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PubMed2000

Uses of Behavioral Risk Factor Surveillance System data, 1993-1997.

OBJECTIVES: The purpose of this study was to document and describe Behavioral Risk Factor Surveillance System (BRFSS) data use patterns, benefits, and barriers from 1993 to 1997. METHODS: Data use information was gathered via a Medline database search and a telephone survey of BRFSS program directors (n = 54). RESULTS: The database search uncovered 109 BRFSS-based reports. Program directors indicated that BRFSS data frequently were used to support health policies regarding diabetes, physical activity, and smoking. Frequent data use barriers included insufficient special population data, insufficient city- or county-specific data, and insufficient staff. CONCLUSIONS: Use of BRFSS data, which aid several state health activities, increased from 1993 to 1997.

Data Interpretation, Statistical↗
PubMed2003

Increases in gonorrhea and sexual risk behaviors among men who have sex with men: a 12-year trend analysis at the Denver Metro Health Clinic.

BACKGROUND: Recent increases in rates of sexually transmitted diseases (STDs) and decreases in safe sex behaviors among men who have sex with men (MSM) in several American and European cities have been noted by researchers. It has been suggested that these trends are the result of perceptions that HIV/AIDS is less serious because of the availability of highly active antiretroviral therapy (HAART). GOAL: The goal of the study was to examine trends in STD rates and risk behaviors among MSM and men who have sex with women (MSW) visiting a public STD clinic in Denver and to determine whether there is an ecological association with the availability of HAART. STUDY DESIGN: This is a two-part retrospective analysis of male visits to the Denver Metro Health Clinic (DMHC). The first part describes gonorrhea and early (primary and secondary) syphilis trends among MSM between 1982 and 2001. For the second part, data were grouped into two 6-year time periods to represent pre-HAART and post-HAART time frames, 1990 to 1995 and 1996 to 2001. RESULTS: Gonorrhea and early syphilis cases among MSM declined precipitously between 1982 and 1988 and then stabilized at low rates. The proportion of male visits to the clinic made by MSM decreased from 14.1% in 1990 to 7.2% in 1995 and then increased to 13.0% in 2001. Gonorrhea positivity rates among MSM increased after 1995 and were significantly higher in the period 1996 to 2001 (12.9%) than in the period 1990 to 1995 (8.1%; P<0.0001). Conversely, gonorrhea rates among MSW dropped from 11.2% in the first period to 6.9% in the second (P<0.0001). Among MSM known to be HIV-infected, gonorrhea rates increased from 11.6% in the first time period to 24.0% in the second period (P<0.0001). Reports of anal sex among MSM increased from 64.4% to 70.9% (P<0.0001). Reporting more than one sex partner increased for MSM from 65.2% to 70.3% (P<0.0001), but it significantly decreased from 52.6% to 46.2% for MSW (P<0.0001). No or inconsistent condom use increased from 60.9% to 63.0% for MSM (P=NS) and decreased from 85.1% to 82.4% among MSW (P<0.0001). CONCLUSIONS: These trends appear to reflect a change toward higher risk-taking behaviors among MSM but not MSW since the time HAART became available and raise concerns about the potential for increased HIV transmission in this group.

Adult↗
PubMed2006

High HIV sexual risk behaviors and sexually transmitted disease prevalence among injection drug users in Northern Vietnam: implications for a generalized HIV epidemic.

BACKGROUND: HIV prevalence in Vietnam is currently concentrated among injection drug users (IDUs). The extent to which this core risk group represents a potential for broader HIV transmission to the general population is currently unknown. METHODS: A community-based cross-sectional study among IDUs in Vietnam assessed sexually transmitted disease (STD) prevalence and behavioral risk factors. Qualitative interview data enhanced quantitative findings. RESULTS: The prevalence of any STDs among 272 IDUs was 30% (chlamydia, 9%; herpes simplex virus type 2 [HSV-2], 22%; gonorrhea, 0%; and syphilis, 1%). Part-time work or unemployment (odds ratio [OR] = 2.74, 95% confidence interval [CI]: 1.1 to 6.9), sex with > or =2 sex workers in the past year (OR = 4.9, 95% CI: 1.91 to 12.6), having ever smoked heroin (OR = 4.5, 95% CI: 1.1 to 18.3), and injecting less frequently than daily (OR = 3.9, 95% CI: 1.43 to 10.6) were independently associated with chlamydial infection. Urban residency (OR = 4.0, 95% CI: 1.4 to 11.0) and daily injecting (OR = 2.2, 95% CI: 1.1 to 4.4) were independently associated with HSV-2. Odds of HSV-2 among older (> or =28 years of age) IDUs who had sex with <2 sex workers in the past year was higher than among younger IDUs who had sex with more sex workers (OR = 6.4, 95% CI: 2.1 to 18.4). CONCLUSIONS: High STD prevalence and high-risk sexual and parenteral behaviors among IDUs indicate the potential for HIV/STD transmission to the general Vietnamese population.

Chlamydia Infections↗
PubMed2005

Sexual risk behavior among injection drug users before widespread availability of highly active antiretroviral therapy.

HIV testing and counseling has been associated with reductions in risk behaviors in some populations. This study examined whether involvement in a long-term study, including exposure to repeated HIV testing and counseling, was associated with increased condom use among injection drug users (IDUs) through a retrospective analysis of an IDU cohort from Baltimore, MD, during 1994-1998. Eligibility included being aged 18 years or older, injecting within 10 years and not having initiated antiretroviral therapy. A logistic model of high versus low risk, based on condom use, was used. Of 322 eligible IDUs, most were male (66%) and African-American (94%). No significant change in the odds of inconsistent condom use was observed with continued study exposure. Condom use remained low, indicating a need for interventions to reduce sexual risks and HIV transmission in this population.

AIDS Serodiagnosis↗
PubMed2001

Injection-related risk behaviors in young urban and suburban injection drug users in Chicago (1997-1999).

We compared injection-related risk practices between urban and suburban injection drug users (IDUs) in a large cross-sectional sample of young IDUs. From 1997 to 1999, we recruited 700 active IDUs aged 18 to 30 years in Chicago and its suburbs. A suburban residence was reported by 38% of participants. Participants were interviewed at four urban locations and screened for HIV and hepatitis C virus antibodies. Receptive sharing of syringes and other paraphernalia by urban and suburban IDUs in the preceding 6 months was compared using univariable and multivariable models. Sharing injection paraphernalia in the total sample was high, with 50% of participants reporting receptive syringe sharing and 70% reporting sharing cotton, cookers, and/or rinse water. After adjusting for demographic characteristics, injection settings, frequency, and duration of injection as well as ease of acquiring new syringes, suburban IDUs were significantly more likely than urban IDUs to share syringes (adjusted odds ratio = 1.7; 95% confidence interval: 1.1-2.5); however, the likelihood of sharing cotton, cookers, or rinse water was roughly equal. Despite overall higher risk profiles among suburban IDUs, HIV and hepatitis C prevalence levels were significantly lower than among urban participants. Current high levels of injection risk behaviors in suburban groups represent a potential for rapid dissemination of infection.

Adolescent↗
PubMed2006

Understanding children's injury-risk behavior: wearing safety gear can lead to increased risk taking.

The present study examined whether school-age children show risk compensation and engage in greater risk taking when wearing safety gear compared to when not doing so when running an obstacle course containing hazards that could lead to physical injury. Because sensation seeking has been shown to influence risk taking, this child attribute was also assessed and related to risk compensation. Children 7-12 years of age were videotaped navigating the obstacle course twice, once wearing safety gear and once without safety gear, with reverse directions used to minimize possible practice effects. The time it took the child to run through the course and the number of reckless behaviors (e.g., falls, trips, bumping into things) that the child made while running the course were compared for the gear and no-gear conditions. Results indicated that children went more quickly and behaved more recklessly when wearing safety gear than when not wearing gear, providing evidence of risk compensation. Moreover, those high in sensation seeking showed greater risk compensation compared with other children. Implications for childhood injury prevention are discussed.

Child↗
PubMed2003

Self-reported asthma and health-related quality of life: findings from the behavioral risk factor surveillance system.

STUDY OBJECTIVES: Few population-based data regarding the impact of asthma on health-related quality of life in the US adult population are available. DESIGN: Cross-sectional study of participants in 50 states in the United States. SETTING: Using data from 163,773 adult respondents in the 2000 Behavioral Risk Factor Surveillance System, we examined how self-reported asthma is associated with general self-reported health and four health-related quality-of-life measures. RESULTS: Participants with self-reported current asthma reported significantly more age-adjusted physically unhealthy days (6.5 days vs 2.9 days, p < 0.001), mentally unhealthy days (5.2 days vs 3.0 days, p < 0.001), days with activity limitation (3.7 days vs 1.6 days, p < 0.001), and unhealthy physical or mental days (10.0 days vs 5.4 days, p < 0.001) in the last 30 days than participants who never had asthma. After adjusting for age, sex, race or ethnicity, educational attainment, employment status, smoking status, physical activity status, and body mass index, the odds ratios among persons with asthma compared with persons who never had asthma, were 2.41 (95% confidence interval [CI], 2.21 to 2.63) for reporting poor or fair self-rated health, 2.26 (95% CI, 2.06 to 2.49) for reporting >or= 14 days of impaired physical health during the previous 30 days, 1.55 (95% CI, 1.40 to 1.72) for reporting >or= 14 days of poor mental health during the previous 30 days, 1.96 (95% CI, 1.73 to 2.21) for reporting >or= 14 activity limitation days, and 1.99 (95% CI, 1.84 to 2.15) for reporting >or= 14 days of physically or mentally unhealthy days during the previous 30 days. Results were consistent for all age groups, for both sexes, and for all race or ethnic groups. Participants who did not currently have asthma, but had it previously, reported having more unhealthy days with all four measures than participants who never had asthma, but fewer than participants who currently had asthma. CONCLUSIONS: These results provide additional measures to evaluate and monitor the impact of asthma on the health of the US adult population.

Adult↗
PubMed1994

HIV-risk behavior among lesbians and bisexual women.

Although limited available data suggest that AIDS is currently less common among lesbians than among heterosexual women, this study suggests considerable HIV-risk behavior among our sample of lesbians and bisexual women. In addition, a majority of respondents, including women at risk, do not use safer-sex practices.

Bisexuality↗
PubMed1990

[Psychological characteristics of patients with ischemic heart disease and behavioral risk factor (type A personality)].

Psychological features were examined in 64 coronary heart disease (CHD) patients with type A behavioral risk factor. CHD was diagnosed after all the patients had undergone selective coronary angiography. To study personality traits, traditional psychological methods were used such as MMPI, the Spilberger questionnaire, Jenkins' questionnaire scores. According to the scores of MMPI (5MF, 8 Sc, Osi, F), type A behavior subjects were demonstrated to have lower ratings than type B behavior ones. No differences in anxiety shown by people were found. The findings suggest that Type A persons are inclined to have intrapersonal contacts, socially active, emotionally responsive on the one hand, and exhibit a provoked hostility, on the other hand. This leads to the formation of an emotional conflict which may be a factor causing a long-term emotional stress and predisposing to a more frequent development of CHD.

Adult↗
PubMed1997

Health habits and risk behavior among youth in three communities with different public health approach.

BACKGROUND: There is a consensus today that comprehensive public health activities including many actors are needed for impact on health compromising behaviors. However, few studies are available to document long term effects regarding youth. We identified three rural, demographically comparable communities dominated by nuclear middle class families. One of these communities demonstrated comprehensive public health activities directed towards adolescents' needs and life-styles for a duration of at least 15 years, while the other two had an outspoken ideology of relying only on national health promotion. METHODS: Local health planners and pediatricians performed in-depth interviews with key people and checked relevant reports to trace the local public health history and to assess conventional and unconventional activities regarding health promotion for adolescents in the three communities. The outcome of at least 15 years of different policy regarding health promotion was studied in 1991 through self-reports of 915 subjects, 13-16 years old, with a questionnaire distributed through schools with questions on health, health habits and health compromising behaviors. The study itself turned out to be an important intervention. The two "inactive" communities changed their policy and methods. For this reason a second survey was done in 1993 with 593 subjects 13-16 years in the "active" and in one of the "inactive" communities. RESULTS: The adolescents in the "active" community with a long duration of energetic and comprehensive public health activities consistently demonstrated better mental health, health habits and less risk behavior in contrast to the state in the two "inactive" communities. Two years of active work in the "inactive" communities marginally improved health there. CONCLUSION: This study suggests that consistent and comprehensive public health activities might have reduced risk taking behavior and improved health and health habits during mid-adolescence.

Adolescent↗
PubMed2006

Lags in behavioral change: A population based comparison of cardiovascular risk behavior in Poland and Sweden.

One thousand and twenty Polish men and women and 1,011 Swedish men and women aged 50 and recruited through primary health care took part in a survey relating to their knowledge of health-related behaviour, attitudes to health-related behaviour and self-reported risk behaviour. The results reveal that Poles know as much about cardiovascular risk factors as Swedes, but that Swedes feel that it is more important to change their dietary habits and to influence factors in the working environment to avoid the risk of developing CVD than did Poles. Swedes also displayed less risk behaviour than Poles and more Swedes than Poles had successfully stopped smoking. These findings suggest that differences in stages of health-related behavior that have previously been observed at an individual level may sometimes also be discerned at a national level.

Cardiovascular Diseases↗
PubMed2006

Repeat voluntary HIV counseling and testing (VCT), sexual risk behavior and HIV incidence in Rakai, Uganda.

We examined the effects of repeat Voluntary HIV counseling and testing (VCT) on sexual risk behaviors and HIV incidence in 6,377 initially HIV-negative subjects enrolled in a prospective STD control for HIV prevention trial in rural Rakai district, southwestern Uganda. Sixty-four percent accepted VCT, and of these, 62.2% were first time acceptors while 37.8% were repeat acceptors. Consistent condom use was 5.8% in repeat acceptors, 6.1% in first time acceptors and 5.1% in non-acceptors. A higher proportion of repeat acceptors (15.9%) reported inconsistent condom use compared to first-time acceptors (12%) and non-acceptors (11.7%). Also, a higher proportion of repeat acceptors (18.1%) reported 2+ sexual partners compared to first-time acceptors (14.1%) and non-acceptors (15%). HIV incidence rates were 1.4/100 py (person-years) in repeat acceptors, 1.6/100 py in first time acceptors and 1.6/100 py in non-acceptors. These data suggest a need for intensive risk-reduction counseling interventions targeting HIV-negative repeat VCT acceptors as a special risk group.

AIDS Serodiagnosis↗
PubMed1998

[AIDS and STD knowledge and risk behaviors among commercial sex workers in Myitkyina, Myanmar].

This study investigated AIDS and STD (Sexually Transmitted Diseases) knowledge, risk behaviors, and condom use among two different groups of female commercial sex workers (CSWs) in Myitkyina, Myanmar. Individual in-depth interviews were conducted with 65 direct and 65 indirect CSWs. These CSW groups differ in the prices they charge, their places and modes of employment, levels of knowledge concerning HIV and STD transmission and prevention, number of clients served, levels of condom use and STD symptoms. Indirect CSWs have higher levels of knowledge, fewer partners, and more frequent condom use; but still have high levels of STD symptoms and frequently engage in unprotected sex with clients. Many CSWs and their clients were originally from other regions; these people could well be agents in the rapid spread of the HIV virus throughout Myanmar. Interventions targeted to specific groups of CSWs and clients should be undertaken as soon as possible, including educational activities concerning AIDS and STD transmission and prevention, condom promotion and distribution, and activities to improve the health sector's capabilities to help both CSWs and their clients.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Risk factors for the transition from noninjection to injection drug use and accompanying AIDS risk behavior in a cohort of drug users.

Although injection drug users have been shown to reduce high-risk injection behaviors in response to the epidemic of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), the total elimination of risk behaviors has not been achieved. A more fundamental preventive measure may be to keep drug users from starting to inject at all. The authors selected 184 drug users from a cohort study in Amsterdam, the Netherlands, from 1985 to 1992, who had reported at entry to the study that they either had never injected drugs or had injected for the last time more than 1 year before the initial visit. Over a 5-year follow-up period, impressively high cumulative rates of transition to injection drug use were found in both groups. Among drug users who had never injected drugs, 30% began injecting; among those who had injected drugs 1-5 years before their entry into the study, 70% started injecting again. These rates were stable over time. The authors also confirmed that new injectors are at high risk of acquisition of HIV infection. With the use of a survival and a nested case-control analysis, the following independent risk factors that increased the likelihood of starting to inject were found: previous injecting history, ethnicity other than Surinamese/Antillean, regular long-term use of cocaine, current use of heroin, and a current steady sexual relationship with a partner who injects drugs. Given the high and stable incidence of initiation of injection among drug users within the cohort study, the prevention of this behavior appears to be difficult. Additional studies are needed to determine effective prevention strategies.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Multiple behavioral risk factor interventions in primary care. Summary of research evidence.

BACKGROUND: An important barrier to the delivery of health behavior change interventions in primary care settings is the lack of an integrated screening and intervention approach that can cut across multiple risk factors and help clinicians and patients to address these risks in an efficient and productive manner. METHODS: We review the evidence for interventions that separately address lack of physical activity, an unhealthy diet, obesity, cigarette smoking, and risky/harmful alcohol use, and evidence for interventions that address multiple behavioral risks drawn primarily from the cardiovascular and diabetes literature. RESULTS: There is evidence for the efficacy of interventions to reduce smoking and risky/harmful alcohol use in unselected patients, and evidence for the efficacy of medium- to high-intensity dietary counseling by specially trained clinicians in high-risk patients. There is fair to good evidence for moderate, sustained weight loss in obese patients receiving high-intensity counseling, but insufficient evidence regarding weight loss interventions in nonobese adults. Evidence for the efficacy of physical activity interventions is limited. Large gaps remain in our knowledge about the efficacy of interventions to address multiple behavioral risk factors in primary care. CONCLUSIONS: We derive several principles and strategies for delivering behavioral risk factor interventions in primary care from the research literature. These principles can be linked to the "5A's" construct (assess, advise, agree, assist, and arrange-follow up) to provide a unifying conceptual framework for describing, delivering, and evaluating health behavioral counseling interventions in primary healthcare settings. We also provide recommendations for future research.

Adult↗
PubMed1995

Cocaine use and HIV risk behavior in methadone maintenance patients.

This study examined sexual and drug use behavior in 247 methadone maintenance patients, to explore the association of cocaine use with human immunodeficiency virus (HIV) risk behavior. In univariate analyses, cocaine use was positively associated with any drug injection, number of injections, and sexual intercourse without condoms. These relationships remained significant after controlling for other drug use and demographic factors. Heroin use also contributed to injection-related risk. We conclude that cocaine use represents a continued source of risk for exposure to HIV in this population, and that more aggressive efforts are warranted to reduce illicit drug use, particularly of heroin and cocaine, in methadone patients.

Adult↗
PubMed2005

Cardiovascular risk factors and risk behaviors in railway workers. Professional stress and cardiovascular risk.

UNLABELLED: The research considers the hypothesis that stressful professions, such as engine driver, influence the morbidity and mortality through cardiovascular diseases and favour some harmful habits with an impact upon cardiovascular morbidity. METHODS: There were selected for study 496 engine drivers, males, and a control group of 305 males. They were questioned about: name, address, family history, pathological personal history, alcohol intake, smoking, diet habits, physical activity, sleeping hours and stress perception. There were measured: height, weight, blood pressure. There were determined: fasting plasma glucose, cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol. RESULTS: Hypertension was registered in 23.5% of the engine drivers and in only 9.5% the control group (P<0.05). Dyslipidemia was noted in 57.4% of the engine drivers and 52.45% of the control group. Prevalence of smoking and overweight was higher in the control group. Unhealthy dietary patterns and physical inactivity were present in both groups, the circadian rhythms were altered only for engine drivers and questionnaires for stress perception showed higher irritability in the control group. CONCLUSIONS: The prevalence of some risk factors is higher for engine drivers, but for the others it is not. Also it seems that professional stress favours some harmful habits such as tobacco smoking, but the control group smokes more and they are inactive individuals with a great amount of irritability. The results do not totally sustain the idea we started from, that engine driver is a stressful profession; it seems that the effort/reward imbalance is more important than job-demand itself.

Adult↗
PubMed1999

Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985-1997.

OBJECTIVES: This study examined whether HIV counseling and testing leads to reductions in sexual risk behavior. METHODS: The meta-analysis included 27 published studies that provided sexual behavior outcome data, assessed behavior before and after counseling and testing, and provided details sufficient for the calculation of effect sizes. The studies involved 19,597 participants. RESULTS: After counseling and testing, HIV-positive participants and HIV-serodiscordant couples reduced unprotected intercourse and increased condom use more than HIV-negative and untested participants. HIV-negative participants did not modify their behavior more than untested participants. Participants' age, volition for testing, and injection drug use treatment status, as well as the sample seroprevalence and length of the follow-up, explained the variance in results. CONCLUSIONS: HIV counseling and testing appears to provide an effective means of secondary prevention for HIV-positive individuals but, as conducted in the reviewed studies, is not an effective primary prevention strategy for uninfected participants. Theory-driven research with attention given to the context of testing is needed to further explicate the determinants of behavior change resulting from HIV counseling and testing, and the effectiveness of specific counseling approaches.

AIDS Serodiagnosis↗