Michael P Anastario

NYU Langone Medical Center, New York, New York, United States

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Publications (29)69.1 Total impact

  • Elizabeth Rink · Kris topher FourStar · Michael P. Anastario
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    ABSTRACT: Objective: We examined the relationship between American Indian men's attitudes toward pregnancy prevention, STI/HIV prevention, and sexual risk behavior. Attention was given to: (1) attitudes and intentions to use condoms and sexual risk behavior; (2) STI/HIV prevention characteristics and sexual risk behavior; (3) attitudes toward abstinence and monogamy and sexual risk behavior; and (4) decision-making in relationships and sexual risk behavior. Study Design: Our sample included 120 heterosexual American Indian men aged 18 to 24 living on a reservation. Data were collected during in-depth interviews. A community-based participatory research framework was used to ensure the relevancy and acceptability of the study given the sensitivity of the topic. Principal Findings: Results demonstrated that attitudinal factors were associated with sexual risk behavior, particularly inconsistent condom use. Attitudes associated with consistent condom use suggested greater levels of positive dispositions toward prevention and intention to use condoms. Consistent condom use was associated with more cautious attitudes toward sex with multiple sex partners. Study results suggested that American Indian men who reported sex with multiple partners exhibited a set of attitudes and beliefs toward pregnancy prevention and STI/HIV prevention that corresponded with a disposition resulting from their behaviors, in that engaging in sexual risk behavior elevated their levels of risk perception. Conclusions: Our findings suggest that heterosexual American Indian men living in rural environments need sexual and reproductive health programs and clinical services that address differing attitudes toward condom use within the context of multiple sex partners and sexual risk behavior.
    No preview · Article · Dec 2015
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    ABSTRACT: Beginning in early 2014, the United States' southern border was flooded with an unprecedented number of Central American migrant youth attempting to enter the United States. In response to the influx of immigrants, the Obama administration requested $3.7 billion in emergency funding to be allocated to border security, detention, removal, immigration courts, and care for children. We conducted this research with the aims of identifying and understanding push factors for Salvadoran youth migration and of raising awareness of the need for services among recently deported youths.
    No preview · Article · Oct 2015 · Children and Youth Services Review
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    ABSTRACT: Background Following the declaration that President Mwai Kibaki was the winner of the Kenyan presidential election held on December 27, 2007, a period of post-election violence (PEV) took place. In this study, we aimed to identify whether the period of PEV in Kenya was associated with systematic changes in sexual assault case characteristics. Methods and Findings Medical records of 1,615 patients diagnosed with sexual assault between 2007 and 2011 at healthcare facilities in Eldoret (n = 569), Naivasha (n = 534), and Nakuru (n = 512) were retrospectively reviewed to examine characteristics of sexual assault cases over time. Time series and linear regression were used to examine temporal variation in case characteristics relative to the period of post-election violence in Kenya. Key informant interviews with healthcare workers at the sites were employed to triangulate findings. The time series of sexual assault case characteristics at these facilities were examined, with a specific focus on the December 2007–February 2008 period of post-election violence. Prais-Winsten estimates indicated that the three-month period of post-election violence was associated with a 22 percentage-point increase in cases where survivors did not know the perpetrator, a 20 percentage-point increase in cases with more than one perpetrator, and a 4 percentage-point increase in cases that had evidence of abdominal injury. The post-election violence period was also associated with an 18 percentage-point increase in survivors waiting >1 month to report to a healthcare facility. Sensitivity analyses confirmed that these characteristics were specific to the post-election violence time period. Conclusion These results demonstrate systematic patterns in sexual assault characteristics during the PEV period in Kenya.
    Full-text · Article · Aug 2014 · PLoS ONE
  • Elizabeth Rink · Michael P Anastario · Kris FourStar
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    ABSTRACT: This study investigated commitment, sexual risk taking behavior and condom use among heterosexual men. The sample was 120 American Indian men ages 18-24 on the Fort Peck Reservation. Measures included sexual risk taking behaviors, attitude towards the relationship, discordance in perception of attitudes toward the relationship, and condom use. Inconsistent condom users comprised 57 % of the sample. Men with more than one sexual partner as well as men who reported inconsistent condom use reported less favorable attitudes toward their relationship. Discordant attitudes were observed in men who reported that their partner was more committed to the relationship then they were. This influenced having multiple sex partners. Inconsistent condom use decreased as respondents perceived an increasing level of partner's attachment to the relationship in comparison to themselves. Further examination of intimate partner relationship characteristics and how these dynamics influence sexual and reproductive health among American Indians is needed.
    No preview · Article · Jun 2014 · Journal of Immigrant and Minority Health
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    ABSTRACT: Worldwide, military personnel have been recognized as a population at elevated risk for sexually transmitted infections (STIs) and HIV; however, it is not well understood how the military occupation itself is implicated in the production of sexual risk behavior. Using qualitative and quantitative data collected from the Belize Defense Force (BDF), we employed a grounded theoretical framework and the Bourdieusian concept of the field and habitus to clarify how the military occupation is implicated in structuring aspects of sexual risk behaviors among personnel. We focus results on in-depth qualitative interviews conducted with 15 male-identified BDF personnel. We identify and describe how two field elements, namely operational tempo and ongoing exposure to occupational hazards, are occupationally specific field elements implicated in the production of sexual risk behavior through the mediating matrix of the military class habitus. Our findings demonstrate a conceptual clarity regarding the institutional field and habitus through which military personnel make sense of and act on the risk of bodily harm with regard to their own sexual behaviors. We conclude by outlining our theoretical concept so that it can be directly applied in public health efforts in order to leverage military occupational field elements for the purpose of HIV and STI prevention.
    No preview · Article · Oct 2013 · Culture Medicine and Psychiatry
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    ABSTRACT: This study compares rates of completion of client intake forms (CIFs) collected via three interview modes: audio computer-assisted self-interview (ACASI), face-to-face interview (FFI), and self-administered paper-based interview (SAPI). A total of 303 clients served through the Avon Breast Health Outreach Program (BHOP) were sampled from three U.S. sites. Clients were randomly assigned to complete a standard CIF via one of the three interview modes. Logistic regression analyses demonstrated that clients were significantly more likely to complete the entire CIF via ACASI than either FFI or SAPI. The greatest observed differences were between ACASI and SAPI; clients were almost six times more likely to complete the CIF via ACASI as opposed to SAPI (AOR = 5.8, p < .001). We recommend that where feasible, ACASI be utilized as an effective means of collecting client-level data in healthcare settings. Adoption of ACASI in health centers may translate into higher completion rates of intake forms by clients, as well as reduced burden on clinic staff to enter data and review intake forms for completion.
    No preview · Article · Aug 2013 · Journal for Healthcare Quality
  • M Anastario · H Chun · E Soto · S Montano
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    ABSTRACT: Modalities of questionnaire administration may affect data quality, particularly when conducting Biological and Behavioral Surveillance Surveys (BBSS) of uniformed personnel. We aimed to examine differences in administration, reporting and data quality across several common modalities of administration for BBSS endeavors. Prior to a large-scale BBSS endeavor with the uniformed services of Peru, we pilot tested three modes of questionnaire administration among personnel engaged in internal combat: face-to-face interview (FFI), self-administered paper-based interview (SAPI), and audio computer-assisted self-interview (ACASI). Individuals who took the survey using ACASI were less likely to have missing data on measures of sexual risk and alcohol abuse and were more likely to report sexual risk behaviours and symptoms of alcohol abuse; however, more individuals took the survey using SAPI given inadequate time to devote to sitting through an entire FFI or ACASI. Sexually transmitted infections did not vary significantly across modes of questionnaire administration. While more logistically complicated for BBSS efforts in resource-constrained settings, we recommend the use of ACASI in collecting BBSS data from uniformed personnel if conditions are permissible.
    No preview · Article · Jul 2013 · International Journal of STD & AIDS
  • Michael P Anastario · Kris Fourstar · Elizabeth Rink
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    ABSTRACT: Native Americans in the United States are not typically regarded as a most at-risk population for HIV or other sexually transmitted infections (STIs), despite emerging evidence which suggests otherwise. As a result, Native Americans lack access to key prevention services and programs. In planning prevention programs for this unique population, however, it is important to take into account the cultural factors that may be implicated in health risk behaviors. Historical Loss is a type of historical trauma that has been reported in Native Americans, and which may be related to health behaviors. We examined whether Historical Loss was associated with sexual risk behaviors in a sample of 120 American Indian men living in Fort Peck Reservation in northeastern Montana who completed questions regarding Historical Loss and sexual risk behaviors. Symptoms of Historical Loss that reflected Anxiety/Depression and Anger/Avoidance were associated with an increased likelihood of individuals' having sex with multiple concurrent partners. Health interventions that aim to address HIV/STI prevention should take symptoms of Historical Loss into account, as Historical Loss could be a potential factor that will mitigate HIV, STI, and pregnancy prevention efforts in this population.
    No preview · Article · Apr 2013 · Journal of Community Health
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    ABSTRACT: Abstract For HIV-positive individuals living in socially vulnerable circumstances, the complexities of accessing and navigating healthcare system can be overwhelming. Peer-driven interventions (PDIs) are increasingly being recognized as effective ways of addressing barriers to HIV care in the USA. The present study is a qualitative investigation of barriers, challenges, and facilitators to implementation of a peer integration program at three health centers in the USA. Findings reveal that health center staff and HIV-positive patients support the integration of HIV-positive peers on multidisciplinary healthcare teams. However, challenges related to peer-clinician communication and the risk of emotional burnout for peers may hinder program efficacy and sustainability. Practical implications and suggestions for improving the peer integration program in light of these findings are also discussed.
    No preview · Article · Jan 2013 · AIDS Care

  • No preview · Article · Dec 2012 · Cancer Research
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    ABSTRACT: Worldwide, military personnel have been recognized as a population at elevated risk for sexually transmitted infections and HIV. However, few evidence based behavioral interventions for the prevention of HIV and STIs have been rigorously evaluated in military personnel. We adapted the Popular Opinion Leaders (POL) intervention and piloted the adapted program with the Barbados Defence Force at one military base in Barbados. Popular Opinion Leaders were selected and trained to focus conversations on condom use. Behavioral questionnaires were administered using audio computer-assisted self interview at baseline (n = 256) and 6-month follow-up (n = 303). Mid-point focus groups were conducted with a sample of 15 POLs at a 3 month mid-point assessment. Quantitative data showed moderate increases in condom use at 6-months, and significant uptake of condom use during oral-genital contact in female personnel. A subgroup analysis suggests that this change was partially mediated by post-intervention changes in injunctive norms surrounding condom use in women. Focus groups revealed that POLs were heavily focusing on condom demonstrations, condom provision within social networks, speaking with coworkers about pleasure associated with condom use, and that the most common venues for conversations included those where alcohol was consumed. During the intervention, POLs dispersed from the intervention site as a result of normal personnel movement across bases, resulting in our having to use a pre and post intervention design across the population. It is likely that larger effect sizes would be observed in efforts that account for the natural dispersion of personnel across bases.
    No preview · Article · Jul 2012 · Journal of Community Health
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    ABSTRACT: Condom use during last sexual contact is a survey measure that may be used to inform monitoring and evaluation indicators of recent condom use in populations at risk for HIV infection and other sexually transmitted infections, such as the uniformed services. The authors tested for differences in condom use measures that were fielded within separate Biological and Behavioral Surveillance Surveys conducted in the armed forces of two separate nations: the Dominican Republic and Belize. Both surveys included measures of condom use during last sexual contact with specified partners and both surveys included the Risk Behavior Assessment (RBA), which measures specific sexual acts and condom use frequency during a specified time period. In both samples, more than 40% of respondents who reported condom use during last sexual contact with a regular partner also reported engaging in unprotected sex when screened with the RBA. Furthermore, more than 60% of respondents who reported condom use during last sexual encounter with a commercial sex worker also reported engaging in unprotected sex when screened with the RBA. The results carry implications for monitoring and evaluation indicators of large-scale HIV prevention programs. The authors recommend that, when feasible, more in-depth instruments such as the RBA be considered to measure recent condom use in populations of uniformed services personnel.
    No preview · Article · Nov 2011 · American journal of men's health
  • Helen Chun · Maria I Tavarez · Grace E Dann · Michael P Anastario
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    ABSTRACT: To determine whether self-reported sexual behavior and mental health varied by interviewer gender in a population of male military personnel. Eight male and six female data collectors verbally administered structured interviews to 474 male Dominican military personnel stationed at border crossing zones in the Dominican Republic. Measurements included sexual behaviors and mental health. Respondents were less likely to report oral and vaginal sex to male interviewers, and were more likely to report sexual coercion and alcohol abuse to male interviewers. Respondents were more likely to report depression and post-traumatic stress disorder to female interviewers. Interviewer gender influenced the prevalence of sexual behaviors and mental health, which carries implications for future research in military personnel.
    No preview · Article · Apr 2011 · International Journal of Public Health
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    ABSTRACT: To examine how the timing of hypoxic exposure results in specific childhood outcomes and whether there is a differential effect by sex. A sample of 10,879 prospectively followed pregnancies was drawn from the Boston and Providence sites (New England, NE) of the National Collaborative Perinatal Project. Based on placental pathology, we developed and validated a measure of probable chronic placental hypoxia (CHP) and contrasted the effects of acute perinatal hypoxia on age 7 emotional, behavioral, and cognitive outcomes. Perinatal hypoxia had a significant impact on multiple behavioral and cognitive outcomes in boys and girls by age 7, in contrast to probable CHP which had a differential effect on girls and boys such that there was decreased verbal IQ and increased inhibition in females alone. Findings underscore the importance of considering the timing of obstetric complications and offspring sex in investigations of the impact of fetal and perinatal hypoxia on offspring's outcomes throughout the life course.
    Full-text · Article · Feb 2011 · Social Psychiatry
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    ABSTRACT: This study is the first Biological and Behavioral Surveillance Survey to be conducted among personnel in the Belize Defense Force. The purpose of the study was to understand the prevalence of HIV infection and risk behaviours, and to identify key correlates of sexual risk behaviours. A representative sample of personnel underwent serological testing and an Audio Computer-Assisted Self Interview. Of those sampled, 351 completed a blood test and 334 completed a behavioural interview. The prevalence of HIV was 1.14%. Twelve percent had ever reported being diagnosed with a sexually transmitted infection (STI) or screened positive for HIV infection. The odds of ever having an STI/HIV were higher among those who had less education, those who had sex with a commercial sex worker (CSW), those who ever engaged in receptive anal sex and those with post-traumatic stress disorder (PTSD). Alcohol abuse and PTSD were prevalent and associated with HIV risk behaviours. These results are being used to inform current prevention efforts.
    No preview · Article · Feb 2011 · International Journal of STD & AIDS
  • Michael P Anastario · Maria Isabel Tavarez · Helen Chun
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    ABSTRACT: To estimate the prevalence of sexual risk behaviors among military personnel stationed along major border-crossing zones between the Dominican Republic and Haiti. From November 2008 to January 2009, behavioral surveys were administered to 498 active duty military personnel stationed along the three largest border-crossing zones on the western border of the Dominican Republic. Participants were selected using systematic random sampling and asked about their sexual behavior over the past 12 months, alcohol use, and mental health. Forty-one percent reported having casual sex during the past 12 months, 37% of men had a history of having sex with a commercial sex worker (19% during the past 12 months), and 7% of men reported a history of having sex with a transmigrating Haitian (6% during the past 12 months). Among sexually non-monogamous respondents (51%), inconsistent condom use exceeded 60% for those engaging in anal, vaginal, or oral sex. Fifteen percent reported using sexual coercion during the past 12 months. Sexual risk behaviors were prevalent among military personnel stationed along border-crossing zones between the Dominican Republic and Haiti. Prevention programs targeted at military personnel in this region should incorporate sexual coercion and mental health as key elements of their HIV prevention programs.
    No preview · Article · Nov 2010 · Revista Panamericana de Salud Pública
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    ABSTRACT: To assess the needs of clients in a home-based care (HBC) program aimed at improving the quality of lives of people living with HIV in Region 4 of Guyana (Demerara-Mahaica region) following their involvement with the HBC program, volunteers, and nurse providers. A cross-sectional analysis of a needs assessment conducted through a verbally administered questionnaire. We collected a cross-sectional sample of 84 HBC clients living with HIV from Region 4 in Guyana. Respondents were administered a questionnaire that asked questions regarding the demographics; services received; quality of service delivery; and mental health and substance abuse. The services most commonly received by respondents included nutritional assessment and counseling, HIV prevention education, emotional support, hygiene education, support for antiretroviral adherence, and support for HIV disclosure. Respondents reported further need of referrals to income-generation opportunities, food and nutritional supplement support, and support for children. Forty-two percent of the respondents screened positive for probable depression, and 37% of respondents screened positive for being at risk for a drinking problem. While a substantial portion of needs were addressed by the HBC program, outstanding needs included linking people living with HIV to income-generation opportunities, food support, mental health, and services for children. We suggest that mental health and substance use services be factored into HIV programming and that referral systems be strengthened to ensure access to support services for people living with HIV.
    No preview · Article · Nov 2010 · Public Health Nursing
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    ABSTRACT: To assess the effect of survey distribution protocol (mail versus handout) on data quality and measurement of patient care experiences. Multisite randomized trial of survey distribution protocols. Analytic sample included 2,477 patients of 15 clinicians at three practice sites in New York State. Mail and handout distribution modes were alternated weekly at each site for 6 weeks. Handout protocols yielded an incomplete distribution rate (74 percent) and lower overall response rates (40 percent versus 58 percent) compared with mail. Handout distribution rates decreased over time and resulted in more favorable survey scores compared with mailed surveys. There were significant mode-physician interaction effects, indicating that data cannot simply be pooled and adjusted for mode. In-office survey distribution has the potential to bias measurement and comparison of physicians and sites on patient care experiences. Incomplete distribution rates observed in-office, together with between-office differences in distribution rates and declining rates over time suggest staff may be burdened by the process and selective in their choice of patients. Further testing with a larger physician and site sample is important to definitively establish the potential role for in-office distribution in obtaining reliable, valid assessment of patient care experiences.
    Full-text · Article · Oct 2010 · Health Services Research
  • Maria I Tavarez · Helen Chun · Michael P Anastario
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    ABSTRACT: A survey was conducted of sexually active male military personnel stationed along major border-crossing zones between the Dominican Republic (DR) and Haiti, taking an applied scientific approach, to better inform prevention programming with military personnel in the region. A subsample of 470 sexually active male military personnel was drawn from a stratified systematic sample of military personnel stationed along the three largest border-crossing zones on the western border of the Dominican Republic. Using a verbally administered questionnaire, an examination of how foci of current HIV prevention programming with military personnel correlated with key sexual risk behavioral outcomes was conducted. Mental health factors such as probable alcohol abuse and posttraumatic stress disorder showed consistent associations with sexual risk behaviors. Participants showed a relatively high level of HIV/AIDS-related knowledge, a moderate level of negative attitudes toward condoms, and a moderate level of stigma toward people living with HIV/AIDS. Psychosocial factors, which are typically preventive in nature, were not associated with decreased sexual risk behaviors. Gaps were identified in HIV prevention programming that need to be addressed in this population of sexually active male military personnel. Although knowledge, attitudes, and psychosocial factors are important foci of HIV prevention programming, they were not associated with sexual risk behaviors, particularly after controlling for mental health factors. The authors suggest that prevalent psychiatric disorders in military personnel, such as posttraumatic stress disorder, should be factored in to the development of HIV prevention programs for military personnel.
    No preview · Article · Apr 2010 · American journal of men's health
  • Michael Anastario · Nadine Shehab · Lynn Lawry

    No preview · Article · Oct 2009 · Disaster Medicine and Public Health Preparedness

Publication Stats

389 Citations
69.10 Total Impact Points


  • 2013
    • NYU Langone Medical Center
      New York, New York, United States
    • RTI International
      Durham, North Carolina, United States
  • 2012-2013
    • CUNY Graduate Center
      New York, New York, United States
  • 2011
    • Brigham and Women's Hospital
      • Department of Medicine
      Boston, Massachusetts, United States
  • 2008
    • Tufts University
      • Institute for Clinical Research and Health Policy Studies
      Бостон, Georgia, United States
    • Uniformed Services University of the Health Sciences
      • Department of Military & Emergency Medicine
      Bethesda, MD, United States