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PubMed2000

Life optimism, substance use, and AIDS-specific attitudes associated with HIV risk behavior among disadvantaged innercity women.

The development of more effective human immunodeficiency virus (HIV) prevention programs for disadvantaged women requires identification of factors associated with risk. In the present study, 158 women - all of whom met criteria indicative of HIV risk - were recruited in innercity primary healthcare clinics and administered measurements that assessed variables in three domains believed pertinent to HIV sexual risk behavior: (1) substance use in the past 3 months, (2) acquired immunodeficiency syndrome (AIDS)-specific cognitive and attitudinal factors, including AIDS risk knowledge, condom attitudes, perceived risk for AIDS, behavior change intentions, and perceived self-efficacy, and (3) life context variables, including self-esteem, fatalism, personal optimism toward the future, and current life satisfaction. When women were categorized into highest and lower groups based on their recent risk behavior, AIDS-specific cognitive and attitudinal factors, as expected, differentiated the groups. However, women at highest risk for HIV also most often used a variety of substances and scored lower in self-esteem, held views more characterized by personal fatalism and low optimism concerning the future, and had greater life dissatisfaction than women at lower risk. HIV prevention programs for disadvantaged women require attention not only to AIDS-specific knowledge, attitudes, and skills development but also to broader issues of life context that, if unaddressed, may limit women's ability and motivation to reduce risk for HIV/AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Injecting risk behavior among drug users in Amsterdam, 1986 to 1992, and its relationship to AIDS prevention programs.

OBJECTIVES: Serial, cross-sectional trends in injecting risk behavior were studied among drug users from 1986 to 1992. METHODS: From a cohort study in Amsterdam, 616 intake visits of drug users who had injected in the 6 months preceding intake were selected. RESULTS: The proportion of drug users who reported borrowing and lending used injection equipment and reusing needles/syringes (in the previous 6 months), continuously declined from 51% to 20%, from 46% to 10% and from 63% to 39%, respectively. In multivariate analysis, it appeared unlikely that a selective recruitment of participants over time was responsible for these trends. Participants, recruited later in time, had been previously tested for human immunodeficiency virus (HIV) more often, had received daily methadone less often, and had obtained a higher proportion of new needles via exchange programs. Indications were found that (1) voluntary HIV testing and counseling leads to less borrowing, lending, and reusing equipment; and (2) obtaining needles via exchange programs leads to less reusing needles/syringes. It appeared that nonattenders of methadone and exchange programs have reduced borrowing and lending to the same extent as attenders. CONCLUSIONS: Methodologically, evaluating specific measures is difficult. However, the combination of various preventive measures in Amsterdam is likely to be responsible for the observed decrease in injecting risk behavior.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Continued sexual risk behavior among HIV-seropositive, drug-using men--Atlanta; Washington, D.C.; and San Juan, Puerto Rico, 1993.

Behaviors associated with increased risk for sexual transmission of human immunodeficiency virus (HIV) by infected persons include unprotected intercourse, multiple sex partners, use of crack cocaine, failure to disclose serostatus to sex partners, and trading sex for money or drugs. Some sexually active, HIV-infected persons in the United States continue to practice risky behaviors. To characterize continued sexual risk behaviors among HIV-positive, illicit-drug using men, in 1993 CDC analyzed data from such men recruited for a small group-intervention program in three cities - Atlanta; Washington, D.C.; and San Juan, Puerto Rico. This report summarizes the results of that analysis, which indicate that some seropositive men continue to engage in unprotected sex.

Adult↗
PubMed1997

The effects of planned duration of residential drug abuse treatment on recovery and HIV risk behavior.

OBJECTIVE: This study assessed the effects of planned duration of residential drug abuse treatment on recovery from drug use and on human immunodeficiency virus (HIV) risk behaviors. METHODS: Two concurrent randomized controlled trials of programs differing in planned duration were conducted: 6-month vs 12-month versions of a traditional therapeutic community program, and 3-month vs 6-month versions of a modified therapeutic community incorporating a relapse prevention and health education program. Outcomes, measured at least 16.5 months after admission, included time from admission to first drug use; severity of drug, alcohol, legal, and employment problems; and risky drug injection and sexual behaviors. RESULTS: Among 539 clients (86% of those enrolled), there were no significant effects of planned duration of treatment upon Addiction Severity Index scores or HIV risk behavior. In the relapse prevention program, clients randomized to the 6-month program had a longer time to first drug use than those in the 3-month program (hazard ratio = 0.74; 95% confidence interval = 0.58, 0.93). Employment problems at follow-up were significantly less severe among clients treated in the therapeutic community than among those in the relapse prevention program. CONCLUSIONS: No overall benefit of extending treatment beyond 6 months was found.

Adult↗
PubMed2002

Risk behaviors and HIV incidence among repeat testers at publicly funded HIV testing sites in San Francisco.

OBJECTIVE: More than 25% of HIV tests are for individuals who have previously been tested. To characterize repeat testers, we 1) estimated the seroincidence of HIV infection, stratified by risk behavior, and examined the association between 2) testing rates and risk level and 3) repeat testing and tester characteristics. METHODS: Records from HIV counseling and testing (C&T) sites were reviewed. Seroincidence was estimated by linking results of current test with date of last reported HIV negative test. A risk hierarchy of behaviors was created. Repeat testing rates were calculated for each risk level strata. Multivariate models explored the association of repeat testing with tester characteristics. RESULTS: The HIV seroincidence among repeaters was 1.3 per 100 person-years (range 0.7-7.0 per 100 person-years). The high-risk level subject had a repeater rate of 92%, with 5.3 tests/person and was more likely (odds ratio = 4.96, 95% confidence interval 3.8-6.5) to have tested two or more times, compared with those in the low risk group. CONCLUSION: The highest users of repeat testing are those who are practicing the highest risk behaviors and have the highest incidence of HIV. This suggests that prevention messages should be modified to more explicitly address the behaviors that are putting individuals at high risk for HIV.

AIDS Serodiagnosis↗
PubMed1994

A computer-based interview to identify HIV risk behaviors and to assess patient preferences for HIV-related health states.

We developed a computer-based utility assessment tool to assess the preferences of patients towards HIV-related health states and identify risk behaviors (both sexual and drug related) of the patient being interviewed. The reliability of the computer-based interview was assessed through comparison with person-to-person interviews. Our pilot study included 22 patients. Twelve of these patients were also interviewed by the research assistants in person-to-person interviews. The agreement between the person-to-person and computer-based interviews was excellent (3 discrepancies of 180 compared answers), and the majority of the patients preferred to use the computer to disclose sensitive information regarding risk behaviors. Our study suggests that assessment of patient preferences and risk factors can be performed reliably through a computer-based interview.

Adult↗
PubMed1998

A comparison of demographic characteristics of selected year 2000 health objectives for the United States, using behavioral risk factor surveillance system data for Alaska.

PURPOSE: The Behavioral Risk Factor Surveillance System (BRFSS) is a nationally developed and state-administered telephone survey which monitors the health behaviors and practices of adults aged 18 and older. One use of the survey is to monitor progress towards some of the Year 2000 Health Objectives for the United States. METHOD: Alaska has been conducting BRFSS monthly since January 1991, collecting approximately 128 interviews each month, for a yearly yield of approximately 1,530. Survey design allows for the aggregation of data over several years to accumulate sufficient sample size to look at health behaviors in subgroups of interest. We look at progress towards Year 2000 objectives for Alaska by various demographic characteristics: age, gender, education, employment, and geographic region. RESULTS: Survey data such as BRFSS can be used to monitor health behaviors and practices in a population in a cost-efficient and systematic manner.

Adolescent↗
PubMed2003

The utility of the PRECEDE model in predicting HIV risk behaviors among Puerto Rican injection drug users.

The PRECEDE model for health promotion proposes three types of influences on health behaviors: Predisposing, Enabling, and Reinforcing factors. This model was used to examine a range of influences on HIV risk behaviors (sharing syringes and other injection-related paraphernalia) among Puerto Rican injection drug users (IDUs). A total of 698 IDUs were interviewed (438 in East Harlem, New York, and 260 in Bayamón, Puerto Rico). Both types of risk behaviors were more prevalent in Puerto Rico. Similarities in influences on syringe sharing behaviors were found in the two sites and included self-efficacy (for reducing injection-related sharing) and norms. Influences on the sharing of other injection-related paraphernalia were primarily Enabling factors in both communities, and purchasing drugs with others was the strongest predictor of paraphernalia sharing. The need to address risks associated with joint drug purchasing in both locations and to enhance efforts to reduce risks among IDUs in Puerto Rico is indicated.

Adult↗
PubMed1998

Trends in sexual risk behaviors among high school students--United States, 1991-1997.

Each year, approximately three million cases of sexually transmitted diseases (STDs) occur among teenagers, and approximately one million become pregnant. Human immunodeficiency virus (HIV) infection is the sixth leading cause of death among persons aged 15-24 years in the United States. Unprotected sexual intercourse and multiple sex partners place young persons at risk for HIV infection, other STDs, and pregnancy. To determine trends in sexual risk behaviors among high school students, CDC analyzed data from the Youth Risk Behavior Survey (YRBS) for the years 1991, 1993, 1995, and 1997. This report summarizes the results of this analysis, which indicate that, from 1991 to 1997, the percentage of U.S. high school students who had ever had sexual intercourse decreased, and the prevalence of condom use among currently sexually active students increased.

Adolescent↗
PubMed2006

Evaluation of a measure of incidental legal risk behaviors in college students who use alcohol.

The purpose of this study was to develop a new measure of incidental behaviors that put college students at increased risk of legal consequences while using alcohol, the Legal Risk Behaviors while using Alcohol (LRBA) scale. Two hundred and twenty one college students who used alcohol were recruited to complete an online study about their use of alcohol, specific behaviors engaged in while using alcohol, and associated consequences. Analyses revealed that the 19-item LRBA consisted of three factors--"Risky Behaviors," "Protective Behaviors," and "Private Settings." Analyses suggested that the LRBA had adequate test-retest reliability and internal consistency. Initial results indicate that the LRBA may be a useful measure to help us better understand what behaviors college student engage in that increase their risk for experiencing a legal encounter.

Adolescent↗
PubMedDate not supplied

Sexual compulsivity and substance use in HIV-seropositive men who have sex with men: prevalence and predictors of high-risk behaviors.

Most persons aware of their HIV-positive serostatus refrain from sexual behavior that could transmit HIV infection to others. However, a minority of men who test HIV-seropositive continue to engage in transmission risk behavior. One factor that may play a role in high-risk sexual activity involves sexual behavior self-management. The present study investigated the role of sexual compulsivity as a contributing factor to high-risk sexual behavior in HIV seropositive men who have sex with men (N = 112). Participants also completed measures of factors known to be related to risky sexual behavior including: personal substance use, sexual partner substance use, pleasure associated with high-risk activities, beliefs about transmission risks, intentions to avoid future instances of risky behavior, and self-esteem. Men scoring high on sexual compulsivity reported engaging in more frequent unprotected sexual acts with more partners, reported greater use of cocaine in conjunction with sexual activity, rated high-risk sexual acts as more pleasurable, and reported lower self-esteem. Mediational analyses indicated that the relationship between sexual compulsivity and high-risk sexual behavior was partially mediated by both personal cocaine use and partner cocaine use in conjunction with sexual activity. The results suggest a need to integrate HIV risk-reduction services and substance use treatment for those persons living with HIV who have difficulty avoiding transmission risk behavior.

Adult↗
PubMed2007

Severe anxiety symptomatology and HIV risk behavior among Hispanic injection drug users in Puerto Rico.

Despite an overall decrease in AIDS incidence in Puerto Rico, our studies continue to show high prevalence of HIV risk behaviors among injection drug users (IDUs). This study seeks to evaluate whether the occurrence of injection-related and sex-related HIV risk behaviors among IDUs in Puerto Rico varies with the presence of anxiety symptomatology. Subjects included 557 IDUs, recruited from street settings in poor neighborhoods in Puerto Rico. Symptoms of severe anxiety were reported by 37.1% of the study sample. Participants with severe anxiety symptoms were more likely to share needles, cotton, and rinse water; to pool money to buy drugs; and to engage in backloading, than those without severe anxiety symptoms. Participants with severe anxiety symptomatology were also more likely to practice unprotected vaginal or oral sex. The findings from this study alert HIV prevention and treatment programs to the need to address anxiety disorders within their programs.

Adult↗
PubMed1989

Management of HIV-positive psychiatric patients who fail to reduce high-risk behaviors.

The authors describe clinical and legal dilemmas faced by staff involved in providing inpatient psychiatric treatment to two HIV carriers who continued to practice high-risk behaviors after learning of their HIV infection. Staff were unsure of their obligation to report the patients under a state law giving the commissioner of health broad discretion to limit the freedoms of HIV-infected individuals who continue to practice high-risk behaviors. Treatment of the patients also raised concerns about the appropriateness of treating noncompliant HIV-infected patients in traditional psychiatric settings and the lack of suitable aftercare facilities. The authors advocate developing a specialized treatment approach for noncompliant HIV-infected patients and provide a series of recommendations that might serve as the foundation for such an effort.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Youth Resilience Framework for reducing health-risk behaviors in adolescents.

Adolescents engage in risky behaviors that compromise their health. Leading causes of morbidity and mortality are associated with a few preventable health-risk behaviors initiated in childhood and early adolescence. Interventions that enhance protective factors in childhood are needed to offset these vulnerabilities and thus promote the health of adolescents. The Youth Resilience Framework is presented that addresses individual and sociocultural risk factors and protective resources that can influence health outcomes throughout adolescence. This framework incorporates a developmental approach to address precursors and health-risk behaviors that may be amenable to early health-promoting interventions.

Adaptation, Psychological↗
PubMed1999

Reproductive health risk behavior survey of Colombian high school students.

PURPOSE: To establish rates of potentially risky sexual behaviors among Colombian adolescent students. METHODS: A total of 230 9th and 11th graders at a Colombian high school (69% of enrolled students) were anonymously surveyed about selected reproductive health behaviors using the Centers for Disease Control and Prevention's self-administered Youth Risk Behavior Survey. RESULTS: The response rate was >90%. The group was demographically representative of students. Twenty-nine percent of the group had engaged in intercourse (13% of 9th and 43% of 11th graders). Male gender [beta = 0.7873; odds ratio (OR) = 2.09; 95% confidence interval (CI) = 1.57-3.08] and increasing age (beta = 0.3413; OR = 1.41; 95% CI = 1.02-1.93) were each significantly correlated with prior sexual activity. Compared with females, males initiated intercourse at a significantly earlier age (beta = 0.284; p < .001) but did not report significantly more partners (means 2.1 vs. 1.4; chi2 = 1.25; p = .262). Forty-eight percent of respondents used contraception during their last encounter. Sixty-three percent used oral contraceptives or condoms, while the remainder used less effective methods. Contraceptive use did not correlate with gender or age. Age was significantly and positively correlated with use of alcohol prior to sexual activity (B = 1.28; OR = 3.6; 95% CI = 1.49-8.44). CONCLUSIONS: Compared with U.S. populations of similar ages, the Colombian group surveyed had fewer sexually active members, reported fewer partners, and used contraception with lower frequency.

Adolescent↗
PubMed2000

[HIV risk behavior in prison and factors associated with reincarceration of injection drug users].

OBJECTIVES: The aim of this study was to estimate the frequency of risk behavior for HIV transmission in prison and to identify the factors associated with reincarceration. PATIENTS AND METHODS: An epidemiologic study was carried out in the penitentiary center of Marseilles between December 1995 and March 1997. Five hundred and seventy-four prisoners answered an anonymous voluntary questionnaire managed by independent interviewers. RESULTS: Among the 574 prisoners, 133 (23%) reported they had injected drugs (intravenous drug users, IDU) including 71 (53%) who had injected drugs during the three months preceding incarceration. Seven percent of the IDU received opiate substitutes before their imprisonment. Nine prisoners of the 120 who have responded to the question (7.5%: 3.7-14.2 95% CI) stated they had injected drugs during the first three months of incarceration. Multivariate analysis showed that reincarceration was significantly more frequent among men, HIV-infected and unemployed prisoners, and prisoners not receiving opiate substitutes at the time of their imprisonment. DISCUSSION: This study show that risk behaviors of HIV and hepatitis virus transmission are frequent among intravenous drug users, including during their incarceration. The relationship between opiate substitution treatment and reincarceration deserves to be studied further on larger samples in order to better evaluate its impact on social rehabilitation of drug addicts. This data also underline the need to strengthen prevention programs in prisons and the importance of social and health policies targeted on drug users especially opiate substitution programs.

Adult↗
PubMedDate not supplied

The effects of the child and adolescent trial for cardiovascular health intervention on psychosocial determinants of cardiovascular disease risk behavior among third-grade students.

PURPOSE: The Child and Adolescent Trial for Cardiovascular Health is a multi-site study of a school-based intervention designed to reduce or prevent the development of risk factors for cardiovascular disease. The goal was to change (or prevent) related risk behaviors and the psychosocial variables that theoretically influence those behaviors. DESIGN: A nested design was used in which schools served as the primary unit of analysis. Twenty-four schools participated at each of four sites (Austin, San Diego, Minneapolis, and New Orleans). Each site had 10 control and 14 intervention schools. SETTING AND SUBJECT: Ninety-six schools (with more than 6000 students) in the four sites were randomized to three treatment conditions: control, school-based interventions, and school-plus-family interventions. The sample included approximately equal numbers of males and females and was 67.5% white, 13.9% African-American, 13.9% Hispanic, and 4.7% other. MEASURES: The psychosocial determinants included improvements in dietary knowledge, intentions, self-efficacy, usual behavior, perceived social reinforcement for healthy food choices, and perceived reinforcement and self-efficacy for physical activity. RESULTS: The findings indicated significant improvements in all the psychosocial determinants measured (p < .0001). The results revealed a greater impact in the school-plus-family intervention schools for two determinants, usual dietary behavior and intentions to eat heart-healthy foods. CONCLUSIONS: These findings support theory-based interventions for changing selected psychosocial determinants of cardiovascular disease risk behavior among children.

Cardiovascular Diseases↗
PubMed1996

Retention in methadone maintenance is associated with reductions in different HIV risk behaviors for women and men.

Using AIDS Initial Assessment questionnaire (AIA) data from 353 injection drug users (IDUs) newly admitted to methadone maintenance (MM), three dimensions of injection risk behavior ("sharing with sexual partner," "sharing with others," and "new needle use") were identified. Among IDUs who continued to inject drugs at 1 year, men retained in treatment obtained lower scores on the "sharing with others" scale than men not retained, even when controlling for initial scale scores and injection frequency. Associations between retention in MM and changes in sexual risk were examined using two AIA measures of sexual risk behavior ("number of IDU sexual partners" and "relative frequency of protected vaginal intercourse"). Controlling for injection frequency, prior sexual risk, and age, there was no difference in sexual risk for men retained in treatment versus those not retained. Among women, those who stayed in MM for 1 year reported significantly fewer IDU partners.

Analgesics, Opioid↗