Smoking behavior among French and American women.

BACKGROUND: This paper presents an analysis of the sociodemographic factors related to cigarette smoking prevalence and the number of cigarettes smoked daily among nationally representative samples of 18- to 64-year-old French (n = 1,956) and American (n = 20,234) women. METHODS: This analysis combines 2 separate years (1992 and 1993) of data collected by the National Health Interview Survey in the United States and the Comité Francais d'Education pour la Santé in France. Weighted data analysis of the effects of age, employment status, education, and socioprofessional status was conducted using both SPSS and the SUDAAN complex sample survey analysis program. RESULTS: The prevalence of smoking among French female smokers was significantly higher than among American women (30.8% vs 26.3%) and particularly among the younger age groups. However, the average number of cigarettes smoked per day was appreciably and significantly lower for French women (12.3) than for American women (18.2). Multivariate logistic regression analysis revealed statistically significant interaction terms differentiating the impact of marital status, age, and education on the smoking status of French and American women, as well as the sociodemographic determinants of the number of cigarettes smoked. Education was inversely related to smoking among American women but positively associated with the smoking behavior of French women. CONCLUSIONS: Differences in the smoking behavior of French and American women support the view that sociodemographic factors do not affect the smoking behavior of women in Western industrialized countries similarly and reinforce the importance of international public health measures targeting the increasing rate of smoking among women.

Social heterogeneity in smoking among African Americans.

OBJECTIVES: This study assessed the effects of sociodemographic variables on the smoking behavior of African Americans. METHODS: Data for 14,397 African-American respondents (18-64 years old) to the National Health Interview Survey in the years 1990 through 1993 were examined in multivariate models. RESULTS: Age was the strongest predictor of smoking, and men were at least 1.75 times as likely as women to be smokers (P < .001). CONCLUSIONS: The Year 2000 goal of an 18% prevalence rate among African-American adults may not be attained without major community interventions focusing on male and middle-aged African Americans.

Issues of disclosure and condom use in adolescents with hemophilia and HIV. Hemophilia Behavioral Evaluative Intervention Project Staff.

PURPOSE: To examine the patterns, facilitators, and barriers to disclosure of HIV seropositivity in an adolescent population and to determine the relationship between disclosure and condom use. BACKGROUND: In recent years, public health efforts have focused on methods to prevent the transmission of the Human Immunodeficiency Virus (HIV). These efforts have included safer sex education, skill building and self-efficacy training, behavioral change techniques, and encouragement of serostatus disclosure to sexual partners. In 1990, the Centers for Disease Control and Prevention (CDC) funded 10 hemophilia treatment centers to develop and implement a theory-based behavioral intervention to prevent the sexual transmission of HIV. METHODS: A baseline survey, focusing on barriers to safer sex, the influence of parents, peers, and sexual partners, alcohol and drug use, and communication and disclosure patterns, was administered to 321 young males (ages 12 to 25) with hemophilia and HIV. RESULTS: Fifty-eight percent of the sexually experienced adolescents did not disclose their HIV status to their most recent sexual partners (i.e., nondisclosers) compared to 42 percent who reported that either they informed their partners or their partners already knew their HIV status (i.e., disclosers). There was no correlation between disclosure and condom use. The most significant predictor of disclosure was the perception that peers would disclose their HIV status. CONCLUSION: The results suggest that disclosure does not necessarily facilitate condom use in this population. This conclusion may have implications for future public health efforts in HIV prevention. Rather than focusing primarily on the promotion of serostatus disclosure, behavioral interventions should emphasize the practice of safer sex, utilizing peer educators and support networks.

Maintaining safer sex behaviours in HIV-infected adolescents with haemophilia. The Hemophilia Behavioral Evaluative Intervention Project Committee.

Adolescents with haemophilia comprise 44% of the reported AIDS cases in teenagers. Unprotected sexual intercourse among this group increases the risk of HIV transmission. Understanding the influences which others may have on the sexual behaviour of adolescents with HIV and haemophilia may lead to the development of effective risk reduction strategies. An evaluative instrument, administered to 307 HIV-infected adolescents with haemophilia, assessed their behavioural stage of change (Prochaska & DiClemente), attitudes, beliefs and behaviours about safer sex practices. The influence of parents, peers and sexual partners on sexual behaviour was compared between (1) those who were sexually experienced and (2) and those who were sexually inexperienced. Barriers and facilitators to practising safer sex were identified. Although parents influenced the sexual behaviour of both groups, this influence was significantly greater in the sexually inactive group. Fewer than 20% reported that their peers impacted their decisions about sexual behaviour. Eighty-six per cent of the sexually active indicated that partners significantly impacted their sexual decisions, while 60% of the sexually inactive indicated that future partners would affect their decisions about sex. Most participants agreed that disclosure of HIV status before intercourse was desirable, but only 31% of the sexually active said they told every partner. Fear of rejection or a negative reaction from the partner, and lack of communication skills were the greatest barriers to disclosure of HIV status and practising safer sex. This study indicates that behavioural interventions for both groups should focus on developing communication skills and self-efficacy. Interventions should include the key influences for each group--parents for the sexually inactive and partners for the sexually active.

Substance use, coping, and safer sex practices among adolescents with hemophilia and human immunodeficiency virus. The Hemophilia Behavioral Intervention Evaluative Project Committee.

PURPOSE: To examine the use of alcohol and other drugs (AOD) to cope with the human immunodeficiency virus (HIV), the use of AOD before or during sex by 306 adolescent males with HIV and hemophilia, and its association with safer sex practices. METHODS: A survey instrument was administered to adolescents at 11 sites of the Hemophilia Behavioral Intervention Evaluative Project. Survey questions focused on knowledge of sexual activity, safer sex practices, AOD use, attitudinal and behavioral influences of parents, peers and sex partners, communication patterns, and perceived facilitators and barriers to practicing safer sex. RESULTS: A total of 68% of all respondents reported using condoms every time they had heterosexual sex. Respondents who did not use AOD to cope were more likely than AOD copers to report that they disclose their HIV status to all sex partners, talk to all of their sex partners about safer sex, find the use of condoms more enjoyable, and have sex partners who approved of their use of condoms. Condom use was not related to the use of AOD to cope or the use of AOD with the most recent female sex partner. CONCLUSIONS: The use of AOD to cope with HIV and its use before or during sex was negatively associated with certain safer sex attitudes and practices. AOD use may help facilitate HIV transmission among adolescents with HIV and/or hemophilia.