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Biomedical subjects

R A Roffman

Publications and source records attributed to R A Roffman.

At least 19 recordsLinked to original sources
PubMed1998

Relapse prevention as an interventive model for HIV risk reduction in gay and bisexual men.

Despite considerable self-initiated HIV risk reduction among men who have sex with men, little is known about how to design interventions that will effectively assist individuals from this population in maintaining safer sex behaviors over time. The present study evaluated the effectiveness of a 17-session group counseling intervention that incorporated components based on a cognitive-behavioral model of relapse. Differential behavioral outcomes following treatment included an increase in the percentage of sexual activities that were protected and a decrease in unprotected oral sex. However, considerable risk reduction (e.g., increased condom use, decreased unprotected sex, and decreases in the number of male partners and in the total number of sexual acts) occurred in both treated and untreated participants. Measures of mediating attitudinal variables drawn from relapse prevention theory largely predicted behavioral changes. Over time, several of the risk reduction behaviors achieved at posttreatment were not maintained, suggesting the importance of further developing effective strategies for supporting behavior change maintenance.

Adult↗
PubMed1997

Randomised, controlled, community-level HIV-prevention intervention for sexual-risk behaviour among homosexual men in US cities. Community HIV Prevention Research Collaborative.

BACKGROUND: Community-level interventions may be helpful in population-focused HIV prevention. If members of populations at risk of HIV infection who are popular with other members can be engaged to advocate the benefits of behaviour change to peers, decreases in risk behaviour may be possible. We assessed a community-level intervention to lower the risk of HIV infection, focusing on men patronising gay bars in eight small US cities. METHODS: We used a randomised community-level field design. Four cities received the intervention and four control cities did not. Participants were men from each city who went to gay bars. Men completed surveys about their sexual behaviour on entering the bars during 3-night periods at baseline and at 1-year follow-up. In the control cities, HIV educational materials were placed in the bars. In the intervention cities, we recruited popular homosexual men in the community and trained them to spread behaviour-change endorsements and recommendations to their peers through conversation. FINDINGS: Population-level of risk behaviour decreased significantly in the intervention cities compared with the control cities at 1-year follow-up, after exclusion of surveys completed by transients and men with exclusive sexual partners in a city-level analysis, in the intervention cities we found a reduction in the mean frequency of unprotected anal intercourse during the previous 2 months (baseline 1.68 occasions; follow-up 0.59: p = 0.04) and an increase in the mean percentage of occasions of anal intercourse protected by condoms (baseline 44.7%; follow-up 66.8%, p = 0.02). Increased numbers of condoms taken from dispensers in intervention-city bars corroborated risk-behaviour self-reports. INTERPRETATION: Popular and well-liked members of a community who systematically endorse and recommend risk-reduction behaviour can influence the sexual-risk practices of others in their social networks. Natural styles of communication, such as conversations, brought about population-level changes in risk behaviour.

Adult↗
PubMed1996

The social marketing of project ARIES: overcoming challenges in recruiting gay and bisexual males for HIV prevention counseling.

This paper reports on the development, implementation, and evaluation of a social marketing campaign designed to recruit clients Project ARIES, and AIDS prevention study funded by the National Institute of Mental Health. Marketing channels employed for the campaign included advertising in the gay press, generating coverage in the mainstream press, distributing materials to HIV testing centers and other health and social service providers, and displaying posters in gay bars and baths. While these approaches all succeeded in eliciting inquiries from individuals engaging in high risk sexual behaviors, they differed in several respects, including their ability to reach specific subgroups that are often underserved by more traditional programs, such as men of color, younger men, and men who self-report as being closeted. Promotional materials displayed in gay bars and baths resulted in the highest percentage of callers who, after inquiring about the program, decided to participate in the counseling. Coverage in the mainstream press was the most successful in reaching closeted men, men who were less active in the gay community, and individuals who did not self-identify as gay. Display and classified ads in the gay press produced the highest number of initial inquiries. Finally, recruitment of participants via materials distributed to HIV test sites and other service providers was the most effective in reaching men who were HIV-positive.

Acquired Immunodeficiency Syndrome↗
PubMed1996

HIV risk behaviors among women living in low-income, inner-city housing developments.

OBJECTIVES: This study describes the prevalence and predictors of human immunodeficiency virus (HIV) risk behaviors among women living in low-income, inner-city housing developments. METHODS: Anonymous questionnaires were administered to 671 women living in 10 inner-city, low-income housing developments in five US cities to determine their levels of HIV risk behavior and predictors of HIV risk practices. RESULTS: Approximately one third of women were at high risk for HIV because of the risk behavior of their sexual partners. HIV risk was highest among women who accurately perceived themselves to be at increased HIV risk, held strong beliefs about barriers to condom use, and reported weak behavioral intentions to reduce risk. Women at higher risk were also younger and reported higher rates of alcohol and substance use. CONCLUSIONS: HIV prevention efforts are needed for inner-city women. Interventions should focus on overcoming women's barriers to condom use, strengthening their intentions to change behaviors, and managing the risk related to their use of substances.

Adolescent↗
PubMed1995

Factors predicting continued high-risk behavior among gay men in small cities: psychological, behavioral, and demographic characteristics related to unsafe sex.

Nearly 6,000 men entering gay bars in 16 small American cities were anonymously surveyed to assess their sexual behavior and to determine predictors of risky sexual practices. Excluding individuals in long-term exclusive relationships, 27% of the men reported engaging in unprotected anal intercourse in the past 2 months. Factors strongly predictive of risk included having a large number of different male partners, estimating oneself to be at greater risk, having weak intentions to use condoms at next intercourse, believing that safer sex is not an expected norm within one's peer reference group, being of younger age, and having less education. These findings indicate that HIV prevention efforts are urgently needed for gay men in smaller cities, with efforts particularly focused on young and less educated men sexually active with multiple partners. Prevention should focus on strengthening intentions to change behavior and on changing social norms to foster safer sex.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Self-efficacy and marijuana cessation: a construct validity analysis.

Hypotheses regarding the relationships between self-efficacy for avoiding marijuana use and theoretically related measures were examined in a sample of 161 men and 51 women who sought treatment aimed at marijuana cessation. Theoretically proposed sources of efficacy judgments showed stronger univariate and multivariate relationships with efficacy for avoiding marijuana use after treatment than before treatment. The cognitive-behavioral relapse prevention treatment resulted in marginally greater self-efficacy, compared with a nonbehavioral treatment, but the link between coping skill training and efficacy was ambiguous. Efficacy contributed incrementally to the prediction of posttreatment marijuana use beyond efficacy source variables, but it did not completely mediate the effects of those sources of efficacy judgments. Predictive validity was stronger for frequency of posttreatment marijuana use than for abstinence status. The need for better assessment of the efficacy construct and potential revisions in efficacy theory as applied to substance use are discussed.

Adult↗
PubMed1995

HIV antibody testing of gay men in smaller US cities.

The incidence of new AIDS diagnoses among gay males indicates that risk reduction in smaller communities may be lagging behind that reported in larger cities. Contradictory evidence exists, largely from urban areas, concerning the utility of HIV testing as a means of promoting behavioural change. This study examined the relationship between HIV antibody testing and subsequent high-risk sexual behaviours among gay men in cities of 180,000 or fewer inhabitants. In February and March of 1992, male gay bar patrons in sixteen small US cities were administered an anonymous questionnaire concerning recent sexual behaviour and HIV testing history. Of the 1820 respondents, 28.1% had recently engaged in unprotected anal intercourse and 60.7% had been tested for HIV antibodies. Those who had been tested were more sexually active and reported more protected and safer sexual activities. Analyses at the individual and city levels converged to demonstrate that communities as well as individuals evidence increased self-protection in association with HIV antibody testing.

Adult↗
PubMed1994

Treating adult marijuana dependence: a test of the relapse prevention model.

Men (n = 161) and women (n = 51) seeking treatment for marijuana use were randomly assigned to either a relapse prevention (RP; G.A. Marlatt & J.R. Gordon, 1985) or a social support (SSP) group discussion intervention. Data collected for 12 months posttreatment revealed substantial reductions in frequency of marijuana use and associated problems. There were no significant differences between the cognitive-behavioral RP intervention and the SSP group discussion conditions on measures of days of marijuana use, related problems, or abstinence rates. Men in the RP condition were more likely than men in the SSP condition to report reduced use without problems at 3-month follow-up. Posttreatment increases in problems associated with alcohol did not appear to relate to reduced marijuana use. Results are discussed in terms of the need for further research with marijuana-dependent adults and the efficacy of RP.

Adaptation, Psychological↗
PubMed1994

High risk sexual behavior and alcohol consumption among bar-going gay men.

OBJECTIVES: To determine whether alcohol use prior to sexual behavior influenced the occurrence of unprotected anal intercourse among bar-going gay men. METHODS: Anonymous AIDS behavioral risk surveys were administered to men entering gay bars in 16 cities on three nights in February 1993 in six states in the United States. RESULTS: Of the 1519 men who completed the survey, 85% were current alcohol drinkers. Men who had unprotected anal intercourse after consuming alcohol drank more and reported more incidents of unprotected anal intercourse than men who had unprotected anal intercourse but not after drinking. Overall, unprotected anal intercourse occurred less frequently after alcohol consumption than without prior consumption. CONCLUSIONS: This study found that heavy alcohol use and frequent high-risk sexual behavior occurred among the same individuals. However, we found no evidence for a causal link between alcohol use and unprotected sexual behavior in this sample of bar-going gay men.

Adult↗
PubMed1993

Predictors of marijuana treatment outcomes: the role of self-efficacy.

This study tested the ability of sets of demographic, socioeconomic, marijuana use/abuse, psychological distress, and self-efficacy variables to predict posttreatment indices of marijuana intake and problems related to use. Subjects were 167 adults who participated in one of two outpatient treatments for marijuana dependence and completed the 3-, 6-, and 12-month posttreatment follow-ups. Only pretreatment marijuana quantity-frequency of intake and self-efficacy variables made significant and consistent contributions to the regression equations predicting posttreatment frequency of use. In contrast, socioeconomic and severity of abuse indicators predicted posttreatment marijuana-related problems. Contrary to social cognitive theory (Bandura, 1986), there was no evidence that self-efficacy mediated the effects of other predictors. Results are discussed in terms of the specificity of predictor-outcome relationships and the need for improvements in self-efficacy measurement.

Adult↗
PubMed1993

Adult marijuana users seeking treatment.

In an effort to study the efficacy of attracting and intervening with adult marijuana users, 290 men and 92 women were screened for participation in a treatment-outcome study focused on marijuana cessation. The well-educated, self-referred sample reported using marijuana on 79 of the past 90 days before testing. Indices of the severity of marijuana abuse and general psychopathology were in the clinical range for a majority of Ss. Ss who did not report evidence of alcohol or other drug abuse (n = 144) reported less severe consequences of marijuana use and experienced less general psychological distress than Ss who also reported lifetime (n = 165) or current abuse (n = 73) of other substances in addition to marijuana. The findings indicate the need for clinical research targeting adults who are dependent on marijuana.

Adult↗
PubMed1992

Acquired immunodeficiency syndrome/human immunodeficiency virus risk behavior among gay men in small cities. Findings of a 16-city national sample.

BACKGROUND: Most research on acquired immunodeficiency syndrome has been conducted in several of the country's largest cities, and little is known about the current level of human immunodeficiency virus risk taking among gay men in other geographical areas. The purpose of this study was to determine the frequency of risk behavior practices among gay men in smaller communities. METHOD: A large sample of men who patronized gay bars in 16 small and moderate-size cities drawn from six states in four different regions of the country was surveyed to determine the frequency of high-risk behavior and factors influencing risk taking. Eighty-five percent of men in all cities' bars completed all survey measures. The community samples were 1991 men; mean age, 31.3 years; mean education, 10.6 years; 90% were white and 10% were of other ethnicities. All participants provided detailed information on their sexual behavior practices over the preceding 2 months and completed measures assessing their perceived peer norms concerning safer sex practices and risk avoidance, intentions to avoid risk, personal risk estimation, acquired immunodeficiency syndrome risk knowledge, perceived threat of acquired immunodeficiency syndrome/human immunodeficiency virus, and serostatus testing history. RESULTS: High-risk patterns were still common among gay men in these smaller cities; nearly one third of all men had engaged in unprotected anal intercourse an average of eight times in the past 2 months, usually outside monogamous relationships. High-risk behavior was most strongly associated with beliefs that safer sex practices would not be well accepted by peers, weak intentions to use condoms, underestimation of personal vulnerability to the acquired immunodeficiency syndrome, younger age, and higher levels of overall sexual activity. Nine percent of men tested said they were seropositive. CONCLUSIONS: Growing human immunodeficiency virus prevalence and continued high rates of risk behavior indicate that a new "front line" for human immunodeficiency virus prevention among homosexually active men has shifted to the country's smaller cities. Community prevention efforts in these areas are urgently needed to avert sharp increases in future human immunodeficiency virus infections in this population.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Assessing need for marijuana dependence treatment through an anonymous telephone interview.

In response to public service announcements directed at adult chronic marijuana users who were concerned about their smoking, 225 individuals were interviewed anonymously by telephone. This study was conducted to determine if a population of chronic dysfunctional marijuana users existed who were both interested in being treated and not concurrently abusing alcohol and/or other psychoactive drugs. Most of the callers (73.8%) were experiencing adverse consequences associated only with marijuana use rather than in combination with other substances. Most (92%) expressed interest in being treated, while very few (18%) had ever been seen in a drug or alcohol treatment program.

Adult↗
PubMed1986

Stress inoculation training in the control of THC toxicities.

Fifty-four marijuana-naive cancer patients undergoing chemotherapy and about to use THC (delta-9-tetrahydrocannabinol) as an antiemetic for the first time were randomly assigned to one of two conditions: stress inoculation or placebo/information training. It was hypothesized that subjects exposed to stress inoculation training would experience fewer adverse subjective effects of THC, experience less stressful nausea and vomiting, and be less likely to voluntarily withdraw from subsequent THC trials. None of the hypotheses was confirmed.

Antineoplastic Agents↗
PubMedDate not supplied

The Controlled Substances Therapeutic Research Act in the state of Washington.

In March 1979, the Governor of the State of Washington signed legislation establishing a THC/marihuana research program within the Washington State Board of Pharmacy. By November 1980, approximately 80 physicians had enrolled more than 400 patients on the chemotherapy protocol which randomly assigned subjects to receive either THC and prochlorperazine or THC and placebo. This report describes the process of implementing the legislation, the administrative and clinical roles of project personnel, and the design of three currently operating protocols.

Antineoplastic Agents↗