Mathtech Questionnaires: Sexuality Questionnaires for Adolescents

1. Abstract

The Mathtech Questionnaires: Sexuality Questionnaires for Adolescents represent a foundational, multi-component psychometric battery designed by Douglas Kirby and Mathtech, Inc., under funding from the Centers for Disease Control and Prevention (CDC). Engineered specifically to evaluate adolescent sex education programs and empirical outcomes, this battery addresses cognitive, affective, evaluative, and behavioral facets of adolescent sexual health. The suite comprises three interrelated instruments: the Knowledge Test, a 34-item multiple-choice instrument assessing biological, relational, and contraceptive knowledge; the Attitude and Value Inventory (AVI), consisting of 14 distinct five-item Likert-type scales (70 items total) measuring personal sexual values, self-esteem, gender roles, and relational dynamics; and the Behavior Inventory (BI), a multidimensional instrument assessing social and sexual decision-making skills, communication assertiveness, subjective comfort, and objective behavioral frequencies (such as lifetime sexual intercourse, recent intercourse, and contraceptive adherence). Psychometric evaluations across diverse adolescent samples (ranging from N = 14 to N = 990 across sub-analyses) demonstrate robust measurement properties. The Knowledge Test exhibits a two-week test-retest reliability coefficient of r = .89 and demonstrated construct and known-groups validity correlated with age and academic achievement. The AVI scales show internal consistency estimates reaching up to Cronbach’s α = .94 (Attitude Toward Premarital Sex). The Behavior Inventory demonstrates high behavioral test-retest stability (e.g., r = 1.00 for lifetime intercourse, r = .97 for protected intercourse) and internal consistencies up to α = .86 for comfort scales. Constructed to remain in the public domain, the Mathtech Questionnaires continue to serve as a seminal paradigm in program evaluation, public health intervention research, and adolescent developmental psychology.

2. Keywords

Mathtech Questionnaires, adolescent sexuality, Douglas Kirby, sex education evaluation, Knowledge Test, Attitude and Value Inventory, Behavior Inventory, contraceptive self-efficacy, sexual health assessment, adolescent reproductive behavior, psychometrics

3. Authors

The Mathtech Questionnaires were developed under the principal leadership of Douglas Kirby, Ph.D., an internationally renowned social scientist and pioneer in adolescent reproductive health research. At the time of the instrument’s definitive psychometric publication and widespread dissemination, Dr. Kirby was affiliated with ETR Associates (Education, Training, and Research) based in Santa Cruz, California. The initial foundational developmental project was executed by Mathtech, Inc., a private research firm, funded through a research and evaluation contract awarded by the United States Centers for Disease Control and Prevention (CDC).

Correspondence regarding the original instruments was directed to Douglas Kirby, Ph.D., ETR Associates, P.O. Box 1830, Santa Cruz, CA 95061–1830 (e-mail: [email protected]). Dr. Kirby’s extensive body of empirical work spanned several decades, during which he directed landmark national studies evaluating comprehensive sexuality curricula and abstinence-based initiatives until his passing in 2012.

4. Purpose

The Mathtech Questionnaires were created in response to a major methodological gap in public health and educational research during the late 1970s and early 1980s. Prior to their development, evaluations of school-based and community-based sex education programs suffered from fragmented, unstandardized, and ad hoc measurement tools. Programs frequently measured idiosyncratic knowledge gains using unvalidated classroom quizzes, entirely omitting the affective, attitudinal, normative, and behavioral mechanisms that actually drive adolescent decisions regarding sexual initiation, contraception, and interpersonal safety.

Funded by the CDC, Mathtech undertook a systematic effort to identify, reach consensus on, and measure the key determinants of positive adolescent sexual development. The battery has two explicitly stated purposes:

• Primary Measurement Purpose: To operationalize and quantify the most critical knowledge domains, personal values, interpersonal attitudes, life skills, and enacted behaviors that either foster a positive, healthy, and fulfilling sexuality or directly reduce unintended adolescent pregnancies and sexually transmitted infections (STIs).
• Evaluative and Research Purpose: To provide a standardized, rigorous evaluation battery for researchers, health departments, school districts, and program developers seeking to assess the short-term, intermediate, and long-term impacts of sexuality education curricula.

In clinical, community, and educational intervention trials, the Mathtech instruments allow evaluators to pinpoint precisely where an intervention succeeds or fails. Rather than treating adolescent sexual behavior as an unmediated outcome, the battery measures the complete cognitive-affective-behavioral chain. For example, an intervention may succeed in elevating biological literacy (Knowledge Test) without altering personal norms around coerced intercourse or contraceptive assertiveness (AVI and Behavior Inventory). By disentangling cognitive comprehension, value clarity, self-efficacy, subjective comfort, and interpersonal behavioral execution, the scale provides actionable insights for curriculum modification, intervention benchmarking, and epidemiological tracking.

5. Psychological Construct

The Mathtech suite conceptualizes adolescent sexual health not as a unidimensional trait, but as a dynamic, multicomponent behavioral ecology. Each component addresses specific latent dimensions:

1. Cognitive Sexual Literacy (The Knowledge Test)

Comprising 34 multiple-choice items, this construct captures foundational reproductive literacy across eight core domains: adolescent physical maturation and pubertal changes, interpersonal relationships, adolescent sexual activity patterns, adolescent pregnancy dynamics, early marriage outcomes, biological probabilities of conception, birth control efficacy and proper administration, and sexually transmitted diseases (symptomatology, prevention, and sequelae). Unlike simple memorization scales, it focuses on actionable health literacy—such as recognizing that a woman can conceive during her first sexual intercourse or identifying that condoms provide dual protection against STIs and pregnancy.

2. Affective, Evaluative, and Identity Dimensions (The Attitude and Value Inventory)

The AVI assesses 14 latent constructs via 70 five-point Likert items (five items per subscale):

• Clarity of Long-Term Goals: Measures the degree to which an adolescent possesses structured future orientation, vocational goals, and teleological self-direction (e.g., item Q34: “I have a clear picture of what I’d like to be doing in the future”).
• Clarity of Personal Sexual Values: Gauges subjective confidence regarding personal boundaries, sexual ethics, and behavioral self-guidelines versus moral ambiguity or confusion (e.g., item Q5: “I’m confused about my personal sexual values and beliefs”).
• Understanding of Emotional Needs: Measures introspective emotional intelligence and self-awareness regarding what fosters personal psychological happiness.
• Understanding of Personal Social Behavior: Operationalizes an individual’s comprehension of why they act in specific ways within peer and relational contexts.
• Understanding of Personal Sexual Response: Captures somatic and psychological self-awareness regarding sexual arousal, physiological reactions, and erotic triggers.
• Attitude Toward Gender Roles: Assesses egalitarianism versus rigid adherence to traditional gender stereotypes regarding vocational and interpersonal behaviors.
• Attitude Toward Sexuality in Life: Reflects the perception of human sexuality as an enriching, constructive aspect of human living versus a source of destructive conflict.
• Attitude Toward the Importance of Birth Control: Measures endorsement of normative responsibility regarding contraceptive use when pregnancy is unintended.
• Attitude Toward Premarital Sex: Captures moral acceptability or proscription of sexual intercourse prior to legal marriage.
• Attitude Toward the Use of Force and Pressure in Sexual Activity: Evaluates rejection versus tolerance of sexual coercion, entitlement, and boundary violations.
• Recognition of the Importance of the Family: Assesses perceived psychological centrality, support, and functional value of primary family systems.
• Self-Esteem: Measures generalized self-worth, self-respect, and positive self-evaluation adapted from classic humanistic paradigms.
• Satisfaction with Personal Sexuality: Gauges subjective contentness or distress regarding one’s current sexual lifestyle and choices.
• Satisfaction with Social Relationships: Captures contentment with the quality, intimacy, and stability of peer friendships.

3. Tripartite Behavioral Competency (The Behavior Inventory)

The Behavior Inventory operationalizes adolescent action across three psychological dimensions:

• Skill Application: Assesses real-world deployment frequency of decision-making, assertiveness, communication, and contraceptive negotiation skills.
• Affective Comfort: Measures subjective anxiety versus ease when discussing sexual health, refusing unwanted sex, or acquiring contraceptives.
• Enacted Behavioral Frequencies: Quantifies lifetime intercourse initiation, monthly sexual activity, and adherence to specific contraceptive methods.

6. Theoretical Framework

The Mathtech Questionnaires are grounded in foundational health behavior and social cognitive theories developed in the late 20th century. Rather than relying on simple biological models of health education, Kirby and colleagues designed the battery around multi-factor behavioral decision-making theories.

Social Learning and Social Cognitive Theory

A primary theoretical foundation of the battery is Albert Bandura‘s Social Cognitive Theory. Bandura posited that knowledge alone rarely changes human behavior; instead, behavior is governed by reciprocal determinism among cognitive factors, environmental influences, and personal agency. Central to the Mathtech framework are:

• Self-Efficacy: Reflected in the Behavior Inventory’s skill and assertiveness measures, assessing whether adolescents feel capable of refusing unwanted sex or insisting on condom use.
• Outcome Expectancies: Operationalized across the AVI subscales, capturing whether teens believe sexual behaviors lead to relational growth, social conflict, or health complications.

The Theory of Reasoned Action and Planned Behavior

The battery also draws on the work of Martin Fishbein and Icek Ajzen through the Theory of Reasoned Action. This framework posits that intentional behavior is directly driven by behavioral attitudes and subjective norms:

• Attitudinal evaluations are measured through the 14 AVI subscales, which evaluate attitudes toward premarital sex, contraception, and interpersonal coercion.
• Subjective norms are assessed by measuring perceived peer expectations, family values, and relational dynamics.

Ericksonian Adolescent Identity Development

Developmentally, the battery integrates Erik Erikson‘s theory of psychosocial development, specifically the stage of Identity versus Role Confusion. Adolescence requires synthesizing personal values, future aspirations, and sexual identity. Subscales such as Clarity of Long-Term Goals, Clarity of Personal Sexual Values, and Understanding of Emotional Needs capture this developmental consolidation, reflecting whether a youth has achieved stable self-definition or remains in identity diffusion.

7. Validity

The validation process for the Mathtech Questionnaires employed a rigorous multi-stage consensus and empirical testing methodology across diverse adolescent populations.

Content Validity and Expert Consensus

Content validity was established through systematic Delphi-style consensus procedures funded by the CDC. Mathtech convened a panel of approximately 20 leading experts in adolescent medicine, developmental psychology, and public health, who generated an initial pool of over 100 potential educational outcomes. Subsequently, an expanded national panel of 100 professionals evaluated each outcome anonymously, rating its importance in preventing unintended pregnancy and fostering healthy sexual development. Items for the Knowledge Test, AVI, and Behavior Inventory were systematically constructed to represent the highest-rated dimensions.

Construct and Known-Groups Validity

Empirical construct validity for the Knowledge Test was confirmed through known-groups comparisons across a large field cohort (N = 729). Statistically significant differences emerged across developmental and academic cohorts:

• Older adolescents in senior high school scored significantly higher than younger junior high school students, consistent with expected cognitive maturation.
• Students with higher cumulative grade point averages (GPAs) scored significantly higher than their lower-performing peers, demonstrating convergent validity with broader academic aptitude measures.

Discriminant Validity and Social Desirability Attenuation

During development of the Attitude and Value Inventory, more than 200 adolescents completed preliminary item pools alongside the Marlowe-Crowne Social Desirability Scale. Items exhibiting a correlation coefficient greater than r = .30 with social desirability were systematically eliminated to minimize evaluative response bias. Furthermore, psychometricians discarded items with extreme ceiling or floor effects, retaining only items with balanced endorsement distributions.

Criterion and Internal Consistency Validity of Behavioral Reporting

Given the sensitivity of self-reported sexual behavior, validity checks were embedded within the Behavior Inventory. Mathtech utilized custom-written cross-tabulation algorithms to evaluate internal consistency across 10 distinct, logically linked items detailing sexual history (e.g., cross-referencing lifetime intercourse with specific monthly coital frequencies, contraceptive methods, and partner communication). Over 95% of adolescent protocols demonstrated internal logical consistency, supporting the empirical validity of self-reported sexual behavior under conditions of assured anonymity.

8. Reliability

Reliability of the Mathtech suite was established through both internal consistency analyses and two-week test-retest stability assessments across independent adolescent cohorts.

Internal Consistency (Cronbach’s Alpha)

Internal consistency for the Attitude and Value Inventory was established on a sample of N = 990 secondary school students across its 14 five-item subscales:

• Attitude toward premarital sex: α = .94
• Clarity of long-term goals: α = .89
• Satisfaction with personal sexuality: α = .85
• Satisfaction with social relationships: α = .81
• Understanding of emotional needs: α = .81
• Understanding of personal sexual response: α = .80
• Understanding of personal social behavior: α = .78
• Attitude toward sexuality in life: α = .75
• Clarity of personal sexual values: α = .73
• Self-esteem: α = .73
• Attitude toward the importance of birth control: α = .72
• Recognition of the importance of the family: α = .70
• Attitude toward gender roles: α = .66
• Attitude toward the use of force and pressure in sexual activity: α = .58

For the Behavior Inventory, internal consistency values across subscales included:

• Comfort getting and using birth control: α = .86 (n = 449)
• Comfort engaging in social activities: α = .81 (n = 517)
• Communication skills: α = .75 (n = 529)
• Comfort talking with parents about sex and birth control: α = .73 (n = 156)
• Comfort being sexually assertive (saying no): α = .68 (n = 455)
• Comfort talking with friends, partner, and parents about sex: α = .66 (n = 461)
• Comfort talking about birth control with friends, partner, and parents: α = .63 (n = 133)
• Assertiveness skills: α = .62 (n = 409)
• Sexual decision-making skills: α = .61 (n = 464)
• Social decision-making skills: α = .58 (n = 541)
• Birth control assertiveness skills: α = .58 (n = 243)

Test-Retest Stability

Two-week test-retest reliability was examined in targeted student samples:

• Knowledge Test: r = .89 (N = 58), demonstrating high temporal stability for cognitive retention.
• Behavior Inventory Skill and Comfort Scales: Stability coefficients ranged from r = .38 to r = .88. Lower coefficients on certain comfort scales (e.g., comfort getting birth control, r = .38, n = 14) reflected limited sample sizes among non-sexually active respondents and genuine shifts in adolescent situational contexts over a two-week window.
• Behavioral Event Measures: Concrete reporting of sexual behaviors demonstrated remarkable temporal stability (N = 41): Lifetime sexual intercourse yielded perfect concordance (r = 1.00); monthly coital frequency yielded r = .88; unprotected intercourse yielded r = .97; and protected intercourse via modern methods (pill, condoms, IUD) yielded r = .97.

9. Factor Analysis

The structural validity of the Mathtech Questionnaires was established through classical item analysis and factor-analytic procedures aimed at ensuring scale unidimensionality.

Item Development and Selection

During the design of the Attitude and Value Inventory, an initial pool of 5 to 10 items was drafted for each targeted construct. Two independent psychometricians trained in scale construction evaluated each item for semantic clarity, developmental appropriateness, and unidimensionality. Experimental field administrations were then conducted with more than 200 adolescents.

Item-reduction criteria included:

• Eliminating items that did not load primarily on their intended conceptual factor.
• Removing items with low item-total correlations within their respective subscale.
• Discarding items with substantial secondary cross-loadings on other subscales.
• Selecting the top five performing items per subscale to balance psychometric depth with administrative efficiency.

Behavior Inventory Factor Structure

A similar empirical strategy was applied to the Behavior Inventory. Rather than treating social skills as an undifferentiated trait, item-level analyses identified three distinct functional dimensions:

• General relational competencies (Social Decision-Making, Communication, Assertiveness).
• Domain-specific reproductive competencies (Sexual Decision-Making, Birth Control Assertiveness).
• Subjective comfort dimensions, which cleanly separated general social comfort from intimate sexual discussions with parents, peers, or partners.

10. Instrument / Measurement Tool

The complete Mathtech battery is organized into three distinct instruments, each with its own administration parameters, item counts, and scoring rubrics:

Instrument Structure & Administration

• Knowledge Test:
  • Format: 34 multiple-choice items, each with 4 or 5 response options and a single correct answer.
  • Administration Time: 15 to 20 minutes for proficient readers; up to 45 minutes for slower readers.
  • Scoring: Binary scoring (0 = incorrect, 1 = correct). Total score is calculated as the sum of correct answers divided by 34, expressed as a percentage correct score: Total Score = (Correct Items / 34) × 100. Omitted items are scored as incorrect.
• Attitude and Value Inventory (AVI):
  • Format: 70 items organized into 14 distinct five-item subscales.
  • Response Scale: 5-point Likert scale (1 = Strongly Disagree, 2 = Somewhat Disagree, 3 = Neutral, 4 = Somewhat Agree, 5 = Strongly Agree).
  • Administration Time: 10 to 30 minutes.
  • Scoring: Positively keyed items are scored 1 to 5. Negatively keyed items are reverse-scored (6 − Response). Subscale scores represent the mean of the 5 constituent items (Sum of item scores / 5). Higher scores denote more favorable, positive, or clear attitudes.
  • Subscale Scoring Keys:
    • Clarity of Long-Term Goals: −Q10, +Q23, +Q30, +Q37, +Q51
    • Clarity of Personal Sexual Values: −Q5, −Q13, −Q25, +Q49, +Q70
    • Understanding of Emotional Needs: +Q14, +Q17, +Q48, +Q56, −Q62
    • Understanding of Personal Social Behavior: −Q6, +Q19, +Q27, −Q34, +Q66
    • Understanding of Personal Sexual Responses: −Q21, +Q31, +Q36, −Q45, −Q52
    • Attitude Toward Gender Roles: −Q8, −Q28, +Q41, +Q50, +Q65
    • Attitude Toward Sexuality in Life: −Q12, −Q42, +Q55, −Q58, +Q64
    • Attitude Toward the Importance of Birth Control: +Q4, −Q16, +Q40, −Q59, +Q61
    • Attitude Toward Premarital Sex: +Q2, +Q20, −Q22, +Q29, −Q63
    • Attitude Toward Use of Force/Pressure: −Q9, +Q15, −Q46, +Q47, +Q54
    • Recognition of Importance of Family: −Q11, −Q24, +Q53, −Q60, +Q69
    • Self-Esteem: +Q3, −Q26, −Q35, +Q44, −Q68
    • Satisfaction with Personal Sexuality: −Q7, −Q18, +Q33, −Q39, +Q57
    • Satisfaction with Social Relationships: +Q1, −Q32, −Q38, −Q43, +Q67
• Behavior Inventory (BI):
  • Format: Three structural sections measuring skills, comfort, and behavioral frequencies.
  • Skill Items Response Scale: 5-point frequency scale: 1 = Almost never (~5% or less), 2 = Sometimes (~25%), 3 = Half the time (~50%), 4 = Usually (~75%), 5 = Almost always (~95% or more), with a separate DNA (Does Not Apply) option.
  • Comfort Items Response Scale: 4-point rating scale from Comfortable to Very Uncomfortable.
  • Direct Behavior Questions: Objective frequency reporting (e.g., number of times during the previous month coitus occurred or specific contraceptive methods were used).
  • Administration Time: 20 to 45 minutes depending on sexual activity status.
  • Scoring: Skill and comfort scales are scored by averaging the constituent item responses after reverse-scoring negative items. Behavioral frequency items are retained as individual numeric indicators and are not summed into composite indices.

11. Permissions & Fee and Test Year

The Mathtech Questionnaires were developed between 1979 and 1983 under contract from the Centers for Disease Control and Prevention, with comprehensive psychometric documentation published by Douglas Kirby in 1984 through Network Publications (a division of ETR Associates).

Licensing and Fee Status: Because their initial creation was financed through public federal research funding from the United States government, the Mathtech Questionnaires reside fully in the public domain. Researchers, educators, psychologists, and healthcare organizations are permitted to administer, adapt, reproduce, and translate the battery without paying licensing fees or securing formal copyright permission. However, professional academic ethics require proper attribution and formal citation of the original source monograph (Kirby, 1984).

12. References

• Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T
• Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Prentice-Hall.
• Crowne, D. P., & Marlowe, D. (1964). The approval motive: Studies in evaluative dependence. John Wiley & Sons.
• Kirby, D. (1984). Sexuality education: An evaluation of programs and their effects. Network Publications.
• Kirby, D. (2001). Emerging answers: Research findings on programs to reduce teen pregnancy. National Campaign to Prevent Teen Pregnancy.
• Kirby, D., Alter, J., & Scales, P. (1979). An analysis of U.S. sex education programs and evaluation methods (Report No. CDC-200-78-0804). Mathtech, Inc., for the Centers for Disease Control.
• Kirby, D., Laris, B. A., & Rolleri, L. A. (2007). Sex and HIV education programs: Their impact on sexual behaviors of young people throughout the world. Journal of Adolescent Health, 40(3), 206–217. https://doi.org/10.1016/j.jadohealth.2006.11.143

13. Items of the Scale