{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:11:06Z","timestamp":1785762666228,"version":"3.56.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2019,5,30]],"date-time":"2019-05-30T00:00:00Z","timestamp":1559174400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"funder":[{"name":"National Institute for Public Health and the Environment","award":["S\/113004\/01\/IP"],"award-info":[{"award-number":["S\/113004\/01\/IP"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Prevention of infectious diseases depends on health-related behavior, which is often influenced by psychological characteristics. However, few studies assessing health-related behavior have examined psychological characteristics to identify risk groups, and this multidimensional approach might improve disease risk assessment. We aimed to characterize subgroups based on psychological characteristics and examine their influence on behavior and disease risk, using chlamydia as a case study. Selected participants (heterosexuals aged 18\u201324 years and females aged 18\u201324 years who had sex with both men and women) in a Dutch longitudinal cohort study (the Mathematical Models Incorporating Psychological Determinants: Control of Chlamydia Transmission (iMPaCT) Study) filled out a questionnaire and were tested for chlamydia (2016\u20132017). Latent class analysis was performed to identify risk classes using psychological predictors of chlamydia diagnosis. Two classes were identified: class 1 (n = 488; 9% chlamydia diagnosis) and class 2 (n = 325; 13% chlamydia diagnosis). The proportion of participants with high shame, high impulsiveness, and lower perceived importance of health was higher in class 2 than in class 1. Furthermore, persons in class 2 were more likely to be male and to report condomless sex compared with class 1, but the number of recent partners was comparable. Thus, risk classes might be distinguished from each other by psychological characteristics beyond sexual behavior. Therefore, the impact of the same intervention could differ, and tailoring interventions based on psychological characteristics might be necessary to reduce chlamydia prevalence most effectively.<\/jats:p>","DOI":"10.1093\/aje\/kwz140","type":"journal-article","created":{"date-parts":[[2019,5,27]],"date-time":"2019-05-27T15:13:01Z","timestamp":1558969981000},"page":"1705-1712","source":"Crossref","is-referenced-by-count":5,"title":["A Multidimensional Approach to Assessing Infectious Disease Risk: Identifying Risk Classes Based on Psychological Characteristics"],"prefix":"10.1093","volume":"188","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6562-7029","authenticated-orcid":false,"given":"Daphne A","family":"van Wees","sequence":"first","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janneke C M","family":"Heijne","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titia","family":"Heijman","sequence":"additional","affiliation":[{"name":"Public Health Service Amsterdam, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karlijn C J G","family":"Kampman","sequence":"additional","affiliation":[{"name":"Public Health Service Twente, Enschede, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Westra","sequence":"additional","affiliation":[{"name":"Public Health Service Hollands Noorden, Alkmaar, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"de Vries","sequence":"additional","affiliation":[{"name":"Public Health Service Kennemerland, Haarlem, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"de Wit","sequence":"additional","affiliation":[{"name":"Department of Interdisciplinary Social Science, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirjam E E","family":"Kretzschmar","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands"},{"name":"Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal","family":"den Daas","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands"},{"name":"Department of Interdisciplinary Social Science, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,5,30]]},"reference":[{"issue":"10053","key":"2019091012141319600_kwz140C1","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/S0140-6736(16)31678-6","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990\u20132015: a systematic analysis for the Global Burden of Disease Study 2015","volume":"388","author":"Global Burden of Disease Study 2015 Collaborators","year":"2016","journal-title":"Lancet"},{"issue":"50","key":"2019091012141319600_kwz140C2","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1098\/rsif.2010.0142","article-title":"Modelling the influence of human behaviour on the spread of infectious diseases: a review","volume":"7","author":"Funk","year":"2010","journal-title":"J R Soc Interface"},{"key":"2019091012141319600_kwz140C3","doi-asserted-by":"crossref","first-page":"Article 336","DOI":"10.1186\/s12889-018-5223-1","article-title":"Infection prevention behaviour and infectious disease modelling: a review of the literature and recommendations for the future","volume":"18","author":"Weston","year":"2018","journal-title":"BMC Public Health"},{"issue":"3","key":"2019091012141319600_kwz140C4","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1093\/her\/cyg113","article-title":"Health behavior theory and cumulative knowledge regarding health behaviors: are we moving in the right direction?","volume":"20","author":"Noar","year":"2005","journal-title":"Health Educ Res"},{"issue":"8","key":"2019091012141319600_kwz140C5","doi-asserted-by":"crossref","first-page":"e235","DOI":"10.1016\/S1473-3099(17)30310-9","article-title":"Sexually transmitted infections: challenges ahead","volume":"17","author":"Unemo","year":"2017","journal-title":"Lancet Infect Dis"},{"issue":"9907","key":"2019091012141319600_kwz140C6","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1016\/S0140-6736(13)61947-9","article-title":"Prevalence, risk factors, and uptake of interventions for sexually transmitted infections in Britain: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal)","volume":"382","author":"Sonnenberg","year":"2013","journal-title":"Lancet"},{"issue":"2","key":"2019091012141319600_kwz140C7","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1097\/OLQ.0b013e31823e2ff7","article-title":"Chlamydia trachomatis trends in the United States among persons 14 to 39 years of age, 1999\u20132008","volume":"39","author":"Datta","year":"2012","journal-title":"Sex Transm Dis"},{"issue":"suppl 2","key":"2019091012141319600_kwz140C8","doi-asserted-by":"crossref","first-page":"S190","DOI":"10.1086\/652401","article-title":"Summary: the natural history and immunobiology of Chlamydia trachomatis genital infection and implications for chlamydia control","volume":"201","author":"Gottlieb","year":"2010","journal-title":"J Infect Dis"},{"issue":"3","key":"2019091012141319600_kwz140C9","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/j.1467-842X.2005.tb00764.x","article-title":"Young people\u2019s use of condoms and their perceived vulnerability to sexually transmitted infections","volume":"29","author":"Abel","year":"2005","journal-title":"Aust N Z J Public Health"},{"key":"2019091012141319600_kwz140C10","doi-asserted-by":"crossref","first-page":"Article 55","DOI":"10.1186\/s12889-016-2689-6","article-title":"Predictors of Chlamydia trachomatis testing: perceived norms, susceptibility, changes in partner status, and underestimation of own risk","volume":"16","author":"Ten Hoor","year":"2016","journal-title":"BMC Public Health"},{"issue":"4","key":"2019091012141319600_kwz140C11","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1007\/s10508-013-0183-0","article-title":"The impact of long-term health goals on sexual risk decisions in impulsive and reflective cognitive states","volume":"43","author":"den Daas","year":"2014","journal-title":"Arch Sex Behav"},{"issue":"141","key":"2019091012141319600_kwz140C12","doi-asserted-by":"crossref","DOI":"10.1098\/rsif.2017.0847","article-title":"Double trouble: modelling the impact of low risk perception and high-risk sexual behaviour on chlamydia transmission","volume":"15","author":"van Wees","year":"2018","journal-title":"J R Soc Interface"},{"issue":"8","key":"2019091012141319600_kwz140C13","doi-asserted-by":"crossref","first-page":"e011312","DOI":"10.1136\/bmjopen-2016-011312","article-title":"Sexual and testing behaviour associated with Chlamydia trachomatis infection: a cohort study in an STI clinic in Sweden","volume":"6","author":"Veli\u010dko","year":"2016","journal-title":"BMJ Open"},{"issue":"2","key":"2019091012141319600_kwz140C14","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1097\/OLQ.0000000000000394","article-title":"Risk factors for incident and redetected Chlamydia trachomatis infection in women: results of a population-based cohort study","volume":"43","author":"Harder","year":"2016","journal-title":"Sex Transm Dis"},{"issue":"5","key":"2019091012141319600_kwz140C15","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1136\/sextrans-2017-053308","article-title":"Ethnicity and sexual risk in heterosexual people attending sexual health clinics in England: a cross-sectional, self-administered questionnaire study","volume":"94","author":"Coyle","year":"2018","journal-title":"Sex Transm Infect"},{"issue":"3","key":"2019091012141319600_kwz140C16","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1007\/s10508-014-0258-6","article-title":"Patterns of adolescent sexual behavior predicting young adult sexually transmitted infections: a latent class analysis approach","volume":"44","author":"Vasilenko","year":"2015","journal-title":"Arch Sex Behav"},{"issue":"9","key":"2019091012141319600_kwz140C17","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1097\/QAD.0000000000001803","article-title":"Sexual risk behaviour trajectories among MSM at risk for HIV in Amsterdam, the Netherlands","volume":"32","author":"Basten","year":"2018","journal-title":"AIDS"},{"issue":"1","key":"2019091012141319600_kwz140C18","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1017\/S0021932009990289","article-title":"Identifying individuals engaging in risky sexual behaviour for chlamydia infection in the UK: a latent class approach","volume":"42","author":"Stuart","year":"2010","journal-title":"J Biosoc Sci"},{"issue":"8","key":"2019091012141319600_kwz140C19","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1093\/aje\/kww239","article-title":"Measuring transitions in sexual risk among men who have sex with men: the novel use of latent class and latent transition analysis in HIV sentinel surveillance","volume":"185","author":"Wilkinson","year":"2017","journal-title":"Am J Epidemiol"},{"issue":"1","key":"2019091012141319600_kwz140C20","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1080\/00224499.2016.1254143","article-title":"A latent class analysis of behavioral and psychosocial dimensions of adolescent sexuality: exploring race differences","volume":"55","author":"Thorsen","year":"2018","journal-title":"J Sex Res"},{"issue":"5","key":"2019091012141319600_kwz140C21","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1027\/1618-3169\/a000201","article-title":"Out of sight, out of mind: cognitive states alter the focus of attention","volume":"60","author":"den Daas","year":"2013","journal-title":"Exp Psychol"},{"issue":"1","key":"2019091012141319600_kwz140C22","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1037\/0021-843X.113.1.90","article-title":"To eat or not to eat: implications of the attentional myopia model for restrained eaters","volume":"113","author":"Mann","year":"2004","journal-title":"J Abnorm Psychol"},{"key":"2019091012141319600_kwz140C23","doi-asserted-by":"crossref","first-page":"Article 559","DOI":"10.1186\/s12879-018-3498-6","article-title":"Study protocol of the iMPaCT Study: a longitudinal cohort study assessing psychological determinants, sexual behaviour and chlamydia (re)infections in heterosexual STI clinic visitors","volume":"18","author":"van Wees","year":"2018","journal-title":"BMC Infect Dis"},{"issue":"6","key":"2019091012141319600_kwz140C24","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1089\/apc.2008.0144","article-title":"Influencing risk behavior of sexually transmitted infection clinic visitors: efficacy of a new methodology of motivational preventive counseling","volume":"23","author":"Kuyper","year":"2009","journal-title":"AIDS Patient Care STDS"},{"issue":"9","key":"2019091012141319600_kwz140C25","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1016\/j.addbeh.2014.02.013","article-title":"Examination of a short English version of the UPPS-P Impulsive Behavior Scale","volume":"39","author":"Cyders","year":"2014","journal-title":"Addict Behav"},{"key":"2019091012141319600_kwz140C26","author":"Statistics Netherlands (CBS)","year":"2016"},{"key":"2019091012141319600_kwz140C27","author":"Visser","year":"2018"},{"issue":"4","key":"2019091012141319600_kwz140C28","doi-asserted-by":"crossref","first-page":"2080","DOI":"10.1214\/17-AOAS1061","article-title":"Variable selection for latent class analysis with application to low back pain diagnosis","volume":"11","author":"Fop","year":"2017","journal-title":"Ann Appl Stat"},{"issue":"1","key":"2019091012141319600_kwz140C29","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s10463-009-0258-9","article-title":"Latent class analysis variable selection","volume":"62","author":"Dean","year":"2010","journal-title":"Ann Inst Stat Math"},{"key":"2019091012141319600_kwz140C30","author":"Clark","year":"2009"},{"issue":"2","key":"2019091012141319600_kwz140C31","first-page":"1","article-title":"Auxiliary variables in mixture modeling: using the BCH method in Mplus to estimate a distal outcome model and an arbitrary secondary model","volume":"21","author":"Asparouhov","year":"2014","journal-title":"Mplus Web Notes"},{"key":"2019091012141319600_kwz140C32","author":"R Development Core Team","year":"2017"},{"key":"2019091012141319600_kwz140C33","doi-asserted-by":"crossref","first-page":"e4316","DOI":"10.1136\/bmj.e4316","article-title":"Effectiveness of yearly register-based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation","volume":"345","author":"van den Broek","year":"2012","journal-title":"BMJ"},{"issue":"suppl 1","key":"2019091012141319600_kwz140C34","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1007\/s10461-015-1217-5","article-title":"Validity of self-reported sexual behavior among adolescents: where do we go from here?","volume":"20","author":"DiClemente","year":"2016","journal-title":"AIDS Behav"},{"issue":"4","key":"2019091012141319600_kwz140C35","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1016\/j.jcps.2015.04.004","article-title":"A researcher\u2019s guide to regression, discretization, and median splits of continuous variables","volume":"25","author":"Rucker","year":"2015","journal-title":"J Consum Psychol"},{"issue":"2\u20133","key":"2019091012141319600_kwz140C36","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.psychres.2015.03.023","article-title":"A multidimensional approach of impulsivity in adult attention deficit hyperactivity disorder","volume":"227","author":"Lopez","year":"2015","journal-title":"Psychiatry Res"},{"issue":"4","key":"2019091012141319600_kwz140C37","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/S1054-139X(01)00391-3","article-title":"The association between impulsiveness and sexual risk behaviors in adolescent and young adult women","volume":"30","author":"Kahn","year":"2002","journal-title":"J Adolesc Health"},{"issue":"3","key":"2019091012141319600_kwz140C38","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1080\/0092623X.2016.1141821","article-title":"The role of impulsivity in the relation between negative affect and risky sexual behaviors","volume":"43","author":"Jardin","year":"2017","journal-title":"J Sex Marital Ther"},{"issue":"6","key":"2019091012141319600_kwz140C39","doi-asserted-by":"crossref","first-page":"573.e1","DOI":"10.1016\/j.jadohealth.2007.01.007","article-title":"Relationship of STD-related shame and stigma to female adolescents\u2019 condom-protected intercourse","volume":"40","author":"Sales","year":"2007","journal-title":"J Adolesc Health"},{"issue":"4","key":"2019091012141319600_kwz140C40","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1363\/4122509","article-title":"Relationships between perceived STD\u2010related stigma, STD\u2010related shame and STD screening among a household sample of adolescents","volume":"41","author":"Cunningham","year":"2009","journal-title":"Perspect Sex Reprod Health"},{"key":"2019091012141319600_kwz140C41","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.beproc.2014.10.010","article-title":"Mechanisms of impulsive choice: II. Time-based interventions to improve self-control","volume":"112","author":"Smith","year":"2015","journal-title":"Behav Processes"},{"issue":"1","key":"2019091012141319600_kwz140C42","first-page":"89","article-title":"I can\u2019t wait: methods for measuring and moderating individual differences in impulsive choice","volume":"13","author":"Peterson","year":"2015","journal-title":"J Agric Food Ind Organ"},{"issue":"29","key":"2019091012141319600_kwz140C43","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1098\/rsif.2008.0271","article-title":"The effect of opinion clustering on disease outbreaks","volume":"5","author":"Salath\u00e9","year":"2008","journal-title":"J R Soc Interface"},{"issue":"2","key":"2019091012141319600_kwz140C44","doi-asserted-by":"crossref","first-page":"344","DOI":"10.4269\/ajtmh.16-1028","article-title":"The role of risk proximity in the beliefs and behaviors related to mosquito-borne diseases: the case of Chikungunya in French Guiana","volume":"97","author":"Flamand","year":"2017","journal-title":"Am J Trop Med Hyg"}],"container-title":["American Journal of Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/aje\/advance-article-pdf\/doi\/10.1093\/aje\/kwz140\/28953620\/kwz140.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/aje\/article-pdf\/188\/9\/1705\/29586826\/kwz140.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,9,10]],"date-time":"2019-09-10T13:09:56Z","timestamp":1568120996000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/aje\/article\/188\/9\/1705\/5506607"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,30]]},"references-count":44,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2019,5,30]]},"published-print":{"date-parts":[[2019,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/aje\/kwz140","relation":{},"ISSN":["0002-9262","1476-6256"],"issn-type":[{"value":"0002-9262","type":"print"},{"value":"1476-6256","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2019,9]]},"published":{"date-parts":[[2019,5,30]]}}}