Condom use among high-risk adolescents: anticipation of partner disapproval and less pleasure associated with not using condoms.

OBJECTIVE: We determined the association of demographic, psychosocial, and contextual factors with condom use among a large community sample of at-risk adolescents recruited from four locations in the U.S. METHODS: We enrolled 1,410 adolescents/young adults between the ages of 15 and 21 with a history of unprotected sex in the past 90 days at four study sites. Subjects completed an audio-assisted, computerized assessment that gathered information about sexual behavior and its contexts, substance use, and relevant risk and protective attitudes. RESULTS: Nearly two-thirds of adolescents did not use condoms at the time of last intercourse and adolescents reported a mean of 15.5 (median = 5) unprotected intercourse occasions in the past 90 days. Controlling for relevant demographic variables, not using condoms was associated with the perception that condoms reduce sexual pleasure, the perception that partners will not approve of condom use, and less discussion with partners about condoms. CONCLUSIONS: Even across racial/ethnic groups, gender, and geographic locations, several important correlates of adolescents' sexual risk reduction were identified. Many adolescents may feel that condoms reduce their sexual pleasure and fear partner reactions if they initiate condom use. These attitudes may be malleable through clinical and community-based interventions.

Outcomes of an asthma program: Healthy Children, Healthy Homes.

PURPOSE: To test the effects of the Healthy Children Healthy Homes program on community perception of susceptibility and severity of asthma, knowledge of common household asthma triggers, misconceptions about asthma, and reported behaviors to control asthma triggers. DESIGN: Quasi experimental study with pre-post survey conducted in English and Spanish. LOCATION: Catholic elementary school community in northern Miami, Florida. SELECTION AND SAMPLE: Convenience sample of 15 Asthma Amigo participants, and pre-post survey sample of 100 parents, teachers, and school staff. INTERVENTION: Program consists of two 90-minute educational sessions with Asthma Amigos, 8-week diffusion of asthma information in the community, educational sessions with 276 school children (grades 1 to 8), and an asthma fair. FINDINGS: Compared to pre-intervention, post-intervention data indicated significantly greater perceived asthma susceptibility and knowledge about common household triggers and fewer asthma misconceptions. CONCLUSIONS: Healthy Children Healthy Homes program can be a valuable tool in asthma prevention and management.

The relationship between self-reported sexual orientation and behavior in a sample of middle-aged male injection drug users.

Data are sparse on injection drug using (IDU) men who have sex with men (MSM). Previous literature suggests perceived taboos can result in an underreporting of atypical sexual orientation (i.e., bisexuality, homosexuality). As a result, HIV prevention programs have been difficult to mount, particularly programs for IDU-MSM. The association between self-reported sexual orientation and sexual behavior at semi-annual study visits was longitudinally assessed in a population of 1300 male IDUs in Baltimore during the period 1993 to 1998. Overall, a small minority (5%) of the male IDUs inconsistently reported their sexual orientation over time. Logistic regression analyses were performed, which yielded five significant predictors. These men tended to be older, to have been incarcerated, to have attended shooting galleries during follow-up, and were more than twice as likely to be HIV-seropositive (OR, 2.66; 95% CI, 1.62-4.36) compared with those who consistently reported their sexual orientation. Furthermore, men reporting inconsistent sexual orientation tended to engage in higher risk behaviors, suggesting that these men should be especially targeted for interventions.

Prognostic factors for survival differ according to CD4+ cell count among HIV-infected injection drug users: pre-HAART and HAART eras.

To identify prognostic indicators of survival at different CD4 cell levels, independent of highly active antiretroviral therapy (HAART), among injection drug users (IDUs). A community-recruited cohort of injection drug users followed semiannually from 1988 through 2000. Five partially overlapping subcohorts were defined by when participants first reached a CD4 cell level of 351 to 500, 201 to 350, 101 to 200, 51 to 100, or

Promoting HIV testing among never-tested Hispanic men: a doctor's recommendation may suffice.

This study examined factors associated with HIV testing intentions among a community sample of 255 never-tested Hispanic men. It compared (1) men who intended to test in the next 6 months with those who did not and (2) men who intended to test only on the day of the interview with those who intended to test in the next 6 months. Eighty-four percent of men had never been offered testing. Yet, 86% would accept testing if recommended by their doctor. The strongest multivariate predictor of testing intention was willingness to accept a physician-endorsed test. Almost 49% of men who intended to test in the next 6 months would only do so if the test were offered on the interview day. These findings highlight the importance of encouraging physicians, particularly in high-prevalence areas, to routinely recommend testing. They also suggest that for some men, there is a window of opportunity for testing that does not endure.

A cohort study of health effects of human T-cell lymphotropic virus type I infection in Jamaican children.

OBJECTIVE: Human T-cell lymphotropic virus type I (HTLV-I) infection in childhood is believed to play an important role in risk for adult T-cell leukemia/lymphoma. Although HTLV-I is known to be associated with infective dermatitis in childhood, other HTLV-I-associated morbidity in children has not been well studied. We sought to determine the HTLV-I-associated health effects in Jamaican children. METHODS: We compared incidence rates of several health outcomes in 28 HTLV-I-infected and 280 uninfected children clinically followed from age 6 weeks to a maximum of 10 years. Cox proportional hazards regression analysis was used to analyze these prospectively collected data, adjusting for confounding effects of other variables as necessary. RESULTS: HTLV-I-infected children had significantly higher incidence rates of seborrheic dermatitis (rate ratio [RR] = 4.8, 95% confidence interval [CI] = 1.9-12.5), eczema (RR = 3.1, CI = 1.2-7.9) and persistent hyperreflexia (RR = 3.7, CI = 1.6-8.2). Additionally, HTLV-I infected children had increased rates of severe anemia (RR = 2.5, CI = 0.8-7.9) and abnormal lymphocytes (RR = 2.4, CI = 0.8-7.6) that were of borderline statistical significance. CONCLUSIONS: Our study suggests that HTLV-I-associated skin diseases of childhood may include seborrheic dermatitis and eczema. Additionally, these data suggest that persistent hyperreflexia of the lower limbs may be an early sign of HTLV-I-associated neurologic involvement in children. Expansion and continued clinical observation of this cohort would be valuable.

Self-efficacy estimates for drug use practices predict risk reduction among injection drug users.

We used baseline outcome efficacy (OE) estimates for human immunodeficiency virus (HIV) risk reduction to predict subsequent risk reduction 6 months hence among 792 injection drug users in a prospective study. Declines in drug use, frequency of injection, and needle sharing were found among those with high OE scores after adjustment for baseline behavior and antecedent factors. No OE effect was found in multivariate analysis for shooting gallery attendance, a risk that substantially declined in this cohort. OE for needle disinfection was associated with reduced drug risk behaviors, but not for improved needle hygiene practices over time. The self-efficacy model is useful in understanding psychological factors in risk reduction among injection drug users.