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

描述(申请人提供)：在少年司法环境中被拘留或缓刑的青少年女性从事多种健康危险行为，使她们面临感染艾滋病毒和怀孕的风险，并受到尼古丁或酒精的影响。具体地说，他们从事频繁的性行为，使他们面临意外怀孕、性传播感染和艾滋病毒的风险，同时吸烟和高风险饮酒，使他们面临尼古丁和酒精暴露的怀孕风险。拟议研究项目的长期目标是开发和测试捆绑(针对一种以上行为)干预措施，以减少青少年司法系统中女性接触尼古丁和酒精的艾滋病毒传播和怀孕风险。在干预高危人群时，捆绑有效地聚合服务以促进“协同收益”。这项研究的总体目标是评估可行性和前景 在接受密集社区试用期的青少年女性中，对降低艾滋病毒、尼古丁暴露妊娠(NEP)和酒精暴露妊娠(AEP)风险的适应性选择先入性干预(CHOICES-TEN)进行评估。最初的选择干预包括四个疗程，对于成年妇女来说，在几个高危环境中降低AEP的风险是有效的。鉴于吸烟和高风险饮酒的共病，以及完成两次疗程的患者与本次疗效试验中四次疗程的结果相似，一种更短、两次疗程的捆绑选择干预措施正在哈里斯县医院区诊所的成年女性随机临床试验中进行测试，以降低AEP和NEP风险。为此，目前的研究假设，针对多种捆绑的健康风险--AEP、NEP和HIV--进行的两次选择干预在降低社区青少年缓刑女性中的这些风险方面是可行的、可接受的和有希望的。本研究将：目标1：修改有效的选择前置干预措施，以针对性地预防HIV、AEP和NEP。其结果将是基于跨理论模型(TTM)和动机访谈的两个会议的个人干预(选择-青少年)和伴随的治疗手册。目标2：对青少年司法系统中的女性进行单臂可行性试验，以评估选择的承诺--青少年。这项试点研究将：1)论证提供选择的可行性--青少年在少年司法环境中与硕士级别的精神卫生专业人员一起；2)确定选择的接受度--以客户依从性、保留率和治疗满意度衡量；3)在3个月的随访中评估客户的改善情况(例如，降低艾滋病毒、NEP和AEP的风险)。这项研究将为随后的第二阶段/第三阶段行为干预研究提供信息，并有助于知识库中缺失的一个基本要素--进一步了解针对高危青少年捆绑健康风险的可行性，以及针对这一人群进行针对性别的干预的潜在前景。 与公共卫生有关：在少年司法环境中被拘留或缓刑的少女具有独特的健康风险，包括感染艾滋病毒的风险。该项目将调查针对性别的“捆绑”短暂干预的可行性和前景，以针对这一高危人群的多种健康风险。这些发现将为Fuure为这一弱势群体制定以证据为基础的预防规划提供参考，他们中的许多人都是面临风险的少数民族。

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.