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PubMed1995

Reliability of the Youth Risk Behavior Survey Questionnaire.

The Centers for Disease Control and Prevention's Youth Risk Behavior Survey (YRBS) has been used on a biennial basis since 1990 to measure health risk behaviors of high school students nationwide. The YRBS measures behaviors related to intentional and unintentional injury, tobacco use, alcohol and other drug use, sexual activity, diet, and physical activity. The authors present the results from a test-retest reliability study of the YRBS, conducted by administering the YRBS questionnaire to 1,679 students in grades 7 through 12 on two occasions 14 days apart. The authors computed a kappa statistic for each of 53 self-report items and compared group prevalence estimates across the two testing occasions. Kappas ranged from 14.5% to 91.1%; 71.7% of the items were rated as having "substantial" or higher reliability (kappa = 61-100%). No significant differences were found between the prevalence estimates at time 1 and time 2. Responses of seventh grade students were less consistent than those of students in higher grades, indicating that the YRBS is best suited for students in grade 8 and above. Except for a few suspect items, students appeared to report personal health risk behaviors reliably over time. Reliability and validity issues in health behavior assessment also are discussed.

Adolescent↗
PubMed1999

The intergenerational transmission of health-risk behaviors: adolescent lifestyles and gender moderating effects.

The present longitudinal study of 330 adolescents used structural equation models to investigate whether (1) health-risk lifestyles exist among adults and adolescents, (2) parents' health-risk behaviors influence adolescents' health-risk behaviors, and (3) intergenerational transmission occurs by way of a health-risk lifestyle, by direct transmission of specific behaviors, or through both mechanisms. To address these questions, we estimated several models. The findings were generally supportive of the expectations. Results of single factor measurement models provided modest evidence for the existence of an underlying health-risk lifestyle factor among parents and adolescents. Results of structural equation models also demonstrated that parents' health-risk behaviors were transmitted to adolescents both at the lifestyle factor level and the unique component level. These associations prevailed even after controlling for family social status. However, parents' health-risk lifestyles mediated the effect of family social status on adolescents' lifestyles, net of the direct effect of family social status on adolescents' lifestyle. In these two-parent families, the effects of parents' health-risk lifestyles on adolescents seems to have gender symmetry. The findings of the separate models for boys and girls demonstrated that (1) fathers' health-risk lifestyle affected only boys' health-risk lifestyle, whereas (2) mother's health-risk lifestyle affected only girls' health-risk lifestyle. A similar gender moderating effect was not found for specific health-risk behaviors. Implications of these findings for future research and theoretical development are discussed.

Adolescent↗
PubMed2005

The impact of adolescent spirituality on depressive symptoms and health risk behaviors.

PURPOSE: The purpose of this study was to examine spirituality as a meaningful construct in adolescents' lives, and to examine the contribution of spirituality above and beyond that of religiosity to depressive symptoms and health-risk behaviors. METHOD: A total of 134 adolescents from a suburban high school completed a questionnaire assessing spirituality, religiosity, depressive symptoms, and health-risk behaviors. Spirituality was measured with 2 subscales: (1) religious well-being ("I believe that God loves/cares about me") and (2) existential well-being ("Life doesn't have much meaning"). Religiosity was assessed via belief in God/Higher Power and importance of religion. The Children's Depression Inventory-Short Form and the Youth Risk Behavior Survey (YRBS) were used to assess depressive symptoms and health-risk behaviors. RESULTS: The majority of the sample was Caucasian, with a mean age of 16.2 years. Eighty-nine percent reported a belief in God/Higher Power and 77% stated that religion was important in their lives. After controlling for demographics and religiosity, existential well-being and religious well-being accounted for an additional 29% of the variability in depressive symptoms and 17% of the variability in risk behaviors. Existential well-being was the only predictor significant in both final models (p < .01). CONCLUSIONS: Most of these adolescents reported some connection with religious and spiritual concepts, and those with higher levels of spiritual well-being, in particular, existential well-being, had fewer depressive symptoms and fewer risk-taking behaviors. This supports the inclusion of these concepts in our efforts to help promote resilience and healthy adolescent development, and in expanding our investigations beyond religious identification or attendance at religious services to broader concepts of spirituality.

Adolescent↗
PubMed2006

Perpetration of intimate partner violence associated with sexual risk behaviors among young adult men.

OBJECTIVE: We assessed the association between intimate partner violence (IPV) perpetration and sexual risk behaviors and fatherhood (having fathered children) among young men. METHODS: Sexually active men aged 18 to 35 years who visited an urban community health center and who reported having sexual intercourse with a steady female partner during the past 3 months (N = 283) completed a brief self-administered survey about sexual risk behaviors, IPV perpetration, and demographics. We conducted logistic regression analyses adjusted for demographics to assess associations between IPV and sexual risk behaviors and fatherhood. RESULTS: Participants were predominantly Hispanic (74.9%) and Black (21.9%). Participants who reported IPV perpetration during the past year (41.3%) were significantly more likely to report (1) inconsistent or no condom use during vaginal and anal sexual intercourse, (2) forcing sexual intercourse without a condom, (3) having sexual intercourse with other women, and (4) having fathered 3 or more children. CONCLUSION: IPV perpetration was common among our sample and was associated with increased sexual risk behaviors. Urban community health centers may offer an important venue for reaching this at-risk population.

Abortion, Induced↗
PubMed1997

Personality differences predict health-risk behaviors in young adulthood: evidence from a longitudinal study.

In a longitudinal study of a birth cohort, the authors identified youth involved in each of 4 different health-risk behaviors at age 21: alcohol dependence, violent crime, unsafe sex, and dangerous driving habits. At age 18, the Multidimensional Personality Questionnaire (MPQ) was used to assess 10 distinct personality traits. At age 3, observational measures were used to classify children into distinct temperament groups. Results showed that a similar constellation of adolescent personality traits, with developmental origins in childhood, is linked to different health-risk behaviors at 21. Associations between the same personality traits and different health-risk behaviors were not an artifact of the same people engaging in different health-risk behaviors; rather, these associations implicated the same personality type in different but related behaviors. In planning campaigns, health professionals may need to design programs that appeal to the unique psychological makeup of persons most at risk for health-risk behaviors.

Accidents, Traffic↗
PubMed2006

Association between cannabis use and sexual risk behavior among young heterosexual adults.

To study the association between cannabis use and frequent sexual risk behavior, we tested the hypothesis of a situational influence of cannabis use in sexual encounters using a combination of global association study and event-level analysis and examined possible mediator variables, including the personality trait of hedonism/risk preference, psychosocial stress, and HIV-related beliefs, using mediation models. The results of a computer-assisted telephone interview of a random sample of 2790 heterosexual men and women aged 16-24 years showed that risky sexual behavior was more frequent in cannabis-using men and women than in non-using persons. The results did not support a situational effect of cannabis intoxication on sexual risk behavior. The more frequent sexual risk behavior among cannabis users was mediated by decreased intentions to use HIV protection, by lower HIV-self-efficacy, and higher risk preference/hedonism. Only among women psychosocial stress was a partial mediator. The findings show that HIV prevention programs for cannabis-using young adults should emphasize the role of person variables instead of situation variables.

Adolescent↗
PubMed2001

Parental monitoring: association with adolescents' risk behaviors.

CONTEXT: Contemporary threats to adolescents' health are primarily the consequence of risk behaviors and their related adverse outcomes. Identifying factors associated with adolescents' risk behaviors is critical for developing effective prevention strategies. A number of risk factors have been identified, including familial environment; however, few studies have examined the impact of parental monitoring. OBJECTIVE: To examine the influence of less perceived parental monitoring on a spectrum of adolescent health-compromising behaviors and outcomes. Design. Survey. SETTING: A family medicine clinic. Participants. To assess eligibility, recruiters screened a sample of 1130 teens residing in low-income neighborhoods. Adolescents were eligible if they were black females, between the ages of 14 and 18 years, sexually active in the previous 6 months, and provided written informed consent. Most teens (n = 609) were eligible, with 522 (85.7%) agreeing to participate. MAIN OUTCOME MEASURES: Variables in 6 domains were assessed, including: sexually transmitted diseases, sexual behaviors, marijuana use, alcohol use, antisocial behavior, and violence. RESULTS: In logistic regression analyses, controlling for observed covariates, adolescents perceiving less parental monitoring were more likely to test positive for a sexually transmitted disease (odds ratio [OR]: 1.7), report not using a condom at last sexual intercourse (OR: 1.7), have multiple sexual partners in the past 6 months (OR: 2.0), have risky sex partners (OR: 1.5), have a new sex partner in the past 30 days (OR: 3.0), and not use any contraception during the last sexual intercourse episode (OR: 1.9). Furthermore, adolescents perceiving less parental monitoring were more likely to have a history of marijuana use and use marijuana more often in the past 30 days (OR: 2.3 and OR: 2.5, respectively); a history of alcohol use and greater alcohol consumption in the past 30 days (OR: 1.4 and OR: 1.9, respectively); have a history of arrest (OR: 2.1); and there was a trend toward having engaged in fights in the past 6 months (OR: 1.4). CONCLUSIONS: The findings demonstrate a consistent pattern of health risk behaviors and adverse biological outcomes associated with less perceived parental monitoring. Additional research needs to focus on developing theoretical models that help explain the influence of familial environment on adolescent health and develop and evaluate interventions to promote the health of adolescents.

Adolescent↗
PubMed1993

Prostitution and HIV risk behavior.

The authors discuss prostitution as a high-risk behavior for HIV infection and transmission, using data from interviews with prostitutes in Bridgeport, Connecticut, and New York City. "The primary objective is to share some of the information gained in research interviews and street work so that it can be utilized to assist efforts at reaching such high risk behavior populations with appropriate AIDS prevention information, testing, counseling and health services." Factors considered include prostitute characteristics, the pimp, perceived roles of the prostitute, power and control, risky sexual practices, and knowledge, attitudes, and behavior relating to AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Spiritual beliefs, world assumptions, and HIV risk behavior among heroin and cocaine users.

The relationship between spirituality and HIV risk behavior in a sample of 34 inner-city cocaine-using methadone-maintained patients was examined. Spirituality was operationally defined in terms of "life meaningfulness" and included the Santa Clara Strength of Religious Faith (T. G. Plante & M. T. Boccaccini, 1997b) and the World Assumptions Scale (R. Janoff-Bulman, 1989; assessing benevolence, meaningfulness, and worthiness of the self). Hierarchical multiple regression analyses of self-reported drug- and sex-related risk behavior were conducted with sex and race entered as control variables. The full models accounted for 23% and 42% of the variance in drug- and sex-related risk behavior, respectively. Strength of spiritual/religious faith (B = .37) and belief in a benevolent (beta = .50) and meaningful (beta = .46) world were independent predictors of sex-related, but not drug-related, HIV preventive behavior.

Adult↗
PubMed2004

Intravenous drug users' HIV-risk behaviors with primary/other partners.

The objective of this study was to determine how injection drug users' (IDUs) HIV-risk behavior differs with primary and other sex partners. Interviews were conducted with injection drug users from a needle exchange program (n = 243). Those with one sexual partner were more likely to report never using condoms with primary partners than were those with more than one partner (74% vs. 54%, p < 0.001). Those with more than one partner differed, between primary and other sexual partners, in their disclosure of HIV and IDU status, condom use, and drug use in combination with sex. Primary sexual partners of IDUs are placed at risk from IDUs' risk behavior with other sexual partners. Those planning HIV-risk reduction interventions for IDUs should consider risk behavior with primary partners separately from behavior with other partners. Evaluation of intervention effects should use partner-specific assessments of risk behavior.

Adolescent↗
PubMed2002

Interparental conflict and risk behaviors among Mexican American adolescents: a cognitive-emotional model.

This study used a cognitive-emotional model to examine the relations between multiple dimensions of interparental conflict and health risk behaviors among young adolescents. Participants were 151 Mexican American adolescents and their parents. At initial individual interviews, parents reported on conflict with their spouses, and adolescents reported on their parents' conflict, their appraisals of the conflict, their emotional distress, and their acculturation level. At 6-month follow-ups, adolescents reported on their risk behaviors, including substance use and sexual activity. In general, adolescents' acculturation level was not related to their risk behaviors. More frequent conflict, more conflict about the adolescent, more adolescent involvement in the conflict, and poor conflict resolution were related to greater emotional distress. More conflict about the adolescent, mothers being more demanding/dominating during conflict, and more adolescent involvement in the conflict were related to greater risk behaviors. Adolescents' cognitions mediated the link between two dimensions of parental conflict, frequency and resolution, and emotional distress. Adolescents' emotional distress mediated the association between adolescent involvement in parental conflict and adolescents' risk behaviors.

Acculturation↗
PubMed2003

Depression and HIV risk behavior among Seattle-area injection drug users and young men who have sex with men.

Psychological depression has been identified as a condition that may influence HIV risk behavior among injection drug users (IDUs) and men who have sex with men (MSM). In two Seattle studies, 1,228 IDUs and 429 young MSM completed the Center for Epidemiologic Studies Depression Scale (CES-D); the relationship between depression and injection and sexual risk behavior was assessed using logistic regression analysis. Forty-seven percent of IDUs had CES-D scores > or = 23; a high score was significantly related to injection with a syringe used by another IDU (adjusted odds ratio 1.4) but not other injection risk behavior. Among MSM, CES-D scores > or = 16 were related to reporting 3 or more sex partners in the last 6 months but not to other sexual risk behavior. This analysis suggests that psychological depression may influence certain HIV risk behavior in young MSM and IDUs, and that interventions addressing depression may be indicated.

Adult↗
PubMed2000

HIV risk behaviors in male substance abusers with and without antisocial personality disorder.

Antisocial personality disorder (ASP) is common in male substance abusers and may be associated with increased human immunodeficiency virus (HIV) risk behaviors. In this study, 91 male substance abusers were recruited from the community, and 42% met diagnostic criteria for ASP. Although ASP and non-ASP subjects demonstrated equivalent knowledge about HIV, subjects with ASP participated in more risky behaviors. On a lifetime measure of drug risk behaviors, ASP subjects reported higher rates of intravenous drug use (IVDU), frequency of needle-sharing, and number of equipment-sharing partners and lower rates of needle-cleaning. On a measure of past-month risk behaviors, ASP subjects reported higher rates of IVDU and lower rates of needle-cleaning. Subjects with ASP also reported greater participation in lifetime sexual risk behaviors, including number of sexual partners and frequency of anal sex. These findings suggest that clients entering substance abuse treatment programs should be screened for ASP, and clients identified with ASP should be provided risk-reduction interventions early in treatment.

Adult↗
PubMed2000

Continuation of high-risk behavior by HIV-positive drug users. Treatment implications.

Drug users who are positive for the human immunodeficiency virus (HIV) represent a major vector of HIV transmission, yet relatively little is known about their continued drug- and sex-related HIV-risk behavior, which may impede the development of effective risk-reduction interventions. In this study, 50 HIV-seropositive injection drug users entering methadone maintenance treatment completed a comprehensive risk assessment battery, including self-report of HIV-risk behavior since learning HIV serostatus, and measures of risk-reduction information, motivation, and behavioral skills. We found that a disconcertingly high proportion of patients (66%) reported having engaged in HIV-risk behavior since learning their HIV-seropositive status. Level of HIV-related knowledge did not predict high-risk behavior. Drug-related risk behavior was predicted by psychiatric severity and poor behavioral skills. Sex-related risk was predicted by low levels of motivation and poor behavioral skills. Implications of these findings for treatment are discussed.

Adult↗
PubMed2002

Continued high risk behaviors in HIV infected drug abusers.

To characterize current risk behaviors of HIV drug abusers in the highly active antiretroviral therapy (HAART) era, socio-demographic, medical and behavioral information were obtained and immune measurements determined. High-risk sexual practices were prevalent. Participants diagnosed before 1995 were 6 times more likely to have unprotected sex with HIV+ partners (p = 0.05) and 11 times more likely to use contaminated needles (p = 0.05) than participants with later diagnosis. Consistent condom use was reported by only 7% of the cohort. Many (43%) of the participants reported multiple HIV+ and HIV- concurrent partners. Most (65%), particularly women (OR = 3, p = 0.02), did so for drugs or money. Despite detectable viral loads, 36% reported unprotected anal sex. Antiretroviral-treated men, compared to non-treated, tended to have unprotected anal sex (OR = 2, p = 0.07). The continued high-risk behaviors of HIV drug users, particularly those diagnosed before 1995 and/or on antiretroviral therapy, indicates an urgent need for new public health strategies.

Adult↗
PubMed2006

Risk-behavior reporting by blood donors with an automated telephone system.

BACKGROUND: Donor risk-behavior assessment is important for blood safety. Few evaluations of automated telephone systems for eliciting risk exposure among voluntary blood donors have been reported. STUDY DESIGN AND METHODS: A modified risk-behavior questionnaire was presented after donation via an automated telephone polling system to 805 of 15,092 Hong Kong Chinese voluntary blood donors. Risk-behavior rates were compared to those of all other donors (14,287) simultaneously completing the questionnaire in a pencil-and-paper format. RESULTS: The telephone group included proportionally more women (46.3% vs. 44.9%), previous donors (93.3% vs. 83.6%), and sexually inactive donors (66.5% vs. 71.2%) with lower educational achievement (60.7% vs. 54.5%). The telephone group demonstrated fewer missing data (mean 1.3%, range 0.4%-3.1% vs. mean 9.8%, range 8.0%-14.2%) and more complete demographic detailing, probably accounting for the demographic differences. The telephone group reported higher prevalence rates of needle or syringe sharing (1.5% vs. 0.3%), homosexual and/or bisexual intercourse (4.1% vs. 1.3%), knowing or suspecting that partner had intercourse with another during past year (12.4% vs. 8.5%), and future intention to use blood donation as a means to test for human immunodeficiency virus (HIV; 19.1% vs. 13.7%). There was no difference in knowledge of the HIV window period or proportions visiting or using condoms with commercial sex workers between telephone and pencil-and-paper groups. CONCLUSION: This survey with automated telephone screening of potential blood donors revealed increased reporting of risk exposure relative to commonly used paper-and-pencil methods. This raises questions of possible underreporting of risk among blood donors screened by paper questionnaire and perhaps face-to-face interview.

Adolescent↗
PubMed1992

Changes in acquired immunodeficiency syndrome-related risk behavior after adolescence: relationships to knowledge and experience concerning human immunodeficiency virus infection.

This paper explores the extent of change in acquired immunodeficiency syndrome (AIDS) risk level and in the numbers of AIDS-related risk behaviors in 602 inner-city adolescents as they enter young adulthood. Youths' risk level for human immunodeficiency virus (HIV) infection during adolescence was categorized as high (engaging in prostitution, male homosexual or bisexual activity, or injectable drug use or having ulcerative sexually transmitted diseases), moderate (having six or more sex partners in a 1-year period or nonulcerative sexually transmitted diseases), or low (none of the above). Although a proportion at high or moderate risk during adolescence did move to lower risk levels by young adulthood, the overall risk level stayed fairly stable: 45% were at high or moderate risk levels during adolescence, and 35% were at those levels by young adulthood. Then change in the total number of risk behaviors engaged in by the youths was examined. Knowledge about AIDS or HIV infection and its prevention was not associated with any change in risk behavior, nor were the number of sources of information about the epidemic, acquaintance with those who are infected, estimates of personal risk, or exposure to HIV-test counseling. In fact, youths whose risk behaviors increased the most were more likely to know someone who had died of AIDS and to estimate their own risk as high. Most youths reported that they did not use condoms regularly, disliked them, and had little confidence in their protective ability. Changes in preventive strategies and further research on the causes of behavior change are needed.

Acquired Immunodeficiency Syndrome↗
PubMed2007

Human immunodeficiency virus (HIV) and substance use risk behaviors among tri-ethnic adolescents of Florida.

Previous research documents the co-occurrence of substance use and HIV risk behaviors, but most studies examined these behaviors among adults and White adolescents. The diversity of Florida's adolescents presents a unique setting for examining the variations in these risk behaviors. An in-depth analysis of HIV and substance use behaviors among White, African American, and Hispanic adolescents in Florida was conducted. Results suggest that significant ethnic variations exist in lifetime alcohol and illicit drug use and HIV risk. Compared with Hispanics, African Americans were less likely and Whites were more likely to be frequent alcohol and illicit drug users. White and African American adolescents were 1.3 and 1.5 times, respectively, at higher risk of at least one HIV risk behavior compared with their Hispanic counterparts. Future research should seek to identify sources and consequences of such variations in risk behavior and design culturally appropriate prevention programs for adolescents.

Adolescent↗