Rates Of Risky Sexual Behavior Research Articles

Religion, Geography, and Risky Sexual Behaviors Among International Immigrants Living in China: Cross-Sectional Study.

Behavioral differences exist between countries, regions, and religions. With rapid development in recent decades, an increasing number of international immigrants from different regions with different religions have settled in China. The degrees to which sexual behaviors-particularly risky sexual behaviors-differ by religion and geographical areas are not known. We aim to estimate the associations of religion and geographical areas with sexual behaviors of international immigrants and provide evidence for promoting the sexual health of international immigrants. A cross-sectional study was conducted via the internet with a snowball sampling method among international immigrants in China. In our study, risky sexual behaviors included having multiple sexual partners and engaging in unprotected sex. Descriptive analysis was used to analyze the basic characteristics of international immigrants as well as their sexual behaviors, religious affiliations, and geographical regions of origin. Multivariate binary logistic regression analyses with multiplicative and additive interactions were used to identify aspects of religion and geography that were associated with risky sexual behaviors among international immigrants. A total of 1433 international immigrants were included in the study. South Americans and nonreligious immigrants were more likely to engage in risky sexual behaviors, and Asian and Buddhist immigrants were less likely to engage in risky sexual behaviors. The majority of the Muslims had sexually transmitted infection and HIV testing experiences; however, Muslims had a low willingness to do these tests in the future. The multivariate analysis showed that Muslim (adjusted odds ratio [AOR] 0.453, 95% CI 0.228-0.897), Hindu (AOR 0.280, 95% CI 0.082-0.961), and Buddhist (AOR 0.097, 95% CI 0.012-0.811) immigrants were less likely to report engaging in unprotected sexual behaviors. Buddhist immigrants (AOR 0.292, 95% CI 0.086-0.990) were also less likely to have multiple sexual partners. With regard to geography, compared to Asians, South Americans (AOR 2.642, 95% CI 1.034-6.755), Europeans (AOR 2.310, 95% CI 1.022-5.221), and North Africans (AOR 3.524, 95% CI 1.104-11.248) had a higher probability of having multiple sexual partners. The rates of risky sexual behaviors among international immigrants living in China differed depending on their religions and geographical areas of origin. South Americans and nonreligious immigrants were more likely to engage in risky sexual behaviors. It is necessary to promote measures, including HIV self-testing, pre-exposure prophylaxis implementation, and targeted sexual health education, among international immigrants in China.

Food insecurity and risky sexual behaviors among college students during the COVID-19 pandemic.

Sexually transmitted infections (STIs) and food insecurity are public health concerns in the United States (US) due to their growing prevalence and incidence among young people, and particularly in college students. Studies have reported that college students are at higher risk of STIs due to the high rates of risky sexual behavior (RSB). Most studies report a food insecurity prevalence of more than 30% among college students, which was more than twice the overall national food insecurity rate of 10.5% in 2020. This study aims to assess the relationship between food insecurity and RSB among college students during the early-stages of the COVID-19 pandemic. This was a cross-sectional study from a convenience sample of 320 students enrolled at the University of Nevada, Las Vegas during the 2020 Fall semester. Data was collected using an online survey. Univariate and multivariate logistic regression analyses were conducted. Food insecure students were 2.9 times more likely to report receiving or giving fellatio without using a condom at least once in the past 6months (P < 0.01) compared to food secure students. There was no significant association between food insecurity and other RSBs evaluated in this study. The current study provides valuable information on food insecurity and RSB among college students during the early stages of the COVID-19 pandemic. Larger and longitudinal studies are needed to assess the trajectory of the association between food insecurity and fellatio with no condom use and other RSB among college students.

Impact of psychiatric disorders on antiretroviral therapy response of patients with HIV

Background: Psychiatric disorders (PD) are prevalent among people living with HIV/AIDS (PLWHA). PD occurrence in PLWHA contributes to higher rates of risky sexual behaviors and non-adherence to Antiretroviral Therapy (ART). Aim: The present study aimed to analyze the influence of PD on ART response of PLWHA. Methods: Retrospective cohort of PLWHA followed at a referral center in northeast Brazil, which was classified into two groups: individuals with and without PD. Demographic, behavioral, follow-up adherence and ART response-related variables were analyzed. Results: Of the 443 patients, 5.4% had a diagnosis of PD. Depression was the most prevalent one (66.6%). Both groups were similar in regard to epidemiological and behavioral variables. Although a higher percentage of patients without PD reported 100% adherence to ART (89.3%), there were no differences when comparing service retention rates, number of ART regimens used, mean CD4 T-lymphocyte levels and presence of undetectable viral load at the last appointment. Patients with PD, however, showed lower CD4 T-lymphocyte increase. Conclusion: The incidence of PD was low, with the most prevalent one being depression. There was no difference regarding ART response when comparing the two groups, except for the magnitude of immune response (CD4 T-lymphocyte increase) of the patients with PD, which was lower.

Voter Support for Offering Sexual Health Services through School-Based Health Clinics

School-based health clinics (SBHCs) offer convenient, free, and much-needed health services to adolescents who have been shown to lack access to preventative care and treatment. With high rates of risky sexual behavior and associated negative health outcomes, SBHCs are particularly effective in providing sexual health services. This article presents results of a survey assessing support for such services through SBHCs. Data were collected using computer-assisted telephone interviewing (CATI) software. With significant differences found for each demographic variable assessed, findings document that the majority of participants supported offering all four sexual health services in both middle and high schools: STI/HIV testing, STI/HIV treatment, pregnancy testing, and providing condoms. These findings may be used to reduce barriers in providing SBHCs, advocate for policy change regarding SBHCs, add or expand current SBHCs, and support others in conducting similar studies hoping to document local support to implement these and other sexual health services. Although limited research shows that using local data can impact policy and facilitate local change, more studies are needed to explore the impact of using local data to implement change and further evaluate the impact of sexual health services through SBHCs.

Mental and reproductive health in multisystem youth: An in-depth qualitative approach

BackgroundMultisystem youth involved in both the child welfare and juvenile justice systems report elevated rates of risky sexual behaviors, associated health problems as well as having a disproportionally higher risk for concurrent mental health disorders. ObjectiveThe current study aimed to provide in-depth nuanced insights about mental and reproductive needs and challenges of multisystem youth using a multi-informant approach (youth, parole/probation officers). Participants and settingQualitative in-depth interviews were conducted with multisystem youth (N = 15; 14–17-years-old; 40% females) and parole/probation officers (N = 20; 35–67-years-old; 33% females) working with foster care and juvenile justice systems. MethodsInformed by Socio-Ecological Theory, analyses were conducted using Thematic Network Analysis (TNA) and qualitative software Atlas.ti.7. ResultsYouth and parole/probation officers identified key challenges related to mental health (e.g., criminalization of behaviors, unstandardized screening procedures), reproductive health (e.g., abnormalization of sexual behaviors, lack of parenting and comprehensive reproductive services), and shared challenges across systems (e.g., lack of data sharing across systems, overuse of “crisis” procedures, lack of trauma-informed providers and services). ConclusionsMultisystem youth have significant mental and reproductive health needs that are not adequately met mostly due to system and institutional challenges, differences in protocols, and discontinuance of services and treatment across systems among other problems. Mental and reproductive health disparities are key factors in stigmatization, criminalization and further victimization of youth across systems. Multidisciplinary and multi-sectoral partnerships are key to advance service, protocols and procedural gaps that address the mental and reproductive health needs of multisystem youth.

Adolescent Mediators of Unplanned Pregnancy among Women with and without Childhood ADHD

We aimed to identify adolescent mediators of the significant and sizable link between childhood attention deficit/hyperactivity disorder (ADHD) and later unplanned pregnancy in our prospectively followed, all-female sample. Participants included an ethnically diverse (47% non-White) sample of women with (n = 140) and without (n = 88) childhood ADHD who were assessed 4 times across childhood, adolescence, and adulthood. Potential mediators were measured via self, parent, and teacher report on questionnaires and interviews and by objective testing. We tested 5 early adolescent variables in three domains (personality, behavioral, and academic) as components of serial mediation pathways from (a) childhood ADHD status to (b) the early adolescent putative mediator to (c) risky sexual behavior in late adolescence and finally to (d) unplanned pregnancy by early adulthood. Of these, academic achievement (indirect effect = .1339, SE = .0721), 95% confidence interval (CI) [.0350, .3225] and substance use frequency (indirect effect = .0211, SE = .0167), 95% CI [.0013, .0711] operated through late-adolescent risky sexual behavior to explain rates of unplanned pregnancy, even adjusting for the effects of age, IQ, and family socioeconomic status (SES). When these 2 indirect effects were entered simultaneously, only the pathway from childhood ADHD to low academic achievement to higher rates of risky sexual behavior to unplanned pregnancy was significant (indirect effect = .0295, SE = .0145), 95% CI [.0056, .0620]. We discuss the significance of these early adolescent mediators, particularly academic engagement, as potential intervention targets intended to reduce rates of later unplanned pregnancies among female individuals with ADHD.

Variations in Outcomes Between Foster and Non-foster Youth Following Sex and Relationship Education

Teen pregnancy is associated with increased risk of school dropout, employment challenges and long-term poverty; these risks are exacerbated for foster youth who are at elevated risk for teen pregnancy. Sex education and relationship education can facilitate the development of attitudes and skills associated with behaviors that reduce risky sexual behaviors. However, research on sex education with foster youth is limited as is research exploring the potential benefits of combining relationship education with sex education. This study examines variations in the experiences and outcomes of non-foster youth (n = 160) and foster youth (n = 165) who participated in a federally funded teen pregnancy prevention program that included both relationship and sex education. Path analysis models examined the relationship between several exogenous variables (i.e., youth characteristics, pre-program risky sexual behavior, program experience) and three endogenous variables (i.e., post-program perceived change in intercourse, condom use, and contraceptive use intentions). Multi-group analyses were used with foster youth status as a moderator to determine if the model was invariant by foster youth status. Although foster youth entered programming with elevated rates of risky sexual behavior, both groups reported positive program experiences and safer sexual behavior intentions post-programming. Regardless of their elevated rates of risky sexual behavior prior to receiving programming, foster youth, like non-foster youth, may benefit from both relationship and sex education. For foster youth specifically, their positive program experience and reduced intentions to engage in risky sexual behaviors is an encouraging finding that contrasts with existing literature.

Transactional sexual activity among university students: Prevalence and clinical correlates

Objectives: This study examined the prevalence and mental health correlates of transactional sexual activity (sex for compensation) in a university sample. Methods: A 156-item anonymous survey was distributed via random email generation to 9,449 university students. Results: The prevalence of transactional sex was 2.1%. Respondents who had sold sex (n = 30) reported significantly higher rates of risky sexual behavior and mental health problems than those who had not sold sex (n = 1,405). Conclusions: Transactional sex in our sample of university students was associated with a range of impulsive or compulsive behaviors that may affect students’ health and well-being.

Examining Sexuality Education Preferences Among Youth at Risk for Poor Sexual Health Outcomes Based on Social Determinants of Health Factors

ABSTRACTAt-risk adolescents may experience Social Determinants of Health (SDoH) that lead to higher rates of risky sexual behavior, including increased risk of pregnancy and sexually transmitted infections. These SDoH may include components such as unstable family structures, incomplete education, and poverty. Targeting at-risk youth for sexuality education is one way to work toward decreasing sexual health disparities. However, preferences for sexuality education approaches may differ among at-risk youth by additional factors including sex and sexual orientation. The purpose of this study was to describe sexuality education preferences among at-risk youth and how sexuality education preferences differ based on sex and sexual orientation in an at-risk sample of high school-aged youth in Texas. Results indicate sexuality education preferences differ based on sex and sexual orientation when examined by sexual health topics and methods of delivery. Implications of this study indicate including at-risk youth in sexual health programs may be a way to target those at-risk of adverse SDoH, but these groups also have specific preferences for sexuality education.

Risk Factors for Forced, Incapacitated, and Coercive Sexual Victimization Among Sexual Minority and Heterosexual Male and Female College Students.

Although college students are at high risk for sexual victimization, the majority of research has focused on heterosexual students and often does not differentiate by victimization type. Thus, little is known about prevalence rates and risk factors for sexual victimization among sexual minority college students and whether the interaction between gender and sexual orientation differs by victimization type. To address these gaps, we examine whether risk factors for three types of sexual victimization (i.e., forced, incapacitated, and coerced) differ by gender (n = 681 males; n = 732 females) and sexual orientation (n = 1,294 heterosexual; n = 119 sexual minority) and whether the intersection of gender and sexual orientation is correlated with these three types of sexual victimization among 1,413 college students. Prevalence rate results revealed significant differences between gender and sexual orientation: Sexual minority females had the highest rates of coerced sexual victimization (58%), and their mean was significantly different from the other three groups (i.e., heterosexual females, heterosexual males, and sexual minority males). For both forced and incapacitated sexual victimization, heterosexual males had significantly lower means than the other three groups. Logistic regression results revealed that child sexual abuse increased the odds of experiencing both forced and coerced sexual victimization for both heterosexual and sexual minority students, whereas increased rates of risky sexual behavior were associated with forced and incapacitated sexual victimization but only for heterosexuals. Finally, heavy drinking increased the odds of experiencing incapacitated sexual victimization for both heterosexuals and sexual minorities.

A Study of the Longitudinal Patterns of Stimulant and Amyl Nitrite Use and Sexual Behavior Pre- and Post-HIV Seroconversion Among MSM.

The use of stimulant drugs alone or in combination with amyl nitrites (stimulant/nitrites) has been associated with higher rates of risky sexual behavior and predictive of HIV infection among men who have sex with men. However, the temporal pattern of stimulant/nitrite use pre- and post-seroconversion has not been well established. This study assessed changes in stimulant/nitrite use and risky sexual behavior among seroconverting MSM over time. Data were collected in the Baltimore-Washington, DC; Pittsburgh; Chicago; and Los Angeles sites of the Multicenter AIDS Cohort Study (MACS), a longitudinal study of the natural history of HIV infection among MSM. We used propensity scores to select 1044 MSM from 7087 MACS participants composed of 348 seroconverting, 348 seronegative, and 348 seroprevalent participants matched on demographics, recruitment cohort, and study visits. We centered up to four-years of semi-annual data around the seroconversion visit of the seroconverting case within each matched group of participants. Mixed effects regressions estimated the effects of serostatus, recruitment cohort, and time on self-reported stimulant/nitrite use, numbers of male intercourse partners, and numbers of unprotected receptive anal intercourse (URAI) partners. Covariates included demographics, binge drinking, and marijuana use. Seroconverters had the highest odds of stimulant/inhaled nitrite use (AOR 10.3, CI 4.8-22.0), incident rates of intercourse (IRR 1.6, CI 1.3-2.1), and URAI partners (IRR 5.1, CI 3.5-7.3). All participants decreased drug use and sexual risk behavior over time. However, the decreases were largest for seroconverters who nevertheless maintained the highest rates of stimulant/nitrite use and sexual risk. Cohort-related effects were associated with sharp reductions in stimulant/nitrite use and URAI in the early 1990s that rebounded considerably within the first decade of the 2000s. Although all participants decreased risky sexual behavior and stimulant and/or nitrite use over time, seroconverters had the largest decreases. There was no evidence for abrupt or substantial increases in drug use or risky sex post-seroconversion. However, there was substantial variation at the individual level, with the factors underlying this variation not well understood and worth further study. Moreover, stimulant/nitrite use and risky sexual behavior appear to have been strongly influenced by contextual historical and socio-cultural effects. The manner in which contextual factors influence individual behavior is also not well understood and also warrants further study.

Current drug users and women have higher rates of risky sexual behaviors

Current drug users and women have higher rates of risky sexual behaviors

ADHD and risky sexual behavior in adolescents: conduct problems and substance use as mediators of risk.

Recent studies have linked attention-deficit/hyperactivity disorder (ADHD) to elevated rates of risky sexual behavior (RSB) in adult samples. The current study tested whether ADHD symptoms were associated with RSB among adolescents, and examined comorbid conduct problems and problematic substance use as joint mediators of this association. ADHD symptoms, conduct problems (oppositional defiant disorder/conduct disorder symptoms), problematic alcohol use (alcohol use disorder symptoms, alcohol use frequency), problematic marijuana use (marijuana use disorder symptoms, marijuana use frequency), and RSB were assessed among an ethnically diverse cross-sectional sample of adolescents (N=115; mean age=14.9years) involved in the juvenile justice system. Bootstrapped mediation models revealed an initial association between ADHD symptoms and RSB that was accounted for fully by the influence of problematic alcohol and marijuana use, but not conduct problems. A follow-up multiple groups mediation analysis demonstrated that the relationship between ADHD symptoms and RSB emerged only among youth with clinically elevated conduct problems, and that problematic marijuana use fully accounted for this relationship. Hyperactive/impulsive, but not inattentive, symptoms were related to RSB, although the pattern of indirect effects was consistent with the multiple groups analysis. The association between ADHD and adolescent RSB is restricted to youth with elevated comorbid conduct problems and reflects the contributions of comorbid marijuana use problems, and to a lesser extent alcohol use problems. Early identification and treatment of these comorbid conditions may be important for the prevention of negative sexual health outcomes among youth with ADHD.

The Influence of Sexual Scripts and the “Better than Average” Effect on Condom Responsibility

Young adults attending college are especially susceptible to sexually transmitted infections (STIs) due to high rates of risky sexual behavior (Fisher, Fisher, Misovich, Kimble, & Malloy, 1996). Many college students are aware of the disease risks involved in vaginal and anal intercourse with heterosexual partners (Spears, Abraham, Sheeran, & Abrams, 1995); however, only 35% of sexually active students reported condom use (American College Health Association, 2006; Douglas et al., 1997; Lewis, Miglez-Burbano, & Malow, 2009). Sexual scripts are the socially prescribed sexual behaviors (Gagnon & Simon, 1973) determined by such factors as gender or culture (Bandura, 1984). For instance, Holland and Ramazanoglu (1992) noted that women may abide by the sexual script that, “Women must maintain a feminine role by being submissive to male partners.” Women who endorse this sexual script may lack the assertiveness skills needed to initiate purchasing condoms, providing condoms, and enforcing condom use (Sacco, Rickman, Thompson, Levine, & Reed, 1993). Only one study was found that examined the influence of sexual scripts among men. In their study, Dworkin and O’Sullivan (2005) showed that men exemplified traditional “male-dominated” sexual scripts, such as “I’m the man,” and “I’m more aggressive.” The men who endorsed such traditional sexual scripts stated that they initiated sex most of the time; moreover, these men desired to maintain their status as the person who initiates sexual activity. Previous research suggests that men tend to assume a proactive part in sexual scripts (Rose & Frieze, 1993), which may generalize to sexual behaviors such as condom suggestion and condom provision; however, Dworkin and O’Sullivan also documented men’s tendencies to desire a more egalitarian, and even femaledominated, approach to sexual initiation. Sexual scripts may have less of an impact in the realm of sexual decision making than previously thought. Other psychological mechanisms, such as the better-than-average (BTA) bias, may also contribute to risky sexual decision making (Alicke, Klotz, Breitenbecher, Yurak, & Vredenburg, 1995). Grounded in social comparison theory (Wills, 1981), the BTA bias suggests that people believe that their personal characteristics (e.g., morality) and behavior are “above the 50th percentile” of the population (Larrick, Burson, & Soll, 2007). Overall, the

Patterns and Disparities in Sexual Health Service Utilization among Adolescent Males: A Report From a National Teen Pregnancy Prevention Initiative

Male adolescents have higher rates of risky sexual behaviors compared to females, including earlier age of first sexual intercourse, higher rates of sexual experience, unprotected intercourse, and sex while high on drugs and/or alcohol. However, compared to females, male adolescents are less likely to receive routine primary care, disease screenings, sexual health counseling, and pregnancy prevention service. Although gender disparities in sexual and reproductive healthcare (SRH) have been well documented, there has been little research on racial/ethnic disparities in adolescent male utilization of SRH services. The current report aims to address this gap in research using data from a national initiative to reduce teen pregnancy in communities with the highest rates. Health center data was collected in 2011 for 59 health centers via a Clinical Partner Needs Assessment (CPNA). CPNA data included information describing health center practice setting, number of unduplicated adolescents clients, and utilization of SRH services by adolescent clients, stratified by age, gender, race and ethnicity. Basic descriptive statistics were calculated on the proportion of adolescent male SRH visits, and disaggregated by age, race, and ethnicity. Patterns in utilization of services were compared across age, race, and ethnic categories to identify disparities. All data was analyzed using Stata statistical analytic software. Out of the 59 partner health centers, only 37 (63%) reported valid data. Collectively, these 37 health centers reported serving 27,683 adolescent clients, of which 19,917 (72%) were female and 7,766 (28%) were male. Among all the male client-visits, 19.9% were SRH visits whereas among all the female client-visits, 55.3% were SRH visits. The proportion of adolescent males accessing SRH care services varies considerably across race/ethnic groups. Hispanic males have the lowest proportion of SRH visits compared to the other racial/ethnic groups (6.7%). In contrast, black males have the highest proportion of SRH visits (39.3%). The frequency of visits per client varies substantially among racial/ethnic groups as well. On average, Hispanic male adolescents have the highest frequency of visit per client (2.4) whereas black males have the lowest frequency of visits per client (1.7). Analysis of data point to persistent disparities in access of SRH utilization for adolescent clients, with adolescent males significantly less likely to access SRH services as compared to their female peers. Among adolescent males, black males have the lowest frequency of visits per client. While Hispanic male adolescents visit health centers in a more recurrent manner compared to other racial/ethnic groups, they are less likely to receive SRH services compared to their non-Hispanic peers. Despite efforts to achieve health equity in teen pregnancy prevention efforts, considerable work needs to be done to address disparities in provision of SRH services for male adolescents. Future efforts should focus on addressing barriers to sexual and reproductive healthcare for black and Hispanic adolescent males in particular.

Assessing base rates of sexual behavior using the unmatched count technique

Estimating the prevalence of sexual behaviors is difficult because of self-report biases. This is particularly relevant in assessing high-risk sexual behaviors for the purpose of reducing the transmission and acquisition of sexually transmitted infections (STIs) and HIV/AIDS. The present study employed the unmatched count technique (UCT), which provides estimates of the prevalence of risky sexual behaviors without requiring participants to confess to socially undesirable or stigmatized behaviors. Compared to a standard, anonymous self-report questionnaire, the UCT protocol revealed that people were less likely to notify their partners about STIs or discuss their history of sexual experiences. Effects were particularly large in women suggesting that women may be more likely to misrepresent their sexual behaviors. The findings suggest that conventional, anonymous self-report questionnaire data of base rates of risky sexual behavior and sexual communication are consistently inaccurate. These discrepant base rates suggest that the UCT might provide a better estimate of the frequency of these behaviors. Results suggest that inconsistent sexual behavior is more rampant than anonymous questionnaires suggest. They also underscore the need for improvements in the anonymity of assessment of sexual behaviors, which could in turn improve the targeting of prevention efforts. Results have important public health implications because accurate assessment of sexual behaviors is crucial for developing effective STI prevention interventions among target populations.

Risk behaviors, suicidal ideation and suicide attempts in a nationally representative French sample

BackgroundData from large nationally representative samples are needed to provide the empirical foundation to inform health policies for the prevention of suicide risk and risk behaviors in men and women. MethodsData were extracted from the 2010 Health Barometer, a large telephone survey on a representative sample of the general population aged 15–85 years living in France (n=27,653), carried out by the National Institute for Health Promotion and Health Education. Data were collected between October 2009 and July 2010. A computer-assisted telephone interview (CATI) system was used. ResultsOverall, 3.9% of respondents aged 15 to 85 reported past year suicidal ideation, and 0.5% reported a suicide attempt in that time period. Increased rates of risky sexual behavior are associated with ideation and attempt in both men and women, after controlling for sociodemographic variables. Homosexuality or bisexuality are associated with suicidal ideation for both men and women, but not with attempts. Substance misuse, physical and sexual assaults are strongly associated with suicidal symptoms for both men and women. Early first experiences with sex, tobacco, and alcohol are associated with suicidal symptoms though somewhat differentially for men and women. LimitationsCross-sectional survey. ConclusionThe findings underscore associations between suicidal thoughts and behaviors and risk behaviors such as unprotected sex and substance use in men and women throughout the lifespan. These associations highlight the need for preventive strategies such as screening for risk behaviors in order to identify men and women particularly at risk for suicidal behavior.

The relationships of sexual identity, hazardous drinking, and drinking expectancies with risky sexual behaviors in a community sample of lesbian and bisexual women.

This study examined the influence of demographic characteristics, sexual identity, hazardous drinking, and sexuality/intimacy enhancement alcohol expectancies on rates of risky sexual behaviors in a community sample of women who self-identified as lesbian, mostly lesbian, and bisexual (N = 349). Structured interview data were collected as part of a larger longitudinal study of sexual minority women's health, the Chicago Health and Life Experiences of Women study. We used structural equation modeling, controlling for demographic characteristics, to evaluate the influence of sexual identity, hazardous drinking, and alcohol-related sexuality/intimacy enhancement expectancies on sexual risk behaviors. Controlling for demographic characteristics and for sexual identity, higher levels of both hazardous drinking and sexuality/intimacy enhancement alcohol expectancies were associated with higher sexual risk scores. The final model predicted 36% of the variance in risky sexual behavior scores. Our findings regarding the central role of alcohol use and sexuality/intimacy enhancement expectancies in sexual risk behaviors among sexual minority women are consistent with previous research focusing on predominantly heterosexual women. Future efforts at sexual risk reduction in sexual minority women will need to address the influences of alcohol use and drinking-related expectancies on sexual behaviors and decision making.

P3.147 Prevalence of HIV/STIs and Risk Behavior in Men Who Have a Sex with Men, Belize, 2012

BackgroundIn Central America, the HIV epidemic is primarily concentrated in a few populations; including men who have a sex with men (MSM). The lack of reliable HIV prevalence estimates among...

Project Health: evaluation of a project‐based health education program

PurposeMilwaukee has very high rates of risky sexual behavior and low rates of academic achievement among adolescents. Milwaukee school representatives partnered with researchers to create and implement an innovative project‐based learning (PBL) high school health curriculum to engage students in school. This health education program, Project Health (PH), aimed to engage Milwaukee Public Schools high school students, by PBL, into the urban health classroom. The purpose of this paper is to examine the impact of the curriculum on student engagement and document the process of implementing this program, in order to identify strengths, weaknesses and areas of needed improvement.Design/methodology/approachStudent engagement was measured with an 18‐item scale at three time points in intervention and control schools. Attendance data were collected by tracking the number of days students were absent from school the semester the curriculum was implemented. Analysis of covariance was used to test whether students in PH classes were more engaged and if they had fewer absences than students in the control classes. The process evaluation included interviews with teachers, focus groups with high school students, and focus groups with teaching assistants. Interviews were transcribed and analyzed using thematic analysis to extract key themes and categories across all data.FindingsStudents in the intervention health class were significantly less absent from school than control students. However, they were not more engaged than their peers in control schools as measured by a student engagement scale. Various components of the PBL teaching approach used in the Project Health high school curriculum were viewed as positive by health educators, students, and teaching assistants. Results indicate that PBL used in health education may increase school attendance.Originality/valueThis study was original in that it documented how a novel health education program that incorporated PBL can positively impact urban students’ school attendance. It also highlighted the process of implementing this program from the vantage point of students, assistants, and health education.