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PubMed2000

Interventions to prevent HIV risk behaviors. National Institutes of Health Consensus Development Conference Statement February 11-13, 1997.

OBJECTIVE: To provide health care providers, patients, and the general public with a responsible assessment of behavioral intervention methods that may reduce the risk of HIV infection. PARTICIPANTS: A non-Federal, nonadvocate, 12-member panel representing the fields of psychiatry, psychology, behavioral and social science, social work, and epidemiology. In addition, 15 experts in psychiatry, psychology, behavioral and social science, social work, and epidemiology presented data to the panel and a conference audience of 1000. EVIDENCE: The literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel, answering predefined questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. CONCLUSIONS: Behavioral interventions to reduce risk for HIV/AIDS are effective and should be disseminated widely. Legislative restriction on needle exchange programs must be lifted because such legislation constitutes a major barrier to realizing the potential of a powerful approach and exposes millions of people to unnecessary risk. Legislative barriers that discourage effective programs aimed at youth must be eliminated. Although sexual abstinence is a desirable objective, programs must include instruction on safer sex behaviors. The erosion of funding for drug abuse treatment programs must be halted because research data clearly show that such programs reduce risky drug abuse behavior and often eliminate drug abuse itself. Finally, new research must focus on emerging risk groups such as young people, particularly those who are gay and who are members of ethnic minority groups, and women, in whom transmission of HIV virus to their children remains a major public health problem.

Female↗
PubMedDate not supplied

Interventions to prevent HIV risk behaviors.

OBJECTIVE: To provide health care providers, patients, and the general public with a responsible assessment of behavioral intervention methods that may reduce the risk of HIV infection. PARTICIPANTS: A non-Federal, nonadvocate, 12-member panel representing the fields of psychiatry, psychology, behavioral and social science, social work, and epidemiology. In addition, 15 experts in psychiatry, psychology, behavioral and social science, social work, and epidemiology presented data to the panel and a conference audience of 1,000. EVIDENCE: The literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel, answering predefined questions, developed its conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. CONCLUSIONS: Behavioral interventions to reduce risk for HIV/AIDS are effective and should be disseminated widely. Legislative restriction on needle exchange programs must be lifted because such legislation constitutes a major barrier to realizing the potential of a powerful approach and exposes millions of people to unnecessary risk. Legislative barriers that discourage effective programs aimed at youth must be eliminated. Although sexual abstinence is a desirable objective, programs must include instruction on safer sex behaviors. The erosion of funding for drug abuse treatment programs must be halted because research data clearly show that such programs reduce risky drug abuse behavior and often eliminate drug abuse itself. Finally, new research must focus on emerging risk groups such as young people, particularly those who are gay and who are members of ethnic minority groups, and women, in whom transmission of the HIV virus to their children remains a major public health problem.

Adolescent↗
PubMed1995

Perception of AIDS risk and high-risk behaviors in African-American methadone-dependent women.

AIDS poses a particularly serious threat to African-American women who are or have been intravenous drug users. This study evaluated relationships among AIDS knowledge, perceptions of chances of contracting AIDS, and high-risk AIDS behaviors in 102 low-income African-American women from four methadone-maintenance clinics in Baltimore, who volunteered to answer questions about AIDS and their sexual and drug-use behaviors. The participants demonstrated a high level of AIDS knowledge, which was significantly correlated with their perception of likelihood of having the AIDS virus (r = .49, p < .05). However, there was little evidence of avoidance of high-risk sexual behaviors. Despite this knowledge, these data indicate that understanding how the virus is transmitted does not assure a change in behavior. The issue is complicated by the question of how knowledge possessed by individuals relates to their sense of powerlessness or empowerment and the risks and benefits associated with using that knowledge.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Assessment of behavioral risk for coronary disease by voice characteristics.

Behavior characterization is increasingly used and studied in the pathogenesis and management of coronary disease. A specific behavior pattern called Type A has been found to be independently associated with fatal and nonfatal coronary disease. The assessment of Type A is made without quantitative guidelines based on verbal and nonverbal behaviors in a standardized interview. This study has attempted to make this classification solely on the basis of quantifiable verbal behaviors. Two naive persons were trained to code speech behaviors from tape recorded behavior pattern interviews on which Type A had previously been assessed. Intercoder and intracoder reliability was acceptable. Using regression analysis 87% of the interviews were classified in agreement with the previous, standard assessment. Volume of voice and speed of speech were found to make the greatest predictive contribution. Other verbal characteristics including plosiveness were also important. It is concluded that Type A can be validly and repeatably measured by verbal behaviors in the standardized interview.

Aggression↗
PubMed2000

Reduction of high-risk behaviors among incarcerated youths: a challenge in prevention.

The adolescent population in America is at increasing risk for acquiring the human immunodeficiency virus (HIV) that causes AIDS (CDC, 1998; 1996; 1994; 1993). Although the total number of reported AIDS cases among adolescents 12 to 19 years of age is, thus far, fairly small, the identified caseload in this age group has increased by over 40% during one year alone. In fact, one-fifth of all reported AIDS cases occur among persons 20 to 29 years of age. Many of these young adults contracted HIV infections as teenagers (CDC, 1996). But the trend is changing. In fact, among younger youths, especially those of African heritage, the infection rates are rapidly increasing (CDC, 1999; CDC, 1998). These increases will require focused attention by all health professionals, and public policy officials (Lai, Tsai, Hardy, 1997; Porter, Oakley, Guthrie & Killion, 1999). The purpose of this current study was to describe risk-related behaviors of incarcerated youths that are significant factors when planning community-based programs for HIV/AIDS prevention. Several research questions were generated in this regard and tested. Several significant findings emerged from the data that indicate that African-American youths incarcerated are at greater risk for development of HIV/AIDS than their other ethnic counterparts.

Adolescent↗
PubMed2004

Increase in sexual risk behavior associated with immunologic response to highly active antiretroviral therapy among HIV-infected injection drug users.

This study identifies factors associated with high-risk sexual and drug injection behaviors among human immunodeficiency virus (HIV)-infected injection drug users (IDUs) after initiation of highly active antiretroviral therapy (HAART). Participants of a large cohort study of IDUs in Baltimore were seen at semiannual visits; blood samples to determine HIV serostatus and CD4+ cell count were obtained, as well as questionnaire data on risk behaviors and medication. Survival analysis conducted for 190 HIV-infected participants who initiated HAART during 1996-2000 revealed that an increase in CD4+ cell count (categorized as an increase of >0 cells/mm3 or of < or =0 cells/mm3) after HAART initiation was independently associated with engaging in any sexual intercourse (adjusted relative hazard [ARH], 1.83; 95% CI, 1.22-2.73) and with a 3-fold increase in the hazard of engaging in unprotected sexual intercourse (ARH, 3.29; 95% CI, 1.57-6.93) after HAART initiation. An increase in CD4+ cell count after HAART initiation was not associated with injection of drugs or needle sharing. Risk reduction counseling remains important, despite improvements in the treatment of HIV infection.

Adult↗
PubMedDate not supplied

Family characteristics and sexual risk behaviors among black men in the United States.

CONTEXT: Past research indicates that family characteristics are associated with sexual risk-taking behaviors in adolescence and adulthood Because the prevalence of sexually transmitted diseases is higher among black males than among males of other races, it is important to understand factors associated with sexual risk in this group. METHODS: Data from 1,125 black men participating in the 1991 National Survey of Men were used in structural equation modeling to examine the association of individual and family characteristics with age at sexual initiation and the lifetime number of sexual partners. RESULTS: Men whose mothers worked were likely to have first intercourse at a younger age than others (beta, -.104), whereas those raised by both parents were likely to delay sexual initiation (.072) and to have fewer partners during their lifetime (-.062). Men who were married or had had first intercourse at an old erage were likely to have a lower total number of partners than others (-.297 and -.369, respectively). CONCLUSIONS: School and community programs should provide culturally appropriate and accessible activities for black youth, and should reach black males early, while they are still in elementary school. Programming targeted at parents mayhelp them learn skills for communicating effectively with children about sexuality-related issues.

Adult↗
PubMed2003

Interventions to modify sexual risk behaviors for preventing HIV infection in men who have sex with men.

BACKGROUND: MSM remain at great risk for HIV infection. Program planners and policy makers need descriptions of interventions and quantitative estimates of intervention effects to make informed decisions concerning prevention efforts. OBJECTIVES: 1. To locate and describe outcome studies evaluating the effects of behavioral and social interventions targeting MSM. 2. To summarize the effectiveness of these interventions among MSM. 3. To stratify results by characteristics of interventions and participants. 4. To identify gaps and indicate future research, policy, and practice needs. SEARCH STRATEGY: We searched electronic databases (MedLine, PsycInfo, etc.); several current journals (e.g., AIDS, AIDS and Behavior, AIDS Education and Prevention, American Journal of Public Health, Journal of Acquired Immune Deficiency Syndromes, etc.); manuscripts submitted by researchers; bibliographies of relevant articles; and other published reviews, for published and unpublished reports from 1988 through 1997. SELECTION CRITERIA: Studies were considered in scope if they examined the effects of behavioral interventions to reduce risk for HIV or STD transmission. We reviewed studies in scope for criteria of outcome relevance (measurement of at least one of a list of behavioral or biologic outcomes, e.g., unprotected sex or incidence of HIV infections) and methodologic rigor (randomized controlled trials or certain strong quasi-experimental designs with comparison groups). DATA COLLECTION AND ANALYSIS: As of June 1998 we had identified 13 eligible studies. Twelve studies (7 trials of small group interventions, 3 community-level interventions, and 2 individual level interventions) reported intervention effects on unprotected sex. Because few studies reported effects on condom use (3 studies), number of sex partners without regard to condom use (4 studies), or HIV or STD incidence (1 study in which no infections occurred) we do not address these outcomes at this time. We present those analyses which can be performed in the current Cochrane RevMan software, followed by more complete analyses that permit inclusion of community-level studies, adjustment for baseline conditions, calculation of effect sizes from a wider variety of statistics (e.g., an F-statistic from a one-way ANOVA), and simultaneous meta-analysis of continuous and dichotomous outcomes (Johnson 2002b). We translate the summary effect to reduction in risk behavior based on the background prevalence of unprotected sex. Finally we provide analyses stratified by intervention content (interpersonal skills addressed or not), intervention format (community vs small group or individual) and mean age of participants (23 to 31 vs. 32 to 36). MAIN RESULTS: A summary measure of intervention effects on reducing unprotected sex was favorable (odds ratio = 0.73) and statistically significant (CI, 0.60 to 0.88), corresponding to a 23% reduction in the proportion of men engaging in unprotected sex. Effects were homogeneous among studies, but were slightly more favorable among community-level interventions, those that served populations in their 20s rather than their 30s, and those that promoted interpersonal skills. REVIEWER'S CONCLUSIONS: These studies demonstrate that interventions can promote risk reduction among MSM. Yet given the epidemiology of HIV in Pattern I countries, the small number of rigorous controlled intervention trials for this population is striking. Many more rigorous evaluations of HIV prevention efforts with MSM are needed to ascertain with confidence the effects of specific intervention components, population characteristics, and methodologic features.

HIV Infections↗
PubMed1997

Behavioral risk indicators of attachment loss in adult Floridians.

This study investigated behavioral and sociodemographic risk indicators of attachment loss (AL) at baseline in subjects of the Florida Dental Care Study: 873 subjects with at least 1 tooth, and who were 45+ years or older, participated for an in-person interview and dental examination; 761 subjects were probed for AL. Calibrated examiners used a modified NIDR protocol from the 1985-86 Survey of US Employed Adults and Seniors. Results were weighted to reflect actual population proportions. 92% of subjects had at least 1 site of 4+ mm AL, and 35% had at least 1 severe site (7+ mm AL). In a single multivariate regression, not having a recent dental check-up, not using dental floss, being a current smoker, and being diabetic were significantly associated with a higher probability of having 1 or more severe sites. Blacks were less likely than whites to be regular users of dental care, use dental floss, and be non-smokers. Similar findings were found for low income adults and rural residents. Risk groups (low income, blacks, rural residents) were more likely to present with modifiable risk indicators for AL, suggesting the need for targeted interventions.

Black or African American↗
PubMed1995

Psychosocial predictors of AIDS risk behavior and drug use behavior in homeless and drug addicted women of color.

The present study examined a causal model consisting of personal and social resources, threat appraisal processes, coping styles, and barriers to risk reduction as predictors of general AIDS risk and specific drug use behaviors among homeless African American (N = 714) and Latina (N = 691) women. The model, which was based on a stress and coping framework, supported many of the hypothesized relationships. Active coping was associated with fewer general AIDS risk behaviors for both groups and less specific drug use behavior among African American women. Specific drug use behavior was predicted by high threat appraisal and avoidant coping for both groups. Ethnic differences and implications for intervention are discussed.

Acculturation↗
PubMed2000

Prevention of sexual risk behavior for HIV infection with women.

This paper defines the components of gender-specific interventions for HIV infections for women, i.e. negotiation skills with male partners for condom use, integration of strategies against HIV and other STD infections and for contraception, the urgent need for female controlled methods, the importance of the inclusion of heterosexual men and an expansion to couples in prevention programs. This paper also presents a critical update in HIV prevention articles for women since the beginning of the AIDS epidemic through March 1996. All reviewed interventions were conducted in the U.S., Canada or Puerto Rico and described a psychological, behavioral, or educational component that addressed sexual risk reduction and included a behavioral evaluation. Manual and computer searches identified 47 studies that targeted women and provided a female-specific analysis of intervention effects. Overall, the findings demonstrate that HIV prevention programs can be effective in reducing risky sexual behavior among women. Program effectiveness varied by intervention type, session duration, and whether studies included women alone or both men and women. The most efficacious HIV prevention programs were specifically directed toward women, focused on relationship and negotiation skills, and involved multiple, sustained contacts. Evidence also indicated that community-level interventions hold promise. It is recommended that outcomes for women be expanded to include strategies beyond the male condom, such as refusing or avoiding unsafe sex or using the female condom.

Clinical Trials as Topic↗
PubMed1999

Methamphetamine use and sexual and injection risk behaviors among out-of-treatment injection drug users.

Our primary objective was to examine the relationship between methamphetamine use and sexual risk-taking behaviors--number of sexual partners, frequency of sexual behaviors with regular and casual partners, trading money or drugs for sex, and condom use--among male and female out-of-treatment injection drug users (OTIDUs). As a risk group for human immunodeficiency virus (HIV) transmission, we also investigated injection behaviors by methamphetamine use. Data were collected from 1392 OTIDUs within the California counties of Fresno, Sacramento, and San Diego. Excluded from this cross-sectional survey were male OTIDUs engaging in sex with only or mostly men since 1978. In bivariate analyses, we found that male OTIDUs with a history of methamphetamine use had more sex partners and participated in more acts of anal insertive intercourse with casual partners and vaginal intercourse with regular and casual partners than male OTIDUs never using methamphetamines. In addition, a greater percentage of male OTIDUs using methamphetamines reported trading sex for money or drugs. Methamphetamine-using female OTIDUs participated in more acts of vaginal intercourse with regular male sex partners than female OTIDUs never using methamphetamines. By multivariate logistic regression, we found methamphetamine use related to consistent condom use among male OTIDUs and among male sex partners of female OTIDUs. Discriminant function analyses revealed that sexual risk taking could be differentiated by methamphetamine use among male OTIDUs. Methamphetamine use also correlated with using shared needles or syringes among male and female OTIDUs and was related to not always disinfecting used needles or syringes with bleach. Our findings suggest that methamphetamines may contribute to heterosexual HIV transmission.

Adolescent↗
PubMed2001

Violent behaviors in early adolescent minority youth: results from a "middle school youth risk behavior survey".

OBJECTIVES: To describe the prevalence and characteristics of violence and violence-related behaviors among six populations of U.S. minority adolescents in grades 6-8. METHODS: Six thousand four hundred non-White adolescents were recruited from six sites that were part of a collaborative project. Surveys were administered either during the school day or at community facilities. All students at each site were asked 10 questions about recent violence-related behaviors (including use of threats, fighting, weapon carrying, and weapon use). Prevalence of each violence-related behavior was reported within and across sites, and stratified by race/ethnicity, gender, age, and other characteristics expected to influence the behaviors. RESULTS: Sixty-six percent (66%) of the middle school students sampled reported being involved in some type of recent fighting and/or weapon-related behaviors. Sixty-one percent (61%) indicated some form of fighting behavior in the past 3 months (threatening to beat someone up, physical fighting, and/or being hurt in a fight). Thirty percent (30%) of participating youth reported one or more weapon-related behaviors (threatening to use a weapon, carrying a weapon, using a weapon, and/or being cut, stabbed or shot at). Reported gun carrying among males varied depending upon site, but was as high as 20%. Grade in school was positively associated with reported violent behaviors. Adolescents who reported living full-time with a parent or parent figure, and those who reported religious observance or beliefs, were less likely to report violence involvement. All violence-related behaviors were more common among male than female adolescents. CONCLUSIONS: Violence prevention efforts should begin in elementary school and continue throughout adolescence. Programs should be prepared to provide services or referrals to victims of violence, implement programs tailored toward females as well as males, and build partnerships with churches and other community organizations in which youth are involved.

Adolescent↗
PubMedDate not supplied

Gambling and other risk behaviors on university campuses.

To examine the prevalence of problem gambling and its relationship to other risk-taking behaviors, the authors surveyed 1,350 undergraduates at the 4 campuses of Connecticut State University (CSU) during fall 2000. On the basis of a modified version of the South Oaks Gambling Screen, a widely used screening instrument, they found that 18% of the men and 4% of the women reported that gambling had led to at least 3 negative life consequences (eg, felt guilty, gambled more than intended), commonly defined as problem gambling. Students identified as problem gamblers, compared with other students, were significantly more likely to be heavy drinkers, report negative consequences of alcohol consumption, and be regular tobacco and marijuana users. Problem gambling was related to binge eating and greater use of weight-control efforts. University athletes were also found to have significantly greater problem gambling rates than nonathletes. The majority of students gambled but experienced few of the negative consequences reported by problem gamblers.

Adolescent↗
PubMed1985

Behavioral risk factors in adolescence as a basis for health planning.

Adolescence has been described as the age when the population is at its peak of health and physical performance. While this may be correct, it is also the age at which the future adult's state of health may be strongly influenced by behavior. It is therefore possible that the identification of behavior patterns that pose a risk to the adolescent (either immediately or for the later development of disease) could form the basis for logical health planning for this age-group. A model has been developed that itemizes the major behavioral risk factors in adolescence and indicates the possibilities for intervention. This model includes the following behavior characteristics: violent behavior (leading to accidents, etc.), cigarette smoking, drug use, sexual intercourse without contraception, the imbibing of alcoholic beverages, the taking of medicines without medical advice, and over- and undereating. The relevance of certain of these practices to the high school dropout phenomenon as a major social problem is emphasized. It is suggested that, on the basis of the model and of knowledge of certain demographic characteristics, risk groups can be identified and relevant health and welfare services planned.

Adolescent↗
PubMed2002

Sexual risk behaviors of male current and ex-opiate users in Chiang Rai, Thailand.

Injecting drug use and unsafe sexual practice are both considered major risk factors for HIV infection. This study reports sexual behaviors among male "current" (i.e. using heroin and/or opium at least once in the past 3 months) and "ex-" opiate users in Chiang Rai province in Northern Thailand. Between January 1999 and August 2000, 206 male opiate users were recruited by mail callback. Of the 206 drug users, 89 (43.2%) could be classified as current users. Current users did not differ from ex-users, except for educational level and ethnicity. Current and ex-opiate users showed no difference in number of regular sexual partners, proportion of having sex with commercial and non-commercial sex partners, and reported histories of sexually transmitted diseases. This study suggests that the importance of sexual risk behaviors in HIV transmission cannot be ignored in both current and ex-opiate users.

Adult↗
PubMed1990

Worksite follow-up and engagement strategies for initiating health risk behavior changes.

Information is presented from a multiplant study of interventions to improve cardiovascular health among employees. Risk factors targeted were high blood pressure, obesity, and cigarette smoking. The study utilized on-site wellness counselors who periodically contacted all employees identified through screening as having one or more of the three risks. Use of a structured protocol for client outreach resulted in the large majority of clients being seen in follow-up during the three-year intervention period. Drawing from caseload experience and from various theoretical perspectives, seven engagement strategies were used to help guide at-risk clients toward successful behavior changes to reduce health risks. Results showed that of the three at-risk groups, clients with high blood pressure were most likely to be seen in follow-up, and most likely to begin a risk reduction program. For the overweight and smokers, clients seen three or more times were more likely to begin a weight-loss/smoking cessation program than clients seen less often. Frequency of follow-up showed a positive relationship with risk reduction for all three risks, in samples of employees rescreened at the end of the intervention period, but the relationship was not statistically significant for smoking cessation.

Cardiovascular Diseases↗