Helen Wilson - US grants

DESCRIPTION (provided by applicant): This R03 proposal requests funds to build on a larger longitudinal study with low-income, urban African American (AA) girls seeking outpatient mental health services (G. Donenberg, PI) by exploring the relationship between childhood violence exposure and risky sexual behavior. Underscoring the crucial need to reduce sexual risk-taking in this population, recent CDC estimates indicate that nearly half of all AA adolescent women are infected with a sexually transmitted disease (STD).1 Reflecting this pattern, AA women account for the largest proportion of HIV/AIDS cases among women in the US,2 and the vast majority of infections in AA women occur through heterosexual intercourse.3 Early violence exposure has been linked to risky sexual behavior, and low income, urban AA girls are exposed to high rates of violence.4, 5 Moreover, childhood violence exposure is likely to be prevalent in youth seeking psychiatric treatment since violence exposure is associated with mental health symptoms.6 Thus, high rates of exposure to family and community violence may be a critical factor increasing risk for HIV and other STDs among young women of color in mental health treatment.7 Building on a federally funded study of 12-16 year-old AA girls seeking mental health services and their female caretakers (N=265;G. Donenberg, PI), this small study will: (1) examine links between violence exposure in childhood and risky sexual behavior among 14-18 year old AA girls in mental health treatment;and (2) explore potential explanatory pathways from childhood violence exposure to risky sexual behavior in this population. We will re-contact all families who completed the larger longitudinal study and conduct a comprehensive assessment of lifetime trauma and victimization history (including 7 categories of trauma, age, perpetrator, frequency, and severity). Statistical analyses will employ regression and structural equation modeling, capitalizing on existing data from the larger longitudinal study. Results from this study will inform the design of a larger, prospective study of these relationships and will provide guidance for developing innovative, gender-sensitive, and culturally appropriate programs to reduce rates of HIV and other STDs among young AA women with histories of violence exposure and mental health problems. PUBLIC HEALTH RELEVANCE: Recent estimates from the CDC indicate that nearly 50% of teenage African American girls are infected with sexually transmitted diseases, and African American women account for the largest proportion of HIV/AIDS cases among women in the United States. Early exposure to home and community violence may be a crucial risk factor contributing to the development of risky sexual behavior in low-income, urban African American girls. The proposed project builds on a larger longitudinal study to examine the pathway from childhood violence exposure to risky sexual behavior in a sample of low-income, urban African American girls seeking mental health services and will yield information that can ultimately be used to reduce health compromising sexual behavior in this population.

DESCRIPTION (provided by applicant): Dating violence and unsafe sexual behavior represent major public health concerns that disproportionately affect young African American (AA) women.1-3 This R01 proposal responds to the Research on Teen Dating Violence Program Announcement (PA-09-169) by requesting funds to build on an NIH-funded longitudinal study of AA adolescent women from low-income, urban neighborhoods in Chicago. Consistent with the goals of the program, the proposed etiological research is aimed at providing a better understanding of the precursors and consequences of teen dating violence through use of longitudinal, multivariate analyses to examine pathways from early violence exposure to dating violence and unsafe sexual behavior in late adolescence. AA women ages 18-22 represent the demographic group at highest risk for both intimate partner violence (IPV)1, 4-6 and sexually transmitted infections (STIs).2, 7 Dating violence is a health concern not only because of direct physical and emotional risks, but also due to increased risk of unsafe sexual behavior in violent relationships.8, 9 The specific aims of this project are to: (1) Prospectively examine the pathway from violence exposure to dating violence and unsafe sexual behavior; (2) Examine relationships among dating violence, unsafe sexual behavior, and STIs; (3) Examine romantic relationship characteristics that may explain the pathway from violence exposure to dating violence and unsafe sexual behavior; (4) Examine physiological stress response as a mediator of the pathway from violence exposure to dating violence and unsafe sexual behavior; and (5) Examine psychological mechanisms that may explain the pathway from violence exposure to dating violence and unsafe sexual behavior. Adolescent girls who participated in a 2-year longitudinal study focused on HIV risk behavior (R01 MH65155) and a follow-up assessment of trauma and victimization history (R03 MH086361) will be re-contacted to participate in a new wave of data collection focused on romantic relationships in late adolescence (ages 18-22). To capture the interactive processes that contribute to violence and unsafe sex in romantic relationships, we will also attempt to interview a romantic partner of each young woman and observe a structured interaction between the two. The proposed study will expand upon previous work in a number of innovative ways that include: (1) broadening relationship risk to dating violence; (2) assessing romantic partners; and (3) measuring biological markers of physiological stress response and sexually transmitted infections. Using multiple measures and methods (self report, partner report, observation, official records, and biological markers), we will examine links among early violence exposure, teen dating violence, and unsafe sexual behavior, and we will examine mechanisms that may explain the pathway from early violence exposure to dating violence and unsafe sexual behavior in late adolescent relationships. These findings can be used to develop culturally tailored, gender sensitive interventions to foster healthy romantic and sexual relationships in young African American women with histories of violence exposure. PUBLIC HEALTH RELEVANCE: Dating violence and unsafe sex represent major public health concerns that take place within romantic relationships and disproportionately affect young, urban African American (AA) women. The proposed study will examine pathways from early violence exposure to dating violence and unsafe sex in a sample of low- income, urban AA women at ages 18-22. Results will yield information that can be used to foster healthy dating relationships in late adolescent urban AA women.