Is there a role for stress management in reducing hypertension in African Americans?

When stress is considered as any demand placed on the body, the focus is shifted away from the stressor to how the body responds to the stress. There are psychological, physiological, and behavioral responses to excessive stress. Left unaddressed, cardiovascular or cerebrovascular diseases may occur. The goal of meditation is to decrease mental activity while simultaneously resting and rejuvenating the body. There are internal and external approaches to meditation. The most researched internal form of meditation is the Transcendental Meditation technique, which has been found to reduce stress, depression, anxiety, and blood pressure in hypertensive African Americans. Clinical use of stress management approaches, particularly Transcendental Meditation to reduce hypertension, is supported by randomized clinical trials. Studies with larger numbers of participants and more diverse ethnic groups should continue.

Sex, drugs, and HIV: does methadone maintenance reduce drug use and risky sexual behavior?

This study examined differences in drug use, sexual behavior, attitudes, and perceptions of vulnerability for AIDS between injection drug users who received methadone treatment in the previous 6 months and those who did not. Of the 123 participants assessed, 62 (50%) received methadone treatment. Methadone patients reported fewer sexual partners and greater use of condoms compared to nonmethadone patients. Methadone patients also reported fewer high-risk sexual partners than those not in treatment. Women reported more high-risk partners than men. Methadone patients reported drinking alcohol less, but smoking marijuana more than nonmethadone users. Methadone users had more positive beliefs about the efficacy of condoms for preventing AIDS and expressed less anger than nonmethadone users in situations related to condom usage. These findings have important implications for using methadone maintenance to reduce the dual risk for HIV in injection drug users.

The efficacy of the health belief model for predicting condom usage and risky sexual practices in university students.

This investigation examined the ability of the health belief model (HBM) to predict condom usage and risky sexual practices in 122 white heterosexual college students (ages 17 to 33 years). The HBM did not significantly explain condom usage in the 58 men and 64 women surveyed; rather it partially explained the variance in sexual risk behaviors. Results were not consistent for men and women. The HBM components significantly explained 18% of the variance in multiple sexual partnerships in men and 22% of the variance in this behavior in women. The HBM constructs also explained 9% of the variance in the likelihood of women being intoxicated or high during sex and 18% of the variance in the number of sexual risk behaviors endorsed by women. These findings suggest that the HBM has differential and limited utility for predicting sexual practices in university students. Future research is needed to examine more comprehensive models of behavior change.

PIP: The ability of the health belief model (HBM) to predict condom use and high-risk sexual behaviors was investigated in a survey conducted in 1992-93 of 122 US college students 17-35 years of age. The HBM conceptualizes preventive health behavior as a function of perceived severity of illness, perceived susceptibility to illness, perceived benefits for taking a health action, and perceived barriers to engaging in a health action. Students completed the Attitudes Toward Condom Usage Questionnaire, a Perceived AIDS Risk Scale, and a sociodemographic questionnaire. Among the 58 male students, the HBM components did not significantly explain any variance in condom use for vaginal or oral sex after controlling for education and cocaine use. The HBM explained 18% of the variance in men's multiple sexual partnerships in the 6 months preceding the survey. Perceived AIDS risk made a significant contribution to the relationship between HBM components and multiple sexual partnerships. The HBM components were more efficacious in predicting risk behaviors in the 64 female students. Among females, the HBM significantly explained 9% of the variance in the reported likelihood of being high on drugs or intoxicated during sex, 22% of the variance in multiple sexual partnerships, and 18% of that in total number of risk behaviors after controlling for demographic variables and recreational drug use. As with male students, the HBM was not able to predict condom use with oral or vaginal sex, however. Unless the HBM is expanded to include other behavior-specific cognitive factors (e.g., benefits and barriers associated with multiple sexual partnerships), its ability to explain more than a small proportion of the variance in behaviors that prevent AIDS will remain limited.

Obesity and hypertension among African Americans: do African-American primary care providers address these conditions when secondary to primary illness?

This study examined the extent that black family medicine residents manage African-American patients with hypertension and obesity secondary to the primary health problem. A retrospective chart survey of 1806 outpatients was used to select a sample of 362 patients being treated by 12 African-American family medicine residents. Of the 362 patient charts, 31.2% of the patients had hypertension (ie, blood pressure > or = 140/90 mm Hg). A plan for managing hypertension was found in the charts for 77% of these patients. Obesity was present among 37% of the patients, and yet there was documentation of a treatment plan for managing this condition for only 38% of these patients. Black family medicine residents appear to be sensitized about addressing the problem of hypertension among African-American patients being treated for other illnesses. However, there is a vital need to teach family medicine physicians how to address and aggressively manage the problem of obesity among African-American patients, particularly those patients for whom obesity was not the primary reason for seeking medical care.

Characteristics of African-Americans with multiple risk factors associated with HIV/AIDS.

Multiple risk factors in young African-Americans have tremendous implications for the spread of AIDS. Two hundred forty-two heterosexual college students were classified as having low, moderate, or high risk for HIV infection based upon their self-reported sexual practices. Results indicated that subjects differed in AIDS knowledge and attitudes toward condoms with respect to both Gender and Risk level, with men and High Risk individuals being less knowledgeable and having more negative attitudes than their female and Low Risk counterparts respectively. Interaction effects revealed that High Risk men were less knowledgeable than both Low Risk men and High Risk women. High Risk men as well as High and Low Risk women reported more anger surrounding condom usage than Low Risk men. Low perceptions of vulnerability for AIDS were reflected in the entire sample. The implications of this study for primary prevention and future research are discussed.

What is the significance of black-white differences in risky sexual behavior?

A sample of African-American and white young adults were classified as having multiple sex partners or one sexual partner. Subjects with multiple sexual partners were more likely to use drugs and practice risky sexual behaviors such as having anal intercourse, having sexual experiences with a prostitute, and having a history of gonorrhea (P < .001) and genital warts (P < .01). Additional analyses were conducted to determine African-American versus white differences in risky sexual behaviors. Results indicated that whites in the multiple partners and single partner groups were more likely to engage in anal and oral sex, while African Americans were more likely to have sex with prostitutes. Attitudes about the use of condoms differed significantly by multiple partner status (P < .004) and gender (P < .007), but not ethnicity. However, angry reactions about the use of condoms occurred more with African Americans (P < .003) and males (P < .05) than with whites or females. While whites reported a greater use of drugs and a significantly higher level of knowledge about HIV/AIDS, African Americans reported a significantly greater perception of risk for being exposed to human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (P < .01) and significantly more gonorrhea (P < .10), syphilis (P < .05), and HIV/AIDS (P < .05). No whites in our sample were treated for syphilis nor had they tested positive for HIV/AIDS. On the other hand, 4.5% of the total sample of African Americans reported testing positive for HIV/AIDS. Finally, the results from discriminant analysis indicate that a large number of variables significantly discriminate between subjects who engage in risky sexual behaviors and those who do not. Although there is some similarity in the variables for African Americans and whites, there was tremendous variability between the ethnic groups in the factors that predict risky behaviors. These findings are discussed with reference to the need to develop HIV/AIDS prevention programs for African Americans that are based on data derived from African-American populations rather than from black versus white comparison studies.

PIP: The need to design acquired immunodeficiency syndrome (AIDS) prevention programs specifically tailored to the African-American community was underscored in a study that found substantial variability between Blacks and Whites in high-risk sexual behaviors. Included in the survey were 149 Black males, 155 Black females, 40 White males, and 64 White females attending the same college in the southern US. 71 (47%) Black males, 29 (19%) Black females, 20 (50%) White males, and 24 (38%) White females were currently involved with more than one sexual partner. 4.5% of Black students and no White subjects had tested positive for human immunodeficiency virus (HIV). Students with multiple sexual partners were significantly more likely than their monogamous counterparts to use illegal drugs, practice anal intercourse, have experience with prostitutes, have a history of gonorrhea and genital warts, and to believe condom use is not necessary if you love your partner. Blacks in the multiple partners subgroup were significantly more likely than their White counterparts to have experience with prostitutes, indicate an intense anger response to condom use, and perceive themselves as at high risk for HIV/AIDS; knowledge of AIDS scores did not differ. White students were significantly more likely than Blacks to engage in anal and oral sex. Discriminant function analyses revealed that having multiple partners was in large part (32%) determined for Whites by consistent condom use and having sex with women, while sex with women, oral sex, history of syphilis, and sex with prostitutes predicted 25% of the variance among Blacks. 41% of anal intercourse variance among Whites was contributed by having multiple sex partners, sex with males, sex with females, and marijuana use; 47% of the variation among Blacks was explained by previous treatment for gonorrhea, genital warts, and herpes; condom acceptance and the perception condoms are inconvenient; sex with males; being male; sex with a prostitute; and oral sex.

African-American women who always use condoms: attitudes, knowledge about AIDS, and sexual behavior.

Given the alarming increase in the incidence of sexually transmitted diseases (STDs), including AIDS, among African-American women, it is apparent that many people are engaging in sexual intercourse without using condoms. The current study examined the interrelationships among attitudes about condom use, knowledge about AIDS, sexual behavior, and drug use among 121 adult African-American women who varied in their intentions to use condoms: 21 (17%) were classified as Steady Users, 75 (62%) did not use condoms but they had High Intentions to, while 25 (21%) did not use condoms and had Low Intentions to use them. Results indicate that the three groups did not differ in their overall knowledge about AIDS or their attitudes toward using condoms as contraceptives. Significant group differences were noted for other scales that assessed attitudes about condoms. Attitudes about the use of condoms were very similar for the Steady Users and the women in the High Intentions group. However, these two groups were significantly (p < .01) different in their belief that condoms are uncomfortable and interrupt sex. Women with Low Intentions to use condoms had significantly (p < .05) more intense angry reactions regarding the negotiation of condom use and significantly more negative attitudes about the use of condoms than women in the other groups. The three groups were not differentiated by drug use, previous treatment for STDs, or their perceived risk for being exposed to AIDS. The present study is cross-sectional in nature and future research using better methodology is needed to establish causal relationships.