PS11-003 Minority AIDS Research Initiative

项目摘要 本申请响应申请请求中的第四个研究主题RFA-PS-11-003 黑人和西班牙裔青年的性健康方法：预防、筛查和治疗的新战略 促进健康选择。在宾夕法尼亚州费城，城市黑人青少年受到 意外的性结果，如艾滋病毒、性传播感染和意外怀孕。 新的研究转化为非传统的社区项目，以解决全面性健康和 减少性感染对这一人群至关重要。拟议的研究是为了将 首席调查员(PI)有益于性健康教育需求的初步研究结果确定 在当地青少年心理健康社区内。PI创新性地提出了计划中的第一步 进行研究，以解决黑人社区历史上服务不足的部分的艾滋病毒/性传播感染预防需求- 患有精神疾病的黑人青少年。申请者是一位年轻的非裔美国护士科学家 在实施具有文化和语言能力的研究方法方面有良好的记录， 为黑人社区服务的历史，与目标人群的密切联系和杰出的研究 通过宾夕法尼亚大学护理学院健康公平研究中心进行培训。 因此，一个基于社区的参与性研究(CBPR)框架被提出，并由 著名资深科学家洛蕾塔·杰莫特博士和吉娜·温古德博士。难以触及，被剥夺了公民权 青少年是我国艾滋病毒/性传播疾病流行的中心，而患有精神健康疾病的人是 冒着更高的风险。早出性接触、滥用药物、贫穷和教育程度有限都是原因 有记录的风险因素。患有精神疾病的黑人青少年感染艾滋病毒/性传播疾病的风险增加，因为 他们更有可能遇到艾滋病毒/性传播感染流行的社会和结构性驱动因素。进一步，研究 表明他们从事与艾滋病毒/性传播感染风险相关的性行为的比率高于其他青少年。这个 在非传统环境中提供艾滋病毒/性传播感染预防方案，如门诊精神卫生 治疗计划，可能被证明有效地让患有精神疾病的高危黑人青少年参与进来。行为 干预措施在一般青少年人群中证明了有效性；然而，它仍然不清楚。 这些发现是否适用于患有精神疾病的青少年。为了提高疗效，干预措施 这一群体应该考虑到独特的社会和心理因素，这些因素可能会损害 他们准确评估危险情况、控制冲动和协商避孕套使用的能力。尽管如此 事实是，缺乏全面的循证干预措施来降低艾滋病毒/性传播感染的风险 患有精神疾病的黑人青少年。通过健康公平的视角，和社会决定因素的方法 艾滋病毒/性传播感染预防，这项研究的目的是开发和试点一种理论驱动的、性别和 在文化上、发展上和心理上适当的行为干预，以降低风险 在患有精神疾病的异性行为活跃的黑人青少年(13至17岁)中，艾滋病毒/性传播疾病的发生率。A CBPR 框架、计划行为理论和研究人员与目标人群的初步工作 将指导研究过程。目前正在接受门诊精神健康治疗的男性和女性(N=128) 来自费城社区行为健康(CBH)提供者的治疗将随机分为两组 条件：1)有针对性的减少艾滋病毒/性传播感染风险干预措施，以降低他们感染艾滋病毒和其他性传播感染的风险；或2) 一般健康促进的注意控制条件，以降低不良健康状况的风险 包括癌症、肥胖症和心脏病。在与社区的合作中，具体目标是集中的 HIV/STI风险影响因素阐述、干预进展、干预措施检验 对HIV/STI风险相关性行为和STI发病率的影响，并检验 干预。主要研究结果是在基线时评估自我报告的一致避孕套使用情况， 干预后即刻、3、6、12个月随访。次要结果包括性行为 活动、同时发生和连续发生的性伴的数量、干预的理论中介 影响(青少年的态度、信仰、意图和自我效能)和实验室确认性传播感染。这些数据 将有助于为黑人制定以证据为基础的艾滋病毒/性传播感染风险降低计划 患有精神疾病的青少年。具体地说，预期的影响是：1)生成数据以寻址唯一的， 通过性别和文化相关性、发展和心理上未满足的艾滋病毒/性传播感染风险减少需求 针对患有精神疾病的黑人青少年的适当工具；2)与社区合作 利益相关者在嵌入面临风险的社区的非传统环境中提供新的干预 加强青少年与值得信赖的成人促进者之间的性健康对话和预防工作；以及 3)告知心理健康政策对于性健康评估和干预的标准化 社区精神卫生门诊治疗。研究人员的长期目标是建立一种艾滋病毒 流行病学预防方案的研究重点是降低高感染人群中艾滋病毒/性传播感染的发病率 费城市区，并可推广到其他城市社区。鉴于青少年健康是当务之急 对公共卫生而言，本研究具有时效性、创新性和重要意义。

Project Summary This application is responsive to the fourth research topic in Request for Applications RFA-PS-11-003, "A Sexual Health Approach for Black and Hispanic Youth: New strategies for prevention, screening and facilitating healthy choices." In Philadelphia, PA, urban Black adolescents are disproportionately impacted by unintended sexual outcomes, such as HIV, sexually transmitted infections (STIs) and unwanted pregnancies. Novel studies translated into nontraditional community programs to address overall sexual health and decrease sexual infections are essential for this population. The proposed study is an effort to translate the Principal Investigator's (PI's) preliminary research findings to benefit sexual health education needs identified within the local adolescent mental health community. The PI innovatively proposes the first steps in a program of research to address HIV/STI prevention needs in a historically underserved sector of the Black community- Black adolescents suffering from mental illnesses. The applicant is a young African American nurse scientist with a proven track record to implement culturally and linguistically competent research methodology, a history of service to Black communities, strong linkages to the targeted population and outstanding research training through the Center for Health Equity Research at the University of Pennsylvania School of Nursing. Accordingly, a community-based participatory research (CBPR) framework is proposed with mentorship by renowned senior scientists, Drs. Loretta Jemmott and Gina Wingood. Hard to reach, disenfranchised adolescents are at the epicenter of our national HIV/STI epidemic, and those with mental health illnesses are at heightened risk. Early sexual debut, substance abuse, poverty and limited educational attainment are all documented risk factors. Black adolescents with mental illnesses are at increased risk for HIV/STIs because they are more likely to encounter social and structural drivers of the HIV/STI epidemic. Further, research indicates that they engage in HIV/STI risk related sexual behaviors at higher rates than other adolescents. The delivery of HIV/STI prevention programming in a nontraditional setting, such as an outpatient mental health treatment program, may prove effective to engage at-risk Black adolescents with mental illnesses. Behavioral interventions have demonstrated efficacy in the general adolescent population; however, it remains unknown whether these findings translate to adolescents with mental illnesses. To enhance efficacy, interventions for this population should be targeted to account for unique social and psychological factors which may impair their ability to accurately appraise risky situations, control impulses and negotiate condom use. Despite these facts, a paucity of comprehensive evidence-based interventions are available to reduce HIV/STI risk among Black adolescents with mental illnesses. Through a health equity lens, and a social determinants approach to HIV/STI prevention, the purpose of this study is to develop and pilot a theoretically-driven, gender and culturally relevant, developmentally and psychologically appropriate behavioral intervention to reduce the risk of HIV/STIs among heterosexually-active Black adolescents (ages 13 to 17) with mental illnesses. A CBPR framework, the Theory of Planned Behavior, and the investigators' preliminary work with the target population will guide the research process. Both males and females (N= 128) currently receiving outpatient mental health treatment from a Philadelphia Community Behavioral Health (CBH) provider will be randomized to one of two conditions: 1) a targeted HIV/STI risk reduction intervention to reduce their risk of HIV and other STIs; or 2) an attention control condition on general health promotion to reduce their risk of adverse health conditions including cancer, obesity, and heart disease. In partnership with the community, the specific aims are focused on elucidation of factors that influence HIV/STI risk, intervention development, testing the intervention's effects on HIV/STI risk related sexual behavior and STI incidence, and testing the mediation of effects of the intervention. The primary study outcome is self-reported consistent condom use assessed at baseline, immediately post-intervention, and at 3-, 6- and 12-month follow-ups. Secondary outcomes include sexual activity, the number of concurrent and sequential sexual partners, the theoretical mediators of intervention effects (adolescents' attitudes, beliefs, intentions and self-efficacy) and laboratory confirmed STIs. These data will contribute to the development of evidence-based HIV/STI sexual risk reduction programs for Black adolescents with mental illnesses. Specifically, the intended impact is to: 1) generate data to address unique, unmet HIV/STI risk reduction needs via a gender and culturally relevant, developmentally and psychologically appropriate vehicle targeted to reach Black adolescents with mental illnesses; 2) partner with community stakeholders to deliver a novel intervention in a nontraditional setting embedded in the community at risk to enhance sexual health dialogue and prevention efforts between adolescents and trusted adult facilitators; and 3) inform mental health policy toward the standardization of sexual health assessment and intervention in community outpatient mental health treatment. The investigator's long-term goal is to build an HIV epidemiologic prevention program of research focused on decreasing HIV/STI morbidity in highly affected urban Philadelphia, and generalizable to other urban communities. Given that adolescent health is imperative to public health, the proposed research is timely, innovative and bears great significance.