PS11-003 Minority AIDS Research Initiative

描述（由PI提供）：本申请响应申请申请RFA-PS-11-003中的第四个研究课题，“黑人和西班牙裔青年的性健康途径：预防、筛查和促进健康选择的新策略”。在宾夕法尼亚州费城，城市黑人青少年受到意想不到的性后果的不成比例的影响，如艾滋病毒，性传播感染（sti）和意外怀孕。新研究转化为非传统的社区计划，以解决整体性健康和减少性感染对这一人群至关重要。这项拟议的研究是将首席研究员（PI）的初步研究结果转化为有利于当地青少年心理健康社区确定的性健康教育需求的一项努力。PI创新地提出了一个研究项目的第一步，以解决黑人社区历史上服务不足的部门-患有精神疾病的黑人青少年的艾滋病毒/性传播疾病预防需求。PI是一名年轻的非洲裔美国护士科学家，在实施文化和语言上有能力的研究方法方面有良好的记录，为黑人社区服务的历史，与目标人群的紧密联系，以及通过宾夕法尼亚大学护理学院健康公平研究中心进行的杰出研究培训。因此，在著名资深科学家dr .。洛丽塔·杰莫特和吉娜·温伍德。难以接触、被剥夺权利的青少年是我国艾滋病毒/性传播疾病流行的中心，而患有精神疾病的青少年面临的风险更高。过早的性行为，药物滥用，贫穷和受教育程度有限都是记录在案的风险因素。患有精神疾病的黑人青少年感染艾滋病毒/性传播感染的风险增加，因为他们更有可能遇到导致艾滋病毒/性传播感染的社会和结构因素。此外，研究表明，他们从事与艾滋病毒/性传播感染风险相关的性行为的比例高于其他青少年。在非传统环境中提供艾滋病毒/性传播感染预防方案，例如门诊精神健康治疗方案，可能对有精神疾病风险的黑人青少年有效。行为干预在一般青少年人群中已证明有效；然而，尚不清楚这些发现是否适用于患有精神疾病的青少年。为了提高效果，针对这一人群的干预措施应考虑到可能损害他们准确评估危险情况、控制冲动和协商使用避孕套能力的独特社会和心理因素。尽管有这些事实，可用于降低患有精神疾病的黑人青少年感染艾滋病毒/性传播感染风险的综合循证干预措施仍然缺乏。本研究的目的是通过健康公平视角和社会决定因素方法来预防艾滋病毒/性传播感染，开发和试点一种理论驱动的、与性别和文化相关的、发展和心理上适当的行为干预措施，以降低患有精神疾病的异性恋活跃黑人青少年（13至17岁）感染艾滋病毒/性传播感染的风险。CBPR框架、计划行为理论和研究者对目标人群的初步工作将指导研究过程。目前在费城社区行为健康（CBH）提供者处接受门诊心理健康治疗的男性和女性（N= 128）将被随机分配到两种情况中的一种：1)有针对性的艾滋病毒/性传播感染风险降低干预，以降低他们感染艾滋病毒和其他性传播感染的风险；或2)一般健康促进的注意力控制条件，以减少他们的不良健康状况，包括癌症，肥胖和心脏病的风险。通过与社区合作，具体目标集中在阐明影响艾滋病毒/性传播感染风险的因素、干预措施的制定、测试干预措施对与艾滋病毒/性传播感染风险相关的性行为和性传播感染发生率的影响，以及测试干预措施的调解效果。主要研究结果是在基线、干预后立即、3个月、6个月和12个月的随访中评估自我报告一致的安全套使用情况。次要结局包括性活动、并发性伴侣和连续性伴侣的数量、干预效果的理论中介（青少年的态度、信念、意图和自我效能）和实验室确认的性传播感染。这些数据将有助于为患有精神疾病的黑人青少年制定以证据为基础的艾滋病毒/性传播感染风险降低方案。具体而言，预期的影响是：1)产生数据，通过性别和文化相关，发展和心理适当的工具，以达到患有精神疾病的黑人青少年为目标，解决独特的，未满足的减少艾滋病毒/性传播感染风险的需求；2)与社区利益相关者合作，在风险社区的非传统环境中提供新的干预措施，以加强青少年与可信赖的成人促进者之间的性健康对话和预防工作；3)为规范社区门诊性健康评估和干预提供心理健康政策依据。研究者的长期目标是建立一个艾滋病流行病学预防项目，研究重点是降低艾滋病/性传播感染在费城城市的发病率，并推广到其他城市社区。鉴于青少年健康是公共卫生的当务之急，提出的研究是及时的，创新的，具有重要意义。

DESCRIPTION (provided by PI): This application is responsive to the fourth research topic in Request for Applications RFA-PS-11-003, "A Sexual Health Approach for Black and Hispanic Youth: New strategies for prevention, screening and facilitating healthy choices." In Philadelphia, PA, urban Black adolescents are disproportionately impacted by unintended sexual outcomes, such as HIV, sexually transmitted infections (STIs) and unwanted pregnancies. Novel studies translated into nontraditional community programs to address overall sexual health and decrease sexual infections are essential for this population. The proposed study is an effort to translate the Principal Investigator's (PI's) preliminary research findings to benefit sexual health education needs identified within the local adolescent mental health community. The PI innovatively proposes the first steps in a program of research to address HIV/STI prevention needs in a historically underserved sector of the Black community- Black adolescents suffering from mental illnesses. The PI is a young African American nurse scientist with a proven track record to implement culturally and linguistically competent research methodology, a history of service to Black communities, strong linkages to the targeted population and outstanding research training through the Center for Health Equity Research at the University of Pennsylvania School of Nursing. Accordingly, a community-based participatory research (CBPR) framework is proposed with mentorship by renowned senior scientists, Drs. Loretta Jemmott and Gina Wingood. Hard to reach, disenfranchised adolescents are at the epicenter of our national HIV/STI epidemic, and those with mental health illnesses are at heightened risk. Early sexual debut, substance abuse, poverty and limited educational attainment are all documented risk factors. Black adolescents with mental illnesses are at increased risk for HIV/STIs because they are more likely to encounter social and structural drivers of the HIV/STI epidemic. Further, research indicates that they engage in HIV/STI risk related sexual behaviors at higher rates than other adolescents. The delivery of HIV/STI prevention programming in a nontraditional setting, such as an outpatient mental health treatment program, may prove effective to engage at-risk Black adolescents with mental illnesses. Behavioral interventions have demonstrated efficacy in the general adolescent population; however, it remains unknown whether these findings translate to adolescents with mental illnesses. To enhance efficacy, interventions for this population should be targeted to account for unique social and psychological factors which may impair their ability to accurately appraise risky situations, control impulses and negotiate condom use. Despite these facts, a paucity of comprehensive evidence-based interventions are available to reduce HIV/STI risk among Black adolescents with mental illnesses. Through a health equity lens, and a social determinants approach to HIV/STI prevention, the purpose of this study is to develop and pilot a theoretically-driven, gender and culturally relevant, developmentally and psychologically appropriate behavioral intervention to reduce the risk of HIV/STIs among heterosexually-active Black adolescents (ages 13 to 17) with mental illnesses. A CBPR framework, the Theory of Planned Behavior, and the investigators' preliminary work with the target population will guide the research process. Both males and females (N= 128) currently receiving outpatient mental health treatment from a Philadelphia Community Behavioral Health (CBH) provider will be randomized to one of two conditions: 1) a targeted HIV/STI risk reduction intervention to reduce their risk of HIV and other STIs; or 2) an attention control condition on general health promotion to reduce their risk of adverse health conditions including cancer, obesity, and heart disease. In partnership with the community, the specific aims are focused on elucidation of factors that influence HIV/STI risk, intervention development, testing the intervention's effects on HIV/STI risk related sexual behavior and STI incidence, and testing the mediation of effects of the intervention. The primary study outcome is self-reported consistent condom use assessed at baseline, immediately post-intervention, and at 3-, 6- and 12-month follow-ups. Secondary outcomes include sexual activity, the number of concurrent and sequential sexual partners, the theoretical mediators of intervention effects (adolescents' attitudes, beliefs, intentions and self-efficacy) and laboratory confirmed STIs. These data will contribute to the development of evidence-based HIV/STI sexual risk reduction programs for Black adolescents with mental illnesses. Specifically, the intended impact is to: 1) generate data to address unique, unmet HIV/STI risk reduction needs via a gender and culturally relevant, developmentally and psychologically appropriate vehicle targeted to reach Black adolescents with mental illnesses; 2) partner with community stakeholders to deliver a novel intervention in a nontraditional setting embedded in the community at risk to enhance sexual health dialogue and prevention efforts between adolescents and trusted adult facilitators; and 3) inform mental health policy toward the standardization of sexual health assessment and intervention in community outpatient mental health treatment. The investigator's long-term goal is to build an HIV epidemiologic prevention program of research focused on decreasing HIV/STI morbidity in highly affected urban Philadelphia, and generalizable to other urban communities. Given that adolescent health is imperative to public health, the proposed research is timely, innovative and bears great significance. PUBLIC HEALTH RELEVANCE: Heterosexually-active Black adolescents diagnosed with mental illnesses report increased rates of early sexual debut, noncondom use, and having sex with multiple sexual partners. Theory-based, gender and culturally relevant HIV/STI risk reduction interventions that focus on the psychopathology of mental illness are needed to improve sexual health within the target population. Delivery of HIV/STI prevention programming in outpatient mental health treatment, a nontraditional community-based setting, may reach adolescents who are not engaged in other settings (i.e. schools and churches).