Child and Adolescent Self-Awareness and Health (CASAH)

Principal Investigator: 

Funding Agency:

National Institute of Mental Health (NIMH)

Collaborating Institution: 

Jacobi Medical Center

Harlem Hospital

Metropolitan Hospital

Study Location:

New York, NY, USA


Growing numbers of perinatally HIV-infected (PHIV+) or HIV-exposed, but uninfected (PHIV–) youth are approaching young adulthood, an age increasingly recognized as one of the most challenging transition periods as youth begin to assume adult responsibilities and establish patterns of positive and risky health behaviors that carry through to later life.  PHIV+ young adults are making critical choices about treatment, sex, relationships, and child-bearing having grown up with a chronic sexually transmittable virus. CASAH examines extended behavioral health trajectories from childhood to young adulthood, theoretically informed and modifiable predictors of these trajectories and young adult transitions, and the role of HIV, critical to much needed intervention development. 

CASAH 3 is a competing continuation of Child and Adolescent Self-awareness and Health study (NIMHR01-MH6913, CASAH 1 and 2), in which we have prospectively followed PHIV+ and PHIV– youth across older childhood and adolescence, collecting data informed by our theoretical model, Social Action Theory (SAT) on individual, family, social, and contextual determinants of behavioral health. Participants were originally recruited at ages 9-16 years from four medical centers in NYC.  In CASAH 1, we collected data on youth and their caregivers at two time points, 18 months apart, and in CASAH 2, we followed the youth into older adolescence at three additional time points, one year apart. In CASAH 3, young adults, ages 18-26 years, are being re-recruited and interviewed at three annual visits. In addition, multiple indicators of adherence are being utilized, including monthly, unannounced phone-based pill counts, self-reports, and medical record data.CASAH-3 will result in a 12-year profile of the psychosocial determinants of behavioral health in PHIV+ and PHIV– youth., including: 1) the impact of HIV infection on behavioral health (mental health, sexual and substance use risk behavior) and transitions in young adulthood; 2) how critical risk and protective factors from earlier developmental stages, drawn from SAT, as well as a risk and resilience framework affect young adult behavioral health and transitions; 3) trajectories of behavioral health across adolescence and the influence of these trajectories on young adult transitions; and 4) (among PHIV+ youth) influences on adherence to ART and health care over time.