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 Project Title
Strengthening
Today's Youth Life Experience (STYLE)
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Investigators:
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Larry Brown, MD, PI; Ralph DiClemente, PhD; Geri
Donenberg, Co-PI; Celia Lescano, PhD, Co-I; Richard Crosby,
PhD, Co-I; Cami McBride, PhD, Co-I
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Key Personnel (Chicago):
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Charu Thakral, Ph.D.; Gloria
Coleman, MA; Emily Hasselquist, BA
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Funding Sources:
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National Institute of Mental Health
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Collaborators:
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Linden Oaks Hospital; Riveredge Hospital; Hartgrove Hospital; Alexian Brothers
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Adolescents
in psychiatric care are at risk for HIV because of sexual and drug
use behavior initiated during this developmental period and because
of significant cognitive and emotional impairments that hinder their
decision making (Brown et al., 1997; Donenberg & Pao, 2003).
Teens with psychiatric disorders are twice as likely to be sexually
active, twice as likely to report having intercourse without condoms,
and more than twice as likely to use intravenous (IV) drugs compared
to adolescents in public schools (DiClemente & Ponton, 1993).
Youths in outpatient psychiatric care also engage in high rates of
unprotected sex, sex while using drugs and alcohol, and self-cutting
behaviors (Donenberg et al., 2001). HIV prevention programs for teens
that include caregivers show reduced risk behavior, in part because
caregivers can reinforce
prevention messages learned in the intervention. Because families are
already involved in the mental health service system, they may be
particularly receptive to HIV prevention programs delivered through
outpatient clinics.
Project STYLE is the first multi-site (Providence,
Rhode Island; Atlanta,
Georgia; Chicago,
Illinois) HIV prevention program
designed specifically for parents and youths with significant mental
health disorders. The specific aim of the study is to evaluate the
efficacy of a family-focused HIV-prevention program and an
adolescent-only HIV-prevention program, relative to a health
promotion control group, in increasing safe sex behavior and reducing
incidents of STDs across a 12-month period. Each site will enroll 250
parents and adolescents over three years for a total sample of 750
families. Teens are 13 – 18-years old and are recruited from
psychiatric hospitals and outpatient mental health centers.
Differences across sites provide unique opportunities to reach
diverse youths with a range of psychiatric problems. Project STYLE is
a 3-arm randomized controlled trial that will compare the effects of
adolescent HIV prevention versus general health promotion on the
risky sexual behavior and substance use among youths with psychiatric
disorders. The HIV-prevention arms address parent-teen communication,
parental monitoring and assertive communication with partners and
peers about safe sex behaviors. The control arm focuses on promotion
of healthy living through proper nutrition, exercise and self-care.
Each arm is delivered as a one-day 7-hour workshop by two trained
facilitators. Approximately 24 families are invited to participate in
a single workshop, with eight youths randomly assigned to each
condition. Two weeks after the workshop, the facilitators meet
individually with each family for a one-hour “check-up” to evaluate
their reaction to the intervention and to assess whether they carried
out the homework assigned at the end of the workshop. Three months
after the full day workshop, adolescents and parents return for a
3-hour group booster session to review and practice material
introduced at the workshop and to problem-solve barriers to using the
skills that were taught. Youths and parents participate in four
assessments over the course of the study: Baseline, 3-, 6-, and 12
months after the workshop. Data include self-report questionnaires,
structured clinical interviews, behavioral observations, and
biological markers at baseline and 12 months (i.e., urine screening
for Sexually Transmitted Infections). Parents and teens are
compensated at each assessment period.
Summary
of Research Findings
Published Articles
Lescano, C., Brown, L.,
DiClemente, R., Donenberg, G., Barve, C., Crosby, R., Hadley, W.,
Johnson, R., Lang, D., & McBride, C. (July, 2003). Family program
for youth with psychiatric disorders. Presented at the Annual Meeting
of the American Academy of Child
and Adolescent Psychiatry, Miami, Florida.
Donenberg, G. (2004, July).
Parents enhancing HIV prevention among adolescents. Invited paper at
the annual NIMH Research Conference on the Role of Families in
Preventing and Adapting to HIV/AIDS, Atlanta, GA.
McBride, C.K., Nappi, C.M.,
Barve, C., & Donenberg, G.R. (July, 2004). General and sexual
communication between parents and adolescents and between adolescent
couples. Presented at the annual NIMH Research Conference on the Role
of Families in Preventing and Adapting to HIV/AIDS, Atlanta, GA.
Barve, C., Nappi, C., Hall,
C., Donenberg, G. & Project STYLE (July, 2004).Does parent’s
level of psychological functioning matter: Implications for
family-focused HIV-prevention programs. Presented at the annual NIMH
Research Conference on the Role of Families in Preventing and
Adapting to HIV/AIDS, Atlanta, GA.
Coleman, G., Brake, A.,
Nappi, C.M., Donenberg, G., & Project STYLE (July, 2004).
Recruitment of families of troubled youth to an HIV prevention
intervention study: Key strategies and lessons learned. Presented at
the annual NIMH Research Conference on the Role of Families in
Preventing and Adapting to HIV/AIDS, Atlanta, GA.
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