AIDS and Behavior

, Volume 22, Issue 6, pp 1919–1931 | Cite as

Sexual Positioning Practices and Sexual Risk Among Black Gay and Bisexual Men: A Life Course Perspective

  • Derek T. DangerfieldII
  • Laramie R. Smith
  • Janeane N. Anderson
  • Omar J. Bruce
  • Jason Farley
  • Ricky Bluthenthal
Original Paper


Increased attention has highlighted the role of age and sexual development on HIV risk among Black MSM (BMSM); limited focus has been given to the relationship of sexual positioning to HIV risk along the life course. This study examined BMSM’s life course sexual positioning practices and accompanying HIV/STI risks. Twenty-six Black gay and bisexual men ages 24–61 completed life history interviews in Los Angeles, California, between September and November 2015. Thematic analysis evaluated domains including major life events, substance use, social support, and partner selection. Varying exposure to HIV treatment and prevention options and venues to meet male partners revealed generational differences in sexual risks. Childhood sexual abuse and internalized homonegativity impacted personal development, sexual positioning, and condom negotiation. BMSM also assumed sexual positioning using masculinity stereotypes and body language. Clarifying the sexual development and HIV/STI risk contexts among BMSM could better inform current treatment and prevention needs.


Sexual positioning Black MSM HIV risk STI risk Culture 



We acknowledge and thank Greg Wilson and the staff at REACH LA for all their support as the research site for this study.


This research was funded by the National Science Foundation Graduate Research Fellowship Program (Award Year 2013). Additional support was also provided by NIDA grant K01 DA039767.

Complains with Ethical Standards

Conflicts of interest

The authors declare no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Centers for Disease Control and Prevention. Lifetime risk of HIV diagnosis in the United States [Internet]. 2016 [cited 2016 Feb 28].
  2. 2.
    Hess KL, Hu X, Lansky A, Mermin J, Hall HI. Lifetime risk of a diagnosis of HIV infection in the United States. Ann Epidemiol. 2017;27(4):238–43.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Flores SA, Bakeman R, Millett GA, Peterson JL. HIV risk among bisexually and homosexually active racially diverse young men. Sex Transm Dis. 2009;36(5):325–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Millett GA, Peterson JL, Flores SA, Hart TA, Jeffries WL 4th, Wilson PA, et al. Comparisons of disparities and risks of HIV infection in black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet. 2012;380(9839):341–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Millett GA, Flores SA, Peterson JL, Bakeman R. Explaining disparities in HIV infection among black and white men who have sex with men: a meta-analysis of HIV risk behaviors. AIDS. 2007;21(15):2083–91.CrossRefPubMedGoogle Scholar
  6. 6.
    Mayer KH, Wang L, Koblin B, Mannheimer S, Magnus M, del Rio C, et al. Concomitant socioeconomic, behavioral, and biological factors associated with the disproportionate HIV infection burden among black men who have sex with men in 6 U.S. Cities. PLoS ONE. 2014;9(1):e87298.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Arrington-Sanders R, Morgan A, Oidtman J, Qian I, Celentano D, Beyrer C. A medical care missed opportunity: preexposure prophylaxis and young Black men who have sex with men. J Adolesc Health. 2016;59(6):725–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Fields EL, Bogart LM, Smith KC, Malebranche DJ, Ellen J, Schuster MA. HIV risk and perceptions of masculinity among young Black men who have sex with men. J Adolesc Health. 2012;50(3):296–303.CrossRefPubMedGoogle Scholar
  9. 9.
    Arnold EA, Rebchook GM, Kegeles SM. ‘Triply cursed’: racism, homophobia and HIV-related stigma are barriers to regular HIV testing, treatment adherence and disclosure among young Black gay men. Cult Health Sex. 2014;16(6):710–22.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Koblin BA, Mayer KH, Eshleman SH, Wang L, Mannheimer S, del Rio C, et al. Correlates of HIV acquisition in a cohort of Black men who have sex with men in the United States: HIV prevention trials network (HPTN) 061. PLoS ONE. 2013;8(7):e70413.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Centers for Disease Control and Prevention. CDC—HIV/AIDS—Gay and bisexual men’s Health [Internet]. 2014 [cited 2014 Dec 3].
  12. 12.
    Arrington-Sanders R, Leonard L, Brooks D, Celentano D, Ellen J. Older partner selection in young African–American men who have sex with men. J Adolesc Health. 2013;52(6):682–8.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Bruce D, Harper GW, Fernández MI, Jamil OB. Adolescent medicine trials network for HIV/AIDS interventions. age-concordant and age-discordant sexual behavior among gay and bisexual male adolescents. Arch Sex Behav. 2011;41(2):441–8.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Chamberlain N, Mena L, Geter A, Crosby RA. Does age matter among young Black men who have sex with men? A comparison of risk behaviors stratified by age category. AIDS Educ Prev. 2016;28(3):246–51.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Scott HM, Vittinghoff E, Irvin R, Sachdev D, Liu A, Gurwith M, et al. Age, race/ethnicity, and behavioral risk factors associated with per-contact risk of HIV infection among men who have sex with men in the United States. J Acquir Immune Defic Syndr 1999. 2014;65(1):115–21.CrossRefGoogle Scholar
  16. 16.
    Austin EL, Bozick R. Sexual orientation, partnership formation, and substance use in the transition to adulthood. J Youth Adolesc. 2011;41(2):167–78.CrossRefPubMedGoogle Scholar
  17. 17.
    Elder GH Jr. Human lives in changing societies: Life course and developmental insights. In: Cairns RB, Elder Jr GH, Costello EJ, editors. Developmental science. New York: Cambridge University Press; 1996. p. 31–62.CrossRefGoogle Scholar
  18. 18.
    Nelson KM, Gamarel KE, Pantalone DW, Carey MP, Simoni JM. Sexual debut and HIV-related sexual risk-taking by birth cohort among men who have sex with men in the United States. AIDS Behav. 2016;10:1–10.Google Scholar
  19. 19.
    Glick SN, Cleary SD, Golden MR. Increasing acceptance of homosexuality in the United States across racial and ethnic subgroups. J Acquir Immune Defic Syndr [Internet]. 2015 Jun 26 [cited 2016 Dec 5].
  20. 20.
    Callander D, Senn C. Examining the role of relationships, body image, closeness to HIV/AIDS, and HIV optimism in the sexual risks of young men who have sex with men. J HIVAIDS Soc Serv. 2013;12(2):205–23.CrossRefGoogle Scholar
  21. 21.
    Hammack PL, Cohler BJ. Narrative, identity, and the politics of exclusion: social change and the gay and lesbian life course. Sex Res Soc Policy. 2011;8(3):162.CrossRefGoogle Scholar
  22. 22.
    MacKellar DA, Hou S-I, Whalen CC, Samuelsen K, Valleroy LA, Secura GM, et al. A plausible causal model of HAART-efficacy beliefs, HIV/AIDS complacency, and HIV-acquisition risk behavior among young men who have sex with men. AIDS Behav. 2011;15(4):788–804.CrossRefPubMedGoogle Scholar
  23. 23.
    Mansergh G, Marks G. Age and risk of HIV infection in men who have sex with men. AIDS Lond Engl. 1998;12(10):1119–28.CrossRefGoogle Scholar
  24. 24.
    Mustanski B, Newcomb ME, Clerkin EM. Relationship characteristics and sexual risk-taking in young men who have sex with men. Health Psychol. 2011;30(5):597–605.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Osmond DH, Pollack LM, Paul JP, Catania JA. Changes in prevalence of HIV infection and sexual risk behavior in men who have sex with men in San Francisco: 1997 2002. Am J Public Health. 2007;97(9):1677–83.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Coates RA, Calzavara LM, Read SE, Fanning MM, Shepherd FA, Klein MH, et al. Risk factors for HIV infection in male sexual contacts of men with AIDS or an AIDS-related condition. Am J Epidemiol. 1988;128(4):729–39.CrossRefPubMedGoogle Scholar
  27. 27.
    Griensven GJPV, Tielman RAP, Goudsmit J, Noordaa JVD, Wolf FD, Vroome EMMD, et al. Risk factors and prevalence of HIV antibodies in homosexual men in the Netherlands. Am J Epidemiol. 1987;125(6):1048–57.CrossRefPubMedGoogle Scholar
  28. 28.
    Kent CK, Chaw JK, Wong W, Liska S, Gibson S, Hubbard G, et al. Prevalence of rectal, urethral, and pharyngeal chlamydia and gonorrhea detected in 2 clinical settings among men who have sex with men: San Francisco, California, 2003. Clin Infect Dis. 2005;41(1):67–74.CrossRefPubMedGoogle Scholar
  29. 29.
    Schechter MT, Boyko WJ, Douglas B, Willoughby B, McLeod A, Maynard M, et al. The vancouver lymphadenopathy-AIDS study: 6. HIV seroconversion in a cohort of homosexual men. CMAJ Can Med Assoc J Assoc Medicale Can. 1986;135(12):1355–60.Google Scholar
  30. 30.
    Beyrer C, Baral SD, van Griensven F, Goodreau SM, Chariyalertsak S, Wirtz AL, et al. Global epidemiology of HIV infection in men who have sex with men. Lancet. 2012;380(9839):367–77.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Lyons A, Pitts M, Smith G, Grierson J, Smith A, McNally S, et al. Versatility and HIV vulnerability: investigating the proportion of Australian gay men having both insertive and receptive anal intercourse. J Sex Med. 2011;8(8):2164–71.CrossRefPubMedGoogle Scholar
  32. 32.
    Wolitski RJ, Branson BM. “Gray area behaviors” and partner selection strategies. In: O’Leary A, editor. Beyond Condoms [Internet]. Springer US; 2002 [cited 2015 Apr 21]. pp. 173–98.
  33. 33.
    Dangerfield D II, Smith LR, Williams J, Unger J, Bluthenthal R. Sexual positioning among men who have sex with men: a narrative review. Arch Sex Behav. 2016;13:1–16.Google Scholar
  34. 34.
    Hoppe T. Circuits of power, circuits of pleasure: sexual scripting in gay men’s bottom narratives. Sexualities. 2011;14(2):193–217.CrossRefGoogle Scholar
  35. 35.
    Johns MM, Pingel E, Eisenberg A, Santana ML, Bauermeister J. Butch tops and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men. Am J Mens Health. 2012;6(6):505–18.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Grov C, Parsons JT, Bimbi DS. The association between penis size and sexual health among men who have sex with menn. Arch Sex Behav. 2009;39(3):788–97.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Carballo-Diéguez A, Dolezal C, Nieves L, Díaz F, Decena C, Balan I. Looking for a tall, dark, macho man … sexual-role behaviour variations in Latino gay and bisexual men. Cult Health Sex. 2004;6(2):159–71.CrossRefGoogle Scholar
  38. 38.
    Dworkin SL, Zakaras JM, Campbell C, Wilson P, Grisham K, Chakravarty D, et al. Relationship power among same-sex male couples in New York and San Francisco: laying the groundwork for sexual risk reduction interventions focused on interpersonal power. J Sex Res. 2017;4:1–13.Google Scholar
  39. 39.
    Malebranche DJ, Fields EL, Bryant LO, Harper SR. masculine socialization and sexual risk behaviors among Black men who have sex with men: a qualitative exploration. Men Masculinities. 2009;12(1):90–112.CrossRefGoogle Scholar
  40. 40.
    Pachankis JE, Buttenwieser IG, Bernstein LB, Bayles DO. A longitudinal, mixed methods study of sexual position identity, behavior, and fantasies among young sexual minority men. Arch Sex Behav. 2013;42(7):1241–53.CrossRefPubMedGoogle Scholar
  41. 41.
    Bronfenbrenner U. Contexts of child rearing: problems and prospects. Am Psychol. 1979;34(10):844–50.CrossRefGoogle Scholar
  42. 42.
    Friedman SR, Rossi D. Some musings about big events and the past and future of drug use and of HIV and other epidemics. Subst Use Misuse. 2015;50(7):899–902.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Rhodes T. The ‘risk environment’: a framework for understanding and reducing drug-related harm. Int J Drug Policy. 2002;13(2):85–94.CrossRefGoogle Scholar
  44. 44.
    Rhodes T, Singer M, Bourgois P, Friedman SR, Strathdee SA. The social structural production of HIV risk among injecting drug users. Soc Sci Med. 2005;61(5):1026–44.CrossRefPubMedGoogle Scholar
  45. 45.
    Arreola S, Bluthenthal RN, Wenger L, Chu D, Thing J, Kral AH. Characteristics of people who initiate injection drug use later in life. Drug Alcohol Depend. 2014;1(138):244.CrossRefGoogle Scholar
  46. 46.
    Friedman SR, Mateu-Gelabert P, Sandoval M. Group sex events amongst non-gay drug users: an understudied risk environment. Int J Drug Policy. 2011;22(1):1–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Friedman SR, Mateu-Gelabert P, Sandoval M, Hagan H, Jarlais DC. Positive deviance control-case life history: a method to develop grounded hypotheses about successful long-term avoidance of infection. BMC Public Health. 2008;8(1):94.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Hser Y-I, Longshore D, Anglin MD. The life course perspective on drug use a conceptual framework for understanding drug use trajectories. Eval Rev. 2007;31(6):515–47.CrossRefPubMedGoogle Scholar
  49. 49.
    Rhodes T. Risk environments and drug harms: a social science for harm reduction approach. Int J Drug Policy. 2009;20(3):193–201.CrossRefPubMedGoogle Scholar
  50. 50.
    Elder GH. The life course as developmental theory. Child Dev. 1998;69(1):1–12.CrossRefPubMedGoogle Scholar
  51. 51.
    Grov C. HIV risk and substance use in men who have sex with men surveyed in bathhouses, bars/clubs, and on venue of recruitment matters. AIDS Behav. 2011;16(4):807–17.CrossRefGoogle Scholar
  52. 52.
    McFarlane M, Bull SS, Rietmeijer CA. The internet as a newly emerging risk environment for sexually transmitted diseases. JAMA. 2000;284(4):443–6.CrossRefPubMedGoogle Scholar
  53. 53.
    Rice E. The positive role of social networks and social networking technology in the condom-using behaviors of homeless young people. Public Health Rep. 2010;125(4):588–95.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Young SD, Rice E. Online social networking technologies, HIV knowledge and sexual risk and testing behaviors among homeless youth. AIDS Behav. 2010;15(2):253–60.CrossRefPubMedCentralGoogle Scholar
  55. 55.
    Mimiaga MJ, Reisner SL, Bland S, Cranston K, Isenberg D, Driscoll MA, et al. “It’s a quick way to get what you want”: a formative exploration of HIV risk among urban Massachusetts men who have sex with men who attend ex parties. AIDS Patient Care STDs. 2010;24(10):659–74.CrossRefPubMedGoogle Scholar
  56. 56.
    Denzin NK, Lincoln YS. The SAGE Handbook of Qualitative Research. SAGE; 2011. 785 p.Google Scholar
  57. 57.
    Ober AJ, Dangerfield II DT, Shoptaw S, Ryan G, Stucky B, Friedman SR. Using a “positive deviance” framework to discover adaptive risk reduction behaviors among high-risk HIV-negative Black men who have sex with men. AIDS Behav. 2017;1–14.Google Scholar
  58. 58.
    Ryan GW, Bernard HR. Techniques to identify themes. Field Methods. 2003;15(1):85–109.CrossRefGoogle Scholar
  59. 59.
    Wei C, Raymond HF. Preference for and maintenance of anal sex roles among men who have sex with men: sociodemographic and behavioral correlates. Arch Sex Behav. 2010;40(4):829–34.CrossRefPubMedGoogle Scholar
  60. 60.
    Morgan EM. Outcomes of sexual behaviors among sexual minority youth. New Dir Child Adolesc Dev. 2014;2014(144):21–36.CrossRefPubMedGoogle Scholar
  61. 61.
    Herrick AL, Stall R, Goldhammer H, Egan JE, Mayer KH. Resilience as a research framework and as a cornerstone of prevention research for gay and bisexual men: theory and evidence. AIDS Behav. 2014;18(1):1–9.CrossRefPubMedGoogle Scholar
  62. 62.
    Dyer TP, Shoptaw S, Guadamuz TE, Plankey M, Kao U, Ostrow D, et al. Application of syndemic theory to Black men who have sex with men in the Multicenter AIDS Cohort Study. J Urban Health. 2012;89(4):697–708.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Adam BD, Hart TA, Mohr J, Coleman T, Vernon J. HIV-related syndemic pathways and risk subjectivities among gay and bisexual men: a qualitative investigation. Cult Health Sex. 2017;4:1–14.Google Scholar
  64. 64.
    Hart T, Peterson JL. Predictors of risky sexual behavior among young African American men who have sex with men. Am J Public Health. 2004;94(7):1122–4.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Sullivan PS, Peterson J, Rosenberg ES, Kelley CF, Cooper H, Vaughan A, et al. Understanding racial HIV/STI disparities in Black and white men who have sex with men: a multilevel approach. PLoS ONE. 2014;9(3):e90514.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Cahill S, Taylor SW, Elsesser SA, Mena L, Hickson D, Mayer KH. Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care. 2017;4:1–8.Google Scholar
  67. 67.
    Brandon DT, Isaac LA, LaVeist TA. The legacy of Tuskegee and trust in medical care: is Tuskegee responsible for race differences in mistrust of medical care? J Natl Med Assoc. 2005;97(7):951–6.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Bernstein KT, Liu K-L, Begier EM, Koblin B, Karpati A, Murrill C. Same-sex attraction disclosure to health care providers among New York City men who have sex with men: implications for HIV testing approaches. Arch Intern Med. 2008;168(13):1458–64.CrossRefPubMedGoogle Scholar
  69. 69.
    Patton ME, Kidd S, Llata E, Stenger M, Braxton J, Asbel L, et al. Extragenital gonorrhea and chlamydia testing and infection among men who have sex with men—STD Surveillance Network, United States, 2010–2012. Clin Infect Dis. 2014 Mar 18;ciu184.Google Scholar
  70. 70.
    Konkle-Parker DJ, Amico KR, Henderson HM. Barriers and facilitators to engagement in HIV clinical care in the Deep South: results from semi-structured patient interviews. J Assoc Nurses AIDS Care. 2011;22(2):90–9.CrossRefPubMedGoogle Scholar
  71. 71.
    Doshi RK, Malebranche D, Bowleg L, Sangaramoorthy T. Health care and HIV testing experiences among Black men in the South: implications for “Seek, Test, Treat, and Retain” HIV prevention strategies. AIDS Patient Care STDs. 2012;27(2):123–33.CrossRefPubMedGoogle Scholar
  72. 72.
    Saunders BE, Kilpatrick DG, Resnick HS, Tidwell RP. Brief screening for lifetime history of criminal victimization at mental health intake: a preliminary study. J Interpers Violence. 1989;4(3):267–77.CrossRefGoogle Scholar
  73. 73.
    Hales RE. The aAmerican psychiatric publishing textbook of psychiatry. Washington: American Psychiatric Pub; 2008. 1820 p.Google Scholar
  74. 74.
    Kessler RC. The world mental health (WMH) survey initiative version of the world health organization (WHO) composite international diagnostic interview (CIDI). Int J Methods Psychiatr Res. 2004;13(2):93–121.CrossRefPubMedGoogle Scholar
  75. 75.
    Metzl JM, Hansen H. Structural competency: theorizing a new medical engagement with stigma and inequality. Soc Sci Med. 2014;103:126–33.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Levy ME, Wilton L, Phillips G, Glick SN, Kuo I, Brewer RA, et al. Understanding structural barriers to accessing HIV testing and prevention services among Black men who have sex with men (BMSM) in the United States. AIDS Behav. 2014;18(5):972–96.CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Wilton L, Herbst JH, Coury-Doniger P, Painter TM, English G, Alvarez ME, et al. Efficacy of an HIV/STI prevention intervention for Black men who have sex with men: findings from the many men, many voices (3MV) project. AIDS Behav. 2009;13(3):532–44.CrossRefPubMedGoogle Scholar
  78. 78.
    Lloyd S, Operario D. HIV risk among men who have sex with men who have experienced childhood sexual abuse: systematic review and meta-analysis. AIDS Educ Prev. 2012;24(3):228–41.CrossRefPubMedGoogle Scholar
  79. 79.
    Mimiaga MJ, Noonan E, Donnell D, Safren SA, Koenen KC, Gortmaker S, et al. Childhood sexual abuse is highly associated with HIV risk–taking behavior and infection among MSM in the EXPLORE study. J Acquir Immune Defic Syndr 1999. 2009;51(3):340–8.CrossRefGoogle Scholar
  80. 80.
    Phillips G, Magnus M, Kuo I, Rawls A, Peterson J, Montanez L, et al. Childhood sexual abuse and HIV-related risks among men who have sex with men in Washington, DC. Arch Sex Behav. 2014;43(4):771–8.CrossRefPubMedGoogle Scholar
  81. 81.
    Stall R, Mills TC, Williamson J, Hart T, Greenwood G, Paul J, et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93(6):939–42.CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Fields SD, Malebranche D, Feist-Price S. Childhood sexual abuse in black men who have sex with men: results from three qualitative studies. Cultur Divers Ethnic Minor Psychol. 2008;14(4):385–90.CrossRefPubMedGoogle Scholar
  83. 83.
    Murray SA, Kendall M, Carduff E, Worth A, Harris FM, Lloyd A, et al. Use of serial qualitative interviews to understand patients’ evolving experiences and needs. BMJ. 2009;28(339):b3702.CrossRefGoogle Scholar
  84. 84.
    Polkinghorne DE. Language and meaning: data collection in qualitative research. J Couns Psychol. 2005;52(2):137–45.CrossRefGoogle Scholar
  85. 85.
    Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.The REACH InitiativeJohns Hopkins School of NursingBaltimoreUSA
  2. 2.Division of Global Public HealthUniversity of CaliforniaSan DiegoUSA
  3. 3.Department of Preventive MedicineUniversity of Tennessee Health Science CenterMemphisUSA
  4. 4.Department of Family and Community HealthUniversity of Pennsylvania School of NursingPhiladelphiaUSA
  5. 5.Department of Community Public HealthJohns Hopkins School of NursingBaltimoreUSA
  6. 6.Department of Preventive Medicine, Institute for Prevention Research, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA

Personalised recommendations