Frequency Of Risk Behaviors Research Articles

Gender non-binary adolescents' somatic and mental health throughout 2020.

Non-binary gender adolescents are particularly vulnerable and more likely to be exposed to several socio-psychological difficulties and disorders. It is vital to discover and act on the vulnerabilities they encounter. The present study aims to describe the somatic and mental health, affect state, frequency of risk behaviors, victimization and negative psychosocial factors, as well as the personality profiles of non-binary adolescents. In this study the concept of gender non-binary is used and captured respondents who selected "neither of these" as their gender from the possible options (female/male/neither of these). Data was collected between September 2020 and February 2021 in Sweden, Morocco, Serbia, Vietnam, and the United States. The cross-sectional, retrospective study utilized the electronic version of the Mental and Somatic Health without borders (MeSHe) survey. From the over 5,000 responses of 15-19-year-old adolescents, 58 respondents identified as being non-binary, and built our study population. Their data was analyzed with descriptive statistic methods. Close to a fourth of adolescents identifying as non-binary reported the existence of at least one somatic disease. The most prevalent somatic disease was allergies. Almost one-third had suffered from pain either often or all the time in the past 12 months. The highest levels of perceived psychological distress were measured using obsessive-compulsive symptoms, depression, and interpersonal sensitivity. The average level of alcohol and drug use during the past 12 months was low. About 40% of non-binary adolescents reported having experienced physical abuse, and half of them experienced psychological abuse at some point in their lives. Seventeen percent reported living with adults with alcohol-use problems. Non-binary adolescents' personalities were found to be dominated by high scores in Openness, Neuroticism, and Agreeableness. This study presents a detailed biopsychosocial picture of a multinational sample of non-binary adolescents. Our study suggests that awareness and support are required from all fields of society, including family, school, healthcare, and educational institutions, for cis-normative culture to progress toward a greater understanding of and respect for gender diversity.

Trauma and institutional risk in a secure developmental disorder service: does the SAVRY inflate risk in adolescents exposed to ACEs?

PurposeAdverse childhood experiences (ACEs) are highly prevalent in people with developmental disorders who engage in offending behaviour. Many violence-based risk assessment tools include items pertaining to ACEs, and may inflate risk scores in trauma-exposed groups. This paper aims to explore the relationships between ACEs, risk assessment scores, incidents of risk and restrictive practices, in adolescents with developmental disorders in a forensic inpatient setting.Design/methodology/approachSecondary analysis was conducted on clinical data for 34 adolescents detained to a developmental disorder service. Data were extracted for Structured Assessment of Violence Risk in Youth (SAVRY) risk scores and risk behaviours and restrictive practices, as measures of observed risk.FindingsParticipants exposed to more ACEs had higher SAVRY risk scores (p < 0.001, two-tailed), with elevations specifically on the historical subscale (p < 0.001, two-tailed). Neither ACEs nor risk scores were associated with the frequency of risk behaviours. Nevertheless, participants exposed to four or more ACEs were secluded more frequently (p = 0.015, two-tailed), indicating a potential association between trauma and risk severity. Those with more complex developmental disorders experienced fewer ACEs (p = 0.02, two-tailed) and engaged in self-harm behaviours less frequently (p = 0.04, two-tailed).Research limitations/implicationsThe inclusion of ACEs in risk assessment tools may lead to the inadvertent stigmatization of trauma-exposed individuals. Further investigation is necessary to offer clarity on the impact of early adversity on risk assessment accuracy and levels of institutional risk, and the role of developmental disorders in this relationship.Originality/valueTo the best of the authors’ knowledge, this study is the first to explore the relative associations between ACEs, risk assessment scores and observed institutional risk and does so in a highly marginalized population.

English

Bovine brucellosis is a major zoonosis caused by Brucella abortus. It is a disease with a high hygienic and economic impact that mainly affects breeders, handlers and consumers of dairy products and animal health professionals. It is therefore a real public health problem. The objective of this study was to assess seroprevalence and risk behaviour for zoonotic transmission of bovine brucellosis in Namentenga Province in Burkina Faso. To do this, a 2-degree random sampling was conducted. Thus, a blood sample was taken from 600 randomly selected cattle. The individual serological status of these 600 cattle in 60 farms was determined by two tests: Tamponed Antigen Test and indirect Enzyme Linked Immunosorbent Assay for confirmation. The frequency of risk behaviours towards this zoonotic disease was determined through two epidemiological questionnaires that identified known risk factors for the transmission of brucellosis between animals and humans. Individual seroprevalence was estimated at 6.8% CI 95% [5.4-8.2]. At least one animal was infected in 30% (18/60) of herds. Positivity in the indirect Enzyme Linked Immunosorbent Assay test was significantly associated with age, breed, livestock conditions and vaccination status in cattle. The most frequently observed risk behaviours in humans in Namentenga Province are assisted calving and abortions, handling of the runt without a glove, consumption of raw milk or unpasteurized curd milk and fresh cheese. In view of this result, Brucella abortus circulates in cattle farms in Namentenga Province. Since animal products such as milk and meat from these farms are consumed by the population, adequate measures must be taken to better protect and guide the means of prevention against this zoonosis among the inhabitants. &nbsp; Key words: Bovine brucellosis, Burkina Faso, Namentenga Province, Public health, Seroprevalence, Zoonosis.

Quality of life, risk behaviors and depression among carriers of hepatitis C virus and human T-cell lymphotropic virus type 1: a comparative study

Human T-cell lymphotropic virus type 1 (HTLV-1) has low prevalence rates, but is endemic in some regions of the world. It is usually a chronic asymptomatic infection, but it can be associated with serious neurologic and urinary conditions. Hepatitis C virus (HCV) is broadly spread out worldwide. The majority of these infections have a chronic course that may progress to cirrhosis and hepatocellular carcinoma. ObjectivesTo compare sociodemographic and mental health (risk behaviors, depression, and suicide) aspects, and quality of life among patients with HCV or HTLV-1. MethodsObservational, comparative and cross-sectional study involving outpatients with HCV or HLTV-1 infection. Sociodemographic characteristics, risk behaviors and quality of life were assessed through the questionnaires Mini International Neuropsychiatric Interview – MINI Plus (depression and suicide) and Medical Outcomes Study 36-Item Short-Form Health Survey (quality of life). Univariate and multivariate statistical analyses (hierarchical logistic regression) were conducted. Results143 individuals with HCV and 113 individuals with HTLV-1 infection were included. Males were predominant in the HCV group (68.8%) and females in the HTLV-1 group (71.7%). The frequency of risk behaviors (sexual and drug use) was greater in those with HCV (p < 0.05). A past depressive episode was more common in the HTLV-1 group (p = 0.037). Quality of life was significantly worse in the physical functioning, vitality, mental health, and social functioning domains in those with HTLV-1 (p < 0.05). HTLV-1 infection remained independently associated with worse quality of life in multivariate analysis. ConclusionsRisk behaviors are frequent among those infected with HCV. Additionally, despite HTLV-1 being considered an infection with low morbidity, issues related to mental health (depressive episode) and decreased quality of life are relevant.

Epidemiology of HIV, syphilis, and hepatitis B and C among manual cane cutters in low-income regions of Brazil

BackgroundIn recent decades the epidemic of asymptomatic sexually transmitted infections has extended deep into Brazil, including small towns and rural areas. The purpose of this study was to investigate the epidemiology of HIV, syphilis, and hepatitis B (HBV) and hepatitis C viruses (HCV), and to evaluate immunization coverage against hepatitis B in a group of rural workers in Brazil.MethodsIn 2016, a cross-sectional study was conducted with 937 manual sugarcane cutters of the Midwest and Northeast Regions of Brazil. All individuals were interviewed and screened for HIV, syphilis, HBV and HCV. Correlating factors with lifetime HBV infection were investigated using logistic regression. Positive Predictive Values, Negative Predictive Values, sensitivity and specificity were also calculated relative to vaccination against Hepatitis B, comparing anti-HBs titers to vaccination reports.ResultsMost reported previous hospitalization (55%), occupational injuries (54%), sharing of personal items (45.8%), alcohol consumption (77.2%), multiple sexual partners in previous 12 months (39.8%), and no condom use during sexual intercourse in last 12 months (46.5%). Only 0.2% reported using injection drugs. Anti-HIV-1 was detected in three individuals (0.3%). Serological markers of lifetime syphilis (treponemal test) were detected in 2.5% (95% CI: 1.6–3.6) of participants, and active syphilis (treponemal test and VDRL) present in 1.2%. No samples were positive for anti-HCV. The prevalence of lifetime HBV infection (current or past infection) was 15.9%, and 0.7% (95% CI 0.4 to 1.5) were HBsAg-positive. Previous hospitalization (OR 1.53, CI 1.05–2.24, p < 0.01) and multiple sexual partners in the last 12 months (OR 1.80, CI 1.25–2.60, p < 0.01) were predictors for lifetime HBV infection. Although 46.7% (95% CI 43.4–49.9) of individuals reported having been vaccinated against hepatitis B, only 20.6% (95% CI 18.1–23.3) showed serological evidence of previous hepatitis B vaccination (positive for anti-HBs alone).ConclusionsThe high prevalence of syphilis and HBV compared to the general population and the high frequency of risk behaviors show the potential for sexual and parenteral dissemination of these agents in this rural population. In addition, the low frequency of hepatitis B vaccinated individuals suggests a need for improved vaccination services.

Prevalence and correlates of HIV infection among men who inject drugs in a remote area of Vietnam

BackgroundLack of information on the HIV epidemic among men who inject drugs (MWID) in northwestern Vietnam, a remote area, may hamper national efforts to control the disease. We examined HIV prevalence, needle–syringe sharing behaviors, and associated factors among MWID in three areas of northwestern Vietnam.MethodsWe used descriptive analysis to report the characteristics, frequency of risk behaviors, and of access to healthcare services among the MWID. Univariable logistic regression was used to assess the associations between the HIV infection, needle–syringe sharing behaviors, and their independent variables. We further explored these associations in multivariable analyses where we included independent variables based on a priori knowledge and their associations with the dependent variables determined in univariable analyses (p < 0.25).ResultsThe HIV prevalence was 37.9, 16.9, and 18.5% for Tuan Giao, Bat Xat, and Lao Cai City, respectively, and 25.4% overall. MWID of Thai minority ethnicity were more likely to be HIV-positive (adjusted odds ratio (AOR) 3.55; 95% confidence interval (CI) 1.84–6.87). The rate of needle–syringe sharing in the previous 6 months was approximately 9% among the MWID in Tuan Giao and Lao Cai City, and 27.8% in Bat Xat. Two thirds of the participants never underwent HIV testing before this study. Ever having been tested for HIV before this study was not associated with any needle–syringe sharing behaviors. Among the HIV-positive MWID, those who received free clean needles and syringes were less likely to give used needles and syringes to peers (AOR 0.21; 95% CI 0.06–0.79). Going to a “hotspot” in the previous week was associated with increased odds of needle–syringe sharing in multiple subgroups.ConclusionOur findings on HIV prevalence and testing participation among a subset of MWID in the northwestern Vietnam were corroborated with trend analysis results from the most recent HIV/STI Integrated Biological and Behavioral Surveillance report (data last collected in 2013.) We provided important insights into these MWID’s risky injection behaviors. We suggest heightened emphasis on HIV testing and needle and syringe provision for this population. Also, policymakers and program implementers should target hotspots as a main venue to tackle HIV epidemics.

Profiles of Student Perceptions of School Climate: Relations with Risk Behaviors and Academic Outcomes.

School climate has been linked to a variety of positive student outcomes, but there may be important within-school differences among students in their experiences of school climate. This study examined within-school heterogeneity among 47,631 high school student ratings of their school climate through multilevel latent class modeling. Student profiles across 323 schools were generated on the basis of multiple indicators of school climate: disciplinary structure, academic expectations, student willingness to seek help, respect for students, affective and cognitive engagement, prevalence of teasing and bullying, general victimization, bullying victimization, and bullying perpetration. Analyses identified four meaningfully different student profile types that were labeled positive climate, medium climate-low bullying, medium climate-high bullying, and negative climate. Contrasts among these profile types on external criteria revealed meaningful differences for race, grade-level, parent education level, educational aspirations, and frequency of risk behaviors.

Comparative study on health risk behaviors between male and female freshmen among medical universities, scientific and technologic universities

Objective To explore the distribution and characteristics of health risk behaviors between the male and female college freshmen in the medicine and science, and to provide evidence for appropriate health intervention measures. Methods A questionnaire investigation was performed on college students' health risk behaviors among 1019 freshmen from medical and science college in urban area of Harbin. Results ⑴There were statistically significant among the different gender in difference of risky behaviors except playing video games, net surfing, considered suicide, drug abuse and a few activities outside the 60 minutes every day(P<0.01). ⑵Medical male risk behavior of the frequency(56.4%, 19.2%, 12.7% and 47.1%)higher than that of science and engineering male(35.6%, 5.2%, 1.6% and 17.3%)in trying to smoking, current smoking, sexual behavior and breakfast skipping.Recent medical males drinking rate was 85.3% higher than male of science and engineering 72.2%. The incidence of female science and engineering students, respectively(89.3%, 50.8% and 38.5%) than female medical students (72.4%, 36.9% and 8.0%) in trying to drinking and recent drinking and breakfast skipping. Conclusion The risk behaviors of college freshmen were prevalent. The frequency of risk behaviors are different among the College Freshmen in different genders and with different major, respectively. Therefore, it is necessary to take measures for intervention. Key words: Health risk behaviors; Medicine; Science; Gender; College freshmen

Prévalence de la brucellose bovine et comportements à risque associés à cette zoonose dans la zone périurbaine de Dakar au Sénégal

L’objectif de cette étude a été d’évaluer la prévalence et la fréquence des comportements à risque de transmission zoonotique de la brucellose bovine dans la zone périurbaine de Dakar. Le statut sérologique individuel de 300 bovins répartis dans 30 élevages de cette zone a été déterminé par les tests au rose Bengale et de fixation du complément. La fréquence des comportements à risque envers cette zoonose a été déterminée à travers deux questionnaires épidémiologiques qui ont permis de faire le recensement de facteurs connus de risque de transmission de la brucellose entre animaux et humains. En considérant la sensibilité et la spécificité des tests au rose Bengale et de fixation du complément utilisés en série, respectivement de 85 et 98,75 p. 100, la prévalence réelle a été évaluée à 36,36 p. 100. Au moins un animal a été infecté dans 96,6 p. 100 des troupeaux. La positivité au test de fixation du complément a été significativement associée à l’âge, la race, l’avortement et la présence d’hygromas chez les bovins. Les comportements à risque les plus fréquemment observés chez les humains dans cette zone ont été l’assistance aux mises bas et aux avortements, la manipulation de l’avorton sans gant, la consommation de lait cru ou de lait caillé non pasteurisés, et de fromage frais. Ces résultats montrent que la brucellose existe dans les élevages bovins laitiers en périphérie de Dakar. Etant donné que le lait produit par ces élevages sert à ravitailler la ville de Dakar, des mesures adéquates doivent être prises afin d’orienter les moyens de prévention contre la brucellose chez les habitants.

Identity development as a buffer of adolescent risk behaviors in the context of peer group pressure and control

We examined identity development as a moderator of the relation between peer group pressure and control and adolescents’ engagement in risk behaviors. Participants (n=1070; Mage=15.45 years) completed a self-report measure of identity exploration, the degree to which they have explored a variety of self-relevant values, beliefs and goals, and identity commitment, the degree to which they have secured a personal identity. Participants further reported on their frequency of risk behaviors (substance use and general deviancy) and experienced peer group pressure and control. Results confirmed that identity commitment was a buffer of substance use and identity exploration was a buffer of general deviancy in more pressuring peer groups. In more controlling peer groups, teens with greater identity commitment engaged in less risk behavior than teens with low-identity commitment. Thus, identity development may be a suitable target to deter negative effects of peer pressure in high-risk adolescents.

Risk perception, emotion regulation and impulsivity as predictors of risk behaviours among adolescents in Switzerland

The purpose of this study was to explore the frequency of risk behaviours among Swiss adolescents and their links with risk perception, impulsivity and emotion regulation abilities, operationalized with the concepts of alexithymia and emotional openness. We recruited 144 subjects (aged 14–20), who completed the Risk Involvement and Perception Scale (RIPS-R), the UPPS Impulsive Behavior Scale, the 20-item Toronto Alexithymia Scale (TAS-20), and the 20-item Dimensions of Openness to Emotional Experiences (DOE-20) questionnaire. Findings revealed that a greater perception of benefits and a higher level of sensation seeking were associated with more involvement in risk behaviours, which are essentially socially accepted behaviours. Notably, the path model indicated that the perception of benefits was a mediator in the relationship between sensation seeking and risk behaviours. The results add to the psychological understanding of factors associated with risk behaviours in adolescence. The limitations and implications of these results for developmental theories, research, and prevention are stated.

Comportamentos de jovens no trânsito: um inquérito entre acadêmicos de enfermagem

Os acidentes de trânsito (AT) constituem-se em importante problema de saúde pública pela elevada morbi-mortalidade e por ocasionarem altos custos sociais e econômicos. Realizou-se, portanto, um estudo epidemiológico e transversal em Goiânia, Goiás, em 2006, que teve por objetivo verificar a freqüência de comportamentos de risco que pudessem contribuir para a ocorrência e gravidade de AT entre jovens universitários. A amostra constou de 310 acadêmicos do curso de Enfermagem da Universidade Católica de Goiás, com mediana de idade de 20 anos, predominantemente do gênero feminino, cor branca e de classe social média. Cerca de 80% dos alunos relataram hábito de dirigir. Destes, 52.2% dirigem sem habilitação. Apenas 73.2% responderam que sempre utilizam cinto de segurança como condutores. Aproximadamente 37% relataram envolvimento em acidentes de trânsito. Falta de atenção (69%), desrespeito à sinalização (27.8%) e excesso de velocidade (27%) foram os fatores que contribuíram para ocorrência ou gravidade do acidente. Um significativo percentual de participantes dirige na contramão, faz ultrapassagem proibida e ultrapassa o limite de velocidade. Ressalta-se que o levantamento das características comportamentais no trânsito entre indivíduos jovens possibilita a criação e aprimoramento de estratégias que podem reduzir a ocorrência, gravidade e conseqüências deste tipo de acidente.

Legislation: The implementation of health policies in a female prison in Durban, South Africa

abstract The Bill of Rights of the South African Constitution, Section 27 allows all citizens the right to health and medical treatment. The Correctional Services Act 111 of 1998 stipulates that the Department of Correctional Services (DCS) provide adequate health care services to all prisoners so that they can lead a healthy life. In theory the DCS has a commitment to provide adequate healthcare and access to material that educates prisoners, including female prisoners, effectively about HIV and AIDS infection. In reality is this being realised? The research was based on the assumption that female prisoners have different levels of experiences, perceptions, and awareness of sexually transmitted infections (STIs), HIV and AIDS. In most instances, avoidance or infection of such diseases is rooted in a complex set of issues. One of them is the mental state and educational level of female prisoners. Another factor influencing protection against STIs is their vulnerability to the conditions that they are faced with within the prison environment. A third factor is the extent to which female prisoners might have a proclivity towards unprotected sexual relationships with other female inmates within the prison. This Focus aims to discuss the complex set of issues as uncovered in a South African prison to identify the challenges that exist in the implementation of the law on health care within prisons. Focus group discussions were held with female inmates at Durban Female Centre in order to analyse their experiences and perceptions of HtV and AIDS and identify discrepancies in legislation and the implementation of health policies. Information on the knowledge and perceptions about HIV, the level and frequency of risk behaviours related to the transmission of HIV is important in identifying, understanding, and responding to the gender profile of HIV and AIDS. Part of the crisis of HIV is that it has exposed the gap between what we say and what actually happens, and this dissonance can cause the proliferation of the HIV epidemic.

Feasibility of a preventive HIV-1 vaccine cohort among persons attending sexually transmitted disease clinics in Thailand.

Persons attending sexually transmitted disease clinics at three sites in Thailand were recruited to participate in a 1-year study of HIV-1 incidence. Between September 1995 and February 1996, 31% (371 of 1205) of eligible men and 24% (161 of 659) of eligible women agreed to participate. At enrollment, HIV-1 seropositivity was 3.8% among men and 2.5% among women. Follow-up of the 514 participants who were seronegative at baseline was 78% at the 12-month visit. During the study period, 53% of men reported 2 or more sexual partners, 31% reported sex with a commercial sex worker (CSW), and 33% with a casual partner. Of those visiting CSWs, 72% reported consistent condom use. Among women, 11% reported 2 or more sexual partners. Decreased HIV risk behaviors among men were observed during the study. Four incident infections occurred in men (1.4/100 person-years, 95% confidence interval [CI] = 0.4-3.6) and none among women. Based on the observed HIV-1 incidence, HIV vaccine efficacy trials in such populations would have to be larger than previously planned or more selective of high risk subgroups for recruitment.

Post-exposure prophylaxis for HIV.

The advent of preventive treatment for HIV highlights the urgent need for basic, clinical, and epidemiologic research targeting the pathogenesis and prevention of cutaneous and mucosal infection. In addition, the impact of HIV prophylaxis on the frequency of risk behaviors and antiretroviral drug resistance, especially in cities with high HIV prevalence, must be evaluated. In our view, the available data (albeit not definitive) are strong enough to support the provision of post-exposure prophylaxis in select cases of sexual and injection drug use exposure in addition to occupational exposures. However, post-exposure treatment should be used judiciously and only in the context of a comprehensive prevention program. Ultimately, primary exposure prevention, whether in health care facilities or in the community, is the most important strategy to prevent AIDS.

The Importance of Contextualizing Research

SUMMARY A comparative analysis of the effects of various forms of sexual relationship on;the frequency of risk behavior was conducted among gay men in Germany who participated in a survey via the gay press in 1996 (n = 3048). Of the West Germans, 22.1% of the men had at least one act of unprotected anal intercourse with a partner whose status was unknown (in the twelve months preceding the survey) as compared to 25.7% of the East Germans. Unprotected anal intercourse without knowing the partner'S HIV status is considerably more frequent in steady relationships. Although risk behavior does occur in the context! of casual sexual encounters, this form of risk contact remains sporadic (one to four times in the twelve months preceding the survey). Unprotected anal intercourse between partners with differing HIVstatus was found among 3.1% of the West Germans and 3.7% of the East Germans. Differences according to type of partnership are less pronounced for these men. The data from the 1996 survey provide no support for younger gay men being at greater risk for HIV infection through sexual contact. For the un-der-21 age group, the percentage of men without anal-genital sexual experience is particularly jhigh and the percentage of men having had a higher number of sexual partners (more than 20 over the last twelve month) is considerably less for men under 25year than for the rest of the sample.

Prevalence of chlamydial infection and frequency of risk behaviours for STDs and HIV infection among adolescents in public juvenile facilities in the province of Quebec.

This study aimed to determine the prevalence of chlamydial infection in adolescents entering public juvenile facilities in the province of Quebec and the frequency of their risk behaviours for STDs and HIV infection. Adolescents were asked to complete an anonymous self-administered questionnaire and to be screened for Chlamydia trachomatis. Of 731 sexually active adolescents, 62% agreed to be tested. The overall prevalence rate was 7.7% (95% confidence interval: 5.1%-10.3%). The prevalence was significantly higher in female than in male teenagers: 12% vs 3% (p < 0.001, Fisher's exact test). These results suggest that screening for chlamydial infection should be offered to all sexually active female teenagers admitted into juvenile facilities. For males, selective screening taking into account sexual history would be a more realistic approach. The frequency of high risk activities for STDs and HIV infection points to the importance of specific prevention programs for this population.

HIV Prevalence and Frequency of Risk Behavior in Injecting Drug Users Entering Treatment and Out of Treatment: A Cross-Sectional Study in Five Italian Cities

We conducted a study to describe current patterns of drug-related behaviors, and to identify characteristics that may distinguish injecting drug users entering treatment from those out of treatment, in five Italian cities. Overall, 1,180 subjects were recruited — 568 entering treatment and 612 out of treatment. Male to female ratio was 6.6:1. The median age was similar in the two groups. A high proportion of injecting drug users recruited out of treatment had been in treatment at least once. HIV prevalence among injecting drug users entering treatment was not higher than that of those who were out of treatment. Furthermore, a large proportion of injecting drug users who still were out of treatment reported having adopted safe behaviors. The results of the study emphasize the need to implement outreach programs aimed at harm reduction.

The Implementation of an Experimental Research Design in the Evaluation of an Intervention to Prevent AIDS among IV Drug Users

A demonstration project, currently in progress in Miami, is using an experimental research design to evaluate an AIDS intervention program among IV drug users and the sexual partners of IV drug users. At the time of the initial assessment, which includes a blood test to determine HIV serostatus and an extensive interview, study participants are randomized into either a standard or an enhanced intervention protocol. The enhanced intervention group receives more intensive counseling including individual as well as group sessions. Follow-up assessments of both groups are made at six-month intervals. The before/after comparisons will assess whether frequency of risk behaviors have changed and whether observed changes are greater in the enhanced group than the standard group. Randomization to two alternative intervention groups allows for the control of many potential biases that plague other types of before/after research designs.