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PubMed2006

Socio-demographic correlates of betel, areca and smokeless tobacco use as a high risk behavior for head and neck cancers in a squatter settlement of Karachi, Pakistan.

BACKGROUND: Head and neck cancers are a major cancer burden in Pakistan. They share a common risk factor profile including regular consumption of products of betel, areca and tobacco. Use of paan, chaalia, gutka, niswar and tumbaku is acceptable in Pakistan and is considered a normal cultural practice. This cross-sectional study was carried out to understand the relation of socio-demographic factors for the consumption of paan, chaalia, gutka, niswar and tumbaku in Pakistani population. Through systematic sampling, 425 subjects from a squatter settlement in Karachi were interviewed using a structured questionnaire. High risk behavior was defined as Daily use of any of the above products. RESULTS: Daily use of all the substances except chaalia was higher among males compared to females. Chaalia use was higher among adolescents than adults while non-married consumed both chaalia and gutka more than married. Mohajir ethnicity had higher prevalence of paan, gutka and tumbaku use while Pathans had higher prevalence of niswar use. CONCLUSION: Prevalence of use of chewable products is high in Pakistan with particularly high use of certain substances related with socio-demographic profiles. Industrially prepared products, chaalia and gutka, are gaining popularity among youth. Policies and focused interventions can be developed taking into consideration the preferred use of products among different socio-demographic groups.

Journal Article↗
PubMed2002

Sexual risk behaviors associated with having older sex partners: a study of black adolescent females.

BACKGROUND: Volunteer black adolescent females from neighborhoods characterized by high rates of unemployment, substance abuse, violence, and sexually transmitted disease were studied to determine the frequency of condom use and unprotected vaginal sex with steady, older partners during various time periods over the previous 6 months. GOAL: To examine associations between having male sex partners who were typically older (by at least 2 years) and adolescent females' sexually transmitted disease (STD)/HIV-associated sexual risk behaviors. STUDY DESIGN: In this cross-sectional study, 522 sexually active black adolescent females completed a questionnaire and a structured interview, of which a portion assessed the age difference between the adolescents and their typical sex partners. The adolescents' ages, length of relationship and their use of hormonal contraception were identified as covariates. Adjusted odds ratios (AOR), their 95% confidence intervals, and respective P values were calculated to detect significant associations. RESULTS: Sixty-two percent of the adolescents reported their typical sex partners were at least 2 years older. These adolescents were more likely to report never using condoms during the most recent sexual encounter (AOR = 2.0), during the last five sexual encounters (AOR = 2.0), and during the past month (AOR = 2.2). Similarly, having older partners was associated with greater odds of reporting any unprotected vaginal sex in the past 30 days (AOR = 1.7) or the past 6 months (AOR = 1.5). CONCLUSION: Our findings suggest that many adolescent females have sex partners who are at least 2 years older and that their relationship dynamics do not favor the adoption and maintenance of behavior protective against STD or HIV infection. Prevention programs could include training designed to help adolescent females overcome barriers to safer sex with older male partners.

Adolescent↗
PubMed2006

A comparison of genital HIV-1 shedding and sexual risk behavior among Kenyan women based on eligibility for initiation of HAART according to WHO guidelines.

BACKGROUND: Guidelines for initiating antiretrovirals are based on markers of advanced disease and are not directly linked to markers of HIV-1 transmission such as viral shedding. METHODS: We evaluated genital HIV-1 shedding and risk behavior among 650 antiretroviral-naïve women stratified by WHO criteria for initiating antiretrovirals based on CD4 count and symptoms. RESULTS: Genital HIV-1 concentrations increased in stepwise fashion with declining CD4 counts and the presence of symptoms. Compared with the reference group (asymptomatic with CD4 >350 cells/microL), those with advanced immunosuppression (CD4 <200 cells/microL) had significantly higher cervical HIV-1 RNA concentrations (2.4 log10 copies/swab vs. 3.8 log10 copies/swab, P < 0.001). However, women with CD4 counts <200 cells/microL were also less likely than the reference group to report intercourse during the past week (58% vs. 26%, P < 0.001). CONCLUSIONS: Antiretroviral guidelines focusing on individuals with the most advanced immunosuppression will target those with the highest genital HIV-1 concentrations. However, individuals with less advanced immunosuppression also have high levels of genital HIV-1 and may be more sexually active. The effect of increased antiretroviral availability on the spread of HIV-1 might be enhanced by extending treatment, in addition to other risk reduction services, to those with less advanced disease.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Absence of prolonged immunosilent infection with human immunodeficiency virus in individuals with high-risk behaviors.

PURPOSE: The presence in some individuals of a prolonged phase of infection with human immunodeficiency virus type 1 (HIV-1) before seroconversion remains controversial. This study was undertaken to determine with a sensitive in vitro amplification technique, the polymerase chain reaction (PCR), whether seronegative individuals with high-risk behaviors could harbor HIV-1 sequences in their peripheral blood mononuclear cells (PBMCs) and remain seronegative for more than 6 months. PATIENTS AND METHODS: Seronegative individuals who engaged in unprotected anogenital intercourse with HIV-1-infected partners or with more than 10 individuals per year, and seronegative individuals who shared needles with seropositive partners, were recruited prospectively over 18 months. HIV-1 DNA and RNA sequences were detected in PBMCs of these individuals with three PCR assays using SK38/SK39, SK145/SK431, and SK68/SK69. Seronegative but PCR-positive patients were also evaluated with p24 antigen capture assay, radioimmunoprecipitation assay, and Western blot. The latter patients were followed prospectively to reproduce PCR-positive results and monitor serologic responses. RESULTS: Sixty-one men and 18 women, with an average age of 34.1 +/- 7.6 years, were recruited: 56 were homosexual men, 18 were heterosexual women, and 5 were heterosexual men. Amplification reactions for HIV-1 of 104 PBMC specimens from 79 patients with negative or indeterminate serologies revealed that 4 patients (5.1%) were positive with PCR for HIV-1 DNA and RNA at the time of enrollment. Positive amplification reactions could not be reproduced in prospective samples for one patient. The analysis of a variable human genomic locus in this patient's PBMCs demonstrated that the first PCR-positive sample and following PCR-negative samples originated from different patients, suggesting a specimen mix-up. Two of the three PCR-positive seronegative patients had symptoms suggestive of acute retroviral disease. Sera from all three patients contained p24 antigen. Two patients seroconverted within 1 month whereas one patient could not be followed prospectively. CONCLUSION: Prolonged infection with HIV-1 without seroconversion was not found in our population of patients at very high risk for HIV-1 infection. All PCR-positive patients seroconverted in less than 1 month.

Adult↗
PubMed1998

Self-assessed health status and selected behavioral risk factors among persons with and without health-care coverage--United States, 1994-1995.

Persons without health-care coverage are more likely to have poor health and be at greater risk for chronic disease outcomes than persons who have health-care coverage. In the United States, the number of persons and the proportion of the population without health-care coverage has increased each year since 1987. State-specific surveillance of health-care coverage can be used to identify subgroups of the population who lack such coverage and may be at increased risk for poor health. To determine state-specific estimates of the prevalence of self-assessed health status and risk factors for chronic disease by health-care coverage status among adults aged 18-64 years, CDC analyzed data from the 1994 and 1995 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis and indicates that adults without health-care coverage were more likely than those with health-care coverage to have poor health status, to be current smokers, and to be less physically active.

Adult↗
PubMedDate not supplied

Sexual initiation with older male partners and subsequent HIV risk behavior among female adolescents.

Data from a 1993-1994 survey of 150 black and Hispanic teenagers were used to examine differences in HIV risk-related behavior between young women who have a first sexual partner three or more years older than themselves and those whose first partner is their age. Compared with teenagers whose first partner had been roughly their age, the 35% of adolescents with an older partner had been younger at first intercourse (13.8 years vs. 14.6) and less likely to use a condom at first intercourse (63% vs. 82%). They also were less likely to report having used a condom at last intercourse (29% vs. 44%) or having used condoms consistently over their lifetime (37% vs. 56%) or in the previous six months (44% vs. 66%). Some 38% of teenagers with an older first partner had ever been pregnant, compared with 12% of those with a peer-age first partner. The mean number of partners and history of sexually transmitted diseases did not differ between the two groups.

Adolescent↗
PubMed1999

Use of stage of change (SOC) to develop an STD/HIV behavioral intervention: phase 1. A system to classify SOC for STD/HIV sexual risk behaviors--development and reliability in an STD clinic.

This paper reports on the initial phase in the development, program implementation, and inter-rater reliability of an application of Stage of Change (SOC) behavioral theory for use in STD/HIV risk reduction. SOC was adapted to assess readiness for sexual behavior change in an urban STD clinic in Rochester, New York. A standardized staging grid and protocol were developed and implemented as part of HIV pre- and post-test counseling. A "client instructor" methodology was used to assess standardization and staff inter-rater reliability. Percent agreement for stage assessment for target behaviors was calculated. The Rochester STD/HIV Behavioral Counseling (RoSHBeC) Staging Grid and Protocol was used to train staff and this staging system was implemented in the STD clinic. After training, staff identified the correct behavioral target and stage 90% of the time. Inter-rater agreement for SOC classification was greater than 70%. Our experience demonstrates that it is possible to develop, implement, and sustain an integrated provider-delivered STD/HIV behavioral intervention in a busy urban STD Clinic. This staging system has the potential for use in other settings and for other health-related behaviors.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Prevalence of gonococcal and chlamydial infections and sexual risk behavior among youth in Addis Ababa, Ethiopia.

BACKGROUND: No community-based study on the magnitude of sexually transmitted diseases (STDs) has ever been conducted among young people in Ethiopia. GOAL: To assess the magnitude of Chlamydia trachomatis and Neisseria gonorrhoeae infections and status of sexual risk behavior among youths (15-24 years old) in Addis Ababa, Ethiopia. STUDY DESIGN: Youths in or out of school residing in two (of the six) administrative zones in Addis Ababa served as the study population. Participants filled out a self-administered questionnaire related to sexuality and its sociocultural determinants. First-void urine (FVU) was analyzed for gonorrhea and chlamydial infection by polymerase chain reaction (PCR). RESULTS: A total of 561 youths took part in the study. Urine PCR was performed for 522 of them. Nine subjects (1.7%) were found to have and N gonorrhoeae and C trachomatis infections. There were five cases (1.0%) involving each agent. Double infection was noted in one female subject. All but one of the infections were detected among the out-of-school youths (chi-square = 4.5; < 0.05). None of these subjects complained of symptoms suggestive of an active STD. One-third (188/561) reported having had sexual intercourse. The prevalence among sexually active youths was thus 4.8% (9/188) for both infections combined (2.7% for each agent). While 7/52 (13.5%) of the sexually active females were found to also have STDs, only 2/136 (1.5%) of the males had an STD (chi-square = 8.0; < 0.01). Report of sexual activity was significantly associated with being male, an age of >/=20 years, out-of-school status, and report of alcohol/khat (amphetamine-like substance) consumption. Females reported less condom use, whether they were in or out of school and independent of age. CONCLUSIONS: Out-of-school youths, especially females, took more sexual risk and were exceedingly susceptible to STDs. This calls for alternative group-targeted strategies for sex education, disease prevention, and STD screening and management.

Adolescent↗
PubMedDate not supplied

Sexually transmitted disease prevention approaches that work. Interventions to reduce risk behavior among individuals, groups, and communities.

Behavior change remains the only available means to curtail new HIV infections. Although much remains to be learned about the effectiveness of different prevention strategies, there has already been evidence that both face-to-face interventions focused on individuals and community-level interventions focused on vulnerable communities can produce substantial reductions in high-risk sexual behavior. This article briefly describes the results of controlled outcome studies that have employed cognitive-behavioral and norm change elements to reduce HIV risk behaviors in face-to-face and community-level trials with both inner-city women and homosexual men.

Clinical Trials as Topic↗
PubMed1990

A skills-training group intervention model to assist persons in reducing risk behaviors for HIV infection.

Fifteen gay men with a history of recent high-risk sexual activities attended seven group sessions that provided risk education, training in self-management skills pertinent to risk reduction, sexual assertiveness training, and problem solving with respect to health consciousness, social supports, and efficacy of risk-reduction change. Before and after intervention, subjects completed measures of AIDS risk knowledge, sexual practices occurring over 4-month retrospective periods, and self-monitored records of ongoing sexual activities and participated in role plays assessing behavioral assertiveness skill for resisting high-risk coercions. Eight-month follow-up data were also collected. Subjects exhibited substantial and well-maintained change following intervention in behaviors relevant to HIV infection risk, including frequency of unprotected anal intercourse (which decreased to near-zero levels), condom use (which increased to almost 90% of intercourse occasions), and in an index that reflects the multiplicative function of risk behaviors frequency by the number of partners with whom high-risk behaviors occurs. This demonstration provides further evidence that skills-training approaches can assist individuals in implementing behavior changes to reduce risk for AIDS and identifies a model relevant to counseling efforts in AIDS prevention programs, HIV counseling and testing programs, drug abuse and STD clinics, and other applied settings.

Adolescent↗
PubMed1996

Radon awareness and testing behavior: findings from the Behavioral Risk Factor Surveillance System, 1989-1992.

Radon is considered an important environmental risk factor for lung cancer. Previous studies have shown that relatively few homes have been tested for radon. Results from the Behavioral Risk Factor Surveillance System from 1989--1992 show significant interstate and demographic variation in levels of radon awareness and home testing. There was evidence that levels of radon awareness and testing homes for radon have increased from 1989 through 1992. Although these trends in the data are encouraging, the data also suggest that continued education and other interventions may be necessary to reach the Public Health Service's testing and mitigating objectives for residential radon.

Adolescent↗
PubMed2001

Prevalence and associated factors of diabetes mellitus in Puerto Rican adults: behavioral risk factor surveillance system, 1999.

OBJECTIVE: To estimate the self-reported weighted prevalence of diabetes mellitus among different population subgroups and determine associated factors in Puerto Rico. METHODS: Data gathered from the Behavioral Risk Factor Surveillance Survey (BRFSS) during 1999 was analyzed. RESULTS: The weighted prevalence in Puerto Rico in 1999 was 9.6% (95% CI: 8.5%-10.7%), highest than reported nationally. It was higher among individuals with increasing age, female sex, decreasing annual income, decreasing educational attainment, being non-employed, having a health care coverage, high blood pressure, high blood cholesterol, and increasing body mass index. Health behaviors and co-morbid conditions significantly associated with diabetes among individuals aged less than 65 years were high blood pressure, high blood cholesterol, obesity and low educational attainment. However, the only significant characteristic associated with diabetes in individuals aged 65 years or more was female sex. Analysis of the data gathered in the diabetes module revealed that nearly 35% were using insulin, 57.4% were using insulin once a day, 14.4% self-monitored their blood glucose one to three times per day, 18.3% reported they have heard of the glycosylated hemoglobin test, and of these, 71.8% had their test performed between one and six times within the past year. Nearly 42% reported their feet were checked and 54.1% had a dilated eye examination last year. CONCLUSION: The high prevalence of diabetes in Puerto Rico underscores the need for developing integrated management strategies for improving quality of diabetes care.

Adolescent↗
PubMed1998

Violence and HIV sexual risk behaviors among female sex partners of male drug users.

OBJECTIVE: Violence and HIV are emerging as interconnected public health hazards among drug users and their families. The purposes of this study are to (1) determine the prevalence of sexual and physical abuse of non-drug-using female sex partners of male drug users, and (2) ascertain the association between such violence and HIV-related risk behaviors. METHODS: From 11/93 to 11/95, 208 female sex partners of injection drug or crack users in Collier County, FL, Tucson, AZ, and Portland, OR, were interviewed as part of a NIDA-funded HIV risk reduction project. Their mean age was 30 years (range 18-54); 21% were White, 6% African American, 7% Native American, and 63% Hispanic. RESULTS: Of the 208 women, 28% reported being sexually molested and 20% raped before age 13; 41% reported being raped at least once in their lifetime. Forty-two percent of the women were physically assaulted by their sex partners; 36% had been threatened with assaulted by their sex partners. Those who were raped or threatened with assault were more likely to have multiple sex partners and engage in unprotected anal sex; there was a trend for women who had been physically assaulted to be more likely to engage in unprotected anal sex. DISCUSSION: Rape, assault and the threat of assault are commonplace in the histories of female sex partners of male drug users. Experiences of violence and threats of violence are associated with heightened risk for the sexual transmission of HIV. Providers of HIV prevention need to understand the sequelae of violence, and design interventions which empower women to protect themselves from sexual transmission of HIV.

Adult↗
PubMedDate not supplied

[Prevalence, risk behavior, and level of information on urinary schistosomiasis in primary school students from the Primeiro de Junho Health District, Maputo, Mozambique].

To assess the prevalence and identify levels of information and risk behavior associated with vesical schistosomiasis, a cross-sectional study was conducted in October-November 1996, involving students from 3 primary schools in the Primeiro de Junho health district in Maputo, Mozambique. Epidemiological interviews and urine samples were taken from 434 male and female students from grades 2 through 5, randomly selected. Estimated prevalence was 11.3% (49/434). Highest prevalence was in the age group ( 15 years old, and the highest intensity of infection among the 10-14-year age group, with 204 eggs/10 ml urine. Approximately 18.9% had heard of schistosomiasis, and of these, only 19.5% (16/82) knew how the disease is manifested. Approximately 50% of the students reported frequent water contacts with potential sources of schistosomiasis. The study shows that vesical schistosomiasis is a public health problem among students in this health district.

Adolescent↗
PubMed1996

Reliability of self-reported human immunodeficiency virus risk behaviors in a residential drug treatment population.

This study examined test-retest reliabilities of self-reported human immunodeficiency virus (HIV) sexual and drug injection behaviors among 246 prior drug users admitted to either of two residential drug treatment programs in Westborough, Massachusetts, and Providence, Rhode Island, between June 1990 and September 1992. Participants, selected by their date of admission, were administered admission and reliability questionnaires pertaining to HIV risk behaviors, the latter at approximately 2 weeks after admission. Estimated reliabilities (kappa coefficients) of the sexual behaviors ranged from 0.72 to 0.91; those for the drug injection variables ranged from 0.63 to 0.98. These results were consistent across groups defined by sex and injection of drugs. The consistently good reliabilities are significant to the design of independent studies of drug treatment populations utilizing self-report measures of sexual and drug behaviors.

Female↗
PubMed2002

Risk behaviors of Filipino methamphetamine users in San Francisco: implications for prevention and treatment of drug use and HIV.

OBJECTIVE: This study describes the demographics, HIV risk and drug use behaviors, and psychosocial status of Filipino American methamphetamine users in the San Francisco Bay area. METHODS: Individual interviews were conducted with 83 Filipino American methamphetamine users, recruited through snowball sampling methods. A structured survey questionnaire included measures of drug use behaviors, HIV-related sexual behaviors, psychosocial factors, and demographics. RESULTS: Filipino methamphetamine users tended to be male, to have low levels of perceived personal control in their lives, and to report low levels of shame about their drug use. Methamphetamine use was strongly associated with HIV-related risk behaviors. Frequent methamphetamine users tended to engage in drug use before or during sex and to use condoms infrequently. Commercial sex activity was associated with frequency of methamphetamine use. About one-third of the study participants had never been tested for HIV. CONCLUSION: HIV/STD and drug abuse prevention programs that target Filipino Americans are needed. These programs should be tailored to meet clients' needs on the basis of gender, employment status, acculturation, and psychosocial variables that affect drug use and sexual behaviors.

Adolescent↗
PubMed2003

Risk behavior for transmission of human immunodeficiency virus (HIV) among HIV-seropositive individuals in an urban setting.

We conducted interviews with 256 human immunodeficiency virus (HIV)-infected patients who attended an HIV clinic in New York City to assess ongoing risk behaviors for HIV transmission. After learning that the result of an HIV test was positive, 106 subjects (41%) had unprotected sex, 63 (25%) had a new sexually transmitted disease diagnosis, and 38 (15%) used injection drugs. Unprotected sex was reported by 50% of women, 29% of heterosexual men (P=.006, compared with women), and 42% of men who have sex with men, and it was reported more often by persons with a history of trading sex for money or drugs (P<.001). In multivariate analysis, unprotected sex was associated with a history of trading sex for money or drugs (adjusted odds ratio [AOR], 4.0; 95% confidence interval [CI], 2.2-7.0) and use of highly active antiretroviral therapy (AOR, 1.8; 95% CI, 1.1-3.1). Ongoing risk-reduction counseling and substance abuse treatment for HIV-infected persons are needed to reduce behaviors associated with HIV transmission.

Adult↗
PubMed2006

Changes in high-risk behaviors over time among young drug users in South Vietnam: a three-province study.

Vietnam is in the midst of an expanding HIV epidemic, primarily driven by an increase in injection drug use in young people. This study was conducted to understand the patterns and initiation of drug use, and the sexual risk behavior among youth in three provinces in southern Vietnam. A cross-sectional survey was conducted among male and female drug users under age 25 recruited from drug treatment centers (N = 560) and the community (N = 240) in Ho Chi Minh City, Dong Nai and Ba Ria-Vung Tau. The majority of those surveyed (82%) began by smoking heroin; after a year, 57% were injecting heroin and/or opium. Initiation of drug use frequently occurred in entertainment venues. Among injectors, 23% shared needles; 71% of all users were sexually active of whom 77% had unprotected sex. More than half of those recruited from treatment centers had previously been in drug treatment. Public health programs to prevent and treat the dual epidemics of HIV and drug abuse must be able to access and respond to the needs of youth, many of whom are unemployed and exposed to drug traffic.

Adolescent↗