Cognitive and Behavioral Outcomes of Sexual Behavior Scale

Cognitive and Behavioral Outcomes of Sexual Behavior Scale

KIMBERLY R. MCBRIDE,1 MICHAEL REECE, AND STEPHANIE A. SANDERS, Indiana University

The term sexual compulsivity (SC) is used to describe sexual behaviors that may be beyond an individual’s control and that subsequently could lead to impairment in functioning as well as a range of negative outcomes. The Society for the Advancement of Sexual Health (SASH) has offered a list of outcomes that may occur if a person or behaviors are sexually compulsive. This outcomes-based understanding of sexual compulsivity would suggest that individuals and their behaviors (including behaviors that they do alone, such as masturbation, as well as those that they do with other people, such as having intercourse) could lead to negative consequences in various domains, including social, emotional, physical, legal, financial/ occupational, and spiritual areas of life (Reece, Dodge, & McBride, 2006). The Cognitive and Behavioral Outcomes of Sexual Behavior Scale (CBOSBS) was developed to measure the extent to which an individual has experienced negative outcomes in one or more of the six domains identified by SASH.

Description

Items were generated by the researchers based on theoretical understandings of SC and guided by the outcomes suggested by SASH. The scale includes a cognitive out- comes component and a behavioral outcomes component to measure both the extent to which a person is concerned about negative outcomes resulting from their sexual behaviors, and the extent to which such outcomes are actually experienced. For each, items assess six potential types of outcomes (financial/occupational, legal, physical, psychological, spiritual, social). The cognitive outcomes scale consists of 20 items based on a 4-point Likert-type scale ranging from Never to Always. The behavioral outcomes scale includes 16 items that are measured dichotomously, using a Yes or No option.

Pilot testing was conducted in a nonclinical sample of young adults (Perera, Reece, Monahan, Billingham, & Finn, 2009a, 2009b). Scale validation was performed in a nonclinical sample of young adults (N = 390; McBride, Reece, & Sanders, 2007, 2008). Analyses were conducted to assess the psychometric properties of the CBOSBS and the extent to which those in the sample reported experiencing negative outcomes resulting from their sexual behaviors.

Response Mode and Timing

The cognitive items ask participants to rate the extent to which they have worried that the things they have done sexually in the past year have resulted in a specified outcome. The behavioral items ask participants to indicate whether they have experienced a particular outcome within the previous year. The scale is self-administered and typically takes 10 minutes to complete.

Scoring

Cognitive items are scored on a scale of 0 = Never to 3 = Always. Total score range for the cognitive outcome items is 0 to 60. The dichotomous behavioral items are scored by assigning a 0 score to items answered “No” and 1 to “Yes” responses. Total score range for the behavioral items is 0 to 16. Total CBOSBS scores range from 0 to 76 and are calculated by adding cognitive and behavioral scores. The threshold for SC is reached when scores meet or exceed the 80th percentile.

Reliability

Reliability of the CBOSBS was assessed using Cronbach’s alpha for internal consistency reliability; separate analyses of the cognitive and behavioral items were conducted. Internal consistency for the 20-item cognitive scale was high (α = .89), with a slightly lower level of reliability (α = .75) for the 16-item behavioral scale. However, given that the response scale for the behavioral items was dichotomous, this level is quite acceptable. Separate reliability estimates were calculated for each of the six factors (or subscales). Cronbach’s alpha for internal consistency was found to be high for all of the factors, or subscales, indicating scale reliability in this sample. Although some of the subscales with high Cronbach’s alpha levels and elevated correlations may be worth revising, the overall inter-item correlation matrix, again, does not suggest a unidimensional scale. Testing in large samples with diverse demographic characteristics and perhaps greater numbers of negative outcomes is warranted before making the decision to drop items. Given the low occurrence of negative outcomes associated with sexual behaviors in this young nonclinical sample, the decision was made to use total scale scores for remaining analyses.

Validity

Construct validity for the 20 cognitive outcomes items was tested using a principal component analysis with varimax rotation, specifying six factors because items were con- structed to focus on the six outcome categories articulated by SASH. Overall, the six-factor solution explained 74.8% of the total variance. The inter-item correlation matrix did not yield correlations high enough to suggest that the scale is unidimensional. However, a few specific inter-item cor- relations were high enough that it may be appropriate to eliminate one or more of the items. For example, items assessing worry about financial problems and worry about wasting money were highly correlated, suggesting they were essentially measuring the same thing in this sample.

Additional Information

Kimberly McBride is also affiliated with The Academic Edge, Inc., Bloomington, Indiana.

Address correspondence to Kimberly R. McBride, Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47405; e- mail: [email protected]

Cognitive and Behavioral Outcomes of Sexual Behavior

Below is a list of things that some people worry about as a result of their sexual activities (including things people do alone and those they do with others). Please indicate the extent to which the following apply to you:

Never = A Sometimes = B Often = C Always = D I am worried that the things I have done sexually:

1. might have placed me or one of my sex partners at risk for pregnancy.

2. might have placed me or one of my sex partners at risk for a sexually transmitted infection (like herpes, gonorrhea, or crabs).

3. might have placed me or one of my sex partners at risk for HIV.

4. might have resulted in pain, injury, or other problems for one of my sex partners.

5. might have resulted in pain, injury, or other problems for myself.

6. might have presented the potential for serious physical injury or death.

7. might be leading to problems with my friends.

8. might be leading to problems with my family members.

9. might be leading to problems with my boyfriend/girlfriend/spouse.

10. might have placed me at risk of being arrested.

11. might have been against the law.

12. might have led to financial problems.

13. might have caused me to waste my money.

14. were interfering with my ability to complete tasks for work or school.

15. might have presented the potential for me to lose my job.

16. could lead to school-related problems, such as probation, expulsion, or other sanctions.

17. were inconsistent with my spiritual beliefs.

18. were inconsistent with my religious values.

19. were making me feel guilty.

20. were making me ashamed of myself.

    Instructions: Below is a list of things that sometimes happen to people as a result of their sexual activities (including those they do alone and those they do with others). Please indicate whether these things have happened to you during the last year as a result of your sexual activities.

    In the past year, as a result of the things you have done sexually, did the following happen to you:

21. I or my sexual partner(s) became pregnant.

    1. Yes

    2. No

22. I contracted a sexually transmitted infection. a

23. I contracted HIV.

24. I gave someone else a sexually transmitted infection.

25. I gave someone else HIV.

26. I caused pain, injury, or other physical problems for myself.

27. I caused pain, injury, or other physical problems for a sex partner.

28. My relationships with friends and/or family members were damaged.

29. My relationships with a spouse or other relationship partner were damaged.

30. I was arrested.

31. I experienced financial problems.

32. I experienced problems at school.

33. I experienced problems at work.

34. I experienced spiritual distress.

35. I was embarrassed or ashamed of myself.

36. I felt guilty.

The response scale directly above is repeated after each item.

References