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The relational determinants of condom use with commercial sex partners in Thailand.

OBJECTIVE: To analyze the extent and determinants of condom use with commercial sex partners among lower socioeconomic status groups in the Thai population. DESIGN: Respondents were sampled in Udon Thani, Saraburi and Bangkok in 1992. Completed sample size was 678 women in brothels, 330 male truck drivers and 1,075 men aged 17-45 years. Behavioral data and local sexual network information were collected using structured questionnaires (face-to-face interviews), focus groups and in-depth unstructured interviews. METHODS: Data were analyzed using univariate and multivariate logistic regression. RESULTS: Condom use with commercial partners remains inconsistent. Consistent use was reported by 61% of women in brothels, 25% of truck drivers, and 29% of men in the low-income population. The single strongest predictor of consistent condom use for all groups is type of partnership. Consistent use drops significantly with regular (multivisit) commercial sex partners compared with casual (single visit) commercial partners; adjusted odds of consistent use are 0.22 for women and 0.25 for men. Brothel women report that one in five of their commercial partners is a 'regular', and 20% of the young men who report a commercial partner report a 'regular'. DISCUSSION: The strongest determinant of consistent condom use is the nature of the relational bond between the partners, rather than their individual characteristics, knowledge or attitudes. To raise condom use further, programs will have to move beyond the standard knowledge-attitudes-practices paradigm focus on individual attributes to address the contextual determinants of behavior.

Adolescent↗

Dimensions of self-efficacy among three distinct groups of condom users.

Condom use self-efficacy can be defined as expectations about one's ability to use condoms under a variety of circumstances. This investigation examined the factor structure of the Condom Use Self-Efficacy Scale (CUSES) in an 18- to 23-year-old college population (N = 339) and tested the ability of the factors to distinguish among three groups of condom users (nonusers, sporadic users, and ritualistic users). Emerging from a principal components analysis were four reliable factors labeled Mechanics, Partner's Disapproval, Assertive, and Intoxicants. Results from a discriminant analysis indicated that sporadic users were best distinguished from ritualistic users by number of sex partners, use of intoxicants, and intensity of alcohol use. The sporadic users had more sex partners, were less confident of their ability to use condoms when intoxicated, and were heavier drinkers than were the ritualistic users. Nonusers were best distinguished from ritualistic users by the factor labeled Assertive. Nonusers were significantly less confident in their ability to discuss condoms and to insist on their use with a sexual partner. Implications of the findings for improving campus-based programs to prevent the spread of human immunodeficiency virus infection and sexually transmitted diseases are discussed.

Acquired Immunodeficiency Syndrome↗

Behavioral determinants of mental illness concerns: a comparison of community subcultures.

A stratified sample (race, sex, and social class) of 469 laymen from two North Carolina communities responded to a 190-item MMPI-based questionnaire with the degree of mental illness concern evoked by each item. The results reflected systematic race and social class differences in the behavioral bases for mental illness attributions--differences not explainable by overall differences in toleration for deviance. Although laymen had roughly similar rank orderings for the 13 homogeneous clusters of items, blacks indicated greater concern over breakdowns in social orientation than whites, while the opposite pattern held for traditionally defined psychopathy (internal distresses). Upper-class concerns were, comparatively, with cognitive dysfunction, middle-class with moral and social responsibility, and lower-class with social inadequacies.

Adult↗

Parents' behavioral norms as predictors of adolescent sexual activity and contraceptive use.

The influence of parental factors on adolescent sexual behavior and contraceptive use has been examined previously, and findings have been contradictory. Previous studies, which found little relationship between parental norms and adolescent sexual activity, have been limited by their failure to recognize developmental differences in the relative weight of parent and peer influences between younger and older teens and by use of selected samples, resulting in a restriction of range. The current study differs in that it utilizes a clustered sample household survey of 329 males and females, aged 14 to 17, and 470 of their parents. Using multiple regression analysis, it was found that parents' reported behavioral norms account for 5% of the variance in whether adolescents have had intercourse, and for 33% of the variance in use of contraception at last intercourse. The study suggests that while parents' normative beliefs have limited effect in the decision to become sexually active, they have considerable impact on later contraceptive use.

Adolescent↗

Prevalence and correlates of AIDS-related behavioral intentions among urban minority high school students.

Using data from a cross-sectional survey of 926 predominantly black and Hispanic ninth through twelfth graders in three New York City public high schools, the explanatory power of theoretically and empirically derived predictors (i.e., demographic, contextual, and cognitive) of intentions to engage in sexual intercourse, to be sexually monogamous, to use condoms during intercourse, and to ascertain intercourse partners' sexual and drug-use histories was compared. One-third of sampled students "definitely" intended to have sexual intercourse in the next year, one-half "definitely" intended to be sexually monogamous, two-thirds "definitely" intended to use condoms during intercourse, and three-quarters "definitely" intended to ascertain intercourse partners' sexual and drug-use histories. In a predictive model including all investigated variables, those variables derived from the cognitive set (i.e., beliefs about susceptibility to getting AIDS, and beliefs about barriers, self-efficacy, norms, and values pertaining to AIDS-preventive actions) were most strongly associated with the four investigated behavioral intentions. However, certain variables derived from the demographic set (i.e., age, gender, race/ethnicity) and contextual set (i.e., previous behavioral involvement, cues, academic failure, substance use) also contributed explained variance to all four intentions.

Acquired Immunodeficiency Syndrome↗

Teenage pregnancy in the United States.

One out of every 10 women aged 15-19 becomes pregnant each year in the United States. Of these pregnancies, five out of every six are unintended--92 percent of those conceived premaritally, and half of those conceived in marriage. The teenage pregnancy rate is high because only a minority (one in three) of sexually active young women always use contraceptives, and only one in two of these women rely on the most effective methods. The two most common reasons given by adolescents for not using contraceptives are believing that the risk of pregnancy is small, and failing to anticipate intercourse. Experience in other developed countries clearly shows that the incidence of adolescent pregnancy can be reduced if effective contraceptives are made widely available. Although high quality sex education programs that include information about contraception, reproductive biology and responsible sexual behavior can enhance the effectiveness of contraceptive delivery systems, they are not a substitute for the actual provision of services and supplies. However, there is formidable political opposition to the provision of such services by a vocal minority who believe that the crux of the problem is premarital sexual activity, and that lowering the cost of such behavior by reducing the risk of pregnancy will both legitimize adolescent sex and increase its prevalence. Consequently, there is a political impasse that guarantees a continuing large number of adolescent pregnancies. Further, even if contraceptives and sex education were readily available to all adolescents, there would still be a pool of teenagers who would see little benefit in postponing parenthood. This pool would be composed overwhelmingly of the poor and of blacks and Hispanics. Increasing the demand for pregnancy prevention among young women and men in this hard-core, high-risk group will be extremely hard to achieve without a fundamental restructuring of society.

Adolescent↗

Alcohol use as a situational influence on young women's pregnancy risk-taking behaviors.

Recent studies have found that many young women just beginning their sexual lives use alcohol prior to intercourse. A large number appear to drink heavily enough prior to sex to compromise their ability to use contraceptives. The question emerges whether there is a relationship between drinking before intercourse, the nonuse of birth control methods, and unplanned pregnancies. The present research describes 43 instances of intercourse which resulted in unplanned pregnancies in 14- to 21-year-olds. Variables examined included alcohol use prior to sex, amount of alcohol consumed, the use of other drugs, the planning of intercourse, respondents' stated reasons for nonuse of contraceptives, and other general demographic data.

Adolescent↗

Effects of ethnic, age, and bereavement on complete denture patients.

Geriatric patients in prosthodontics require neverending patience and a unique consideration of the "healing" concept. Old people may act helplessly and hopelessly, and even though they are cooperative during treatment, they may lack the capacity to verbalize their distress. The dentist must look for unspoken clues instead, keeping an eye open for various possible factors which might explain a patient's behavior. Many elderly people have experienced the loss of a spouse or other relative. Usually such experiences are associated with increased rate of disease and death and certainly qualify as a severe psychological trauma. Because the effects of bereavement in the prosthodontic patient are often inconspicuous, they pose a diagnostic challenge. The most important direct conclusion to be drawn from this study is the overwhelming importance of patients' ethnoclutural background which shapes the basic characteristics of their response. People of Oriental origin tended to increase their (indirect) expression of emotional distress after bereavement, while Ashkenazis reacted to bereavement with decreasing complaints. Maximum results can be attained in treating prosthodontic patients when their ethnocultural and socioeconomic behavioral determinants of their therapeutic response are based upon these data.

Age Factors↗

Factors associated with Hispanic women's HIV-related communication and condom use with male partners.

To determine factors influencing Hispanic women's HIV-related communication and condom use with their primary male partner, 189 Dominican, Puerto Rican, and Mexican women were interviewed regarding sexual behaviour and condom use, relationship characteristics, perceived risk for HIV, and HIV-related communication with the primary male partner. Level of HIV-related communication with the primary male partner was associated with the woman's perceived risk for HIV and her rating of the openness with which she could communicate with her primary partner. Mexican women were less likely than Puerto Rican or Dominican women and women with multiple partners were less likely than those with one partner to communicate about HIV-related issues with their primary partner. Women reporting more condom use with their primary partner were younger, had discussed HIV-related issues more with the primary partner, and were less likely to expect negative reactions to requests for condom use than those reporting less condom use. These results suggest that prevention programmes that increase both general and HIV-specific communication between members of a couple may facilitate safer sex practices by the couple. Prevention programmes that encourage women to insist on condom use should consider the woman's expectations about her partner's reaction as a potential barrier to the initiation of safer sex practices.

Acculturation↗

Crack, sex, and STD.

Increasing rates of syphilis, gonorrhea, chancroid, and sexually transmitted human immunodeficiency virus infection appear to be related to crack cocaine use. This article critically reviews 16 epidemiologic studies that examine drug use, sexual behavior, and sexually transmitted disease (STD). Eight studies found an association between crack and STD, one study found no association between crack and STD, and seven studies found STD to be related to other drugs or methods of cocaine use. The exchange of sex for money or drugs was associated with STD in seven studies. Publications that were reviewed have numerous methodologic weaknesses: broader sampling, uninfected comparison groups, and greater specification of drug use and sexual risk behaviors are needed. Further research should compare different drugs and associated sexual behavior and STD to assess the unique risk conferred by crack. Designing effective interventions will require investigation of risk behavior determinants and barriers to health care.

Chancroid↗

Adolescents and sexually transmitted diseases.

Sexually transmitted diseases (STDs) are a serious health problem for adolescents, occurring in an estimated one-quarter of sexually active teen-agers. Many of the health problems--including STDs--result from specific risk-taking behaviors. Determinants of STD risks among adolescents include behavioral, psychological, social, biological, institutional factors. Education is an important component in STD control in adolescents. The goal of education is to increase adolescent self-efficiency in practicing STD prevention and risk-reduction. A comprehensive approach including quality, theory-based education, accessible and effective health clinics, and improved social and economic conditions has the most promise of controlling STDs in adolescents.

Adolescent↗

Newborn dopamine-beta-hydroxylase, minor physical anomalies, and infant temperament.

The authors examined newborn anomaly scores for 193 normal infants in relation to obstetrical history, newborn dopamine-beta-hydroxylase (DBH), and 5-month (N=185) and 1-year (N=123) infant behavior, determined by a questionnaire completed by their mothers. There was no significant relationship between anomaly score and obstetrical history or 5-month infant temperament; low significant correlations were found between newborn DBH and 1) infant irritability and unsociable response and 2) 1-year anomaly scores and reported activity levels. The authors discuss the possible importance of these findings.

Child Behavior↗

Is homosexuality hormonally determined?

This paper suggest there is insufficient evidence to conclude that homosexuality has endocrine bases. The search for hormonal correlates occurs within a model that views homosexuality as a medical problem requiring biological explanations and a program of treatment or prevention. This search is heavily rooted in popular conceptions of gender-appropriate behavior, as well as in naive concepts of the significance of hormonal changes. Two kinds of hormonal study are considered here. Researchers may either (a) investigate hormone levels in adult populations or (b) investigate hypotheses of behavioral determination by prenatal hormones. Much of the latter information derives from animal studies, commonly on the laboratory rat. This paper questions the validity of assumptions underlying these studies--assumptions about the behavior of the laboratory rat itself and, more importantly, about the legitimacy of this animal as a model for human behavior. It is suggested that, although such hypotheses are naive, their current popularity arises from their potential role in "controlling" homosexuality.

Animals↗