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(申请人提供)：寄养中心的绝大多数青少年在幼年时曾遭受公开的身体虐待、性虐待、长期忽视、父母滥用药物和/或曾目睹人际暴力。这些暴露会导致与早期照顾者的极度无序或无组织的依恋，这可能会极大地影响他们在以后的生活中与其他人的关系，包括性伴侣、医疗保健提供者和重要的成人导师。事实证明，这些麻烦的关系都会影响包括人类免疫缺陷病毒(艾滋病毒/STI)在内的性传播感染的风险。事实上，寄养系统中的青少年与一般人口中的青少年相比，性传播感染的风险增加了2-14倍。候选人的长期目标是开发一种增强的行为干预措施，以减少寄养青少年的需求，减少艾滋病毒/性传播感染。干预发展将以成人依恋理论为指导，特别是通过了解依恋风格(例如，具有回避型、焦虑型或安全型)如何影响浪漫/性关系、保健和指导关系，从而影响艾滋病毒/性传播疾病的风险。为了实现这一目标，应聘者将接受教学和经验培训，以提高三个具体领域的知识和技能：1)评估行为HIV/STI研究中常用的中介关系的技术；2)成人依恋理论的应用，包括使用该理论来改进寄养青少年中的HIV/STI预防工作；以及3)与有早期不良暴露史的青少年的HIV/STI预防研究相关的社区干预发展技术。候选人确定了在艾滋病毒/性传播感染研究(Jane Simoni博士)和在儿童福利系统中涉及青年的研究(Mark Courtney博士)方面具有互补专长的两位导师。其他指导将由具有中介分析技术、成人依恋理论、社区研究、生物伦理学和生物统计学专业知识的顾问提供，还将包括一名在高危青少年人群中进行社区艾滋病毒/性传播感染研究的国家专家(拉尔夫·迪克莱门特博士)。本申请中提出的三项相互关联的研究以候选人的培训目标为基础，每项研究都将有助于更好地理解如何应用成人依恋理论来制定加强干预措施，其中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量化分析，以了解关系因素(例如，与浪漫伴侣、医疗保健提供者和非父母成人榜样的依恋的影响)如何中介寄养青少年的依恋风格和性风险之间的关联；用定性的方法阐明能够直接促进不同依恋类型寄养青少年的健康性行为和艾滋病毒/性传播感染防护行为的因素；制定和试行寄养青少年艾滋病毒/性传播感染强化干预措施，其中包括利用对成人依恋方式的了解来促进健康的浪漫/性关系、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-大西雅图青年成人中心基督教青年会和华盛顿州卫生和社会服务机构-的牢固现有关系，将加强候选人的培训，促进项目目标。在通过K23奖项获得培训、经验和技能后，候选人将准备寻求资金，以进行一项更大规模的干预随机对照试验，以降低寄养系统中青年的艾滋病毒/性传播感染风险。 与公共卫生相关：这项提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包括人类免疫缺陷病毒(艾滋病毒/STI)在内的性传播疾病的风险。与普通人群中的青年相比，寄养中的青年患几次性传播感染的几率增加了2至14倍。因此，这项申请是解决2010年健康人优先事项的一个重要机会，即在极端脆弱的人群中降低艾滋病毒/性传播感染风险，同时为早期职业调查员提供必要的工具，以便在行为艾滋病毒/性传播感染研究中开始富有成效的职业生涯。