Reducing HIV Risks among African American Teens in High Poverty Urban Settings

描述(申请人提供)：这项严格的三臂随机实验将测试一种创新的父母中介的艾滋病毒干预措施，即为我们的儿女们做好健康未来的准备，是否降低生活在高度贫困城市社区的非裔美国人和其他黑人青年的艾滋病毒风险。在NICHD之前的一笔赠款下，一套三张包含与文化相关的榜样故事的音频CD被发送给有青春期前儿子和女儿的家庭。一项对800多个家庭(主要是非裔美国人)进行的随机试验结果表明，收到音频CD的父母报告了显著更高的监测水平、亲子沟通、对青少年行为的感知影响以及应对青春期性行为和艾滋病毒风险的自我效能感。与对照组青少年相比，干预条件下的青少年报告了更多的家庭规则，更高的家庭支持水平，更重要的是，与性行为启动相关的行为风险更少。扩展这项工作，这项研究的目标是：(1)开发更多的健康未来音频-CD，以促进积极的育儿实践，并支持年轻人建立预防艾滋病毒的行为模式；(2)进行随机现场试验，将1500名非裔美国人/黑人父母和他们6年级的儿女随机分配到三种情况之一：(A)多年音频-CD干预，健康未来；(B)注意力控制的情况；或(C)非注意力控制的情况；(3)在基线和从7年级到10年级的四个跟踪时间点对父母进行调查，以测试健康未来是否有效地促进和维持积极的育儿做法；(4)在基线和从7年级到10年级的四个时间点进行青少年评估，以测试健康未来是否延迟了性行为的开始，减少了危险行为，并在10年级导致较少的性传播感染；(5)检查父母的养育做法是否可以解释青少年的结果，并确定哪些育儿做法在实验条件和青少年结果之间的关系中起到了中介作用；(6)研究干预效果是否因青少年的性别或基线危险行为水平而有所不同(即，是否有所缓和)，以更好地了解干预对谁有效；。(7)研究在不同的环境下，在哪里以及如何使用音频-CD促进的家长中介干预(我们最初的一年储蓄性行为)，以提供传播策略。健康未来解决了高度贫困城市社区的非裔美国人/黑人中的艾滋病毒流行问题，让父母做好准备，应对他们十几岁的儿子和女儿所面临的挑战。

DESCRIPTION (provided by applicant): This rigorous three-arm randomized experiment will test whether an innovative parent-mediated HIV intervention, Preparing Our Sons and Daughters for Healthy Futures, reduces HIV risks among African American and other Black youth living in high-poverty urban neighborhoods. Under a prior NICHD grant, a set of three audio-CDs containing culturally relevant role-model stories were sent to families with preteen sons and daughters. Results of a randomized trial with over 800 mostly African American families indicate that parents receiving the audio-CDs reported significantly higher levels of monitoring, parent-child communication, perceived influence over youths' behaviors, and self efficacy to address adolescent sexuality and HIV risks. Adolescents in the intervention condition reported more household rules, higher levels of family support and, importantly, fewer behavioral risks related to sexual initiation than control- group youth. Extending this work, this study aims to: (1) Develop additional Healthy Futures audio-CDs to promote positive parenting practices and support youth in establishing patterns of behavior that are protective against HIV; (2) Conduct a randomized field trial in which 1500 African American/Black parents and their 6th grade sons and daughters are randomly assigned one of three conditions: (a) a multi-year audio-CD intervention, Healthy Futures; (b) an attention-controlled condition; or (c) a non-attention controlled condition; (3) Survey parents at baseline and at four follow up time-points extending from 7th into 10th grade, to test whether Healthy Futures is effective in promoting and sustaining positive parenting practices; (4) Conduct youth assessments at baseline and four time-points from 7th to 10th grade to test whether Healthy Futures delays sexual initiation, reduces risk behaviors and, at 10th grade, results in fewer STI; (5) Examine whether youth outcomes are explained by parenting practices and identify which parenting practices mediate the relationship between experimental condition and youth outcomes; (6) Examine whether intervention effects vary (i.e., are moderated) by youths' gender or level of baseline risk behaviors to better understand for whom the intervention works; (7) Examine where and how an audio-CD facilitated parent-mediated intervention (our original one-year Saving Sex for Later) is being used in diverse settings to inform dissemination strategies. Healthy Futures addresses the HIV epidemic among African Americans/Blacks in high-poverty urban communities by preparing parents to address the challenges their adolescent sons and daughters face.