Gay identity, interpersonal violence, and HIV risk behaviors: an empirical test of theoretical relationships among a probability-based sample of urban men who have sex with men.

The highest absolute number of new HIV infections and AIDS cases still occur among men who have sex with men (MSM). Numerous theoretical approaches have been used to understand HIV risk behaviors among MSM; however, no theoretical model examines sexual risk behaviors in the context of gay identity and interpersonal violence. Using a model testing predictive correlational design, the theoretical relationships between childhood sexual abuse, adverse early life experiences, gay identity, substance use, battering, aversive emotions, HIV alienation, cue-to-action triggers, and HIV risk behaviors were empirically tested using confirmatory factor analysis and structural equation modeling. The relationships between these constructs are complex, yet childhood sexual abuse and gay identity were found to be theoretically associated with HIV risk behaviors. Also of importance, battering victimization was identified as a key mediating variable between childhood sexual abuse, gay identity, and adverse early life experiences and HIV risk behaviors among urban MSM.

The impact of health information on the Internet on health care and the physician-patient relationship: national U.S. survey among 1.050 U.S. physicians.

BACKGROUND: Public use of the Internet for health information is increasing but its effect on health care is unclear. We studied physicians' experience of patients looking for health information on the Internet and their perceptions of the impact of this information on the physician-patient relationship, health care, and workload. METHODS: Cross-sectional survey of a nationally-representative sample of United States physicians (1050 respondents; response rate 53%). RESULTS: Eighty-five percent of respondents had experienced a patient bringing Internet information to a visit. The quality of information was important: accurate, relevant information benefited, while inaccurate or irrelevant information harmed health care, health outcomes, and the physician-patient relationship. However, the physician's feeling that the patient was challenging his or her authority was the most consistent predictor of a perceived deterioration in the physician-patient relationship (OR = 14.9; 95% CI, 5.5-40.5), in the quality of health care (OR = 3.4; 95% CI, 1.1-10.9), or health outcomes (OR = 5.6; 95% CI, 1.7-18.7). Thirty-eight percent of physicians believed that the patient bringing in information made the visit less time efficient, particularly if the patient wanted something inappropriate (OR = 2.5; 95% CI, 1.5-4.4), or the physician felt challenged (OR = 3.6; 95% CI, 1.8-7.2). CONCLUSIONS: The quality of information on the Internet is paramount: accurate relevant information is beneficial, while inaccurate information is harmful. Physicians appear to acquiesce to clinically-inappropriate requests generated by information from the Internet, either for fear of damaging the physician-patient relationship or because of the negative effect on time efficiency of not doing so. A minority of physicians feels challenged by patients bringing health information to the visit; reasons for this require further research.

The impact of health information on the internet on the physician-patient relationship: patient perceptions.

BACKGROUND: Use of the Internet for health information continues to grow rapidly, but its impact on health care is unclear. Concerns include whether patients' access to large volumes of information will improve their health; whether the variable quality of the information will have a deleterious effect; the effect on health disparities; and whether the physician-patient relationship will be improved as patients become more equal partners, or be damaged if physicians have difficulty adjusting to a new role. METHODS: Telephone survey of nationally representative sample of the American public, with oversample of people in poor health. RESULTS: Of the 3209 respondents, 31% had looked for health information on the Internet in the past 12 months, 16% had found health information relevant to themselves and 8% had taken information from the Internet to their physician. Looking for information on the Internet showed a strong digital divide; however, once information had been looked for, socioeconomic factors did not predict other outcomes. Most (71%) people who took information to the physician wanted the physician's opinion, rather than a specific intervention. The effect of taking information to the physician on the physician-patient relationship was likely to be positive as long as the physician had adequate communication skills, and did not appear challenged by the patient bringing in information. CONCLUSIONS: For health information on the Internet to achieve its potential as a force for equity and patient well-being, actions are required to overcome the digital divide; assist the public in developing searching and appraisal skills; and ensure physicians have adequate communication skills.

A randomized comparison of A-CASI and phone interviews to assess STD/HIV-related risk behaviors in teens.

PURPOSE: To compare response bias associated with a telephone survey of sexually transmitted disease/human immunodeficiency virus (STD/HIV)-related risk behaviors and an in-home self-administered audio computer assisted self interview (A-CASI). METHODS: We randomly assigned an urban household sample of 223 African-American adolescents to a telephone interview or an A-CASI in their home. The sample was previously recruited by telephone for an earlier study regarding STDs and sexual behavior. We queried participants about their STD/HIV-related risk behaviors. We also assessed their perceived comfort, honesty, and accuracy in answering questions in the different modes through a telephone computer-assisted self-interview (T-CASI). RESULTS: There were no significant differences by mode in percentages of participants reporting STD/HIV-related risk behaviors, except more A-CASI participants reported having engaged in sexual intercourse in past 3 months (43.8% vs. 33.3%). There were no differences in perceived comfort, honesty, and accuracy in answering questions in the different modes. These results also did not change after we adjusted for age, household structure, and current school enrollment. CONCLUSIONS: Telephone interviews, a more economical mode, can be employed without much risk of increasing the response bias in the data assessing crude measures of risk.