Health Risk Behavior

Koopman, C., T. Ismailji, et al. (2007). "Relationships of depression to child and adult abuse and bodily pain among women who have experienced intimate partner violence." J Interpers Violence 22(4): 438-55.
This study investigates whether depression in women who experienced intimate partner violence is associated with having also experienced childhood sexual and physical abuse, psychological abuse by an intimate partner, recent involvement with the abusive partner, and bodily pain. Fifty-seven women who had left a violent relationship with an intimate partner completed measures assessing their demographic characteristics, experiences of abuse in childhood and in their relationship with their intimate partner, and depressive symptoms. Multiple regression analysis showed that women's depression was significantly greater among those who had experienced childhood physical and sexual abuse, more severe psychological abuse, and greater bodily pain (p<.001), adjusted R(2)=.32. These results suggest characteristics that can help to identify abused women who are most at risk for depression, and they suggest specific issues that may need to be addressed in this population.

Remien, R. H., T. M. Exner, et al. (2007). "Medication Adherence and Sexual Risk Behavior among HIV-Infected Adults: Implications for Transmission of Resistant Virus." AIDS Behav.
As more people are living long-term with HIV there are growing concerns about specific behaviors that can affect both personal and the public health. This study examined the relationship between antiretroviral therapy (ART) adherence and sexual risk behavior and their association with psychosocial and health factors among a diverse sample of 2,849 HIV-infected adults. Only 8.5% of the sample reported both non-adherence and sexual risk. Individuals were 46% more likely to report one of these risk outcomes when the other one was present and the presence of both outcomes was associated with an increased likelihood of having a detectable viral load. A simultaneous polytomous regression analysis revealed complex relationships among a range of psychosocial variables and the two primary behavioral risk outcomes. There is a need for targeted interventions and integration of mental health and substance use services into primary HIV care settings.

Butler, L. M., W. P. Koh, et al. (2006). "Prospective study of dietary patterns and persistent cough with phlegm among Chinese Singaporeans." Am J Respir Crit Care Med 173(3): 264-70.
RATIONALE: Using principal components analysis to examine dietary patterns complements the evaluation of individual food and nutrient intake in relation to health outcomes, but has not yet been applied to nonmalignant respiratory disease or symptoms. OBJECTIVE: To examine the relation between patterns of dietary intake at baseline and new onset of persistent cough with phlegm in a population-based cohort of Singapore Chinese. METHODS: A 165-item validated food frequency questionnaire was administered in-person at baseline in 1993. We identified 623 cases of incident cough with phlegm among 52,325 subjects by telephone interview from 1999 through 2004. We identified two distinct food patterns: a "meat-dim sum" pattern characterized by pork and chicken dim sum foods and noodle dishes, and a "vegetable-fruit-soy" pattern characterized by vegetables, fruit, and soyfood items. MAIN RESULTS: The meat-dim sum pattern was positively associated with new-onset cough with phlegm (odds ratio, 1.43; 95% confidence interval, 1.08, 1.89; comparing fourth to first quartile, p for trend = 0.02), after adjustment for age, sex, total energy intake, smoking, education, and nonstarch polysaccharide intake, a protective factor for cough with phlegm in this cohort. Weaker associations were seen for more chronic symptoms and for incident asthma. A weak inverse association for the vegetable-fruit-soy pattern disappeared after adjustment for nonstarch polysaccharide intake. CONCLUSION: A diet rich in meats, sodium, and refined carbohydrates may increase risk of developing cough with phlegm, independently of the apparent beneficial effects of a diet high in fiber in this Singapore Chinese cohort.

Hong, D. S., R. B. Goldstein, et al. (2006). "Perceived partner serostatus, attribution of responsibility for prevention of HIV transmission, and sexual risk behavior with "MAIN" partner among adults living with HIV." AIDS Educ Prev 18(2): 150-62.
Persons living with HIV (PLH) often attribute HIV status to sexual partners based on observable partner characteristics. The present study investigated the relationship of sexual behavior with most recent "main" partner to that partner's perceived serostatus among 1,232 PLH interviewed in clinics and community agencies in Los Angeles, California. PLH who believed their most recent main partner to be HIV-negative more often identified partner appearance as a basis for their perceptions than those who believed their most recent main partner to be HIV-positive. PLH who perceived their most recent main partner as HIV-negative were more likely to assume responsibility for partner protection and always to use condoms, and less likely to report recent unprotected vaginal or anal sex with that partner. Unprotected receptive anal intercourse with their most recent main partner was less common among African American, Latino, and White participants who believed that partner to be HIV-negative. Although PLH appear protective toward HIV-negative main partners, interventions to encourage valid methods of identifying partner serostatus are needed.

Steffen, P. R., T. B. Smith, et al. (2006). "Acculturation to Western society as a risk factor for high blood pressure: a meta-analytic review." Psychosom Med 68(3): 386-97.
OBJECTIVE: A number of studies have documented that acculturation to western society is related to an increase in blood pressure (BP). Although there is evidence that higher socioeconomic status appears related to better cardiovascular health, increasing acculturation to western society appears related to worse cardiovascular health. The purpose of this meta-analysis was to investigate the association between acculturation and BP. METHODS: Literature searches yielded 125 relevant research manuscripts, which were coded by teams of two independent raters. This study was conducted in 2003 and 2004, and research databases such as MEDLINE and PsychINFO were searched through 2004. Measures of association (effect sizes) were extracted for both systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings. Random effects models were used to analyze the resulting data. RESULTS: The overall effect sizes associated with acculturation were 0.28 for SBP and 0.30 for DBP, with increasing acculturation to western society related to higher BP. More acculturated individuals had an average of 4 mm Hg higher BP than less acculturated individuals, which is similar to the effect sizes of known risk factors for high BP such as diet and physical activity. The effects of acculturation on BP appear to be universal, with similar effect sizes found across all regions of the world. Change in BP due to acculturation was not related to body mass index (BMI) or cholesterol but was related to length of residence in the new culture, with the largest effect sizes seen on initial entry and then decreasing rapidly within the first few years. Sudden cultural changes, such as migration from rural to urban settings, resulted in the largest effect sizes, which finding supports the hypothesis that the stress of cultural change is important role in the acculturation effect. CONCLUSIONS: Acculturation to western society is associated with higher BP, and the distress associated with cultural change appears to be more influential than changes in diet or physical activity. Future studies would benefit from investigating how cultural change affects health and examining whether some non-Western cultural values and practices are health protective.

Gore-Felton, C., M. J. Rotheram-Borus, et al. (2005). "The Healthy Living Project: an individually tailored, multidimensional intervention for HIV-infected persons." AIDS Educ Prev 17(1 Suppl A): 21-39.
The NIMH Healthy Living Project (HLP), a randomized behavioral intervention trial for people living with HIV, enrolled 943 individuals, including women, heterosexual men, injection drug users, and men who have sex with men from Los Angeles, Milwaukee, New York, and San Francisco. The intervention, which is based on qualitative formative research and Ewart's Social Action Theory, addresses three interrelated aspects of living with HIV: stress and coping, transmission risk behavior, and medication adherence. Fifteen 90-minute structured sessions, divided into 3 modules of five sessions each, are delivered to individuals. Sessions are tailored to individuals within a structure that uses role-plays, problem solving, and goal setting techniques. A 'Life Project'--or overarching goal related to personal striving-provides continuity throughout sessions. Because this is an ongoing project with efficacy yet to be established, we do not report intervention outcomes. However, the intervention was designed to be useful for prevention case management, settings where repeated one-on-one contact is possible, and where a structured but highly individualized intervention approach is desired.

Johnson, M. O., E. Charlebois, et al. (2005). "Perceived adverse effects of antiretroviral therapy." J Pain Symptom Manage 29(2): 193-205.
Adverse effects from antiretroviral therapy (ARV) for HIV are associated with medication nonadherence. The purposes of this study were to explore group differences in the reporting of adverse effects, identify individual adverse effects that are linked to nonadherence, and to explore the role of coping in the relationship between adverse effects and adherence. Cross-sectional interviews of 2,765 HIV-positive adults on ARV therapies in four U.S. cities were performed using a computerized assessment of self-reported adverse effects, coping self-efficacy, and adherence. There were no gender differences in the rate or severity of adverse effects reported. Latino respondents reported more adverse effects than either White or African Americans. Those taking a protease inhibitor (PI) reported a higher rate and greater severity of adverse effects. Older participants reported fewer adverse effects despite being more likely to be on a regimen containing a PI. Respondents with less than 90% adherence reported greater numbers and severity of adverse effects overall. In multivariate analyses, nausea, skin problems, vomiting, and memory adverse effects were independently related to less than 90% adherence over the prior three days. Coping moderated the relationship between nausea and adherence such that individuals who reported lower coping self-efficacy and experienced nausea were at increased risk for nonadherence, regardless of the length of time on the current ARV regimen. Women and men are similar in their overall reports of adverse effects, and Latinos report more adverse effects to ARVs than White or African American patients. Specific adverse effects (skin problems, memory problems, vomiting, and nausea) are more likely than others to be associated with missing ARV medications. Increasing adaptive coping self-efficacy among patients experiencing nausea may be a particularly effective strategy in increasing medication adherence.

Ksobiech, K., A. M. Somlai, et al. (2005). "Demographic characteristics, treatment history, drug risk behaviors, and condom use attitudes for U.S. and Russian injection drug users: the need for targeted sexual risk behavior interventions." AIDS Behav 9(1): 111-20.
Two separate databases, one on Russian (n = 444) injection drug users (IDUs), and the other on U.S. IDUs (n = 241), were merged, and responses were compared. Results indicated that Russian IDUs perceived themselves to be at greater risk for HIV/AIDS based upon behaviors over the past 90 days. U.S. IDUs were more likely to be tested for HIV, report a negative HIV result, and know more people with HIV. U.S. IDUs consumed greater amounts of alcohol and marijuana, and made more alcohol/drug treatment attempts than Russian IDUs. Russian IDUs injected more frequently, although were more likely to recently use clean needles. Russian and U.S. IDUs responded significantly differently to eight AIDS knowledge questions. Eight condom attitude questions were asked of each group, and each revealed significantly different responses. Gender differences for Russian IDUs were also observed. There is a clear need to create culturally targeted sexual risk reduction interventions.

Benotsch, E. G., A. M. Somlai, et al. (2004). "Drug use and sexual risk behaviours among female Russian IDUs who exchange sex for money or drugs." Int J STD AIDS 15(5): 343-7.
Countries of the former Soviet Union are experiencing the steepest increases in annual HIV incidence in the world. Over 80% of registered HIV cases in Russia have occurred among intravenous drug users (IDUs), but current conditions set the stage for a heterosexually-transmitted epidemic. IDUs who also trade sex for money or drugs may serve as a conduit, or 'bridge' group, through which HIV could make inroads into the general Russian population. The present study examined the prevalence of sex trading among female Russian IDUs, and further examined drug use, sexual behaviour, and perceived vulnerability in this group. Female IDUs (n=100) in St Petersburg, Russia participated; 37% reported a history of sex trading. This group reported a mean of 49.5 male sexual partners in the previous month and an average of 15.4 unprotected vaginal intercourse acts in the previous 30 days. A significant minority (44%) also reported sharing injection equipment with others. Mathematical models to calculate risk estimates for HIV seroconversion indicated that participants were at significant risk of contracting HIV and infecting sexual partners. Despite significant rates of risk behaviours, most participants perceived themselves to be at little risk of contracting HIV. Effective HIV prevention programmes targeted at this group are urgently needed and are likely to be a cost-effective step in curtailing the spread of HIV in the region.

Epel, E. S., E. H. Blackburn, et al. (2004). "Accelerated telomere shortening in response to life stress." Proc Natl Acad Sci U S A 101(49): 17312-5.
Numerous studies demonstrate links between chronic stress and indices of poor health, including risk factors for cardiovascular disease and poorer immune function. Nevertheless, the exact mechanisms of how stress gets "under the skin" remain elusive. We investigated the hypothesis that stress impacts health by modulating the rate of cellular aging. Here we provide evidence that psychological stress--both perceived stress and chronicity of stress--is significantly associated with higher oxidative stress, lower telomerase activity, and shorter telomere length, which are known determinants of cell senescence and longevity, in peripheral blood mononuclear cells from healthy premenopausal women. Women with the highest levels of perceived stress have telomeres shorter on average by the equivalent of at least one decade of additional aging compared to low stress women. These findings have implications for understanding how, at the cellular level, stress may promote earlier onset of age-related diseases.

Kalichman, S. C., C. Gore-Felton, et al. (2004). "Trauma symptoms, sexual behaviors, and substance abuse: correlates of childhood sexual abuse and HIV risks among men who have sex with men." J Child Sex Abus 13(1): 1-15.
Childhood sexual abuse is associated with high-risk sexual behavior in men who have sex with men. This study examined psychological and behavioral correlates of HIV risk behavior associated with childhood sexual abuse in a sample of men who have sex with men. Men attending a large gay pride event (N = 647) completed anonymous surveys that assessed demographic characteristics, childhood sexual abuse history, symptoms of dissociation and trauma-related anxiety, borderline personality characteristics, substance use, and sexual risk behavior. Results indicated that men who have a history of childhood sexual abuse were more likely to: engage in high-risk sexual behavior (i.e., unprotected receptive anal intercourse), trade sex for money or drugs, report being HIV positive, and experience non-sexual relationship violence. Results of this study extend previous research to show that men who have sex with men and who have a history of child sexual abuse are more likely to be at high risk for HIV infection.

Sikkema, K. J., M. J. Brondino, et al. (2004). "HIV risk behavior among ethnically diverse adolescents living in low-income housing developments." J Adolesc Health 35(2): 141-50.
PURPOSE: To describe patterns and predictors of HIV risk behaviors among ethnically diverse, low-income adolescents. METHODS: Computer-assisted surveys were administered to 1172 adolescents between the ages of 12 and 17 years living in 15 low-income housing developments in three urban areas in the United States to characterize and identify predictors of HIV risk behavior. Data were analyzed using multinomial logistic regression to identify variables predictive of "no risk," "lower risk," and "higher risk" group classification. RESULTS: Most adolescents were not yet sexually active; nonetheless, a subset of youth reported high rates of HIV risk-related behaviors. HIV risk was highest among adolescents who were older, had weaker intentions to reduce risk, stronger beliefs that their sexual partners did not favor risk-reduction, lower risk-reduction behavioral skills, higher risk-reduction outcome expectation, and higher rates of substance use. CONCLUSIONS: HIV prevention efforts are needed that are tailored to ethnically diverse communities of adolescents, including those in early adolescence and those at highest risk.

Stockman, J. K., S. K. Schwarcz, et al. (2004). "HIV prevention fatigue among high-risk populations in San Francisco." J Acquir Immune Defic Syndr 35(4): 432-4.

Weinhardt, L. S., J. A. Kelly, et al. (2004). "HIV transmission risk behavior among men and women living with HIV in 4 cities in the United States." J Acquir Immune Defic Syndr 36(5): 1057-66.
Determining rates of HIV transmission risk behavior among HIV-positive individuals is a public health priority, especially as infected persons live longer because of improved medical treatments. Few studies have assessed the potential for transmission to the partners of HIV-positive persons who engage in high-risk activities. A total of 3723 HIV-infected persons (1918 men who have sex with men [MSM], 978 women, and 827 heterosexual men) were interviewed in clinics and community-based agencies in Los Angeles, Milwaukee, New York City, and San Francisco from June 2000 to January 2002 regarding sexual and drug use behaviors that confer risk for transmitting HIV. Less than one quarter of women and heterosexual men had 2 or more sexual partners, whereas 59% of MSM reported having multiple partners. Most unprotected vaginal and anal sexual activity took place in the context of relationships with other HIV-positive individuals. Approximately 19% of women, 15.6% of MSM, and 13.1% of heterosexual men engaged in unprotected vaginal or anal intercourse with partners who were HIV-negative or whose serostatus was unknown. The majority of sexually active participants disclosed their serostatus to all partners with whom they engaged in unprotected intercourse. An estimated 30.4 new infections (79.7% as a result of sexual interactions with MSM) would be expected among the sex partners of study participants during the 3-month reporting period. Eighteen percent of 304 participants who injected drugs in the past 3 months reported lending their used injection equipment to others. In addition to the more traditional approaches of HIV test counseling and of focusing on persons not infected, intensive prevention programs for persons with HIV infection are needed to stem the future spread of the virus.

Winningham, A., S. Corwin, et al. (2004). "The changing age of HIV: sexual risk among older African American women living in rural communities." Prev Med 39(4): 809-14.
BACKGROUND: African American women aged 50 and older are disproportionately affected by the HIV/AIDS epidemic. Despite African Americans making up 11% of all older women in the United States, in 2001, they accounted for more than 50% of AIDS cases among older women and more than 65% of HIV cases among older women. Using the AIDS Risk Reduction Model as a conceptual framework, this study investigated HIV risk behavior among older rural African American women (mean age = 58 years). METHODS: A cross-sectional survey was conducted (n = 181) in three rural counties in South Carolina. RESULTS: Most (67%) of the women had at least one sex partner in the past five years, and of these, more than half (59.5%) reported at least one sexual risk behavior. High-risk behavior was associated with less education, lower condom use self-efficacy, more peers who discussed HIV-related risk behavior, and less comfort communicating with partners about sex. CONCLUSIONS: A significant proportion of older African American women living in rural counties are at increased risk for HIV infection, suggesting an urgent need for HIV prevention efforts to target this population.

Gore-Felton, C., A. M. Somlai, et al. (2003). "The influence of gender on factors associated with HIV transmission risk among young Russian injection drug users." Am J Drug Alcohol Abuse 29(4): 881-94.
HIV infection rates are dramatically increasing in the Russian Federation. Epidemiological studies indicate that the greatest rise of HIV incidence has been among injection drug users (IDU). Young adults (N = 188) who reported injecting drug use completed surveys and interviews that assessed injection drug use behavior, sexual behavior, and HIV-related knowledge. The average age of participants was 21.3 years. Multiple linear regression analysis found male gender and younger age at sexual debut was positively and significantly associated with having multiple sexual partners. Gender moderated the effects of sexual debut and number of times injected drugs were used in the past month. Males who initiate sex at a younger age were more likely to report multiple sex partners and females who reported higher frequency of drug use were more likely to report multiple sex partners. Gender is an important factor, as well as moderator of risk behavior among Russian injection drug users. Delaying sexual debut, particularly for males, may be an effective strategy to reduce subsequent risk behavior. Prevention efforts among IDUs need to address sexual risk behavior in conjunction with injection risk behavior.

Matano, R. A., C. Koopman, et al. (2003). "Assessment of binge drinking of alcohol in highly educated employees." Addict Behav 28(7): 1299-310.
This study evaluated the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and CAGE, a standardized screening instrument for detecting alcohol dependence in identifying binge drinking among highly educated employees. Brochures were mailed to an entire workforce inviting employees to learn about their coping strategies, stress levels, and risk for alcohol-related problems, with 228 employees providing complete data. Binge drinking in the previous 3 months was reported by 29% of the employees, with greater binge drinking reported by White employees, of mixed/other ethnic background, or younger. The AUDIT achieved a sensitivity of 35% in identifying respondents who reported binge drinking and a specificity of 98% in accurately identifying respondents who did not report binge drinking. Sensitivity using the cut-off of scoring one or more positive hits on the CAGE was 67%, and specificity was 84%. Therefore, neither the AUDIT nor the CAGE achieved adequate sensitivity, as well as specificity, as screening tools for assessing binge drinking. A more accurate method for assessing binge drinking appears to be by directly asking for the largest number of drinks consumed in a single drinking session.

Rotheram-Borus, M. J., J. Song, et al. (2003). "Reductions in HIV risk among runaway youth." Prev Sci 4(3): 173-87.
Runaway youth are 6-12 times more likely to become infected with HIV than other youth. Using a quasi-experimental design, the efficacy of an HIV prevention program was evaluated over 2 years among 2 groups of runaways: (1) those at 2 shelters who received Street Smart, an intensive HIV intervention program, and (2) youth at 2 control shelters. Street Smart provided youth with access to health care and condoms and delivered a 10-session skill-focused prevention program based on social learning theory to youth. Prior to analysis of the intervention's outcomes, propensity scores were used to identify comparable subgroups of youth in the intervention (n = 101) and control conditions (n = 86). Compared to females in the control condition, females in the intervention condition significantly reduced their unprotected sexual acts at 2 years and alcohol use, marijuana use, and the number of drugs used over 12 months. Male adolescents in the intervention condition showed significant reductions in marijuana use over 6 months compared to control youth. Adolescent HIV prevention programs must proactively identify mechanisms for maintaining behavior change over the long-term, and innovative research designs are needed to allow examination of agency-level interventions.

Thompson, M., M. Minkler, et al. (2003). "Facilitators of well-functioning consortia: national Healthy Start program lessons." Health Soc Work 28(3): 185-95.
Social workers often are central to the work of community-based consortia to improve service delivery and enhance community participation in health initiatives. This article presents qualitative findings from a multisite case study of consortia in the federal Healthy Start Initiative to reduce infant mortality in high-risk communities. The authors examine the facilitators of well-functioning consortia in a framework of empowerment theory and community organizing with women of color. These facilitators include flexibility in the design of locally appropriate consortia structures; broad institutional support; diverse incentives for participation; adequate resources on multiple levels; and identification with the program and its mission. Implications for social work practice and for policy are provided.

Koopman, C., B. Nouriani, et al. (2002). "Sleep disturbances in women with metastatic breast cancer." Breast J 8(6): 362-70.
We examined sleeping problems in women with metastatic breast cancer in relation to depression, social support, and salivary cortisol. Ninety-seven women with metastatic breast cancer were drawn from a larger study on the effects of group therapy on quality of life and survival. This study is based on the baseline assessments conducted prior to randomization into treatment conditions. Sleep, depression symptoms, and social support were assessed by self-reporting. Cortisol was assessed from saliva samples taken over a 3-day period. Medical status and demographic characteristics were also examined in relation to each sleep variable in multiple regression analysis. Most women (63%) reported one or more types of sleep disturbance and 37% reported using sleeping pills in the previous 30 days. Problems with falling to sleep were significantly related to greater pain and depressive symptoms. Problems of waking during the night were significantly associated with greater depression and less education. Problems in waking/getting up were significantly associated with greater depressive symptoms and less social support. Sleepiness during the day was not significantly related to the variables in the regression model. Fewer hours of sleep were significantly associated with metastases to the bone, higher depressive symptoms, and more social support. Women who reported sleeping 9 or more hours per night, compared to those who reported a moderate amount of sleep (6.5-8.5 hours), had significantly lower 9 p.m. cortisol levels. Use of sleeping pills was more frequent among women reporting greater pain and depressive symptoms. These results suggest that women with metastatic breast cancer who are at higher risk for having sleeping problems are those who are less educated, in pain, depressed, have bony metastases, or lack social support.

Koopman, C., K. R. Pelletier, et al. (2002). "Stanford presenteeism scale: health status and employee productivity." J Occup Environ Med 44(1): 14-20.
Workforce productivity has become a critical factor in the strength and sustainability of a company's overall business performance. Absenteeism affects productivity; however, even when employees are physically present at their jobs, they may experience decreased productivity and below-normal work quality--a concept known as decreased presenteeism. This article describes the creation and testing of a presenteeism scale evaluating the impact of health problems on individual performance and productivity. A total of 175 county health employees completed the 34-item Stanford Presenteeism Scale (SPS-34). Using these results, we identified six key items to describe presenteeism, resulting in the SPS-6. The SPS-6 has excellent psychometric characteristics, supporting the feasibility of its use in measuring health and productivity. Further validation of the SPS-6 on actual presenteeism (work loss data) or health status (health risk assessment or utilization data) is needed.

Otto-Salaj, L. L., C. Gore-Felton, et al. (2002). "Psychiatric functioning and substance use: factors associated with HIV risk among incarcerated adolescents." Child Psychiatry Hum Dev 33(2): 91-106.
This study examined several types of psychiatric functioning (neuropsychiatric, emotional, and cognitive functioning) and substance use in relation to HIV risk behavior among 894 incarcerated girls and boys. Youth remanded to juvenile correctional facilities in a southern US state completed a structured interview regarding abuse history, emotional and behavioral difficulties, and demographics. Adolescents who experienced sullen affect were significantly more likely to engage in behaviors that put them at risk for HIV infection. Moreover, higher levels of alcohol use predicted HIV risk behavior. HIV prevention efforts need to address emotional distress as well as substance use among delinquent adolescents to reduce HIV risk behavior. Implications for treatment and future research are discussed.

Somlai, A. M., J. A. Kelly, et al. (2002). "Characteristics and predictors of HIV risk behaviors among injection-drug-using men and women in St. Petersburg, Russia." AIDS Educ Prev 14(4): 295-305.
The purpose of this study was to establish the prevalence of high-risk sexual behaviors and drug-using behaviors in a large community sample of male and female injection drug users (IDUs) in St. Petersburg, Russia. This investigation used a data collection plan that systematically recruited a drug user sample from venues where IDUs were known to congregate and could be accessed. Surveys were completed by 239 IDUs (males = 139, females = 100), aged 13-25. Participants averaged 44 injections (range = 0-240) in the past 30 days, with heroin (70%) and heroin plus other drugs (20%) the most frequently used. Participants' mean age of first drug injecting was 17.6 years, 41% of participants regularly shared needles, most had multiple sexual partners (mean = 9.3 partners in the past 3 months), and 70% reported engaging in vaginal intercourse without condoms. Stepwise logistic regression showed that high-risk sexual behavior was predicted by being female, young, using heroin several times a month, and less negative attitudes toward using condoms. Effective HIV prevention efforts for IDUs in Russia must be tailored to their age, gender, drug use, and condom attitudes. These programs will also have to address the dual risk factors, unique to IDUs, of risky sexual behaviors and needle sharing. Without a rapid intervention response, Russia's HIV/AIDS crisis will soon turn catastrophic.

Cacioppo, J. T., J. M. Ernst, et al. (2000). "Lonely traits and concomitant physiological processes: the MacArthur social neuroscience studies." Int J Psychophysiol 35(2-3): 143-54.
Loneliness is a complex set of feelings encompassing reactions to unfulfilled intimate and social needs. Although transient for some individuals, loneliness can be a chronic state for others. Prior research has shown that loneliness is a major risk factor for psychological disturbances and for broad-based morbidity and mortality. We examined differences between lonely and socially embedded individuals that might explain differences in health outcomes. Satisfying social relationships were associated with more positive outlooks on life, more secure attachments and interactions with others, more autonomic activation when confronting acute psychological challenges, and more efficient restorative behaviors. Individuals who were chronically lonely were characterized by elevated mean salivary cortisol levels across the course of a day, suggesting more discharges of corticotropin-releasing hormone and elevated activation of the hypothalamic-pituitary-adrenocorticol axis. An experimental manipulation of loneliness further suggested that the way in which people construe their self in relation to others around them has powerful effects on their self concept and, possibly, on their physiology.

Spiegel, D. (1996). "Cancer and depression." Br J Psychiatry Suppl(30): 109-16.
Half of all cancer patients have a psychiatric disorder, usually an adjustment disorder with depression. Anxiety about illness, such as cancer, often leads to delay in diagnosis, which has been estimated to reduce prospects of long-term cancer survival by 10% to 20%. Although earlier studies showed that depressed individuals were at higher risk for cancer incidence, later studies have not confirmed this predictive relationship. Nonetheless, effective psychotherapeutic treatment for depression has been found to affect the course of cancer. Psychotherapy for medically ill patients results in reduced anxiety and depression, and often pain reduction. In three randomised studies, psychotherapy resulted in longer survival time for patients with breast cancer (18 months), lymphoma, and malignant melanoma. The physiological mechanisms for these findings have not yet been determined, but four fundamental possibilities for psychotherapeutic effects on physiological change include health maintenance behaviour, health-care utilisation, endocrine environment, and immune function. Thus, effective treatment of depression in cancer patients results in better patient adjustment, reduced symptoms, reduced cost of care, and may influence disease course. The treatment of depression in these patients may be considered a part of medical as well as psychiatric treatment.

Canterbury, R. J., E. L. McGarvey, et al. (1995). "Prevalence of HIV-related risk behaviors and STDs among incarcerated adolescents." J Adolesc Health 17(3): 173-7.
PURPOSE: To determine the HIV-related risk behaviors and STDs in a population of incarcerated adolescents in order to strategically target education and prevention efforts. METHODS: A single point-in-time prevalence study based on an analysis of intake medical records of 1,215 incarcerated youth were analyzed for HIV risk behaviors and STD history. RESULTS: Incarcerated adolescents report high rates of risk behaviors for HIV infection and STDs, with 75% reporting three or more sex partners, 25% never using condoms and 19% having a current diagnosis of at least one STD. Significantly more females than males reported a history of STDs and had higher rates of current diagnoses of chlamydia/non-gonococcal urethritis, trichomonas and gonorrhea. CONCLUSIONS: Ethnic/racial and gender differences were found in risk behaviors for STDs among a sample of incarcerated adolescents.

Rotheram-Borus, M. J., M. Rosario, et al. (1995). "Predicting patterns of sexual acts among homosexual and bisexual youths." Am J Psychiatry 152(4): 588-95.
OBJECTIVE: This longitudinal study examined predictors of patterns of change in HIV sexual risk acts among homosexual and bisexual adolescent males. METHOD: A consecutive series of 136 homosexual and bisexual males aged 14-19 years were recruited into the study. Subjects were predominantly Hispanic (51%) and African American (31%) and seeking services at a homosexual-identified community-based agency in New York City. All subjects participated in an intensive HIV intervention program. Patterns of change in HIV sexual risk acts were based on assessments at four points (intake and 3, 6, and 12 months later) and were used to classify youths as demonstrating one of five patterns of anal and oral sexual acts: protected (anal: 45%, oral: 25%), improved (32% and 28%, respectively), relapse (5% and 8%), variable (8% and 15%), and unprotected (10% and 24%). Components of the health belief, self-efficacy, peer influence, coping, and distress models were assessed as predictors of these patterns. RESULTS: Protected and improved patterns of sexual risk acts were associated with low levels of anxiety, depression, and substance use and high self-esteem. CONCLUSIONS: These data suggest that HIV interventions must address non-HIV-related issues confronting youths in difficult life circumstances, particularly emotional distress and the role of peer networks for homosexual and bisexual youths.

Koopman, C., M. Rosario, et al. (1994). "Alcohol and drug use and sexual behaviors placing runaways at risk for HIV infection." Addict Behav 19(1): 95-103.
Lifetime and current alcohol and drug use and sexual risk acts were examined among 154 male and 148 female runaways, aged 11-19, predominantly Black and Hispanic, residing at four residential shelters in the New York City area. Most runaways reported alcohol (71%) and drug use (46%), with about a quarter (27%) using either alcohol or drugs at least once a week during the past 3 months. Physical symptoms of substance abuse were reported by 47%; 17% reported addiction. Current substance use was higher among males and Hispanics, and increased with age. Substance use was significantly related to reporting more sexual partners and less frequent condom use. The results suggest that HIV/AIDS prevention programs must target the reduction of alcohol and drug use as well as sexual risk acts.

Spiegel, D. (1993). "Psychosocial intervention in cancer." J Natl Cancer Inst 85(15): 1198-205.

Koopman, C., M. J. Rotheram-Borus, et al. (1992). "Beliefs and behavioral intentions regarding human immunodeficiency virus testing among New York City runaways." J Adolesc Health 13(7): 576-81.
From 1988 to 1991, 139 runaways aged 11-19 years in the New York City area (n = 70 males, 69 females) were recruited from four shelters. Each runaway participated in a semistructured interview assessing beliefs and behavioral intentions regarding human immunodeficiency virus (HIV) testing. When asked how they would respond to being seropositive for HIV, 29% of runaways reported that they would engage in self-destructive acts and/or harm others (e.g., suicide, unprotected sex), 80% anticipated extreme distress, 47% expected difficulty securing housing and food, and 61% believed that friends were likely to avoid them. When presented with specific alternatives, fewer runaways anticipated self-destructive acts. Drug use, rather than sexual behaviors, would lead runaways to get tested for HIV. These results suggest that health-care providers must anticipate emotional distress and potential self-destructive behavior following receipt of documentation of HIV positive serostatus among runaways. Furthermore, prior to testing, youths' access to food, shelter, medical care, and social support must be secured.

Rotheram-Borus, M. J., J. V. Becker, et al. (1991). "AIDS knowledge and beliefs, and sexual behavior of sexually delinquent and non-delinquent (runaway) adolescents." J Adolesc 14(3): 229-44.
This study assessed general knowledge of AIDS, beliefs about preventing AIDS, and sexual behavior among two groups of male adolescents at high risk of HIV/AIDS: 60 sexually delinquent males and 57 non-delinquent runaway males. Significantly fewer sexually delinquent than non-delinquent (runaway) males had experienced sexual intercourse with a consenting female partner (45 vs. 89 per cent). Sexually delinquent youths scored significantly lower than non-delinquent youths in general knowledge of AIDS (65 vs. 73 per cent) and were not able to discriminate safer behaviors from those which were less safe (42 vs. 71 per cent). Both groups reported moderate support for beliefs about preventing AIDS. These results suggest HIV/AIDS prevention programs that attempt to increase knowledge are needed by these youths, particularly for sexually delinquent youths.

Rotheram-Borus, M. J. and C. Koopman (1991). "Sexual risk behavior, AIDS knowledge, and beliefs about AIDS among predominantly minority gay and bisexual male adolescents." AIDS Educ Prev 3(4): 305-12.
Current sexual risk behavior, AIDS knowledge, and beliefs about AIDS prevention were examined among 59 black and Hispanic male adolescents attending a community center for gay and lesbian youth. Most (73%) were sexually active in the last 3 months, with a median of 2.0 partners and with only 21% reporting consistent condom use. These youths demonstrated moderately high AIDS knowledge (82%) and positive beliefs endorsing AIDS prevention (71%). When risk pattern was defined on the basis of partners, risk acts, and condom use, positive AIDS prevention beliefs were significantly and inversely associated with the high-risk pattern, but not with abstinence. These results suggest that youths who frequently engage in high-risk acts need intervention targeting changes in beliefs and behavior, as well as knowledge.

Rotheram-Borus, M. J. and C. Koopman (1991). "Sexual risk behaviors, AIDS knowledge, and beliefs about AIDS among runaways." Am J Public Health 81(2): 208-10.
Sexual risk behaviors, knowledge of acquired immunodeficiency syndrome (AIDS), and beliefs about AIDS prevention were examined among 126 runaways. In the previous 3 months, 65 percent of youths had been sexually active. Among the sexually active runaways, males reported a median of 2.7 partners and females reported 1.3 partners, and only 18 percent reported consistent condom use. Runaways demonstrated moderately high AIDS knowledge and beliefs endorsing AIDS prevention. Condom use and abstinence were directly related to beliefs about preventing AIDS.

Rotheram-Borus, M. J., C. Koopman, et al. (1991). "Reducing HIV sexual risk behaviors among runaway adolescents." Jama 266(9): 1237-41.
OBJECTIVE. Reductions in runaways' sexual risk behaviors were evaluated in response to an intensive program to prevent human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS). DESIGN. In a nonrandomized control trial, sexual risk behaviors among 78 runaways at one residential shelter who received up to 30 HIV/AIDS intervention sessions were compared with 67 runaways at a nonintervention shelter with sexual behaviors assessed at baseline and 3 and 6 months. SETTING. Runaways were recruited from the only two publicly funded shelters in New York, NY. PARTICIPANTS. The runaways were aged 11 to 18 years, 64% female, and predominantly black or Hispanic. INTERVENTION. The intervention addressed general knowledge about HIV/AIDS, coping skills, access to health care and other resources, and individual barriers to safer sex. MAIN OUTCOME MEASURES. Consistent condom use, a high-risk pattern of sexual behavior, and sexual abstinence over a 3-month time frame were assessed. MAIN RESULTS. As the number of intervention sessions increased, runaways' reports of consistent condom use increased significantly (at 3 months, unique R2 = .06, P less than .05; at 6 months, unique R2 = .09, P less than .05), and their reports of engaging in a high-risk pattern of sexual behavior decreased significantly (at 3 months, unique R2 = .03, P = .06; at 6 months, unique R2 = .04, P less than .05). Abstinence did not change. CONCLUSIONS. The demonstrated effectiveness of the intensive HIV/AIDS program highlights the importance of enlarging the scope of most current HIV/AIDS prevention programs.

Koopman, C., M. J. Rotherman-Borus, et al. (1990). "Assessment of knowledge of AIDS and beliefs about AIDS prevention among adolescents." AIDS Educ Prev 2(1): 58-69.
This report describes the development of measures of AIDS knowledge and beliefs about AIDS prevention for adolescents. Review of the literature, focus groups, pilot testing, and reviews by advisory councils assured that the process of developing the measures contributed to their validity. These measures were administered to three samples of adolescents at high risk for contracting AIDS: 43 runaway males, 43 runaway females, and 36 self-identified gay males. Both the knowledge and the beliefs instruments showed moderately high internal consistency and test-retest reliability and successfully avoided ceiling effects. Gay males demonstrated significantly greater knowledge of AIDS; however, there were few differences in beliefs among the groups. Knowledge of AIDS was significantly correlated with beliefs about AIDS prevention. The results suggest that these measures identify gaps in knowledge and beliefs among high-risk youth.

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