CHOICES-TEEN: A Bundled Risk Reduction Intervention for Juvenile Justice Females

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DESCRIPTION (provided by applicant): Adolescent females detained or on probation in juvenile justice settings engage in multiple health risk behaviors that place them at risk for HIV and pregnancy affected by nicotine or alcohol. Specifically, they engage in frequent sexual risk behaviors, placing them at risk of unplanned pregnancy, STIs and HIV, while also smoking and engaging in high risk alcohol use, placing them at risk of both nicotine- and alcohol-exposed pregnancy. The long-term goal of the proposed line of research is to develop and test bundled (targeting more than one behavior) interventions to reduce HIV transmission and the risk of pregnancies exposed to nicotine and alcohol among females in the juvenile justice system. Bundling efficiently aggregates services to promote "synergistic gain" when intervening with high-risk populations. The overall objective of this study is to assess the feasibility and promise of an adapted CHOICES preconception intervention (CHOICES-TEEN) in reducing the risk of HIV, nicotine-exposed pregnancy (NEP), and alcohol-exposed pregnancy (AEP) in adolescent females on intensive community probation. The original CHOICES intervention consisted of four sessions and was efficacious for adult women in reducing the risk of AEP in several high risk settings. Given the comorbidity of smoking and risky drinking, and similar outcomes of those completing two sessions compared to four in this efficacy trial, a shorter, two-session bundled CHOICES intervention to reduce both AEP and NEP risk is being tested in a randomized clinical trial in the Harris County Hospital District clinics with adult females. To this end, the current study posits that a two-session CHOICES intervention adapted to target multiple bundled health risks-AEP, NEP, and HIV-will be feasible, acceptable, and promising in reducing these risks among females on community-based juvenile probation. This study will: Aim 1: Modify the efficacious CHOICES preconception intervention to target the prevention of HIV, AEP, and NEP. The result will be a two session individual intervention (CHOICES-TEEN) and accompanying therapy manual based on the Transtheoretical Model (TTM) and Motivational Interviewing. Aim 2: Conduct a one-arm feasibility trial with females in the juvenile justice system to assess the promise of CHOICES-TEEN. This pilot study will: 1) demonstrate the feasibility of delivering CHOICES-TEEN with master's level mental health professionals within a juvenile justice setting; 2) determine acceptance of CHOICES-TEEN as measured by client adherence, retention, and treatment satisfaction; and 3) assess client improvement at 3-month follow-up (e.g., reduction of risk of HIV, NEP, and AEP). This study will inform subsequent Stage II/III behavioral intervention studies and contribute to a missing, fundamental element in the knowledge base - further understanding of the feasibility of targeting bundled health risks in high-risk adolescents, and the potential promise of a gender-specific intervention for this population. PUBLIC HEALTH RELEVANCE: Adolescent females detained or on probation in juvenile justice settings present with a unique health risk profile, including the risk of HIV infection. Ths project will investigate the feasibility and promise of a gender-specific "bundled" brief intervention to target multiple health risks for this high-risk population. Findings will inform fuure evidence-based prevention programming for this vulnerable population, many of whom are ethnic minorities disproportionately at risk.