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Using Composite Scores to Summarize Adolescent Sexual Risk Behavior: Current State of the Science and Recommendations

Archives of Sexual Behavior volume 48, pages 2305–2320 (2019)Cite this article

Abstract

Composite scores offer the advantage of summarizing across multiple sexual risk behaviors to both simplify results and better capture the influence of core contextual, interpersonal, and intrapersonal dynamics that affect multiple sexual risk behaviors. There is inconsistency in how researchers utilize composite scores with minimal guidance on the advantages and disadvantages of frequently used approaches. Strengths and weaknesses of each approach are discussed in the context of assessing adolescent sexual risk behavior. A latent variable model and three commonly used composites were applied to data combined across four clinical trials (n = 1322; 50% female). Findings suggested that the latent variable approach was limited due to minimal correlations among sexual risk behaviors, that choice of composite had minimal impact on cross-sectional results so long as there is sufficient variability in risk behavior in the sample, but composite choice could impact results from clinical trials particularly for subgroup analyses. There are unique challenges to creating composites of adolescent risk behavior, including the fluidity and infrequency of adolescent sexual relationships that result in many participants reporting no sexual behavior at any given assessment and a low correlation between the number of partners and condomless sex acts. These challenges impede application of data-driven approaches to defining sexual risk composites. Recommendations to improve consistency in reporting include: (1) reporting each type of risk behavior separately prior to forming a composite, (2) aggregating across assessments to increase the chance of observing sexual risk behaviors, and (3) continued work toward a unified definition of adolescent sexual risk behavior that can guide the development of appropriate measurement models.

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Acknowledgements

This work was supported by the National Institute of Mental Health (K23MH102131 to David H. Barker) and by the National Institute on Alcohol Abuse and Alcoholism (R01AA021355 to Lori A. J. Scott-Sheldon) of the National Institutes of Health. The work was facilitated by the Providence/Boston Center for AIDS Research (P30AI042853). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding

This study was funded by the following grants: National Institute of Mental Health (K23MH102131); National Institute on Alcohol Abuse and Alcoholism (R01AA021355), and National Institute of Allergy and Infectious Diseases (P30 AI042853).

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Affiliations

  1. Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Box-G-BH, Providence, RI, 02906, USA

    David H. Barker, Lori A. J. Scott-Sheldon & Larry K. Brown

  2. Division of Child and Adolescent Psychiatry, Rhode Island Hospital, Providence, RI, USA

    David H. Barker & Larry K. Brown

  3. Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA

    Lori A. J. Scott-Sheldon

  4. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA

    Lori A. J. Scott-Sheldon

  5. Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA

    Daniel Gittins Stone

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Appendices

Appendix 1: Details About Treatment Studies

See Table 3.

Table 3 Overview of prevention trials
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Appendix 2: Class Enumeration Results

See Tables 4, 5, 6, 7, and 8.

Table 4 Class enumeration fit statistics used to decide on the number of classes
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Table 5 Estimated means for each sexual risk behavior by class (three-class model)
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Table 6 Average latent class probabilities for most likely latent class membership (3-class model)
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Table 7 Estimated means for each sexual risk behavior by class (four-class model)
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Table 8 Average latent class probabilities for most likely latent class membership (four-class model)
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Barker, D.H., Scott-Sheldon, L.A.J., Gittins Stone, D. et al. Using Composite Scores to Summarize Adolescent Sexual Risk Behavior: Current State of the Science and Recommendations. Arch Sex Behav 48, 2305–2320 (2019). https://doi.org/10.1007/s10508-019-01526-8

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Keywords

  • Adolescence
  • Sexual risk behavior
  • HIV
  • Clinical trials