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Health behaviors, risk factors, and health indicators associated with cigarette use in Mexican Americans: results from the Hispanic HANES.

BACKGROUND: Cigarette smokers often engage in other, potentially deleterious, health behaviors. Such behaviors have not been well documented in Mexican American smokers. METHODS: Data from the Southwestern sample of the Hispanic Health and Nutrition Examination Survey (HHANES) were employed to investigate differences in health behaviors, risk factors and health indicators between cigarette smokers and nonsmokers among Mexican Americans. Differences between those smoking less than 10 and 10 or more cigarettes per day were also examined by age group and gender. RESULTS: Positive associations between smoking status and heavy coffee and alcohol consumption were found across gender and age groups. Less consistent was the finding that smokers weighed less than nonsmokers. Lower systolic and diastolic blood pressures in middle-aged smokers, and higher levels of depressive symptomatology among smoking women were found. Those smoking 10 or more cigarettes per day were more likely to report heavy coffee consumption, with younger men reporting greater activity limitation due to poor health. Middle-aged men and women in the 10+ category were generally in better health than lighter smokers. CONCLUSIONS: Modest associations between cigarette smoking, health behaviors and risk factors found in other studies were confirmed in this Mexican American population. Few significant associations between smoking and health status were noted.

Activities of Daily Living↗

A survey of sexual risk behavior for HIV infection in Nakhonsawan, Thailand, 2001.

OBJECTIVE: To determine the prevalence of sexual risk behaviors for HIV in the general population aged 15-44 years in Nakhonsawan province, Thailand. DESIGN: Cross-sectional survey. METHODS: A two-stage cluster sampling technique was used to select 630 participants aged 15-44 years from the general population. Tape-recorders with earphones provided questions to the respondents, who used self-administered answer sheets to record their responses. RESULTS: Most participants were rural, married and educated at the primary school level. The mean age was 31.5 years. Seventy-eight percent of all participants had ever had sexual intercourse. The prevalence of premarital sex among married participants was 41%. In the previous year, 20% of the participants had had sex with commercial or non-regular partners. Sex with non-regular partners occurred more frequently than sex with commercial partners. Sixty-one percent had used condoms the last time they had sex with a commercial partner and 46% had used condoms the last time they had sex with non-regular partners. Consistent condom use with non-regular partners was lower than with commercial partners. Voluntary HIV testing during the previous year was reported by 24% of the participants who had had sex with commercial or non-regular partners. CONCLUSIONS: The results suggest that Nakhonsawan needs to strengthen implementation of the 100% condom programme, address condom use with non-commercial partners, promote awareness of personal risk rather than identification of risk groups and increase voluntary HIV testing among people who engage in risky behaviors.

AIDS Serodiagnosis↗

Reductions in HIV risk behaviors among depressed drug injectors.

OBJECTIVE: To determine if, by reducing depressive symptoms, combined psychotherapy and pharmacotherapy reduces HIV drug risk behavior compared to an assessment-only condition for active drug injectors over 9 months. DESIGN: Randomized controlled trial. SETTING: Outpatient academic research office. PATIENTS: Active injection drug users with a DSM-IV diagnosis of major depression, dysthymia, substance-induced mood disorder with depressive features persisting for at least 3 months, or major depression plus dysthymia. In addition, participants had a Hamilton Rating Scale for Depression (MHRSD) score > 13. INTERVENTION: Psychotherapy (8 sessions of cognitive behavioral therapy) plus antidepressant pharmacotherapy over 3 months. MAIN OUTCOME MEASURES: HIV Risk Assessment Battery (RAB) drug scale scores measured at three, six and nine months, and depression remission (MHRSD score < or = 8). RESULTS: Participants (n= 109) were 64% male, 82% Caucasian, with a mean baseline MHRSD score of 20.7. Depression subtypes included major depression only (63%), substance-induced depression (17%), and double-depression (17%). Overall, study retention at nine months was 89%. Reported HIV drug risk scores decreased sharply over the first 3 months and continued to decline throughout the follow-up period. Between group differences were not significant in the intention-to-treat analysis. However, highly adherent participants had significantly lower HIV drug risk scores at 3 months (p<05), but not 6 and 9 months. Depression remission was significantly associated with lower HIV drug risk scores at follow-ups. CONCLUSIONS: Combined psychotherapy and pharmacotherapy did not produce a significant reduction in HIV drug risk beyond that seen in an assessment-only control group. The greatest declines in HIV drug risk were found in participants with high protocol adherence and those with depression remission.

Adult↗

Sexual risk behavior, AIDS knowledge, and beliefs about AIDS among predominantly minority gay and bisexual male adolescents.

Current sexual risk behavior, AIDS knowledge, and beliefs about AIDS prevention were examined among 59 black and Hispanic male adolescents attending a community center for gay and lesbian youth. Most (73%) were sexually active in the last 3 months, with a median of 2.0 partners and with only 21% reporting consistent condom use. These youths demonstrated moderately high AIDS knowledge (82%) and positive beliefs endorsing AIDS prevention (71%). When risk pattern was defined on the basis of partners, risk acts, and condom use, positive AIDS prevention beliefs were significantly and inversely associated with the high-risk pattern, but not with abstinence. These results suggest that youths who frequently engage in high-risk acts need intervention targeting changes in beliefs and behavior, as well as knowledge.

Acquired Immunodeficiency Syndrome↗

Using the youth risk behavior survey to estimate prevalence of sexual abuse among Oregon high school students.

To estimate the extent of childhood sexual abuse, questions were added to the 1993 Oregon Youth Risk Behavior Survey of students in grades 9-12. Twenty-five high schools throughout Oregon participated in the survey. Among the 2,332 students who answered sexual abuse questions, 20.9% had ever been sexually abused; females (33.1%) were much more likely to have ever been abused than were males (8.1%). Females (10.3%) also were more likely than males (3.4%) to have been sexually abused within the past year. High school students sexually abused in the past year engaged in many high risk health behaviors such as weapon carrying, substance abuse, seriously considering suicide in the past year, and sexual activity when compared with students who had never been sexually abused. Further educational efforts with teachers, health care providers, parents, and child care providers, as well as development and use of school curricula, are needed to reduce sexual abuse.

Adolescent↗

Influence of alcohol and drug use on AIDS risk behavior among youth in dropout prevention.

Youth enrolled in dropout prevention and alternative school programs engage in a number of high risk behaviors in greater numbers than those in traditional school settings [1, 2]. However, data on alcohol and drug use influences and risky sexual behavior are often not collected or reported among these youth due to small enrollments and rapid turnover. In this study alcohol and drug use and sexual behaviors were surveyed among 212 youth in dropout prevention. A risk profile score for HIV/AIDS was developed and the contribution of alcohol and drug use to HIV/AIDS risk was determined. Results showed that use of alcohol and drugs and age of sexual initiation were significantly associated with a high risk profile score. Of sexually active youth, 28 percent reported using alcohol or drugs prior to having sexual intercourse and more than half reported not using condoms during their last sexual experience. Males were more likely than females to use alcohol and drugs before having sex, and were more likely to have had sex with two or more partners. Findings from this study suggest that among youth in dropout prevention, the association of alcohol and drug use to HIV/AIDS risk is significant and that prevention programs need to target alcohol and drug use as important influences on risky sexual behavior.

Acquired Immunodeficiency Syndrome↗

Young adults on the Internet: risk behaviors for sexually transmitted diseases and HIV(1).

PURPOSE: To examine the sexual behaviors and related risk factors for sexually transmitted diseases and HIV among young adults who seek sex partners on the Internet. METHODS: Study staff recruited participants in online chat rooms, bulletin boards, and other online venues. A total of 4507 participants responded to a 68-item, self-administered, online survey of Internet sex-seeking practices. The survey solicited information on sexual behavior with partners found on the Internet; in addition, a parallel set of questions addressed sexual behaviors with partners found off the Internet. Of the respondents, 1234 (27.4%) were 18-24 years old. Of the young adults, 61% were male and 75% were white. Responses from young adults were compared to those received from older adults. In addition, responses from young adults who seek sex partners online were compared to responses from young adults who do not seek sex partners online. Analyses, including logistic regression, Chi-square tests, Student's t-tests, and analyses of variance, focused on the difference between young and older adults, as well as the differences in sexual behavior with partners located online and offline. RESULTS: Young adults who seek sex on the Internet report substantially different sexual behavior patterns than young adults who do not seek sex on the Internet. Young adults with online partners reported sexual behaviors similar to older respondents who used the Internet to find sex partners; however, older respondents were more likely than young adults to have been tested for sexually transmitted diseases and HIV. CONCLUSIONS: Young adults who seek sex partners online may be at significantly greater risk for sexually transmitted diseases than their peers who do not seek sex partners online. These data point to an urgent need for online sexual health promotion.

Adolescent↗

[Study on the behavioral risk of toxoplasma infection in population working in the slaughterhouse].

OBJECTIVE: To explore the behavioral risk of toxoplasma infection in special population. METHODS: Serum samples from workers in slaughterhouse were collected and tested for the detection of cAg, toxo-IgG, toxo-IgM antibody to toxoplasma, using ELISA. Behavioral measurements were conducted through questionnaire, which was developed according to theory of reasoned action which consists of a measurement model that specifies the relation of measured to behavioral variables and a behavioral variable model to show the influence of behavior variables on each other. Factor analysis methods were used for estimating the parameter of the former and path analyses method for the latter. RESULTS: With data from 302 research subjects, the responding rate was 95.87%. The overall infection rate was of 19.20% including 15.89% having cAg, 5.63% with toxo-IgG, 2.32% with toxo-IgM, 1.32% with the third of cAg, toxo-IgG and toxo-IgM, 2.65% with the both cAg and toxo-IgG, 1.99% with the both cAg and IgM respectively. There was significant association between toxoplasma infections and contact with dystocia or live pigs, body fluid or harslet. There was no relation between toxoplasma infections and abortion. RESULTS: from miscarriage factor analyses showed that except evaluation of behavioral outcomes and behavioral attitudes, internal consistence reliability of others behavioral variables was good (Cronbach's alpha > 0.7). These behavior variables could be explained by their measure items. Path analyses suggested that two components had provided significant independent contributions to those preventive behaviors which significantly correlated to toxoplama infections. Half of the contribution leading to toxoplasma infections had come from behavioral factors. Belief was relatively more important in predicting the preventive behavior than subjective norm. CONCLUSION: Our findings supported the application of reasoned action theory in understanding the role of behavioral factors in toxoplasma infection.

Abattoirs↗

Images of smokers and willingness to smoke among African American pre-adolescents: an application of the prototype/willingness model of adolescent health risk behavior to smoking initiation.

OBJECTIVE: This study used the prototype/willingness model of adolescent health risk behavior to examine factors related to onset of smoking. METHODS: Two waves of data were collected from a panel of 742 African American children (mean age=10.5 at Wave 1) and their primary caregivers. Measures included cognitions outlined by the prototype model as well as self-reports of smoking by the parent and child. RESULTS: Structural equation modeling revealed a pattern consistent with expectations generated by the prototype model. The relation between contextual, familial, and dispositional factors-including neighborhood risk, parental smoking, and children's academic orientation-and the initiation of smoking at Wave 2, two years later, was mediated by the children's cognitions. Primary among these cognitions were the children's images of smokers and children's willingness to smoke. CONCLUSIONS: Smoking cognitions mediate the impact of important distal factors (such as context, family environment, and disposition) on the onset of smoking in children. Perhaps more important, it is possible to predict onset of smoking in African American children as young as age 10 by assessing the cognitive factors suggested by the prototype model.

Achievement↗

Can self-reported drug use data be used to assess sex risk behavior in adolescents?

To better understand and control the spread of sexually transmitted diseases among high-risk youth, we must first acquire reliable reports of sexual risk behavior. This study evaluates one potential method for validating such reports. We examined the association between marijuana and cocaine use reporting patterns and the number of reported recent sexual partners in a sample of juvenile arrestees/detainees. Using urinalysis to validate self-reported drug use, we categorized drug use reporting patterns into four groups: overreporters, underreporters, honest users, and honest nonusers. Analyses showed, in general, that overreporters reported more sexual partners than either underreporters or accurate reporters, suggesting that overreporters of drug use may also exaggerate sex partner reports. Findings suggest a new method for validating self-reported sexual behavior and provide a challenge to theories of juvenile delinquency.

Adolescent↗

Test-retest reliability of colorectal testing questions on the Massachusetts Behavioral Risk Factor Surveillance System (BRFSS).

BACKGROUND: Information on use of colorectal cancer tests, particularly for the purpose of population surveillance, is often obtained through self-report. The Behavioral Risk Factor Surveillance System (BRFSS) is a major source for population-based estimates and is used by health professionals, public health organizations, and researchers to identify and quantify self-reported utilization of screening procedures. METHODS: We provide estimates of the reliability of responses among persons age > or = 50 to questions on the 1999 BRFSS questionnaire addressing two colorectal cancer testing procedures, fecal occult blood test (FOBT), and sigmoidoscopy or colonoscopy (endoscopy), based on responses of 868 persons who responded to a callback survey. RESULTS: We found moderate reliability for questions addressing ever having an FOBT exam, (Kappa [K] = 0.55, 95% confidence interval [95% CI]: 0.49-0.61) and good reliability for questions addressing ever having an endoscopy exam (K = 0.69, 95% CI: 0.65-0.74). Questions addressing the timing of the most recent exam were only slightly less reliable (K = 0.49, 95% CI: 0.43-0.55 and K = 0.62, 95% CI: 0.57-0.67, respectively). We observed comparable reliability across levels of most demographic and risk factor characteristics for both ever having and recency of exam. CONCLUSION: Our results suggest that colorectal cancer testing questions on the BRFSS display a reasonable level of test-retest reliability.

Age Distribution↗

HIV sexual risk behavior among Puerto Rican women.

We examined the association of primary or nonprimary sexual partner relationship status on sexual risk behaviors, including condom use, among Latina women who are at self-disclosed increased heterosexual risk for human immunodeficiency virus (HIV) infection. Data were collected via structured interviews of 187 Puerto Rican women, aged 18-35, who attended a health clinic in the Bronx, New York. Approximately 13% of participants reported sexual activities with both primary and nonprimary sexual partners during the 6 months prior to the interview. Primary or nonprimary sexual partner status was associated with significant differences in frequency of condom use during anal sex and oral-penile sex, with more frequent condom use reported during these sexual activities with nonprimary sexual partners. Thus, potential contextual differences associated with primary or nonprimary relationship status may represent important factors to consider when designing interventions to facilitate HIV-protective behaviors among populations of urban women identified at increased heterosexual risk for HIV infection.

Adult↗

Sexual risk behavior among HIV-positive men who have sex with men: a literature review.

OBJECTIVE: To review research on sexual risk behavior among HIV-positive men who have sex with men (MSM) after the year 2000. METHOD: The review included 53 published studies that reported on unprotected anal intercourse (UAI) in cross-sectional and longitudinal surveys of HIV-positive MSM and MSM of mixed HIV status. RESULTS: The findings indicate high levels of UAI among HIV-positive MSM, particularly with HIV-negative or HIV status unknown partners. In studies of MSM of mixed HIV status, we found that the rate of UAI among HIV-positive MSM was much higher than that of HIV-negative MSM. Furthermore, the prevalence of UAI among HIV-positive MSM has increased in recent years. CONCLUSION: Although studies indicate that HIV-positive MSM have adopted risk reduction strategies, roughly two in five HIV-positive MSM continue to engage in UAI, which represents a risk for continued HIV and STI (sexually transmitted infection) transmission. PRACTICE IMPLICATIONS: Prevention efforts targeting HIV-positive MSM to assist them in adopting and maintaining safer sexual behaviors need to be intensified.

Antiretroviral Therapy, Highly Active↗

Pregnancy and other risk behaviors among adolescent girls in Ohio.

PURPOSE: The purpose of this study was to determine whether teenage girls who had been pregnant were more likely to engage in other risk or problem behaviors than girls who had had sexual intercourse without becoming pregnant. METHODS: The 1993 Ohio Youth Risk Behavior Survey was administered to a random sample of 2461 high school students. A subset of 592 girls (mean age 16.1 +/- 1.1 years, 69.2% Caucasian, 24.1% African-American, 2.4% Hispanic, 4.3% other) reported sexual activity (SA) on the anonymous survey. Demographic factors plus risk and problem behaviors were compared between 98 girls who had been pregnant and 494 girls who had never been pregnant using Chi-square analysis. Risk and problem behaviors were classified into four distinct groups: recent risk behaviors, age of onset of behavior, lifetime behavior, and general behavior. Variables which were univariately significant at p < 0.15 were considered in one of four stepwise multiple logistic regression models based on behavior type, with demographic factors considered in all four models. The final logistic regression model was developed using variables which were significant at p < 0.01. Variables which were significantly associated with pregnancy were summarized as odds ratios (OR) and 99% confidence intervals (CI); these ORs were adjusted for the effects of the other variables in the model. RESULTS: Pregnancy was more common in girls of color than in Caucasian girls (OR 99% and CI, 2.09, 1.06-4.11) and in older girls than in younger girls (1.52, 1.12-2.08). Among SA girls, weapon carrying in the past 30 days (4.06, 1.75-9.42) was significantly associated with pregnancy, whereas alcohol use in the past 30 days (0.37, 0.18-0.76) was less likely to be associated with pregnancy. The risk of pregnancy increased 1.75 times (1.26-2.43) for each additional sexual partner. Girls who had tried cocaine were 4.88 times (1.40-16.95) more likely to have been pregnant, and the risk of having been pregnant increased 1.43 times (1.14-1.80) for each additional year of SA. Past history of sexually transmitted disease (3.50, 1.28-9.55) was associated with increased pregnancy risk. CONCLUSIONS: Girls who had been pregnant also had engaged in other risk behaviors, including recent weapon carrying and cocaine use. A history of previous sexually transmitted diseases plus increasing numbers of partners add to the risk of pregnancy. Counseling and educational efforts should continue to identify teens at risk both to prevent pregnancy and to decrease associated risks.

Adolescent↗

Association of adolescent risk behaviors with mental health symptoms in high school students.

PURPOSE: To examine the hypothesis that self-reported symptoms of depression and stress may be associated with other risk behaviors. METHODS: A secondary data analysis of the 1992 Massachusetts Adolescent Health Survey involving a representative sample of 2,224 ninth and twelfth grade students was performed. The dichotomous dependent variable was positive if the adolescent reported feeling depressed or stressed for 10 or more days in the past month. Potential independent variables examined were age, gender, race/ethnicity, and 14 risk or protective behaviors: each scored on a seven point scale representing increasing frequency of a behavior in the past month. A four-level sexual risk variable was constructed as well. Associations were assessed using Chi-square, and phi/contingency coefficients, and logistic regression analyses to predict the odds of reporting depression/stress. RESULTS: The mean age of the sample was 16.2 +/- 1.6 years; 52% males; 78% were white, 9% black, 6% Latino, 2% Asian, and 4% other racial/ethnic heritage; 35% reported feeling depressed/stressed > or = 10 days in the past month. A logistic regression model found that feelings of depression/stress were associated with increasing age (OR = 1.09 with each additional year [95% CI, 1.02-1.18]), female gender (3.28 [2.62-4.12]); increasing levels of tobacco use (1.07 [1.01-1.12]), physical fights (1.19 [1.11-1.28]); and non-use of birth control compared with never having been sexually active (1.81 [1.31-2.49]). Independent variables of reporting depression/stress for males included increasing age (1.15 [1.03-1.28]), and physical fights (1.20 [1.10-1.30]), and non-use of birth control compared with never sexually active (1.91 [1.28-2.92]). Independent risk and protective factors for females included tobacco use (1.10 [1.02-1.19]), healthy diet (0.89 [0.83- 0.96]), and always (1.49 [1.03-2.28]) or sometimes used birth control (1.56 [1.03-1.28]) compared with never sexually active. CONCLUSIONS: Female gender had greater than threefold increased odds of reporting depression/stress. Other associations, with some gender differences, include older age, physical fights, non-use of birth control, lack of a healthy diet, and use of tobacco.

Adolescent↗

An exploratory analysis of communication sources: targeting high risk behavior among injection drug users.

Currently, most AIDS education and prevention programs attempt to change the high risk behavior of injection drug users (IDU's) (e.g., sharing needles and engaging in unsafe sex) through the implementation of two distinct strategies. First, empirical-rational strategies suggest that people maximize their rational self-interest. Second, normative re-education strategies suggest that people change their individual behavior when they believe that there has been change in the sociocultural norms, values, and habits around them. Both of these strategies make assumptions about how communication changes IDU's beliefs and behavior. An empirical-rational strategy emphasizes non-personal mass communications (e.g., television, radio, newspaper); while normative re-education strategies make use of personal communications (e.g. friends, family, educational outreach workers, and group discussion). The purpose of this paper is to compare these strategies by examining the impact of AIDS communication sources on the beliefs and behaviors of IDU's.

Acquired Immunodeficiency Syndrome↗

The role of family and friend social support in reducing risk behaviors among HIV-positive Gay men.

Researchers have intimated a link between social support and risk-taking behaviors for HIV-positive persons, yet few have empirically examined this assumption. This study examined HIV-positive Gay men regarding their perceptions of family and friend social support, behavioral intentions, and risk-taking behaviors. Results indicated that the more family members were perceived as supportive the less likely participants intended to behave in risky ways. In addition, family availability for support was more predictive of reduced risky behaviors than the availability of friends. Implications for researchers and helping professionals are discussed.

Adult↗

Tooth loss and heart disease: findings from the Behavioral Risk Factor Surveillance System.

BACKGROUND: The purpose of this study was to examine the association between tooth loss and heart disease. METHODS: Data were analyzed from the 1999 to 2002 Behavioral Risk Factor Surveillance System, an ongoing telephone survey operated by state health agencies with assistance from the Centers for Disease Control and Prevention. The study was conducted based on 41,891 adults aged 40 to 79 years old in 22 states and the District of Columbia. RESULTS: A significant association was observed between the extent of tooth loss and heart disease prevalence. After adjustment for age, gender, race/ethnicity, education, and marital status, respondents who had 1 to 5 missing teeth, 6 to 31 missing teeth, or were edentulous were significantly more likely than those without tooth loss to have heart disease (adjusted prevalence: 6.8%, 10.2%, and 11.5%, respectively, vs. 5.3%; p<0.001). These associations persisted after further adjustment for smoking status, diabetes, alcohol consumption, hypertension, hypercholesterolemia, and body mass index (5.7%, 7.5%, and 8.5%, respectively, vs. 4.7%; p<0.05); and after stratification by age group (40 to 59 years and 60 to 79 years) and smoking status (ever smoked and never smoked). CONCLUSIONS: Tooth loss is associated in a consistent and graded fashion with the self-reported prevalence of heart disease. Health promotion counseling should include the prevention and control of cardiovascular disease risk factors and the maintenance of good oral health.

Adult↗