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BACKGROUND AND OBJECTIVES: To describe (a) demographic characteristics, (b) sexual history, (c) perceived HIV susceptibility, and (d) current sexual behavior, condom use, and alcohol and marijuana use of heterosexual, low-income African American and Hispanic youth categorized as relatively monogamous (n = 577), serial monogamous (n = 171), or nonmonogamous (n = 278). STUDY DESIGN: Data were drawn from personal interviews with a probability sample of low-income youth, age 15 to 24 years, conducted in Detroit in 1991. RESULTS: Many group differences were found. For example, relatively monogamous youth were most likely to be female and Hispanic and to have engaged in unprotected intercourse. Serial monogamous youth were younger and most likely to have used condoms at last intercourse. Nonmonogamous youth initiated intercourse earlier and were most likely to have experienced oral and anal intercourse and to have used alcohol and marijuana. CONCLUSION: Risk reduction programs may need to be tailored differently to accommodate the needs of these three distinct subgroups of youth.

PIP: An understanding of differences in contraceptive use patterns among monogamous, serially monogamous, and nonmonogamous adolescents is essential to the design and targeting of condom promotion interventions. Interviews were conducted in Detroit, Michigan (US), in 1991 with a probability sample of 1062 heterosexual, low-income, African American and Hispanic youth 15-24 years of age. 577 were categorized as relatively monogamous, 171 as serially monogamous, and 278 as nonmonogamous. Monogamous youth were most likely to be female, Hispanic, married, and to have engaged in unprotected intercourse. Those who practiced serial monogamy were likely to be younger and to have used condoms at last intercourse. Nonmonogamous youth initiated intercourse earlier, were most likely to have experienced oral and anal intercourse, tended not to use contraception, and had the highest use rates of alcohol and marijuana. Condom use at last intercourse was reported by 38.6% of monogamous youth, 57.3% of the serially monogamous, and 38.2% of nonmonogamous youth; consistent condom use during the past year was reported by only 3.0%, 3.1%, and 2.5%, respectively. Discriminant analysis indicated that age at first intercourse, experience with oral sex, and number of partners best distinguished monogamous youth from serial and nonmonogamous youth. The 3 groups differed significantly in their perceived susceptibility to HIV; 11.0%, 17.8%, and 23.6%, respectively, had ever worried about contracting HIV from a partner. Risk reduction programs should be tailored to accommodate the different needs of these 3 subgroups. For example, nonmonogamous youth tend to be sensation seekers and may be more responsive to condom promotion campaigns that emphasize pleasure enhancement than to fear-based interventions.

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This study investigated the prevalence of pure and overlapping forms of somatization and depression in a sample of former Soviet immigrants and whether pure somatization or pure depression could be differentiated using the study variables. Study respondents completed a demographic questionnaire, the Demands of Immigration Scale, and the Symptom Checklist 90R. Respondents were classified as (a) neither depressed nor somatic, (b) only somatic, (c) only depressed, or (d) both depressed and somatic. Univariate analyses and logistical regression were used to compare these four groups and to predict the likelihood of being only depressed or only somatic. The four groups differed in terms of immigration demands, age, education, employment, and years in the U.S. A logistic regression analysis was able to classify 75% of the participants as only somatic or only depressed on the basis of certain demographic characteristics. Age, being unemployed and not looking for work, and not having a college education increased the risk of being somatic rather than depressed.

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This study examined the relations between alcohol use, perceived effects of alcohol use, and condom use in three different types of sexual partners in African American and Hispanic youth. Data were drawn from a household probability sample of minority youth (N = 1435) living in Detroit. Relationships were examined among three types of sexual partners: "married/lived with" partners, "knew well" partners, and "casual" partners. The effects of alcohol on condom use and perceived effects of alcohol on condom use were investigated using multiple regression with controls for demographic variables and sexual history. The quantity of alcohol consumed with partners was negatively related to condom use in all types of partners. The quantity of alcohol use was also negatively related to the perceived effect of alcohol use on condom use only with "knew well" partners.

PIP: The effects of alcohol use and type of partner on condom use were explored through use of data from a 1991 household probability sample of 1435 African American and Hispanic youth 15-24 years of age from low-income areas of Detroit, Michigan (US). Overall, alcohol use with partners was high (56% for females and 57% for males). This rate was highest when the respondent was married or cohabitating (62% for females and 70% males) and lowest with casual partners (45% and 56%, respectively). The mean perceived effect of alcohol use on the likelihood of having sex was 3.37 with married/cohabitating partners and 3.51 if the partner was known well. The mean perceived effects of alcohol drinking on condom use were much lower, especially condom use with a casual partner (1.72). The quantity of alcohol consumed with a partner was associated with reduced condom use regardless of type of partner, but the association was strongest for African American males. The quantity of alcohol use was negatively related to the perceived effect of alcohol use on condom use only with "well known" partners. Given concerns about the rapid spread of HIV among urban minority youth in the US, substance use interventions should be considered.

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This study investigated whether age, gender, marital status, education, employment, length of time in the U.S. and immigration demands (novelty, occupation, language, discrimination, loss, and not feeling at home) were predictors of psychological distress in a sample of 1,647 former Soviet immigrants. Multiple regression analysis indicated that the combined model of demographic and demand of immigration variables was significant. Results indicated that women, older immigrants, those with less than a college education, and those with greater immigration demands related to novelty, language, discrimination, loss, and not feeling at home were most distressed.

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The Demands of Immigration Scale (DI) measures demands associated with immigration, including loss, novelty, occupational adjustment, language accommodation, discrimination, and not feeling at home in the resettlement country. The DI scale was evaluated in a sample of 1,647 immigrants from the former Soviet Union who had resided in the United States from a few months to 20 years. Confirmatory factor analysis supported the proposed factor model. The DI subscales were internally consistent and had good test-retest reliability. Support for concurrent validity was demonstrated by correlations in the expected direction between the DI total and subscale scores and measures of depression and somatization. Support for discriminant validity was demonstrated by mean group differences in some or all of the DI dimensions according to age and years in the United States.

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OBJECTIVES: The objectives of this study were to assess: (1) ethnic and gender differences in reporting of diagnoses of sexually transmitted diseases (STDs), symptoms related to STDs and sexual behavior and (2) behavioral risk factors for STDs in a probability sample of low income African American and Hispanic youth. METHODS: Data were analyzed from a household probability sample of youth. The study collected data on self reported STDs, symptoms of STDs and sexual behavior. The sample was drawn from households in low income areas of urban Detroit: 1435 African American and Hispanic low income youth age 15-24 living in Detroit were interviewed face to face in 1991. RESULTS: Patterns of sexual activity as well as experience with STDs differ by ethnicity and gender. Within ethnic groups, women report more symptoms of STDs. Risk factors for diagnosed STDs included age, a young age at first intercourse, numbers of sexual partners, oral intercourse and anal intercourse. CONCLUSIONS: The data underscore the importance of development of effective safer sex intervention programs for these youth as well as careful assessment of STD risks in medical clinics serving these youth.

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We have used data from a probability sample of African-American and Hispanic youth living in low-income urban household to describe their heterosexual experiences and the influence of relationships with different kinds of sexual partners (married/lived with, well known, casual) on types of intercourse (oral, anal, vaginal), condom use, and use of other birth control methods. The Generalized Estimating Equation method for data sets with multiple observations on the same subject was used to examine whether an individual's behavior differs with different kinds of partners and how behavior with a given partner is affected by experience with other relationships. Results indicate that (a) with the exception of African-American men, sexual and contraceptive behavior varied considerably with different kinds of partners; (b) heterosexual oral and anal intercourse is more common among Hispanic than African- American youth; and (c) regardless of experience with other relationships, consistent condom use as well as use of any type of contraceptive method tend to be less likely with a casual sex partner. Data regarding percentages of consistent condom use (20%-45%) and increased involvement in risky behavior associated with multiple partners further emphasize the need for interventions that enhance condom use and discourage involvement with multiple partners.

PIP: Data from a probability sample survey of 1435 low-income Black and Hispanic youth living in households in Detroit, Michigan, revealed the importance of type of sexual partner to condom use. 81.9% of respondents were sexually active. Hispanic men and women were more likely to report oral intercourse than Black men and women; Hispanic men were most likely to have practiced anal sex. Black men reported the highest number of lifetime sexual partners. Oral and anal intercourse occurred more often with a married/live-in partner than a well-known or casual partner. Use of the Generalized Estimating Equation method indicated that Black men showed the most consistency in their sexual and contraceptive behaviors across categories of sexual partners. The proportion of young adults using condoms consistently ranged from 20% with a married/live-in partner to 45% with a well-known partner. Use of other birth control methods was most likely with a married/live-in partner, while non-use of any method was most common with casual partners. Blacks were more likely than Hispanics to report condom ever-use, but less likely to have used other methods or have had unprotected sex. When pairwise comparisons for gender-ethnic subgroups were conducted, the likelihood of condom ever-use and unprotected sex did not vary among Black men with type of partner. Overall, these findings raise concerns that the behaviors of urban, low-income Black and Hispanic youth are placing them at high risk of human immunodeficiency virus and other sexually transmitted diseases.

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Constructs from the Health Belief Model and the Theory of Reasoned Action were tested for their relationship to condom use with casual partners in a probability sample of urban African-American and Hispanic males aged 15-24. The results indicate the importance of 1) promoting a sense of male responsibility regarding condom use; 2) promoting the belief that condoms should be used with all partners; 3) developing skills for condom use and partner communication; and 4) increasing perceived susceptibility to HIV infection in design of intervention programs.

PIP: The authors report their findings from an examination of factors related to condom use with casual female partners among a probability sample of urban African-American and Hispanic males aged 15-24 years from low-income areas of Detroit. 1435 interviews were completed during February-July 1991, resulting in an overall response rate of 85%. 137 of the 590 male respondents who reported having had sexual intercourse with women during the past year reported casual partners. The men with casual partners were similar in age and educational level to other males, although a larger proportion of males with casual partners were not married and were Hispanic. Moreover, men with casual partners had a larger mean number of partners ever and during the past year. Based upon the use of constructs from the Health Belief Model and the Theory of Reasoned Action, the authors stress the importance of promoting a sense of male responsibility regarding condom use, promoting the belief that condoms should be used with all partners, developing skills for condom use and partner communication, and increasing perceived susceptibility to HIV infection when designing intervention programs.

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This paper discusses negative experiences with using condoms reported by the condom user subsample of (n = 975) of a household probability sample of low income, urban, African-American and Hispanic youth. Condom users were asked about 12 specific experiences with condoms. Although the pattern of the association varied with the particular belief and experience, it appeared that, overall, having had a negative experience increased the likelihood that the user would agree with a negative belief about condoms (p < or = .005). In addition, users who had experienced a condom making it hard to move in and out of the vagina or anus were less likely both to intend to use a condom and to have used a condom at last intercourse (p < or = .005). Condom use was also less likely if the user had experienced condoms interrupting love-making or reducing feeling or sensation.

PIP: Recent data suggests that the rate of HIV infection is increasing rapidly among African-American and Hispanic youths who live in low-income, urban areas; consistent use of condoms and condom use at last intercourse remain low. The authors describe and discuss negative experiences with using condoms reported by 568 African-Americans and 407 Hispanics aged 14-25 years (mean age 19.5-19.9 years). These 975 subjects comprise the 68% subsample which reported having used a condom at least once of a total 1435 interviews completed in the household probability study of low-income, urban, African-American and Hispanic youths. The average response rate was 85% in this sample of 45.6% males and 54.4% females. Participants were asked during February through July 1991 to describe 12 experiences in using condoms. Patterns of association varied with beliefs and experiences, but it seemed overall that having had negative experiences increased the likelihood that users would agree with a negative belief about condoms. Users having experienced difficulty in achieving and maintaining normal coital motion without undue obstruction when using a condom were less likely both to intend to use a condom and to have used a condom at last intercourse. Condom use was also less likely if the user had experienced condoms interrupting lovemaking or reducing feeling or sensation.

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This article focuses on the condom beliefs of low income, urban African American and Hispanic youth living in the Midwest. The condom beliefs under investigation were derived from prior research with members of this population and through consultation with African American and Hispanic youth and service providers. Significant gender, ethnic, and acculturation differences were found among beliefs related to frequency of condom use in the past year (p < .05). These differences indicated that women, African American respondents, and Hispanic respondents high in acculturation tended to have more neutral or more positive views about condoms than other types of respondents.

PIP: To investigate the effect of ethnicity on beliefs about condoms, a sample of 726 Black and 709 Hispanic, 15-24 year old, low-income residents of a midwestern US city was interviewed between February and July 1991. Acculturation measured with Marin et al.'s assessment of language use was high among the Hispanic respondents. Interview questions on demographic characteristics, condom beliefs, condom use, and factors related to condom use were developed through a pilot study, consultations, and pretests. At the end of each interview, respondents were given information on AIDS prevention. Data were analyzed for the respondents who knew what a condom was and reported vaginal intercourse in the past year. 54% were Black (62% of these were female), 46% Hispanic (51% were male), with 57% of Mexican origin. Mean age for each subgroup was 20 years. Hispanic respondents were more usually married (18 vs. 2%) and employed (40 vs. 31%) but less well educated (37 vs. 51% still in school) than Black respondents. Condom beliefs significantly related to frequency of condom use for vaginal intercourse were that they extend sex, destroy the mood for sex, are only necessary with a prostitute, are embarrassing to purchase, come off during use, break often, are hard to dispose of after use, are uncomfortable, are only used with people to be kept at a distance emotionally, are embarrassing to put on, interfere with sensation, are messy, denote unfaithfulness to your partner, are only carried by women looking for sex, are a symbol of a lack of trust, and that men will promise to withdraw to avoid using a condom. Significant gender differences were found in all but 5 beliefs (embarrassing to buy, come off, break often, embarrassing to put on, promise to withdraw). The largest gender difference related to women carrying condoms, which women think does not denote a desire for sex. Ethnic differences occurred for all but 6 beliefs (extend sex, destroy the mood, uncomfortable, interfere with sensation, denote unfaithfulness, promise to withdraw). Ethnic differences persisted after analysis for gender and age except for the issue of trust which was explained by gender differences. There were significant differences in acculturation among Hispanic respondents for all but 4 beliefs (embarrassing to purchase, come off, break, embarrassing to put on). The largest acculturation difference was in the belief that woman who carry condoms are seeking sex (high acculturation means no belief in this). Gender and age analysis accounted for 3 effects of acculturation (duration of sex, uncomfortable, and messy). Acculturation differences seemed to drive ethnic differences for sex with prostitutes, condom use with people to be kept at a distance, and interfering with sensation. Significant age differences were found only for coming off, trust, and withdraw as an excuse, with no consistent patterns. In general, women, Blacks, and acculturated Hispanics were more positive towards condoms. Further research is needed to compare these results with those of other surveys and to clarify whether beliefs are formed prior to or in response to condom experience.

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Low-income, urban, African-American and Hispanic youth have been identified as a group that may be at risk for the spread of human immunodeficiency virus (HIV). This article evaluates general knowledge of acquired immunodeficiency syndrome (AIDS), knowledge of routes of sexual transmission of HIV, risk behaviors related to sex, and perceived susceptibility to AIDS of urban low-income youth in Detroit. We drew data from a household probability sample of 1,435 of these Detroit youth. The data indicate that, with a few exceptions, general knowledge of AIDS and routes of sexual HIV transmission was good; there were small ethnic and gender differences in knowledge. However, we found substantial ethnic and gender differences in risk behaviors. Young African-American men reported the earliest initiation of sexual activity and the most partners. Young Hispanic women reported the latest initiation of sexual activity and the fewest partners. A substantial minority of the youth were concerned about becoming infected with HIV, and these concerns were related to risk behavior. We demonstrate from these data a need for interventions in this population to correct misconceptions and to promote use of condoms and other safer sexual behaviors.

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Research suggests that the rate of HIV infection is increasing dramatically in African-American and Hispanic youths who live in low-income, urban areas. Nurses need information about these youths' negative experiences with condoms to intervene effectively in the spread of acquired immune deficiency syndrome. This article discusses negative experiences with using condoms that were reported by a subsample of condom users (n = 975) from a household probability sample of low-income, urban, African-American and Hispanic youths. Condom users were asked about 12 different negative experiences with condoms. Results from this household survey highlight a need for nurses to provide clients with specific directions about how to use condoms correctly and to encourage clients to practice putting on condoms.

PIP: The rate of HIV infection is increasing rapidly and significantly among African-American and Hispanic youths in low income urban areas. This article reports finding from a study of negative experiences with using condoms reported by a subsample of 975 condom users from a household probability sample of low-income urban African-American and Hispanic youths in Detroit. Participants reported using a condom at least once over the preceding year. 568 were African-American and 407 were Hispanic, they were of mean age 19.7 years, and they were almost equally represented by male and female respondents. An 85% response rate was realized in interviews for both ethnic groups over the period February 1991 to July 1991. 40% reported condom breakage, 73% reported either condom breakage or slippage, 84% reported being always aware that the condom was on, 45% reported reduced sensation when using condoms, and 29% reported that a condom was too small or too tight. A mean number of 4 negative experience was reported. These findings therefore point to the difficulty encountered by these youths in effectively using condoms. These difficulties combined with the host of negative experiences may discourage the future use of condoms in this population. To minimize the extent to which current condom users move away from use, all effort must be made to reach out and encourage condom use among youths in clinic, hospital, and school settings. Specific directions should be provided or how to use condoms correctly and sexually active individuals should be encouraged to practice putting them on.

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PIP: The construct accessibility model (CAM) holds that constructs are most likely to influence behavior when they are accessible in memory. While the theory of reasoned action sees intention as an important determinant of behavior, the CAM predicts that the intention to act upon a given health behavior is not likely to be acted upon unless the intention is in an accessible state. Therefore, people who frequently talk about or think about using condoms are likely to have condom related constructs available and use them when needed. This paper reports findings from the pilot phase of a project to identify beliefs which influence condom use in Hispanic and African-American youth living in Detroit. 15 male and 15 female Hispanics and 17 male and 17 female African-Americans aged 15-21 years of mean and median age 18.5, were interviewed face-to-face in 1989 with the goal of identifying condom beliefs which may influence their condom use. 80-82% of male participants, 53% of Hispanic females, and 100% of Black females had experienced sexual intercourse, with age at first intercourse ranging between 13.1 and 16.5 years. 88% of Black women and 7% of Hispanic women were pregnant at the interview. Regarding participants' level of preventive knowledge, all but 1 recently immigrated Hispanic female knew HIV was transmitted by needles and sexual intercourse. 87% of Hispanics and 94% of African-Americans responded that condoms protect against AIDS, but only 13% of Hispanics and 47% of African-Americans knew that nonlatex condoms do not. Some participants expressed concern that condoms reduce sensitivity and/or break during intercourse. Controlling for sexual activity, 25% of Hispanic females, 83% of Hispanic males, 71% of African-American females, and 80% of African-American males had ever used a condom; no Hispanic and 14% of Blacks reported using them consistently in the 12 month period preceding the interview. With 100% of African-American males and 97% of Black females reporting thinking about using condoms compared to 80% of Hispanics, the study findings suggest that condom intentions are more accessible in African-Americans than among Hispanics.^ieng

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During summer 1989, 30 Hispanic (15 men, 15 women) and 34 African American (17 men, 17 women) adolescents and young adults from Detroit participated in face-to-face interviews designed to provide preliminary descriptive data of this population's AIDS and condom knowledge, sexual behavior, and condom and needle use behavior. Results suggest almost all knew that AIDS could be transmitted sexually or by needle sharing, and most participants knew condoms protect against AIDS. Although many sexually active participants reported using condoms, the majority reported engaging in unprotected vaginal intercourse. More Hispanic women reported episodes of unprotected intercourse than any other group. The following results may be useful in designing AIDS prevention strategies. Many participants seemed unaware of the ineffectiveness of nonlatex condoms. Hispanic female participants seemed to have a low level of knowledge concerning their own reproductive health. Small numbers of Hispanic and African American participants reported that people in their neighborhood used needles to self-administer steroids or vitamins.

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1. The antiseizure medication carbamazepine, when used to treat psychosis, does not produce the same side effects that appear as problematic in neuroleptic treatment, most notably tardive dyskinesia. 2. Carbamazepine has useful sedating, antianxiety, and antidepressant properties that make it an effective treatment for manic psychosis. 3. Nursing actions include assisting psychiatry in establishing and maintaining effective carbamazepine treatment, ensuring safe treatment, enhancing the patient's self-care agency, and facilitating research regarding the effects of carbamazepine treatment.

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