Risk Behavior Interventions Research Articles

A randomized comparative effectiveness study of Healthy Directions 2—A multiple risk behavior intervention for primary care

ObjectiveTo evaluate the effectiveness of the Healthy Directions 2 (HD2) intervention in the primary care setting. MethodsHD2 was a cluster randomized trial (conducted 3/09–11/11). The primary sampling unit was provider (n=33), with secondary sampling of patients within provider (n=2440). Study arms included: 1) usual care (UC); 2) HD2—a patient self-guided intervention targeting 5 risk behaviors; and 3) HD2 plus 2 brief telephone coaching calls (HD2+CC). The outcome measure was the proportion of participants with a lower multiple risk behavior (MRB) score by follow-up. ResultsAt baseline, only 4% of the participants met all behavioral recommendations. Both HD2 and HD2+CC led to improvements in MRB score, relative to UC, with no differences between the two HD2 conditions. Twenty-eight percent of the UC participants had improved MRB scores at 6months, vs. 39% and 43% in HD2 and HD2+CC, respectively (ps≤.001); results were similar at 18months (p≤.05). The incremental cost of one risk factor reduction in MRB score was $310 for HD2 and $450 for HD2+CC. ConclusionsSelf-guided and coached intervention conditions had equivalent levels of effect in reducing multiple chronic disease risk factors, were relatively low cost, and thus are potentially useful for routine implementation in similar health settings.

Modeling Risk Factors and Disease Conditions to Study Associated Lifetime Medical Costs

We develop a mathematical model that captures the complex interactions within the health service system featuring chronic diseases and provides valuable lessons that could assist in controlling escalating healthcare costs. We utilize a Monte Carlo simulation framework to simulate the evolution of a population subject to deaths, births, and disease conditions. The model estimates the lifetime health expenditures of individuals based on demographics including race, age, and gender, as well as risk factors that contribute to the development of specific disease conditions. We further incorporate interactions between multiple disease conditions and the effect of risk factors in chronic disease incidence as well as the corresponding medical expenditures over the remaining life years within a single framework. The comprehensive nature of the model allows for the ability to project changes in medical costs as demographic changes occur and to evaluate the impact of changes in behavioral risk factors on medical costs. We demonstrate model applications through various illustrative examples, including cost analysis of targeted interventions for various risk behaviors.

보건 의료용 기능성 게임의 효과적 개발 방향 연구

기능성 게임은 현재 정부, 교육, 군사, 기업 그리고 보건 및 의료분야에 이르기까지 다양하게 확장되고 있다. 특히 보건/의료 기능성 게임은 예방과 치료를 위한 유용한 도구로 인식되고 있으며, 구체적으로 천식, 당뇨, 암, 뇌질환, 백혈병 등의 질환을 가진 환자들의 상태를 호전시키는 결과가 보고되고 있다. 이러한 효과들을 토대로, 미국과 유럽 등에서는 건강심리, 가상현실, 행동의학 등의 다학제간 융합연구를 통해 다양한 형태의 게임 개발이 시도되고 있다. 그러나, 국내에서는 아직까지 이에 대한 체계적인 학문적 접근은 물론 개발사의 효과적인 기획 전략 수립과 다양한 개발 노력도 부족한 상황이다. 따라서, 본 연구는 보건/의료 기능성 게임에 대한 기존의 연구결과를 바탕으로 그 개념과 효과, 분류체계를 정리하고, 대표적인 성공사례를 분석하여, 향후 관련 연구와 개발 및 기획에 대한 개괄적인 방향성을 제시하고자 한다. 특히, 보건/의료 기능성 게임의 성공적 개발을 위해서는 의학적 근거와 과학적 설명을 근간으로 기획 단계부터 관련 이론을 체계적으로 적용시키는 것이 중요하다. 이에 따라, 본 연구는 보건/의료 기능성 게임에 적용되었거나 향후 활용 가능한 이론들을 정리하고, 성공사례 분석과 결부해 연구자와 개발자, 그리고 의료 전문가들이 고려할 사항과 방향성에 대한 제언을 정리하였다.

S13.1 Current and Future Challenges in Gay Men’s Health

Epidemics of HIV in men who have sex with men (MSM) were first recognised in the early 1980s. Since the introduction of antiretroviral treatment (ART) in the mid-1990s incidence of...

Young Men's Condom Use Resistance Tactics: A Latent Profile Analysis

Research suggests that many men have used a variety of tactics to avoid using condoms when having sex with women. Guided by previous work demonstrating that men's use of coercive condom resistance tactics was predicted by negative attitudes toward women, inconsistent condom use, multiple partners, and sexual sensation seeking, the current study used latent profile analysis (LPA) to determine whether similar constructs were associated with a variety of resistance tactics. A community sample of 313 moderate-drinking men participated, of whom 80% reported employing at least one condom use resistance tactic since adolescence. The LPA revealed three classes of men. In general, men with the least negative beliefs about women, low levels of sexual sensation seeking and impulsivity, and positive beliefs about condoms (Condom Positive/Low Hostility) reported less use of resistance tactics than men with moderate sexual sensation seeking and impulsivity, negative beliefs about condoms, and moderate (Condom Negative/Moderate Hostility) or high (Condom Negative/High Hostility) negative attitudes about women. The classes also differed in terms of their sexual behaviors. This study demonstrated that sexual risk behavior interventions should not only address the tactics through which men resist using condoms but also tailor these efforts to men's individual characteristics.

Medicaid Pay Hike Has Been Delayed Until at Least April

Medicaid Pay Hike Has Been Delayed Until at Least April

Differences between Men and Women in Condom Use, Attitudes, and Skills in Substance Abuse Treatment Seekers

For substance abuse treatment-seekers engaging in high risk sexual behavior, their inconsistent condom use may be related to their condom use attitudes and skills. This study compared treatment-seeking male and female substance abusers in their reported barriers to condom use and condom use skills. Men and women (N = 1,105) enrolled in two multi-site HIV risk reduction studies were administered the Condom Barriers Scale, Condom Use Skills, and an audio computer-assisted structured interview assessing sexual risk behavior. Men endorsed more barriers to condom use, especially on the Effects on Sexual Experience factor. For both men and women, stronger endorsement of barriers to condom use was associated with less use of condoms. However, the difference between condom users and non-users in endorsement of condom barriers in general is greater for men than women, especially for those who report having casual partners. Findings support the need to focus on gender-specific barriers to condom use in HIV/STI prevention interventions, especially risk behavior intervention techniques that address sexual experience with condoms. Results provide additional information about the treatment and prevention needs of treatment-seeking men and women.

Update: Primary-Care Risk Assessment and Behavioral Interventions Can Reduce Child Abuse and Neglect

In 2004, the U.S. Preventive Services Task Force found insufficient evidence to recommend behavioral interventions to prevent child abuse and neglect.

Psychopathology, physical complaints and health risk behaviors among youths who were victims of childhood maltreatment: A comparison between home and institutional interventions

Abstract Based on investigations of child maltreatment by Child Protective Services (CPS), several children who are identified receive some kind of individual or familial intervention. However, the literature has shown conflicting results in regard to the later functioning of the children who are target of different protective measures in different settings, compared to other youths who receive no intervention. We assessed childhood adversity, psychopathology, physical complaints and health risk behaviors among youths who received one of two different protective interventions during childhood (home vs. institutionalization group), and we compared them with youths who receive no intervention (comparison group). In total, 216 youths participated, with ages ranging from 14 to 23 years ( M = 17.05 years, SD = 1.8 years; 105 males, 111 females), including 136 youths that were contacted based on their CPS records completed during their childhood, and 80 youths from the community without CPS identification. Results There were no differences between groups in terms of global psychopathology, global index of risk behaviors, and physical complaints. However, additional analyses showed different associations between each type of risk behavior and different interventions applied. Our findings suggest that when the decision is to keep the child at home, families show limitations applying the rules and supervising after CPS intervention. When the decision is to remove the child from home, the results suggest that professionals need to focus on protecting youths from engaging in risky and destructive acts. Families that do not meet the criteria for CPS investigation also need help to protect their children from subsequent risk behaviors.

Screening and brief intervention for patients with tobacco and at-risk alcohol use in a dental setting

Despite the relevance of screening and brief intervention (SBI) to the prevention of dental pathology, particularly with tobacco and at-risk alcohol use, there has been little attention to the determination of its effectiveness in dental settings. Further, most SBI research efforts have focused on the treatment of single risk factors despite the fact that use of psychoactive substances tends to co-occur. There is also debate about the optimal timing of interventions for multiple risk behaviors, i.e., whether to intervene simultaneously or sequentially. This study was designed to test the efficacy of SBI practices aimed at dental patients who were both smokers and at-risk drinkers. Participants (N = 288) were randomized into four experimental conditions to test the efficacy of comparative interventions for tobacco and at-risk alcohol use when delivered separately and in combined forms, and to compare the effects of sequential versus simultaneous interventions. The results indicated that individuals in each of three active brief intervention (BI) groups (alcohol BI, tobacco BI, and combined alcohol and tobacco BI) significantly reduced self-reported drinks per week and cigarettes per day compared with those in the wait-list control group. There was no advantage to the combined versus single-substance focused interventions as individuals changed both behaviors regardless of the treatment intervention received. No significant differences in self-reported drinks per week or cigarettes per day were found between those receiving simultaneous versus sequential interventions. These findings have implications for the design of BI aimed at multiple substance use and imply that no matter where a provider begins with respect to behavior-change focus, she or he may affect change in patients across multiple substance use behaviors.

Relationships between Social Resources and Healthful Behaviors across the Age Spectrum

Background. We examined cross-sectional relationships of social resources with health behaviors in adults ages 18–93 years. Methods. Baseline data from a 2009 risk behavior intervention trial were used to measure social resources, physical activity, and fruit and vegetable intake in 2,440 adults. To evaluate associations overall and within 4 age groups (18–34, 35–49, 50–64, and 65–93 y), we used multivariable regression. Results. Mean (SD) age was 49.4 (15) years, physical activity was 346 (304) minutes/week, and fruit and vegetable intake was 3.4 (2.4) servings/day. Mean social resource score was 1.2 (0–4 scale) in 18–34 year olds, 1.1 in all other age groups (P = 0.04). In multivariable models, for each one-point increment in social resource score, the odds ratio for getting 150–959 minutes of physical activity/wk (compared to <150 min/wk) was 3.7 (95% CI 3.0–4.6). Each one-point increment in score was also associated with 29% (95% CI: 23–35%) more servings of fruit and vegetables. We did not observe effect modification by age group. Conclusions. Although younger adults reported slightly higher resources than older adults, the magnitude of association between social resources and healthful behaviors did not differ between them.

P-598 - Prevalence of pathological internet use among adolescents in Europe: demographic and health-related risk factors

Aims To investigate the prevalence of pathological Internet use (PIU) among adolescents in eleven European countries in relation to demographic and health-related risk factors and Internet accessibility using homogenous methodology. Design Cross-sectional analysis. Setting The 7th Framework European Union funded project, Saving and Empowering Young Lives in Europe (SEYLE), is a Randomized Controlled Trial (RCT) evaluating preventive interventions for risk-behaviors among adolescents in Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain with Sweden as the coordinating site. Participants 11,956 adolescents (F/M: 6731/5225; mean age: 14.9 ± 0.89) recruited from randomly selected schools within the eleven study sites. Measurements Internet users were classified by gender into three categories: adaptive, maladaptive and pathological, based on the Young Diagnostic Questionnaire for Internet Addiction (YDQ). Findings The overall prevalence of PIU was 4.4%. The rate was higher among males than females (5.2% vs. 3.8%). Students not living with a biological parent or relative had the highest risk for both maladaptive and pathological Internet use. Low-parental involvement and parental unemployment showed high relative risk for both maladaptive and pathological Internet use. PIU significantly correlated with the average number of hours spent online. No correlation was found between national levels of Internet accessibility and pathological Internet use. Conclusion Prevalence of PIU varied by gender. Youth in households without a biological parent and/or low level of parental involvement had the most significant health-related factors associated with PIU. National levels of Internet accessibility were not a risk factor for either maladaptive or pathological Internet use.

Cardiac Rehabilitation and Exercise in Secondary Prevention

Cardiac rehabilitation (CR) and exercise prescription in secondary prevention patients is a class I indication in most clinical guidelines. CR programs not only include exercise components but also provide comprehensive care and education about cardiovascular risk factors, cigarette smoking, and behavioral interventions. However, CR programs are scarce or inexistent in many developing countries; in the United States and Europe, where they do exist, they are underused.

Healthy Bodies, Healthy Souls: Design of a church‐based environmental intervention program to prevent diabetes risk behaviors

Churches have great potential to engage communities and sustain health interventions. We are conducting a diabetes risk behavior intervention trial in 12 African American churches in Baltimore city, divided into 4 cohorts (3 churches/cohort) matched by size and denomination. One church in each cohort is randomly selected to receive a workshop intervention (American Diabetes Association's Project POWER), while a second church receives an environmentally‐enhanced intervention plus workshop intervention, and a third church is comparison. The enhanced program includes changes to church food and physical activity environments. The program will be evaluated in 375 non‐diabetic adults, using psychosocial, behavioral (diet, physical activity) and health (BMI, blood pressure, waist circumference) measures. Initial baseline data (n=138) show that 68% are female, mean age 48 years. Over 78% of respondents have a high school degree, and 73% have household incomes &gt;$30,000. 32.4% of the sample is obese and 51.8% are overweight. 44.2% are prehypertensive and 24.6% are hypertensive. Mean waist circumference is 100.8cm (SD: 16.9) for men and 97.2cm (SD: 18.2) for women, which indicate that 40.9% of men and 69.1% of women at high risk for heart disease. This study will test church‐specific interventions to reduce diabetes risk behaviors and improve health measures in a high‐risk minority population.Grant Funding Source: American Diabetes Association Clinical Research Award

Discussion of Sexual Risk Behavior in HIV Care is Infrequent and Appears Ineffectual: A Mixed Methods Study

Consensus guidelines in HIV care call for clinicians to provide a brief sexual risk behavioral intervention in each visit. Studies based on participant reports find this occurs infrequently, but studies based on direct observation of clinical encounters are lacking. We conducted a mixed method study that used audio recordings of 116 routine outpatient visits by 58 different patients with HIV, in five different practice sites. Transcripts of the visits were coded and analyzed using a quantitative system. In addition, we conducted a qualitative analysis of the dialogue segments in which sexual risk behaviors arose as a topic. Discussion of sexual risk behavior occurred in 10 visits, and was generally quite brief. Two visits featured substantial counseling about sexual risk reduction; two others included substantial discussion which was not evidently directed at the patient's changing behavior. Cues suggesting a need or opportunity for such discussion that physicians did not follow up on occurred in seven additional visits. Interactions about sexual risk had less patient engagement than interactions about other health behaviors. Physicians seldom provide sexual risk reduction counseling in HIV care, even where specific indications are present.

Personality, Sexuality, and Substance Use as Predictors of Sexual Risk Taking in College Students

Sexual risk taking among college students is common and can lead to serious consequences, such as unintended pregnancies and sexually transmitted infections. This study utilized responses from 310 undergraduate psychology students aged 18 to 23 to examine personality, sexuality, and substance use predictors of sexual risk behaviors over a six-month period. Data were collected from 2005 to 2006 at a medium-sized Midwestern U.S. university. Results indicated that greater alcohol and recreational drug use, higher extraversion, and lower agreeableness were related to sexual risk taking in men. For women, greater alcohol and drug use, higher sexual excitation, and lower sexual inhibition were predictive of sexual risk taking. Among women, but not men, sensation seeking was found to mediate the relationship between the four significant substance use, personality, and sexuality variables and sexual risk taking. Implications for sexual risk behavior prevention and intervention programming are discussed.

Sexual risk behaviour of men who have sex with men: emerging patterns and new challenges

Antiretroviral treatment means that an increasing number of men who have sex with men (MSM) are living with HIV. The present review focuses on continuing transmission of HIV, risk factors for HIV infection in HIV-negative MSM, risk behaviour and risk reduction interventions among HIV-positive MSM, sexually transmitted infections, HIV and ageing and new and emerging populations of MSM communities. Transmission of HIV infection continues in populations of MSM; transmission may be particularly high from main partners. Serosorting offers limited protection against HIV infection for HIV-negative MSM; negotiated safety and strategic positioning may be partially protective. For HIV-positive men, serosorting is a strategy to prevent HIV transmission, but has contributed to high rates of new non-HIV sexually transmitted infections. Sexual networks are important to the understanding of emerging sexually transmitted infections; ageing brings a new dimension to research on HIV. Strategies other than exclusive condom use have emerged in communities of MSM to reduce the risk of HIV transmission, including serosorting and strategic positioning. 'Combination prevention' - using social structural, behavioural and biomedical approaches in tandem - could reduce the risk of HIV transmission, and may be particularly suited to HIV-positive MSM.

Risk behaviours among early adolescents: risk and protective factors

This paper is a report of a study conducted to examine the influence of risk/protective factors on risk behaviours of early adolescents and whether protective factors moderate their impact. An understanding of how risk and protective factors operate to influence risk behaviours of early adolescents will better prepare nurses to perform interventions appropriately to reduce risk behaviours of early adolescents. A cross-sectional study was carried out, based on a sample of public junior high schools (from 7th to 9th grades) in one city and one county in Taiwan. An anonymous questionnaire designed to measure five risk factors, six protective factors and risk behaviours was administered from October 2006 to March 2007. Data from 878 students were used for the present analysis. Pearson's correlations, anova with random effect models, and generalized linear models were used to analyse the statistically significant explanatory variables for risk behaviours. Gender, perceived father's risk behaviour, perceived mother's risk behaviour, health self-efficacy, interaction of health self-efficacy and perceived peers' risk behaviour, and interaction of emotional regulation and perceived peers' risk behaviour were statistically significant explanatory variables of risk behaviours. Health self-efficacy and emotional regulation moderated the negative effects of peers' perceived risk behaviour on risk behaviours. All protective factors were negative statistically correlated with risk behaviours, and all risk factors positively statistically correlated with risk behaviours. Male adolescents should be considered an at-risk group for risk behaviour intervention. Nurses could provide early adolescents with training regarding health self-efficacy improvement, self-esteem enhancement, emotional regulation skills to reduce their risk behaviours.

Interactive voice response technology to measure HIV-related behavior

Computerized telephone technology has garnered increasing interest as an assessment tool specifically for the collection of daily, near-contemporaneous self-reports of HIV risk behaviors. In this review, we discuss advantages and recent applications of interactive voice response technology (IVR) to HIV risk behavior research, including feasibility studies, assessment mode comparisons between IVR and alternative self-reporting methods, and unique findings derived from event-level data analyses illuminating risk factors for unprotected intercourse on within-person level. We also review reactivity effects of daily IVR self-reports and applications of IVR systems in risk behavior intervention research. We conclude that IVR is a feasible and highly promising tool for various research and health care applications that should be considered more frequently for use in HIV-risk populations.

HIV risk behavior based on intervention among men who have sex with men peer groups in Anhui province

To determine the feasibility and the effectiveness of HIV risk behavior intervention characterized by initiator taking the lead combined with peer's participation, as to preventing HIV epidemic through promoting condom use and reducing the number of sexual partners among men who have sex with men (MSM) groups. Subjects were recruited via peer referral chain. Twelve key MSM were recruited as initiators in bars or other MSM venues in 3 cities of Hefei, Wuhu and Fuyang. Then, each initiator recruited up to 3 MSM to participate and also each of them continued recruiting others. A total of 218 eligible MSM were recruited, and there were four intervention activities conducted. Firstly, twelve initiators were trained according to intervention manual and then intervention activities were implemented by initiators based on their referral chain. Participants were required to complete self-administrated questionnaire at baseline and the third month after intervention finished. The comparison of the results before and after intervention was conducted two months later to see any improvement in HIV/AIDS knowledge, and condom use. Of 218 participants, 170 (77.9%) were followed up in assessment three months later. The results from paired t-Test and Chi Square Test showed that intervention increased HIV/STDs related knowledge (baseline, 14.71 +/- 2.59; follow-up, 16.95 +/- 1.81; t = -10.647, P < 0.01) and the rate of having female sexual partner during previous 2 months (baseline, 17.6%; follow-up, 11.2%; P < 0.01) were of significant differences. Meanwhile, the intervention increased rate of condom use in the last three times of anal intercourse with homosexual partners, casual homosexual partners and primary homosexual partners (baseline, 55.3%, 43.2%, 49.1%; follow-up, 65.2%, 52.2%, 60.9%; chi(2) = 9.979, P < 0.01; chi(2) = 5.797, P < 0.05; chi(2) = 13.082, P < 0.01; respectively) and decreased rate of non-condom use in the last anal intercourse with homosexual partners, casual homosexual partners and primary homosexual partners (baseline, 41.2%, 35.3%, 45.3%; follow-up, 25.3%, 27.1%, 31.2%; P < 0.01, P < 0.05, P < 0.01; respectively) were all of some improvement. Other relevant indicators of 218 participants with 170 followed were compared, excepting the above similar findings, there were no differences in rate of number of female sexual partner during previous 2 months and rate of condom use in the last three anal intercourse with casual homosexual partners and rate of non-condom use in the last anal intercourse with casual homosexual partners. HIV risk behavior intervention based on MSM peer groups is feasible and might increase the condom use among MSM.