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Multifaceted approach to sexual risk reduction effective in juvenile justice system
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Adolescents involved in the juvenile justice system demonstrated reduced incidence of sexually transmitted infections after taking part in a one-time sexual risk reduction intervention that incorporates content related to alcohol and cannabis use.
“In any given year, approximately 2 million young people come into contact with the juvenile justice system, so there are a huge number of kids who get processed through facilities like the one where our work was conducted,” Angela D. Bryan, PhD, from the department of psychology and neuroscience at the University of Colorado, Boulder, told Infectious Diseases in Children. “Most of these facilities and systems do not have the resources they need to do intensive multi-session interventions.”
“The fact that our intervention can be conducted in a single session with limited additional resources gives it great potential for dissemination,” she said. “Also, kids who come into contact with the juvenile justice system tend to have higher rates of substance use and risky sexual behavior than their non-justice-involved peers. Our intervention was developed exactly for the kids who most need it.”
To explore whether rates of STIs could be reduced with the use of a theory-based sexual risk-reduction intervention that includes content related to cannabis and alcohol, the researchers conducted a cluster randomized trial that compared the intervention with one that included information about alcohol only and one that did not include substance use. All trials were conducted between July 1, 2010, and Dec. 10, 2014, at a juvenile detention facility in southwestern United States.
Participants were tested and treated for STIs before being randomly assigned to a group and again 12 months after the intervention was used. All adolescents included in the study were between 14 and 18 years of age and could speak English. Additionally, all participants had less than 1 month left of their detention term and granted the researchers access to STI results if they were tested at intake.
The clinicians presented 460 teenagers who completed baseline assessment-led discussions, group activities and received active feedback from participants.
Of those who participated and were randomly assigned into one of three cohorts, 75.4% were male and the average age was 15.8 (1.1) years. More than half were Hispanic (57.0%). Through testing, the researchers observed that attrition at follow-up was reached by 21.5% of participants. Those who received a sexual risk reduction intervention with alcohol and cannabis content were less likely to have an STI at their 12-month follow-up (3.9%) when compared with those who received a sexual risk reduction intervention alone (12.4%; OR = 0.29; 95% CI, 0.10-0.84) or a sexual risk reduction intervention with only alcohol-related content (10.2%; OR = 0.36; 95% CI, 0.12-1.05).
“I think aspects of the intervention have potential for the pediatric health care system, but only if clinicians and health care providers were comfortable having frank and nonjudgmental discussions of sexual activity and development with their patients,” Bryan said. “The young people themselves would also need to feel comfortable talking about sexual activity and substance use with their providers. Finally, we would also need to know whether the intervention was effective done on a one-on-one basis, as the trial we conducted involved delivering the intervention to groups of adolescents.” – by Katherine Bortz
Disclosure: Bryan reports receiving support from grant 2R01AA013844 from the National Institute on Alcohol Abuse and Alcoholism. All other authors report no relevant financial disclosures.
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