Adolescent Risk Reduction in the Peers & Parents

描述（由申请人提供）：艾滋病毒/艾滋病在整个加勒比地区，特别是巴哈马仍然是一个重大问题。巴哈马估计有4%的成年人感染艾滋病毒，是加勒比海英语国家中艾滋病年发病率最高的国家。为此，美国和巴哈马卫生部/玛嘉烈公主医院的调查人员制定并实施了一项以理论为基础的面对面减少青少年风险的干预措施，即“关注加勒比青年” （FOYC），通过两次试点测试发现，该干预措施在干预两个月后显著增加了性活跃女性的安全套使用，并改变了男性和女性之间的观念和意图。随后，应巴哈马卫生部的要求，美国-巴哈马研究小组制定了一项补充性的父母干预措施，即“加勒比知情父母和儿童在一起” （CImPACT），旨在改善父母与青少年在安全性行为方面的沟通。CImPACT的可行性测试表明，家长可以通过学校招募和注册，愿意参与，并且可以纵向跟踪。在FOYC和CImPACT的试点测试期间，相关评估工具在巴哈马得到了验证。因此，本提案寻求资助，对来自15所巴哈马小学的900名六年级青少年（基线年龄为11至13岁）及其父母进行三单元对照随机试验，以评估以下措施对青少年风险行为的不同影响：1)青少年降低风险干预加家长控制干预（FOYC加对照）；2)父母和青少年联合风险降低干预（FOYC + CImPACT）；对比3)青少年和父母的注意力控制（控制加控制）来评估短期（6个月）和长期（12、18、24和36个月）干预效果。主要结果领域将是青少年性风险行为，包括a)性行为的开始，b)无套性行为和c)有保护的性行为。次要结果域将是药物滥用，包括烟草、酒精和药物，以及两组中介变量：a)由行为改变指导模型——保护动机理论构建的青少年对风险和保护行为的感知；b)父母和青少年对父母监控和亲子沟通的认知。

DESCRIPTION (provided by applicant): HIV/AIDS remains a significant problem in the Caribbean in general, the Bahamas in particular. With an estimated 4% of adults infected with HIV, the Bahamas has the highest annual incidence rate of AIDS in the English speaking Caribbean. In response, investigators from the United States and the Bahamian Ministry of Health/Princess Margaret Hospital developed and implemented a theory-based, face-to-face adolescent risk reduction intervention, "Focus on Youth in the Caribbean" (FOYC) which was found through two pilot-tests to significantly increase condom use among sexually active females two months post intervention and to alter the perceptions and intentions among males and females. Subsequently, in response to a request from the Bahamian Ministry of Health, the US-Bahamian research team developed a complementary parental intervention, "Caribbean Informed Parents and Children Together" (CImPACT) which was designed to improve parent-adolescent communication regarding safer-sex. Feasibility testing of CImPACT demonstrated that parents could be recruited and enrolled through the schools, would participate, and could be tracked longitudinally. During the pilot testing of both FOYC and CImPACT, relevant assessment instruments were validated for use in the Bahamas. Accordingly, this proposal seeks funding to conduct a three-cell controlled, randomized trial among 900 sixth grade adolescents (ages 11 to 13 at baseline) and their parents from 15 Bahamian elementary schools to assess the differential impact on adolescent risk behavior of: 1) an adolescent risk reduction intervention plus a parent control intervention (FOYC plus control); versus 2) a combined parent and adolescent risk reduction intervention (FOYC plus CImPACT); versus 3) an attention-control for youth and parents (control plus control) to assess both short-term (six months) and long-term (12, 18, 24, and 36 months) intervention effect. The primary outcome domain will be adolescent sexual risk behavior, including a) initiation of sex, b) sex without a condom and c) protected sex. Secondary outcome domains will be substance abuse, including tobacco, alcohol and drugs, and, two sets of mediating variables: a) youth perceptions of risk and protective behaviors organized by the constructs of the guiding model of behavioral change, Protection Motivation Theory; and, b) parent and adolescent perceptions of parental monitoring and parent-adolescent communication.