title: Comparison of a theory-based (AIDS Risk Reduction Model) cognitive behavioral intervention versus enhanced counseling for abused ethnic minority adolescent women on infection with sexually transmitted infection: results of a randomized controlled trial.
abstract: BACKGROUND
  Ethnic minority adolescent women with a history of sexual or physical abuse and sexually transmitted infections represent a vulnerable population at risk for HIV. Community-based interventions for behavior modification and subsequent risk reduction have not been effective among these women.
  
  
  OBJECTIVE
  To evaluate the effects of a theory-based (AIDS Risk Reduction Model) cognitive behavioral intervention model versus enhanced counseling for abused ethnic minority adolescent women on infection with sexually transmitted infection at 6 and 12 months follow-up.
  
  
  METHODS
  Controlled randomized trial with longitudinal follow-up.
  
  
  METHODS
  Southwestern United States, Metropolitan community-based clinic.
  
  
  METHODS
  Mexican-and-African American adolescent women aged 14-18 years with a history of abuse or sexually transmitted infection seeking sexual health care.
  
  
  METHODS
  Extensive preliminary study for intervention development was conducted including individual interviews, focus groups, secondary data analysis, pre-testing and feasibility testing for modification of an evidence-based intervention prior to testing in the randomized controlled trial. Following informed consents for participation in the trial, detailed interviews concerning demographics, abuse history, sexual risk behavior, sexual health and physical exams were obtained. Randomization into either control or intervention groups was conducted. Intervention participants received workshop, support group and individual counseling sessions. Control participants received abuse and enhanced clinical counseling. Follow-up including detailed interview and physical exam was conducted at 6 and 12 months following study entry to assess for infection. Intention to treat analysis was conducted to assess intervention effects using chi-square and multiple regression models.
  
  
  RESULTS
  409 Mexican-(n=342) and African-(n=67) American adolescent women with abuse and sexually transmitted infection histories were enrolled; 90% intervention group attendance; longitudinal follow-up at 6 (93%) and 12 (94%) months. Intervention (n=199) versus control (n=210) group participants experienced fewer infections at 0-6 (0% versus 6.6%, p=.001), 6-12 (3.6% versus 7.8%, p=.005, CI 95% lower-upper .001-.386) and 0-12 (4.8% versus 13.2%, p=.002, CI 95% lower-upper, .002-.531) month intervals.
  
  
  CONCLUSIONS
  A cognitive behavioral intervention specifically designed for ethnic minority adolescent women with a history of abuse and sexually transmitted infection was effective for prevention of infection. These results provide evidence for development of evidence-based interventions for sexually transmitted infection/HIV. Implications include translation to community-clinic-based settings for prevention of adverse outcomes regarding sexual health of adolescent women.
authors.affiliation: Texas Tech University Health Science Center, School of Nursing, Lubbock, TX, USA. jane.dimmitt-champion@ttuhsc.edu
authors.forename: Jane Dimmitt
authors.initials: JD
authors.lastname: Champion
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Collins
mesh_terms: D000293:Adolescent; D001741:Black or African American; D002650:Child Abuse, Sexual / Q000208:ethnology / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000208:ethnology / Q000517:prevention & control*; D006801:Humans; D017058:Mexican Americans; D015999:Multivariate Analysis; D040242:Risk Reduction Behavior; D012749:Sexually Transmitted Diseases / Q000208:ethnology / Q000517:prevention & control; D015206:Southwestern United States