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PubMed1996

Changes in HIV risk behavior following alternative residential programs of drug abuse treatment and AIDS education.

We compared the effectiveness in changing human immunodeficiency virus (HIV) risk behavior of two different approaches to acquired immunodeficiency syndrome (AIDS) education given by residential drug abuse treatment programs differing in their planned duration. Two randomized controlled trials compared (a) a 6-month with a 12-month therapeutic community (TC) program, and (b) a 6-month with a 3-month relapse prevention (RP) program. Three composite variables assessing HIV risk (a) drug injection, (b) sexual partners, and (c) condom use-were measured for the 3 months prior to admission and follow-up. The TC program comprised a four-part AIDS information intervention. The RP program comprised a 21- or 42-session small-group program in the principles of RP, 5 skills-building AIDS education sessions, and 6 other health education sessions. Four hundred ninety-five clients were enrolled in the study and completed a follow-up interview within 6 months of exit (79% of those enrolled). Clients in the RP program reduced their drug injection and condom use risk. Female clients in the TC program reduced their condom use risk. There were no differential effects on risk behavior change of either planned duration (randomization assignment) or program type (RP versus TC). Thus, differences in the treatment programs, including AIDS education components, had no apparent effect on HIV risk behavior change. The contribution of residential drug abuse treatment programs to AIDS prevention remains unproved.

Adult↗
PubMed2002

Adolescent health risk behavior: when do pediatric psychologists break confidentiality?

OBJECTIVE: To determine the circumstances under which pediatric psychologists believe it is ethical to break confidentiality when presented with adolescent health risk behavior. METHOD: Members of the Society of Pediatric Psychology (N = 92) responded to a survey containing a vignette about an adolescent patient engaging in health-compromising behaviors. Participants rated the degree to which it is ethical to break confidentiality for health risk behaviors of varying frequency, intensity, and duration. RESULTS: Respondents generally find it ethical to break confidentiality when health risk behaviors are more intense, more frequent, and of longer duration. Respondents also find it more ethical to break confidentiality for female smoking than for male smoking. Similarly, they find it more ethical to break confidentiality for female sexual behavior than for male sexual behavior, but only as the frequency/duration increases. CONCLUSIONS: At a certain point, maintaining the adolescent's health is more important for pediatric psychologists than maintaining confidentiality.

Adolescent↗
PubMedDate not supplied

Effects of spirituality and psychosocial well-being on health risk behaviors in Appalachian pregnant women.

OBJECTIVE: To determine the relationships of spirituality and psychosocial well-being to health risk behaviors in pregnant Appalachian women. METHOD: Descriptive study of 120 women between 16 and 28 weeks of pregnancy. The instruments used were the Spiritual Perspective Scale and religiosity items from the Jarel Well-Being Scale. Psychosocial well-being was measured by the Prenatal Psychosocial Profile. Four items measured health risk behaviors. RESULTS: Higher levels of spirituality (spiritual perspective and religiosity) were significantly correlated with greater satisfaction with social support, higher levels of self-esteem, and decreased levels of smoking. Sociodemographic, psychosocial, and spiritual variables explained 25% of the variance in frequency of smoking, and in the logistic regression analysis, psychosocial stress was the only variable that significantly predicted substance use. CONCLUSION: Higher levels of spirituality and lower levels of stress are associated with decreased health risk behaviors among pregnant women from Appalachia. Increasing spiritual resources and decreasing stress during pregnancy offer the potential to improve health promotion efforts in pregnancy with women from Appalachia.

Adaptation, Psychological↗
PubMed1991

Eating attitudes, health-risk behaviors, self-esteem, and anxiety among adolescent females in a suburban high school.

In order to determine whether adolescent females with abnormal eating attitudes display lower levels of self-esteem and higher levels of anxiety than their peers, and whether these adolescents participate in health-risk behaviors to a greater or lesser degree than their peers, we administered a series of questionnaires to the females attending a suburban high school in New York State. The questionnaires, completed by 268 students (mean age, 16.2 years), included data on health-risk behaviors and weight attitudes, an Eating Attitudes Test, a self-esteem scale, and an anxiety inventory. Results indicated that almost two-thirds of the students described themselves as overweight, almost three-quarters felt they were above the healthiest weight for their age and height, and almost four-fifths were above the weight at which they would be most happy; 18% of the students scored 30 or more on the Eating Attitudes Test, a score suggestive of an eating disorder. Use of Spearman-rank correlation coefficients and multiple linear regression analysis revealed that those with more unhappiness with their weight and higher scores on the eating attitudes test were more likely to have lower self-esteem and higher anxiety and to participate more in health-risk behaviors, including cigarette smoking, alcohol use, drug use, and sexual activity with more total partners. The data from this study further corroborate the growing belief that health-risk behaviors tend to cluster together in vulnerable adolescents and demonstrate that abnormal eating attitudes and behaviors may be part of this cluster, especially in females with low self-esteem and high levels of anxiety.

Adolescent↗
PubMedDate not supplied

HIV risk behaviors among inner-city African American women. The Community Housing AIDS Prevention Study Group.

This study examined the prevalence and predictors of HIV risk behaviors among a sample of 875 low-income, African American women residents of inner-city housing developments. The women completed an anonymous questionnaire that revealed that one third of them were at high risk for HIV either because they had multiple partners or because of the high-risk behaviors of their regular partner. HIV risk was highest among women who accurately perceived themselves to be at increased HIV risk, reported weak behavioral intentions to reduce risk, and held stronger beliefs about psychosocial barriers to condom use. Women at high risk were also younger, reported higher rates of substance use, and indicated that their housing development lacked social cohesiveness. These findings suggest that HIV prevention efforts for this population should focus on strengthening women's risk reduction behavioral intentions and self-efficacy through skill development, overcoming psychosocial barriers to condom use, managing the risk related to substance use, and incorporating approaches that take into account the social, psychological, and relationship barriers to change among economically impoverished African American women.

Adolescent↗
PubMed2003

HIV risk behaviors among older American drug users.

Despite increasing numbers of Americans older than 50 years of age, little is known about the impact of HIV/AIDS on aging drug users. The current study assesses the drug-related and sex-related HIV risk behaviors of older and younger injection drug users and crack smokers. Structured interview responses from 1508 out-of-treatment active drug users older than 50 years of age were compared with those of 1515 out-of-treatment active drug users who were 50 years old or younger. Comparisons were also made within the older cohort to examine differences in risk behaviors between crack smokers and nonsmokers, men and women, and users older than 60 years of age and those in their 50s. Results indicated that although older drug users (older than 50 years of age) were less likely to have had sex in the prior month, those who did were as risky as their younger counterparts with regard to sex-related risk behaviors. They were, however, significantly less risky in their needle sharing practices than those 50 years old or younger. Among the older cohort, those who smoked crack were extremely risky. Men older than 50 years of age were riskier than women older than 50 years of age; however, users older than 60 years of age were no less risky than those in their 50s. Interventions designed for older drug users should focus on sex risk behaviors, especially among those who smoke crack.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Triangle of risk: urban American Indian women's sexual trauma, injection drug use, and HIV sexual risk behaviors.

A community-based mail survey of 155 urban American Indian women revealed 91% engaged in at least one lifetime HIV sexual or drug risk behavior, including 19% who had sex with an injection drug user and 7% who had traded sex. Sixty-eight percent of the respondents were sexually active in the last year, with more than half never using condoms. Six percent had ever injected nonprescription drugs; 62% drank alcohol in the last year, with 28% reporting at least one occasion of consuming six or more drinks containing alcohol. Respondents reported high rates of lifetime physical (37%) and sexual (39%) assault, which was generally associated with lifetime but not more recent indicators of sexual and drug risk behavior. Injection drug use mediated the relationship between nonpartner sexual (but not physical) trauma and high-risk sexual behaviors. Findings underscore the need for the integrated assessment and treatment of abuse and substance use as well as more research on the risk behaviors of this understudied and underserved population.

Adolescent↗
PubMed1994

Trends in risk behavior and HIV seroprevalence in heterosexual injection drug users in San Francisco, 1986-1992.

We examine changes and stability in risk behaviors and HIV-1 seroprevalence among heterosexual injection drug users (IDUs) over 13 cross-sectional surveys, 1986-1992. Interviews (n = 5,956) were conducted with IDUs in street settings and drug detoxification clinics over 6.5 years, and respondents were tested for HIV-1 antibody. Trends in use of condoms and bleach and HIV seroprevalence were assessed using multiple logistic and linear regression analyses. The percentage of time condoms were reportedly used during intercourse among men increased from 4.5% to 31.0%. Among the declining population of IDUs who reported needle sharing, reported use of bleach increased from 3% to 89%. Significant changes in use of bleach 100% of the time were reported: 29.8% in 1988, 52.8% in 1990, and 40.0% in 1992. HIV seroprevalence doubled from 7% in 1986 to 14% in 1987. Post-1987 fluctuations in HIV seroprevalence were not significant. Significant changes in risk behaviors among IDUs were reported over the study period. These changes coincided with the implementation of HIV prevention in San Francisco, including outreach programs, HIV testing and counseling, bleach distribution, and syringe exchange. The moderate and stable rate of HIV seroprevalence beginning in 1987 parallels self-reported reductions in risk behavior.

Condoms↗
PubMed2002

Association between first injection risk behaviors and hepatitis C seropositivity among injecting drug users.

HCV infection is rapidly acquired after drug addicts first inject drug intravenously. The risk behaviors accompanying the first intravenous substance injection are not well known. We used in 1997 a structured questionnaire to investigate the relationships between risk behaviors at the first injection and current reported HCV status. We interviewed 151 injecting drug users from four treatment centers and one prison in Paris. Risk markers for reported HCV seroconversion were explored by use of logistic regression models. One hundred and forty-three injecting drug users (95%) agreed to participate in the study. At the first injection, 50% shared preparation equipment; 22% borrowed and 26% lent injecting equipment. At the time of the study, 46% reported that they were HCV-positive. Sharing preparation equipment (odds ratio=3.1; 95% confidence interval: 1.2-7.8) and lending injection equipment (odds ratio=3.0; 95% confidence interval: 1.1-8.5) during the first injection were independently associated with reported HCV seropositivity. The high-risk behaviors accompanying the first intravenous injection of drugs justifies the implementation of specific prevention measures, aimed at young drug users who have not started to inject.

Adult↗
PubMed1992

Acquired immunodeficiency syndrome/human immunodeficiency virus risk behavior among gay men in small cities. Findings of a 16-city national sample.

BACKGROUND: Most research on acquired immunodeficiency syndrome has been conducted in several of the country's largest cities, and little is known about the current level of human immunodeficiency virus risk taking among gay men in other geographical areas. The purpose of this study was to determine the frequency of risk behavior practices among gay men in smaller communities. METHOD: A large sample of men who patronized gay bars in 16 small and moderate-size cities drawn from six states in four different regions of the country was surveyed to determine the frequency of high-risk behavior and factors influencing risk taking. Eighty-five percent of men in all cities' bars completed all survey measures. The community samples were 1991 men; mean age, 31.3 years; mean education, 10.6 years; 90% were white and 10% were of other ethnicities. All participants provided detailed information on their sexual behavior practices over the preceding 2 months and completed measures assessing their perceived peer norms concerning safer sex practices and risk avoidance, intentions to avoid risk, personal risk estimation, acquired immunodeficiency syndrome risk knowledge, perceived threat of acquired immunodeficiency syndrome/human immunodeficiency virus, and serostatus testing history. RESULTS: High-risk patterns were still common among gay men in these smaller cities; nearly one third of all men had engaged in unprotected anal intercourse an average of eight times in the past 2 months, usually outside monogamous relationships. High-risk behavior was most strongly associated with beliefs that safer sex practices would not be well accepted by peers, weak intentions to use condoms, underestimation of personal vulnerability to the acquired immunodeficiency syndrome, younger age, and higher levels of overall sexual activity. Nine percent of men tested said they were seropositive. CONCLUSIONS: Growing human immunodeficiency virus prevalence and continued high rates of risk behavior indicate that a new "front line" for human immunodeficiency virus prevention among homosexually active men has shifted to the country's smaller cities. Community prevention efforts in these areas are urgently needed to avert sharp increases in future human immunodeficiency virus infections in this population.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Patterns of sexual risk behaviors and psychiatric disorders in a community sample of young adults.

This cross-sectional study documents significant associations between patterns of sexual risk behaviors and psychiatric diagnoses in a multiethnic community sample of young adults (N = 1803) in South Florida. Self-report data regarding sexual behavior and psychiatric symptoms were collected in structured interviews in a follow-up of an earlier school-based study. Cluster analysis was used to group participants with regard to levels of sexual risk behaviors during the past year. Chi-square analysis and ANOVA identified significant associations between cluster membership and (a) lifetime and (b) past year diagnoses for affective disorders, conduct disorder, antisocial personality disorder, alcohol abuse/dependence, marijuana abuse/dependence, and other drug abuse/dependence. In addition, higher levels of sexual risk behaviors were associated with higher levels of cumulative lifetime psychiatric disorders. Implications for selected prevention of sexually transmitted diseases (STDs) and the treatment of psychiatric disorders in young adulthood are discussed.

Adult↗
PubMed1996

HIV risk behaviors among women in methadone maintenance treatment.

This article reports on the HIV risk behaviors of a sample of 158 women heroin addicts admitted into the Los Angeles Enhanced Methadone Maintenance Project. Risk behaviors for HIV were associated with age, lack of education, ethnicity, relationship with a drug user, HIV status, and higher scores on measures of illegal activity, suicidality, depression, polydrug use, and alcohol use. Significant reductions in number of male sex partners and needle-sharing partners were reported at follow-up, although frequency of condom use was unchanged. Methadone maintenance programs need to screen women for risk factors and assist them in developing new behavioral skills in order to implement a harm reduction approach to treatment.

Adult↗
PubMed2000

Self-esteem, self-serving cognitions, and health risk behavior.

The current article reviews prospective and experimental research on the relation between self-esteem and perceptions of vulnerability. These studies demonstrate that individuals with high self-esteem who engage in risk behavior often utilize a variety of self-serving cognitive strategies that protect them from fully acknowledging their vulnerability to the potential negative consequences of their behavior; e.g., they minimize their estimates of personal risk and overestimate the prevalence of the risk behavior among their peers. The article also provides data on an additional self-serving cognitive strategy employed by adolescents with high self-esteem--alteration of perceptions of others' reactions to their own risk behavior. Finally, the article reviews the emerging literature on the relation between these cognitive strategies and maladaptive health behavior, and proposes that whether these strategies are maladaptive depends on the nature of the threat and the availability of opportunities to engage in compensatory self-enhancement.

Adolescent↗
PubMed2006

Parent-child communication processes: preventing children's health-risk behavior.

PURPOSE: Review individual, family, and environmental factors that predict health-risk behavior among children and to propose parent-child communication processes as a mechanism to mediate them. CONCLUSIONS: Improving parent-child communication processes may: reduce individual risk factors, such as poor academic achievement or self-esteem; modify parenting practices such as providing regulation and structure and acting as models of health behavior; and facilitate discussion about factors that lead to involvement in health-risk behaviors. PRACTICE IMPLICATIONS: Assessment strategies to identify youth at risk for health-risk behavior are recommended and community-based strategies to improve communication among parents and children need development.

Adolescent↗
PubMedDate not supplied

Prevalence of behavioral risk factors in two American Indian populations in Montana.

Despite great improvements in recent decades, the health status of American Indians continues to lag behind that of other Americans. Continued health improvement will depend largely on changes in individual behavior. However, few data exist on health risk behaviors among American Indians. We used face-to-face interviews to estimate the prevalence of some of these behaviors among American Indians 15-49 years of age in two Montana locations: on the Blackfeet Reservation and in Great Falls. The prevalence of several important health risk behaviors was higher in these populations than in adult Montana residents in general. Tobacco use was very prevalent. Fifty percent of on-reservation women, 62% of off-reservation women, 34% of on-reservation men, and 63% of off-reservation men were smokers at the time of the survey. Thirty-three percent of reservation men used smokeless tobacco. Other risk behaviors of high prevalence included acute heavy drinking (26% to 42% of men); overweight (29% to 41% of females); sedentary lifestyle (46% to 62% of all respondents); and nonuse of seat belts (64% to 79% of all respondents). Tribal leaders and the Indian Health Service are using the survey results to reduce the prevalence of behaviors harming the health of Indian people. In addition to providing valuable information about the surveyed populations, the survey served as a pilot for subsequent surveys of other American Indian groups.

Adolescent↗
PubMed2003

Use of data from the Behavioral Risk Factor Surveillance System optional diabetes module by states.

An optional diabetes module of the Behavioral Risk Factor Surveillance System was first made available to states in 1993. In 2002, 49 states administered this module. In October 2001 we asked state Diabetes Prevention and Control Program coordinators to complete a two-part questionnaire regarding the use of data from the diabetes module and their usefulness in guiding programmatic activities. Seventy percent of state coordinators reported using data from at least one module question to perform program evaluation, develop publications, and development of community interventions; 45 percent of coordinators used data from at least one module question for activities related to passage of legislation. Questions on self monitoring of blood glucose, hemoglobin A1c test, annual foot exam, annual dilated eye exam, and diabetes education were rated as highly useful by the state coordinators. The results from the optional diabetes module are widely used by states and are essential to Diabetes Prevention and Control Program activities. It is important that the optional diabetes module continue to be included in each state's yearly Behavioral Risk Factor Surveillance System.

Behavioral Risk Factor Surveillance System↗
PubMed1994

Reducing HIV risk behavior among injection drug users: effect of methadone maintenance treatment on number of sex partners.

Some studies have found that sex-related HIV risk behavior is less common among drug users in treatment than among users not in treatment; other studies have found no such relationship. However, past studies have not controlled for drug-user background characteristics that might confound the relationship between treatment and risk behavior. Among this sample of injection drug users in Los Angeles, those enrolled in methadone maintenance treatment report fewer past-year sex partners than those not in treatment; among treatment clients, number of past-year partners is negatively related to time in treatment. These findings persist after age and other background characteristics are controlled. Path analyses suggest that treatment may reduce sex-risk behavior by facilitating clients' disengagement from paid sex and raising their perceived self-efficacy for risk reduction.

Adult↗
PubMed1997

Health behaviors of students attending historically black colleges and universities: results from the National College Health Risk Behavior Survey.

The National College Health Risk Behavior Survey was administered to a convenience sample of students at 8 historically Black colleges and universities in 7 states. Analyses showed major differences in the men's and women's responses. The men were significantly more likely than the women to be current smokers. Also, they more frequently reported heavy drinking, drinking and driving in the past days 30 days, and carrying a weapon. The women were significantly more likely to view themselves as overweight, and more than one third reported they were trying to lose weight. More than one third of the students had not exercised or participated in sports activities for more than 20 minutes in the past 7 days. Because historically Black colleges and universities educate the majority of undergraduate Black college students, multidimensional programs to promote disease prevention and health promotion for Black college students must be expanded and evaluated.

Adult↗