Risk Behavior Assessment

Risk Behavior Assessment

DENNIS G. FISHER,1 LUCY E. NAPPER, AND GRACE L. REYNOLDS, California State University, Long Beach

MARK E. JOHNSON, University of Alaska, Anchorage

The Risk Behavior instrument was developed to document behaviors that put individuals at risk for infection with the Human Immunodeficiency Virus (HIV). A companion instrument, the Risk Behavior Follow-up Assessment (RBFA), is avail- able in 3-month and 6-month versions. The RBA-RBFA system was originally designed to measure intervention effects in the National Institute on Drug Abuse (NIDA) Cooperative Agreement for HIV/AIDS Community-Based Outreach/Intervention Research program (CA).

Description

The Risk Behavior instrument was developed by the Community Research Branch of NIDA along with principal investigators in the NIDA CA. The original RBA was revised twice with the final version consisting of the following sections: preliminary data, such as ID number, and interview date and time (Section P); demographics (A); drug use (B); C is only for those respondents who have injected drugs in the 30 days prior to interview (C); recent drug use in the last 48 hours (D); drug treatment history (E); sexual risk behavior with separate subsections for men who have sex with men, men who have sex with women, men who have sex with both men and women, women who have sex with women, women who have sex with men, and women who have sex with both men and women (F); sex trading (G); health-related conditions (H); arrest and incarceration (I); economic questions (J); and interviewer’s impressions of interviewee’s understanding, honesty, and accuracy (K).

Response Mode and Timing

The RBAtakes from 18 to 60 minutes to administer depending upon the interviewer’s skill and the interviewee’s responses. Most items are responded to as a single-, a double-, a triple-, or a quadruple-digit answer. There are a few yes/no and categorical questions, and some questions, such as other race or country of origin, require word responses. All items have the capability of being coded Don’t Know/ Unsure or Refused. Skip patterns are included in most sections to expedite completion of the interview.

Scoring

As all items are self-report of behavior, no scoring is required. A data entry package, NOVA-DE, is available, which produces a raw ASCII file. This file is readable by either SAS or SPSS code, includes labels and formats, and can be saved as either a permanent SAS dataset or an SPSS SAV file.

Address correspondence to Dennis G. Fisher, Center for Behavioral Research and Services, 1090 Atlantic Ave., Long Beach, CA 90813; e-mail: [email protected]

Reliability and Validity

The original reliability study collected data on 48-hour test- retest administration and found that, with the exception of needle sharing, most questions had acceptable reliability and validity (Needle et al., 1995; Weatherby, Needle, Cesari, & Booth, 1994). The reliability and validity of a revision of the RBA, with improved needle-sharing questions, was conducted using a 48-hour test-retest interval for the basic drug and sex variables, and a comparison of recent drug use and urine test results (Dowling-Guyer, Johnson, Fisher, & Needle, 1994). Subsequent analyses have examined the reliability and validity of the questions pertaining to amphetamine use (Napper, Fisher, Johnson, & Wood, 2008); hepatitis infection (Fisher, Kuhrt-Hunstiger, Orr, & Davis, 1999; Schlicting et al., 2003); syphilis infection (Fisher, Reynolds, Creekmur, Johnson, & Deaugustine, 2007); and HIV/AIDS testing and infection (Fisher, Reynolds, Jaffe, & Johnson, 2007). Similarly, further analyses have examined the reliability of questions per- taining to homelessness (Klahn, Fisher, Wood, Reynolds, & Johnson, 2004); gonorrhea infection (Paschane, Fisher, Cagle, & Fenaughty, 1998); drug treatment (Edwards, Fisher, Johnson, Reynolds, & Redpath, 2007); economic issues (Johnson, Fisher, & Reynolds, 1999); and alcohol use (Johnson, Pratt, Neal, & Fisher, in press). Finally, the reliability and validity of the RBFA 6-month follow-up version have been reported (Johnson et al., 2000).

Relative to the RBA sexual risk items, the 48-hour test- retest reliability coefficients ranged from a low of .07 for male reporting of oral sex (cunnilingus) with barrier, to a high of .92 for the number of different sex partners in the last 30 days (Dowling-Guyer et al., 1994). Four of the sexual risk behavior items have reliability coefficients greater than .80, and four have reliability coefficients greater than .70. Two have reliability coefficients greater than .60, one each for .50 and .40, and two greater than .30 (Dowling- Guyer et al., 1994). For the RBFA, the 48-hour test-retest reliability coefficients for the sexual risk behavior questions range from a low of .57 for the number of drug-injecting sex partners, to a high of .87 for the male reporting of number of times for vaginal sex (Johnson et al., 2000).

Other Information

Annotated versions of all Cooperative Agreement instruments are in the public domain and are available as .pdf files from the Inter-University Consortium for Political and Social Research, Substance Abuse Mental Health Data Archive at the University of Michigan, http://www.icpsr. umich.edu/SAMHDA/survey-inst/CAA_1.pdf.

Risk Behavior Assessment (sample items)

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

image

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?

DK/Unsure

Refused

Skip

NA

Times                 

777

888

999

666

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

DK/Unsure

Refused

Skip

NA

Times                 

777

888

999

666

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

DK/Unsure

Refused

Skip

NA

Times                 

777

888

999

666

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)?

777

888

999

C Crack?

777

888

999

D Cocaine by itself (other than crack) that you injected or snorted?

777

888

999

E Heroin (by itself)?

777

888

999

F Heroin and cocaine mixed together (e.g., speedball)?

777

888

999

G Nonprescription methadone?

777

888

999

H Other opiates (e.g., demerol, codeine, dilaudid)?

777

888

999

I Amphetamines (e.g., speed, uppers, bennies)?

777

888

999

J Some other drug?

777

888

999

(Specify:                                      )

References

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.