Safe Sex Behavior Questionnaire

Abstract

The Safe Sex Behavior Questionnaire (SSBQ) is a psychometric instrument developed by Colleen DiIorio to quantify the frequency with which individuals engage in practices recommended to mitigate the risk of exposure to and transmission of the Human Immunodeficiency Virus (HIV). The initial item pool was derived directly from the 1988 U.S. Surgeon General’s information pamphlet, Understanding AIDS. The definition guiding item selection was “sexually-related practices, which avoid or reduce the risk of exposure to HIV and the transmission of HIV.”

Originally comprising 27 items, the scale was refined following expert review and subsequent factor analysis, resulting in the final, reliable 24-item version. The SSBQ is primarily utilized with sexually active college students and young adults to assess behavioral compliance with recommended safer sex practices.

Keywords

Safe Sex Behavior Questionnaire, SSBQ, HIV prevention, safer sex practices, risk reduction, college students, health behavior, construct validity, Cronbach’s alpha.

Authors

Colleen DiIorio

Purpose

The primary purpose of the SSBQ is to provide a standardized, quantitative measure of an individual’s engagement in safe sex behavior. This measure is essential for health researchers and educators attempting to evaluate the efficacy of interventions aimed at promoting sexual health and reducing the spread of HIV.

The scale focuses specifically on the frequency of practices known to reduce the likelihood of contracting or transmitting the virus. It serves as a valuable tool for behavioral assessment and surveillance in target populations, particularly young adults and college students, who may be at elevated risk due to transitional life stages and changing sexual partnerships.

Construct

The SSBQ measures the frequency of safe-sex behaviors. The development process classified these behaviors into four distinct conceptual categories, ensuring comprehensive coverage of preventative strategies outlined by public health authorities at the time of its creation.

• Protection during intercourse (e.g., condom use).
• Avoidance of risky behaviors (e.g., substance abuse prior to or during sexual activity).
• Avoidance of bodily fluids (e.g., semen, vaginal secretions, blood).
• Interpersonal skills (e.g., communication and assertiveness regarding safer sex practices).

Validity

The construct validity of the scale was established using rigorous psychometric methods, including hypothesis testing and factor analysis. Hypothesis testing confirmed that SSBQ scores correlated in the predicted directions with related psychological constructs, notably measures of risk taking and assertiveness (DiIorio et al., 1993).

The scale’s initial content validity was ensured through expert review, where specialists evaluated each of the 27 original items for clarity, meaning, and correspondence to the defined criteria for safe-sex behaviors. The subsequent refinement based on factor analysis further solidified the empirical validity of the 24-item structure.

Reliability

The SSBQ consistently demonstrated satisfactory reliability across multiple study cohorts of sexually active college students. Initial reliability assessment of the original 27-item scale yielded an internal consistency coefficient alpha of .82 (N=89).

For the final 24-item instrument, the estimated reliability coefficient, measured using Cronbach’s alpha, remained stable at .82 across larger samples (N=531 and N=584 in subsequent studies). Furthermore, the scale exhibited moderate temporal stability, demonstrated by a test-retest correlation of .82 over a two-week period among 100 college students.

Factor Analysis

The item pool was subjected to factor analysis, which was instrumental in refining the instrument from 27 to 24 items by identifying and deleting three weak items (original items 6, 7, and 16). The analysis of the retained items revealed a clear underlying structure.

The factor analysis identified five distinct factors, all possessing eigenvalues greater than 1.0, which represent the primary dimensions of safe sex behavior measured by the SSBQ:

1. Risky behaviors (avoidance).
2. Assertiveness (sexual communication skills).
3. Condom use.
4. Avoidance of bodily fluids.
5. Avoidance of anal sex.

Instrument

Test Type: Self-report questionnaire / Behavioral frequency scale

Format: 24 Likert-style items. Each item is rated on a 4-point scale ranging from 1 (Never) to 4 (Always). Completion typically requires 5 to 10 minutes.

Language Available: English (Original development)

Population Group: Sexually active individuals, primarily young adults/college students.

Age Group: Late adolescence to young adulthood (College age).

Population Details: Validation and reliability studies focused specifically on sexually active college students. The scale’s format is flexible and can be modified for administration via Computer-Assisted Interview (CAI) programs or traditional face-to-face interviews.

Test Methodology: Scoring involves summing responses to the 24 individual items after reverse coding the 9 negatively worded items (indicated by an asterisk). Total scale scores range from 24 to 96, where higher scores indicate greater frequency of safer-sex practices.

Keywords

Psychometrics, sexual health, HIV, AIDS prevention, college students, behavioral assessment, risk behaviors, condom use, sexual assertiveness.

Authors

Author ORCID Identifier: Not provided in source.

Affiliation Email addresses: [email protected]

Correspondence Address: Colleen DiIorio, Emory University, Rollins School of Public Health, Department of Behavioral Sciences and Health Education, 1518 Clifton Road NE, Atlanta, GA 30322

Permissions & Fee and Test Year

The scale was initially developed and published based on research conducted in the early 1990s (1992, 1993). The item list provided indicates copyright by Colleen DiIorio (2009). Users interested in administering the SSBQ should contact the author directly for information regarding permissions and associated usage fees.

Reference’s

• DiIorio, C., Dudley, W., Lehr, S., & Soet, J. (2000). Correlates of safer sex communication among college students. Journal of Advanced Nursing, 32, 658–665.

• DiIorio, C., Parsons, M., Lehr, S., Adame, D., & Carlone, J. (1992). Measurement of safe sex behavior in adolescents and young adults. Nursing Research, 41, 203–208.

• DiIorio, C., Parsons, M., Lehr, S., Adame, D., & Carlone, J. (1993). Factors associated with use of safer sex practices among college fresh- men. Research in Nursing and Health, 16, 343–350.

Items of the Safe Sex Behavior Questionnaire

Directions: Below is a list of sexual practices. Please read each statement and respond by indicating your degree of use of these practices.

1 = Never 2 = Sometimes 3 = Most of the Time 4 = Always

*Negatively worded items.