Stages of change, decisional balance, and self-efficacy in condom use among rural African-American stimulant users

The association between interactive health literacy and dietary behaviors among Chinese college students: a large-scale cross-sectional study

Background

The association between health literacy and healthy dietary behaviors has been explored in the European population. However, there is currently no evidence available specifically pertaining to Chinese college students particularly for interactive health literacy.

Aims

The objective of this study was to investigate the association between interactive health literacy (IHL) and dietary behaviors in Chinese college students.

Methods

This study included 11,856 Chinese college students (mean age = 18.8 years, SD = 1.2 years). We defined nine healthy dietary behaviors as consumption of water, egg, milk and milk products, vegetables, fruit, red meat, soy and soy products, seafood, and sugar-sweetened beverages. For each food group, participants who met the criterion for being a regular consumer of the item were assigned a score of 1, and otherwise were assigned a score of 0. Thus, the dietary behaviors score ranged from 0 to 9, with higher scores indicating healthier dietary behaviors. We used the revised 28-item Chinese Adolescent Interactive Health Literacy Questionnaire (CAIHLQ) to evaluate IHL; a higher score on this scale indicates a greater health literacy. Multivariate logistic regression was used to analyze the association between IHL level and frequency of different numbers of dietary behaviors.

Results

After adjusting for sex, age, annual family income, place of residence, father's education level, and mother's education level, there was a clear and significant positive association between IHL and the likelihood of exhibiting diverse dietary behaviors. The adjusted odds ratio (95% CI) of exhibiting given nine dietary behaviors with reference to tertile 1 according to categories of IHL was as follows: 1.055 (0.694, 1.603) for tertile 2 and 1.849 (1.269, 2.696) for tertile 3 (p for trend = 0.001). Similarly, there are significant positive associations between IHL and the likelihood of exhibiting 2-8 dietary behaviors, except for exhibiting any one dietary behavior. We further found that, in addition to the health awareness factor, there were significant positive associations between physical activity and nutrition factors, and healthier dietary behaviors. Further, there was a significant negative association between interpersonal relationships and dietary behavior.

Conclusion

The findings indicate a positive relationship between IHL and dietary behavior, such that the higher the level of IHL among college students, the healthier the dietary behavior they tend to adopt in their daily lives. These findings suggest the importance of developing stages of change-based educational interventions, which could help individuals with limited IHL to not only acquire necessary health-related knowledge but also to strengthen their motivation to engage in healthy dietary behaviors. Future studies should employ longitudinal prospective designs or randomized controlled trials to establish a causal association between IHL and healthy dietary behaviors.

Transtheoretical Model of Health Behavioral Change: A Systematic Review

Background:

Transtheoretical model (TTM) is one of the most commonly used methods in behavioral change modeling. The aim of this study was to conduct a systematic review (SR) to determine research gaps with regard to this template with an emphasis on intervention for patients with chronic diseases (CDs).

Materials and Methods:

ISI-WOS, Scopus, PubMed, SID, and Magiran databases were examined systematically and on the basis of defined criteria. Titles, abstracts, and full texts of articles retrieved were examined for the presence of defined criteria. Then finalized articles were analyzed in consensus meetings. After that, references of selected articles and full text of those meeting the criteria were also analyzed.

Results:

We screened 103 articles, excluded 27 in abstract review and 34 in full-text review, leaving 42 articles for critical appraisal. Then the references of these 42 articles were also screened. Fifty articles were excluded on abstract review and 5 on full-text review, leaving 15 articles. The result of the analysis of 57 final articles of this SR determined that 28 articles were about aspects of TTM and 5 stages of change were the most commonly used aspect. Eight articles used TTM in intervention about CDs. A total of 21 articles examined TTM's pros and cons, most of which were about TTM's pros.

Conclusions:

The majority of studies focused on the effectiveness of TTM on the behavioral change management. This finding supported the hypothesis that TTM can be applied in the prevention of CDs.

Psychosocial Functioning and Decisional Balance to Use Condoms in a Racially/Ethnically Diverse Sample of Young Gay/Bisexual Men Who Have Sex with Men

Young gay/bisexual and other men who have sex with men (YGBMSM; ages 18-24) are experiencing an increase in HIV infection rates, particularly if they are Black or Latino. Psychosocial functioning is consistently implicated in HIV risk behaviors; however, less is known about the role of these factors in YGBMSM's decision-making process to use condoms (i.e., decisional balance to use condoms; DBC). We examined whether YGBMSM's psychological functioning was associated differentially with their DBC across racial/ethnic groups. Using data from a cross-sectional web-survey of single YGBMSM (N = 1380; 9.9% Black; 18.6% Latino; 71.5% White), we performed racial/ethnic-specific multivariable regression models to explore the association between DBC and psychological factors (e.g., depression, anxiety), demographics (e.g., age, education, HIV status, prior STI diagnosis), and perceived difficulty implementing safer sex strategies. Black YGBMSM reported lower DBC if they reported higher depression symptoms (β = -.31, p < .05), were HIV-negative (β = -.20, p < .05), and had greater difficulty implementing safer sex strategies (β = -.32, p < .001). Latino participants reported greater DBC to use condoms if they reported greater anxiety symptoms (β = .21, p < .05). White participants reported greater DBC if they were younger (β = -.09, p < .01), did not report a prior STI (β = .10, p < .001), and had fewer difficulties implementing safer sex strategies (β = -.27, p < .001); DBC had no association to psychological well-being among White participants. Psychological factors may be differentially associated with DBC across racial/ethnic group categories. Health promotion initiatives targeting condom use may benefit from culturally tailored interventions that address psychosocial functioning and its role in YGBMSM's condom use decision-making.

A behavioral strategy to minimize air pollution exposure in pregnant women: a randomized controlled trial

Background

Pregnant women and their fetus belong to a sensitive group in response to air pollution hazards. The aim of this study was to evaluate the effectiveness of a theory-based educational program to change pollution exposure behavior in pregnant women.

Methods

In this randomized controlled trial, pregnant women attending a prenatal clinic in Tehran, Iran were selected and randomized into the experimental and control groups. The inclusion criteria were age between 18 and 35 years, having a history of pregnancies without adverse outcomes and not suffering from chronic diseases. Data collected at baseline and 2-month follow-up. At baseline face-to-face interviews were conducted using a valid and reliable questionnaire including items on demographic characteristics, stages of change, self-efficacy, decisional balance and practice regarding air pollution preventive behaviors. The intervention composed of three parts: motivational interviewing, a booklet and daily small message service (SMS). The control group received no intervention except receiving usual care. Follow-up data were collected after the intervention. Data were analyzed performing t-test, Mann–Whitney U test, and chi-squared.

Results

In all the data for 104 pregnant women (53 in the intervention and 51 in the control group) were analyzed. The mean age of participants was 27.2 (SD = 4.11) years and it was 22.89 (SD = 8.75) weeks for gestational age. At baseline there were no significant statistical differences between intervention and control groups on the study measures while we found significant group differences in terms of stages of change, self-efficacy, perceived benefits and practice regarding air pollution preventive behaviors at follow-up assessment (P < 0.05).

Conclusion

The findings indicated that the TTM-based intervention was effective in increasing air pollution preventive behaviors among pregnant women. This study provided a framework to modify some psychosocial determinants of air pollution preventive behavior other than knowledge using constructs of Transtheoretical model of behavior change, additionally results suggests the importance of education and makes enlightenment of the air pollution risk knowledge accelerate.

Trial registration

IRCT2012091010804N1

Female Adolescents' Sexual Assertiveness Types: Q Methodology

PURPOSE

The purpose of this study was to identify the type of sexual assertiveness of female adolescents.

METHODS

A Q methodology which provided a method of analyzing the subjectivity of each type was used. Thirty-three female high school students classified 40 selected Q statements into 9 points standard. The collected data was analyzed by using the PC-QUNAL program.

RESULTS

Four types of sexual assertiveness manifested by female adolescents were identified: Type 1: Self-normative line-drawing type, Type 2: Pleasure-seeking negotiation type, Type 3: Passive relationship maintenance type, Type 4: future-oriented satisfaction-delay type.

CONCLUSION

This study is meaningful because it provides empirical information necessary for the development of theories by verifying integrated attributes related to the female adolescents' sexual assertiveness. Results also induced the measuring tools and succeeding studies, and presented educational material for sex education that is tailored to the developmental level and characteristics of female adolescents.

Evaluation of Transtheoretical Model-Based Family Education Among Females of Zahedan (Southeast of Iran)

Background:

It cannot be denied that many improvements in female and child health have been achieved worldwide through international family planning programs. More than half of the females (57%) with unintended pregnancy admitted that they had not used birth control the month before conception.

Objectives:

The aim of this study was to promote family planning practice among females of Zahedan (southeast of Iran) through the transtheoretical model (TTM).

Patients and Methods:

The current quasi-experimental study was conducted on 96 eligible females, who were allocated either to the case or the control group and were selected from homes in the border of Zahedan city (southeast of Iran) during 2010. Convenience sampling by door-to-door visits was used for finding eligible cases. A TTM-based self-administrated family planning questionnaire was used for data collection. Participants in the intervention group received education in two groups, based on their stage of change: precontemplation, contemplation, preparation, action, maintenance, and all groups were followed for three months.

Results:

The result of the chi-square test did not show any significant difference in the stage of change: precontemplation, contemplation, preparation, action, maintenance before education between the control and intervention groups (P = 0.55). After education, subjects in the intervention group moved forward through stage of change and got at least one step closer to the family planning behavior., with this change being significant (P < 0.001), while the movement of participants through stage of change not being significant in control group (P = 1). The results of statistical tests illustrated that the mean knowledge of the intervention group was 7.5 ± 7.1 versus 0.5 ± 4 for the control group (P < 0.001), mean of attitude of the intervention group was 5.5 ± 5.41 versus 0.09 ± 2.04 for the control group (P < 0.001), and practicing family planning methods (P < 0.007) in the intervention group was higher than the control group after education based on TTM.

Conclusions:

According to this study, the educational plan based on TTM was effective in changing knowledge, attitude, and practice and directing females towards taking action. Moreover, self-efficacy, perceived barriers and benefits are factors that affect the use of family planning methods.

Substance use, mental illness, and familial conflict non-negotiation among HIV-positive African-Americans: latent class regression and a new syndemic framework

We evaluated a synergistic epidemic (syndemic) of substance use, mental illness, and familial conflict non-negotiation among HIV-positive injection drug users (IDU). Baseline BEACON study data was utilized. Latent class analyses identified syndemic classes. These classes were regressed on sex, viral suppression, and acute care non-utilization. Females were hypothesized to have higher syndemic burden, and worse health outcomes than males. Nine percent of participants had high substance use/mental illness prevalence (Class 4); 23 % had moderate levels of all factors (Class 3); 25 % had high mental illness (Class 2); 43 % had moderate substance use/mental illness (Class 1; N = 331). Compared to Classes 1-3, Class 4 was mostly female (p < .05), less likely to achieve viral suppression, and more likely to utilize acute care (p < .05). Interventions should target African-American IDU females to improve their risk of negative medical outcomes. Findings support comprehensive syndemic approaches to HIV interventions, rather than singular treatment methods.

Use trajectories of amphetamine-type stimulants (ATS) in Shanghai, China

BACKGROUND

Although amphetamine-type stimulant (ATS) use is an important issue that has caused growing concerns in China as well as other countries, the knowledge of long-term patterns of ATS use in China is limited. This study explored long-term patterns of ATS use in Shanghai, China, and compared the differences by ATS use trajectory groups, seeking to identify risk factors that have implications for the development of targeted intervention programs.

METHODS

A total of 377 ATS users were recruited from the Compulsory Isolation Center for Drug Rehabilitation in Shanghai. Group-based trajectory modeling was applied to identify distinctive trajectories of ATS use over 8 years at the time of interviews conducted in 2012. The mean number of days using ATS per month over a year from years 2005 to 2012 was analyzed with a censored normal model.

RESULTS

Three distinctive groups were identified: high-use (19.1%), low-use (66.0%), and increasing-use (14.9%). Relative to the low-use group, the high-use and increasing-use groups were more likely to report having used opiate-type drugs and to have more craving experiences. Psychiatric symptoms following ATS use were frequently reported, with ATS users in the increasing-use and high-use groups more likely to report depression symptoms and suicide behaviors compared to the low-use group. The low-use and increasing-use groups reported more months in drug abuse treatment programs compared to the high-use group.

CONCLUSIONS

Addressing ATS use should take into consideration patients' use-related psychiatric symptoms as well as other risk factors, particularly among those with persistent high-level ATS use trajectories.

Differences between men and women in condom use, attitudes, and skills in substance abuse treatment seekers

BACKGROUND

For substance abuse treatment-seekers engaging in high risk sexual behavior, their inconsistent condom use may be related to their condom use attitudes and skills.

OBJECTIVE

This study compared treatment-seeking male and female substance abusers in their reported barriers to condom use and condom use skills.

METHODS

Men and women (N = 1,105) enrolled in two multi-site HIV risk reduction studies were administered the Condom Barriers Scale, Condom Use Skills, and an audio computer-assisted structured interview assessing sexual risk behavior.

RESULTS

Men endorsed more barriers to condom use, especially on the Effects on Sexual Experience factor. For both men and women, stronger endorsement of barriers to condom use was associated with less use of condoms. However, the difference between condom users and non-users in endorsement of condom barriers in general is greater for men than women, especially for those who report having casual partners.

CONCLUSIONS

Findings support the need to focus on gender-specific barriers to condom use in HIV/STI prevention interventions, especially risk behavior intervention techniques that address sexual experience with condoms.

SCIENTIFIC SIGNIFICANCE

Results provide additional information about the treatment and prevention needs of treatment-seeking men and women.

Concurrent partnering and condom use among rural heterosexual African-American men

Background Limited research has targeted HIV risk among heterosexual African-American men in the rural south-eastern United States.

METHODS

A cross-sectional survey was administered to 538 men to assess HIV knowledge, attitudes towards HIV testing and sexual risk behaviour.

RESULTS

Fifty-one percent reported consistent condom use in the past 3 months. Monogamous men reported more consistent condom use (t=3.47, d.f.=536, P<0.001). In concurrent partnerships, condom use was inversely related to age (adjusted odds ratio (AOR)=0.98, 95% confidence interval (CI)=0.95-0.998, P=0.03) and increased with the number of female partners (AOR=1.49, 95% CI=1.26-1.76, P<0.001).

CONCLUSIONS

African-American HIV prevention outreach should include focus on concurrent partnering in rural settings.

Validity and reliability of a dietary stages of change measure among economically disadvantaged African-American adolescents

PURPOSE

To examine the construct validity and 2-month test-retest reliability of a staging measure for assessing readiness to consume five or more daily servings of fruits and vegetables among economically disadvantaged African-American adolescents.

DESIGN

Longitudinal survey.

SETTING

Youth services agencies serving low-income communities in New York, New Jersey, and Pennsylvania.

SUBJECTS

African-American adolescents (N  =  390) aged 11 to 14 years.

MEASURES

Self-report measures of stage of change and fruit and vegetable consumption.

ANALYSIS

Correlation analysis and analysis of covariance were used to examine, cross-sectionally, whether fruit and vegetable consumption differed by stage of change (validity assessment). Correlation analysis and Cohen's kappa (κ) were used to assess the degree of association and level of agreement between stages longitudinally (test-retest reliability assessment).

RESULTS

Fruit and vegetable consumption was moderately correlated with stage of change (r ≥ .54, p  =  .000). Consistent with the transtheoretical model, youths' consumption increased from earlier to later stages (p  =  .000). Forty-six percent of youths were in the same stage at both measurements. The correlation between stages was .26, and Cohen's κ was .20 (p  =  .000).

CONCLUSIONS

Despite preliminary evidence of construct validity, the low test-retest reliability found suggests that further research and testing are needed to improve the stability of the measure.

Sexual behaviors, decisional balance, and self-efficacy among a sample of Chinese college students in the United States

OBJECTIVES

To assess sexual behaviors and condom use including perceived benefits, barriers, and self-efficacy among Chinese college students in the United States.

PARTICIPANTS

One hundred thirty-three Chinese undergraduate and graduate students studying at 3 US universities.

METHODS

Self-report Internet questionnaire grounded in the Transtheoretical Model (TTM) framework analyzed with multivariate linear regression.

RESULTS

More than half (57.9%) have initiated sex. Only 27.3% used condoms every time. Frequent reasons for not using condoms were trust in partner, reduced pleasure, and partner dislike for condoms. Participants in the earlier TTM stages (precontemplation, contemplation, preparation) reported more worry about making partners angry if condoms were used and lower self-efficacy in situations involving alcohol or drug use and perceived low-risk scenarios.

CONCLUSIONS

Interventions should increase condom availability to students and should also make condom use more acceptable, more often expected, and easier to discuss.

Condom use and stages of change among college students in Taiwan

OBJECTIVES

To explore the correlates for nonuse of condoms and the factors that affect stages of change for regular condom use among college students in Taiwan.

DESIGN AND SAMPLE

Cross-sectional, quantitative survey design. A total of 996 college students were recruited from two universities in Northern Taiwan.

MEASURES

Questionnaires collected data on demographic information, condom use, HIV/AIDS knowledge, confidence in using condoms in different situations, and perceived benefits and barriers to using condoms.

RESULTS

The common reasons for not using condoms were trust in the partner (21.30%), partner dislike for condoms (19.49%), and perception of low risk (18.77%). Most sexually active students (52.4%) were in the earliest 2 stages of readiness to change (i.e., precontemplation, contemplation). Participants in action/maintenance were (a) 43.4% less likely to show a high knowledge score, (b) 4.08 times more likely to present high self-efficacy, and (c) 2.24 times more likely to be more religious than those in contemplation/preparation.

CONCLUSIONS

Among a highly literate group, college students, condom use is inconsistent and readiness to change is not imminent. This study reveals that preventive steps targeted at young adults should address other concerns related to condom use such as trust in partners and the alleged appeal of unprotected sex.