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PubMed2003

Patterns of HIV risk behavior and condom use among youth in Yaoundé and Douala, Cameroon.

This study describes the levels of sexual risk behavior and condom use among Cameroonian urban youth in order to evaluate the need for reproductive health programs targeting youth and to inform the design of such programs. We use data from a survey conducted in July-August 2000 among a representative sample of 1,956 unmarried youth aged 15-24 years. The data show that in urban Cameroon, first intercourse often occurs at an early age. Despite the HIV epidemic, a substantial fraction of youth, particularly males, continue to have high rates of partner change. A substantial fraction of youth consistently use condoms with casual partners. However, consistent condom use in regular relationships remains low, even though many youth have multiple regular partners. These findings illustrate the need for youth-targeted reproductive health programs in urban Cameroon. To ensure that youth are reached before they adopt risky behaviors, there is a need for programs that target very young teenagers and emphasize consistent condom use.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Differences in impulsivity and sexual risk behavior among inner-city crack/cocaine users and heroin users.

The current study utilized a sample of 123 inner-city drug users in residential treatment, comparing sexual risk behavior (SRB) across primary users of (a) heroin and not crack/cocaine, (b) crack/cocaine and not heroin, and (c) both heroin and crack/cocaine. Additional analyses also examined impulsivity as a mediator of drug choice and SRB. Results indicated that SRB was higher in primary crack/cocaine users than in primary heroin users, with those using both drugs evidencing intermediate levels of SRB. Beyond differences in SRB, a similar pattern across drugs was found for impulsivity. Finally, impulsivity mediated the relationship between drug choice and SRB. Although further research is necessary to establish causal relationships, these results support a relationship between SBR and crack/cocaine, and suggest that disinhibition processes including impulsivity may underlie this relationship.

Adult↗
PubMed1996

Predictors of African American adolescents' condom use and HIV risk behavior.

This study evaluated predictors of risky and safer behavior in a sample of low-income African American adolescents, assessed their perceptions of the risk associated with their sexual behavior, and examined differences between adolescents who used condoms consistently, inconsistently, or engaged only in unprotected intercourse. African American adolescents (N = 312) completed measures related to AIDS knowledge, frequency of condom use, attitudes toward condoms, and sexual behavior over the preceding 2 months. Multiple regression analyses for the sexually active youths (N = 114) revealed that lower self-efficacy, higher perceived risk, and male gender were associated with high-risk behavior. Positive attitudes toward condoms and younger age had the strongest association with condom use. Consistent condom users were more knowledgeable and held more positive attitudes toward condoms, and nonusers were older. Regardless of their behavior, the adolescents generally did not perceive themselves to be a risk for HIV infection. The findings suggest that precautionary practices (condom use) and high-risk behavior (unprotected sex with multiple partners) may have different correlates. In addition, the data indicate that theoretical models developed with homosexual male populations may also be generalizable to African American adolescents' sexual behavior.

Adolescent↗
PubMed2005

Predicting high-risk behaviors in veterans with posttraumatic stress disorder.

The present study sought to identify posttraumatic stress disorder (PTSD) patients at high risk for negative behavioral outcomes (violence, suicide attempts, and substance use). The Mississippi Scale for Combat-Related PTSD, the Beck Depression Inventory, and demographic and behavioral data from 409 male combat veterans who completed a VA residential rehabilitation program for PTSD were analyzed using signal detection methods (receiver operating characteristics). A validation sample (N = 221) was then used to test interactions identified in the signal detection analyses. The best predictors of behaviors at follow-up were those same behaviors shortly before intake, followed by depressive and PTSD symptoms. However, for each of the models other than that for hard drug use, cutoffs determined at the symptom level did not lend themselves to replication. Recent high-risk behaviors, rather than patients' history, appear to be more predictive of high-risk behaviors postdischarge.

Adult↗
PubMed1993

HIV-1 seroprevalence and risk behaviors in an urban African-American community cohort.

OBJECTIVES: Previous attempts at obtaining population estimates of human immunodeficiency virus type 1 (HIV-1) seroprevalence have been beset by problems of cooperation bias. As part of the fourth round of study with an urban African-American community cohort, the following investigation was aimed at assessing HIV-1 prevalence and the relative importance of sex and drug injection as risk factors in infection. METHODS: Personal interviews were conducted in the home with 364 respondents, followed by voluntary blood sample collection from 287 of these individuals. RESULTS: Blood assays showed a point prevalence of 8.4% HIV-1 seropositivity in this community cross section, with a higher female-to-male ratio than appears among acquired immunodeficiency syndrome (AIDS) case reports. Most infected persons were unaware and unsuspecting of their infection. CONCLUSIONS: First, findings underscore the need to focus on risk behaviors rather than on risk groups. Second, the smaller than 2:1 ratio of infected men to women suggests that current AIDS case reports seriously underestimate HIV-1 infection among certain cohorts of African-American women. Finally, widespread ignorance of own infected status and inaccurate risk assessment signal the substantial task for community health educators in reaching inner-city African-American men and women at risk.

Adult↗
PubMed1995

AIDS knowledge and risk behaviors among domestic clients of female sex workers in Bali, Indonesia.

This study investigated AIDS and STD knowledge, risk behaviors and condom use among clients of female commercial sex workers in Bali, Indonesia. Although these clients were varied in their socioeconomic status, they all tended to have low levels of knowledge concerning HIV and STD transmission and prevention, multiple sexual partners, low frequencies of condom use with these partners, and experienced frequent STDs. Although HIV sero-prevalence rates are currently low in Indonesia, clients of CSWs are at high risk of HIV transmission. Given their high mobility and frequent sexual encounters with CSWs in other parts of Indonesia, these men could well be agents of rapid spread of the virus throughout Indonesia. Interventions to prevent the spread of the HIV virus must be targeted not only to CSWs, but also to their clients. These interventions should include educational activities concerning AIDS and STD transmission and prevention, condom promotion, efforts to improve condom availability, and activities to strengthen the health sectors' STD diagnosis and treatment capabilities for both CSWs and their clients.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Smoking status and health-related quality of life: as findings from the 2001 Behavioral Risk Factor Surveillance System data.

PURPOSE: To examine the relationship between smoking status and health-related quality of life (HRQOL). DESIGN: Our study used a cross-sectional analysis with self-reported data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS). SETTING: United States. SUBJECTS: Subjects were a representative sample of noninstitutionalized adults aged 18 years and older. After excluding respondents who reported being pregnant and for whom smoking status could not be determined, we included 209,031 respondents. MEASURES: Multiple logistic regressions were performed to examine the associations of smoking status with the four HRQOL items, controlling for demographic and health-related characteristics. RESULTS: Current smokers had a higher likelihood of reporting poor general health status compared with nonsmokers and ex-smokers. Compared with nonsmokers, current smokers had a higher likelihood of reporting > or = 14 days of poor physical health (odds ratio [OR] = 1.64, 95% confidence interval [CI] = 1.51-1.77), poor mental health (OR = 1.99, 95% Cl = 1.84-2.16), and activity limitations (OR = 1.80, 95% Cl = 1.63-2.00). Similarly, compared with ex-smokers, current smokers had a higher likelihood of reporting > or = 14 days of poor physical health (OR = 1.30, 95% CI = 1.19-1.42), poor mental health (OR = 1.65, 95% CI = 1.50-1.81), and activity limitations (OR = 1.48, 95% CI = 1.32-1.65). Age, income, and presence of comorbidities also significantly explained variation in HRQOL. CONCLUSIONS: Our study reaffirms the significant association between smoking and HRQOL in a large nationally representative sample. Poor health associated with smoking persists as a major public health problem, and effective preventive and smoking cessation efforts should be undertaken.

Adult↗
PubMed1994

Human immunodeficiency virus type 1 antibody status and changes in risk behavior among drug users.

The associations of human immunodeficiency virus type 1 (HIV-1) antibody status and recent testing with risk behavior change were examined in a cohort of drug users enrolled in a randomized trial of acquired immunodeficiency syndrome (AIDS) education programs at a short-term inpatient detoxification facility. Four hundred ninety-seven subjects completed baseline interviews, and 402 (81%) of them had analyzable follow-up information. Changes in eight ordinal self-reported drug and sexual behaviors were assessed using the cumulative logit model for repeated ordinal response data. There was only limited evidence for differential behavior change by either perceived serostatus or recent testing, which was mainly confined to sharing of injection equipment among those who continued to inject, and condom use.

Adolescent↗
PubMed1996

Predictors of HIV-related risk behaviors among heterosexuals in alcoholism treatment.

OBJECTIVE: To determine which measures of alcohol and drug use are associated with HIV-related sexual risk and protective behaviors. METHOD: Entrants (N = 743, 72% male) to alcoholism treatment clinics underwent a structured interview including an assessment of demographics, substance abuse characteristics and sexual behaviors. Associations were examined between alcohol- and drug-related behaviors, and demographic variables, with the prevalence of high-risk sexual behaviors. RESULTS: Those more likely to use alcohol or drugs when having sex, and those who expect to have high-risk sex when they drink alcohol, were more likely to engage in high-risk sexual behavior. Measures of severity of alcohol or drug problems alone were not consistently related to high-risk or protective behaviors. Several other concurrently used measures (such as the Addition Severity Index and alcohol expectancies) showed more consistent association with high-risk behaviors. There was no apparent reduction in the likelihood of practicing risk-reducing behaviors among those more severely addicted and those who combined alcohol and/or drugs with sex. CONCLUSIONS: This study suggests that sexual risk and protective behaviors are not consistently associated with severity of addiction problems. Some measures of alcohol and drug use (i.e., the ASI Drug Composite Score and the Enhanced Risk subscale of the alcohol expectancy measure) were more consistently related to the specific risk behaviors measured than were others (e.g., the ASI Alcohol Composite Score), while most measures showed little or no association with protective behaviors.

Adult↗
PubMedDate not supplied

Correlates and distribution of HIV risk behaviors among homeless youths in New York City: implications for prevention and policy.

Homeless youths are at high risk for poor health outcomes, including repeated exposure to STDs and high rates of unplanned pregnancies, untreated TB, HIV infection, and accelerated immune dysfunction associated with AIDS. This article examines the nature and distribution of HIV-risk behavior in a broad, street-based sample of homeless and runaway youths in New York City (N = 929). Although street youths in general are shown at high risk, the highest risks nest within older age segments of the male street youth population. Paradoxically, these youths are least likely to be in contact with prevention services. The data demonstrate the need to reconsider the use of chronological age as a determinant for service eligibility and to reconfigure funding streams so as to more effectively and consistently target older and more vulnerable youths.

Adolescent↗
PubMed2004

A prospective study of sensation seeking and alcohol use as predictors of sexual risk behaviors among men and women receiving sexually transmitted infection clinic services.

Sensation seeking, the propensity to seek optimal stimulation and engage in risk behaviors, correlates with alcohol expectancies, which are related to alcohol use in sexual situations, potentially increasing risks for sexually transmitted infections (STIs). In the current prospective study of 313 male and 140 female STI clinic patients, path analyses showed that sensation seeking predicted unprotected intercourse 6 months later. Sensation seeking also predicted alcohol outcome expectancies, which predicted alcohol use in sexual contexts 6 months later, which in turn predicted unprotected sex. Tests for mediation showed that alcohol expectancies accounted for the association between sensation seeking and alcohol use in sexual contexts. These findings replicate previous research, with the prospective design confirming directional hypotheses and supporting causal conclusions.

Adult↗
PubMed2002

Motivation to modify lifestyle risk behaviors in women treated for breast cancer.

OBJECTIVE: To determine motivators of health behaviors (relevant to risk for chronic disease and cancer recurrence) after a cancer diagnosis. PATIENTS AND METHODS: Eighty-six women who had been treated for breast cancer (mean age, 54.8 years; median time since diagnosis, 23.5 months) participated in this cross-sectional study (1997-1998). Respondents completed a questionnaire assessing overweight or obesity status, dietary fat intake, energy expenditure, motivational readiness for exercise and weight loss, and variables associated with readiness for exercise adoption and weight loss. RESULTS: Forty-six women (54%) were overweight or obese, and 47 women (55%) reported dietary fat intake of 30% or higher. Sixty-one women (72%) were in action/ maintenance stages for exercise adoption. A majority believed that diet and exercise can change the course of cancer. Overweight and obese women in the sample were more likely to be in early stages of motivational readiness for weight loss, and they reported significantly lower exercise self-efficacy and lower eating self-efficacy than their nonoverweight peers. However, they endorsed more benefits associated with weight loss than the nonoverweight subgroup. Thirty-three women (39%) reported both a low-fat diet and exercising at recommended levels. CONCLUSIONS: Only a minority of respondents reported consuming a diet low in fat and exercising at recommended levels, which suggests a need to improve both diet and exercise behaviors among women treated for breast cancer. Overweight and obese women reported low self-efficacy for exercise and eating, suggesting that interventions should focus on increasing self-efficacy for behavior change.

Adult↗
PubMed2005

Psychosocial correlates of transmission risk behavior among HIV-seropositive gay and bisexual men.

OBJECTIVES: We sought to identify the determinants of sexual transmission risk behavior by HIV-positive individuals. We examined social cognitive theory (SCT) variables, which have been found to mediate the effectiveness of HIV risk reduction interventions. We also sought to identify contextual influences that might contribute to initial levels of SCT factors such as self-efficacy. METHOD: In the present study, a series of social cognitive variables and a number of factors hypothesized to influence self-efficacy were assessed among participants at baseline in the Seropositive Urban Men's Intervention Trial. Variables tested for their effects on self-efficacy included hedonistic and self-evaluative outcome expectancies, sexual compulsivity, a history of childhood sexual abuse, drug use, and race. Models predicting condom use during anal sex with partners of HIV-negative or unknown status were tested separately for main partners and for non-main partners. RESULTS: Self-efficacy was associated with condom use in both analyses. Contextual influences on condom use with main partners were fewer and operated mostly via effects on self-efficacy. Influences on condom use with non-main partners exerted both direct effects on condom use and effects mediated by self-efficacy. Drug use was predictive of condom use with non-main, but not main, partners. DISCUSSION: The present results support the approach of addressing both standard SCT factors, and when possible contextual factors in interventions for HIV-positive men.

Adult↗
PubMed1993

Young men's risk behaviors for HIV infection and sexually transmitted diseases, 1988 through 1991.

OBJECTIVES: This paper analyzes age- and period-related changes in risk behaviors for human immunodeficiency virus (HIV) infection and sexually transmitted diseases among young men in the United States between 1988 and 1991. METHODS: Data were from the 1988 and 1991 waves of the National Survey of Adolescent Males. The 1988 survey was a nationally representative survey of 1880 males aged 15 through 19 years. The 1991 survey was a longitudinal follow-up of 1676 males aged 17 through 22 years. RESULTS: As they aged, the young men increased their levels of sexual activity and decreased their condom use. Period-related changes between 1988 and 1991 were examined by comparing similar cohorts of 17.5- through 19-year-old men: there were signs that sexual activity and intravenous drug injection increased, but condom use did not change significantly. In 1991 51% of the young men said they were occasionally "high" during sex, a state that is related to reduced condom use. CONCLUSIONS: Early progress in fostering safer behaviors among young men slowed and possibly stopped as the nation entered the 1990s. Prevention efforts need to be renewed and should focus on older youth and young adults.

Adolescent↗
PubMed2002

The relationship of depression to health risk behaviors and health perceptions in Korean college students.

The purpose of this study was to investigate the relationship of depression to health risk behaviors and health perceptions in Korean college students. The sample consisted of 434 students, ranging in age from 18 to 28 years, who were attending four universities in Korea. Data were collected using the Beck Depression Inventory, the Symptom Pattern Scale, and the Short Form Health Survey. Results indicate that the students were mildly depressed. The prevalence of alcohol consumption during the previous month was 84.6% and for smoking it was 33.6%. The majority of the students reported a low occurrence of symptoms of psychological distress and evaluated their health as either very good or good. The level of depression predicted alcohol consumption, symptom pattern, and physical health. Students who were more depressed reported more symptoms and perceived their health as worse compared with those who were less depressed. The students who were less depressed drank more alcohol. Depression did not predict smoking.

Adolescent↗
PubMedDate not supplied

Age-related disparities in cancer screening: analysis of 2001 Behavioral Risk Factor Surveillance System data.

PURPOSE: Although few studies have explored age-related health care disparities, some researchers have asserted such disparities uniformly disfavor the elderly and are largely attributable to ageism in the health care system. We compared age-related patterns of screening for colorectal cancer with those for breast and prostate cancer in persons aged 50 years and older. METHODS: We analyzed data for all adults aged 50 years and older (N = 88,213) in the 2001 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative, telephone-administered survey of personal health behaviors. Main outcome measures were adjusted prevalence by 5-year age-groups of colorectal cancer screening using fecal occult blood testing, flexible sigmoidoscopy, or colonoscopy for men and women; rates of mammography screening for women; and rates of prostate-specific antigen (PSA) screening for men. RESULTS: After adjustment for race/ethnicity, education level, income, health insurance, and self-rated health, predicted reported colorectal cancer screening (all modalities) increased significantly from when patients reached age 50 years until 70 to 74 years (66.0%, standard error [SE] 0.8%), remained constant until age 80 years, and then declined. The age-related gain in colorectal cancer screening was confined to whites among patients older than 60 years. Reported PSA screening increased until age 75 to 79 years (79.3%, SE 1.1%) and then declined, whereas reported mammography screening peaked at age 55 to 59 years (83.3%, SE 1.2%) and then declined. CONCLUSIONS: Significant age-related disparities appear to exist for both evidence-based and non-evidence-based cancer-screening interventions. The issue of age-related disparities in cancer screening is complex, with the direction of disparity favoring the elderly for some services yet disfavoring them for others.

Age Factors↗
PubMed2006

Young urban women's patterns of unprotected sex with men engaging in HIV risk behaviors.

This study explored reasons women engaged in unprotected sex with male partners they distrusted and perceived to engage in HIV risk behaviors. Seven focus groups were held in public housing and neighborhood centers in the urban Northeast with 43 African American and Latina women. Content analysis was conducted by open and axial coding. Barrett's theory of power as knowing participation in change and sex script theory guided interpretation. Results indicated that Patterns of Unprotected Sex is a usual practice to maintain hope, sensuality, intimacy, strategic gain, and stability with a male partner. In low power sex scripts the salient risks of HIV were buried under an awareness of oneself as having to satisfy a man and accept cheating. High power sex scripts involved women's awareness of themselves as worthy of self care with diverse choices. High power scripts can be integrated into normative sex scripts as exemplars of more powerful ways of being and acting to reduce HIV risk.

Association Learning↗
PubMed2005

Sexual risk behaviors and substance use among alcohol abusing HIV-positive men who have sex with men.

An ethnically diverse sample (79.0% men of color) of HIV seropositive (HIV+) men who have sex with men (MSM) with alcohol use disorders from the New York City metropolitan area was recruited from a variety of settings frequented by such men. Data were collected using quantitative assessments and calendar based techniques at the baseline assessment of a longitudinal study assessing the relationship between alcohol and substance use and sexual risk behaviors as well as alcohol use and HIV disease progression. Data were selected on a sample of 253 HIV+ MSM (mean age = 38.55, SD = 6.73). Of these, the majority of participants (80.2%, n=203) reported engaging in sexual behaviors with casual partners. In terms of sexual behaviors that put partners at greatest risk for HIV transmission, unprotected anal insertive intercourse was most likely to occur with unknown status casual partners (46.8%, n=95) than with either HIV negative casual partners (19.2%, n=39) or with HIV+ casual partners (40.8%, n=83). Further, bivariate analyses indicated significant relationships between the use of several substances and sexual behaviors that put partners at greatest risk for HIV transmission, as well as a significant positive relationship between drinks per drinking day and viral load.

Adult↗