Web-Based Substance Abuse STD/HIV Prevention

说明(申请人提供)：目前减少青少年艾滋病毒/性传播疾病风险的预防工作已显示出一些效果，但仍然需要制定和仔细评估既更有效又更容易传播的干预措施。与此同时，先前关于媒体和课堂预防干预措施的研究表明，设计得更新颖和更具参与性的干预措施在改变一些关键的青少年健康危险行为方面更有效。对青少年健康行为定制网络项目有效性的研究表明，通过包括专门为吸引、保持和说服那些最有可能处于风险中的人而设计的元素，行为得到了成功的改变。这些高度互动、生动、快节奏的刺激可能有效地引起本研究项目感兴趣的人群的注意：那些最有可能承担增加艾滋病毒/性传播疾病暴露可能性的风险的人。我们的目标是1)将成功的性危险行为预防课程调整为自我管理的基于网络的课程，该课程将针对高感觉寻求和低感觉寻求的年轻人，并分别传达信息；2)在高中早期环境中实施示范计划；3)评估干预对青少年意图的改变的影响，这些意图包括禁欲、避免在性行为前使用药物以及在阴道或肛交时使用避孕套。其他评估包括知识、艾滋病毒/性传播疾病的显着性、感染艾滋病毒/性传播疾病的感知风险，以及与保持禁欲、谈判安全性行为和使用避孕套有关的自我效能技能。网站干预将在尚未开始发生性行为的青年中促进节欲，并在正在进行性行为并打算继续在青年中预防/减少艾滋病毒/性传播疾病传播的人中推广使用安全套和其他安全性行为的做法。为实现这些目标，提出了一个分两个阶段的项目。第一阶段(1-2年级)将通过重点和反应小组进行干预开发，帮助改进问题和设计有效的课程材料以及在互联网环境下制作多媒体产品和节目。利用之前基于互联网的预防研究中开发的软件引擎，HIV/STD预防计划将为尚未性行为活跃的学生定制旨在延长禁欲的信息，并为性行为活跃的学生定制信息以增加避孕套的使用，并减少其他危险的性行为。在该项目的第二阶段(3-5年)，将以阿尔伯克基和丹佛的公立学校为分析单位，采用分组随机前测-后测控制组设计，实施和评估基于互联网的方案。干预对HIV/STD预防技能、行为意向和性行为风险行为的影响将在三次后续后测中(干预结束时、干预后6个月和干预后1年)进行评估。研究的最后一年将包括最后的数据分析和实地试验结果。公共卫生相关性：青少年，特别是少数族裔青少年的艾滋病毒和性传播疾病感染率以及过早发生性行为的相关负面后果，仍然是预防研究人员关注的问题。饮酒显然也与早期性活动相关，并可能以复杂的方式与性风险有关。通过结合研究项目和为高感觉寻求者制作预防性媒体信息的专业知识，利用信息暴露和感觉寻求原则，以及利用我们在开发和测试多媒体预防网站方面的专业知识，我们将为青少年开发一个针对青少年用户感觉寻求水平的艾滋病毒/性传播疾病和酒精预防网站。因此，将制定的网站干预措施将以经验性验证的预防原则为基础，一旦确定网站的效力，将有可能迅速广泛传播。

DESCRIPTION (provided by applicant): Current prevention efforts to curtail HIV/STD risk among adolescents has shown some efficacy, but interventions that are both more effective and more easily diffused still need to be developed and carefully evaluated. At the same time, prior research on media and classroom preventive interventions has shown that interventions designed to be more novel and participatory are more effective in altering a number of crucial adolescent health risk behaviors. Research examining the effectiveness of tailored web-based programs on adolescent health behaviors have demonstrated that behaviors were successfully changed by including elements designed specifically to attract, hold the attention of, and persuade those most likely at risk. These highly interactive, vivid, quickly-paced stimuli may be effective in eliciting the attention of the population-of- interest for this research project: those most likely to take risks that increase the likelihood of HIV/STD exposure. Our objectives are to 1) adapt the successful sexual risk behavior prevention curricula to a self- administered Web-based curriculum that will target high sensation-seeking and low sensation-seeking youth with separate messages; 2) implement the model program in the early high school environment; and 3) evaluate the effect of the intervention on the change in adolescents' intentions to remain abstinent from sexual intercourse, to avoid the use of drugs before sex and to use condoms for vaginal or anal intercourse. Other evaluations include knowledge, salience of HIV/STD, perceived risk of contracting HIV/STD, and self-efficacy skills related to remaining abstinent, negotiating safe sexual behavior, and using condoms. The website intervention will promote abstinence among youth who have not yet started having sex and promote condom use and other safe-sex practices among those who are engaging in sex and intend to continue for the goal of prevention/reduction of HIV/STD transmission among youth. A two-phase project is proposed to address these aims. The first phase (Years 1-2), will involve intervention development through focus and reaction groups that help refine issues and design effective curricular materials and multimedia production and programming in the Internet environment. Using a software engine developed in previous Internet-based prevention research, the HIV/STD prevention program will tailor messages intended to prolong sexual abstinence for students who are not yet sexually active and messages to increase condom use, and reduce other risky sexual behaviors for those who are sexually active. The Internet- based program will be implemented and evaluated in the second phase of the project (Years 3-5) using a group-randomized pretest-posttest control group design, with public schools in Albuquerque and Denver as the unit of analysis. The impact of the intervention on HIV/STD prevention skills, behavioral intentions, and sexual risk-taking behaviors will be assessed in three follow-up posttests (at completion of the intervention, 6-month post, and at 1-year post). The final year of the study will involve final data analysis and field trial outcomes. PUBLIC HEALTH RELEVANCE: The rate of HIV and STD infection as well as related negative consequences of early onset of sexual behavior among adolescents, especially minority adolescents, continues to be a concern for prevention researchers. Alcohol use is also clearly a correlate of early initiation of sexual activity and may be related in complex ways to sexual risk-taking. By combining research programs and expertise in crafting preventive media messages for high sensation seekers, employing information exposure and sensation seeking principles, and utilizing our expertise in developing and testing multimedia prevention websites, we will develop a HIV/STD and alcohol prevention website for adolescents that will be tailored to the adolescent user's level of sensation seeking. As a result, the website intervention to be developed will be grounded in empirically verified prevention principles, and will have the potential to be quickly and widely disseminated once the efficacy of the website has been determined.