Transtheoretical model and risky sexual behaviour in HIV + youth in Thailand

The purpose of the study was to determine the applicability of the Transtheoretical Model for predicting unprotected intercourse in HIV+ Thai youth. Questionnaires and interviews about sexual behaviour, readiness to change, self-efficacy, substance use, emotional distress and social support were obtained from 70 HIV+ Thai youth (ages 17 to 25). Path analysis suggested the model was an excellent fit with the data. Readiness to change but not self-efficacy was directly related to unprotected intercourse acts. This differed from HIV+ youth in the US where self-efficacy fully mediated the relationship between readiness to change and condom use. In the Thai sample, social support and self-efficacy were indirectly related to unprotected intercourse through stage of change. Substance use was unrelated to unprotected intercourse, but rates of use were low. Potential cultural differences in the construct of self-efficacy and its relationship to risky behaviours in Thailand require further study. However, results highlight the potential of prevention interventions that increase readiness to change through boosting self-efficacy and social support specific to practicing safer sex while addressing mental health concerns.     

Beliefs about HIV non-infection and risky sexual behavior among MSM.

As part of a larger investigation examining genetic immunity to HIV, we undertook a cross-sectional investigation of 97 HIV-seronegative men who have sex with men (MSM). Our aim was to better understand the factors to which these men attributed their HIV serostatus and to relate these attributions to sexual risk taking. Three beliefs were related to sexual risk taking with HIV-negative/status unknown casual partners: (a) medication treatment advances, (b) the low probability related to HIV transmission, and (c) a healthy immune system, capable of resisting infection. A multivariate regression model suggested that use of recreational drugs, in combination with the belief that treatment advances reduce the risk of HIV seroconversion, in part, may explain the frequency with which individuals engage in unprotected anal receptive intercourse. Our findings suggest that MSM who intentionally engage in unprotected anal sex may be influenced by perceptions that medical advances have mitigated the threat of HIV and corroborate previous studies depicting an intimate relationship between illicit drug use and sexual risk taking.     

Associations between heavy drinking and changes in impulsive behavior among adolescent boys

Background: Impulsive behavior in humans predicts the onset of drinking during adolescence and alcohol use disorders (AUDs) in adulthood. It is also possible, however, that heavy drinking may increase impulsive behavior by affecting the development of brain areas that support behavioral control or through other associated mechanisms. This study examined whether drinking heavily during adolescence is related to changes in impulsive behavior with a specific focus on how the association differs across individuals, contingent on the developmental course of their impulsiveness. Method: Data came from a sample of boys (N = 503) who were followed annually from approximate age 8 to age 18 and again at approximate age 24/25. Heavy drinking was defined as experiencing a blood alcohol concentration (BAC) level of 0.08% or higher. At each assessment, the parent and child each reported whether the child was impulsive. Results: First, group‐based trajectory analysis was used to identify 4 groups differing in the level and slopes of their trajectories of impulsive behavior from age 9 to age 17: low (13.9%), early adolescence‐limited (18.7%), moderate (60.8%), and high (6.6%). These trajectory groups differed in their prevalence of any heavy drinking, peak BACs, and rates of alcohol dependence in adolescence and AUD in early adulthood, with the less impulsive groups being lower on these measures than the more impulsive groups. Heavy drinking was then entered into the model as a time‐varying covariate; this measure was lagged so that the results represent change in impulsive behavior the year following heavy drinking. Among boys on the moderate trajectory, those who drank heavily were rated as significantly more impulsive the following year compared to those who did not drink heavily. Conclusions: The association between heavy drinking and impulsive behavior may depend on earlier levels of impulsive behavior with those who are moderately impulsive appearing to be at greatest risk for increased impulsive behavior following heavy drinking. Further research is needed to clarify this association.     

Intervention can help reduce risky sexual behavior

The National Institute of Mental Health conducted the largest randomized, controlled, HIV behavioral intervention study ever conducted in the United States. The study involved 3,706 people attending 37 inner-city community-based clinics. The intervention consisted of seven 90- to 120-minute HIV risk-reduction educational sessions. Participants were at least 18 years old, and had engaged in risky sexual behavior within the previous 90 days. Participants were followed for 1 year after the intervention and reported significantly fewer unprotected sexual acts and more consistent condom use.     

Evaluation of a body image prevention programme for adolescent boys

Most previous programmes to address body dissatisfaction and body change strategies have been designed for females, particularly adolescent girls. Programmes are also needed for adolescent boys due to high levels of body dissatisfaction and unhealthy behaviours in this population. The present study developed, implemented and evaluated a prevention programme for young adolescent boys designed to address body image concerns and body change strategies and improve psychological adjustment. One hundred and twenty‐one boys between the ages of 12 and 13 years participated, with 69 boys in the control group and 52 in the prevention programme. The programme focused on self‐esteem and accepting differences and was run over two sessions. The results indicated an increase in satisfaction with muscles, the attribute of greatest concern to boys. The programme was also successful in increasing self‐esteem and lowering levels of negative affect. Future programmes need to build on the findings of this study and develop strategies to improve the body image concerns and unhealthy body change strategies among adolescent boys before they become entrenched. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Circumcision among adolescent boys in rural northwestern Tanzania

Objective  Male circumcision reduces risk of HIV among heterosexual men by about 60%. Modelling the impact of circumcision on HIV transmission, and planning service expansion, relies on self-reported circumcision status. We investigated the validity of self-reported status.
Methods  Survey and in-depth interview (IDI) data from adolescents enrolled in a community randomized sexual health intervention trial in rural Mwanza, Tanzania were analysed.
Results  The 5354 male school attenders (median age 15.5 years) were recruited in 1998 and followed for 3 years. At baseline, circumcision prevalence was 13.7% by self-report and 11.8% by clinical examination, rising to 17.3% by clinical examination at final survey. Only 61.5% of Muslim males were circumcised at the final survey. Of 506 participants who reported being circumcised at baseline, only 78.9% reported this at interim. Similarly, only 84.2% of participants clinically assessed as circumcised at baseline were also assessed as circumcised at interim. At both baseline and interim surveys, about 80% of participants who reported being circumcised were also found to be so at clinical examination. There was a high tolerance and respect for circumcision among male IDI respondents, with widespread belief that it was beneficial for penile hygiene and disease prevention. The majority of female IDI respondents said that they did not know what male circumcision was.
Discussion  Attitudes to male circumcision were positive in this population despite its low prevalence. There were substantial inconsistencies in both self-reported and clinically assessed circumcision status. Methods are needed to improve self-report and training of clinicians in this setting.     

Infectious disease,injection practices,and risky sexual behavior among anabolic steroid users

Anabolic-androgenic steroids (AAS) and other performance-enhancing drugs (PEDs) are commonly misused to increase muscle size and strength, as well as improve physical appearance. Many AAS and certain PEDs are administered via injection and therefore pose a risk for transmission of infectious diseases such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and skin and soft tissue infections (SSTIs). Further, AAS users may be more likely to take part in high-risk sexual behaviors than non-AAS users. This review explores the prevalence of infectious diseases as well as risky injection practices and sexual behaviors of AAS users in the current literature. A comprehensive MEDLINE search (1984–17 April 2015) for English language reports was performed on AAS users. Ten studies analyzed the prevalence of HIV infection, 6 studies analyzed HBV infection, and 6 studies analyzed HCV infection; 20 studies analyzed injection practices and 7 studies analyzed high-risk sexual behaviors of AAS users. HIV, HBV, HCV, and SSTIs have been associated with AAS users. In particular, HIV infection seems much higher among homosexual male AAS users. AAS users also take part in high-risk injection practices but to a much lower extent than intravenous drug users. AAS users are also more likely to engage in high-risk sexual behaviors than the general population. Clinicians and health-policy leaders may utilize these findings to implement strategies to decrease the spread of infectious diseases.     

Relationship between methamphetamine use and risky sexual behavior in adolescents

Substance abuse and risky sexual behavior have been identified as behaviors that can endanger adolescent psychosocial development. This study examined the relationship between methamphetamine (MAMP) use and risky sexual behavior in adolescents. Risky sexual behavior was compared not only between MAMP users and non-users, but also between high-frequency and low-frequency MAMP users. We compared the sexual intercourse histories of 85 adolescents formally charged as MAMP users with those of 170 gender-matched adolescents with no record of MAMP use. MAMP usage characteristics were compared between users who had and those who had not experienced sexual intercourse. Previous sexual experience was more likely in MAMP users than in non-users. MAMP users were also more likely to have had a greater total number of sexual partners and were more likely to have had unplanned sex under the influence of alcohol. High-frequency MAMP use was associated with increased tendencies to engage in unprotected sex and to use MAMP before sexual intercourse. In general, the chance of sexual intercourse increased in proportion to frequency of MAMP use. Given the clear link between MAMP use and risky sexual behavior, risk-reduction programs directed at teen MAMP users are urgently needed.     

South African adolescents: pathways to risky sexual behavior.

This study tested a developmental model of pathways to risky sexual behavior among South African adolescents. Participants comprised 633 adolescents, 12-17 years old, recruited from households in Durban, South Africa. Data were collected using in-person interviews. Topics included adolescents' sexual behaviors, household poverty levels, vulnerable personality and behavioral attributes, parent-child relations, and deviant peers. Structural equation modeling was used to assess the pathways to risky sexual behavior among the adolescents. The goodness-of-fit index (GFI) was .93. One major pathway indicated that family poverty was associated with difficulty in the parent-child relationship. This was related to vulnerable personality and behavioral attributes and to association with deviant peers, which, in turn, were related to risky sexual behavior. Findings suggest that poverty, parent-child relations, personality and behavioral vulnerabilities, and peer influences should be among factors addressed by prevention and intervention programs to reduce sexual risk behaviors by South African adolescents.     

Brief prevention for adolescent risk-taking behavior

Aims Despite widespread prevention efforts to decrease adolescent risk‐taking, substance use and driving after drinking (DD) are prevalent in the United States. The current study compared the efficacy of an abbreviated version of Drug Abuse and Resistance Education (DARE‐A) to a new Risk Skills Training Program (RSTP). Design Adolescent participation in drinking, drug use, DD and riding with a drunk driver was examined longitudinally. After baseline assessments, adolescents were randomly assigned to the RSTP, DARE‐A or a no intervention control group and then completed 2‐month post‐test and 6‐month follow‐up assessments. Setting Adolescents attended a mid‐sized suburban high school. Participants The sample (N = 300) was comprised of 58% females and the age range was 14–19 years. Intervention The RSTP was developed to target several risk behaviors and to examine the feasibility of conducting a brief personalized prevention program in a group setting. DARE‐A focused on increasing knowledge and understanding the deleterious effects of substance use. Measurements Risk‐taking behavior, perception of peer risk‐taking and positive and negative alcohol expectancies were assessed. Findings RSTP participants decreased participation in several risk behaviors at post‐test, but reductions were not maintained at 6‐month follow‐up. The control and DARE‐A groups increased their positive and decreased their negative alcohol expectancies. The control group increased their alcohol consumption. Conclusions Results suggest that a brief, personalized, group prevention program is a feasible approach to reducing adolescent risk‐taking. Strategies must be developed to solidify these positive changes so that they are longer‐lasting.     

Substance use, risky behaviors, and victimization among a US national adolescent sample

Data from the National Adolescent Student Health Survey were used to study the interrelations among substance use, risky (dangerous) behaviors, and victimization among 8th and 10th graders. Pearson correlations indicated significant associations between substance use and both higher levels of risky behaviors (e.g., hitchhiking, going on a blind date) and victimization among adolescents. Regression analyses indicated the potency of risky behaviors as a predictor of victimization for male adolescents, and a significant risky behavior by illicit drug use interaction for female adolescents. Results are discussed with regard to potential short- and long-term health consequences of risky behaviors and violent victimization for psychological development in adolescence and adulthood.     

Impact of self esteem on risky sexual behaviors among Nigerian adolescents

Although improved knowledge is often the first approach in HIV prevention for adolescents, studies have shown that despite being well informed, adolescents still engage in risky sexual behavior (RSB). Low self-esteem has been considered to be a psychological explanation for behavioral problems, but little is known about the impact of self-esteem on RSB among adolescents in Nigeria. The purpose of this study was to determine whether adolescents with high self-esteem demonstrate lower RSB compared to those with low self-esteem. We conducted a cross-sectional survey of 361 adolescents in 9 secondary schools in Jos Plateau, Nigeria. The Rosenberg Self Esteem Scale was used to measure self-esteem and the Brief HIV Screener (BHS) was used to measure RSB. All data were analyzed using SPSS 21. Chi square and odds ratios were calculated to determine differences in BHS questions based on predetermined low or high self-esteem categories. Independent t-test were utilized to determine difference in mean BHS scores based on self-esteem categories. Participants were 169 male (46.8%) and 192 female (53.2%) with a mean age of 16.9. Mean self-esteem score was 27.6 with no significant difference in self-esteem scores by gender. Adolescents with low self-esteem were 1.7 times more likely to be sexually active and had a higher mean BHS scores compared to adolescents with high self-esteem. Programs aimed at reducing RSB and in-turn HIV/AIDS should consider interventions to raise adolescents’ self-esteem.     

Gender, work, and HIV risk: determinants of risky sexual behavior among female entertainment workers in China.

We proposed to integrate cognitive and social factors in the study of unprotected commercial sex. Data from 159 female entertainment workers from 15 establishments in Shanghai who reported commercial sex in the month prior to interview were used to test the approach. Two-sample t tests and multivariate logistic regression were conducted to examine if and how individual cognitive and social influence factors affect the odds of consistent condom use. About 21% of participants reported consistent condom use. Both individual cognitive and social influence factors were important correlates of condom use; models containing either alone suffered significantly in explanatory power. Perceived easiness in condom use was the most proximate determinant of condom use. It helped to translate HIV knowledge and prevention motivation into behavior and to mediate the impact of sexual relationship power. Prevention intervention is urgently needed and should focus on self-efficacy training and promoting supportive social and working environments.     

Promotion of safer sexual behaviour and HIV/STD prevention among adolescent students and army recruits

Estonia is a country with a low incidence rate of HIV infection, but a high rate of STDs. Drug use is increasing among young people, with an unknown number of users. A considerable number of IVDUs are infected with hepatitis B and C viruses. There are conditions for rapid spread of HIV infection in Estonia. From 1997 to 1999, three prevention projects were carried out with young people by the Estonian Association Anti-AIDS. The idea of preventive strategies was to promote the young people's own decision making about risk behaviour. Interactive learning methods were designed for work with young people. Teachers and peer educators were seen as collaborators in prevention: for them an innovative methodological manual was issued and they were also provided with training sessions. During interactive workshops the project staff learnt from young people background issues such as aspects of their psychosocial and sexual development. From our experience, prevention must be carried out among the young people continuously as they need the development of the motivation and personal insight to establish the goals of personal (and sexual) health.     

Body image and body change techniques among young adolescent boys

The aim of the present study was to examine the level of body image disturbance among adolescent boys and to determine how body image disturbance was related to body change techniques. Twenty boys from year 7 (mean age = 12.55 years, SD = 0.61) and 20 boys from year 9 (mean age = 14.85 years, SD = 0.59) were interviewed individually about their body image and body change strategies. The boys were questioned about the importance and their satisfaction with their weight, body size, body shape, muscle tone and parts of their body and the frequency with which they used the following techniques: eating less to lose weight, eating more to gain weight, and exercise to change body size, shape or muscle tone. The results demonstrated that of those boys who wanted to change their body (50 per cent), 12 wanted to lose weight and eight wanted to gain weight. The most frequent strategy used to change body size or shape was exercise, rather than changing eating patterns. Year 7 boys were more satisfied with their weight than year 9 boys, and boys with a larger body mass index (BMI) were less satisfied with their muscle tone and more likely to change their eating habits to decrease their body size or shape than boys with a smaller BMI. The implications of these findings for obtaining a better understanding of how male body image and body change strategies are different from girls are discussed. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association.     

Smoking behavior among adolescents in Thailand and Malaysia

The objective of this study was to examine the smoking behavior among adolescents in Thailand and Malaysia. Population-based, national surveys were conducted among 1,704 adolescents between the ages of 13 and 18 from Thailand (n = 927) and Malaysia (n = 777). Respondents were selected using multistage cluster sampling. Respondents were asked to complete self-administered questionnaires. Approximately 5% of Thai and Malaysian adolescents were current smokers, while an additional 8.6% of Thai and 8.1% of Malaysian adolescents reported being beginning smokers. On average, Thai smokers reported first smoking a whole cigarette at 14.6 years old (SD = 1.9), while Malaysian smokers at age 13.9 years (SD = 2.2). More than half of Thai smokers (60.4%) reported they bought cigarettes themselves and 29.9% got cigarettes from friends. In Malaysia, most smokers (68.3%) reported they bought cigarettes themselves, only 20.7% got cigarettes from friends. Seventy-six percent of Thai adolescent smokers smoked factory-made brands as their usual brand compared to 27.7% of Malaysian adolescent smokers. Eight percent of Thai adolescents and 10% of Malaysian adolescents reported smoking hand-rolled cigarettes. Approximately half of Thais and more than 40% of Malaysian smokers reported they tried to quit smoking within the past month. The smoking prevalence of Thai adolescents is close to that of Malaysian adolescents. Factory-made cigarette consumption is an important problem in Thai adolescents and needs to be targeted.     

Effectiveness of a health network in secondary prevention among coronary patients

OBJECTIVE: To improve the secondary prevention, particularly hypertension management among coronary patients. METHODS: In 2004-2005, out of 175 coronary patients having taken part in a cycle of the Educoeur center of the health network Rivarance, 131 (75%) aged between 32-79 years of age (an average of 61 years with 11% women, 52% hypertensive, 24% smokers, 10% diabetics and 72% with unbalanced dyslipidemia (LDL>1g/l)) were re-examined within 12 months and were compared with a French cohort of the EuroAspire II study (365 patients - Lancet 2001). 56% were treated by angioplasty, 24% by coronary bypass and 20% by medical treatment. The 4-week ambulatory educational program consisted of a physical education with 22 meetings of cardiac rehabilitation (ergo cycle, carpet, segmentary muscular work, steps and balneotherapy) and a therapeutic and dietetic education (18 courses and cooking workshops, supermarket visits and self BP measurement). These 131 patients were re-examined 3, 6 and 12 months after by the paramedical team. The GP and nurses were taught recommendations on CV risk factors management. The patients were followed by a computerized medical file. BP (average of 3 measurements by OMRON M4), total cholesterol (CT), weight, physical activity (insufficient if less than 3 walks of 30 min per week), smoking and drugs intake were analyzed on J0 then at one year and were compared with the French results of EuroAspire II. [table: see text] CONCLUSION: The education and the follow-up of the patient in a network of health improve CV risk factors and particularly hypertension management of these coronary patients but this decreases with time.     

Current sexual activity and risky sexual behavior in older men with or at risk for HIV infection.

In a cross-sectional analysis, we investigated frequency of sexual activity and factors associated with risky sexual behavior among 624 oldermen, aged 49-80, with or at risk for HIV infection. During the prior 6 months, 75% reported sexual activity with at least one partner, and one quarter of both the HIV-negative and HIV-positive men had more than one sexual partner. Only 18% of the HIV-negative men and 58% of the HIV-positive men always used condoms with their sexual partners. Factors independently and positively associated with risky sexual behavior included lack of HIV infection, any drug use in the past 6 months, greater importance of sex in one's life, weekly or more frequent sexual activity in the past 6 months, and ever taking sildenafil. These results suggest that older men with or at risk for HIV infection are sexually active, participate in risky sexual behavior, and need safer sex interventions.