INTERVENTION TO REDUCE HIV/STD RISK IN TEEN PREGNANCY

描述(改编自申请人的摘要)： 这项研究是为了降低艾滋病毒和其他性传播疾病的风险 不同种族青少年(年龄段)孕期和孕后性传播疾病 14-19)在两个城市的公共诊所接受产前护理：纽黑文CT和 佐治亚州亚特兰大因为各个年龄段的女性都会在 怀孕(例如，改善饮食；减少/消除烟草、酒精和非法药物 )，我们认为怀孕也可能是一个重要的窗口 促进高危性行为改变的机会。行为改变 在怀孕开始后可以有效地维持产后 干预。整合创新扩散、社会学习等理论 关于性别和权力的理论，拟议研究的具体目标是 要：(1)实施独特的集体产前护理干预，重点是 风险评估、教育/技能发展和社会支持，以减少 健康危害行为和促进健康促进行为；(2)检查 在整个产前期间和最多一次的行为变化 一年后，并确定这些行为变化对 生物学结果，包括性传播疾病和重复妊娠的发生率；和(3) 确定与艾滋病毒风险相关的心理社会特征 生物学和行为结果。 作为这项随机对照试验的一部分，进入产前护理的妇女 合作的诊所将被随机分配到三种治疗中的一种 条件：产前护理个体化标准，以妊娠为中心标准 集体产前护理方案和强化中心妊娠方案 包括艾滋病毒/性传播疾病技能发展。主要结果将是随后的 衣原体或淋病感染，在意向治疗的基础上进行评估 Logistic回归分析。拟议研究的优点包括：其 随机的、前瞻性的纵向设计；最大化性生活的机会 在青少年怀孕期间和怀孕后降低风险；生物学和 行为结果；在两个艾滋病毒/性传播疾病高发城市实施干预 流行率；改变有关高危行为的社会规范 通过在同辈群体中进行产前护理来怀孕/产后；以及 持续干预，因为大多数标准都覆盖了产前护理 报销制度--公共的和私人的(即技术简易性 转移)。

DESCRIPTION (adapted from the applicant's abstract): The long-term objective of this study is to reduce risk for HIV and other sexually transmitted diseases (STDs) during and after pregnancy among ethnically-diverse adolescents (aged 14-19) receiving prenatal care in public clinics in 2 cities: New Haven CT and Atlanta GA. Because women of all ages make numerous behavioral changes during pregnancy (e.g., improve diet; reduce/eliminate tobacco, alcohol and illicit drug use), we believe that pregnancy may also present an important window of opportunity to promote changes in high-risk sexual behavior. Behavior changes initiated in pregnancy could be maintained postpartum with an effective intervention. Integrating theories of diffusion of innovation, social learning theory, and theory of gender and power, specific aims of the proposed study are to: (1) Implement a unique group prenatal care intervention that focuses on risk assessment, educational/skills development, and social support to reduce health risk behaviors and promote health enhancing behaviors; (2) examine prospectively changes in behavior throughout the prenatal period and up to one year later, and to determine the effects of these behavioral changes on biological outcomes, including incidence of STDs and repeat pregnancy; and (3) Identify HIV risk-related psychosocial characteristics associated with biological and behavioral outcomes. As part of this randomized controlled trial, women entering prenatal care in the collaborating clinics will be randomly assigned to one of three treatment conditions: individual standard of prenatal care, standard Centering Pregnancy Program for group prenatal care, and enhanced Centering Pregnancy Program including HIV/STD skills development. The principal outcome will be subsequent chlamydial or gonorrheal infection, evaluated on an intent-to-treat basis by logistic regression analysis. The strengths of the proposed study include: its randomized, prospective longitudinal design; opportunity to maximize sexual risk reduction during and after teen pregnancy; integration of biological and behavioral outcomes; intervention implemented in two cities with high HIV/STD prevalence; change social norms regarding high-risk behavior during pregnancy/postpartum by conducting prenatal care in peer groups; and ability to sustain the intervention because prenatal care is covered by most standard reimbursement systems -- both public and private (i.e. ease of technology transfer).