Temporal Fluctuations in Behavior,Perceived HIV Risk,and Willingness to Use Pre-Exposure Prophylaxis (PrEP)

Individual perceptions of HIV risk influence willingness to use pre-exposure prophylaxis (PrEP) for HIV prevention. Among men who have sex with men (MSM) and male sex workers (MSWs), temporal or episodic changes in risk behavior may influence perceived risk and PrEP acceptability over time. We investigated fluctuations in perceived HIV risk and PrEP acceptability, comparing MSWs against MSM who do not engage in sex work. We conducted 8 focus groups (n = 38) and 56 individual interviews among MSM and MSWs in Providence, RI. Perceived HIV risk shaped willingness to use PrEP among both MSWs and MSM who did not engage in sex work, and risk perceptions changed over time depending on behavior. For MSWs, perceived risk cycled according to patterns of substance use and sex work activity. These cycles yielded an “access-interest paradox”: an inverse relationship between willingness to use and ability to access PrEP. MSM who did not engage in sex work also reported temporal shifts in risk behavior, perceived risk, and willingness to use PrEP, but changes were unrelated to access. MSM attributed fluctuations to seasonal changes, vacations, partnerships, behavioral “phases,” and episodic alcohol or drug use. Efforts to implement PrEP among MSM and street-based MSWs should address temporal changes in willingness to use PrEP, which are linked to perceived risk. Among MSWs, confronting the access-interest paradox may require intensive outreach during high-risk times and efforts to address low perceived risk during times of reduced sex work.     

The contribution of gene-environment interaction to psychopathology

The study of gene-environment interaction (G x E) constitutes an area of significant social and clinical significance. Different types of research study designs are being used to investigate the contribution of G x E to psychopathology, although the term G x E has also been used and interpreted in different ways. Despite mixed evidence that G x E contributes to psychopathology, some promising and consistent findings are emerging. Evidence is reviewed in relation to depression, antisocial behavior, schizophrenia, and attention-deficit/hyperactivity disorder. Although findings from various research designs have different meaning, interestingly much of the evidence with regard to the contribution of G x E that has arisen from twin and adoption studies has been for antisocial behavior and depression. It is for these same forms of psychopathology that molecular genetic evidence of G x E has also been most convincing. Finally, current and anticipated methodological challenges and implications for future research in this area are considered.     

Health and social impact assessment of the South East Queensland Regional Plan (2005-2026)

A health and social impact assessment of the South East Queensland Regional Plan was undertaken in 2005 (Queensland Government, 2005). It is one of few attempts nationally and globally to apply health and social impact assessment to a regional planning process. The assessment methodology builds on existing evidence-based research, methodologies and the combined professional experience of both health and social impact assessment practices in Queensland. The approach adds further strength and rigour to planning strategies to enhance the health and well-being of communities. The way the South East Queensland Regional Plan is implemented, and how the plan influences access to jobs, education, affordable housing and social infrastructure, and the achievement of social inclusion and connectedness within communities, will be central to future health and well-being of people in South East Queensland.     

Comparison of alternative methods of collection of service use data for the economic evaluation of health care interventions

Economic evaluation of health care interventions usually requires the collection of service use data to estimate the total cost of participants in an evaluation. There are a number of methods available to measure the quantity of services used but little is known about the relative accuracy of alternative methods. In a multicentre randomised controlled trial of interventions for the treatment of adults with recurrent episodes of deliberate self-harm (the POPMACT trial), health service data were collected by patient self-report after six and twelve months and also from GP records by independent investigators. Agreement for overall costs was relatively high. However, this hides substantial variation in agreement between the two sources of information for different services. The results suggest that GP records provide more accurate data on the use of general practice-based contacts than patient report, but less reliable information on contacts with other health services. Thus reliance on GP records for data on hospital services and other community health services based outside of general practice surgeries is not recommended. Future research should explore the level of agreement between patient report and other providing sector records, such as hospital records.     

Smoking policies in small worksites in Minnesota

PURPOSE: To examine correlates of smoking policies in a stratified sample of small worksites in Minnesota and to determine knowledge and attitudes of the owners and managers regarding the Minnesota Clean Indoor Air Act (MCIAA) rules that newly applied to their businesses. DESIGN: Cross-sectional survey. SETTING: Minnesota offices and factories/warehouses with 5 to 50 employees. Subjects. Owners or managers of offices and factories/warehouses; sample size = 233; response rate = 66%. MEASURES: Existence and strength of worksite smoking policies. ANALYSIS: Comparison of factories/warehouses and offices in metropolitan and greater Minnesota using chi square and linear and logistic regression analyses. RESULTS: Approximately two-thirds of the worksites claimed to have a smoking policy, but only 26% of the total sample had a policy in writing. Worksites that offered health insurance to their employees were more likely to have a written policy (p < .0001), as were offices in the metro area compared with other worksites (p = .003). Policies of both types of outstate worksites were stronger compared with those at metro sites, and offices had stronger policies than factories and warehouses in the metro area. Only about one-third of the businesses had heard of the MCIAA rule changes. CONCLUSION: Most small businesses in Minnesota do not have a smoking policy in writing and thus their employees are at risk of exposure to secondhand smoke at work.