This is a resubmission of R34 MH082644-01, "Testing a Sexual Risk Event History Calendar Intervention with Adolescents." Unprotected sexual activity among adolescents poses significant risk for HIV infection. While there have been a number of behavioral interventions related to reducing sexual risk behaviors, few interventions have been developed at the provider level, have focused on sexual risk assessment and communication during a health care encounter, or have addressed the interrelationship of sexual risk behaviors with other risk behaviors and life events. The broad objective of this study is to evaluate the effect of EHC clinical assessment on sexually active female and male adolescents'cognitive appraisal of risk, sexual risk behavior and intentions, and quality of communication with providers. The EHC provides more complete history information which allows the provider to tailor communication and develop a more effective treatment plan with the adolescent;and raises the adolescent's cognitive awareness of the interconnectedness of risk behaviors, the context in which their behaviors occur, and the outcome of their decisions. In the proposed randomized controlled trial (RCT), 15-19 year old sexually active adolescents from diverse racial and ethnic populations (n=184) will be recruited from 4 school-based health centers (SBHC) and randomly assigned to (a) an EHC intervention or (b) a Guidelines for Adolescent Preventive Services (GAPS) history control condition. During one clinic visit, adolescents in the EHC group will complete a self-administered EHC that will be used to facilitate provider-patient communication;adolescents assigned to the control group will complete a self administered GAPS history. The EHC or GAPS will be used by health care providers (nurse practitioners or physicians) (n=8) during the clinic visit. Providers will be randomly assigned and trained on either the EHC or GAPS condition to identify risks and tailor communication about the adolescent's risk behavior history with the adolescents. Adolescent survey data will be collected in both groups immediately pre- and post-intervention, and at 3, 6, and 12-months. Measures include sexual risk behaviors, intentions, attitudes, and perceptions, and communication with providers (quality and processes). Outcome measures include adolescent sexual intercourse and condom use. Providers'pre and post-intervention surveys, chart documentation, and interview data will be collected. RM-ANOVA, chi-square, t-test, regression, and qualitative analysis will be performed to address 3 Aims: (1) Does EHC intervention reduce self-reported sexual risk behavior and intentions compared with the control condition? (2) Does adolescent cognitive appraisal and perception of communication with providers mediate effects of the EHC intervention on risk behavior and intentions compared to the control? (3) What are providers'perceptions and documentation of clinical use of the EHC and GAPS histories? This study is critical for developing provider interventions designed to decrease adolescent sexual risk behavior.
Research on a teen history calendar method that providers can use to help teens to think and talk about their history of sexual activity is needed. If providers use this teen history calendar they should be better able to help reduce teen sexual risk behavior.
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