Psychosocial factors associated with self-reported male condom use among women attending public health clinics.

BACKGROUND: Previous research has identified factors associated with condom use. However, less information exists on the impact that a history of sexually transmitted disease (STD) has on condom use. GOAL: To identify factors associated with self-reported male condom use that relate to a history of STD. STUDY DESIGN: Women attending STD clinics completed a survey that assessed sexual behavior, STD history, and psychosocial characteristics. Binomial regression was used to estimate the association between these factors and condom use. RESULTS: Of the 12 factors included in the regression model, 11 were significant for all women. When the analysis was stratified by STD history, high condom use self-efficacy, high convenience of condom use, and high frequency of condom use requests were significantly associated with increased condom use among women with or without a history of STD. Factors such as greater perceived condom use norms, higher perceived level of risk, and greater need for condom use in long-term relationships were significantly associated with increased condom use among women with a history of STD. Factors such as shorter duration of a relationship, less violence in the relationship, and lifetime drug use were associated with increased condom use among women with no history of STD. CONCLUSIONS: The pattern of psychosocial factors determining condom use is modified by a positive history of STD. These findings suggest that a history of STD could be an important factor in targeting condom use interventions.

Mobility impairments in crash-involved older drivers.

OBJECTIVE: To evaluate potential associations of impairments in physical function with motor vehicle crash involvement in older drivers. METHODS: Case participants were randomly selected residents of Mobile County, Alabama, greater or less than 65 years old who had sustained an at-fault motor vehicle crash in 1996. Similarly selected crash-free controls were frequency matched to cases on gender and age. Self-report data on demographic variables, medical conditions, medications, driving exposure, and function were collected by telephone interviewers. RESULTS: Relative to crash-free subjects, crash-involved drivers were significantly more likely to report difficulty walking one fourth mile and moving outdoors. Marginally significant associations were observed for trouble carrying a heavy object 100 yards and for the occurrence of falls in the prior year. Increasing numbers of functional limitations were directly related to the odds of crash involvement. DISCUSSION: In comparison to crash-free controls, crash-involved older drivers are more likely to report other mobility-related impairments, possibly including falls.

Driving after stroke: driving exposure, advice, and evaluations.

OBJECTIVE: Little is known about the extent to which stroke survivors return to driving and the advice and/or evaluations they receive about driving. This study sought to estimate the prevalence of driving after stroke and to determine whether stroke survivors receive advice and evaluation about driving. DESIGN: A convenience sample of stroke survivors was surveyed regarding driving status following stroke, driving exposure, advice received about driving, and evaluation of driving performance. PARTICIPANTS: Two hundred ninety stroke survivors who were between 3 months to 6 years poststroke. RESULTS: Thirty percent of stroke survivors who drove before the stroke resumed driving after the stroke. Stroke survivors are often poorly informed by health care professionals about driving, with 48% reporting that they did not receive advice about driving and 87% reporting that they did not receive any type of driving evaluation. Almost one third of poststroke drivers had high exposure, driving 6 to 7 days per week and/or 100 to 200 miles per week. CONCLUSIONS: These findings suggest that many stroke survivors are making decisions about their driving capabilities without professional advice and/or evaluation. The results also suggest that rehabilitation professionals need to devote more attention and resources to driving issues when working with stroke survivors and their families.

Why a peer intervention program for Mexican-American women failed to modify the secular trend in cancer screening.

INTRODUCTION: We evaluated an intervention program for Mexican-American women to increase Pap smear and mammography screening. METHODS: The three-year intervention included the presentation of role models in the media and reinforcement by peer volunteers. We used a two-community (intervention and comparison) pre-post test design. Activities were targeted to a mainly Spanish-speaking, poverty-level, immigrant population. Pre- and postintervention screening rates were based on independent random samples of Mexican-American women 40 years and older. RESULTS: Women reported a 6% absolute increase in Pap smear use similar to the 7% increase in the comparison community. Both communities experienced large but similar increases in recent mammography use (17% and 19%). Adjusting for differences in demographic factors, intervention and comparison changes remained identical. CONCLUSIONS: Our peer intervention failed to accelerate the secular trend in cancer screening low-income Mexican-American women. Likely, promotional activities were too diffuse and the comparison community was contaminated with similar interventions. Strong social and market forces make it difficult to measure the effect of a specialized intervention on cancer screening rates.

Prevention campaigns for hard-to-reach populations at risk for HIV infection: theory and implementation.

Using applied behavioral science techniques that have been successful in other areas of health promotion, community-level campaigns were implemented in 5 cities to prevent HIV infection among hard-to-reach, at-risk populations: men who have sex with men but do not self-identify as gay; women who engage in sex for money or drugs; injecting drug users (IDUs), female sex partners of IDUs; and youth in high-risk situations. Communication materials presented positive role models for risk-reducing behaviors, and peer networks prompted and reinforced the behavior change process. This article describes the first year of intervention experience and documents the practical application of theoretical concepts of persuasion and learning. The use of theory and data to develop 188 educational messages is illustrated and training methods and experiences are reported for 150 peer leaders, 104 other community networkers, and 22 outreach workers. These activities are feasible and appear to offer an effective, general approach for diverse, special populations.

Community level cancer control in a Texas barrio: Part II--Base-line and preliminary outcome findings.

In a quasiexperimental demonstration study, screening rates for breast and cervical cancers were measured among Mexican-American women in selected areas of San Antonio and Houston, Tex. This research was primarily designed to evaluate a cancer-screening promotion program in San Antonio by comparing changes in screening rates in panels from the two barrio communities. In a base-line population survey, we found a small, but significant, proportion of women (10%-15%) lacking Pap smears and a larger proportion (30%-40%) lacking mammography. In a panel study following women who lacked screening at base line, there was a trend toward greater Pap smear use among younger women and a significant increase in mammography for all age groups in San Antonio compared with groups in Houston. Although there was a difference in language use between the communities, rates of newly initiated screening within the communities were similar among monolingual Spanish speakers and among those who used English, supporting the hypothesis that the program increased both groups' participation in breast-cancer screening.

Smoking cessation in Texas-Mexico border communities: a quasi-experimental panel study.

UNLABELLED: BACKGROUDd. Smoking-related disease and injury is prominent among the numerous health problems on the U.S.-Mexico border, but little is known about the methods that might help promote smoking cessation among the low-income populations in this region. METHOD: Media campaigns were combined with different forms of intensive and community-wide interpersonal communication to encourage smoking cessation in a border U.S. city and in a Mexican city. Panels of moderate to heavy smokers were followed in four groups to allow quasi-experimental comparison of smoking cessation rates. RESULTS: Over a five-year study period smoking cessation rates of 17% (self-reported) and 8% (verified) were observed in panels in the program community (N = 160). In the comparison community (N = 135) corresponding rates of smoking cessation were 7% (self-reported) and 1.5% (verified). Within the program community, no differences were observed in smoking cessation among smokers exposed to a community-wide program and those assigned to receive personal counseling. DISCUSSION: Although the observed changes in smoking were unexpectedly small in the treatment and comparison groups, the approximately 8% effect size for the community-wide program was close to what was predicted. Results indicate that such programs may yield effects similar to those of more intensive approaches, but further research with greater statistical power will be necessary to confirm that point.