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标题：Effect of Economic Assets on Sexual Risk-Taking Intentions Among Orphaned Adolescents in Uganda
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作者：Fred M. Ssewamala ; Chang-Keun Han ; Torsten B. Neilands 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2010
卷号：100
期号：3
页码：483-488
DOI：10.2105/AJPH.2008.158840
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined the effect of economic assets on sexual risk-taking intentions among school-going AIDS-orphaned adolescents in rural Uganda. Methods . AIDS-orphaned adolescents from 15 comparable schools were randomly assigned to control (n = 133) or treatment (n = 127) conditions. Treatment participants received child savings accounts, workshops, and mentorship. This economic intervention was in addition to the traditional care and support services for school-going orphaned adolescents (counseling and school supplies) provided to both treatment and control groups. Adolescents in the treatment condition were compared with adolescents in the control condition at baseline and at 10 months after the intervention. Results . After control for sociodemographic factors, child-caregiver/parental communication, and peer pressure, adolescents in the economic intervention group reported a significant reduction in sexual risk-taking intentions compared with adolescents in the control condition. Conclusions . The findings indicate that in Uganda, a country devastated by poverty and disease (including HIV/AIDS), having access to economic assets plays an important role in influencing adolescents' sexual risk-taking intentions. These findings have implications for the care and support of orphaned adolescents, especially in poor African countries devastated by poverty and sexually transmitted diseases. Twelve million children worldwide have lost 1 or both parents as a result of AIDS.¹ Growing up as an orphaned child poses psychosocial and economic challenges to these children and the households raising them. Orphaned children are at an elevated risk for early onset of sexual relations and sexual exploitation, which raises their risk of contracting sexually transmitted diseases, including HIV/AIDS.^{2 – 4} Sub-Saharan Africa is 1 of the most economically deprived regions on earth and the epicenter of HIV/AIDS: 63% of all persons infected with the HIV virus reside in this region, and 65% of reported new infections occur there.⁵ Orphaned adolescents—especially those in households affected by HIV/AIDS—are at elevated risk of growing up in poverty owing to the loss of at least 1 family provider, and usually the deteriorating health of the second member.⁶ Such circumstances not only deprive the family of resources as the result of lost earnings but often lead to families devoting scarce household resources to the care of ill family members. Although several studies have documented the impact of household economic assets on orphaned children's school enrolment⁷ and psychological well-being, including mental health functioning,^{8 – 11} very few studies have explored the unique effect of household economic assets on orphaned children's risk-taking behaviors, including sexual risk taking. Yet, as described below, theory exists that explicitly connects household economic assets to child outcomes, including behavioral-related outcomes.^{12 , 13} Today, only 15% of orphaned children in countries with high HIV/AIDS prevalence live in households receiving some kind of assistance.¹⁴ Moreover, although creating economic opportunities for households caring for orphaned adolescents is critical for children's material well-being and psychosocial development, few programs have gone beyond granting “aid” mainly for physical needs. Even fewer programs have explicit interventions aimed at economic security or stability. Economic stability not only affects the adolescents' health by impacting access to basic human needs such as nutrition, medicine, and education, but may also affect overall household or family stability and functioning.^{7 , 15 – 20} Thus, the failure to explicitly include approaches aimed at economic security in the care and support of orphaned adolescents may increase the likelihood that this group of children will be trapped in a vicious cycle of hopelessness, further increasing their likelihood for risk-taking behaviors—including sexual risk taking. To mitigate the impacts of these risks, risk and resilience theory suggests that family resources, including economic assets, can balance the effect of risks and adversities^{21 , 22} by buffering the effects of factors that would otherwise push adolescents toward engaging in sexual risk behavior. Similarly, asset theory^{12 , 13} posits that if the family care system can be strengthened economically, and if adolescents have an increased belief that their future holds the promise of success, then adolescents' engagement in sexual risk taking might be reduced. People with more assets in the present expect to have more resources in the future.²³ In addition, studies have found that a positive family environment is 1 of the primary reasons youth refrain from engaging in risky behaviors.^{24 – 26} Finally, empirical studies have affirmed the efficacy of family-focused interventions for the prevention of a variety of adolescent risk behaviors leading to teen pregnancy, HIV infection, substance abuse, and other negative health outcomes.^{27 – 34} Unfortunately, orphaned children may not experience a typical developmental trajectory. Many of these children, especially those orphaned by AIDS, are not able to count on the support (economic and emotional) of their ailing parents or surviving caretakers, who are usually aging grandmothers overwhelmed with the economic responsibility of supporting these children.³⁵ Thus, these children experience significant and unique stressors. Given this background, the specific question we addressed was as follows: With control for sociodemographic characteristics, to what extent are sexual risk-taking behaviors among AIDS-orphaned adolescents impacted by household economic assets? This question is important for 2 reasons. First, because AIDS-orphaned adolescents in sub-Saharan Africa are at elevated risk of growing up in poverty and hopelessness, they are likely to have some unique economic needs—over and above their psychosocial needs—that may impact their risk-taking behaviors and that may necessitate interventions addressing economic security. Second, countries in sub-Saharan Africa are among the poorest in the world and are also heavily affected by HIV/AIDS, part of which could be addressed by dealing with sexual risk-taking behaviors among the current generation of adolescents. Teasing out the role of economic resources in such environments may help public health practitioners working with orphaned children in low-resources communities within sub-Saharan Africa. Accordingly, given the theoretical frameworks guiding this study and the Ugandan context, we hypothesized that children given the opportunity to accumulate assets through an intervention providing opportunities for economic security or stability (in this case, the SUUBI program described more fully below) would be less likely to engage in sexual risk behaviors.