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PubMed2004

HIV risk behavior among ethnically diverse adolescents living in low-income housing developments.

PURPOSE: To describe patterns and predictors of HIV risk behaviors among ethnically diverse, low-income adolescents. METHODS: Computer-assisted surveys were administered to 1172 adolescents between the ages of 12 and 17 years living in 15 low-income housing developments in three urban areas in the United States to characterize and identify predictors of HIV risk behavior. Data were analyzed using multinomial logistic regression to identify variables predictive of "no risk," "lower risk," and "higher risk" group classification. RESULTS: Most adolescents were not yet sexually active; nonetheless, a subset of youth reported high rates of HIV risk-related behaviors. HIV risk was highest among adolescents who were older, had weaker intentions to reduce risk, stronger beliefs that their sexual partners did not favor risk-reduction, lower risk-reduction behavioral skills, higher risk-reduction outcome expectation, and higher rates of substance use. CONCLUSIONS: HIV prevention efforts are needed that are tailored to ethnically diverse communities of adolescents, including those in early adolescence and those at highest risk.

Adolescent↗
PubMed2006

Behavioral HIV risk reduction among people who inject drugs: meta-analytic evidence of efficacy.

We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate behavioral HIV risk reduction interventions targeting people who inject drugs. We included 37 RCTs evaluating 49 independent HIV risk reduction interventions with 10,190 participants. Compared to controls, intervention participants reduced injection drug use (IDU) and non-IDU, increased drug treatment entry, increased condom use, and decreased trading sex for drugs. Interventions were more successful at reducing IDU when participants were non-Caucasians, when content focused equivalently on drug-related and sex-related risks, and when content included interpersonal skills training specific for safer needle use. Condom use outcomes improved when two intervention facilitators were used instead of one. IDU outcomes did not decay, but condom use outcomes did. Behavioral interventions reduce risk behaviors among people who inject drugs, especially when interventions target both drug risk and sexual risk behaviors, and when they include certain behavioral skills components. Implications for future interventions are presented.

HIV Infections↗
PubMed1997

Reductions in high-risk drug use behaviors among participants in the Baltimore needle exchange program.

OBJECTIVE: To determine whether enrollment in the Baltimore Needle Exchange Program (NEP) was associated with short-term reduction in risky injection practices. METHODS: Demographic information was collected on NEP participants upon enrollment. A systematic sample of enrollees was interviewed at program entry, 2 weeks, and 6 months later on recent drug-related behaviors. Comparisons were performed using paired t-tests. RESULTS: Among 221 NEP participants who completed baseline, 2-week and 6-month follow-up visits, significant reductions (p < .01) were reported in using a previously used syringe (21.6%, 11.0%, 7.8%, respectively), lending one's used syringe to a friend (26.7%, 18.4%, 12%, respectively), and several indirect sharing activities. Reductions were reported in the mean number of injections per syringe and the mean number of injections per day (p < .001). CONCLUSIONS: These results show rapid and mostly large reductions in a variety of risky injection drug use behaviors. Study findings are consistent with earlier reports showing an association between behavioral risk reduction and participation in a needle exchange program.

Adult↗
PubMed1992

Osteoporosis risk assessment of mature working women: primary and secondary prevention strategies.

1. Occupational health nurses have a prime opportunity to promote a healthy and stable population of working women through teaching osteoporosis risk reduction behaviors and conducting periodic osteoporosis risk assessments. 2. Health teaching about osteoporosis prevention is needed to foster health promotion and risk reduction behaviors among pre-, peri-, and postmenopausal women to lessen the incidence of fractures and secondary consequences. 3. By incorporating primary and secondary prevention strategies into occupational health nursing practice, great strides can be made in guiding women to initiate osteoporosis prevention behaviors to promote a more healthy and less restrictive lifestyle in later years.

Female↗
PubMed2006

Understanding recent increases in the incidence of sexually transmitted infections in men having sex with men: changes in risk behavior from risk avoidance to risk reduction.

OBJECTIVE: The objective of this study was to explore risk behavior and routes of transmission in men having sex with men (MSM) with newly diagnosed sexually transmitted infections (STIs). METHODS: A questionnaire on clinical diagnosis and manifestation site for acute STIs was completed by physicians participating in a sentinel study. Patients contributed information on sexual risk behavior and the likely route of STI transmission. RESULTS: Three hundred fifty-six diagnosis forms and 169 matching patient questionnaires could be analyzed. The most frequent diagnosis was syphilis (n = 147; 33% primary syphilis with ulcer localization 71% genital, 22% anorectal, and 8% oral; 67% secondary syphilis), followed by gonorrhea (n = 136; 59% genital, 34% rectal, 7% pharyngeal) and Chlamydia trachomatis infection (n = 51; 48% genital, 48% rectal, 4% pharyngeal). In 12 patients, more than one infection was diagnosed, and 2 or 3 sites were affected in 11 patients. Approximately 60% of infections were acquired by genital-oral and oral-anal practices. Unprotected anal intercourse (UAI) was reported more often by HIV-positive men (mostly receptive) and men with high partner numbers. CONCLUSION: High partner numbers, an important role of genital-oral sexual practices for the transmission of STIs, and relatively high frequencies of mostly receptive UAI in HIV-positive men are all contributing to increasing STI incidences among MSM.

Adolescent↗
PubMed1999

A pilot study of immigration status, homosexual self-acceptance, social support, and HIV reduction in high risk Asian and Pacific Islander men.

This article reports the results of a cross-sectional study that was conducted to describe the sexual behavior and HIV risk reduction behaviors of homosexual and bisexual Asian and Pacific Islander men and to relate immigration status, self-acceptance as a homosexual, and levels of social support to the adoption of safe sexual behaviors in this population. Thirty-one gay and bisexual Asian and Pacific Islander men in San Diego County, California, participated. Generally high levels of knowledge about HIV and transmission risks as well as self-acceptance and social support were found. While most (84%) reported some attempts to increase condom use in the previous 6 months, 42% reported engaging in unprotected intercourse during that same time period. An inverse relationship between self-acceptance and utilization of risk reduction strategies was found. No association was found between immigration status or self-reported HIV status and level of HIV knowledge, level of HIV risk behavior, or level of HIV risk reduction efforts. The findings are discussed within the context of other social network studies and HIV prevention programs for gay and bisexual Asian and Pacific Islander men.

Journal Article↗
PubMed2005

Reductions in transmission risk behaviors in HIV-positive clients receiving prevention case management services: findings from a community demonstration project.

Prevention case management (PCM) for HIV-infected persons is an HIV risk reduction intervention designed to assist clients who are aware of their HIV infection and who continue to engage in risk transmission behaviors. PCM combines individual risk reduction counseling with case management to address the psychosocial factors affecting HIV transmission. More than 350 HIV-positive clients participated in PCM in Wisconsin between 2000 and 2003, and 109 completed both baseline and follow-up risk assessments. The percentage of clients reporting risk transmission behaviors, specifically unprotected vaginal intercourse, insertive anal intercourse, or needle sharing with partners of negative or unknown HIV status, declined from 41.3% at baseline to 29.4% at follow-up (p = 0.04). Furthermore, clients showed progression (p < or =.05) through stages of change using Prochaska and DiClemente's transtheoretical model on seven domains related to HIV transmission risk, including personalizing risk of HIV transmission and sexual risk behavior.

Adult↗
PubMed2005

HIV and intimate partner violence among methadone-maintained women in New York City.

Intimate partner violence (IPV) has been recognized as a risk factor for HIV and sexually transmitted infections (STIs) among women, particularly among those who are drug involved. This study examines the temporal relationships between sexual and/or physical partner violence (IPV) and sexual risk of HIV/STI transmission in a longitudinal study with a random sample of 416 women enrolled in methadone maintenance treatment programs in New York City. Two hypotheses are tested: whether sexual risk-related factors or risk reduction behavior leads to subsequent IPV (H1); and whether IPV decreases likelihood of subsequent risk reduction behavior (i.e., requesting to use condoms) or increases likelihood of certain sexual risk-related factors (i.e., inconsistent condom use, having unprotected anal sex, having more than one partner, exchanging sex for drugs or money, having had an STI, being HIV positive, having a partner who engaged in HIV risk) (H2). Participants were interviewed at three waves: baseline, six months and twelve months. Hypotheses were examined using propensity score matching and multiple logistic regression analyses. The prevalence rate of any physical or sexual IPV was 46% at baseline. Findings for H1 indicate that women who reported always using condoms at wave 2 were significantly less likely than women who reported inconsistent or no condom use to experience subsequent IPV at wave 3. Similarly, increased risk of IPV at wave 3 was associated with self-reported STIs (OR=2.0, p=.03), and unprotected anal sex (OR= 2.0, p<.01); always requesting that partners use condoms was associated with a significant decrease in subsequent IPV (OR=.18, p<.01). Findings for H2 suggest that IPV at wave 2 decreased the subsequent likelihood of always using condoms at wave 3 (OR=.41, p<.01) and always requesting that a partner use condoms (OR=.42, p=.02). The implications of the findings for HIV prevention interventions for women on methadone are discussed.

Adolescent↗
PubMed2003

Readiness to change and brief educational interventions: successful strategies to reduce stroke risk.

Despite recent advances in stroke treatment and prevention, identifying effective educational interventions for "at-risk" groups that will help reduce their stroke risk and improve the speed of seeking treatment remains of paramount importance. The purpose of this pilot study was to determine whether a brief educational intervention, tailored to the patient's stage of readiness to change, could affect the initiation and achievement of stroke risk-reducing behaviors for this at-risk population. The study also explored potential demographic and medical confounders that could influence behavioral and knowledge goal achievement. Three groups of 20 participants, each with multiple risk factors for stroke, from a family practice clinic were randomly assigned to a control, simple-advice, or brief intervention group. The majority of the participants were African American with a mean age of 68 years. Selected findings showed (a) significant differences in the number of newly initiated stroke-risk-reduction behaviors and stroke knowledge among the three groups and (b) significant positive correlations between the action stage of readiness to change and the initiation and achievement of the new stroke-risk-reduction behaviors. Although results supported the usefulness of the brief intervention model to reduce modifiable stroke-risk factors and increase stroke knowledge, the necessity of additional longitudinal research that refines the targeting of interventions for diverse racial, cultural, and age groups was acknowledged.

Aged↗
PubMed1990

Relapse from safer sex: the next challenge for AIDS prevention efforts.

Prevention campaigns to reduce sexual transmission of human immunodeficiency virus (HIV) typically emphasize the initial adoption of safer sex techniques. We present data from a 5-year prospective study to show that the vast majority of resident gay men in San Francisco have made these initial risk reductions. Rather, relapse from safer sex techniques is now the predominant predominant kind of high-risk sex, accounting for approximately two thirds of all prevalent high-risk sex in the 1988 wave of data collection. Predictors of relapse from safer sex are identified, and these are discussed in terms of their implications for preventing relapse from the exclusive practice of safe sex. In communities that have already manifested widespread behavioral risk reductions and in which HIV infection is highly prevalent, finding ways to prevent relapse of behavioral risk reductions will be the next important challenge in the fight against acquired immune deficiency syndrome.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Group intervention to reduce HIV transmission risk behavior among persons living with HIV/AIDS.

Results of a randomized controlled trial show that a behavioral intervention grounded in social cognitive theory reduces unprotected sexual behaviors among men and women living with HIV infection, with the greatest reductions in HIV transmission risk behaviors occurring with non-HIV-positive sex partners. In this article, the authors describe the intervention development and intervention content of the social cognitive risk reduction intervention for HIV-positive persons. The effective five group session intervention focused on enhancing motivation through self-reflection and developing coping efficacy skills for HIV disclosure decision making, active listening, assertiveness, and problem solving for disclosure and transmission risk reduction behaviors. Intervention components were tailored for gender and sexual orientation and integrated skills practice sessions used role-plays couched within scenes from popular films. This intervention was demonstrated to be effective in a community-service delivery setting and can be adapted for implementation in HIV-related services delivered within support groups.

Adult↗
PubMed1994

Screening for cardiovascular disease and risk reduction counselling behaviors of general practitioners.

BACKGROUND: This study presents prevalence of risk factors for cardiovascular disease in general practice patients and screening rates for risk factors. Conditions addressed include smoking, weight, alcohol intake, blood pressure, and cholesterol. METHODS: Adult patients (7,160) attending 230 general practitioners in a metropolitan (Brisbane) and rural (Toowoomba) region in Queensland were recruited to a cross-sectional study. A self-administered patient questionnaire provided self-reported information on lifestyle risk factors and rates of previous screening. A doctor's questionnaire completed at the conclusion of the consultation provided information about physician knowledge of patient risk factors and details of preventive care provided in the consultation. RESULTS: Twenty-five percent of patients reported that they smoked, 2% drank beyond defined safe limits, 40% had body mass index > 24.9 (kg/m2). Doctors identified 66% of self-reported smokers, 40% of heavy drinkers, and 59% of overweight patients. Over 90% of patients reported prior blood pressure measurements in agreement with national recommendations; cholesterol screening within the past 5 years was reported by 51% of patients. Screening and/or counselling of patients in the consultation was highest for blood pressure (47%) and smoking (34%) and considerably lower for overweight (22%), alcohol (19%), and cholesterol (6%). CONCLUSIONS: Although preventive activities are being undertaken in general practice, performance of these activities is less than ideal. The barriers to undertaking these activities need to be addressed for change to occur.

Adolescent↗
PubMed1993

Barriers to human immunodeficiency virus related risk reduction among male street prostitutes.

Two hundred eleven male street prostitutes between the ages of 18 and 51 years were interviewed and tested for antibodies to the human immunodeficiency virus (HIV). Economic, social, and emotional barriers to the reduction of HIV-related risk behavior were examined within the context of several concepts present in the Health Belief Model (HBM). Three lifestyle factors were found to function as barriers to engaging in risk reduction behavior. Subjects who were more economically dependent on prostitution, perceived less control over the hustling encounter, and reported increased pleasure from sexual activity with their customers were more likely to engage in risk-taking behavior. Prostitutes' perception of the severity of HIV infection was not significantly associated with their risk behavior. Unexpected findings indicated that increases in perceived susceptibility to HIV and perceived benefit of condom use for HIV prevention were significantly related to increased risk-taking behavior. Practical applications of findings in the design and implementation of future HIV-related preventive health education programs are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Reductions in HIV risk behaviors among depressed drug injectors.

OBJECTIVE: To determine if, by reducing depressive symptoms, combined psychotherapy and pharmacotherapy reduces HIV drug risk behavior compared to an assessment-only condition for active drug injectors over 9 months. DESIGN: Randomized controlled trial. SETTING: Outpatient academic research office. PATIENTS: Active injection drug users with a DSM-IV diagnosis of major depression, dysthymia, substance-induced mood disorder with depressive features persisting for at least 3 months, or major depression plus dysthymia. In addition, participants had a Hamilton Rating Scale for Depression (MHRSD) score > 13. INTERVENTION: Psychotherapy (8 sessions of cognitive behavioral therapy) plus antidepressant pharmacotherapy over 3 months. MAIN OUTCOME MEASURES: HIV Risk Assessment Battery (RAB) drug scale scores measured at three, six and nine months, and depression remission (MHRSD score < or = 8). RESULTS: Participants (n= 109) were 64% male, 82% Caucasian, with a mean baseline MHRSD score of 20.7. Depression subtypes included major depression only (63%), substance-induced depression (17%), and double-depression (17%). Overall, study retention at nine months was 89%. Reported HIV drug risk scores decreased sharply over the first 3 months and continued to decline throughout the follow-up period. Between group differences were not significant in the intention-to-treat analysis. However, highly adherent participants had significantly lower HIV drug risk scores at 3 months (p<05), but not 6 and 9 months. Depression remission was significantly associated with lower HIV drug risk scores at follow-ups. CONCLUSIONS: Combined psychotherapy and pharmacotherapy did not produce a significant reduction in HIV drug risk beyond that seen in an assessment-only control group. The greatest declines in HIV drug risk were found in participants with high protocol adherence and those with depression remission.

Adult↗
PubMedDate not supplied

Health promotion for older Americans in the 21st century.

OBJECTIVES: To provide a broad overview of the role of the individual, the physical environment, and the social environment on health and functioning in older adults (65 and older), and to highlight interventions and recommendations for action on each of these levels. DATA SOURCES: Published studies and government reports on health and functioning in older Americans and on the individual, social, and physical environmental contributors to health were identified through journal and government documents review and computer library searches of medical and social science data bases for 1980-1999. STUDY SELECTION: Preference was given to published studies and government reports that focused specifically on behavioral and environmental contributors and barriers to health promotion in Americans 65 and older and/or that highlighted creative interventions with relevance to this population. Both review articles and presentations of original research were included, with the latter selected based on soundness of design and execution and/or creativity of intervention described. DATA EXTRACTION: Studies were examined and their findings organized under three major headings: (1) behavioral risk factors and risk reduction, including current government standards for prevention and screening; (2) the role of the physical environment; and (3) the role of the social environment in relation to health promotion of older adults. DATA SYNTHESIS: Although most attention has been paid to the role of behavioral factors in health promotion for older adults, a substantial body of evidence suggests that physical and social environmental factors also play a key role. Similarly, interventions that promote individual behavioral risk reduction and interventions targeting the broader social or physical environment all may contribute to health in the later years. CONCLUSIONS: With the rapid aging of America's population, increased attention must be focused on health promotion for those who are or will soon be older adults. Promising intervention strategies addressing the individual, the physical environment, and the social environment should be identified and tested, and their potential for replication explored, as we work toward a more comprehensive approach to improving the health of older Americans in the 21st century.

Aged↗
PubMed2004

Interventions for seropositive injectors-research and evaluation: an integrated behavioral intervention with HIV-positive injection drug users to address medical care, adherence, and risk reduction.

BACKGROUND: Behavioral interventions to address the complex medical and HIV risk reduction needs of HIV-seropositive (HIV-positive) injection drug users (IDUs) are urgently needed. We describe the development of Interventions for Seropositive Injectors-Research and Evaluation (INSPIRE), a randomized controlled trial of an integrated intervention for HIV-positive IDUs, and the characteristics of the baseline sample. METHODS: HIV-positive IDUs were recruited from community settings in 4 US cities. After completing a baseline assessment, participants who attended the first session were randomly assigned to (1) a 10-session peer mentoring intervention designed to improve utilization of HIV care, to improve adherence to HIV medications, and to reduce sexual and injection risk or (2) an 8-session videotape control. Periodic follow-up for 12 months is ongoing. RESULTS: A total of 1161 HIV-positive IDUs completed the baseline assessment, and 966 (83%) were randomized. Retention rates are greater than 80% for all follow-up periods. Approximately 79% of baseline participants reported a recent medical visit, 49% were taking highly active antiretroviral therapy, and 19% had an undetectable viral load. Use of injection and noninjection substances was prevalent, and sexual and injection risks were each reported by more than 25% of participants. CONCLUSION: There is a need for an integrated intervention for HIV-positive IDUs, and these data show the acceptability of such an approach.

Educational Status↗
PubMed1990

Promoting AIDS risk reduction via behavioral training.

The present study employed behavioral techniques to teach assertive strategies designed to reduce the risk of contracting AIDS and to promote "safer-sex" behaviors. A total of 79 university students (38 male and 41 female) were included in the final data analysis. Subjects participated in three one-hour training sessions which included live modeling of assertive interactions, role-playing, behavior shaping, corrective feedback, verbal reinforcement, assertiveness training, and an AIDS educational lecture. Dependent measures included ratings of the key components of assertive behavior from videotaped role-plays at pre- and posttests. Behavioral training had a positive effect on participants' assertive behavior. On the role-play ratings, experimental subjects were rated higher on overall assertiveness than the controls. Even brief behaviorally based educational interventions can produce increases in assertive behaviors known to be related to AIDS prevention, for example, insisting on condom use and requesting information about a prospective partner's sexual and drug use histories. Behavior changes extended to in vivo situations, of course, remain less assured.

Acquired Immunodeficiency Syndrome↗