National Institute on Drug Abuse
National Institutes of Health
Workshop on the Development of the Posit HIV/STD-Risk Mini-Questionnaire
Bethesda, MD
July 31, 1997
SUMMARY
Elizabeth Rahdert, Ph.D.
Summary of Meeting:
Although adolescents 12 through 19 years represent less than 1 percent
of the cumulative total reported AIDS cases in the United States, many youths
are at risk of sexually transmitted HIV infection. About 18 percent of reported
AIDS cases involve young adults age 20 to 29 years, but because of the roughly
10 years between HIV seropositivity and onset of AIDS-related symptoms,
it is thought that many of these young adults acquired HIV infection as
teenagers. Other evidence of elevated risk includes the relatively high
rates of other sexually transmitted diseases (STDs). These statistics highlight
the importance of identifying as early as possible adolescents at risk for
HIV infection or other STDs so that early preventive or therapeutic measures
can be taken. Unfortunately, no developmentally appropriate HIV/STD-risk
screen is currently available that can be used by practitioners and researchers
in the wide range of settings in which potentially at-risk adolescents are
or might be seen.
Toward producing an adolescent-appropriate HIV/STD-risk screen, the Problem
Oriented Screening Instrument for Teenagers (POSIT) was chosen to serve
as the prototype for an HIV/STD-risk questionnaire. The POSIT was selected
because it is a validated, reliable 139-item, self-report screening instrument
designed for adolescents and has been shown to have utility in mental and
medical heath care settings, schools and social service agencies, drug treatment
programs, and juvenile justice assessment centers. The POSIT screens for
potential problems in ten functional areas (i.e., drug use/abuse; mental
health; physical health; family relations; peer relations; social skills;
educational status; vocational status; leisure/recreation; aggressive behavior/delinquency),
thus providing clinicians and researchers with a valuable tool for use in
identifying problems potentially in need of preventive, therapeutic or supportive
services. The intention of convening this Workshop was to begin the process
of developing a POSIT-like problem screen for an eleventh functional area,
that being a short, detachable HIV/STD-risk mini-questionnaire that could
be administered and scored with or without administering the POSIT.
To accomplish this goal the Workshop, comprised of researchers and clinicians
with expertise in the area of HIV infection and other STDs in high and low
risk adolescent populations, was held July 31, 1997. The meeting was co-chaired
by Drs. Elizabeth Rahdert and Dorynne Czechowicz, Division of Clinical and
Services Research. Through the Delphi Method (i.e., review, discussion,
and voting), Workshop participants (1) identified over 20 behavioral categories
(e.g., introduction to sex; drug use & sex; forced sex; condom use &
sex) known from research findings and clinical experience to be associated
with risk for HIV/STD exposure in younger (12-15 years) and older (16-19
years) male and female adolescents; (2) created 180 items representing those
behaviors that had been identified as risk for HIV/STD exposure; then (3)
selected from the pool of 180 items 30 that could be formatted like items
on the POSIT. The task that remains for Workshop participants is to carefully
reword items so that each question can elicit the most reliable response.
When the "final" 30-item POSIT HIV/STD-risk screening tool
is produced by the Workshop participants, it will be examined by adolescent
focus groups to improve it's "readability." The refined 30-item
questionnaire will then undergo small scale pilot testing to start the process
of reducing the 30-item version to something like a 15-item POSIT HIV/STD-risk
mini-questionnaire. Pilot testing may be accomplished through support from
administrative supplements to existing projects that already focus on adolescent
subjects. After those developmental steps have been completed, researchers
will be encouraged to submit grant proposals, the primary aim of which will
be to establish the psychometric properties of this (approximately) 15-item
POSIT HIV/STD-risk screen.
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