Eric J. Nehl

Social ecological correlates of physical activity in normal weight, overweight, and obese individuals

OBJECTIVE:Research is limited concerning the moderating influence of weight status (ie normal, over, and obese) on the social ecological correlates of physical activity (PA) in adults. Therefore, the present study attempted to shed light on this issue.DESIGN:In 2001, a national cross-sectional mail out panel survey was conducted over a 3-month period in the United States.SUBJECTS:There were 1867 normal weight (ie body mass index (BMI)=20–24.99 kg/m2), 2145 overweight (ie BMI=25–29.99 kg/m2), and 1902 obese (ie BMI>30 kg/m2) adults.MEASURES:Various demographic measurements were taken in addition to social support (SS), self-efficacy (SE), access to facilities, and PA.RESULTS:Normal weight individuals engaged in significantly more PA than overweight individuals, who in turn engaged in significantly more PA than obese individuals F(2,5991)=55.51, P<0.01. Further regression analyses showed that higher SE, SS, the access to facilities in a neighborhood, and various interactions among these constructs were significantly and positively associated with PA. Interestingly, the strength of these relationships varied depending on weight status.CONCLUSION:Weight status needs to be taken into consideration when examining social ecological correlates of PA.

Social Network and Other Correlates of HIV Testing: Findings from Male Sex Workers and Other MSM in Shanghai, China

Although the Chinese government provides free-of-charge voluntary HIV counseling and testing, HIV testing rates among men who have sex with men (MSM) are reported to be extremely low. This study examines the association of structural and psychosocial factors and social network characteristics with HIV testing behaviors among “money boys” and general MSM in Shanghai. Overall, 28.5% of “money boys” and 50.5% of general MSM had never tested for HIV despite high rates of reported HIV risk behaviors. Factors associated with not testing for HIV included: not knowing of a testing site, limited HIV knowledge, low perceived HIV risk, concern about HIV testing confidentiality, being a closeted gay, not using the Internet, and having a small social network or network with few members who had tested for HIV. Future efforts to promote HIV testing should focus on outreach to general MSM, confidentiality protection, decreasing the stigma of homosexuality, and encouraging peer education and support through the Internet and social networks.

Validity of Self-reported Solar UVR Exposure Compared with Objectively Measured UVR Exposure

Background: Reliance on verbal self-report of solar exposure in skin cancer prevention and epidemiologic studies may be problematic if self-report data are not valid due to systematic errors in recall, social desirability bias, or other reasons. Methods: This study examines the validity of self-reports of exposure to ultraviolet radiation (UVR) compared to objectively measured exposure among children and adults in outdoor recreation settings in 4 regions of the United States. Objective UVR exposures of 515 participants were measured using polysulfone film badge UVR dosimeters on 2 days. The same subjects provided self-reported UVR exposure data on surveys and 4-day sun exposure diaries, for comparison to their objectively measured exposure. Results: Dosimeter data showed that lifeguards had the greatest UVR exposure (24.5% of weekday ambient UVR), children the next highest exposures (10.3% ambient weekday UVR), and parents had the lowest (6.6% ambient weekday UVR). Similar patterns were observed in self-report data. Correlations between diary reports and dosimeter findings were fair to good and were highest for lifeguards (r = 0.38–0.57), followed by parents (r = 0.28–0.29) and children (r = 0.18–0.34). Correlations between survey and diary measures were moderate to good for lifeguards (r = 0.20–0.54) and children (r = 0.35–0.53). Conclusions: This is the largest study of its kind to date, and supports the utility of self-report measures of solar UVR exposure. Impact: Overall, self-reports of sun exposure produce valid measures of UVR exposure among parents, children, and lifeguards who work outdoors. Cancer Epidemiol Biomarkers Prev; 19(12); 3005–12. ©2010 AACR.

Smoking frequency among current college student smokers: distinguishing characteristics and factors related to readiness to quit smoking

Given the increased prevalence of non-daily smoking and changes in smoking patterns, particularly among young adults, we examined correlates of smoking level, specifically motives for smoking, and readiness to quit smoking among 2682 college undergraduates who completed an online survey. Overall, 64.7% (n = 1736) were non-smokers, 11.6% (n = 312) smoked 1-5 days, 10.5% (n = 281) smoked 6-29 days and 13.2% (n = 353) were daily smokers. Ordinal regression analyses modeling smoking level indicated that correlates of higher smoking level included having more friends who smoke (β = 0.63, 95% CI 0.57-0.69) and more frequent other tobacco use (β = 0.04, 95% CI 0.02-0.05), drinking (β = 0.04, 95% CI 0.02-0.07) and binge drinking (β = 0.09, 95% CI 0.06-0.13). Bivariate analyses indicated that daily smokers (versus the subgroups of non-daily smokers) were less likely to smoke for social reasons but more likely to smoke for self-confidence, boredom, and affect regulation. Controlling for sociodemographics, correlates of readiness to quit among current smokers included fewer friends who smoke (P = 0.002), less frequent binge drinking (P = 0.03), being a social smoker (P < 0.001), smoking less for self-confidence (P = 0.04), smoking more for boredom (P = 0.03) and less frequent smoking (P = 0.001). Specific motives for smoking and potential barriers to cessation particularly may be relevant to different groups of college student smokers.

Alternative tobacco use among college students: who is at highest risk?

OBJECTIVE To examines smoking status, substance use, sociodemographics, and psychosocial characteristics in relation to alternative tobacco use among college students. METHODS Current tobacco use (cigarettes, cigar-like products, hookah, chew, snus) and correlates (sociodemographics, sensation-seeking, attitudes toward tobacco and smokers, social factors) were assessed among students aged 18-25 at 6 Southeastern US colleges using an online survey. RESULTS Those who were younger, male, black, cigarette and marijuana users, and demonstrating at-risk psychosocial factors were at increased risk of alternative tobacco product use (p < .001). Among current smokers, never daily nondaily smokers were 3 times as likely as former daily non-daily smokers and daily smokers to use alternative tobacco products (p < .001). CONCLUSIONS Important risk factors for alternative tobacco use included important sociodemographic and psychosocial characteristics.

Validity of covering-up sun-protection habits: Association of observations and self-report

BACKGROUND Few studies have reported the accuracy of measures used to assess sun-protection practices. Valid measures are critical to the internal validity and use of skin cancer control research. OBJECTIVES We sought to validate self-reported covering-up practices of pool-goers. METHODS A total of 162 lifeguards and 201 parent/child pairs from 16 pools in 4 metropolitan regions in the United States completed a survey and a 4-day sun-habits diary. Observations of sun-protective behaviors were conducted on two occasions. RESULTS Agreement between observations and diaries ranged from slight to substantial, with most values in the fair to moderate range. Highest agreement was observed for parent hat use (kappa = 0.58-0.70). There was no systematic pattern of over- or under-reporting among the 3 study groups. LIMITATIONS Potential reactivity and a relatively affluent sample are limitations. CONCLUSION There was little over-reporting and no systematic bias, which increases confidence in reliance on verbal reports of these behaviors in surveys and intervention research.

Understanding Nonsmoking in African American and Caucasian College Students: An Application of the Theory of Planned Behavior.

Few studies have considered whether psychological determinants of nonsmoking among college students vary by ethnicity. The authors tested the theory of planned behavior (TPB) to explain differences in nonsmoking intentions of 238 African American and 197 Caucasian college students who completed an in-class TPB questionnaire and a smoking assessment 1 week later. After removing 35 students who reported smoking at the baseline assessment, regressions were used to examine ethnic effects on TPB constructs when predicting nonsmoking intentions. Caucasians had statistically significant higher nonsmoking intentions than African Americans. Further, subjective norms for Caucasians and attitudes for African Americans had small but significant relations to intention, but perceived behavioral control (PBC) was a strongly significant predictor for both ethnic groups. However, the prediction of nonsmoking intentions was not statistically moderated by ethnicity for any of the TPB constructs. This study suggests that the TPB may aid in understanding collegiate nonsmoking intentions and help begin to explain differences in smoking on the basis of ethnicity. Last, because of strong associations shown in this study, PBC should be considered when developing ethnic-specific smoking interventions in college students.

Bridge population: sex workers or their clients?--STI prevalence and risk behaviors of clients of female sex workers in China.

Abstract As the HIV/AIDS epidemic and the spread of sexually transmitted infections (STIs) in China has come to the forefront of public health attention, female sex workers (FSWs) and their clients (CFSWs) are becoming increasingly important to HIV/STI prevention efforts. This secondary analysis uses data abstracted from the Chinese Health and Family Life Survey 1999–2000 to report prevalence rates of two STIs as well as sexual risk behaviors for CFSWs – men who paid for sex with FSWs in the past 12 months – in comparison with men who had not patronized FSWs. Among 1879 Chinese CFSWs who completed anonymous interviews and urine testing, 152 (6.3%, weighted) said they had paid for sex in the past 12 months and 18.8% of CFSWs (weighted) tested positive for gonorrhea. CFSWs were 10 times more likely to have an STI (either self-reported or tested) than non-client Chinese men, and they were equally likely to use condoms inconsistently with their spouses. This study highlights the importance of studying CFSWs who use condoms inconsistently and do not practice safe sex with their spouse as a potential bridge population. Prevention and intervention efforts should target this bridge population and include education on HIV/AIDS and STI transmission, condom promotion, marriage counseling, destigmatization of HIV and STIs, and promotion of STI diagnosis and treatment.

Disparities and Risks of Sexually Transmissible Infections among Men Who Have Sex with Men in China: A Meta-Analysis and Data Synthesis

Background Sexually transmitted infections (STIs), including Hepatitis B and C virus, are emerging public health risks in China, especially among men who have sex with men (MSM). This study aims to assess the magnitude and risks of STIs among Chinese MSM. Methods Chinese and English peer-reviewed articles were searched in five electronic databases from January 2000 to February 2013. Pooled prevalence estimates for each STI infection were calculated using meta-analysis. Infection risks of STIs in MSM, HIV-positive MSM and male sex workers (MSW) were obtained. This review followed the PRISMA guidelines and was registered in PROSPERO. Results Eighty-eight articles (11 in English and 77 in Chinese) investigating 35,203 MSM in 28 provinces were included in this review. The prevalence levels of STIs among MSM were 6.3% (95% CI: 3.5–11.0%) for chlamydia, 1.5% (0.7–2.9%) for genital wart, 1.9% (1.3–2.7%) for gonorrhoea, 8.9% (7.8–10.2%) for hepatitis B (HBV), 1.2% (1.0–1.6%) for hepatitis C (HCV), 66.3% (57.4–74.1%) for human papillomavirus (HPV), 10.6% (6.2–17.6%) for herpes simplex virus (HSV-2) and 4.3% (3.2–5.8%) for Ureaplasma urealyticum. HIV-positive MSM have consistently higher odds of all these infections than the broader MSM population. As a subgroup of MSM, MSW were 2.5 (1.4–4.7), 5.7 (2.7–12.3), and 2.2 (1.4–3.7) times more likely to be infected with chlamydia, gonorrhoea and HCV than the broader MSM population, respectively. Conclusion Prevalence levels of STIs among MSW were significantly higher than the broader MSM population. Co-infection of HIV and STIs were prevalent among Chinese MSM. Integration of HIV and STIs healthcare and surveillance systems is essential in providing effective HIV/STIs preventive measures and treatments. Trial Registration PROSPERO No: CRD42013003721

Male-on-male intimate partner violence and sexual risk behaviors among money boys and other men who have sex with men in Shanghai, China

Background Intimate partner violence (IPV) is known to increase HIV risk among heterosexual women, but less is known about IPV and HIV among men who have sex with men (MSM), with almost no data from non-Western countries. This study examined the prevalence of IPV and links between IPV and HIV risks among MSM in Shanghai, China. Methods A cross-sectional sample of 404 money boys (male sex workers) and other MSM were recruited via respondent-driven sampling. Results Overall, 51% of the sample reported emotional, physical, or sexual abuse from a male sexual partner. Money boys reported more overall abuse than did other MSM, and more were likely than other MSM to report experiencing multiple types of abuse. MSM who reported violence or abuse from male partners reported more overall sexual risk behavior, and specifically, more unprotected sex and more sex linked to alcohol and other substance use. The association between experience of abuse from male partners and increased HIV risk did not differ between money boys and other Chinese MSM. Conclusions We conclude that violence and abuse from male partners are highly prevalent among Chinese MSM, and that experience of violence from male sexual partners is linked to increased HIV risk. HIV prevention targeting Chinese MSM must address the increased risk associated with experience of male-on-male IPV. Future research should explore links between HIV risk and MSM’s perpetration of violence against male partners, as well as exploring the role of violence in the male-female relationships of men who have sex with and men and women.