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PubMed1999

Health behaviors among American Indians with spinal cord injury: comparison with data from the 1996 Behavioral Risk Factor Surveillance System.

OBJECTIVE: To identify patterns of health behaviors and health outcomes among a sample of American Indian men with spinal cord injury. DESIGN: Telephone interviews with all participants, except those who did not have telephones (they returned materials by mail). SETTING: Large rehabilitation hospital in the Western mountain region of the United States. PARTICIPANTS: Seventy-six American Indian men with traumatic SCI of at least 1 year in duration. MAIN OUTCOME MEASURE: Selected health-related behaviors from the Behavioral Risk Factor Surveillance System (BRFSS) were used to assess health behaviors and general health outcomes among the American Indian SCI sample and to compare findings with those from American Indian men without SCI based on nationwide BRFSS data. RESULTS: The study participants reported lower overall health and satisfaction with health care than the non-SCI BRFSS group. They also reported a different pattern of health behaviors, including a greater frequency of inoculations for flu and pneumonia but a lower rate of HIV testing and cholesterol screening. A smaller percentage of American Indians used alcohol, but those who did reported more heavy drinking. CONCLUSIONS: American Indians with SCI are more likely to receive health care consistent with the prevention of secondary conditions of SCI (eg, pneumonia), but less likely to receive basic health screens intended to prevent chronic health diseases.

Adult↗
PubMed1990

Health risk behaviors and attempted suicide in adolescents who report prior maltreatment.

We hypothesized that high school students who experienced prior maltreatment would be more likely than their peers to report health risk behaviors and suicide attempts. Before the establishment of a high school-based clinic, an anonymous needs assessment survey was completed by 600 adolescents (grades 9 to 12). Sociodemographic information was obtained and questions were asked about physical and sexual abuse, health-related behaviors and habits, and suicide attempts. Thirteen percent of the adolescents had been maltreated: 5.2% reported prior physical abuse, 5.4% sexual abuse, and 2.7% both physical and sexual abuse. Multivariate statistical techniques were used to clarify how previous abuse was related to adolescent risk-taking behaviors and suicide. Students with a history of physical abuse were three times more likely than non-abused peers to drink alcohol and smoke cigarettes, almost twice as likely to use illicit drugs, six times more likely to self-induce vomiting, and five times more likely to attempt suicide. A student with a history of prior sexual abuse had a three and one-half times greater chance of being sexually active and was more than three times more likely to attempt suicide. These data on a nonclinical, nondeviant population of adolescents indicate that physical or sexual abuse in childhood may have a significant impact on adolescent health risk behaviors and suicide attempts.

Adolescent↗
PubMed1995

High-risk behaviors among high school students in Massachusetts who use anabolic steroids.

OBJECTIVE: To assess the association between the frequency of anabolic steroid use and the frequency of other health risk and problem behaviors among high school students in Massachusetts. METHODS: The 1993 Massachusetts Youth Risk Behavior Survey was conducted on a random sample of 3054 high school students (49% male; mean age, 16 +/- 1.2 years). The frequency of lifetime anabolic steroid use was measured on an ordinal scale from 1 to 6, representing "0" to "40 or more times." Other health risk and problem behaviors measured were sexual behaviors, suicidal behaviors, frequency of not wearing a passenger seat belt, riding a motorcycle, not wearing a helmet while riding a motorcycle, driving after drinking alcohol, riding with a driver who had been drinking alcohol, fighting, and carrying a weapon. The associations between the frequency of anabolic steroid use and other high-risk behaviors were determined using the Spearman correlation coefficient for ordinal data and the Kruskall-Wallis analysis of variance for categorical data. Representative indicators of each risk behavior significantly associated with anabolic steroid use were then analyzed using a stepwise multiple-regression analysis. RESULTS: The frequency of anabolic steroid use was associated with all of the other high-risk behaviors analyzed. Using multiple-regression analysis, driving after drinking alcohol accounted for 12.5% of the variance of the model. Carrying a gun, the number of sexual partners within the past 3 months, not using a condom during last intercourse, injury in a physical fight requiring medical attention, history of a sexually transmitted disease, not wearing a helmet on a motorcycle, not wearing a passenger seatbelt, and a suicide attempt requiring medical attention accounted for an additional 9.0% of the variance. The full model accounted for greater than 21% of the variation. CONCLUSIONS: The frequency of anabolic steroid use among adolescents is associated with other high-risk behaviors, thus supporting the hypothesis that anabolic steroid use is part of a "risk behavior syndrome" rather than an isolated behavior. This finding emphasizes the need for comprehensive high-risk behavior screening and counseling among teens who use anabolic steroids.

Adolescent↗
PubMed2005

The Miami, Florida, Young Men's Survey: HIV prevalence and risk behaviors among urban young men who have sex with men who have ever runaway.

Youth in urban areas with a history of running away from home often have special needs. Importantly, risk factors for HIV/AIDS might be associated with such a history. We assessed the association between having a history of running away from home and the occurrence of HIV infection and risk behavior among young men who have sex with men (YMSM), aged 15-22 years. A cross-sectional epidemiologic and behavioral survey was conducted between 1995 and 1996 in Miami, Florida, as part of a national Young Men's Survey. Of 488 YMSM, the prevalence of HIV infection among those with a history of running away from home was 10.5% (adjusted odds ratio=3.4; 95% CI 1.5-7.8). YMSM who had ever run away were more likely to be HIV infected, be out of school, and have ever had vaginal or anal sex with females, been forced to have sex, injected drugs, and used needles for self-tattooing or body piercing. The prevalence of HIV infection and associated risk behaviors among runaways was high, highlighting the ongoing need for prevention and social support services for youth with a history of running away from home.

Adolescent↗
PubMed2000

Testing the application of a Western scientific theory of AIDS risk behavior among adolescents in Ethiopia.

OBJECTIVE: To test whether a theoretical scheme developed in the United States within the framework of Western science could be applied to a study of HIV risk behaviors among Ethiopian youths. METHODS: Informal interviews and focus group discussions were conducted to determine the relevance of particular AIDS-related risk and protective factors suggested by Jessor's theoretical framework and to generate additional risk and protective factors that were not suggested by a review of the (predominantly Western) literature on adolescent risk behavior. Data from informal interviews and focus group discussions were used to develop survey instruments and procedures for administering survey instruments A pilot study among 99 youths was conducted to examine the reliability and construct validity of the survey instrument. RESULTS: Based on information from focus group discussions and informal interviews, we confirmed the relevance of particular AIDS-related risk and protective factors. The definition of existing constructs was expanded and additional risk and protective factors were incorporated into the existing framework. Existing items and procedures for administering survey instruments were improved and new items were generated. The reliability of survey instruments was determined and improved whenever possible. CONCLUSIONS: We discuss the value of these preliminary steps for securing external validity by identifying theoretical constructs that are relevant to the population at hand and the use of a survey instrument that adequately captures these constructs and provides reliable information.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Prenatal behavioral risk screening by computer in a health maintenance organization-based prenatal care clinic.

Cigarette smoking, alcohol and drug abuse, and stressful life events are significant contributors to prematurity and low birth weight in the United States. Identification and treatment of pregnant women with these risk factors require obtaining complete and accurate psychosocial histories. The purpose of this study was to determine whether a computer interview developed by our staff is appropriate for assessing behavioral risk factors for adverse pregnancy outcomes and for educating pregnant women about healthy behaviors during pregnancy. This computer interview asks about pregnant patients' perceived life stressors, diet, use of cigarettes and alcohol, and abuse of drugs. The study population consisted of 201 medically insured Hispanic and non-Hispanic white women attending a health maintenance organization--based prenatal clinic. Almost all subjects rated the computer interview favorably. Medical record reviews were conducted to compare participants' reports of cigarette, alcohol, and drug use obtained from paper-and-pencil interviews with behaviors reported during the computer interview. Although self-reported rates of smoking did not differ between the two interview techniques, a much higher percentage of women reported alcohol and drug use during the computer interview. Study participants scored significantly higher on a test measuring knowledge of the effects of stress, diet, and substances of abuse on pregnancy than did a control group. Results demonstrated the potential value of computer-interactive software programs for assessing high-risk behaviors among pregnant women in this population and educating them about healthy behaviors during pregnancy.

Adolescent↗
PubMed2006

Risk behaviors and HIV, hepatitis B, and hepatitis C seroprevalence among injection drug users in Georgia.

INTRODUCTION: HIV is an emerging epidemic in Eastern Europe. Most HIV infections in this region have occurred among injection drug users (IDUs) and their sexual partners. The objective of this study was to determine the seroprevalence and risk behaviors for HIV, HBV, and HCV infection among IDUs in Georgia. METHODS: Between 2000 and 2001, we studied 583 IDUs aged 18 to 46 years from 3 cities in Georgia. Tbilist, Poti, and Batumi, Structured questionnaires were administered to measure risk behaviors, including IDU, sexual, and other risks. Blood was drawn for HIV hepatitis B (HBV), and hepatitis C (HCV) serologies. RESULTS: 401 (68.8%) participants were seropositive for HCV; 322 (55.2%) for HBV (HBsAg or anti-HBc): and 10 (1.7%) for HIV, Heroin (58.7%) was the most frequently used drug, followed by homemade drugs (31.6%) and opium, (9.8%). In multivariate analysis, risk factors, for HCV and HBV infection included unsafe cleaning practices for injection parapheralia. The number of drug-using partners was associated with HCV infection. Sexual risk factors (i.e., the number of sex partners, paying for sex, and a history of sexually transmitted infections [STIs] were associated with HIV but not with HCV infection. Those injecting homemade drugs and optium most frequently reported risky drug-using behavior. DISCUSSION: Our data suggest a high prevalence of HBV and HCV infection among IDUs in Georgia associated with significant drug- and needle-sharing behaviors. HIV seroprevalence appears to be relatively low and is associated with risky sexual behaviors, rather than drug-using behaviors. Further research is needed among Georgian IDUs to develop effective prevention strategies and limit the transmission of HIV in this population.

Adolescent↗
PubMed2002

Information-motivation-behavioral skills model-based HIV risk behavior change intervention for inner-city high school youth.

This study assessed the effects of 3 theoretically grounded, school-based HIV prevention interventions on inner-city minority high school students' levels of HIV prevention information, motivation, behavioral skills, and behavior. It involved a quasi-experimental controlled trial comparing classroom-based, peer-based, and combined classroom- and peer-based HIV prevention interventions with a standard-of-care control condition in 4 urban high schools (N = 1,532, primarily 9th-grade students). At 12 months postintervention, the classroom-based intervention resulted in sustained changes in HIV prevention behavior. This article discusses why both of the interventions involving peers were less effective than the classroom-based intervention at the 12-month follow-up and, more generally, suggests a set of possible limiting conditions for the efficacy of peer-based interventions.

Adolescent↗
PubMed1999

HIV prevalence and risk behaviors among new initiates into injection drug use over the age of 40 years old.

Injection drug users (IDUs) who have recently initiated an injecting career have high risk behaviors for HIV infection. The average age of an IDUs first injection is typically reported as 19-20 years, and some literature has reported 'maturing out' of drug use typically around 40 years old. The purpose of this study was to discriminate risk behaviors among newer injectors by age of initiation. This cross-sectional study includes volunteers enrolled using extensive community recruitment techniques in 1988 and 1989 in Baltimore, MD. Of the 722 injection drug users who had initiated injection within the prior six years, 124 were over 35 years old of whom 53 were 40 years and older. Rates of HIV were lower among those over 40 years (13.2%) than those who were 35-39 years (22.5%) or under 35 years old (20.9%). The behavioral characteristics of those aged 35-39 were similar to those under 35 years old, but those over 40 years old when compared with less than 39 years reported injecting at least daily less frequently (88.7% vs 76.5%, p = 0.042), using a needle from a sterile wrapper (19.0% vs 36.6%, p = 0.006), and injecting with their own works (52.6% vs 28.8%, p = 0.021). This study shows that people initiate injection drug use across a wide age range and that needle hygiene practices early after initiation tend to be safer in older compared to younger initiates.

Adult↗
PubMed1997

Behavioral risk factor surveillance of aged Medicare beneficiaries, 1995.

The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing State-based telephone survey of adults, administered through State health departments. The survey estimates health status and the prevalence of various risk factors among respondents, who include both fee-for-service and managed care Medicare beneficiaries. In this article the authors present an overview of the BRFSS and report 1995 regional results among respondents who were 65 years of age or over and who had health insurance. The advantages and disadvantages of using the BRFSS as a tool to monitor beneficiary health status and risk factors are also discussed.

Aged↗
PubMed1995

HIV risk behavior among homeless adults.

Very little information is available regarding HIV risk behavior among homeless adults despite increasing evidence that HIV infection disproportionately affects inner-city residents and disadvantaged populations. In the present study, adults (N = 94) entering a storefront medical clinic for the homeless completed an AIDS risk survey. The results suggest that homeless adults are engaging in sexual and substance-use behaviors that place them at high risk for HIV infection. Sixty-nine percent of the present sample was at risk for HIV infection from either 1) unprotected intercourse with multiple partners, 2) intravenous drug use (IVDU), 3) sex with an IVDU partner, or 4) exchanging unprotected sex for money or drugs. Many persons within the sample evidenced multiple risk factors: 45% reported at least two of the risk factors described above and 26% reported three or more risk factors. The results suggest there is an urgent need to develop and evaluate AIDS-prevention strategies for homeless adults.

Adolescent↗
PubMed2003

Methodological challenges in research on sexual risk behavior: I. Item content, scaling, and data analytical options.

Investigation of sexual behavior involves many challenges, including how to assess sexual behavior and how to analyze the resulting data. Sexual behavior can be assessed using absolute frequency measures (also known as counts) or with relative frequency measures (e.g., rating scales that range from never to always). We discuss these 2 assessment approaches in the context of research on HIV risk behavior. We conclude that these 2 approaches yield nonredundant information and, more important, that only data yielding information about the absolute frequency of risk behavior have the potential to serve as valid indicators of HIV contraction risk. However, analyses of count data may be challenging because of non-normal distributions with many outliers. Therefore, we identify new and powerful data analytical solutions that have been developed recently to analyze count data and discuss limitations of a commonly applied method (viz., analysis of covariance using baseline scores as covariates).

Data Collection↗
PubMed2002

Sex-related alcohol expectancies predict sexual risk behavior among severely and persistently mentally ill adults.

Three hundred three adults (57% male, average age 42 years) with severe and persistent mental illness receiving treatment at community mental health clinics completed a survey, which included B. C. Leigh's (1990) sex-related alcohol expectancy scale and measures of alcohol use and sexual risk behavior. Hierarchical logistic regression analyses, controlling for drinking behavior, revealed that participants with stronger expectancies that drinking would lead to enhanced sexual experience were more likely to have drank prior to intercourse and that, among participants who drank prior to intercourse, those with stronger expectancies that alcohol would lead to riskier sexual behavior were more likely to have engaged in sexual risk behavior. Implications for preventing HIV infection among people with severe mental illness are discussed.

Adult↗
PubMed1996

The supplement to HIV-AIDS Surveillance project: an approach for monitoring HIV risk behaviors.

A variety of surveillance methods are used to characterize the epidemic of HIV infection and AIDS. Such surveillance includes AIDS case reporting, reporting of diagnosed HIV infections, and HIV seroprevalence surveys among targeted sentinel populations. The need for additional surveillance systems to monitor HIV-related risk behaviors has been increasingly evident. One approach to behavioral surveillance, the CDC's Supplement to HIV-AIDS Surveillance project, uses the infrastructure of HIV infection and AIDS case reporting to collect additional information on risk behaviors among HIV-infected persons, who by definition represent those at highest risk.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Ethnic and generational influences on emotional distress and risk behaviors among Chinese and Filipino American adolescents.

The purpose of this study was to explore ethnic and generational influences among Chinese, Filipino, and Euro American adolescents on emotional distress and risk behaviors. Hierarchical multiple regression analyses were conducted with 216 Chinese, 387 Filipino, and 400 Euro American adolescents from the National Longitudinal Study on Adolescent Health to investigate the influence of ethnicity on depression, somatic symptoms, delinquency, and substance use; and to examine the influence of generation on the outcome variables among Chinese and Filipino American adolescents. Ethnicity predicted depression and delinquency scores, while generation within ethnic groups predicted somatic symptoms and substance use. The findings diverge from theories using acculturation as an explanatory mechanism for distress and risk behaviors and underscore the importance of examining sub-groups and generations of Asian American youth.

Adolescent↗
PubMed2006

Childhood sexual abuse and sexual risk behavior among men and women attending a sexually transmitted disease clinic.

Childhood sexual abuse (CSA) is associated with a wide range of negative outcomes. The authors investigated the relation between CSA and sexual risk behavior in 827 patients recruited from a sexually transmitted disease (STD) clinic. Overall, CSA was reported by 53% of women and 49% of men and was associated with greater sexual risk behavior, including more sexual partners, unprotected sex, and sex trading. Alcohol use for men and drug use for women mediated the relation between CSA and the number of sexual partners in the past 3 months; intimate partner violence mediated the relation between CSA and the number of episodes of unprotected sex in the past 3 months for women. These results document the prevalence of CSA among patients seeking care for an STD and can be used to tailor sexual risk reduction programs for individuals who were sexually abused.

Adult↗
PubMedDate not supplied

Adverse childhood experiences and sexual risk behaviors in women: a retrospective cohort study.

CONTEXT: Adverse childhood experiences such as physical abuse and sexual abuse have been shown to be related to subsequent unintended pregnancies and infection with sexually transmitted diseases. However, the extent to which sexual risk behaviors in women are associated with exposure to adverse experiences during childhood is not well-understood. METHODS: A total of 5,060 female members of a managed care organization provided information about seven categories of adverse childhood experiences: having experienced emotional, physical or sexual abuse; or having had a battered mother or substance-abusing, mentally ill or criminal household members. Logistic regression was used to model the association between cumulative categories of up to seven adverse childhood experiences and such sexual risk behaviors as early onset of intercourse, 30 or more sexual partners and self-perception as being at risk for AIDS. RESULTS: Each category of adverse childhood experiences was associated with an increased risk of intercourse by age 15 (odds ratios, 1.6-2.6), with perceiving oneself as being at risk of AIDS (odds ratios, 1.5-2.6) and with having had 30 or more partners (odds ratios, 1.6-3.8). After adjustment for the effects of age at interview and race, women who experienced rising numbers of types of adverse childhood experiences were increasingly likely to see themselves as being at risk of AIDS: Those with one such experience had a slightly elevated likelihood (odds ratio, 1.2), while those with 4-5 or 6-7 such experiences had substantially elevated odds (odds ratios, 1.8 and 4.9, respectively). Similarly, the number of types of adverse experiences was tied to the likelihood of having had 30 or more sexual partners, rising from odds of 1.6 for those with one type of adverse experience and 1.9 for those with two to odds of 8.2 among those with 6-7. Finally, the chances that a woman first had sex by age 15 also rose progressively with increasing numbers of such experiences, from odds of 1.8 among those with one type of adverse childhood experience to 7.0 among those with 6-7. CONCLUSIONS: Among individuals with a history of adverse childhood experiences, risky sexual behavior may represent their attempts to achieve intimate interpersonal connections. Having grown up in families unable to provide needed protection, such individuals may be unprepared to protect themselves and may underestimate the risks they take in their attempts to achieve intimacy. If so, coping with such problems represents a serious public health challenge.

Adolescent↗