Alabama STI surveillance reports reveal rates of chlamydia, syphilis, and gonorrhea among African American (AA) girl increase more than 1000% between age groups 10 to 14 and 15 to 19, suggesting increase vulnerability among the 15 to 19 age group for contracting HIV/AIDS. The high incidence of STIs among AA adolescent girls aged 15 to 19 in Alabama is an indication that current sexual risk reduction programs have resulted in very little change in sexual risk-taking behaviors. With the rapidly increasing HIV epidemic among AA women in the South, there is an urgent need for HIV risk reduction interventions that target AA adolescent girls. It is imperative that these interventions target girls prior to the onset of high-risk sexual behavior, which according to the Alabama STI surveillance reports would be those females age 14 and younger. The purpose of the proposed research is to modify/extend an evidence-based HIV risk reduction intervention (EBI) protocol to be culturally relevant and developmentally appropriate for use with AA adolescent girls aged 12 to 14. Formative qualitative research using individual interviews and focus groups will be conducted to identify developmental and socio-contextual factors that influence the sexual decision-making processes of AA adolescent girls. The research plan will be carried out in two stages.
Specific aims for Stage 1: 1) explore descriptions of factors that influence decisions about initiating or abstaining from sexual activity;2) explore perceptions of risks/benefits of engaging in or abstaining from sexual activity;3) explore perceptions of ability to delay sexual debut;and 4) explore perceptions of ability to negotiate condom use.
Specific aims for Stage 2: 5) identify themes and concepts associated with sexual decision-making processes of AA adolescent girls;6) compare identified themes and concepts to the core elements of EBIs designed for AA adolescents;7) integrate findings to inform the modification/extension of an EBI protocol;and 8) assess the relevance and acceptability of the modified/extended intervention protocol to the target population. In Stage 1, 30 girls will be recruited to participate in individual interviews to generate data about the developmental and socio-contextual factors that influence their sexual decision-making processes. An additional 40 girls will be recruited to participate in focus groups to validate content identified in individual interviews. In Stage 2, the findings from Stage 1 will be used to inform the modification/extension of an EBI protocol, which will be validated through focus group discussions with the target population. Verbatim transcripts of audiotapes from interviews and focus groups, observation notes, and demographic data will be the primary data for analysis. Content analysis will be used in analysis and interpretation of the data. The qualitative research software, QSR N-Vivo(R), will be used in coding and sorting data into thematic categories. Descriptive statistical analyses will be conducted using SPSS version 16.0 to analyze demographic data. The evidence-based intervention protocol will be modified/extended based on application of the findings within a framework for modification of evidence-based interventions. The proposed research career development plan is designed to provide additional training in qualitative research methods, cognitive development, behavioral science research methods and theory, and intervention development. The knowledge and skills acquired through this additional training are essential for 1) conducting exploratory qualitative, descriptive research to identify developmental, socio-contextual and personal factors that influence the sexual decision-making process of African American adolescent girls, and 2) developing a culturally relevant, and developmentally appropriate HIV risk reduction intervention protocol. The K01 award period will culminate in a R21 or R01 application to pilot test the modified intervention protocol developed under the K01 Career Development Award. Dr. Childs'long-term career goal is to become a funded independent investigator and recognized leader in the field of adolescent sexual decision-making with expertise in development of interventions that are culturally relevant and developmentally appropriate.

Public Health Relevance

Alabama STI surveillance reports showed rates of chlamydia, syphilis, and gonorrhea among African American (AA) girls increase more than 1000% between age groups 10 to 14 and 15 to 19 age groups. The high incidence of STI suggests increasing vulnerability for contracting HIV/AIDS. The Southern United States has been underrepresented in HIV risk reduction intervention studies. With a growing HIV epidemic in the Southern part of the United States, it is imperative to develop HIV risk reduction programs for African American adolescent girls prior to sexual debut or onset of high-risk sexual behavior.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Scientist Development Award - Research & Training (K01)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Hardy, Lynda R
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University of Alabama Birmingham
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Schools of Nursing
United States
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Childs, Gwendolyn D; Knight, Candace; White, Reashanda (2015) Never-pregnant African American adolescent girls' perceptions of adolescent pregnancy. J Pediatr Nurs 30:310-20
Childs, Gwendolyn D; White, Reashanda; Hataway, Connie et al. (2012) Early adolescent African American girls' perceptions of virginity and romantic relationships. Nursing (Auckl) 2012:55-65