Improving the Reproductive Health of Families

改善家庭的生殖健康

基本信息

批准号：
9752321
负责人：
JANET S ST LAWRENCE
金额：
$ 49.54万
依托单位：
PORTLAND STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-07-28 至 2023-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9752321
关键词：
Acquired Immunodeficiency Syndrome Address Adolescent Adolescent Risk Behavior Adolescent sexual risk Africa South of the Sahara Age Alcohol or Other Drugs use Attitude Award Behavior Behavior Therapy Behavioral Biological Biological Markers Botswana Child Child Rearing Chlamydia Cognitive Communication Communities Contraceptive methods Cost Analysis Data Developing Countries Education Effectiveness Effectiveness of Interventions Face Family Family health status Feasibility Studies Feedback Female Adolescents Future Gender Gonorrhea HIV Health Healthcare Human Herpesvirus 2 Incidence Informed Consent Intervention Interview Knowledge Measures Mediating Modeling National Institute of Mental Health Outcome Parent-Child Relations Parents Participant Play Positive Reinforcements Practice Management Pregnancy Rate Pregnancy in Adolescence Prevalence Psychometrics Public Health Randomized Controlled Trials Reproductive Health Risk Role Safety Schools Self Efficacy Sex Behavior Sex Education Sexual Development Sexually Transmitted Diseases Strategic Planning Student Dropouts Teenagers Testing Time Violence Youth adolescent health outcomes arm condoms conflict resolution cost effectiveness delay sexual debut design evidence base feasibility trial follow-up gender disparity girls improved income disparities informant intergenerational intimate partner violence longitudinal analysis male parental monitoring peri-urban pilot trial post intervention prevent programs psychosocial recruit reproductive health intervention reproductive health of adolescents satisfaction sex sexual debut sexual predators sexual risk behavior skills social social disparities therapy design treatment arm urban area

项目摘要

Adolescents in Botswana face extraordinary reproductive health challenges. Teen pregnancy forces girls to leave school after which few resume their education. Botswana has the second highest HIV prevalence in the world, with incidence increasing rapidly at ages 15-19, peaking at 40.2% prevalence by ages 30-34. STIs are prevalent despite the availability of free health care. Traditional sex education, provided in now banned village initiation schools, is no longer available and parents are uncomfortable discussing reproductive health within the family. In an earlier R34 award, guided by a Community Advisory Board and Adolescent Advisory Group, we conducted formative interviews, assessed the psychometric adequacy of the proposed measures, and adapted and assessed the feasibility and acceptability of interventions for youth and their parents. We now propose to conduct a 3-arm randomized controlled trial with 500 families, ½ with a male and ½ with a female adolescent age 13-18. Arm 1 (N = 200) will receive the parent intervention “Families Matter 2!” (FM2!) and their adolescent will participate in “Living as a Safer Teen” (LAST). In Arm 2 (N = 200), parents receive FM2! Only and six months later their adolescents will receive LAST allowing us to assess the impact of the parent program alone and potential boost in outcomes when adolescents are also engaged in intervention. Arm 3 (N = 100), the comparison arm, will be the current, widely-delivered program in Botswana. Each adolescent and parent dyad will complete ACASI assessments in English or Setswana at baseline, post-intervention, 6- and 12-month follow-ups on family communication, parenting practices, knowledge of sexual development, and sexual behavior. Youth will also complete psychosocial measures assessing attitudes toward condoms, perceived barriers to sexual safety, attitudes toward transactional sex, acceptance of gender violence, and self-efficacy. Gonorrhea, chlamydia, herpes simplex virus type 2 (HSV2), and human immunodeficiency virus (HIV) will be tested at baseline and 12-month follow-up for adolescents. A pilot trial affirmed the feasibility of recruiting parent(caretaker)/adolescent dyads and retention exceeded 95% for both parents and adolescents. While the pilot trial was underpowered, results suggest that the interventions improved family communication, child management skills, knowledge of sexual development, attitudes toward contraception; lowered tolerance for intergenerational transactional sex and gender violence; and lowered sexual risk behavior of both parents and adolescents in the intervention arm. In addition, youths who were abstinent upon entering the pilot intervention appear to have delayed sexual debut more successfully than the comparison arm. This study addresses the highest priority in Botswana’s current national strategic plan. If the results provide strong evidence of effectiveness, the Ministries of Education, Health, Youth & Culture, National AIDS Coordinating Agency, and the Office of the President have committed to its dissemination throughout Botswana.

博茨瓦纳的青少年面临非凡的生殖健康挑战。青少年怀孕迫使女孩离开此之后，很少有人恢复他们的教育。博茨瓦纳（Botswana）是世界第二高的艾滋病毒患病率 15-19岁的发病率迅速增加，30-34岁的发病率在40.2％的患病率上达到峰值。性病是普遍性的免费医疗保健。如今已禁止的乡村启动学校提供的传统性教育没有可用的时间更长，父母是家庭内部生殖健康的不舒服讨论。在较早的R34中在社区顾问委员会和青少年咨询小组的指导下，我们进行了形成性访谈，评估了拟议措施的心理测量适当性，并适应和评估了可行性和对青年及其父母的干预措施的可接受性。我们现在建议进行3臂随机控制与500个家庭的审判，½男性和½，女性青少年13-18岁。 ARM 1（n = 200）将收到父母干预“家庭很重要2！” （FM2！）及其青少年将参加“以更安全的青少年生活” （最后的）。在第2臂（n = 200）中，父母会收到FM2！只有六个月后，他们的青少年才能获得最后允许我们仅评估父母计划的影响，并在青少年也是进行干预。 ARM 3（n = 100），比较臂，将是当前的宽范围传递程序博茨瓦纳。每个青少年和父母二元组将在基线时完成英语或setswana的ACASI评估，干预后，6个月和12个月的家庭交流，育儿惯例，性知识发展和性行为。青年还将完成评估与会者的心理心理措施避孕套，感知到性安全的障碍，参加交易性行为，接受性别暴力和自我效能。淋病，衣原体，单纯疱疹病毒2型（HSV2）和人类免疫缺陷病毒（HIV）将在基线和12个月的随访中进行青少年测试。试点试验影响了招聘的可行性父母（看守）/青少年二元组和保留率的父母和青少年均超过95％。试点审判结果不足，结果表明干预措施改善了家庭沟通，儿童管理技能，对性发展的知识，参加避孕；代际交易的公差降低性别和性别暴力；并降低了干预部门的父母和青少年的性风险行为。此外，拒绝进入飞行员干预后拒绝的年轻人似乎延迟了性的首次亮相比比较部门成功。这项研究涉及博茨瓦纳当前国家战略的最高优先事项计划。如果结果提供了有效性的有力证据，那么教育，健康，青年和文化部，国家艾滋病协调局和总统办公室已致力于整个博茨瓦纳。