Puerto Rico Cuidalos Parent-adolescent Program
Condition: HIV/AIDS and Infections; Sexually Transmitted Diseases; Pregnancy Prevention
MeSH terms: Acquired Immunodeficiency Syndrome; HIV Infections; Sexually Transmitted Diseases
Study type: Interventional

Summary: 
      Latino adolescents are at high risk for HIV/AIDS, other sexually transmitted infections
      (STIs), and unintended pregnancies. Puerto Rican adolescents, in particular, experience
      disparities in these areas, yet few adolescent and even fewer parent interventions have been
      developed to address these important issues with this underserved population.
      Parent-adolescent programs are an effective approach to reduce adolescent sexual risk
      behavior and associated negative consequences. A web-based parent communication intervention
      provides an opportunity to strengthen and enhance programs that are designed for adolescents
      by providing additional support for safer sex decisions, and to increase parents' access to
      sexual health education programs by decreasing barriers that keep them from participating in
      these interventions (e.g., low cost, can be viewed privately, at parents convenience,
      minimizes competing time with work and family). The purpose of this proposed study is to
      evaluate a brief theoretically informed (i.e., Ecodevelopmental Theory, Theory of Reasoned
      Action/Planned Behavior, Social Cognitive Theory 1-6), culturally appropriate, and
      linguistically tailored web-based parental communication program, Cuídalos ("Take care of
      them"), designed to improve parent-adolescent sexual communication and reduce adolescent
      sexual risk behavior. Recent findings from an NIH funded R21 randomized control trial (RCT)
      testing a brief computer-based version of the Cuídalos program indicated that the program
      increased parent-adolescent general communication and sexual risk communication with English
      and Spanish speaking U.S. Latinos. Further, despite limited or no previous computer use,
      parents reported they liked and learned from the program, and that it was easy to use and
      accessible.
    

Detailed description: 
      In this proposed RCT, and based on recommendations from parents who participated in the
      initial Cuídalos7 intervention trial, the investigators plan to modify the program by: 1)
      increasing the amount of content related to sexual communication (e.g., more case studies and
      interactive activities); 2) adding a module on stigma (towards HIV/AIDS); 3) increasing
      access by moving from a computer-based to a web-based platform; and 4) increasing the
      flexibility in how the program is used (e.g., ability to view the entire program or specific
      modules more than once). In order to examine the efficacy of the program, the investigators
      will recruit 680 parents and one of the participant's adolescents from schools,
      community-based and governmental organizations in Puerto Rico, and will randomly assign
      parents to receive: 1) the Cuídalos intervention; or 2) a web-based health promotion control
      intervention focused on the prevention of diabetes and cardiovascular disease. Parents and
      adolescents will complete measures at pre-intervention and at 3- (parents only), 6-, and 12
      month follow-ups.

      The investigators will address the five following specific aims:

        1. Determine whether the Cuídalos intervention increases parents' comfort with, as well as
           the amount of, general and sexual risk-specific communication with adolescents and
           whether it decreases stigma (towards HIV/AIDS) at 3-,6-, and 12- month follow-ups as
           compared to the general health promotion control intervention.

        2. Determine whether the Cuídalos intervention decreases self-reported adolescent
           intercourse and unprotected intercourse at 6-, and 12- month follow-ups as compared to
           the general health promotion control intervention.

        3. Identify theory-based variables (e.g., attitudes, subjective norms, perceived behavioral
           control, and intentions) that mediate the intervention effects of Cuídalos on parents'
           self-reported comfort with and amount of communication with their adolescents.

        4. Determine whether the effects of the Cuídalos intervention on adolescents sexual
           behavior and parent adolescent communication are moderated by individual (adolescents:
           sexual experience, gender, age, stigma; parents: gender, age, computer access and
           experience, frequency and time engaged in the program), and microsystem (adolescents:
           parent-adolescent communication) factors.

        5. Examine the cost-effectiveness of the web-based Cuídalos intervention on adolescent
           sexual behavior.

      Results from this study will inform the use and efficacy of a web-based Cuídalos program for
      Puerto Rican parents. This study is an innovative and timely effort given the existing
      disparities in sexual health outcomes among Latino youth, the lack of culturally and
      linguistically effective interventions for Latino parents and adolescents, and the absence of
      web-based interventions with Latinos. If the program is efficacious, the web-based format
      will accelerate the translation of this program into public health practice and will be an
      important contribution in supporting adolescent sexual health behaviors.
    

Intervention name(s): Parental Communication intervention; Health promotion control condition
Intervention type(s): Behavioral; Behavioral
Intervention description(s): In this intervention, we focus on providing parents with basic knowledge about pregnancy, HIV/AIDS, and STDs as a basis for effectively communicating with their adolescents. We work to support attitudes and develop skills to facilitate communication in general and specifically sexual communication. Based on our prior work we focus on prevention beliefs, reaction beliefs, and communication efficacy. Importantly, we include a component on HIV/AIDS stigma as we conceptualize this to impact attitudes and communication about sex. We will program the intervention in such a way so that parents will have to view the Cuídalos program sequentially and in its totality before being able to review any content.; In this intervention, we provide a web-based program relying on existing Spanish language web-sites to provide participants with helpful information to prevent significant health problems affecting Puerto Rican adolescents that are related, not to sexual behavior, but to other behaviors. Similar to the experimental condition, we will develop a set of "homework" related to diet and exercise that we will ask parents to complete with their adolescents.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Basic Science
Keywords: Adolescents; Parents; Web-based; Puerto Rico; Latino; Sexual communication; Stigma; Randomized controlled trial; STD; Intercourse; Sexual behavior; HIV/AIDS