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PubMed1994

Prophylactic vaccines, risk behavior change, and the probability of eradicating HIV in San Francisco.

Theory is linked with data to assess the probability of eradicating human immunodeficiency virus (HIV) in San Francisco through the use of prophylactic vaccines. The necessary vaccine efficacy levels and population coverage levels for eradication are quantified. The likely impact of risk behavior changes on vaccination campaigns is assessed. The results show it is unlikely that vaccines will be able to eradicate HIV in San Francisco unless they are combined with considerable reductions in risk behaviors. Furthermore, if risk behavior increases as the result of a vaccination campaign, then vaccination could result in a perverse outcome by increasing the severity of the epidemic.

AIDS Vaccines↗
PubMedDate not supplied

Predicting adolescent risk behaviors based on an ecological framework and assets.

OBJECTIVES: To examine the relationship between an aggregate risk score (smoking, drinking, and number of sex partners) and measures of youth assets in a sample of 3439 youth aged 14-18 years. METHODS: Linear regression models for African American and white males and females predicted an aggregate risk score. RESULTS: After adjustments, the youth asset most predictive of risk was self/peer values regarding risk behaviors. Perceived school support was also predictive. CONCLUSIONS: Taking an ecological approach to the measurement of adolescent health behaviors contributes to our understanding of these risk behaviors.

Adolescent↗
PubMed1999

American Indian and Alaska Native health behavior: findings from the behavioral risk factor surveillance system, 1992-1995.

OBJECTIVE: The purpose of this study was to evaluate differences between American Indian and white adults in behavioral risk factors for chronic disease and injury. METHODS: Data were drawn from the 1992-1995 Behavioral Risk Factor Surveillance System, an ongoing telephone survey of health behaviors of adults. Prevalence estimates by sex were calculated for American Indian and white respondents in 15 states and the significance of their differences evaluated by chi-square tests. RESULTS: American Indians were found to be at significantly higher risk than whites for fair to poor general health status, medical cost difficulties, binge drinking, cigarette smoking, not always using safety belts, being diagnosed as diabetic, and obesity. CONCLUSIONS: To reduce the gap in behavioral risk factors between American Indians and whites, more resources need to be dedicated to American Indian health. Note. The term "American Indian" henceforth refers to those who identify themselves as American Indian or Alaska Native.

Adolescent↗
PubMed2004

Ethnicity, serostatus, and psychosocial differences in sexual risk behavior among HIV-seropositive and HIV-seronegative women.

Childhood sexual abuse and related life traumas, and other psychosocial variables were investigated as contributors to ethnic differences in sexual risk behaviors among women who differed in HIV-serostatus. A multiethnic sample of 457 HIV-positive and HIV-negative women residing in Los Angeles county was recruited and studied over 2 years as part of the UCLA-Charles R. Drew University Women and Family Project (WFP) study. Comprehensive interviews were administered to participants by ethnically- and linguistically matched interviewers. Data on demographic information, sexual trauma, substance abuse/dependence, psychiatric distress, and sexual history and risk behaviors were collected. The sample for these analyses consisted of 155 African American, 153 European American, and 149 Latina women, and nearly two-thirds of the sample was HIV-seropositive. HIV-positive women were significantly more likely to report more posttraumatic stress, chronic stress, negative health behaviors, drug use, and psychiatric history than HIV-negative women. European American and African American women were more likely to report a history of sexual trauma than Latina women. Finally, Poisson regression analyses revealed that history of trauma, ethnicity, drug and alcohol use, homelessness, and being HIV-positive were associated with greater likelihood of engaging in high-risk sexual behaviors, with history of trauma increasing the likelihood of engaging in high-risk behaviors by 5.1%. These findings highlight important differences among women as a function of ethnicity and HIV status, and underscore the need for special services for HIV-positive women that address the risk-enhancing effects of substance abuse/dependence, homelessness, and sexual trauma.

Adult↗
PubMed2001

Variation in health and risk behavior among youth living with HIV.

Lifetime and current health practices and risk behaviors were examined among 350 youth living with HIV (YLH) aged 14-23 years from four AIDS epicenters (72.6% male; 26.2% African American, 36.9% Latino). YLH were relatively healthy (M CD4 cells = 499), had used substantial health care and were satisfied with the care. YLH's sexual and substance-use histories indicated substantial HIV related risk acts: the median number of lifetime partners was 25 with only 8% using condoms consistently; 14.9% had injected drugs, and 61.2% had used hard drugs. Compared with females, males had more lifetime and recent sexual partners and had used more drugs. Youth who were recently sexually active (81.3%) had multiple partners. Most of the sexually active YLH used condoms consistently (81.6%). YLH who were symptomatic or had an AIDS diagnosis were likely to have recently had more seropositive sexual partners than the asymptomatic youth. Youth disclosed their serostatus to about half of their sexual partners (53.9%). YLH with AIDS used fewer hard drugs than those without an AIDS diagnosis. Health and risk behaviors of the YLH varied significantly based on their disease stage, gender, and ethnicity, suggesting the need for tailoring interventions for subgroups of YLH.

Adolescent↗
PubMedDate not supplied

Peer contagion of aggression and health risk behavior among adolescent males: an experimental investigation of effects on public conduct and private attitudes.

Peer contagion of adolescent males' aggressive/health risk behaviors was examined using a computerized "chat room" experimental paradigm. Forty-three 11th-grade White adolescents (16-17 years old) were led to believe that they were interacting with other students (i.e., "e-confederates"), who endorsed aggressive/health risk behaviors and whose ostensible peer status was experimentally manipulated. Adolescents displayed greater public conformity, more internalization of aggressive/health risk attitudes, and a higher frequency of actual exclusionary behavior when the e-confederates were high in peer status than low. Participants' level of social anxiety moderated peer contagion. Nonsocially anxious participants conformed only to high-status peers, whereas socially anxious participants were equally influenced by low- and high-status peers. The role of status-maintenance motivations in aggression and risk behavior, and implications for preventive intervention, are discussed.

Adolescent↗
PubMed2005

A meta-analysis of the relationship of child sexual abuse to HIV risk behavior among women.

OBJECTIVE: This study is a meta-analysis of the literature exploring the relationship between child sexual abuse (CSA) and HIV risk behavior among women. Four outcome variables were tested: unprotected sex; sex with multiple partners; sex trading; and adult sexual revictimization. METHOD: Forty-six studies met the inclusion criteria and were included in the analysis, and separate meta-analyses were performed for each of the four dependent variables described above. RESULTS: Using the correlation coefficient r as an effect size estimate, results indicate an average effect size of .05 for the unprotected sex meta-analysis (N = 16 studies), .13 for the sex with multiple partners meta-analysis (N = 23 studies), .12 for the sex trading meta-analysis (N = 23 studies), and .17 for the adult sexual revictimization meta-analysis (N = 21 studies). We conducted a test of three potential moderator variables (source of sample, definition of CSA based on type of contact, and definition of CSA based on maximum age of victim). Results did not support the hypothesis that these three variables explain a significant amount of variability in effect sizes with one exception: Studies that define CSA more broadly to include adolescent victims (e.g., victims up to 17 years of age) had larger and more homogenous effect sizes for the sex trading meta-analysis than those that defined CSA as having occurred at younger ages. CONCLUSIONS: These findings suggest a small positive relationship between CSA and subsequent HIV risk behavior among women that varies as a function of how CSA and HIV risk behavior are operationalized.

Adult↗
PubMed2001

Residential status and HIV risk behaviors among Puerto Rican drug injectors in New York and Puerto Rico.

This article investigates the association between residential status and human immunodeficiency virus (HIV) risk behaviors among island and New York Puerto Rican injection drug users (IDUs). We assigned 561 subjects from New York City and 312 from Puerto Rico to five residential status categories: living in parent's home, living in own home, living in other's home, living in temporary housing (hotel, single-room occupancy [SRO] hotels), and homeless (living in streets/shelters). Dependent variables included injection- and sex-related risk behaviors (sharing syringes, sharing other injection paraphernalia, shooting gallery use, and having paid sex). Chi square, t tests, and multivariate logistic analysis tests were performed separately by site. About one-quarter of the sample in each site was homeless. Island Puerto Ricans were more likely to live with their parents (44% vs. 12%, p < .001), and more New York IDUs lived in their own home (30% vs. 14%, p < .001). In New York, gallery use and paid sex were associated with living in other's home, living in parent's home, and being homeless. Sharing paraphernalia was related to living in other's home, living in temporary housing, and being homeless. In Puerto Rico, having paid sex was associated with homelessness. High-risk behaviors were more likely among homeless IDUs in both sites. Programs to provide housing and target outreach and other prevention programs for homeless IDUs would be helpful in reducing HIV risk.

Adult↗
PubMed2000

Prevalence of youth access to alcohol, guns, illegal drugs, or cigarettes in the home and association with health-risk behaviors.

PURPOSE: To describe the prevalence of access to alcohol, guns, drugs, or cigarettes in the home and its association with related health-risk behaviors among adolescents.METHODS: We analyzed cross-sectional data from the 1995 in-home survey of the National Longitudinal Study on Adolescent Health which used a nationally representative school-based sample (N = 6,504) of adolescents in grades 7-12. We used logistic regression analysis, adjusted for gender, race/ethnicity and age, to examine the associations between access to alcohol, guns, drugs, and cigarettes in the home and the practice of risk behaviors involving those variables.RESULTS: Overall, 1,817 (28%) adolescents reported having easy access to alcohol in the home, 1,616 (25%) had access to a gun, 189 (3%) had access to drugs, and 2,067 (32%) had access to cigarettes. Associations were found between easy home access to alcohol and drinking during the past 12 months (Adj. OR = 2.16, 95% CI = 1.89-2.47), ever being drunk at school (Adj. OR = 2.33, 95% CI = 1.85-2.95, and ever driving drunk (Adj. OR = 1.64, 95% CI = 1.29-2.09). Access to a gun at home was associated with carrying a gun to school (Adj. OR = 2.54, 95% CI = 1.40-4.64). Associations were also found between access to drugs and cigarettes in the home and ever using drugs and smoking regularly.CONCLUSIONS: Easy access to alcohol, guns, and cigarettes in the home is prevalent among adolescents and may increase involvement in risky behaviors. Limiting access therefore is important in order to reduce the occurrence of health-risk behaviors associated with substance use, deliquency and injury among adolescents.

Journal Article↗
PubMed2006

Promoting social inclusion in schools: a group-randomized trial of effects on student health risk behavior and well-being.

OBJECTIVES: We sought to test the efficacy of an intervention that was designed to promote social inclusion and commitment to education, in reducing among students health risk behaviors and improving emotional well-being. METHODS: The design was a cluster-randomized trial in 25 secondary schools in Victoria, Australia. The subjects were 8th-grade students (aged 13 to 14 y) in 1997 (n=2545) and subsequent 8th-grade students in 1999 (n=2586) and 2001 (n=2463). The main outcomes were recent substance use, antisocial behavior, initiation of sexual intercourse, and depressive symptoms. RESULTS: At 4-year follow-up, the prevalence of marked health risk behaviors was approximately 20% in schools in the comparison group and 15% in schools in the intervention group, an overall reduction of 25%. In ordinal logistic regression models a protective effect of intervention was found for a composite measure of health risk behaviors in unadjusted models (odds ratio [OR]= 0.69; 95% confidence interval [CI]= 0.50, 0.95) and adjusted models (OR= 0.71; CI =0.52, 0.97) for potential confounders. There was no evidence of a reduction in depressive symptoms. CONCLUSION: The study provides support for prevention strategies in schools that move beyond health education to promoting positive social environments.

Adolescent↗
PubMedDate not supplied

Protective and risk behaviors of rural minority adolescent women.

Studies of adolescent risk and protective behaviors have focused on identifying modifiable psychosocial variables that predict differential outcomes for subsequent intervention efforts. Research has been scarce in studies of rural minority adolescent women. This study examined the protective and risk behaviors of these women and their relationship to physical or sexual abuse. Rural minority adolescent women endured high levels of psychological distress and many high risk behaviors, yet experienced many protective behaviors. Barriers to health care included access and confidentiality. Physically or sexually abused adolescents endured relatively greater risk and fewer protective behaviors than nonabused adolescents. The prevalence of risk behaviors and abuse among rural minority adolescent women presents a need for development of psychotherapeutic interventions as part of behavioral interventions for risk reduction. These women may benefit from confidential identification and assessment of abuse history and risk and protective behaviors so that appropriate psychological treatment can accompany accessible medical treatment.

Adolescent↗
PubMed2001

HIV risk behavior and psychological correlates among native American women: an exploratory investigation.

Native American women are at increased risk for HIV infection, but few studies have studied this threat. To address this gap in the literature, we assessed HIV risk behavior and explored the hypothesized psychological antecedents of risk behavior in 53 Native American women. Survey results indicated that women's HIV-related knowledge was incomplete and many women still held misconceptions about HIV. One third of the sample reported having two to five sexual partners in the past 5 years, and 30% of the women reported alcohol use prior to sexual intercourse. Women who were classified at higher risk, that is, who did not use condoms consistently, felt less vulnerable to HIV and were less ready to change their risky sexual behaviors compared with their lower-risk counterparts. These findings indicate that Native American women are at risk for HIV infection and can no longer be neglected by those seeking to prevent HIV infections. Culturally congruent and gender-specific interventions that provide information and behavioral skills to Native American women as well as increase their motivation to adopt safer sexual behaviors are needed.

Adolescent↗
PubMed2006

Neurological correlates of high-risk behavior: a case study of Alphonse Capone.

Neurological impairment, traumatic brain injury, and childhood trauma and abuse are all associated with violent and high-risk behaviors among prison inmates. This case study examines the medical history of a notorious criminal--Alphonse Capone. Records suggest an association between Capone's declining neurological condition and an increase in high-risk behaviors. Prison, criminal, media, and medical records from the National Archives and other sources were studied to identify relationships to current research data describing neurological abnormalities of prison inmates. Healthcare providers can play a critical role in identifying at-risk youths, potentially reducing the incidence of high-risk behaviors associated with both crime and infectious disease transmission.

Crime↗
PubMed1995

Effects of a community outreach program in HIV risk behaviors among injection drug users in San Juan, Puerto Rico: an analysis of trends.

This report assesses the effects of a community outreach program in reducing HIV risk behaviors among injection drug users (IDUs) in San Juan, Puerto Rico. Participants were 1,113 IDUs, 88.3% of whom were also assessed at post-intervention. The analytic strategy consisted in modeling pre- and post-intervention trends in risk behavior levels from successive cohorts of IDUs. The trend analyses showed that secular trends, unrelated to the direct effects of the outreach intervention, accounted for significant portions of the reported risk reductions. Nevertheless, the post-intervention trends in the shared use of cookers and in needle bleaching showed shifts that could not be accounted for by the modeled secular trends. The outreach intervention appears to have had significant but partial effects on the behavioral risks associated to drug injection and no effect on sexual behaviors. The strengths and weaknesses of time-trend analyses for evaluating community HIV-prevention programs lacking experimental designs are discussed.

Adult↗
PubMed2006

A model of sexual risk behaviors among young gay and bisexual men: longitudinal associations of mental health, substance abuse, sexual abuse, and the coming-out process.

Sexual risk behaviors of young gay and bisexual men must be understood within the context of other health concerns (e.g., anxiety, substance abuse), population specific factors (i.e., the coming-out process and gay-related stress), childhood sexual abuse, and other theoretical factors (e.g., safer-sex intentions). The current report proposes and longitudinally examines a model of risk factors for subsequent sexual risk behaviors among young gay and bisexual men in New York City. As hypothesized, more negative attitudes toward homosexuality, more substance abuse symptoms, and poorer intentions for safer sex were directly associated with a greater likelihood of unprotected anal sex over the following year. Furthermore, lower self-esteem, more anxious symptoms, and childhood sexual abuse were related to more unprotected anal sex indirectly through more sexual partners, sexual encounters, and substance abuse symptoms. These findings suggest that interventions targeting sexual risk behaviors of young gay and bisexual men may be more effective if they also address mental health concerns and aspects of the coming-out process.

Adolescent↗
PubMed2004

The relation of age, gender, ethnicity, and risk behaviors to self-esteem among students in nonmainstream schools.

This cross-sectional study investigated self-esteem in relation to age, gender, ethnicity, and risk behaviors among a sample of nonmainstream students. Participants were 149 students in the 6th to 12th grades from two nonmainstream schools (one charter and one alternative school). Self-esteem and youth risk behaviors were determined by using a modified version of the Rosenberg Self-Esteem Scale (Rosenberg, 1965) and the National Alternative High School Youth Risk Behavior Survey (Grunbaum et al., 1999), respectively. Results indicated that nonmainstream students with high self-esteem were more likely to engage in their first sexual experience and to begin marijuana use later in life. African American students reported having their first sexual experience at an older age, but having more sexual partners than did Latino students. The implications of these findings are discussed.

Adolescent↗
PubMed2002

Factors associated with risk behaviors for sexually transmitted disease/AIDS among urban Brazilian women: a population-based study.

BACKGROUND: The proportion of women among persons with sexually transmitted disease (STD)/AIDS in Brazil is increasing rapidly, and studies are needed to understand risk behaviors. GOAL: The goal of this study was to identify factors associated with risk behaviors for acquiring STD/AIDS among women aged 15 to 49 years in Pelotas, Brazil. STUDY DESIGN: A representative sample of women was surveyed by means of interviewer-administered and self-administered confidential questionnaires. Of the women we sought to include, 3.5% refused and 1543 participated. RESULTS: Risk behaviors included nonuse of condoms (72%); first intercourse before the age of 18 years (47%); use of drugs or alcohol by the partner (14%) or by the woman (7%); multiple partners (7%); and anal sex (3%). The risk score was significantly associated with being younger than age 30 years, having <5 years of schooling, being divorced or separated, and being a smoker. CONCLUSION: Preventive strategies should prioritize efforts toward young women, those with little schooling, smokers, and those who are divorced or separated.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Risk behavior for HIV infection in participants in preventive HIV vaccine trials: a cautionary note.

We conducted a longitudinal study of participants in phase I and II HIV vaccine safety and immunogenicity trials to examine changes in sexual risk behavior that are associated with risk of HIV transmission. The participants were 48 HIV-negative men and women enrolled in one of two placebo-controlled HIV vaccine trials conducted at San Francisco General Hospital. There was a significant increase in insertive unprotected anal intercourse (UAI) from 9% at baseline (trial entry), to 13% at the month 6 assessment, to 20% at the month 12 assessment (p = .02). The primary predictor of either insertive or receptive UAI during the vaccine trials was having engaged in this behavior prior to entry (p = .001). Higher-risk behavior was also seen among participants who were younger and had multiple sexual partners (each, p = .06) and who indicated that one of their reasons for participation in the vaccine trial was hope of protection from HIV infection (p = .07). These findings indicate that despite instructions otherwise, participants with a history of high-risk behavior or who express hope of protection from HIV infection by enrolling in vaccine trials may be candidates for more intensive risk-behavior counseling prior to and during their participation.

AIDS Vaccines↗