Interventions for Risk Reduction and Avoidance in Youth

每年在青少年中发现 300 万新的性传播疾病 (STD) 病例。 拟议的研究应用认知行为理论的最新进展来提高多成分干预措施的有效性和持久性，从而促进青少年减少和避免风险。 在第一阶段，我们调查青少年对决策选择的心理表征（即禁欲与冒险）、问题行为的风险估计以及相关的信念和态度。 具体来说，将对 200 名青少年进行调查，向他们提供现实的性决策场景，并深入询问他们对重要风险和后果（例如感染性病的累积风险）的看法。 西班牙裔人将被过度抽样，以提供足够的统计能力来评估种族差异。 在第二阶段，800 名青少年将被随机分配到三组之一：标准多成分干预（降低风险）、基于要点的标准干预增强或接受不相关干预的对照组。 强化干预将基于认知行为理论（例如，Reyna 和 Ellis，1994），以及第一阶段中确定的从事和不从事危险行为的青少年之间的差异。 干预前和干预后调查将评估危险行为自我报告和性病治疗等结果，并在 3、6 和 12 个月进行后续调查。 控制背景和基线特征的多变量方差分析（随后是单变量检验）将用于比较标准组、增强组和对照组之间的差异。逻辑回归将用于分类结果测量，例如性交的开始。 因此，拟议的研究将提供有关西班牙裔和非西班牙裔青少年性决策过程的证据，并评估基于理论的干预措施，该干预措施侧重于特定行为并使用随机分配设计解决社会（例如拒绝技巧）和认知发展因素。 我们还将使用相同的调查工具将我们的调查数据与全州范围内的禁欲计划评估结果进行比较。 通过强调要点表征，这些表征在很长一段时间内得到了很好的保存，并且是决策中使用的关键记忆，增强的干预应该对降低和避免风险产生更大、更持久的影响。

Three million new cases of sexually transmitted diseases (STD) are identified in adolescents every year. The proposed research applies recent advances in cognitive-behavioral theory to increase the effectiveness and durability of multicomponent interventions that promote risk reduction and avoidance in adolescents. In Phase I, we investigate adolescents' psychological representations of decision options (i.e. abstinence vs. risk taking), risk estimates of problem behaviors, and relevant beliefs and attitudes. Specifically, 200 adolescents will be surveyed, presented with realistic sexual decision-making scenarios, and questioned in-depth concerning their perceptions of important risks and consequences (e.g., the cumulative risk of contracting a STD). Hispanics will be oversampled to provide sufficient statistical power to evaluate ethnic differences. In Phase II, 800 adolescents will be randomly assigned to one of three groups: a standard multicomponent intervention (Reducing the Risk), a gist-based enhancement of the standard intervention, or a control group receiving an unrelated intervention. The enhanced intervention will be based on cognitive behavioral theory (e.g., Reyna and Ellis, 1994), as well as on differences identified in Phase 1 between adolescents engaging versus not engaging in risky behaviors. Pre- and post-intervention surveys will assess such outcomes as self-reports of risky behaviors and STD treatment, with follow-up surveys at 3, 6, and 12 months. Multivariate analyses of variance (followed by univariate tests) controlling for background and baseline characteristics, will be used to compare differences among standard, enhanced, and control groups. Logistic regression will be used for categorical outcome measures, such as initiation of intercourse. Thus, the proposed research will provide evidence concerning sexual decision processes in Hispanic and non-Hispanic adolescents, and evaluate a theory-based intervention that focuses on specific behaviors and addresses both social (e.g., refusal skills) and cognitive- developmental factors using a randomized assignment design. We will also compare our survey data to results of a statewide evaluation of abstinence-only programs using the same survey instrument. By emphasizing gist representations, which are well preserved over long time periods and are key memories used in decision making, the enhanced intervention should produce larger and more sustained effects on risk reduction and avoidance.