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Enhanced Intervention to Improve Adolescent Outcomes: A Clinical Trial

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? DESCRIPTION (provided by applicant): Limited access to care is a major contributor to sexually transmitted infections (STIs), human immunodeficiency virus (HIV) infection, and unintended pregnancy for U.S. adolescents and contributes to significant health disparities, including rates of STIs that are 6-7 times higher for uninsured youths than for insured youths. Racial/ethnic disparities also exist, with African American and Hispanic adolescents evidencing pregnancy rates that are 4 times higher than White youths. The emergency department (ED) represents an important but underutilized location for reaching large numbers of sexually at-risk adolescents with limited access to evidence-based care and there is growing support for use of the ED to improve adolescent sexual health outcomes. Because few proven interventions are available in the ED to motivate youth to safer sexual behavior and provide health services (e.g., STI testing, condoms), novel interventions are needed. Dr. Miller, a pediatric emergency medicine physician and the candidate for this Career Development Award, is committed to conducting patient-oriented behavioral research to improve adolescent health outcomes, focusing on underserved communities. Together with a strong multi-disciplinary mentorship team, Dr. Miller has created a four-year career development plan which includes structured mentoring, completion of a Master of Science in Clinical Research, and focused training in the use of health behavior change theories to develop multi-level interventions, research methods and statistical analyses for behavioral intervention trials, effective counseling strategies for health behavior change, health care system and payment models, and responsible conduct of research. Dr. Miller's training activities will be complemented by an innovative project that will facilitate practical application of these new skills. The goal of the project is to enhance and tes a previously piloted ED SexHealth intervention that uses a dedicated health educator to provide risk reduction counseling, point-of care health services, and referral for ongoing care. Following intervention refinement, Dr. Miller will conduct a randomized trial of the enhanced intervention versus a standard information arm to determine the effect size of rates of health service uptake and enhanced intervention feasibility. We hypothesize that the intervention will result in higher health service uptake and increased condom use versus a standard information arm. The rationale is that it will produce the first controlled data on an intervention designed to improve adolescent sexual health outcomes using a novel and effective method of delivering care. We expect to use these critical effect size estimates to inform the design of a larger clinical trial o evaluate efficacy. Dr. Miller's training efforts will culminate in the submission of an R01 proposa to fund this trial. This training and research plan are consistent with the mission of the National Institutes of Health and the National Institute of Child Health and Human Development, the Healthy People 2020 objectives from the United States Department of Health and Human Services, and the 2009 Academic Emergency Medicine consensus conference.
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