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PubMedDate not supplied

Sexual abuse, sex before age 16, and high-risk behaviors of young females with sexually transmitted diseases.

OBJECTIVE: To compare rates of sexually transmitted diseases (STDs) in young women who were sexually abused, sexually precocious, and engaged in high-risk behaviors with the rates of STDs in young women who had none of these experiences. DESIGN: In this descriptive, comparative study, purposive, nonrandom sampling was used to obtain representation of women in four ethnic groups. Women completed a questionnaire on their sexual history and high-risk behaviors, sexual abuse and age of occurrence, and health issues, including STDs. Chi-square analyses were used to explore differences in these risk factors for STDs. SETTING: Data were collected at 44 urban and rural sites, including health clinics, private care providers, academic institutions, and Indian reservations. PARTICIPANTS: A convenience sample of 1,994 women ages 18-22 years and representing four ethnic groups. RESULTS: Sexually abused, precocious women who also engaged in high-risk sexual behaviors were the most likely to have had an STD: The sequence of these events was not significant. High-risk sexual behaviors appeared to be a greater risk factor for STDs than sexual abuse or precocity. CONCLUSIONS: Young women who engage in high-risk sexual behaviors, such as sex on a first date or with a stranger, are at great risk for acquiring STDs. Nurses must be advocates for sex education in high schools to inform teenagers about the dangers of high-risk behaviors and STDs, and to explain ways to handle sexual coercion and possible rape.

Adolescent↗

PubMed2001

No change in health risk behaviors over time among HIV infected adolescents in care: role of psychological distress.

PURPOSE: To investigate the association of psychological distress and health risk behaviors among HIV infected adolescents. It was hypothesized that higher levels of distress would be associated with increased sexual risk behaviors, and increased use of alcohol and drugs. METHODS: HIV infected adolescents (N = 323) were recruited into an observational study in 15 clinical sites; for the 323 subjects, a total of 1212 visits were used in a repeated measures analysis. Data on depression (using the CES-D), anxiety (manifest anxiety scale), sexual behaviors and alcohol and marijuana use were obtained through computer-assisted self-administered interview. RESULTS: Approximately 65% of the sample was sexually active across all six study visits, with approximately 43% consistently reporting having unprotected sex at last intercourse. Higher levels of depression were associated with frequent alcohol use and with unprotected sex at last intercourse, with depressed adolescents significantly more likely to have had unprotected sex than those who were not depressed. Health anxiety was associated with frequent marijuana use and with recent sexual activity, and physiological anxiety was also associated with recent sexual activity. CONCLUSIONS: Despite the fact that these HIV infected adolescents are all engaged in primary care, overall the sample is maintaining its high-risk sexual behavior. In addition, these adolescents may be self-medicating to deal with health-related anxiety. Health interventions for HIV infected adolescents should examine whether psychological distress is contributing to maintenance health risk behaviors.

Adaptation, Psychological↗

PubMed2006

The relationship between drugs use and risk behaviors in Brazilian university students.

The aim was to describe relationships between gender and drug use as well as risk behaviors that may be associated with drug use among first-year students at the University of São Paulo-Ribeirão Preto. The Youth Risk Behavior Survey (YRBS) is an anonymous survey that was used for this descriptive correlational study. It was developed by the Centers for Disease Control and Prevention in the United States. The sample (n=200) included (50%) males and (50%) females. Their ages ranged from 18 to 26 years. Results showed that more female than male students use alcohol and tobacco, but that the probability of heavy consumption is higher among men. There was a low incidence of illicit drug use for both groups. Male students were more likely to drive under the influence of alcohol than female students and more men were involved in violent behaviors such as fights with friends and police. In relation to sexual behavior, male students were likely to have more partners and less protection while under influence of alcohol. It was concluded that gender is associated with recreational drug use, specifically tobacco and alcohol, as well as other risk behaviors in university students.

Adolescent↗

PubMed2006

Desire for children and pregnancy risk behavior among HIV-infected men and women in Uganda.

To identify ways to improve prevention of mother-to-child transmission (PMTCT) of HIV, we conducted a cross-sectional study of 1,092 HIV-infected men and women attending an AIDS support organization in Jinja, Uganda, between October 2003 and June 2004. Pregnancy risk behavior was defined as having sex without contraceptive or condom. Overall, 42% of participants were sexually active, 33% practiced pregnancy risk behavior, and 18% desired more children. Men were almost four times to want more children than the women (27% vs. 7%). Among those practicing pregnancy risk behavior, 73% did not want more children and were at high risk for unwanted pregnancies. Although 81% knew that mother-to-child transmission of HIV could be prevented, only 22% believed that an HIV-infected woman who received PMTCT therapy could still deliver an HIV-infected child. Lack of MTCT information, having attended the program for </=2 years and desire for children were independently associated with pregnancy risk behavior. PMTCT and other HIV prevention and care programs should ensure provision of family planning for HIV-infected populations who do not want to become pregnant.

Adult↗

PubMedDate not supplied

Developing culture-specific interventions for Latinas to reduce HIV high-risk behaviors.

Latina women are among the fastest-growing segments of the U.S. population to become infected with HIV. Health care providers must use culture-specific HIV prevention strategies and must address cultural roles and values of the Latin community to empower Latinas to reduce high-risk behaviors. Some Latinas adhere to their cultural traditions that place the female subservient to the male in the sexual relationship. A review of the literature reveals that skills-building, a group participatory tool that engages the individual to examine high-risk behaviors and provides methods to make behavior changes, and nurse counseling, which focuses on an individual's specific risk behaviors, are more effective modes of reducing high-risk behaviors in women than an information-only intervention.

Cultural Diversity↗

PubMed2003

Adolescent risk behavior screening: the difference between patients who come in frequently and infrequently.

Charts were examined retrospectively to identify evidence of risk behavior screening in adolescents, identified from billing data as visiting at least 9 times during a 1-year period (n=55), frequent attenders (FA). These were matched 2:1 on age, gender, and ethnicity with 121 nonfrequent attenders (NFA), < or = 3 visits in 1 year. FA had more evidence of risk behavior screening than NFA, but less preventive care. Risk screening in males occurred less than in females in both FA and NFA. Chart review demonstrated many missed opportunities. Providers are encouraged to fully utilize well teen exams as well as acute visits for risk behavior screening.

Adolescent↗

PubMed1992

Alcohol use and high-risk behavior by intravenous drug users in an AIDS education paradigm.

The relationship between alcohol consumption and high-risk behavior for HIV infection was examined among 313 in-treatment intravenous drug users (IVDUs) by random assignment of these subjects to one of three interventions: (1) structured interview regarding risk behavior; (2) interview plus one group AIDS education session; (3) interview, AIDS education plus optional HIV testing. Alcohol users (n = 148) had more needle sharing and sexual partners than did nondrinkers. Follow-up interviews revealed no significant behavioral changes as a function of intervention condition or alcohol use. Better interventions, including more vigorous treatment of alcohol use, are needed to reduce risk behaviors among IVDUs.

AIDS Serodiagnosis↗

PubMed2001

Adolescent sexual risk behavior: a multi-system perspective.

Adolescents are at high risk for a number of negative health consequences associated with early and unsafe sexual activity, including infection with human immunodeficiency virus, other sexually transmitted diseases, and unintended pregnancy. As a result, researchers have attempted to identify those factors that influence adolescent sexual risk behavior so that meaningful prevention and intervention programs may be developed. We propose that research efforts so far have been hampered by the adoption of models and perspectives that are narrow and do not adequately capture the complexity associated with the adolescent sexual experience. In this article, we review the recent literature (i.e., 1990-1999) pertaining to the correlates of adolescent sexual risk-taking, and organize the findings into a multisystemic perspective. Factors from the self, family, and extrafamilial systems of influence are discussed. We also consider several methodological problems that limit the literature's current scope, and consider implications of the adoption of a multisystemic framework for future research endeavors. We conclude with a discussion of the implications of the available research for practitioners working to reduce sexual risk behavior among adolescents.

Adolescent↗

PubMed1995

Health risk behavioral survey from 39 juvenile correctional facilities in the United States.

PURPOSE: The study surveyed adolescents in juvenile detention facilities to determine the incidence of health risk behaviors. METHODS: A modified version of the United States Centers for Disease Control Youth Risk Behavior Surveillance System was administered to 1801 minors at 39 facilities in the United States. RESULTS: Risky behavior begins early, the initiation plateauing at age 15 or 16 years. Girls and boys reported comparable rates of drinking, binge drinking, and illicit drug use. North American Natives and those individuals who designated themselves as being other than any of the offered choices for racial designation ("Other") began drinking at earlier ages, had more binge drinking, more illegal drug use, and the most fight-related behavior. By age 12 years 62% reported onset of sexual intercourse and by age 14 years 89% were sexually active. Fighting was reported by 69% of detainees. Fight-related injuries within the past year were reported by 25% of the respondents. Nearly 47% belonged to a gang. Drug/alcohol use, fighting, and gang membership were related. Suicide was considered by 22% of the detainees, planned by 20%, tried by 16%, 8% were injured because of a suicide attempt. Younger teens (White, N.A. Natives, and "Other") had the most frequent suicide ideation. Drug/alcohol use correlated with suicidal thoughts. Onset of sexual intercourse was at an average age of 12. Multiple partners and pregnancy, was highest among blacks and "Others". Blacks had the highest sexually transmitted disease (STD) rate. Less than half of all respondents used condoms at last intercourse. STDs were related to being female, being black, and having multiple sexual partners. Pregnancy was related to multiple sexual partners and violent behavior. CONCLUSION: Male and female detainees report a high incidence and early onset of risky behaviors. N.A. Natives and those of "other" races reported the highest incidence of risk behaviors.

Adolescent↗

PubMed2003

Anxiety and impulsivity levels identify relevant subtypes in adolescents with at-risk behavior.

BACKGROUND: Impulsivity (I) and anxiety (A) were hypothesized to be crucial clinical features in adolescents with at-risk behavior. We therefore classified them into sub-groups according to these two major dimensions. The study examined the relevance of these groups by describing their major diagnoses and behavioral characteristics. METHODS: During a 1-year period, all in-patients consecutively admitted for at-risk behavior, except those with a previous psychotropic treatment and/or schizophrenic disorders, were rated for anxiety and impulsivity, and categorized into four groups: impulsive and anxious (IA), impulsive and non-anxious (Ia), non-impulsive and anxious (iA), non-impulsive and non-anxious (ia). We assessed the main behavioral disturbances (suicide attempt, carving, violence, delinquency, substance abuse, and eating disorder) and the main current axis I disorder in each sub-group. RESULTS: A total of 69 patients were included. In the IA group 62% exhibited hypomanic episodes and 87% recurrent suicide attempts. In the Ia group all exhibited conduct disorders, 93% were males, 80% delinquents, and 100% violent with others. Both groups reported a high percentage of cannabis use (67%). The iA group exhibited anorexia nervosa (73%) with a major depressive episode. The ia patients were mainly non-violent, first suicide attempts with low risk. LIMITATIONS: Long-term data are needed to assess the stability of these groups. CONCLUSIONS: We found that sub-typing adolescents with at-risk behavior into four groups according to their level of anxiety and impulsivity was highly predictive of being suicidal with mood disorders (AI), delinquent with conduct disorder (Ia), anorectic or depressed (Ai), and with substance abuse associated only to impulsivity. It is likely that this sub-typing of patients may be useful for prevention and therapeutics. The impulsive-anxious group (IA) appears closely related to the soft bipolar spectrum. A replication and follow-up data are now needed.

Adolescent↗

PubMed1995

Prospective effects of perceived risk of developing HIV/AIDS on risk behaviors among injection drug users in Puerto Rico.

The relationship between perceived risk of developing AIDS and subsequent behavioral risk status is estimated for 1740 Puerto Rican injection drug users (IDUs). Prospective behavioral effects were examined comparing data collected at two intervals approximately 6 months apart. We estimated the association between perceived risk at baseline and risky behaviors at follow-up with unadjusted odds ratios. We confirmed the results with adjusted odds ratios using logistic regressions which included baseline risk status as well as socio-demographic and health status covariates. The analyses showed that having a high HIV/AIDS risk perception was related to subsequent sharing of needles, injection of drugs in shooting galleries and sharing of cookers. None of the tests between risk perception and sex risk behaviors showed a significance association. Increasing IDUs' perceived vulnerability to HIV/AIDS might not be effective in helping reduce HIV risk behaviors. IDUs perceiving themselves to be at high risk of AIDS might believe there is little they can do to reverse the consequences of risky behavior.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Relationships of sexual imposition, dyadic trust, and sensation seeking with sexual risk behavior in young Urban women.

This study was designed to examine the relationships of sexual imposition, dyadic trust, and sensation seeking with HIV sexual risk behavior in 257 young urban women. Interviews were conducted using Audio Computer-Assisted Self-Interview (ACASI). Hierarchical multiple regression revealed that sexual imposition, dyadic trust, and sensation seeking explained 18.3% of the variance in sexual risk behavior. Although sexual imposition was positively related to sexual risk, pressure to satisfy a male partner sexually was more common than physical coercion. Dyadic trust was negatively related, indicating that women engaged in sexual risk behavior with men they distrusted. Sensation seeking was positively related to sexual risk. Findings suggest the need for enhancing awareness of non-sexually imposing relationship alternatives and incorporating thrill and excitement in health promotion messages.

Adult↗

PubMed2004

Interregional differences in health in Slovenia. II. Estimated prevalence of selected behavioral risk factors for cardiovascular and related diseases.

AIM: To estimate the prevalence of selected behavioral risk factors for cardiovascular and related diseases in western, central, and eastern region of Slovenia and to determine interregional differences. METHODS: A national survey on health status and health behavior of the adult population included 15,379 Slovene inhabitants, aged 25 to 64. The overall response rate to a mailed questionnaire was almost 64%, and 9,043 questionnaires were eligible for analysis. Prevalence rates per 100 population (smoking, nutrition, alcohol intake, physical activity, stress) were determined, chi-square test was used for global assessment of interregional differences, and logistic regression for adjusting them for sex and age. RESULTS: Interregional differences in prevalence were observed in very unhealthy nutrition related to obesity and diabetes (west: 34.0, center: 30.6, east: 41.8; p<0.001), very unhealthy nutrition related to hypertension (west: 25.5, center: 29.4, east: 28.4; p=0.011), very unhealthy nutrition related to atherosclerosis-based diseases (angina pectoris, myocardial and brain infarction, etc.) (west: 33.1, center: 31.8, east: 44.1; p<0.001), heavy alcohol drinking (west: 11.2, center: 12.0, east: 15.2; p<0.001), and physical inactivity (west: 18.0, center: 21.0, east: 15.3; p<0.001), but not in smoking (west: 22.4, center: 24.5, east: 23.9; p=0.230) or stress (west: 23.2, center: 24.4, east: 24.7; p=0.388). CONCLUSION: We confirmed significant interregional differences in the prevalence of most observed behavioral risk factors. In behaviors with statistically significant interregional differences, the highest prevalence was confirmed for eastern Slovenia.

Cardiovascular Diseases↗

PubMed1998

AIDS risk behavior in opioid dependent patients treated with community reinforcement approach and relationships with psychiatric disorders.

This study examined the Community Reinforcement Approach's (CRA) effect on AIDS risk behaviors and the relationship between comorbid psychiatric disorders and the risk for AIDS behavior in opioid dependent patients entering methadone maintenance treatment. Additionally, we looked at AIDS risk behaviors as they related to the Addition Severity Index (ASI), Beck Depression Inventory, Symptom Checklist-90-Revised (SCL-90-R), and the Social Adjustment Scale-Self Report (SAS-SR). Subjects (N = 227) were drawn from a large clinical trial that examined the effectiveness of a Community Reinforcement Approach for treatment of opioid dependence. Both CRA and standard treatment demonstrated a significant effect on reduction of AIDS risk behaviors. There was no relationship found regarding comorbid psychiatric disorders with the risk for AIDS behavior. However, there were correlations with other psychiatric, social, and substance abuse variables. Multivariate analyses indicated that increased drug and legal ASI composite scores were the primary predictors of increased AIDS risk behavior.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Behavioral risks for HIV infection associated with HIV-testing decisions.

Adolescent and adult women were offered HIV testing as part of a clinic-based research program on HIV/AIDS in New York City. Sixty-four percent consented to testing and 87% of those tested returned to receive their results. This paper uses two-stage regression methods to identify sexual behavioral risk factors for HIV infection associated with the decision to accept the HIV test and subsequently to return for the results. Of the risk factors examined, having more than a single sex partner and never using a condom in the last year were strong predictors of taking the test; three or more sex partners had the strongest effects on the decision to return for the HIV test results. We conclude that voluntary HIV testing in this group can identify women with behavioral risks of HIV infection. Thus, voluntary HIV testing may be effective in targeting persons at high risk because behavioral risks are associated with the decision to take the HIV test.

AIDS Serodiagnosis↗

PubMedDate not supplied

Tobacco use and other risk behaviors among adolescents in an STD clinic.

BACKGROUND: This study examined the potential for tobacco use and other health risk behavior interventions in the context of an urban sexually transmitted diseases (STD) clinic. METHODS: A cross-sectional survey of two populations. Adolescents seen at an STD clinic or at the teen clinic of a community health center completed a self-administered computer survey in 1996. Risk behaviors, attitudes, and readiness to stop smoking were analyzed for 225 patients at the STD clinic and 248 patients at the teen clinic. RESULTS: Compared with adolescents in the teen clinic, adolescents in the STD clinic were more likely to have smoked frequently (OR 1.7, 95% CI 1.1, 3.0), used any illegal drug (OR 2.7, 95% CI 1.3, 5.5), recently binged on alcohol (OR 1.7, 95% CI 1.0, 2.8), and had more than 10 lifetime sexual partners (OR 1.9, 95% CI 1.0, 3.4). Weapon carrying, readiness to stop smoking, and attitudes toward smoking did not differ between sites. CONCLUSIONS: Cigarette smoking and other health risk behaviors are more prevalent among adolescents in an STD clinic than among adolescents in a community health center. STD clinics are potential sites for cigarette, alcohol, and drug use interventions among "hard to reach" adolescents.

Adolescent↗

PubMedDate not supplied

Double jeopardy: workplace hazards and behavioral risks for craftspersons and laborers.

PURPOSE: To address three specific questions in a sample of craftspersons and laborers: (1) Do craftspersons and laborers exposed to workplace hazards have higher behavioral risks, such as smoking and high-fat diets, than those with few job risks? (2) Compared to workers with few job risks, do workers exposed to risks on the job have higher intentions to reduce their behavioral risks? (3) Does concern about the level of exposure to risks on the job increase workers' intentions to reduce behavioral risks? DESIGN: A cross-sectional self-administered survey was conducted in participating worksites. SETTING: Twenty-two predominantly manufacturing worksites in Massachusetts. SUBJECTS: Craftspersons and laborers responding to the survey and employed in these 22 worksites (completion rate = 61%, N = 1841). MEASURES: By using standardized items, this survey measured self-reported exposure to workplace hazards, concern about job exposures, smoking status, fat and fiber intake, readiness to quit smoking, plans to reduce fat intake, plans to eat more fruits and vegetables, and sociodemographic variables. RESULTS: Workers reporting exposure to chemical hazards on the job were significantly more likely to be smokers than were unexposed workers, even when results were controlled for gender. Compared with unexposed workers, smokers exposed to chemical hazards were significantly more likely to be thinking of quitting or taking action to quit, when results were controlled for gender, race, and education. Among workers exposed to occupational chemical hazards, concern about this exposure was significantly associated with intentions to decrease fat intake and increase fruit and vegetable intake, and, among men, intentions to quit smoking. CONCLUSIONS: Efforts aimed at integrating health promotion and health protection are needed to address simultaneously the job risks and personal risks these workers face.

Adult↗

PubMed2004

A longitudinal study of the association between treatment optimism and sexual risk behavior in young adult gay and bisexual men.

To determine whether optimism about highly active antiretroviral therapy is associated with sexual risk behavior among young adult HIV-negative gay and bisexual men, and to test 2 alternative explanations for this association: that treatment optimism leads to increased sexual risk or that treatment optimism is the result of previous sexual risk. Data on sexual risk behavior, treatment optimism, and perceived susceptibility to HIV infection were obtained from a sample of 538 HIV-negative or untested gay and bisexual men (ages 18-30) who were not in monogamous relationships. Follow-up data were collected 18 months later. In the cross-sectional data, treatment optimism was associated with the 2-month cumulative incidence of unprotected anal intercourse (UAI) with nonprimary partners; however, this effect was observed only among men who felt highly susceptible to HIV infection. Longitudinal analyses revealed that treatment optimism did not predict subsequent UAI, but UAI did predict later treatment optimism. Treatment optimism is associated with sexual risk behavior among young adult gay and bisexual men. However, these data suggest that optimism may result from, rather than precede, sexual risk.

Adolescent↗