Adolescent decision making and HIV risk avoidance: Neurocognitive factors

描述（由申请人提供）：青少年感染性传播疾病（STD）（包括HIV/AIDS）的风险很大，是HIV/AIDS发病率没有下降的少数HIV风险群体之一（CDC，2005）。与一般青少年人口相比，涉及司法的青少年在第一次性交时更年轻，有更多的性伴侣，避孕套使用率更低，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，在高风险情况下做出行为决定的关键大脑区域在青春期仍在发育。不幸的是，目前，许多得到最好支持的性风险预防方案都依赖于发达的认知控制系统（例如，动机访谈; MI），这可能是不太容易为青少年在这个阶段的神经发育。因此，拟议研究的目标是建立在我们以前对该人群的成功工作（1 R 01 AA 017390 -01）的基础上，以测试两种不同类型的基于理论的干预措施;一种依赖于发达的控制系统（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办法，我们希望在我们先前工作的基础上：（1）证明危险性行为与大脑中的奖励和控制网络之间的联系，（2）了解与控制和奖励系统相关的神经认知激活的变异性是否预测了这两种干预方法在减少司法人员危险性行为方面的有效性。涉及艾滋病毒/性病高危青少年，（3）检查神经认知反应之间的相关性，以功能磁共振成像为基础的任务，一组平行的认知任务，很容易管理的扫描仪外，以评估潜在的神经认知研究结果转化为现实世界的应用。拟议的研究预计将提供关键数据，将改善艾滋病毒/性病风险降低规划与高危青少年。 公共卫生相关性：与未犯罪的青少年相比，参与司法的青少年第一次性交的年龄更小，有更多的性伴侣，安全套的使用率更低。这种高水平的性风险导致意外怀孕和包括艾滋病毒/艾滋病在内的性传播疾病的发生率更高。研究表明，特定的大脑区域在风险情况下的决策中至关重要。然而，这些领域中的许多仍然在青春期发展，这可能有助于在这个发展阶段看到的高水平的性风险。青少年这些领域发展的个体差异可能导致对各种干预方法的不同反应。这项研究明确地将发展认知神经科学的基础生物科学，冲动和风险决策的神经认知模型以及心理社会性风险预防干预联系起来，以评估如何最好地预防这一高度脆弱人群的性风险行为。

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. PUBLIC HEALTH RELEVANCE: Justice-involved adolescents are younger at first intercourse, have a greater number of sex partners, and lower rates of condom use than their non criminally-involved counterparts. This high level of sexual risk results in greater rates of unintended pregnancy and STDs including HIV/AIDS. Research supports that specific brain regions are critical in decision-making about risky situations. However, many of these areas are still developing during adolescence, and this may contribute to the high level of sexual risk seen at this stage of development. Individual differences in the development of these areas in adolescents may result in differential responses to various intervention approaches. This study explicitly links the basic biological science of developmental cognitive neuroscience, neurocognitive models of impulsive and risky decision making, and psychosocial sexual risk prevention interventions to evaluate how best to prevent sexual risk behavior in this highly vulnerable population.