Developing an HIV/STI intervention for Foster Youth Using Attachment Theory

利用依恋理论为寄养青少年制定艾滋病毒/性传播感染干预措施

• 批准号: 8102890
• 负责人: KYM R AHRENS
• 金额: $ 17.8万
• 依托单位: SEATTLE CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8102890
• 关键词: Address; Adolescence; Adolescent; Adult; Age; Area; Behavior Therapy; Behavioral; Bioethics; Biological; Biometry; Brain; Caregivers; Categories; Child Welfare; Childhood; Chronic; Communities; Data Set; Development; Disease; Environment; Fostering; Funding; General Population; Goals; Grant; HIV; HIV/STD; Health; Health Personnel; Health behavior; Healthcare; Healthcare Systems; Healthy People 2010; Independent Living; Institute of Medicine (U.S.); Interpersonal Violence; Intervention; Knowledge; Lead; Life; Mediating; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentors; Pattern; Pediatric Hospitals; Population; Prevention; Prevention Research; Psychological Impact; Qualitative Methods; Randomized Controlled Trials; Recording of previous events; Research; Research Institute; Research Personnel; Research Project Grants; Risk; Risk Behaviors; Secure; Sex Behavior; Sexual Health; Sexual Partners; Sexual abuse; Sexuality; Sexually Transmitted Diseases; Social Health Services; Substance abuse problem; System; Techniques; Time; Training; United States; Universities; Vulnerable Populations; Washington; Work; Youth; age difference; base; care systems; career; condoms; design; experience; foster care; high risk; improved; maltreatment; neglect; peer; physical abuse; programs; protective behavior; public health relevance; role model; sexual relationship; skills; successful intervention; theories; therapy development; tool; young adult

DESCRIPTION (provided by applicant): The vast majority of youth in foster care have been exposed early in life to overt physical abuse, sexual abuse, chronic neglect, parental substance abuse and/or have been witnesses to interpersonal violence. These exposures can result in extremely disordered or disorganized attachments with early caregivers, which can greatly impact how they relate to others later in life including sexual partners, health care providers, and important adult mentors. These troubled relationships all have been shown to impact risk of sexually transmitted infections including Human Immunodeficiency Virus (HIV/STI). Indeed, adolescents in the foster care system are at between 2-14 times increased risk of sexually transmitted infections compared with youth in the general population. The candidate's long-term objective is to develop an enhanced behavioral intervention to reduce HIV/STI tailored to the needs of adolescents in foster care. Intervention development will be guided by adult attachment theory and specifically by an understanding of how attachment style (e.g., having an avoidant, anxious or secure style) can impact romantic/sexual, health care, and mentoring relationships and consequently can impact HIV/STI risk. To achieve this objective, the candidate will pursue didactic and experiential training to improve knowledge and skills in three specific areas: 1) techniques to assess mediational relationships commonly used in behavioral HIV/STI research, 2) application of adult attachment theory including the use of this theory to improve HIV/STI prevention efforts among adolescents in foster care, and 3) techniques in community-based intervention development that are relevant to HIV/STI prevention research in adolescents with histories of early adverse exposures. The candidate has identified two mentors with complementary expertise in HIV/STI research (Dr. Jane Simoni) and research involving youth in the child welfare system (Dr. Mark Courtney). Additional mentoring will be provided by consultants with expertise in mediational analysis techniques, adult attachment theory, community-based research, bioethics, and biostatistics, and will also include a national expert on community-based HIV/STI research in high-risk adolescent populations (Dr. Ralph DiClemente). The three inter-related studies proposed in this application build on the candidate's training goals and will each contribute to an improved understanding of how adult attachment theory can be applied to develop an enhanced intervention that involves the promotion of healthy relationships to reduce HIV/STI risk among adolescents in the foster care system. The specific aims are to: 1.) conduct a quantitative analysis using an existing longitudinal dataset to understand how relationship factors (e.g., influences of attachments with romantic partners, health care providers, and non-parental adult role-models) mediate the association between attachment style and sexual risk for youth in foster care; 2.) use qualitative methods to elucidate the factors that can directly promote healthy sexuality and HIV/STI-protective behaviors among foster youth in foster care with different attachment styles; and 3.) develop and pilot an enhanced HIV/STI intervention for youth in foster care that includes components that utilize an understanding of adult attachment style to promote healthy romantic/sexual relationships, health care and mentoring relationships. The excellent research environments provided by both Seattle Children's Hospital Research Institute and the University of Washington, as well as the candidate's strong existing relationships with two community partners - the YMCA of Greater Seattle's Center for Young Adults and the Washington State Department of Health and Social Services agency - will enhance the candidate's training and facilitate project goals. After obtaining training, experience, and skills through this K23 Award, the candidate will be prepared to pursue funding to conduct a larger randomized controlled trial of an intervention to reduce HIV/STI risk among youth in the foster care system. PUBLIC HEALTH RELEVANCE: This proposal will result in the development of a tailored intervention to reduce the risk of sexually transmitted infections including Human Immunodeficiency Virus (HIV/STI) for adolescents in the foster care system. Youth in foster care have between 2 and 14 times increased odds of several STIs compared with youth in the general population. This application therefore represents an important opportunity to address a priority of Healthy People 2010, the reduction of HIV/STI risk, in an extremely vulnerable population while providing an early career investigator with the tools necessary to launch a productive career in behavioral HIV/STI research.

描述（由申请人提供）：寄养的绝大多数年轻人在生命的早期就暴露于公开的身体虐待，性虐待，长期忽视，父母滥用药物和/或已成为人际暴力的见证人。这些暴露会导致与早期护理人员的无序或混乱的依恋，这可能会极大地影响他们以后与他人在生活中的关系，包括性伴侣，医疗保健提供者和重要的成人导师。这些陷入困境的关系都被证明会影响性传播感染的风险，包括人类免疫缺陷病毒（HIV/STI）。实际上，与普通人群的年轻人相比，寄养系统中的青少年的性传播感染风险增加了2-14倍。 候选人的长期目标是制定增强的行为干预措施，以减少根据寄养者在寄养方面的需求量身定制的HIV/STI。干预开发将以成人依恋理论为指导，特别是了解依恋风格（例如，具有回避，焦虑或安全的风格）如何影响浪漫/性，医疗保健和指导关系，因此会影响HIV/STI风险。为了实现这一目标，候选人将进行教学和体验性培训，以提高三个特定领域的知识和技能：1）评估行为HIV/STI研究中通常使用的中介关系的技术，2）成人依恋理论的应用，包括使用该理论，包括使用该理论来改善青少年在基于社区的技术方面的预防效果，以及在寄养方面的相关技术，以及3）在寄养方面的发展。早期不良暴露的历史。候选人已经确定了两名具有艾滋病毒/STI研究（Jane Simoni博士）补充专业知识的导师，以及涉及儿童福利系统青年的研究（Mark Courtney博士）。具有中介分析技术，成人依恋理论，基于社区的研究，生物伦理学和生物统计学方面的专业知识的顾问将提供额外的指导，还将包括在高风险青少年人群中基于社区的HIV/STI研究专家（Ralph Diclemente博士）。 本申请中提出的三项相互关联研究以候选人的培训目标为基础，并将有助于改进对如何应用成人依恋理论的理解，以开发增强的干预措施，涉及促进健康关系以减少寄养护理系统中青少年的HIV/STI风险。具体目的是：1。）使用现有的纵向数据集进行定量分析，以了解关系因素（例如，与浪漫伴侣，卫生保健提供者和非父母成人角色模型的依恋的影响）如何调解福特护理中青年人的依恋风格与性风险之间的关联； 2.）使用定性方法来阐明可以直接促进健康性和艾滋病毒/艾滋病毒/艾滋病毒/艾滋病毒/艾滋病毒/艾滋病保护行为的因素，并具有不同的依恋方式； 3.）为寄养护理中的年轻人开发和试点增强的HIV/STI干预，其中包括利用对成人依恋风格的理解来促进健康的浪漫/性关系，医疗保健和指导关系的组成部分。西雅图儿童医院研究所和华盛顿大学提供的优秀研究环境以及候选人与两个社区合作伙伴的牢固关系 - 大西雅图的年轻人中心的基督教青年会和华盛顿州卫生和社会服务部 - 将增强候选人的培训和促进项目目标。 在通过该K23奖获得培训，经验和技能之后，候选人将准备进行资金，以进行一项更大的干预措施随机对照试验，以降低寄养系统中青年的HIV/STI风险。 公共卫生相关性：该提案将导致制定量身定制的干预措施，以降低寄养系统中青少年的性传播感染风险，包括人类免疫缺陷病毒（HIV/STI）。与普通人群中的青年相比，寄养的青年在几个性传播疾病的几率上增加了2至14倍。因此，该应用是一个重要的机会，可以在极度脆弱的人群中解决健康人2010的优先级，艾滋病毒/STI风险的减少，同时为早期职业调查员提供了在行为HIV/STI研究中发起富有成效职业所需的工具。