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Life events, cardiovascular reactivity, and risk behavior in adolescent boys.

BACKGROUND: Risk behavior contributes to injuries, one of the most important sources of morbidity and mortality in adolescents. Although research has shown that environmental stress makes adolescents more likely to engage in risk behavior and to sustain injuries, the magnitude of these associations has been small. Little is known about the role of individual differences in psychobiologic reactivity to stress in moderating the impact of stressful events. In this study, we examined associations among environmental stressors, cardiovascular reactivity to stress, and the level of risk behavior in adolescent boys. METHODS: Twenty-four 14- to 16-year-old boys underwent a laboratory protocol designed to measure responses to psychologically and physically stressful tasks. Changes in heart rate and mean arterial blood pressure were measured serially at standard points in the protocol, and levels of positive and negative life events and recent risk behavior were measured using self-report questionnaires. RESULTS: Neither life events nor cardiovascular reactivity were independently associated with risk behavior. Positive life events and mean arterial blood pressure reactivity significantly interacted, however, in predicting risk behavior (R2 increment = .25). Boys with high reactivity who reported numerous positive life events engaged in markedly less risk behavior than their peers. CONCLUSION: We conclude that adolescents with exaggerated cardiovascular responses to laboratory stressors are associated with less risk behavior in a setting of positive life circumstances. This result suggests that reactivity may exert protective, rather than harmful, influences in some environments.

Adolescent↗

HIV risk behavior and risk-related characteristics of young Russian men who exchange sex for money or valuables from other men.

One of the world's newest HIV epidemics is emerging now in Russia and other countries of Central and Eastern Europe. We report on the HIV risk characteristics of young Russian men who exchange sex for money or valuables, a group that constitutes almost one-fourth of men surveyed recently in gay-identified venues in St. Petersburg. Among 96 MSM who have sex for economic gain, most reported multiple male and female partners, 45% had unprotected anal intercourse with their male partners in the past three months, and many not only received but also gave money or valuables themselves to their male partners. Relative to men who did not give sex for economic gain (n = 326), those who did were younger (n = .0001), less well-educated (p = .0001), and more often unemployed (p = .02). They also were less knowledgeable concerning even basic HIV risk reduction steps (p = .02) and held many misconceptions about safer sex. Men who exchanged sex for economic gain had more male (p = .001) and female partners (p = .01) in the past three months than men who did not, and one-third had been treated for STDs. In the context of Russia's rapid cultural and social changes, economic turmoil, and gay communities not yet experienced in AIDS, HIV prevention programs must be tailored to risk patterns and dynamics different than those found in the gay communities of many western countries.

Adolescent↗

Guidelines for designing a Web-delivered college health risk behavior survey: lessons learned from the University of Florida Health Behavior Survey.

Collecting health-risk behavior data from college students is a Web survey research application with extraordinary potential that has implications for individual schools and for the next National College Health Risk Behavior Survey. Recent evidence suggests that it is now feasible to collect health-risk behavior data from college students using the Web. This article describes the eight steps used in the 1999 University of Florida Health Behavior Survey that demonstrated the feasibility of the Web to collect health-risk behavior data from undergraduates. Practical issues researchers should consider when conducting Web-delivered survey research also are presented. Information in this article can be used by college and university health survey researchers and student health service administrators to plan and conduct their own health-risk behavior Web-delivered survey, and to develop an electronic college health-risk behavior surveillance system for their schools.

Behavioral Risk Factor Surveillance System↗

The association of sexual risk behaviors and problem drug behaviors in high school students.

PURPOSE: To examine the associations among early age of onset of sexual intercourse and drug use, lifetime and current problem drug behaviors, and sexual risk behaviors. METHODS: The 1993 Massachusetts Youth Risk Behavior Survey was administered to a sample of 3,054 students from randomly selected high schools and classrooms; 36% (1,078) consistently reported having had sexual intercourse. Three indicators of sexual risk behaviors were assessed: (1) number of lifetime sexual partners, (2) number of recent partners, and (3) condom nonuse at last intercourse. Three sets of independent variables were analyzed: (1) age of onset of sexual intercourse and drug use, (2) lifetime drug use, and (3) recent drug use. RESULTS: Years of sexual intercourse, early age of onset of marijuana and cocaine use, lifetime frequency of marijuana, crack/freebase cocaine and alcohol use, and black race accounted for moderate amounts of the variation in the number of lifetime sexual partners. Years of sexual intercourse, early age of onset of marijuana use and cocaine use, lifetime frequency of crack/freebase and marijuana use, and recent use of cocaine, alcohol, and cigarettes accounted for smaller but significant amounts of the variation in the number of recent partners. Students more likely to report recent condom nonuse were older, females, had more years of sexual intercourse, had tried cocaine at a younger age, had used marijuana and cocaine more times (lifetime), and had more frequent recent use of marijuana. CONCLUSION: Increased frequency and severity of drug use behaviors and more years of sexual intercourse are associated with an increased number of sexual partners and recent condom nonuse. These findings may guide history-taking and referral practices of health care providers. Programs designed to prevent sexually transmitted diseases and pregnancy should address drug use as well as sexual behavior.

Adolescent↗

Effect of race category redefinition on hypertension and hypercholesterolemia prevalence in the behavioral risk factor surveillance system, 1999 and 2001.

Race information in the United States is used to identify populations at risk for cardiovascular disease (CVD) or associated risk factors. Behavioral Risk Factor Surveillance System data from 1999 and 2001 were used to examine shifts in racial distributions and CVD risk factors after a multiracial category was added in 2001. We compared age-adjusted, weighted, race-specific prevalence estimates of self-reported high blood pressure (HBP) and high blood cholesterol (HBC) from 1999 and 2001 with descriptive statistics and 95% confidence intervals. The proportion of non-Hispanic Whites decreased significantly after the multiracial category was added. Overall, the prevalence of HBC did not significantly change, but HBP increased significantly, from 24.2% in 1999 to 25.6% in 2001 (P<.05). Among racial groups, only non-Hispanic Whites showed a statistically significant increase in HBP prevalence from 23.1% to 24.4% (P<.05); however, larger percentage increases in HBP were seen among non-Hispanic Asian/Pacific Islanders (3.5%) and non-Hispanic Blacks (1.6%). Among non-Hispanic Whites, when combining multiracial respondents whose preferred single race was non-Hispanic White, the prevalence of HBP was significantly higher in 2001 than in 1999. The race-specific prevalence of HBP and HBC was virtually unchanged, whether or not multiracial respondents were included in prevalence estimates. Observed HBP increases for non-Hispanic Whites were not caused by the addition of a multiracial category. In 2001, multiracial respondents had the second highest prevalence of HBP after non-Hispanic Blacks. To promote heart health, we must focus on the needs of this emerging multiracial group and on groups with increasing rates of HBP.

Adolescent↗

Demographic characteristics, treatment history, drug risk behaviors, and condom use attitudes for U.S. and Russian injection drug users: the need for targeted sexual risk behavior interventions.

Two separate databases, one on Russian (n = 444) injection drug users (IDUs), and the other on U.S. IDUs (n = 241), were merged, and responses were compared. Results indicated that Russian IDUs perceived themselves to be at greater risk for HIV/AIDS based upon behaviors over the past 90 days. U.S. IDUs were more likely to be tested for HIV, report a negative HIV result, and know more people with HIV. U.S. IDUs consumed greater amounts of alcohol and marijuana, and made more alcohol/drug treatment attempts than Russian IDUs. Russian IDUs injected more frequently, although were more likely to recently use clean needles. Russian and U.S. IDUs responded significantly differently to eight AIDS knowledge questions. Eight condom attitude questions were asked of each group, and each revealed significantly different responses. Gender differences for Russian IDUs were also observed. There is a clear need to create culturally targeted sexual risk reduction interventions.

AIDS Serodiagnosis↗

Heterosexual risk behaviors in at-risk young men from early adolescence to young adulthood: prevalence, prediction, and association with STD contraction.

Health-compromising lifestyles involve stable patterns of behavior and are associated with high-risk social environments and accelerated developmental trajectories. Developmentally, antisocial behavior is associated with such lifestyles. Mediational models predicting a measure of lifetime average sexual risk behavior assessed over a 10-year period (from ages 13-14 to 22-23 years) were examined for a sample of at-risk young men. The measure included years of abstinence from intercourse as well as levels of 3 key heterosexual indicators of risk: frequency of intercourse, number of intercourse partners, and condom use. Predictors included lifetime average measures of contextual, family, and peer process variables and individual behaviors. In addition, similar models for prediction of STD contraction were assessed. A younger age of onset of intercourse was associated with higher numbers of intercourse partners after onset. As hypothesized, findings indicated mediational associations of socioeconomic status, parental monitoring, deviant-peer association, antisocial behavior, and substance use in the prediction of sexual risk behavior. Lower condom use also predicted STD contraction.

Adolescent↗

The raw oyster consumer--a risk taker? Use of the Behavioral Risk Factor Surveillance System.

We used the 1988 Behavioral Risk Factor Surveillance System in Florida to determine the prevalence of consumption of raw oysters, a vehicle implicated in the transmission of several pathogens. One-third of survey respondents reported ever eating raw oysters. The prevalence was higher for persons 18-49 years old and for males, and, when controlled for age and sex, for persons who reported being cigarette smokers or acute or chronic alcohol drinkers, and driving while intoxicated.

Adolescent↗

Suicidal behavior in the family and adolescent risk behavior.

PURPOSE: The purpose of this study was to examine the prevalence and sociodemographic characteristics of adolescents exposed to suicide attempts and suicide deaths by a family member and to evaluate the separate associations between exposure to a family member's suicide attempts or suicide death and risk behaviors, social-emotional functioning, and family connectedness. METHOD: We performed a cross-sectional analysis of data collected in 1995 for wave I of the National Longitudinal Survey of Adolescent Health (n = 5,918). The independent variable was the exposure to suicidal behavior by a family member during the past 12 months (death by suicide, suicide attempt, and no suicidal behavior). The dependent variables were substance use, suicidal behavior, violent behavior, perceived shortened life expectancy, emotional distress, and parental and adolescent reports of family connectedness. RESULTS: In the year before the survey, 3.9% of adolescents experienced a family member's suicide attempt whereas 1.2% experienced a family member's death by suicide. In regression analyses adjusting for sociodemographic variables, adolescents who had experienced the suicide attempt of a family member were more likely than those with no exposure to report the following: cigarette and marijuana use, alcohol misuse, suicidal ideation and attempts, fighting and inflicting injuries, decreased life-expectancy, emotional distress, and decreased adolescent reports of parent-child and family connectedness. Adolescents who had experienced a family member's death by suicide were more likely to report marijuana use and alcohol misuse, suicidal ideation and attempts, inflicting severe injuries, and emotional distress. CONCLUSIONS: Adolescents who have experienced suicide attempts or suicide deaths in the family show high levels of at-risk behaviors, most notably their own suicidal ideation and attempts.

Adolescent↗

Associations between health-related quality of life and demographics and health risks. Results from Rhode Island's 2002 behavioral risk factor survey.

BACKGROUND: Health-Related Quality of Life (HRQOL) has received much attention in recent years. HRQOL indicators have been used to track population trends, identify health disparities, and monitor progress in achieving national health objectives for 2010. Prior studies have examined health risks and HRQOL at the national level as well as at the state level. This paper examines multiple indicators of HRQOL by demographic characteristics and selected health behaviors for Rhode Island adults. METHODS: Data from Rhode Island's 2002 Behavioral Risk Factor Surveillance System (BRFSS), a random digit dialled telephone survey, were used for this study. The state wide sample contained a total of 3,843 respondents ages 18 and older. Multiple Imputation (MI) was applied to handle missing data, and data were modelled for each of 10 HRQOL indicators using multivariable logistic regression. RESULTS: By examining HRQOL through a multivariable approach we identified the strongest predictors for multiple indicators of poor HRQOL as well as predictors for specific indicators of poor HRQOL. Predictors for multiple indicators of poor HRQOL were: disability, inability to work, unemployment, lower income, lack of exercise, asthma, and smoking (specifically associated with poor mental health). CONCLUSION: Using multiple measures of HRQOL can help to assess the burden of poor health in a population, identify subgroups with unmet HRQOL needs, inform the development of targeted interventions, and monitor changes in a population's HRQOL over time. Use of these HRQOL measures in longitudinal and intervention studies is needed to increase our understanding of the causal relationships between demographics, health risk behaviors, and HRQOL.

Adult↗

A meta-analytic review of HIV behavioral interventions for reducing sexual risk behavior of men who have sex with men.

This meta-analysis examines the efficacy of international HIV prevention interventions designed to reduce sexual risk behavior of men who have sex with men (MSM). We performed a comprehensive search of published and unpublished English-language reports of HIV prevention interventions that focus on MSM and evaluated changes in risky sexual behavior or biologic outcomes related to sexual risk. Data from 33 studies described in 65 reports were available as of July 2003. Studies with insufficient data to calculate effect sizes were excluded from the meta-analysis. Interventions were associated with a significant decrease in unprotected anal intercourse (odds ratio [OR] = 0.77, 95% confidence interval [CI]: 0.65-0.92) and number of sexual partners (OR = 0.85, 95% CI: 0.61-0.94) and with a significant increase in condom use during anal intercourse (OR = 1.61, 95% CI: 1.16-2.22). Interventions successful in reducing risky sexual behavior were based on theoretic models, included interpersonal skills training, incorporated several delivery methods, and were delivered over multiple sessions spanning a minimum of 3 weeks. Behavioral interventions provide an efficacious means of HIV prevention for MSM. To the extent that proven HIV prevention interventions for MSM can be successfully replicated in community settings and adapted and tailored to different situations, the effectiveness of current HIV prevention efforts can be increased.

Centers for Disease Control and Prevention, U.S.↗

[Risk behaviors of intravenous drug users: are females taking more risks of HIV and HCV transmission?].

BACKGROUND: This work was aimed at identifying differences in HIV and HCV risk behaviors among intravenous drug users (IDUs) according to the gender and their determinants. METHODS: IDUs over 18 years, having had sexual intercourse and able to answer the questionnaire were interviewed in 10 drug abuse treatment centers or social institutions using a questionnaire adapted from the one used in the survey of sexual lifestyle in France. RESULTS: Over 612 eligible IDUs, 595 completed the questionnaire (women: 29%);37% had multiple partners with no difference according to the gender; 14% of the women and 7% of the men reported trading sex. More women reported inconsistent condom use (46% vs. 55%) and inconsistent clean equipment use (65% vs. 73%). A younger age, independently associated to sharing equipment (men: OR = 0.94; 95% CI = 0.90-0.99; women: OR = 0.92; 95% CI = 0.85-0.99) and inconsistent HIV serology testing, independently associated to inconsistent condom use (men: OR = 3.36; 95% CI = 2.02-5.60; women: OR = 10.72; 95% CI = 3.18-36.18), were the only risk markers common to both genders. For women, being HIV negative increased the risk of inconsistent condom use. Low educational level increased the risk of inconsistent clean equipment use. No risk marker among those analyzed was associated to having had multiple partners. For men, low socioeconomic status markers, a steady sexual partner or not living in couple and educational level were associated with sexual risk behaviors (inconsistent condom use and having multiple partners); low socioeconomic status markers were associated with injecting risk behaviors (inconsistent clean equipment use and sharing). CONCLUSIONS: Women were more likely to have both sexual and injecting risk behaviors; their significant risk markers are less numerous thus harm reduction could be more difficult than for men.

Adult↗

An adolescent age group approach to examining youth risk behaviors.

PURPOSE: To investigate relationships among youth risk behaviors and demographic factors using an adolescent age group approach. DESIGN: Cross-sectional data from a randomly selected population. Risk behaviors were compared within specific demographic factors and by adolescent age groups. SETTING: Racially diverse, inner-city neighborhoods in two midwestern cities. SUBJECTS: Teenagers (n = 1350) and parents (n = 1350) of the teenagers. MEASURES: Truancy; arrested/picked up by police; weapon carrying; fighting; sexual intercourse; tobacco, alcohol, and other drug use; demographic factors; and family structure. RESULTS: Youth mean age was 15.4 (+/- 1.7) years and 52% were female; racial/ethnic characteristics were 47% White, 22% Black, 19% Hispanic, and 10% Native American. Parents' mean age was 42.2 (+/- 8.4) years and 81% were female. chi 2 analyses indicated numerous significant (p < .05) youth risk behavior differences within the demographic factors and that many of the differences varied by adolescent age group. For example, risk behavior differences within racial/ethnic groups were most profound in the middle and older age groups, whereas risk behavior differences within parent income, education levels, and family structure were most apparent in the younger age groups. Of the demographic factors, family structure was most frequently associated with the risk behaviors. CONCLUSIONS: The results generally suggest that the relationships among risk behaviors and demographic factors vary within the adolescent age groups included in this study. The results will be useful for developing age-appropriate prevention programs for youth who fit the profile for these risk behaviors. The study protocol also includes specific sampling methods that may be useful for future studies that intend to collect data from difficult-to-reach populations.

Adolescent↗

Youth risk behavior survey: Bangkok, Thailand.

PURPOSE: To identify the prevalence of risk behaviors and related risk factors in adolescents in Bangkok, Thailand. METHODS: Youth risk behavior survey questionnaires were collected from 2311 adolescents in 8 schools, 13 communities and 2 Juvenile Home Institutions from January to February 2001. Their mean age was 15.5 +/- 1.8 years, and 59% were female. Risk factors of interest were gender, parental marital status, socioeconomic status, family relationship, parental drug addiction, peer group, loneliness, self-esteem, and school performance. Multiple logistic regression was used to identify significant risk factors associated with each risk behavior. RESULTS: The risk behaviors leading to traffic accidents were rarely or never having worn a seat belt (30.6%) or helmet while bicycling (66.9%) and while motorcycling (50.1%), riding with drivers who had consumed alcohol (18.8%), and driving after consuming alcohol (12.1%). The studied group carried weapons (8.5%) and has been involved in a violent event (31.5%). Among 13.9% who were assaulted, 6.7% needed hospitalization; rape was reported by 2.4%. Depression was reported by 19.9%, with 12% having suicidal tendencies and 8% attempting suicide. The lifetime use vs. heavy use prevalence of substance abuse, respectively, was: 15.4% and 3.5% for smoking, 37.3% and 1.7% for alcohol, 37.8% and 4.6% for amphetamine use, and 37.9% and 0.1% for other drugs. Among the 10% who have had sexual intercourse, 1% were homosexual, 7.1% have never used a condom, and 2.1% resulted in pregnancy. Being male was a risk factor for every untoward behavior except depression. Other risk factors included poor self-esteem, poor school performance, and early school leaving. Factors relating to the family included a low socioeconomic status, poor relationships, broken families, and parental substance abuse. Socioenvironmental factors included being in a gang and loneliness. Some risk behaviors started at younger than 8 years old. Schools and media were given as the sources of information regarding sex, human immunodeficiency virus infection, and substance abuse. CONCLUSIONS: The prevalence of six major-risk behaviors in adolescents in Bangkok was significantly high. Several risk factors were identified, the knowledge from which may help to form preventive measures in this population.

Accidents, Traffic↗

Online Risk Behavior in Adolescents: A Systematic Review.

Identifying and categorizing online risk behaviors is crucial for assessing their impact on adolescents. Despite extensive research, previous studies have not provided a clear classification of these behaviors. This systematic review synthesizes the quantitative literature on adolescent online risk behaviors from the inception of research to September 2023, aiming to: (a) offer a comprehensive overview of the types of online risk behaviors and the specific actions encompassed within each category among adolescents; (b) summarize the adverse outcomes associated with these behaviors; and (c) discuss the implications and future research directions. Utilizing key terms, this study sourced studies from four electronic databases (Scopus, PubMed, Web of Science, and EMBASE), ultimately including 22 English-language quantitative studies. The review reveals that online risk behaviors are primarily categorized into content risk behaviors, contact risk behaviors, and conduct risk behaviors. Adolescents engaging in these behaviors are at an increased risk of experiencing physical health issues, mental health problems, externalizing behaviors, and even self-harm and suicidal thoughts or actions. Further research is needed to develop and validate an online risk behavior scale and conduct longitudinal and experimental studies to establish causal relationships and examine the long-term effects of these behaviors on adolescent well-being. The review concludes with implications for future research and potential prevention, intervention, and policy strategies to mitigate online risk behaviors in adolescents.

Humans↗

Alcohol use, smoking, and feeling unsafe: health risk behaviors of two urban seventh grade classes.

Health risk behaviors undertaken in adolescence, such as drinking alcohol and smoking, can have a lasting consequence on both short-term and long-term health. To better describe the health risk behaviors being undertaken by an urban adolescent population, a study was conducted at two parochial, middle schools in the Southwest section of Philadelphia, Pennsylvania, USA. The study purpose was to describe the types of health risk behaviors being undertaken by a seventh grade student population, the frequency of health risk behaviors, and the age of initiation of the health risk behavior.A descriptive, correlational study was undertaken with 105 seventh graders (ages of 11 to 13 years) from two middle schools using the Youth Risk Behaviors Surveillance System (YRBSS) Questionnaire. Information was collected about health risk behaviors such as alcohol use and tobacco use and feeling safe. Findings indicated that these adolescent students reported increased incidence of health risk behaviors including alcohol use, smoking, and carrying weapons to combat their feeling unsafe in their neighborhoods. Interestingly, there were differences between schools in the type of health risk behaviors in which the students participated. Nurses are often in an ideal position to assess the health and behaviors of adolescents and to offer education, health promotion, and support to this at-risk population.

Adolescent↗

Effects of the mediterranean lifestyle program on multiple risk behaviors and psychosocial outcomes among women at risk for heart disease.

BACKGROUND: The Mediterranean Lifestyle Program was evaluated for its effects on multiple behavioral risk factors for coronary heart disease (CHD) among postmenopausal women with diabetes. PURPOSE: Our purpose is to test a comprehensive lifestyle management intervention to reduce CHD risk in postmenopausal women with type 2 diabetes. METHODS: Participants (N = 279) were randomized to usual care (UC) or Mediterranean Lifestyle Program, a lifestyle change intervention aimed at the behavioral risk factors (eating patterns, physical activity, stress management, and social support) affecting risk for CHD in postmenopausal women with type 2 diabetes. RESULTS: In original and intent-to-treat analyses, Mediterranean Lifestyle Program participants showed significantly greater improvement in dietary behaviors, physical activity, stress management, perceived support, and weight loss at 6 months compared to UC. CONCLUSIONS: This study demonstrated the effectiveness of the Mediterranean Lifestyle Program in improving self-care among women with type 2 diabetes, showed that postmenopausal women could make comprehensive lifestyle changes, and provided evidence that a program using social-cognitive strategies and peer support can be used to modify multiple lifestyle behaviors.

Aged↗

Risk perceptions and their relation to risk behavior.

BACKGROUND: Because risk perceptions can affect protective behavior and protective behavior can affect risk perceptions, the relations between these 2 constructs are complex and incorrect tests often lead to invalid conclusions. PURPOSE: To discuss and carry out appropriate tests of 3 easily confused hypotheses: (a). the behavior motivation hypothesis (perceptions of personal risk cause people to take protective action), (b). the risk reappraisal hypothesis (when people take actions thought to be effective, they lower their risk perceptions), and (c). the accuracy hypothesis (risk perceptions accurately reflect risk behavior). METHODS: Longitudinal study with an initial interview just after the Lyme disease vaccine was made publicly available and a follow-up interview 18 months later. Random sample of adult homeowners (N = 745) in 3 northeastern U.S. counties with high Lyme disease incidence. Lyme disease vaccination behavior and risk perception were assessed. RESULTS: All 3 hypotheses were supported. Participants with higher initial risk perceptions were much more likely than those with lower risk perceptions to get vaccinated against Lyme disease (OR = 5.81, 95% CI 2.63-12.82, p <.001). Being vaccinated led to a reduction in risk perceptions, chi2(1, N = 745) = 30.90, p <.001, and people vaccinated correctly believed that their risk of future infection was lower than that of people not vaccinated (OR =.44, 95% CI.21-.91, p <.05). CONCLUSIONS: The behavior motivation hypothesis was supported in this longitudinal study, but the opposite conclusion (i.e., that higher risk led to less protective behavior) would have been drawn from an incorrect test based only on cross-sectional data. Health researchers should take care in formulating and testing risk-perception-behavior hypotheses.

Adult↗