Susan C. Weller

The effectiveness of condoms in reducing heterosexual transmission of HIV.

CONTEXT It is not established whether the condom is as effective at preventing heterosexual transmission of HIV as it is for preventing conception. An overall estimate of condom effectiveness for HIV prevention is needed. METHODS Information on condom usage and HIV serology was obtained from 25 published studies of serodiscordant heterosexual couples. Condom usage was classified as always (in 100% of acts of intercourse), sometimes (1-99%, 0-99% or 1-100%) or never (0%). Studies were stratified by design, direction of transmission and condom usage group. Condom efficacy was calculated from the HIV transmission rates for always-users and never-users. RESULTS For always-users, 12 cohort samples yielded a consistent HIV incidence of 0.9 per 100 person-years (95% confidence interval, 0.4-1.8). For 11 cohort samples of never-users, incidence was estimated at 6.8 per 100 person-years (95% confidence interval, 4.4-10.1) for male-to-female transmission, 5.9 per 100 (95% confidence interval, 1.5-15.1) for female-to-male transmission and 6.7 per 100 (95% confidence interval, 4.5-9.6) in samples that specified the direction of transmission. Generally, the condoms effectiveness at preventing HIV transmission is estimated to be 87%, but it may be as low as 60% or as high as 96%. CONCLUSIONS Consistent use of condoms provides protection from HIV. The level of protection approximates 87%, with a range depending upon the incidence among condom nonusers. Thus, the condoms efficacy at reducing heterosexual transmission may be comparable to or slightly lower than its effectiveness at preventing pregnancy

Cultural Consensus Theory: Applications and Frequently Asked Questions

In the ethnographic context, where answers to questions are unknown, consensus theory estimates the culturally appropriate or correct answers to the questions and individual differences in cultural knowledge. The cultural consensus model is a formal model of the process for asking and answering questions and is limited to categorical response data. An informal version of the model is available as a set of analytic procedures and obtains similar information with fewer assumptions. This article describes the assumptions, appropriate interview materials, and analytic procedures for carrying out a consensus analysis. Finally, issues that sometimes arise during the application of a consensus analysis are discussed.

Metric scaling : correspondence analysis

Introduction The Basic Structure of a Data Matrix Principal Components Analysis Multidimensional Preference Scaling Correspondence Analysis of Contingency Tables Correspondence Analysis of Non-Frequency Data Ordination, Seriation, and Guttman Scaling Multiple Correspondence Analysis

A meta-analysis of condom effectiveness in reducing sexually transmitted HIV.

Before condoms can be considered as a prophylaxis for sexually transmitted human immunodeficiency virus (HIV), their efficacy must be considered. This paper reviews evidence on condom effectiveness in reducing the risk of heterosexually transmitted human HIV. A meta-analysis conducted on data from in vivo studies of HIV discordant sexual partners is used to estimate the protective effect of condoms. Although contraceptive research indicates that condoms are 87% effective in preventing pregnancy, results of HIV transmission studies indicate that condoms may reduce risk of HIV infection by approximately 69%. Thus, efficacy may be much lower than commonly assumed, although results should be viewed tentatively due to design limitations in the original studies.

Sexual Activity, Contraceptive Use, and Other Risk Factors for Symptomatic and Asymptomatic Bacteriuria: A Case-Control Study

In a study to determine the risk factors for urinary tract infection in college-aged women, women who presented with acute urinary tract infection to the student health service were compared to women without bacteriuria who presented with complaints of other acute illnesses. Among women who were sexually active, the following multivariate adjusted odds ratios (95% confidence intervals) were found; intercourse in the previous 48 hours, 58.1 (11.9 to 284.1); intercourse only in the previous 3 to 7 days, 9.1 (1.9 to 44.1); diaphragm use in the previous 48 hours, 8.4 (3.4 to 21.1); urination after intercourse, 0.5 (0.3 to 0.9); and past history of urinary tract infection, 2.7 (1.5 to 5.0). Several other factors previously postulated to be related to urinary tract infection were found not to be associated, including oral contraceptive use, tampon use, and direction of wiping after a bowel movement. When the women with symptomatic bacteriuria were compared to women with asymptomatic bacteriuria, the results were similar, except diaphragm use and urination after intercourse were no longer associated with urinary tract infection. When the women with asymptomatic bacteriuria were compared to women without symptoms and without bacteriuria, diaphragm use remained the only statistically significant risk factor. These findings should be taken into account in attempts to prevent urinary tract infection, as well as in subsequent studies of this disease.

Psychosocial implications of chronic illness in adolescence

One hundred forty-four young adults and adolescents representative of an upstate New York community were studied on two occasions to identify relationships between chronic illness and psychosocial well-being. In the 8 years since the original survey, the health status of 62 of the 106 with a chronic medical condition improved, remained unchanged in 27, and worsened in 17. Subjects whose chronic medical problem persisted and was associated with at least mild impairment in daily living demonstrated significantly more psychosocial problems, centering around future plans, perceptions of family life, and having a drivers license. Those who had recovered from their illness or did not have any associated impairment appeared no different from the controls. Multidimensional scaling confirmed that chronic illness and poor psychosocial functioning are related, as are physical wellness and better psychosocial function. These results confirm the contention that chronic illness persisting into adolescence has a small but measurable effect on psychosocial adjustment.

Variation in Asthma Beliefs and Practices Among Mainland Puerto Ricans, Mexican-Americans, Mexicans, and Guatemalans

This study reports on community surveys of 160 representative Latino adults in Hartford, CT; Edinburg, TX; Guadalajara, Mexico; and in rural Guatemala. A 142-item questionnaire covered asthma beliefs and practices (e.g., causes, symptoms, and treatments). The cultural consensus model was used to analyze the agreement among respondents within each sample and to describe beliefs. Beliefs were then compared across the four samples. Analysis of the questionnaire data shows that there was overall consistency or consensus regarding beliefs and practices among individuals at each site (intraculturally) and to a lesser extent across respondents of all four different Latino cultural groups (i.e., interculturally). This pattern of response is indicative of a shared belief system among the four groups with regard to asthma. Within this shared belief system though, there is systematic variation between groups in causes, symptoms, and treatments for asthma. The most widely recognized and shared beliefs concerned causes of asthma. Notable differences were present between samples in terms of differences in beliefs about symptoms and treatments. The biomedical model is shown to be a part of the explanatory model at all sites; in addition to the biomedical model, ethnocultural beliefs such as the humoral (“hot/cold”) aspects and the importance of balance are also evident. The Connecticut Puerto Ricans had a greater degree of shared beliefs about asthma than did the other three samples (p<0.00005). It was concluded that the four Latino groups studied share an overall belief system regarding asthma, including many aspects of the biomedical model of asthma. In addition, traditional Latino ethnomedical beliefs are present, especially concerning the importance of balance in health and illness. Many beliefs and practices are site-specific, and caution should be used when using inclusive terms such as “Hispanic” or “Latino,” since there is variation as well as commonality among different ethnic groups with regard to health beliefs and practices.

Predicting informant accuracy from patterns of recall among individuals

Abstract This paper examines the question of informant accuracy in reporting patterns of communication in face-to-face groups. We are attempting to establish the extent to which it is possible to predict individual differences in accuracy from the patterns of recall among informants. We use data from a series of studies by Bernard, Killworth, and Sailer ( Killworth and Bernard, 1976 , Killworth and Bernard, 1979 Bernard and Killworth 1977; Bernard et al., 1980 , Bernard et al., 1982 ) in which they collected observed behavior interaction frequencies and subsequently asked informants to recall and rate the degree of previous communication. In this paper we attempt to predict the accuracy of recall, i.e. how well each individuals ranking corresponds to the overall observed interactions for the group as a whole, by looking solely at the recall ranking. Using this method, we are able to account for a major share of the variance in accuracy among the subjects. We outline a theory and method for predicting accuracy based upon recall data that may be generalized to a variety of situations beyond social interaction data.

A Cross-Cultural Approach to the Study of the Folk Illness Nervios

To systematically study and document regional variations in descriptions of nervios, we undertook a multisite comparative study of the illness among Puerto Ricans, Mexicans, Mexican Americans, and Guatemalans. We also conducted a parallel study on susto (Weller et al. 2002, Culture, Medicine and Psychiatry 26(4): 449– 472), which allows for a systematic comparison of these illnesses across sites. The focus of this paper is inter- and intracultural variations in descriptions in four Latino populations of the causes, symptoms, and treatments of nervios, as well as similarities and differences between nervios and susto in these same communities. We found agreement among all four samples on a core description of nervios, as well as some overlap in aspects of nervios and susto. However, nervios is a much broader illness, related more to continual stresses. In contrast, susto seems to be related to a single stressful event.

Factors Associated with Racial/Ethnic Differences in Colorectal Cancer Screening

Introduction: Racial/ethnic differences in colorectal cancer (CRC) screening rates are thought to account, in part, for the racial/ethnic differences in CRC disease burden. The purpose of this study was to examine which factors mediate racial/ethnic differences in CRC screening. Methods: Five hundred sixty participants attending a primary care clinic, aged 50 to 80 years, and of African-American, Hispanic, or non-Hispanic white race/ethnicity were interviewed. The goal was to assess the contribution of sociodemographic characteristics, knowledge, beliefs about CRC, and the health care experience with their primary care doctor to racial/ethnic differences in CRC screening. The outcome variable was self-reported screening. All analyses were weighted; bivariate testing and multivariate logistic regression was conducted. Results: The response rate was 55.7%, with no sociodemographic differences noted between respondents and nonrespondents. Respondents were African-American (n = 194), Hispanic (n = 162), and non-Hispanic white (n = 204); 64.5% were aged 50 to 64 years; 63.1% were women; 96.9% were insured; and over half reported a total annual income of less than