CHOICES-TEEN: Efficacy of a Bundled Risk Reduction Intervention for Juvenile Justice Females

项目概要/摘要 NOT-DA-19-048青少年司法环境中的青少年女性参与多种健康风险行为， 她们因酒精和大麻而面临感染艾滋病毒和怀孕的风险。具体来说，他们经常进行性行为 危险行为，使她们面临怀孕、性传播感染和艾滋病毒的风险，同时还使用大麻和酒精。与 近一半的美国怀孕是计划外的，不知道自己怀孕的女性将继续喝酒或吸毒。 大麻在怀孕的早期和关键的几周，这使他们处于物质暴露的风险 怀孕这一研究方向的长期目标是开发高效和机会主义的 减少接触毒品怀孕和艾滋病毒/性传播感染风险的干预措施， 青年因此，本研究的总体目标是测试CHOICES-TEEN（CT）减少 参与社区缓刑或分流方案的年轻妇女中的SEP和艾滋病毒/性传播感染风险。CT进行了调整 从选择孕前干预及其较短的版本，选择加，其中有一个强大的 降低高危成年女性妊娠期酒精和烟草暴露风险的有效性史。CT 利用动机访谈（MI），这已经证明了显着的承诺与青少年和犯罪 正义的人群。我们最近的初步研究（R 03 DA 034099; CHOICES-TEEN; CT-P），我们在其中调整了 青少年的选择，并测试其可行性与青年社区缓刑，产生了可喜的成果。CT 基于该试点工作进行了修改，以1）关注大麻（CT-P研究中89%的人报告）而不是烟草 考虑到青少年报告的尼古丁使用的低流行率和零星性质; 2）增加移动的健康 应用程序，以增加与日报的接触; 3）纳入CT后自我调节组件 改变行为过程（POC）。这项研究将通过阐明重要的 影响青年健康行为变化的因素，同时测试旨在减少个人和 这一高风险、得不到充分服务的青少年群体的社会成本。下一个合乎逻辑的步骤是进行严格的 RCT旨在评估这种针对年轻人的性别敏感、量身定制的捆绑式风险降低干预措施的有效性， 主要是少数民族妇女参与社区少年司法转送或缓刑方案。ii期 行为干预有效性试验将：1）主要目的：测试CHOICES-TEEN（CT）在减少 与青少年接触的高危女青年中接触药物怀孕（SEP）和艾滋病毒/性传播感染的风险 司法系统通过减少酒精使用，增加大麻戒烟，减少怀孕风险， 使用避孕套。目的2：测试CT与SC相比在提高认知自我调节能力方面的功效;目的3： 按人种/种族总体检测拟定的CT干预介质/作用机制;目的4：检测 改变的初始准备对SEP风险和HIV/STI风险的调节作用。如果CT有效， 可扩展，有可能不仅向少年司法环境传播，而且向 为有可能接触毒品怀孕和感染艾滋病毒/性传播感染的年轻少女提供服务。

PROJECT SUMMARY/ABSTRACT NOT-DA-19-048 Adolescent females in juvenile justice settings engage in multiple health risk behaviors that place them at risk for HIV and pregnancy affected by alcohol and marijuana. Specifically, they engage in frequent sexual risk behaviors, placing them at risk of pregnancy, STIs and HIV, while also using marijuana, and alcohol. With nearly half of U.S. pregnancies being unplanned, females unaware of their pregnancy will continue to drink or use marijuana during the early and critical weeks of gestation, which places them at risk of substance-exposed pregnancy. The long-term goal of this proposed line of research is to develop efficient and opportunistic interventions that reduce the risk of substance-exposed pregnancy (SEP) and HIV/STIs for justice involved female youth. Therefore, the overall objective of this study is to test the efficacy of CHOICES-TEEN (CT) for reducing the risks of SEP and HIV/STI in young women involved in community probation or diversion programs. CT was adapted from the CHOICES preconception intervention and its shorter version, CHOICES-PLUS, which have a robust history of efficacy in reducing the risk of alcohol and tobacco-exposed pregnancy with high-risk adult women. CT utilizes Motivational Interviewing (MI), which has demonstrated significant promise with adolescents and criminal justice populations. Our recent pilot study (R03DA034099; CHOICES-TEEN; CT-P), in which we adapted CHOICES for teens and tested its feasibility with youth on community probation, produced promising results. CT was modified based on this pilot work to 1) focus on marijuana (reported by 89% in CT-P study) rather than tobacco given the low prevalence and sporadic nature of nicotine use reported by the teens; 2) add a mobile health application to increase engagement with the daily journal and; 3) incorporate a post-CT self-regulation component targeting behavioral processes of change (POC). This study will move the field vertically by elucidating important factors influencing youth health behavior change, while testing an intervention designed to reduce individual and societal costs for this high risk, underserved adolescent population. The next logical step is to conduct a rigorous RCT to assess the efficacy of this gender-responsive, tailored bundled risk reduction intervention for young, primarily minority, women involved in a community-based juvenile justice diversion or probation program. A stage II behavioral intervention efficacy trial will: 1) Primary Aim: Test the efficacy of CHOICES-TEEN (CT) on reducing the risk of substance-exposed pregnancy (SEP) and HIV/STI among high-risk female youth involved with the juvenile justice system by reducing alcohol use, increasing marijuana cessation, reducing pregnancy risk, and increasing condom use. Aim 2: Test the efficacy of CT, compared to SC, in increasing cognitive self-regulation abilities; Aim 3: Test proposed intervention mediators/mechanisms of action for CT overall and by race/ethnicity; Aim 4: Test the moderating effect of initial readiness to change on risk of SEP and risk of HIV/STI. If efficacious, CT is readily scalable and has the potential for dissemination not only to juvenile justice settings, but to a wealth of settings that serve young adolescent women at risk of substance-exposed pregnancies and HIV/STI.