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PubMedDate not supplied

Sexually transmitted diseases and acquired immunodeficiency syndrome (AIDS). Changes in risk reduction behaviors among young adults.

Increasing attention has focused on the medical risk to young, unmarried, sexually active adults of contracting sexually transmitted diseases (STDs) in general and acquired immunodeficiency syndrome (AIDS) in particular. Yet little is known empirically about the extent to which this group perceives themselves to be at risk for contracting specific STDs or is changing their behaviors to reduce their risk. In the current study, the authors report findings from two matched samples of unmarried young adults, 182 assessed in the winter of 1986 and 182 in the fall of 1987. Results demonstrated greater worry and concerns about all STDs, including AIDS, in the second sample assessed than in the first. Some behavioral changes also were noted in the second group, including increased use of condoms. Nevertheless, 44% of sexually experienced participants in the fall of 1987 reported that they had not changed their behavior in any way to reduce their risk of acquiring human immunodeficiency virus (HIV) infection.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Conscientiousness, perceived risk, and risk-reduction behaviors: a preliminary study.

Participants (N = 343) from an Oregon community completed surveys at baseline, 3 months, and 12 months to assess personality, the perceived health risk of radon in combination with smoking, and changes in smoking behavior. Conscientiousness predicted instituting a more restrictive household smoking rule (p < .01), and perceived risk predicted reduction in cigarettes smoked per day for men (p < .001). Perceived risk predicted a reduction in the proportion of cigarettes smoked in the home for those who had high (p < .05) but not low or moderate levels of Conscientiousness, a dimension in one personality model. The results demonstrate the importance of Conscientiousness in the prediction of health behavior, particularly behavior that affects others as well as oneself.

Adult↗
PubMed2000

Behavioral risk reduction in a declining HIV epidemic: injection drug users in New York City, 1990-1997.

OBJECTIVES: This study assessed trends in HIV risk behaviors among injection drug users in New York City from 1990 to 1997. METHODS: Injection drug users were recruited continuously from a large drug detoxification treatment program (N = 2588) and a research storefront located in a high-drug-use area (N = 2701). Informed consent was obtained, and a trained interviewer administered a structured interview covering sociodemographics, drug use history, HIV risk behavior, and participation in syringe exchange. RESULTS: Trends were assessed for 5 risk behaviors in the 6-month period before the interview. The 3 injection risk behaviors declined significantly over time at each site (all P < .01). When data were pooled across sites, all 5 risk behaviors declined significantly over time (all P < .01). Participation in syringe exchange programs and in HIV counseling and testing increased greatly from 1990 to 1997. CONCLUSIONS: The continuing risk reduction among injection drug users indicates a "declining phase" in the large HIV epidemic in New York City. HIV prevention programs appear to be making an important contribution to the declining phase.

Adult↗
PubMed2000

HIV risk reduction behavioral interventions with heterosexual adolescents.

This article provides a comprehensive review of research on the effects of behavioral interventions on heterosexual adolescents' HIV sexual-risk behavior. It details adolescents' risk of sexually transmitted HIV infection and describes challenges associated with adolescent intervention research, including obtaining school and parent approval and the validity of self-reported measures. It describes central characteristics of 36 controlled intervention studies assessing the HIV sexual-risk behavior of over 30,000 male and female adolescents 11-21 years of age. It summarizes the participants' race/ethnicity and age, the theoretical framework, and the intervention setting, duration and outcome. This review reveals that the most commonly assessed behavioral outcomes were condom use and abstinence, and the largest effects sized were on condom use and condom acquisition. Effect sizes for abstinence and number of sexual partners were the smallest. Perceived self-efficacy and behavioral interventions were the most commonly assessed theoretical mediators. Key questions this research engaged in included whether behavioral skills can be increased, whether intervention-induced behavior change can be sustained, whether matching the race/ethnicity and gender of facilitators and participants enhances the effectiveness of culturally sensitive interventions, whether classroom teachers can effectively facilitate interventions, whether the behavior of high-risk populations can be changed, and which kinds of interventions are most effective. This review concludes that carefully designed theory-based interventions that take into account the characteristics of the particular population or culture can cause positive changes in adolescents' HIV sexual-risk behavior, but boundary conditions for their effectiveness still need to be identified. Several suggestions for additional research are proffered.

Adolescent↗
PubMed1993

Self-reported sexually transmitted diseases among family planning clients: ethnic differences in sexual risk behavior and HIV risk reduction.

The relationship between sexually transmitted diseases (STDs) and risk for human immunodeficiency virus (HIV) has been established. Little is known, however, about the relationship between being infected with an STD and initiating HIV risk-reduction behavior. We interviewed 267 young women who were family planning clients of the San Francisco Bay-Area Planned Parenthood clinics, of whom 40% were white, 37% African American, and 23% women of other ethnic origins. Fifty-three percent of the women surveyed reported having been diagnosed with an STD, and 22% reported two or more episodes of infection. African-American women who reported lower educational attainment and being unemployed were more likely to report having been infected with an STD than were women from other ethnic and demographic groups. Ethnic differences were also found in the prevalence of the risk behaviors associated with the self-reported STDs and in the relationship between reporting a history of STD and practicing HIV risk-reduction behavior. Women who reported an STD were significantly more likely to report having a nonmonogamous primary partner. Risk-reduction behaviors associated with a personal history of STD included being less likely to report having asked a sexual partner about his number of previous partners and being more likely to have been tested for antibodies to HIV. Results from this survey suggest that these family planning clients report a frequent history of STDs and that while some have attempted to reduce their risk, these efforts are inadequate. These data underscore a need for ethnically relevant HIV risk-reduction interventions for this population.

Adolescent↗
PubMed1997

HIV risk behavioral surveillance in Bangkok, Thailand: sexual behavior trends among eight population groups.

OBJECTIVE: To assess trends in HIV risk behaviors over a 3-year period in eight population groups in Bangkok, Thailand. DESIGN AND SUBJECTS: Using a repeated cross-sectional survey design with a structured questionnaire, we collected five sets of self-reported sexual behavior data related to HIV risk from the following subject groups at the same sampling sites during 1993-1996: direct and indirect female sex workers, male attenders of sexually transmitted disease (STD) clinics, female attenders of antenatal care clinics, male and female vocational students, and male and female factory workers. RESULTS: Reported patronage of commercial sex by the three male groups declined by an overall average of 48% over the 3-year period. Other non-regular sexual partnerships declined among male STD clinic attenders and vocational students. Condom use during most recent sexual intercourse between sex workers and clients peaked at high levels (>90%) in the early data waves, while among indirect sex workers and their clients, consistent condom usage increased from 56% to 89%. Low condom use persisted among sex workers and their non-paying sex partners. Single women reported low levels of sexual activity and condom use with no signs of an increase. Similarly, married women from antenatal clinics reported low condom use with their husbands, with no change throughout the period of the study. CONCLUSIONS: HIV risk behavioral surveillance is a useful way of determining whether behavior change has occurred in specific population groups. The results here confirm and add to a growing set of evidence of risk behavior reduction in Thailand. The behavioral changes did not occur uniformly but varied depending on the sexual dyad and the population group under study. Behavioral surveillance should be promoted and its methodologies strengthened in attempts to understand the local dynamics of HIV epidemics.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Cardiovascular disease risk reduction in the Behavioral Risk Factor Surveillance System.

BACKGROUND: Cardiovascular disease (CVD) risk-reduction practices are suboptimal in populations at high risk for CVD, and this problem may be worse in women than in men. METHODS: In 2003, CVD risk-reduction practices were compared between men and women after stratification by CVD risk status (high, intermediate, low) in a cross-sectional analysis of the 1999 Behavioral Risk Factor Surveillance System (BRFSS), a random-digit telephone survey of state population-based samples of the civilian non-institutionalized population of adults. This analysis included persons aged >40 years who answered questions regarding lipid and blood pressure screening, recommendations for lifestyle modification, that is, exercise and reduced fat intake, and aspirin use. Risk status was defined according to Adult Treatment Panel III definitions. RESULTS: In the 97,387 adults included in this analysis, high CVD risk was associated with lipid and blood pressure screening, lifestyle modification, and aspirin use in both men and women compared to intermediate-risk and low-risk (p <0.001). Among high-risk adults, men and women reported similar frequency of blood pressure and cholesterol measurement and physician advice on lifestyle modification; among intermediate- and low-risk adults, women reported slightly more frequent screening and lifestyle modification than men (p <0.001). In all CVD risk categories, women reported significantly less aspirin use than in men (p <0.001). CONCLUSIONS: Among people at high risk for CVD, women report lifestyle modification more often than men, while men report use of aspirin more often than women. These findings may assist with targeting interventions to reduce CVD risk to the unique needs of men and women.

Aspirin↗
PubMed1996

Injection drug use and risk of HIV transmission among homeless men with mental illness.

OBJECTIVE: The high seroprevalence of HIV that has been reported among homeless individuals with mental illness indicates an urgent need to examine HIV risk behavior in this population. METHOD: Injection drug use and sexual behavior were assessed in comprehensive interviews with 218 homeless mentally ill men in a New York City shelter. First, the proportion of men who had injected drugs was established. Then, among those who had injected drugs, the injection drug use behaviors associated with HIV transmission (i.e., whether they had ever engaged in high-risk behaviors and had ever engaged in risk-reduction behaviors) and their current sexual risk behaviors were examined. RESULTS: Fifty (23%) of the 218 men had injected drugs. Among these 50, the great majority had engaged in high-risk behaviors, including sharing needles (66%) and using shooting galleries (64%). Few had engaged in risk-reduction behaviors, such as cleaning needles with bleach (22%) and using a needle exchange program (2%). In the past 6 months alone, the majority of the injection drug users had had unprotected sex with women (48%) or with men (10%). CONCLUSIONS: This study documents a high lifetime prevalence of injection drug use in a group of homeless men with mental illness. The men who had injected drugs reported injection drug use and sexual behaviors with high risk of HIV transmission and gave scant evidence of risk-reduction behaviors. These individuals may fall between service systems and may be difficult to reach but, nonetheless, must be included in efforts to prevent transmission of HIV infection.

Adult↗
PubMed2007

A longitudinal study of adolescents with perinatally or transfusion acquired HIV infection: sexual knowledge, risk reduction self-efficacy and sexual behavior.

As HIV-positive children are surviving to adolescence and beyond, understanding their HIV knowledge and sexual behavior is critical. Forty HIV+ adolescents/young adults were interviewed twice, approximately 21 months apart (mean age 16.6 and 18.3 years, respectively). Data on demographics, safer sex knowledge, sexual risk behaviors, risk reduction self-efficacy, and Tanner stage were collected. Twenty-eight percent of HIV+ youth at Time 1 and 41% at Time 2 reported being sexually active. HIV transmission/safer sex knowledge was low, increased with age, and both self-efficacy for and actual condom use was relatively high. Secondary prevention messages should be incorporated into routine medical settings.

Adolescent↗
PubMed1997

Reduction in risk behavior among adults with severe mental illness who learned to advocate for HIV prevention.

OBJECTIVES: The study evaluated the relative impact of HIV risk reduction interventions for adults with severe mental illness living in the inner city. METHODS: A total of 104 chronically mentally ill men and women were interviewed to determine sexual risk behavior over the past month and to assess HIV risk-related psychological characteristics, including their knowledge about risk behavior, their belief in their ability to change their behavior, their perceptions of peer and social norms about safer sex, their expectancies about the outcomes of these changes, and their perceived barriers to condom use. Participants were then randomly assigned to one of three conditions: a single AIDS education session, a seven-session cognitive-behavioral HIV risk reduction group intervention, or a seven-session group intervention that combined the cognitive-behavioral intervention with training to act as a risk reduction advocate to friends (advocacy training). Individuals were reinterviewed three months after completion of the intervention. RESULTS: Although all participants exhibited change at follow-up in some risk-related psychological characteristics and sexual risk behaviors, participants who received the cognitive-behavioral intervention that included the advocacy training reported greater reductions in rates of unprotected sex and had fewer sexual partners at follow-up. CONCLUSIONS: HIV prevention interventions that teach risk reduction skills and then encourage participants to advocate behavior change to others appear to strengthen participants' capacity to change their behavior to reduce HIV risk, even those from a disenfranchised group such as severely mentally ill adults.

Adult↗
PubMed2003

HIV risk reduction in a cohort of injecting drug users in Bangkok, Thailand.

OBJECTIVE: To determine changes in risk behavior in relation to study participation among injecting drug users (IDUs) in Bangkok, Thailand. METHODS: During 1995-1996, 1,209 HIV-seronegative IDUs were recruited from Bangkok Metropolitan Administration drug abuse treatment programs to participate in a prospective cohort study. Study visits occurred every 4 months, at which the participants underwent an interview to assess risk behavior and HIV counseling and testing. Eight hundred nine of the IDUs were considered "long-term" participants, who remained in the study through at least the first four scheduled follow-up visits (16 months). Injection risk behavior at each study visit was measured on a four-point scale strongly associated with incident HIV infections in the cohort. Individual regression slopes were used to assess changes in injection risk behavior (risk increase, no change, or risk reduction). RESULTS: Of the 806 long-term study participants, 79% showed declines, 4% showed no change, and 17% showed increases in injection risk behavior. The percentage of participants in the highest-risk category (injecting daily or more frequently and sharing needles and syringes) declined from 42% at baseline to 3% at the final follow-up visit. Being in methadone maintenance treatment was associated with stable low rates of injection risk behavior, while recruitment from the 45-day detoxification treatment was associated with reductions in injection risk behavior. The risk reduction was independent of decline in risk behavior among IDUs in the community at large. CONCLUSIONS: Participation in this cohort study was associated with substantial declines in injection risk behavior. This information is important in the evaluation of possible adverse behavioral effects of participation in future preventive HIV vaccine trials including IDUs, particularly in developing country settings.

Adult↗
PubMedDate not supplied

The utility of the Transtheoretical Model of behavior change for HIV risk reduction in injection drug users.

The spread of HIV among injection drug users (IDUs) is the second most common mode of transmission next to sexual contact. Although HIV infections can be prevented by changing high-risk behaviors such as needle sharing, these high-risk behaviors are highly complex. Initially developed for smoking cessation, Prochaska's Transtheoretical Model (TTM) is well-suited to the IDU population because it recognizes that chronic behavior patterns are usually under some combination of biological, social, and self-control. The objective of this article is to examine the utility of the TTM for promoting risk reduction behaviors among IDUs. This article will outline (a) the challenges of applying the TTM to IDU behaviors with respect to HIV prevention, (b) the four major components of the TTM as they relate to IDUs, (c) how risk reduction practitioners are currently using the TTM, and (d) current and future research using the TTM.

Attitude to Health↗
PubMed2003

Screening, education, and associated behavioral responses to reduce risk for falls among people over age 65 years attending a community health fair.

BACKGROUND AND PURPOSE: Because of the high risk of falling and the recognition that falling is a "geriatric syndrome," screening for risk of falls has become popular at community health fairs. The purposes of this study were to determine whether health fair screening and educational intervention would result in behaviors that could reduce the risk of falls and to determine whether adoption of risk-reduction behaviors differed between people over age 65 years screened as being at high risk for falls and those screened as being at lower risk for falls. SUBJECTS AND METHODS: The Berg Balance Test was used to classify fall risk in 68 individuals aged 57 to 89 years who were attending a community health fair. A score of 45 or lower led to a categorization of the person being at high risk for falls. All subjects were provided recommendations intended to reduce fall risk. Participants were interviewed by telephone 30 days after the screening to assess implementation of these recommendations. RESULTS: Seventy-two percent of the participants reported implementing at least one risk-reduction behavior. The high-risk group was more likely to implement risk-reduction behaviors than the low-risk group. DISCUSSION AND CONCLUSION: Screening and education in a health fair setting appear to promote behaviors that could reduce fall risk among elderly people. Future study with a control group that does not receive an educational intervention is needed to draw more definite conclusions about the value of this health promotion activity for fall prevention.

Accidental Falls↗
PubMed1999

The influence of HIV-related knowledge and exposure fears on behavior change and incident STDs.

Using a sample of 678 HIV-seronegative women, we measured self-reports of HIV-related cognitions, specifically knowledge, perceived exposure risks, and outcome expectations. We also ascertained prevalent and incident bacterial STDs and measured self-reports of behavioral risk reductions. We tested for associations between (a) cognitions and STD prevalence, (b) cognitions and incident STDs, (c) cognitions and behavioral risk reductions, and (d) risk reductions and incident STDs. Symptom knowledge was associated with lower prevalence, but not incidence. Beliefs in the efficacy of risk reductions showed a protective effect against incident STDs. Perceived exposure risk and symptom knowledge were associated with risk reduction behavior.

Adolescent↗
PubMed1993

Comparison of AIDS knowledge and HIV-related sexual risk behaviors among adolescents in low and high AIDS prevalence communities.

Data were collected from students attending high school in a rural, low acquired immunodeficiency syndrome (AIDS) prevalence community in Northern California, and compared with students in an inner-city AIDS epicenter (San Francisco). The findings demonstrate that rural adolescents have higher levels of human immunodeficiency virus (HIV) knowledge, especially about risk-reduction strategies. However, rural adolescents also report higher rates of HIV-related sexual risk behaviors. Rural adolescents may not perceive the personal salience of practicing HIV risk-reduction behaviors thus increasing their risk for exposure to sexually-transmitted diseases, including HIV infection. School-based HIV prevention programs developed for rural communities will need to enhance the personal salience of HIV for adolescents' and discourage their discounting of personal risk attributable to a lower prevalence of AIDS in the community. Physicians must become more actively involved in HIV prevention efforts by routinely assessing adolescent patient's sexual behavior and utilizing their clinical interaction to provide HIV education and promote the adoption of HIV risk-reduction behaviors.

Acquired Immunodeficiency Syndrome↗
PubMed2004

HIV risk behavior among ethnically diverse adolescents living in low-income housing developments.

PURPOSE: To describe patterns and predictors of HIV risk behaviors among ethnically diverse, low-income adolescents. METHODS: Computer-assisted surveys were administered to 1172 adolescents between the ages of 12 and 17 years living in 15 low-income housing developments in three urban areas in the United States to characterize and identify predictors of HIV risk behavior. Data were analyzed using multinomial logistic regression to identify variables predictive of "no risk," "lower risk," and "higher risk" group classification. RESULTS: Most adolescents were not yet sexually active; nonetheless, a subset of youth reported high rates of HIV risk-related behaviors. HIV risk was highest among adolescents who were older, had weaker intentions to reduce risk, stronger beliefs that their sexual partners did not favor risk-reduction, lower risk-reduction behavioral skills, higher risk-reduction outcome expectation, and higher rates of substance use. CONCLUSIONS: HIV prevention efforts are needed that are tailored to ethnically diverse communities of adolescents, including those in early adolescence and those at highest risk.

Adolescent↗