An evidence-based socioecological framework to understand men’s use of anabolic androgenic steroids and inform interventions in this area

Research into men’s use of anabolic androgenic steroids (AAS) over the past three decades has identified many factors that contribute to decision making in this area. However there are limited theoretical frameworks to synthesize this research and guide practice, such as interventions to prevent use or reduce health risks. To address this gap a socioecological framework is presented based upon the international literature examining AAS use. Socioecological models recognize that individuals and behaviors exist within complex physical and social systems and are useful tools for guiding interventions to ensure consideration is given to multiple influential factors. This framework proposes that use of AAS is the result of the interaction of a range of factors at the individual, social network, institutional, community and societal levels that are likely to change over time and with experience. Viewed through this framework it becomes clear that AAS use can be a complex behavior with many influential environments and relationships impacting on a diverse population in different ways and at different times. The implications of findings for engaging with people who use AAS and delivering interventions are discussed, such as the identification of important transition times and influencing norms within social groups and communities

Non-AIDS defining cancers in the D:A:D Study-time trends and predictors of survival : a cohort study

BACKGROUND:Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004-2010, and described subsequent mortality and predictors of these.METHODS:Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient's last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient's death, 1st February 2010 or 6 months after the patient's last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression.RESULTS:Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin's lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004-2010 in this large observational cohort.CONCLUSIONS:The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC

Parenting Styles and Health-Related Behavior in Childhood and Early Adolescence Results of a Longitudinal Study

Lohaus A, Vierhaus M, Ball J. Parenting Styles and Health-Related Behavior in Childhood and Early Adolescence Results of a Longitudinal Study. Journal of Early Adolescence. 2009;29(4):449-475.This study addresses the development of health-related behavior during childhood and adolescence and the protective influence of an authoritative parenting style. The study is based on two samples followed from Grades 2 through 5 and from Grades 4 through 7. The first sample consisted of 432 second graders with a mean age of 7.9 years at the beginning of the study, while the second sample consisted of 366 fourth graders with a mean age of 10.1 years. Later health behavior showed substantial correlations to previous health behavior over a 3-year interval. Moreover, there was an increase of favorable health behavior during elementary school and a decrease in the subsequent age periods. The slope for negative health behavior showed an inverted pattern. The level of this general trend was significantly affected by the perceived maternal and paternal parenting style and by gender. The significance of the results for health promotion is discussed