Brown Larry K, Whiteley Laura, Houck Christopher D, Craker Lacey K, Lowery Ashley, Beausoleil Nancy, Donenberg Geri
Rhode Island Hospital in Providence, RI; Warren Alpert Medical School, Brown University, Providence.
Rhode Island Hospital in Providence, RI; Warren Alpert Medical School, Brown University, Providence.
J Am Acad Child Adolesc Psychiatry. 2017 Jun;56(6):524-531. doi: 10.1016/j.jaac.2017.03.010. Epub 2017 Mar 31.
Adolescents in alternative schools for behavioral and emotional problems have an earlier sexual onset and higher rates of sexual risk than their peers. They also often have difficulty managing strong emotions, which can impair sexual decision making. Human immunodeficiency virus (HIV) prevention programs for these adolescents may be most effective if skills for coping with strong emotions during sexual situations are included.
This article reports the 6-month outcomes of a three-arm randomized controlled trial comparing an HIV prevention intervention with affect management (AM) to a standard, skills-based HIV prevention intervention (SB), and a general health promotion intervention (HP). HP was similar to a general health class, and SB was based on previous effective HIV prevention programs used with community adolescents, whereas AM included affect management skills in addition to effective HIV prevention skills. Youth (N = 377) in two US cities were 13 to 19 years of age and attending alternative schools for behavioral and emotional problems.
Multiple logistic regression analyses, adjusted for the baseline scores, age, and gender, found that adolescents in AM were significantly less likely to report being sexually active at follow-up (80% versus 91%, adjusted odds ratio = 0.28, 95% CI = 0.08-0.96) and more consistently using condoms than those in HP at follow-up (62%, versus 39%, adjusted odds ratio = 3.42, CI = 1.10-10.63).
Affect management techniques tested in this project, focused on sexual situations, are similar to those that are used in dialectical behavioral therapy (DBT) and in clinical practice. These data suggest that these techniques might decrease risk behaviors and improve the health of adolescents with emotional/behavioral problems. Clinical trial registration information-Therapeutic Schools: Affect Management and HIV Prevention; http://clinicaltrials.gov/; NCT00500487.
在针对行为和情绪问题的替代学校就读的青少年比同龄人更早开始性行为，且性风险发生率更高。他们在管理强烈情绪方面也常常存在困难，这可能会损害性决策能力。如果在针对这些青少年的艾滋病毒预防项目中纳入在性情境中应对强烈情绪的技能，可能会最为有效。
本文报告了一项三臂随机对照试验的6个月结果，该试验将一项包含情感管理（AM）的艾滋病毒预防干预措施与一项标准的、基于技能的艾滋病毒预防干预措施（SB）以及一项一般健康促进干预措施（HP）进行了比较。HP类似于普通健康课程，SB基于先前用于社区青少年的有效艾滋病毒预防项目，而AM除了有效的艾滋病毒预防技能外还包括情感管理技能。美国两个城市的13至19岁青少年（N = 377）就读于针对行为和情绪问题的替代学校。
在对基线分数、年龄和性别进行调整后的多项逻辑回归分析发现，与HP组相比，AM组的青少年在随访时报告有性行为的可能性显著更低（80%对91%，调整后的优势比 = 0.28，95%置信区间 = 0.08 - 0.96），并且在随访时比HP组更持续地使用避孕套（62%对39%，调整后的优势比 = 3.42，置信区间 = 1.10 - 10.63）。
本项目中测试的、专注于性情境的情感管理技术与辩证行为疗法（DBT）及临床实践中使用的技术相似。这些数据表明，这些技术可能会减少有情绪/行为问题的青少年的风险行为并改善其健康状况。临床试验注册信息 - 治疗学校：情感管理与艾滋病毒预防；http://clinicaltrials.gov/；NCT00500487。
