Rectal douching in a community sample of men and women.

Rectal douching (RD) may be a vector for sexually transmitted infection (STI) acquisition. The aim of this study was to describe the relationship between RD, and the prevalence of various STIs and sexual behaviors in a sample of women and men in Long Beach, California. Five hundred and forty-seven men (mean age 42.8 years) and 530 women (mean age 37 years) recruited from a community-based setting between April 2010 and August 2014 completed the Risk Behavior Assessment and a questionnaire eliciting information on use of lubricants and enemas for vaginal intercourse (VI) and anal intercourse (AI). Participants were screened for high-risk behaviors for human immunodeficiency virus infection including injection drug use. Bivariate analyses were conducted separately for women and men. Based on the empirical results, separate logistic regression models for women and men were constructed. Sensitivity analysis was conducted to assess model fit for reduced samples of only those men and women who reported AI. For men, RD was associated with a lower odds of being hepatitis C antibody positive, greater odds of being positive for hepatitis B virus surface antigen, syphilis, and using lubricants for receptive anal intercourse (RAI). RD in women was associated with higher odds of a positive test for syphilis, ever vaginally douching for VI, and using lubricants for RAI. Men and women who practice RD report positive syphilis test results and use of lubricants for RAI. RD should not be perceived as preventing STIs.

Gender differences in risk taking behaviors for Chlamydia trachomatis.

Chlamydia trachomatis (CT) is a global problem. We compared the risk taking behaviors for CT infection between men and women. Adults (2299 females, 5559 males) were administered the Risk Behavior Assessment. In women, CT was associated with candidiasis, in men with gonorrhea, genital warts, and syphilis. Risk factors for both genders were trading sex for money, use of marijuana for women, and use of Ecstasy and Viagra for men. Those with CT had higher risk perception for HIV infection and were more likely to obtain HIV testing. Patient teaching and concurrent testing for HIV and CT are imperative.

Arrest and Trait Aggression Correlates of Emergency Department Use.

This study examined the associations between arrest and incarceration, trait aggression, and emergency department (ED) use. Data were collected from 525 clients who visited the Center for Behavioral Research and Services in Long Beach, CA, using the following instruments: Risk Behavior Assessment, Risk Behavior Follow-Up Assessment, the Aggression Questionnaire (AQ), the Displaced AQ, and the parole and Legal Status section of the Addiction Severity Index. The bivariate analysis suggested that ED use was significantly associated with trait aggression and trait-displaced aggression among those with a history of incarceration. In the logistic regression, weapons offenses, manslaughter/homicide, being male, and being Black were significantly associated with ED use. Identification and management of aggressive trait personality are important in improving the management of postrelease care in transition to clinical networks and community-based health care settings.

Associations of Social Media Use With Physical Activity and Sleep Adequacy Among Adolescents: Cross-Sectional Survey.

BACKGROUND: Adolescents' use of social media, which has increased considerably in the past decade, has both positive and negative influences on adolescents' health and health behaviors. As social media is the most prominent communication tool of choice for adolescents, it is important to understand the relationship between the frequency of social media use and health behaviors among this population. OBJECTIVE: The objective of our study was to examine the associations between the frequency of social media use and physical activity and sleep adequacy among middle and high school students. METHODS: We used data from the Monitoring the Future survey (2014 and 2015), a nationally representative, annual, cross-sectional survey of American 8th-, 10th-, and 12th-grade students (N=43,994). Health behaviors examined were frequency of vigorous physical activity and frequency of getting 7 hours of sleep (never/seldom, sometimes, and every day/nearly every day). We measured frequency of social media use using a Likert-like scale (never, a few times a year, 1-2 times a month, once a week, or every day). Multivariable generalized ordered logistic regressions examined the association of social media use with different levels of physical activity and sleep. We estimated marginal effects (MEs) for the main independent variable (social media use frequency) by holding all other variables at their observed values. RESULTS: The study population comprised 51.13% (21,276/42,067) female students, 37.48% (17,160/43,994) from the South, and 80.07% (34,953/43,994) from a metropolitan area, with 76.90% (33,831/43,994) reporting using social media every day. Among physically active students, frequent social media use was associated with a higher likelihood of vigorous daily exercise (ME 50.1%, 95% CI 49.2%-51.0%). Among sedentary students, frequent social media use was associated with a lower likelihood of vigorous daily exercise (ME 15.8%, 95% CI 15.1%-16.4%). Moderately active students who used social media once or twice a month had the highest likelihood of reporting vigorous daily exercise (ME 42.0%, 95% CI 37.6%-46.3%). Among those who normally got adequate sleep, daily social media users were least likely to report adequate sleep (ME 41.3%, 95% CI 40.4%-42.1%). Among those who were usually sleep deprived, daily social media users were more likely to report adequate sleep (ME 18.3%, 95% CI 17.6%-19.0%). CONCLUSIONS: Regular social media use every day was associated with a reinforcement of health behaviors at both extremes of health behaviors, whereas a medium intensity of social media use was associated with the highest levels of physical activity and lowest sleep adequacy among those with moderate health behaviors. Hence, finding an optimal level of social media use that is beneficial to a variety of health behaviors would be most beneficial to adolescents who are in the middle of the health behavior spectrum.

HEALTH INSURANCE INFORMATION-SEEKING BEHAVIORS AMONG INTERNET USERS: AN EXPLORATORY ANALYSIS TO INFORM POLICIES.

The purpose of this study was to explore characteristics of Internet users who seek health insurance information online, as well as factors affecting their behaviors in seeking health insurance information. Secondary data analysis was conducted using data from the 2012 Pew Internet Health Tracking Survey. Of 2,305 Internet user adults, only 29% were seeking health insurance information online. Bivariate analyses were conducted to test differences in characteristics of those who seek health insurance information online and those who do not. A logistic regression model was used to determine significant predictors of health insurance information-seeking behavior online. Findings suggested that factors such as being a single parent, having a high school education or less, and being uninsured were significant and those individuals were less likely to seek health insurance information online. Being a family caregiver of an adult and those who bought private health insurance or were entitled to Medicare were more likely to seek health insurance information online than non-caregivers and the uninsured. The findings suggested the need to provide quality health insurance information online is critical for both the insured and uninsured population.

Hepatitis C Infection Among Hispanics in California.

Hispanics in California are more likely to be infected with hepatitis C, and those infected have had their infection detected later. A total of 1,567 Hispanic and Caucasian individuals were tested for antibodies to hepatitis C from 2000 through 2013. Interviewers administered the Risk Behavior Assessment. Hepatitis C-infected Hispanics were incarcerated longer than hepatitis C-infected Caucasians, and they used marijuana less and illicit methadone more. They were more likely to use crack, heroin, speedballs, and to have been in methadone treatment. Hispanics need hepatitis C testing linked to methadone treatment and written information in Spanish and English.

Comparison of Rapid Point-of-Care Tests for Detection of Antibodies to Hepatitis C Virus.

Background. Hepatitis C is one of the most prevalent blood-borne diseases in the United States. Despite the benefits of early screening, among 3.2 million Americans who are infected with hepatitis C virus (HCV), 50%-70% are unaware of their infection status. Methods. Data were collected between 2011 and 2014, from 1048 clients who were in the following groups: (1) injection drug users, (2) women at sexual risk, (3) gay and bisexual men, and (4) transgender individuals. The sensitivity and specificity of point-of-care tests included (1) the MedMira rapid human immunodeficiency virus (HIV)/HCV antibody test, (2) MedMira hepatitis B (HBV)/HIV/HCV antibody test, (3) Chembio HCV Screen Assay used with both whole blood and (4) oral specimens, (5) Chembio HIV-HCV Assay also used with both whole blood and (6) oral specimens, (7) Chembio HIV-HCV-Syphilis Assay, and (8) OraSure HCV Rapid Antibody Test used with whole blood. The gold standard for the HCV tests were HCV enzyme immunoassay (EIA) 2.0. Results. OraSure had the highest sensitivity at 92.7% (95% confidence interval [CI] = 88.8%-96.5%) followed closely by Chembio's 3 blood tests at 92.1% (95% CI = 87.7%-96.4%), 91.5% (95% CI = 87.2%-95.7%), and 92.3% (95% CI = 88.4%-96.2%). The sensitivities of MedMira HIV/HCV and MedMira HIV/HCV/HBV tests were the lowest, at 79.1% (95% CI = 72.6%-85.5%), and 81.5% (95% CI = 75.2%-87.8%), respectively. Specificity for the OraSure was 99.8% (95% CI = 99.4%-100%); specificity for the Chembio blood tests was 99.2% (95% CI = 98.6%-99.9%), 99.4% (95% CI = 98.8%-99.9%), and 99.3% (95% CI = 98.8%-99.9%); and specificity for the MedMira was100% and 100%. False-negative results were associated with HIV and hepatitis B core antibody serostatus. Conclusions. The OraSure and Chembio blood tests (including those multiplexed with HIV and syphilis) appear to good performance characteristics. This study has identified potential limitations of rapid testing in those testing positive for HIV and HBcAb. There should be discussion of updates to the 2013 CDC guidance.

Medical service use among individuals receiving HIV prevention services in Los Angeles County.

Timely provision of medical services among communities at increased risk of HIV infection is crucial to detect the infection and to further prevent the spread of HIV. In the US, about one third of HIV cases were identified in the later stage of infection. The current study utilized the Gelberg-Andersen behavioral model for predicting medical service use among people who were at risk of HIV infection. The candidate variables included: social support, attitudinal, and behavioral variables. The data were collected from clients of HIV prevention agencies in Los Angeles County in 2004 who participated in the Countywide Risk Assessment Survey (CRAS). Using a logistic regression model, the study suggested that factors that were positively associated with use of medical services included living in a treatment center/halfway house or mission/shelter, experience of physical/sexual abuse, and ever receiving HIV testing/counseling. Factors inversely associated with medical service use were male gender, education, and consumption of alcohol. Analysis was conducted using SAS 9.3. Most of the findings are consistent with the Gelberg-Andersen model. The exception was that victims of physical or sexual abuse were more likely to use services instead of less likely as predicted by the model.

Expanding health insurance to increase health care utilization: will it have different effects in rural vs. urban areas?

OBJECTIVES: This study investigates the importance of medical fee and distance to health care provider on individual's decision to seek care in developing countries. METHODS: The estimation method used a mixed logit model applied to data from the third wave of the Indonesian family life survey (2000). The key variables of interest include medical fee and distance to different types of health care provider and individual characteristic variables. RESULTS: Urban dweller's decision to choose health care providers are sensitive to the monetary cost of medical care as measured by medical fee but they are not sensitive to distance. For those who reside in rural area, they are sensitive to the non-medical component cost of care as measured by travel distance but they are not sensitive to medical fee. CONCLUSIONS: As a result of those findings, policy makers should consider different sets of policy instruments when attempting to expand health service's usage in urban and rural areas of Indonesia. To increase access in urban areas, we recommend expansion of health insurance coverage in order to lower out-of-pocket medical expenditures. As for rural areas, expansion of medical infrastructures to reduce commuting distance and costs will be needed to increase utilization.