Self-reported Risk Behaviors Research Articles

Development and Validation of the Personalized Sexual Health Promotion (SexPro) HIV Risk Prediction Model for Men Who Have Sex with Men in the United States.

Accurate HIV risk assessment among men who have sex with men (MSM) is important to help providers assess risk, and target HIV prevention interventions. We sought to develop an evidence-based HIV risk assessment tool for US MSM that is inclusive of Black MSM. Data from four large longitudinal cohorts of MSM were used to develop (EXPLORE), and validate (VAX004, HPTN061, and HVTN505). These data included visits in which participants self-reported HIV risk behavior and underwent HIV testing. We developed a pooled logistic model for incident HIV infection based on self-reported risk behaviors during the 6months before each study visit. A total of 4069 MSM were used for the development cohort, and 8047 MSM in the three validation cohorts through 2013. The final model includes age (< 35, ≥ 35); Black race and Latino ethnicity; numbers of HIV-negative anal sex partners; number of insertive or receptive anal intercourse episodes; having 1 HIV-negative partner only; self-reported substance use; and bacterial sexually transmitted infection diagnosis. The model showed good discrimination in internal validation (C-statistic = 79.5). The external validation cohorts also showed good discrimination, with C-statistics of 73.1, 71.0, 71.9 in VAX004, HPTN061, and HVTN505 respectively, and acceptable calibration. We developed and validated an HIV risk assessment tool for MSM, which showed good predictive ability, including among the largest cohort of HIV-uninfected Black MSM in the US. This tool is available online (mysexpro.org) and can be used by providers to support targeting of HIV prevention interventions such as pre-exposure prophylaxis for MSM.

Demographic and sexual risk predictors of delay discounting of condom-protected sex

Objective: Sexual delay discounting describes the decreased likelihood of condom-protected sex if a condom is not immediately available, which can be quantitatively summarised using the Sexual Delay Discounting Task (SDDT). The present studies determined the extent to which condom use likelihood as assessed by the SDDT is associated with self-reported sexual risk behaviours and demographics in two online samples of adults. Design: Study 1 (n = 767) assessed demographics, sexual risk behaviour, and delay discounting, and examined relations between these variables using correlation and regression. Study 2 (n = 267) examined whether real-world instances of unprotected sex because a condom was not immediately available predicted greater sexual discounting. Main outcome measures: Sexual delay discounting, condom use. Results: Both studies observed significant positive relations between sexual delay discounting and self-reported sexual risk behaviours, and found that males tended to show greater sexual discounting. In Study 2, 46% of the sample self-reported having unprotected sex because a condom was not immediately available, and these individuals showed significantly greater sexual delay discounting. Conclusion: These results extend prior findings by demonstrating that delay is a critical variable underlying real-life sexual risk behaviour among non-clinical samples. The SDDT is an ecologically valid measure of these processes.

Adolescent Connectedness and Adult Health Outcomes.

Because little is known about long-term effects of adolescent protective factors across multiple health domains, we examined associations between adolescent connectedness and multiple health-related outcomes in adulthood. We used weighted data from Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (n = 14 800). Linear and logistic models were used to examine associations between family and school connectedness in adolescence and self-reported health risk behaviors and experiences in adulthood, including emotional distress, suicidal thoughts and attempts, physical violence victimization and perpetration, intimate partner physical and sexual violence victimization, multiple sex partners, condom use, sexually transmitted infection (STI) diagnosis, prescription drug misuse, and other illicit drug use. In multivariable analyses, school connectedness in adolescence had independent protective associations in adulthood, reducing emotional distress and odds of suicidal ideation, physical violence victimization and perpetration, multiple sex partners, STI diagnosis, prescription drug misuse, and other illicit drug use. Similarly, family connectedness had protective effects for emotional distress, all violence indicators, including intimate partner violence, multiple sex partners, STI diagnosis, and both substance use indicators. Compared to individuals with low scores for each type of connectedness, having high levels of both school and family connectedness was associated with 48% to 66% lower odds of health risk behaviors and experiences in adulthood, depending on the outcome. Family and school connectedness may have long-lasting protective effects across multiple health outcomes related to mental health, violence, sexual behavior, and substance use. Increasing both family and school connectedness during adolescence has the potential to promote overall health in adulthood.

PG-12 Viral suppression among HIV-infected methadone-maintained patients: The role of ongoing injection drug use and adherence to antiretroviral therapy (ART)

Introduction: Methadone maintenance therapy (MMT) is associated with improved virologic outcomes among HIV-infected opioid-dependent individuals, which support the use of MMP as part of the integrated approach to improve HIV treatment and care continuum. However, opioid-dependent individuals stabilized on MMT are highly diverse and beyond the benefit of HIV treatment as prevention (TasP) efforts. Given the critical role of sustained viral suppression in maximizing benefits of antiretroviral therapy (ART), we sought to assess factors associated with viral suppression in patients stabilized on MMT. Identifying subgroups at-risk for not achieving viral suppression and addressing factors causing the disparities could inform approaches to optimize HIV treatment outcomes and prevention efforts (eg, HIV TasP). Methods: A sample of 133 HIV-infected, methadone-maintained patients who reported HIV-risk behaviors were enrolled from a community-based methadone maintenance drug treatment facility in New Haven, Connecticut. Participants were recruited through clinic-based advertisements and flyers, word-of-mouth, and direct referral from counselors in the methadone clinic. Participants were assessed using an audio-computer assisted self-interview (ACASI). Multivariable logistic regression was used to identify significant correlates of viral suppression. Additionally, we examined the interactive effect of pairs of variables in the main effects model to determine the moderated effect on viral suppression. Model fit was assessed using a Hosmer and Lemeshow Test. Results: The mean age of participants was 49.3 (±8.3) years. The mean duration of HIV diagnosis was 14.1 (±9.6) years and 63.2% of participants reported to have disclosed their HIV status to a sexual partner. Of 121 (91.0%) individuals who were taking ART, 57.9% had achieved optimal adherence, and 80.4% had achieved viral suppression. Self-reported HIV risk behaviors were highly prevalent among study samples. Almost half of participants (46.6%) reported injecting illicit drugs in the past 30 days. Of those, 58.1% reported having shared injection equipment. Similarly, 21.1% of participants reported having sex with more than one sexual partner, and only 14.3% reported always using condoms with their sexual partners in the past 30 days. Having optimal adherence to ART was associated with an over four-fold odds (aOR = 4.883, P = 0.009) and having high CD4 count was associated with a two-fold odds of being virally suppressed (aOR = 2.483, P = 0.045). Additionally, participants who reported having injected drugs in the past 30 days (aOR = 0.081, P = 0.036) were significantly less likely to achieve viral suppression. Furthermore, we found a significant interaction effect that involved optimal ART adherence and injection of drugs on viral suppression (aOR = 2.953, P = 0.029). That is, the influence of optimal ART adherence on viral suppression was reduced due to ongoing injection drug use practices. Conclusions: Overall, our findings illustrated how the benefit of MMT programs may be negated among a significant segment of methadone-maintained patients and highlights unaddressed HIV-related treatment challenges faced by this risk group. These findings have important implications for the recently identified concept of HIV TasP as a clinical care strategy to reduce the harmful impact of ongoing HIV replication among HIV-infected individuals as well as transmission risk between serodiscordant couples. As advocates have recently called for the recognition of “undetectable = untransmittable” (U=U) campaign, clinical care of HIV-infected individuals, including those for methadone-maintained patients, could be enhanced by improving communication and counseling about the importance of consistent ART adherence and viral suppression. As such, future interventions should encourage both HIV-infected individuals and their partners to discuss options for HIV and other sexually transmitted infections (STIs) prevention, including HIV and STI treatment, condoms, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) within substance abuse treatment settings.

Health risk behaviors, violence exposure, and current asthma among adolescents in the United States.

Asthma may worsen during adolescence, due to both health risk behaviors and psychosocial stressors commonly encountered during this life stage. Cross-sectional study of 24 612 high school students who participated in the 2009 and 2011 National Youth Risk Behavior Survey. Multivariable logistic regression was used to examine the relation between self-reported health risk behaviors or psychosocial stressors and current asthma. Mediation analysis was performed to assess whether depressive symptoms or suicidal behavior contribute to the link between psychosocial stressors and asthma. Current asthma was reported by 13.1% of the study participants. In a multivariable analysis, female sex, obesity, shorter sleep duration, frequent soda/pop consumption, and marijuana use were each significantly associated with 14-36% increased odds of asthma. Any violent behavior (adjusted odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.02-1.24), any victimization (OR = 1.43, 95%CI = 1.29-1.58), any suicidal behavior (OR = 1.41, 95%CI = 1.22-1.64) and having felt sad or hopeless in the past year (OR = 1.57, 95%CI = 1.40-1.75) were each associated with current asthma. In a mediation analyses, having felt sad/hopeless and suicidal behaviors accounted for 21% and 14%, respectively, of the victimization-asthma association. Potentially modifiable risk factors, including obesity, short sleep duration, frequent soda/pop consumption, and psychosocial stressors are associated with asthma in US adolescents. Promoting healthier lifestyles, as well as screening for violence exposure and treating depressive symptoms, could help reduce asthma burden in this population.

Prevalence and predictors of self-reported risk behaviors among male injecting drug users.

Unsafe injecting drug use is a documented risk factor for the transmission of human immunodeficiency virus infection. Harm reduction strategy aims at reducing this deleterious consequence. To study the prevalence and predictors of injecting as well as sexual risk behavior among male injecting drug users (IDUs). A cross-sectional study was conducted among 250 male IDUs from January 2017 to March 2018. Risk behavioral data were collected after obtaining informed consent of the study participants. This included information on sharing, reusing needles/injections, and sexual behavior. Descriptive statistics and logistic regression model was run using the Epi Info software version 7.2 for Windows. In the past one month, 25.3% had shared needles/syringes by either borrowing or lending or both. Inconsistent condom use during sexual intercourse with a regular, casual, and paid sex partner was practiced by 64.7% (77/119), 65.8% (48/73), and 45.0% (18/40), respectively. The binary logistic regression analysis revealed that unsafe injecting drug behavior was higher among daily users: (OR = 3.0 [1.3-6.6]) and comparatively lower among those who preferred to avail needles/syringes from Needle Syringe Exchange Program (OR = 0.4 [0.2-0.9]); as compared to their counterparts. The findings suggest that IDUs in the study area are engaging in risk behaviors. Behavior change communication and harm reduction strategy should be strengthened.

Testing for comorbid conditions among people with HIV in medical care

ABSTRACTPeople living with HIV (PLWH) are frequently affected by comorbid medical conditions. Despite the importance of diagnosing and treating these conditions, testing rates for common comorbidities often fall short of primary care recommendations for PLWH. Clinical care data were obtained from the 2012 New York City (NYC) Medical Monitoring Project (MMP), a multi-site surveillance project that includes demographically representative cohorts of PLWH receiving medical care. Medical record abstraction data were analyzed to determine testing frequencies for potential comorbid conditions, including tuberculosis, hepatitis B and C, diabetes, syphilis, gonorrhea, and chlamydia, and to assess demographic, behavioral, and clinical factors associated with testing. Among the NYC MMP cohort (N = 439), testing frequencies ranged from 18% for hepatitis B to 66% for diabetes in a 12-month period. In multivariate analyses, having three or more medical visits with a CD4 or HIV viral load test over 12 months was significantly associated with sexually transmitted infection (STI) and hepatitis C testing. Compared with Black PLWH, Latino/Hispanics were more likely to be tested for hepatitis C and Whites were less likely to be tested for diabetes. Self-reported sexual risk behaviors were not associated with testing for STI, and history of injection drug use was not associated with testing for hepatitis C. These results indicate a need for improved risk assessment, adherence to clinical guidelines, and integration of primary care services with HIV care.

Limited Knowledge and Mixed Interest in Pre-Exposure Prophylaxis for HIV Prevention Among People Who Inject Drugs.

People who inject drugs (PWID) experience sexual and injection-related HIV risks, but uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among PWID has been low. Improving PrEP uptake in this population will require understanding of PrEP knowledge and interest. In 2017, we conducted in-depth, semistructured interviews with HIV-uninfected PWID and key informants (PrEP and harm reduction providers) in the US Northeast. Thematic analysis of coded data explored PrEP knowledge and the factors that influence PrEP interest. Among PWID (n = 33), median age was 36 years, 55% were male, 67% were white, and 24% identified as Hispanic/Latino. Accurate PrEP knowledge among PWID was low, which key informants (n = 12) attributed to PrEP marketing focused on other risk populations, as well as healthcare providers' lack of time and unwillingness to discuss PrEP with PWID. There was a discrepancy between self-reported HIV risk behaviors, which were common, and HIV risk perceptions, which varied and strongly influenced PrEP interest. Most PWID and key informants thought that PrEP would be most beneficial for those who shared syringes, used discarded syringes, engaged in transactional sex, or were homeless. Improving uptake of PrEP for HIV prevention among high-risk PWID will require education to increase PrEP knowledge and addressing factors that negatively influence PrEP interest such as perceptions regarding low HIV risk and the process for obtaining PrEP. This may require specialized PrEP marketing and outreach efforts and improved capacity of healthcare providers to effectively assess HIV risk (and perceptions) and communicate the benefits of PrEP to at-risk PWID.

Health risk behaviors among high school and university adolescent students.

Tobacco, alcohol and drug abuse constitute a public health concern. Data regarding health risk behaviors among Greek youth are scarce. The aim of the present study was to investigate health risk behaviors of a large adolescent sample (730 adolescents, 294 males and 436 females), residing in different areas of Greece, trace perceived side effects and associate the findings with the adopted lifestyle. High school students and University newcomers, aged 14–21 years (17.8±4.5 years), self-reported health risk behaviors via an anonymous, closed-type, validated questionnaire. Simultaneous adoption of unhealthy habits, such as smoking and drug abuse, were not independent (χ2=38.668, P=0.01). Age was the most significant factor in the adoption of unhealthy behaviors; smoking (χ2=27.220, P=0.01), misuse of cannabis and recreational drugs (χ2=9.874, P=0.05) and combining alcohol and smoking with entertainment (χ2=8.708, P=0.05; χ2=317.309, P=0.05, respectively) were adopted more by the elder (18–20 years) than the younger (15–18 years) teenagers. Males were more prone to abuse of cannabis (χ2=8.844, P=0.01), whereas females combined drinking and smoking with loud music during entertainment (χ2=6.618, P=0.05). The majority (64%) reported driving after drinking alcohol and intense entertainment, especially in urban areas. Almost half of smokers (53.1%) and drug users (46.3%) first encountered smoking or drugs from friends. Educational institutions and entertainment venues were the main places of initiation of smoking (26%) or drug use (35.2%), respectively. Adolescents from touristic regions were more prone to smoking (33.9%, P=0.01) and drug abuse (53.7%, P=0.01). The lower the frequency of exercise, the higher the consumption of psychoactive substances (P=0.022). Youth engaging in unhealthy habits were also willing to use prohibited doping substances (56%, P=0.043). Health problems were the main reason to consider changing habits (72%). In conclusion, health risk behaviors were multifactorial and tended to cluster. Thus, preventive youth strategies should target negative peer influences, especially during late adolescence.

Infection Pressure in Men Who Have Sex With Men and Their Suitability to Donate Blood.

Deferral of men who have sex with men (MSM) from blood donation is highly debated. We therefore investigated their suitability to donate blood. We compared the antibody prevalence of 10 sexually and transfusion-transmissible infections (TTIs) among 583 MSM and 583 age-matched repeat male blood donors. MSM were classified as low risk (lr) or medium-to-high risk (hr) based on self-reported sexual behavior and as qualified or unqualified using Dutch donor deferral criteria. Infection pressure (IP) was defined as the number of antibody-reactive infections, with class A infections (human immunodeficiency virus-1/2, hepatitis B virus, hepatitis C virus, human T-cell lymphotropic virus-1/2, syphilis) given double weight compared to class B infections (cytomegalovirus, herpes simplex virus-1/2, human herpesvirus 8, hepatitis E virus, parvovirus B19). Donors had a lower median IP than qualified lr-MSM and qualified hr-MSM (2 [interquartile range {IQR}, 1-2] vs 3 [IQR, 2-4]; P < .001). Low IP was found in 76% of donors, 39% of qualified lr-MSM, and 27% of qualified hr-MSM. The prevalence of class A infections did not differ between donors and qualified lr-MSM but was significantly higher in qualified hr-MSM and unqualified MSM. Recently acquired class A infections were detected in hr-MSM only. Compared to blood donors, human herpesviruses were more prevalent in all MSM groups (P < .001). IP correlates with self-reported risk behavior among MSM. Although lr-MSM might form a low threat for blood safety with regard to class A infections, the high seroprevalence of human herpesviruses in lr-MSM warrants further investigation.

Economic strengthening for HIV prevention and risk reduction: a review of the evidence

ABSTRACTHousehold economic strengthening (HES) is increasingly implemented alongside HIV programing to address economic drivers of the epidemic. The evidence base on HES for HIV outcomes is growing, and this evidence review aimed to comprehensively consolidate and synthesize the research linking 15 types of HES interventions with a range of HIV prevention and treatment outcomes. The review was conducted between November 2015 and October 2016 and consisted of an academic database search, citation tracking of relevant articles, examination of secondary references, expert consultation, and a gray literature search. Studies were included if they evaluated an HES intervention(s), reported on an HIV outcome(s), were available in English, and were relevant to low-income contexts or vulnerable populations. All evidence was assessed for quality. Over 108 citations were included and a matrix framework was used to map the evidence, linking each HES intervention with each HIV outcome, providing a precise visual depiction of the evidence base.Given the volume of evidence, the results are presented and discussed in three papers, each focused on a different HIV outcome area. This is the first paper in the series and focuses on the 64 studies that reported HIV prevention outcomes. Conditional and unconditional cash transfers, and educational support were each associated with reductions in self-reported risk behaviors, particularly among adolescents. Food assistance in combination with other support also shows a positive trend for adolescent risk reduction. Most studies relied on self-reported behavioral data, and clinical outcomes such as HIV or other sexually transmitted infection (STI) incidence or prevalence were mostly null or underpowered, calling into question the true effectiveness of these interventions in preventing HIV. Limited evidence also supports the effectiveness of financial incentives in increasing voluntary medical male circumcision. Well-designed vocational/entrepreneurial training and savings interventions could bolster HIV prevention efforts for female sex workers, while findings are less conclusive for adolescents.

Risky behaviors of youth living in the slums of Kampala: a closer examination of youth participating in vocational training programs

ABSTRACTObtaining formal education is associated with a decreased risk of HIV transmission among youth in sub-Saharan Africa. However, little is known about the role vocational skills training programs may have on risk behaviors linked to HIV transmission among vulnerable youth in sub-Saharan Africa. This study examined the characteristics and risk behaviors among vulnerable youth who receive vocational skills training by a community-based organization. Empirical analyses were conducted using a cross-sectional survey administered in 2014 to youth (ages 12–18 years) in the slums of Kampala (n = 1,134). Five multivariable logistic regression models were computed to determine the association between participating in a vocational training program and self-reported risk behaviors pertaining to alcohol use, lack of condom use, sex with multiple partners, and transactional sex. In our study, 29.6% of youth attended a vocational training program. Our findings show that youth who participated in vocational training were more likely to report often feeling hopeful (AOR: 1.7; 95% CI: 1.1, 3.0) and less likely to report alcohol use (AOR: 0.4; 95% CI: 0.2, 0.7) than those not attending vocational training programs, in multivariable analyses. Overall, findings varied for males and females. These findings, while preliminary, indicate that self-reported behaviors associated with risk for HIV transmission vary in some respects for youth participating in vocational training versus those who do not. However, additional research is needed, as are evaluations of the benefits and potential impact of vocational training in both the short and long-term for vulnerable youth in resource-poor settings and with limited access to formal education.

Viral suppression among HIV-infected methadone-maintained patients: The role of ongoing injection drug use and adherence to antiretroviral therapy (ART)

IntroductionMethadone maintenance therapy (MMT) is associated with improved virologic outcomes, yet no studies have explored factors associated with viral suppression in HIV-infected patients on MMT. Given the critical role of sustained viral suppression in maximizing benefits of antiretroviral therapy (ART), we sought to assess factors associated with viral suppression in patients stabilized on MMT. MethodsA sample of 133 HIV-infected, methadone-maintained patients who reported HIV-risk behaviors were assessed using an audio-computer assisted self-interview (ACASI). Multivariable logistic regression was used to identify significant correlates of viral suppression. ResultsAmong all participants, self-reported HIV risk behaviors were highly prevalent and over 80% had achieved viral suppression. Independent correlates of viral suppression were: having optimal adherence to ART (aOR = 4.883, p = .009), high CD4 count (aOR = 2.483, p = .045), and ongoing injection drug use (aOR = 0.081, p = .036). Furthermore, results revealed a significant interaction effect that involved optimal ART adherence and injection of drug use on viral suppression (aOR = 2.953, p = .029). ConclusionOverall, our findings highlight unaddressed HIV-related treatment challenges faced by certain group of methadone-maintained patients. These findings have significant implications for the HIV treatment as prevention efforts and, thus, indicate the need for comprehensive efforts to promote viral suppression in this risk population.

Travel-related health problems in the immunocompromised traveller: An exploratory study.

Immunocompromised travellers (ICTs) are at increased risk of travel-related health problems. Therefore, they are advised to attend specialised pre-travel clinics for advice on vaccination, malaria chemoprophylaxis and on-demand antibiotics. However, studies yield conflicting data regarding travel-related health problems encountered by ICTs; questioning the rationale for certain advices, and particularly the advice of on-demand antibiotics. To evaluate self-reported travel-related health problems, antibiotic use, medical visits and risk behaviours in ICTs and controls. We conducted a questionnaire-based observational study with pilot character. We recruited participants from a (medical) pre-travel clinic. Telephone interviews were conducted 2-4 weeks post-travelling, applying a structured questionnaire. We included 30 ICTs and 30 controls. More ICTs than controls reported travel-related health problems, antibiotic use and medical visits, although not statistically significant. Travellers' diarrhoea appeared to be more severe in ICTs. Furthermore one ICT was hospitalized post-travel due to pneumonia. Of ICTs, 2/30 (7%) used on demand antibiotics while not indicated (according to the protocol of the Dutch national coordinating centre for travel advice or prescribed by a physician). Reversely, 6/30 (20%) did not use on demand antibiotics while actually indicated according to this protocol. Our findings substantiate the recommendation of on demand antibiotics. However, ICTs did often not use on demand antibiotics correctly; they therefore need very careful instructions.

Prior Individual Risk Behavior Predicts Subsequent Individual and Peer Risk Behavior: A Longitudinal Examination From Fifth to Ninth Grade

To better understand the longitudinal relations between risk and relationship variables during early to middle adolescence, we employed latent variable cross-lagged panel models using data ( N = 1,050) from the National Institute of Child Health and Human Development Study. Results showed self-reported individual risk behavior (β = .77–.88) and mother-reported child-parent relationship quality (CPRQ; β = .59–.76) were stable, whereas the self-report of one’s peer’s risk behavior (β = .21–.27) was less stable. After controlling for previous levels of peer risk behavior and CPRQ, higher levels of individual risk behavior resulted in subsequent increases in the number of peers who demonstrated risk behavior (β = .38–.54) across early to middle adolescence. CPRQ and peer risk behavior, however, did not influence subsequent individual risk behavior. School psychologists can encourage friendship selection strategies that reduce potential risk affiliation while increasing healthy, supportive friendships and teach adolescents stress management skills.

Health condition and risk attitude in the Dutch population: an exploratory approach

Risk is a central aspect of health condition because attitudes towards risk may influence the inclination to adopt behaviours that can influence health condition. Taking preventive health care measures or purchasing a private health insurance are examples of decisions individuals make based on their preferences. This study analysed the relationship between health condition and behaviour under conditions of uncertainty and examined personal characteristics related to risk behaviour. Data was obtained from a survey on a representative sample of the Dutch adult population (n = 2,822) conducted between May and June of 2014. Risk attitude was assessed through a self-reported scale and risk behaviours through a simulated lottery game, both included in the same survey. The relationship between risk attitudes and behaviours was examined, as well as certain socio-economic variables, including health condition, demographic characteristics, social status, and confidence in government institutions. Surveyed participants perceived themselves as risk-avoiding. However, their behaviour tended to be risk-seeking when playing lottery games, even when they faced potential (but limited) economic losses. Participants with poorer mental health condition tended to be less risk-inclined, which was not the case for participants who reported poor general health status. Participants feeling a higher satisfaction with their lives were willing to take greater risks in the lottery games. These findings allow for understanding risk behaviour as the interaction between personal perception of risk attitude and the assessment of risk associated to a specific situation. This assessment may be directly modulated by one’s state of mind and not by physical health condition.

Self-Reported Risk and Delinquent Behavior and Problem Behavioral Intention in Hong Kong Adolescents: The Role of Moral Competence and Spirituality.

Based on the six-wave data collected from Grade 7 to Grade 12 students (N = 3,328 at Wave 1), this pioneer study examined the development of problem behaviors (risk and delinquent behavior and problem behavioral intention) and the predictors (moral competence and spirituality) among adolescents in Hong Kong. Individual growth curve models revealed that while risk and delinquent behavior accelerated and then slowed down in the high school years, adolescent problem behavioral intention slightly accelerated over time. After controlling the background socio-demographic factors, moral competence and spirituality were negatively associated with risk and delinquent behavior as well as problem behavioral intention across all waves as predicted. Regarding the rate of change in the outcome measures, while the initial level of spirituality was positively linked to the growth rate of risk and delinquent behavior, the initial level of moral competence was negatively associated with the growth rate of problem behavioral intention. The theoretical and practical implications of the present findings are discussed with reference to the role of moral competence and spirituality in the development of adolescent problem behavior.

Sleep Disturbances, Psychosocial Difficulties, and Health Risk Behavior in 16,781 Dutch Adolescents

ObjectiveTo investigate the prevalence of adolescent sleep disturbances and their relation to psychosocial difficulties and health risk behaviors with the use of data from a province-wide health survey (n = 16,781). MethodsPsychosocial difficulties were measured with the Strength and Difficulties Questionnaire. Additional assessments included self-reported sleep disturbances, suicidality, and health risk behaviors including current use of tobacco, alcohol, and drugs, physical inactivity, and compulsive use of multimedia. We used multilevel analyses to investigate the relationhips, including differences, between boys and girls, as well as the mediating role of emotional problems. ResultsJust under 20% of adolescents reported sleep disturbances in the previous month. These sleep disturbances were associated with psychosocial problems (odds ratio [OR], 6.42; P < .001), suicidality (OR, 3.90–4.14; P < .001), and all health risk behaviors (OR, 1.62–2.66; P < .001), but not with physical inactivity. We found moderation by gender for the relations between sleep and suicide attempts (OR, 0.38; P < .002) and between sleep and cannabis use (OR, 0.52; P = .002), indicating attenuated relationships in girls compared with boys. Emotional problems partially mediated the relationships between sleep disturbances and multimedia use. ConclusionsThis study reiterates the high prevalence of sleep disturbances during adolescence. These sleep disturbances were strongly related to psychosocial problems and a wide range of health risk behaviors. Although the direction of causality cannot be inferred, this study emphasizes the need for awareness of impaired sleep in adolescents. Moreover, the gender differences in associated suicide attempts and cannabis use call for further research into tailored intervention strategies.

Educational and criminal justice outcomes 12 years after school suspension.

A third of US students are suspended over a K-12 school career. Suspended youth have worse adult outcomes than non-suspended students, but these outcomes could be due to selection bias: that is, suspended youth may have had worse outcomes even without suspension. This study compares the educational and criminal justice outcomes of 480 youth suspended for the first time with those of 1193 matched non-suspended youth from a nationally representative sample. Prior to suspension, the suspended and non-suspended youth did not differ on 60 pre-suspension variables including students' self-reported delinquency and risk behaviors, parents' reports of socioeconomic status, and administrators' reports of school disciplinary policies. Twelve years after suspension (ages 25-32), suspended youth were less likely than matched non-suspended youth to have earned bachelors degrees or high school diplomas, and were more likely to have been arrested and on probation, suggesting that suspension rather than selection bias explains negative outcomes.

Sexting, cyber-violence and sexually risk behaviour among college students

This research explores the relationship between sexting, committing and experiencing cyber-violence, and risk sexually behaviour among college students. A total of 202 college students filled out an adjusted version of the Sex and Tech Survey Questionnaire (STSQ), the Committing and Experiencing Cyber Violence Scale (CECVS) and the subscale on sexually risk behaviour from the Youth Self-reported Delinquency and Risk Behaviours Questionnaire (SRDP-2007). It has been found that a total of 60.89% of the participants have sent a sexually explicit text message and/or video content at least once, 60.33% have received such content, and 13.12% have forwarded or shown the received content to other people. Furthermore, 3.5% of the participants have experienced, and 2.01% have committed, cyber-violence. The majority of the participants have sent explicit content to their boyfriends/girlfriends. Most of the participants perceived sexting as a kind of joke, as a gift to their partner or as an answer to receiving sexually explicit content, while a minority of the participants mentioned negative motives for practicing sexting, such as peer or partner pressure. Almost all of the participants were aware of the danger sexting bore, but most of them still indulged in sexting, noting its positive outcomes, such as the excitement that followed it. Both committing/experiencing cyber-violence and sexually risk behaviour correlate positively and moderately with sexting. Positive and moderate correlations were found between committing and experiencing cyber-violence. Also, positive but weak correlations were found between practicing/experiencing cyber-violence and sexually risk behaviour in real life. Predicting sexting by experiencing and committing cyber violence and sexually risk behaviour has shown that only sexually risk behaviour is significant predictor. Such behaviour likely serves as a mediator for the relationship between committing cyber-violence and sexting, yet it explains only 8.2% of sexting variance, while the model as a whole explains almost 20%. The results indicate that different forms of risk behaviour are correlated, and that sexting is perceived not only as a risk behaviour, but as a behaviour that can be used to facilitate committed relationships in young adulthood.