Skin cancer risk behaviors in sexual minority men: A mixed methods approach.

OBJECTIVE: Sexual minority men experience disproportionately elevated rates of skin cancers, likely driven by excess ultraviolet radiation exposure-namely through tanning behaviors. However, limited integrated theoretical models exist to explain sexual minority men's elevated skin cancer risk. The aim of the current study is to further test and refine an integrated theory of skin cancer risk behaviors among sexual minority men by incorporating minority stress into the integrated health behavior model of tanning. METHOD: The study employed a parallel mixed methods design, with a Phase 1 qualitative stage (N = 30) and a Phase 2 quantitative stage (Model 1: N = 320; Model 2: N = 319). In both phases, participants were sexual minority men, equally stratified as those with versus without recent tanning exposure and were recruited from across the United States. RESULTS: Qualitative and quantitative data supported the overall integrated model, with some quantitative paths varying depending on the tanning behavior outcome. Overall, appearance-related motives to tan and beliefs that tanning regulates affect emerged as the most consistent proximal predictors. Minority stress significantly predicted holding more positive attitudes toward tanning as an effective affect regulation strategy. CONCLUSIONS: The results from this mixed methods study support the inclusion of minority stressors into the adapted integrative health behavior model of tanning. Replication within prospective designs would strengthen the evidence for this model, which may be helpful in guiding future skin cancer prevention programs tailored to sexual minority men. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Hypnotizability-related risky experience and behavior.

Risk is the probability of an adverse event. The proneness to take a risk and the risk taking behavior differ among the general population. Hypnotizability is a stable psychophysiological trait expressing the individual proneness to modify perception, memory and behavior following specific suggestions also in the ordinary state of consciousness. Some hypnotizability-related neurophysiological and behavioral correlates suggest that hypnotizability level, measured by standard scales classifying individuals as low (lows), medium (mediums) and high hypnotizable (highs) subjects, can be related to risk propensity and risk-taking. To study whether hypnotizability modulates risk propensity and behavior, we recruited healthy participants, classified through the Standford Hypnotic Susceptibility scale, form A, and compared lows' (n = 33), mediums' (n = 19) and highs'(n = 15) experiential and behavioral risk perception and propensity variables through the Domain-specific risk-taking scale and the Balloon Analogue Risk Task. MANOVA results indicated that different hypnotizability levels are not associated with different risky behavior and experience, except for higher expected financial benefits from risky behavior in lows. However, hypnotizability-related risk profiles were identified through correlational analyses. In fact, highs exhibited a negative association between risk perception and propensity to risk-taking, whereas mediums and lows displayed a positive association between risk propensity and expected benefit. In conclusion, the highs' profile indicates a more automatic behavior with respect to mediums and lows.

Participation in Australian drug treatment programs for individuals engaging in high-risk substance use: Data from a nationally representative sample.

INTRODUCTION: Substance use, including drugs, alcohol and smoking have a significant health, social and economic impact. We aim to assess the rate and factors associated with treatment access among individuals with high-risk substance use. METHOD: This study is a cross-sectional analysis of the 2019 Australian National Drug Strategy Household Survey (N = 22,015). Participants were persons with high-risk substance use based on the Alcohol, Smoking and Substance Involvement Screening Test-Lite (ASSIST-Lite) and current smokers. We measured self-reports of past 12-month engagement in a tobacco, alcohol or other drugs treatment program. RESULTS: Overall, 0.4% had high-risk drug use (0.3% cannabis, 0.1% meth/amphetamine or 0.1% opioids), 7.4% had high-risk alcohol use, and 14.0% currently smoked. Among high-risk users, past 12-month treatment access rates were 50.6% [22.3-78.9%] for opioids, 27.1% [8.1-46.1%] for meth/amphetamine, 14.5% [4.3-24.7%] for cannabis, 9.6% [8.1-11.0%] for alcohol and 11.7% [10.6-12.9%] for current smoking. The primary source of treatment support was information and education (12.7% drugs, 4.6% alcohol, 4.0% smoking), followed by counselling (6.7% drugs, 4.5% alcohol, 3.0% smoking). Online or internet support was accessed by 5.9% (drug) and 1.6% (alcohol) people with high-risk use. Psychological distress was associated with treatment access (drugs: odds ratio 3.03 [0.77-11.95], p = 0.111; alcohol: odds ratio 3.16 [2.20-4.56], p ≤ 0.001; smoking: odds ratio 1.95 [1.52-2.49], p ≤ 0.001). DISCUSSION AND CONCLUSIONS: The proportion of people engaging in risky substance use who had used treatment programs remains low, especially for alcohol. Public health strategies to scale up treatment access are warranted.

The role of emotional sensitivity to missed opportunity and grey matter volume of thalamus in risk-taking behaviour.

The ability to make suitable risky decision is necessary for individuals' survival and development. However, individuals vary in risk preference. The current study, adopting a decision task, aimed to explore the emotional sensitivity to missed opportunity and grey matter volume (GMV) of thalamus in high risk-takers by using voxel-based morphology analysis. In the task, eight boxes should be opened successively. Seven boxes contained coins and one box contained the devil to zero coins. Once stopped, collected and missed (missed opportunity) coins were presented. Participants were divided into high- and low risk-takers according to their risk-taking behaviour in the decision task. We found that high risk-takers showed stronger emotional sensitivity to missed opportunity and smaller GMV of thalamus than low risk-takers. In addition, the GMV of thalamus partially mediated the effect of emotional sensitivity to missed opportunity on risk-taking behaviour among all participants. Overall, the current study highlights the role of emotional sensitivity to missed opportunity and the GMV of thalamus in risk-taking behaviour, which helps us understand the possible reason for the variation among individuals in risk preference.

How Old Is He Really? The Association Between "Gay Age" and Sexual Behaviors Among Men Who Have Sex With Men.

Men who have sex with men (MSM) are disproportionately impacted by HIV and other sexually transmitted infections, with sexual behaviors acting as a primary predictor of disease acquisition. Predictors of engagement in specific sexual behaviors may act as key targets for preventive strategies. We hypothesized that time since first engaging in oral or anal sex with another man, or one's "gay age," is associated with sexual behavior among MSM. We examined 5280 MSM aged 18 to 40 years who were recruited from social and sexual connection Web sites. We used modified Poisson regression to examine associations between gay age and 4 sexual behaviors (enema use, group sex, receptive anal intercourse, insertive anal intercourse). We used time-varying effect models to examine how the prevalence of these behaviors varies across gay age. In total, 76% of participants reported receptive anal intercourse in the past year, and 76% reported insertive anal intercourse. Group sex and enema use in the past year were reported by 39% and 36%, respectively. Modified Poisson and time-varying effect model analyses indicated that the prevalence of enema use, group sex, and insertive anal intercourse significantly increased with increasing gay age. Gay age may serve as an important marker of engagement in sexual behaviors associated with sexually transmitted infection/HIV acquisition among MSM.

Syndemic Conditions and Their Association with HIV/STI Sexual Risk Behaviors Among Transgender Women and Cisgender Men Sex Workers in Catalonia: The SexCohort Project.

BACKGROUND: Transgender women and cisgender men sex workers are vulnerable to HIV and sexually transmitted infections (STIs). This study aimed to explore in depth the prevalence of syndemic conditions and their association with the sexual risk behaviors for HIV/STI acquisition in cis men and trans women sex workers in Barcelona (Catalonia, Spain). METHOD: We conducted a study between 2014 and 2018 to determine whether syndemic conditions (frequent alcohol consumption and polydrug use (> 2) during sex with clients; experience of violence; and lack of healthcare access) are associated with HIV/STI sexual risk behaviors. A "syndemic index" was calculated based on the cumulative number of syndemic conditions (0 to 4). RESULTS: In the last year (2018), 78.8% of cisgender men and 68.1% of transgender women reported at least one syndemic condition. The most prevalent syndemic factor in both cisgender men and transgender women was violence (38.8% and 43.6% respectively). In multivariable analysis, an association was found between condomless anal sex and violence (aOR = 1.81), and frequent alcohol consumption and violence with reporting > 10 clients/week (aOR = 2.73 and 1.88, respectively). The higher the number of syndemic factors, the greater probability of having > 10 clients/week and reporting condomless anal sex with clients. CONCLUSION: Psychosocial conditions have a syndemic effect on risky sexual behaviors highlighting the need for a more holistic approach to HIV/STI prevention targeting these populations.

A meta-analytic review of the effectiveness of mood inductions in eliciting emotion-based behavioral risk-taking and craving in the laboratory.

Urgency research supports the role of emotions in risk-taking and craving. However, much of this work is based in self-report. It is not yet known whether existing experimental methods can effectively induce emotion-based risk-taking and craving. The present meta-analysis quantified the effectiveness of mood inductions in inducing risk-taking and craving in the laboratory. We also examined potential moderators, including participant factors, changes in emotional arousal, and study design factors. For negative mood inductions, the degree of changes in risk-taking, k = 35, Hedge's g (SE) = .12 (.04), 95% CI [.04, .21], and craving, k = 37, Hedge's g (SE) = .30 (.06), 95% CI [.19, .40] were small. Increases in emotional arousal were significantly related to increases in craving (B* = .26). For positive mood inductions, there was no significant change in risk-taking, k = 18, Hedge's g (SE) = .17 (.11), 95% CI [-.04, .38] nor craving, k = 8, Hedge's g (SE) = -.10 (.10), 95% CI [-.31, .10]; however, false positive feedback produced the largest increase in risk-taking. Study samples using guided imagery produced a moderate decrease in risk-taking. Overall, existing negative mood inductions increased risk-taking and craving in the laboratory to a small degree. Existing positive mood inductions failed to elicit risk-taking or craving, although the literature in this domain was sparser. We suggest that there is a great need to develop and optimize mood induction methods to better study emotion-based risk-taking and craving in the laboratory. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Prévention au premier trimestre de la grossesse : perspective des professionnels.

INTRODUCTION: The environment and living conditions of parents during the "first 1000 days" period influence the short- and long-term health trajectories of children. Professionals following pregnancies play an important role in advising future parents to adopt health-promoting behaviors. It appeared necessary to describe the prevention messages transmitted by professionals early in pregnancy. OBJECTIVES: To identify the prevention messages systematically delivered during the first trimester of pregnancy and determine the degree of priority that professionals (midwives, obstetricians, general practitioners) of Bourgogne-Franche-Comté give to them. RESULTS: Prevention messages on infectious risk were addressed by 96.5% of respondents, and those on risk behaviors and addictions by 93.7%. Dietary balance and sports activities (78.5%), as well as risks in the daily life (47.1%) were less delivered. The messages that professionals declared to be delivered systematically to pregnant women during the first trimester were generally those that they considered to be priorities. There were some differences depending on the professional. Regarding information media, the majority of respondents did not use any. They agreed on the importance of a paper-based information medium and wished to be able to rely on a digital medium (62.6%). CONCLUSION: The co-construction of support that meets the needs of both women and professionals and that is validated by health authorities would contribute to better consideration and promotion of health-promoting behaviors by parents, by promoting empowerment of women and couples from the beginning of pregnancy.

Effectiveness of a Cognitive Behavioral Randomized Controlled Trial for People Living with HIV Who are Heavy Drinkers: The Holistic Health Recovery Program (HHRP) Trial in Miami.

This study evaluates the impact of an intervention targeting high-risk behaviors among diverse, alcohol-using adults living with HIV (N = 267) from 2009 to 2013 in Miami, FL. The intervention took place in a group setting for eight sessions over 4 weeks and was compared to a didactic health promotion group. Assessments were conducted pre-intervention, post-intervention, and at 3, 6, and 12 months follow-up. Intervention participants (48% of sample) evidenced greater knowledge about HIV, more condom self-efficacy, and greater intentions to use condoms after participation. This was particularly noteworthy because associations among knowledge about HIV, more condom self-efficacy, and greater intentions to use condoms were negatively associated with intervention status at baseline. Participants also reported fewer heavy drinking days after participating in the intervention than those in the control group. Greater HIV knowledge, more condom self-efficacy and intentions to use condoms predicted more condom assertiveness; greater intentions to use condoms predicted fewer unprotected sexual behaviors. These findings underscore the importance of taking a comprehensive, multi-systemic approach to address risky behaviors in high-risk, diverse populations.

Learned self-regulation in top-level managers through neurobiofeedback training improves decision making under stress.

Top-level management teams are particularly exposed to stress factors as they frequently have to make important decision under stress. While an existing body of research evidence suggests that stress negatively affects decision-making processes, very little is known about possible strategies to reduce these negative effects. The aim of the current work is to investigate the effect of training self-regulation ability through neurobiofeedback on managers' intertemporal and risky decision making. Twenty-three managers were assigned to the experimental or the control condition. All participants performed, two decisional tasks, before and after a training phase. The tasks were administered through mouse tracker software, in order to measure participants' delay discounting and risk taking propensity on both explicit and implicit choice parameters. During the training phase, the experimental condition received a training protocol based on stress assessment tests via neurobiofeedback signals (i.e., temperature and skin conductance), with the goal of improving self-regulation ability while the control condition was administered a control training. The main result of this study is to have conclusively demonstrated that NBF training increases an individual's ability to self-regulate stress-related psychophysiological phenomena. Consequently, the improved ability to manage one's own reaction to stress enables a reduction in instinctive behavior during a probabilistic choice task.

Effects of the psychoactive compounds in green tea on risky decision-making.

Epigallocatechin-3-gallate (EGCG) and caffeine are the two primary compounds found in green tea. While EGCG has anxiolytic and anti-inflammatory effects, its acute effects on cognition are not well understood. Furthermore, despite widespread green tea consumption, little is known about how EGCG and caffeine co-administration impacts behavior. Here, we investigated the effects of multiple doses of either EGCG or caffeine on a rat model of risk-taking. This was assessed using the risky decision-making task (RDT), in which rats choose between a small, well-tolerated reward and a large reward with escalating risk of mild footshock. Rats were tested in RDT after acute systemic administration of EGCG, caffeine or joint EGCG and caffeine. EGCG caused a dose-dependent reduction in risk-taking without affecting reward discrimination or task engagement. Caffeine did not impact risk-taking, but elevated locomotor activity and reduced task engagement at high doses. Finally, exposure to both EGCG and caffeine had no effect on risk-taking, suggesting that low-dose caffeine is sufficient to mask the risk-aversion caused by EGCG. These data suggest EGCG as a potential therapeutic treatment for psychological disorders that induce compulsive risky decision-making.

Sexually Transmitted Infections in the U.S. Military: A Sexual Health Paradigm to Address Risk Behaviors, Unintended Pregnancy, Alcohol Use, and Sexual Trauma.

To address the ongoing epidemic of sexually transmitted infections (STIs) in the United States, the National Academies of Sciences, Engineering, and Medicine (National Academies) conducted a consensus study on STI control and prevention in the United States to provide recommendations to the Centers for Disease Control and Prevention and the National Association of County and City Health Officials. The culminating report identified military personnel as one of the priority groups that require special consideration given the high prevalence of STIs and their associated behaviors (e.g., concurrent sexual partners and infrequent condom use) that occur during active duty service. Universal health care access, the relative ease and frequency of STI screening, and the educational opportunities within the military are all assets in STI control and prevention. The report offers a comprehensive framework on multiple and interrelated influences on STI risk, prevention, health care access, delivery, and treatment. It also provides an overview of the multilevel risk and protective factors associated with STIs that could be applied using a sexual health paradigm. The military context must integrate the multilevel domains of influences to guide the effort to fill current gaps and research needs. The Department of Defense, with its large clinical and preventive medicine workforce and its well-established universal health care system, is well positioned to enact changes to shift its current approach to STI prevention, treatment, and control. STI control based on highlighting behavioral, social, cultural, and environmental influences on service members' sexual health and wellness may well drive better STI care and prevention outcomes.

An observational study of Internet behaviours for adolescent females following sexual abuse.

Child sexual abuse (CSA) is associated with revictimization and sexual risk-taking behaviours. The Internet has increased the opportunities for teens to access sexually explicit imagery and has provided new avenues for victimization and exploitation. Online URL activity and offline psychosocial factors were assessed for 460 females aged 12-16 (CSA = 156; comparisons = 304) with sexual behaviours and Internet-initiated victimization assessed 2 years later. Females who experienced CSA did not use more pornography than comparisons but were at increased odds of being cyberbullied (odds ratio = 2.84, 95% confidence interval = 1.67-4.81). These females were also more likely to be represented in a high-risk latent profile characterized by heightened URL activity coupled with problematic psychosocial factors, which showed increased odds of being cyberbullied, receiving online sexual solicitations and heightened sexual activity. While Internet activity alone may not confer risk, results indicate a subset of teens who have experienced CSA for whom both online and offline factors contribute to problematic outcomes.

Spirituality of hopeful risk-taking (Bahala na) among Filipino healthcare workers.

BACKGROUND: Mental health problems are prevalent among medical frontliners, as demonstrated in the study by Ghaleb et al. in the case of the Eastern Mediterranean Region. As mental health can be strengthened by spirituality, this study probed into the spirituality of bahala na of overseas Filipino health care workers. METHODOLOGY: A phenomenological research was conducted that includes an interview of 17 Filipino Catholic migrant nurses in five countries, on the situations when they find themselves exclaiming "bahala na" in their work as frontliners, and what this means for them. RESULTS: Affirming the notion of bahala na as an expression of hopeful risk-taking, the study showed that the nurses usually exclaim bahala na when they have done everything in their power in a given situation and they are now leaving the rest to God. The spirituality of bahala na helped the nurses face the stresses brought about by the pandemic, and when tapped, can further aid them in fighting against institutional racism to promote health equity in the medical community.

Mind training, stress and behaviour-A randomised experiment.

In this paper, we evaluate the effects of a psychological training, called Mindfulness-Based Stress Reduction (MBSR) on stress and risk and time preferences. MBSR is a well-known psychological technique, which is believed to improve self-control and reduce stress. We conduct the experiment with 139 participants, half of whom receive the MBSR training, while the other half are asked to watch a documentary series, both over 4 consecutive weeks. Using a range of self-reported and physiological measures (such as cortisol measures), we find evidence that mindfulness training reduces perceived stress, but we only find weak evidence of effects on risk and inter-temporal attitudes.

Youth susceptibility to tobacco use: is it general or specific?

BACKGROUND: Susceptibility to tobacco use predicts tobacco use onset among youth. The current study aimed to estimate the extent of overlap in susceptibilities across various tobacco products, investigate sociopsychological correlates with susceptibilities, and examine whether the relationship linking susceptibility with the onset of use is product-specific or is accounted for by a general susceptibility-onset relationship. METHODS: The study population consisted of US youth 12-17 years old who had never used a tobacco product, sampled in the longitudinal Population Assessment of Tobacco and Health study wave 4 (Dec. 2016-Jan. 2018; n = 10,977). Tobacco product-specific susceptibility at wave 4 was assessed via questions about curiosity, likelihood to try, and likelihood of use if a best friend offered. The onset of use of various tobacco products was defined as first use occurring between the wave 4 and wave 4.5 (Dec. 2017-Dec. 2018) assessments (n = 8841). Generalized linear regression and structural equation models were used for data analysis. RESULTS: There is a large degree of overlap in susceptibilities across tobacco products (65% of tobacco-susceptible youth were susceptible to more than one tobacco product). Tobacco-susceptible youths were more likely to have recently used cannabis, consumed alcohol, or to have been associated with tobacco-using peers. Structural equation models suggest that the susceptibility-onset relationship largely operates in a non-product-specific manner after accounting for the general susceptibility-to-tobacco-onset relationship. CONCLUSIONS: Youth susceptibility to tobacco use overlaps widely across different tobacco products and other risky behaviors. Findings from this study support a holistic approach towards the prevention of risk behaviors, supplemented by product-specific strategies when needed.

Supplemental findings of the 2019 National Blood Collection and Utilization Survey.

INTRODUCTION: Supplemental data from the 2019 National Blood Collection and Utilization Survey (NBCUS) are presented and include findings on donor characteristics, autologous and directed donations and transfusions, platelets (PLTs), plasma and granulocyte transfusions, pediatric transfusions, transfusion-associated adverse events, cost of blood units, hospital policies and practices, and implementation of blood safety measures, including pathogen reduction technology (PRT). METHODS: National estimates were produced using weighting and imputation methods for a number of donors, donations, donor deferrals, autologous and directed donations and transfusions, PLT and plasma collections and transfusions, a number of crossmatch procedures, a number of units irradiated and leukoreduced, pediatric transfusions, and transfusion-associated adverse events. RESULTS: Between 2017 and 2019, there was a slight decrease in successful donations by 1.1%. Donations by persons aged 16-18 decreased by 10.1% while donations among donors >65 years increased by 10.5%. From 2017 to 2019, the median price paid for blood components by hospitals for leukoreduced red blood cell units, leukoreduced apheresis PLT units, and for fresh frozen plasma units continued to decrease. The rate of life-threatening transfusion-related adverse reactions continued to decrease. Most whole blood/red blood cell units (97%) and PLT units (97%) were leukoreduced. CONCLUSION: Blood donations decreased between 2017 and 2019. Donations from younger donors continued to decline while donations among older donors have steadily increased. Prices paid for blood products by hospitals decreased. Implementation of PRT among blood centers and hospitals is slowly expanding.

Genetic underpinnings of risky behaviour relate to altered neuroanatomy.

Previous research points to the heritability of risk-taking behaviour. However, evidence on how genetic dispositions are translated into risky behaviour is scarce. Here, we report a genetically informed neuroimaging study of real-world risky behaviour across the domains of drinking, smoking, driving and sexual behaviour in a European sample from the UK Biobank (N = 12,675). We find negative associations between risky behaviour and grey-matter volume in distinct brain regions, including amygdala, ventral striatum, hypothalamus and dorsolateral prefrontal cortex (dlPFC). These effects are replicated in an independent sample recruited from the same population (N = 13,004). Polygenic risk scores for risky behaviour, derived from a genome-wide association study in an independent sample (N = 297,025), are inversely associated with grey-matter volume in dlPFC, putamen and hypothalamus. This relation mediates roughly 2.2% of the association between genes and behaviour. Our results highlight distinct heritable neuroanatomical features as manifestations of the genetic propensity for risk taking.

Impaired working memory, cognitive flexibility and reward processing in mice genetically lacking Gpr88: Evidence for a key role for Gpr88 in multiple cortico-striatal-thalamic circuits.

The GPR88 orphan G protein-coupled receptor is expressed throughout the striatum, being preferentially localised in medium spiny neurons. It is also present in lower densities in frontal cortex and thalamus. Rare mutations in humans suggest a role in cognition and motor function, while common variants are associated with psychosis. Here we evaluate the influence of genetic deletion of GPR88 upon performance in translational tasks interrogating motivation, reward evaluation and cognitive function. In an automated radial arm maze 'N-back' working memory task, Gpr88 KO mice showed impaired correct responding, suggesting a role for GPR88 receptors in working memory circuitry. Associative learning performance was similar to wild-type controls in a touchscreen task but performance was impaired at the reversal learning stage, suggesting cognitive inflexibility. Gpr88 KO mice showed higher breakpoints, reduced latencies and lengthened session time in a progressive ratio task consistent with enhanced motivation. Simultaneously, locomotor hyperactivity was apparent in this task, supporting previous findings of actions of GPR88 in a cortico-striatal-thalamic motor loop. Evidence for a role of GPR88 in reward processing was demonstrated in a touchscreen-based equivalent of the Iowa gambling task. Although both Gpr88 KO and wild-type mice showed a preference for an optimum contingency choice, Gpr88 KO mice selected more risky choices at the expense of more advantageous lower risk options. Together these novel data suggest that striatal GPR88 receptors influence activity in a range of procedures integrated by prefrontal, orbitofrontal and anterior cingulate cortico-striatal-thalamic loops leading to altered cognitive, motivational and reward evaluation processes.

Sexual risk-taking among homeless young people in Pakistan.

Homeless young people who engage in sex work are at increased risk of HIV and other sexually transmitted infections like chlamydia, gonorrhoea, syphilis and herpes. Semi-structured interviews were conducted with 29 homeless young people between the ages of 16 and 25 years from Rawalpindi, Pakistan, to explore how sexual practices were mediated through social and contextual conditions. Participants engaged in sex for a range of reported reasons, most commonly to generate income, but also to build intimacy and to establish intimate partnerships which could bring physical protection and social and emotional support. Although participants were aware of the sexual health risks attached to condomless sex, they engaged in it due to the social obligations of intimate partnerships, financial considerations and to better manage potentially violent situations. Instead of condoms, participants used alternate methods like withdrawal, oral sex, post-sex douching and specific sexual positions. These were not always useful, and some methods might have inadvertently increased their risk of HIV. The study findings suggest that an integrated health promotion approach that goes beyond the health sector and a singular emphasis on risk awareness may help reduce young people's risk of homelessness and sexual health risks.