Violence Exposure and HIV Risk in Adolescent Women of Color

描述（由申请人提供）：本R03提案申请资金，通过探索儿童暴力暴露与危险性行为之间的关系，对寻求门诊心理健康服务的低收入城市非洲裔美国女孩（G. Donenberg， PI）进行更大规模的纵向研究。美国疾病控制与预防中心最近的估计表明，近一半的AA青少年妇女感染了性传播疾病（STD），这突显了在这一人群中减少性冒险行为的关键必要性反映这一模式的是，在美国女性中，AA女性占HIV/AIDS病例的比例最大，并且绝大多数AA女性的感染是通过异性性行为发生的早期的暴力暴露与危险的性行为有关，低收入的城市AA女孩暴露于暴力的比例很高。4,5此外，在寻求精神病治疗的青少年中，儿童时期遭受暴力可能很普遍，因为暴力与心理健康症状有关因此，家庭和社区暴力的高暴露率可能是增加有色人种年轻妇女在心理健康治疗中感染艾滋病毒和其他性传播疾病风险的关键因素在联邦政府资助的一项关于寻求心理健康服务的12-16岁AA女孩及其女性看护人的研究（N=265； G. Donenberg， PI）的基础上，这项小型研究将：(1)调查14-18岁AA女孩在心理健康治疗中的童年暴力暴露与危险性行为之间的联系；(2)探索儿童期暴力暴露与高危性行为之间的潜在解释途径。我们将重新联系所有完成较大纵向研究的家庭，并对终身创伤和受害史（包括7类创伤、年龄、施暴者、频率和严重程度）进行全面评估。统计分析将采用回归和结构方程模型，利用来自较大纵向研究的现有数据。这项研究的结果将为这些关系的更大的前瞻性研究的设计提供信息，并将为开发创新的、性别敏感的和文化上适当的项目提供指导，以降低有暴力暴露史和精神健康问题的年轻AA妇女的艾滋病毒和其他性传播疾病的发病率。公共卫生相关性：美国疾病控制与预防中心最近的估计表明，近50%的非洲裔美国少女感染了性传播疾病，非洲裔美国妇女在美国妇女中艾滋病毒/艾滋病病例所占比例最大。在低收入的城市非洲裔美国女孩中，早期暴露于家庭和社区暴力可能是导致危险性行为发展的关键风险因素。拟议的项目建立在一个更大的纵向研究的基础上，以寻求心理健康服务的低收入城市非洲裔美国女孩为样本，研究从童年暴力暴露到危险的性行为的途径，并将产生最终可用于减少这一人群中危害健康的性行为的信息。

DESCRIPTION (provided by applicant): This R03 proposal requests funds to build on a larger longitudinal study with low-income, urban African American (AA) girls seeking outpatient mental health services (G. Donenberg, PI) by exploring the relationship between childhood violence exposure and risky sexual behavior. Underscoring the crucial need to reduce sexual risk-taking in this population, recent CDC estimates indicate that nearly half of all AA adolescent women are infected with a sexually transmitted disease (STD).1 Reflecting this pattern, AA women account for the largest proportion of HIV/AIDS cases among women in the US,2 and the vast majority of infections in AA women occur through heterosexual intercourse.3 Early violence exposure has been linked to risky sexual behavior, and low income, urban AA girls are exposed to high rates of violence.4, 5 Moreover, childhood violence exposure is likely to be prevalent in youth seeking psychiatric treatment since violence exposure is associated with mental health symptoms.6 Thus, high rates of exposure to family and community violence may be a critical factor increasing risk for HIV and other STDs among young women of color in mental health treatment.7 Building on a federally funded study of 12-16 year-old AA girls seeking mental health services and their female caretakers (N=265; G. Donenberg, PI), this small study will: (1) examine links between violence exposure in childhood and risky sexual behavior among 14-18 year old AA girls in mental health treatment; and (2) explore potential explanatory pathways from childhood violence exposure to risky sexual behavior in this population. We will re-contact all families who completed the larger longitudinal study and conduct a comprehensive assessment of lifetime trauma and victimization history (including 7 categories of trauma, age, perpetrator, frequency, and severity). Statistical analyses will employ regression and structural equation modeling, capitalizing on existing data from the larger longitudinal study. Results from this study will inform the design of a larger, prospective study of these relationships and will provide guidance for developing innovative, gender-sensitive, and culturally appropriate programs to reduce rates of HIV and other STDs among young AA women with histories of violence exposure and mental health problems. PUBLIC HEALTH RELEVANCE: Recent estimates from the CDC indicate that nearly 50% of teenage African American girls are infected with sexually transmitted diseases, and African American women account for the largest proportion of HIV/AIDS cases among women in the United States. Early exposure to home and community violence may be a crucial risk factor contributing to the development of risky sexual behavior in low-income, urban African American girls. The proposed project builds on a larger longitudinal study to examine the pathway from childhood violence exposure to risky sexual behavior in a sample of low-income, urban African American girls seeking mental health services and will yield information that can ultimately be used to reduce health compromising sexual behavior in this population.