Relation between perceived vulnerability to HIV and precautionary sexual behavior

Perceptions of COVID-19 and HIV Risk and Related Preventive Health Behaviors in Rural Zambia

Risk perception, its relationship to preventive health behaviors and other factors (e.g., direct experience of a disease) are important for determining effective targets for disease prevention. Whether these relationships are the same for various diseases has not been well-researched. Drawing on a holistic model of risk perception, this study compares levels of perceived risk for COVID-19 and HIV in a rural Zambian community, examines hypothesized correlates of perceived risk, and evaluates whether higher perceived risk and/or its correlates are associated with practicing preventive behaviors for each disease. The sample included 118 adults participating in a larger study of families affected by HIV. Via surveys, information about risk perception, preventive behaviors, knowledge about, trust in information sources, direct experience and hearing about each disease, and prosociality, were collected. For each disease, perceived risk was not related to its preventive behaviors. Levels of perceived risk for COVID-19 and HIV differed significantly, as did their correlates. Having trusted sources of information about HIV was related to higher perceived risk of HIV. Direct experience of COVID-19 was related to higher perceived risk of COVID-19, but only at a level of interest. Although practicing preventive behaviors for each condition was related to higher levels of knowledge about each disease at a level of interest, willingness to engage in behavior beneficial to others (prosociality) was significantly related only to COVID-19 preventive behaviors. Different diseases provoke different levels of perceived risk and engagement with preventive behaviors and may be correlated with distinct factors. These differences may be due to history of experience with a disease, as well as cultural factors.

A Longitudinal Examination of HIV Risk Perception Accuracy among Sexual Minority Men with History of Childhood Sexual Abuse

Men who have sex with men (MSM) with history of childhood sexual abuse (CSA) are at high risk for HIV acquisition. One reason is posttraumatic responses compromise ability to accurately appraise risk for danger/vulnerability. Health behavior change models and related interventions assume risk perception can be changed in an enduring manner. Given paucity of studies examining how risk perception changes or sustains over time post-intervention, this underlying assumption is not confirmed. Among this particularly high-risk group who struggle with perceiving risk due to trauma-related cognitions, it may be accuracy of risk perception is fluid. The study primarily aimed to examine accuracy of HIV risk perception over time post-HIV prevention behavioral intervention. Leveraging data from a larger RCT, N = 190 MSM in Boston, MA and Miami, FL USA completed a psychosocial baseline assessment, an intervention aimed to increase awareness of personal HIV risk level, then four follow-up assessments three months apart for a year. Linear mixed effect models were used to examine the degree to which accuracy of HIV risk perception (vs. traditional construct of risk perception with no information about accuracy) predicts sex risk behavior over time delineated by between-person (trait level) and within-person (state level) effects. Majority (92%) of participants fluctuated in HIV risk accuracy over time post-intervention. Within-person risk accuracy (one's accuracy at any given timepoint) predicted sex risk behavior (condomless sex not protected by adherent PrEP) over time, but not between-person (one's average of accuracy). Findings have implications for intervention and counseling related to specific HIV prevention strategies.

Is the "avoidance" group truly defensive? The interplay between perceived risk, efficacy, and behaviors

This study examines the inconsistent theories surrounding the roles of perceived threat and efficacy in risk communication theories, focusing on behavioral changes during a public health crisis. Utilizing a two-wave panel survey, the research found a nuanced interaction between efficacy beliefs and risk perceptions in dictating individuals' engagement in protective or defensive behaviors. Notably, those with high risk perceptions but lower efficacy beliefs were more likely to engage in future protective behaviors, contradicting previous assumptions about the avoidance group's propensity for defensive reactions. These findings initiate a complex discussion on the dynamics of risk and efficacy perceptions influencing behavior.

HIV Treatment Optimism Moderates the Relationship between Sexual Risk Behavior and HIV Risk Perception among Urban HIV-negative Gay, Bisexual, and Other Men who have Sex With Men

Using baseline data of the Engage Cohort Study, a Canadian study of sexually active gay, bisexual and other men who have sex with men (GBM), we evaluated the association between sexual behavior and risk perception among HIV-negative participants and whether HIV treatment optimism moderated this relationship. Participants were recruited by respondent-driven-sampling (RDS). We defined high-risk sexual behavior in the past six months as any condomless anal sex with a casual partner (i.e. not the participant's main partner) with either unknown HIV-status where neither used pre-exposure prophylaxis or with a partner living with HIV having detectable/unknown viral load. We assessed HIV treatment optimism-skepticism using a 12-item scale. RDS-II-weighted adjusted logistic regression models examined associations with risk perception measured by the question "How would you assess your current risk of getting HIV?" (response options were on a 6-point Likert-scale ranging from "very unlikely" to "very likely", dichotomized into "No Perceived Risk" (very unlikely/unlikely) and "Perceived Risk" (somewhat likely/likely/very likely/I think I already have HIV). Of 1961 participants, engagement in high-risk sexual behavior was reported by 155 (17.0%), 62 (12.4%), 128 (17.2%) of participants in Montréal, Toronto, and Vancouver, respectively. High-risk sexual behavior increased the odds of perceived HIV risk (pooled adjusted odds ratio = 2.9, 95%CI = 2.2-3.8). HIV treatment optimism-skepticism scores moderated the relationship: for GBM engaging in high-risk sexual behavior, higher HIV treatment optimism-skepticism scores increased perceived HIV risk. Promoting awareness around advances related to HIV prevention and treatment is important for appropriate risk assessment and for increased engagement in prevention interventions.

Chinese undergraduates' mental health help-seeking behavior: the health belief model

The detection rate of mental health problems among undergraduates has recently risen significantly. However, undergraduates underutilize mental health services; approximately a third only of undergraduates in need of treatment use school counseling resources. Based on a social psychological theoretical framework, the health belief model, factors of undergraduates' willingness to seek help when dealing with psychological problems were investigated. A cross-sectional online questionnaire and a snowball sampling method with 446 undergraduates investigated perceived susceptibility, perceived severity, perceived behavioral benefits, perceived barriers, self-efficacy, and cues to action to understand how students' mental health-seeking behaviors are affected. We found that perceived susceptibility (p < 0.01), perceived severity (p < 0.01), perceived benefits (p < 0.01), perceived barriers (p < 0.01), self-efficacy (p < 0.01), and cues to action (p < 0.01) significantly correlated with behavioral intention. Encouragement or counseling from others would be more likely to motivate undergraduates to seek mental health help. In addition, we used a bias-corrected Bootstrap approach to test the significance of the mediating effect, the mediation effect of cues to action between undergraduates' perceived susceptibility and mental health help-seeking behavior was utterly significant [mediation effect value of 0.077, with an SE value of 0.027 and a 95% CI (0.028, 0.133)]. It demonstrated that those who perceived themselves to be at high risk of developing a mental illness and who had received encouragement or counseling to seek mental health help were more likely to be motivated to seek mental health help. Multiple regression analyses indicated that self-efficacy (Z = 5.425, p < 0.01) and cues to action (Z = 6.673, p < 0.01) independently influenced behavioral intentions. Encouragement or counseling from others would be more likely to motivate undergraduates to seek mental health help.

Factors Associated with HIV Testing Among Spanish and English-Speaking Latino Adolescents Aged 13-18

Adolescent Latino men who have sex with men (LMSM) in the U.S. are disproportionately impacted by HIV. However, there has been limited focus on their HIV prevention and risk behaviors. In this study, we examine the rates of HIV testing and explore the significant demographic and healthcare factors that influence HIV prevention among adolescent LMSM. The analysis for this study utilized data collected during the baseline assessment of SMART, a pragmatic trial aimed at evaluating the effectiveness of an online HIV prevention intervention for adolescent LMSM (N = 524). Only 35.5% of participants had ever had an HIV test in their lifetime. Rates of testing increased among adolescent LMSM who had a doctor with whom they spoke about their sexual health (odds ratio: 4.0; 95% confidence interval: 2.1-8.4; P < 0.001) or HIV testing (odds ratio: 5.8; 95% confidence interval: 3.1-10.7; P < 0.001). Out of the 61 participants who took part in the survey conducted in Spanish, only 26% reported ever having an HIV test. Additionally, 24.5% stated that they had discussed their sexual orientation with a doctor, and only 8.2% had undergone HIV testing. Spanish-speaking adolescents who completed the SMART survey were less likely to openly discuss their sexual orientation or sexual health with most people or have a doctor with whom they discussed these topics, compared to those who completed the survey in English. These findings suggest that Spanish-speaking adolescent LMSM may face obstacles in accessing HIV prevention services in the U.S.

Measurement of Perceived Risk of Developing Diabetes Mellitus: A Systematic Literature Review

BACKGROUND

This systematic review describes approaches to measuring perceived risk of developing type 2 diabetes among individuals without diagnoses and describes the use of theories, models, and frameworks in studies assessing perceived risk. While a systematic review has synthesized perceived risk of complications among individuals with diabetes, no reviews have systematically assessed how perceived risk is measured among those without a diagnosis.

METHODS

Medline, PubMed, PsycINFO, and CINAHAL databases were searched for studies conducted through October 2022 with measures of perceived risk among adults ≥ 18 years without a diabetes diagnosis. Extracted data included study characteristics, measures, and health behavior theories, models, or frameworks used.

RESULTS

Eighty-six studies met inclusion criteria. Six examined perceived risk scales' psychometric properties. Eighty measured perceived risk using (1) a single item; (2) a composite score from multiple items or subconstructs; and (3) multiple subconstructs but no composite score. Studies used items measuring "comparative risk," "absolute or lifetime risk," and "perceived risk" without defining how each differed. Sixty-four studies used cross-sectional designs. Twenty-eight studies mentioned use of health behavior theories in study design or selection of measures.

DISCUSSION

There was heterogeneity in how studies operationalized perceived risk; only one third of studies referenced a theory, model, or framework as guiding design or scale and item selection. Use of perceived lifetime risk, absolute risk, or comparative risk limits comparisons across studies. Consideration of context, target population, and how data are utilized is important when selecting measures; we present a series of questions to ask when selecting measures for use in research and clinical settings. This review is the first to categorize how perceived risk is measured in the diabetes prevention domain; most literature focuses on perceived risk among those with diabetes diagnoses. Limitations include exclusion of non-English and gray literature and single reviewer screening and data extraction.

Exploring the long-term sequelae of childhood sexual abuse on risky sexual behavior among Chinese transgender women

Introduction

Childhood sexual abuse (CSA) is a hidden but serious public health issue that can lead to a series of behavioral consequences and health problems in adulthood. It has been well documented that transgender women (TGW) have a high prevalence of CSA victimization. Moreover, risky sexual behaviors are also widespread among TGW; nevertheless, research investigating the associations between CSA victimization and risky sexual behaviors in TGW represents a gap in the literature.

Methods

Our research was carried out mainly in Shenyang of China from November 2018 to January 2019. Sociodemographic characteristics, as well as information on participants' HIV awareness and sexual behaviors, were collected through face-to-face interviews. The impact of CSA was examined through hierarchical logistic regression, adjusted for sociodemographic factors and HIV awareness.

Results

In the sample of 247 adult TGW, 14.2% of them had a CSA history. In the previous 6 months, 30.8% of the participants reported condomless anal intercourse (CAI) and 38.5% of them had multiple sexual partners (MSP). The findings demonstrated that TGW with CSA history were more likely to take part in CAI (p = 0.001, OR = 4.252) or have MSP (p = 0.004, OR = 3.260) in adulthood. Furthermore, HIV knowledge was not a predictor of CAI or MSP, but higher HIV risk perception was associated with a greater probability of CAI.

Conclusion

Transgender women with a history of CSA were more prone to engage in CAI and have MSP in China.

Cross-temporal relations of conditional risk perception measures with protective actions against COVID-19

Two decades ago a research team clarified that cross-sectional associations of risk perceptions and protective behavior can only test an “accuracy” hypothesis: e.g., people with higher risk perceptions at T_i should also exhibit low protective behavior and/or high risky behavior at T_i. They argued that these associations are too often interpreted wrongly as testing two other hypotheses, only testable longitudinally: the “behavioral motivation” hypothesis, that high risk perception at T_i increases protective behavior at T_i+1, and the “risk reappraisal” hypothesis, that protective behavior at T_i reduces risk perception at T_i+1. Further, this team argued that risk perception measures should be conditional (e.g., personal risk perception if one's behavior does not change). Yet these theses have garnered relatively little empirical testing. An online longitudinal panel study of U.S. residents' COVID-19 views across six survey waves over 14 months in 2020–2021 tested these hypotheses for six behaviors (hand washing, mask wearing, avoiding travel to infected areas, avoiding large public gatherings, vaccination, and [for five waves] social isolation at home). Accuracy and behavioral motivation hypotheses were supported for both behaviors and intentions, excluding a few waves (particularly in February–April 2020, when the pandemic was new in the U.S.) and behaviors. The risk reappraisal hypothesis was contradicted—protective behavior at one wave increased risk perception later—perhaps reflecting continuing uncertainty about efficacy of COVID-19 protective behaviors and/or that dynamic infectious diseases may yield different patterns than chronic diseases dominating such hypothesis-testing. These findings raise intriguing questions for both perception-behavior theory and behavior change practice.

Exploring direct and indirect predictors of heart disease information seeking

BACKGROUND

Based on the integrative model of behavioral prediction, we examined predictors of heart disease information seeking. We also examined demographic and individual factors associated with seeking-related perceived norms, attitudes, and perceived behavioral control.

METHODS

Non-Hispanic White and Black participants, aged 45 and older, completed a cross sectional online survey (N = 383). Stepwise logistic and multiple linear regression models were tested to assess study hypotheses, as well as tests of indirect effects.

RESULTS

Perceived norms, attitudes and perceived behavioral control were positively associated with heart disease information seeking, but when controlling for distal variables only the perceived norm-behavior association remained significant (p <.05). Indirect effects of distal variables (race, heart disease risk, perceived heart disease susceptibility and information engagement orientation) on information seeking were also detected via perceived norms.

CONCLUSIONS

Our results provide support for the integrative model as a framework for predicting information seeking, but further highlight the important role of distal predictors and perceived norms on heart disease seeking intentions. When communicating to promote heart disease information acquisition, communicators should pay particular attention to promoting information seeking as a normative behavior, particularly among those who perceive a lower risk of heart disease and who may be less engaged with health information more generally.

The Double-Edged Impact of the COVID-19 Pandemic on Chinese Family Relationships

To comprehensively understand the Chinese family relationships (i.e., marital relationship, parent-child relationship, sibling relationship, and grandparent-grandchild relationship) during the COVID-19 pandemic, this study investigated the changes of family relationships and the individual differences related to knowledge of the COVID-19, personality traits (i.e., neuroticism and optimism), and emotional characteristics (i.e., emotion regulation and negative emotional reactions). From March 1 to April 5, 2020, 8821 participants were involved, including 3995 teenagers, 1146 unmarried young adults, 3571 married adults, and 109 grandparents. Results revealed a double-edged pattern that people experienced both positive changes and negative changes during the pandemic. Teenagers reported significant negative changes in the relationships with their parents. Peoples' knowledge of the COVID-19, neuroticism, optimism, emotion regulation, and negative emotional reactions were in varying extents to which accounted for the individual differences in the changes of family relationships. These findings help recognize the overall Chinese family relationships during the hard period.

Older Adults Vastly Overestimate Both HIV Acquisition Risk and HIV Prevalence in Rural South Africa

Perceptions of HIV acquisition risk and prevalence shape sexual behavior in sub-Saharan Africa (SSA). We used data from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa baseline survey. Data were collected through home-based interviews of 5059 people ≥ 40 years old. We elicited information on perceived risk of HIV acquisition and HIV prevalence among adults  ≥ 15 and ≥ 50 years old. We first describe these perceptions in key subgroups and then compared them to actual estimates for this cohort. We then evaluated the relationship between sociodemographic characteristics and accurate perceptions of prevalence in regression models. Finally, we explored differences in behavioral characteristics among those who overestimated risk compared to those who underestimated or accurately estimated risk. Compared to the actual HIV acquisition risk of < 1%, respondents vastly overestimated this risk: 35% (95% CI: 32-37) and 34% (95% CI: 32-36) for men and women, respectively. Respondents overestimated HIV prevalence at 53% (95% CI: 52-53) for those ≥ 15 years old and 48% (95% CI: 48-49) for those ≥ 50 years old. True values were less than half of these estimates. There were few significant associations between demographic characteristics and accuracy. Finally, high overestimators of HIV prevalence tested themselves less for HIV compared to mild overestimators and accurate reporters. More than 30 years into the HIV epidemic, older people in a community with hyperendemic HIV in SSA vastly overestimate both HIV acquisition risk and prevalence. These misperceptions may lead to fatalism and reduced motivation for prevention efforts, possibly explaining the continued high HIV incidence in this community.

Cognitive and Affective Risk Beliefs and their Association with Protective Health Behavior in Response to the Novel Health Threat of COVID-19

The COVID-19 global pandemic is an unprecedented health threat for which behavior is critical to prevent spread and personal factors could contribute to decisions for protective action. The purpose of this study was to describe associations of COVID-19 related behaviors capturing a snapshot in time during the height of the first wave of the pandemic. We tested perceptions of likelihood and severity of infection, worry, and their associations with behavior. We further explored relationships by demographic characteristics, and tested main and interactive relationships between these characteristics and beliefs and protective behaviors. Using an online cross-sectional survey, U.S. adults (N = 795) reported their perceptions of likelihood and severity of, and worry about, contracting COVID-19 for self and others, and engagement in protective behaviors. In bivariate tests, all cognitive and affective beliefs were positively associated with hygiene behaviors, but only worry and personal and others' severity were associated with greater likelihood of social distancing. Controlling for other beliefs and demographic factors, perceived personal severity remained associated with social distancing, and worry with hygiene behaviors. How people think and feel about risk could have implications for communicating information about this novel health threat and motivating action to mitigate its spread.

PrEP eligibility, HIV risk perception, and willingness to use PrEP among high-risk men who have sex with men in India: A cross-sectional survey

HIV pre-exposure prophylaxis (PrEP) is not yet included in India's national AIDS program, with demonstration projects for MSM in planning stages. In order to support PrEP roll-out for MSM, we assessed: (1) associations between guideline-informed PrEP eligibility, HIV risk perception, and perceived PrEP benefits and costs, with willingness to use PrEP (WTUP); and (2) correlates of non-WTUP among PrEP-eligible MSM. Data were collected from MSM (n = 197) sampled from cruising sites in Mumbai and Chennai. More than half (58.4%) reported inconsistent condom use with male partners, 88.3% >1 male partner, and 48.6% engaging in sex work (all past month). Overall, 76.6% reported they would "definitely use" PrEP. Among 92.9% deemed PrEP-eligible, 79.2% reported WTUP. In adjusted analyses, PrEP eligibility (aOR = 5.31, 95% CI 1.11, 25.45), medium (aOR = 2.41, 95% CI 1.03, 5.63) or high (aOR = 13.08, 95% CI 1.29, 132.27) perceived HIV risk, and greater perceived benefits (aOR = 1.13, 95% CI 1.03, 1.24) were associated with higher odds of WTUP. Among PrEP-eligible MSM, non-WTUP was associated with low HIV risk perception and lower perceived benefits. Facilitating accurate risk assessment and promoting awareness of PrEP benefits and eligibility criteria may increase PrEP uptake among MSM in India.

Correlates of STI Testing Among US Young Adults: Opportunities for Prevention

The purpose of this study was to examine sex cognitions and behavioral strategy correlates for chlamydia, gonorrhea, and HIV testing among a national sample of young adults ages 18-20. Young adults (18-20 years) were recruited nationally (n = 1144). The sample was restricted (n = 817) based on inclusion/exclusion criteria for analysis. The outcome variables were gonorrhea, chlamydia, and HIV testing, respectively, in the last 12 months. Covariates included demographic variables, alcohol use, perceived vulnerability, protective behavioral strategies, and sexual behavior in the last 3 months. Adjusted logistic regression models were estimated in SAS 9.4. Approximately 24% of respondents were tested for chlamydia and gonorrhea, and 21% were tested for HIV in the past year. Women were more likely than men to be tested for chlamydia (OR = 1.67, 95% CI 1.13, 2.46) and gonorrhea (OR = 1.55, 95% CI 1.05, 2.28). Persons who were worried about an STI after a sexual encounter and who engaged in casual sex were more than two times as likely to be tested for all three STIs. Similarly, persons who used more non-condom-related protective behavioral strategies were more likely to be tested. Future studies may consider these correlates as potential intervention points for promoting STI testing among young adults.

Risk perception during the 2014-2015 Ebola outbreak in Sierra Leone

BACKGROUND

Perceived susceptibility to a disease threat (risk perception) can influence protective behaviour. This study aims to determine how exposure to information sources, knowledge and behaviours potentially influenced risk perceptions during the 2014-2015 Ebola Virus Disease outbreak in Sierra Leone.

METHODS

The study is based on three cross-sectional, national surveys (August 2014, n = 1413; October 2014, n = 2086; December 2014, n = 3540) that measured Ebola-related knowledge, attitudes, and practices in Sierra Leone. Data were pooled and composite variables were created for knowledge, misconceptions and three Ebola-specific behaviours. Risk perception was measured using a Likert-item and dichotomised into 'no risk perception' and 'some risk perception'. Exposure to five information sources was dichotomised into a binary variable for exposed and unexposed. Multilevel logistic regression models were fitted to examine various associations.

RESULTS

Exposure to new media (e.g. internet) and community-level information sources (e.g. religious leaders) were positively associated with expressing risk perception. Ebola-specific knowledge and hand washing were positively associated with expressing risk perception (Adjusted OR [AOR] 1.4, 95% Confidence Interval [CI] 1.2-1.8 and AOR 1.4, 95% CI 1.1-1.7 respectively), whereas misconceptions and avoiding burials were negatively associated with risk perception, (AOR 0.7, 95% CI 0.6-0.8 and AOR 0.8, 95% CI 06-1.0, respectively).

CONCLUSIONS

Our results illustrate the complexity of how individuals perceived their Ebola acquisition risk based on the way they received information, what they knew about Ebola, and actions they took to protect themselves. Community-level information sources may help to align the public's perceived risk with their actual epidemiological risk. As part of global health security efforts, increased investments are needed for community-level engagements that allow for two-way communication during health emergencies.

Protective Behavior against COVID-19 among the Public in Kuwait: An Examination of the Protection Motivation Theory, Trust in Government, and Sociodemographic Factors

With the COVID-19 pandemic threatening millions of lives around the world with no clear promises for treatment or vaccine yet, motivating the public to change their behaviors to prevent the spread of the disease becomes crucial and moral imperative. The current study investigated the associations between self-reported intentions to perform protective behaviors against COVID-19, the seven constructs of the Protection Motivation Theory PMT, trust in government, and sociodemographic factors within the general population in Kuwait. A cross-sectional design was adapted to explore the associations between study factors in a nonprobability voluntary response sample of 679 participants who completed an online public survey. Results indicate that the scores of trust in government and the severity, vulnerability, response efficacy, and self-efficacy subconstructs of the PMT were positively related to protective behavior intention, whereas intrinsic and extrinsic reward and response cost subconstructs were negatively associated with protective behavior intention. The results were discussed considering previous literature and future applications.

Risk of Antibiotic-Resistant Staphylococcus aureus Dispersion from Hog Farms: A Critical Review

The World Health Organization has declared antibiotic resistance "one of the biggest threats to global health." Mounting evidence suggests that antibiotic use in industrial-scale hog farming is contributing to the spread of antibiotic-resistant Staphylococcus aureus. To capture available evidence on these risks, we searched peer-reviewed studies published before June 2017 and conducted a meta-analysis of these studies' estimates of the prevalence of swine-associated, antibiotic-resistant S. aureus in animals, humans, and the environment. The 166 relevant studies revealed consistent evidence of livestock-associated methicillin-resistant S. aureus (MRSA) in hog herds (55.3%) raised with antibiotics. MRSA prevalence was also substantial in slaughterhouse pigs (30.4%), industrial hog operation workers (24.4%), and veterinarians (16.8%). The prevalence of swine-associated, multidrug-resistant S. aureus (MDRSA)-with resistance to three or more antibiotics-is not as well documented. Nonetheless, sufficient studies were available to estimate MDRSA pooled prevalence in conventional hog operation workers (15.0%), workers' household members (13.0%), and community members (5.37%). Evidence also suggests that antibiotic-resistant S. aureus can be present in air, soil, water, and household surface samples gathered in or near high-intensity hog operations. An important caveat is that prevalence estimates for humans reflect colonization, not active infection, and the health risks of colonization remain poorly understood. In addition, these pooled results may not represent risks in specific locations, due to wide geographic variation. Nonetheless, these results underscore the need for additional preventive action to stem the spread of antibiotic-resistant pathogens from livestock operations and a streamlined reporting system to track this risk.

Relationships between changes in HIV risk perception and condom use in East Zimbabwe 2003-2013: population-based longitudinal analyses

BACKGROUND

Perceiving a personal risk for HIV infection is considered important for engaging in HIV prevention behaviour and often targeted in HIV prevention interventions. However, there is limited evidence for assumed causal relationships between risk perception and prevention behaviour and the degree to which change in behaviour is attributable to change in risk perception is poorly understood. This study examines longitudinal relationships between changes in HIV risk perception and in condom use and the public health importance of changing risk perception.

METHODS

Data on sexually active, HIV-negative adults (15-54 years) were taken from four surveys of a general-population open-cohort study in Manicaland, Zimbabwe (2003-2013). Increasing condom use between surveys was modelled in generalised estimating equations dependent on change in risk perception between surveys. Accounting for changes in other socio-demographic and behavioural factors, regression models examined the bi-directional relationship between risk perception and condom use, testing whether increasing risk perception is associated with increasing condom use and whether increasing condom use is associated with decreasing risk perception. Population attributable fractions (PAFs) were estimated.

RESULTS

One thousand, nine hundred eighty-eight males and 3715 females participated in ≥2 surveys, contributing 8426 surveys pairs. Increasing risk perception between two surveys was associated with higher odds of increasing condom use (males: adjusted odds ratio [aOR] = 1.39, 95% confidence interval [CI] = 0.85-2.28, PAF = 3.39%; females: aOR = 1.41 [1.06-1.88], PAF = 6.59%), adjusting for changes in other socio-demographic and behavioural factors. Those who decreased risk perception were also more likely to increase condom use (males: aOR = 1.76 [1.12-2.78]; females: aOR = 1.23 [0.93-1.62]) compared to those without change in risk perception.

CONCLUSIONS

Results on associations between changing risk perception and increasing condom use support hypothesised effects of risk perception on condom use and effects of condom use on risk perception (down-adjusting risk perception after adopting condom use). However, low proportions of change in condom use were attributable to changing risk perception, underlining the range of factors influencing HIV prevention behaviour and the need for comprehensive approaches to HIV prevention.

Sanctification and Cheating Among Emerging Adults

Cheating-a general term for extradyadic romantic or sexual behavior that violates expectations in a committed romantic relationship-is common and leads to a number of poor outcomes. Religion has historically influenced conceptions of romantic relationships, but societal attitudes about religion are in flux as many seek to retain spirituality even as affiliations with formal religion decrease. The present study evaluated a potential predictor of cheating that is more spiritual than formally religious, the "psychospiritual" concept of relationship sanctification (i.e., the idea that one's relationship itself is sacred). In a sample of college students in committed relationships (N = 716), we found that higher levels of self-reported relationship sanctification were associated with a lower likelihood of both physical and emotional cheating even when accounting for plausible alternate explanations (general religiosity, problematic alcohol use, and trait self-control). This association was mediated via permissive sexual attitudes; specifically, higher levels of sanctification were associated with less permissive sexual attitudes which, in turn, predicted a lower likelihood of emotional and physical cheating.

Factors Associated With HIV Testing in Teenage Men Who Have Sex With Men

BACKGROUND

Adolescent men who have sex with men (AMSM) have a high rate of HIV diagnoses. An estimated 14.5% of HIV infections in the United States are undiagnosed; but among 13- to 24-year-olds, the rate is 51.4%. We describe HIV testing rates and identifies salient individual, family, school, and health care influences among AMSM.

METHODS

Data were collected as part of SMART, an ongoing pragmatic trial of an online HIV prevention intervention for AMSM (N = 699). Measures included lifetime HIV testing, demographics, sexual behaviors, condom use, HIV education from school and family, sexual health communication with doctors, HIV knowledge, and risk attitudes.

RESULTS

Only 23.2% of participants had ever had an HIV test. Rates of testing increased with age (5.6% in 13- to 14-year-olds; 15.8% in 15- to 16-year-olds; 37.8% in 17- to 18-year-olds), and sexual experience was a strong predictor of testing (odds ratio: 6.54; 95% confidence interval: 3.95-11.49; P < .001). Most participants had a regular doctor (67.5%), but few had conversations about same-sex sexual behaviors (21.3%), HIV testing (19.2%), or sexual orientation (29.2%). Speaking to a doctor about HIV testing had a large effect (odds ratio: 25.29; confidence interval: 15.91-41.16; P < .001), with 75.4% who had such conversations having been tested, compared to only 10.8% of those who had not had such conversations.

CONCLUSIONS

Despite higher risk, few participants reported ever having received an HIV test. Data indicate pediatricians are an important, but largely untapped, source of testing and could be integral to achieving testing rates needed to end the epidemic.

Discordance between self-perceived and actual risk of HIV infection among men who have sex with men and transgender women in Thailand: a cross-sectional assessment

INTRODUCTION

Low uptake of HIV testing and services, including pre-exposure prophylaxis (PrEP), in Thai men who have sex with men (MSM) and transgender women (TGW) may be due to the inaccuracy in self-risk assessment. This study investigated the discordance between self-perceived HIV risk and actual risk.

METHODS

Data were obtained between May 2015 and October 2016 from MSM and TGW enrolled in key population-led Test and Treat study in six community health centres in Thailand. Eligible participants were at least 18 years old, Thai national, had sex with men, had unprotected sex with a man in the past six months or had at least three male sex partners in the past six months, and were not known to be HIV positive. Baseline demographic behavioural characteristics questionnaires, including self-perceived HIV risk, were self-administered. Participants received HIV/STI (syphilis/gonorrhoea/chlamydia) testing at baseline. Participants who self-perceived to have low risk, but engaged in HIV-susceptible practices were categorized as having risk discordance (RD). Regression was conducted to assess factors associated with RD among MSM and TGW separately.

RESULTS

Of the 882 MSM and 406 TGW participants who perceived themselves as having low HIV risk, over 80% reported at least one of the following: tested HIV positive, engaged in condomless sex, tested positive for a sexually transmitted infection sexually transmitted infection (STI; or used amphetamine-type stimulants. Logistic regression found that living with a male partner (p = 0.005), having never tested for HIV (p = 0.045), and living in Bangkok (p = 0.01) and Chiang Mai (p < 0.001) were associated with increased risk discordance among MSM. Living with a male partner (p = 0.002), being less than 17 years old at sexual debut (p = 0.001), and having a low knowledge score about HIV transmission (p < 0.001) were associated with increased risk discordance among TGW. However, for TGW, being a sex worker decreased the chance of risk discordance (p = 0.034).

CONCLUSIONS

Future HIV prevention messages need to fill in the gap between self-perceived risk and actual risk in order to help HIV-vulnerable populations understand their risk better and proactively seek HIV prevention services.

Impact of HIV risk perception on both pre-exposure prophylaxis and condom use

Risk perception is one of the several important factors impacting sexual health behaviours. This study investigated the evolution of HIV risk perception on pre-exposure prophylaxis adherence and condom use in men who have sex with men at high risk of HIV and associated factors. Group-based trajectory modelling helped in identifying patterns of risk perception, pre-exposure prophylaxis adherence and condom use over time. The association between the former and the latter two dimensions was then investigated. An estimated 61 per cent (p < 0.001) of participants perceiving low risk and 100 per cent (p < 0.001) of those perceiving high risk had systematic pre-exposure prophylaxis adherence, while an estimated 49 per cent (p < 0.001) and 99.8 per cent (p < 0.001), respectively, reported low-level condom use.

Delay Discounting of Protected Sex: Relationship Type and Sexual Orientation Influence Sexual Risk Behavior

Sexual discounting, which describes delay discounting of later protected sex vs. immediate unprotected sex (e.g., sex now without a condom vs. waiting an hour to have sex with a condom), is consistently linked to sexual risk behavior. Estimates suggest that over two-thirds of HIV transmissions occur between individuals in committed relationships, but current sexual discounting tasks examine sexual discounting only with hypothetical strangers, leaving a gap in our understanding of sexual discounting with committed sexual partners. We used the Sexual Discounting Task (SDT) to compare discounting rates between men who have sex with men (MSM; n = 99) and heterosexual men (n = 144) and tested a new SDT condition evaluating sexual discounting with main partners. MSM in committed relationships discounted protected sex with their main partner at higher rates than heterosexual men, and discounting rates correlated with self-report measures of condom use, impulsivity/sensation seeking, and substance use. These findings suggest that sexual discounting is a critical factor potentially related to increased HIV transmission between MSM in committed relationships and may be an important target for intervention and prevention.

Accuracy of HIV Risk Perception in East Zimbabwe 2003-2013

Risk perception for HIV infection is an important determinant for engaging in HIV prevention behaviour. We investigate the degree to which HIV risk perception is accurate, i.e. corresponds to actual HIV infection risks, in a general-population open-cohort study in Zimbabwe (2003-2013) including 7201 individuals over 31,326 person-years. Risk perception for future infection (no/yes) at the beginning of periods between two surveys was associated with increased risk of HIV infection (Cox regression hazard ratio = 1.38 [1.07-1.79], adjusting for socio-demographic characteristics, sexual behaviour, and partner behaviour). The association was stronger among older people (25+ years). This suggests that HIV risk perception can be accurate but the higher HIV incidence (1.27 per 100 person-years) illustrates that individuals may face barriers to HIV prevention behaviour even when they perceive their risks. Gaps in risk perception are underlined by the high incidence among those not perceiving a risk (0.96%), low risk perception even among those reporting potentially risky sexual behaviour, and, particularly, lack of accuracy of risk perception among young people. Innovative interventions are needed to improve accuracy of risk perception but barriers to HIV prevention behaviours need to be addressed too, which may relate to the partner, community, or structural factors.

Age Group Differences in Household Accident Risk Perceptions and Intentions to Reduce Hazards

Very little is known about the extent to which seemingly vulnerable younger and older adults appraise household risks and relatedly whether safety information focused on raising risk awareness influences intentions to reduce hazards in the home. The present study assessed age differences in accident experience, risk attitudes, household accident risk perceptions, comparative optimism, personal control, efficacy judgements, and intentions to remove household hazards. It also examined the predictors of these intentions. Thirty-eight younger adults (aged 18 to 25) and forty older adults (aged 65 to 87) completed study booklets containing all measures. There were significant age group differences for all accident experience and risk-related variables. Younger adults experienced more accidents, had riskier attitudes, and had significantly lower cognitive risk perceptions (i.e., they were less likely to be injured due to a household accident). They also had lower affective risk perceptions (i.e., they were less worried) about their accident risk and perceived more personal control over the risk compared with older adults. Young adults were comparatively optimistic about their risk while older adults were pessimistic. Older adults had higher response efficacy and intentions to reduce hazards in the home. Only worry, response efficacy, and risk attitudes predicted intention, however, these relationships were not moderated by age or efficacy appraisal. Although tentative theoretical and practical implications are presented, further research is required in order to better understand the objective and subjective risk associated with household accidents, and to determine the factors that may improve safety, particularly for those most vulnerable.

Generalized or Origin-Specific Out-Group Prejudice?: The Role of Temporary and Chronic Pathogen-Avoidance Motivation in Intergroup Relations

Researchers have proposed that intergroup prejudice is partially caused by behavioral immune system mechanisms. Across four studies (total N = 1,849), we used both experimental (pathogen priming) and individual differences (pathogen disgust sensitivity [PDS]) approaches to test whether the behavioral immune system influences prejudice toward immigrants indiscriminately (the generalized out-group prejudice hypothesis) or specifically toward immigrants from a pathogen-rich ecology (the origin-specific out-group prejudice hypothesis). Internal meta-analyses lend some support to both hypotheses. At the experimental level, pathogen primes had no effect on attitudes toward origin-unspecified immigrants or immigrants from a pathogen-rich ecology. At the individual differences level, PDS has a unique negative effect on comfort with immigrants from pathogen-rich ecologies but not on comfort with immigrants from unspecified ecologies. However, pathogen disgust sensitivity was negatively related to the decision to allow entry to both origin-unspecified immigrants and immigrants from a pathogen-rich ecology.

Complex contagion leads to complex dynamics in models coupling behaviour and disease

Models coupling behaviour and disease as two unique but interacting contagions have existed since the mid 2000s. In these coupled contagion models, behaviour is typically treated as a 'simple contagion'. However, the means of behaviour spread may in fact be more complex. We develop a family of disease-behaviour coupled contagion compartmental models in order to examine the effect of behavioural contagion type on disease-behaviour dynamics. Coupled contagion models treating behaviour as a simple contagion and a complex contagion are investigated, showing that behavioural contagion type can have a significant impact on dynamics. We find that a simple contagion behaviour leads to simple dynamics, while a complex contagion behaviour supports complex dynamics with the possibility of bistability and periodic orbits.

Facilitators and Barriers to Pre-Exposure Prophylaxis (PrEP) Use Among Black Individuals in the United States: Results from the National Survey on HIV in the Black Community (NSHBC)

This study explores willingness to use PrEP among Black individuals in the US. From February to April 2016, an online survey was administered to a nationally representative sample of Black individuals. 855 individuals who were HIV negative by self-report participated [mean age: 33.6 (SD 9.2); 45.5% male]. Among all respondents, 14.5% were aware of, and 26.0% would be willing to use PrEP. Among high-risk individuals (N = 327), 19.8% knew about and 35.1% would be willing to use PrEP. The most common reason for lack of willingness among high-risk individuals was low self-perceived risk (65.1%). In multivariate analysis, individuals reporting single marital status [OR 1.8 (1.2, 2.5), p = 0.002], depressive symptoms [OR 1.6 (1.2, 2.2), p = 0.0054], arrest history [OR 1.7(1.2, 2.4), p = 0.0003], PrEP knowledge [OR 1.5 (1.0, 2.3), p = 0.0247] and belief in HIV conspiracies [OR 1.3 (1.1, 1.5), p = 0.0075] were more willing to use PrEP. Participants who saw a health care provider less frequently were less willing to use PrEP [OR 0.5 (0.4, 0.8), p = 0.0044]. Among a nationally representative sample of Black individuals, few high risk individuals were willing to use PrEP. Interventions to increase risk awareness, PrEP knowledge and access to care are necessary to improve PrEP uptake.

Exploring the Determinants of Perceived Risk of Middle East Respiratory Syndrome (MERS) in Korea

The world is turning into a risky society. Although modernization based on the developments in science and technology has increased individuals' well-being and wealth, the perceived risk toward the complex technological system has increased. In a risky society, social accidents amplify the existing fear among individuals. It is generally assumed that each value, perception, and resource influences the fear of risk. However, very few studies have tested these three factors together within an integrated causal model. Therefore, the present study aimed to examine the determinants that influence the perceived risk in cases of Middle East Respiratory Syndrome (MERS), a deadly epidemic disease, in Korea. Based on the theoretical model, we analyzed the survey data collected from respondents (N = 814) in Korea. After controlling for variables such as sociodemographic characteristics, we examined how three competing factors, i.e., value, perception, and resource, influence the perceived risk of MERS. The analysis showed that trust and vulnerability variables in the perception factor, health state, and perceived knowledge in the resource factor had a significant impact on the perceived risk of MERS.

Perceived vulnerability moderates the relations between the use of protective behavioral strategies and alcohol use and consequences among high-risk young adults

Drinking protective behavioral strategies (PBS) have been associated with reductions in alcohol use and alcohol-related consequences in young adults. PBS subscales, Limiting/Stopping (LS), Manner of Drinking (MOD), and Serious Harm Reduction (SHR), have been examined in the literature; LS, MOD, and SHR have mixed support as protective factors. Understanding moderators between PBS and alcohol use and related consequences is an important development in PBS research in order to delineate when and for whom PBS use is effective in reducing harm from alcohol use. Perceptions of vulnerability to negative consequences, included in health-risk models, may be one such moderator. The current study examined whether two types of perceived vulnerability (perceived vulnerability when drinking; perceived vulnerability in uncomfortable/unfamiliar situations) moderated the relations between LS, MOD, SHR strategies and alcohol use and related negative consequences. High-risk young adults (N = 400; 53.75% female) recruited nationally completed measures of PBS, alcohol use and related consequences, and measures of perceived vulnerability. Findings demonstrated that perceived vulnerability when drinking moderated the relations between MOD strategies and alcohol use. The interactions between perceived vulnerability when drinking and PBS did not predict alcohol-related consequences. Perceived vulnerability in unfamiliar/uncomfortable social situations moderated relations between MOD strategies and both alcohol use and related negative consequences; no other significant interactions emerged. Across both perceived vulnerability types and MOD strategies, those with the highest levels of perceived vulnerability and who used MOD strategies the most had the greatest decrements in alcohol use and related negative consequences. Prevention and intervention implications are discussed.

Inter-partner and Temporal Variations in the Perception of Sexual Risk for HIV

This study uses longitudinal qualitative methods to examine how gay and bisexual men perceive sexual risk across both a variety of partners and across time. Over ten weeks, participants completed three quantitative personal relationship diaries (PRD) describing sexual encounters during that time period. Participants then completed a timeline-based individual in-depth interview to unpack the PRD data. Participants used multiple factors to determine their own sexual risk (e.g., type of sex, partner concurrency, emotional connections), which often resulted in inconsistencies in defining sexual risk and determining the level of risk both within and across partners and across time. These findings can inform HIV prevention messages and programming.

Great Expectations: HIV Risk Behaviors and Misperceptions of Low HIV Risk among Incarcerated Men

Incarcerated populations have relatively high HIV prevalence but little has been reported about their aggregate HIV risk behaviors or perceptions of risk. A random selection of HIV-negative men (n = 855) entering a US state prison system were surveyed to assess five risk behaviors and his self-perceived HIV risk. Using multivariate logistic regression, we identified factors associated with having elevated actual but low perceived risk (EALPR). Of the 826 men with complete data, 88% were at elevated risk. While 64% of the sample had risk perceptions concordant with their actual risk, 14% had EALPR (with the remainder at low actual but high perceived risk). EALPR rates were lower in those with a pre-incarceration HIV test but higher for those with a negative prison entry HIV test. HIV testing counseling should assess for discordance between actual and perceived risk and communicate the continued risk of HIV despite a negative result.

Modifiable risk factors for prescription medicine sharing behaviours

BACKGROUND

Prescription medicine sharing has been defined as giving one's own medicine to someone else (lending) or taking someone else's medicine (borrowing). Medicines can be shared for non-medical purposes (recreational sharing or drug abuse) or for their intended therapeutic benefits (non-recreational sharing, e.g. sharing antibiotics to self-treat); the latter is the focus of this research. Limited research evidence is available about modifiable risk factors for non-recreational medicine sharing and addressing this issue was the main aim of this research.

METHODS

An online, cross-sectional survey design was used. The study population comprised a convenience sample of 233 adults, who were primarily recruited through patient support groups across New Zealand. Principal component analysis was used to develop scales assessing attitudes toward medicine lending and borrowing. Logistic regression was used to examine the relationship between explanatory (demographics, medical conditions, and attitudes towards medicine sharing) and outcome (medicine sharing behaviours) variables.

RESULTS

Half of the study participants reported ever borrowing/lending medicines, and approximately a third of participants reported borrowing/lending in the past year. Modifiable risk factors associated with an increased risk of medicine borrowing behaviour were having more difficulty with accessing medicine ('access-related issue'), stronger 'emotional beliefs about borrowing', and greater 'concern about missing doses.' Greater 'concern for the wellbeing of others' and stronger 'beliefs about the benefits and safety of lending' were associated with an increased risk of medicine lending behaviour. Those with a higher 'perceived risk of harm' were less likely to borrow or lend medicines.

CONCLUSIONS

This research expands the current knowledge of medicine sharing by examining underlying behavioural factors which predict sharing behaviours and that can be modified by interventions. This research suggests using multifaceted interventions which consider health status, behavioural, and psychosocial factors, as these appear to contribute most to medicine sharing.

The patient rationale for seeking HIV PEP: Qualitative results from a nurse-led program

BACKGROUND

HIV PEP is an intervention to prevent HIV seroconversion among HIV-negative persons after they have come into contact with the virus. The literature suggests PEP is greater than 80% effective at reducing HIV seroconversion. To expand access to this prevention strategy, we established a nurse-led PEP program in two STI clinics.

AIMS

We sought to explore why people seek PEP, and their experiences using it.

MATERIALS & METHODS

We invited participants who used our PEP program to engage in semi-structured qualitative interviews. These were audio-recorded, transcribed verbatim, and analyzed using the techniques of thematic analysis.

RESULTS

Twelve men who initiated PEP through our program participated in an interview. Thematic analysis of the data identified three themes: (1) assessing risk, (2) euphoria and distress, and (3) reducing distress.

DISCUSSION

Based on our findings, it appears as though instances of condomless sex were atypical and unplanned, they occurred due to contextual factors (e.g., consent, desire to explore, sexual chemistry/intensity), and they resulted in a state of temporary euphoria, which, afterward, transformed into distress (i.e., "feel[ing] stupid"). The participants used PEP not only for HIV prevention, but also (and perhaps more so) to address their emotional state. PEP used seemed to primarily occur to address situations of atypical sexual contact with partners they did not "know" or "trust".

CONCLUSION

We feel these results help contextualize how potential PEP users view HIV risk assessments, and how they determine their need for this intervention.

Targeted versus non-targeted HIV testing offered via electronic questionnaire in a Swiss emergency department: A randomized controlled study

Background

In Switzerland, the national HIV testing recommendations propose targeted testing. Although the emergency department (ED) is mentioned specifically as a site where HIV testing should take place, the testing rate in our ED is 1% of patients seen. The aim of this study was to use electronic tablets to offer testing to ED patients and to examine whether non-targeted screening increased testing rates compared to targeted testing.

Methods

This randomised, cross-over design study took place at Lausanne University Hospital, Switzerland, between August and November 2015. Eligible patients were randomised to a targeted testing or a non-targeted screening arm. Using electronic tablets, targeted arm patients completed a risk factor assessment; patients with risk factors were offered free rapid HIV testing. Non-targeted arm patients received information about HIV and HIV testing on their tablet and were then offered testing. In a second step, patients who declined testing were crossed over to the other strategy. The primary endpoint was the HIV testing rate per arm.

Results

Eighty patients were recruited to each study arm. In the targeted arm, 17 patients (of 80, 21%) had at least one risk factor and were offered testing, of whom eight (of 17, 47%) accepted. HIV testing rate in the targeted arm was 10% (8/80) compared to 48% (38/80) in the non-targeted arm (P<0.001). Secondary cross–screening, where targeted arm patients without risk factors were offered non-targeted screening, increased the testing rate in the targeted arm to 45% (36/80). Among patients offered testing, the acceptance rate did not differ between targeted and non-targeted arms, at 48% and 53%, respectively (P = 0.9)

Discussion

In our centre, non-targeted HIV screening resulted in a higher testing rate than targeted testing due to more patients being offered a test. The acceptance rate of testing offered did not differ between targeted and non-targeted arms. Electronic tablets were well-received by patients and easy to use. We conclude that non-targeted HIV screening using electronic tablets would increase the HIV testing rate in our ED.

Trial registration

ClinicalTrials.gov NCT03038724

Perceived Risk Among Human Immunodeficiency Virus Serodiscordant Couples in East Africa Taking Oral Pre-Exposure Prophylaxis

OBJECTIVES

Perceived risk of human immunodeficiency virus (HIV) infection is thought to drive low adherence in pre-exposure prophylaxis (PrEP) trials. We explored the level of perceived risk of incident HIV infection in the Partners PrEP Study, in which adherence was generally high.

METHODS

A cross-sectional questionnaire assessed perceived risk of HIV at 12 months after enrollment. Logistic regression was used to analyze the relationship between perceived risk and other demographic and behavioral variables.

RESULTS

Three thousand two hundred twenty-six couples from the Partners PrEP Study were included in this analysis. Only 15.4% of participants reported high or moderate perceived risk. Participants at high risk of acquiring HIV were slightly more likely to report high perceived risk (odds ratio, 1.60; 95% confidence interval, 1.30-1.95; P < 0.001); nevertheless, only 20% of participants with high-risk reported high perceived risk.

CONCLUSIONS

Participants reported low perceived risk of HIV but were adherent to PrEP. Perceptions of risk are likely socially determined and more complex than Likert scale questionnaires capture.

Narrative Impressions of Literature: The Availability Bias and the Corrective Properties of Meta-Analytic Approaches

Participants (N = 280) reviewed 20 fictional research summaries of studies examining the relation between similarity and attraction. Although there were some inconsistencies across the fictional studies, there was a positive relation overall (d = 0.2). The authors manipulated the salience of the titles and the serial order in which the studies were presented without changing the results of the studies themselves. Participants recalled the salient titles better than the nonsalient titles. Participants who were given very brief training in meta-analytic techniques gave estimates of the similarity-attraction relation that were close to the actual magnitudes. Participants who were not given such training (narrative reviewers) were influenced by the salience manipulation and gave estimates that were biased toward the studies that had salient titles. Although the salience manipulation influenced participants in the meta-analytic and narrative groups equally, memory mediated the effects of salience on estimates of effect magnitude only for the narrative review participants.

Risk Perception and Prototype Perception: Independent Processes Predicting Risk Behavior

Three studies examined the relative influence of two social-cognitive processes, risk perception and prototype perception, on the willingness of young adults to engage in unprotected sex. In the first two studies, despite participants' expressed intentions to engage in protected sex, perceived risk and prototype perception processes were independently predictive of their willingness to engage in unprotected sex. In a third study, prototype perception and risk perception independently predicted willingness to engage in unprotected sex, which, in turn, predicted actual contraceptive behavior 6 months later. Although the two constructs have some commonality reflecting a social comparison basis, results from all three studies suggest that they embody some unique or independent processes that can be differentially elicited. Theoretical and practical implications of the results are considered.

Risky Sexual Behavior in American White College Women: The Role of Sex Guilt and Sexual Abuse

Ninety-five sexually active White American female college students participated in a questionnaire study about their sexual behavior in the past 12 months. A path model was tested in order to assess specific hypothesized predictors of risky sexual behavior. As predicted, participants with greater sex guilt reported using condoms more and having had fewer sexual partners. The findings of this study suggest that White American female college students are at some degree of risk due to risky sexual behavior. Taking into account attitudes about sexuality and past sexual abuse along with the requisite training in condom use self-efficacy may enhance the success of interventions designed to reduce risky sexual behavior among White American female college students.

Personality, Preventive Health Behaviour and Comparative Optimism about Health Problems

The aim was to test a model whereby personality influences preventive health behaviour which in turn influences comparative optimism about possible future health problems. Students ( N 5 150) completed measures of personality (five-factor), preventive health behaviour and comparative optimism. The model was tested using structural equation modelling with observed variables. In the final model, agreeableness and conscientiousness had positive main effects and an interactive effect upon preventive health behaviour. Preventive health behaviour had a positive effect upon comparative optimism. In addition, extraversion had a direct positive effect (not mediated by preventive health behaviour) upon comparative optimism. It is speculated that agreeableness and conscientiousness combine to produce a general regard for social convention that is conducive to healthier behaviour. The effect of extraversion is explicable in terms of positive affectivity.

Decision Aids for Benign Prostatic Hyperplasia: Applicability across Race and Education

Background/Method. Decision aids have not been widely tested in diverse audiences. The authors conducted interviews in a 2 2 race by education design with participants who were 50 years old (n = 188). The decision aid was a benign prostatic hyperplasia videotape. Results. There was an increase in knowledge equal in all groups, with baseline knowledge higher in whites. The decision stage increased in all groups and was equivalent in the marginal-illiterate subgroup (n = 0.15). Conclusion. Contrary to expectations, results show no difference by race or college education in knowledge gain or increase in reported readiness to decide. The video appeared to produce change across race and education. The end decision stage was high, especially in less educated men. Results suggest that decision aids may be effective without tailoring, as suggested previously to enhance health communication in diverse audiences. Research should test findings in representative samples and in clinical encounters and identify types of knowledge absorbed from decision aids and whether the shift to decision reflects data/ knowledge or shared decision-making message.

Theoretical Domains: A Heuristic for Teaching Behavioral Theory in HIV/STD Prevention Courses

The HIV/STD epidemics have broadened the need for better behavioral intervention programs and highlighted the importance of providing training in behavioral theory to frontline program practitioners. However, there is a lack of effective methods for teaching theoretical concepts to people who may not have a background in behavioral science. This article presents a solution to this challenge by introducing a new heuristic for teaching theory and for placing individual theories/models in a broader context. Using a broad framework, we identify five domains that influence behavior: risk appraisal, self-perceptions, emotions and arousal, relationships and social influence, and environmental and structural factors. Each domain is described, and a brief overview of supporting literature is provided. Following the presentation of domains, we discuss course structure and activities.

Perceived Versus Actual Risk for Hypertension and Diabetes in the African American Community

Hypertension and diabetes mellitus are leading health concerns in the United States. Despite a disproportionate burden of both conditions among African Americans, it is estimated that 44% of diabetes cases and one quarter of hypertension cases within this population are undiagnosed. Lack of awareness of the risk of these conditions may hinder preventive efforts and the adoption of positive lifestyle changes. Based on the findings from a pilot study to develop and standardize uniform screening forms for hypertension and diabetes, this article reports on the perceived risk versus actual risk of developing these conditions among primarily African American participants using a community-based screening tool. Each form assessed both perceived and actual risk of diabetes and hypertension, respectively. A total of 265 hypertension and 225 diabetes screening forms were randomly selected from eight sites across the country. The risk perception of the overall study sample was similar to its actual risk for developing either condition. However, a significant proportion of individuals who scored at high risk for diabetes or hypertension were unaware of their risk for these conditions. These results suggest the need for developing culturally relevant interventions, public health education, and policies that address the risk misperceptions among this group.

Self-Esteem, Compensatory Self-Enhancement, and the Consideration of Health Risk

Acknowledging that one engages in risk-increasing behavior is a form of self-generated negative feedback that can engender self-protective responses. This experiment examined the use of one of these reactions, compensatory self-enhancement, following a manipulation that made high and low self-esteem participants explicitly consider their sexual risk behaviors. Participants with high (but not low) self-esteem responded to the manipulation by self-enhancing on both personality ratings and ratings of their contraceptive behavior. Positive self-ratings on personality traits were negatively associated with subsequent ratings of perceived vulnerability to sexually transmitted diseases.

Accentuate the Relevant

People need information in order to make effective choices and to feel competent in managing their own affairs Decision-making research provides tools for identifying and addressing these informational needs The tools allow formal analyses of what information is critical to particular decisions, as well as descriptive analyses of how well those facts are understood Communication should be focused on critical information that is either missing or available but not understood Decision-relevant situations range from ones posing well-formulated, imminent choices to ones in which people are trying to understand what choices are even possible This article reviews briefly the formal and descriptive approaches to dealing with such decisions Including these approaches in behavioral interventions might help people to be as systematic as they would like in their decision making It might even make them want to be more systematic

Perceived HIV risk, actual sexual HIV risk and willingness to take pre-exposure prophylaxis among men who have sex with men in Toronto, Canada

Pre-exposure prophylaxis (PrEP) reduces HIV acquisition. Our goal was to determine the willingness of men who have sex with men (MSM) to take PrEP given perceived and actual HIV risk. HIV-negative MSM were recruited from September 2010 to June 2012 and asked about PrEP willingness and perceived HIV risk. Actual sexual HIV risk was measured by three condom-use components generated through principal components analysis. General HIV risk was measured using the HIV Incidence Risk Index for MSM (HIRI-MSM). Model 1 measured PrEP willingness given perceived and actual sexual HIV risk. Model 2 included actual HIV sexual risk, perceived HIV risk and general HIV risk. Model 3 removed actual sexual HIV risk. We recruited 150 HIV-negative MSM. About 55% were willing to take PrEP. Reasons for PrEP unwillingness were: low perceived risk (64%), side-effect concerns (44%), daily pill burden (16%) and efficacy concerns (4%). Model 1: MSM with high compared to low actual sexual HIV risk were more willing to use PrEP (OR 27.11, 95% CI 1.33-554.43) after adjusting for perceived risk, which was not significantly associated with PrEP willingness (OR 4.79, 95% CI 0.72-31.96). Model 2: MSM with high compared to low actual sexual HIV risk were more willing to use PrEP (OR 29.85, 95% CI 1.39-640.53) after adjusting for perceived and general HIV risk, neither of which was significantly associated with PrEP willingness (OR 5.07, 95% CI 0.73-35.09) and (OR 1.58, 95% CI 0.37-6.79), respectively. Model 3: After removing actual sexual HIV risk, MSM with high compared to low perceived risk were more willing to use PrEP (OR 6.85, 95% CI 1.23-38.05), and the HIRI-MSM general risk index was not associated with PrEP willingness (OR 1.87, 95% CI 0.54-6.54). Therefore, actual sexual HIV risk was the best predictor of PrEP willingness and general HIV risk did not inform PrEP willingness.

Factorial validity and measurement invariance of the Perceived Susceptibility to Sport Injury scale

The Perceived Susceptibility to Sport Injury (PSSI) scale is a measure that has recently surfaced in the sport injury literature. The factor structure of the PSSI scale has not been subjected to a rigorous factor analysis; thus, the factorial validity of the measure in athlete populations is unknown. To establish the validity of the PSSI scale in sports medicine research, the purpose of this study was to examine the factor structure and measurement invariance across gender of the PSSI scale. Male and female intercollegiate athletes (N = 217) completed the PSSI scale during the off-season. The factor structure was analyzed using confirmatory factor analysis (CFA) procedures and maximum likelihood estimation. The measurement invariance analysis was conducted via comparisons of fit indices within a series of hierarchically constrained models. Results of the CFA yielded a very good fit of the measurement model: χ² (2) = 4.535, P = 0.104; RMSEA = 0.076; SRMR = 0.018; CFI = 0.995; NNFI = 0.985. Results of the measurement invariance analysis demonstrated strict invariance across gender, and no significant latent mean differences emerged between men and women. Study results support the factorial validity of the PSSI scale for use in future sports medicine research.