Relationships, Sexual Norms, and HIV Prevention Among African American Youth

描述（由申请人提供）：城市少数族裔青年，特别是非洲裔美国人，受到艾滋病毒/艾滋病和其他性传播疾病（STIs）的不成比例的影响（CDC, 2007a, 2007b, 2008a）。虽然青春期早期是集中预防工作的宝贵窗口，但在学校环境中经过测试并发现有效的针对中学生的循证艾滋病毒预防干预措施相对较少。与NICHD RFA的目标一致，拟议的研究旨在通过开发和测试一种新的基于理论的干预措施来解决这些差距，该干预措施针对城市、少数民族和中学生，建立在性发展、性风险行为预防和积极的青少年发展的基本要素之上。拟议的研究将评估两种基于理论的干预成分的影响，这些干预成分旨在促进关系发展，作为减少性冒险行为的途径：(1)以技能和规范为基础的艾滋病毒、其他性传播感染和怀孕预防课程，重点关注可能影响疾病风险的关系和相关行为，例如发展健康的关系、性伙伴关系（例如，多名并发伴侣）、关系规范（例如，在关系中何时发生性行为）、在关系中使用安全套和进行艾滋病毒/性传播感染检测，以及结束不健康的关系；(2)全校范围内的社会规范组成部分，将以每月由同伴主导的活动（有些通过电子媒体进行）为特色，在学校环境中渗透有关健康关系的亲社会规范——加强和扩大课堂课程的潜在影响，并为其他青少年提供积极的榜样。将对该项目进行评估，以确定其在改变行为意图和性冒险行为（如性开始、伴侣的数量和类型、避孕套的使用）以及相关决定因素（如功能知识、态度、信仰、感知规范、亲子沟通、性限制和对危险情况的认识）方面的效果。评估将采用随机对照设计，涉及10所学校（约1500名学生）。五所学校将接受干预；其他五个将作为比较网站。在研究期间，学生将接受3次评估——基线、6个月和18个月，使用音频增强型个人数字助理（apda）进行自我报告调查。这项被提议的研究将是第一个评估以人际关系为核心主题的中学生艾滋病预防计划的研究。此外，所得数据将扩大关于早期青少年预防活动的有限文献；这也将为越来越多的关于青少年关系发展的文献增添新的内容，尤其是关于非裔美国人和其他城市少数族裔青年的关系发展。

DESCRIPTION (provided by applicant): Urban minority youth, particularly African Americans, are disproportionately affected by HIV/AIDS and other sexually transmitted infections (STIs) (CDC, 2007a, 2007b, 2008a). Although early adolescence is a valuable window to focus prevention efforts, there are relatively few evidence-based HIV prevention interventions for middle school youth that have been tested and found effective in school settings. Consistent with the objectives of the NICHD RFA, the proposed study is designed to address these gaps by developing and testing a new theory-based intervention for urban, minority, middle school youth that builds on essential elements of sexuality development, sexual risk behavior prevention, and positive youth development. The proposed study will assess the effects of two theoretically based intervention components that aim to promote relationship development as an avenue of reducing sexual risk taking behaviors: (1) a skills- and norm-based HIV, other STI, and pregnancy prevention curriculum that will focus on relationships and related behaviors that may affect disease risk, such as developing healthy relationships, sexual partnering (e.g., multiple and concurrent partners), relationship norms (e.g., when to have sex in relationships), condom use and HIV/STI testing within relationships, and ending unhealthy relationships; and (2) a school-wide social norms component that will feature monthly peer-led activities (some delivered via electronic media) to permeate the school environment with pro-social norms regarding healthy relationships--reinforcing and extending the potential effects of the classroom curriculum, and providing positive models for other youth. The program will be evaluated to determine its efficacy in altering behavioral intentions and sexual risk taking behaviors (e.g., sexual initiation, number and type of partners, condom use) and related determinants, such as functional knowledge, attitudes, beliefs, perceived norms, parent-child communication, sexual limits, and awareness of risky situations. The evaluation will feature a randomized controlled design involving 10 schools (approximately 1,500 students). Five schools would receive the intervention; the other five would serve as comparison sites. Students would be assessed 3 times during the study--baseline, 6 and 18 months, using self report surveys administered with audio-enhanced personal digital assistants (APDAs). The proposed study would be among the first to evaluate an HIV prevention program for middle school youth that features relationships as a core theme. Further, resulting data would expand the limited literature on prevention activities for early adolescents; it would also add to a growing body of literature on adolescent relationship development, particularly among African American and other urban minority youth. PUBLIC HEALTH RELEVANCE: Urban minority youth, particularly African Americans, are disproportionately affected by HIV/AIDS and other sexually transmitted infections (STIs). Although early adolescence is a valuable window to focus prevention efforts, there are relatively few evidence-based HIV prevention interventions for middle school youth that have been tested and found effective in school settings. The proposed school-based project has several significant features that advance public health efforts to prevent HIV, other STI, and unplanned pregnancy for urban minority youth. It: 1) features a theoretically-based intervention that integrates essential elements drawn from sexuality development, evidence-based sexual risk behavior prevention programs, and positive youth development; 2) integrates HIV, other STI, and pregnancy prevention to enhance the relevance and salience of the program content; 3) addresses the characteristics of effective programs identified by Kirby (2007); and 4) centers on adolescent relationship development, an innovative approach to HIV prevention.