Random Community Sample Research Articles

Credibility clusters, preferences, and helpfulness beliefs for specific forms of psychotherapy

There is some evidence that the perceived credibility of specific forms of psychotherapy, beliefs about helpful and not-so-helpful interventions, and differential treatment preferences may influence both therapeutic alliance and outcome, at least in the short term. The present study explored whether distinct clusters exist, based on credibility ratings, and how these may be related to treatment preferences and beliefs about the helpfulness of specific interventions. Written descriptions of psychodynamic, cognitive, and cognitive-behavioural psychotherapy were rated by a random community sample with the 'normal' level of psychiatric treatment (n= 121), psychiatric outpatients with limited previous experience of psychiatric care (n= 118), and a group of psychiatric 'veterans' with long experience of psychiatric care (n= 48). Participants completed a questionnaire focusing on beliefs about the helpfulness of specific therapy components, rated the credibility of each form of psychotherapy, and ranked the alternatives in terms of preferences. Using cluster analysis, six distinct groups of participants were delineated. Some approached psychotherapy in an undifferentiated manner, tending to either embrace all or reject all of the methods examined. Others had differentiated ideas about the credibility of specific therapeutic approaches. These clusters were strongly associated with differential treatment preferences. They were also associated with helpfulness beliefs, type of psychological problems, previous experiences with psychotherapy, and gender. Analysis of the interactions among these factors revealed that the distribution across clusters was almost entirely accounted for by the helpfulness beliefs. For clinicians, it may be important to investigate the differential appeal of specific components of psychotherapy as well as entire therapy packages in individual cases prior to commencing therapy. For researchers, it may be important to consider whether outcome studies would become more informative by taking patients' beliefs and preferences into account.

Community participation and mental health during retirement in community sample of Australians

Objectives: This study considered whether community participation during later adulthood is more strongly associated with mental health during retirement than it is while in employment; i.e. in the absence of paid work. Method: Participants were 322 men and 311 women aged 45 years and older, who were part of a random sample of an Australian coastal community. The frequency of participation across 14 types of community-based activities was assessed. Overall mental health was measured on a 10-item Kessler Psychological Distress Scale. Linear regression models tested the multivariate associations between distress and community participation, and whether this association differed for retired and working people. Results: Retirees did not participate in their communities more than working people. The association between community participation and psychological distress did not differ by retirement status when people of all ages were considered together; however, stronger associations between several activities and (less) distress were found for retirees compared to their working peers in a younger cohort (aged 45 to 54). This cohort coincides with the average age of transition to retirement in Australia. Conclusion: These findings offer some support for the view that community participation may assist in managing the mental health implications of the transition from work to retirement.

Confirmatory Factor Analysis of the Stagnation Scale—A Traditional Chinese Medicine Construct Operationalized for Mental Health Practice

BackgroundTraditional Chinese medicine stagnation (“yu”) syndrome is characterized by a cluster of mind/body obstruction-like symptoms. Previous studies have operationalized the concept as a psychological construct through scale development, producing a three-factor 16-item inventory with good psychometric properties.PurposeThe study aimed to further validate the Stagnation Scale by confirmatory factor analysis (CFA) and examine self-appraisal of stagnation as an illness.MethodA cross-sectional questionnaire survey was conducted on a random community sample of 755 adults recruited by cluster sampling in Hong Kong.ResultsCFA revealed a good fit of the three-factor model (CFI = .95; RMSEA = .077; SRMR = .043). ROC analysis suggested a cutoff score at 50 on stagnation total score for predicting self-appraisal of an illness condition, with false positive and negative rates at 25.8% and 23.3%, respectively. Overall, 6.2% participants self-appraised to suffer stagnation symptoms to a degree of an illness, and for it, 1.9% participants intended to seek treatment. Stagnation showed positive correlations with physical distress, depression, and anxiety (r = .59–.76, p < .01) and negative correlation with age (r = −.22, p < .01).ConclusionThe Stagnation Scale appeared to be robust in factorial and construct validity. With prevalence of illness by self-appraisal at 6.2% and intention for treatment at 1.9%, stagnation is a fairly common condition associated with treatment-seeking behaviors.

Relationships between cognitive function and frontal grey matter volumes and thickness in middle aged and early old-aged adults: The PATH Through Life Study

The study examined the relationship of lateral frontal cortical volume and thickness with cognitive function in two samples of healthy middle aged (MA, 44–48years old) and early old-age (OA, 64–68years old) adults. T1-weighted magnetic resonance imaging scans were acquired in 400 MA and 397 OA adults from respective random community samples. Cortical volumes and thickness were measured with a surface-based segmentation procedure (http://surfer.nmr.mgh.harvard.edu). Volumes of lateral frontal grey matter were found to be significantly lower for OA than MA. Structure–function relationships were investigated using path analyses. In OA, smaller lateral frontal volumes were associated with better episodic memory (EM) (p<0.012, B=−0.117), and Symbol-Digit Modalities Test (SDM) (p<0.031, B=−0.118) performance. Smaller frontal cortical thickness was also associated with better EM (p<0.01) and SDM (p<0.01) performance in OA. However, in MA greater cortical thickness was associated with better EM and (p<0.01) and reaction time (RT) (p<0.01). OA cohort showed significant positive correlations between Total Brain Volume and SDM, Digit-Backwards span and RT. Possible explanations and implications of the relationships in the context of cognitive aging in healthy adults, and limitations of cross-sectional research are discussed.

Screening for Barrettʼs Esophagus in the Population: Results from a Population Based Survey

Purpose: Knowledge and attitudes regarding BE and esophageal adenocarcinoma (EAC) screening in the community are unknown. Screening for BE has been hampered by the lack of an acceptable and widely applicable tool. The acceptability of screening using novel non-invasive techniques in the general population compared to sedated endoscopy (sEGD) is unknown. We AIMED to assess attitudes towards these issues using a survey administered to the population in south-eastern Minnesota. Methods: A population-based, mixed-mode (mail and telephone) survey approach focused on a random community sample of adults aged 50 and older in the seven county area in Southeastern Minnesota was used. The core variables for this survey consisted of items assessing awareness regarding BE and its premalignant potential, willingness to participate in screening for BE/esophageal adenocarcinoma, preferences regarding optimal method of screening for BE: Sedated endoscopy (sEGD), unsedated transnasal endoscopy (uTNE) and capsule endoscopy (CE) were described in the survey, potential barriers to participation in population based screening for BE/esophageal adenocarcinoma, and selected demographics. Results: 114 of 413 (28%) of surveys have been returned. 58 (51%) of the respondents were females, with a mean age of 63 years (SD10.2) compared to non-responders who had a mean age of 65 years (SD 11.4) and similar gender distribution (females 147 (49%). 30 (27%) subjects had heard of BE before the survey, however 72% of subjects were moderately to extremely interested in a screening test for BE/EAC after reading the educational section of the survey. 64 (66%)were aware of sEGD (22% had undergone sEGD), while only 18 (16%) and 15 (13%) were aware of uTNE and CE (5.5% had undergone uTNE and 1% had undergone CE before). 72 (67%) preferred unsedated techniques (CE: 56% or uTNE: 11%) while the rest (33%) preferred sEGD. 18 (16%) had been diagnosed with cancer before (5 breast, 3 prostate, 2 colon, 6 skin, 6 others). 99 (87%) had undergone colonoscopy, 51 (86%) mammography and 45 (82%) prostate cancer screening. 99 (87%) were interested in being invited to undergo screening using one of the three techniques described in the survey. Conclusion: Though only a minority of residents in south eastern Minnesota were initially aware of BE, following education about BE, a majority of subjects expressed willingness to undergo screening. Respondents appear to be more willing to undergo screening by unsedated techniques with Esophageal capsule endoscopy being the most acceptable technique. Responders appear to be willing to undergo non-invasive screening tests for BE. Predictors of participation in screening need to be identified.

Gender-specific patterns of multiple concurrent sexual partnerships: a national cross sectional survey in Botswana

A priority of AIDS prevention in Botswana is to reduce multiple concurrent sexual partnerships. We analysed data from interviews with people aged 16–60 years in a 2007 national stratified random cluster sample of communities across Botswana. Among 768 male and 1784 female respondents, 10% reported multiple sexual partners in the month prior to the survey (MP1); 19% of men and 6% of women. In a multivariate analysis, men were more likely to report MP1 if they had not completed primary education (adjusted Odds Ratio (ORa) 2.13, 95% confidence intervals with adjustment for clustering (CIca) 1.19–3.85), if they were single (ORa 2.29, 95% CIca 1.28–4.11), if they had experienced intimate partner violence in the last year (ORa 2.59, 95% CIca 1.51–4.45) and if they reported acquiescence to high risk sex (ORa 8.32, 95% CIca 3.38–20.46). Women who said they earned more or the same as their partner were also more likely to report MP1 (ORa 1.76, 95% CIca 1.21–2.56). The higher rate of MP1 among men with different forms of choice-disability shows an important potential multiplication of male risk factors. Women with higher income were more likely to have more partners, questioning the idea that multiple concurrent partners is mainly a question of male disposable income.

THE BURDEN OF CARDIOVASCULAR RISK FACTORS AMONG THE INHABITANTS OF AN URBAN CONGOLESE COMMUNITY: RESULTS OF THE VITARAA STUDY: PP.7.291

Objective: To assess cardiovascular risk profile in an urban Congolese population. Design and Methods: We obtained anthropometric measurements and information on gender, ethnic group, life habits, medical history and use of medication for chronic diseases in a random sample of an urban Congolese community ≥10 years (n = 1823). We recorded blood pressure, pulse rate and determined proteinuria, plasma glucose and lipids. We assessed cardiovascular risk factors by body mass index status and modeled the probability of diabetes and hypertension using logistic regression analysis. Results: In 1287 adults ≥20 years, (727 women; 54.5%) 92.1% had cardiovascular risk factors. The prevalence of risk factors was 30.8% for hypertension, 4.8% for diabetes, 5.5% for smoking, 42.2% for overweight/obesity, 28.0% for abdominal obesity, 4.6% for proteinuria and 18.7% for hypercholesterolemia. Smoking predominated among men, obesity and hypercholesterolemia among women. Rarely isolated condition hypertension clustered with three or more risk factors or co-morbid conditions in 68.8% with no ethnic difference. Overweight/obese participants had higher (P < 0.001) prevalence of hypertension, diabetes, central obesity and hypercholesterolemia. In multivariable-adjusted analysis, the probability of diabetes was increased by overweight/obesity (OR 2.39; 95% CI [1.28–4.45];P = 0.006), hypertension (2.24 [1.25–4.01];P < 0.0001) and hypercholes-terolemia (1.85 [1.01–3.41];P = 0.048); that of hypertension by age (for age≥55 years 6.25 [4.11C9.50];P < 0.001), pulse rate (1.02 [1.003C1.033];P < 0.05), male gender (1.57 [1.13C2.17];P < 0.01), overweight/obesity (1.54 [1.09–2.17];P < 0.05), central obesity (2.41 [1.63C3.57];P < 0.001) and diabetes (1.90 [1.03C3.50];P < 0.05). 47.3% were aware of their hypertension, 18.4% were controlled. The control was better among women and the young patients, it was lower in the overweight/obese. Conclusion: The burden of uncontrolled risk factors in urban Africans emphasizes that control and prevention of cardiovascular disease should deserve more attention on the political agenda in sub-Saharan Africa.

Utilization of Public Mental Health Services in a Random Community Sample

The aim of this study was to examine patterns of service utilization in the public mental health service in the Australian state of Victoria. Lifetime contact with the public mental health system will be used to approximate lifetime prevalence for schizophrenia in the community. A case-linkage design joined a statewide psychiatric register with a random sample of community members drawn from a statewide electoral roll (n = 4830). In cases where individuals had been in contact with public mental health services, their full contact history was extracted. Members of the community come into contact with public mental health services for a variety of reasons, including those beyond the scope of psychiatric diagnosis and treatment, with 23% of those who made contact not receiving a psychiatric diagnosis and/or ongoing treatment. Although only 0.7% of the sample had a lifetime diagnosis of schizophrenia, these persons accounted for a significant proportion of public mental health service use. Schizophrenia-spectrum disorders were particularly prevalent among psychiatric crisis and extended care and supervision services. The Australian public mental health system has undergone significant reform in recent years. As a result, there has been a shift towards community-based care and a marked reduction in inpatient facilities. The public mental health system is a service that primarily serves those with a psychotic illness, thereby dictating that persons with so-called high-prevalence disorders, including affective and/or substance use disorders, seek psychiatric treatment elsewhere.

Increased antenatal HIV testing among rural pregnant women: a community-based HIV prevention services program in rural Maharashtra, India

Methods Between August 2006 and April 2007, a communitybased HIV prevention campaign and antenatal clinicintegrated voluntary HIV testing program was initiated in 52 villages in rural Aurangabad district, Maharashtra, India. Questionnaires assessing HIV risk factors and HIV testing utilization were administered to random cross-sectional community samples of 400 adult women who had given birth in the prior 12 months, at Baseline and, after six months, to 400 women each in the PostIntervention and a separate Control community.

Rates of depression and anxiety in urban and rural Canada

Studies of urban-rural differences in rates of non-psychotic psychiatric disorders have produced contradictory results, with some finding higher urban rates and others no difference. This study aimed to compare geographic variability of rates of depression and three anxiety disorders in a large, random community sample of Canadian residents. Data from the 2002 Canadian Community Health Survey 1.2 were analyzed, using a four-category classification of urban-rurality. Significant bivariate urban-rural differences were found for age, marital status, country of birth, ethnicity, education, household income, income adequacy, employment, home ownership, physical activity, perceived stress, and physical health. In addition, participants in the urban core and urban fringe had a weaker sense of belonging to their community and reported lower social support. There was a modest urban excess of depression in the previous 12 months but no difference in rates of agoraphobia, panic disorder or social phobia across the geographical areas. The multivariate modeling showed a lower prevalence of depression for people living in the most rural environment only (odds ratio = 0.76, 95% confidence interval = 0.59, 0.98). Factors associated with an increased rate of depression in the model were female gender, younger age, being not married, being born in Canada, white ethnicity, higher education, unemployment, not owning one's home, and poor physical health. Also, participants with a stronger sense of belonging to their community and higher social support reported lower rates of depression. These results confirmed a lower risk of depression amongst rural dwellers, which was associated with a stronger sense of community belonging. Further research on this topic could usefully include community-level variables, usually subsumed under the rubric of social capital.

Overweight and obesity among elderly Nigerians

Introduction: A growing health problem, obesity exacerbates decline in physical function. We determined the prevalence of overweight and obesity and associated risk factors among an elderly Nigerian population. Methods: We screened a stratified, random community sample of 274 persons aged 65 years and older for overweight (BMI 25.0-29.9 kg/m2), obesity (BMI >30 kg/m2), and known risk factors. Results: The overall prevalence of overweight and obesity was 13.5% (95%CI 9.7-18.1%) and 4.7% (2.6-8.0%), respectively. Obesity among females was 7.0% compared with 2.3% among males (OR 3.4; 95%CI 0.9-12.4). Hypertension was more frequent in those overweight or obese (70.0%) than in those of normal weight (43.9%; P=0.002). Hypertension (OR 2.9; 1.3-6.7) and female sex (OR 3.3; 1.4-7.9) were significant risk factors for overweight and obesity in logistic regression. Conclusion: Overweight and obesity affect a substantial proportion of elderly Nigerians and are associated with hypertension, potentially increasing the risk of cardiovascular disease. Key Words: nutrition, geriatric, Africa, body mass index, epidemiology

The Impact of Managed Care on Psychiatric Hospitalizations and Length of Stay in Puerto Rico

The objective of this paper is to estimate the impact of managed care on psychiatric hospitalizations and length of stay of medically indigent residents in Puerto Rico. A quasi-experimental design and three waves of data from a random community sample were used. Results indicate that, after 2 years, managed care had minimal impact on the number of psychiatric hospitalizations; while the mean length of hospitalization decreased after implementation of managed care, this change was not significant. Based on the data in this study, the managed care initiative developed as part of health reform in Puerto Rico did not appear to affect rates of psychiatric hospitalization and produced only a nonsignificant reduction in the average length of psychiatric hospital stays. Additional research is needed to determine trends in mental health care provision in Puerto Rico based on more recent data.

An information–motivation–behavioral skills assessment of curbside recycling behavior

Despite annual increases in the amount of material solid waste (MSW) that is recycled in the United States, the overall amount of MSW generated continues to increase. In an effort to identify and test specific predictors of curbside recycling behavior, the current study adapted the empirically validated Information–Motivation–Behavioral Skills model (IMB), traditionally used to predict personal health behavior, to explain curbside recycling behavior. Using structured computer assisted telephone surveys with two random community samples; structural equation models indicated that the IMB model significantly predicted curbside recycling. Data from the current study provides specific information about critical psychosocial determinants of curbside recycling behavior and public policy implications.

Practice and Attitudes towards CYP2D6 Testing for Patients on Tamoxifen among US Oncologists.

Abstract Background: CYP2D6 genotype has been associated with breast cancer outcomes for patients on Tamoxifen (TAM) and testing is commercially available. In the context of emerging data regarding the clinical relevance of CYP2D6 testing (CYPT) and uncertainty regarding how test results should be used in practice, we evaluated current practice and attitudes with regard to this novel pharmacogenomic test among U.S. oncologists.Methods: A survey was mailed to all breast cancer oncologists identified at National Comprehensive Cancer Network (NCCNO) centers and a random sample of community based oncologists (CBO) identified from the American Society of Clinical Oncology directory. The survey evaluated knowledge of the CYP2D test, use of the test, requests for the test by patients and third parties, and response to hypothetical test results. Associations between practice setting and CYP2D6 knowledge, CYPT, and practice patterns were evaluated. All statistical tests were two-sided.Results: 201 of 459 (44%) oncologists responded, including 97/173 (56%) of NCCNO and 104/286 (36%) of CBO. While 90% of all oncologists were aware of CYPT, only 31% had ever ordered CYPT, and only 14% used CYPT for ≥ 10% of patients on TAM. 22% had received a request for CYPT from a 3rd party. While NCCNO were more likely to be aware of CYPT (98% vs. 82%, p &amp;lt; 0.001), and to receive requests for CYPT (33% vs. 12%, p &amp;lt; 0.001), CBO reported higher frequency of CYPT in routine practice (21% vs. 11%, p = 0.06). Despite rare use, 66% of CBO and 44% of NCCNO reported they would order the test upon patient request (p &amp;lt; 0.001). In hypothetical scenarios involving CYPT for patients on TAM, for premenopausal women with poor metabolism, 33% would make no change, while 38% would switch to ovarian suppression (OS) plus aromatase inhibitor (AI), 9% would switch to OS alone, and 8% would add OS to TAM. CBO were more likely to switch to OS + AI in this setting (47% vs. 31%, p &amp;lt; 0.02), while NCCNO were more likely to recommend no change (50% vs. 18%, p &amp;lt; 0.001). For premenopausal intermediate metabolizers, 33% of CBO would change management, compared to 8% of NCCN (p &amp;lt; 0.001), with addition of OS to TAM being most frequent among both groups. For postmenopausal women with poor metabolism the majority of both CBO and NCCNO would switch to AI (82% vs. 71%, p = 0.08). Among oncologists who indicated they might change management based on CYPT results, 43% had never ordered the test. Respondents cited data from randomized trials, and professional guidelines as most influential for decisions regarding ordering tests.Conclusion: Despite calls for increased CYP2D6 testing at academic meetings and occasional requests by 3rd parties, use of CYPT is currently infrequent in oncology practice. Greater familiarity with breast cancer management correlated with lower use of CYPT and greater reluctance to change management based on test results at this time. Diversity in practice patterns and knowledge suggests a need for greater consensus on CYPT in routine practice, and highlights the need for further clinical research in this area. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1077.

Technical Note: Patterns of Urban Forest Debris from the 2004 and 2005 Florida Hurricane Seasons

Abstract Urban tree debris generation and damage resulting from seven hurricanes during the 2004 and 2005 Florida hurricane seasons was analyzed using a random sample of communities in highly affected counties. Woody debris amounts, rates, and costs for cleanup were quantified, as were the spatial patterns of damage across the state. Average debris volume per mile of street segment was 488 cubic yards, and cost of removal and disposal averaged $21.50 per cubic yard. Urban forest structure, community characteristics, and hurricane severity influenced debris and cost results. Spatial analyses indicated that debris results were clustered into northwest and southeast areas of the state, which represent two distinct ecoregions in Florida. Although southeastern Florida had much higher costs per cubic yard than the northwest, the debris volume per road mile was higher in the northwest portion of the state. On a per-mile basis, Hurricane Ivan was responsible for the greatest debris volume, and Hurricane Katrina was the most expensive. These results can be used to help communities plan for hurricane response and management activities and to estimate potential damage to their urban forest resource.

Similarity in depressive symptom profile in a population-based study of migrants in the Netherlands

Depression is a clinical syndrome developed in Western Europe and North-America. The expression of symptoms and the impact of symptoms on functioning may therefore be expected to vary across cultures and languages. Our first aim was to study differences in depressive symptom profile between indigenous and non-Western immigrant populations in the Netherlands. We hypothesized that differences in expression of depressive symptoms would be more likely in the domains of mood and cognitions, and less likely in the domains of psychomotor and vegetative symptoms. Our second aim was to study ethnic differences in the association of depressive symptoms and general functioning. In a random community sample stratified for ethnicity in Amsterdam, the Netherlands, depressive symptoms were assessed by bilingual interviewers using the Composite International Diagnostic Interview (CIDI 2.1) and the Symptom Checklist-90-Revised (SCL-90-R). Impairments in functioning were measured by the World Health Organization Disability Assessment Schedule II (WHODAS II). Results were obtained from 812 subjects: N=321 native Dutch, N=213 Turkish-Dutch, N=191 Moroccan-Dutch, N=87 Surinamese-Dutch. Differences in depressive symptom expression were tested by differential item functioning. The prevalence of DSM-IV depressive disorder and the overall level of depressive symptoms were higher in the Turkish and Moroccan immigrant groups compared to native Dutch subjects. Ethnic differences in item functioning of depressive symptoms were rare, and equally unlikely in all four symptom domains. Depression was equally associated with functional impairment across ethnic groups. Although depressive symptoms were more common among migrants than in the indigenous population, both the depressive symptom profile and the associated functional impairments were comparable. These findings may help diminishing concerns about the validity of using existing diagnostic procedures among ethnic minority groups.

Personality for free: Psychometric properties of a public domain Australian measure of the five-factor model

Fifty items from Goldberg's International Personality Item Pool were compiled to form a public-domain measure of personality, the Australian Personality Inventory (API). Data from a random community sample (N = 7615) and a university-based sample (N = 271) were used to explore psychometric properties of this 50-item measure of the five-factor model of personality (FFM). In both samples, internal reliabilities were adequate. In the university-based sample an appropriate pattern of convergent and divergent relationship was found between scale scores and domain scores from the NEO Five-Factor Inventory. After adjusting for an apparent response set (mean response across items), exploratory factor analyses clearly retrieved the FFM in both samples. It is provisionally concluded that raw scale scores from the API provide reliable estimates of the FFM, but adjustment for mean response across the 50 items might clarify the five-factor structure, especially in less educated samples.

Prevalence of cigarette smoking in the Rafsanjan urban population

This study determined the smoking rate in the urban population of Rafsanjan, Islamic Republic of Iran, in a random community sample of 491 adults (247 males and 244 females) aged > 20 years. The overall prevalence of current smoking (1+ cigarettes per day) was 24.2%; 38.5% in males and 9.8% in females. The mean number of cigarettes consumed per day was 12.1 [standard deviation (SD 8.6)]; 13.6 (SD 8.9) in men and 6.5 (SD 4.5) in women. The prevalence and mean number of cigarettes smoked per day increased significantly in older age groups.

Early maternal separation and the trajectory of borderline personality disorder symptoms

Extended maternal separations before age 5 were evaluated as a predictor of long-term risk for offspring borderline personality disorder (BPD) symptoms in longitudinal data from a large random community sample. Early separations from mother predicted elevations in BPD symptoms assessed repeatedly from early adolescence to middle adulthood. Early separations also predicted a slower than normal rate of decline in symptoms with age. Other theoretically grounded risks were examined and shown to predict elevated BPD symptoms over the developmental trajectory. Long-term effects of early separations were largely independent of childhood temperament, child abuse, maternal problems, and parenting risks. These data provide the first prospectively collected data on the developmental course of BPD symptoms and suggest a series of environmental and other influences on these very disabling problems.

Test and Tell: Correlates and Consequences of Testing and Disclosure of HIV Status in South Africa (HPTN 043 Project Accept)

As the numbers of HIV-positive diagnoses rise in South Africa, it is important to understand the determinants and consequences of HIV disclosure. Cross-sectional survey from random community samples of men and women in urban and rural South Africa (n = 217 HIV-positive individuals, 89% female). Two thirds of all known HIV-infected adults in these communities had disclosed their status to sexual partner(s). On average, individuals who disclosed were 2 years older, higher in socioeconomic assets, and had known their HIV status 7 months longer than those who had not told their sexual partner(s). The "need for privacy" was the most cited reason (45%) for nondisclosure among those who had never disclosed. People who eventually disclosed their HIV status to sexual partner(s) were significantly more likely to report always or more frequently using condoms, reducing their number of sexual partners, and/or becoming monogamous. Among individuals who disclosed their HIV status, 77% reported increases in social support, with families providing the most support. Disclosure is associated with reports of consequent safer sexual behavior and greater social support. Interventions might be informed by the costs and benefits of disclosure and differences in disclosure to sexual partner vs. to one's social network.