The effectiveness of interventions to change six health behaviours: a review of reviews

Background: Several World Health Organisation reports over recent years have highlighted the high incidence of chronic diseases such as diabetes, coronary heart disease and cancer. Contributory factors include unhealthy diets, alcohol and tobacco use and sedentary lifestyles. This paper reports the findings of a review of reviews of behavioural change interventions to reduce unhealthy behaviours or promote healthy behaviours. We included six different health-related behaviours in the review: healthy eating, physical exercise, smoking, alcohol misuse, sexual risk taking (in young people) and illicit drug use. We excluded reviews which focussed on pharmacological treatments or those which required intensive treatments (e. g. for drug or alcohol dependency). Methods: The Cochrane Library, Database of Abstracts of Reviews of Effectiveness (DARE) and several Ovid databases were searched for systematic reviews of interventions for the six behaviours (updated search 2008). Two reviewers applied the inclusion criteria, extracted data and assessed the quality of the reviews. The results were discussed in a narrative synthesis. Results: We included 103 reviews published between 1995 and 2008. The focus of interventions varied, but those targeting specific individuals were generally designed to change an existing behaviour (e. g. cigarette smoking, alcohol misuse), whilst those aimed at the general population or groups such as school children were designed to promote positive behaviours (e. g. healthy eating). Almost 50% (n = 48) of the reviews focussed on smoking (either prevention or cessation). Interventions that were most effective across a range of health behaviours included physician advice or individual counselling, and workplace- and school-based activities. Mass media campaigns and legislative interventions also showed small to moderate effects in changing health behaviours. Generally, the evidence related to short-term effects rather than sustained/longer-term impact and there was a relative lack of evidence on how best to address inequalities. Conclusions: Despite limitations of the review of reviews approach, it is encouraging that there are interventions that are effective in achieving behavioural change. Further emphasis in both primary studies and secondary analysis (e.g. systematic reviews) should be placed on assessing the differential effectiveness of interventions across different population subgroups to ensure that health inequalities are addressed.</p

Psychosocial health problems increase risk for HIV among urban young men who have sex with men: Preliminary evidence of a syndemic in need of attention

BACKGROUND: Young men who have sex with men (YMSM) experience disparities in HIV rates and potentially in mental health, substance abuse, and exposure to violence.\ud \ud PURPOSE: We assessed the extent to which these psychosocial health problems had an additive effect on increasing HIV risk among YMSM.\ud \ud METHODS: An urban sample of 310 ethnically diverse YMSM reported on psychosocial health problems, sexual risk behaviors, and HIV status. A count of psychosocial health problems was calculated to test the additive relationship to HIV risk.\ud \ud RESULTS: The prevalence of psychosocial health problems varied from 23% for regular binge drinking to 34% for experiencing partner violence. Rates of sexual risk behaviors were high and 14% of YMSM reported receiving a HIV+ test result. Psychosocial health problems cooccurred, as evidenced by significant bivariate odds ratios (ORs) between 12 of the 15 associations tested. Number of psychosocial health problems significantly increased the odds of having multiple anal sex partners (OR=1.24), unprotected anal sex (OR=1.42), and an HIV-positive status (OR 1.42), after controlling for demographic factors.\ud \ud CONCLUSIONS: These data suggest the existence of cooccurring epidemics, or "syndemic," of health problems among YMSM. Disparities exist not only in the prevalence of HIV among YMSM but also in research to combat the epidemic within this vulnerable population. Future research is needed to identify risk and resiliency factors across the range of health disparities and develop interventions that address this syndemic.\ud \u

Sexual Behavior and Intention to Engage in Sexual Behavior Among Young Adolescents in Hong Kong: Findings Based on Four Waves of Data

This study examined the growth trajectories of sexual behavior and intention to engage in sexual behavior among young adolescents in Hong Kong across 4 years. Besides, the impact of family structure and economic disadvantage on the rate of change in adolescent sexual behavior and intention was studied, and the concurrent and longitudinal impact of family functioning and positive youth development on adolescent sexual behavior and intention was explored. Four waves of data were collected from adolescents (n = 3328 at Wave 1) in 28 secondary schools in Hong Kong. Individual growth curve models generally showed that adolescents from economically disadvantaged and non-intact families increased their sexual behavior at a faster rate than their counterparts, but they did not affect the rate of acceleration in intention to engage in sexual behavior. Multiple regression analyses revealed that family functioning and positive youth development influenced adolescent sexual behavior and intention.Department of Applied Social Science

Sexual Behavior and Perceived Peer Norms: Comparing Perinatally HIV-Infected and HIV-Affected Youth

A large proportion of perinatally HIV-infected (PHIV) children are becoming adolescents and exploring their sexuality. This study explored the prevalence of sexual behaviors (kissing, touching, engaging in oral sex, or having vaginal/anal intercourse) in a sample of predominantly ethnic minority youths (N = 339; 54.1% Black and 30.4% Latino; 51% female; ages 9-16) perinatally exposed to HIV (61% HIV+). Using logistic regression, we tested the association between sexual behavior and HIV status, demographic characteristics, and peer influences regarding sexual behavior. PHIV youth were less likely to be sexually active. Among sexually active youth, PHIV youth were more likely to engage in touching behavior than HIV-negative youth and were less likely to engage in penetrative sex. Youths reporting that a greater number of their peers believed that sexually active boys were cool or popular were more likely to report sexual behavior. The association between sexual behavior and peers believing sexually active girls were cool or popular varied by age, gender, and HIV status. Furthermore, friends' sexual activity was associated with sexual intercourse. Prevention programs should strengthen messages addressing peer norms regarding sexuality, as well as address specific issues related to adolescent HIV.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/85192/1/Bauermeister_CASAH_JOYO.pd