Adolescent decision making and HIV risk avoidance: Neurocognitive factors

说明(申请人提供)：青少年感染包括艾滋病毒/艾滋病在内的性传播疾病的风险很大，是艾滋病毒/艾滋病发病率没有下降的少数艾滋病毒风险群体之一(CDC，2005年)。与一般青少年人口相比，涉及正义的青少年在第一次性交时更年轻，性伴侣数量更多，避孕套使用率更低，从而导致意外怀孕和性传播疾病的发生率更高(例如，Teplin，Mericle，McClelland&Abram，2003年)。数据表明，在青春期，在高危情况下做出行为决定所必需的关键大脑区域仍在发育。不幸的是，目前，许多得到最好支持的性风险预防方案依赖于完善的认知控制系统(例如，动机访谈；MI)，这可能是处于神经发育阶段的青少年较难获得的。因此，拟议研究的目标是在我们之前对这一人群(1R01 AA017390-01)的成功工作的基础上，测试两种不同类型的基于理论的干预；一种依赖于完善的控制系统(MI)，另一种依赖于更基本的行为方法(行为技能培训；BST)。通过这种创新的、综合的方法，我们希望在我们先前工作的基础上：(1)展示危险的性行为与大脑中的奖赏和控制网络之间的关联，(2)了解与控制和奖赏系统相关的神经认知激活的变异性是否可以预测这两种干预方法在减少艾滋病毒/性传播疾病高危青少年中的危险性行为的有效性，以及(3)检查基于功能磁共振成像的任务与一组平行的认知任务之间的神经认知反应之间的相关性，这些认知任务很容易在扫描仪之外进行管理，以评估将神经认知结果转化为现实应用的潜力。预计拟议的研究将提供关键数据，以改善高危青少年的艾滋病毒/性传播疾病风险降低规划。

DESCRIPTION (provided by applicant): Adolescents are at great risk for sexually transmitted diseases (STDs) including HIV/AIDS, and are one of few HIV risk groups for whom HIV/AIDS incidence is not declining (CDC, 2005). Compared to the general adolescent population, justice-involved adolescents are younger at first intercourse, have a greater number of sex partners, and lower rates of condom use, resulting in higher rates of unintended pregnancy and STDs (e.g., Teplin, Mericle, McClelland & Abram, 2003). Data suggests that key brain regions integral for making decisions about behavior in high risk situations are still developing during adolescence. Unfortunately, at present, many of the best-supported sexual risk prevention programming rely on well-developed cognitive control systems (e.g., motivational interviewing; MI), which may be less accessible for adolescents at this stage of neurodevelopment. Thus, the goal of the proposed study is to build on our previous successful work with this population (1R01 AA017390-01) to test two different types of theory-based interventions; one that relies upon well-developed control systems (MI) versus one that relies on a more basic behavioral approach (Behavioral Skills Training; BST). Through this innovative, integrative approach, we hope to build upon our prior work to: (1) demonstrate associations between risky sexual behavior with the reward and control networks in the brain, (2) understand whether variability in neurocognitive activation associated with the control and reward systems predicts the effectiveness of these two intervention approaches to reduce risky sexual behavior among justice- involved adolescents at high risk for HIV/STDs, and (3) examine the correlation between neurocognitive responses to the fMRI-based tasks to a parallel set of cognitive tasks that are easily administered outside of the scanner to assess the potential for the translation of neurocognitive findings into real-world application. The proposed research is expected to provide critical data that will improve HIV/STD risk reduction programming with high risk adolescents.