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PubMed2006

HIV risk behaviors during pharmacologic treatment for opioid dependence: a comparison of levomethadyl acetate [corrected] buprenorphine, and methadone.

The efficacies of three opioid substitution medications for reducing HIV risk behaviors in opioid-dependent patients were assessed in a randomized double-blind clinical trial comparing levomethadyl acetate [corrected] (LAAM), buprenorphine (BUP), and methadone (METH). Individually optimized flexible dosing was used for each group, with weekly possible doses of 255-391 mg of LAAM, 56-112 mg of BUP, and 420-700 mg of METH. An interview regarding specific HIV risk behaviors, including injecting, equipment sharing, and sexual activity, yielded data for pretreatment and four in-study time points for 137 subjects. Declines in risk behaviors during treatment were evident in all groups for most measures of injecting and equipment sharing. Only the METH group showed consistent declines in measures of sexual behaviors. These results demonstrate that all three medications can be highly effective in decreasing HIV risk behaviors when the dose is optimized. Reductions in sexual behaviors for the METH group are consistent with known METH side effects.

Adult↗
PubMed1999

When asked, patients tell: disclosure of sensitive health-risk behaviors.

OBJECTIVES: National health care organizations recommend routinely screening patients for behavioral health risks, the effectiveness of which depends on patients' willingness to disclose risky behaviors. This study aimed to determine if primary care patients' disclosures of potentially stigmatizing behaviors would be affected by (1) their expectation about whether or not their physician would see their disclosures and (2) the assessment method. METHODS: One thousand nine hundred fifty-two primary care patients completed a questionnaire assessing human immunodeficiency virus (HIV), alcohol, drug, domestic violence, tobacco, oral health, and seat belt risks; half were told their responses would be seen by the researcher and their physician and half were told that their responses would be seen by the researcher only. Patients were randomly assigned to one of five assessment methods: written, face-to-face, audio-based, computer-based, or video-based. RESULTS: Across all risk areas, patients did not disclose differently whether or not they believed their physician would see their disclosures. Technologically advanced assessment methods (audio, computer, and video) produced greater risk disclosure (4%-8% greater) than traditional methods in three of seven risk areas. CONCLUSIONS: These findings suggest patients are not less willing to disclose health risks to a research assistant knowing that this information would be shared with their physician and that a number of assessment methods can effectively elicit patient disclosure. Potentially small increases in risk disclosure must be weighed against other factors, such as cost and convenience, in determining which method(s) to use in different health care settings.

Adult↗
PubMed2002

Tattooing and high-risk behavior in adolescents.

OBJECTIVES: We sought to determine the prevalence and sociodemographic characteristics of tattooed adolescents in a nationally representative sample and to evaluate the association between tattooing and several high-risk behaviors. METHODS: This is a secondary analysis of the National Longitudinal Survey of Adolescent Health Public Use Dataset, which provides a nationally representative sample of 6072 adolescents collected in 1995 and 1996. The association among permanent tattoos, sociodemographic factors, and high-risk behaviors was evaluated using bivariate and logistic regression analyses using SUDAAN. RESULTS: Of the total sample of youths, 4.5% reported having permanent tattoos. Tattooing was significantly associated with older age, living in a single-parent household, and lower socioeconomic status but was not significantly associated with gender, ethnicity, or neighborhood type. Tattooing was strongly associated with peer substance use. Adjusting for sociodemographic factors and peer substance use, tattooing in adolescents was independently and significantly associated with reported sexual intercourse, substance use, violent behaviors, and school problems. CONCLUSION: Permanent tattoos are strongly associated with high-risk behaviors among adolescents. In the clinical setting, the presence of a tattoo noted during clinical examination of an adolescent should prompt in-depth assessment for a variety of high-risk behaviors.

Adolescent↗
PubMed2006

Work stress and health risk behavior.

This contribution discusses current knowledge of associations between psychosocial stress at work and health risk behavior, in particular cigarette smoking, alcohol consumption and overweight, by reviewing findings from major studies in the field published between 1989 and 2006. Psychosocial stress at work is measured by the demand-control model and the effort-reward imbalance model. Health risk behavior was analyzed in the broader context of a health-related Western lifestyle with socially and economically patterned practices of consumption. Overall, the review, based on 46 studies, only modestly supports the hypothesis of a consistent association between work stress and health risk behavior. The relatively strongest relationships have been found with regard to heavy alcohol consumption among men, overweight, and the co-manifestation of several risks. Suggestions for further research are given, and the need to reduce stressful experience in the framework of worksite health promotion programs is emphasized.

Alcohol Drinking↗
PubMed2005

Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda.

OBJECTIVE: To assess the acceptance of voluntary HIV counseling and testing (VCT) and the effects of VCT on sexual risk behavior and HIV acquisition in Rakai, Uganda. METHODS: In a rural cohort, 10 694 consenting adults were interviewed, provided blood for HIV testing and were offered free VCT by community resident counselors. The proportions receiving VCT and the adjusted risk ratio (adj. RR) of VCT acceptance were estimated by log binomial regression. Risk behaviors and HIV incidence per 100 person-years (PY) in HIV-negative acceptors and non-acceptors of VCT were assessed prospectively. RESULTS: Although 93% initially requested HIV results, 62.2% subsequently accepted VCT. VCT acceptance was lower among persons with no prior VCT [Adj. RR = 0.88; 95% confidence interval (CI), 0.85-0.90], individuals with primary education (adj. RR = 0.94; 95% CI, 0.90-0.99) or higher (adj. RR = 0.91; 95% CI, 0.87-0.97), individuals who were HIV-positive (adj. RR = 0.72; 95% CI, 0.68-0.76), and persons reporting condom use in the past 6 months (inconsistent users, adj. RR = 0.95; 95% CI, 0.90-0.99; consistent users, adj. RR = 0.88; 95% CI, 0.82-0.95). VCT acceptance was higher among the currently married (adj. RR = 1.14; 95% CI, 1.08-1.20) and previously married (adj. RR = 1.11; 95% CI, 1.04-1.18). Receipt of results was not significantly associated with age, gender, and self-perception of HIV risk. There were no significant differences in sexual risk behaviors, or in HIV incidence between acceptors (1.6/100 PY) and non-acceptors (1.4/100 PY) of VCT. CONCLUSION: In this rural cohort where VCT services are free and accessible, there is self-selection of individuals accepting VCT, and no impact of VCT on subsequent risk behaviors or HIV incidence.

Adolescent↗
PubMed1993

Anthropology and AIDS: the cultural context of sexual risk behavior among urban Baganda women in Kampala, Uganda.

One hundred and thirty Baganda women (65 HIV antibody positive and 65 HIV antibody negative), recruited from the Makerere University-Case Western Reserve University Collaborative Pediatric follow-up clinic in Kampala, Uganda were interviewed about cultural rules and norms for sexual behavior and HIV-specific risk behaviors. Interviews were analyzed for themes related to sexual risk, cultural rules regarding sex, and individual sexual practices. Statistical relationships were tested using chi 2 and t-test statistics. The mean age of the women was 21 years (range 15-30). Despite sexual norms prohibiting sex for women outside marriage, subjects reported that there are certain circumstances when a woman may take other partners, including economic need, desire for greater sexual satisfaction, or revenge on a husband with other partners. Cases were more likely to state that women may have outside partners for economic reasons (P < 0.05) and that women have outside partners for sexual satisfaction (P < 0.01). Women interviewed for this study are complying with Ugandan AIDS control messages to 'zerograze' and 'stick to one partner'. Fear of AIDS remains high, however, because women fear that their partners have not responded to risk reduction messages. Of those women stating fear of AIDS, 57% of cases and 62% of controls based their fear on their perceptions of their partners' activities. Therefore, women feel that they remain at risk of infection despite their own behavior change. We find that, while the potential for risk reduction is high for these women, cultural norms permitting males to have multiple partners limit a woman's ability to control her risk reduction. Important conclusions are: (1) a focus on women's behavior alone is not sufficient as both partners must respond to risk reduction messages; (2) knowledge about AIDS is not sufficient to achieve change in sexual behavior because sexual behavior is linked to economics, gender relations, and other complex socio-cultural factors; and (3) a study of Baganda male sexual values and behavior is urgently needed.

Acquired Immunodeficiency Syndrome↗
PubMed2004

The transition to widowhood and the social regulation of health: consequences for health and health risk behavior.

OBJECTIVES: This study estimates the effects of the transition to widowhood on changes in the social regulation of health and examines the consequences of this association for health and health risk behavior following spousal death. METHODS: Analysis of longitudinal data from the Changing Lives of Older Couples Study tests the following hypotheses: (a) Widowed individuals experience greater declines in health regulation over time than their married counterparts and (b) the extent to which widowhood undermines health and increases health risk behavior depends on whether it is accompanied by a decline in health regulation. RESULTS: Compared with their continually married counterparts, those who experience the transition to widowhood report a significant decline in the frequency of health reminders and health assistance received from others. The decline in the frequency of health regulation has important consequences for health behavior and health outcomes. Widowhood undermines health and increases health risk behaviors only when it is accompanied by a decline in health regulation. Widowed individuals who experience increases in health regulation show improvements in health and declines in health risk behavior. DISCUSSION: Interventions targeted at improving the health habits of widowed individuals by mobilizing health-related support systems may be effective at minimizing the negative health consequences of spousal loss.

Aged↗
PubMed1989

DMI-measured defenses and HIV-related risk behaviors in i.v. compared to non-i.v. substance abusers.

The Defense Mechanism Inventory (DMI) and The Risk Behavior Inventory (RBI) were administered to substance abusers hospitalized on a drug detoxification service. The groups were categorized on the basis of self-reported IV versus non-IV substance abuse. Significant between-group differences were obtained on the DMI and RBI. The non-IV group responded less often than the IV group with the Turning Against Object (TAO) response option, resulting in higher scores when Turning Against Self (TAS), Reversal (REV), Principalization (PRN) and Projection (PRO) were summed into a single score. Significant within-group differences were obtained for DMI response levels and defenses. Both groups relied less on TAO at the thought level and more on PRN and REV as primary defenses. The IV group reported twice as many risk behaviors as the non-IV group and risked HIV exposure through needle use and sexual transmission modes. Consideration was given to the role of principalization and denial within the addicted individual's defense structure and the relationship of these defenses to HIV-related risk behavior.

Adult↗
PubMed2006

The urban environment and sexual risk behavior among men who have sex with men.

Increasingly, studies show that characteristics of the urban environment influence a wide variety of health behaviors and disease outcomes, yet few studies have focused on the sexual risk behaviors of men who have sex with men (MSM). This focus is important as many gay men reside in or move to urban areas, and sexual risk behaviors and associated outcomes have increased among some urban MSM in recent years. As interventions aimed at changing individual-level risk behaviors have shown mainly short-term effects, consideration of broader environmental influences is needed. Previous efforts to assess the influence of environmental characteristics on sexual behaviors and related health outcomes among the general population have generally applied three theories as explanatory models: physical disorder, social disorganization and social norms theories. In these models, the intervening mechanisms specified to link environmental characteristics to individual-level outcomes include stress, collective efficacy, and social influence processes, respectively. Whether these models can be empirically supported in generating inferences about the sexual behavior of urban MSM is underdeveloped. Conceptualizing sexual risk among MSM to include social and physical environmental characteristics provides a basis for generating novel and holistic disease prevention and health promotion interventions.

Homosexuality, Male↗
PubMed1996

HIV risk behaviors among Dominican brothel and street prostitutes in New York City.

Latina women are overrepresented among AIDS cases in the United States. To assist in developing appropriate prevention and intervention programs, information regarding HIV risk behaviors is needed on the many diverse Latina subgroups. This study examined sociodemographic characteristics and HIV risk behaviors of Dominican female prostitutes, comparing those who worked primarily in brothels with those who were street workers. A total of 77 Dominican prostitutes (54 brothel; 23 street) were recruited in New York City to participate in a structured interview and were offered HIV testing. Ethnographic interviews were conducted with a subscale. Results indicated that there were many significant differences in demographics and risk behaviors between the two groups, and those working in brothels engaged in lower levels of risk behaviors. In addition, those working in brothels had closer ties to the Dominican and Spanish cultures. Implications for AIDS prevention efforts are discussed.

AIDS Serodiagnosis↗
PubMed2002

Health risk behaviors among adolescents attending rural, suburban, and urban schools: a comparative study.

This study describes differences in health risk behaviors among 2,017 adolescents attending rural, suburban, and urban school districts in upstate New York. Differences in risk behaviors regarding use of tobacco, alcohol, and illegal substances; sexual activity; and carrying weapons were analyzed. A consistent pattern emerged from the analysis of the data, with rural students at most risk. The findings reinforce the need to focus on the relationship between residence and health risk behaviors, so that intervention programs specific to the needs of rural, suburban, and urban adolescents can be developed.

Adolescent↗
PubMed2001

Psychosocial and risk behavior correlates of youth suicide attempts and suicidal ideation.

OBJECTIVE: To identify the independent psychosocial and risk behavior correlates of suicidal ideation and attempts. METHOD: The relationships between suicidal ideation or attempts and family environment, subject characteristics, and various risk behaviors were examined among 1,285 randomly selected children and adolescents, aged 9 through 17 years, of whom 42 (3.3%) had attempted suicide and 67 (5.2%) had expressed suicidal ideation only. The youths and their parents were enumerated and interviewed between December 1991 and July 1992 as part of the NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. RESULTS: Compared with subjects with suicidal ideation only, attempters were significantly more likely to have experienced stressful life events, to have become sexually active, to have smoked more than one cigarette daily, and to have a history of ever having smoked marijuana. After adjusting for sociodemographic characteristics, a statistically significant association was found between suicidal ideation or attempt and stressful life events, poor family environment, parental psychiatric history, low parental monitoring, low instrumental and social competence, sexual activity, marijuana use, recent drunkenness, current smoking, and physical fighting. Even after further adjusting for the presence of a mood, anxiety, or disruptive disorder, a significant association persisted between suicidal ideation or attempts and poor family environment, low parental monitoring, low youth instrumental competence, sexual activity, recent drunkenness, current smoking, and physical fighting. CONCLUSION: Low parental monitoring and risk behaviors (such as smoking, physical fighting, alcohol intoxication, and sexual activity) are independently associated with increased risk of suicidal ideation and attempts, even after adjusting for the presence of psychiatric disorder and sociodemographic variables.

Adolescent↗
PubMed2006

Same-sex domestic partnerships and lower-risk behaviors for STDs, including HIV infection.

To determine the association between domestic partnership status and risk behaviors for sexually transmitted diseases, including HIV infection, we analyzed data from a population-based interviewer-administered telephone survey of 2,881 gay men in San Francisco, Los Angeles, New York and Chicago conducted in November 1996 to February 1998. Men in domestic partnerships had a statistically significantly lower prevalence of multiple partnerships, "one-night stands," and unprotected anal intercourse with a non-primary partner than either men with steady partners not identified as domestic partners or men without a steady partner. These findings were independent of age. Men in domestic partnerships had decreased risk behaviors for sexually transmitted diseases, including HIV infection, suggesting but not proving, that conferring legal status to same-sex unions might decrease sexual risk behavior.

Adolescent↗
PubMed2001

Ethnic differences in risk behaviors and related psychosocial variables among a cohort of maltreated adolescents in foster care.

This study examined the cross-ethnic equivalence of measures and the relationships between psychosocial variables and risk behaviors in an ethnically diverse sample of maltreated adolescents 6 years after their placement in foster care. Overall, there was cross-ethnic measurement equivalence, except for the self-destructive behavior and perceived opportunities constructs, which did not demonstrate internal consistency for African American youth. The authors found few differences between White (non-Latino), Hispanic, and African American youth on levels of engagement in risk behaviors and across domains of psychosocial functioning. The relationships between the psychosocial variables and risk behaviors were then examined across ethnic groups. The pattern of results was different as a function of ethnicity, as fewer of the psychosocial variables were significantly related to the risk behavior variables for African American youth. Possible explanations for these differences are presented and implications for intervention discussed.

Adolescent↗
PubMed1996

The relative contributions of psychiatric symptoms and AIDS knowledge to HIV risk behaviors among people with severe mental illness.

BACKGROUND: This study was designed to determine whether psychiatric symptoms and acquired immunodeficiency syndrome (AIDS) knowledge predict human immunodeficiency virus (HIV) risk behavior among people with severe mental illness. METHOD: We interviewed 178 psychiatric patients to determine Axis I diagnosis, level of functioning, severity of psychiatric symptoms, knowledge about AIDS, sexual risk behaviors in the previous 6 months, and drug injection since 1978. Severity of psychiatric symptoms was rated on the Positive and Negative Syndrome Scale within the classification of positive, negative, cognitive, excited, and depressed/anxious symptoms. RESULTS: Ninety-two patients (51.7%) reported being sexually active in the previous 6 months. Of sexually active patients for whom data were available, 44 (47.8%) of 92 had multiple sex partners; 32 (35.2%) of 91 used drugs during sex; 27 (29.7%) of 91 traded sex for drugs, money, or other goods; and 50 (58.1%) of 86 never used condoms. Thirty-one patients (17.5%) had drug-injection histories. The median AIDS knowledge score was 23 (82.1%) of 28. Although AIDS knowledge was negatively correlated with cognitive and negative symptoms and positively correlated with excitement, knowledge alone did not predict any risk behavior. However, when AIDS knowledge was taken together with age and excited symptoms, the odds of being sexually active versus abstinent were three times higher among patients with better AIDS knowledge and twice higher among patients with greater excited symptoms. Having multiple sex partners was nearly three times as likely among patients with greater positive symptoms. Trading sex was more than three times as likely among patients with schizophrenia than among those with other diagnoses and more than five times as likely among those with more excitement symptoms. CONCLUSION: Patients, particularly those who were sexually active, were well informed about AIDS. Specific psychiatric conditions, including the presence of positive and excited symptoms and a diagnosis of schizophrenia, predicted certain sexual risk behaviors and must be the focus of innovative prevention efforts.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Trends in human immunodeficiency virus-related risk behaviors among high school students--United States, 1991-2005.

This paper examined changes in human immunodeficiency virus (HIV)-related risk behaviors among high school students in the United States during 1991-2005. Data from 8 national Youth Risk Behavior Surveys conducted during that period were analyzed. During 1991-2005, the percentage of US high school students engaging in HIV-related sexual risk behaviors significantly decreased.

Adolescent↗
PubMed2002

Use of psychoactive substances and sexual risk behavior in adolescents.

This study investigated the relationship between the use of illicit drugs and sexual-risk-behavior in a sample of students aged 14 to 21 years at a public high school in São Paulo in 1997. A total of 689 useable questionnaires documented the sample in consumption of psychoactive substances and sexual behavior. Sexual behavior of drug users and non-users was compared regarding history of complete sexual intercourse, age at first sexual intercourse, use of condoms, sexual intercourse with sex workers, and prostitution. Drug users (N = 366) presented a higher frequency of complete sexual intercourse (80.8% of users versus 53.5% of non-users), (N = 323, p < .001), a younger age at first sexual intercourse (on average 15.2 years in users versus 15.7 among non-users, p < .005), a trend toward lower use of condoms (56.7% among users versus 65.3% among non-users, p < .1), and more sexual intercourse with sex workers (31.1% among users versus 15% among non-users, p < .001). Sexual-risk-behavior increased with the number of drugs used. Alcohol and marijuana use were associated with the highest sexual-risk-behavior. These data are essential for the development of more specific preventive strategies, focusing on male alcohol and marijuana users.

Adolescent↗
PubMed2005

Homelessness and HIV risk behaviors among drug injectors in Puerto Rico.

This report examines associations between homelessness and HIV risk behaviors among injection drug users (IDUs) in Puerto Rico. The study sample consisted of 557 IDUs who were not in treatment, recruited in inner-city neighborhoods of the North Metro Health Care Region. Subjects were categorized into three groups by residential status (last 30 days): housed, transitionally housed (living with friends, family, or others but considering themselves homeless), and on-the-street homeless (living on the street or in a shelter). Multiple logistic regression models were fitted to assess effects of residential status on each HIV risk behavior after adjusting for sociodemographic and drug-use related covariates. Transitionally housed and on-the-street homeless subjects made up 16% of the total sample. On-the-street homeless IDUs were more likely to test positive for HIV than were transitionally housed and housed IDUs. In the adjusted analysis, on-the-street homeless subjects were significantly more likely to share needles, share rinse water, and practice back loading than the other two groups. Sexual risk behaviors (last 30 days) were not significantly associated with residential status after adjustment. Findings from this study present an added challenge to drug treatment and HIV prevention and treatment programs, to provide services that can address the additional needs of drug users suffering the stressors of homelessness.

Adult↗