Biomedical subjects

J S St Lawrence

Publications and source records attributed to J S St Lawrence.

At least 19 recordsLinked to original sources

PubMed2006

Sex work in Tallinn, Estonia: the sociospatial penetration of sex work into society.

BACKGROUND: It is important to describe and understand the underlying patterns and dynamics that govern sex work in societies undergoing rapid political and social changes, its heterogeneity across populations, and its evolution through time in order to inform future research, sound policy formation, and programme delivery. OBJECTIVES: To describe the socioeconomic and cultural determinants, organisational structure, distinct categories, and spatial patterning of sex work in Tallinn, Estonia, and identify recent temporal changes in sex work patterns. METHODS: In-depth interviews with key informants; naturalistic observations of sex work and drug use venues, geo-mapping of sex work sites, review of media, public policy, and commissioned reports, and analyses of existing data. RESULTS: Sex work takes place in a hierarchy of locations in Tallinn ranging from elite brothels and "love flats" to truck stops. These sites vary in terms of their public health importance and social organisation. There are full time, part time, and intermittent male and female sex workers. Among others, the taxi driver, madam and the bartender are central roles in the organisation of sex work in Tallinn. Cell phone and internet technology enable sex work to be highly dispersed and spatially mobile. CONCLUSION: Future research and programmatic service delivery or outreach efforts should respond to the changing profile of sex work in Tallinn and its implications for STD/HIV epidemiology.

Adolescent↗

PubMed2006

Factors associated with HIV prevalence in a pre-partum cohort of Zambian women.

An ongoing study of mother-to-child human herpes virus-8 (HHV-8) transmission in Zambian women (n = 3160) allowed us to examine the association of medical injections with HIV serostatus while simultaneously accounting for other factors known to be correlated with HIV prevalence. Multi-method data collection included structured interviews, medical record abstraction, clinical examinations, and biological measures. Medically administered intramuscular or intravenous injections in the past five years (but not blood transfusions) were overwhelmingly correlated with HIV prevalence, exceeding the contribution of sexual behaviours in a multivariable logistic regression. Statistically significant associations with HIV also were found for some demographic variables, sexual behaviours, alcohol use, and sexually transmitted diseases (STD). The results confirmed that iatrogenic needle exposure, sexual behaviour, demographic factors, substance use, and STD history are all implicated in Zambian women's HIV+ status. However, the disproportionate association of medical injection history with HIV highlights the need to investigate further and prospectively the role of health-care injection in sub-Saharan Africa's HIV epidemic.

Alcohol Drinking↗

PubMed2004

Physicians' opinions about partner notification methods: case reporting, patient referral, and provider referral.

BACKGROUND: The United States has relied upon partner notification strategies to help break the chain of infection and re-infection for sexually transmitted diseases (STD). Physicians are a vital link in the system of STD control, but little is known of physician opinions about partner notification strategies. METHODS: We collected opinions about partner notification from a national probability sample of physicians in specialties diagnosing STDs. Physicians responded to 17 questions about three relevant forms of STD partner notification: patient based referral, provider based referral, and case reporting. RESULTS: Exploratory factor analyses showed that responses for each form of partner notification could be grouped into four categories: perceived practice norms, infection control, patient relationships, and time/money. Multivariate analyses of the factors showed that physicians endorsed patient based referral most favourably and provider based referral least favourably. CONCLUSION: Physicians' opinions about partner notification strategies appear to reflect objective reality in some areas, but not in others. Strategies that improve the fit between physicians' opinions and effective notification are needed: some are discussed here.

Adult↗

PubMed2003

National survey of doctors' actions following the diagnosis of a bacterial STD.

OBJECTIVES: Little is known about the post-STD diagnosis management practices of community based doctors. The purpose of this study was to describe the reported actions that doctors take after diagnosing gonorrhoea, chlamydia, or syphilis and to determine if these actions differ across the three STDs. METHODS: A random national sample of 7300 doctors (70% response rate) practising in five medical specialties responded to 13 questions related to STD management. Mean differences across STDs were examined using the General Linear Model function of SPSS. RESULTS: Most doctors reported instructing patients to abstain from sex during treatment, to use condoms, and to inform their sexual partners of their exposure after diagnosing gonorrhoea, chlamydia, or syphilis. For syphilis, however, doctors were less likely to treat the patients presumptively and to give them drugs for their partners; and more likely to collect partner information, to follow up with the patient to see if the partner was referred for treatment and to send patient information to the health department. CONCLUSIONS: Doctors' post-STD diagnosis actions were similar for gonorrhoea and chlamydia compared to syphilis. Study findings suggest low levels of STD case reporting and partner follow up by doctors in the sample. Interventions are needed to educate community based doctors about the importance of partner follow up and case reporting in the management of STDs.

Adult↗

PubMed2001

Normative studies with the Scale for Interpersonal Behaviour (SIB): II. US students. A cross-cultural comparison with Dutch data.

The Scale for Interpersonal Behaviour (SIB), a multidimensional, self-report measure of state assertiveness, was administered to a nationwide sample of 2375 undergraduates enrolled at 11 colleges and universities across the USA. The SIB was developed in the Netherlands for the independent assessment of both distress associated with self-assertion in a variety of social situations and the likelihood of engaging in a specific assertive response. This is done with four factorially-derived, first-order dimensions: (i) Display of negative feelings (Negative assertion); (ii) Expression of and dealing with personal limitations; (iii) Initiating assertiveness; and (iv) Praising others and the ability to deal with compliments/praise of others (Positive assertion). The present study was designed to determine the cross-national invariance of the original Dutch factors and the construct validity of the corresponding dimensions. It also set out to develop norms for a nationwide sample of US students. The results provide further support for the reliability, factorial and construct validity of the SIB. Compared to their Dutch equivalents, US students had meaningfully higher distress in assertiveness scores on all SIB scales (medium to large effect sizes), whereas differences on the performance scales reflected small effect sizes. The cross-national differences in distress scores were hypothesized to have originated from the American culture being more socially demanding with respect to interpersonal competence than the Dutch, and from the perceived threats and related cognitive appraisals that are associated with such demands.

Adolescent↗

PubMed2001

Community-based interventions to reduce low income, African American women's risk of sexually transmitted diseases: a randomized controlled trial of three theoretical models.

A community-based sample of disadvantaged African American women (n = 445) was recruited to participate in 1 of 3 theoretically driven experimental interventions based on either the theory of gender and power, social learning theory, or cognitive behavioral theory. Intervention outcomes were compared with a waiting list control condition. From baseline to postintervention, women in the experimental interventions showed differential change on cognitive indices (knowledge and attitudes) and skill acquisition (partner negotiation skills, correct condom application, lubricant selection, and information-provision to social networks) whereas control participants were unchanged. Women in the 3 experimental interventions also completed follow-up assessments for 1 year following the interventions. In all 3 experimental conditions, condom use increased relative to the control group and there were no differences between the experimental interventions. Women who participated in one of the theoretically grounded interventions continued to increase condom use over the following year. Women entering new relationships reported significantly more condom use than did women who remained in ongoing relationships. The findings suggest that intervention models that have proven effective for women who engage in high-risk behavior may be less effective for women in established relationships for whom risk is primarily derived from the extrarelationship behavior of their partners.

Adult↗

PubMed2001

The effects of variations in mode of delivery and monetary incentive on physicians' responses to a mailed survey assessing STD practice patterns.

High response rates from physicians are key to obtaining valid and generalizable data regarding their sexually transmitted disease (STD) diagnosis, treatment, and control practices. A factorial (3 x 2) study was designed using varying cash incentives ($0, $15, $25) and delivery modes (Federal Express, U.S. mail). Surveys, with three follow-up mailings, were sent to a national probability sample of 311 physicians in OB-GYN, family practice, internal and emergency medicine, and pediatrics specialties. Overall, 156 physicians returned completed surveys (56% overall response rate). Significant effects for incentive level (F = 28.2, df = 2, p < .01) and delivery mode (F = 4.1, df = 1, p < .05) existed. Highest response was among physicians in the $25-FedEx condition (81%). High response rates from busy practicing physicians can be achieved if surveys are relevant to clinical practice, sponsored by a reputable organization (the Centers for Disease Control and Prevention), include a monetary incentive, and are delivered by courier.

Health Care Surveys↗

PubMed1999

Adolescents' recall of sexual behavior: consistency of self-report and effect of variations in recall duration.

PURPOSE: To describe the relationship between adolescents' 2-week, 2-month, and 12-month recall of sexual behavior; to assess the variability of adolescents' self-reported sexual behaviors over a period of 1 year; and to draw conclusions regarding the use of recall periods in measuring self-reported sexual behavior in adolescents. METHODS: Data from 296 African-American adolescents (age 12-19 years; 28% male) were analyzed. Baseline data comprise 2-week, 2-month, and 12-month recall of number of partners and frequency of condom-protected and unprotected vaginal, oral, and anal sex. Self-reported frequency of refusal of unprotected sex during the 2-week and 2-month recall periods are also included. To assess variability in self-reports of number of partners and frequency of behaviors over time, repeated measures of 2-week and 2-month recall were collected from a subset of the sample (n = 129; 24% male). RESULTS: The strength of correlation among responses from the three recall periods was dependent upon (a) the difference in length of the recall periods, and (b) the nature of the construct being recalled (e.g., number of partners vs. number of behaviors). Longitudinally, the variability of 2-week recall responses was generally larger than the variability in 2-month recall responses. CONCLUSIONS: Consistent estimates of adolescents' sexual behavior over a 1-year period may be obtained from several assessments of 2-week recall, or from relatively fewer assessments of 2-month recall data.

Adolescent↗

PubMed1999

Emerging behavioral strategies for the prevention of HIV in rural areas.

HIV/AIDS prevention efforts have been concentrated in urban areas, despite increases in HIV in nonmetropolitan areas. This study reviews behavioral prevention programs initiated in rural areas and programs that could be adapted for rural contexts. Outcomes from these interventions demonstrate that preventive interventions at the population, community, targeted populations subgroups, and small group levels can reduce high-risk behavior in rural environments and are cost effective to deliver.

HIV Infections↗

PubMed1999

Measuring perceived barriers to condom use: psychometric evaluation of the Condom Barriers Scale.

A programmatic series of three studies developed and evaluated the Condom Barriers Scale (CBS), an instrument measuring women s perceived barriers to condom use for prevention of HIV and other sexually transmitted diseases. Following item generation and selection, Study 1 evaluated the CBS in a sample of minority women (N = 178), reduced the number of items, assessed the factor structure, evaluated the internal consistency, and explored the convergent validity of the CBS. In Study 2, the CBS was administered to a cross-validation sample (N = 278). Confirmatory factor analysis and internal consistency were compared against the original sample and construct, criterion, and discriminant validity were assessed. In Study 3 (N = 30), temporal stability of the CBS was evaluated. The resulting instrument appears to have sound psychometric properties and can be used to measure a key construct in the leading theoretical models of health behavior for which a measure with known psychometric properties previously has not been available.

Adolescent↗

PubMed1998

Factors influencing condom use among African American women: implications for risk reduction interventions.

Examined factors associated with condom use in a community-based sample of 423 sexually active African American women. Measures were selected to reflect the components in prevailing models of health behavior. Condom users were higher on AIDS health priority, prevention attitudes, stage of change, behavioral intentions, reported more frequent and comfortable sexual communication with partners, perceived greater partner and peer approval for condom use, and reported that peers also used condoms. Women in exclusive relationships evidenced earlier stage of change, lower intentions to use condoms, fewer peers who engaged in preventive behaviors, perceived themselves to have lower risk, and had lower rates of condom use, higher education, and family income. Women in fluid relationships were at particularly high risk, with lower rates of condom use relative to women not in a relationship and greater sexual risk for HIV. Implications for HIV-risk reduction interventions with African American women are discussed.

Adolescent↗

PubMed1998

Behavioral and psychosocial consequences of HIV antibody counseling and testing with African American women.

This study compared a sample of low-income African American women in the southeastern United States who had and had not yet undergone HIV counseling and testing on risk-related cognitive mediating variables and self-reported sexual behaviors. Four hundred sixty (N = 460) African American women were recruited from health clinics and community settings in a southern city. Forty-five percent of the women (n = 207) had undergone HIV counseling and testing, whereas 55% (n = 253) had never been tested. Women who were seropositive were excluded from the analyses. After providing informed consent, the women completed a battery of cognitive mediating measures assessing AIDS knowledge, attitudes theoretically relevant to risk reduction, and self-reported sexual behavior. In addition, each participant demonstrated condom application skills using a penile model. Women who had undergone testing were younger, rated HIV disease as more serious, considered AIDS a greater health concern, had more positive attitudes toward HIV prevention, expressed greater intentions to use condoms, and evidenced a greater commitment to self-protective behavior than women who were not yet tested. Women who had undergone HIV antibody testing, however, showed no differences in sexual behavior from women who were never tested. Sexual behavior, including numbers of partners, frequency of unprotected intercourse, and inconsistent condom use, left women in both groups at significant and comparable risk for HIV and sexually transmitted disease infection. HIV counseling and testing alone may not be effective primary prevention strategies for promoting risk reduction among African American women.

AIDS Serodiagnosis↗

PubMed1997

Prevention research in rural communities: overview and concluding comments.

This paper provides an overview of the challenges that confront researchers in rural settings, synthesizing the manuscripts in this special issue of The American Journal of Community Psychology. Researchers typically focus on issues of research design, measurement, and data analyses. However, when applied research is conducted in rural settings, greater time and attention are required to identify how the research can be conducted successfully. In this overview of the challenges that confront researchers in rural contexts, qualitative differences between rural and urban environments are described with particular attention to their implications for the conduct of rural research. Finally, theoretical and research topics that can better inform future rural research efforts are discussed.

Adolescent↗

PubMed1997

Evaluation of the HIV risk reduction intervention for women entering inpatient substance abuse treatment.

OBJECTIVES: Interventions to lower HIV risk behavior among drug users have concentrated on reduction of high risk injection practices. Less attention has been directed to non-injecting drug users and drug-involved women. Female non-injecting drug users (e.g., women who abuse alcohol or crack cocaine) are also at substantial risk for sexual transmission of HIV due to multiple partners, partners who self-inject and share needles, exchange of sex for drugs, coerced sex, high rates of sexually transmitted diseases, and low rates of condom use. This study compared the effectiveness of an educational intervention (EC) against the behavior skills training intervention (BST) in reducing sexual risk behavior among women (N = 117) court-ordered into inpatient drug treatment. METHODS: Participants were assessed at baseline, post intervention, and 2 months after discharge from the drug treatment facility. RESULTS: Women in both conditions reported high rates of sexual risk behavior prior to the intervention. Women in both conditions had more positive attitudes toward HIV prevention and reported greater partner agreement with condom use at the post intervention assessment. However, these changes were not maintained at follow-up for women in the EC condition, whereas women in BST continued to show improvement post discharge. Women in the BST condition showed marked, while women in EC showed little improvement in communication skills and no improvement in condom application skill. At follow-up, women in both conditions had reduced drug use and drug-related high risk sex activities. BST women had increased their condom use while women in EC evidenced a decrease. Condom use increased from 35.7% to 49.5% of vaginal intercourse occasions for BST women and decreased from 28.8% to 15.8% for women in EC. CONCLUSIONS: Results suggest a brief skills training intervention embedded in drug treatment programs can reduce sexual risk for HIV-infection after discharge.

Adult↗

PubMed1996

Predictors of African American adolescents' condom use and HIV risk behavior.

This study evaluated predictors of risky and safer behavior in a sample of low-income African American adolescents, assessed their perceptions of the risk associated with their sexual behavior, and examined differences between adolescents who used condoms consistently, inconsistently, or engaged only in unprotected intercourse. African American adolescents (N = 312) completed measures related to AIDS knowledge, frequency of condom use, attitudes toward condoms, and sexual behavior over the preceding 2 months. Multiple regression analyses for the sexually active youths (N = 114) revealed that lower self-efficacy, higher perceived risk, and male gender were associated with high-risk behavior. Positive attitudes toward condoms and younger age had the strongest association with condom use. Consistent condom users were more knowledgeable and held more positive attitudes toward condoms, and nonusers were older. Regardless of their behavior, the adolescents generally did not perceive themselves to be a risk for HIV infection. The findings suggest that precautionary practices (condom use) and high-risk behavior (unprotected sex with multiple partners) may have different correlates. In addition, the data indicate that theoretical models developed with homosexual male populations may also be generalizable to African American adolescents' sexual behavior.

Adolescent↗

PubMed1995

Comparison of education versus behavioral skills training interventions in lowering sexual HIV-risk behavior of substance-dependent adolescents.

Substance-dependent adolescents (N = 34) in a residential drug treatment facility received either a 6-session behavior skills training HIV-risk reduction intervention or standard HIV education. After the intervention, adolescents who received behavior skills training exhibited increased knowledge about HIV-AIDS, more favorable attitudes toward prevention and condom use, more internal locus of control, increased self-efficacy, increased recognition of HIV risk and decreases in high-risk sexual activity. Self-report data were corroborated by records for the treatment of sexually transmitted diseases. The results from this pilot demonstration effort suggest that skills training based on cognitive-behavioral principles may be effective in lowering high-risk adolescents' vulnerability to HIV infection and warrant evaluation in a controlled comparison with a larger sample.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Cognitive-behavioral intervention to reduce African American adolescents' risk for HIV infection.

Two hundred forty-six African American adolescents were randomly assigned to an educational program or an 8-week intervention that combined education with behavior skills training including correct condom use, sexual assertion, refusal, information provision, self-management, problem solving, and risk recognition. Skill-trained participants (a) reduced unprotected intercourse, (b) increased condom-protected intercourse, and (c) displayed increased behavioral skills to a greater extent than participants who received information alone. The patterns of change differed by gender. Risk reduction was maintained 1 year later for skill-trained youths. It was found that 31.1% of youths in the education program who were abstinent at baseline had initiated sexual activity 1 year later, whereas only 11.5% of skills training participants were sexually active. The results indicate that youths who were equipped with information and specific skills lowered their risk to a greater degree, maintained risk reduction changes better, and deferred the onset of sexual activity to a greater extent than youths who received information alone.

Adolescent↗

PubMed1995

Cross-cultural comparison of US and Nigerian adolescents' HIV-related knowledge, attitudes, and risk behaviour: implications for risk reduction interventions.

Attitudes towards AIDS prevention, AIDS-related knowledge, and sexual behaviour of Nigerian adolescents and their African-American counterparts in two geographic regions of the United States were compared to assess cross-cultural similarities and differences between the adolescents. This study was conducted as the first in a programmatic sequence of activities leading toward the adaptation of a risk reduction intervention that was developed in the US for implementation with Nigerian youths. Subjects (n = 511) completed self-report measures of AIDS-related knowledge, attitudes towards condoms, attitudes towards AIDS prevention, sexual behaviour over the past two months, self- and response efficacy, and perceived vulnerability. Between-group comparisons revealed that US adolescents were more knowledgeable, held more favourable attitudes towards prevention and toward condoms, reported more sex partners, engaged in higher frequencies of unprotected vaginal intercourse, and became sexually active at later age than Nigerian adolescents. The findings are discussed with respect to their implications for translating risk reduction interventions developed in the US for African-American adolescents for later cross-cultural implementation with adolescents in developing countries where such risk reduction efforts are urgently needed.

Adolescent↗