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Randomized Trial to Reduce Risky Sexual Behavior Among Justice-Involved Adolescents.

Abstract：

INTRODUCTION:Justice-involved adolescents are at high risk for sexually transmitted infections; one primary reason is co-occurring substance use. This study investigates the additive benefit of including alcohol and cannabis use content in a theory-based sexual risk reduction intervention, delivered using group-based motivational enhancement therapy. STUDY DESIGN:This study had a cluster randomized design, with randomization of single-sex clusters to 1 of 3 interventions. SETTING/PARTICIPANTS:Participants were male and female justice-involved adolescents (N=460) residing in youth detention facilities. Data were collected from 2010 to 2014; analyses were completed in 2018-2019. INTERVENTION:Adolescents were randomized to 1 of 3 motivational enhancement therapy interventions: sexual risk reduction intervention, sexual risk reduction intervention with alcohol content, or sexual risk reduction intervention with alcohol and cannabis content. MAIN OUTCOME MEASURES:The primary outcome was risky sexual behavior (aggregation of condom use and frequency of intercourse), measured every 3 months for 1 year. Secondary outcomes were theoretical mechanisms on which the intervention was based (condom use attitudes, self-efficacy, peer norms, and behavioral intentions), collected at baseline and post-test. RESULTS:Risky sexual behavior significantly decreased from baseline to 3-month follow-up (t=10.59, p<0.001) and this decrease was maintained 1 year later (t=9.04, p<0.001). Intervention was associated with improved values on all theoretical mechanisms. Although all outcomes improved over time, changes did not differ by intervention condition (p>0.29 for all). Comparisons to a historical, information-only, sexual risk reduction control arm conducted with a similar juvenile justice sample confirm the effectiveness of all 3 motivational enhancement therapy-based interventions. CONCLUSIONS:All 3 interventions were associated with decreased sexual risk up to 1 year later, suggesting that the intervention modality (motivational enhancement therapy) may resonate with this population beyond the specific substance use content. This single-session manualized intervention can be readily disseminated to juvenile justice settings. TRIAL REGISTRATION:This study is registered at www.clinicaltrials.gov NCT01170260.

journal_name

Am J Prev Med

journal_title

American journal of preventive medicine

authors

Schmiege SJ,Magnan RE,Yeater EA,Feldstein Ewing SW,Bryan AD

doi

10.1016/j.amepre.2020.07.009

subject

Has Abstract

pub_date

2021-01-01 00:00:00

pages

47-56

issue

eissn

0749-3797

issn

1873-2607

pii

S0749-3797(20)30338-X

journal_volume

pub_type

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Randomized Trial to Reduce Risky Sexual Behavior Among Justice-Involved Adolescents.