Improving the Reproductive Health of Families

改善家庭的生殖健康

基本信息

批准号：
9920731
负责人：
JANET S ST LAWRENCE
金额：
$ 48.78万
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/9920731
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 Comparison arm 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着巨大的生殖健康挑战。青少年怀孕迫使女孩离开。博茨瓦纳是世界上艾滋病毒感染率第二高的国家。尽管性传播感染在 15-19 岁年龄段发病率迅速上升，但在 30-34 岁年龄段发病率达到峰值 40.2%。现已被禁止的乡村启蒙学校不提供免费医疗服务。更早的 R34 中，家长们不愿意在家庭中讨论生殖健康。在社区咨询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充分性，并调整和评估了可行性和我们现在建议进行三组随机对照研究。试验涉及 500 个家庭，其中 1/2 个家庭为 13-18 岁的男性青少年，1/2 个家庭为女性，第 1 组（N = 200）将获得该奖励。家长干预“家庭很重要 2！”（FM2！），他们的青少年将参加“生活更安全” （最后）。在第 2 组（N = 200）中，父母仅接受 FM2！六个月后，他们的青少年将接受最后一次。使我们能够单独评估家长计划的影响，以及当青少年也参与其中时对结果的潜在促进作用。第 3 组（N = 100），即比较组，将是当前广泛实施的计划。博茨瓦纳每个青少年和家长都将在基线时用英语或茨瓦纳语完成 ACASI 评估，干预后，针对家庭沟通、养育方式、性知识等进行 6 个月和 12 个月的随访青少年还将完成评估对性行为的态度的心理社会测量。安全套、对性安全的感知障碍、对性交易的态度、对性别暴力的接受程度，以及淋病、衣原体、2 型单纯疱疹病毒 (HSV2) 和人类免疫缺陷病毒 (HIV)。将对青少年进行基线测试和 12 个月随访，试点试验证实了招募的可行性。试点试验期间，父母（看护者）/青少年二人组的保留率均超过 95%。动力不足，结果表明干预措施改善了家庭沟通、儿童管理技能、对性发育的了解、对避孕的态度；对代际交易的容忍度降低；性和性别暴力；并降低干预组中父母和青少年的性风险行为。此外，在进入试点干预措施时禁欲的青少年似乎更推迟了首次性行为这项研究解决了博茨瓦纳当前国家战略的最高优先事项。如果结果提供了有效的有力证据，教育部、卫生部、青年和文化部，国家艾滋病协调机构和总统办公室已承诺在全国范围内传播该信息博茨瓦纳。