Relationships and diseases among drug users and nonusers

Human immunodeficiency virus (HIV) and syphilis are relationship-based diseases that are typically transmitted by the cooperative activities (sex or drug injection) of two persons. A sample of 215 drug users and 52 sociodemographically matched nonusers was collected to examine the behaviors and relationships related to HIV and syphilis transmission. Results showed that, although drug users had more risk opportunities (more sex partners and, of course, more injection partners) than nonusers, actual sex risk behaviors (never using condoms) did not differ appreciably among drug users and nonusers or with opposite-sex partners and same-sex partners. The similarity of sexual risk was supported by the similar levels of syphilis between drug users and nonusers. The unique risk to drug users was drug injection, although drug users were found to engage in fewer risky injection behaviors (sharing of drug injection equipment) than the risky sexual behaviors in which all participants engaged. Although drug users interacted as frequently with partners as nonusers, nonuser relationships were longer lasting and emotionally closer.     

What Girls Won't Do for Love: Human Immunodeficiency Virus/Sexually Transmitted Infections Risk Among Young African-American Women Driven by a Relationship Imperative

PurposeRates of Human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs) continue to increase among African-American youth. Adolescents who have a stronger identity in relation to others (relational identity) rather than to themselves (self-identity) may view intimate relationships as imperative to a positive self-concept, which may lead to risky sexual behavior and abuse. Therefore, the present study assessed the associations among a relationship imperative and HIV/STI-related risk factors and behaviors.MethodsParticipants were 715 African-American adolescent females, aged 15 to 21 years. They completed measures that assessed how important a relationship was to them and HIV-related risk factors and behaviors. Participants also provided vaginal swab specimens for STI testing.ResultsMultivariate logistic regression analyses, controlling for covariates, were conducted. Females who endorsed a relationship imperative (29%), compared to those who did not, were more likely to report: unprotected sex, less power in their relationships, perceived inability to refuse sex, anal sex, sex while their partner was high on alcohol/drugs, and partner abuse. Furthermore, participants with less power, recent partner abuse, and a perceived ability to refuse sex were more likely to test STI positive.ConclusionThese results indicate that if African-American adolescent females believe a relationship is imperative, they are more likely to engage in riskier sexual behaviors. Additionally, less perceived power and partner abuse increases their risk for STIs. HIV/STI prevention programs should target males and females and address healthy relationships, sense of self-worth, self-esteem and the gender power imbalance that may persist in the community along with HIV/STI risk.     

Racial/Ethnic Differences in Patterns of Sexual Risk Behavior and Rates of Sexually Transmitted Infections Among Female Young Adults

Objectives. We examined patterns of sexual behavior and risk for sexually transmitted infections (STIs) in young adulthood for Black, Hispanic, and White females.Methods. We used a nationally representative sample of 7015 female young adults from wave III of the National Longitudinal Study of Adolescent Health. Sexual risk items assessed behaviors occurring in the previous 6 years and past year to determine classes of sexual risk and links to STIs in young adulthood.Results. Latent class analysis revealed 3 sexual risk classes for Black and Hispanic youths and 4 sexual risk classes for White youths. The moderate and high risk classes had the highest probabilities of risky sexual partners, inconsistent condom use, and early age of sexual initiation, which significantly increased odds for STIs compared with recent abstainers.Conclusions. We found different classes of sexual behavior by race/ethnicity, with Black and Hispanic young women most at risk for STIs in young adulthood. Preventive efforts should target younger adolescents and focus on sexual partner behavior.Sexually transmitted infections (STIs) are on the rise among young adults in the United States, with chlamydia and gonorrhea reported as the most common curable infectious diseases. According to the Centers for Disease Control and Prevention,1 close to one quarter of adolescent and young adult females are diagnosed with an STI each year, and nearly half of newly reported cases are found in Black females aged 15 to 24 years. In fact, Black females are 8.7 times more likely to contract chlamydia and 20.5 times more likely to contract gonorrhea than are White females. The rate of STIs in the Hispanic population is also high, with Hispanics twice as likely to acquire chlamydia and gonorrhea as Whites. To better understand the disproportional rates of STIs within diverse racial/ethnic groups, we used a person-centered approach to elucidate unique patterns of individual and partner sexual risk behaviors in adolescence and young adulthood and links to risk for chlamydia, gonorrhea, and trichomoniasis in Black, Hispanic, and White youths. A person-centered approach, which has rarely been used in STI research, allowed us to examine how unique patterns of sexual risk behaviors within racial/ethnic groups differentially relate to risk for STIs and provided us with a more nuanced understanding of areas on which to focus preventive efforts.Research has demonstrated that rates of risky sexual behavior increase in adolescence and peak in early adulthood.2 Risky sexual behavior in adolescence is commonly characterized in the literature by early age of sexual initiation (i.e., vaginal intercourse before age 15 years) and greater number of sexual partners.3,4 Engaging in sexual activity at a young age increases the likelihood of multiple sexual partners and exposure to older, riskier partners.5 In fact, longitudinal research has directly linked early sexual onset and involvement with multiple partners to increased risk for STIs. Using survey data and biological tests for STIs, researchers found that adolescent girls who were younger at time of first intercourse were more likely to enter into a new sexual relationship during the study, and acquisition of a new sexual partner significantly increased risk for STIs.6 These findings point to early sexual debut and engaging in sex with multiple partners as strong predictors of increased risk for STIs. In this study, we examined age of onset for vaginal intercourse as well as accumulation of vaginal, oral, and anal sex partners over a 6-year timeframe.A unique contribution of this study is its inclusion of a range of sexual activity, including vaginal, oral, and anal sex, as markers of risky sexual behavior. Research has found that oral and anal sex may lead to engagement in riskier sexual practices and, therefore, increase risk for STIs.7 Racial/ethnic differences have been substantiated in rates of oral and anal sex, with some studies finding that Black females were more likely to engage in vaginal sex only, whereas White youths were more likely to engage in vaginal, oral, and anal sex.8 Few studies have examined varied types of sexual activity in addition to partners’ sexual risk behaviors, particularly using a person-centered approach. Thus, we add to the literature by exploring both individual and partner behaviors within racial/ethnic groups and associated risk for STIs on the basis of unique patterns of sexual behavior.Lack of contraception use is another well-substantiated marker of risky sexual behavior. Although condoms are highly effective in protecting against most STIs, gender and racial/ethnic differences exist in the frequency and initiation of use. Research has found that females report lower initiation of condom use than males and often have less decision-making power regarding the use of condoms, increasing risk for STI exposure.9–11 This power differential in condom use is especially present in Hispanic culture, whereby males are less likely to use condoms and females are expected to defer to their partner’s decisions about contraception use.12 In addition, condoms are not effective protection against STIs if they are used inconsistently, which is often the case among adolescents and young adults.13 Whereas many researchers have inquired about condom use during most recent vaginal intercourse,4 we attempted to gain a broader picture of condom use by asking about overall frequency of use with sexual partners in the past year.Engaging in sex with concurrent partners and short duration between sexual partners also influence risk for STIs. Youths who are in single-partner or monogamous sexual relationships may reduce or eliminate condom use, often on the basis of trust of partner’s monogamy and perceived low risk for exposure to STIs.12 Although youths in monogamous relationships may perceive less risk for STIs, one cannot be certain of a partner’s behaviors, which puts oneself at risk. Moreover, having concurrent partners or partners who overlap between sexual relationships has been associated with the rapid spread of STIs and HIV.14 Shorter time intervals between sexual partners decrease the likelihood of STI testing and the manifestation of STI symptoms. Two of the STIs under investigation in this study, chlamydia and gonorrhea, often present with no symptoms in females, which may partially explain the rapid spread of these particular strains. A strength of this study is that we examined both self-reports of STIs in the past year as well as the use of biological markers of STIs to gain a more comprehensive and accurate estimate of STI rates in a national sample of youths from various racial/ethnic backgrounds.Considering sexual networks as a risk context for the spread of STIs is also important. In Black communities in particular, the network of sexual partners is often limited by the smaller ratio of men to women.15 As the pool of available sexual partners becomes more restricted, sexual networks are much denser and individuals are more closely connected to one another, increasing risk for STI exposure.16 Thus, one would expect the spread of STIs to be more rapid, which supports the alarming statistics indicating high rates of STIs among Black females. In this study, we included self-reported indicators of partner risk behavior, such as partners’ concurrent sexual activity in the past 6 years as well as partners’ lifetime STI history.Overall, we added to the existing research by using latent class analysis (LCA) to examine patterns of sexual risk behavior over an extended period beginning in adolescence and continuing into young adulthood within different racial/ethnic groups, aiming to link sexual risk patterns over time to risk for STIs. Only 2 known studies have identified distinct patterns of sexual behaviors among adolescent populations using LCA.17,18 These studies found evidence for 4 distinct groups—abstainers, with no history of sexual activity; those with a monogamous pattern of limited sexual activity primarily with 1 partner; those with a low risk pattern with few sexual partners; and those with a high risk pattern with multiple sexual partners and early age of sexual initiation. However, neither of these studies looked within distinct racial/ethnic groups using a large, nationally representative sample or used the risk indicators in our study, including varied types of sexual activity over a 6-year time span.On the basis of the limited research that has used LCA, we hypothesized similar abstainer, monogamous, and risky patterns of sexual behavior within racial/ethnic groups. We also expected engagement in more risky sexual patterns to be related to increased risk for STIs, with White females engaged in a wider variety of individual sexual risk behaviors (e.g., more partners, varied sexual activity) and Black females having the highest prevalence of partner risk behaviors, resulting in higher rates of STIs. Although less research has examined Hispanic females’ sexual risk behaviors using a person-centered approach, we expected to find groups that exhibited monogamous patterns and lower condom use, which would increase risk for STIs.     

Social contexts of risk behaviors for HIV among male, unskilled, unregistered laborers in urban Vietnam

In Vietnam there has been relatively little success in controlling the HIV epidemic, in part because the subpopulations most exposed to the virus are often difficult to engage in prevention research and programs. In this qualitative study we explored social contexts shaping HIV risk behaviors among Vietnamese men involved in unskilled, unregistered, and low-income labor in urban settings. Based on self-disclosed behaviors, it is clear that these men were at high risk of sexually transmitted infection (STI). Evidence emerged from the interview data highlighting equivalent influences of individual psychological factors, social integration, social barriers, and accessibility regarding drug use and sexual risk behavior. Psychological influences such as tedium, distress, fatalism and revenge, and the strong effects of collective decision making and fear of social isolation appeared important for these men living on the economic and social margins of this rapidly urbanizing society. The study findings suggest directions for research and culturally appropriate HIV preventive education and services for these men.     

Behaviorally Bisexual Men and their Risk Behaviors with Men and Women

Gay and bisexual men are often treated as a homogenous group; however, there may be important differences between them. In addition, behaviorally bisexual men are a potential source of HIV infection for heterosexual women. In this study, we compared 97 men who have sex with men only (MSM) to 175 men who have sex with men and women (MSMW). We also compared the 175 MSMW to 772 men who have sex with women only (MSW). Bivariate and multiple logistic regression analyses were performed to assess correlates of MSMW risk behaviors with men and with women as well as whether MSMW, compared with MSW, engaged in more risky behaviors with women. Compared with MSM, MSMW were less likely to be HIV-positive or to engage in unprotected receptive anal intercourse. In contrast, MSMW were more likely than MSW to be HIV-positive and to engage in anal intercourse with their female partners; however, rates of unprotected anal intercourse were similar. The study findings suggest that there may be important differences in HIV risk behaviors and HIV prevalence between MSM and MSMW as well as between MSMW and MSW.     

Behaviorally Bisexual Men and their Risk Behaviors with Men and Women

Gay and bisexual men are often treated as a homogenous group; however, there may be important differences between them. In addition, behaviorally bisexual men are a potential source of HIV infection for heterosexual women. In this study, we compared 97 men who have sex with men only (MSM) to 175 men who have sex with men and women (MSMW). We also compared the 175 MSMW to 772 men who have sex with women only (MSW). Bivariate and multiple logistic regression analyses were performed to assess correlates of MSMW risk behaviors with men and with women as well as whether MSMW, compared with MSW, engaged in more risky behaviors with women. Compared with MSM, MSMW were less likely to be HIV-positive or to engage in unprotected receptive anal intercourse. In contrast, MSMW were more likely than MSW to be HIV-positive and to engage in anal intercourse with their female partners; however, rates of unprotected anal intercourse were similar. The study findings suggest that there may be important differences in HIV risk behaviors and HIV prevalence between MSM and MSMW as well as between MSMW and MSW.     

'Mobile men with money': the socio-cultural and politico-economic context of 'high-risk' behaviour among wealthy businessmen and government officials in urban China

China's transition from an injection drug-driven HIV epidemic to one primarily transmitted through sexual contact has triggered concern over the potential for HIV to move into the non-drug-injecting population. Much discussion has focused on the migrant men of China's vast 'floating population' who are considered a high-risk group. As a result, many men who frequently engage in high-risk behaviour but are not included in this especially vulnerable group are evading HIV prevention messages. This paper highlights the socio-cultural and politico-economic factors that motivate many of China's wealthy businessmen and government officials, sometimes referred to as 'mobile men with money', to engage in such behaviour. Examination of the activities related to the work of these men reveals a situation where the confluence of a market-oriented economy operating within a socialist-style political system under the influence of traditional networking practices has engendered a unique mode of patron-clientelism that brings them together over shared social rituals including feasting, drinking and female-centered entertainment that is often coupled with sexual services. As a result, consideration of the socio-cultural factors influencing these men's sexual practices is important for responding to the newly emerging stage of China's HIV epidemic.     

Cross-generational relationships in rural Jamaica

In keeping with trends in the most affected regions of the world, Jamaican young women are at greater risk of becoming infected with HIV than their male peers. Cross-generational relationships (CGRs), or sexual relationships between younger females and older men, have been reported as contributing to this increased risk. Utilizing a qualitative research design, this study aimed to (1) delineate the context in which CGRs occurred in some rural communities in Jamaica and (2) investigate the sexual risk behaviors that occurred in these relationships. The results indicated that young women engaged in these relationships for three main reasons: economic gain, status, and emotional support. At the intrapersonal, interpersonal, and community levels based on the social ecological model, findings also highlighted various factors which facilitated the occurrence of these relationships in some rural communities, including the transactional nature of the relationships, as well as family knowledge and encouragement. The results also highlighted the occurrence of sexual risk behaviors, such as multiple concurrent partnerships and lack of consistent condom use, which may increase young girls' risk of exposure to HIV and other sexually transmitted infections (STIs). This study's findings are consistent with previous research and underscore the challenges faced by intervention planners when promoting safe sex.     

Detecting the Determinants of Health in Social Media

Objective

Create an analysis pipeline that can detect the behavioral determinants of disease in the population using social media data.

Introduction

The explosive use of social media sites presents a unique opportunity for developing alternative methods for understanding the health of the public. The near ubiquity of smartphones has further increased the volume and resolution of data that is shared through these sites. The emerging field of digital epidemiology[1] has focused on methods to analyze and use this “digital exhaust” to augment traditional epidemiologic methods. When applied to the task of disease detection they often detect outbreaks 1–2 weeks earlier than their traditional counterpart [1]. Many of these approaches successfully employ data mining techniques to detect symptoms associated with influenza-like illness [2]. Others can identify the appearance of novel symptom patterns, allowing the ability to detect the emergence of a new illness in a population [3]. However, behaviors that lead to increased risk for disease have not yet received this treatment.

Methods

We have created a methodology that can detect the behavioral determinants of disease in the population. Initially we have focused on risky behaviors that can contribute to HIV transmission in a population, however, the methodology is generalizable.We collected 15 million tweets based on 32 broad keywords relating to three types of risky behaviors associated with the transmission of HIV: drug use (e.g. meth), risky sexual behaviors (e.g. bareback), and other STIs (e.g. herpes). We then hand coded a subset of 2,537 unique tweets using a crowd-sourceable “game” that can be distributed online. This hand-coded set was used to train a simple n-gram classifier, which resulted in an algorithm to select relevant tweets from the larger database. We then generated geocodes from text locations provided by the tweet author, supplemented by the ∼1% of tweets that are already geolocated. We scaled these geocodes to the state and county levels, which allowed us to compare HIV prevalence in our collected data with public health data.

Results

We present the correlation between behaviors identified in social media and the corresponding impacts on disease incidence across a large population. Hand coding revealed that 34% of tweets with one or more of the 32 initial keywords was relevant to behaviors associated with HIV transmission. Among the three categories of initial search terms, the drug category yielded 21% true positives, compared to 9% for risky behaviors, and 2% for other STIs. The n-gram classifier measured 66% sensitivity and 44% specificity on a test set. In addition, our geolocation algorithm found coordinates for 88% of text locations. Of those, a test sample of 59 text locations showed that 83% of geolocations are correctly identified. These components combine to form an analysis pipeline for detecting risky behaviors across the United States.

Conclusions

We present a surveillance methodology to help sift through the vast volumes of these data to detect behaviors and determinants of health contributing to both disease transmission and chronic illness. This effort allows for identification of at-risk communities and populations, which will facilitate targeted, primary and secondary-prevention efforts to improve public health.     

AIDS-related knowledge, perceptions, and behaviors among impoverished minority women.

OBJECTIVES. The aims of this study were to (1) describe AIDS-related knowledge, perceptions, and risky behaviors of impoverished African-American and high- and low-acculturated Latina women; (2) delineate relationships involving high-risk behaviors; and (3) determine whether risky behaviors differ by race and levels of acculturation. METHODS. Survey instruments were administered to 1173 impoverished women of color residing in homeless shelters and drug recovery programs. RESULTS. Differences based on ethnicity and level of acculturation were found in AIDS-related knowledge, perceived risk of acquiring AIDS, and risky behaviors. Low-acculturated Latinas reported low perceived risk and were least likely to engage in illegal drug use and sexual activity with multiple partners. Intravenous drug use was most prevalent among high-acculturated Latinas, whereas nonintravenous drug use and high-risk sexual activity was most prevalent among African-American women. CONCLUSIONS. The data indicate the need for culturally sensitive AIDS prevention programs for women that deal with general issues of drug use and unprotected sex, and that include separate sessions for women of different ethnic backgrounds and acculturation levels to address specialized areas of concern.     

Pathway From Child Sexual and Physical Abuse to Risky Sex Among Emerging Adults: The Role of Trauma-Related Intrusions and Alcohol Problems

PurposeSome evidence suggests that risk reduction programming for sexual risk behaviors (SRB) has been minimally effective, which emphasized the need for research on etiological and mechanistic factors that can be addressed in prevention and intervention programming. Childhood sexual and physical abuse have been linked with SRB among older adolescents and emerging adults; however, pathways to SRB remain unclear. This study adds to the literature by testing a model specifying that traumatic intrusions after early abuse may increase risk for alcohol problems, which in turn may increase the likelihood of engaging in various types of SRB.MethodsParticipants were 1,169 racially diverse college students (72.9% female, 37.6% black/African-American, and 33.6% white) who completed anonymous questionnaires assessing child abuse, traumatic intrusions, alcohol problems, and sexual risk behavior.ResultsThe hypothesized path model specifying that traumatic intrusions and alcohol problems account for associations between child abuse and several aspects of SRB was a good fit for the data; however, for men, stronger associations emerged between physical abuse and traumatic intrusions and between traumatic intrusions and alcohol problems, whereas for women, alcohol problems were more strongly associated with intent to engage in risky sex.ConclusionsFindings highlight the role of traumatic intrusions and alcohol problems in explaining paths from childhood abuse to SRB in emerging adulthood, and suggest that risk reduction programs may benefit from an integrated focus on traumatic intrusions, alcohol problems, and SRB for individuals with abuse experiences.     

Transmission of STIs/HIV at the partnership level: Beyond individual-level analyses

Mathematical modeling of transmission dynamics of sexually transmitted infections (STIs) and HIV has considerably advanced HIV research by highlighting the importance of certain types of partnerships in epidemic spread. Notably, concurrent partnerships, defined as a sexual partnership in which one or more of the partnership members have other sexual partners while continuing sexual activity with the original partner, have been shown to play a fundamental role in potentiating the spread of STIs and HIV. Risk behaviors such as concurrency and sex without condoms as well as STI/HIV prevalence vary with physical, social, and emotional factors within partnerships. The efficiency of STI/HIV transmission appears to vary across types of concurrent partnerships according to the differing dynamics within them. Previous research on partnership dynamics has improved our understanding of the multidimensional aspects of sexual partnering, but little is understood of how these aspects of sexual partnering interact and increase risks for HIV, nor how types of partnerships, partnership dynamics, and concurrency work together to affect both the behavior of condom use and the biological transmission of disease. In this article, we discuss the need to extend our understanding of concurrency to include partnerships among men who have sex with men (MSM) and to differentiate between types of partnerships and to develop interventions to modify risk within partnerships. We also introduce a conceptual framework that reflects how individual and partner characteristics influence partnership dynamics that in turn influence risk behaviors, such as concurrency and not using condoms, and associated risks for STIs and HIV.     

Recreational Use of Erectile Dysfunction Medications in Undergraduate Men in the United States: Characteristics and Associated Risk Factors

Mounting evidence indicates that erectile dysfunction medications (EDMs) have become increasingly used as a sexual enhancement aid among men without a medical indication. Recreational EDM use has been associated with increased sexual risk behaviors, an increased risk for STIs, including incident HIV infection, and high rates of concomitant illicit drug use. The aim of the present study was to investigate the characteristics and associated risk factors for recreational EDM use among young, healthy, undergraduate men. A cross-sectional sample of 1,944 men were recruited from 497 undergraduate institutions within the Unites States between January 2006 and May 2007. The survey assessed patterns of EDM use, as well as demographic, substance use, and sexual behavior characteristics. Four percent of participants had recreationally used an EDM at some point in their lives, with 1.4% reporting current use. The majority of recreational EDM users reported mixing EDMs with illicit drugs and particularly during risky sexual behaviors. Recreational EDM use was independently associated with increased age, gay, or bisexual sexual orientation, drug abuse, lifetime number of sex partners, and lifetime number of “one-night stands.” Recreational EDM users also reported a 2.5-fold rate of erectile difficulties compared to nonusers. Overall, recreational use of EDMs was associated with sexual risk behaviors and substance abuse; however, a relatively small proportion of undergraduates reported using EDMs. Results also suggest that a sizable portion of recreational EDM users are heterosexual men, and that use does not solely occur within the environments of venues that cater to men having sex with men.     

Social Network Characteristics and HIV Sexual Risk Behavior among Urban African American Women

HIV/AIDS has emerged as a significant health threat for African American women with well-documented disparities. The purpose of this study was to assess the association between social network characteristics and high-risk sexual behaviors among a sample of urban African American women at risk of heterosexually acquired HIV/STIs. We performed a cross-sectional study of baseline data collected from the CHAT study, a randomized HIV-prevention trial targeting urban HIV-at-risk women in Baltimore, MD. Our primary outcomes were risky sexual behaviors defined as either (a) two or more sexual partners or (b) having a risky sex partner within the past 90 days. Bivariable and multivariable logistic regression examining the associations between individual and social network factors and our two outcomes of interest were conducted. The study population included 513 sexually active African American women with a mean age of 41.1 years. High levels of unemployment (89.5%), depressive symptoms (60.0%), and drug use (68.8%) were present among this high-risk urban cohort. Controlling for individual factors including participant drug use, age, and depression, having two or more sex partners within the past 90 days was associated with having a larger personal network (OR = 1.11; 95% CI, 1.06 and 1.17); more network members who pitched in to help (OR = 1.22; 95% CI, 1.04 and 1.44), provided financial support (OR = 1.33; 95% CI, 1.11 and 1.60), or used heroin or cocaine (OR = 1.26; 95% CI, 1.14 and 1.40). Having a risky sexual partner within the past 90 days was associated with having a larger social network (OR = 1.06; 95% CI, 1.00 and 1.12) and having more social networks who used heroin or cocaine (OR = 1.30; 95% CI, 1.14 and 1.49).In summary, social network characteristics are associated with HIV sexual risk behaviors among African American urban women. Social-network-based interventions that promote norms pertaining to HIV risk reduction and provide social support are needed for African American women at risk of heterosexually acquired HIV/STIs.     

Sexual risk factors for HIV and violence among Puerto Rican women in New York City

The authors examined sexual factors for HIV risk in 1,003 women of Puerto Rican heritage who attended a community-based NewYork City hospital clinic. Participants' ages ranged from 18 to 73 years. Half were born in the continental United States, and half were born in the Commonwealth of Puerto Rico. All were sexually active within the past 90 days with a male partner.The authors compared sociodemographic characteristics, experience of intimate partner violence (IPV), and HIV sexual risk factors (number of partners, history of sexually transmitted infections [STIs],condom use, and so on).Multiple regression analyses considering sociodemographic characteristics were a predictor for IPV and sexual risk behaviors. The authors found differences in sexual risk behaviors by place of birth (continental United States versus Commonwealth of Puerto Rico) and language chosen for the interview (Spanish or English).Puerto Rican women reported fewer sexual partners and STIs. Mainland-born and English-preference women reported more IPV, risky partners, and condom use. Birth in the continental United States and preference for English appear to be indicators of greater risk for IPV, risky sexual practices, and risky partners. HIV prevention intervention strategies for Puerto Rican women must address differences in heterosexual risk according to language and place of birth.     

Disease ecology and the global emergence of zoonotic pathogens

The incidence and frequency of epidemic transmission of zoonotic diseases, both known and newly recognized, has increased dramatically in the past 30 years. It is thought that this dramatic disease emergence is primarily the result of the social, demographic, and environmental transformation that has occurred globally since World War II. However, the causal linkages have not been elucidated. Investigating emerging zoonotic pathogens as an ecological phenomenon can provide significant insights as to why some of these pathogens have jumped species and caused major epidemics in humans. A review of concepts and theory from biological ecology and of causal factors in disease emergence previously described suggests a general model of global zoonotic disease emergence. The model links demographic and societal factors to land use and land cover change whose associated ecological factors help explain disease emergence. The scale and magnitude of these changes are more significant than those associated with climate change, the effects of which are largely not yet understood. Unfortunately, the complex character and non-linear behavior of the human-natural systems in which host-pathogen systems are embedded makes specific incidences of disease emergence or epidemics inherently difficult to predict. Employing a complex systems analytical approach, however, may show how a few key ecological variables and system properties, including the adaptive capacity of institutions, explains the emergence of infectious diseases and how an integrated, multi-level approach to zoonotic disease control can reduce risk.     

Associations Between Changing Developmental Contexts and Risky Sexual Behavior in the Two Years Following High School

The present study tested associations between common developmental contexts (relationship involvement, independent living, college attendance, work) and risky sexual behavior (casual sex, inconsistent condom use, high-risk sex) across the 2 years following high school. Data were drawn from the Raising Healthy Children project, and included 801 participants aged 18–21 years. Longitudinal analyses, which controlled for early sexual debut, high school substance use, and high school grades, showed that living with a parent was protective against all three sexual risk behavior outcomes (ORs about 0.70). Being in a romantic relationship was associated with a lower probability of casual sex, but a higher probability of inconsistent condom use. Attending college was associated with a lower probability of high-risk sex (OR = 0.67). Working was not related to the sexual risk behaviors examined. Levels of sexual risk behavior showed little change across the 2 years following high school. Findings from this study suggest that developmental context may affect young adults’ engagement in risky sexual behavior. Programs aimed at promoting sexual health and reducing risk behaviors for STIs among young adults should consider targeting those in romantic relationships, those not living with parents, and those not attending college. Further, to develop effective prevention programs for these targeted youth, it is critical that we understand the mechanisms leading to risky sex in these groups.     

Risky eating behaviors of young adults-implications for food safety education

Young adults engage in risky eating behaviors like eating raw/undercooked foods of animal origin that put them at increased risk for foodborne disease. This cross-sectional survey assessed the self-reported risky eating behaviors of young adults enrolled in higher education as a part of a large-scale survey administered over 10 months. Participants (N=4,343) completed a risky eating questionnaire by indicating which of the foods listed they consumed (the list included a random sequence of foods that are considered safe or risky to eat). Each risky food consumed earned one point, with the risky eating score calculated by summing points earned (range 0 to 27). Higher scores indicated more risky eating behaviors. Food safety knowledge and self-efficacy and stage of change for safe food handling were also assessed. Mean risky eating score (5.1±3.6) indicated that young adults consumed risky foods. Male respondents and whites consumed more risky foods compared with female respondents and nonwhites, respectively. As stage of change (movement to higher stages) and self-efficacy increased, risky eating score decreased; those who believed food poisoning was a personal threat tended to eat fewer risky foods. Regression models indicated that the strongest predictor of risky eating was self-efficacy score followed by stage of change. These variables, together with sex and race, explained about 10% of the variance in risky eating score. Although food safety knowledge correlated weakly with risky eating score, it did not significantly predict it. Efforts to improve current food-handling behaviors and self-efficacy through education are important to reduce prevalence of risky eating behaviors within this population.