PubMed Health⌕ Search

Biomedical subjects

C B Boyer

Publications and source records attributed to C B Boyer.

At least 19 recordsLinked to original sources
PubMed2001

Prevention of sexually transmitted diseases and HIV in young military men: evaluation of a cognitive-behavioral skills-building intervention.

BACKGROUND: Military personnel deployed to foreign countries with high endemic rates of sexually transmitted diseases (STDs) are at risk. GOAL: To evaluate a cognitive-behavioral, skills-building intervention to prevent STDs in junior, enlisted, male US Marines deployed to the Western Pacific aboard ships with periodic liberty visits to foreign ports. STUDY DESIGN: This study, using a quasi-experimental design, assigned 584 men to a cardiopulmonary resuscitation training (n = 288) or a cognitive-behavioral intervention (n = 296). The intervention aimed to increase prevention knowledge, reduce high-risk psychosocial (motivation) factors, and build decision-making and communication skills to reduce risky sexual behaviors and alcohol consumption. RESULTS: Participation in the intervention was associated with increased knowledge regarding symptoms and treatment of STDs and HIV (P < 0.001), decreased alcohol use (P < 0.01), and sexual risk (P < 0.01) during liberty ports of call. CONCLUSION: A multiple-session, cognitive-behavioral, skills-building intervention can be successfully implemented for deployed military personnel.

Behavior Therapy↗
PubMed2001

Chlamydial infection and unplanned pregnancy in women with ready access to health care.

OBJECTIVE: To apply urine-based ligase chain reaction for Chlamydia trachomatis (C. trachomatis) and Neisseria gonorrhoeae (N. gonorrhoeae) detection and standard urine-based pregnancy testing for Navy-enlisted women, and to compare the prevalence and epidemiologic correlates of these adverse reproductive outcomes. METHODS: Participants were surveyed and urine was collected for pregnancy testing using standard laboratory methods and detection of C. trachomatis and N. gonorrhoeae infection by ligase chain reaction. Self-administered surveys facilitated collection of demographics, sexual behavior, including contraceptive use, sexual partners, sexually transmitted disease, and pregnancy history. RESULTS: Among 299 of 314 participants, the prevalence of chlamydial infection was 4.7% and of pregnancy was 9.7%, with 48.3% of the pregnancies unplanned. Chlamydia trachomatis infection was univariately associated with having a new sex partner within the last 6 months, more sexual partners, single marital status, condom use, drinking until passing out or vomiting in the past 30 days (alcohol misuse), and current pregnancy. Unplanned pregnancy was univariately associated with young age, single marital status, inconsistent condom use, having a new sex partner within the last 6 months, and more recent sexual partners. Among the pregnant women, four (13.8%) were infected with C. trachomatis. CONCLUSION: The high rates of chlamydial infection and unplanned pregnancy found in this population of employed young women with ready access to health care and health education underscore the challenge of enhancing reproductive health via compliance with effective contraceptive and sexually transmitted disease prevention methods. This is a challenge that remains unmet.

Adolescent↗
PubMed2000

Adolescent violence prevention practices among California pediatricians.

OBJECTIVES: To examine pediatricians' provision of violence prevention services to their adolescent patients and to identify factors associated with pediatricians' implementation of these services. DESIGN: A cross-sectional sample of California pediatricians completed a self-report questionnaire. The "Precede/Proceed" theoretical model guided the questionnaire in identification of factors associated with pediatricians' screening and intervening practices in preventing adolescent violence. RESULTS: Two hundred twenty pediatricians (54% female, 66% white, 24% Asian, 5% Latino, and 5% other) participated in the study. On average, participants screened their patients for violence-related risk factors 31% of the time for fighting, 39% of the time for violence in the home, and 29% of the time for weapon carrying. Participants provided their at-risk patients with violence-related interventions less than 50% of the time (on average) implementing the following interventions: written materials, follow-up appointments, discipline counseling, or referral to a community organization, Child Protective Services, or a specialized adolescent clinic. Factors associated with violence prevention screening practices included the following: positive attitudes and beliefs regarding screening for violence, familiarity with violence prevention guidelines, use of prompts in medical records, perceptions of greater skills, and positive reinforcement from patients and colleagues for providing violence prevention services (R(2)=0.44; P<.001). Factors associated with violence prevention intervention practices included: positive attitudes and beliefs in screening for violence, availability of resources, and positive reinforcement from patients and colleagues for providing violence prevention services (R(2)=0.37; P<.001). CONCLUSIONS: California pediatricians are not widely screening their adolescent patients for risk factors associated with adolescent violence, nor are they providing interventions to their adolescent patients who may be at risk for violence. The factors associated with pediatricians' implementation of violence prevention services may assist in the development of effective interventions designed to enhance their delivery of these services to their adolescent patients.

Adolescent↗
PubMed2000

Associations of sociodemographic, psychosocial, and behavioral factors with sexual risk and sexually transmitted diseases in teen clinic patients.

PURPOSE: To examine the influence of sociodemographic characteristics, sexually transmitted disease (STD)/human immunodeficiency virus knowledge, and psychosocial and behavioral risk factors on sexual risk and STDs in adolescents using constructs from the Information, Motivation, and Behavioral Skills model (IMB). METHODS: A convenience sample of 303 sexually experienced, racially diverse adolescents (mean age 16.7 years, 57.9% female) who were seeking health care at a general health maintenance organization teen clinic were recruited for the study and completed a self-reported questionnaire which assessed sociodemographic, knowledge, and psychosocial factors, risk behaviors, and history of STDs. Multiple regression analyses were used to assess factors associated with sexual risk behavior and STD history. RESULTS: Many of the study participants were at risk for STDs; 43.8% had four or more lifetime sexual partners, 62.8% did not consistently use condoms, 21.1% had a history of pregnancy or impregnation, and 28.2% had a history of STDs. A multiple linear regression model to assess factors associated with sexual risk behavior (a nine-item index) indicate that perceptions of higher STD risk, perceptions that friends engage in risk behaviors, perceptions that friends will not support their STD risk-reduction efforts, knowing someone of a similar age who has had an STD, and having no intention of using condoms in the future are significantly associated with sexual behavioral risk (R(2) =.22, p <.000). A logistic regression model to examine history of STDs reveals that teens who are female, African-American, frequently use marijuana, have an older steady sexual partner, have a history of pregnancy or impregnation, have a greater number of lifetime sexual partners, and perceive that monogamy will not decrease STD risk are significantly more likely to report a history of STDs. CONCLUSIONS: Sociodemographic factors and constructs of the IMB model are associated with adolescents' risk and acquisition of STDs. Teens with such risk profiles should be targeted for risk-reduction intervention.

Adolescent↗
PubMed1999

Sexually transmitted diseases in a health maintenance organization teen clinic: associations of race, partner's age, and marijuana use.

OBJECTIVE: To determine the role of sociodemographic risk markers and behavioral risk factors associated with sexually transmitted diseases (STDs) in sexually experienced youth seeking care at an urban, general health maintenance organization teen clinic. DESIGN: Cross-sectional. PARTICIPANTS: A consecutive, racially and ethnically diverse sample of 285 sexually experienced youth who were preponderantly female (58.6%) and who were aged 16.7 years on average. METHODS: All participants completed a self-report questionnaire and were screened for Chlamydia trachomatis using the ligase chain reaction technique and for Neisseria gonorrhoeae and other STDs using conventional methods. RESULTS: Many of these youth were at high risk for STDs, having a self-reported history of sex with multiple partners (49.1%), sex with a new partner (42.5%), inconsistent use of condoms (71.9%), and frequent substance use (24.5% used marijuana 1-2 times per week or more). Sexually transmitted disease screening revealed that 11.6% of the participants had 1 or more STDs. A logistic regression analysis to determine the best model for predicting STDs indicated that youth who are African American (odds ratio, 3.34; 95% confidence interval, 1.52-7.35), had sexual partners who were 2 or more years older (odds ratio, 2.63, 95% confidence interval, 1.22-5.67), and used marijuana 1 to 2 times or more per week (odds ratio, 2.27; 95% confidence interval, 1.01-5.13) were more likely to have STDs at screening. CONCLUSIONS: A brief sociodemographic and behavioral risk assessment that includes these factors may be useful for clinicians in deciding when to screen for STDs in sexually active youth seeking care for reasons not related to reproductive health.

Adolescent↗
PubMed1999

Predictors of risk for sexually transmitted diseases in ninth grade urban high school students.

This study examined risk factors associated with acquisition of sexually transmitted diseases (STDs) including HIV in adolescents, using the AIDS Risk Reduction Model. The study participants were 985 students who were 54% female, ethnically/racially diverse, had a mean age of 14.7 years, and were mostly 9th graders (74%). Logistic regression was used to predict sexual experience. Linear regression was used to predict risky sexual behaviors and condom use within the previous month. The results indicate that demographic factors are associated with being sexually experienced, but few demographics are associated with specific STD-related risk behaviors. STD and AIDS knowledge are not associated with any risk behaviors. Use of alcohol and drugs is associated significantly with being sexually experienced and sexual risk. The results also indicate that peer affiliation, perceptions of peer norms, perceptions of risk, perceptions of self-efficacy, and social support are associated with STD-related risk among sexually experienced youth.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Asymptomatic sexually transmitted disease prevalence in four military populations: application of DNA amplification assays for Chlamydia and gonorrhea screening.

The prevalence of asymptomatic chlamydial and gonococcal infections in male and female military populations was determined using urine-based ligase chain reaction DNA amplification assays (DAAs). Cross-sectional surveys in four military settings revealed an overall prevalence of asymptomatic chlamydial infection of 4.2% (56/1338). This included 3.4% (21/618) of Western Pacific shipboard US Marine Corps enlisted men; 5.2% (21/406) of male marines shore-based in Okinawa, Japan; 2.7% (5/183) of female enlisted US Navy subtender personnel in dry dock; and 6.9% (9/131) of shore-based female naval personnel in San Diego. No gonococcal infections were detected. All subjects were treated within 2 weeks of screening; none of them had progressed to symptomatic disease. General population-based screening for asymptomatic sexually transmitted diseases, and in particular chlamydial infection, can be successfully implemented using urine-based DAA tests. Benefits are maximized in a population in which compliance for follow-up therapy is high.

Adult↗
PubMed1998

Risk factors for repeated gonococcal infections: San Francisco, 1990-1992.

Gonococcal (GC) infections are very common and are sustained by a core group of persons who often have repeated GC infections. Identifying individual risk factors for repeated GC infection is essential so that infection control programs can develop better strategies for decreasing the incidence of GC infection. A case-control study among high-risk persons found that being African American, having previous chlamydia infection, and having less than a high-school education were associated with repeated GC infections. Remarkably, measures of sexual behavior and access to health care were not associated with repeated GC infections. These findings suggest that among high-risk persons, the community prevalence of GC infection is more important in predicting risk for repeated GC infections than individual behavior. Interventions should include continued use of resources in high-prevalence communities and better understanding of the roles social and economic discrimination play in the risk for GC infections.

Adolescent↗
PubMed1997

Sexually transmitted disease (STD) and HIV risk in heterosexual adults attending a public STD clinic: evaluation of a randomized controlled behavioral risk-reduction intervention trial.

OBJECTIVE: To evaluate the efficacy of a cognitive/behavioral skills-building intervention to prevent sexually transmitted diseases (STD) in high-risk heterosexual adults. DESIGN: A randomized controlled trial with assessments at baseline, and at 3 and 5 months. SETTING: San Francisco STD Clinic. PATIENTS: A total of 399 patients were randomly assigned to a four-session, individual, multi-component, cognitive/behavioral intervention (n = 199), or a brief standardized counseling session offered to all patients (n = 200). INTERVENTION: Based on the AIDS Risk-Reduction Model, the aims of the intervention were to increase prevention knowledge, reduce high-risk psychosocial factors, and build decision-making and communication skills to modify sexual behaviors. MAIN OUTCOME MEASURES: The primary outcome of interest was STD. The secondary outcome was number of risky sexual activities. RESULTS: There were no differences between the intervention (13%) and control (11%) groups in their acquisition of STD. Among men, condom use increased more at 3 months in the intervention group than the control group (56.8 versus 42.3%; P < 0.05). In addition, the mean number of sexual partners without condom use was lower in the intervention group than in the control group at 5 months (0.6 versus 0.9; P < 0.01). CONCLUSIONS: The results suggest that a cognitive/behavioral, skills-building intervention consisting of individual, multiple sessions and follow-up assessments can be implemented and evaluated with high-risk heterosexually active adults attending public STD clinics. Our intervention did not have a significant impact on STD, although it had some impact on behavior in men, but not in women.

Adolescent↗
PubMed1997

Evaluation of a knowledge- and cognitive-behavioral skills-building intervention to prevent STDs and HIV infection in high school students.

The purpose of this study was to evaluate the efficacy of a school-based knowledge- and cognitive-behavioral skills-building STD/HIV prevention intervention. Subjects were 513 ethnically and racially diverse students attending four urban public high schools. The sample was 59% female and had a mean age of 14.4 years. A quasi-experimental design was utilized to evaluate the intervention which consisted of three class sessions. Results of hierarchical regression analyses, controlling for baseline scores and demographic factors, indicate that this intervention was effective at increasing STD knowledge (p < .05), and skills related to prevention of risky sexual (p < .05) and drug use (p < .001) behavior. Although significant changes in risk behaviors were not detected, it is too soon to conclude that school-based education and skills building STD/HIV prevention interventions are ineffective at changing risk behaviors in adolescents. Implications for future study are addressed.

Adolescent↗
PubMed1996

Adolescents' perceived risk for STDs and HIV infection.

PURPOSE: (1) To determine whether adolescents systematically underestimate their relative risk for STDs and HIV; and (2) to determine to what extent anxiety about STDs and HIV, past condom use, number of lifetime partners and STD/HIV-related beliefs predict perceived relative risk. METHODS: Two hundred and thirty-one sexually experienced, racially diverse, urban high school teenagers (mean age = 15.5 years; 53% male) were surveyed regarding their STD/HIV-related attitudes, beliefs, and behaviors. RESULTS: The subjects did not perceive themselves to be at lower risk compared to their perceptions of the risk of other people their age for STDs or HIV. Using hierarchical multiple linear regression analysis, perceptions of lower relative risk for STDs and for HIV were predicted by higher levels of anxiety (p < .001) but not by past condom use, number of lifetime partners or STD/HIV-related beliefs (p > .05). CONCLUSIONS: Adolescents' perceptions of risk appear to be related to anxiety about STDs and HIV and their behaviors may be related to peer influences and attitudes toward using condoms.

Adolescent↗
PubMed1996

Types of adolescent sexual relationships and associated perceptions about condom use.

PURPOSE: The purpose of this study was to describe the various types of adolescent sexual relationships and to examine the association between the type of sexual relationship and adolescents' perceptions about the consistency with which other adolescents use condoms. METHODS: Adolescents attending a university-based adolescent medicine clinic completed a self-administered questionnaire. Subjects were asked to rate the importance of six qualities (caring about each other, length of time of relationship, ability to talk about anything, ability to talk about sex and condoms, doing things together, and attraction to partner's looks) for each of four different types of sexual relationships (steady, casual, friends, and "one-night stands"). Subjects were also asked to estimate the frequency with which adolescents use condoms with each type of sexual partner. RESULTS: Questionnaires were completed by 75 sexually experienced adolescents. The mean age of the sample was 16.6 years, and 41.3% were male. All qualities, except attraction to partner's looks, were rated more important for steady partners compared with the other partner types, and more important for sexual relationships with casual partners and friends than for "one-night stands" (p < .001). Sexually experienced subjects believed that condoms are used less frequently with steady partners and more frequently with "one-night stands" (p < .001). CONCLUSIONS: Interventions designed to increase the consistency with which adolescents use condoms should take into account the different types of sexual relationships, each with distinct expectancies about the consistency of condom use.

Adolescent↗
PubMed1993

Evaluation of urine-based screening strategies to detect Chlamydia trachomatis among sexually active asymptomatic young males.

OBJECTIVE: To evaluate the performances of diagnostic screening tests alone or in combination to detect asymptomatic chlamydial urethral infection in young males. DESIGN: Comparisons of the performance profiles of the following chlamydia screening strategies were done: urethral culture; identification of polymorphonucleocytes (PMNs) on spun first-void urine (FVU); urinary leukocyte esterase test (LET) on unspun FVU; chlamydial enzyme immunoassay (EIA) applied to FVU sediment; combining LET on unspun FVU followed by EIA with or without direct fluorescent antibody (DFA) confirmation on FVU sediment; and combining PMNs on spun FVU followed by EIA with or without DFA confirmation. SETTING: General clinics at a youth detention center, university-based teen clinic, college health service, and a military screening clinic. PATIENTS: A total of 618 males aged 12 to 35 years (mean, 17 years) were recruited as a convenience sample; site participation rates ranged from 50% to 80%. Eligible subjects were sexually active, denied symptoms of urethritis, and had taken no antibiotics in the prior 2 weeks. MAIN OUTCOME MEASURES: Sensitivity, specificity, and positive and negative predictive values of each test strategy's ability to detect Chlamydia trachomatis infection, and cost to confirm each positive case. RESULTS: With a 7% prevalence of chlamydial infection, tissue culture had a sensitivity of only 61%. However, two strategies yielded significantly better performance profiles compared with the others: EIA confirmed by DFA test with a sensitivity of 84%, a specificity of 100%, and a cost to identify each positive case of $434; and PMNs followed by EIA confirmed by DFA test with a sensitivity of 78%, a specificity of 100%, and a cost to identify each positive case of $199. The LET followed by EIA-DFA had a similar performance profile to the PMN test strategies. CONCLUSIONS: A combination of a nonspecific screening of FVU for PMNs or LET followed by specific testing with EIA with DFA confirmation has superior clinical and cost-effective performance for detecting asymptomatic C trachomatis urethritis in young males compared with other strategies. However, an evaluation of the medical, fiscal, and psychological benefits and risks associated with a specific screening strategy for sexually transmitted diseases must be made before adopting a specific strategy for a particular population.

Adolescent↗
PubMed1993

Implementing a school-based STD/HIV prevention intervention: collaboration between a university medical center and an urban school district.

To effectively implement a school-based STD/HIV prevention intervention program developed by a community-based agency, several issues must be addressed to build a collaborative partnership between the agency and the school district. Steps taken by the Division of Adolescent Medicine, University of California, San Francisco, in achieving partnership with a local urban school district are outlined. The process of recruiting school district administrators, health education liaisons, teachers, parents, and students is emphasized.

Academic Medical Centers↗
PubMed1991

AIDS risk and prevention among adolescents.

Although relatively few teenagers have been diagnosed with AIDS and the extent of asymptomatic human immunodeficiency virus (HIV) infection among adolescents remains largely unknown, there is cause for concern about teens' risk of contracting HIV disease The incubation period (the time from initial infection to the development of full-blown AIDS) is estimated to average eight years, and therefore it is probable that most of the individuals in their twenties who have AIDS (20% of all the people with AIDS) contracted HIV during their teenage years. The sexual and drug use activities of many teenagers place them at increased risk for HIV transmission. Sexually transmitted diseases (STDs) are pervasive and a major cause of morbidity among sexually active adolescents. The rates of STDs have continued to rise even during the 'age of AIDS'. These rates are of concern since the behaviors associated with the acquisition and transmission of STDs are also the behaviors associated with HIV transmission. In addition, the presence of STDs may increase the likelihood of HIV transmission. Although condoms reduce the risk of HIV transmission, their use remains low among sexually active teenagers. Reducing or eliminating high risk behaviors is the only way to limit further spread of HIV. Effective prevention programs should be based on models and theories of risk behavior so that the programs can be designed to change those factors which lead to the undesirable risky behaviors. The AIDS Risk Reduction Model (ARRM) is presented as an example of such a social-physiological model. The ARRM model characterizes why people persist in engaging in high risk activities or make efforts to alter those activities. The three stages theorized to be necessary to reduce risky sexual activities are: (1) recognizing that one's activities make oneself vulnerable to contracting HIV; (2) making the decision to alter risky sexual behaviors and committing to that decision; (3) overcoming barriers to enacting the decision, including problems in sexual communication and seeking help when necessary to learn strategies to reduce risky behaviors. Each stage includes a number of constructs identified in prior research as important for engaging in 'healthy' or low risk behaviors. Innovative strategies must be developed and implemented to reach all adolescents, ranging from teenagers who attend school and live with their families to those teens who are runaways, live in detention facilities or are otherwise 'disenfranchised'. To be most effective, HIV prevention programs must utilize strategies which combine cognitive and behavioral skills training.(ABSTRACT TRUNCATED AT 400 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1991

Psychosocial and behavioral factors associated with risk of sexually transmitted diseases, including human immunodeficiency virus infection, among urban high school students.

The main purpose of this study was to evaluate the role of multiple psychosocial and knowledge-related antecedent factors that may predict sexual and alcohol and drug use behaviors that are associated with the transmission of sexually transmitted diseases (STDs), including human immunodeficiency virus infection. Five hundred forty-four ninth-grade urban high school students were surveyed regarding knowledge, attitudes, and behaviors related to STDs and acquired immunodeficiency syndrome (AIDS). Results of multiple regression analyses indicate that higher levels of STD and AIDS knowledge were associated with lower levels of STD and AIDS anxiety (R2 delta = 0.09; p less than 0.001), fewer negative attitudes toward people with AIDS (R2 delta = 0.09; p less than 0.001), stronger perceptions of self-efficacy (R2 delta = 0.03; p less than 0.01), and stronger peer affiliation (R2 delta = 0.02; p less than 0.05). Negative attitudes toward people with AIDS were inversely related to knowledge (R2 delta = 0.08; p less than 0.001), social support (R2 delta = 0.02; p less than 0.01), and perceived self-efficacy (R2 delta = 0.01; p less than 0.05). Predictors of alcohol and drug use included perceived peer norms (R2 delta = 0.08; p less than 0.001) and strong peer affiliation (R2 delta = 0.05; p less than 0.001). The best predictor of sexual risk behavior was alcohol and drug use (R2 delta = 0.07; p less than 0.001). Lower levels of knowledge (R2 delta = 0.14; p less than 0.01) and perceived peer norms (R2 delta = 0.05; p less than 0.05) predicted nonuse of condoms. Our results indicate that several factors relate to adolescent risk for STDs: the connection between peer influence and adolescent risk behaviors, the link between alcohol and drug use and sexual risk behavior, and the role of knowledge in determining nonuse of condoms.

Acquired Immunodeficiency Syndrome↗