The Elimination of Health Disparities through Translation Research

描述（由申请人提供）：我们建议在美国印第安人和阿拉斯加原住民（AI/ an）青年中评估名为RESPECT的艾滋病毒/性病预防干预措施的可翻译性。在公共性病诊所，在种族和种族不同的异性恋成人（15-39岁）人群中，RESPECT已被证明在减少性风险行为和性传播疾病（STD）发病率方面是有效的。这些发现给人工智能/非人工智能人群带来了巨大的希望，这一群体承担着全国性传播疾病水平的2-4倍。事实上，印度卫生服务（IHS）的12个服务区域中有11个显示沙眼衣原体（衣原体）的发病率高于美国平均水平，其中3个服务区域的水平高出5-6倍。15-19岁的AI/AN青少年在大多数性传播疾病中所占比例不成比例，分别占IHS服务区报告的所有衣原体和淋病奈瑟菌病例的34%和28%。这是由许多因素造成的。像其他青少年一样，AI/AN青年的生物脆弱性增加，面临交通限制（特别是在距离很远的保留地或村庄环境中），并且不愿使用为成年人设计的服务。那些生活在农村或保留地的人尤其关心在他们通常是小而紧密的社区中获得保密护理。最后，与全国其他年龄组相比，AI/AN青年经历了更高水平的性风险行为。疾病控制和预防中心（CDC）已经认识到这一问题，最近开始努力在AI/ an社区实施以学校为基础的衣原体筛查。正如疾病预防控制中心在这项工作中指出的那样，在人工智能/学校诊所进行性病筛查也提供了通过咨询进行预防的关键点；RESPECT是一种经过验证的艾滋病毒/性病预防干预措施，被推荐为一种模式。然而，到目前为止，还没有关于尊重在人工智能/人工智能社区中的可行性或外部有效性的研究。与此同时，很少有传播研究来描述AI/AN社区中可能促进广泛使用任何基于证据的干预措施的因素和过程，更不用说由于围绕性活动的耻辱和价值观而可能引起特别抵制的干预措施了。如果我们要有效地解决年轻人在艾滋病毒/性传播疾病和性冒险方面的巨大差距，我们需要了解AI/AN社区的外部有效性和传播过程。为此，我们提出以下建议：b[1]通过部落伙伴关系、区域联盟和国家合作，我们将利用创新扩散理论指导与人工智能/人工智能社区一起制定RESPECT传播计划；[2]我们会利用“再教育目标”框架，加强外部效度，在特定人工智能社区的校本诊所推行“尊重”干预措施；[3]基于[1]和[2]的结果评价RESPECT的潜在扩散。

DESCRIPTION (provided by applicant): We propose to assess the translatability of an HIV/STD prevention intervention called RESPECT among American Indian and Alaska Native (AI/AN) youth. RESPECT has been shown to be efficacious in reducing sexual risk behaviors and the incidence of sexually transmitted diseases (STDs) in public STD clinics among ethnically and racially heterogeneous heterosexual adult (ages15-39) populations. Such findings hold great promise for AI/ANs, a group that shoulders 2-4 times the level of STDs nationally. In fact, 11 of the 12 service areas of the Indian Health Service (IHS) show rates of Chlamydia trachomatis (Chlamydia) higher than the US average, with 3 of these service areas at levels 5-6 times higher. AI/AN adolescents ages 15-19 bear a disproportionate share of most STDs, comprising 34% and 28% of all Chlamydia and Neisseria gonorrhea (gonorrhea) cases, respectively, reported in IHS services areas. This is due to a number of factors. Like other adolescents, AI/AN youth have increased biological vulnerability, face transportation limitations (especially in reservation or Village settings where distances are great), and are reluctant to use services designed for adults. Those in rural or reservation settings are especially concerned about receiving confidential care in their often small and close-knit communities. Finally, AI/AN youth experience higher levels of sexual risk behaviors compared to others in their age group nationally. The Centers for Disease Control and Prevention (CDC) have recognized this problem, and recently initiated an effort to implement school-based Chlamydia screening in AI/AN communities. As noted by the CDC in that effort, STD screening at AI/school clinics also provides a critical point of prevention through counseling; RESPECT, a proven HIV/STD prevention intervention, was recommended as a model. As yet, however, no research on the viability, or external validity, of RESPECT in AI/AN communities exists. At the same time, little dissemination research exists to delineate the factors and processes in AI/AN communities which might facilitate the widespread use of any evidence-based intervention, let alone one that may incur particular resistance because of stigma and values surrounding sexual activity. We need to know about the external validity and the dissemination processes in AI/AN communities if we are to address effectively the daunting disparities in HIV/STDs and sexual risk-taking among youth. To do this, we propose the following: [1] With tribal partnerships, regional alliances, and national collaboration, we will use the Theory of Diffusion of Innovations to guide the development of a dissemination plan for RESPECT with AI/AN communities; [2] using the RE-AIM framework of enhancing external validity, we will implement the RESPECT intervention in school-based clinics in a specific AI community; and [3] evaluate the potential diffusion of RESPECT based on the results of [1] and [2].