Sexual behavior of college women in 1975, 1986, and 1989

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.

Ambiguity of Monogamy as a Safer-sex Goal Among Single, Pregnant, Inner-city Women

We examined the ambiguity of monogamy as a safer-sex goal in a sample of young, inner- city women ( N = 447), of whom 58 percent were African- American and 42 percent European-American. It was our premise that women may be misperceiving and underestimating their risk due to differences in their definition and beliefs about monogamy, and thus are not changing their behavior. When compared to long-term monogamous women (self-reporting one partner in the past year), serially monogamous women (reporting two or more partners in the past year) perceived themselves at greater risk but did not report more frequent use of condoms. It is possible that a suggestion of monogamy may be subject to multiple interpretations and thus could be providing women with a false sense of safety. Risk reduction should be defined in specific behavioral terms.

Prevalence and Frequency of Heterosexual Anal Intercourse Among Young People: A Systematic Review and Meta-analysis

We aim to assess if heterosexual anal intercourse (AI) is commonly practiced and how frequently it is practiced by young people. We searched PubMed for articles published 1975 to July 2014 reporting data on the proportion of young people (mean age <25) practicing heterosexual AI (AI prevalence) and on number of AI acts (AI frequency). Stratified random-effects meta-analysis and meta-regression were used to produce summary estimates and assess the influence of participant and study characteristics on AI prevalence. Eighty-three and thirteen of the 136 included articles reported data on lifetime AI prevalence and monthly AI frequency, respectively. Estimates were heterogenous. Overall summary estimates of lifetime AI prevalence were 22 % (95 % confidence interval 20-24) among sexually active young people, with no statistically significant differences by gender, continent or age. Prevalence increased significantly with confidentiality of interview method and, among males and in Europe, by survey year. Prevalence did not significantly differ by recall period. An estimated 3-24 % of all reported sex acts were AI. Reported heterosexual AI is common but variable among young people worldwide. To fully understand its impact on STI spread, more and better quality data on frequency of unprotected AI, and trends over time are required.

Changes in sexual behaviours: from secular trends to public health policies

OBJECTIVE

To explore the relative contribution of secular trends and public health policies to changes in sexual behaviour.

DESIGN

Three random probability surveys of the sexual behaviour of people aged 18-69 years were conducted in 1970, 1992 and 2006 in France.

METHODS

Data of the 2006 survey (n = 12,364) were compared with those from two surveys carried out in 1970 (n = 2625) and 1992 (n = 20,055).

RESULTS

Over the last decades, median age at first intercourse has decreased by 4 years for women (22.0 in the 1930s vs. 17.6 in the 2000s) and 1 year for men (18.1 vs. 17.2). Lifetime number of sexual partners increased for women (1.8 in 1970 vs. 4.4 in 2006), but not for men (11.8 vs. 11.6). At the same time, the proportion of respondents, especially women, who reported nonpenetrative sexual practices and considered sexual intercourse essential to well being was on the increase. These changes are mainly attributed to an increase in women's social status. A marked increase in condom use was observed following the first AIDS/HIV prevention campaigns in the 1980s.

CONCLUSION

Public health interventions that are synergistic with trends in social norms are likely to be more effective than those that run counter to them. In France, sexual health and HIV prevention policies aimed at harm limitation appear to have chimed with secular trends. The evidence of greater diversification of sexual practices offers potential to increase the range of safer sex messages used in public health interventions.

Human papillomavirus vaccination: the policy debate over the prevention of cervical cancer--a commentary

The human papillomavirus (HPV) family causes a variety of benign, premalignant, and malignant lesions in men and women. HPV types 16 and 18 are responsible for causing 70% of all cases of cervical cancer each year. Recently, a vaccine that can prevent cervical cancer by protecting women from infection with the most common types of HPV has been made available. Following Food and Drug Administration approval and endorsement by the Centers for Disease Control and Prevention, it is the right and the duty of the state legislatures to implement vaccination programs. This vaccine, a vaccine for a sexually transmitted disease, has stirred a fierce debate. Religion and sexuality have dominated the discussion, and political calculations are inherent to the process; nonetheless, epidemiological analyses are also essential to the decision to mandate the HPV vaccine. HPV vaccine program implementation processes are at many stages in many states, and programs vary widely. Some provide information to families, whereas others allot a range of funding for voluntary vaccination. Virginia is, thus far, the only state to have enacted a mandate. This article discusses the various programs in place, the proposed legislation, and the debate surrounding the political process.

Sexual knowledge, attitudes, and risk behaviors of students in Turkey

This survey produced baseline information about student knowledge of sexually transmitted diseases (STDs), their sexual attitudes, and their behavior to help establish control and education programs. The study was conducted at Ege University, Izmir, Turkey, during the 1999-2000 academic year. A total of 2,217 first- and fourth-year students determined by stratified sampling constituted the study group. All students who volunteered to participate completed a questionnaire assessing sociodemographic and knowledge factors, sexual attitudes, behavior, and history of STDs. The rate of students having had sexual experience was 36.6%. Males were more sexually active than females. Most students (71.4%) began sexual activity at ages 15-19 without any difference by gender. Males reported significantly more sexual partners than females. Similarly, the rate of male students never using condoms was significantly higher than females. Condom was the most frequent contraception method, followed by oral contraceptives and withdrawal. Mean score on the knowledge questions was 16.29 (highest score 30). The most widely known STD was HIV infection and AIDS. Students' knowledge of transmission routes, signs and symptoms, and risk groups of STDs was insufficient. Main sources of knowledge were visual and print media, and friends. Most students (84.7%) viewed prevention from STDs as a person's own responsibility. Young people in Turkey are sexually active and tend to engage in high-risk behavior. However, their knowledge on sexual health and sexually transmitted diseases is insufficient. Study results suggest a need for implementation of STD control programs and provision of school sexuality education for adolescents and young adults.

The association of campus resources for gay, lesbian, and bisexual students with college students' condom use

The author and colleagues examined campus resources for gay, lesbian, and bisexual (GLB) students at 119 US colleges to determine how the presence of such resources affected sexually active students' condom use. A random sample of unmarried, sexually active college students surveyed in 1999 completed questionnaires. Condom use was compared across schools with different levels of GLB resources. Condom use rates, analyzed by sex and sex-partner groups, ranged from 32% to 52%. With additional college variables controlled for, GLB resources were positively associated with the proportion of sexually active students who used condoms (p < .001). This association existed primarily for students with only opposite-sex partners. The author's findings suggest that campus resources for GLB students may be associated with college students' condom use.

Women, alcohol, and sexuality

Alcohol consumption increases subjective sexual desire, arousal, and pleasure for many women, although it lowers physiological arousal. Despite the general belief that alcohol disinhibits female sexual behaviors, alcohol leads to changes in sexual behavior only for a minority of women. Expectancies about the effects of alcohol on sexual behavior may be important mediators of the alcohol-sexual behavior linkage. There also is a relationship between overall alcohol consumption and risky sexual behavior for women, but when alcohol use at or preceding individual instances of sexual activity is examined, there is no association in the majority of studies. Alcohol use by both perpetrators and victims has been implicated in instances of sexual victimization. Heavy alcohol consumption and alcohol problems in women are associated with heightened risk of childhood incest, sexual assault, and sexual dysfunction.

College students' reasons for nonuse of condoms within dating relationships

Two hundred ten heterosexual undergraduates in dating relationships were surveyed about reasons for not using condoms every time for vaginal and anal sex and for increasing or decreasing condom use during their relationships. Half of the respondents reported consistent condom use in the first month of their relationships, while only 34% reported consistent condom use in the past month. Subjective assessments of partner safety and the belief that sufficient measures were being taken to avoid pregnancy were important reasons for condom nonuse. Study results suggest that interventions should emphasize the importance of objectively assessing HIV/STD risk before reducing condom use within relationships. Interventions also need to provide additional information on the riskiness of heterosexual anal sex.

The prevalence of sexually transmitted pathogens in patients presenting to a Casablanca STD clinic

The objective of this study conducted at the sexually transmitted diseases (STD) clinic of the Pasteur Institute of Morocco (SCPIM) is to describe clinical complaints and biological findings in patients attending this facility. Two thousand two hundred sixty-four patients had visited the STD clinic from 1992 to 1996. The main reported symptom was genital discharge for men (44.5%) and women (68.6%). Genital eruption and ulcer were more frequent in men. The principal biological result shows a seroprevalence of 0.62% for human immunodeficiency virus (HIV), 3.05% for hepatitis B virus (HBV), 51.5% for chlamydiae and 13.2% for syphilis. Factors associated with clinical findings were age and Gonococcus for men (odds ratio (OR): 1.94 and 5.96, respectively) and Trichomonas and positive TPHA for women (OR: 9.49 and 0.25, respectively). This work describes for the first time the distribution of various germs involved in sexually transmitted diseases in Moroccan population and underlines the importance of studying its sexual behavior as well as determinants of STD incidence.

[Evaluation by HIV/AIDS specialists of risk of HIV infection in university students, based on different sex practices]

To detect the beliefs concerning the risk levels related to several sexual practices/habits and the HIV infection among undergraduate students and to compare their opinion with the AIDS experts were the objectives of this study. A 25-item questionnaire (Likert Probability Scale) about sexual practices/habits were answered by undergraduate students enrolled in the courses of nursing, medical school, pharmacy-biochemistry, psychology. Based on Factorial analysis and by using the Varimax Rotation System, 25 patients were distributed in 7 factors, and 5 patients were excluded. From the 20 patients, 5 were reunited in 2 factors and studied in this paper. Factor X reunited the patients 1 (vaginal intercourse with condom) and 2 (anal sex with condom). In factor Y the patients included were: 3 (heterosexual intercourse), 4 (vaginal intercourse without condom) and 5 (anal intercourse without condom). In 80% of the 5 patients, it was observed that the students have knowledge similar to the experts"s evidences But, continuing education is necessary to these people, as human beings and as future health care givers to the HIV infected/AIDS patients.

Model for using hip-hop music for small group HIV/AIDS prevention counseling with African American adolescents and young adults

Currently little attention has been directed, with the exception of peer education efforts, to constructively develop new and innovative ways to promote HIV/AIDS primary prevention among African American (AA) adolescents and young adults. With this in mind, the aim of this conceptual effort is to present a HIV/AIDS preventive counseling protocol developed for use with AA young adults that makes use of hip-hop music, a form of music popularized by young AAs. The author contend that an increased understanding of the relationships that many AA young adults have with hip-hop music may be used by disease prevention personnel to educate these populations about protective factors for HIV. Making use of hip-hop music is one strategy for integrating counseling in prevention and health maintenance. The overall implications of using hip-hop music in health promotion are unlimited. First, this method makes use of cultural relevant materials to address the educational and health needs of the target community. Second, it is grounded in an approach that serves to stimulate cooperative learning based on peer developed content. Moreover, the use of this medium can be applied to other health promotion activities such as violence/harm reduction and substance abuse prevention, upon reviews of songs for appropriate content. The authors contend that such an approach holds heuristic value in dealing with HIV/AIDS prevention among AA young adults. Additional testing of the intervention is warranted in the refinement of this innovative intervention.

Increasing the effectiveness of contraceptive usage in university students

Prevention of pregnancy requires correct and consistent use of an effective method of contraception and knowledge alone is not sufficient to ensure such use, as many complex social and behavioral factors influence contraceptive behavior. Women are particularly likely to change their contraceptive method after a contraceptive 'shock'. In this study, the change in contraceptive behavior of a group of university students who presented for emergency contraception is studied. Each student participated in a single individualized educational session. A total of 465 women requested emergency contraception in a 3.5-year period at a large student health center. Of these, 24% had not previously used contraception, 50% had previously used condoms and 25% had taken the pill (COC). Of those who usually used condoms, 79% had had a condom accident and 21% had not used them at the last intercourse. Only 30% of COC users had had a problem with the pill and the remaining 70% were not taking it at the time of last intercourse, for social rather than medical reasons. Follow-up is available for 309 (66.5%). Paired-sample analysis of these women shows a decrease in the number using no contraception (22% to 8%), and an increase in the number using COCs (33% to 66%). These changes reached statistical significance (p < 0.0001). University students, despite their intelligence, exhibit a high degree of risk-taking behavior but become more effective contraceptive users after an interactive counselling session following a contraceptive scare.

A profile of sexual health behaviors among college women

This study examined the risk taking and preventive behaviors related to sexually transmitted diseases among sexually active college women. Self-report questionnaires were distributed at two mid-Atlantic universities yielding a final sample of 556 students. Data were collected regarding frequencies of pelvic examinations, numbers of vaginal, oral, and anal sex partners, and number of partners who had forced sex against their will. Also, frequencies of tests for sexually transmitted disease and HIV before having sex with new partners, methods of protection and birth control, and types of relationships were assessed. Finally, subjects reported the types of questions asked before having sex with a new partner and diagnoses of sexually transmitted diseases. Because most college-aged women are sexually active and vulnerable to a host of short- and long-term complications from sexually transmitted infections, educational interventions, in addition to promoting condom use, must focus on the need for regular pelvic examinations, screenings for sexually transmitted disease/HIV (self and partner), and lower risk sexual activity.

Sexual behaviour of adolescents before and after the advent of AIDS

OBJECTIVES

To asses changes in sexual behaviour and use of contraceptive methods in Danish adolescents from the period before the advent of AIDS up to the present.

DESIGN

Comparative study comparing data obtained from two identical cross sectional surveys

SETTING

Grenaa Gymnasium, Denmark.

SUBJECTS

626 high school students in 1982 and 499 high school students in 1996.

METHODS

An anonymous standardised self administered questionnaire handed out to high school students at Grenaa Gymnasium in spring 1982. In spring 1996 an identical questionnaire was handed out to every high school student at the same gymnasium.

MAIN OUTCOME MEASURES

Age at first sexual intercourse, contraceptive use, and reasons for choice of contraceptive strategy.

RESULTS

Today more males had experienced the first sexual intercourse before their 16th birthday (p = 0.047) compared with 1982, the reverse held for females (p = 0.003). From 1982 to 1996 condom use increased in males with no regular partner (p = 0.009). In females with no regular partner, there was during the same period an increase in considering the condom a personal contraceptive method (p = 0.017). In 1982 and 1996 protection from sexually transmitted diseases was given as reason for the choice of contraceptive strategy by 21% and 72% of males with no regular partner (p < 0.001), and by 7% and 32% of males with a regular partner (p < 0.001). The corresponding figures for females in 1982 and 1996 were 10% and 71% (p < 0.001) for those with no regular partner and 4% and 21% (p < 0.001) for those with a regular partner.

CONCLUSION

Condom use has increased among adolescents with no regular partner brought up under the widespread awareness of AIDS, and the reason for this is to be protected from sexually transmitted diseases. A future decline in the incidence of various sexually transmitted diseases may be expected, and information on safe sexual practices should be continued.

Risk factors for gonorrhoea: case-control study

OBJECTIVE

To define risk factors for gonococcal infection.

METHODS

A case-control study comparing 200 gonorrhoea cases with 400 patients with non-gonococcal genitourinary infections and 400 patients with various skin diseases, all of them attending City Department for Skin and Venereal Diseases In Belgrade (Yugoslavia) from October 1993 to December 1994.

RESULTS

According to multivariate logistic regression analysis the following factors were significantly related to gonorrhoea in men: education level, sexual contact same day as meeting, condom use, history of prior gonorrhoea, and casual and/or new sex partner in the past month. Age, sexual contact same day as meeting, number of partners in the past year, and frequency of sexual intercourse in the past month were independently, significantly related to gonorrhoea in women. Also, in females, gonorrhoea was significantly more frequent in industrial workers and supported people.

CONCLUSION

Since sexual behaviour, low education level, younger ages, and low socioeconomic status were found to be related to gonococcal infection, health education at early age seems to be the most appropriate means of altering high risk behaviour.

A normative analytic framework for development of practice guidelines for specific clinical populations

BACKGROUND

A central problem in practice guideline development is how to develop guidelines that appropriately account for variations in clinical populations and practice settings. Despite recognition of this problem, there is no formal mechanism for assessing what the need is for flexibility in guidelines, or for deciding how to incorporate such flexibility into recommendations.

OBJECTIVE

This research sought to provide a formal basis to determine when clinical circumstances vary sufficiently that guideline recommendations should differ, how recommendations should be tailored for a specific clinical setting, and whether the benefit associated with such site-specific guidelines justifies the expense of their development.

RESULTS

The authors describe an approach for estimating the maximum health benefit that developers can obtain by eliminating uncertainty about differences in the patient populations and practice settings in which a guideline will be used. This estimate, the expected value of customization, provides a mechanism to evaluate the cost-effectiveness of the development of site-specific guidelines that account explicitly for variation in clinical circumstances. Application of this method to the development of screening guidelines for human immunodeficiency virus (HIV) infection indicates that the development of site-specific guidelines potentially is cost-effective. Site-specific guidelines either improve, or leave unchanged, the efficiency of HIV screening; whether they increase or decrease total expenditures and health benefits depends on the choice of a cost-effectiveness threshold, and the clinical problem.

CONCLUSIONS

Development of guideline recommendations based on decision models provides a normative approach for evaluating the need for and the cost-effectiveness of site-specific guidelines that have been tailored to specific practice settings. Such site-specific guidelines can improve substantially the expected health benefit and the economic efficiency of practice guidelines.

Communication types and sexual protective practices of college women

Sexually transmitted disease, such as the fatal HIV disease, continues to threaten the health of young women. Adolescents have typically been inconsistent users of effective strategies that prevent the spread of disease during sexual activity. Communication practices related to disease-related sexual protection have received little attention as a variable separate from sexual protection. The purpose of this study was to explore the relationship among different types of interpersonal communication of young women and their new sexual partners and their implementation of disease-related sexual protection. A sample of 163 young women who had experienced sexual intercourse completed the Safe Sex Behavior Questionnaire. Interpersonal communication was explored using the general-information-seeking (getting to know a partner), sexual self-disclosure, and specific-disease risk-information-seeking scales. These scales were combined; factor analysis revealed three subscales closely related to the original scales. Findings suggest that young women who seek specific information about their new sexual partner's disease risk status are more likely to implement sexual protective practices. These findings provide guidance to nurses who work with adolescent women in advising on aspects of interpersonal relationships that need to be enhanced to protect one's health status.

Using the Youth Risk Behavior Survey to compare risk behaviors of Texas High School and college students

This study used the Youth Risk Behavior Survey (YRBS) to assess selected health behaviors of Texas high school and college students. The YRBS was administered during 1993 in paper and pencil form to 6,015 high school students representing 329 classrooms from 78 school districts. A total of 1,408 college students representing 23 college and universities were surveyed by telephone in 1993 using a modified version of YRBS. Texas college students reported a higher percentage who had experienced sexual intercourse (82% versus 55.4%), but Texas high school students reported a younger age of first sexual intercourse. High school students also initiated alcohol consumption at a younger age, although college students were more likely to binge drink (33.5% versus 31%). Regular cigarette use also was higher among college students (25.4% versus 19.3%), but was initiated at a younger age by high school students. Study results indicate that health education programs must begin much earlier than during the high school years. Due to early initiation of negative health behaviors, emphasis must be placed on abstinence and risk-reduction techniques for both populations.

Perceptions and Use of the Male Condom among African American University Students

This study examines differences in condom use among female and male African-American young adults; investigates how perceptions of contraceptive characteristics vary by gender; and determines which combination of contraceptive attitudes best discriminates between condom users and nonusers. In a classroom setting, 244 African-American college students completed the Contraceptive Attributes Questionnaire-2. Significantly more men than women reported condom use, both actual and intended. Women and men differed in the importance they place on contraceptive characteristics and in their perceptions of both the condom and the contraceptive pill. Finally, perceived contraceptive attributes significantly differentiated men and women who used condoms from those who did not and predicted those who reported that they definitely intend to use condoms from those who do not. These findings suggest that prevention efforts to promote condom use must be gender specific as well as culture specific if they are to be effective.

The sexual practices of adolescent virgins: genital sexual activities of high school students who have never had vaginal intercourse

OBJECTIVES

The purpose of this study was to determine whether high school-aged virgins engage in sexual practices that can transmit sexually transmitted diseases, including the human immunodeficiency virus (HIV).

METHODS

Data were collected from an anonymous self-administered survey of 2026 urban students in 9th through 12th grades.

RESULTS

Forty-seven percent of adolescents were virgins (42% of male adolescents and 53% of female adolescents). Of those who were virgins, 29% and 31% reported that, during the prior year, they had engaged in heterosexual masturbation of a partner and masturbation by a partner, respectively. The corresponding rates for heterosexual fellatio with ejaculation, cunnilingus, and anal intercourse were 9%, 10%, and 1%. Homosexual sexual activities were rare. Condom use for fellatio was also rare. Level of risk of virgins' sexual activities was associated with illicit substance use and other non-sexual risk behaviors, even after demographic variables had been controlled.

CONCLUSIONS

Few high school-aged virgins engaged in anal intercourse, but many engaged in other genital sexual activities. Some of these activities can transmit disease, and all can indicate a need for counseling about sexual decision making, risk, and prevention.

Partner-specific sexual practices among heterosexual men and women with multiple partners: results from the French national survey, ACSF. Analyse des Comportements Sexuel en France

Heterosexual men and women with several partners are at risk of acquiring and transmitting sexually transmitted diseases and HIV. Risk depends on parameters such as the sexual practices themselves which may vary according to the type of partner (regular vs. casual). It is therefore important to describe the sexual practices and identify the correlations between the type of partner and these practices among heterosexuals with multiple partners. A subsample of all subjects having had at least two sexual partners during the previous year (n = 1644) was obtained from the ACSF survey (n = 20,055), the French national telephone survey on sexual behavior conducted between September 1991 and February 1992. Questions concerned in particular sexual practices of the last encounter as well as type of partner. Petting and vaginal penetration were almost systematic, mutual manual stimulation and orogenital sex were common, while self-masturbation and anal sex were infrequent. On average, a condom was seldom used. However, it was used more often when the partner was occasional. Nonpenetrative and oral practices were also more frequent with occasional partners. Women tended to report lower frequencies of practices and of condom use than men. A subset of heterosexuals with multiple partners engaged in safe sex. Practices tend to be partner-specific, with safer sex practices more likely to occur with occasional partners, although the magnitude of the difference is moderate.

Trends in chlamydia and other sexually transmitted diseases in a university health service

The incidence of sexually transmitted diseases in a primarily student-based patient population served by a university health service was reviewed because of the perception that the number of positive chlamydia tests was declining. The most striking finding that emerged was that there was, indeed, a persistent and steady decline in the rates of chlamydia infection over the study time period of 1989 to 1994. Other sexually transmitted diseases showed less definite declines or no significant change. The authors evaluated the number of positive chlamydia tests in the health service with symptoms suggestive of chlamydia infection. Of all university health service patients who tested positive for chlamydia, 48.8% were asymptomatic. A majority (75.2%) of the female patients who tested positive on their annual routine family-planning examination were also asymptomatic for chlamydia. Chlamydia-positive men presenting to the health service were far more likely to be symptomatic than were the women who were positive. Overall, a significant decrease in chlamydia occurred over the 5-year period in spite of an increasing enrollment, a fact that could perhaps be attributable to students' increased awareness of the risk of sexually transmitted infections and their use of condoms.

Attitudes about condoms and condom use among college students

The authors assessed the relationships of ethnicity, gender, previous condom use, and intended condom use to perceived attributes of the condom and the contraceptive pill in a multiethnic sample of 197 college students. Factors that appeared to underlie attitudes toward the condom and the Pill included prevention of health problems, peer acceptance, sexual pleasure and spontaneity, convenience, embarrassment, and effectiveness in preventing HIV and sexually transmitted diseases. African American participants viewed the condom more positively than did students from other ethnic groups and were more likely to use condoms than White participants were. The African Americans appeared to know less about the characteristics of the Pill and were less likely to use it than were the White respondents. Only 60% of the persons in the student sample had used condoms in the last 6 months, and less than one half definitely intended to use condoms in the next month. Those who had used a condom at their most recent intercourse and those who intended to use a condom in the next month viewed the condom more favorably than others did. Intended condom use was associated with a perception of oral contraceptives as a less convenient method of birth control.

Assessing variability of HIV transmission attitudes and behaviors at an urban northeastern university

Teenagers in the United States are one of the populations whose HIV infection rates are increasing most rapidly. This study was designed to measure college students' knowledge of HIV transmission methods using Kittleson and Venglarcik's HIV Transmission Survey. Participants (N= 167) were divided into two groups, 99 students from a rural background and 68 students from an urban background. Students from an urban background were significantly more knowledgeable about documented HIV transmission modes than students from a rural background. Men were significantly less aware of documented HIV transmission modes than women. These results suggest that education about AIDS needs to be improved. The current educational procedures do not properly inform students in a fashion which exhibits the true risk of infection and those behaviors which increase risk. Fifteen years after the discovery of the HIV virus students are still largely unaware that they are at risk for contracting a fatal disease.

Use of pharmacy computer prescription database to access hypertensive patients for mailed survey research

OBJECTIVE

To evaluate the use of a pharmacy computer prescription database (PCPD) to identify and sample hypertensive patients outside of their treatment setting for mailed, self-administered survey research comparing the presence and lack of participation incentives and mailed follow-up reminders.

SETTING

Two independent, privately owned, free-standing community pharmacies.

PARTICIPANTS

A total of 735 individuals identified from a PCPD search who had been prescribed at least 1 of 130 PCPD medications potentially used in hypertensive therapy.

METHODS

PCPD was searched by the pharmacist/owner per protocol; participants were sent an individually addressed cover letter on pharmacy letterhead signed by the pharmacist that requested voluntary anonymous completion of an enclosed self-administered, quality-of-life opinion survey; the first search used no incentive or follow-up; the second search used an incentive and mailed a follow-up reminder. Research protocol followed published ethics guidelines.

RESULTS

There was a mean 84% return with incentive and follow-up strategies compared with a mean 25% return without strategies (p < 0.01) for all drug groups between searches; no statistical difference in response was shown between the same drug groups (alpha 1-blockers, calcium-channel blockers, and centrally acting alpha 2-agonists) within searches.

CONCLUSIONS

Acceptable response rates (74-93% return) can be obtained with traditional follow-up mailed incentives, prescription issuance within 6 months, incentives to both hypertensive and nonhypertensive responders, and sampling strategies within potential drug groups. Methodology can be adapted to other populations by alternative drug sampling strategies.

Ethnic and gender differences in sexuality: variations in sexual behavior between Asian and non-Asian university students

Seven hundred and two (346 non-Asian, 356 Asian) undergraduate volunteers were assessed in a confidential laboratory setting on levels of interpersonal sexual behavior (e.g., petting, intercourse), intrapersonal sexual behavior (e.g., fantasy, masturbation), and sociosexual restrictiveness (e.g., lifetime number of partners, number of "one-night stands"). The purpose was to examine possible differences in sexual behavior between Asian and non-Asian Canadian university students and to determine the association between North American residency and the sexual behavior of Asians. The role of gender on sexual behavior both across and within ethnic groups was also examined. Statistical analyses revealed that Asian students were significantly more conservative than non-Asian students on all measures of interpersonal sexual behavior and sociosexual restrictiveness. Significant differences were also noted between Asian and non-Asian students on most measures of intrapersonal sexual behavior. With the exception of two fantasy items, length of residency in Canada was unrelated to interpersonal sexual behavior, intrapersonal sexual behavior, or sociosexual restrictiveness among Asians. Although gender differences were substantial for intrapersonal sexual behaviors such as fantasy and masturbation, no significant gender differences were found for measures of interpersonal sexual experience, with the exception of reported number of one-night stands.

Patients misrepresenting their risk factors for AIDS

To determine the truthfulness of patients' and research subjects' self-reports of their sexual and drug use histories in studies of human immunodeficiency virus (HIV) transmission and acquired immunodeficiency syndrome (AIDS) risk factors, studies of or pertinent to lying about AIDS risk factors were extracted from MEDLINE and PSYCLIT. The present paper describes normal and pathological motives for misrepresenting risk factors, and reviews the literature on such underreporting. There is much evidence for lying about anal intercourse and intravenous drug use risk factors, implying that the estimates of risk for vaginal transmission of HIV (particularly in Pattern-I industrialized countries) have been inflated. Research on HIV/AIDS behavioural risk factors must include sophisticated methods for the assessment of self-report validity, such as the use of behavioural markers, improved lie scales and interview methods, and physical methods.

Barriers to condom use among heterosexual male and female college students

The authors used a questionnaire to assess gender differences in barriers to condom use among 198 female and 89 male heterosexual undergraduate college students. Participants were divided into three groups--consistent users, inconsistent users, and nonusers--based on their reported condom use. Factor analyses on each gender revealed similar barrier factor structures, but the barriers explained more of the variance in condom use among women than among men. Of the 9 or 10 predictors assessed, the low perceived need barrier was the most powerful predictor of condom use for both genders. Male and female participants who were nonusers, in a current monogamous relationship, and using oral contraceptives were more likely to report a low perceived need to use condoms. Implications for future research are discussed.

Quality of condom use as reported by female clients of a family planning clinic

OBJECTIVES

This study analyzed the prevalence and determinants of the quality of condom use after a woman's first visit to a family planning clinic.

METHODS

This report presents data from 360 female family planning clients who reported using condoms as their primary method of contraception for at least 1 sexually active month during the study's follow-up period after their first clinic visit.

RESULTS

Only 1% always engaged in all five use behaviors studied: using a condom for each sexual intercourse, putting the condom on before first entry, withdrawal after intercourse while there is still an erection, holding on to the condom's rim during withdrawal, and using foam. Multiple linear regression indicated that more effective condom use was reported by women who had not had an induced abortion, were not using condoms just because they were starting oral contraceptive pill regimens, had more knowledge about birth control in general, had received a nursing intervention, and had more communication with their partner.

CONCLUSIONS

Increasing attention needs to be devoted to understanding determinants of the specific actions that differentiate between more and less effective contraceptive use.

Hepatitis B immunization in adolescents

This article reviews the epidemiology of hepatitis B in the United States, previous vaccination strategy, and reasons for its failure and issues leading to the recommendation to vaccinate all adolescents. A review of specific hepatitis B virus risk behaviors of adolescents and barriers to vaccinating adolescents is covered. Strategies that favor successful completion of the immunization series are also examined. Hepatitis B infection is an important public health concern for adolescents. The previous vaccine strategy to immunize only individuals though to be at high risk was unsuccessful, especially because providers of care could not identify these individuals. Furthermore, many individuals thought not to be at high risk for infection were exposed through contacts which could not be identified. Challenges to immunization of adolescents include logistical issues, patient education, cost of the vaccine, and patient compliance. Several of these issues can be addressed by a school-based hepatitis B immunization program. The body of evidence and national policy is rapidly changing to support the recommendation that all adolescents receive the hepatitis B immunization series. The series would be most effective if administered during the middle-school years. A universal adolescent hepatitis B vaccination program would result in the most immediate health benefits and acceleration toward the eradication of hepatitis B in the United States.

Trends in female sexual behaviour and sexually transmitted diseases in London, 1982-1992

OBJECTIVE

To measure changes in female sexual behaviour, including condom use, and their relationship with the incidence of sexually transmitted and other genital diseases in women during the decade 1982-92.

DESIGN

A prospective series of cross-sectional surveys of sexual behaviour reported by a standardised self-administered questionnaire in new patients who presented for screening and diagnosis.

SETTING

A genitourinary medicine clinic in West London.

SUBJECTS

4089 consecutive newly attending patients who completed sexual behaviour questionnaires during 1982, 1987, 1989 and 1992.

MAIN OUTCOME MEASURES

Trends in socio-demographic status, sexual behaviour, condom-use, sexually transmitted diseases and other genital infections diagnosed by routine clinical and laboratory methods.

RESULTS

Women reported significantly increasing condom use (from 3.6% to 20.7%) and decreasing oral contraception (from 51.2% to 40.1%), but the proportion who used no contraception (23.6% to 24.7%) and the proportion who had never been pregnant (58.3% to 59.9%) remained similar. Numbers of sexual partners in the preceding year decreased (p < 0.001) and an increasing proportion of women practised oral intercourse (p < 0.001). During the same period, there was a progressive decline (p < 0.001) in the incidence of gonorrhoea, chlamydial infection and trichomoniasis by approximately two-thirds. However, the incidence of vaginal candidosis (p < 0.001), bacterial vaginosis (p < 0.001) and genital warts (p < 0.01) increased.

CONCLUSIONS

Increasing use of condoms for vaginal intercourse with both regular and non-regular partners has been associated with a decrease in the incidence of gonorrhoea, chlamydial infection and trichomoniasis. There was also an increase in the practice of fellatio and a change in the spectrum of STD and other genital infections with little net reduction in morbidity. HIV infection showed no evidence of heterosexual spread.

A multiyear analysis of changes in AIDS concerns and homophobia on a university campus

The authors studied changes in personal concerns and fears about AIDS and homophobia from 1985 to 1992 among four samples of heterosexual undergraduate students on a university campus. Over time, students' self-reported knowledge about AIDS increased, as did personal worry about HIV infection. Interest in attending an educational program increased initially, then leveled off, and fear of casual contact with people with AIDS decreased. The study findings showed no changes in homophobia. High fear of AIDS was associated with being less informed, having greater concern about infection, and being more homophobic.

Risk of HIV transmission in sexual behaviors of college students

The purpose of this study was to investigate the sexual behaviors of college students and assess the extent to which they were engaging in behaviors that have a risk for contracting AIDS. A total of 132 single sexually active students and 58 married students responded to a survey on their sexual behaviors and attitudes. Risk behaviors such as engaging in unprotected sex, having multiple sex partners, practicing anal sex, alcohol use, and infidelity and deceptive communication with partner were examined. Compared with earlier surveys on the same population, there was an increase in concern about contracting AIDS and a significant increase in the percentage of students who took the AIDS antibody test. Although none indicated they would lie to partners about a seropositive AIDS test, a few would not tell their partner unless specifically asked. A small percentage of subjects would have extradyadic relations without informing their steady partners and a small number of respondents indicated they might continue to engage in sexual relations with a seropositive partner or a new partner who recently had a seronegative AIDS test. The risks most predominant in this sample were the practice of unprotected sex, having multiple sex partners, and the consumption of alcohol in conjunction with sexual activity. With the exception of unprotected intercourse, the majority of respondents were engaging in behaviors that pose a minimal risk for contracting AIDS.

Use of levonorgestrel implants versus oral contraceptives in adolescence: a case-control study

OBJECTIVE

We compared continuation rates, effectiveness, satisfaction with method, side effects, and condom practices among adolescents using levonorgestrel implants (Norplant, Wyeth-Ayerst Laboratories, Philadelphia) as compared with oral contraceptives.

STUDY DESIGN

We conducted a case-control study comparing 94 adolescents < or = 18 years old who received Norplant between March 1, 1992, and Nov. 1, 1993 (cases), with 94 age-matched controls who selected oral contraceptives during this same time period. By use of a structured questionnaire, information was obtained on pregnancy status, duration of use, patient satisfaction, side effects, and condom practices 6 months after initiation. Objective measures included weight on Norplant and oral contraceptive users and hematocrit on implant patients.

RESULTS

Forty (43%) oral contraceptive patients compared with no Norplant patients discontinued their selected method before the 6-month interview (p = 0.00). Six patients prescribed oral contraceptives became pregnant. Ninety-three percent of Norplant users expressed overall satisfaction despite experiencing menstrual irregularity and cramping, amenorrhea, nervousness, abnormal hair growth or loss, rashes, and an increase in appetite more often than oral contraceptive users. Although Norplant patients also reported an increase in the duration of menstrual flow and number of days of spotting more often than oral contraceptive users, evaluation of hematocrits in these patients demonstrated a significant increase over the 6-month period (p = 0.00). Assessment of condom practices since initiation demonstrated that Norplant patients used condoms less often than oral contraceptive users (p = 0.00).

CONCLUSION

Use of levonorgestrel implants may cause more side effects than oral contraceptives in the early months after initiation but provide superior protection against unintended pregnancy. We concluded that Norplant is a reasonable alternative for adolescents, especially when compliance is an issue.