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: 8512789
• 负责人: KYM R AHRENS
• 金额: $ 17.54万
• 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/8512789
• 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）：绝大多数寄养的青少年在生命早期就暴露于明显的身体虐待、性虐待、长期忽视、父母药物滥用和/或目睹了人际暴力。这些暴露会导致他们与早期照顾者的依恋关系极度混乱，这可能会极大地影响他们在以后的生活中与他人的关系，包括性伴侣、卫生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（HIV/STI）。事实上，与普通人群中的青少年相比，寄养系统中的青少年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，以根据寄养青少年的需要减少艾滋病毒/性传播感染。干预发展将以成人依恋理论为指导，特别是通过理解依恋类型（例如，具有回避型，焦虑型或安全型）如何影响浪漫/性，卫生保健和指导关系，从而影响艾滋病毒/性传播感染风险。为了实现这一目标，候选人将接受教学和体验式培训，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，包括使用该理论改善寄养青少年的HIV/STI预防工作；3)与早期不良暴露史青少年HIV/STI预防研究相关的社区干预开发技术。该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少年的研究方面具有互补的专业知识（Mark Courtney博士）。在中介分析技术、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群体中社区艾滋病毒/性传播感染研究方面的国家专家（Ralph DiClemente博士）。本申请中提出的三个相互关联的研究建立在候选人的培训目标之上，每个研究都有助于更好地理解如何将成人依恋理论应用于开发一种增强的干预措施，包括促进健康的关系，以降低寄养系统中青少年的艾滋病毒/性传播感染风险。具体目的是：1)利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榜样的依恋的影响）如何调解寄养青少年依恋类型与性风险之间的关联；2)采用定性方法，探讨不同依恋类型寄养青少年健康性行为和HIV/ sti保护行为的直接促进因素；3)为寄养青年制定和试点加强的艾滋病毒/性传播感染干预措施，其中包括利用对成人依恋方式的理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——大西雅图青年会青年中心和华盛顿州卫生和社会服务部——的牢固关系，将加强候选人的培训，促进项目目标的实现。在通过K23奖获得培训、经验和技能后，候选人将准备寻求资助，开展一项更大规模的随机对照试验，以降低寄养系统中青少年的艾滋病毒/性传播感染风险。