Reducing at-risk behaviors.
All to often, one of the most deeply seated roots of system problems--an organizational culture with a high tolerance of at-risk behaviors--is overlooked.
Health Facilities↗
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AIDS risk behaviors among late middle-aged and elderly Americans. The National AIDS Behavioral Surveys.
OBJECTIVES: Although 10% of all acquired immunodeficiency syndrome (AIDS) cases diagnosed in the United States have been among Americans aged 50 years of age or older, little attention has been devoted to understanding AIDS risk-taking behaviors among middle-aged or older Americans. This study describes the prevalence of AIDS risk among Americans aged 50 years of age or older. DESIGN AND STUDY POPULATION: We present data from the National AIDS Behavioral Surveys, two large cross-sectional national surveys taken in 1990-1991. MAIN OUTCOME VARIABLE: Prevalence of risk behaviors for human immunodeficiency virus (HIV) transmission and of HIV testing. RESULTS: Findings from both surveys provide replication of several important points. First, the prevalence of having at least one risk factor for HIV infection was about 10% among Americans aged 50 years or older in both samples. Very small proportions of Americans past the age of 50 years with a known behavioral risk for HIV infection used condoms during sex or had undergone HIV testing. At-risk Americans past the age of 50 years were one sixth as likely to use condoms during sex and one fifth as likely to have been tested for HIV as a comparison group of at-risk individuals in their 20s. CONCLUSIONS: Despite the fact that HIV infection is clearly present among those past the age of 50 years, a small proportion of individuals in this age group take behavioral risks for HIV infection. High-risk individuals older than 50 years are much less likely to have adopted AIDS prevention strategies than are younger individuals who engage in the same behavioral risks.
AIDS Serodiagnosis↗
A prospective study of psychological distress and sexual risk behavior among black adolescent females.
OBJECTIVE: The purpose of the study was to examine the association between adolescents' psychological distress and their sexually transmitted disease/human immunodeficiency virus (STD/HIV)-associated sexual behaviors and attitudes. METHOD: Sexually active black adolescent females (N = 522) completed, at baseline and again 6 months later, a self-administered questionnaire that assessed sexual health attitudes and emotional distress symptoms (using standardized measures, alpha =.84), a structured interview that assessed STD/HIV-associated sexual risk behaviors, and a urine screen for pregnancy. RESULTS: In multivariate analyses, controlling for observed covariates, adolescents with significant distress at baseline were more likely than their peers, after 6 months, to be pregnant (adjusted odds ratio [AOR]: = 2.0), have had unprotected vaginal sex (AOR = 2.1), have nonmonogamous sex partners (AOR = 1.7), and not use any form of contraception (AOR = 1.5). Additionally, they were also more likely to: perceive barriers to condom use (AOR = 2.2), be fearful of the adverse consequences of negotiating condom use (AOR = 2.0), perceive less control in their relationship (AOR = 2.0), have experienced dating violence (AOR = 2.4), feel less efficacious in negotiating condom use with a new sex partner (AOR = 1.6), and have norms nonsupportive of a healthy sexual relationship (AOR = 1.7). DISCUSSION: The findings suggest that psychological distress is predictive over a 6-month period of a spectrum of STD/HIV-associated sexual behaviors and high-risk attitudes. Brief screening to detect distress or depressive symptoms among adolescent females can alert the clinician to the need to conduct a sexual health history, initiate STD/HIV-preventive counseling, and refer for comprehensive psychological assessment and appropriate treatment. Among adolescents receiving STD treatment, those with even moderate emotional distress may be at heightened risk for further unhealthy outcomes. STD/HIV interventions should also consider psychological distress as one potential risk factor that may impact program efficacy.
Adolescent↗
The association between health insurance coverage and diabetes care; data from the 2000 Behavioral Risk Factor Surveillance System.
OBJECTIVE: To describe the association between type of health insurance coverage and the quality of care provided to individuals with diabetes in the United States. DATA SOURCE: The 2000 Behavioral Risk Factor Surveillance System. STUDY DESIGN: Our study cohort included individuals who reported a diagnosis of diabetes (n=11,647). We performed bivariate and multivariate logistic regression analyses by age greater or less than 65 years to examine the association of health insurance coverage with diabetes-specific quality of care measures, controlling for the effects of race/ethnicity, annual income, gender, education, and insulin use. PRINCIPAL FINDINGS: Most individuals with diabetes are covered by private insurance (39 percent) or Medicare (44 percent). Among persons under the age of 65 years, 11 percent were uninsured. The uninsured were more likely to be African American or Hispanic and report low incomes. The uninsured were less likely to report annual dilated eye exams, foot examinations, or hemoglobin A1c (HbA1c) tests and less likely to perform daily blood glucose monitoring than those with private health insurance. We found few differences in quality indicators between Medicare, Medicaid, or the Department of Veterans Affairs (VA) as compared with private insurance coverage. Persons who received care through the VA were more likely to report taking a diabetes education class and HbA1c testing than those covered by private insurance. CONCLUSIONS: Uninsured adults with diabetes are predominantly minority and low income and receive fewer preventive services than individuals with health insurance. Among the insured, different types of health insurance coverage appear to provide similar levels of care, except for higher rates of diabetes education and HbA1c testing at the VA.
Adult↗
Reliability of self-reported sexual behavior risk factors for HIV infection in homosexual men.
This study was undertaken to determine the reliability of self-reported sexual behavior using the test and retest technique when used with self-reported sexual behavior. The subjects were 116 asymptomatic homosexual men who participated in another study (an examination of behavioral and demographic determinants of HIV antibody status). The subjects were asked to complete two questionnaires. The first contained demographic and sexual behavior questions. The second, administered an average of 6 weeks later, used a subset of the questions in the first questionnaire. The reliability of the test-retest procedure was measured by the Kappa statistic, which assesses the proportion of agreement between two data items, accounting for the amount of agreement expected by chance. The highest degree of reliability as measured by Kappa was found with demographic information, smoking history, and sexual orientation. Self-reported sexual behaviors for the previous 6 months generally had the next highest degree of reliability as measured by Kappa. Questions examining change over the previous 5 years had the lowest reliability. Behavior changes during the time between questionnaires, subjectivity of the answer categories, and social desirability of the answers are three factors that may result in a lack of reliability in this self-reported sexual behavior questionnaire. This raises methodological concerns about the measurement of behavioral risk factors for AIDS and the ability to assess meaningfully subjective reports of behavioral change.
Acquired Immunodeficiency Syndrome↗
False consensus and adolescent peer contagion: examining discrepancies between perceptions and actual reported levels of friends' deviant and health risk behaviors.
Adolescents' perceptions of their friends' behavior strongly predict adolescents' own behavior, however, these perceptions often are erroneous. This study examined correlates of discrepancies between adolescents' perceptions and friends' reports of behavior. A total of 120 11th-grade adolescents provided data regarding their engagement in deviant and health risk behaviors, as well as their perceptions of the behavior of their best friend, as identified through sociometric assessment. Data from friends' own report were used to calculate discrepancy measures of adolescents' overestimations and estimation errors (absolute value of discrepancies) of friends' behavior. Adolescents also completed a measure of friendship quality, and a sociometric assessment yielding measures of peer acceptance/rejection and aggression. Findings revealed that adolescents' peer rejection and aggression were associated with greater overestimations of friends' behavior. This effect was partially mediated by adolescents' own behavior, consistent with a false consensus effect. Low levels of positive friendship quality were significantly associated with estimation errors, but not overestimations specifically.
Adolescent↗
Risk behaviors, HIV seropositivity, and tuberculosis infection in injecting drug users who operate shooting galleries in Puerto Rico.
This study was designed to assess HIV risk behaviors, HIV seroprevalence, and tuberculosis (TB) infection in shooting gallery managers in Puerto Rico. The subjects were 464 injection drug users (IDUs), of whom 12.5% reported managing shooting galleries. The median frequency of drug injection was higher in shooting gallery managers than in nonmanagers. A trend was observed for purified protein derivative (PPD) reactivity to increase according to the length of time spent as a gallery manager, but this trend was not statistically significant. However, anergy rates increased significantly with increase in the number of months spent as shooting gallery manager (p = .021). Multivariate analyses showed that IDUs reporting shooting gallery management experience of > or = 25 months were more likely to be infected with HIV. Prevention programs need to emphasize strategies to protect the health of shooting gallery clients and, in particular, shooting gallery managers. Additional studies are required to determine effective strategies for reducing the risk of HIV and TB infection in shooting galleries.
AIDS-Related Opportunistic Infections↗
Use of a behavioral risk survey by employers to identify leading health problems among employees and their dependents.
In an effort to identify high-burden health conditions among employees and their families for worksite, community, and health care quality improvement interventions, The Mid-America Coalition on Health Care, with assistance from the Kansas Department of Health and Environment, conducted a broad behavioral risk survey among a random sample of employees of eight participating employers and their family members. By working with an established coalition of businesses, providers, payers, and other entities with a stake in controlling health care costs, state public health officials were able to assist the business community to adopt an acceptable approach to assessment of health risk and a community approach to risk reduction.
Adult↗
Exploratory cluster analysis of behavioral risks for chronic disease and injury: implications for tailoring health promotion services.
Identifying population subgroups with similar behavioral risks could assist in the social marketing of health promotion programs by providing target segments to whom services and outreach could be specifically matched. In this paper we describe an exploratory application of cluster analysis to health behavior data from a representative telephone sample of Michigan adults (n = 2,285). In addition to replication of the cluster solution through cross validation, we found significant between cluster demographic differences further confirming cluster validity. Demographic and risk profiles of four clusters are presented, and key health promotion services appropriate to each cluster are discussed. Although further research on the construct validity of the clusters is critical, we conclude that this approach can be useful in tailoring health promotion messages, materials, and services.
Adolescent↗
Rasch modeling of the structure of health risk behavior in South african adolescents.
The study used Rasch analysis to investigate the presence of a syndrome of health risk behavior in South African adolescents. A total of 2186 in-school adolescents participated in the study (males = 1077; females = 1119; age range = 12-16 years; median = 13 years). The data are baseline from a longitudinal study of a leisure-based drug abuse and HIV/AIDS prevention program at Mitchell's Plain in Cape Town, South Africa. The adolescents completed a self-report measure on various health risk vulnerabilities, including use of alcohol, tobacco and other drugs (ATOD), co-occurrence of penetrative sex with use of ATOD, health related self-efficacy, personal beliefs about health, peer perceptions, and use of contraceptives. The Rasch analysis calibrated data on 50 items from the aforesaid conceptually distinct health risk domains. Infit and Outfit mean square statistics and principal components analysis of the standardized residuals suggested a fit of the data to the unidimensional Rasch measurement model. The findings support a syndrome view of health risk in teenagers as proposed by problem behavior theory.
Adolescent↗
Jailed youth at high risk of HIV, researchers find. Youngest kids also have high-risk behaviors.
Investigators have found that among incarcerated youths in Chicago, there are very high rates of behavior, which place that group fo children and teen-agers at risk for HIV infection. The study examined youth, ages 10 to 18, who were held between 1995 and 1998 at the Cook County Juvenile Temporary Detention Center, using the AIDS Risk Behavior Assessment.
Adolescent↗
Risk behavior and social-cognitive determinants of condom use among ethnic minority communities in Amsterdam.
This study assessed sexual risk behavior and determinants of condom use among migrants in Amsterdam, The Netherlands. We tested the predictive utility of constructs derived from the health belief model and the theory of planned behavior. Data were collected by means of a cross-sectional study in a community sample of 537 Surinamese, Antillean, and sub-Saharan African heterosexual men and women randomly recruited from participants in an epidemiological study. Participants donated saliva for HIV testing and were interviewed using two structured questionnaires. Inconsistent condom use occurred in 82% of the primary partnerships and in 25% of the casual partnerships. Multivariate analyses, controlling for sociodemographic and behavioral factors, showed that perceived behavioral control and subjective norm regarding condom use were main social-cognitive determinants of consistent condom use. However, contrary to predictions, the relation between consistent condom use and sociodemographic and behavioral factors was not entirely mediated by these social-cognitive factors.
Adolescent↗
Changes in AIDS risk behavior among intravenous drug abusers in New York City.
Forty newly admitted patients to a methadone treatment clinic in New York City were interviewed to assess their patterns of intravenous (IV) drug abuse, sexual activity, and other risk behaviors for the acquired immunodeficiency syndrome (AIDS). The study revealed a marked decline in needle sharing since 1984 (46% to 14%), despite a concurrent doubling of the number of weekly IV drug injections per subject (10 to 21). High rates of promiscuous heterosexual activity were noted among men (80% said they were currently active with more than one woman), while the rates of condom use were low, as reported by both men and women (less than 30%). Recent reduction in weight were reported by 40% of subjects, and the average body mass of all individuals was subnormal. Thus, despite an apparent decline in needle sharing, high risk sexual behavior is apparently persisting, drug use is increasing, and nutritional deficits are prevalent among IV drug abusers. Synergism of these factors should be considered in the manifestation of HIV infection among IV drug abusers.
Acquired Immunodeficiency Syndrome↗
Do street youths' perceptions of their caregivers predict HIV-risk behavior?
This study examined street youths' perceptions of their caregivers and the association between these perceptions and HIV-risk behavior in a random probability sample of 715 12- to 23-year-old street youths from Los Angeles and San Diego, CA (mean age, 18.7 years). All participants had been homeless at some point during the past 12 months, with 70% recruited from nonshelter sites. Although youths reported high rates of hostility, unavailability, substance use, and legal problems among their caregivers, 86% reported that their caregivers had at least one attribute associated with support. Caregiver problems were associated with youth having had more sexual partners in the past 30 days and having higher risk drug use. High caregiver support was associated with more sexual partners and lower use of condoms with steady partners. Caregiver attributes did not predict condom use with transient partners.
Adolescent↗
High risk behavior related to HIV transmission among recently diagnosed TB patients in Jakarta.
This study investigated the demographic and high risk behavior characteristics among recently diagnosed pulmonary tuberculosis patients aged 18-40 years old in Jakarta, Indonesia. Three hundred and four participants were recruited voluntarily from two general hospitals. Among the study population, 38.5% were unemployed, 69.7% were in low socio-economic condition, and 69.7% had a high school or higher level of education. About 8% had received a transfusion, 0.3% were intravenous drug users (IVDU) and had sex with other IVDU's no males admitted to being homosexual, 3.2% of males were bisexual, 20.1% (35.5% of males, 4% of females) engaged in extramarital heterosexual intercourse, and 3.6% (7.1% of males) had one or more sexually transmitted diseases (STD). We found very strong associations between gender and extramarital heterosexual activity (p < 0.001, prevalence odds ratio (POR 13.11), between occupation and extramarital heterosexual activity (p < 0.001, POR 3.84), and between extramarital heterosexual contact and a history of an STD (p < 0.001, POR 20.86). High risk activities were common among these TB patients, especially among males. These results suggests that the necessary social conditions for transmission of HIV are common in Jakarta.
Adult↗
Validation of self-reported pneumococcal vaccination in behavioral risk factor surveillance surveys: experience from the sickness prevention achieved through regional collaboration (SPARC) program.
Behavioral risk factor surveillance system (BRFSS) is the primary surveillance tool for the ongoing measurement of state-specific delivery of pneumococcal polysaccharide vaccine. This study is the first validity assessment of self-reported pneumococcal vaccination status in a population-wide BRFSS survey. A subset of respondents to the sickness prevention achieved through regional collaboration (SPARC) BRFSS survey, which was conducted from June to September 1997 in a four-county area were assessed. Self-reporting of pneumococcal vaccination status was validated either by matching to Medicare claims or by reviewing of medical records. Self-reporting of pneumococcal vaccination had a sensitivity of 75% and a specificity of 83%. We conclude that self-reporting of pneumococcal immunization is a moderately sensitive and specific measure and that population-based surveys in the community can be validated when undertaken in collaboration with a local health care agency.
Aged↗
Is antisocial personality disorder associated with increased HIV risk behaviors in cocaine users?
Previous reports have shown antisocial personality disorder (ASPD) to be strongly associated with injection equipment sharing and increased rates of human immunodeficiency virus (HIV) infection in a sample of heroin injectors. Another report has shown ASPD to be associated with injection drug use, needle sharing, sexual promiscuity, and prostitution in a sample of methadone maintenance clients. The current study extends this work by examining the relationship of ASPD and human immunodeficiency virus (HIV) risk behaviors in a sample of cocaine users (48% out of treatment and 52% just entering treatment). Associations were tested for sexually risky behaviors in addition to injection behaviors. The principle finding of this study is that ASPD was shown to be associated with increased rates of injection drug use and sharing syringes, with earlier age of onset of injection drug use, with certain venereal diseases, and with a variety of HIV risk sexual behaviors. When men and women were tested separately, the pattern of association of risky behaviors with ASPD varied considerably. Overall, this work confirms that psychiatric status, especially the presence of ASPD, may have to be considered in evaluating the results of HIV risk-reduction interventions.
Black or African American↗
Tuberculosis knowledge, perceived risk and risk behaviors among homeless adults: effect of ethnicity and injection drug use.
The objectives of this study were to investigate Tuberculosis (TB) knowledge, perceived risk, and risk behaviors in a sample of homeless persons with latent TB in the Skid Row district of Los Angeles. Particular emphasis was given to comparing these variables among homeless persons of varying ethnic backgrounds and among those who did and did not report a history of injection drug use (IDU). Baseline data were collected from 415 homeless individuals recruited to participate in a Tuberculosis chemoprophylaxis intervention. Areas of interest relative to TB knowledge and perceived risk for infection were behavioral factors surrounding substance use and abuse; personal factors measured in terms of current depression; and sociodemographic and situational factors, such as age, ethnicity, history of incarceration, and duration of homelessness. Findings revealed differences in substance abuse. IDUs were more likely to have histories of daily drug use and alcohol dependency, but were less apt to report recent use of crack cocaine. TB knowledge deficits centered on ignorance with respect to modes of transmission and risk factors for TB infection. IDU was also associated with depression. Latinos and IDUs were most likely to lack TB knowledge. There is a pressing need for accessible, available, culturally acceptable and sustained TB screening and intervention programs designed to address multiple risk factors and knowledge deficits with respect to TB infection in homeless populations.
Adult↗