BACKGROUND: Structural, interpersonal and individual level factors can present barriers for HIV prevention behaviour among people at high risk of HIV acquisition, including women who sell sex. In this paper we document the contexts in which women selling sex in Kampala meet and provide services to their clients.
METHODS: We collected qualitative data using semi-structured interviews. Women were eligible to participate if they were 18 years or older, self-identified as sex workers or offered sex for money and spoke Luganda or English. Ten women who met clients in venues and outdoor locations were selected randomly from a clinic for women at high risk of HIV acquisition. Ten other women who met clients online were recruited using snowball sampling. Interviews included demographic data, and themes included reasons for joining and leaving sex work, work locations, nature of relationships with clients and peers, interaction with authorities, regulations on sex work, and reported stigma. We conducted interviews over three months. Data were analysed thematically using a framework analysis approach. The coding framework was based on structural factors identified from literature, but also modified inductively with themes arising from the interviews.
RESULTS: Women met clients in physical and virtual spaces. Physical spaces included venues and outdoor locations, and virtual spaces were online platforms like social media applications and websites. Of the 20 women included, 12 used online platforms to meet clients. Generally, women from the clinic sample were less educated and predominantly unmarried, while those from the snowball sample had more education, had professional jobs, or were university students. Women from both samples reported experiences of stigma, violence from clients and authorities, and challenges accessing health care services due to the illegality of sex work. Even though all participants worked in settings where sex work was illegal and consequently endured harsh treatment, those from the snowball sample faced additional threats of cybersecurity attacks, extortion from clients, and high levels of violence from clients.
CONCLUSIONS: To reduce risk of HIV acquisition among women who sell sex, researchers and implementers should consider these differences in contexts, challenges, and risks to design innovative interventions and programs that reach and include all women.

Health risk behaviour, as it pertains to adolescent behaviour, poses a massive challenge for many fields of medicine, not only due to developmental and psychological concerns but also its inevitable contribution to the burden of disease through trauma and non-communicable diseases resulting from risky behavioural choices. The objective study is to explore the prevalence of health risk behavior engagement among grade 4-7 learners at four primary schools in the Western Cape, South Africa, as well as establish a need for a prevention program starting at primary school level. An observational, descriptive, quantitative design was used to conduct this study. Non-probability, heterogenous, purposive sampling was used to select the study population. A needs analysis assessment using a modified self-administered Child Health Risk Behaviour survey was conducted using 7-inch electronic tablets. Four primary schools agreed to participate yielding a total sample size of n=1147 learners in grades 4 to 7. Learners\' age ranged from nine years old to fourteen years old with a mean age of 11.45 (SD 1.271). Riding a bicycle without a helmet, physical fight (86.1 and 64.1% among boys and girls respectively), ever smoked a cigarette (boys 36.3%; girls 28.3%) and consuming alcohol without permission (boys 28.7%; girls 23.8%) had the most engagement. Sexual curiosity questions had by far the most positive engagement and consistency of engagement among both boys and girls. This evidence reaffirms the need that early, bespoke and scientific intervention/prevention programs are needed to combat health risk behaviour and subsequently reduce the burden of disease.

Objectives: Sensation seeking (SS) is associated with engaging in risk behaviors and it is also positively correlated with engaging in physical activity and building beneficial personality resources for coping processes. This study investigates the role of SS in building resiliency and the risk of tobacco and alcohol use. Methods: A total of 649 adolescents, who either practice or do not practice sports, took part in this study. Participants completed a set of questionnaires which verify level of: SS, resiliency, tobacco and alcohol use. Results: No statistically significant gender- or sports-related differences were observed on the tobacco and alcohol use, as well as for SS according to the ANOVA results. Furthermore, mediation analysis showed that the effect of SS on tobacco and alcohol use through resiliency was significant for the female PE and the male athlete group. Conclusion: Higher influence of SS on resiliency was noted in the male athlete group, and in this case resiliency was a factor protecting against tobacco use. Engaging in sports fosters resiliency, the mechanisms underlying the development of resiliency seem to be aided by SS.

Energy drinks are consumed for a variety of reasons, including to boost mental alertness and energy. We assessed associations between demographic factors and various high-risky behaviours with energy drink consumption as they may be linked to adverse health events.
We conducted cross-sectional analysis including basic descriptive and multivariable-adjusted logistic regression analyses to characterise demographic and behavioural factors (including diet quality, binge drinking and illicit drug use, among others obtained via questionnaires) in relation to energy drink consumption.
We used data from two large US-based cohorts.
46 390 participants from Nurses\' Health Study 3 (NHS3, n 37 302; ages 16-31) and Growing Up Today Study (GUTS, n 9088, ages 20-55).
Of the 46 390 participants, 13·2 % reported consuming ≥ 1 energy drink every month. Several risky behaviours were associated with energy drink use, including illegal drug use (pooled OR, pOR: 1·45, 95 % CI: 1·16, 1·81), marijuana use (pOR: 1·49, 95 % CI: 1·28, 1·73), smoking (pOR: 1·88. 95 % CI: 1·55, 2·29), tanning bed use (pOR: 2·31, 95 % CI: 1·96, 2·72) and binge drinking (pOR: 2·53, 95 % CI: 2·09, 3·07). Other factors, such as high BMI, e-cigarette use and poor diet quality were found to be significantly associated with higher energy drink consumption (P values < 0·001).
Our findings show that energy drink consumption and high-risk behaviours may be related, which could potentially serve as not only as a talking point for providers to address in outreach and communications with patients, but also a warning sign for medical and other health practitioners.

The aim of this study is to examine age, period and birth cohort trends in the prevalence of any alcohol-related risky behaviour and to compare these trends between men and women.
We used an age-period-cohort analysis of repeated cross-sectional survey data from the Australian National Drug Strategy Household Survey from 2001 to 2016.
Participants were 121 281 people aged 14-80 years who reported consuming alcohol in the past 12 months.
Any risky behaviour undertaken while under the influence of alcohol in the past 12 months (e.g. operating a motor vehicle) was measured: male or female.
Controlling for age and cohort, cubic spline models showed that any alcohol-related risky behaviour declined with time among participants who consumed alcohol [2016 versus 2007 rate ratio (RR) = 0.80, 95% confidence interval (CI) = 0.76-0.84]. Risky behaviour peaked in the 1954 birth cohort (1954 versus 1971 RR = 1.42, 95% CI = 1.30-1.55) and then steadily declined with more recent birth cohorts (2002 versus 1971 RR = 0.32, 95% CI = 0.27-0.39). Risky behaviour peaked at age 21 years, followed by steady decline and stabilization at approximately age 70 years. Males were overall twice as likely as females to report alcohol-related risky behaviour (RR = 2.10, 95% CI = 1.84-2.39), but this effect was smaller in cohorts born after 1980 [1980 prevalence rate ratios (PRR) = 2.09, 95% CI = 1.81-2.43; 2002 PRR = 1.31, 95% CI = 1.03-1.68].
Alcohol-related risky behaviour in Australia has declined generally since 2001, with rates for recent cohorts having the sharpest decline. Risky behaviour remains most prevalent in young adults, and the male-female gap in risky behaviour is closing for more recent birth cohorts. These trends are consistent with alcohol consumption trends observed in Australia and world-wide.

Adolescent girls and young women, including adolescent mothers, in Southern Africa have high HIV seroconversion and transmission. We need to know which risks drive HIV infections, and what can reduce these risks.
We interviewed 1712 adolescent girls and young women (11-23 years), including 1024 adolescent mothers who had conceived before age 20 and had a living child, from two health municipalities of South Africa\'s Eastern Cape Province between March 2018 and July 2019. Recruitment was through multiple community, school and health facility channels. Associations between adolescent motherhood and seven HIV risk behaviours (multiple sexual partners, transactional sex, age-disparate sex, condomless sex, sex on substances, alcohol use and not in education or employment) were investigated using the generalized estimating equations method for multiple outcomes specified with a logit link and adjusting for nine covariates. Using the same model, we investigated associations between having enough food at home every day in the past week (food security) and the same seven HIV risk behaviours. When we found evidence of moderation by HIV status, we report stratum-specific odds ratios.
Mean age was 17.51 years (SD: 2.54), 46% participants were living with HIV. Compared to non-mothers, adolescent mothers had lower odds of alcohol use (AOR = 0.47, 95% CI = 0.29-0.75), but higher odds of multiple sexual partners (AOR = 1.93, 95% CI = 1.35-2.74), age-disparate sex (HIV-uninfected AOR = 1.73, 95% CI = 1.03-2.91; living with HIV AOR = 5.10, 95% CI = 2.98-8.73), condomless sex (AOR = 8.20, 95% CI = 6.03-11.13), sex on substances (AOR = 1.88, 95% CI = 1.10-3.21) and not in education/employment (HIV-uninfected AOR = 1.83, 95% CI = 1.19-2.83; living with HIV AOR = 6.30, 95% CI = 4.09-9.69). Among non-mothers, food security was associated with lower odds of multiple sexual partners (AOR = 0.45, 95% CI = 0.26-0.78), transactional sex (AOR = 0.32, 95% CI = 0.13-0.82) and not in education/employment (AOR = 0.48, 95% CI = 0.29-0.77). Among adolescent mothers, food security was associated with lower odds of transactional sex (AOR = 0.17, 95% CI = 0.10-0.28), age-disparate sex (AOR = 0.66, 95% CI = 0.47-0.92), sex on substances (AOR = 0.51, 95% CI = 0.32-0.82), alcohol use (AOR = 0.45, 95% CI = 0.25-0.79) and not in education/employment (AOR = 0.56, 95% CI = 0.40-0.78).
Adolescent motherhood is associated with multiple vulnerabilities to HIV infection and transmission. Social protection measures that increase food security are likely to reduce HIV risk pathways for adolescent girls and young women, especially adolescent mothers.

Different childhood experiences may affect adult health differently.
To explore the association of different types of positive childhood experiences(PCEs) and adverse childhood experiences (ACEs) with risky behaviours and mental health indicators, andhow PCEs and ACEs are associated with health outcomes in the context of each other.
This was an exploratory cross-sectional online survey including 332 university students in Hong Kong. ACEs (abuse and household challenges), PCEs (perceived safety, positive quality of life, and interpersonal support), risky behaviours (smoking, binge drinking, and sexual initiation), and mental health indicators(depression, anxiety, loneliness, self-rated health, multimorbidity, meaning in life, and life satisfaction)were measured.
The multivariable logistic regression analysis indicated cumulative effects of PCEs in lowered risks of depression, anxiety, loneliness, as well as better self-rated health, life satisfaction, and meaning in life (p < .05), after adjusting for ACEs. Results also indicated that ACEs had an increasing relationship with poorer mental health indicators, such as anxiety, loneliness, and life satisfaction (p < .05), after adjusting for PCEs. There was also an adverse association between having ≥4 ACEs with smoking and binge drinking. In addition, each type of PCE and ACE was significantly associated with one or more risky behaviours and mental health indicators. Stratified results showed that PCEs had stronger associations with mental health indicators in participants with fewer ACEs. Furthermore, ACEs had stronger associations with mental health indicators in participants with more PCEs than in those with fewer PCEs.
In this study, PCE was proven to be an independent protective factor against poor mental health after accounting for ACE. ACE was also proven to be an independent risk factor for poor mental health and risky behaviours. These findings suggest a crucial need for the active promotion of PCEs and the prevention of child maltreatment. The results of subtypes and stratifications can be taken into consideration when developing targeted interventions in the future.
PCE is an independent protective factor against poor mental health after accounting for ACE. ACE is an independent risk factor for poor mental health and risky behaviours.PCEs and ACEs have different associations with health outcomes in the context of one another.
Antecedentes: Las diferentes experiencias de la infancia pueden afectar la salud de los adultos de manera diferente.Objetivo: Explorar la asociación de diferentes tipos de experiencias infantiles positivas (EIP) y experiencias infantiles adversas (EIA) con conductas de riesgo e indicadores de salud mental, y cómo las EIP y las EIA se asocian con resultados de salud en el contexto de cada uno.Método: Esta fue una encuesta transversal exploratoria en línea que incluyó a 332 estudiantes universitarios en Hong Kong. EIA (abuso y desafíos domésticos), EIP (seguridad percibida, calidad de vida positiva y apoyo interpersonal), comportamientos de riesgo (fumar, beber en exceso e iniciación sexual) e indicadores de salud mental (depresión, ansiedad, soledad, salud autoevaluada, multimorbilidad, sentido de la vida y satisfacción con la vida) fueron medidos.Resultados: El análisis de regresión logística multivariable indicó efectos acumulativos de EIP en disminuir el riesgo de depresión, ansiedad, soledad, así como mejor autoevaluación de la salud, satisfacción con la vida y sentido de la vida (p < 0,05), después de ajustar por EIA. Los resultados también indicaron que EIA tuvo una relación de incremento con indicadores de salud mental más deficientes, como ansiedad, soledad y satisfacción con la vida (p < 0,05), después de ajustar por EIP. También hubo una asociación adversa entre tener ≥4 EIA con fumar y beber en exceso. Además, cada tipo de EIP y EIA se asoció significativamente con uno o más comportamientos de riesgo e indicadores de salud mental. Los resultados estratificados mostraron que EIP tuvo asociaciones más fuertes con indicadores de salud mental en participantes con menos EIA. Además, EIA tuvo asociaciones más fuertes con indicadores de salud mental en participantes con más EIA que en aquellos con menos EIP.Conclusiones: En este estudio, se demostró que EIP es un factor protector independiente contra una pobre salud mental después de tomar en cuenta EIA. También se demostró que EIA es un factor de riesgo independiente para una pobre salud mental y comportamientos de riesgo. Estos hallazgos sugieren una necesidad crucial para la promoción activa de EIPs y la prevención del maltrato infantil. Los resultados de los subtipos y estratificaciones se pueden tener en cuenta al desarrollar intervenciones focalizadas en el futuro.
背景：不同的童年经历可能对成年后的健康有不同的影响。目的：为了探索在香港的大学生中不同类型的积极童年经历和不良童年经历与成年后危险行为和健康的关系，以及积极和不良童年经历如何在彼此存在的情况下与行为和健康的关系。方法：本探索性研究在2020年10月至12月对香港332名大学生进行了横断面调查，并测量了不良童年经历（虐待和家庭难题）、积极童年经历（安全感、积极的生活质量和人际支持）、危险行为（吸烟、酗酒和性启蒙)和健康相关结果指标（抑郁、焦虑、孤独、自评健康、共病、人生意义和生活满意度）。结果：在多变量逻辑回归中调整了不良童年经历和人口特征后，积极童年经历与低风险的抑郁、焦虑和孤独以及较好的自评健康、生活满意度和人生意义之间存在累积效应（p <0.05）。在调整了积极童年经历和人口特征后，不良童年经历与较差的健康（焦虑、孤独和生活满意度）之间存在累积效应（p < 0.05），并且有四种及以上不良童年经历与吸烟和酗酒呈负相关。每种类型的积极和不良童年经历与至少一种危险行为和健康结果显著相关。分层结果显示，在不良童年经历较少的参与者中，积极童年经历与健康结果的关联性更强。与积极童年经历较少的参与者相比，在积极童年经历较多的参与者中，不良童年经历与各种健康结果的关联性更强。结论：在考虑不良童年经历后，积极童年经历似乎是不良健康的独立保护因素; 而不良童年经历也是不良健康和危险行为的独立风险因素。这些发现表明有必要促进积极的童年经历和防止儿童虐待。亚型和分层的结果有助于设计有针对性的干预措施。关键词：积极童年经历；不良童年经历；心理健康；冒险行为；风险因素；保护因素.

Executive function (EF) may predict sexual risk-taking and HIV risk in young women in rural South Africa. We tested associations between EF and seven risky behavioural outcomes: binge drinking, illicit substance use, unprotected vaginal sex, concurrent sexual relationships, transactional sex, herpes simplex virus type 2 (HSV-2) infection, and HIV infection. We compared EF in young women with HIV to matched controls. 1080 young women underwent cognitive assessments. Better verbal short-term memory was associated with a lower risk of HSV-2 (OR 0.77; 95% CI 0.69, 0.86; p < 0.001). Uncorrected trends (p < 0.05) were better verbal working memory being associated with a lower risk of concurrency, better planning with a lower risk of illicit drug use, and better affective inhibition with a lower risk of transactional sex. 78 participants with sexually acquired HIV were matched with 153 HIV-negative controls and had poorer verbal working memory than controls (Hedge\'s g = -0.38; 95% CI -0.66, -0.10; p = 0.0076), but this was non-significant after adjustment. EF\'s contribution to young women\'s risky behaviour in this context does not hold when stringent statistical corrections are applied, with only verbal short term memory reaching statistical significance as predictor. Replication in other samples is recommended.

Globally 71% of deaths are attributed to non-communicable diseases (NCD). The workplace is an opportune setting for health promotion programs and interventions that aim to prevent NCDs. However, much of the current evidence is from high-income countries.
The aim of this study was to evaluate changes in NCD risk factors, associated with the Healthy Choices at Work programme (HCWP), at a commercial power plant in South Africa.
This was a before-and-after study in a randomly selected sample of 156 employees at baseline and 137 employees at 2-years. The HCWP focused on food services, physical activity, health and wellness services and managerial support. Participants completed questionnaires on tobacco smoking, harmful alcohol use, fruit and vegetable intake, physical activity, psychosocial stress and history of NCDs. Clinical measures included blood pressure, total cholesterol, random blood glucose, body mass index, waist circumference and waist-to-hip ratio. The 10-year cardiovascular risk was calculated using a validated algorithm. Sample size calculations evaluated the power of the sample to detect meaningful changes in risk factors.
Paired data was obtained for 137 employees, the mean age was 42.7 years (SD 9.7) and 64% were male. The prevalence of sufficient fruit and vegetable intake increased from 27% to 64% (p < 0.001), those meeting physical activity guidelines increased from 44% to 65% (p < 0.001). Harmful alcohol use decreased from 21% to 5% (p = 0.001). There were clinical and statistically significant improvements in systolic and diastolic blood pressure (mean difference -10.2 mmHg (95%CI: -7.3 to -13.2); and -3.9 mmHg (95%CI: -1.8 to -5.8); p < 0.001) and total cholesterol (mean difference -0.45 mmol/l (-0.3 to -0.6)). There were no significant improvements in BMI. Psychosocial stress from relationships with colleagues, personal finances, and personal health improved significantly. The cardiovascular risk score decreased by 4.5% (> 0.05).
The HCWP was associated with clinically significant reductions in behavioural, metabolic and psychosocial risk factors for NCDs.

The relationship between Dark Triad traits and risky behaviours has been shown in recent years. However, few studies have attempted to disentangle this relationship using a person-centred approach. The goal of the current study was to identify subgroups of individuals on the basis of their scores on Machiavellianism, psychopathy, and narcissism and analyse the differences between them in a set of risky behaviours (i.e., frequency of substance use, reactive and proactive aggression, risk perception and risk engagement, and problematic internet use). The sample consisted of 317 undergraduates aged 18-34 (46% males). The results of the latent profile analysis showed five subgroups of individuals that were identified based on their scores on the Dark Triad traits: low-Dark Triad, narcissistic, Machiavellian/narcissistic, psychopathic, and Machiavellian/psychopathic. Overall, the Machiavellian/narcissistic and Machiavellian/psychopathic subgroups showed higher scores for most risky behaviours. The low-Dark Triad scored higher for risk perception. No significant differences between subgroups were found as regards frequency of alcohol, tobacco, and cannabis use. These findings suggest that the combination of the Dark Triad traits lead to more negative outcomes as regards risky behaviour than individual components. Moreover, they highlight the relevance of using a person-centred approach in the study of dark personalities.