The optimal mean arterial blood pressure for maintenance of spinal cord perfusion is not known. Our aim was to describe vasopressor usage and examine their effects in patients with spinal cord injury (SCI). We undertook a retrospective cohort study of 131 patients with SCI who received any kind of vasopressors to maintain blood pressure in the neurocritical care unit of a Level 1 trauma center (2005-2011). Vasopressor usage and complications were obtained from the medical record. Neurological outcomes were evaluated by the American Spinal Injury Association score. Dopamine was the most commonly used vasopressor (48.0%), followed by phenylephrine (45.0%), norepinephrine (5.0%), epinephrine (1.5%), and vasopressin (0.5%). Logistic regression analysis demonstrated that complications (e.g., ventricular tachycardia, troponin elevation, atrial fibrillation, heart rate >130 or <50, etc.) due to vasopressors were independently associated with the overall usages of dopamine (odds ratio [OR] 8.97; p<0.001) and phenylephrine (OR, 5.92; p=0.004), age ≥60 years old (OR, 5.16; p=0.013), and complete SCI (OR, 3.23; p=0.028). There was no difference in neurological improvement with either dopamine (OR, 1.16; p=0.788) or phenylephrine (OR 0.96; p=0.940). Incomplete SCI (OR, 2.64; p=0.019) and surgery <24 h after SCI (OR, 4.25; p=0.025) were independently associated with improved outcome. In summary, vasopressors are associated with increased complications in SCI patients. Further prospective studies are required in order to determine the potential benefits and risks of blood pressure management in patients with SCI.

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At the end of 2016, there were approximately 36.7 million people living with HIV worldwide with 1.6 million people being newly infected. In the same year, 1 million people died from HIV-related causes globally. The vast prevalence of HIV calls for an urgent need to develop and implement prevention programs aimed at reducing risk behaviors. Bronfenbrenner’s socio-ecological model provides an organizing framework to discuss HIV prevention interventions implemented at the individual, relational, community, and societal level. Historically, many interventions in the field of public health have targeted the individual level. Individual-level interventions promote behavior change by enhancing HIV knowledge, attitudes, and beliefs and by motivating the adoption of preventative behaviors. Relational-level interventions focus on behavior change by using peers, partners, or family members to encourage HIV-preventative practices. At the community-level, prevention interventions aim to reduce HIV vulnerability by changing HIV-risk behaviors within schools, workplaces, or neighborhoods. Lastly, societal interventions attempt to change policies and laws to enable HIV-preventative practices. While previous interventions implemented in each of these domains have proven to be effective, a multipronged approach to HIV prevention is needed such that it tackles the complex interplay between the individual and their social and physical environment. Ideally, a multipronged intervention strategy would consist of interventions at different levels that complement each other to synergistically reinforce risk reduction while simultaneously creating an environment that promotes behavior change. Multilevel interventions provide a promising avenue for researchers and program developers to consider all levels of influences on an individual’s behavior and design a comprehensive HIV risk-reduction program.

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Adolescence is a period of time between the ages of 12 and 25 that is marked by rapid change in physical, psychological, sociocultural, and cognitive development. As a result, adolescents show an increasing involvement in health risk behaviors. This entry focuses on four prominent health risk behaviors that begin during adolescence: alcohol use, substance use, tobacco use, and the sexual transmission of diseases. Each section highlights the prevalence of the risk behavior, discusses its short‐ and long‐term consequences, and concludes with prevention interventions that have successfully addressed the risk behavior.