The long term objective of this study is to contribute to our understanding of the influence of the family on adolescent sexuality, in particular, delay of sexual intercourse, acquisition of information about HIV/AIDS, and the use of HIV risk-reduction practices. These objectives are in concert with the goals of the Department of Health and Human Services initiative entitled """"""""Healthy People 2000"""""""".
The specific aims of the proposed study are to (a) develop and test two interventions designed to promote sexual abstinence and the use of HIV risk-reduction practices among adolescents and to enhance the mothers role in promoting sexual abstinence and HIV prevention behaviors among their adolescents and (b) to compare the efficacy of a social cognitive HIV prevention intervention to a problem behavior intervention, and c) to test the mediators of abstinence for each intervention. The Boys and Girls Clubs of Metro Atlanta (B&G Clubs) will serve as the sites for this study. A nested cohort design will be used with sites other than individuals randomly assigned to one of three experimental conditions with participants nested within sites. Adolescent and mother participants will first complete a baseline interview, and then will be assigned together to one of three conditions: Condition 1 (Comparison) consists of a 1-hour HIV prevention video presentation with a question and answer session. Condition 2 (Social Cognitive Treatment) consists of a social cognitive HIV prevention intervention in which abstinence is promoted by enhancing self-efficacy, positive outcome expectancies, and mother-adolescent communication about sex. Condition 3 (Problem Behavior Treatment) consists of a problem behavior intervention in which abstinence is promoted through enhancement of self-concept, racial identity, future time perspective, and mother-adolescent interaction and reduction of stress. Follow-up interviews will be conducted at 4, 12, and 24 months. Participants will be adolescents ages 11-14 years who are members of the B&G Clubs and their mothers (or female guardians). The total time to recruit participants and conduct interventions will be 18 months. With the effects of intracluster correlations and attrition incorporated into the sample size calculations, we will assign 213 adolescents and their mothers to each condition (639 adolescents + 639 mothers =1,278 total participants). With a 20% attrition rate over 24 months, we expect 170 mothers and 170 adolescents to complete the study. To test the primary hypothesis that a greater proportion of the non sexually active adolescents at baseline who are exposed to the interventions will be more likely to remain abstinent at posttestings than those in the comparison group, we will use a mixed model regression program (SAS Proc MIXED). To determine if the effects of the interventions are mediated by a different set of variables for each intervention, we will use structural equation modeling.
