The goal of this study is to implement and to evaluate the effectiveness of a prevention program designed to delay the initiation of sexual activity and/or to eliminate/reduce HIV-related risk behaviors among adolescents with high-risk profiles: psychiatrically disturbed Latina adolescent girls living in a major AIDS epicenter. A central question in this AIDS prevention program is whether mothers can enhance the effectiveness of the program. Two hundred forty girls ages 13-18 enrolled in the Child Psychiatry Outpatient Clinic at Columbia Presbyterian Medical Center will receive brief, standard psychiatric treatment and be randomly assigned to one of three conditions for receiving an intensive HIV prevention program: Adolescent Alone; 2) Adolescent-Mother Intervention; or 3) No-Intervention Control Condition. Based on a social action model, this project considers HIV in the context of reproductive health and health promotion, rather than a disease prevention model, considers the potential role that the mother can play to help shape her daughter's skills to protect herself and serve as a source of social rewards for effective problem solving, and includes behavioral, emotional and contextual determinants of risk behavior in addition to cognitive-perceptual factors. The Adolescent Alone and the Adolescent-Mother Conditions are comprised to two modules: 1) a Family Life Module aimed at enhancing the benefits for self-protective health actions, self-regulatory skills, and identifying the contextual factors that place the adolescent at risk, particularly when adolescents are depressed and anxious or using alcohol and drugs. This module will be comprised of four 6-hour workshops. 2) A Maintenance Module that reinforces maintenance of behavior change delivered during two 6-hour workshops. The relative effectiveness of the Adolescent Alone and the Adolescent-Mother Intervention Conditions will be evaluated by changes in HIV sexual risk behaviors, non-HIV risk acts, and positive health practices over two years. Effectiveness will also be examined as a function of background factors: 1) the adolescents' age, acculturation, and depression; and 2) mother's acculturation and depression. The mediating factors that will be assessed are: 1) the adolescent's acquisition of skills, attitudes, and norms taught in the intervention; and 2) the mother's comfort with daughter's sexuality and mother-daughter communication regarding sexuality.
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