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Stage of behavior change for condom use: the influence of partner type, relationship and pregnancy factors.

A theoretical model was used to examine the influence of relationship factors, pregnancy intentions, contraceptive behavior and other psychosocial characteristics on stages of behavior change in condom use among heterosexual black women of reproductive age. Data from an inner-city street survey compared women who were not contemplating condom use, women who were attempting to use condoms or had used them consistently for short periods of time, and those who had achieved long-term consistent use. Women's relationship with their main partner appears to be an important factor in understanding their use of condoms both with main partners and with other partners. For condom use with the main partner, factors such as emotional closeness and partner support were significant predictors of the likelihood that women would be attempting to use condoms rather than not contemplating use. Cohabitation and the belief that condom use builds trust were significant predictors of long-term consistent condom use. Having a regular or main partner was strongly associated with intentions to use condoms with other partners. Women who wanted to become pregnant were much less likely to intend to use condoms with their main partner, and women using oral contraceptives were less likely to be long-term consistent condom users.

Adolescent↗

Measuring the adoption of consistent use of condoms using the stages of change model. AIDS Community Demonstration Projects.

The stages of behavior change model has been used to understand a variety of health behaviors. Since consistent condom use has been promoted as a risk-reduction behavior for prevention of human immunodeficiency virus (HIV) infection, an algorithm for staging the adoption of consistent condom use during vaginal sex was empirically developed using three considerations: HIV prevention efficacy, analogy with work on staging other health-related behaviors, and condom use data from groups at high risk for HIV infection. This algorithm suggests that the adoption of consistent condom use among persons at high risk can be meaningfully measured with the model. However, variations in the algorithm details affect both the interpretation of stages and apportionment of persons across stages.

Acquired Immunodeficiency Syndrome↗

Changes in skin protection behaviors, attitudes, and sunburn: in a population with the highest incidence of skin cancer in the world.

This study describes changes in skin protection attitudes and outdoor behaviors of adults in Queensland, Australia, using two cross-sectional telephone surveys conducted in 1988/89 (N = 1699) and 1991/92 (N = 2317). After adjustment for potential confounders, there were significant improvements in some skin protection attitudes, time spent outside, hat wearing, sunscreen use, overall skin protection (p < 0.01) and shade use (p < 0.05) between 11:00 AM and 3:00 PM on the previous Sunday. The degree of attitudinal and behavioral change varied with age, gender, region, and reported skin type. However, recent sunburn experience remained unchanged. A similar study in Victoria, Australia, observed changes in skin protection attitudes, behaviors, and recent sunburn. We speculate on possible explanations for the lack of improvement in recent sunburn experience despite the improvement in skin protection attitudes, and behaviors, and suggest that part of the explanation may be environmental differences. This has implications for generalizability of such studies outside the geographical region in which they were conducted.

Adolescent↗

Perinatal methanol exposure in the rat. II. Behavioral effects in neonates and adults.

The use of methanol as a component of automobile fuel will increase perinatal exposures in the general population. Few studies have addressed questions concerning neurotoxicity stemming from such exposures. In the current study, four cohorts of pregnant Long-Evans rats, each cohort consisting of an exposure and a control group, were exposed to 4500 ppm methanol vapor in Rochester-type inhalation chambers for 6 hr daily beginning on Gestation Day 6. Exposure continued for both dams and pups through Postnatal Day 21 (PND 21) to model gestational and neonatal toxicity in humans. Several behavioral procedures were used to assess exposure effects in the offspring. Male-female littermates were studied whenever possible to examine sex differences, with one pair from a litter for each procedure. Exposure to methanol did not affect suckling latency and nipple attachment on PND 5 or performance on an aversive olfactory conditioning procedure on PND 10. Exposure to methanol did alter performances in a motor activity procedure. Methanol-exposed neonates were less active on PND 18, but more active on PND 25 than the equivalent control group pups. Two operant conditioning procedures, not used previously in this context, assayed other littermates as adults. A fixed ratio schedule required the rat to rotate a running wheel a specified number of revolutions to obtain food-pellet reinforcers. When the fixed ratio requirement changed, number of responses (revolutions) per 1-hr session displayed a complex interaction with treatment. Changes in performance over the course of training differed between males and females depending on exposure to methanol. Compared to initial baseline performances, methanol-exposed males showed decreases, and methanol-exposed females increases, in the rate of running. A stochastic spatial discrimination procedure permitted subjects to respond on any three levers, with the probabilities of food-pellet delivery determined by the location of the preceding response. A reinforcement matrix defined the response sequence required to maximize reinforcements. When the matrix was changed, the methanol-exposed subjects responded less efficiently at asymptotic levels of performance than controls. Across procedures, developmental exposure to 4500 ppm methanol vapor was associated with subtle behavioral changes in both neonates and adults.

Administration, Inhalation↗

Effectiveness of a violence prevention curriculum among children in elementary school. A randomized controlled trial.

OBJECTIVE: To determine if a commonly used violence prevention curriculum, Second Step: A Violence Prevention Curriculum, leads to a reduction in aggressive behavior and an increase in prosocial behavior among elementary school students. DESIGN: Randomized controlled trial. SETTING: Urban and suburban elementary schools in the state of Washington. PARTICIPANTS: Six matched pairs of schools with 790 second-grade and third-grade students. The students were 53% male and 79% white. INTERVENTION: The curriculum uses 30 specific lessons to teach social skills related to anger management, impulse control, and empathy. MAIN OUTCOME MEASURES: Aggressive and prosocial behavior changes were measured 2 weeks and 6 months after participation in the curriculum by parent and teacher reports (Achenbach Child Behavior Checklist and Teacher Report Form, the School Social Behavior Scale, and the Parent-Child Rating Scale) and by observation of a random subsample of 588 students in the classroom and playground/cafeteria settings. RESULTS: After adjusting for sex, age, socioeconomic status, race, academic performance, household size, and class size, change scores did not differ significantly between the intervention and control schools for any of the parent-reported or teacher-reported behavior scales. However, the behavior observations did reveal an overall decrease 2 weeks after the curriculum in physical aggression (P=.03) and an increase in neutral/prosocial behavior (P=.04) in the intervention group compared with the control group. Most effects persisted 6 months later. CONCLUSIONS: The Second Step violence prevention curriculum appears to lead to a moderate observed decrease in physically aggressive behavior and an increase in neutral and prosocial behavior in school.

Aggression↗

HIV risk behavioral surveillance in Bangkok, Thailand: sexual behavior trends among eight population groups.

OBJECTIVE: To assess trends in HIV risk behaviors over a 3-year period in eight population groups in Bangkok, Thailand. DESIGN AND SUBJECTS: Using a repeated cross-sectional survey design with a structured questionnaire, we collected five sets of self-reported sexual behavior data related to HIV risk from the following subject groups at the same sampling sites during 1993-1996: direct and indirect female sex workers, male attenders of sexually transmitted disease (STD) clinics, female attenders of antenatal care clinics, male and female vocational students, and male and female factory workers. RESULTS: Reported patronage of commercial sex by the three male groups declined by an overall average of 48% over the 3-year period. Other non-regular sexual partnerships declined among male STD clinic attenders and vocational students. Condom use during most recent sexual intercourse between sex workers and clients peaked at high levels (>90%) in the early data waves, while among indirect sex workers and their clients, consistent condom usage increased from 56% to 89%. Low condom use persisted among sex workers and their non-paying sex partners. Single women reported low levels of sexual activity and condom use with no signs of an increase. Similarly, married women from antenatal clinics reported low condom use with their husbands, with no change throughout the period of the study. CONCLUSIONS: HIV risk behavioral surveillance is a useful way of determining whether behavior change has occurred in specific population groups. The results here confirm and add to a growing set of evidence of risk behavior reduction in Thailand. The behavioral changes did not occur uniformly but varied depending on the sexual dyad and the population group under study. Behavioral surveillance should be promoted and its methodologies strengthened in attempts to understand the local dynamics of HIV epidemics.

Acquired Immunodeficiency Syndrome↗

The efficacy of the health belief model for predicting condom usage and risky sexual practices in university students.

This investigation examined the ability of the health belief model (HBM) to predict condom usage and risky sexual practices in 122 white heterosexual college students (ages 17 to 33 years). The HBM did not significantly explain condom usage in the 58 men and 64 women surveyed; rather it partially explained the variance in sexual risk behaviors. Results were not consistent for men and women. The HBM components significantly explained 18% of the variance in multiple sexual partnerships in men and 22% of the variance in this behavior in women. The HBM constructs also explained 9% of the variance in the likelihood of women being intoxicated or high during sex and 18% of the variance in the number of sexual risk behaviors endorsed by women. These findings suggest that the HBM has differential and limited utility for predicting sexual practices in university students. Future research is needed to examine more comprehensive models of behavior change.

Acquired Immunodeficiency Syndrome↗

How concerned are elderly patients without coronary heart disease about hypercholesterolemia and heart disease? An UPRNet study. Upper Peninsula Research Network.

BACKGROUND: There has been much controversy in the medical literature regarding the benefit of treating elevated cholesterol levels in asymptomatic elderly people (65 years of age and older) to prevent coronary heart disease (CHD). Little has been published about the attitudes and beliefs of elderly patients regarding the importance of cholesterol levels to their health. This study seeks to describe the importance that elderly persons place on cholesterol in regard to heart disease, how worried they are about it, and what behavior changes they are making to control their own cholesterol levels. METHODS: We used a cross-sectional questionnaire to study elderly primary care patients in a rural setting with no personal history of coronary heart disease. RESULTS: Six hundred eighty patient questionnaires were analyzed. Ninety-six percent of respondents believed high cholesterol to be at least moderately important for heart disease; 67% believed it to be very important. Fifty-nine percent were at least slightly worried about their own cholesterol level. Seventy-four percent said they had had their cholesterol checked within the past 2 years, and 66% had discussed their cholesterol level with their physician within the past 2 years. Sixty-six percent were trying to keep their cholesterol level down by dieting (42%), exercising (39%), or taking prescription medicine (15%). CONCLUSIONS: Elderly patients who responded to this questionnaire are aware that hypercholesterolemia is a risk factor for CHD, and many eat a low-fat diet, exercise, or take prescription medication to lower their cholesterol. Physicians should be aware that many elderly patients without an established diagnosis of CHD are concerned about their cholesterol level. Physicians should be prepared to discuss with their elderly patients the potential advantages and disadvantages of the treatment of asymptomatic hypercholesterolemia.

Age Factors↗

[Perception of risk for infection with the human immunodeficiency virus].

Prevention of AIDS is very complex and requires, apart from basic knowledge about modes of transmission and protection, individual awareness of personal risk of infection and modification of one's risky behavior. Perception of risk has been suggested as an important element of sexual behavior change among people who engage in behaviors that place them at risk of HIV infection. This study investigates perceived risk of an HIV infection among inhabitants of municipality of Palilula. The purpose of this study was to determine the relative accuracy of risk assessment, especially for those with high-risk sexual behavior and to assess the factors related to self perception of developing AIDS. The survey was conducted as a household survey in Belgrade municipality "Palilula". The design of the survey was based on a two-stage stratified random sample. The population of Palilula municipality was divided in two stratums and 840 households were selected from each stratum. All members of selected households aged 15-49 years were interviewed. Total of 2659 persons was interviewed. Self administered questionnaire, developed by WHO and described in the Evaluation of National AIDS Programme: A Methods Package 1. Prevention of HIV infection, Geneva, 1994, was translated and adapted for local application. For analysis of findings methods of descriptive statistics, chi square test and logistic regression were used. Statistical analysis was performed using SPSS/PC. The results showed that most of the respondents (1662, 62.5%) do not perceive themselves to be at risk of HIV infection. Interestingly, almost one quarter of the sample couldn't estimate personal chances of being HIV infected. Significantly larger proportion of respondents living in urban area than those living in rural area perceived themselves at risk (17.1% of urban vs. 7.7% from rural area, chi square = 54.06, Ir0.00). Significant differences between age groups were found for perception of personal risk. Respondents up to 19 and those older than 25 in more than 60 percent and only a half of those between 20 and 24 believed that there was no chance they could become HIV infected. Almost 16% of respondents between 20 and 24 believed that they had some chances of contracting HIV, also approximately one third of them couldn't estimate personal risk of contracting HIV infection (chi square = 2.10, p = 0.00)(Graphe 1). Those who engaged in sex with irregular partners were found to perceive themselves in higher risk then those who were engaged in sex only with regular partners in previous 12 months. One fifth of those with irregular partners estimated their chances as good versus only 10% of those with only regular partners. A logistic regression analysis found that those who believed they were personally at risk knew someone with HIV, had more irregular sexual partners in last 12 months, were younger, and lived in urban area (Table 1). People correctly perceived the risk of HIV infection as being minimal as most of them didn't engage in risk behavior. Risk perception was higher among those who had more irregular partners, younger and those from urban area. Most important predictor of risk perception was knowledge of HIV positive individual.

Adolescent↗