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PubMed1989

Risk behaviors and health. Contrasting individual and population perspectives.

This article discusses risk behaviors, seemingly voluntary actions of individuals that have adverse health consequences. The central theme is to examine these behaviors from two contrasting perspectives, that of the individual and that of the population as a whole. It is argued that distinguishing between individual and population views is important for understanding and interpreting health risk data, for developing conceptual and theoretical models for explaining these behaviors, and for devising intervention strategies to modify them. It is argued that an appreciation of both the individual and the population perspectives is important to developing effective action strategies for reducing these behaviors as public health problems.

Health Behavior↗
PubMed2005

Predictors of sexual transmission risk behaviors among HIV-positive young men.

Reduction in the incidence of high-risk sexual behaviors among HIV-positive men is a priority. We examined the roles of proximal substance use and delinquency-related variables, and more distal demographic and psychosocial variables as predictors of serious high-risk sexual behaviors among 248 HIV-positive young males, aged 15-24 years. In a mediated latent variable model, demographics (ethnicity, sexual orientation and poverty) and background psychosocial factors (coping style, peer norms, emotional distress, self-esteem and social support) predicted recent problem behaviors (delinquency, common drug use and hard drug use), which in turn predicted recent high-risk sexual behaviors. Hard drug use and delinquency were found to predict sexual risk behaviors directly, as did lower self-esteem, white ethnicity and being gay/bisexual. Negative peer norms strongly influenced delinquency and substance use and positive coping predicted less delinquency. In turn, less positive coping and negative peer norms exerted indirect effects on sexual transmission risk behavior through delinquency and hard drug use. Results suggest targeting hard drug use, delinquency, maladaptive peer norms, dysfunctional styles of escaping stress and self-esteem in the design of intervention programs for HIV-positive individuals.

Adolescent↗
PubMed1994

Behavioral risk factors: a comparison of Latinos and non-Latino whites in San Francisco.

OBJECTIVES: The purpose of the study was to evaluate differences between Latino and non-Latino White adults in health-related behavioral risk factors. METHODS: Telephone interviews were conducted with 652 Latinos and 584 non-Latino Whites in San Francisco selected by random-digit dialing. RESULTS: Latino men and women, compared with their non-Latino White counterparts, were less likely to have consumed any alcoholic beverage in the previous month (59% and 29% vs 77% and 75%, respectively), consumed fewer drinks per week (6.6 and 3.0 vs 8.9 and 5.1, respectively), and were more likely to be sedentary (40% and 46% vs 17% and 23%). Latina women were less likely than non-Latina Whites to smoke cigarettes (8% vs 29%), to have ever had a Pap smear (76% vs 93%), and to have ever had a clinical breast examination (81% vs 96%). Multivariate analyses adjusting for sex, age, education, and employment confirmed univariate findings. CONCLUSIONS: Behavioral risk factor profiles by ethnicity help emphasize priorities of health promotion programs for a community. Latino needs include maintenance of limited consumption of alcohol and cigarettes, promotion of regular physical activity, and increasing use of low-cost cervical and breast cancer screening tests.

Adolescent↗
PubMedDate not supplied

Knowledge and risk behaviors of people seeking HIV antibody testing at a community site.

People seeking HIV antibody testing at a community-based AIDS service organization (N = 342) were asked to complete a self-report questionnaire to determine knowledge of HIV transmission, source(s) of HIV-related knowledge, and recent risk behaviors. The overall knowledge level of risk for transmitting HIV associated with 16 related behaviors was relatively high. Yet, 69% of the participants reported engaging in unsafe sex during the previous six months. Poorly informed subjects tended to overestimate their level of knowledge. In a multiple regression analysis, knowledge, age, and gender were the only significantly predictors of engaging in unsafe sex in this cohort. Nurses must be on the forefront in developing (1) strategies to reach people at high risk for HIV infection and HIV transmission, (2) culturally relevant and sensitive education, and (3) interventions that will enable people to make appropriate choices concerning high-risk behaviors.

Adolescent↗
PubMed1993

Comparison of AIDS knowledge and HIV-related sexual risk behaviors among adolescents in low and high AIDS prevalence communities.

Data were collected from students attending high school in a rural, low acquired immunodeficiency syndrome (AIDS) prevalence community in Northern California, and compared with students in an inner-city AIDS epicenter (San Francisco). The findings demonstrate that rural adolescents have higher levels of human immunodeficiency virus (HIV) knowledge, especially about risk-reduction strategies. However, rural adolescents also report higher rates of HIV-related sexual risk behaviors. Rural adolescents may not perceive the personal salience of practicing HIV risk-reduction behaviors thus increasing their risk for exposure to sexually-transmitted diseases, including HIV infection. School-based HIV prevention programs developed for rural communities will need to enhance the personal salience of HIV for adolescents' and discourage their discounting of personal risk attributable to a lower prevalence of AIDS in the community. Physicians must become more actively involved in HIV prevention efforts by routinely assessing adolescent patient's sexual behavior and utilizing their clinical interaction to provide HIV education and promote the adoption of HIV risk-reduction behaviors.

Acquired Immunodeficiency Syndrome↗
PubMed1998

HIV seroprevalence, risk behaviors, and cognitive factors among Asian and Pacific Islander American men who have sex with men: a summary and critique of empirical studies and methodological issues.

The goals of this article are to (a) summarize and discuss published empirical studies addressing HIV seroprevalence rates and HIV-related behaviors and cognitive factors among Asian and Pacific Islander American (API) men who have sex with men (MSM) in the United States, (b) examine existing population-based research methodologies for studying HIV and AIDS prevention, (c) describe a conceptual framework to facilitate the identification of ecologically sound or culturally appropriate and competent methodologies for studying HIV prevention among API MSM, and (d) discuss methodological issues and recommend alternative methodologies to better understand this population in HIV prevention. A total of eight published empirical studies reported the HIV seroprevalence rates, HIV-risk behaviors, and attitudes toward HIV and AIDS among API MSM. Specifically, seven studies reported HIV seroprevalence rates that were based on either self-disclosure of HIV status or HIV test results among the study participants. Four studies also reported findings about the relationships between HIV-related behaviors and cognitive factors. There are five population-based databases on HIV and AIDS epidemiology and surveillance which have been managed by the Centers for Disease Control and Prevention. Findings from the seven studies indicate that API MSM are as likely to engage in HIV-risk behaviors as other groups. The present analysis reveals that conventional surveillance or epidemiological techniques (e.g., random digit telephone dialing), based on a singular model of populations, are not appropriate to address culturally, linguistically and racially/ethnically diverse groups of API MSM. To address the diversity of this group, ecologically sound or culturally appropriate and competent research methodologies are needed. Thus, a conceptual framework for such methodologies with examples was reviewed. Two alternative methodologies, network analysis and venue-based sampling, were briefly discussed.

Asian↗
PubMed2006

Behavioral risk profiles for coronary heart disease among apparently healthy individuals of African ancestry.

OBJECTIVE: Mortality from coronary heart disease (CHD) is lower in foreign-born Blacks compared to their US-born counterparts. The purpose of this study was to determine if behavioral risk factors for CHD are different between foreign-born Afro Caribbeans (FBAC) and their US-born counterparts (US-born Afro Caribbean Americans, USBAC and African Americans, AA). DESIGN AND PARTICIPANTS: For a cross-sectional study, 66 FBAC (31 males; 35 females) living in the United States <10 years, 62 USBAC (30 males; 32 females), and 61 AA (30 males; 31 females) adults (18-40 years) were recruited. Dietary, anthropometric, physical activity, cigarette smoking, and alcohol consumption data were collected and analyzed. MAIN OUTCOME MEASURE: Risk factors for CHD. RESULTS: Significantly (P<.05) more USBAC (50.0%) and AA (31.0%) males consumed an unhealthy diet compared to the FBAC (16.7%) males. Also, significantly (P<.05) more USBAC and AA males compared to FBAC males were obese (20.0% and 33.3% vs 6.5%). No significant differences were observed between the female ethnic groups. Although less USBAC and AA males and females compared to FBAC males and females played sports, the differences were not significant. More USBAC and AA males compared to FBAC (10.0% and 3.3% vs 0.0%) smoked cigarettes and consumed alcoholic beverages (43.3% and 63.3% vs 16.1%). Among the female ethnic groups, only the AA smoked cigarettes. Significantly (P<.05) more USBAC (36.7%) and AA (33.3%) males compared to FBAC (3.2%) males had poorer behavioral habits, with no significant differences observed between the female ethnic groups. CONCLUSIONS: Our study showed significant differences in CHD risk behaviors among individuals of African decent. The FBAC participants had more favorable behaviors in preventing CHD compared to their US-born counterparts.

Adolescent↗
PubMed2005

Associations of poverty, substance use, and HIV transmission risk behaviors in three South African communities.

The majority of the world's HIV infections occur in communities ravished by poverty. Although HIV/AIDS and poverty are inextricably linked, there are few studies of how poverty-related stressors contribute to HIV risk behavior practices. In this study, surveys were conducted in three South African communities that varied by race and socio-economic conditions: people living in an impoverished African township (N = 499); an economically impoverished but well infrastructured racially integrating township (N = 995); and urban non-impoverished neighborhoods (N = 678). Results showed that HIV/AIDS risks were closely related to experiences of poor education, unemployment, discrimination, violence, and crime. Although poverty-related stressors were associated with a history of alcohol and drug use, substance use did not moderate the association between poverty-related stressors and HIV risk behaviors. The findings suggest that HIV prevention strategies should not treat AIDS as a singled out social problem independent of other social ills.

Adult↗
PubMed1983

Parental marital status and adolescents' health-risk behavior.

This article reports the results of a questionnaire survey of a representative random sample of all the in-school Francophone adolescents of Montreal. The sample size was 4,539 and included adolescents from legally intact homes, separated/divorced homes, and homes in which a parent was decreased. Health-risk behavioral indicators were smoking (how many cigarettes a day), fastening of car seat belts, and intemperate drinking. Adolescents who lived in intact families engaged less in health-risk behavior than the other adolescents, especially those from separated/divorced families. The results for adolescents from widowed families were mixed. Several mutually complementary explanations are presented.

Adolescent↗
PubMed2000

A clinical profile to predict decision making, risk behaviors, clinical status, and health-related quality of life for cancer-surviving adolescents: part 2.

This is the second part of a two-part article describing a multifactorial model of clinical factors predicting decision-making quality, risk behaviors, clinical status, and health-related quality of life for cancer-surviving adolescents. To support the conceptualization of the model, findings from the literature and from the research program of the current author are presented. In part 1, support for the antecedent predictors, both primary and secondary factors, was presented. In part 2, the mediator of decision making, the moderator of risk motivation, and the expected outcomes related to risk behaviors, clinical status, and health-related quality of life are addressed. Besides a description supporting the second part of the clinical profile and its empirical underpinnings in part 2, methodologic challenges in future research and implications for clinical trials and clinical use specific to cancer-surviving adolescents also are discussed.

Adolescent↗
PubMed1998

HIV-related attitudes and risk behavior of young adolescent mothers.

This article reports on the prevalence of HIV-related risk behaviors among young adolescent mothers. To determine the facilitators and barriers to condom use for young adolescent mothers, a survey of HIV-related knowledge, attitudes and behavior and focus groups was conducted. Young mothers (N = 58) have basic knowledge and some personal concern about HIV, but also hold common misconceptions about HIV and people with AIDS. Despite their anxiety about HIV, almost half rarely or never protect themselves against HIV by using a condom. Although 70% of the sample use hormonal contraceptives, more than one third of the sample have had a second child within an average of 18 months after the birth of their first baby. Personal concern about HIV was significantly associated with consistency of condom use. Because of low rates of condom use and substantial rates of multiple sex partners, STDs and second pregnancies, disadvantaged adolescent mothers are at risk of exposure to HIV. Increased personalized concern for HIV may lead to greater motivations for safer behavior for these mothers. In addition to protecting their own safety, the protection of their child may be an important motivator for safe behavior. Cultural taboos against safe sex and the perception of such behavior as "unfeminine" also need to be addressed for these women.

Adolescent↗
PubMed2006

Upregulation of interferon-alpha and RANTES in the cervix of HIV-1-seronegative women with high-risk behavior.

OBJECTIVE: The expression of innate immune molecules associated with potential blocking activity of HIV-1 propagation was analyzed in the cervical tissue of a group of African HIV-1 IgG-negative commercial sex workers (CSWs) with an HIV-1-encountering risk behavior. METHODS: Cervical biopsies from the superior portion of the ectocervix were assessed for innate immune molecules and evaluated in situ by computerized image analysis at the single-cell level. RESULTS: A higher expression of interferon-alpha (IFNalpha) and RANTES was detected in CSWs and HIV-1-infected individuals as compared to low-risk HIV-1-uninfected controls (Neg Ctrls). Most (>90%) of RANTES-expressing cells were CD8 cells as determined by confocal microscopy. In contrast, the expression of leukemia inhibitory factor (LIF) and secretory leukocyte protease inhibitor (SLPI) was comparable between the groups. The expression of beta-defensin 2 was highest in HIV-1-infected individuals. CONCLUSIONS: Induction of IFNalpha and RANTES expression in cervical mucosa may contribute to protection of sexual HIV-1 transmission in subjects with a higher risk behavior.

Adolescent↗
PubMed2002

Human immunodeficiency virus incidence and risk behavior in the 'Projeto Rio': results of the first 5 years of the Rio de Janeiro open cohort of homosexual and bisexual men, 1994-98.

OBJECTIVES: In preparation for a phase III HIV vaccine trial, we report the results of men who have sex with men (MSM) cohort ('Projecto Rio'). METHODS: HIV-negative MSM were followed 6-monthly over a 3-year period. RESULTS: High seroprevalence for sexually transmitted disease (HIV, syphilis and hepatitis B seropositivities of 24%, 29%, and 37%, respectively) was seen in the 1165 potential volunteers, and this seroprevalence showed significant differences according to HIV serologic status. Among the 647 HIV-negative cohort participants, HIV incidence rate (IR) was 3.33 (95% CI 1.93-4.67) per 100 men-years, with 21 newly acquired HIV infections during 7572 men-months of observation. IR differences were observed in four categories: (1) non-commercial sex workers and non-transvestites who had protected sex prior to study entry (IR 1.6 per 100 men-years); (2) non-commercial sex workers and non-transvestites who had unprotected sex prior to study entry (IR 2.7 per 100 men-years); (3) commercial sex workers (IR 3.5 per 100 men-years); and (4) transvestite groups (IR 16.8 per 100 men-years). Unprotected penetrative anal sex was frequent (66%) in the 6 months before study entry, and when we take into consideration the fact that bisexual men engaged in unprotected vaginal intercourse with their female partners, the risk behavior in this group escalates to 73%. HIV seroconverters had high risk behavior prior to study entry (76%), and all but one admitted to having unprotected penetrative sex prior to infection. CONCLUSIONS: MSM in this study had a high rate of unprotected penetrative sexual practices, which caused a significant HIV incidence rate, and, with improved study adherence, this study site could be used for future vaccine trials.

AIDS Vaccines↗
PubMed2003

Behavioral risk factors for STD/HIV transmission in Bangladesh's trucking industry.

To examine behaviors that could influence STD/HIV transmission in Bangladesh's trucking industry, a survey was orally administered to 388 truck drivers/helpers at Tejgaon truck stand in Dhaka. A two-tiered sampling strategy was used: 38 trucking agencies were randomly selected and a mean of 10.2 subjects was recruited from each agency. Focus group and in-depth interviews were also conducted. The focus was on behaviors that affect (i) exposure to STD/HIV infection, (ii) efficiency of transmission of infection and (iii) duration of infectiousness. The findings illustrated that intravenous drug use was not an important risk factor; only 1 subject had used drugs intravenously. Sexual risk behaviors, however, were prevalent: the mean number of sexual partners in the past year was 4.57 (SD=8.70) and in the past 3 months was 1.82 (SD=3.27). Premarital and extramarital sex was common, often with commercial sex workers (CSW); 54% of all subjects had relations with at least 1 CSW in the past year. In a multiple logistic regression analysis, subjects who engaged in other types of socially risky behavior (drinking alcohol, ingesting or smoking recreational drugs, having sex with other men) were significantly (p<0.05) more likely to have had sex with a CSW in the past year. While 7.2% of subjects had a male sex partner in the past year, 21% had ever had one (likely youthful experimentation for most). Condom use was very infrequent: of the 343 subjects who had ever had sexual intercourse only 31% had ever used a condom and most of those subjects had used only once or occasionally. Having sex with CSWs, being married, having heard of AIDS and age were significantly associated (p<0.05) with ever use of condoms. Frequently, subjects who had genital symptoms either did not have those symptoms treated at all or treated in a timely fashion, and over 1/3 did not change their sexual behavior while infected. To reduce the potential for the spread of STD/HIV in this population, appropriate treatment practices for sexually transmitted infections need to be encouraged and condom use promoted, particularly in the context of casual sexual relations.

Adolescent↗
PubMed2007

Availability of high school extracurricular sports programs and high-risk behaviors.

BACKGROUND: The Surgeon General has called for an expansion of school-based extracurricular sports programs to address the obesity epidemic. However, little is known about the availability of and participation in high school extracurricular sports and how participation in these sports is related to high-risk behaviors. METHODS: We surveyed Los Angeles County public high schools in 2002 to determine the number of extracurricular sports programs offered and the percentage of students participating in those programs. We used community data on rates of arrests, births, and sexually transmitted diseases (STDs) among youth to examine associations between risk behaviors and participation in sports programs. RESULTS: The average school offered 14 sports programs, and the average participation rate was 39% for boys and 30% for girls. Smaller schools and schools with higher percentages of disadvantaged students offered fewer programs. The average school offering 13 or fewer programs had 14% of its students participating, while the average school offering 16 or more programs had 31% of its students participating in sports. Controlling for area-level demographics, juvenile arrest rates and teen birth rates, but not STD rates, were lower in areas where schools offered more extracurricular sports. CONCLUSIONS: Opportunities for participation in high school extracurricular sports are limited. Future studies should test whether increased opportunities will increase physical activity and impact the increasing overweight problem in youths.

Adolescent↗
PubMedDate not supplied

Sexual risk behavior of incarcerated, drug-using women, 1992.

In this study, sexual risk behavior of 104 incarcerated female drug users is examined. Findings demonstrate that incarcerated women who use drugs are at high risk for human immunodeficiency virus (HIV) infection because of their behavior prior to arrest. During the month prior to arrest, the majority of respondents were sexually active. Half reported past sexual contacts with injecting drug users, and more than one-third had traded sex for money or drugs. Consistent with other studies, condom use was more frequent with casual or commercial partners. Those who traded sex for money were less likely to be white Anglo or regular heroin users, and more likely to be regular crack users and alcoholic, have fathers who were drug or alcohol users, and perceive themselves as at-risk for contracting HIV and other sexually transmitted diseases.

Attitude↗
PubMed2003

Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO Study).

Female injection drug users (IDUs) represent a large proportion of persons infected with HIV in the United States, and women who inject drugs have a high incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. Therefore, it is important to understand the role of gender in injection risk behavior and the transmission of blood-borne virus. In 2000-2002, 844 young (<30 years old) IDUs were surveyed in San Francisco. We compared self-reported risk behavior between 584 males and 260 female participants from cross-sectional baseline data. We used logistic regression to determine whether demographic, structural, and relationship variables explained increased needle borrowing, drug preparation equipment sharing, and being injected by another IDU among females compared to males. Females were significantly younger than males and were more likely to engage in needle borrowing, ancillary equipment sharing, and being injected by someone else. Females were more likely than males to report recent sexual intercourse and to have IDU sex partners. Females and males were not different with respect to education, race/ethnicity, or housing status. In logistic regression models for borrowing a used needle and sharing drug preparation equipment, increased risk in females was explained by having an injection partner who was also a sexual partner. Injecting risk was greater in the young female compared to male IDUs despite equivalent frequency of injecting. Overlapping sexual and injection partnerships were a key factor in explaining increased injection risk in females. Females were more likely to be injected by another IDU even after adjusting for years injecting, being in a relationship with another IDU, and other potential confounders. Interventions to reduce sexual and injection practices that put women at risk of contracting hepatitis and HIV are needed.

Adolescent↗
PubMedDate not supplied

HIV risk behaviors in African American males.

Human immunodeficiency virus/acquired immune syndrome (HIV/AIDS) infection is the fifth leading cause of death for people who are 25-44 years in the United States, and is the leading cause of death for African American men ages 35-44. The incidence rates for HIV among African Americans are steadily increasing, despite wide-spread campaigns to educate the public about the disease. The purpose of this article is to review the epidemiology and statistics related to HIV/AIDS, as well as changes in the epidemic among African American males. A review of the literature was conducted which specifically focused on HIV risk behaviors, changing patterns of behavior, and risk modification among African American males. Opportunities for future research are also detailed.

Adolescent↗