Adolescent Risk Reduction in the Peers & Parents

描述（申请人提供）：艾滋病毒/艾滋病仍然是加勒比地区的一个重大问题，特别是巴哈马。据估计，巴哈马有4%的成年人感染艾滋病毒，是讲英语的加勒比地区艾滋病年发病率最高的国家。对此，来自美国和巴哈马卫生部/玛嘉烈公主医院的调查人员制定并实施了一项基于理论的、面对面的减少青少年风险的干预措施，即“关注加勒比青年”，通过两次试点试验发现，在干预措施实施两个月后，性活跃女性的避孕套使用率大幅提高，并改变了男性和女性的观念和意图。随后，应巴哈马卫生部的要求，美国-巴哈马研究小组制定了一项补充性的父母干预措施，“加勒比知情父母和儿童一起”，旨在改善父母与青少年在安全性行为方面的沟通。CImPACT的可行性测试表明，家长可以通过学校招募和注册，将参与，并可以纵向跟踪。在FOYC和CImPACT的试点测试期间，验证了相关评估工具可在巴哈马使用。因此，该提案寻求资金，在900名六年级青少年中进行三细胞对照，随机试验（基线年龄为11 - 13岁）和他们的父母从15所巴哈马小学，以评估对青少年风险行为的不同影响：1）青少年风险降低干预加家长控制干预（FOYC加对照）;对比2）父母和青少年联合风险降低干预（FOYC加上CImPACT）;对比3）对青少年和父母的注意力控制（对照加对照）以评估短期（6个月）和长期（12、18、24和36个月）干预效果。主要结果领域将是青少年性风险行为，包括a）开始性行为，B）不使用避孕套的性行为和c）有保护的性行为。次要结果领域将是物质滥用，包括烟草、酒精和药物，以及两组中介变量：a）青少年对风险和保护行为的看法，由行为改变的指导模型，保护动机理论的结构组织;和，B）父母和青少年对父母监督和父母-青少年沟通的看法。

DESCRIPTION (provided by applicant): HIV/AIDS remains a significant problem in the Caribbean in general, the Bahamas in particular. With an estimated 4% of adults infected with HIV, the Bahamas has the highest annual incidence rate of AIDS in the English speaking Caribbean. In response, investigators from the United States and the Bahamian Ministry of Health/Princess Margaret Hospital developed and implemented a theory-based, face-to-face adolescent risk reduction intervention, "Focus on Youth in the Caribbean" (FOYC) which was found through two pilot-tests to significantly increase condom use among sexually active females two months post intervention and to alter the perceptions and intentions among males and females. Subsequently, in response to a request from the Bahamian Ministry of Health, the US-Bahamian research team developed a complementary parental intervention, "Caribbean Informed Parents and Children Together" (CImPACT) which was designed to improve parent-adolescent communication regarding safer-sex. Feasibility testing of CImPACT demonstrated that parents could be recruited and enrolled through the schools, would participate, and could be tracked longitudinally. During the pilot testing of both FOYC and CImPACT, relevant assessment instruments were validated for use in the Bahamas. Accordingly, this proposal seeks funding to conduct a three-cell controlled, randomized trial among 900 sixth grade adolescents (ages 11 to 13 at baseline) and their parents from 15 Bahamian elementary schools to assess the differential impact on adolescent risk behavior of: 1) an adolescent risk reduction intervention plus a parent control intervention (FOYC plus control); versus 2) a combined parent and adolescent risk reduction intervention (FOYC plus CImPACT); versus 3) an attention-control for youth and parents (control plus control) to assess both short-term (six months) and long-term (12, 18, 24, and 36 months) intervention effect. The primary outcome domain will be adolescent sexual risk behavior, including a) initiation of sex, b) sex without a condom and c) protected sex. Secondary outcome domains will be substance abuse, including tobacco, alcohol and drugs, and, two sets of mediating variables: a) youth perceptions of risk and protective behaviors organized by the constructs of the guiding model of behavioral change, Protection Motivation Theory; and, b) parent and adolescent perceptions of parental monitoring and parent-adolescent communication.