Risky sexual behavior among substance-abusing adolescents: psychosocial and contextual factors.

Of 120 substance-abusing adolescents and young adults undergoing treatment, the majority reported engaging in several types of risky sexual behavior, both with and without concurrent substance use. Data analysis revealed that AIDS knowledge, decision-making style, drinking motives, and perceived vulnerability to HIV were significant predictors of such behavior. Findings are discussed with a view to enhancing prevention efforts among high-risk adolescents.

The link between the use of crack cocaine and the sexually transmitted diseases of a clinic population. A comparison of adolescents with adults.

BACKGROUND AND OBJECTIVES: To determine whether personal and/or a partner's use of crack cocaine is associated with the diagnosis of early syphilis or gonorrhea independent of high-risk sex behaviors, and to determine whether the relationships between crack cocaine and associated sexually transmitted diseases (STDs) are similar for adolescents and adults. STUDY DESIGN: A cross-sectional behavioral survey of hetero-sexual males and females attending public STD clinics in three cities. Logistic regression was used to identify risk behavior patterns associated with each STD compared with no STD. RESULTS: Multivariate analysis revealed that men who were high on drugs, including crack cocaine, before or during sex were more likely to be diagnosed with syphilis (Odds Ratio [OR] = 1.49; Confidence Intervals [CI] = 1.06, 2.13). Males more likely to be diagnosed with gonorrhea were younger (OR = 0.94; CI = 0.92, 0.96), had sex with a crack cocaine user (OR = 1.99; CI = 1.36, 2.91), did not use condoms last time they had sex with a nonmain partner (OR = 1.59; CI = 1.09, 2.13), and did not have sex with an intravenous drug user (OR = 0.45; CI = 0.22, 0.95). For women, there were no independent risk factor for syphilis but younger age was a risk factor for gonorrhea (OR = 0.95; CI = 0.91, 0.99). The associations between crack cocaine and syphilis and gonorrhea in men and between crack cocaine and syphilis in women were not significant among adolescents in this study. CONCLUSION: The results of this study highlight the differences in the crack cocaine-related behaviors of adults and adolescents at risk for gonorrhea and syphilis. The nature of these differences support the use of distinct intervention strategies for each STD and for adolescents and adults.

Adolescents' perceived ability to say "no" to unwanted sex.

PIP: The authors examined the degree to which adolescents believe they can resist a dating partner's verbal pressure to have sex when they themselves really do not want to. 2472 10th-grade students of mean age 15.5 years from eight public high schools in Dade County, Florida, participated in the study. 49% were male, 27.8% White, 38.2% Hispanic, and 27.7% Black. 50.1% reported having ever experienced sexual intercourse. The female students were found to be more likely than males to believe that they could refuse unwanted sex. No consistent differences were found along ethnic and racial lines. The multivariate analysis identified the following as predictors of the ability to refuse sex: a less-permissive attitude toward sex, the low importance of peer influence, and, for females, a generalized sense of self-efficacy.^ieng

"About last night": the social ecology of sexual behavior relative to alcohol use among adolescents and young adults in substance abuse treatment.

Data were collected in face-to-face interviews from 120 substance-abusing adolescents and young adults (87 men, 33 women; M age = 17.2 years old) recruited from residential and nonresidential treatment facilities in South Florida. Participants described two recent sexual events, one with and one without concurrent alcohol use. Participants described social aspects of these sexual events, actual and intended behaviors, and their feelings about sex in the two alcohol-use contexts. High levels of discrete, risky behaviors occurred in both contexts. Event analysis produced only limited evidence suggesting a higher level of risk in the alcohol-use context. Participants reported less positive feelings about sex when alcohol was used.

Perceived versus actual condom skills among clients at sexually transmitted disease clinics.

The primary aim of this study was to investigate whether individual self-reports of perceived ability to use a condom correctly correlated with the actual ability to do so. Participants in the study were 3,059 clients of a sexually transmitted disease clinic. The findings revealed that the participants' perceived self-efficacy with regard to using a condom effectively was a poor indicator of their clinically demonstrated skills using a penile model as scored on the 6-point Condom Skills Index. Condom skills, in general, were found to be at a moderate level only. Even though 89 percent of the sample were persons who said they were somewhat or very sure that they could put a condom on and take it off correctly, the sample mean score on the Condom Skills Index was only 3.6, or 60 percent correct. Perceived versus demonstrated condom skills showed poor correlations for both the relatively lower-risk group (r = .09; P < .001 and the pooled higher risk groups (r = .12; P < .001). Although men were significantly more likely than women to believe they had adequate condom skills, no significant differences were found between the clinically demonstrated condom skills of males and females. Although condom promotion has included issues of product quality and consistent use, little attention has focused on correct use. Hence, when interventions aimed at reducing risk for HIV focus on developing communication-negotiation skills regarding the consistent use of condoms, attention also should be directed toward developing skills for using condoms effectively.

Which is more important to high school students: preventing pregnancy or preventing AIDS?

A sample of about 2,900 high school students in greater Miami, Florida, was surveyed to determine their attitudes toward pregnancy prevention vs. AIDS prevention and how these attitudes affect condom use. Female, Hispanic and black respondents were the most likely to consider pregnancy and AIDS prevention to be equally important. White non-Hispanics and males were relatively more likely to believe that preventing pregnancy is less important than preventing AIDS, whereas males and females involved in a steady relationship placed more emphasis on pregnancy prevention than AIDS prevention. The more knowledge about HIV and AIDS a respondent had, the less importance he or she placed on pregnancy prevention, and as the importance of preventing pregnancy declined, so did the frequency of condom use. Males who were in a steady dating relationship and perceived pregnancy prevention as more important than AIDS prevention were the most likely to report using condoms often.

PIP: The study aim was to examine adolescents' attitudes toward the importance of preventing pregnancy or preventing AIDS and the frequency of condom use among adolescents with different attitudes and demographic characteristics. Panel data was collected over a 5-month period in November and December 1988 and January and April 1989. The sample included 2896 10th-grade students in 8 public high schools in Dade County, Florida, who were administered an attitude, beliefs, skills, behavior survey. Sample populations included Blacks, Hispanics, and Whites. Measures were obtained for the importance of pregnancy or AIDS prevention, frequency of condom use, parents' educational status, worries about AIDS and pregnancy, family structure, interpersonal skills, and knowledge about AIDS. Sociodemographic data on the sample was reported. Respondents in steady relationships were more likely to be living with one parent and to worry about pregnancy; they also were less knowledgeable about AIDS, had lower grades, and were more likely to be female and older than average. Those in a steady relationship were sexually active and had their first sexual experience at an older age than those not in a steady relationship. 84% considered themselves very or somewhat at risk for HIV infection. 55% of females and 45% of males considered pregnancy and AIDS risk important. 7% of males versus 4% of females thought AIDS prevention was more important than pregnancy prevention. 48% of males and 41% of females thought pregnancy prevention was more important than AIDS prevention. Females without sexual experience were more likely to be equally concerned about risks. Fewer Whites reported pregnancy prevention as more important than AIDS prevention. Hispanics and Blacks responded similarly that pregnancy prevention was equal or more important than preventing AIDS. As knowledge of AIDS increased, less importance was attached to pregnancy prevention. Students who were not in a steady relationship, sexually inactive Black males, and sexually active Black females were more likely to be more concerned with preventing AIDS. Condom use declined with concern for pregnancy prevention. Males in steady relationships and more concerned with pregnancy prevention were most likely to use condoms.

Decision-making orientation and AIDS-related knowledge, attitudes, and behaviors of Hispanic, African-American, and white adolescents.

How adolescents' personal sense of directedness (i.e., peer, parent, or self-directed orientation) affects the decision-making processes of adolescent students regarding AIDS-related knowledge, attitudes, beliefs, behaviors, and skills (KABBS) is examined. The sample consisted of 10th-grade students in 8 public high schools (N = 2,515) in Dade County (greater Miami), Florida. The findings showed that decision-making orientation and directedness was a significant predictor of AIDS-related KABBS of adolescents. Overall, the level of AIDS-related KABBS that were associated with low risk was found significantly more often among self-directed students and least often among peer-directed students. The findings of this study suggest that future preadult health-risk research should incorporate the concept of differences of information processing across adolescents.

Prevalence of bulimic behaviors and bulimia among a sample of the general population.

Data are presented on the prevalence of bulimic symptoms and bulimia among a sample of adults residing in north-central Florida (n = 2,075). The data were gathered between 1984 and 1986. The sample included 1,736 whites and 339 blacks, of whom 1,040 were females and 1,035 were males. A current diagnosis of bulimia was made using the criteria of the Diagnostic and Statistical Manual, Third Edition (DSM-III), of the American Psychiatric Association. Females had significantly higher rates than did males on nine of the 10 bulimic symptoms. Blacks had symptom rates equal to or greater than whites on eight of the 10 items, and those in the lowest socioeconomic groups (SES) had rates greater than those in the highest SES group on nine of the 10 symptoms. Eight persons, 0.4% of the total sample, met the DSM-III criteria for a diagnosis of bulimia. These included six white females and two black males. Five of the females were aged 18-29 years; one was over 45. Five of the females were in the lower middle SES group; one was in the upper middle SES group. Both of the black males were aged 30-44, and both were in the lowest SES group. The data emphasize the need to distinguish between bulimic type symptoms and bulimia when estimating the prevalence of eating-related problems in the general population.

The Pre-Adult Health Decision-Making Model: linking decision-making directedness/orientation to adolescent health-related attitudes and behaviors.

In light of the broad consequences of the acquired immunodeficiency syndrome (AIDS) epidemic, as well as the increased rates of sexually transmitted diseases (STDs), pregnancy, and alcohol and drug abuse among adolescents, there is a great need to understand how adolescents make health decisions. This paper presents a model for adolescent health behavior, the Pre-Adult Health Decision-Making Model (PAHDM), which takes into account the differential information processing from peer sources, parent sources, or through critical or reflexive self-analysis. Also presented is a review of the large corpora of psychological and sociological literature on adolescent development, adolescent health behaviors, and, more specifically, AIDS and other STDs as a public health problem. The need for additional research in the area of adolescent health decision-making, and for a health behavior model that is specific to the "lifeworld" of the adolescent, is stressed.

Effect of Magic Johnson's HIV status on HIV-related attitudes and behaviors of an STD clinic population.

This paper reports data on the effects that Earvin "Magic" Johnson's announced HIV infection had on the clients of an Philadelphia sexually-transmitted-disease (STD) clinic. Interviews conducted after Johnson's announcement (N = 148) included questions about whether respondents had heard his announcement and how this news had influenced their sexual attitudes and behaviors. The findings include comparisons of matched samples (N = 138) of respondents interviewed before and after the news. The comparisons focused on 3 areas related to the human immunodeficiency virus (HIV): 1) passive concern; 2) sense of personal risk; and 3) resolve to be tested for HIV in the next 6 months. A significantly greater percent (92%) of the postannouncement respondents reported planning HIV tests than did the preannouncement respondents (52%). Although the differences in perceived risk were not statistically significant, 25% of the preannouncement and 34% of the postannouncement respondents indicated high perceived risk for HIV. Forty-four percent of the postannouncement sample indicated that, as a result of the news, they were now using condoms; 32% reported no effect; and 54% reported a variety of behavior changes that included monogamy (21%), greater selectivity (10.6%), fewer sexual partners (9.2%), and abstinence (3.5%). Overall, the announcement by Magic Johnson that he had been infected with HIV was associated with increased concern about HIV and with attitude and behavior changes that would lead to reduced risk. This was especially true for those in the sample at relatively higher risk.

Epidemiological study of problem eating behaviors and related attitudes in the general population.

This article presents data on the eating behaviors and related attitudes among a probability sample of 2,075 adults living in the southeastern United States. These following results were found: 45.2% felt guilty after eating, 44.2% thought they had a weight problem, 21.9% had been dieting in the past 2 months; 12.9% reported some lifetime binging, 1.2% admitted self-induced vomiting, and 7.9% said their life was often dominated by food-related conflicts. Females, blacks, and those in the middle and lower socioeconomic status percentiles tended to have higher problem rates than their counterparts.

Use of an expanded-whole-wheat product in the reduction of body weight and serum lipids in obese females.

To achieve weight reduction and alter serum lipid profiles, an air-expanded whole-wheat protein product (SNW) was used by moderately obese women as a meal substitute for 12 wk. Results were compared with those from a standard low-calorie diet (LCD). The SNW group lost 3.9 kg (means) over the first 6 wk and a further 1.6 kg between weeks 6 and 12. In contrast, the LCD group lost 2.8 kg during the initial 6 wk but failed to achieve weight loss during the second 6 wk. Consequently, the SNW group lost nearly twice as much weight over the 12-wk period as did LCD participants. A beneficial effect of SNW on serum cholesterol and triglycerides was noted; both measures declined in conjunction with the weight loss. Such alterations were greater in the SNW group than in LCD participants. Both schemes proved safe. SNW is safe and effective in weight reduction and serum lipid modification in moderately obese women.