Biomedical subjects

Richard Crosby

Publications and source records attributed to Richard Crosby.

At least 19 recordsLinked to original sources

PubMed2006

Correlates of unprotected anal sex with casual partners: a study of gay men living in the southern United States.

This study identified demographic and behavioral correlates of engaging in unprotected anal sex (UAS) with non-main partners among men having sex with men (MSM). Just over 1,000 men completed anonymous surveys with 25% of the men reporting their most recent sexual act with a non-main male partner was UAS. These men tended to be white, older, HIV seropositive, and high (or drunk) when having sex. In multivariate analysis being seropositive, and being high or drunk retained significance. Subsequent research may build upon these findings to determine the causal pathway to UAS among MSM having sex with non-main partners. Findings may be useful in constructing prevention interventions for MSM frequenting gay venues.

Data Collection↗

PubMed2006

Family influences and biologically confirmed sexually transmitted infections among detained adolescents.

Data from a convenience sample of 476 detained adolescents were used to examine the relationship between family influences and biologically confirmed sexually transmitted diseases (STDs). Results indicated that frequent parental monitoring was negatively associated with STD infection and that this relationship was modified by age, gender, and race. Findings suggest that STD prevention efforts for detained adolescents (particularly high-risk minority females older than age 16) might focus on increasing monitoring by a parent or parental figure.

Adolescent↗

PubMed2006

Erection loss in association with condom use among young men attending a public STI clinic: potential correlates and implications for risk behaviour.

BACKGROUND: To assess prevalence of condom-associated erection loss and to identify correlates of erection loss among men attending a sexually transmissible infections (STI) clinic. METHODS: Men (n = 278) attending an STI clinic responded to an anonymous questionnaire aided by a CD recording of the questions. The sample was screened to include only men who had used a condom during penile-vaginal sex at least three times in the past 3 months. Erection loss was assessed for 'the last three times a condom was used'. RESULTS: The mean age of the participants was 23.7 years (s.d. = 4.1); 37.1% of the men reported condom-associated erection loss on at least one occasion. Men who had reported condom-associated erection loss were also reported having more frequent unprotected vaginal sex (P = 0.04) and were less likely to use condoms consistently (P = 0.014) than men without erection loss. Men with erection loss were also more likely to remove condoms before sex was over (P = 0.001). Age and race/ethnicity were not associated with erection loss. In multivariate analysis, three significant statistical predictors were identified: low self-efficacy to use condoms (P = 0.001); problems with 'fit or feel' of condoms (P = 0.005); and having more than three sex partners during the previous 3 months (P = 0.02). CONCLUSIONS: Condom-associated erection loss may be common among men at risk for STIs. This problem may lead to incomplete or inconsistent condom use. Men may be more likely to experience condom-associated erection loss if they lack confidence to use condoms correctly, if they experience problems with the way condoms fit or feel, and if they have sex with multiple partners.

Adult↗

PubMed2005

Is social capital a protective factor against obesity and diabetes? Findings from an exploratory study.

PURPOSE: The aim of this exploratory study is to examine the relationship between social capital and the important public health variables of obesity and diabetes in the adult population in the United States. METHODS: State-level correlational analyses were conducted. Predictor variables included social capital (Putnam's measure), income inequality, and poverty. Outcome variables were state-level rates of obesity and diabetes as reported by the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System. RESULTS: Social capital and poverty had significant bivariate relationships with obesity and diabetes; multivariate linear regression showed social capital to be the strongest predictor of both outcome variables (explaining 10% of the variance in obesity and 44% of the variance in diabetes). Social capital was related inversely to both variables, indicating a protective effect. Sensitivity analyses showed that an alternate measure of income inequality had a bivariate relationship with diabetes, but was not as strong a predictor as social capital in multivariate analyses. CONCLUSIONS: These exploratory study results suggest that greater levels of social capital are protective against obesity and diabetes. This initial finding warrants subsequent empirical investigations designed to identify strategies that can be used to foster the creation of social capital in areas of the United States with an especially high prevalence of obesity and diabetes. In addition, these investigations should operate at multiple levels, examining individual, social-network, and community-level measures of social capital.

Adult↗

PubMed2005

Teacher connectedness and health-related outcomes among detained adolescents.

PURPOSE: Data were collected from a convenience sample of 550 detained adolescents (ages 14-18 years) to explore the association between adolescents' perception of teacher connectedness and a range of health risk behaviors, such as gang membership, use of in alcohol, drugs, and tobacco, and engagement in sexual risk behaviors prior to detainment. METHODS: Participants answered survey questions using audio-computer assisted self-interviewing procedures that assessed demographic, pro-social, problem, and drug and sexual risk behaviors. RESULTS: Multiple logistic regression analyses controlling for demographic and socioeconomic status, truancy, number of days in the detention center, and family factors indicated that adolescents who reported low teacher connectedness, relative to their peers reporting high teacher connectedness, were twice as likely to use marijuana and amphetamines, and twice as likely to be sexually active, have sex while high on alcohol or drugs, have a partner who was high on alcohol or other drugs during sex, and have multiple sexual partners. CONCLUSIONS: The association between teacher connectedness and adolescents' health risk behaviors prior to detainment suggests that school-based interventions that enhance the school environment, particularly teachers' skills and training to enhance and maximize the effectiveness of their student interactions, may be one strategy for reducing health risk behaviors and their associated adverse health outcomes among youth at high risk.

Adolescent↗

PubMed2005

Correlates of perceived difficulty in potentially disclosing HIV-positive test results: a study of low-income women attending an urban clinic.

BACKGROUND: The study identified correlates of women's perception that testing positive for HIV would be very difficult to communicate to friends, family members and sex partners. We also determined whether perceived disclosure difficulty was associated with HIV-testing intent. METHODS: Face-to-face interviews were conducted with 143 women attending an urgent care centre in Atlanta, Georgia. The centre served primarily low-income or indigent African-American women. A three-item scale (alpha = 0.81) assessed disclosure difficulty. Assessed correlates included selected social/contextual factors and intrapersonal factors. RESULTS: In controlled multivariate analyses, only the social/contextual factors were associated with HIV disclosure difficulty. Women perceiving an inability to cope with positive results were more likely to report high disclosure difficulty (P = 0.01). Women perceiving an inadequate support system and those believing that HIV would substantially complicate their lives were more likely to anticipate high disclosure difficulty (P = 0.006 and P = 0.03, respectively). Disclosure difficulty was not associated with intent for HIV-testing 'today' (P = 0.50) or within the next 12 months (P = 0.27). CONCLUSION: Findings provide initial evidence suggesting that selected social/contextual factors rather than intrapersonal factors are associated with anticipated disclosure difficulty of HIV-positive test results among low-income minority women, residing in the urban south. High levels of anticipated disclosure difficulty may not preclude HIV test acceptance.

AIDS Serodiagnosis↗

PubMed2005

Accounting for failures may improve precision: evidence supporting improved validity of self-reported condom use.

OBJECTIVES: To determine whether a measure of unprotected vaginal sex that is adjusted for condom failures would produce improved accuracy in predicting biologically confirmed STDs (chlamydia and gonorrhea) among female teens. METHODS: Self-reported measures were collected using audio-computer-assisted self-interviewing. DNA amplification for the presence of Chlamydia trachomatis and Neisseria gonorrhoeae was conducted. RESULTS: The unadjusted measure of unprotected vaginal sex was not significantly associated with biologically confirmed prevalence of STDs (prevalence ratio [PR] = 1.51; 95% CI = 0.71-3.21; P = 0.28). Alternatively, the adjusted measure achieved significance (PR = 3.59; 95% CI = 1.13-11.38; P = 0.014). More than one quarter (25.6%) of teens using condoms inconsistently and/or incorrectly tested positive for an STD compared to 7.1% among those reporting the consistent and correct use of condoms. CONCLUSION: Findings demonstrate that studies of condom effectiveness should use an adjusted measure of condom use to achieve precision and rigor.

Adolescent↗

PubMed2005

Gay men who attend sex resorts: a typology associated with high-risk sexual behaviour.

Our objective was to determine a sociodemographic profile (typology) of men for whom a relatively greater number of sex partners was associated with engaging in unprotected anal sex. A cross-sectional survey of 150 men who have sex with men (MSM) attending a large sex resort was conducted. The sex resort was located in the Southeastern United States. Men from 14 states attended the resort and completed an anonymous, self-administered, questionnaire. The typology that emerged showed that the co-occurring risk behaviours (greater number of partners and having unprotected sex) were reported by older men (P = 0.002), men with incomes of at least US 50,000 dollars (P = 0.018), men growing up in rural areas (P = 0.005), men who were not knowingly HIV positive (P = 0.004), and men who had received the full series of vaccinations against hepatitis B (P = 0.029). This typology may be useful for more efficient targeting of prevention and counselling programmes designed to reduce sexually transmitted infection incidence among this high-risk (and understudied) population of MSM.

Adult↗

PubMed2004

A descriptive analysis of HIV risk behavior among men having sex with men attending a large sex resort.

This study assessed the prevalence of various HIV-associated risk behaviors among men who have sex with men (MSM) attending a popular sex resort in the southern United States. One hundred fifty men completed an anonymous self-administered questionnaire (91% response rate). Men currently resided in 14 states. One sixth reported being HIV-positive. During a typical resort visit, men averaged 4 sex partners. About two thirds of the men had anal sex during a typical resort stay; of these, 21% reported never using condoms and 41% reported always using condoms. HIV risk behavior over the past few months was also assessed. Men averaged 10 sex partners. Meeting partners by means of the Internet (57%) and bathhouses--excluding sex resorts--(40%) was common. Most men (62%) reported having group sex. About one half (49%) engaged in unprotected anal sex. Significant differences in recent frequency of unprotected anal sex between HIV-positive and HIV-negative men were not found (P = 0.74). Among those using condoms, 20% reported not using condoms from start to finish of sex, 7% reported breakage, and 6% reported slippage. Twenty-three percent had anal sex without lubrication. Fisting and the use of nonprescription sildenafil citrate (Viagra) was reported by about one sixth of the men. The findings suggest that MSM attending sex resorts may experience substantial risk of HIV infection. Sex resorts may be an important venue for HIV prevention.

Condoms↗

PubMed2004

Health risk factors among detained adolescent females.

OBJECTIVES: To identify the prevalence of health risk factors among a sample of detained adolescent females and determine whether there are racial/ethnic differences. DESIGN AND SETTING: A cross-sectional survey of 197 adolescent females (aged 14 to 18 years) recruited within eight detention facilities. OUTCOME MEASURES: Thirty-five measures, comprising four domains, were assessed. Domains were sex-related risk factors, violence-related risk factors, selected mental health issues, and substance abuse behaviors. Measures were collected using audio-computer-assisted self-interviewing. A biological assessment for the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis was also conducted. RESULTS: Several health risk factors were especially prominent. Mean age of sexual debut was 13 years. The mean number of sex partners (lifetime) was 8.8. Twenty percent tested positive for an STD, and 32.2% had ever been pregnant. Of those reporting sexual activity, 33.9% had not used any form of contraception in the past 2 months and about 40% reported having recent sex with a casual partner. More than 40% reported that a friend had been beaten, attacked, or hurt by others in the past year. More than one half had witnessed violence (past year) and nearly 30% had ever belonged to a gang. Forty percent had thought about committing suicide in the past 2 months, with 35% informing someone of their intent, and 25% attempting suicide. Recent use of illegal substances was common. Correlations between the four domains were significant (p < 0.03), but weak. With some notable exceptions (STD prevalence, trading sex for money, witnessing violence), no difference was found between minority and nonminority adolescents with respect to risk factors. After creating an index of all the risk factors, a normal distribution was obtained (mean number of factors, 10.3; standard deviation, 5.0). CONCLUSIONS: Preventive medicine programs for adolescent females within detention facilities are warranted. Our evidence suggests that health risk behaviors in this population may be quite diverse; therefore, these programs should be broad in scope and that depth of the programs should vary as a function of risk level.

Adolescent↗

PubMed2004

Behavioral interventions to reduce incidence of HIV, STD, and pregnancy among adolescents: a decade in review.

PURPOSE: To review adolescent sexual risk-reduction programs that were evaluated using quasi-experimental or experimental methods and published in the 1990s. We describe evaluated programs and identify program and evaluation issues for health educators and researchers. METHODS: We systematically searched seven electronic databases and hand-searched journals to identify evaluations of behavioral interventions to reduce sexual risk behaviors among adolescents. Articles were included if they were published in the 1990s, provided a theoretical basis for the program, information about the interventions, clear aims, and quasi-experimental or experimental evaluation methods. We identified 101 articles, and 24 met our criteria for inclusion. RESULTS: We reviewed these evaluations to assess their research and program characteristics. The majority of studies included randomized controlled designs and employed delayed follow-up measures. The most commonly measured outcomes were delay of initiation of sexual intercourse, condom use, contraceptive use, and frequency of sexual intercourse. Programs ranged from 1 to 80 sessions, most had adult facilitators, and commonly included skills-building activities about sexual communication, decision-making, and problem solving. The programs included a wide range of strategies for content delivery such as arts and crafts, school councils, and community service learning. CONCLUSIONS: Analysis of these programs suggest four overall factors that may impact program effectiveness including the extent to which programs focus on specific skills for reducing sexual risk behaviors; program duration and intensity; what constitutes the content of a total evaluated program including researchers' assumptions of participants' exposure to prior and concurrent programs; and what kind of training is available for facilitators.

Adolescent↗

PubMed2004

Correlates of having unprotected vaginal sex among detained adolescent females: an exploratory study of sexual factors.

BACKGROUND: Erotophilia, motivations for engaging in sex, and pleasure-related barriers to using condoms may all be important determinants of whether high-risk adolescent females have sex unprotected by a condom. This exploratory study identified associations between these factors and engaging in unprotected vaginal sex (UVS) among a sample of adolescent females recruited from short-term detention facilities in the USA. METHODS: A cross-sectional survey of 211 adolescent females (14-18 years of age) was conducted. Only those indicating they had sex within the past 2 months were included in the analysis. Adolescents were recruited within eight detention facilities. Measures were assessed using audio-computer assisted self-interviewing (A-CASI). RESULTS: In race-adjusted analyses, adolescents indicating greater pleasure-associated barriers to using condoms were more than 4.3 times more likely than those indicating fewer barriers to report having UVS in the past 2 months (AOR = 4.36; 95% CI = 2.15-8.86). Similarly, those scoring higher in erotophilia (compared with those scoring lower) were more than twice as likely to report UVS (AOR = 2.08; 95% CI = 1.02-4.24). Finally, adolescents who had ever been pregnant were approximately 2.5 times more likely to report having recent UVS (AOR = 2.48; 95% CI = 1.1-5.34). With the exception of having five or more sex partners in the past 2 months (P = 0.08), none of the remaining correlates approached multivariate significance. CONCLUSIONS: Constructs such as erotophilia and pleasure-related barriers to condom use may be important correlates of UVS among this population of high-risk adolescents.

Adolescent↗

PubMed2004

Repeat HIV testing among low-income minority women: a descriptive analysis of factors influencing decisional balance.

OBJECTIVE: This exploratory study quantified potential barriers to repeat HIV testing, as well as perceptions supporting further testing among women previously tested for HIV. The study also determined associations between summative measures of barriers (and supportive factors) and women's intent to be tested for HIV. DESIGN AND SETTING: One hundred forty-three women (95.4% African-American) who attended an urgent care center, and reported a history of HIV testing, completed a face-to-face interview. RESULTS: Frequently perceived barriers included perceptions that repeat testing was unnecessary, either based on: 1) having only one sex partner since the last test (38.1% of responders); 2) obtaining a negative test result in the past year (36.7%); 3) worry about coping with a positive diagnosis (30.7%); 4) a belief that "guys I have sex with always use condoms" (27.5%); or 5) a belief that treatment may not be affordable (25.2%). Other barriers were endorsed with less frequency. A broad range of supportive factors were endorsed, including: 1) testing is part of self-care (85.8%); 2) knowing to avoid sex if HIV-positive (85.8%); 3) test results are reliable and important (84.7%); 4) early diagnosis can improve odds of staying healthy (83.0%); and 5) coping with a positive test result, and paying for treatment, would be manageable (78.6% and 78.2%, respectively). CONCLUSIONS: Findings suggest that barriers and supportive factors played equally important roles in women's intent to be tested for HIV. Intervention efforts designed to promote repeat HIV test acceptance among low-income, African-American women should focus on changing perceptions of barriers, and enhancing supportive factors.

AIDS Serodiagnosis↗

PubMed2003

Condom-use errors and problems: a neglected aspect of studies assessing condom effectiveness.

OBJECTIVE: To assess and compare condom-use errors and problems among condom-using university males and females. METHODS: A convenience sample of 260 undergraduates was utilized. Males (n=118) and females (n=142) reported using condoms in the past 3 months for at least one episode of sex (penis in the mouth, vagina, or rectum) with a partner of the other sex. A questionnaire assessed 15 errors and problems associated with condom use that could be observed or experienced by females as well as males. RESULTS: About 44% reported lack of condom availability. Errors that could contribute to failure included using sharp instruments to open condom packages (11%), storing condoms in wallets (19%), and not using a new condom when switching from one form of sex to another (83%). Thirty-eight percent reported that condoms were applied after sex had begun, and nearly 14% indicated they removed condoms before sex was concluded. Problems included loss of erection during condom application (15%) or during sex (10%). About 28% reported that condoms had either slipped off or broken. Nearly 19% perceived, at least once, that their condom problems necessitated the use of a new condom. Few differences were observed in errors and problems between males and females. CONCLUSIONS: Findings suggest that condom-use errors and problems may be quite common and that assessment of errors and problems do not necessarily need to be gender specific. Findings also suggest that correcting "user failure" may represent an important challenge in the practice of preventive medicine.

Adult↗

PubMed2003

Correlates of recent unprotected anal sex among men having sex with men attending a large sex resort in the South.

BACKGROUND: Published studies have not investigated sexually transmitted disease-associated risk behaviors among men who have sex with men (MSM) attending U.S. sex resorts. GOAL: We conducted an exploratory study to identify demographic and behavioral correlates of recently engaging in unprotected anal sex (UAS) among MSM attending a sex resort in the southern United States. STUDY DESIGN: A cross-sectional survey of 150 men. RESULTS: In multivariate analyses, men were more likely to practice risky sex if they also recently engaged in the practices of having group sex (adjusted odds ratio [AOR], 3.0), rimming (AOR, 2.0), or if they used public restrooms to meet potential sex partners (AOR, 2.6). UAS was also more likely among men vaccinated against hepatitis B (AOR, 1.9). Men who reported having primary partners and men who reported being HIV-positive were no less likely than other men in the sample to report recent UAS. CONCLUSION: Sex resorts can be an important venue for sexually transmitted disease and HIV prevention among MSM. Tailored prevention messages could be warranted for men who report group sex, rimming, meeting partners in public restrooms, or being vaccinated against hepatitis B.

Adult↗

PubMed2003

Correlates of sexual experience among a nationally representative sample of alternative high school students.

Little is known about risk and protective factors associated with sexual experience among alternative school students that might prove useful in targeting and guiding early interventions to prevent onset of sexual risk behavior. Researchers analyzed data from the national Alternative High School Youth Risk Behavior Survey. Principal components analysis identified six risk and protective factors: weapon carrying; tobacco use; cocaine, inhalant, and needle use; alcohol and marijuana use; participation in sports; and fighting. Composite variables with significant bivariate relationships to sexual experience, as well as demographic variables, were entered into a logistic regression analysis to determine independent effects of these correlates on students' sexual experience (N = 6.037). Nearly 90% of students reported having sexual intercourse. In multivariate analysis, significant demographic correlates of sexual experience included female gender (58% more likely than males to report ever having sex), African American race (2.83 times more likely than non-Hispanic Whites), and age (28% more likely with each advancing year). Attending school in a rural or suburban region corresponded to a 31% decrease and 46% decrease, respectively, in the odds of ever having sex. Weapon carrying, and cocaine, inhalant, and needle use, were associated with a 35% and 46% increase, respectively, in the odds of ever having sex. Students reporting they had ever used alcohol or marijuana, and those reporting recent fighting behavior, were 2.7 and 1.6 times more likely, respectively, to report sexual experience. Most alternative school students have had sexual intercourse, with those students engaging in substance use, weapon carrying, and fighting behaviors being at greater risk for sexual experience. Prevention programs for high-risk youth attending alternative high schools need to consider how to promote continued abstinence among the small but important minority of alternative school students not yet sexually experienced.

Adolescent↗

PubMed2002

Pregnant African-American teens are less likely than their nonpregnant peers to use condoms.

OBJECTIVE: The aim of this study was to prospectively compare pregnant and nonpregnant adolescents' recent condom use and sexually transmitted disease (STD) acquisition. METHODS: Sexually active African-American females (N = 522), ages 14-18, were recruited from clinics and schools. Adolescents completed baseline interviews and provided vaginal swabs for STD testing, and urine for pregnancy testing. Assessments were repeated 6 and 12 months post baseline assessment. Analyses compared adolescents who became pregnant between baseline and the 6-month assessment with their peers who had negative pregnancy tests. Condom use between the 6- and 12-month assessments and incidence of STDs at the 12-month assessment served as outcomes. Adolescents who did not report sexual activity between the 6- and 12-month assessments were excluded. RESULTS: Ten percent of the adolescents became pregnant and continued sexual activity. Pregnant adolescents reported less overall condom use (P < 0.0001), more infrequent condom use (adjusted odds ratio [AOR] = 4.5, P < 0.001), and more unprotected vaginal sex (AOR = 4.7, P < 0.003). Pregnant adolescents were equally likely to test positive for STDs (31% vs 26%) and to self-report having STDs at the 12-month follow-up period (30% vs 23%). CONCLUSIONS: Findings suggest that pregnant adolescents may be less likely to use condoms than their nonpregnant peers and that STD incidence among pregnant adolescents may be high. Condom use promotion may be important during adolescents' prenatal care.

Adolescent↗

PubMed2002

Psychosocial and behavioral correlates of refusing unwanted sex among African-American adolescent females.

PURPOSE: To identify psychosocial and behavioral correlates of refusing unwanted sex among African-American female adolescents. We hypothesized that greater power in relationships, less concern about negative emotional consequences, supportive family and peers, positive self-perceptions, greater perceived risk, and fewer sexual risk behaviors would be associated with increased odds of refusing unwanted sex. METHODS: Data regarding demographics, sexual behaviors, communication with parents, and psychosocial factors relevant to romantic and sexual partnerships were collected both via self-administered questionnaire and structured interview from a clinic- and school-based sample of 522 African-American adolescent females ages 14-18 years in Birmingham, Alabama. Adjusted odds ratios were calculated using logistic regression. RESULTS: Of those who had experienced pressure for unwanted sex (n = 366), 69% consistently refused to engage in unwanted sex. Adolescents with high safer sex self-efficacy and low perceived partner-related barriers (i.e., concerns about partners' negative emotional reactions) to condom negotiation were over 2.5 times more likely to consistently refuse unwanted sex than were those reporting low safer sex self-efficacy and high partner-related barriers. Adolescents who spoke more frequently with their parents about sexual issues were nearly twice as likely to consistently refuse unwanted sex than were those who spoke less frequently with their parents. CONCLUSIONS: Sexual-risk reduction efforts directed toward adolescent females should seek to build self-efficacy to negotiate safer sex and provide training in social competency skills that may help to reduce or eliminate partner barriers to condom use. Further, sexual risk-reduction programs may be more effective if they include parents as advocates of safer sexual behaviors.

Adolescent↗