This project is a continuation of an ongoing controlled randomized trial evaluation the efficacy of two risk-reduction intervention modules (standard intervention with and without the option of attending support groups) versus enhanced clinical counseling. The standard intervention without support groups, evaluated in a prior study, had a significant impact on subsequent rates of gonorrhea and chlamydia and high-risk behavior. Preliminary results from the ongoing study show significant STD reduction for both interventions, controlling for age, abuse and drug use. The proposed work will extend existing 2-year follow-up to 5 years (annual interviews/exams and semi-annual brief interviews). Because the 2-year retention rate is expected to be 90%, anticipated sample size at 3 years is 706 women. The sample consists of 830 high-risk, Mexican- and African-American women; 54% are <20 years, 80% are ,25, 34% are substance users and 64% have been sexually or physically abused. Broad goals are to determine long-term intervention efficacy; to more fully understand the relationships between clinical outcomes, behavioral strategies, and behavioral measures; and to determine the effects of physical/sexual abuse and substance use on sexual behavior, infection, and intervention efficacy.
Specific aims are to 1) determine psychosocial and situational factors (and combinations) associated with high-risk sexual behavior over time, 2) determine psychodynamic factors (derived primarily from ARRM constructs [the theory we adapted to guide this research]) associated with high-risk behavior over time, 3) determine the effects of various psychosocial and situational factors particularly abuse, on ARRM constructs, 4) determine patterns of sexual behavior and effects modifiers (e.g., douching) that contribute to infection over time; behavioral risk-reduction strategies will be evaluated by determining their impact on infection. 5) assess the utility of various measures of similar behavioral constructs with respect to explaining infection; risk indices incorporating multiple constructs will be developed. 6) evaluated long- term (3-5 years) effects of standard and support-group intervention versus enhanced counseling on ARRM constructs, sexual behavior, health- seeking behavior, and infection with gonorrhea and/or chlamydia. 7) evaluate intervention effects with respect to age, abuse, and substance use. A prospective random design, using repeated measures is employed. Repeated measures analysis of variance and linear and logistic regression are the principal multivariate analysis techniques used.
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