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PubMed2004

A randomized controlled trial to reduce HIV transmission risk behaviors and sexually transmitted diseases among women living with HIV: The WiLLOW Program.

OBJECTIVE: To evaluate the efficacy of an intervention to reduce HIV transmission risk behaviors and sexually transmitted diseases (STDs) and enhance HIV-preventive psychosocial and structural factors among women living with HIV. DESIGN: A randomized controlled trial of 366 women living with HIV in Alabama and Georgia. INTERVENTION: The intervention emphasized gender pride, maintaining current and identifying new network members, HIV transmission knowledge, communication and condom use skills, and healthy relationships. PRIMARY OUTCOME: Unprotected vaginal intercourse. OTHER OUTCOMES: Proportion never used condoms, incident STDs, psychosocial factors, and number of supportive network members. RESULTS: Over the 12-month follow-up, women in the WiLLOW intervention, relative to the comparison, reported fewer episodes of unprotected vaginal intercourse (1.8 vs. 2.5; P = 0.022); were less likely to report never using condoms (odds ratio [OR] = 0.27; P = 0.008); had a lower incidence of bacterial infections (Chlamydia and gonorrhea) (OR = 0.19; P = 0.006); reported greater HIV knowledge and condom use self-efficacy, more network members, fewer beliefs that condoms interfere with sex, and fewer partner-related barriers to condom use; and demonstrated greater skill in using condoms. CONCLUSION: This is the first trial to demonstrate reductions in risky sexual behavior and incident bacterial STDs and to enhance HIV-preventive psychosocial and structural factors among women living with HIV.

Adult↗
PubMed1991

Psychosocial influences on acquired immunodeficiency syndrome-risk behaviors among high school students.

A survey measuring acquired immunodeficiency syndrome (AIDS)-related behaviors and selected psychosocial factors was administered to 1091 tenth grade students residing in or near an AIDS epicenter. The purpose of the survey was to identify salient risk factors that could be targeted in AIDS prevention programs. By 15 years of age, one quarter of students reported engaging in behaviors that placed them at higher risk for acquiring infection with human immunodeficiency virus, and 3% of students reported engaging in very high-risk behaviors. Students exposed to certain psychosocial stressors (ie, adverse life circumstances and poor parental support), who engaged in other problem behaviors (ie, substance use and academic problems) and who had higher self-esteem, were more likely to engage in higher risk behaviors. Pediatricians and other clinicians, particularly those working in or near AIDS epicenters, who encounter adolescents with multiple psychosocial problems, should be alert to the possibility that these youths also are engaging in behaviors that place them at risk for AIDS. Comprehensive care for these teenagers must include an assessment of involvement in AIDS-risk behaviors and appropriate behavioral counseling.

Acquired Immunodeficiency Syndrome↗
PubMed1996

HIV risk behaviors and obstacles to condom use among Puerto Rican men in New York City who have sex with men.

OBJECTIVES: This paper describes the sexual risk behaviors of Puerto Rican men who have sex with men and their perceived obstacles to condom use. METHODS: Interviews were conducted with 182 Puerto Rican men living in New York, NY. RESULTS: Condoms were used inconsistently or not at all by half of the men who had anal sex with other men, by two thirds of the men who had vaginal sex, and by three fifths of those who had anal sex with women. Most of the men had had unprotected oral sex and more than one sexual partner in the previous year. Three of 10 were positive for the human immunodeficiency virus (HIV). Dislike of condoms was the most frequently cited obstacle, followed by perception of low risk, trust in and emotional connection with partner, unavailability and inconvenience of condom use, lack of control, and indifference. CONCLUSIONS: Barrier methods other than condoms, such as a microbicidal, gel, need to be developed.

Condoms↗
PubMed2006

Consumption of dietary supplements containing Citrus aurantium (bitter orange)--2004 California Behavioral Risk Factor Surveillance Survey (BRFSS).

BACKGROUND: Following the marketing ban of ephedra-containing supplements in April 2004, many manufacturers substituted the herb Citrus aurantium for ephedra and marketed the products as "ephedra-free" supplements. Extracts of C. aurantium contain synephrine, a sympathomimetic alkaloid. OBJECTIVE: To determine the prevalence of consumption of dietary supplements containing C. aurantium in California during 2004. METHODS: We used the 2004 California Behavioral Risk Factor Surveillance Survey to determine the prevalence of consumption of dietary supplements containing C. aurantium in California during 2004. RESULTS: Two percent (n = 70) of the 4140 survey respondents reported taking a dietary supplement containing C. aurantium in the previous year. Reasons stated included energy enhancement, weight loss, and appetite suppression. Compared with nonusers, users were more likely to report being single, aged 18-34 years, and Hispanic; consuming 3 or more alcoholic drinks on days that they imbibed; and having a heavier body mass index. Among the 5 users who reported experiencing an adverse event that they attributed to the supplement, 3 indicated that the severity was mild. CONCLUSIONS: Given that supplements containing ephedra were banned in April 2004, the results from this study may serve as a baseline estimate against which future studies of the use of C. aurantium products may be compared.

Adolescent↗
PubMed1994

Self-esteem, problem solving, and sexual risk behavior among women with and without Chlamydia.

Self-esteem and problem-solving appraisal were evaluated as an explanation of sexual risk behavior for the sexually transmitted disease (STD), chlamydia. Chlamydia, the most prevalent bacterial STD in the United States, is linked to a variety of problems which affect women, their offspring, and their sex partners. Data were collected by two nurse practitioners during scheduled gynecology visits for 105 military women. There was a statistical association among women with chlamydia (chi 2 = 3.623, df = 1, p = .057) and trichomonas (chi 2 = 12.83, df = 1, p = < .001) and a friable cervix. With a 10% prevalence of chlamydia, accurate diagnosis and treatment are imperative. No differences between the prevalence of chlamydia and self-esteem and problem-solving appraisal were noted. These findings support the strategies for diagnoses, treatment, and prevention of chlamydia recommended by the Centers for Disease Control.

Adult↗
PubMed2003

Associations between recommended levels of physical activity and health-related quality of life. Findings from the 2001 Behavioral Risk Factor Surveillance System (BRFSS) survey.

BACKGROUND: Although the benefits of regular physical activity on morbidity and mortality are established, relationships between recommended levels of physical activity and health-related quality of life (HRQOL) have not been described. The authors examined whether recommended levels of physical activity were associated with better HRQOL and perceived health status. METHODS: Using data from 175,850 adults who participated in the 2001 Behavioral Risk Factor Surveillance System survey, the authors examined the independent relationship between recommended levels of moderate or vigorous physical activity and four measures of HRQOL developed by the U.S. Centers for Disease Control and Prevention. Multivariate logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for age, race/ethnicity, sex, education, smoking status, and body mass index. RESULTS: The proportion of adults reporting 14 or more unhealthy days (physical or mental) was significantly lower among those who attained recommended levels of physical activity than physically inactive adults for all age, racial/ethnic, and sex groups. After multivariate adjustment, the relative odds of 14 or more unhealthy days (physical or mental) in those with the recommended level of activity compared to physically inactive adults was 0.67 (95% CI: 0.60, 0.74) for adults aged 18-44 years, 0.40 (95% CI: 0.36, 0.45) for adults aged 45-64 years, and 0.41 (95% CI: 0.36, 0.46) for adults aged 65 years or older. The results persist even among adults with a chronic condition such as arthritis. CONCLUSIONS: These results highlight the need for health programs to increase participation in regular physical activity.

Activities of Daily Living↗
PubMed2002

Prevalence of arthritis: analysis of data from the US Behavioral Risk Factor Surveillance System, 1996-99.

OBJECTIVE: Arthritis and other rheumatic conditions are a large and growing public health problem and constitute the most frequent cause of disability in the United States. Because many people with arthritis do not see a doctor for it, this study uses community surveys to estimate the prevalence of arthritis among adults and to identify subgroups with high prevalence rates of arthritis. METHODS: We used data from a cross sectional random digit telephone survey (the Behavioral Risk Factor Surveillance System) of noninstitutionalized adults aged 18 years or older conducted from 1996 through 1999. Estimates of self-reported arthritis, defined as chronic joint symptoms or doctor diagnosed arthritis, were derived from data in 15 states and Puerto Rico, all of which used an optional arthritis survey module for one or more years from 1996 through 1999. RESULTS: After adjusting for age, we found that arthritis was more common among several groups not recognized consistently in previous studies to have high prevalence rates of arthritis: separated and divorced people, those out of work or unable to work, and current and former smokers. It was also more common among several previously recognized groups with high prevalence rates of arthritis: older people, women, people with low education, people with low household incomes, physically inactive people, and overweight and obese people. CONCLUSION: Because appropriate management can minimize the influence of arthritis, health care providers should ask patients in high risk groups about arthritis symptoms. In addition, clinical and public health interventions may be targeted toward those subgroups with high prevalence rates of arthritis to reduce the disability from arthritis and improve their health related quality of life.

Adolescent↗
PubMed2001

Maryland dental hygienists' assessment of patients' risk behaviors for oral cancer.

PURPOSE: This study examined Maryland dental hygienists' knowledge of tobacco and alcohol use as oral cancer risk behaviors; the practice of obtaining comprehensive medical histories regarding patients' current, past, and type/amount of alcohol and tobacco used; and their opinions about the adequacy of their tobacco and alcohol cessation educational preparation in a state that ranks unusually high for oral cancer mortality rates. METHODS: The data source was the Maryland Oral Cancer Survey of Dental Hygienists conducted in November 1997 (MDOCSDH, 1997) with a simple random sample of 700 dental hygienists selected from a registry of 2,677 licensed dental hygienists in Maryland. Data were collected with a 40-item self-administered mailed questionnaire. Unweighted data from 331 returned surveys (response rate = 60%) were analyzed using SAS and SUDAAN Software. Stratified and logistic data analysis techniques were utilized, and the results were evaluated statistically using a .05 level of significance. RESULTS: Nearly all of the responding dental hygienists knew that tobacco is an oral cancer risk factor. Most probed their patients' present use of tobacco in medical histories; however, fewer assessed patients' past use and type/amount of tobacco used. Very few believed that they were adequately prepared to provide tobacco cessation education, although the majority agreed that dental hygienists should be prepared to provide this type of information. The majority of respondents also knew that alcohol use is an oral cancer risk factor; however, less probed their patients' present use of alcohol in medical histories compared to assessing present tobacco use. Even fewer assessed patients' past use and type/amount of alcohol used. A very small minority believed that they were adequately prepared to provide alcohol cessation education. Yet, in contrast to tobacco cessation counseling preparation, few respondents believed that dental hygienists should be prepared to provide alcohol cessation education. There was a significant relationship (p < .05) between screening for all three aspects of tobacco use and agreement of dental hygienists that they were adequately prepared to provide tobacco cessation education. Of seven background characteristics, practice setting was the only one found to be positively associated (p < .05) with even one of three complete medical history screening indices--the practice of assessing all three tobacco screening items. CONCLUSION: There is a need to provide more complete and accurate information in tobacco and alcohol educational programs for Maryland dental hygienists. Additional research is needed to explore sources of noninterest or discomfort in assessing patients' use of these substances, since a substantial number of Maryland dental hygienists do not assess all aspects of patients' tobacco and alcohol usage and do not agree that dental hygienists should be prepared to provide tobacco and alcohol cessation education for their patients. Maryland dental hygienists' opinions regarding the adequacy of their tobacco and alcohol cessation education appear to accurately reflect their practice of obtaining comprehensive medical histories regarding these substances.

Adult↗
PubMed2004

The process of changing health risk behaviors: an Oregon rural clinic experience.

PURPOSE: A counseling intervention was conducted by nurse practitioners (NPs) at a rural clinic in Oregon. The intervention was designed to help individuals change health risk behaviors. Three focus groups were conducted to aid in understanding the barriers to changing health behaviors and to identify resources that rural individuals needed to succeed in behavior change. DATA SOURCES: Quantitative data were collected using appraisal forms that were specific to five behaviors. Qualitative data were from written comments submitted by focus group participants in answer to questions sent prior to each meeting and from written summaries of focus group meetings submitted by the focus group leader. CONCLUSIONS: Most participants were not successful in changing their health behaviors. The issues raised in the focus group discussions provide an overview of the barriers to health behavior change as perceived by a group of adults in a rural environment. Both individual lack of will and the rural community environment were barriers to adopting new health behaviors. IMPLICATIONS FOR PRACTICE: NPs in rural health care clinics could provide important support for individuals attempting to adopt new health behaviors. Specific suggestions from focus group participants included discussing risky behaviors more often, forming support groups that do not charge a fee, and developing a peer-mentoring program.

Adult↗
PubMed2007

Perceived physical maturity, age of romantic partner, and adolescent risk behavior.

Early pubertal timing and advanced physical maturity for age confer elevated risk for problem behaviors for both boys and girls. However, examinations of possible biological and social mediators have been limited. Using more than 4,000 adolescents under age 15 who participated in Waves I and II of the National Longitudinal Study of Adolescent Health (Add Health), we examined the relationship between perceived physical maturity and membership in risk behavior clusters, and tested whether having a romantic partner mediates the maturity/risk behavior relationship. Results of multinomial regression models indicated that for both boys and girls, advanced physical maturity was associated with membership in higher risk clusters, and that having a romantic partner plays an important mediating role in this association. For females, the additional impact of having an older partner, versus any partner at all, was substantial and particularly important for the highest risk clusters. The role of partner age could not be tested for males. Because romantic partners elevate risk for young adolescent males and females, there is a need to identify and understand facets and developmental functions of adolescent romantic relationships that play a role in substance use and sexual decisions.

Adolescent↗
PubMed1998

Health risk behaviors of adolescent participants in organized sports.

PURPOSE: To assess differences in health-related behaviors between athletes and nonathletes. METHODS: In Grades 9-12 in seven high schools during the 1991-1992 academic year, 7179 (82%) students were asked to complete a survey with six categories of health-related behaviors associated with adolescent morbidity and mortality. Of the 6849 students who completed the survey, 4036 (56%) were classified as athletes. Analyses of differences were controlled for age, race, and gender. RESULTS: Athletes and nonathletes differed in specific health-risk behaviors. Nonathletes were more likely than athletes ever to have smoked cigarettes (15% vs. 10%) or used marijuana (24% vs. 23%), and fewer ate breakfast daily (34% vs. 45%), never added salt to food (18% vs. 22%), consumed calcium (56% vs. 64%), or consumed fruit or vegetables (40% vs. 47%) daily. More nonathletes reported frequent feelings of hopelessness (15% vs. 10%) and rarely or never using seatbelts (24% vs. 20%), but more athletes reported exceeding the speed limit by 10 mph (39% vs. 35%) and riding bicycles (40% vs. 28%) and/or motorcycles (13% vs. 8%) without helmets. These differences were statistically significant. CONCLUSIONS: Because of their behaviors, adolescent athletes put themselves at significant risk for accidental injuries. However, athletes appear less likely to smoke cigarettes or marijuana, more likely to engage in healthy dietary behaviors, and less likely to feel bored or hopeless.

Adolescent↗
PubMed1997

State smoking prevalence estimates: a comparison of the Behavioral Risk Factor Surveillance System and current population surveys.

OBJECTIVES: This study examined whether there are systematic differences between the Behavioral Risk Factor Surveillance System (BRFSS) and the Current Population Survey (CPS) for state cigarette smoking prevalence estimates. METHODS: BRFSS telephone survey estimates were compared with estimates from the US Census CPS tobacco-use supplements (the CPS sample frame includes persons in households without telephones). Weighted overall and sex- and race-specific BRFSS and CPS state estimates of adults smoking were analyzed for 1985, 1989, and 1992/1993. RESULTS: Overall estimates of smoking prevalence from the BRFSS were slightly lower than estimates from CPS (median difference: -2.0 percentage points in 1985, -0.7 in 1989, and -1.9 in 1992/1993; P < .05 for all comparisons), but there was variation among states. Differences between BRFSS and CPS estimates were larger among men than among women and larger among Blacks than among Hispanics or Whites; for most states, these differences were not significant. CONCLUSIONS: The BRFSS generally provides state estimates of smoking prevalence similar to those obtained from CPS, and these are appropriate for ongoing state surveillance of smoking prevalence.

Adult↗
PubMed1996

Use of health services by urban youth: a school-based survey to assess differences by grade level, gender, and risk behavior.

PURPOSE: The purpose of this study was: (a) to describe reported access to health care among urban youth, and (b) to compare intention to seek care and risk behaviors for youth who did and did not seek care. METHODS: A cross-sectional survey measuring knowledge, attitudes, self-efficacy, and behavioral intentions related to sexuality and use of and access to health care was administered to 3,677 urban middle and high school students in health education classes. RESULTS: A total of 13% of students reported no established health care, whereas 25% reported no care within the past 6 months. A physical examination was the most common reason for seeking care. Younger teenagers, males, and those not under care were less aware of teen clinics, thought it more difficult to access care, and had less intention to seek care within the next year (P < .001). Older students had greater knowledge and self-efficacy concerning sexual matters, were less positive about abstinence, and higher life and sex risk scores (P < .001). Females reported greater self-efficacy regarding sexual matters, were more positive about abstinence, and had lower life risk scores (P < .001). Adolescents receiving care had higher knowledge and self-efficacy scores, were more positive about condoms, had greater intention to seek care, but had higher life and sex risk scores. CONCLUSIONS: Awareness and use of health care remain low for a sizable number of at risk urban youth, especially younger and male teenagers. The school is a setting in which adolescents not under care can be reached for provision of information about health care.

Adolescent↗
PubMed1994

Understanding ethnicity, identity formation, and risk behavior among adolescents of Mexican descent.

The population of adolescents of Mexican descent is growing rapidly in the United States. However, the health needs of this group are not being adequately addressed by the health care system. Understanding the factors contributing to risk behavior in adolescents of Mexican descent may help improve service delivery and use. This article presents a sociodemographic profile of this group as well as a description of how one's degree of ethnic identification, acculturation, and other risk factors may contribute to problem behavior. Recommendations are provided to increase culturally appropriate prevention programs for youth of Mexican descent.

Acculturation↗
PubMed2005

Sexuality and sexual risk behavior in HIV-positive men who have sex with men.

The purpose of this study was to examine the psychological processes pertaining to sexuality and sexual risk behavior among HIV-positive men who have sex with men (MSM). The authors analyzed transcripts of 30 semistructured interviews. Findings suggest that sexual problems in HIV-positive MSM might be primarily caused by the perceived risk of transmitting HIV to others. Furthermore, safer sexual behavior seems to be related to feelings of personal responsibility for safer sex. This study illustrates that although some men might have a clear notion of personal responsibility for safer sex, contextual factors can influence whether behavior is consistent with their norms of personal responsibility. The implications of the study are discussed for the practice of HIV prevention for HIV-positive MSM.

Adult↗
PubMed1995

Trends in risk behaviors for HIV infection among U.S. high school students, 1989-1991.

The objective of this study was to examine trends in rates of self-reported HIV-related instruction and behaviors among high school students in the United States. Self-administered questionnaires were completed by three independent, multistage national probability samples of public and private school students in grades 9 through 12 who were surveyed in the spring of 1989, 1990, and 1991, respectively. Controlling for demographic characteristics, we used logistic regression to test for trends from 1989 to 1991. From 1989 to 1991, the proportion of students who had received HIV instruction in school significantly increased from 53.7% in 1989 to 83.3% in 1991. At the same time, the proportion of students engaging in selected sexual behaviors generally decreased. We found significant declines in the proportion of students who had engaged in sexual intercourse (58.5% in 1989 to 54.1% in 1991), had two or more sex partners during their lifetime (40.1% in 1989 to 35.2% in 1991), and had four or more lifetime sex partners (23.6% in 1989 to 18.7% in 1991). School-based HIV instruction, which is reaching greater numbers of U.S. students, may be contributing to the decline in reported risk behavior. However, because the current level of HIV-related behavior is still too high, risk-reduction efforts for adolescents should be maintained and strengthened.

Adolescent↗
PubMed2006

HIV knowledge and sexual risk behaviors of street children in Takoradi, Ghana.

A pilot survey was conducted among 100 street children aged 11-19 years and data collected regarding HIV knowledge, risk behaviors, home and sexual experiences, and factors that contributed to their relocation to the street environment. Data indicated that 80% of the street children had at least minimal knowledge of HIV and 54% perceived themselves to be at risk for contracting HIV. More than three-fourths of the females, and over half of the boys reported ever having sex. There were significant differences between males and females for sexual activity, physical and sexual abuse, and prostitution, as girls were more likely to be sexually active, physically abused, and involved in prostitution.

Attitude to Health↗
PubMed2003

Traumatic stress and gender differences in relationship to substance abuse, mental health, physical health, and HIV risk behavior in a sample of adolescents enrolled in drug treatment.

Research on traumatic stress (TS) among adolescent substance users is limited, with research indicating that not all adolescents who experience trauma are substance users and not all adolescent substance users report symptoms of TS. In the general adolescent population, research on TS symptoms indicates gender differences, with more females reporting traumatic life events and more symptoms associated with traumatic stress. A gap in research exists, however, with regard to gender differences among adolescent substance users who report low versus acute levels of TS symptoms. This study included 274 male and 104 female adolescents enrolled in four drug treatment programs in Arizona. Comparisons between males and females and those with low versus acute levels of TS symptoms were examined with regard to substance use, mental health, physical health, and HIV risk-taking behavior. Results indicate significant differences between males and females and between those reporting low versus acute TS. In general, females and those with acute levels of TS symptoms had higher levels of substance use, mental health, and physical health problems as well as greater HIV risk behaviors when compared to males and those with low levels of TS symptoms. Results of this study indicate the need to assess adolescents for TS, including victimization and maltreatment histories, when entering substance abuse treatment and the need to simultaneously address issues of substance use, TS, and related mental health, physical health, and HIV sex risk behavior while in treatment.

Adolescent↗