Texas Tech University Health Science Center, School of Nursing, Lubbock, TX, USA.
Int J Nurs Stud. 2012 Feb;49(2):138-50. doi: 10.1016/j.ijnurstu.2011.08.010. Epub 2011 Sep 21.
Ethnic minority adolescent women with a history of sexual or physical abuse and sexually transmitted infections represent a vulnerable population at risk for HIV. Community-based interventions for behavior modification and subsequent risk reduction have not been effective among these women.
To evaluate the effects of a theory-based (AIDS Risk Reduction Model) cognitive behavioral intervention model versus enhanced counseling for abused ethnic minority adolescent women on infection with sexually transmitted infection at 6 and 12 months follow-up.
Controlled randomized trial with longitudinal follow-up.
Southwestern United States, Metropolitan community-based clinic.
Mexican-and-African American adolescent women aged 14-18 years with a history of abuse or sexually transmitted infection seeking sexual health care.
Extensive preliminary study for intervention development was conducted including individual interviews, focus groups, secondary data analysis, pre-testing and feasibility testing for modification of an evidence-based intervention prior to testing in the randomized controlled trial. Following informed consents for participation in the trial, detailed interviews concerning demographics, abuse history, sexual risk behavior, sexual health and physical exams were obtained. Randomization into either control or intervention groups was conducted. Intervention participants received workshop, support group and individual counseling sessions. Control participants received abuse and enhanced clinical counseling. Follow-up including detailed interview and physical exam was conducted at 6 and 12 months following study entry to assess for infection. Intention to treat analysis was conducted to assess intervention effects using chi-square and multiple regression models.
409 Mexican-(n=342) and African-(n=67) American adolescent women with abuse and sexually transmitted infection histories were enrolled; 90% intervention group attendance; longitudinal follow-up at 6 (93%) and 12 (94%) months. Intervention (n=199) versus control (n=210) group participants experienced fewer infections at 0-6 (0% versus 6.6%, p=.001), 6-12 (3.6% versus 7.8%, p=.005, CI 95% lower-upper .001-.386) and 0-12 (4.8% versus 13.2%, p=.002, CI 95% lower-upper, .002-.531) month intervals.
A cognitive behavioral intervention specifically designed for ethnic minority adolescent women with a history of abuse and sexually transmitted infection was effective for prevention of infection. These results provide evidence for development of evidence-based interventions for sexually transmitted infection/HIV. Implications include translation to community-clinic-based settings for prevention of adverse outcomes regarding sexual health of adolescent women.
有性虐待或身体虐待和性传播感染史的少数民族青少年女性是艾滋病毒感染的高危人群。针对这些女性的行为改变和随后降低风险的基于社区的干预措施并未取得成效。
评估基于理论（艾滋病风险降低模型）的认知行为干预模型对受虐待的少数民族青少年女性的影响，与增强咨询相比，该模型对 6 个月和 12 个月随访时的性传播感染的影响。
有纵向随访的对照随机试验。
美国西南部，都市区社区诊所。
14-18 岁有虐待或性传播感染史的墨西哥裔和非裔美国青少年女性，寻求性健康护理。
在进行随机对照试验之前，进行了广泛的干预措施开发的初步研究，包括个人访谈、焦点小组、二次数据分析、预测试和基于证据的干预措施的修改可行性测试。在获得参与试验的知情同意后，进行了详细的访谈，内容涉及人口统计学、虐待史、性风险行为、性健康和体检。参与者被随机分配到对照组或干预组。干预组参与者参加了研讨会、支持小组和个别咨询会议。对照组参与者接受了虐待和增强型临床咨询。在研究开始后的 6 个月和 12 个月进行随访，包括详细访谈和体检，以评估感染情况。采用卡方检验和多元回归模型进行意向治疗分析，以评估干预效果。
共有 409 名有虐待和性传播感染史的墨西哥裔（n=342）和非裔（n=67）美国青少年女性入组；干预组 90%的出勤率；6 个月（93%）和 12 个月（94%）的纵向随访。与对照组（n=210）相比，干预组（n=199）参与者在 0-6 个月（0%对 6.6%，p=.001）、6-12 个月（3.6%对 7.8%，p=.005，CI 95%下限-上限.001-.386）和 0-12 个月（4.8%对 13.2%，p=.002，CI 95%下限-上限.002-.531）的间隔时间内感染人数较少。
专为有虐待和性传播感染史的少数民族青少年女性设计的认知行为干预措施对预防感染有效。这些结果为性传播感染/艾滋病毒的基于证据的干预措施的开发提供了证据。其意义包括将其转化为社区诊所环境，以预防青少年女性性健康不良后果。
