EVALUATING INTERACTIVE VIDEO PLUS COUNSELING FOR ADOLESCENT STD PREVENTION

这项为期五年的研究建议开发和评估一项教育干预措施，以利用波士顿两家青少年诊所的服务，在性活跃的市中心青年中预防性传播疾病。(波士顿医疗中心和儿童医院)。一项涉及实验组(N=1938)和常规护理组(N=1938)的随机对照试验将被用来测试15分钟的互动视频和由训练有素的健康教育人员提供的15分钟互动咨询课程的效果。这项研究有几个特点。首先，干预措施将根据青少年的年龄、性别、对性行为的意图(二次禁欲或持续的性行为)以及在持续使用避孕套方面的变化阶段来提供个性化的内容。个性化是在干预的视频和咨询部分进行的。其次，对干预措施的评估将基于持续使用避孕套的生物标记物-衣原体感染-以及行为措施，而不是仅基于自我报告的行为措施。这种干预建立在社会认知理论和个人对个人咨询的基础上。视频部分将涉及为参与者的特点量身定做的多个模块。在互动视频中，参与者将可以根据主题的突出度自由选择内容序列。咨询会议的结构也反映了这种方法。参与者从主题菜单中进行选择，并确定讨论内容的顺序。第三，随着时间的推移，干预将利用助推器会议来提高有效性。第四，干预效果将在六周、六个月和一年的随访中进行评估。在每次随访时，将使用非侵入性(尿液)方法确定疾病(衣原体)状态。对于那些在登记时感染的参与者，在六周的随访中将使用RNA信使分析来区分活跃的衣原体感染和残留的DNA。第五，将开发一个基于计算机的数据收集系统，以提高自我报告的行为和态度措施的有效性。我们的假设是，与对照组相比，干预参与者在6个月和1年的随访中会发现衣原体感染率有25%的差异(12%比9%)。

This five-year study proposes to develop and evaluate an educational intervention to prevent STDs among sexually active inner-city youth using the services of two Boston adolescent clinics. (Boston Medical Center and Children's Hospital). A randomized controlled trial involving an experimental group (N=1938) and a routine care group (N=1938) will be used to test the efficacy of a 15-minute interactive video in combination with a 15-minute interactive counseling session delivered by a trained health educator. Several characteristics distinguish this study. First, the intervention will be designed to deliver individualized content depending upon the adolescent's age, gender, intentions with respect of sexual activity (secondary abstinence or continued sexual activity), and stage of change with regard to adoption of consistent condom use. The individualization takes place within both the video and counseling components of the intervention. Second, evaluation of the intervention will be based on a biological marker for consistent condom use- Chlamydia infection-along with behavioral measures, as opposed to self- reported behavioral measures alone. The intervention builds upon Social Cognitive Theory, and person-to-person counseling. The video component will involve multiple modules tailored to the characteristics of participants. Within the interactive video, the participant will be free to select the sequence of content according to the salience of topics. The structure of the counseling session reflects this approach as well. The participant selects from a menu of topic and determines the order with which content is discussed. Third, the intervention will use booster sessions to enhance effectiveness over time. Fourth, intervention effectiveness will be assessed at six-week, six-month, and one-year follow-up visits. Non-invasive (urine) methods will be used to determine disease (Chlamydia) status at each follow-up. RNA messenger analysis will be used at six week follow-up to distinguish between active Chlamydia infection and residual DNA, for those participants with infection at enrollment. Fifth, a computer-based data collection system will be developed to enhance the validity of self-reported behavioral and attitudinal measures. Our hypothesis is that, relative to controls, intervention participants will evidence at 6-month and one-year follow-up a 25% differences (12% versus 9%) in Chlamydia infection rates.