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The sexual behavior of men in the United States.

A nationally representative study of the sexual behavior of men aged 20-39 in the United States shows that the prevalence and frequency of sexual acts (vaginal, anal and oral) and sexual orientation vary by social and demographic characteristics. Analysis of data from 3,321 respondents to the 1991 National Survey of Men reveals that 95% of men have had vaginal intercourse; among them, 23% have had 20 or more vaginal sex partners in their lifetime. About one-fifth of never-married and formerly married men had four or more partners over a recent 18-month period. However, 41% of never-married men and 32% of formerly married men did not have coitus during the four weeks preceding the interview. Only 20% of men have ever engaged in anal intercourse. Among these, 51% had not done so during the previous 18 months, and 90% had not done so during the previous four weeks. Seventy-five percent of men have performed oral sex and 79% have received oral sex, although 53% of men who ever performed oral sex had not done so during the four weeks prior to interview, and only 11% had done so six or more times. The frequency of receiving oral sex is similar. Only 2% of sexually active men aged 20-39 have had any same-gender sexual activity during the last 10 years, and only 1% reported being exclusively homosexual during this interval.

Acquired Immunodeficiency Syndrome↗

Condom use among U.S. men, 1991.

A 1991 study of a nationally representative sample of men aged 20-39 finds that 27% of sexually active men had used a condom in the four weeks before interview. Black men are more likely than white men to report condom use (38% vs. 25%), and men younger than 30 are more likely to do so than are those older than 30 (36% vs. 19%). Among white men, condom use increases with years of education; among black men, however, those with 12 years of education are much less likely to report condom use than are those with more or less than 12 years (28% vs. 43-50%). Condom use is positively related to number of partners. Men who have engaged in anal intercourse, those who have had a one-night stand and those who are bisexual or homosexual are also more likely to report condom use. Among those who reported using a condom in the previous four weeks, 55% of whites and 18% of blacks had done so only for birth control and 7% of whites and 9% of blacks had done so only for protection against infection with the human immunodeficiency virus and other sexually transmitted organisms; the remainder had used a condom for both reasons.

Acquired Immunodeficiency Syndrome↗

HIV-1 infection in relation to educational status, use of hypodermic injections and other risk behaviours in Ethiopian sailors.

Information on the prevalence and risk factors for HIV infection among sailors is generally scarce. The objectives of the study were to determine the prevalence and risk factors for HIV-1 infection among sailors in Ethiopia. A cross-sectional study was carried out in a population of sailors identified from their employment records. Two hundred and sixty sailors were personally interviewed to obtain information on risk factors. Blood samples were collected for the determination of antibodies against HIV-1 infection by ELISA with confirmation by Western blot. The prevalence of HIV-1 infection was 9.6% and the prevalence was observed to decrease with increasing level of education. The risk of acquiring infection was also found to increase with the use of hypodermic injections (OR = 3.42, 95% CI: 1.19 to 9.80). Fourteen percent of the studied population reported condom use. However, the use was irregular. We did not find marital status and consumption of alcohol to be associated with HIV-1 infection. The high prevalence of HIV-1 infection in this population is alarming. Specific education programmes targeted to this group need to be established in order to reduce the increasing risk of infection in this population and the spread of infection to other segments of the population.

Adolescent↗

Correlates of condom use in the young adult population in Ontario.

OBJECTIVES AND METHODS: Data from the Ontario Health Survey were used to identify sociodemographic, lifestyle and sexual history characteristics associated with the use of condoms for protection against sexually transmitted diseases (STDs) in randomly selected adults between the ages of 16 and 44 years who had had two or more sexual partners in the 12 months before the survey (n = 2,699). RESULTS: Forty-two percent reported not having used condoms for protection against STDs. Those most likely to use condoms were 16 to 24 years of age, males, students, non-binge-drinkers, urban residents, and those at higher risk for HIV/AIDS. Of those who used condoms, 68% did not use them consistently. Individuals most likely to always use condoms were 16 to 24 years of age, males, students, non-binge-drinkers, and those with secondary school education. Age, gender, occupational activity, and non-binge-drinking were common correlates of both condom use and consistent use. CONCLUSIONS: Public health messages should be focused on people with multiple sex partners who are not using condoms for STD protection, including rural residents, those with high levels of education, and those over 34 years of age.

Adolescent↗

Smoking, drinking, and thinking. The Zutphen Elderly Study.

The authors examine the cross-sectional and longitudinal relation of smoking habits and current alcohol intake to cognitive status and decline over a 3-year period as well as the extent to which these relations are modified by the presence of clinical conditions indicating atherosclerosis (cardiovascular disease (CVD)/diabetes). Data are from the cohort of men followed in the longitudinal Zutphen Elderly Study in 1990 (n = 489) and 1993 (n = 333). Cognitive function was measured in 1990 and 1993 with the 30-point Mini-Mental State Examination (MMSE). After adjustment for age, education, and alcohol intake, current smokers made 20% more errors on the MMSE than never smokers in the cross-sectional analyses. Cognitive decline was greatest in those with CVD/diabetes who currently smoked and never smoked (-1.9 and -1.3 points, respectively). After adjustment for age, education, and smoking status, men with CVD/diabetes and low-to-moderate alcohol intake had a significantly lower risk for poor cognitive function (MMSE < or = 25) than abstainers (odds ratios of 0.3 for less than one drink and 0.2 for one to two drinks per day). Alcohol intake was not associated with cognitive decline. These findings do not support the hypothesis of a protective effect of smoking on cognitive function; they suggest that smoking may be harmful among those with CVD/diabetes. Alcohol may result in an acute beneficial effect on cognitive function among those with CVD/diabetes. However, selection bias and unmeasured confounding should be of concern when evaluating these results.

Age Factors↗

Does low socioeconomic status potentiate the effects of heightened cardiovascular responses to stress on the progression of carotid atherosclerosis?

OBJECTIVES: This study examined whether heightened cardiovascular reactivity and low socioeconomic status had synergistic effects on the progression of carotid atherosclerosis in a population of eastern Finnish men. METHODS: Data from the Kuopio Ischemic Heart Disease Risk Factor Study were used to measure 4-year progression of intima-media thickness in 882 men according to cardiovascular reactivity and socioeconomic status. Associations were examined in relation to risk factors and were stratified by baseline levels of atherosclerosis and prevalent ischemic heart disease. RESULTS: The effect of reactivity on atherosclerotic progression depended on socioeconomic status. Men who had heightened cardiovascular responsiveness to stress and were born into poor families, received little education, or had low incomes had the greatest atherosclerotic progression. CONCLUSIONS: An understanding of associations between individual risk factors and disease should be based on etiologic hypotheses that are conceived at the population level and involve fundamental social and economic causes of disease. This study demonstrates how examining the interaction of an individual biological predisposition will low socioeconomic status over the life course is etiologically informative for understanding the progression of atherosclerotic vascular disease.

Arteriosclerosis↗

Sexual behavior among university students in Nigera.

Sexual behavior patterns among Nigerian university students and factors influencing them were studied. While permarital cohabitation is common, a large percentage (48%) had their first coital experience between the ages of 22 and 27. Religion does not appear to have a strong inhibiting influence on premarital sex, although it does affect the frequency of changing partners. Contraceptives, although known to almost all the respondents, are not widely used. The use of contraceptives had little influence on premarital cohabitation. Oral-genital, male-male, and female-female sexual practices are very uncommon.

Adolescent↗

Barriers to acceptance of cataract surgery among patients presenting to district hospitals in rural Malawi.

The objective of this research was to assess the barriers to cataract surgical acceptance by blind rural Malawians recognized and referred for surgical correction at district hospitals. Cataract blind recognized and referred for surgery by the ophthalmic assistants in Chikwawa and Nsanje Districts were interviewed 9-12 months after enrolment to determine if they had undergone cataract surgery and to assess factors associated with surgical acceptance. There were significant gender-specific baseline differences between men and women presenting to the ophthalmic assistants. Patients living near the district hospital were also most likely to present to the ophthalmic assistant. Men with lower socioeconomic status were more likely to accept surgery than men with higher socioeconomic status. Men and women who either talked to someone about cataract surgery or knew another aphakic patients were more likely to accept surgery. The best approaches to improving cataract acceptance given existing resources might be to encourage patients undergoing cataract surgery to educate and motivate others to accept surgery and to train existing village level health staff in cataract recognition and referral. Economic barriers and lack of family support are likely to continue to impede improved cataract surgical acceptance, especially among women.

Cataract Extraction↗

Measuring socioeconomic mortality differentials over time.

Using 1973 Current Population Survey data matched to 1973-1978 Social Security mortality records, this study measures the relationship between the income and education of men and their subsequent mortality. The estimated relationships are compared with socioeconomic mortality differentials found by Kitagawa and Hauser in their study of 1960 census-death certificate matched data. The comparison suggests that there has been no improvement in the relative mortality experience of low socioeconomic status men. More generally, the article discusses how Social Security data could be used to monitor, on a continual basis, our progress toward eradicating significant mortality differentials in the United States.

Data Collection↗

Comparing inequalities in women's and men's health: Britain in the 1990s.

Data on over 20,000 women and men aged 20-59 are analysed from the British General Household Survey for 1991 and 1992, showing the importance of separately analysing educational qualifications, occupational class and employment status for both women and men. Own occupational class and employment status are the key structural factors associated with limiting long-standing illness, but educational qualifications are particularly good predictors of women's self-assessed health. Class inequalities in health are less pronounced among women who are not in paid work. Women's limiting long-standing illness relates solely to their own labour market characteristics, whereas self-assessed health relates to wider aspects of women's everyday lives, including their household material conditions, and for married women, their partner's occupational class and employment status. Men's unemployment has adverse consequences for the health of their wives, which occurs through the mechanism of the family living in disadvantaged material circumstances. Women's labour market position and role in the family have undergone substantial changes since the 1970s. Approaches to measuring inequalities in women's health need to reflect changes in women's employment participation and changes in marital status and living arrangements.

Adult↗

Survey of condom-related beliefs, behaviors, and perceived social norms in Mexican migrant laborers.

This study reports findings from a survey of condom-related beliefs, behaviors, and perceived social norms in Mexican migrant laborers that live and work in the United States for extended periods of time. Snowball sampling was used to recruit 501 Mexican migrants from five "sending towns" in Jalisco, Mexico, with historically high rates of out-migration to the United States. Results showed that subjects reported few negative beliefs about condom use and high efficacy to use condoms in challenging sexual situations but social norms sanctioning condoms were limited. Results also revealed mixed knowledge of HIV transmission, poor knowledge of condom use, and higher condom use with occasional versus regular sex partners. Forty-four percent of male migrants reported sex with prostitutes while in the U.S., with married men reporting less condoms use with prostitutes than single men. It was concluded that condom promotion efforts with Mexican migrants should concentrate on men to encourage consistent use with occasional sex partners, including prostitutes. AIDS prevention education should be provided with sensitivity to the language needs, limited education, and extreme social and geographic marginality of this highly underresearched Latino population.

Adult↗

The buccra-massa and the little man's broker in a Jamaican sugartown: implications for community health education.

In societies that have been historically stratified by class, interclass communication is frequently hampered by behaviors of higher status people that lower status people interpret as denigrating. To escape what they perceive as denigration, lower status people may attempt to avoid interclass interaction, and, when it is unavoidable, adopt such strategies as not making direct eye contact, saying very little except what they think the higher status people want to hear (including flattery), and using a lower status peer as an intermediary. Such behavioral patterns have important implications for the design of health services programs. This paper presents a case study of such interaction difficulties observed during 13 months of anthropological research in a Jamaican town. The lower status people in the town of Haversham (a pseudonym) refer to this avoidance behavior as the 'buccra-massa'. The antonym of buccra-massa is 'buck-the-massa'. 'Buck-the-massa' is characterized by being able to look higher status people in the eye and boldly engage them in conversation. Lower status persons who are known for bucking the massa are frequently used as intermediaries in cross-class interactions. Because Havershamians refer to higher status men as 'big men' and to lower status men as 'little men', the author calls the intermediaries used by lower status people in Haversham, 'little man's brokers'. The author argues that the buccra-massa and buck-the-massa behavioral traditions had their roots in the complex and extreme social inequalities of the slavery period in Jamaica. It is further argued that economic difficulties in Jamaica since the slavery period have contributed to the persistence of these behavioral dynamics to the present day. The buccra-massa/buck-the-massa behavioral complex is often manifested in health care settings in Jamaica. Thus, the author suggests that the little man's broker can be very useful in promoting less threatening, and therefore more effective, interactions between the clients and the staff of health and other human service programs. He notes that while staffmembers often view brokering behavior as trouble making, many of the clients they wish to serve view this same behavior as bucking-the-massa. It is a mistake, according to this analysis, to ignore the little man's broker. As this case of Jamaica shows, accomplished brokers can choose to exert their extensive influence against utilization of services offered by specific programs.(ABSTRACT TRUNCATED AT 400 WORDS)

Communication↗

Sexual and socioeconomic factors affecting the risk of past infections with herpes simplex virus type 2.

Between November 1978 and May 1980, a cross-sectional survey of 566 females and 391 males, aged 35 to 50 years, living in metropolitan Toronto, was conducted to examine the influence of socioeconomic status and sexual behavior on the occurrence of antibodies to herpes simplex virus type 2. Antibodies to the virus were detected in 17.5% of females and 12.8% of males. Lower socioeconomic status was associated with an increased risk of herpes simplex virus type 2 seropositivity for females but not for males. An increased risk of seropositivity was associated in both sexes with young age at first intercourse, multiple sexual partners, and renting rather than owning their residence. The risk associated with each of these attributes remained when the effects of the other attributes including socioeconomic status and age at interview were controlled. The greatest risk was associated with renting. If the renting effect is real, it suggests that there is some determinant of risk not measured by this study, which is more important than socioeconomic status or sexual behavior.

Adult↗