Do brain differences influence HIV risk behavior? A study of young urban women

大脑差异会影响艾滋病毒危险行为吗？

• 批准号: 8330061
• 负责人: Anna Rose Childress
• 金额: $ 24万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-18 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8330061
• 关键词: AIDS prevention; Accounting; Address; Adolescence; Adolescent; Adult; Affect; African American; Age; Attention deficit hyperactivity disorder; Behavior; Behavior Therapy; Behavioral; Biological; Brain; Brain region; Characteristics; Cities; Clinic; Clinical; Cognitive; Coitus; Data; Data Set; Databases; Decision Making; Development; Developmental Delay Disorders; Epidemic; Ethnic Origin; Family Planning; Female; Functional Magnetic Resonance Imaging; Funding; Goals; HIV; HIV Infections; Health; Healthcare; Heating; Impulsivity; Income; Individual; Infection prevention; Intervention; Life; Link; Mental Depression; Minority; Mission; Paper; Pattern; Phenotype; Population; Prevention; Prevention Research; Preventive Intervention; Process; Public Health; Publishing; Pump; Race; Recruitment Activity; Reproductive Health; Research; Rewards; Risk; Risk Behaviors; Risk-Taking; Scanning; Sexual Partners; Sexually Transmitted Diseases; Specific qualifier value; Subgroup; Surveys; Syndrome; Testing; Time; Unsafe Sex; Woman; analog; base; brain behavior; design; high risk; high risk sexual behavior; improved; interest; news; novel; novel strategies; partner violence; pediatric trauma; response; safer sex; sex; sexually active; skills; social; urban area; young woman

DESCRIPTION (provided by applicant): Young, urban minority women account for a growing number of new HIV/sexually transmitted infections (STIs), while prevention efforts are seriously lagging behind. Our overarching hypothesis is that efficacy of standard HIV interventions may be undermined in certain individuals by brain differences in the ability to make optimal "in the heat of the moment" risk decisions. In normal development, the reward-sensitive, impulse-driven brain of adolescence gradually becomes an adult brain with improved inhibition of reward impulses. This brain maturation, however, has a great deal of individual variability - and developmental delay (temporary or sustained) can result in a chronological adult with decision-making characteristics of an 'adolescent' brain. Based on our pilot dataset (n=142), we hypothesize that developmental delay may contribute to sub-optimal sexual decision-making (reflected in a cluster of risk behaviors - including early age of 1st sex, frequent unprotected sex, multiple sexual partners, multiple STIs) putting a subgroup of young women, at high sexual risk (HSR) for HIV. Do young women with this HSR phenotype indeed have a pattern of "younger" brain- behavioral vulnerabilities (BBVs are reward-relevant brain processes that can undermine optimal decision- making)? A between-groups design (HSR vs. low sexual risk, LSR) will recruit 18-24 year-old females from an urban family planning in a city with 5 times the national HIV rate with blacks accounting for 66% of new HIV cases. The study will compare BBVs for the HSR v LSR group in 4 domains with HIV risk-relevance (heightened reward sensitivity, greater risk taking and poor inhibition of reward impulses, and greater rejection sensitivity), using selected fMRI probes and behavioral tasks. The specific aim of our pioneering "proof-of- concept" R21 study is to determine whether young urban women with HSR have greater BBVs compared to those that have LSR. To accomplish this we will: A) Compare activation in a priori regions of the brain between those with HSR vs. LSR and~ B) Correlate brain activation patterns obtained in the on-scanner tasks with linked (off-scanner) behavioral scores. We hypothesize that those with HSR will evidence significantly greater vulnerability (greater response in a priori regions) in one or more domains relevant for HIV risk, and that behavioral scores will be significantly correlated with the brain activity in the specified a prior regions of interest, directly linking brain activity with the risk-relevant behavior. Our exploratoy aim is to characterize demographic, health and HIV risk behaviors of the HSR and LSR groups through survey assessment, providing an hypothesis-generating data-base for examining other potential associations (childhood trauma, partner violence, depression, cognitive ability) with our HIV risk-relevant brain data. Demonstrating a difference in BBVs for young women at HSR v. LSR for HIV and identifying the underlying brain processes would enable our long-term goals: to encourage a broader biologically-based understanding of HIV risk, and to open the way for new brain-targeted and/or brain-informed strategies for vulnerable individuals, with life-saving benefit. PUBLIC HEALTH RELEVANCE: The proposed research is relevant to public health because it may identify previously undetected brain vulnerabilities which can undermine optimal safer-sex decision-making and help explain why some young women are at especially high risk for acquiring HIV/STIs. The proposed research is relevant to NIH's mission because it may inform a new approach in HIV/STI prevention research with potential to improve the efficacy of existing HIV/STI prevention and/or generate novel biological and /or behavioral interventions.

描述（由申请人提供）：年轻的城市少数民族妇女是新感染艾滋病毒/性传播感染 (STI) 的人数不断增加的原因，而预防工作却严重滞后。我们的总体假设是，标准艾滋病毒干预措施的功效可能会因某些人在做出最佳“一时冲动”风险决策的能力方面存在差异而受到削弱。在正常发育过程中，青春期对奖赏敏感、冲动驱动的大脑逐渐变成成人大脑，对奖赏冲动的抑制能力得到改善。然而，这种大脑成熟具有很大的个体差异，并且发育迟缓（暂时的或持续的）可能导致成年后具有“青春期”大脑的决策特征。 根据我们的试点数据集 (n=142)，我们假设发育迟缓可能导致次优的性决策（反映在一系列危险行为中 - 包括第一次性行为的年龄过早、频繁的无保护性行为、多个性伴侣、多次性传播感染），使年轻女性亚群处于感染艾滋病毒的高性风险 (HSR) 中。具有这种 HSR 表型的年轻女性是否确实具有“年轻”的大脑行为脆弱性模式（BBV 是与奖励相关的大脑过程，可能会破坏最佳决策）？组间设计（HSR 与低性风险，LSR）将从城市计划生育中招募 18-24 岁女性，该城市的艾滋病毒感染率是全国艾滋病毒感染率的 5 倍，其中黑人占新发艾滋病毒病例的 66%。该研究将使用选定的功能磁共振成像探针和行为任务，比较 HSR 与 LSR 组在 4 个与 HIV 风险相关性的领域（奖励敏感性更高、冒险程度更高、奖励冲动抑制能力较差以及拒绝敏感性更高）的 BBV。我们开创性的“概念验证”R21 研究的具体目的是确定患有 HSR 的年轻城市女性是否比患有 LSR 的女性具有更大的 BBV。为了实现这一目标，我们将：A）比较 HSR 与 LSR 之间大脑先验区域的激活，以及〜B）将扫描仪任务中获得的大脑激活模式与相关的（扫描仪外）行为分数相关联。我们假设，患有 HSR 的人在与 HIV 风险相关的一个或多个领域将表现出明显更大的脆弱性（先验区域的反应更大），并且行为评分将与指定的先前感兴趣区域的大脑活动显着相关，将大脑活动与风险相关行为直接联系起来。我们的探索性目标是通过调查评估来描述 HSR 和 LSR 群体的人口、健康和艾滋病毒风险行为特征，提供一个假设生成数据库，用于检查其他潜在关联（童年创伤、伴侣暴力、抑郁、认知能力）与我们的研究 艾滋病毒风险相关的大脑数据。在 HSR 与 LSR 的 HIV 治疗中展示年轻女性 BBV 的差异，并确定潜在的大脑过程，将使我们的长期目标得以实现：鼓励对 HIV 风险有更广泛的基于生物学的理解，并为弱势个体开辟新的针对大脑和/或大脑知情的策略，从而挽救生命。 公共健康相关性：拟议的研究与公共健康相关，因为它可能会发现以前未被发现的大脑脆弱性，这些脆弱性可能会破坏最佳的安全性行为决策，并有助于解释为什么一些年轻女性感染艾滋病毒/性传播感染的风险特别高。拟议的研究与 NIH 的使命相关，因为它可能为 HIV/STI 预防研究提供新方法，有可能提高现有 HIV/STI 预防的功效和/或产生新的生物和/或行为干预措施。