title: Measuring Concurrency Attitudes: Development and Validation of a Vignette-Based Scale.
abstract: BACKGROUND
  Concurrent sexual partnerships (partnerships that overlap in time) may contribute to higher rates of HIV transmission in African Americans. Attitudes toward a behavior constitute an important component of most models of health-related behavior and behavioral change. We have developed a scale, employing realistic vignettes that appear to reliably measure attitudes about concurrency in young African American adults.
  
  
  METHODS
  Vignette-based items to assess attitudes about concurrency were developed following focus groups and cognitive testing of items adapted from existing scales assessing psychosocial constructs surrounding related sexual behaviors. The new items were included in a telephone survey of African American adults (18-34 years old) in Eastern North Carolina immediately before and after a radio campaign designed to discourage concurrency. We performed an exploratory factor analysis on each sample (pre- and post-campaign) to cross-validate results. We retained factors with a primary loading of ≥0.50 and no secondary loading >0.30. Cronbach's coefficient alpha was used to evaluate internal reliability. Associations in the predicted direction between the mean responses to items on the final factor and known correlates of concurrency validated the scale.
  
  
  RESULTS
  Factor analysis in a random pre-campaign subsample yielded a one-factor 6-item scale with acceptable internal consistency (Cronbach's α = 0.79). As expected, the attitude factor was positively associated with participation in concurrent partnerships, whether assessed by self-report (r = 0.298, p<0.0001) or deduced from dates of recent sexual partnerships (r = 0.298, p<0.0001). The factor was also positively associated with alcohol (r = 0.216, p<0.0001) and drug use (r = 0.225, p<0.0001) and negatively associated with increasing age (r = -0.088, p- = 0.02) and female gender (r = -0.232, p<0.0001). Factor analyses repeated in the second random pre-campaign subsample and post-campaign sample confirmed these results.
  
  
  CONCLUSIONS
  A vignette-based scale may be an effective measure of key attitudes related to concurrency and potentially a useful tool to evaluate interventions addressing this network pattern.
authors.affiliation: Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Anna B
authors.identifier: http://orcid.org/0000-0001-7599-196X
authors.initials: AB
authors.lastname: Cope
authors.affiliation: Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
authors.forename: Catalina
authors.initials: C
authors.lastname: Ramirez
authors.affiliation: Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America.
authors.forename: Robert F
authors.initials: RF
authors.lastname: DeVellis
authors.affiliation: Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America.
authors.forename: Robert
authors.initials: R
authors.lastname: Agans
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America.
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Schoenbach
authors.affiliation: Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.|Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America.
authors.forename: Adaora A
authors.initials: AA
authors.lastname: Adimora
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000428:Alcohol Drinking; D001290:Attitude / Q000208:ethnology*; D005163:Factor Analysis, Statistical; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000175:diagnosis* / Q000635:transmission; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D020377:Self Efficacy; D012737:Sex Factors; D012725:Sexual Behavior; D012747:Sexual Partners; D019966:Substance-Related Disorders / Q000473:pathology; D011795:Surveys and Questionnaires; D013689:Telephone; D055815:Young Adult