National Sexual Health Survey [NSHS-180]

Description

The CAPS National Sexual Health Survey (NSHS-180) is a comprehensive survey instrument developed within the Center for AIDS Prevention Studies (CAPS) at the University of California, San Francisco (UCSF). It was designed to collect population-level information on a broad range of topics related to sexual behavior, HIV and sexually transmitted infection (STI) risk, prevention practices, sexual experiences, and sexual health.

The NSHS was administered as a national telephone survey of adults aged 18 years and older living in the 48 contiguous United States. Its measures were developed to investigate multiple aspects of HIV-related behavior and human sexuality, making the instrument particularly relevant to public health and sexual health research.

Rather than functioning as a single psychometric scale that produces one overall score, the NSHS is better understood as a multidimensional survey instrument composed of different thematic sections and variables.

Objective

The primary objective of the NSHS is to provide systematic information about sexual behaviors, sexual health practices, HIV/STI-related experiences, and associated psychosocial factors at the population level.

The survey can be used to investigate patterns of sexual behavior, identify potential risk and protective factors, examine differences between demographic groups, and support the development of evidence-based HIV and sexual health prevention strategies.

Its broader purpose is to improve understanding of how sexual practices, attitudes, experiences, and health-related behaviors interact within different population groups.

Main Areas Assessed

The original CAPS description indicates that the NSHS includes measures covering a wide range of topics. These include:

Condom Attitudes: beliefs and attitudes regarding condom use and its role in sexual relationships.

Condom Use Problems: experiences involving condom slipping, breaking, or other difficulties during use.

HIV Testing: history of HIV testing, attitudes toward testing, and use of home HIV testing.

Sexually Transmitted Infection History: previous experiences or diagnoses involving sexually transmitted infections.

Perceived HIV and STI Risk: individuals’ perceptions of their likelihood of acquiring HIV or other sexually transmitted infections.

Optimistic Bias: perceptions that personal risk may be lower than the risk faced by comparable individuals.

Sexual Relationships and Extramarital Sex: patterns and experiences associated with sexual partnerships and sexual activity outside primary relationships.

Sexual Development: experiences related to the development of sexuality across the life course.

Sexual Abuse and Rape: assessment of experiences involving sexual coercion, abuse, or assault.

Sexual Dysfunction: difficulties associated with sexual functioning and sexual experiences.

The CAPS documentation specifically identifies these domains as examples of the topics assessed in the national survey.

Structure

The NSHS-180 should be regarded as a survey battery rather than a unidimensional 180-item psychological scale.

Its approximately 180 questions cover multiple constructs and use different response formats depending on the topic assessed. These may include categorical responses, behavioral frequency questions, yes/no responses, numerical responses, and rating-scale items.

Consequently, the instrument does not necessarily generate a single overall “sexual health score.” Instead, researchers analyze individual questions, groups of related variables, or specific subscales according to their research objectives.

Scoring and Data Analysis

Because the NSHS assesses multiple independent or related areas of sexual health, scoring depends on the specific variable or section being analyzed.

Categorical questions can be coded according to the presence or absence of a particular behavior or experience, while frequency variables may be treated as ordinal or quantitative measures. Attitudinal measures may be combined into scores when the relevant items were specifically designed to measure the same construct.

Typical statistical analyses include descriptive statistics, prevalence estimates, cross-tabulations, group comparisons, correlation analyses, and regression models.

For example, logistic regression can be used to examine factors associated with outcomes such as HIV testing, condom use, STI history, or particular sexual risk behaviors.

Psychometric Considerations

The NSHS should not be evaluated psychometrically as though all 180 questions constituted a single latent construct. Measures of internal consistency such as Cronbach’s alpha or McDonald’s omega are appropriate only for subsets of items that form a theoretically and empirically coherent scale.

Similarly, exploratory or confirmatory factor analysis may be appropriate for specific attitudinal or psychosocial item sets but not necessarily for the entire survey instrument.

For behavioral and epidemiological variables, the principal methodological considerations include question validity, reliability of self-report, recall accuracy, sampling procedures, response bias, and appropriate handling of sensitive information.

Applications

The NSHS is particularly relevant to research in sexual health, HIV prevention, epidemiology, behavioral medicine, psychology, and public health.

It can be used to investigate the prevalence and correlates of sexual behaviors, condom-use practices, HIV testing, STI-related experiences, perceived sexual health risks, sexual functioning, and other sensitive aspects of human sexuality.

Population-level findings can support the development of prevention campaigns, health education initiatives, testing strategies, and targeted interventions for groups with different patterns of risk or healthcare needs.

The survey also illustrates the value of large-scale sexual health research for understanding how behavioral, interpersonal, and psychosocial factors contribute to population health.

Conclusion

The CAPS National Sexual Health Survey is a broad population-based sexual health research instrument rather than a conventional psychometric scale. Its main strength lies in its ability to assess numerous dimensions of sexuality, HIV/STI prevention, sexual experiences, and health-related behavior within a common research framework.

Its multidimensional design makes it useful for epidemiological and public health research, particularly when researchers seek to identify patterns of sexual behavior, examine risk and protective factors, and inform evidence-based sexual health interventions.

References

Center for AIDS Prevention Studies, University of California, San Francisco. National Sexual Health Survey (NSHS). Division of Prevention Science, UCSF.

Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The Social Organization of Sexuality: Sexual Practices in the United States. University of Chicago Press.

Wellings, K., Collumbien, M., Slaymaker, E., Singh, S., Hodges, Z., Patel, D., & Bajos, N. (2006). Sexual behaviour in context: A global perspective. The Lancet, 368(9548), 1706–1728.

Fenton, K. A., Mercer, C. H., McManus, S., Erens, B., Wellings, K., Macdowall, W., & Johnson, A. M. (2005). Ethnic variations in sexual behaviour in Great Britain and risk of sexually transmitted infections: A probability survey. The Lancet, 365(9466), 1246–1255.