title: Behavioral disinhibition and sexual risk behavior among adolescents and young adults in Malawi.
abstract: BACKGROUND
  While behavioral factors such as early age of sexual debut, inconsistent use of condoms and multiple sexual partners have been studied in Africa, less is known about how characteristics such as impulsivity and externalizing behaviors relate to HIV-related sexual risk-taking in that region. The purpose of this study was to develop a culturally adapted behavioral disinhibition index in a sample of adolescents and young adults in Malawi. We then sought to examine the relationship between the index and sexual risk behavior as measured by multiple sexual partners and number of lifetime sexual partners.
  
  
  METHODS
  Cross-sectional data were collected from 2342 participants in rural Malawi aged 15 to 29 years. We constructed a disinhibitory behavior score (DBS) using questions assessing disinhibitory behaviors. Bivariate analyses were conducted to assess the relationships among the individual DBS component behaviors. We utilized multivariable logistic regression to determine the association of the DBS with multiple sexual partners, and negative binomial regression to model the relationship between the DBS and number of lifetime sexual partners.
  
  
  RESULTS
  Nearly all the DBS component behaviors were significantly associated in the bivariate analyses. The DBS was associated with having multiple sexual partners (OR 1.97; 95% CI 1.57-2.48) in the multivariable logistic regression analysis. Further, negative binomial regression results demonstrated that the DBS was associated with an increased number of lifetime sexual partners (OR 1.11; 95% CI 1.07-1.16).
  
  
  CONCLUSIONS
  HIV preventive programs in Africa should take into consideration disinhibitory behaviors that may be associated with sexual risk-taking. The DBS can be used as a simple tool to identify those who may be more likely to engage in these behaviors and provide useful information regarding which groups of individuals particularly need to be targeted for behavior change interventions.
authors.affiliation: Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado, United States of America.
authors.forename: Maureen
authors.initials: M
authors.lastname: Muchimba
authors.forename: Megan
authors.initials: M
authors.lastname: Burton
authors.forename: Sara
authors.initials: S
authors.lastname: Yeatman
authors.forename: Abdallah
authors.initials: A
authors.lastname: Chilungo
authors.forename: Brett C
authors.initials: BC
authors.lastname: Haberstick
authors.forename: Susan E
authors.initials: SE
authors.lastname: Young
authors.forename: Robin P
authors.initials: RP
authors.lastname: Corley
authors.forename: Matthew B
authors.initials: MB
authors.lastname: McQueen
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000209:etiology; D006801:Humans; D008295:Malawi; D008297:Male; D012309:Risk-Taking; D012725:Sexual Behavior; D012747:Sexual Partners; D055815:Young Adult
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