Engagement In High-risk Behaviors Research Articles

Promoting a Culture of Care for College Students with Marginalized Identities Using an Embedded Prevention Navigation Model

ABSTRACT College students are at risk for mental and physical health concerns such as depression, anxiety, substance use, HIV, and other sexually transmitted infections, creating greater demands for timely and responsive services. However, students from marginalized groups often face greater challenges accessing physical and behavioral health services due to historic and systemic barriers. One unique and economical approach to helping students access care is to train peers to provide psychoeducation and timely and responsive linkages to behavioral and physical health resources and embed them in spaces where students naturally congregate. This approach has proven effective in reducing engagement in high-risk behaviors and encouraging resource utilization in community settings, but little research exists on using an embedded prevention navigator approach in college settings. The present study describes the development, implementation, and evaluation of such an approach piloted among 88 undergraduates, the majority of whom identified as students of color and first-generation college students. Findings support the feasibility of using a peer-delivered prevention navigation approach to provide students with mental health, substance use, and sexual health education and referrals to relevant resources. Lessons learned and recommendations for college mental health professionals are discussed.

Assessment of Adverse Childhood Experiences in the South Bronx on the Risk of Developing Chronic Disease as Adults.

Background Adverse childhood experiences (ACEs) have a negative impact on health outcomes. Using a cross-sectional study design, our objective was to identify the prevalence of ACEs among residents of South Bronx and the increased relationship between such childhood stressors and the prevalence of both chronic disease and modifiable high-risk behavior in adulthood. Methods We recruited patients from a hospital-based, adult primary care clinic in the metropolitan area of the South Bronx. A prospectively designed, observational study recruited patients in a consecutive fashion to conduct a cross-sectional survey between September 2017 and January 2018. The demographic representation comprises a low socioeconomic sector of urban New York City, with low education and immigrant population. A modified ACE questionnairethat included nine ACE categories (Physical Abuse, Sexual Abuse, Household Substance Abuse, Separation from Parents, Incarcerated Household Member, Parental Separation/Divorce, and Bullying)in addition to questions on demographics, high-risk behavior, and diagnosis of chronic disease. Our primary objective was to gather the incidence of ACEs organized by domains. Secondary objectives were to demonstrate any expected increase (as odds ratios (ORs)) in chronic disease or maladaptive social habits when compared to patients with no ACEs within the cohort. The ORfor the associations was calculated with logistic regression. Individual logistic regression models for each chronic disease, high-risk behavior, and demographics were used to measure the exposure response of the nine ACE categories. Results A total of 454 patients completed the survey. The average age was 53.1±14.2 years, and females were 49% of the sample. Hispanics were at 61% followed by Blacks at 34%. Participants reported high-risk behavior at 24%, had a high prevalence of chronic illness (82%), and had ACE events at 70%. We found a significant relationship between ACE events and having a chronic disease diagnosis and engagement in high-risk behavior with higher odds of reporting chronic illnesses among participants with exposure to childhood stressors (OR 1.26, 95% confidence interval 1.1-1.5, p=0.002). Of the nine ACE categories, many were independently associated with one or more chronic diseases in adulthood. Conclusion According to our survey data, ACE events in our patient population were more prevalent (30% with four or more exposures), higher than the proposed average of one out of six Americans with four or more exposures nationally according tonational statistics. These childhood stressors appeared to have a strong association with the development of high-risk behavior and chronic illnesses.

Intergenerational Associations of Adverse Childhood Experiences and Adolescent Engagement in High-Risk Behaviors

Purpose: While the association between Adverse Childhood Experiences (ACEs) and negative health outcomes in adulthood is well established, very few studies have examined the cumulative impact of ACEs across generations (intergenerational ACEs – caregiver and youth) on health outcomes in adolescence. The purpose of this study is to examine whether intergenerational ACEs are associated with an increased likelihood of participation by youth in high-risk behaviors including tobacco use, vaping, alcohol use, engagement in sexual activity, or result in higher rates of affective disorders such as depression. Methods: 234 caregiver-youth dyads were recruited via a convenience sample from pediatric clinics at East Tennessee State University and Western Michigan University Homer Stryker M.D. School of Medicine. Participant dyads completed a survey assessing both caregiver and youth ACEs, youth depression, and youth participation in high-risk behaviors. Caregiver-youth dyads were sorted into an ACEs matrix with the following groups: Low Caregiver-Low Youth ACEs (LC-LY), Low Caregiver-High Youth ACEs (LC-HY), High Caregiver-Low Youth ACEs (HC-LY), and High Caregiver-High Youth ACEs (HC-HY). Results: HC-HY dyads were 11.4 times more likely to report moderate to severe depression compared to LC-LY dyads (p<0.01). HC-HY dyads were 4.5, 3.3, and 7.5 times more likely to have youth participate in alcohol use (p<0.05), vaping (p<0.05), and sexual activity (p<0.01), respectively, compared to LC-LY dyads. Conclusions: Intergenerational ACEs exposure was related to greater youth engagement in high-risk behaviors and risk of depression. Assessing both caregiver and youth ACEs would better identify youth at risk for alcohol use, vaping, sexual debut, and depression.

Teacher attitudes toword and awareness of adolescent gambling behavior in the UK

ABSTRACT Numbers of adolescents experiencing gambling related harm are increasing. Teachers spend a significant amount of time with students and their attitudes can make an impact on engagement in high-risk behavior. However, teachers’ awareness of, and attitudes towards adolescent gambling are under-researched; this study aimed to address this gap. 157 UK schoolteachers completed an online survey assessing their perceptions of adolescent gambling. Cochran’s-Q tests of association and regression analyses revealed that teachers perceived adolescent gambling as significantly less serious than other high-risk behaviors. Teachers also reported having significantly less frequent conversations about gambling and were less confident addressing gambling issues than other high-risk behaviors. Arguments are made for increased teacher training around problematic youth gambling. Such a strategy would be a prerequisite for the development and implementation of targeted prevention from harms.

Medial orbitofrontal cortex and nucleus accumbens mediation in risk assessment behaviors in adolescents and adults.

Risk assessment behaviors are necessary for gathering risk information and guiding decision-making. Risky decision-making heightens during adolescence, possibly as a result of low risk awareness and an increase in sensitivity to reward-associated cues and experiences. Higher adolescent engagement in high-risk behaviors may be, in part, due to developing circuits that contribute to risk assessment behaviors. Nucleus accumbens (NAc) activity is linked to risky decision-making and receives inputs carrying sensory and emotional information. Namely, the medial orbitofrontal cortex (MO) contributes to behavior guided by reward probability and sends direct projections to the NAc (MO→NAc), which may permit risk assessment in a mature circuit. Here, we evaluated risk assessment behaviors in adult and adolescent rats during elevated plus maze (EPM) exploration, including stretch and attend postures, head dips, and rears. We found that adolescents exhibited fewer EPM risk assessment behaviors than adults. We also quantified MO→NAc projections using a fluorescent anterograde tracer, Fluoro-Ruby, in both age groups. Labeled MO→NAc pathways exhibited greater total fluorescence in adults than in adolescents, indicating MO→NAc fibers increase over development. Using a disconnection approach to measure the contribution of the MO-NAc pathway in adults, we found that ipsilateral inactivation of the MO-NAc did not alter risk assessment behavior; however, MO-NAc disconnection reduced the number of stretch-and-attend postures. Together, this work suggests that the development of MO-NAc pathways can contribute to age-dependent differences in risk assessment.

Impulsivity mediates the impact of early life adversity on high risk behaviors among Tunisian adolescents.

Adverse childhood experience (ACE) has become an alarming phenomenon exposing youth at a great risk of developing mental health issues. Several studies have examined the mechanism by which ACE affects adolescent's engagement in risky behaviors. However, little is known about these associations in the Tunisian/African context. We investigated the role of impulsivity in the link between ACE and health risk behaviors among schooled adolescents in Tunisia. We performed a cross sectional study among 1940 schooled adolescents in the city of Mahdia (Tunisia) from January to February 2020. To measure ACE, we used the validated Arabic version of the World Health Organization ACE questionnaire. The Barratt Impulsivity Scale and the Internet Addiction Test were used as screening tools for impulsivity and internet addiction. A total of 2520 adolescents were recruited. Of those, 1940 returned the questionnaires with an overall response rate of 77%. The majority (97.5%) reported experiencing at least one ACE. Emotional neglect (83.2%) and witnessing community violence (73.5%) were the most reported intra-familial ACEs. Males had higher rates of exposure to social violence than females. The most common risky behavior was internet addiction (50%, 95%CI=[47.9-52.3%]). Our survey revealed that ACEs score predict problematic behaviors through impulsiveness (% mediated=16.7%). Specifically, we found a major mediating role of impulsivity between the exposure to ACE and the risk of internet addiction (% mediated=37.5%). Our results indicate the role of impulsivity in translating the risk associated with ACE leading to engagement in high risk behaviors.

Attitudes towards and Relationships with Cave-Roosting Bats in Northwest Cambodia

Bat populations are declining worldwide because of anthropogenic activities, including habitat destruction and hunting. Cambodia represents an important case study for studying human-bat interactions, as loss of karst caves and the destruction of forests threaten the stability of bat populations and the ecosystem services they provide. Cambodians rely on bats for tourism revenue, fertilizer from guano, and as a source of protein. However, there is a lack of information on people's attitudes towards and relationships with cave-roosting bats. In 2018, we interviewed 60 residents around three karst outcrops (Sampeau Hill, Banan Hill, and Reichiatra Hill) in Battambang Province, northwestern Cambodia, along with agricultural professionals in Battambang Town, the province's capital. The primary objectives of the interviews were to examine people's (1) attitudes towards bats, (2) experiences with bats, and (3) engagement in high-risk behaviors associated with transmission of bat-related diseases (e.g., guano mining, hunting, etc.). Most respondents (70%) held positive attitudes towards bats and listed guano production, pest control, and tourism as benefits bats provide. Additionally, all informants believed bats should be protected and stated that they would feel sad if bats were extirpated. Conversely, respondents noted that many people eat bats. We followed these semi-structured interviews with five key informant interviews involved with the conservation of bats, which provided information on the history of human-bat interactions within these communities. Respondents' positive attitudes towards bats and recognition of ecosystem services bats provide indicate they would support bat conservation policy and may be interested in developing community-based conservation programs around karst outcrops.

African American Survivors of Intimate Partner Violence: Lived Experience and Future Directions for Research

ABSTRACT Research indicates that African American women experience especially high rates of intimate partner violence (IPV). Unique contributing factors, such as experiences of racism, compound the experience of IPV for African American women. This complex web of victimization is associated with a host of significant mental and physical health consequences, social and economic consequences, and increased engagement in high-risk behaviors for these women. African American women’s help-seeking efforts are hindered by a diverse set of circumstances. In addition, the picture of the African American community has changed significantly in recent decades. The growing diversity of the “African American” community in the U.S. implores us to enhance our understanding of the unique sub-populations of Black women in America (African Americans, African immigrants and refugees, African Caribbean immigrants, African American lesbian, bisexual, and transgender women) to better meet their needs, and ultimately reduce IPV within the African American community. Despite over two decades of growth in the research and literature on IPV in the African American community, many sub-populations remain neglected. This paper aims to present a brief overview of the current state of the literature regarding the experience of IPV for African American female survivors and identify areas for further research.

Why Is the U.S. Preterm Birth Rate So Much Higher Than the Rates in Canada, Great Britain, and Western Europe?

The portion of newborns delivered before term is considerably higher in the United States than in other developed countries. We compare the array of risk exposures and protective factors common to women across national settings, using national, regional, and international databases, review articles, and research reports. We find that U.S. women have higher rates of obesity, heart disease, and poor health status than women in other countries. This is in part because more U.S. women are exposed to the stresses of racism and income disparity than women in other national settings, and stress loads are known to disrupt physiological functions. Pregnant women in the United States are not at higher risk for preterm birth because of older maternal age or engagement in high-risk behaviors. However, to a greater extent than in other national settings, they are younger and their pregnancies are unintended. Higher rates of multiple gestation pregnancies, possibly related to assisted reproduction, are also a factor in higher preterm birth rates. Reproductive policies that support intentional childbearing and social welfare policies that reduce the stress of income insecurity can be modeled from those in place in other national settings to address at least some of the elevated U.S. preterm birth rate.

Trends in Gambling Behaviour among NCAA College Student-Athletes: A Comparison of 2004, 2008 and 2012 NCAA Survey Data

Student-athletes represent a vulnerable subgroup of the college student population with regards to engagement in high-risk behaviours, including gambling. Three large samples of National Collegiate Athletic Association (NCAA) student-athletes in 2004 (N = 20,587), 2008 (19,942), and 2012 (N = 22,935) were surveyed about their gambling behaviour and attitudes.

Outcomes of the “STEPS” HIV prevention training program for young males in the penitentiary institution, Ukraine

PurposeUkraine has one of the fastest growing HIV epidemics globally. Due to their engagement in high-risk behaviors, adolescents and emerging adults involved with the penitentiary system are at a particularly high risk of HIV-acquisition. To address the epidemic, young males (aged 14 to 20 years) in penitentiary institutions across Ukraine participated in a ten-week, group-based HIV-prevention intervention (STEPS). The paper aims to discuss these issues.Design/methodology/approachThe authors analyzed clinical and programmatic services data collected as part of an evaluation of the STEPS intervention. Paired t-tests and χ2 were used to examine pre- and post-intervention differences in HV knowledge, attitudes, and risk behaviors and alcohol and other drug use knowledge.FindingsIn total, 105 male youths participated in the ten-session STEPS intervention. At baseline, males reported high frequencies of risk behaviors (e.g. unprotected sexual activity, injection drug use), moderate levels of HIV-related knowledge, and negative attitudes toward HIV and people living with HIV. At follow-up (immediately following the last STEPS session), participants’ HIV-related knowledge substantially improved and participants tended to have more favorable attitudes toward HIV.Research limitations/implicationsOutcomes suggest that knowledge and attitudes about HIV among Ukrainian incarcerated youth can improve as a result of group-based HIV-prevention intervention.Originality/valueIn Ukraine, individuals involved with the criminal justice system are one of the populations most-at-risk for HIV; criminal justice-involved adolescents and young adults are disproportionately affected by the HIV epidemic. Research among this sub-population is limited. This study aims to address this gap by evaluating an on-going group-based HIV-prevention program designed to reduce adolescent risk of HIV.

The Relationship between Parental Control and High-Risk Internet Behaviours in Adolescence

One of the main predictors of being a victim of cyber-aggression is engaging in high-risk behaviours on the internet. The main objective of this research is to analyse the relationship between two types of parental control (restriction and supervision) and engagement in high-risk internet behaviours during adolescence. To that end, and as a secondary objective, we designed and validated the High-risk Internet Behaviours Questionnaire for adolescents, used in this study. We analysed the responses of 946 adolescents aged between 12 and 18 to the High-risk Internet Behaviours Questionnaire and the Questionnaire on Parental Control of Internet Use in Adolescence. The results show that the questionnaire has appropriate metrics of reliability and validity, and show the existence of a statistically significant negative relationship, albeit small, between supervision and engaging in high-risk internet behaviours. We discuss the practical implications of these results.

Social Support, Self-Control, Religiousness and Engagement in High Risk-Behaviors among Adolescents

This research explored links between social support, self-control, religiousness and engagement in risk-behaviors among adolescents in Palestine. Results found that higher scores on social support correlated with lower scores on risk behaviors, while higher levels of self-control were correlated with lower scores on specific behaviors including drinking, smoking and drug use. Higher scores on religiousness were correlated with lower levels of drinking, drug use and premature sexual activity. While the parameters of the factors must be discovered, the implications of these findings for research are ample and include not only the mechanism of the relationships but how to enhance the protective factors in potentially disenfranchised youth in Palestine.

Using a "Positive Deviance" Framework to Discover Adaptive Risk Reduction Behaviors Among High-Risk HIV Negative Black Men Who Have Sex with Men.

Despite the high incidence of HIV among young Black MSM in the United States and engagement in high risk behaviors, many men in this group avoid infection. This suggests that some men may engage in systematic risk reduction behaviors when not always using condoms or abstaining from substances. Using a "positive deviance" framework, we conducted qualitative interviews with HIV-negative, Black MSM between 25 and 35 who reported unprotected anal sex and drug use in the past six months or current heavy drinking (N=29) to discover behaviors that could facilitate remaining HIV-uninfected. Findings showed that MSM who remain HIV negative despite continuing to engage in high-risk behaviors may be engaging in adaptive risk reduction behaviors that, through successive decisions and advance planning along the timeline to a sexual event, could lead to increased condom use, avoidance or delay of a risky sexual event, or reduction of HIV positive partners.

Effect of Educational Intervention on Knowledge Regarding HIV/AIDS among Nursing Assistant Students of Shree Birendra Hospital, Nepal

Introduction: HIV/AIDS is a serious health problem all across the world. The modes of HIV transmission are unprotected sex with infected individual, injection or transfusion of HIV infected blood or blood products, donations of infected semen, organ transplants taken from an infected person and sharing of unsterilized injection equipment. The alarmingly increasing rate of prevalence of HIV among the youths due to engagement in high risk behaviors show that there is a desperate need for assessments to be conducted to ascertain the existing knowledge, attitudes and sexual practices of youths. Methods: One group pre and post-test experimental research design was adopted for the study. The pretest study was conducted on 4 December, 2012; followed by post- test study after two weeks. The study group was provided with course on HIV/AIDS between the tests. The study was carried out in 121 students of nursing assistants of Shree Birendra Hospital. Results: The findings show that the level of knowledge after educational intervention increases significantly. Conclusion: Educational intervention is likely to be significant in increasing awareness about HIV/AIDS.

‘Haven of safety’ and ‘secure base’: a qualitative inquiry into factors affecting child attachment security in Nairobi, Kenya

ABSTRACTSecure attachment in childhood and adolescence protects children from engagement in high-risk behaviors and development of mental health problems over the life span. Poverty has been shown to create impoverishment in certain aspects of caregiving and correspondingly to compromise development of secure attachment in children. Nineteen children 8–14 years old from two schools in a middle-income area and an urban informal settlement area of Nairobi were interviewed using an adapted Child Attachment Interview (CAI) protocol. CAI was developed to provide a glimpse into the ‘meta-theories’ children have about themselves, parents, parenting, and their attachment ties with parents and extended family members. Narratives obtained with the CAI were analyzed using thematic analysis. Both Bowlby’s idea of ‘secure base’ and Bronfrenbrenner’s ‘ecological niche’ are used as reference points to situate child attachment and parenting practices in the larger Kenyan context. We found that with slight linguistic alterations CAI can be used to assess attachment security of Kenyan children in this particular age range. We also found that the narration ability in both groups of children was generally good such that formal coding was possible despite cultural differences. Our analysis suggested differences in narrative quality across the children from middle class and lower socioeconomic class schools on specific themes such as sensitivity of parenting (main aspects of sensitivity were associated with disciplinary methods and child’s access to education), birth order, parental emotional availability, and severity of interparental conflicts and child’s level of exposure. The paper puts in context a few cultural practices such as greater household responsibility accorded to the eldest child and stern to harsh disciplinary methods adopted by parents in the Kenyan setting.

Recurrent Major Depressive Disorder of a Young Woman.

Questions are presented at “consideration points” that follow a section that gives information about the case. One or more choices may be correct for each question; make your choices on the basis of your clinical knowledge and the history provided. Read all of the options for each question before making any selections. You are given points on a graded scale for the best possible answer(s), and points are deducted for answers that would result in a poor outcome or delay your arriving at the right answer. Answers that have little or no impact receive zero points. At the end of the exercise, you will add up your points to obtain a total score.

Engagement in High-Risk Behaviors Among Young Adult Survivors of Childhood Cancer Compared to Healthy Same-Age Peers Surveyed in the National Longitudinal Study of Adolescent Health.

This secondary data analysis compared smoking rates, alcohol consumption, and binge drinking, and examined risk factors for engaging in these behaviors among 90 young adult-aged childhood cancer survivors (CSS) with 15,490 young adults in the general population. The sample was drawn from the National Longitudinal Study of Adolescent Health. The sampling distribution of these healthy matched young adults was estimated through the use of bootstrapping, which involved randomly repeated for 10,000 samples of healthy controls. The findings of repeated sampling analysis revealed that CCS were more likely to smoke daily (34.5% vs. 20.6 healthy matched controls; p = 0.03). The proportion of respondents who had any signs of alcohol abuse symptoms was 72.2% of CCS compared with 81.1% of matched controls (p = 0.16), while CCS with severe alcohol abuse was 51.1% compared with 59.1% of matched controls (p = 0.28). Whether they engaged in binge drinking in the past 12 months was 43.3% for CCS and 46.4% for healthy respondents. Logistic regression analyses were performed to examine predictors of smoking, alcohol use, and binge drinking among CCS. Smoking was very strongly associated with optimism. An optimism score of one unit higher was associated with a 39% reduction in odds of smoking (odd ratio [OR] = 0.61, p < 0.0001). Black CSS were less likely to smoke (OR = 0.15, p < 0.05). CCS in good health were more likely to binge drink (OR = 3.67, p < 0.05). Data generated from this secondary data analyses add to the evidence base about the engagement in high risk behaviors among young adult-aged CCS. These findings further emphasize the need for widespread, available effective theory-based screening guidelines and interventions.

Qualitative Assessment of Barriers and Facilitators of Access to HIV Testing Among Men Who Have Sex with Men in China.

Diagnosis of HIV is the entry point into the continuum of HIV care; a well-recognized necessary condition for the ultimate prevention of onward transmission. In China, HIV testing rates among men who have sex with men (MSM) are low compared to other high risk subgroups, yet experiences with HIV testing among MSM in China are not well understood. To address this gap and prepare for intervention development to promote HIV testing and rapid linkage to treatment, six focus groups (FGs) were conducted with MSM in Beijing (40 HIV-positive MSM participated in one of four FGs and 20 HIV-negative or status unknown MSM participated in one of two FGs). Major themes reported as challenges to HIV testing included stigma and discrimination related to HIV and homosexuality, limited HIV knowledge, inconvenient clinic times, not knowing where to get a free test, fear of positive diagnosis or nosocomial infection, perceived low service quality, and concerns/doubts about HIV services. Key facilitators included compensation, peer support, professionalism, comfortable testing locations, rapid testing, referral and support after diagnosis, heightened sense of risk through engagement in high-risk behaviors, sense of responsibility to protect self, family and partner support, and publicity via social media. Themes and recommendations were generally consistent across HIV-positive and negative/status unknown groups, although examples of enacted stigma were more prevalent in the HIV-positive groups. Findings from our study provide policy suggestions for how to bolster current HIV prevention intervention efforts to enhance 'test-and-treat' strategies for Chinese MSM.

Connecting PLWHA in Rural Virginia to Health and Mental Health Care-Perspectives from the Life Worlds of Frontline Health Workers and PLWHA

Many areas in the rural south have historically been impoverished and medically underserved.1-4 Virginia encompasses two geographically underserved regions: Appalachia and the Southeast. According to the Virginia HIV Epidemiology Profile (2011), at the end of 2009, approximately 18% of residents resided in rural locations. Virginia’s Rural Health Plan (2008) utilizes the Isserman rural definition which combines all counties and county equivalents that are classified as rural or mixed rural as “rural” (see “defining rural” http://www.va-srhp.org/ docs/plan/11-appendix-d.pdf). Among this population, nearly 53% had progressed to AIDS. Seventy-five percent of rural Persons Living with HIV/AIDS (PLWHA) were male, and 60% were African American. The majority of rural PLWHA without evidence of care were male (79%) and African American (47%). Forty-nine percent of rural PLWHA with unmet need reported a risk of MSM followed by high-risk heterosexual contact (19%). Cene and colleagues (2011) and the research teams of Akers et al.5 and Sutton et al.6 found that rural African American PLWHA are concentrated in areas lacking crucial resources necessary for self-sufficiency which may lead to engagement in high-risk behaviors as an escape mechanism. Other researchers concluded that there is a great need to assess the conditions of rural PLWHA regarding their susceptibility to new infections of HIV and to uncover the barriers to affective delivery of HIV testing, care, and treatment. Further, they contend that such efforts can serve a dual role by identifying unmet needs for a wide range of services (i.e. mental health, substance abuse, STI screening) for PLWHA in the rural south.7,8