Cognitive Models of HIV Decision Making in Young Adults

描述（由申请人提供）：尽管开展了广泛的教育工作，并传播了旨在提高风险意识的材料，但年轻人中艾滋病毒感染的发病率继续以惊人的速度加速。由于25岁以下的年轻人占所有新感染艾滋病毒的一半以上，因此迫切需要减少这一人群的发病率。许多旨在提高艾滋病毒知识的干预措施并没有实质性地减少危险的性行为，这种有效性的缺乏可能是年轻人在抽象的、原型的情况下与具体的、现实生活中的情况下做出决定的方式不同的结果。矛盾的是，年轻人在推理典型的性情境时会做出安全的选择，但在现实生活中却仍然表现出危险的行为。通过检查年轻人在真实和原型情况下的决策，我们可以确定推理过程的差异，这些差异揭示了为什么以前的干预无效，并描绘了这种悖论的维度，必须在未来的干预中加以解决。我们的目标是(1)通过定性研究来描述年轻人风险行为选择的背景，并应用专门的认知话语分析方法来研究年轻人决策的潜在过程；(2)开发和完善年轻人在现实生活和假设情境中使用的决策过程认知模型；(3)比较这些决策模型，以识别和分离风险情况下健康与不安全选择相关的因素或特征。我们将从当地一所城市大学招募30名异性恋男性和30名异性恋女性，他们将在两周内完成他们的性行为日记。我们将使用我们对期刊内容的分析来指导项目的后续阶段。其中包括半结构化访谈，以调查以下两种情况下决策的推理策略和情境因素：(a)日志中记录的现实生活情况，以及(b)从日志综述中开发的不安全性接触实例汇编的典型风险情况。从半结构化访谈中，我们将实施认知分析技术，包括命题分析和语义网络的构建，以模拟两种情况下的决策过程。模型的比较将揭示决策过程背后的因素，以及它们在现实生活和原型情况下的差异。我们预计，我们的分析将确定那些促进健康选择和那些导致危险行为选择的因素。我们的研究结果将为年轻人决策的各个方面提供有价值的见解，这些方面是干预措施中最关键的目标。

DESCRIPTION (provided by applicant): The incidence of HIV infection among young adults continues to accelerate at alarming rates despite widespread educational efforts and dissemination of materials designed to increase awareness of risk. With young adults under the age of 25 accounting for more than half of all new HIV infections, there is an urgent need to reduce the incidence in this population. Many interventions aimed at increasing HIV knowledge have not produced substantial decreases in risky sexual behaviors, and this lack of effectiveness may be a result of differences in how young adults make decisions about abstract, prototypical situations versus specific, real-life instances. Paradoxically, young adults make safe choices when reasoning about prototypical sexual situations, yet still exhibit risky behavior in actual, real-life settings. By examining young adults' decision-making in both real and prototypical situations, we may identify differences in reasoning processes that reveal why previous interventions were ineffective and also delineate dimensions of this paradox that must be addressed in future interventions. We aim to (1) conduct qualitative research to characterize the context surrounding young adults' risky behavioral choices and apply specialized cognitive methods of discourse analysis to examine processes underlying young adults' decision-making; (2) develop and refine cognitive models of the decision-making processes used by young adults in both real-life and hypothetical situations; and (3) compare these models of decision-making to identify and separate factors or characteristics associated with healthy vs. unsafe choices in risky situations. We will recruit 30 heterosexual men and 30 heterosexual women from a local city college who will complete daily journals chronicling their sexual activity over two weeks. We will use our analyses of journal contents to guide subsequent phases of the project. These include semi-structured interviews to investigate the reasoning strategies and situational factors underlying decision-making in both (a) real-life situations as recorded in the journals and (b) a prototypical risky situation compiled from instances of unsafe sexual encounters developed from review of the journals. From the semi-structured interviews, we will implement cognitive techniques of analysis, including propositional analysis and construction of semantic networks, to model the process of decision- making in each of the two contexts. Comparison of models will reveal the factors underlying the decision-making process and how they differ in real-life and prototypical situations. We anticipate that our analysis will identify those factors that promote healthy choices and those that lead to risky behavioral choices. Our findings will provide valuable insight into the aspects of young adults' decision-making that are most critical to target in interventions.