Over the last quarter century, substantial progress has been made in effecting purposeful behavioral change to reduce HIV/AIDS risk. Nevertheless, specific demographic and socio-geographic sub-groups remain at high risk and substantial challenges in maintaining purposeful behavioral change persist. Among those groups remaining at high risk are adolescents and young adults, persons of color, and individuals residing in transitional and developing countries. Challenges that have continued to confront behavioral risk reduction interventions include: a) waning intervention effects over time;b) changing environmental exposures and responses thereto that occur during adolescence;and c) the resource intensive nature of multiple session behavioral interventions especially in resource poor settings such as developing and transitional countries. This competitive renewal of R01MH069229 will focus on a particularly high risk population (youth of African descent attending Grade 10 in government high schools in The Bahamas, a nation with an HIV sero- prevalence of 3%) and proposes a four-cell, randomized, controlled trial designed to address each of the four challenges outlined above, building upon our ongoing research. During the past 4.5 years in our current funding period, the US-Bahamian research team has been evaluating the Bahamian adaptation of a 10- session adolescent HIV prevention program entitled "Focus on Youth in The Caribbean" (FOYC) and the 1- hour adapted parental monitoring intervention entitled "Caribbean Informed Parents and Children Together" (CImPACT) through a randomized, controlled three-celled trial involving 1360 Grade 6 youth and 1175 of their parents. Beginning at the 6 months follow-up and extending through 24 months follow-up, condom-use, condom-use intention, and relevant perceptions and knowledge were significantly higher among FOYC youth compared to control youth. Despite the efficacy of FOYC, the and 36 (preliminary data) actual rates among both FOYC and control youth are concerningly low (e.g. condom-use rates at 24 months and 36 months was 30% and 40% among FOYC youth and 20% and 25% among controls). Therefore, the Department of Education of The Bahamas and the US-Bahamian Research Team seek to identify an effective intervention that can be delivered to Grade 10 students in The Bahamas. In the research described in this submission, we propose to: a) Recruit 2600 youth (and their parents) from 172 Grade 10 FHLE classrooms over two years from all 7 government high schools in New Providence, The Bahamas;b) Randomly assign at the level of the classroom 2400 youth (and their parents) from 160 classes to one of four intervention conditions: 1) HFLE only (no parent intervention);2) BFOOY only (no parent intervention);3) BFOOY plus ImPACT (delivered to parent-youth dyads with a six month parent booster); or 4) BFOOY plus GFI (delivered to parent-youth dyads with a six month parent booster);c) Randomly assign one of the seven high schools (with ~12 HFLE classes and ~200 students) to a "control school" condition to explore possible class-to-class contamination within schools;d) Assess intervention effects on the entire sample at 6, 12, 18 and 24 months post-intervention (and among parents at 6 and 12 months);and e) Conduct sub-group analyses to explore: i) the impact of interventions received at two critical junctures during adolescence;ii) the effect of being part of a longitudinal trial on risk/protective behaviors;and iii) the extent of intervention contamination if the unit of randomization is the class rather than the school.

Public Health Relevance

The proposed research will allow us to determine the best way to intervene with youth as they enter into the age of greatest HIV risk whether they have or have not had previous exposure to HIV risk reduction efforts. The project will help us to elucidate the role that parents may be able to assume in collaboration with a formal, school-based HIV prevention program to help protect their youth.. This research is both timely and of great global importance addressing many of the key research questions confronting AIDS researchers throughout the world. 1

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Brouwers, Pim
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Wayne State University
Schools of Medicine
United States
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Stanton, Bonita; Li, Xiaoming (2014) A quarter century of HIV prevention intervention efforts among children and adolescents across the globe. Health Psychol Behav Med 2:231-251
Wang, Bo; Stanton, Bonita; Deveaux, Lynette et al. (2014) The impact of parent involvement in an effective adolescent risk reduction intervention on sexual risk communication and adolescent outcomes. AIDS Educ Prev 26:500-20
Dinaj-Koci, Veronica; Lunn, Sonja; Deveaux, Lynette et al. (2014) Adolescent age at time of receipt of one or more sexual risk reduction interventions. J Adolesc Health 55:228-34
Wang, Bo; Deveaux, Lynette; Li, Xiaoming et al. (2014) The impact of youth, family, peer and neighborhood risk factors on developmental trajectories of risk involvement from early through middle adolescence. Soc Sci Med 106:43-52
Wang, Bo; Stanton, Bonita; Li, Xiaoming et al. (2013) The influence of parental monitoring and parent-adolescent communication on Bahamian adolescent risk involvement: a three-year longitudinal examination. Soc Sci Med 97:161-9
Stanton, Bonita; Chen, Xinguang; Koci, Veronica et al. (2012) Effect of a grade 6 HIV risk reduction intervention four years later among students who were and were not enrolled in the study trial. J Adolesc Health 50:243-9
Stanton, Bonita; Kaljee, Linda; Lunn, Sonja et al. (2011) Implementation of effective health innovations and pediatricians. Clin Pediatr (Phila) 50:995-1000
Chen, Xinguang; Lunn, Sonja; Harris, Carole et al. (2010) Modeling early sexual initiation among young adolescents using quantum and continuous behavior change methods: implications for HIV prevention. Nonlinear Dynamics Psychol Life Sci 14:491-509
Chen, X; Stanton, B; Gomez, P et al. (2010) Effects on condom use of an HIV prevention programme 36 months postintervention: a cluster randomized controlled trial among Bahamian youth. Int J STD AIDS 21:622-30
Gong, Jie; Stanton, Bonita; Lunn, Sonja et al. (2009) Effects through 24 months of an HIV/AIDS prevention intervention program based on protection motivation theory among preadolescents in the Bahamas. Pediatrics 123:e917-28

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