex with?

DK/Unsure Refused Skip

777 888 999

Q27. How many of your sex partners were likely to have been drug injectors or shooters?

DK/Unsure Refused Skip

777 888 999

Q28. How many of your sex partners were female?

DK/Unsure Refused Skip

777 888 999

Q29. How many of your sex partners were male?

DK/Unsure Refused Skip

777 888 999

Now I want to ask you more specific questions about your vaginal, oral, and/or anal sexual practices. When I ask you these questions, I want you to think about all the partners that you have had sex with in the last 30 days, not just your main or last partner.

Q30. How many times in the last 30 days when you had sex did you put your penis in your partner’s vagina?

DK/Unsure Refused Skip NA

Times                 

(IF “000,” GO TO Q31.)

777 888 999 666

Q30a. Of these   (NUMBER FROM Q30) times, how many times did you use a condom?

DK/Unsure Refused Skip NA

Times         777 888 999 666

Q31. How many times in the last 30 days when you had sex did you put your penis in your partner’s mouth?

DK/Unsure Refused Skip NA

Times                 

(IF “000,” GO TO Q32.)

777 888 999 666

Q31a. Of these   (NUMBER FROM Q31) times, how many times did you use a condom?

DK/Unsure Refused Skip NA

Times         777 888 999 666

Q32. How many times in the last 30 days when you had sex did you put your mouth on your partner’s vagina?

DK/Unsure Refused Skip NA

Times                 

(IF “000,” GO TO Q33.)

777 888 999 666

Q32a. How many of those   (NUMBER FROM Q32) times did your partner use latex or other barrier protection?

Times                  777 (DK/Unsure) 888 (Refused) 999 (Skip) 666 (NA)

Q33. How many times in the last 30 days when you had sex did you put your penis in your partner’s anus?

Times                  777 (DK/Unsure) 888 (Refused) 999 (Skip) 666 (NA)

Q33a. Of these   (NUMBER FROM Q33) times, how many times did you use a condom?

Times                  777 (DK/Unsure) 888 (Refused) 999 (Skip) 666 (NA)

Q58. In the last 30 days, how many times have you used the following drugs immediately before or during sex?

• A Alcohol (Times: ___ DK/Unsure 777 Refused 888 Skip 999)

• B Marijuana/hashish (weed, grass, reefers)? (Times: ___ DK/Unsure 777 Refused 888 Skip 999)

• C Crack? (Times: ___ DK/Unsure 777 Refused 888 Skip 999)

• D Cocaine by itself (other than crack) that you injected or snorted? (Times: ___ DK/Unsure 777 Refused 888 Skip 999)

• E Heroin (by itself)? (Times: ___ DK/Unsure 777 Refused 888 Skip 999)

• F Heroin and cocaine mixed together (e.g., speedball)? (Times: ___ DK/Unsure 777 Refused 888 Skip 999)

• G Nonprescription methadone? (Times: ___ DK/Unsure 777 Refused 888 Skip 999)

• H Other opiates (e.g., demerol, codeine, dilaudid)? (Times: ___ DK/Unsure 777 Refused 888 Skip 999)

• I Amphetamines (e.g., speed, uppers, bennies)? (Times: ___ DK/Unsure 777 Refused 888 Skip 999)

• J Some other drug? (Specify: ____________________) (Times: ___ DK/Unsure 777 Refused 888 Skip 999)