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PubMed2004

Preventive health behaviors, health-risk behaviors, physical morbidity, and health-related role functioning impairment in veterans with post-traumatic stress disorder.

An examination of the relationships between health behaviors (preventive and risk-related), physician-diagnosed medical problems, role-functioning impairment because of physical morbidity, and post-traumatic stress disorder was conducted on a large cohort of consecutive treatment-seeking cases (N = 826) presenting to an outpatient Veterans Affairs post-traumatic stress disorder clinic. Results revealed that the sample rates of several medical conditions were markedly elevated when compared with general population rates for men of comparable age. The rates of smoking and other behavioral risk variables were greater than rates among men in the general population. Moreover, the majority of the sample did not engage in preventive health behaviors such as exercise and medical screening at levels consistent with health care guidelines. Physical role functioning indices of the SF-36 reveal greater role-functioning impairment because of physical morbidity in this psychiatric sample relative to the age adjusted general population norms. The health care implications of these data are discussed, as are areas for future research.

Aged↗

PubMed1997

Cognitive and behavioral predictors of sexually transmitted disease risk behavior among sexually active adolescents.

OBJECTIVE: To identify important cognitive and behavioral predictors of sexually transmitted disease (STD) risk behavior among a sexually active adolescent cohort. DESIGN: One-year longitudinal study of health beliefs, sexual behaviors, and STD acquisition among 549 adolescents, 14 to 21 years of age. SETTING: School- and community-based health clinics in a large metropolitan area. PARTICIPANTS: Data from 410 sexually active adolescents completing surveys at baseline and 1-year follow-up. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Sexually transmitted disease risk behavior--a composite measure of condom use consistency with most recent sexual partner(s), number of vaginal sex partners, and frequency of intercourse with most recent sexual partner(s). RESULTS: For girls (n = 335), a model including baseline STD risk behavior, condom use self-efficacy, oral contraceptive use, communication with sexual partners about STD prevention, and alcohol use in connection with sexual activity explained 21.1% of the variance in STD risk behavior at 1-year follow-up. For boys (n = 75), the strongest predictors of STD risk behavior at follow-up included baseline STD risk behavior, perceived susceptibility to STD, condom use self-efficacy, negative outcome expectations associated with condom use, and perceived barriers to STD prevention. CONCLUSIONS: Efforts targeting reduction in STD risk behavior must begin before the onset of somewhat stable patterns of sexual risk behavior. Among adolescents who are sexually active, interventions should include components that increase condom use self-efficacy, build skills to communicate with sexual partners about STD prevention, and address behaviors associated with STD risk behavior including oral contraceptive use.

Adolescent↗

PubMed1986

Overweight adults in the United States: the behavioral risk factor surveys.

Using data on 19,405 adults from telephone interviews across the US, 1981-1983, we examined the sociodemographic characteristics, health-risk behaviors, body image, and dieting of overweight adults classified by the 1959 Metropolitan Life Insurance tables for weight and height. By self-report, 23% were overweight vs 29% in 1960-62. This modest decline in overweight remained after age-adjusting the 1981-1983 rate to the 1960 population. In 1981-1983, more blacks and Hispanics than whites were overweight [rate ratio (RR) = 1.43]. After adjustment for age and education, more over- than average-weight adults had uncontrolled hypertension, were binge drinking, and had a sedentary lifestyle. Among overweight men and women, 72% and 52%, respectively, were not dieting. Overweight adults acknowledging they were overweight were dieting more often than those without this perception (RR = 1.53). Results are discussed in light of research documenting weight gain and overweight as independent risk factors for cardiovascular disease incidence and mortality.

Adult↗

PubMed2005

Health-related quality of life and health risk behaviors among smokers.

BACKGROUND: It is well established that smoking has detrimental effects on physical health, but its associations with health-related quality of life (HRQOL) and a variety of health behaviors have not been widely investigated in the U.S. population. METHODS: Data obtained from the Behavioral Risk Factor Surveillance System (BRFSS), an ongoing, state-based, random-digit-dialed telephone survey of non-institutionalized persons aged > or =18 years in the United States, Guam, Puerto Rico, and the Virgin Islands, were used in this investigation. The BRFSS monitors the prevalence of key health- and safety-related behaviors and characteristics. In 2001 and 2002 combined, trained interviewers administered HRQOL questions in 23 states and the District of Columbia (n=82,918). This analysis was conducted in 2004. RESULTS: Overall, an estimated 22.4% of adults were current smokers, 24.1% were former smokers, and 53.6% never smoked. Current smokers had significantly poorer HRQOL than those who had never smoked, and were more likely to drink heavily, to binge drink, and to report depressive and anxiety symptoms. Additionally, current smokers were significantly more likely than those who never smoked to be physically inactive, to report frequent sleep impairment, to report frequent pain, and to eat less than five servings of fruits and vegetables per day. CONCLUSIONS: While there are strong positive relationships between smoking and both alcohol consumption and mood disturbance, smoking is also associated with an array of other modifiable risk factors meriting assessment and intervention. In addition to smoking cessation, the increased morbidity and mortality characterizing smokers may potentially be further reduced by improvements in diet, physical activity, and sleep.

Adolescent↗

PubMed2004

Mental and physical distress and high-risk behaviors among reproductive-age women.

OBJECTIVE: To examine the prevalence of mental and physical distress indicators among women of reproductive age and the association of these indicators with cigarette smoking and alcohol use, by pregnancy status. METHODS: The Behavioral Risk Factor Surveillance System data for several years were aggregated across states and weighted for this analysis. Seven measures of self-reported mental and physical distress and general health were examined along with demographic variables. RESULTS: Overall, 6.7% (95% confidence interval [CI] 6.5-6.9) of women reported frequent physical distress, 12.3% (95% CI 12.0-12.6) reported frequent mental distress, 9.9% (95% CI 9.4-10.4) reported frequent depression, 18.4% (95% CI 17.8-19.1) reported feeling anxious, and 34.3% (95% CI 33.5-35.1) reported that they frequently did not get enough rest. At the time of the survey 4.6% of the women were pregnant. Pregnant women were less likely than nonpregnant women to report frequent mental distress. Although there was attenuation of cigarette smoking and alcohol use during pregnancy, those with mental and physical distress were more likely to consume cigarettes and alcohol than were those without such experiences. CONCLUSION: High proportions of reproductive-age women report frequent mental and physical distress. Women experiencing mental and physical distress were more likely to report consuming cigarettes and alcohol than women without such experiences.

Adolescent↗

PubMed2006

A systematic review and meta-analysis of behavioral interventions to reduce HIV risk behaviors of Hispanics in the United States and Puerto Rico.

This systematic review examines the overall efficacy of HIV behavioral interventions designed to reduce HIV risk behaviors or incident sexually transmitted diseases (STDs) among Hispanics residing in the United States or Puerto Rico. Data from 20 randomized and nonrandomized trials (N = 6,173 participants) available through January 2006 were included in this review. Interventions successfully reduced the odds of unprotected sex and number of sex partners, increased the odds of condom use, and decreased the odds of acquiring new STD infections. Interventions successful in reducing the odds of any sex risk behavior used non-peer deliverers; included >or=4 intervention sessions; taught condom use or problem solving skills; or addressed barriers to condom use, sexual abstinence, or peer norms. Interventions that included the Hispanic cultural belief of machismo or those developed based on ethnographic interviews were successful in reducing the odds of sex risk behaviors among non-drug users. Interventions targeting injection drug users (IDUs; N = 3,569) significantly reduced the odds of injection drug use and the odds of sharing cotton or cookers, but did not significantly reduce the odds of engaging in risky sex behavior or needle sharing. Further development of culturally appropriate HIV prevention interventions for Hispanic populations, particularly men and persons living with HIV, are warranted.

Female↗

PubMed2006

Cardiovascular prevention in the Hartslag Limburg project: effects of a high-risk approach on behavioral risk factors in a general practice population.

BACKGROUND: This study describes a general-practice-based high-risk cardiovascular prevention approach in Maastricht, The Netherlands (1999-2003). The intervention consisted of a complete registration of risk factors, optimization of medical treatment and health counseling on high fat consumption, smoking and physical inactivity. METHODS: Behavioral effects were assessed in a trial, randomization by practice and usual care as control. Validated questionnaires were completed by 1300 patients at baseline, 1174 after 4 months (90.3%) and 1046 (80.5%) after 18 months. RESULTS: After 4 months, intention-to-treat analyses revealed a decrease in saturated fat intake of 1.3 points (scale ranging from 7 to 30 points, p=0.000). This was partly sustained after 18 months (-0.5 points, p=0.014). After 18 months, obese intervention patients were more likely to be sufficiently physically active than their control counterparts (OR=1.90, p=0.023). No intervention effects were found for smoking. CONCLUSION: Given the multiple factor and multiple component high-risk approach, the intervention had modest effects on only some of the behavioral risk factors addressed. Process data showed that the registration of risk factors and the optimization of medical treatment were only partly implemented, that the health counseling component could be further improved and that the intervention could benefit from additional health promoting strategies.

Aged↗

PubMed1991

Intravenous drug users and AIDS: risk behaviors.

Risk-taking behaviors were studied in this assessment of 345 intravenous drug users from Baltimore, El Paso, and Denver. Over 50% reported injecting drugs daily and 70% shared needles with others, averaging 6.3 partners. In addition, 86% had shared a "cooker" and nearly 50% injected in a "shooting gallery." More than half of the males sampled had two or more sex partners, including 18% with five or more. Females averaged 19 sex partners in the preceding 6 months, with 22% reporting sex with five or more. Two-thirds of the total sample never used a condom, while only 6% always used this form of protection. On the other end of this risk continuum were those subjects who did not share needles or always cleaned their needles with an effective agent, had no sexual relations or always used a condom. Subjects following such practices could be considered low risk if they adopted safe behaviors in other associated areas of their lives. However, in an analysis of total risk, it was found that only 14 subjects (4%) practiced safe needle use and safe sex. Despite these findings, some encouraging results were seen. In an analysis of risk according to location, Baltimore subjects were significantly less at risk according to number of needle-sharing partners, borrowing needles, sharing a "cooker," injection in a "shooting gallery," cleaning needles, use of disinfectants, number of sexual partners, and use of condoms than either their cohorts in El Paso or Denver. Street outreach to modity risk behaviors among IVDUs began in Baltimore approximately 2 years prior to funding in El Paso and Denver. These results suggest that there may be a potential to moderate risk through intervention.

Acquired Immunodeficiency Syndrome↗

PubMed2003

A cognitive-behavioral intervention to reduce HIV risk behaviors in crack and injection drug users.

This paper presents the results of a study evaluating the efficacy of a theory-based cognitive-behavioral intervention to reduce HIV risk among street-based crack and injection drug users not currently in drug treatment in Long Beach, California. A nine-session, 4-month enhanced intervention (including HIV counseling and testing) was compared to a two-session standard counseling and testing intervention developed by the National Institute on Drug Abuse (NIDA) in terms of their efficacy for reducing drug- and sex-related risk behaviors. The theory-based enhanced intervention rarely was found to be different from NIDA's standard counseling and testing intervention in reducing both drug- and sex-related risks, as indicated by cessation and/or reduction of drug use (measured by urine test and self-report), entry into drug treatment, and increased frequency of condom use. One of the few significant effects was that the enhanced intervention significantly increased injecting drug users' use of their own injection equipment. On the other hand, for both interventions, most risk behaviors were significantly reduced. It is concluded that the theory-based cognitive-behavioral intervention has limited advantage over the standard intervention in terms of both magnitude and frequency of HIV risk reduction achieved by high-risk, active drug users.

Adult↗

PubMed1994

Reliability of information on chronic disease risk factors collected in the Missouri Behavioral Risk Factor Surveillance System.

The Behavioral Risk Factor Surveillance System (BRFSS) is widely used by state health agencies to measure the prevalence of chronic disease risk factors. We completed a test-retest study to assess the reliability of the Missouri Behavioral Risk Factor Surveillance System. We conducted telephone reinterviews for 222 respondents of completed Behavioral Risk Factor Surveillance System interviews from March and April 1993. The second interview was completed between 6 and 30 days after the first interview. Agreement was high for sociodemographic variables (kappa values from 0.85 to 1.00). Reliability of information on chronic conditions and risk factors was also high, with kappa values from 0.82 for hypertension to 1.00 for current smoking status. Regarding cancer screening practices, reliability was lower for knowledge of the prostate-specific antigen test (kappa = 0.21) than for women's cancer screening practices (that is, the mammogram and Papanicolaou smear). Questions on attitudes toward environmental tobacco smoke showed lower reliability than did questions on individual actions to reduce exposure to environmental tobacco smoke.

Adolescent↗

PubMed1993

Correct and incorrect interpretations of correlations between risk perceptions and risk behaviors.

Correlations between risk perceptions and risk behaviors are used by investigators to answer 2 important and easily confused questions: Are individuals' perceptions of their personal risk accurate, correctly reflecting their precautions and their risk-increasing behaviors? and Does recognition of high personal risk cause people to adopt precautions to reduce that risk? Researchers who use survey data to investigate these questions often look at the wrong correlations to get their answers. Furthermore, as members of a population adopt precautions and change their risk status, correlations between perceived risk and risk behavior in this population also change. A mathematical model of precaution adoption--allowing a bidirectional relationship between perception and behavior--is used to illustrate the different correlations between risk perception and risk behavior that can be examined and the changes in correlations that can occur with the passage of time. Recommendations are provided concerning the correlations most appropriate for answering each of the 2 preceding questions. Which correlation is appropriate to answer the second question varies depending on whether a study is begun before people have taken precautions or after ample time to take precautions has already passed.

Acquired Immunodeficiency Syndrome↗

PubMed2004

Cardiovascular disease risk reduction in the Behavioral Risk Factor Surveillance System.

BACKGROUND: Cardiovascular disease (CVD) risk-reduction practices are suboptimal in populations at high risk for CVD, and this problem may be worse in women than in men. METHODS: In 2003, CVD risk-reduction practices were compared between men and women after stratification by CVD risk status (high, intermediate, low) in a cross-sectional analysis of the 1999 Behavioral Risk Factor Surveillance System (BRFSS), a random-digit telephone survey of state population-based samples of the civilian non-institutionalized population of adults. This analysis included persons aged >40 years who answered questions regarding lipid and blood pressure screening, recommendations for lifestyle modification, that is, exercise and reduced fat intake, and aspirin use. Risk status was defined according to Adult Treatment Panel III definitions. RESULTS: In the 97,387 adults included in this analysis, high CVD risk was associated with lipid and blood pressure screening, lifestyle modification, and aspirin use in both men and women compared to intermediate-risk and low-risk (p <0.001). Among high-risk adults, men and women reported similar frequency of blood pressure and cholesterol measurement and physician advice on lifestyle modification; among intermediate- and low-risk adults, women reported slightly more frequent screening and lifestyle modification than men (p <0.001). In all CVD risk categories, women reported significantly less aspirin use than in men (p <0.001). CONCLUSIONS: Among people at high risk for CVD, women report lifestyle modification more often than men, while men report use of aspirin more often than women. These findings may assist with targeting interventions to reduce CVD risk to the unique needs of men and women.

Aspirin↗

PubMed2006

Physical activity and sedentary behavior patterns are associated with selected adolescent health risk behaviors.

OBJECTIVE: Little is known about how physical activity (PA), sedentary behavior, and various adolescent health risk behaviors are associated. The objective of this study was to examine relationships between PA and sedentary behavior patterns and an array of risk behaviors, including leading causes of adolescent morbidity/mortality. METHODS: Nationally representative self-reported data were collected (National Longitudinal Study of Adolescent Health; wave I: 1994-1995; II: 1996; N = 11957). Previously developed and validated cluster analyses identified 7 homogeneous groups of adolescents sharing PA and sedentary behaviors. Poisson regression predicted the relative risk of health risk behaviors, other weekly activities, and self-esteem across the 7 PA/sedentary behavior clusters controlling for demographics and socioeconomic status. Main outcome measures were adolescent risk behaviors (eg, truancy, cigarette smoking, sexual intercourse, delinquency), other weekly activities (eg, work, academic performance, sleep), self-esteem. RESULTS: Relative to high television (TV) and video viewers, adolescents in clusters characterized by skating and video gaming, high overall sports and sports participation with parents, using neighborhood recreation center, strict parental control of TV, reporting few activities overall, and being active in school were less likely to participate in a range of risky behaviors, ranging from an adjusted risk ratio (ARR) of 0.42 (outcome: illegal drug use, cluster: strict parental control of TV) to 0.88 (outcome: violence, cluster: sports with parents). Active teens were less likely to have low self-esteem (eg, adolescents engaging in sports with parents, ARR: 0.73) and more likely to have higher grades (eg, active in school, ARR: 1.20). CONCLUSIONS: Participation in a range of PA-related behaviors, particularly those characterized by high parental sports/exercise involvement, was associated with favorable adolescent risk profiles. Adolescents with high TV/video viewership were less likely to have positive risk behavior outcomes. Enhancing opportunities for PA and sport may have a beneficial effect on leading adolescent risk behaviors.

Absenteeism↗

PubMed2000

[Evolution of the prevalence of HIV infection and risk behavior of drug injection among intravenous drug users infected or not infected by HIV in 3 Spanish cities. Working Group of Physicians of the World for the monitoring of HIV infection and risk behaviors in intravenous drug users].

OBJECTIVE: To know the evolution of HIV prevalence and risk behavior practices of drug injection in three spanish cities on the basis of the serologic status of injecting drug users. METHODS: Cross-sectional surveys among users in syringe interchange programmes. RESULTS: HIV prevalence (self-reported) decreased in Madrid from 50% (1992) down to 41% (1996) (p = 0.01) and did not change in Seville and Valencia from 1994 to 1996. Among HIV-positive injecting drug users, a decrease was observed in the practice of giving and taking used syringes in the three cities, although this decrease reached a statistically significance (p = 0.006) only for giving in Valencia from 1994 to 1996 and was almost significant (p = 0.08) for taking in Madrid from 1993 to 1996. Among HIV-negative injecting drug users, no decreases were observed in the practice of giving and taking used syringes and even a significant increase in giving syringes in Seville was recorded (p = 0.01) from 1994 to 1996. CONCLUSIONS: HIV prevalence among injecting drug users is stabilized or decreasing in the three studied cities. The prevalence of injecting risk behavior evolves differently according to the serologic status.

Adult↗

PubMed2000

Prevalence and co-occurrence of health risk behaviors among high-risk drinkers in a primary care population.

BACKGROUND: Approximately 10% of patients seen in the primary care setting meet criteria for high-risk (HR) drinking. Little data are available about the co-occurrence of other risk behaviors (RBs) in this population. This study examines the co-occurrence of smoking, poor diet, and sedentariness, and several change-related variables, among 479 HR drinkers participating in Project Health, a NIAAA-funded study testing the effectiveness of a provider-delivered intervention to reduce HR drinking. METHOD: Data were collected at study entry via standardized interview and questionnaire. RESULTS: The prevalence of additional RBs among HR drinkers was smoking, 35%; poor diet, 28%; and sedentariness, 44%. In addition to HR drinking, 67% of participants had at least one RB, and 61% reported smoking, sedentariness, or both. Perception of drinking as a problem was generally low (20%), as was intention to change drinking. Seventy-two percent of participants with multiple RBs perceived at least one of these RBs as a problem. Younger, unmarried, less-educated, blue-collar, and non-working participants were more likely to have multiple RBs than white-collar workers. CONCLUSION: Additional RBs are common among HR drinkers and may increase their already elevated health risks. Implications of these findings for interventions integrating multiple RBs into primary care settings are discussed.

Adult↗

PubMed1996

Cumulative sexual intercourse patterns among middle adolescents: problem behavior precursors and concurrent health risk behaviors.

PURPOSE: The purpose of this study is to document associations among problem behaviors in childhood and early adolescence and several health risk behaviors in middle adolescence, including a cumulative index of sexual intercourse risk. METHOD: A nontreatment sample of 1167 10th and 11th grade students was recruited from three homogeneous suburban high schools in western New York. Intercourse activity and number of sexual partners were assessed four times at 6-month intervals over a 2-year period via self-report questionnaires administered in classroom settings. RESULTS: Sexual intercourse activity, once initiated, was found to be relatively persistent, rather than sporadic, for most adolescents. Repeated intercourse experience with multiple partners over the assessed time periods was associated with higher levels of externalizing childhood behavior problems, earlier onset of antisocial behaviors and substance use, and higher concurrent substance use. An avoidant, withdrawn behavioral style in childhood was associated with lower rates of sexual involvement in adolescence. CONCLUSIONS: Temporal linkages among childhood precursors and adolescent sexual behaviors were identified as critical to understanding adolescent risk behaviors. These cross-time relationships may identify potential targets for future intervention/prevention efforts among high risk subsamples of children and adolescents.

Adolescent↗

PubMed1993

Cultural bases of risk behavior: Danish adolescents.

Risk behavior was investigated among 1,053 Danish adolescents aged 12-20. Driving a care while intoxicated was rare even among the oldest adolescents, but riding a bicycle while intoxicated was reported by the majority of adolescents aged 14-20. Driving a car at high speeds was widespread among the oldest adolescents (aged 18-20), but still lower than rates reported for same-age American adolescents. Rates of sex without contraception were higher than expected, in spite of early and extensive sex education, while rates of illegal drug use other than marijuana were extremely low. Participation in risk behavior was analyzed in relation to sensation seeking, city size, and various family variables. Results are discussed in the context of the theory of broad and narrow socialization, in which a cultural and multidimensional understanding of socialization is emphasized.

Adolescent↗

PubMed1998

The Healthy for Life project: sexual risk behavior outcomes.

Sexual risk behavior outcome data from the Healthy for Life (HFL) project is presented. Using a social influences model, the intervention was designed to positively affect the health behaviors of middle school students in five related areas: alcohol use, tobacco use, marijuana use, nutrition, and sexuality. The in-school program was supplemented by parent, community and peer components. The research used self-report data on an initial sample of 2,483 middle school students followed from Grade 6 to Grade 10. Twenty-one schools were assigned to three conditions--age appropriate (program taught in Grades 6, 7, and 8), intensive (program taught in Grade 7) and control--using blocked randomization. Attrition was 20% (by Year 4) and 33% (by Year 5). By ninth grade the lifetime intercourse rate among both groups of HFL subjects was significantly higher than for controls (controlling for baseline substance use risk and involvement with the opposite sex), but reported past month intercourse rates and condom use did not differ. At the tenth grade follow-up, the age appropriate subjects reported higher adjusted rates of lifetime and past month intercourse than did the controls. Intensive subjects perceived significantly lower normative rates of intercourse than controls at ninth grade follow-up, but age appropriate subjects perceived significantly higher norms at tenth grade. Our expectation that this approach would be effective in reducing adolescent sexual risk behavior has not been supported. The influence of social and community norms and contextual factors has a far greater influence on the behavior of students (even 6 years later) than this school-based social influences program targeting only one grade cohort.

Adolescent↗