Developing an HIV/STI intervention for Foster Youth Using Attachment Theory

利用依恋理论为寄养青少年制定艾滋病毒/性传播感染干预措施

基本信息

批准号：
8512789
负责人：
KYM R AHRENS
金额：
$ 17.54万
依托单位：
SEATTLE CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-08-01 至 2015-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8512789
关键词：
Address Adolescence Adolescent Adult Age Area Behavior Therapy Behavioral Bioethics Biological Biometry Brain Caregivers Categories Child Welfare Childhood Chronic Communities Data Set Development Disease Environment Fostering Funding General Population Goals Grant HIV HIV/STD Health Health Personnel Health behavior Healthcare Healthcare Systems Healthy People 2010 Independent Living Institute of Medicine (U.S.)Interpersonal Violence Intervention Knowledge Lead Life Mediating Mental Health Mentored Patient-Oriented Research Career Development Award Mentors Pattern Pediatric Hospitals Population Prevention Prevention Research Psychological Impact Qualitative Methods Randomized Controlled Trials Recording of previous events Research Research Institute Research Personnel Research Project Grants Risk Risk Behaviors Secure Sex Behavior Sexual Health Sexual Partners Sexual abuse Sexuality Sexually Transmitted Diseases Social Health Services Substance abuse problem System Techniques Time Training United States Universities Vulnerable Populations Washington Work Youth age difference base care systems career condoms design experience foster care high risk improved maltreatment neglect peer physical abuse programs protective behavior public health relevance role model sexual relationship skills successful intervention theories therapy development tool young adult

项目摘要

DESCRIPTION (provided by applicant): The vast majority of youth in foster care have been exposed early in life to overt physical abuse, sexual abuse, chronic neglect, parental substance abuse and/or have been witnesses to interpersonal violence. These exposures can result in extremely disordered or disorganized attachments with early caregivers, which can greatly impact how they relate to others later in life including sexual partners, health care providers, and important adult mentors. These troubled relationships all have been shown to impact risk of sexually transmitted infections including Human Immunodeficiency Virus (HIV/STI). Indeed, adolescents in the foster care system are at between 2-14 times increased risk of sexually transmitted infections compared with youth in the general population. The candidate's long-term objective is to develop an enhanced behavioral intervention to reduce HIV/STI tailored to the needs of adolescents in foster care. Intervention development will be guided by adult attachment theory and specifically by an understanding of how attachment style (e.g., having an avoidant, anxious or secure style) can impact romantic/sexual, health care, and mentoring relationships and consequently can impact HIV/STI risk. To achieve this objective, the candidate will pursue didactic and experiential training to improve knowledge and skills in three specific areas: 1) techniques to assess mediational relationships commonly used in behavioral HIV/STI research, 2) application of adult attachment theory including the use of this theory to improve HIV/STI prevention efforts among adolescents in foster care, and 3) techniques in community-based intervention development that are relevant to HIV/STI prevention research in adolescents with histories of early adverse exposures. The candidate has identified two mentors with complementary expertise in HIV/STI research (Dr. Jane Simoni) and research involving youth in the child welfare system (Dr. Mark Courtney). Additional mentoring will be provided by consultants with expertise in mediational analysis techniques, adult attachment theory, community-based research, bioethics, and biostatistics, and will also include a national expert on community-based HIV/STI research in high-risk adolescent populations (Dr. Ralph DiClemente). The three inter-related studies proposed in this application build on the candidate's training goals and will each contribute to an improved understanding of how adult attachment theory can be applied to develop an enhanced intervention that involves the promotion of healthy relationships to reduce HIV/STI risk among adolescents in the foster care system. The specific aims are to: 1.) conduct a quantitative analysis using an existing longitudinal dataset to understand how relationship factors (e.g., influences of attachments with romantic partners, health care providers, and non-parental adult role-models) mediate the association between attachment style and sexual risk for youth in foster care; 2.) use qualitative methods to elucidate the factors that can directly promote healthy sexuality and HIV/STI-protective behaviors among foster youth in foster care with different attachment styles; and 3.) develop and pilot an enhanced HIV/STI intervention for youth in foster care that includes components that utilize an understanding of adult attachment style to promote healthy romantic/sexual relationships, health care and mentoring relationships. The excellent research environments provided by both Seattle Children's Hospital Research Institute and the University of Washington, as well as the candidate's strong existing relationships with two community partners - the YMCA of Greater Seattle's Center for Young Adults and the Washington State Department of Health and Social Services agency - will enhance the candidate's training and facilitate project goals. After obtaining training, experience, and skills through this K23 Award, the candidate will be prepared to pursue funding to conduct a larger randomized controlled trial of an intervention to reduce HIV/STI risk among youth in the foster care system. PUBLIC HEALTH RELEVANCE: This proposal will result in the development of a tailored intervention to reduce the risk of sexually transmitted infections including Human Immunodeficiency Virus (HIV/STI) for adolescents in the foster care system. Youth in foster care have between 2 and 14 times increased odds of several STIs compared with youth in the general population. This application therefore represents an important opportunity to address a priority of Healthy People 2010, the reduction of HIV/STI risk, in an extremely vulnerable population while providing an early career investigator with the tools necessary to launch a productive career in behavioral HIV/STI research.

描述（由申请人提供）：绝大多数寄养青少年在生命早期就遭受过公开的身体虐待、性虐待、长期忽视、父母滥用药物和/或目睹过人际暴力。这些暴露可能会导致与早期照顾者的极度混乱或无序的依恋，这可能会极大地影响他们在以后的生活中与其他人的关系，包括性伴侣、医疗保健提供者和重要的成年导师。这些问题的关系都已被证明会影响性传播感染的风险，包括人类免疫缺陷病毒（HIV/STI）。事实上，与普通人群中的青少年相比，寄养系统中的青少年感染性传播感染的风险要高 2 至 14 倍。该候选人的长期目标是针对寄养青少年的需求，制定增强的行为干预措施，以减少艾滋病毒/性传播感染。干预措施的制定将以成人依恋理论为指导，特别是了解依恋风格（例如，回避型、焦虑型或安全型）如何影响浪漫/性、医疗保健和指导关系，从而影响艾滋病毒/性传播感染风险。为了实现这一目标，候选人将进行教学和体验式培训，以提高三个特定领域的知识和技能：1）评估艾滋病毒/性传播感染行为研究中常用的中介关系的技术，2）成人依恋理论的应用，包括使用该理论旨在改善寄养青少年中的艾滋病毒/性传播感染预防工作，以及 3) 与有早期不良接触史的青少年的艾滋病毒/性传播感染预防研究相关的社区干预开发技术。候选人已经确定了两位在艾滋病毒/性传播感染研究（简·西蒙尼博士）和涉及儿童福利系统青年的研究（马克·考特尼博士）方面具有互补专业知识的导师。额外的指导将由在中介分析技术、成人依恋理论、社区研究、生物伦理学和生物统计学方面具有专业知识的顾问提供，并且还将包括一名在高危青少年人群中进行社区艾滋病毒/性传播感染研究的国家专家。拉尔夫·迪克莱门特博士）。本申请中提出的三项相互关联的研究以候选人的培训目标为基础，每项研究都将有助于更好地理解如何应用成人依恋理论来开发增强的干预措施，包括促进健康的关系以降低艾滋病毒/性传播感染的风险寄养系统中的青少年。具体目标是：1.）使用现有的纵向数据集进行定量分析，以了解关系因素（例如，与浪漫伴侣、医疗保健提供者和非父母成人榜样的依恋的影响）如何调节之间的关联寄养青少年的依恋风格和性风险； 2.) 使用定性方法阐明可以直接促进不同依恋风格的寄养青少年健康性行为和艾滋病毒/性传播感染保护行为的因素； 3.) 为寄养青少年制定和试点强化艾滋病毒/性传播感染干预措施，其中包括利用对成人依恋风格的理解来促进健康的浪漫/性关系、医疗保健和指导关系。西雅图儿童医院研究所和华盛顿大学提供的优良研究环境，以及候选人与两个社区合作伙伴（大西雅图基督教青年会青少年中心和华盛顿州卫生和社会服务部）之间牢固的现有关系机构 - 将加强候选人的培训并促进项目目标的实现。通过 K23 奖获得培训、经验和技能后，候选人将准备寻求资金来进行更大规模的随机对照干预试验，以降低寄养系统中青少年的艾滋病毒/性传播感染风险。公共卫生相关性：该提案将导致制定量身定制的干预措施，以降低寄养系统中青少年感染性传播感染的风险，包括人类免疫缺陷病毒 (HIV/STI)。与普通人群中的青少年相比，寄养青少年患多种性传播感染的几率增加了 2 至 14 倍。因此，该应用程序提供了一个重要的机会，可以解决“2010年健康人民”的优先事项，即在极其脆弱的人群中降低艾滋病毒/性传播感染的风险，同时为早期职业调查员提供在行为艾滋病毒/性传播感染研究中开展富有成效的职业生涯所需的工具。。