R de Visser

Smoking and erectile dysfunction: findings from a representative sample of Australian men

Objectives: To examine whether there is an association between smoking and erectile dysfunction in a representative sample of Australian men. Design: Secondary analysis of cross-sectional survey data from the Australian Study of Health and Relationships. Participants: 8367 Australian men aged 16–59 years. Main outcome measures: Erectile dysfunction was identified in men who reported having had trouble keeping an erection when they wanted to, a problem which persisted for at least one month over the previous year. Variables examined in multivariate logistic regression analyses included age, education, presence of cardiovascular disease and diabetes, and current alcohol and tobacco consumption. Results: Almost one in 10 of the respondents (9.1%) reported erectile dysfunction that lasted for at least one month over the previous year. More than a quarter (27.2%) of respondents were current smokers, with 20.9% smoking ⩽ 20 cigarettes per day, and 6.3% smoking > 20 cigarettes per day. Compared with non-smokers, the adjusted odds ratios for erectile dysfunction were 1.24 (95% confidence interval (CI) 1.01 to 1.52, p  =  0.04) for those smoking ⩽ 20 cigarettes per day and 1.39 (95% CI 1.05 to 1.83, p  =  0.02) for those smoking > 20 cigarettes per day, after adjusting for other confounding factors. Older age, low level of education, and taking medications for cardiovascular disease were also independently and positively associated with erectile dysfunction. In contrast, moderate alcohol consumption (1–4 drinks per day) significantly reduced the likelihood of having erectile dysfunction. Conclusions: Erectile dysfunction is a significant health concern affecting around one in 10 Australian men aged 16–59 years. Current smoking is significantly associated with erectile dysfunction in Australian males. This association was strengthened as the number of cigarettes smoked increased. Health promotion programmes could use the link between smoking and erectile dysfunction to help reduce smoking levels among men.

Poverty, disease progression and employment among people living with HIV/AIDS in Australia

A national survey of 925 people living with HIV/AIDS (PLWHA) in Australia is used to examine the relationship between disease progression, employment status, poverty and economic hardship. While disease progression has some impact on economic hardship, employment status is found to be the strongest determinant of both poverty and economic hardship. The most commonly cited reasons for leaving work were psychosocial (71%), with declining health cited by half of respondents. It is therefore argued that psychosocial issues are at least as important as changes in health in causing unemployment and therefore poverty and economic hardship among PLWHA in Australia.

Predictors of heterosexual condom use: Characteristics of the situation are more important than characteristics of the individual

An event-specific analysis was conducted in order to assess the relative importance of a number of predictors of condom use. Surveys were completed by 271 heterosexual tertiary students: 60% used a condom in their most recent sexual encounter. Condom use was more closely related to state-like characteristics of the sexual encounter (e.g. having an agreement to use a condom, use of other forms of contraception) than trait-like characteristics of the individual (e.g. attitudes toward condom use, perceived risk of infection with HIV or other STDs). In addition, condom use was more strongly influenced by concerns about pregnancy prevention than concerns about disease prevention. The results of this study show that if we are to understand why heterosexual young adults do not consistently use condoms then we cannot only examine trait-like characteristics of the individual. We must also examine the context of specific sexual encounters.

Employment, accommodation, finances and combination therapy: the social consequences of living with HIV/AIDS in Australia

The research reported here is of a study of the psychosocial impact of living with HIV/AIDS in Australia focusing on employment, accommodation and income in the environment of new treatments for HIV/AIDS. Many people experience profound changes to their lifestyle as a result of living with HIV/AIDS. In addition to detrimental changes in their health, many people experience major changes in their employment, accommodation, finances and relationships. The research highlights the significance of psychosocial factors along with changes in physical health in shaping PLWHAs (People Living with HIV/AIDS) changes in employment and accommodations. The new treatments now available for HIV/AIDS are further transforming peoples attitudes, with many PLWHA considering returning to employment.

Use of alternative therapies by people living with HIV/AIDS in Australia

Few studies of use of complementary and alternative medicine (CAM) among people living with HIV/AIDS (PLWHA) have been conducted since combination antiretroviral (ARV) drug therapy became widespread. In the context of changing ARV treatment options, it is important to consider the prevalence and correlates of use of CAM. In this study, a sample of 924 Australian PLWHA completed a self-administered survey that included questions on use of CAM. Half (55%) of the respondents reported using CAM. Most PLWHA did not choose CAM as an alternative to ARV drugs, but use CAM to complement ARV drugs. Use of CAM was not related to measures of progression of HIV/AIDS disease. In contrast, CAM use was related to characteristics of the ways respondents live with HIV/AIDS, and their attitudes toward treatment. The popularity of CAM among PLWHA highlights a need to ensure that PLWHA can make informed choices about CAM use.

Inconsistent users of condoms: A challenge to traditional models of health behaviour

People who sometimes use condoms present a challenge to the utility of traditional models of health-protective behaviour in safe sex research. This study used a prospective condom use diary to identify predictors of condom use among heterosexual young adults who use condoms inconsistently. Rather than being influenced by the trait-like attitudes and beliefs central to traditional models of health behaviour, condom use was predicted by characteristics of the sexual encounter, particularly negotiation of condom use. The results of this study highlight the limitations of attempts to explain condom use solely on the basis of trait-like characteristics of individuals. The results also show that if we wish to increase rates of condom use among people who use condoms inconsistently, then we must instil in them skills for negotiating condom use, and confidence in their ability to use these skills.

What factors are important in smoking cessation and relapse in women from deprived communities? A qualitative study in Southeast England.

OBJECTIVES Women are relatively more susceptible to smoking-related diseases and find it more difficult to quit; however, little research exists on factors associated with smoking cessation and relapse in women. We examined attitudes towards and perceptions of factors associated with smoking cessation and relapse in women from deprived communities. STUDY DESIGN Qualitative interview study. METHODS Participants included eleven women, smokers and ex-smokers, from disadvantaged communities in East Sussex, England, who had used the National Health Service (NHS) stop smoking service. Data were collected through a focus group and semi-structured interviews, and subjected to thematic analysis. RESULTS Participants opined that it is more difficult for women to quit smoking than men. Women felt that postcessation weight gain was inevitable and acted as a barrier to quitting. Hormonal fluctuations during the menstrual cycle and greater levels of stress were perceived as obstacles to quitting and reasons for relapse. Conversely, the women cited effects of smoking on physical appearance, oral hygiene and guilt about exposing children to passive smoke as powerful motivators to quit; and highlighted the impact of public health campaigns that focused on these factors. Views diverged on whether quitting with someone close to you is a help or hindrance. Other themes including alcohol intake, daily routine and being in the presence of smokers emerged as situational triggers of relapse. CONCLUSIONS Interventions that address womens concerns related to postcessation weight gain, hormonal fluctuations during the menstrual cycle and stress may aid with smoking cessation and reduce relapse. Public health campaigns should consider the impact of smoking on physical appearance and the effect of passive smoke on children.

P193 A mixed-method study of how to increase STI screening among young people

Background STIs are a considerable problem, with diagnoses concentrated among young people. Although the Theory of Planned Behaviour (TPB) predicts many health behaviours, there is a lack of research into how well it explains STI testing. The original TPB emphasised the importance of intentions as the ultimate influence on behaviour. Subsequent research focuses on implementation intentions—people who make explicit plans for how to implement their intentions are more likely to do so. Although some studies have analysed barriers and facilitators in STI testing, no published research has examined what impact developing implementation plans has. This study was designed to address this knowledge gap. Objectives To assess an extended TPB and implementation intention interventions on STI testing; to carry out a qualitative study of barriers and facilitators in those who intend to test. Methods 371 participants completed an online baseline questionnaire and were randomly allocated to a control, information or implementation plan condition to examine differential effects on intentions to undergo STI testing. 172 completed a 6-week follow-up questionnaire to assess actual testing behaviour. In-depth interviews were conducted with a purposive selection of the sample and analysed using interpretative phenomenological analysis. Results Multivariate analysis revealed that TPB variables explained 20% of the variance in past testing behaviour (p<0.01) and 17% of variance in intention (p<0.01). No significant difference between intervention arms was found (p=0.90) (the intervention did not significantly strengthen intentions). Qualitative analysis revealed multiple perceived barriers to STI testing. Conclusion Results provide support for the utility of an extended TPB in predicting past behaviour and intentions to undergo STI testing. Although the implementation plan intervention was ineffective, qualitative data helped explain why a significant intervention effect was not found.