Violence Exposure and HIV Risk in Adolescent Women of Color

描述(由申请人提供)：这份R03提案要求资金，通过探索儿童暴力暴露和危险性行为之间的关系，对寻求门诊精神健康服务的低收入、城市非裔美国人(AA)女孩进行更大规模的纵向研究(G.Donenberg，Pi)。美国疾病控制与预防中心最近的估计显示，近一半的再生障碍性贫血青春期妇女感染了性传播疾病(STD)，这突显了在这一人群中减少性风险的迫切需要。1反映这一模式，再生障碍性贫血妇女的艾滋病毒/艾滋病病例在美国妇女中所占比例最大，2再生障碍性贫血妇女的绝大多数感染是通过异性性交发生的。3早期接触暴力与危险的性行为有关，低收入的再生障碍性贫血女孩遭受暴力的比率很高。6因此，家庭和社区暴力率高可能是增加有色人种年轻妇女在心理健康治疗中感染艾滋病毒和其他性传播疾病风险的关键因素。7基于联邦资助的一项研究，该研究涉及寻求心理健康服务的12-16岁再生障碍性贫血女孩及其女性照顾者(N=265；这项小型研究将：(1)在接受心理健康治疗的14-18岁再生障碍性贫血女孩中检查儿童暴力暴露与危险性行为之间的联系；以及(2)探索在这一人群中儿童暴力暴露与危险性行为之间的潜在解释途径。我们将重新联系所有完成更大规模纵向研究的家庭，并对终身创伤和受害历史(包括7类创伤、年龄、施暴者、频率和严重程度)进行全面评估。统计分析将使用回归和结构方程建模，利用更大的纵向研究的现有数据。这项研究的结果将为设计一项关于这些关系的更大规模的前瞻性研究提供指导，并将为开发创新的、对性别敏感的和文化上合适的计划提供指导，以降低有暴力暴露和精神健康问题史的年轻再生障碍性贫血妇女的艾滋病毒和其他性传播疾病的发生率。与公共卫生相关：美国疾病控制与预防中心最近的估计表明，近50%的非裔美国少女感染了性传播疾病，非洲裔美国妇女在美国妇女中艾滋病毒/艾滋病病例中所占比例最大。早期接触家庭和社区暴力可能是导致低收入城市非裔美国女孩发展危险性行为的关键风险因素。拟议中的项目建立在一项更大规模的纵向研究的基础上，目的是在寻求心理健康服务的低收入城市非裔美国女孩中，研究从童年暴力暴露到危险性行为的途径，并将产生最终可用于减少这一人群中危及健康的性行为的信息。

DESCRIPTION (provided by applicant): This R03 proposal requests funds to build on a larger longitudinal study with low-income, urban African American (AA) girls seeking outpatient mental health services (G. Donenberg, PI) by exploring the relationship between childhood violence exposure and risky sexual behavior. Underscoring the crucial need to reduce sexual risk-taking in this population, recent CDC estimates indicate that nearly half of all AA adolescent women are infected with a sexually transmitted disease (STD).1 Reflecting this pattern, AA women account for the largest proportion of HIV/AIDS cases among women in the US,2 and the vast majority of infections in AA women occur through heterosexual intercourse.3 Early violence exposure has been linked to risky sexual behavior, and low income, urban AA girls are exposed to high rates of violence.4, 5 Moreover, childhood violence exposure is likely to be prevalent in youth seeking psychiatric treatment since violence exposure is associated with mental health symptoms.6 Thus, high rates of exposure to family and community violence may be a critical factor increasing risk for HIV and other STDs among young women of color in mental health treatment.7 Building on a federally funded study of 12-16 year-old AA girls seeking mental health services and their female caretakers (N=265; G. Donenberg, PI), this small study will: (1) examine links between violence exposure in childhood and risky sexual behavior among 14-18 year old AA girls in mental health treatment; and (2) explore potential explanatory pathways from childhood violence exposure to risky sexual behavior in this population. We will re-contact all families who completed the larger longitudinal study and conduct a comprehensive assessment of lifetime trauma and victimization history (including 7 categories of trauma, age, perpetrator, frequency, and severity). Statistical analyses will employ regression and structural equation modeling, capitalizing on existing data from the larger longitudinal study. Results from this study will inform the design of a larger, prospective study of these relationships and will provide guidance for developing innovative, gender-sensitive, and culturally appropriate programs to reduce rates of HIV and other STDs among young AA women with histories of violence exposure and mental health problems. PUBLIC HEALTH RELEVANCE: Recent estimates from the CDC indicate that nearly 50% of teenage African American girls are infected with sexually transmitted diseases, and African American women account for the largest proportion of HIV/AIDS cases among women in the United States. Early exposure to home and community violence may be a crucial risk factor contributing to the development of risky sexual behavior in low-income, urban African American girls. The proposed project builds on a larger longitudinal study to examine the pathway from childhood violence exposure to risky sexual behavior in a sample of low-income, urban African American girls seeking mental health services and will yield information that can ultimately be used to reduce health compromising sexual behavior in this population.