Alwyn T. Cohall

Factors Associated with AIDS Risk Behaviors among High School Students in an AIDS Epicenter.

BACKGROUND A greater understanding of the determinants of risky behaviors is an essential precursor to the development of successful AIDS prevention programs for adolescents. METHODS A survey measuring AIDS-related behaviors, beliefs, and knowledge was administered to a sample of 531 10th-grade students residing in an AIDS epicenter. RESULTS Of the 56.8% of students reporting past-year involvement in sexual intercourse, 67.3% reported unprotected intercourse with low-risk partners, 1.3% reported unprotected intercourse with high-risk partners, and 6.6% reported a past-year history of a sexually transmitted disease. Students whose friends had intercourse and never or inconsistently used condoms, who personally sanctioned intercourse involvement, who believed that the majority of their peers had intercourse, and who perceived low preventive action self-efficacy, were 5.1, 3.0, 2.1, 3.7, and 2.8 times more likely, respectively, to score in the riskier categories of an AIDS behavior index. CONCLUSIONS These findings suggest that addressing socioenvironmental influences on risky and preventive behaviors may prove to be the most effective AIDS prevention strategy among adolescents.

Preventing sexual risk behaviors and pregnancy among teenagers: linking research and programs.

Recent trends in adolescent sexual behavior offer mixed messages. It is very encouraging that teenagers’ overall rates of sexual activity, pregnancy and childbearing are decreasing, and that their rates of contraceptive and condom use are increasing. 1 However, the proportion of young people who have had sex at an early age has increased. 2 Moreover, while adolescent females’ contraceptive use at first sex is rising, their use at most recent sex is falling. 3 There is general consensus that the proportion of teenagers who engage in behaviors that put them at risk of pregnancy and of HIV and other sexually transmitted infections (STIs) remains too high. Each year, approximately one million young women aged 15–19—or one-fifth of all sexually active females in this age-group—become pregnant; the vast majority of these pregnancies are unplanned. 4 In the United States, the risk of acquiring an STI is higher among teenagers than among adults. 5 Moreover, rates of unprotected sexual activity, STIs, pregnancy and childbearing continue to be substantially higher among U.S. adolescents than among young people in comparable industrialized countries. 6 Research has also begun to highlight an alarmingly high rate of involuntary sex among young people. In the 1995 National Survey of Family Growth, 13% of 15–19-year-old females reported that they had been forced to have sex. 7 When asked about their first sexual experience, 22% of 15–44-year-old women for whom it occurred before age 15 reported that the act was involuntary, as did 16% of those who first had sex before age 16. Involuntary sexual activity is typically unprotected and thus puts its victims at very high risk of pregnancy and STIs. Finally, recent research and clinical observations suggest that a substantial proportion of teenagers, including those who report having never had vaginal sex, are engaging in oral sex. 8 This trend has negative implications for teenagers’ sexual health because many seem unaware that STIs can be acquired through unprotected oral sex.

The influence of substance use, social sexual environment, psychosocial factors, and partner characteristics on high-risk sexual behavior among young Black and Latino men who have sex with men living with HIV: A qualitative study.

Understanding the sexual risk behaviors of youths living with HIV/AIDS is critical to secondary prevention of HIV. As part of a larger qualitative study of youths living with HIV, in-depth interviews were conducted with 27 African American and Latino, HIV-infected young men who have sex with men, aged 16-24 years, living in New York City. The study explored the role of substance use, the social-sexual-environmental, and psychological contexts in which sexual risk behaviors occurred. Since learning of their HIV infection, the majority of participants had reduced their risky sexual behaviors; however, a subset (26%) of participants continued to have unprotected sex, in most cases with multiple partners. Substance use, the social environmental context of the sexual encounter, the psychological impact of HIV on sexual behavior, and partner characteristics were associated with high-risk sexual behaviors in this group. Among high-risk participants, factors associated with risky sexual behaviors clustered, with 57% reporting two or more factors. More intensive interventions are needed for this subset of youths living with HIV, including assessment and treatment for substance use and mental health issues, strategies for stress reduction, and partner interventions.

Comparison of Three Theoretical Models of Substance Use among Urban Minority High School Students

OBJECTIVE This study compares the relative explanatory power of three theoretical models of substance use among urban minority high school students. METHOD A substance use survey was administered in the spring of 1991 to a randomly selected sample of classrooms in the ninth through twelfth grades of three public academic high schools in a New York City borough. Survey participants (N = 919) were 59% black and 34% Hispanic; the mean age was 16.4 years. RESULTS Substantial proportions of this sample of students reported experimental or occasional alcohol and cigarette use in the past year, and approximately one-tenth reported frequent use of these substances. Only small proportions of students reported past-year marijuana use, and few or no students reported past-year use of cocaine, crack or intravenous heroin. The socialization model of substance use was much more powerful than either the stress/strain or disaffiliation models in explaining past-year use of alcohol, cigarettes, and marijuana. However, certain variables derived from the stress/strain and disaffiliation models were important risk factors for the frequent use of these substances. CONCLUSIONS These findings suggest that the further elucidation of the social influence process among adolescents, and the development, implementation, and evaluation of especially intensive programs aimed at high-risk youths, should become adolescent substance use prevention research priorities.

Factors Associated with AIDS-Related Behavioral Intentions among High School Students in an AIDS Epicenter:

Using data from a cross-sectional survey of 531 predominantly black and Hispanic 10th graders in two New York City schools, the explanatory power of predictors of intentions to engage in sexual intercourse, to have multiple intercourse partners, and to use condoms was compared. Theoretically derived predictor variables (i.e., susceptibility, severity, benefits, barriers, self-efficacy, values, norms) were derived from the health belief model, social cognitive theory, and a model of social influence. One half of sampled students definitely intended to have sexual intercourse in the next year, one tenth definitely intended to have multiple partners, and two thirds definitely intended to use condoms. In multivariate analyses, variables derived from the model of social influence and from social cognitive theory were most strongly associated with the three investigated behavioral intentions; however, certain background and health belief variables also contributed to the explained variance in intercourse and multiple partner intentions.

Lack of Oral Health Care for Adults in Harlem: A Hidden Crisis

OBJECTIVES Profound and growing disparities exist in oral health among certain US populations. We sought here to determine the prevalence of oral health complaints among Harlem adults by measures of social class, as well as their access to oral health care. METHODS A population-based survey of adults in Central Harlem was conducted from 1992 to 1994. Two questions on oral health were included: whether participants had experienced problems with their teeth or gums during the past 12 months and, if so, whether they had seen a dentist. RESULTS Of 50 health conditions queried about, problems with teeth or gums were the chief complaint among participants (30%). Those more likely to report oral health problems than other participants had annual household incomes of less than

There's always Plan B: adolescent knowledge, attitudes and intention to use emergency contraception

9000 (36%), were unemployed (34%), and lacked health insurance (34%). The privately insured were almost twice as likely to have seen a dentist for oral health problems (87%) than were the uninsured (48%). CONCLUSIONS There is an urgent need to provide oral health services for adults in Harlem. Integrating oral health into comprehensive primary care is one promising mechanism.

Involving men in reproductive health: the Young Men's Clinic.

BACKGROUND It can prove challenging to create social marketing materials aimed at a specific subsection of the population, especially when the topic is relatively new and possibly misunderstood. Therefore, the objective of this study was to assess adolescent knowledge of and attitudes towards emergency contraception (EC), with the goal of creating a locally relevant social marketing campaign and intervention. METHODS This qualitative study consisted of 18 in-depth interviews and four focus groups (n=29) with adolescents and young adults ages 15 to 21 years, conducted in New York City between August and December 2006. RESULTS While respondents seemed generally aware of ECs existence, most were unclear about circumstances warranting its use and its mechanism of action. The FDA change to behind-the-counter availability appeared to increase knowledge and access to EC, although substantial barriers to EC access and use remain, including price. CONCLUSIONS Further work remains in educating those in need of EC, especially adolescents under the age of 18 years. Results from this study initiated a social marketing campaign and intervention aimed at increasing adolescent knowledge of and access to EC.

HIV Testing Preferences Among Young Men of Color Who Have Sex With Men

OBJECTIVES This report describes the population of young men who use the Young Mens Clinic in New York City, presents a profile of their reproductive behaviors, and describes the clinics model of service delivery. METHODS Data were gathered through a routine clinic visit form administered by clinic staff. RESULTS The clinic sees approximately 1200 predominately Dominican young men each year for a wide range of clinical and mental health services. Two thirds of clients had ever been sexually active, three quarters had ever used birth control, and 69% had used birth control at their last sexual encounter. CONCLUSIONS The Young Mens Clinic may serve as a model for health care delivery to adolescent and young adult males.

A cost-effectiveness analysis of interventions to increase repeat testing in patients treated for gonorrhea or chlamydia at public sexually transmitted disease clinics.

OBJECTIVES We assessed awareness of and preferences for rapid HIV testing among young, urban men of color who have sex with men and are engaged in high-risk behaviors for HIV. METHODS A cross-sectional survey was conducted in New York City among 177 young men who have sex with men (MSM). RESULTS Among the 85% of the participants who had previously undergone HIV testing, 43% reported rapid testing at their most recent test. In terms of future tests, 64% would seek rapid testing, as compared with 36% who preferred traditional testing. Those who preferred rapid testing were significantly more likely to have attended at least some college, to have discussed HIV testing with a sexual partner, to be aware of rapid testing, and to have had a previous HIV test. CONCLUSIONS In general, young MSM of color seem aware of rapid testing. However, our results indicate the need to carefully consider the unique needs of those who are particularly disenfranchised or engaged in high-risk behaviors and who may need concerted efforts around HIV counseling and testing. Likewise, our findings point to a need for more effective education and social marketing strategies.