Risk Behavior Interventions Research Articles

The Longitudinal Association between Perceived Powerlessness and Sexual Risk Behaviors among Urban Youth: Mediating and Moderating Effects.

A distal psychosocial factor, perceived powerlessness, has been found to predict various sexual risk behaviors among youth, yet no studies have assessed mediators or moderators in this relationship. Using a demographically diverse, longitudinal sample of urban youth (N = 257), this study assessed whether the need for sexual validation mediates the relationship between perceived powerlessness and sexual risk behaviors and to assess whether this mediated pathway is moderated by socioeconomic status and gender. The mean age of the participants was 21 years old (range: 15-24) and the majority of the sample identified as Black (65%) and female (62%). The results of structural equation modeling showed that the need for sexual validation mediated perceived powerlessness and condomless sex at last sex among Black youth. The need for sexual validation mediated perceived powerlessness and concurrent sexual partnerships among White youth and depended on levels of socioeconomic status. Sexual risk behavior interventions should provide youth with increased opportunities that encourage feelings of validation from other personal achievements in addition to sex while simultaneously addressing the structural conditions that drive young people to feel powerless.

Tobacco Use in South African Emergency Centre Patients: Opportunities for Intervention

Tobacco-attributable deaths in South Africa have increased since 1990, yet data are scanty from healthcare settings. Internationally, emergency centre (EC) visits are increasingly utilised as opportunities for health risk behaviour screening and intervention, but this is not the case in South Africa. Effective advocacy for these services requires data on the prevalence and correlates of tobacco use among South African EC patients. The study objectives were to investigate tobacco prevalence and associated factors in ECs. Demographics, hospital presentation and substance use data were collected as part of a screening and brief intervention programme for alcohol and drugs in three ECs. We conducted descriptive statistics and utilised logistic regression to examine the associations of demographics, presenting complaint and substance use with moderate–high risk-tobacco use as the dependent variable. Of 12,522 patients screened, 37.0% used tobacco and 35.7% showed moderate–high risk for tobacco-related harms. Factors associated with tobacco-related harms included male gender and moderate–high risk for other substances. Of the patients who met criteria and received an intervention for alcohol or drugs, 65.5% were at moderate–high risk for tobacco-related harms. Given the high prevalence of tobacco use among patients attending ECs, intervening on this platform has the potential to reduce risk for non-communicable disease.

User-centered, interaction design research approaches to inform the development of health risk behavior intervention technologies

BackgroundComputers have tremendous potential for helping people change behaviors that put their health at risk. This potential has led to the development of a variety of health behavior intervention technologies (BITs) in recent years. While many of these BITs have been informed by scientific theories on behavior change, poor design can fail to engage intended users. User-centered, interaction design (IxD) research can help BIT developers create tools that are intuitive and enjoyable and that align with intended users' goals. In this manuscript, we describe an IxD research process we used to inform the development of a tablet-optimized web application designed to help heavy drinking gay and bisexual men reduce their risk for HIV when they seek HIV testing. MethodsWe conducted focus groups with subject matter experts (SMEs, N = 10) and intended users (N = 25). In the SME group, HIV test counselors were recruited to provide an understanding of the priorities and challenges of post-test counseling. In focus groups with intended users, participants created detailed, personalized models of two “typical” users of the proposed app (“personas”) that could be used to guide design decisions. ResultsSMEs emphasized the importance of putting patients at ease, and suggested that interventions should prioritize identifying personal risks and provide options for change. Personas created by intended users provided important details about users' attitudinal and emotional contexts, and their possible motivations and goals for using the app. These suggested that users might be most motivated to use the app in order to understand their personal risks, compare their behavior with others like them, help them decide whether they want to change to reduce their risk, and see all their options for doing so. Personas also provided insights about the aesthetic experience that might be most appealing to users. ConclusionsInteraction design research can provide BIT development teams with personal models of likely users to help guide decisions about the allocation of design resources and the overall form and spirit of the software. These insights can help teams build BITs that are more engaging and interesting to intended users.

Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people.

Individual-, family-, and school-level interventions targeting multiple risk behaviours in young people.

Familias Unidas for Health and Wellness: Adapting an Evidence-Based Substance Use and Sexual Risk Behavior Intervention for Obesity Prevention in Hispanic Adolescents.

We describe the adaptation of Familias Unidas, an evidence-based substance use and sexual risk behavior intervention, for obesity prevention in Hispanic adolescents. Intervention developers and experts in pediatric obesity, exercise physiology, dietetics, and the local parks system provided input for changes. Hispanic families also provided input through a series of 21 focus groups conducted before, during, and after an initial pilot test of the adapted intervention. After transcribing audiotaped sessions, we used a general inductive approach and Dedoose qualitative software to derive themes. Results indicated the need for improved health-related family functioning, enhanced nutrition education and skill building, increased family engagement in physical activity, and stronger links between family and environmental supports. Parents who participated in the pilot test expressed high enthusiasm for hands-on nutrition training and reported improvements in family functioning. Adolescents liked outdoor physical activities but wanted parents to be more engaged in joint physical activity sessions. The adapted intervention maintains fidelity to Familias Unidas' core theoretical elements and overall structure, but also includes content focused on physical activity and nutrition, adolescent participation in physical activity sessions led by park coaches, and joint parent-adolescent participation in physical activity and nutrition skill-building activities.

A randomized controlled efficacy trial of behavioral activation for concurrent stimulant use and sexual risk for HIV acquisition among MSM: project IMPACT study protocol

BackgroundIn the United States, problematic stimulant use is a prevalent and difficult to treat problem among men who have sex with men (MSM), as well as a major driver of HIV transmission through the large number of sexual partners and concomitant condomless anal sex (CAS). Evidence-based behavioral studies that address problematic stimulant use in MSM at risk for HIV infection are also lacking. In this paper, we describe the design of a behavioral intervention trial to reduce sexual risk behavior and stimulant use in HIV-uninfected MSM.MethodsThis study, funded by the National Institute on Drug Abuse (NIDA), is a randomized controlled trial (RCT) testing an integrated HIV risk reduction and behavioral activation counseling intervention (IMPACT) for HIV-uninfected, stimulant using MSM in Boston, MA, and Miami, FL. Participants are randomized (2:2:1) to either (1) the IMPACT intervention; (2) a relaxation condition, an active therapy time- and intensity-matched control; or (3) a standard of care risk reduction counseling comparison. At enrollment, all participants receive an HIV test and pre- and post-test counseling. The primary outcome is the difference in the rate of change in the number of self-reported condomless anal sex acts without the protection of consistent Pre-Exposure Prophylaxis (PrEP) use, as well as reductions in stimulant use during the prior 4-months. Major assessments are conducted at baseline, 4-, 8-, and 12-month follow-up visits.DiscussionEffective and sustainable behavioral interventions are sorely needed to reduce HIV acquisition in stimulant using MSM at risk for HIV infection. In this study, we will evaluate the evidence of efficacy of the IMPACT intervention to reduce HIV acquisition in HIV-uninfected, stimulant-using MSM. If found effective, the intervention tested here holds promise for being readily integrated into real-world clinical settings.Trial registrationClinicalTrials.gov number NCT03175159, registered June 5, 2017.

Complex multiple risk intervention to promote healthy behaviours in people between 45 to 75\xa0years attended in primary health care (EIRA study): study protocol for a hybrid trial

BackgroundHealth promotion is a key process of current health systems. Primary Health Care (PHC) is the ideal setting for health promotion but multifaceted barriers make its integration difficult in the usual care. The majority of the adult population engages two or more risk behaviours, that is why a multiple intervention might be more effective and efficient. The primary objectives are to evaluate the effectiveness, the cost-effectiveness and an implementation strategy of a complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in PHC.MethodsThis study is a cluster randomised controlled hybrid type 2 trial with two parallel groups comparing a complex multiple risk behaviour intervention with usual care. It will be carried out in 26 PHC centres in Spain. The study focuses on people between 45 and 75 years who carry out two or more of the following unhealthy behaviours: tobacco use, low adherence to the Mediterranean dietary pattern or insufficient physical activity level. The intervention is based on the Transtheoretical Model and it will be made by physicians and nurses in the routine care of PHC practices according to the conceptual framework of the “5A’s”. It will have a maximum duration of 12 months and it will be carried out to three different levels (individual, group and community). Incremental cost per quality-adjusted life year gained measured by the tariffs of the EuroQol-5D questionnaire will be estimated. The implementation strategy is based on the “Consolidated Framework for Implementation Research”, a set of discrete implementation strategies and an evaluation framework.DiscussionEIRA study will determine the effectiveness and cost-effectiveness of a complex multiple risk intervention and will provide a better understanding of implementation processes of health promotion interventions in PHC setting. It may contribute to increase knowledge about the individual and structural barriers that affect implementation of these interventions and to quantify the contextual factors that moderate the effectiveness of implementation.Trial registrationClinicalTrials.gov, NCT03136211.Retrospectively registered on May 2, 2017.

Multiple Risk Behavior Interventions: Meta-analyses of RCTs.

Multiple risk behaviors are common and associated with developing chronic conditions such as heart disease, cancer, or Type 2 diabetes. A systematic review, meta-analysis, and meta-regression of the effectiveness of multiple risk behavior interventions was conducted. Six electronic databases including MEDLINE, EMBASE, and PsycINFO were searched to August 2016. RCTs of non-pharmacologic interventions in general adult populations were selected. Studies targeting specific at-risk groups (such as people screened for cardiovascular risk factors or obesity) were excluded. Studies were screened independently. Study characteristics and outcomes were extracted and risk of bias assessed by one researcher and checked by another. The Behaviour Change Wheel and Oxford Implementation Index were used to code intervention content and context. Random-effects meta-analyses were conducted. Sixty-nine trials involving 73,873 individuals were included. Interventions mainly comprised education and skills training and were associated with modest improvements in most risk behaviors: increased fruit and vegetable intake (0.31 portions, 95% CI=0.17, 0.45) and physical activity (standardized mean difference, 0.25; 95% CI=0.13, 0.38), and reduced fat intake (standardized mean difference, -0.24; 95% CI=-0.36, -0.12). Although reductions in smoking were found (OR=0.78, 95% CI=0.68, 0.90), they appeared to be negatively associated with improvement in other behaviors (such as diet and physical activity). Preliminary evidence suggests that sequentially changing smoking alongside other risk behaviors was more effective than simultaneous change. But most studies assessed simultaneous rather than sequential change in risk behaviors; therefore, comparisons are sparse. Follow-up period and intervention characteristics impacted effectiveness for some outcomes. Interventions comprising education (e.g., providing information about behaviors associated with health risks) and skills training (e.g., teaching skills that equip participants to engage in less risky behavior) and targeting multiple risk behaviors concurrently are associated with small changes in diet and physical activity. Although on average smoking was reduced, it appeared changes in smoking were negatively associated with changes in other behaviors, suggesting it may not be optimal to target smoking simultaneously with other risk behaviors.

Mental Toughness in South African Youth.

Young people are particularly vulnerable to health risk behaviors and interpersonal violence, stimulating scholars' attention towards identifying factors that may reduce the likelihood that these actions will occur. Associated with positive outcomes in a variety of domains, mental toughness in young people might protect them from engaging in potentially deleterious interpersonal or health-risk behaviors, while potentially promoting positive psychological behaviors. Within this framework, the present study investigated the relationships between mental toughness, attitudes towards physical and psychological risk-taking, and trait forgiveness in a sample of 123 (males = 54, females = 69) South African youth ( M age = 23.97 years, SD = 4.46). Univariate and multivariate analyses indicated higher levels of mental toughness were associated with being more forgiving, ([Formula: see text] = .036), perceiving physical risk-taking more positively ([Formula: see text] = .062), but having more negative attitudes towards psychological risk-taking ([Formula: see text] = .036). These findings give credence to mental toughness as a psychological characteristic involved in youth risk-taking perceptions and interpersonal functioning. Future research might explore the integration of mental toughness into the development of future youth risk behavior interventions.

Sex-specific incidence rates and risk factors of premature cardiovascular disease. A long term follow up of the Tehran Lipid and Glucose Study

ObjectivesTo investigate the risk factors for premature cardiovascular disease (CVD) and to quantify their population attributable fractions (PAFs) among an Iranian population during a median follow-up of 12years. MethodsA total of 2235 men and 3703 women, aged ≥30years, free of CVD at baseline were entered into the study. Premature CVD was defined as having a history of CVD events before the age of 55 and 65 for men and women, respectively. Multivariate Cox proportional hazard regression models were used to determine the risk factors associated with premature CVD events. ResultsDuring the study, incident rates of premature CVD were 4.8 and 3.9 per 1000 person years for men and women, respectively. Low HDL-C [Hazard ratio: 1.74, 95% confidence interval: 1.11–2.74], hypercholesterolemia [3.01: 2.02–4.49], current smoker [1.68: 1.12–2.51], family history of premature CVD [2.04: 1.36–3.07], hypertension [1.65: 0.97–2.81, P=0.06] and type 2 diabetes(T2D) [1.98: 1.16–3.40] were significant predictors among men; the corresponding PAFs were 32.7, 29.4, 19.4, 14.9, 8.7 and 7.9%, respectively. Among women, T2D [3.02: 2.08–4.39], hypercholesterolemia [1.65: 1.19–2.29], being overweight [1.79: 1.01–3.17], hypertension [1.54: 1.01–2.34], family history of premature CVD [1.65: 1.19–2.29], high physical activity [0.67: 0.46–0.96] and prediabetes [1.48: 1.00–2.18] were significant predictors; the corresponding PAFs were 25.4, 22.5, 18.5, 16.8, 11.4, −10.3 and 9.1%, respectively. ConclusionsConsidering the high burden imposed on health system by cardio-metabolic risk factors, dietary, behavioral and pharmacological interventions are need to be initiated early to prevent premature CVD, taking into account the sex-related differences between risk factors.

Maternal Health Risk Assessment and Behavioral Intervention in the NICU Setting Following Very Low Birth Weight Delivery

Objectives To investigate whether maternal health risk assessment and behavioral intervention in the neonatal intensive care unit (NICU) improves women's health care seeking and health behaviors following the birth of a very low birth weight (VLBW) infant. Methods Using a quasi-experimental non-equivalent control group pretest/posttest design, 80 women who had given birth to a VLBW infant that was admitted to the NICU were enrolled into one of two cohorts: 40 into a 'Minimal Intervention' cohort, who received a single session risk assessment and health education pamphlets, and 40 into an 'Enhanced Intervention' cohort, who received five counseling sessions targeting identified risks. The proportion of women with specific health care seeking and health behaviors in the two cohorts were compared at baseline and 3- and 9-months post-intervention. Results Women in the Enhanced Intervention cohort were more likely to attend the postpartum visit (73 % vs. 48 %; p = 0.04), ingest folic acid daily (65 % vs. 19 %, p < 0.001), and correctly and consistently use a method of contraception (82 % vs. 63 %, p = 0.03) over the 9-month follow-up period. In multivariate analysis, the between-cohort differences in daily folic acid use (aOR = 3.45, 95 % CI 1.61-7.40) and correct and consistent use of a method of contraception (aOR = 1.46, 95 % CI 1.05-2.06) remained statistically significant at 9-months and the reduction in risk of unintended pregnancy nearly achieved statistical significance (aOR = 0.62, 95 % CI 0.12-1.0). Conclusions for Practice This study provides support for the implementation of maternal risk assessment and behavioral intervention in the NICU setting to promote women's positive health care seeking and health behaviors.

Methodological and Design Considerations in Evaluating the Impact of Prevention Programs on Violence and Related Health Outcomes.

Drawing on research that has identified specific predictors and trajectories of risk for violence and related negative outcomes, a multitude of small- and large-scale preventive interventions for specific risk behaviors have been developed, implemented, and evaluated. One of the principal challenges of these approaches is that a number of separate problem-specific programs targeting different risk areas have emerged. However, as many negative health behaviors such as substance abuse and violence share a multitude of risk factors, many programs target identical risk factors. There are opportunities to understand whether evidence-based programs can be leveraged for potential effects across a spectrum of outcomes and over time. Some recent work has documented longitudinal effects of evidence-based interventions on generalized outcomes. This work has potential for advancing our understanding of the effectiveness of promising and evidence-based prevention strategies. However, conducting longitudinal follow-up of established interventions presents a number of methodological and design challenges. To answer some of these questions, the Centers for Disease Control and Prevention convened a panel of multidisciplinary experts to discuss opportunities to take advantage of evaluations of early prevention programs and evaluating multiple long-term outcomes. This special section of the journal Prevention Science includes a series of papers that begin to address the relevant considerations for conducting longitudinal follow-up evaluation research. This collection of papers is intended to inform our understanding of the challenges and strategies for conducting longitudinal follow-up evaluation research that could be used to drive future research endeavors.

Prevalence and risk factors associated with suicidal ideation among adolescents in Malaysia.

Suicidal ideation, defined as thoughts, ideas and the desire to commit suicide, is becoming a major public health problem among adolescents. Indeed, suicidal ideation is known as a key predictor of future suicide risk. This study aims to determine the prevalence and risk factors associated with suicidal ideation among adolescents in Malaysia. This study used data from the 2013 Malaysian adolescent health risk behavior (MyAHRB) study, a cross-sectional school survey conducted in Peninsular Malaysia among school-going adolescents aged 16-17 years (n=2789). Logistic regression analysis was used to determine the risk factors associated with suicidal ideation among Malaysian adolescents. The overall prevalence of suicidal ideation among the adolescents was 6.2%. The prevalence was significantly higher among females than males (7.6% vs. 4.7%; p=0.002). Multivariate regression analysis revealed that adolescents who were females [odds ratio (OR)=2.02; 95% confidence interval (CI): 1.40-2.92] or of Indian ethnicity (OR=2.32; 95% CI: 1.35-3.98) were more likely to report suicidal ideation. Loneliness (OR=2.54; 95% CI: 1.57-4.11), anxiety or worry (OR=2.70; 95% CI: 1.70-4.31), no close friends (OR=2.71; 95% CI: 1.43-5.14), and lack of supportive peers (OR=1.69; 95% CI: 1.15-2.47) were identified as risk factors for adolescents' suicidal ideation. Adolescents who ever had sexual intercourse (OR=2.70; 95% CI: 1.48-4.92) and had been in a physical fight (OR=2.45; 95% CI: 1.62-3.70) were also reported to have higher risks of suicidal ideation. This study provides evidence on risk factors associated with suicidal ideation among Malaysian adolescents. Targeted mental health and health risk behavioral interventions for high-risk adolescents are recommended.

Exploring social and cognitive presences in communities of inquiry to perform higher cognitive tasks

The purpose of the current study was to explore social and cognitive relationships among students when they are solving complex cognitive tasks in online discussion forums (self-regulated). An online course targeting interventions for risk behaviors was developed in the Virtual Campus of Andalusia, Spain. A total of 9878 units of meaning posted in 96 online discussion forums during three academic years (2010–11, 2011–12 and 2012–13) were analyzed through the Community of Inquiry (CoI) framework. The degree to which online tasks at three different levels of cognitive demand (analyze, evaluate and create) triggered cognitive and social processes were examined. The results indicate that there was a specific increasing trend in the frequency of cognitive and social activity according to the requirement of the task. This study also found that the nature of the learning task modulated the different components of social and cognitive presence in these contexts.

Familias Unidas for high risk adolescents: Study design of a cultural adaptation and randomized controlled trial of a U.S. drug and sexual risk behavior intervention in Ecuador

BackgroundDeveloping, testing and implementing evidence-based prevention interventions are important in decreasing substance use and sexual risk behavior among adolescents. This process requires research expertise, infrastructure, resources and decades of research testing, which might not always be feasible for low resource countries. Adapting and testing interventions proven to be efficacious in similar cultures might circumvent the time and costs of implementing evidence-based interventions in new settings. This paper describes the two-phase study, including training and development of the research infrastructure in the Ecuadorian university necessary to implement a randomized controlled trial. Methods/designFamilias Unidas is a multilevel parent-centered intervention designed in the U.S. to prevent drug use and sexual risk behaviors in Hispanic adolescents. The current study consisted of Phase 1 feasibility study (n=38) which adapted the intervention and study procedures within a single-site school setting in an area with a high prevalence of drug use and unprotected sexual behavior among adolescents in Ecuador, and Phase 2 randomized controlled trial of the adapted intervention in two public high schools with a target population of families with adolescents from 12 to 14years old. DiscussionThe trial is currently in Phase 2. Study recruitment was completed with 239 parent-youth dyads enrolling. The intervention phase and the first follow-up assessment have been completed. The second and third follow-up assessments will be completed in 2016. This project has the potential of benefitting a large population of families in areas of Ecuador that are disproportionally affected by drug trafficking and its consequences. Trial registrationMSP-DIS-2015-0055-0, Ministry of Public Health (MSP), Quito, Ecuador.

Fidelity After SECOND LIFE Facilitator Training in a Sexual Risk Behavior Intervention

Background. Intensive facilitator training is a critical component to enable the use of Evidence-Based Interventions (EBIs) by communities. Such training ensures that program’s essential elements are implemented with fidelity. Many EBI training programs require resource- and time-intensive face-to-face training, eliminating participation from some community-based organizations due to significant costs and time away from work. The ¡CUÍDATE! (TAKE CARE OF YOURSELF!) program aimed at improving the sexual health of Latino youth is one such EBI limited in widespread dissemination by its current face to face format. The purpose of this study was to examine the efficacy of training by assessing whether facilitators who attended the virtual ¡CUÍDATE! facilitator training in SECOND LIFE™ implemented the ¡CUÍDATE! curriculum with fidelity (e.g. adherence to the curriculum and competent delivery) to adolescent youth. Methods. Using a descriptive design, community-based facilitators (n=19) attended virtual SECOND LIFE™ ¡CUÍDATE! training. Post-training facilitators implemented two identical ¡CUÍDATE! sessions with two groups of adolescents and were instructed to audio record the sessions. The research team reviewed a random, stratified subset of the audio files (n=57) using the standardized curriculum as the standard to determine implementation fidelity adherence and fidelity competency. Results.Fidelity adherence for the ¡CUÍDATE! training for both sessions was high (91.2%) (e.g. the activities were presented as intended). Fidelity competency of facilitators was also high, with the overall quality of the program sessions being 3.95 (SD 1.18, scale 1 to 5). Both fidelity measures (i.e., adherence and competency) improved from implementation of the first to the second session with 100% adherence to the curriculum reported for all facilitators in the second session. Overall quality of the program sessions also improved from the first (x=3.67, SD 1.37) to the second (x=4.43, SD 0.53) session. Discussion. The efficacy of facilitator training using a virtual platform was shown to result in high levels of implementation fidelity, and thus may be a viable platform for widespread national training. Virtual training provides an avenue for reaching community-based agencies that work with adolescent youth and have limited resources for training expenses. Future studies will explore the use of virtual reality for other types of inter-professional education.

Validation of an early childhood caries risk assessment tool in a low-income Hispanic population.

There is a recognized need for valid risk assessment tools for use by both dental and nondental personnel to identify young children at risk for, or with, precavitated stages of early childhood caries (i.e., early stage decalcifications or white spot lesions).The aim of this study is to establish concurrent criterion validity of "MySmileBuddy" (MSB), a novel technology-assisted ECC risk assessment and behavioral intervention tool against four measures of ECC activity: semi-quantitative assays of salivary mutans streptococci levels, visible quantity of dental plaque, visual evidence of enamel decalcifications, and cavitation status (none, ECC, severe ECC). One hundred eight children 2-6 years of age presenting to a pediatric dental clinic were recruited from a predominantly Spanish-speaking, low-income, urban population. All children received a comprehensive oral examination and saliva culture for assessment of ECC indicators. Their caregivers completed the iPad-based MSB assessment in its entirety (15-20 minutes). MSB calculated both diet and comprehensive ECC risk scores. Associations between all variables were determined using ordinal logistic regression. MSB diet risk scores were significantly positively associated with salivary mutans (P < 0.05), and approached significance with visible plaque levels (P < 0.1). MSB comprehensive risk scores were significantly associated with both oral mutans and visible plaque (P < 0.05). Neither was associated with visually evident decalcifications or cavitations. Findings suggest that MSB may have clinical utility as a valid risk assessment tool for identifying children with early precursors of cavitations but does not add value in identifying children with extant lesions.

A scoping review of risk behaviour interventions in young men.

BackgroundYoung adult males commonly engage in risky behaviours placing them at risk of acute and chronic health conditions. The purpose of this scoping review was to provide an overview of existing literature, describing the interventions targeting risk behaviours in young adult males.MethodsA search of seven electronic databases, grey literature and relevant journals reported in English language until May 2013 was conducted. All interventions that promoted healthy behaviours or reductions in risky behaviours to treat or prevent an associated health issue(s) in young adult males (17-35 years) in upper-middle and high-income countries were included. For inclusion the appropriate age range had to be reported and the sample had to be young adult male participants only or the outcomes reported with stratification by age and/or sex to include young adult males. Risk behaviours included: physical inactivity, poor diet, alcohol use, tobacco smoking, recreational drug use, unsafe sexual behaviours, tanning/sun exposure, violence, unsafe vehicle driving, gambling and self-harm.ResultsThe search strategy identified 16,739 unique citations and the full-text of 1149 studies were retrieved and screened with 100 included studies focussed on: physical inactivity (27%), alcohol use (25%), unsafe sexual behaviour (21%), poor diet (5%), unsafe vehicle driving (5%), tobacco smoking (4%), recreational drug use (2%), and tanning/sun exposure (1%) with no relevant studies targeting violence, gambling or self-harm. Also 10% of the studies targeted multiple risk behaviours. The most common study design was randomized controlled trials (62%). Face-to-face was the most common form of intervention delivery (71%) and the majority were conducted in university/college settings (46%). There were 46 studies (46%) that included young adult male participants only, the remaining studies reported outcomes stratified by age and/or sex.ConclusionRisk behaviours in young men have been targeted to some extent, but the amount of research varies across risk behaviours. There is a need for more targeted and tailored interventions that seek to promote healthy behaviours or decrease risky behaviours in young men.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-957) contains supplementary material, which is available to authorized users.

Citation searching: a systematic review case study of multiple risk behaviour interventions.

BackgroundThe value of citation searches as part of the systematic review process is currently unknown. While the major guides to conducting systematic reviews state that citation searching should be carried out in addition to searching bibliographic databases there are still few studies in the literature that support this view. Rather than using a predefined search strategy to retrieve studies, citation searching uses known relevant papers to identify further papers.MethodsWe describe a case study about the effectiveness of using the citation sources Google Scholar, Scopus, Web of Science and OVIDSP MEDLINE to identify records for inclusion in a systematic review.We used the 40 included studies identified by traditional database searches from one systematic review of interventions for multiple risk behaviours. We searched for each of the included studies in the four citation sources to retrieve the details of all papers that have cited these studies.We carried out two analyses; the first was to examine the overlap between the four citation sources to identify which citation tool was the most useful; the second was to investigate whether the citation searches identified any relevant records in addition to those retrieved by the original database searches.ResultsThe highest number of citations was retrieved from Google Scholar (1680), followed by Scopus (1173), then Web of Science (1095) and lastly OVIDSP (213). To retrieve all the records identified by the citation tracking searching all four resources was required. Google Scholar identified the highest number of unique citations.The citation tracking identified 9 studies that met the review’s inclusion criteria. Eight of these had already been identified by the traditional databases searches and identified in the screening process while the ninth was not available in any of the databases when the original searches were carried out. It would, however, have been identified by two of the database search strategies if searches had been carried out later.ConclusionsBased on the results from this investigation, citation searching as a supplementary search method for systematic reviews may not be the best use of valuable time and resources. It would be useful to verify these findings in other reviews.

HIV-related sexual risk behavior among African American adolescent girls.

Latent class analysis (LCA) is a useful statistical tool that can be used to enhance understanding of how various patterns of combined sexual behavior risk factors may confer differential levels of HIV infection risk and to identify subtypes among African American adolescent girls. Data for this analysis is derived from baseline assessments completed prior to randomization in an HIV prevention trial. Participants were African American girls (n=701) aged 14-20 years presenting to sexual health clinics. Girls completed an audio computer-assisted self-interview, which assessed a range of variables regarding sexual history and current and past sexual behavior. Two latent classes were identified with the probability statistics for the two groups in this model being 0.89 and 0.88, respectively. In the final multivariate model, class 1 (the "higher risk" group; n=331) was distinguished by a higher likelihood of >5 lifetime sexual partners, having sex while high on alcohol/drugs, less frequent condom use, and history of sexually transmitted diseases (STDs), when compared with class 2 (the "lower risk" group; n=370). The derived model correctly classified 85.3% of participants into the two groups and accounted for 71% of the variance in the latent HIV-related sexual behavior risk variable. The higher risk class also had worse scores on all hypothesized correlates (e.g., self-esteem, history of sexual assault or physical abuse) relative to the lower risk class. Sexual health clinics represent a unique point of access for HIV-related sexual risk behavior intervention delivery by capitalizing on contact with adolescent girls when they present for services. Four empirically supported risk factors differentiated higher versus lower HIV risk. Replication of these findings is warranted and may offer an empirical basis for parsimonious screening recommendations for girls presenting for sexual healthcare services.