Cuban healthcare providers in Venezuela: a case study.

Approximately 31,000 Cuban healthcare providers reside in Venezuela as part of an initiative to increase Venezuelans' access to health care. The concept began in 1999 as part of the new constitution, and has grown steadily to include 6000 clinics, health promotion and prevention programmes, an integrated healthcare system, and a vision to train and deploy community public health physicians selected from and trained within the neighbourhood. In the case study described herein, physician-patient consultations increased from 3.5 million to 17 million, and the numbers of primary care physicians, nurses and dentists increased dramatically. Furthermore, in Caracas, there has been a 30% reduction in the use of emergency rooms at public hospitals. Estimates are provided for preventive services and potential lives saved. As health care is a politically-laden issue in many countries, all approaches to reducing healthcare disparities are worth analysing for their potential contributions to population health improvement.

Health risk behavior of rural secondary school students in Zimbabwe.

A socioculturally appropriate health risk behavior instrument, modeled after the U.S. Centers for Disease Control and Prevention's Youth Risk Behavior Survey (YRBS), was administered to 717 secondary school students in a rural area of Zimbabwe. Comparisons of risk behaviors by gender and school grade were made using univariate procedures and multiple logistic regression. Males were significantly more likely than females to have had sexual intercourse (odds ratio = 5.02, p < .0001) and to report drug use behaviors. Males also were significantly more likely to report early initiation (by age 13 years) of alcohol use, cigarette smoking, and marijuana use. School site violence and drug use behaviors also were prevalent in this sample. An interaction between gender and grade was evident for some behaviors. Additional research may further the understanding of these risk behaviors and facilitate development of effective, culturally relevant risk reduction programs.

Alcohol attitudes and beliefs related to actual alcohol experience in a fifth-grade cohort.

Despite a gradual overall decrease in alcohol consumption in the United States, alcohol remains the most widely used and abused drug in society. This study assessed lifetime and recent alcohol use in a cohort of fifth graders, and examined attitudes and beliefs held by these youth concerning alcohol. An instrument addressing alcohol use, other substance use, and other health-related problem behaviors was completed by 813 fifth graders in a west central Florida school district. Among respondents, 48.9% had "ever tried" alcohol, and 17.9% had consumed alcohol in the past 30 days (active drinkers). Significant differences in alcohol-related attitudes and beliefs were found according to current drinking status, gender, and race/ethnicity. Possible reasons for these differential findings are presented, and implications for prevention and intervention are discussed.

An academic paradox: high school students' perceptions of their class standing and self-reported risk-taking.

The centers for Disease Control and Prevention (CDC) administered its 75-item 1991 Youth Risk Behavior Surveillance survey to a nationwide random sample of 12,248 high school students. In a secondary analysis of their data, one item on students' perceived class standing, was compared with selected health risk-taking practices. The 7.7% of students who indicated that they were "below the middle" in comparison with their classmates reported more participation in all risk-taking behaviors than students who reported being "in the middle" (28.6%) or "above the middle" (63.7%). Students' grades, ages, and ethnicity showed significant differences, with younger students and selected ethnocultural minority students more likely to report being "below the middle." Perceived class standing may be a proxy measure for estimating participation in health-compromising practices.

Restricting smoking at the University of Köln, Germany: a case study.

The effects of a new policy limiting smoking to separate, designated areas in School of Education buildings at the University of Köln, Germany, were analyzed. Although the majority (77%) of the 1,223 students surveyed did not expect the changed policy to affect their smoking habits, approximately 28% of the men and 30% of the women said they were smoking less at the university after the change went into effect. Ninety-one percent of the nonsmoking students and 68% of the smokers supported the new policy. Smoking rates among Köln students are not significantly different from those of the adult German population, where 34% of the women and 41% of the men are smokers. The findings in this study indicate that such a policy change may result in a net decrease in amount smoked and could be a successful intervention in countries where smoking rates are traditionally higher than they are in the United States.

Acquisition of high-risk behavior by African-American, Latino, and Caucasian middle-school students.

The purpose of this study was to measure the stages of acquisition of selected high-risk health behaviors in 768 randomly selected 7th- and 8th-graders in a Florida school district. Specific high-risk health behaviors included use of alcohol, tobacco, and drugs, fighting and weapon carrying, and suicide ideation. Analysis indicated few behaviors that were significantly different when African-American and Latino students were compared with Caucasian students. The most weapon carrying was reported by Latinos. Fewer Caucasian students than their minority peers used inhalants. Knowledge of stages of acquisition among small diverse samples may assist school personnel to intervene during the inculcation process with appropriate responsive programs.

HIV risk behaviors: a comparison of U.S. Hispanic and Dominican Republic youth.

Sexual behaviors of adolescents place them at a high risk for HIV infection and other sexually transmitted diseases. International comparisons of sexual risk-taking among youth employing a common set of survey items are rare. Moreover, such studies can assist in explaining observed differences in disease rates, or predicting future trends in transmission, and identifying health educational needs unique to a particular population or setting. To assess variations in risk-taking patterns, a comparison of HIV behavioral risk factors was made between U.S. Hispanic and Dominican Republic (D.R.) youth. The Spanish version of the Youth Risk Behavior Surveillance (YRBS) survey was administered to 1,175 D.R. high school students. Responses were compared to those in the U.S. from the Centers for Disease Control and Prevention's 1990 YRBS data tape for 2285 Hispanic youth. Frequency and cross-tabulation data were compared by country and gender. There were significant differences in AIDS education at school, discussions about AIDS conducted in the home, age of first sexual experience, condom use, and past experience with STDs. Results show that adolescents in both countries are at risk, but with different mediating factors. Inadequate condom use and early initiation of sex place the D.R. youth at risk, while more U.S. youth are engaging in sexual intercourse and using alcohol or other drugs in conjunction with sexual episodes. Some implications for prevention education are discussed.

PIP: A comparison of human immunodeficiency virus (HIV) risk factors between US Hispanic and Dominican Republic youth indicated sexual intercourse under the influence of drugs and alcohol places the former group at risk, while early initiation of sex and inadequate condom use are the main risk factors in the latter group. The data on 2285 US Hispanic adolescents (mean age, 15.6 years) were derived from the 1990 Youth Risk Behavior Surveillance survey. A Southeastern-Puerto Rican version of this survey was administered to 1175 Dominican Republic youth (mean age, 16.8 years). 78.5% of US Hispanic youth and 59.9% of Dominican youth had been taught about acquired immunodeficiency syndrome (AIDS) in school, and 51.5% and 70.9%, respectively, had discussed AIDS at home. 54.1% of US teens (66.0% of males and 43.6% of females) and 31.0% of Dominican respondents (61.2% of males and 10.0% of females) were sexually active. 15% of US Hispanics had engaged in sex before 13 years of age, while 30.4% of Dominicans were sexually active by 12 years of age. Four or more life-time sexual partners were reported by 31.1% of US and 37.6% of Dominican youth. US Hispanics were more likely than Dominicans to have used drugs or alcohol prior to the most recent sexual intercourse (24.8% vs. 10.8%, respectively). The frequencies of condom use during the most recent intercourse were 38% and 34%, respectively. Continued unprotected sexual activity in this age group can have profound effects on the growth curve of HIV, suggesting a need for earlier and better sex education programs.

Sexual risk-taking by Muscovite youth attending school.

Sexual behaviors of adolescents place them at a high risk for HIV and other sexually transmissible infections. Studies of sexual risk-taking and other health compromising practices by youth in countries other than the United States are relatively rare. Examination of health practices across cultures provides insights with respect to explaining international differences in disease rates, helps predict future trends in disease transmission, and identifies health education needs of particular populations or settings. Sexual behavioral risk factors were studied in a sample of 1,090 youth (mean age = 14 years) in Moscow using a translated version of the Youth Risk Behavior Surveillance (YRBS) survey developed by the U.S. Centers for Disease Control and Prevention. Only 26.3% of Muscovite youth report being taught about HIV/AIDS infection in school, and just 41.7% indicate discussion of HIV/AIDS occurred with parents or other familial adults. Overall, 15.7% of females and 23.7% of males report at least one sexual intercourse in their lifetime. About 8.8% of the sample reported participation in sexual intercourse before age 12, and 34.9% indicated having had sexual intercourse with four or more partners. Concomitant use of alcohol and other drugs is common (24.4%) prior to the most recent intercourse, and use of a condom occurs in fewer than half (41.7%) of recent sexual episodes.

Establishing health status indicators by surveying youth risk behaviors of high school students in the dominican republic.

The purpose of this survey was to determine the health-risk behaviors among high school students in the Dominican Republic. Samples were taken from communities with an industrial base and an increasing population (n = 1175). The communities under study had dissimilar population sizes (i.e., 5,000, 30,000, 50,000) and were located in various geographical locations. Frequency data are compared by gender and population differences for high-risk health behavior indicators associated with urban migration. We found significant differences in tobacco, alcohol, and crack use among the different population sites, with higher rates reported by the more populous communities. Boys reported more fighting and sexual activity. Girls reported higher rates of suicide ideation and attempts. These results can be used to 1) help focus on those behaviors rooted during the school years that most influence health, 2) monitor those behaviors by establishing baseline data, and 3) supply data that are comparable with recognized categories of high-risk behaviors.