青少年及青年HIV感染影响因素

青少年及青年正处于由儿童向完备成年人转变的阶段,性生理趋于成熟,而性心理尚不完善,具有特有的生理与心理特点,易于发生不安全性行为,从而增加了自身感染HIV的风险。青少年及青年中存在较多的易感因素,近年来HIV感染新报告病例数逐年上升,引起了多方面的关注。本文从青少年及青年HIV感染现状、感染与发现途径、易感因素3个方面...     

Dietary risk factors by race/ethnicity,age-group,and gender in a representative sample of us older adults

Objective

To explore the relationships among ethnicity/race, gender, demographics, age-group and dietary health in a nationally representative sample of older adults.

Design

Cross-sectional study.

Setting

Data for this study were collected by interview in the mobile examination centers from the National Health and Nutrition Examination Surveys, 2011 - 2012.

Participants

U.S. representative sample of adults aged 55 years and older (N = 1860) from five ethnic/racial groups. All participants read, understood, and signed informed consent forms under data collection procedures by trained individuals.

Measurements

Sociodemographics were collected by trained interviewers using a general questionnaire. Food groups were determined by 24-hour recall using the validated USDA Automated Multiple-Pass Method. Data were presented by cross-tabulation and logistic regression to investigate relationships among race/ethnicity, gender, and age groups.

Results

Over 70% of older adults failed to consume 2.75 cups of combined fruits and vegetables. Other Hispanics (Hispanics excluding Mexican Americans) had higher Odds of sugar-containing food consumption compared to non-Hispanic Whites (adjusted model). Being older and female were protective factors for over-consumption of sugar.

Conclusion

Older Americans are not meeting dietary guidelines and there are differences by gender and ethnicity. Since diet has been associated with quality of life and medical costs, public health interventions can benefit by knowing age-, gender- and racial/ethnic- specific dietary behaviors.

     

Behavioral risk factors and unintentional injuries among U.S. immigrant adults

PURPOSE: This study compared 10 risk-taking behaviors generally considered to be risk factors for injuries and unintentional nonfatal injuries between immigrant and U.S.-born adults. METHODS: Data from the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions were analyzed. The prevalence of unintentional injuries that occurred in the past 12 months was calculated for foreign-born and U.S.-born respondents by major sociodemographic characteristics. The proportion of respondents who were involved in risk-taking behaviors was compared between immigrants and U.S.-born adults using a chi(2) test. Negative binominal Poisson regression models were used to study the association among immigrant status, total number of risk-taking behaviors, and injuries while controlling for the confounding effects of sociodemographic variables. RESULTS: Of 43,093 adult respondents, 13.3% (95% confidence intervals [CI] = 12.5%-14.1%) of immigrants reported injuries compared with 19.1% (95% CI = 18.7%-19.5%) of U.S.-born respondents. Immigrants had a significantly lower risk of unintentional injuries than U.S.-born adults by most sociodemographic characteristics, but there was no statistically significant association between years of U.S. residence and injuries. Immigrants were less likely than their U.S.-born counterparts to be involved in all 10 risk-taking behaviors (p < 0.05 from chi(2) test). However, when immigrants engaged in more than four risk-taking behaviors, the difference in injury prevalence between the two groups was not statistically significant (p > 0.05). CONCLUSIONS: Immigrant and U.S.-born adults involved in high-risk behaviors face similar risks for unintentional injuries. Targeting risk-taking behaviors among immigrants warrants special attention in injury-control programs.     

Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults

BACKGROUND: Studies suggest that moderate drinkers have lower cardiovascular disease (CVD) mortality than nondrinkers and heavy drinkers, but there have been no randomized trials on this topic. Although most observational studies control for major cardiac risk factors, CVD is independently associated with other factors that could explain the CVD benefits ascribed to moderate drinking. METHODS: Data from the 2003 Behavioral Risk Factor Surveillance System, a population-based telephone survey of U.S. adults, was used to assess the prevalence of CVD risk factors and potential confounders among moderate drinkers and nondrinkers. Moderate drinkers were defined as men who drank an average of two drinks per day or fewer, or women who drank one drink or fewer per day. RESULTS: After adjusting for age and gender, nondrinkers were more likely to have characteristics associated with increased CVD mortality in terms of demographic factors, social factors, behavioral factors, access to health care, and health-related conditions. Of the 30 CVD-associated factors or groups of factors that we assessed, 27 (90%) were significantly more prevalent among nondrinkers. Among factors with multiple categories (e.g., body weight), those in higher-risk groups were progressively more likely to be nondrinkers. Removing those with poor health status or a history of CVD did not affect the results. CONCLUSIONS: These findings suggest that some or all of the apparent protective effect of moderate alcohol consumption on CVD may be due to residual or unmeasured confounding. Given their limitations, nonrandomized studies about the health effects of moderate drinking should be interpreted with caution, particularly since excessive alcohol consumption is a leading health hazard in the United States.     

STD and HIV testing behaviors among black and Puerto Rican young adults

CONTEXT: Given the high rates of infection among urban young adults, STD and HIV testing promotion is a public health priority. To inform future testing efforts, lifetime and recent testing behaviors of this population within casual and serious relationships should be better understood. METHODS: Data from a 2007–2008 study conducted in select neighborhoods in Hartford and Philadelphia were used to examine self‐reported STD and HIV testing behaviors and attitudes among 483 sexually active black and Puerto Rican young adults aged 18–25. Multivariate ordered logit regression analyses were conducted to assess characteristics associated with lifetime number of STD tests. RESULTS: More than eight in 10 participants reported having been tested for STDs, and a similar proportion for HIV, most of them multiple times. Nineteen percent had ever had an STD diagnosis. A majority—86%—perceived their risk of STD infection in the next year as “not at all likely.” Sixty‐one percent of those in serious relationships reported that both partners had been tested, compared with 25% of those in casual relationships. Characteristics associated with higher lifetime number of STD tests were being female (odds ratio, 2.2), being from Philadelphia (2.5), being black (1.5), having lived with two or more serious partners (1.7) and having ever received an STD diagnosis (2.3). DISCUSSION: Despite their risks, participants did not perceive themselves to be at risk of STDs. However, they did report testing repeatedly. Testing was highly acceptable, particularly within serious relationships. Questions about the timing of testing initiation and repeat testing merit attention for the benefits of widespread testing to be fully realized.     

Condom use and HIV risk behaviors among U.S. adults: data from a national survey

CONTEXT: How much condom use among U.S. adults varies by type of partner or by risk behavior is unclear. Knowledge of such differentials would aid in evaluating the progress being made toward goals for levels of condom use as part of the Healthy People 2000 initiative. METHODS: Data were analyzed from the 1996 National Household Survey of Drug Abuse, an annual household-based probability sample of the noninstitutionalized population aged 12 and older that measures the use of illicit drugs, alcohol and tobacco. The personal behaviors module included 25 questions covering sexual activity in the past year, frequency of condom use in the past year, circumstances of the last sexual encounter and HIV testing. RESULTS: Sixty-two percent of adults reported using a condom at last intercourse outside of an ongoing relationship, while only 19% reported using condoms when the most recent intercourse occurred within a steady relationship. Within ongoing relationships, condom use was highest among respondents who were younger, black, of lower income and from large metropolitan areas. Forty percent of unmarried adults used a condom at last sex, compared with the health objective of 50% for the year 2000. Forty percent of injecting drug users used condoms at last intercourse, compared with the 60% condom use objective for high-risk individuals. Significantly, persons at increased risk for HIV because of their sexual behavior or drug use were not more likely to use condoms than were persons not at increased risk; only 22% used condoms during last intercourse within an ongoing relationship. CONCLUSIONS: Substantial progress has been made toward national goals for increasing condom use. The rates of condom use by individuals at high risk of HIV need to be increased, however, particularly condom use with a steady partner.     

Discrimination and sexual risk among Caribbean Latinx young adults

ABSTRACT

Objectives: Discrimination, such as being treated unfairly due to race, contributes to stress. Individuals may cope with this by engaging in risky behaviors. Consistent with this premise, prior studies found that discrimination is associated with substance use. Research has also shown that sex while ‘high’ on alcohol and drugs is associated with increased risk for HIV and other STIs. The present study examines the relationship between discrimination and sexual risk. We investigate whether discrimination is associated with sex while high on alcohol and drugs.

Design: Analyses focus on a sample of 356 Caribbean Diasporic young adults, primarily Caribbean Latinx, aged 18 to 25 who participated in the Drug Use and HIV Risk among Youth Survey carried out from 1997 to 2000 in Brooklyn, New York. Logistic regression examined the association between self-reported discrimination and sex while high.

Results: More than half (52.3%) of respondents reported moderate discrimination. Sex while high was also reported: 35.7% for alcohol, 43.3% for marijuana, and 32.6% for heroin/cocaine. Discrimination was associated with increased risk of sex while high on (1) marijuana and (2) heroin/cocaine, but was not with alcohol.

Conclusions: Discrimination may be a risk factor for engaging in sex while high on drugs, which may put individuals at risk for HIV as well as other STIs. Future research should explore relationships between discrimination and sex while high on alcohol and drugs among various racial/ethnic groups and Diasporas, while also assessing how this relationship may contribute to HIV incidence.     

Decrements in health-related quality of life associated with gender nonconformity among U.S. adolescents and young adults

Purpose

Gender nonconformity, that is, transgressing conventionally “masculine” vs. “feminine” characteristics, is often stigmatized. Stigmatization and discrimination are social stressors that raise risk of adverse mental and physical health outcomes and may drive health inequities. However, little is known about the relationship between such social stressors and health-related quality of life (HRQOL). This paper aimed to examine associations between perceived gender nonconformity and HRQOL in a cohort of U.S. adolescents and young adults.

Methods

Using data from 8408 participants (18–31 years) in the U.S. Growing Up Today Study (93% white, 88% middle-to-high income), we estimated risk ratios (RRs) for the association of gender nonconformity (three levels: highly gender conforming, moderately conforming, and gender nonconforming) and HRQOL using the EuroQol questionnaire (EQ-5D-5L). Models were adjusted for demographic characteristics, including sexual orientation identity.

Results

Gender nonconformity was independently associated with increased risk of having problems with mobility [RR (95% confidence interval): 1.76 (1.16, 2.68)], usual activities [2.29 (1.67, 3.13)], pain or discomfort [1.59, (1.38, 1.83)], and anxiety or depression [1.72 (1.39, 2.13)], after adjusting for sexual orientation and demographic characteristics. Decrements in health utility by gender nonconformity were observed: compared to persons who were highly gender conforming, mean health utility was lower for the moderately gender conforming [beta (SE): ?0.011 (.002)] and lowest for the most gender nonconforming [?0.034 (.005)].

Conclusions

In our study, HRQOL exhibited inequities by gender nonconformity. Future studies, including in more diverse populations, should measure the effect of gender-related harassment, discrimination, and violence victimization on health and HRQOL.

     

Prevalence of five lifestyle risk factors among U.S. adults with and without stroke

Background

History of stroke increases cardiometabolic risk, which can be exacerbated by the presence of unhealthy lifestyle factors. Population-based estimates of lifestyle risk factors in people with stroke are lacking but could be used to inform research, policy, and healthcare practice.

High prevalence of disability and HIV risk among low socioeconomic status urban adults, 17 U.S. cities

BackgroundIn the United States, approximately 10% of adults 18–64 years are disabled. However, there is scarce literature on the associations between disability and HIV risk.ObjectiveTo assess disability prevalence and its associations to health and HIV risk factors among low socioeconomic status (SES) (≤high school education or ≤ poverty guidelines) urban adults.MethodsWe assessed disability prevalence from a cross-sectional sample of low SES urban heterosexually active adults at risk for HIV participating in the 2016 National HIV Behavioral Surveillance (NHBS) and calculated crude and adjusted prevalence ratios and 95% confidence intervals of disability for health and HIV risk behaviors.ResultsIn the NHBS sample, 39.6% of participants reported any disability. Disability was associated with health care utilization and risk behaviors, even when adjusting for demographics. Participants with disabilities were more likely to have condomless sex with a casual partner and engage in exchange sex.ConclusionsLow SES urban heterosexually active adults reported high prevalence of disabilities and differences in health, health care utilization, and risk factors. Disability might contribute to sexual risk behaviors that increase the likelihood of HIV infection. Further investigations into the intersection of disability and HIV risk are needed, especially in poor communities often excluded from national assessments.     

Bacterial STDs and perceived risk among sexual minority young adults

CONTEXT: Most sexual health interventions focus on heterosexual sexual risk behavior. Health practitioners face a lack of information about the sexual health of sexual minority young adults (aged 18–26). METHODS: Three indicators of sexual minority status (identity, behavior and romantic attractions) were assessed in 10,986 young adults who participated in Wave 3 of the National Longitudinal Study of Adolescent Health (2001–2002). Logistic regression analyses examined associations between these indicators and individuals’ perceived risk for STDs and actual infection with STDs. Data from the 1,154 respondents who had current or recent bacterial STDs were investigated further to determine whether they had underestimated their risk. RESULTS: Outcomes varied by sexual minority status indicator and by sex. Bisexual females had significantly higher odds of STDs than heterosexual females (odds ratios, 1.4), and females attracted to both sexes had significantly higher odds of STDs than females attracted only to males (1.8). In contrast, none of the sexual minority status indicators predicted STDs for males. Among respondents who had an STD, females who reported only same‐sex sexual relationships were more likely to believe they were at very low risk for STDs than were females reporting only opposite‐sex sexual relationships (17.2); homosexual females had a higher likelihood of this outcome than heterosexual females (19.7). CONCLUSIONS: Health practitioners need to assist sexual minority young adults, particularly females, in under‐standing their risk for STDs and in taking safer‐sex precautions.     

Sexual orientation and risk factors for suicidal ideation and suicide attempts among adolescents and young adults

Same-gender sexual orientation has been repeatedly shown to exert an independent influence on suicidal ideation and suicide attempts, suggesting that risk factors and markers may differ in relative importance between lesbian, gay, and bisexual individuals and others. Analyses of recent data from the National Longitudinal Study of Adolescent Health revealed that lesbian, gay, and bisexual respondents reported higher rates of suicidal ideation and suicide attempts than did heterosexual respondents and that drug use and depression were associated with adverse outcomes among heterosexual respondents but not among lesbian, gay, and bisexual respondents.     

性病患者行为危险因素和艾滋病感染情况调查

目的了解性病患者的危险行为特征与性病艾滋病感染情况。方法在2006年2~3月,对乌鲁木齐市各类从事性病诊疗服务的医疗机构就诊的性病患者和疑似性病患者进行HIV抗体检测和问卷调查。结果HIV感染者的检出率为4·32%,明显高于同期开展的孕产妇和服务小姐的检出率,同时高于2003年调查时的检出率(1·2%),与全国其他个别地市开展的同类人群的调查相比,其检出率也是最高的。统计分析表明,艾滋病的传播与商业性行为、性病史、静脉吸毒共用注射器和安全套使用率低有着直接关系。结论在今后的防治工作中,应不断提高干预质量,高度重视并有效阻断艾滋病经性途径的传播。     

Health risks among enlisted males in the U.S. Navy: race and ethnicity as correlates of disease incidence

A cross-sectional study of all Black and Caucasian enlisted males in the U.S. Navy between 1974 and 1979 was conducted to determine if there were any significant racial group differences in disease incidence. First hospitalization rates for sixteen ICDA-8 diagnostic categories and selected diagnoses were examined and compared on the basis of race, age, year hospitalized, education and occupation. Results indicated that total disease incidence among Black males has declined in the past decade, with a reduction in total first hospitalizations from 1652 per 10,000 men in 1974 to 1088 per 10,000 men in 1979. Total incidence rates for Caucasian males in the same period declined from 1347 per 10,000 men to 1100 per 10,000 men. However, Blacks were found to be at significant risk for: mental disorders; diseases of the genitourinary system; diseases of the circulatory system; diseases of the digestive system; diseases of the blood and blood-forming organs; symptoms and ill-defined conditions; supplementary classifications; and diseases of the musculoskeletal system. Caucasians had significant higher incidence rates for diseases of the skin and subcutaneous tissue, and accidents, poisonings and violence. Nevertheless, the study results indicated that the populations of Blacks and Caucasians in the Navy are not uniform with respect to disease incidence. There exist numerous subgroups within either racial group, defined on the basis of certain demographic and social characteristics, which are at risk for particular diseases. In addition, the relationship between race and disease is mediated by several factors, including genetic predisposition, socioeconomic status and cultural patterns of belief and behavior. No single factor can account for the excess risk for all diseases among all members of either racial group.