Risky sexual behavior and alcohol use among young adults: results from a national survey

PURPOSE. To examine the relationship between alcohol use and sexual activity in a sample of young adults. DESIGN. Data were collected as part of a 1990 survey of a multistage area household probability sample. SETTING. In-home interviews were conducted by experienced interviewers. SUBJECTS. In total, 1006 persons from 18 to 30 years of age living in the contiguous United States were contacted. MEASURES. Detailed information was collected on alcohol use and sexual behavior. To minimize the reluctance of respondents to answer queries on sexual behavior, those questions were contained in a self-administered questionnaire. RESULTS. At the population level, having had multiple sexual partners in the past year was more likely among men who consumed five or more drinks per sitting. Condom use was less likely among respondents who had consumed five or more drinks on at least one occasion in the past year. In multivariate analyses, the amount of alcohol consumed at the new partner event was not associated with condom use with a new partner. When the effects of other demographic and psychosocial factors were removed, the number of drinks consumed during the heaviest drinking event was a significant predictor of engaging in sex for women but not for men. CONCLUSION. In young adults, alcohol use with sex does not necessarily lead directly to lapses in judgment about safe sexual practices. Alcohol is but one of a number of factors that play an important role in determining the riskiness of a particular sexual encounter.     

Long-term health correlates of timing of sexual debut: results from a national US study

Objectives. We explored long-term health consequences of age at sexual initiation and of abstinence until marriage to evaluate empirical support for the claim that postponing sexual initiation has beneficial health effects.Methods. We analyzed data from the 1996 National Sexual Health Survey, a cross-sectional study of the US adult population. We compared sexual health outcomes among individuals who had initiated sexual activity at an early or late age versus a normative age. We also compared individuals whose first sexual intercourse had occurred before versus after marriage.Results. Early initiation of sexual intercourse was associated with various sexual risk factors, including increased numbers of sexual partners and recent sexual intercourse under the influence of alcohol, whereas late initiation was associated with fewer risk factors. However, both early and late initiation were associated with sexual problems such as problems with arousal and orgasm, primarily among men. Relationship solidity and sexual relationship satisfaction were not associated with early or late initiation.Conclusions. Early sexual debut is associated with certain long-term negative sexual health outcomes, including increased sexual risk behaviors and problems in sexual functioning. Late initiation was also associated with sexual problems, especially among men. Further research is needed to understand how sexual initiation patterns affect later health outcomes.Adolescent sexual activity has various adverse public health consequences1^–5 that disproportionately affect adolescents from racial/ehtnic minority groups.1^,6^,7 In the United States, adolescent pregnancy rates have declined in recent years,8 but adolescents still account for the highest age-specific proportion of unintended pregnancies,2 with higher rates among African Americans and Latinas than among White women.7Moreover, although rates of certain sexually transmitted infections (STIs) have fallen dramatically,9 age-specific risks for many STIs continue to be highest among adolescents.1 For example, almost half of the estimated 18.9 million STIs reported in 2000 in the United States affected adolescents and young adults.10 Race/ethnicity is a factor as well; rates of gonorrhea and chlamydia among African American and Latino youths are 2 to 7 times higher than are rates among White youths.1 The United States ranks highest among developed countries in terms of both sexual health risks (e.g., nonuse of contraception) and undesirable outcomes (e.g., adolescent pregnancy).11 In addition, Bramlett and Mosher12 showed that the high US divorce rate (in comparison with rates in other developed countries)13 is associated with premarital sexual activity (corrected for the fact that the United States also has the highest marriage rate).Driven by concerns regarding these serious health risks as well as by the conservative belief that expression of sexuality is acceptable only in marriage, promotion of sexual abstinence until marriage has become the cornerstone of US domestic and global policies.4 According to federal guidelines, abstinence-only education should provide adolescents with knowledge about the presumed social, psychological, and health gains to be realized by abstaining from sexual activity. Abstinence-only education has been criticized on multiple grounds, including the promotion of ideas that are not scientifically grounded.4 Beyond government policy, abstinence-only education is part of a broader social movement among conservative Christian groups.14Proponents of abstinence-only education suggest that delaying sexual initiation has beneficial effects in terms of future marital relationship quality and sexual health, whereas initiation of sexual intercourse during adolescence causes later physical and psychological problems, including depression and marriage-related difficulties.4^,15 As part of the DHSS campaign (see http://www.4parents.gov), adolescents are informed about the supposed positive outcomes of postponing sexual activity until marriage, including increased likelihood of “better sex” once married and of a more trusting marriage and decreased likelihood of divorce. Although indeed in theory abstinence is the only certain way to avoid STIs and unintended pregnancies, delaying initiation of sexual activity may also create health risks by impeding development of the emotional, cognitive, and interpersonal skills that are crucial to satisfactory sexual functioning and general well-being.16^,17Very little is actually known about the long-term risks and benefits of abstinence intentions, virginity pledges, or early or late initiation in the context of consensual sexual experiences; however, numerous studies have documented long-term adverse outcomes of sexual abuse, including sexual risk behaviors.18^–28 Some research seems to suggest that early initiation of sexual activity is associated with continuing risk of STIs, HIV, and unintended pregnancy.26^,29^–31 These associations are mediated by number of sexual partners, STI history, alcohol and drug use related to sexual behavior, and partners’ number of sexual partners.5^,32 However, the results of a longitudinal study in which biological STI testing33 was used suggest that initial STI risk related to early onset of sexual intercourse is not persistent.Very few studies have assessed long-term outcomes other than STIs. Examining data from the National Longitudinal Study of Youth, Finger et al.34 found that virginity at age 18 years was positively associated with financial net worth and negatively associated with health problems and use of welfare benefits among women. Both men and women who had been virgins at age 18 years had a higher average level of education and were less likely to have been divorced. Current level of happiness did not differ between those who had been virgins at age 18 years and those who had not. Hallfors et al.35 found that, among women, substance use, sexual experimentation, and history of multiple sexual partners predicted depression 1 year later.As demonstrated in a study conducted by Else-Quest et al.,36 the specific contexts in which initial sexual experiences occur seem to be an important factor in later health outcomes. Using data from the National Health and Social Life Survey,37^,38 a cross-sectional investigation involving 3432 men and women aged 18 to 59 years, these researchers showed that long-term outcomes are determined more by whether initial sexual intercourse occurred in a negative context (e.g., forced intercourse, peer pressure) than by the timing of the experience. Individuals whose first sexual intercourse had occurred in such negative contexts were more likely to have sexual problems and sexual guilt, to be in poor health, to have an STI, and to have reduced life satisfaction.Else-Quest et al. found that, when participants with coercive experiences were excluded, early sexual debut was associated with slightly poorer health, more STIs, slightly poorer life satisfaction, and lower levels of sexual guilt. Sexual problems, such as inability to experience orgasm and experience of pain during intercourse, were not associated with early sexual debut. Causal inferences cannot be made from this study because of the correlational nature of the data. Furthermore, several other factors (e.g., race/ethnicity, sexual socialization, and personality factors) that were not controlled may have biased the relationships observed.Our goal was to explore the adult correlates of early or late sexual initiation and, in so doing, contribute to establishing sexual health policies aimed at adolescents. We chose to conduct a secondary analysis of data from the National Sexual Health Survey because this data set contains information on respondents’ initial sexual experiences, their current sexual behavior and STI risk, and indicators of healthy sexual functioning. We hypothesized that early or late initiation of sexual activity relative to their peers sets young people apart and thus may result in long-term negative health outcomes. Because of the political emphasis on abstinence until marriage, we also compared individuals whose first sexual intercourse occurred after marriage with those whose first experience occurred before marriage.     

Sunbathing habits and sunscreen use among white adults: results of a national survey.

OBJECTIVES: This study assessed current levels of sunbathing and sunscreen use in the United States. METHODS: From a general-population telephone survey of aquatic activities among adults in 3042 US households, we examined responses by the 2459 Whites. RESULTS: Most adults (59%) reported sunbathing during the past year, and 25% reported frequent sunbathing. Of the subsample who reported sunbathing during the month before the interview, 47% routinely used sunscreen. Of these individuals, almost half did not use sunscreens with a solar protection factor of 15 or higher. CONCLUSIONS: About a quarter of US White adults report frequent sunbathing, and only about a quarter of sunbathers use sunscreens at recommended levels. These results should help focus future sun protection educational efforts.     

The impact of a gluten-free diet on adults with coeliac disease: results of a national survey

OBJECTIVE We sought to evaluate the impact of the gluten-free diet on the 5,240 members of the Canadian Celiac Association (CCA). Data are presented on 2,681 adults (>or=16 years) with biopsy-proven celiac disease (CD). METHODS: A mail-out survey was used. Quality of life was evaluated using the 'SF12', and celiac-specific questions. RESULTS: Mean age was 56 years, mean age at diagnosis was 45 years, and 75% were female. The 'SF12' summary scores were similar to normative Canadian data, but were significantly lower for females and newly diagnosed patients. Respondents reported: following a gluten-free (GF) diet (90%), improvement on the diet (83%), and difficulties following the diet (44%), which included: determining if foods were GF (85%), finding GF foods in stores (83%), avoiding restaurants (79%), and avoiding travel (38%). Most common reactions to consumed gluten (among 73%) included pain, diarrhea, bloating, fatigue, nausea, and headache. Excellent information on CD and its treatment was provided by the CCA (64%), gastroenterologists (28%), dietitians (26%) and family doctor (12%). CONCLUSIONS: Quality of life in those with CD could be increased with early diagnosis, increased availability of gluten-free foods, improved food labelling, and better dietary instruction. Education of physicians and dietitians about CD and its treatment is essential.     

Health literacy, health status, and healthcare utilization of taiwanese adults: results from a national survey

Background  

Low health literacy is considered a worldwide health threat. The purpose of this study is to assess the prevalence and socio-demographic covariates of low health literacy in Taiwanese adults and to investigate the relationships between health literacy and health status and health care utilization.     

Media and secondhand smoke exposure: results from a national survey

OBJECTIVES: To investigate whether associations between anti-secondhand smoke (SHS) media, social cognitions about SHS, and home restrictions on smoking follow patterns observed in smoking behavior. METHODS: Based on a nationally representative sample of 2348 US adults drawn from the American Legacy Foundation's American Smoking and Health Survey, we tested relationships among scales of anti-SHS media, social cognitions, and home restrictions. RESULTS: We found anti-SHS media and SHS cognitions, as well as social cognitions and home restrictions, to be significantly associated. Social cognitions mediated the relationship between anti-SHS media and home restrictions. CONCLUSIONS: Previously observed relationships between media, social cognitions, and smoking also exist for SHS. Anti-SHS media campaigns to increase home restrictions may help to reduce SHS exposure.     

Serum magnesium and ischaemic heart disease: findings from a national sample of US adults.

BACKGROUND: Animal and human data suggest that magnesium may play an important role in ischaemic heart disease. Few prospective epidemiological studies have related serum magnesium concentrations to mortality from ischaemic heart disease (IHD) or all-causes. METHODS: Data from the National Health and Nutrition Examination Survey Epidemiologic Followup Study were used to examine the association between serum magnesium concentration, measured between 1971-1975, and mortality from IHD or all-causes in a national sample of 25-74-year-old participants followed for about 19 years. RESULTS: The analytical samples for IHD and all-cause-mortality included 12 340 and 12 952 participants, respectively (1005 IHD deaths, 2637 IHD deaths or hospitalizations, 4282 total deaths). Hazard ratios for IHD mortality from proportional hazards analysis comparing the second (1.59-<1.68 mEq/l), third (1.68-<1.77 mEq/l), and fourth (> or =1.77 mEq/1) quartiles of serum magnesium concentration with the lowest quartile were 0.79 (95% CI: 0.58-1.08), 0.66 (95% CI: 0.47-0.93), 0.69 (95% CI: 0.52-0.90), respectively. For all-cause mortality, hazards ratios were 0.82 (95% CI: 0.72-0.93), 0.84 (95% CI: 0.73-0.96), 0.85 (95% CI: 0.75-0.95). No significant interactions between serum magnesium concentration and age, sex, race, and education were observed. CONCLUSION: Serum magnesium concentrations were inversely associated with mortality from IHD and all-cause mortality.     

Extramarital sex and HIV risk behavior among US adults: results from the National AIDS Behavioral Survey.

Data from the National AIDS Behavioral Survey were used to examine the social distribution of extramarital sex and risk for human immunodeficiency virus (HIV) infection among married individuals in the United States. Of 1686 married respondents living across the United States, 2.2% reported extramarital sex; of 3827 married respondents living in 23 urban areas with large Hispanic or African-American populations, 2.5% reported having sexual partners outside marriage. The data indicate that the correlates of extramarital sex varied by race/ethnicity. Low levels of condom use were found among people reporting extramarital sex (8% to 19% consistent users).     

Radon in Irish schools: the results of a national survey.

This paper presents the results of a survey of radon concentrations in Irish primary and post-primary schools. The objective of this survey was to assess the distribution of radon in Irish schools and to identify those requiring remedial work to reduce radon exposure to children and staff. All primary and post-primary schools were invited to participate in the survey. Indoor radon concentrations were measured during the academic year using integrating passive alpha track-etch detectors with a measurement period from three to nine months. The survey was carried out on a phased basis from 1998 to 2004 and is one of the most comprehensive of its kind undertaken in Europe. Measurements were completed in 38 531 ground floor classrooms and offices in 3826 schools, representing over 95% of the approximate 4000 primary and post-primary schools in Ireland. Of these, 984 schools had radon concentrations greater than 200 Bq m(-3) in 3028 rooms and 329 schools had radon concentrations in excess of 400 Bq m(-3) in 800 rooms. The average radon concentration in schools was 93 Bq m(-3). This results in an annual average effective dose to an Irish child from exposure to radon of 0.3 mSv per year, assuming that the long-term radon concentration is equal to the radon concentration present during the working hours and that the annual average occupancy is 1000 h per year. A programme of remediation of schools with radon concentrations above 200 Bq m(-3) has been put in place.     

Public attitudes about underage drinking policies: results from a national survey

We conducted a national telephone survey of 900 adults in the United States to examine the attitudes of the adult public regarding underage drinking and a series of alcohol control policies aimed at reducing it. Three versions of the survey instrument were administered, each to one-third of the sample, with the versions varying in the stipulations of the policy options. Results showed high levels of public support for most of the alcohol control policies, with relatively lower support for those that would result in restrictions on adults' access to alcohol. Respondents' support of the policy options was significantly related to their sociodemographic and attitudinal characteristics, such as sex, age, drinking frequency, and level of concern about underage drinking. The findings provide important guidelines to policymakers interested in garnering support for policies aimed at curtailing underage drinking.     

Hospital disclosure practices: results of a national survey

New patient safety standards from JCAHO that require hospitals to disclose to patients all unexpected outcomes of care took effect 1 July 2001. In an early 2002 survey of risk managers at a nationally representative sample of hospitals, the vast majority reported that their hospital's practice was to disclose harm at least some of the time, although only one-third of hospitals actually had board-approved policies in place. More than half of respondents reported that they would always disclose a death or serious injury, but when presented with actual clinical scenarios, respondents were much less likely to disclose preventable harms than to disclose nonpreventable harms of comparable severity. Reluctance to disclose preventable harms was twice as likely to occur at hospitals having major concerns about the malpractice implications of disclosure.     

Trends in overweight among US adults from 1987 to 1993: a multistate telephone survey.

OBJECTIVES: Using data from the Behavioral Risk Factor Surveillance System, this study describes trends in the prevalence of overweight between 1987 and 1993. METHODS: Data were examined from 33 states participating in an ongoing telephone survey of health behaviors of adults (n = 387,704). Self-reported weights and heights were used to calculate sex-specific prevalence estimates of overweight for each year from 1987 to 1993. Time trends were evaluated with the use of linear regression. RESULTS: Between 1987 and 1993, the age-adjusted prevalence of overweight increased by 0.9% per year for both sexes (from 21.9% to 26.7% among men and from 20.6% to 25.4% among women). The increasing linear trend was observed in all subgroups of the population but was most notable for Black men (1.5% per year) and men living in the Northeast (1.4% per year). Secular changes in smoking and leisure-time physical activity did not entirely account for the increase in overweight. CONCLUSIONS: The prevalence of overweight among American adults increased by 5% between 1987 and 1993. Efforts are needed to explore the causes of this adverse trend and to find effective strategies to prevent obesity.     

Major depressive episodes and work stress: results from a national population survey

Objectives. We determined the proportion of workers meeting criteria for major depressive episodes in the past year and examined the association between psychosocial work-stress variables and these episodes.Methods. Data were derived from the Canadian Community Health Survey 1.2, a population-based survey of 24324 employed, community-dwelling individuals conducted in 2002. We assessed depressive episodes using the Composite International Diagnostic Interview.Results. Of the original sample, 4.6% (weighted n=745948) met criteria for major depressive episodes. High job strain was significantly associated with depression among men (odds ratio [OR]=2.38; 95% confidence interval [CI]=1.29, 4.37), and lack of social support at work was significantly associated with depression in both genders (men, OR=2.70; 95% CI=1.55, 4.71; women, OR=2.37; 95% CI=1.71, 3.29). Women with low levels of decision authority were more likely to have depression (OR=1.59; 95% CI=1.06, 2.39) than were women with high levels of authority.Conclusions. A significant proportion of the workforce experienced major depressive episodes in the year preceding our study. Gender differences appear to affect work-stress factors that increase risk for depression. Prevention strategies need to be developed with employers and employee organizations to address work organization and to increase social support.Depression is the leading cause of disability and is projected to become the second leading cause of the global burden of disease by 2020.1 Lifetime and 12-month (having had an episode in the past year) prevalence rates of major depressive disorder are estimated at 12.8%2 to 16.6%3 (16.5% of women, 8.9% of men2) and 3.9%2 to 6.7%4 (5.0% of women, 2.6% of men2), respectively. A substantial proportion of those affected by this disorder are of working age, but little is known about its prevalence or risk factors within the general working population. One of the few epidemiological studies conducted on the subject reported that 15.7% of employed individuals (19.5% of women, 11.4% of men) met lifetime criteria for major depressive disorder and that 8.6% (10.2% of women, 5.9% of men) met 12-month criteria.5Changes in workplace structure over the past 30 years may have contributed to increased stress and psychiatric morbidity.6 Aging of the population, coupled with a shortage of younger workers in some sectors, has also resulted in many people remaining in the workforce beyond usual retirement age. Depression at work reduces employees’ productivity,7 increases disability and depression-related absence, and may lead to premature early retirement.8 The prevalence and associated costs of depression necessitate an increased understanding of work-related factors that may contribute to this condition.Previous studies had 2 common methodological limitations that our study addressed. First, most studies have focused on distinct occupational groups9^,10 rather than on the general population.5^,11 Second, most studies have relied on self-report questionnaires to measure depressive symptoms rather than on standardized diagnostic interviews. We determined the proportion of employed individuals who met the 12-month criteria for a major depressive episode as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV )12 and examined the relationship between psychosocial work characteristics and 12-month major depressive episodes. We hypothesized that individuals experiencing increased job strain (higher job demands and lower decision latitude) would be at higher risk for 12-month major depressive episodes.     

Teaching interpersonal skills in family practice: results of a national survey.

The increasing recognition of the importance of a well-developed set of interpersonal skills to the competent family physician has resulted in a rapid growth in the formal teaching of interpersonal skills within family practice residencies. Of the 168 programs responding to a national survey of family practice residencies, 88 percent indicated that they have formal programs in interpersonal skills. It is estimated that there are well over 500 family practice faculty members who have special responsibilities in teaching interpersonal skills. While most programs address the component skills of the interpersonal process (eg, demonstrating empathy, information gathering, information giving, and psychological intervention), it is of concern that only about half offer explicit training in patient education (53 percent), specific types of counseling (eg, family counseling, 55 percent), or some of the specific interpersonal skills important in team practice and practice management (eg, supervisory skills). One of the most striking findings was that 88 percent of the reporting programs use videotechnology, with 77 percent of these planning to increase their use. Although most programs evaluate their interpersonal skills training using both indirect and direct assessment methods, only 25 percent attempt to use patient outcome as a measure of teaching effectiveness.