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PubMed1995

Youth risk behavior surveillance--United States, 1993.

PROBLEM/CONDITION: Priority health risk behaviors that contribute to the leading causes of mortality, morbidity, and social problems among youth and adults often are established during youth, extend into adulthood, and are interrelated. REPORTING PERIOD: February through May 1993. DESCRIPTION OF SYSTEM: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health risk behaviors among youth and young adults: behaviors that contribute to unintentional and intentional injuries, tobacco use, alcohol and other drug use, sexual behaviors, dietary behaviors, and physical activity. The YRBSS includes a national, school-based survey conducted by CDC and state and local school-based surveys conducted by state and local education agencies. This report summarizes results from the national survey, 24 state surveys, and nine local surveys conducted among high school students during February through May 1993. RESULTS AND INTERPRETATION: In the United States, 72% of all deaths among school-age youth and young adults are from four causes: motor vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 1993 YRBSS suggest that many high school students practice behaviors that may increase their likelihood of death from these four causes: 19.1% rarely or never used a safety belt, 35.3% had ridden with a driver who had been drinking alcohol during the 30 days preceding the survey, 22.1% had carried a weapon during the 30 days preceding the survey, 80.9% ever drank alcohol, 32.8% ever used marijuana, and 8.6% had attempted suicide during the 12 months preceding the survey. Substantial morbidity and social problems among adolescents also result from unintended pregnancies and sexually transmitted diseases, including human immunodeficiency virus (HIV) infection. YRBSS results indicate that in 1993, 53.0% of high school students had had sexual intercourse, 52.8% of sexually active students had used a condom during last sexual intercourse, and 1.4% ever injected an illegal drug. Among adults, 67% of all deaths are from three causes: heart disease, cancer, and stroke. In 1993, many high school students practiced behaviors that may increase the risk for these health problems: 30.5% of high school students had smoked cigarettes during the 30 days preceding the survey, only 15.4% had eaten five or more servings of fruits and vegetables during the day preceding the survey, and only 34.3% had attended physical education class daily. ACTIONS TAKEN: YRBSS data are being used nationwide by health and education officials to improve school health policies and programs designed to reduce risks associated with the leading causes of mortality and morbidity. At the national level, YRBSS data are being used to measure progress toward achieving 26 national health objectives and one of eight National Education Goals.

Accidents↗
PubMed2000

Smoking patterns, health behaviors, and health-risk behaviors of college women.

In 1993, 22% of college women smoked; in 1997, the rate increased to 29%. College-age women (<24 years) showed the greatest increase in smoking. The purpose of this study is to describe smoking behaviors of college women. The sample included 21 college-age female smokers. Each woman was interviewed about smoking habits and completed a health survey, the Fagerstrom Test for Nicotine Dependence, a Self-Efficacy Scale for predicting smoking relapse, a Decisional Balance Scale for smoking, a readiness for change tool, and the Derogatis Stress Profile. The majority of the students began smoking at the age of 14 years or younger and smoked fewer than 10 cigarettes per day. The biggest obstacles to quitting were being around other smokers and social activities involving alcohol. These students did not smoke when ill and were interested in quitting smoking. Smoking frequency correlated significantly with dependency and stage of change. Advanced practice nurses have a unique opportunity to identify these young smokers, educate them about smoking-cessation options, and offer specific strategies to help these women stop smoking.

Adolescent↗
PubMed1998

Changes in HIV risk behaviors among cocaine-using methadone patients.

Cocaine use among methadone patients has been related to higher prevalence of HIV risk behaviors. HIV risk behaviors for cocaine-using patients in methadone treatment (N = 207) were examined for two time periods, the current month in-treatment and the month previous to treatment admission. All needle-related and sexually-related risk behaviors (except for needle hygiene) significantly and substantially declined over the average two year time interval. Several variables were associated with needle and sexual risks in multivariate regression analyses. Dropping apparent opiate use underreporters from the analyses did not alter the results. From a harm reduction perspective, high priority should be given to retaining cocaine-using patients in methadone maintenance, intensifying in-program services for those with anti-social personality, bipolar disorder or alcoholism, as well as increasing access to needle exchanges and free condoms.

Adult↗
PubMed2005

Influence of prior sexual risk experience on response to intervention targeting multiple risk behaviors among adolescents.

PURPOSE: To identify correlates of sexual risk variations among African-American adolescents, and to examine the influence of prior sexual experience on response to a HIV risk-reduction intervention. METHODS: Eight hundred seventeen African-American youth aged 13 to 16 years living in and around urban public housing in Baltimore were recruited to participate in a HIV risk-reduction intervention targeting multiple risk behaviors. An instrument designed to measure three levels of sexual risk ("abstinent," "protected sex" [having sex with a condom], and "unprotected sex" [having sex without a condom]) was administered at baseline, 6 months and 12 months postintervention. Multiple regression analyses were conducted to identify predictors of the degree of sexual risk using longitudinal data. Repeated measure analyses were conducted to assess behavioral changes over time among the three groups. RESULTS: Data confirmed the co-variation of sexual risk behavior and other problem behaviors among adolescents, cross-sectionally and longitudinally. After exposure to an 8-session risk-reduction intervention, youth engaging in the highest degree of sexual risk demonstrated the greatest reduction in both sexual risk and other risks. These improvements were seen at both 6 months and 12 months postintervention. Youth who were abstinent at baseline maintained the lowest levels in risk involvement throughout the study period when compared with sexually active youth. However, abstinent youth risk involvement significantly increased at 6 months and 12 months after baseline. Youth engaging in protected sex at baseline demonstrated a significant increase in non-condom use and a significant decrease in multiple risk involvement over time. CONCLUSIONS: Results support HIV risk-reduction intervention efforts that target multiple risk behaviors. Response of adolescents to the intervention is directly related to the sexual risk behavior at baseline. These data may suggest that the response to risk behavior intervention depends in part on the risk behavior profile of the population to which it is being applied.

Adolescent↗
PubMed1998

Mary J. Nielubowicz Award. Sexual risk behaviors among ship- and shore-based Navy women.

It is appropriate to study sexual risk behaviors among ship- and shore-based active duty Navy women. Morbidity and mortality associated with sexually transmitted diseases and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), the increasing number of HIV/AIDS cases among heterosexual women, and the limited information regarding Navy women's sexual health are justification for identifying the determinants of sexual risk behavior(s) among this group of women of childbearing age. This study provides an integrated perspective in which demographic characteristics, motivation, problem-solving, self-esteem, and sexual risk behaviors are used to explore determinants of sexual risk behavior among ship- and shore-based Navy women. The subjects in the study (N = 165) consisted of 53 (32.5%) African-American and 88 (54%) white women whose average age was 26.89 years (SD = 6.10 years); the remaining 13.5% were from four other ethnic/racial groups. Sexual risk behaviors were defined as having more than one sex partner (n = 68) and the partner not using a condom (n = 75). Single women whose partners did not use condoms were observed to have lower self-esteem scores than single women whose partners used condoms (t = 3.37, df = 70.85, p = 0.001). A knowledge of the factors that influence sexual risk behavior(s) will provide direction for the development of interventions to reduce risk.

Adult↗
PubMed1999

The relationship between early age of onset of initial substance use and engaging in multiple health risk behaviors among young adolescents.

BACKGROUND: Previous research based on problem-behavior theory has found that early age of onset of substance use is associated with engaging in multiple health risk behaviors among high school students. It is unknown whether these relationships begin during early adolescence. OBJECTIVE: To examine the relationships between early age of onset of cigarette, alcohol, marijuana, and cocaine use and engaging in multiple risk behaviors among middle school students. METHODS: A modified version of the Centers for Disease Control and Prevention Youth Risk Behavior Survey was administered to 2227 sixth through eighth grade students attending 53 randomly selected middle schools in North Carolina. A Health Risk Behavior Scale was constructed from 16 behaviors, including indicators of violence and weapon carrying; current substance use; nonuse of helmets when biking, in-line skating or skateboarding; not wearing a seat belt; riding with a driver who had been drinking; and suicide plans. Among this sample of middle school students, the scale had a mean (SD) of 4.1 (2.7) (range=O-15), and had a high internal reliability coefficient (alpha(=0.74). The independent variables included first time use of cigarettes, alcohol, marijuana, and cocaine at age 11 years or earlier; actual age of onset of each substance; race and ethnicity; family composition; sex; school grade; academic ranking; and older age for school grade. These data were analyzed with analysis of variance, Spearman r, and multiple linear regression. RESULTS: All the independent variables were found to be associated (P<.005) with the Health Risk Behavior Scale during the bivariate analyses. When each of these significant variables were entered into a multiple regression model, having smoked at age 11 years or younger accounted for 21.9% of the variation in the Health Risk Behavior Scale. Male sex, early marijuana or cocaine use, older age, lower academic rank, white race, and living in a 1-parent family explained an additional 19.1% of variation in the model (adjusted R2=0.41, P<.001). When the actual ages of onset of the use of substances were analyzed, in order of magnitude; age of onset of smoking; male sex; age of onset of alcohol and marijuana use; age; lower academic ranking; age of onset of cocaine use; white race; and lower academic rating accounted for 52.8% (P<.001) of the variation in the Health Risk Behavior Scale. CONCLUSION: Even when considering sociodemographic factors, early age of onset of cigarette use was the strongest correlate of the number of health risk behaviors in which these young adolescents had engaged. Early onset of use of other substances was also associated with a clustering of health risk behaviors among this sample of middle school students. The findings suggest that screening for early experimentation with tobacco and other substance use will help identify young adolescents at increased risk for engaging in multiple health risk behaviors.

Adolescent↗
PubMed2001

Health risk behaviors and health perceptions in the Peruvian Amazon.

Behavioral health risk factor and health belief data for the indigenous population of the Peruvian Amazon are unavailable. Therefore, we conducted structured interviews of adults living in 5 towns in the remote Amazon region of Peru. Respondents (n = 179) were 67% women with a mean age of 35.4 years. The average household size was 6.7 people. A majority (72%) were unable to see a doctor when needed because of lack of money and distance. Only 6% reported excellent health, and nearly half (49%) reported fair health. Forty-eight percent drank alcohol and 73% smoked. Only 34% thought mosquitoes cause malaria, but 98% were using mosquito nets. In conclusion, our findings indicate the indigenous population of the Peruvian Amazon has limited access to basic health care. Although most of those surveyed use mosquito netting, few know that mosquitoes transmit malaria. Tobacco and alcohol use are major behavioral health risk factors.

Adolescent↗
PubMed2003

HIV transmission risk behavior and its relation to antiretroviral treatment adherence.

BACKGROUND: Rising rates of antiretroviral drug resistance among recently infected persons are evidence of high-risk behavior among persons in HIV care. GOAL: The goal was to determine HIV transmission risk behavior among persons in HIV care and evaluate its association with treatment adherence. STUDY DESIGN: The study involved a structured interview of a random sample of patients in HIV care in an urban public clinic. Participants were categorized by transmission risk: high risk = unprotected anal/vaginal sex and/or needle sharing; low risk = protected anal/vaginal sex, unprotected and/or protected oral sex, no needle sharing; no risk = no sex or needle sharing. RESULTS: Of the 95 participants, 21 (22%) reported high-risk behavior, 36 (38%) reported low-risk behavior, and 38 (40%) reported no transmission risk in the past 3 months. Younger, more educated persons and those with an active substance abuse diagnosis were more likely to have high transmission risk (P < or = 0.05). Patients who engaged in high-risk behavior had equivalent use of antiretroviral therapy (P = 0.80) but lower adherence (P < or = 0.01) and higher median plasma viral loads (P = 0.05). CONCLUSIONS: There was a wide spectrum of transmission risk behavior among persons in HIV care. Persons reporting high-risk behavior were less adherent to antiretroviral therapy, providing a behavioral basis for transmission of drug-resistant HIV.

Adult↗
PubMed2001

Untangling the impact of sexual abuse on HIV risk behaviors among youths in foster care.

This study investigates the interrelationships among childhood sexual abuse, other types of child maltreatment, emotional and behavioral problems, and HIV risk behaviors in a sample of 167 adolescents, aged 15-19, participating in an independent living preparation program in one midwestern county. Thirty-three percent of the youths identified as white and 67% as youths of color. The sample was almost evenly split by gender (51% male and 49% female). Thirty-five percent of the youths (n = 59) reported some form of sexual abuse; 21 reported unwanted touching, with no unwanted intercourse, and 38 reported unwanted intercourse. Multivariate analyses demonstrated a significant relationship between the severity of sexual abuse and youths' recent HIV risk behaviors, after accounting for the contribution of other childhood trauma and emotional and behavioral problems. The findings support the need for HIV prevention programs targeting sexually abused youths.

Adolescent↗
PubMed1997

Health risk behaviors among California college students.

Health risk behaviors among students attending 4-year colleges in California were examined. The Youth Risk Behavior Survey for College Students was administered in a two-stage (29 universities, 5,652 students) random sample. All campuses and 3,810 (69%) students participated in the survey. In the 30 days preceding the survey, 36.7% of the students had binged at least once while drinking; 25.3% had driven after consuming alcohol; 32% had ridden in a car with someone who had been drinking; 17.6% had used marijuana; and 6% had carried a knife, gun, or club. More than half of the students who were sexually active and not married or living with a primary partner had not used a condom the last time they had sexual intercourse. Only 5% of regular bicycle riders always wore a helmet. Fewer than half (44%) reported aerobic physical activity on 3 or more of the preceding 7 days. The results of this study indicate a substantial amount of serious, risky health behaviors among California college students.

Adolescent↗
PubMed1998

Cocaine users with antisocial personality improve HIV risk behaviors as much as those without antisocial personality.

Previous work has documented that antisocial personality disorder (APD) is associated with increased rates of HIV risk behaviors and with worse substance abuse treatment outcomes. The question addressed by this paper is whether cocaine users with APD respond to an HIV risk-reduction intervention as well as cocaine users without the disorder. The study subjects were 333 cocaine users followed up at 18 months as part of a NIDA-funded treatment demonstration project. The total sample improved across a wide range of HIV risk behaviors. Improving significantly (P < 0.05) from baseline to the 18-month follow-up were several drug-related behaviors: cocaine use; current cocaine dependence; use of drugs other than cocaine drug injection; injection equipment sharing; and use of syringes that were not cleaned. Several sex-related HIV risk behaviors also improved significantly: having multiple sex partners; being intoxicated during sex; giving drugs for sex; receiving money for sex; and receiving drugs for sex. When the sample was stratified by APD status, very similar improvement was seen in respondents with and without APD. To examine further the relationship of APD to change in HIV risk behaviors, separate logistic regression models of improving and worsening HIV risk behaviors were tested. What the authors found was no association of APD with improvement in HIV risk behaviors but a significant association of APD with worsening HIV risk behaviors. It appears that cocaine users with APD improve their HIV risk behaviors just as much as those without APD but may be at higher HIV risk for the development of such behaviors.

Adult↗
PubMed1995

High-risk behavior and the public burden for funding the costs of acute injury.

OBJECTIVE: To determine if high-risk behavior is associated with increased injury severity and cost and if public agencies bear a disproportionate burden of that cost. DESIGN: Case comparison study utilizing patient data collected over a 10-year period. SETTING: Five level 1 and 2 trauma centers in an urban-suburban community with a population of 2.4 million. PARTICIPANTS: Trauma registry data from 37,304 consecutive hospitalized adult patients with trauma. Financial data were reported and analyzed on 28,842 of these. MAIN OUTCOME MEASURES: Incidence of alcohol intoxication, other drug use, use of vehicular protective devices, and firearm violence injuries in patients with private vs public health care sponsorship. Length of hospital stay, injury severity, and hospital unit charges were assessed for high-risk behavior. RESULTS: High-risk behavior was more prevalent among trauma patients relying on public funding to cover the costs of their injuries (P < .001). Total hospital unit charges were 28% and 35% higher for motorists not wearing seat belts and motorcyclists not wearing helmets, respectively. Injury severity and length of stay were also higher (P < .001). CONCLUSIONS: High-risk behavior is associated with increased injury severity and cost. Trauma victims exhibiting high-risk behavior more often depend on public agencies to cover the cost of acute injury. Failure to establish and enforce laws and policies designed to reduce or prevent injury may generate enormous trauma care costs, borne to a large extent by public agencies. Further restriction of certain types of high-risk behavior and the institution of "users' fees," taxes, or penalties may be necessary to reduce the disproportionate public agency cost generated by this activity.

Acute Disease↗
PubMed2005

Unrecognized HIV infection, risk behaviors, and perceptions of risk among young men who have sex with men: opportunities for advancing HIV prevention in the third decade of HIV/AIDS.

This study evaluated the magnitude and distribution of unrecognized HIV infection among young men who have sex with men (MSM) and of those with unrecognized infection, the prevalence and correlates of unprotected anal intercourse (UAI), perceived low risk for infection, and delayed HIV testing. MSM aged 15-29 years were approached, interviewed, counseled, and tested for HIV at 263 randomly sampled venues in 6 US cities from 1994-2000. Of 5649 MSM participants, 573 (10%) tested positive for HIV. Of these, 91% of black, 69% of Hispanic, and 60% of white MSM (77% overall) were unaware of their infection. The 439 MSM with unrecognized infection reported a total of 2253 male sex partners in the previous 6 months; 51% had UAI; 59% perceived that they were at low risk for being infected; and 55% had not tested in the previous year. The HIV epidemic among MSM in the United States continues unabated, in part, because many young HIV-infected MSM are unaware of their infection and unknowingly expose their partners to HIV. To advance HIV prevention in the third decade of HIV/AIDS, prevention programs must reduce unrecognized infection among young MSM by increasing the demand for and availability of HIV testing services.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Self-reports of HIV risk behavior by injecting drug users: are they reliable?

While most studies of AIDS risk behavior rely on self-reports, few studies have assessed the reliability of these reports. The present study examines self-reports of drug-related and sexual risk behavior among pairs of injecting drug users (IDUs) recruited from the streets in New York City. Since both members of the pair were interviewed, it was possible to compare their responses in order to assess reliability. Subjects reported on their contacts' demographic data (age, gender, race/ethnicity) and on shared risk behaviors, including syringe sharing. Despite the private and/or illegal nature of AIDS risk behaviors, IDU subjects were generally reliable in their reports of both demographic and AIDS risk behaviors.

Adolescent↗
PubMed2001

Health risk behavior of rural secondary school students in Zimbabwe.

A socioculturally appropriate health risk behavior instrument, modeled after the U.S. Centers for Disease Control and Prevention's Youth Risk Behavior Survey (YRBS), was administered to 717 secondary school students in a rural area of Zimbabwe. Comparisons of risk behaviors by gender and school grade were made using univariate procedures and multiple logistic regression. Males were significantly more likely than females to have had sexual intercourse (odds ratio = 5.02, p < .0001) and to report drug use behaviors. Males also were significantly more likely to report early initiation (by age 13 years) of alcohol use, cigarette smoking, and marijuana use. School site violence and drug use behaviors also were prevalent in this sample. An interaction between gender and grade was evident for some behaviors. Additional research may further the understanding of these risk behaviors and facilitate development of effective, culturally relevant risk reduction programs.

Adolescent↗
PubMed2001

Quality of life and health-risk behaviors among adolescents.

PURPOSE: To assess the association between health-risk behaviors and self-perceived quality of life among adolescents METHODS: A sample of 2801 students (957 seventh and eighth graders and 1844 ninth through twelfth graders) completed the Teen Assessment Survey (TAP) and the surveillance module of the Youth Quality of Life Instrument (YQOL-S). TAP responses were used to determine health-risks related to tobacco use, alcohol use, illicit drug use, and high risk sexual behavior. Separate multivariate analyses of variance showed mean differences in contextual and perceptual items of the YQOL-S for each health-risk behavior. Differences among engagers (adolescents who often engage), experimenters (occasionally engage), and abstainers (never engage) in the health-risk behavior were evaluated by gender and junior/senior high school groups. RESULTS: In general, adolescent abstainers reported higher quality of life (QoL) than engagers and experimenters on YQOL-S items. Adolescents who engaged in multiple risk behaviors scored even lower than those who engaged in only one health-risk behavior. Experimenters tended to rate their QoL more similar to that of abstainers than to that of engagers. CONCLUSIONS: The framework of QoL proved useful in the evaluation of adolescents' engagement in health-risk behaviors. Additionally, assessing the areas of QoL that differ between the groups may provide information for planning interventions aimed at risk reduction among engagers and experimenters.

Adolescent↗
PubMed1997

The relationship between patient income and physician discussion of health risk behaviors.

CONTEXT: The US Preventive Services Task Force recommends that physicians assess patients' health risk behaviors, addressing those needing modification. OBJECTIVE: To examine the relationship between patient income, health risk behaviors, the prevalence of physician discussion of these behaviors, and the receptiveness of patients to their physicians' advice. DESIGN: Employee survey. PARTICIPANTS: A random sample of 6549 Massachusetts state employees in 12 health plans. MAIN OUTCOME MEASURES: Data were obtained using a patient-completed mail survey. Trend tests were used to discern differences in the prevalence of health risk behaviors, physician discussion of these behaviors, and patient receptiveness to discussions by patient income. RESULTS: Although unhealthy behaviors were common among all income groups, physician discussion of health risk behaviors fell far short of the universal risk assessment recommended by the US Preventive Services Task Force. Low-income patients were more likely to be obese and smoke than high-income patients and were less likely to wear seat belts and exercise. In contrast, stress and alcohol consumption increased with income, while the proportion of heavy drinkers did not vary significantly. Physicians were more likely to discuss diet and exercise with high-income patients in need of these discussions than with low-income patients, but were more likely to discuss smoking with low-income patients who smoked than with high-income patients who smoked. Among patients with whom discussions occurred, low-income patients were much more likely to report attempting to change their behavior based on physician advice. CONCLUSIONS: Physician counseling of patients regarding health risk behaviors should be greatly improved if the US Preventive Services Task Force recommendations are to be fulfilled. Improvement is especially needed in regard to alcohol consumption, safe sex, and seat belt use. Physicians also need to be more vigilant in properly identifying and counseling low-income patients at risk in regard to diet and exercise and high-income patients who smoke.

Adult↗