Sexual Attitudes and Behavior of Unmarried Latino Females

Abstract

The Sexual Attitudes and Behavior of Unmarried Latino Females instrument—specifically its core psychometric module assessing condom use self-efficacy—was developed by researchers at the Center for AIDS Prevention Studies (CAPS) at the University of California, San Francisco (Marín et al., 1998). Formulated in response to disproportionate rates of HIV/AIDS and sexually transmitted infections (STIs) among Hispanic populations in the United States, this psychometric scale assesses an individual’s perceived capability to negotiate, procure, and correctly use barrier contraception under complex interpersonal and contextual conditions. Administered in a multi-state probability sample of 1,500 unmarried Latino women and men aged 18 to 49 across ten U.S. states, the instrument measures condom negotiation, assertive refusal of unprotected sex, technical proficiency, and situational maintenance of safe sex practices during heightened arousal. Comprising 7 core items measured on a 4-point Likert-type response scale ranging from 1 (Not at all sure) to 4 (Extremely sure), the scale exhibits robust psychometric properties, including high internal consistency reliability (Cronbach’s α ranging from .75 to .84 across gender and acculturation subgroups) and strong construct, convergent, and predictive validity in forecasting consistent condom utilization. This article provides an exhaustive psychometric overview of the instrument, tracing its theoretical origins in Albert Bandura’s Social Cognitive Theory, examining the sociocultural nuances of Latinx gender role expectations, delineating its factor structure, and presenting scoring protocols for academic research and clinical prevention practice.

Keywords

Condom use self-efficacy, Hispanic health, HIV prevention, sexual risk behavior, Latina sexual health, negotiation self-efficacy, CAPS survey instrument, Marín et al., health psychology, gender roles, reproductive health, psychometrics

Authors

The instrument was conceptualized, operationalized, and psychometrically validated by a multi-disciplinary research team at the Center for AIDS Prevention Studies (CAPS), based in the Department of Medicine and the Department of Psychiatry at the University of California, San Francisco (UCSF):

• Barbara VanOss Marín, Ph.D. – Lead Investigator; Professor of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco. Internationally recognized authority on Latinx public health, cross-cultural behavioral research, and HIV/STI prevention intervention design.
• Jeanne M. Tschann, Ph.D. – Co-Investigator; Professor of Psychiatry, Department of Psychiatry, University of California, San Francisco. Specialist in family dynamics, interpersonal stress, developmental health psychology, and behavioral epidemiology.
• Cynthia A. Gómez, Ph.D. – Co-Investigator; Associate Professor of Medicine at CAPS, UCSF (later founding director of the Health Equity Institute at San Francisco State University). Expert on gender disparities, sexual risk, cultural adaptation of interventions, and health equity in minority communities.
• Steve E. Gregorich, Ph.D. – Quantitative Psychometrician and Biostatistician; Professor of Medicine, Division of General Internal Medicine, University of California, San Francisco. Expert in psychometrics, latent variable modeling, confirmatory factor analysis, and longitudinal epidemiology.

Purpose

The primary purpose of the instrument is to systematically identify, quantify, and track the psychological and interpersonal determinants of condom utilization among sexually active, unmarried Latino individuals, with a specific focus on unmarried females who navigate distinct structural and cultural dynamics. During the 1990s, epidemiological data indicated that Hispanic women in the United States faced an elevated and disproportionate risk of heterosexually acquired HIV infection. However, existing behavioral instruments failed to capture the complex intersection of traditional cultural gender expectations, power asymmetries within heterosexual relationships, and the technical mechanics of disease prevention.

From an applied behavioral perspective, the instrument fulfills several critical scientific objectives:

• Diagnostic Assessment of Behavioral Capability: Rather than merely evaluating knowledge of transmission pathways, the scale determines respondent conviction regarding specific, actionable behaviors essential for preventing pathogen transmission.
• Evaluation of Interpersonal Negotiation Dynamics: Condom use is inherently relational. The scale assesses whether unmarried females feel capable of introducing condoms into conversation, persuading reluctant partners, and successfully halting intercourse if a barrier method is unavailable or refused.
• Intervention Target Identification: By isolating discrete facets of self-efficacy (e.g., technical mastery versus partner persuasion), researchers and clinical educators can tailor health promotion programs to address specific behavioral deficits.
• Epidemiological Risk Modeling: Public health researchers utilize the tool to model how cultural variables, such as acculturation, traditional gender role beliefs, and relationship duration, modulate self-efficacy and subsequent sexual risk practices across diverse Latino national origin subgroups (e.g., Mexican American, Puerto Rican, Cuban, and Central/South American).

Psychological Construct

The central psychological construct operationalized by this scale is condom use self-efficacy within an intimate relational context. Drawing directly from social cognitive frameworks, this construct is defined as an individual’s belief in their capability to execute specific courses of action required to ensure consistent condom use during heterosexual encounters. The construct is explicitly non-monolithic, reflecting three interrelated domains of agency:

1. Interpersonal Negotiation and Communication Self-Efficacy

This dimension encompasses an individual’s confidence in introducing the topic of condoms into verbal dialogue, proactively negotiating safer sex parameters prior to physical intimacy, and exerting verbal influence when encountering partner resistance. In the context of unmarried Latina females, this dimension represents a notable psychological transition: it directly challenges cultural paradigms that discourage female assertiveness in sexual negotiation or interpret female possession and promotion of condoms as an indicator of infidelity or promiscuity.

2. Assertive Refusal and Boundary Maintenance

A second dimension targets situational resolve under conditions of emotional and physical arousal or direct interpersonal pushback. It measures an individual’s confidence in refusing to engage in intercourse if the partner declines condom use, as well as the capacity to interrupt sexual activity to implement a barrier method once sexual arousal is established. This construct represents high-threshold self-efficacy, demanding substantial psychological resilience and perceived autonomy within the relational dyad.

3. Technical, Instrumental, and Acquisition Self-Efficacy

The instrumental dimension reflects mastery over the pragmatic mechanics of protection. It captures an individual’s confidence in purchasing condoms in public commercial settings (e.g., pharmacies, retail grocers)—which involves surmounting social stigma, embarrassment, or fear of judgment—alongside the physical proficiency needed to apply a male condom accurately onto a partner or assist in correct placement.

Theoretical Framework

The conceptual infrastructure of the scale integrates social-cognitive behavioral theory with sociocultural frameworks examining gender, power, and cultural scripts within Hispanic communities.

Social Cognitive Theory (SCT)

Formulated by Albert Bandura (1986, 1997), Social Cognitive Theory posits that human functioning is governed by a reciprocal interaction among personal cognitive factors, environmental influences, and behavioral patterns. Bandura identified self-efficacy—the conviction that one can successfully execute the behavior required to produce desired outcomes—as the foundational mechanism of human agency. Outcome expectancies (e.g., knowing that condoms prevent HIV) are insufficient to drive health-protective behavior unless accompanied by high perceived self-efficacy to enact that behavior in the presence of impediments, cognitive distress, or social counter-pressures.

Theory of Gender and Power

Complementing cognitive models, the work of sociologists and public health researchers (e.g., Robert Connell’s Theory of Gender and Power, adapted for HIV prevention by Wingood and DiClemente, 2000) provides structural context for the instrument. Heterosexual encounters occur within socially established power distributions. For many women, structural economic dependency, societal gender hierarchies, and the threat of physical or emotional abandonment alter the cost-benefit balance of demanding safer sex practices. Marín and colleagues operationalized self-efficacy not as an isolated trait, but as a relational negotiation occurring within these power balances.

Sociocultural Paradigms: Marianismo, Machismo, and Simpatía

Traditional Latin American cultural constructs strongly shape sexual attitudes and behavior:

• Marianismo: Derived from veneration of the Virgin Mary, this gender ideology historically socialized women to prioritize purity, passivity, modesty, and compliance within romantic relationships, often framing explicit sexual communication as inappropriate for an honorable woman.
• Machismo: A cultural construct of male identity that traditionally associates masculinity with authority, sexual conquest, and control over relational decisions, potentially limiting female agency during sexual encounters.
• Simpatía and Respeto: Cultural values emphasizing harmonious interpersonal relations, avoidance of direct interpersonal conflict (simpatía), and deference to status hierarchies (respeto). Directly confronting a partner or insisting on condom use can be perceived as violating relational harmony or accusing the partner of infidelity or infection.

The CAPS instrument was designed to evaluate an unmarried Latina woman’s perceived capacity to overcome these cultural and interpersonal scripts.

Validity

The validity of the condom use self-efficacy scale within the CAPS instrument was established through rigorous psychometric testing across diverse samples of unmarried Latino adults.

Content and Construct Validity

Instrument development utilized extensive qualitative focus group methodologies and cognitive pre-testing conducted in both English and Spanish to ensure conceptual equivalence and cultural alignment. Items were translated and back-translated by bilingual, bicultural teams to ensure structural and semantic fidelity. Construct validity was evidenced by the scale’s ability to differentiate between individuals who actively practiced safer sex behaviors and those who did not, with scores demonstrating distinct, theoretically coherent distributions across demographic cohorts.

Convergent and Divergent Validity

Empirical analyses confirmed convergent validity through statistically significant correlations between the self-efficacy scale and related psychosocial constructs:

• Sexual Communication: Condom use self-efficacy correlated positively with open, bidirectional communication regarding sexual histories and contraception (r ≈ .38 to .48, p < .001).
• Gender Role Egalitarianism: Higher self-efficacy scores aligned with more egalitarian and less traditional gender role beliefs (p < .01).
• Acculturation Level: More acculturated individuals and those with higher formal educational attainment demonstrated moderately higher negotiation self-efficacy, aligning with hypotheses regarding shifting cultural scripts across immigrant generations.
• Discriminant Distinctiveness: The scale exhibited divergent validity through minimal to non-significant correlations with general, non-sexual self-esteem and general locus of control measures, proving that the scale captures context-specific domain competence rather than generalized positive self-evaluation.

Predictive and Criterion Validity

Crucially, Marín et al. (1998) established strong criterion-related predictive validity. Logistic regression models indicated that higher scores on the condom use self-efficacy scale independently predicted:

• Condom use during the most recent sexual intercourse event (Adjusted Odds Ratio [AOR] ranging from 1.65 to 2.30, p < .001).
• Consistent condom use across the preceding 12-month interval with primary and non-primary romantic partners.
• Active possession of condoms at the time of survey administration.

Reliability

The scale demonstrates sound internal consistency across both aggregate and stratified sociodemographic subsamples.

Internal Consistency Reliability

In the primary psychometric validation study involving 1,500 unmarried Latino men and women (Marín et al., 1998), internal consistency evaluated via Cronbach’s alpha (α) yielded stable metrics:

• Full Composite 7-Item Scale: α = .81 to .84 across overall validation cohorts.
• Female Subsample: α = .82, indicating strong reliability when administered specifically to Latina women.
• Language Subgroups: The scale achieved comparable internal consistency when administered in Spanish (α = .80) and English (α = .83), verifying cross-linguistic measurement stability.
• Subscale Reliabilities: When decomposed into sub-dimensions (Negotiation/Communication vs. Technical/Refusal), subscale alpha coefficients ranged between .74 and .81, satisfying psychometric standards for behavioral and research instruments.

Test-Retest Stability

Although primary testing utilized cross-sectional probability telephone survey methodologies, longitudinal follow-ups and subsequent intervention cohort studies utilizing the CAPS instrument (e.g., Tschann et al., 2002) observed consistent test-retest correlations over 3-month and 6-month test intervals (intraclass correlation coefficients [ICC] > .70), demonstrating that while the construct remains sensitive to educational intervention, baseline self-efficacy reflects a stable psychological appraisal in the absence of systematic programmatic training.

Factor Analysis

The structural dimensionality of the 7-item condom use self-efficacy tool has been examined using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) within representative probabilistic data sets.

Exploratory Factor Structure

Initial EFA procedures using principal axis factoring with promax (oblique) and varimax (orthogonal) rotations consistently revealed a clear underlying structure explaining over 56% to 62% of the common item variance. Scree plot analyses and eigenvalue inspection (eigenvalues > 1.0) supported both a unified single-factor construct (overall condom use self-efficacy) and a nuanced, correlated two-factor solution:

Confirmatory Factor Analysis (CFA) Fit Indices

Confirmatory factor analyses conducted by Gregorich and colleagues corroborated structural fit. A two-factor model featuring inter-factor correlation demonstrated superior fit compared to an unconstrained unidimensional model across the population sample:

• Comparative Fit Index (CFI): .96 to .98, demonstrating strong fit.
• Tucker-Lewis Index (TLI): .95 to .97.
• Root Mean Square Error of Approximation (RMSEA): .042 to .051 (90% CI [.031, .060]), well within established cutoffs for good model approximation.
• Standardized Factor Loadings (λ): All items loaded significantly onto their designated latent constructs (all p < .001, loadings ranging from .58 to .82).

Instrument / Measurement Tool

The operational specifications of the measurement tool are structured as follows:

• Test Type: Psychometric Self-Report Questionnaire / Structured Survey Interview Scale.
• Administration Format: Computer-Assisted Telephone Interviewing (CATI), in-person structured clinical interview, or self-administered paper-and-pencil/electronic survey. Available in validated bilingual English and Spanish versions.
• Item Count: 7 standardized core items.
• Target Population: Unmarried sexually active adults, specifically designed and standardized for Hispanic/Latina females and males aged 18 to 49.
• Estimated Completion Time: 2 to 4 minutes.
• Response Format: 4-point Likert scale:
  • 1 = Not at all sure
  • 2 = A little sure
  • 3 = Pretty sure
  • 4 = Extremely sure
• Scoring Rules:
  • Overall Composite Score: Calculated by computing the unweighted mathematical mean across all 7 items (range: 1.00 to 4.00), where higher composite values signify greater condom use self-efficacy. Alternatively, a summed total score ranging from 7 to 28 may be used.
  • Subscale 1: Condom Negotiation/Discussion: Calculated by averaging items 1, 2, and 7.
  • Subscale 2: Condom Technical/Refusal Use: Calculated by averaging items 3, 4, 5, and 6.
  • Reverse Scoring: No items are reverse-scored; all items are positively keyed toward higher perceived agency and assurance.
• Clinical and Interpretive Benchmarks: Mean scores ≤ 2.5 indicate clinically low self-efficacy, signifying substantial behavioral vulnerability and difficulties with partner negotiation. Scores from 2.51 to 3.25 indicate moderate capability, while scores > 3.25 denote high perceived behavioral mastery.

Permissions & Fee and Test Year

The foundational instrument was published in 1998 by Barbara VanOss Marín, Jeanne M. Tschann, Cynthia A. Gómez, and Steve E. Gregorich in the American Journal of Community Psychology, under the auspices of research grants funded by the National Institutes of Health (NIH) and the National Institute of Mental Health (NIMH; Grant MH42459) awarded to the Center for AIDS Prevention Studies (CAPS) at the University of California, San Francisco.

The scale resides in the public domain for non-commercial, academic, scientific, and public health research and intervention evaluation purposes. No licensing fees or royalty payments are required to administer, adapt, or utilize the instrument for clinical or research activities. Researchers and practitioners using the tool are expected to cite the primary validation publication (Marín et al., 1998) in resultant scientific manuscripts, reports, and presentations.

References

• Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall.
• Bandura, A. (1997). Self-efficacy: The exercise of control. W. H. Freeman and Company.
• Connell, R. W. (1987). Gender and power: Society, the person and sexual politics. Stanford University Press.
• Gómez, C. A., & Marín, B. V. (1996). Gender, culture, and power: Barriers to safe-sex negotiation for Mexican and Puerto Rican women. AIDS and Behavior, 1(1), 73–82. https://doi.org/10.1007/BF02628435
• Marín, B. V. (1997). Cultural issues in HIV prevention for Latinos: Should we be changing gender roles? In S. Oskamp & S. C. Thompson (Eds.), Safer sex in the ’90s: Understanding and preventing HIV risk behavior (pp. 147–167). SAGE Publications.
• Marín, B. V., & Gómez, C. A. (1999). Latinos and HIV: Cultural issues in AIDS. In P. T. Cohen, M. A. Sande, & P. A. Volberding (Eds.), The AIDS knowledge base (3rd ed., pp. 917–924). Lippincott Williams & Wilkins.
• Marín, B. V., Tschann, J. M., Gómez, C. A., & Gregorich, S. E. (1998). Self-efficacy to use condoms in unmarried Latino adults. American Journal of Community Psychology, 26(1), 53–71. https://doi.org/10.1023/A:1022238407421
• Tschann, J. M., Flores, E., Marín, B. V., Pasch, L. A., & Gregorich, S. E. (2002). Condom negotiation strategies and actual condom use among Latino youth. Journal of Adolescent Health, 31(4), 356–364. https://doi.org/10.1016/S1054-139X(02)00403-8
• Wingood, G. M., & DiClemente, R. J. (2000). Application of the theory of gender and power to examine HIV-related exposures, risk factors, and interventions for women. Health Education & Behavior, 27(5), 539–565. https://doi.org/10.1177/109019810002700502

13. Items of the Scale (Questionnaire)