STD Attitude Scale

1. Abstract

The STD Attitude Scale is a standardized psychometric instrument developed by William L. Yarber, Mohammad R. Torabi, and C. Harold Veenker to evaluate young adults’ attitudes toward sexually transmitted diseases (STDs). Built upon classical tripartite attitudinal theory, the instrument conceptualizes attitude as a multidimensional construct comprising three distinct but interrelated domains: the Cognitive (Belief) component, the Affective (Feeling) component, and the Conative (Intention to Act) component. The scale consists of 27 self-report items distributed evenly across the three subscales (9 items each), formatted on a 5-point Likert-type continuum ranging from Strongly Agree to Strongly Disagree.

Items were designed following a comprehensive table of specifications encompassing three core epidemiological dimensions: the nature of STDs, STD prevention, and STD clinical treatment. The scoring protocol produces both subscale scores and a composite score, structured such that higher point values reflect attitudes predisposing an individual to high-risk sexual behavior, whereas lower scores reflect attitudes supportive of low-risk, preventive health actions. Psychometric evaluations demonstrate acceptable internal consistency (Cronbach’s alpha of .73 for the total scale, with subscale alphas ranging from .48 to .71) and stability (test-retest reliability of .71 over a 5- to 7-day interval). The scale displays verified content, face, and construct validity, notably establishing sensitivity to educational interventions across secondary and postsecondary school populations. It remains a foundational assessment tool in public health education, epidemiological behavioral research, and intervention evaluation.

2. Keywords

STD Attitude Scale, sexually transmitted diseases, sexual health, attitude measurement, tripartite model, health belief model, conative intention, affective evaluation, psychometrics, risk behavior assessment

3. Authors

The STD Attitude Scale was conceptualized and developed by a collaborative team of health behavior scientists and psychometricians:

• William L. Yarber, HSD: Department of Applied Health Science, School of Public Health (formerly HPER), Indiana University, Bloomington, Indiana. Senior Member, The Kinsey Institute for Research in Sex, Gender, and Reproduction. Email: [email protected].
• Mohammad R. Torabi, PhD, MPH: Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, Indiana.
• C. Harold Veenker, HSD: Department of Health, Kinesiology, and Leisure Studies, Purdue University, West Lafayette, Indiana.

The scale development and validation initiatives were supported in part by the U.S. Public Health Service via Grant Award #R30/CCR500638–01 in conjunction with the Centers for Disease Control and Prevention (CDC).

4. Purpose

Sexually transmitted diseases represent persistent public health challenges globally, with adolescent and emerging adult populations consistently demonstrating disproportionate incidence rates. Early public health initiatives often assumed that biological and factual knowledge alone would generate protective health actions. However, behavioral science literature has continually demonstrated that knowledge is a necessary but insufficient predictor of health actions; individual attitudes, emotional perceptions, and behavioral intentions play a far more decisive role in governing personal risk behaviors.

The primary purpose of the STD Attitude Scale is to provide researchers, educators, and clinicians with a reliable, empirically validated instrument designed specifically to measure young adults’ attitudes toward STDs and discriminate between individuals characterized by high-risk attitudes and those characterized by low-risk, protective attitudes. The theoretical rationale rests on the principle that educational curricula and preventive counseling must be guided by diagnostic baselines that identify specific attitudinal vulnerabilities—whether cognitive misconceptions, affective inhibitions, or behavioral hesitations.

In clinical, educational, and research settings, the scale serves several critical functions:

• Curriculum Diagnostics and Needs Assessment: Identifies specific attitudinal deficits within student bodies or community cohorts prior to implementing sexual health education programs.
• Evaluation of Public Health Interventions: Evaluates whether psychoeducational curricula (such as school-based STD and HIV prevention programs) effectively foster health-conducive attitudes across cognitive, affective, and intentional dimensions over time.
• Epidemiological and Behavioral Risk Correlates: Enables researchers to model the statistical relationships between attitudinal profiles, demographic variables, personality constructs, and actual sexual health practices (e.g., condom negotiation, routine screening, and partner notification).

5. Psychological Construct

The STD Attitude Scale operationalizes attitudes through a classic multidimensional structural lens, integrating three distinct psychological components across three epidemiological content domains (Nature of STD, STD Prevention, and STD Treatment). Each subscale contains 9 items carefully balanced across these content areas.

Cognitive Component (Belief Subscale, Items 1–9)

The cognitive dimension encompasses an individual’s intellectual perceptions, factual understandings, and personal concepts regarding STDs. It captures subjective beliefs about personal susceptibility, disease severity, transmission dynamics, and the objective efficacy of preventive health behaviors. For instance, Item 1 (“How one uses his/her sexuality has nothing to do with STD”) captures the cognitive disconnect between individual behavioral agency and infection transmission, while Item 3 (“Responsible sex is one of the best ways of reducing the risk of STD”) evaluates an individual’s belief regarding the protective nature of intentional behavioral moderation.

Affective Component (Feeling Subscale, Items 10–18)

The affective dimension evaluates emotional reactions, visceral feelings, and evaluative sentiments of liking, disliking, comfort, anxiety, embarrassment, or stigma related to STDs, clinical interventions, and sexual communication. Emotional barriers often exert more influence over behavior than cognitive understanding. For example, Item 11 (“If I were sexually active, I would feel uneasy doing things before and after sex to prevent getting an STD”) and Item 16 (“It would be embarrassing to discuss STD with one’s partner if one were sexually active”) detect affective discomfort, shame, and interpersonal awkwardness that inhibit health-protective practices.

Conative Component (Intention to Act Subscale, Items 19–27)

The conative dimension assesses behavioral intention, representing an individual’s declared commitment or stated readiness to perform specific actions in response to real or hypothetical sexual health scenarios. In health psychology, behavioral intention serves as the most immediate proximal determinant of actual behavior. Items in this subscale measure intentions toward clinical testing, barrier method adherence, partner management, and public health cooperation. Examples include Item 20 (“If I had an STD, I would avoid exposing others while I was being treated”) and Item 25 (“The chance of getting an STD would not stop me from having sex”), which assess individual willingness to prioritize disease mitigation over sexual gratification.

6. Theoretical Framework

The development of the STD Attitude Scale is anchored primarily in the Tripartite Model of Attitude Structure, synthesized by prominent social psychologists including Ostrom (1969), Kothandapani (1971), and Bagozzi (1978). Under this theoretical perspective, attitudes are not unidimensional affective responses; rather, they exist as systemic configurations of cognitive appraisals, affective responses, and behavioral intentions. Torabi and Veenker (1986) demonstrated the utility of this tripartite paradigm in measuring adolescent health attitudes, establishing that assessing all three dimensions provides greater predictive validity than assessing any single component in isolation.

Additionally, the conceptualization aligns closely with the Health Belief Model (HBM) and the Theory of Reasoned Action (TRA) formulated by Fishbein and Ajzen. The HBM posits that health behavior is governed by perceived susceptibility, perceived severity, perceived benefits of preventive action, and perceived barriers (such as embarrassment or medical costs). The STD Attitude Scale incorporates these variables across its subscales: the Belief subscale reflects perceived susceptibility and severity; the Feeling subscale captures perceived psychological and interpersonal barriers; and the Intention to Act subscale captures perceived behavioral control and intentional commitment to act.

7. Validity

The STD Attitude Scale underwent rigorous psychometric validation during its development phase, incorporating qualitative expert appraisal and quantitative quasi-experimental designs.

Content and Face Validity

Item generation commenced with a comprehensive review of epidemiological and educational literature, followed by student solicitations and expert panel reviews. A detailed table of specifications was constructed, crossing the three psychological components (Cognitive, Affective, Conative) with three essential content areas: the nature of STDs, prevention modalities, and clinical treatment processes. An external panel of health education and clinical specialists reviewed the initial pool to ensure clarity, developmental appropriateness, linguistic readability, and alignment with national STD curricula sponsored by the Centers for Disease Control (Yarber, 1985).

Construct and Criterion-Related Validity

Construct validity was demonstrated through field evaluations of health curricula. Yarber (1988) tested the instrument’s sensitivity to change in a quasi-experimental study comparing secondary school students enrolled in a standardized, health-behavior-oriented STD curriculum against an uninstructed control cohort. Students completing the curriculum demonstrated statistically significant decreases in risk scores (indicating adoption of low-risk attitudes) from pretest to posttest, whereas control students showed no attitudinal shifts. This finding verified that the scale reliably reflects meaningful educational and behavioral modifications.

8. Reliability

The psychometric reliability of the STD Attitude Scale was established across large student samples during initial scale construction (Yarber, Torabi, & Veenker, 1988).

Internal Consistency

Cronbach’s alpha coefficients across the 27-item scale and its subscales are as follows:

• Total Scale: α = .73
• Belief Subscale (Cognitive): α = .53
• Feeling Subscale (Affective): α = .48
• Intention to Act Subscale (Conative): α = .71

While the internal consistency of the Belief and Feeling subscales is modest—reflecting the broad range of topics covered within each 9-item domain (spanning nature, prevention, and treatment)—the composite instrument demonstrates adequate reliability for group research and program evaluation.

Test-Retest Stability

Temporal stability was evaluated using a 5- to 7-day test-retest design among secondary students:

• Total Scale: r = .71
• Belief Subscale: r = .50
• Feeling Subscale: r = .57
• Intention to Act Subscale: r = .63

All test-retest correlations were statistically significant (p < .001), indicating stable measurement properties across short evaluation intervals.

9. Factor Analysis

The development of the STD Attitude Scale utilized an empirical item-reduction sequence based on item-discrimination indices, item-to-subscale correlations, and factor structural consistency:

• Phase 1 (Item Pool Reduction): An initial item repository was organized into three preliminary forms comprising 45 items each (15 items per tripartite subscale). These forms were administered to 457 college undergraduates. Items failing to demonstrate robust bivariate correlations with subscale totals or failing to discriminate between upper and lower quartiles (top 27% vs. bottom 27%) were eliminated.
• Phase 2 (Cross-Validation Pilot): The refined 45-item instrument was administered to a cohort of 100 high school students to examine linguistic clarity and developmental suitability.
• Phase 3 (Large-Scale Factorial Optimization): A 33-item version (11 items per subscale) was evaluated in a large sample of 2,980 secondary school students. Psychometric analysis confirmed high item-total correlation and discrimination power across all retained indicators. The final, mathematically optimized scale was reduced to 27 items (exactly 9 items per subscale), maximizing content validity across the three conceptual domains while maintaining high discrimination power.

10. Instrument / Measurement Tool

• Instrument Type: Multidimensional Self-Report Attitudinal Inventory
• Target Population: Adolescents, secondary school students, and young adults
• Administration Format: Paper-and-pencil questionnaire or computerized self-administration
• Completion Time: Approximately 15 minutes
• Item Count: 27 items
• Subscale Breakdown:
  • Belief Subscale: Items 1 to 9 (Cognitive dimension)
  • Feeling Subscale: Items 10 to 18 (Affective dimension)
  • Intention to Act Subscale: Items 19 to 27 (Conative dimension)
• Response Scale: 5-point Likert scale (SA = Strongly Agree, A = Agree, U = Undecided, D = Disagree, SD = Strongly Disagree)
• Scoring Protocol:
  • Direct-Coded Items (High-Risk Endorsement): Items 1, 10, 11, 12, 13, 14, 16, and 25.
    Scored: Strongly Agree = 5, Agree = 4, Undecided = 3, Disagree = 2, Strongly Disagree = 1.
  • Reverse-Coded Items (Protective/Low-Risk Endorsement): Items 2, 3, 4, 5, 6, 7, 8, 9, 15, 17, 18, 19, 20, 21, 22, 23, 24, 26, and 27.
    Scored: Strongly Agree = 1, Agree = 2, Undecided = 3, Disagree = 4, Strongly Disagree = 5.
  • Score Interpretation: Subscale scores range from 9 to 45; total scale scores range from 27 to 135. Higher scores reflect attitudes predisposing individuals to high-risk STD behavior, whereas lower scores reflect attitudes supportive of low-risk, protective behaviors.

11. Permissions & Fee and Test Year

The STD Attitude Scale was published in 1988 in the Journal of Sex Education and Therapy following developmental research initiated under U.S. Public Health Service Grant Award #R30/CCR500638–01. The scale is in the public domain for nonprofit academic, clinical, and scientific evaluation purposes. Researchers and educational practitioners may utilize the scale without royalty fees, provided appropriate scholarly attribution is given to the authors (Yarber, Torabi, & Veenker, 1988). Inquiries regarding adaptations, translations, or commercial applications may be directed to Dr. William L. Yarber at Indiana University Bloomington.

12. References

Bagozzi, R. P. (1978). The construct validity of the affective, behavioral, and cognitive components of attitude by using analysis of covariance of structure. Multivariate Behavioral Research, 13(1), 9–31. https://doi.org/10.1207/s15327906mbr1301_2

Kothandapani, V. (1971). A psychological approach to the prediction of contraceptive behavior. Carolina Population Center, University of North Carolina at Chapel Hill.

Ostrom, T. M. (1969). The relationship between the affective, behavioral, and cognitive components of attitude. Journal of Experimental Social Psychology, 5(1), 12–30. https://doi.org/10.1016/0022-1031(69)90003-1

Torabi, M. R., & Veenker, C. H. (1986). An alcohol attitude scale for teenagers. Journal of School Health, 56(3), 96–100. https://doi.org/10.1111/j.1746-1561.1986.tb01185.x

Yarber, W. L. (1985). STD: A guide for today’s young adults [Student and Instructor’s Manual]. American Alliance Publications.

Yarber, W. L. (1988). Evaluation of the health behavior approach to school STD education. Journal of Sex Education and Therapy, 14(1), 33–38. https://doi.org/10.1080/01614576.1988.11074919

Yarber, W. L., Torabi, M. R., & Veenker, C. H. (1988). Development of a three-component sexually transmitted diseases attitude scale. Journal of Sex Education and Therapy, 15(1), 36–49. https://doi.org/10.1080/01614576.1989.11074945

13. Items of the Scale