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

描述（由申请人提供）：绝大多数寄养青年在生命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/或目睹了人际暴力。这些接触可能导致与早期照顾者的关系极度混乱或混乱，这可能会极大地影响他们与其他人的关系，包括性伴侣，医疗保健提供者和重要的成人导师。这些麻烦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（艾滋病毒/性传播感染）。事实上，寄养系统中的青少年感染性传播疾病的风险比一般人群中的青少年高2-14倍。 该候选人的长期目标是制定一项针对寄养青少年需要的强化行为干预措施，以减少艾滋病毒/性传播感染。干预措施的制定将以成人依恋理论为指导，特别是对依恋风格（例如，具有逃避、焦虑或安全的风格）可能会影响浪漫/性、医疗保健和指导关系，从而影响艾滋病毒/性传播感染风险。为了实现这一目标，候选人将追求教学和体验式培训，以提高三个特定领域的知识和技能：1）评估艾滋病毒/性传播感染行为研究中常用的中介关系的技术，2）成人依恋理论的应用，包括使用这一理论来改善寄养青少年中的艾滋病毒/性传播感染预防工作，（3）与有早期不良暴露史的青少年艾滋病毒/性传播感染预防研究相关的社区干预开发技术。候选人确定了两名导师，他们在艾滋病毒/性传播感染研究（Jane Simoni博士）和儿童福利系统中涉及青年的研究（Mark Courtney博士）方面具有互补的专门知识。在中介分析技术、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具有专门知识的顾问将提供额外的指导，还将包括一名在高危青少年人群中进行基于社区的艾滋病毒/性传播感染研究的国家专家（Ralph DiClemente博士）。 本申请中提出的三项相互关联的研究建立在候选人的培训目标之上，每项研究都将有助于更好地理解成人依恋理论如何应用于制定强化干预措施，包括促进健康的关系，以减少寄养系统中青少年的艾滋病毒/性传播感染风险。具体目标是：（1）使用现有的纵向数据集进行定量分析以理解关系因素（例如，与浪漫伴侣，医疗保健提供者和非父母成人角色模型的附件的影响）调解寄养青少年的附件风格和性风险之间的关联; 2.）使用定性方法阐明可以直接促进具有不同依恋方式的寄养青少年健康性行为和艾滋病毒/性传播感染保护行为的因素;和3.）为寄养青年制定和试行强化艾滋病毒/性传播感染干预措施，其中包括利用对成人依恋方式的了解促进健康的浪漫/性关系、保健和指导关系。西雅图儿童医院研究所和华盛顿大学提供的优良研究环境，以及候选人与两个社区合作伙伴--大西雅图基督教青年会青少年中心和华盛顿州卫生和社会服务部机构--的牢固现有关系，将加强候选人的培训并促进项目目标。 在通过K23奖获得培训，经验和技能后，候选人将准备寻求资金，以进行更大规模的随机对照试验，以减少寄养系统中青年的艾滋病毒/性传播感染风险。 公共卫生相关性：这一建议将导致制定一项有针对性的干预措施，以减少寄养系统中青少年感染性传播疾病，包括人体免疫缺陷病毒（艾滋病毒/性传播疾病）的风险。与普通人群中的青年相比，寄养青年患几种性传播感染的几率增加了2至14倍。因此，这一应用程序是一个重要的机会，以解决健康的人2010年的优先事项，减少艾滋病毒/性传播感染的风险，在一个极端脆弱的人口，同时提供必要的工具，启动一个有成效的职业生涯中的行为艾滋病毒/性传播感染研究的早期职业调查。

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.