Preventing HIV/AIDS Among Teens in Juvenile Justice

描述(由申请者提供)：非裔美国人中精神疾病、艾滋病毒/艾滋病/性传播感染和监禁的高比率(AA)反映了严重的健康差距(美国国立卫生研究院2001年消除健康差距战略计划)，特别是在年轻人中。少年司法中的青少年患有不成比例的AA，与普通人群相比，少年犯(JO)报告了更危险的性行为、吸毒和酗酒以及精神障碍，并且更有可能检测出STI呈阳性。尽管如此，几乎没有经验支持的、理论驱动的计划来解决他们的负面健康后果。这项提案通过测试一种创新的、量身定做的艾滋病毒/艾滋病/性传播感染、心理健康和药物使用计划来解决这些健康差距，该计划是为最近被捕的13-17岁城市男性和女性(85%非裔美国人，14%拉丁裔/a)设计并进行试点测试的，这些男性和女性被释放缓刑(Phat Life；R34MH075628)。Phat Life是一个精心安排的过程，包括一个积极的、多样化的、多学科的顾问委员会、一个青年顾问委员会、焦点小组、两个试点测试、广泛的反馈，以及三年来的一系列课程修订。R34确定了可行性和可接受性，显示了青年和利益相关者的积极反馈，并在3个月的随访中产生了良好的初步结果(例如，增加避孕套的使用)，从而证明了有效性试验的合理性。本申请提出了一项双臂随机对照试验，以测试Phat Life与健康促进计划的对比，该计划最近逮捕了13-17岁的男性和女性，主要是少数民族JO(代表库克县)在芝加哥缓刑。我们将使用发展研究中建立的程序和方法来招募、登记、评估、跟踪和干预青少年。我们将随机将青少年分配到Phat Life(N=150)或健康促进对照组(N=150)，我们将在晚间报告中心以5-7个青少年为一组进行干预。评估将在基线、治疗后6个月和12个月进行，我们将在基线和12个月的随访中筛查年轻人三种常见的性传播感染(衣原体、淋病和毛滴虫)。所有STI检测呈阳性的年轻人将免费接受单剂抗生素治疗。使用意向治疗分析，我们将测试并比较Phat Life和健康促进控制组在青少年危险性行为、物质使用和理论中介方面的差异。这项建议满足了对创新预防方案的迫切需要，这些方案解决了青少年司法中青年中交叉的精神疾病和艾滋病毒/艾滋病/性传播感染的健康差距。在没有干预的情况下，这些青少年在释放后继续从事危险行为，放大了他们自己和他们的伴侣感染艾滋病毒/艾滋病/性传播疾病的风险。26、27对社区福祉、个人就业前景和社区健康28的持久影响是深远的，但有效的方案可以改变这一极高风险人群29、30的消极发展轨迹，并开始纠正现有的健康差距。 公共卫生相关性：这项应用对纠正严重的健康差距具有重大的长期影响。少年犯，其中绝大多数是少数民族，艾滋病毒/艾滋病/性传播感染、精神疾病和药物使用使他们负担过重。针对少年司法中的青少年，特别是逮捕后立即返回社区的罪犯，几乎没有经过经验验证、以理论为基础的方案，而且没有一个方案解决这些青年的全面损害问题。高共病药物使用率和精神健康问题对艾滋病毒/艾滋病/性传播感染的预防提出了独特的挑战。不幸的是，大多数JO带着未经诊断和治疗的性传播疾病回到他们的社区，这些年轻人在出院后继续从事危险行为，放大了他们自己的风险，增加了感染他们的伴侣的机会，使他们的社区处于危险之中，并进一步加剧了众所周知的健康差距。这些负面结果对社区福祉、个人就业前景以及社区健康和安全产生了深远的长期影响。这项研究将开始解决这些问题；有了正确的工具，联合组织将更有能力做出更安全的决定，减少他们的风险承担，从而遏制艾滋病毒/艾滋病/性传播感染在其社区的传播。

DESCRIPTION (provided by applicant): High rates of mental illness, HIV/AIDS/STI, and incarceration among African Americans (AA) reflect significant health disparities (NIH 2001 strategic plan to eliminate health disparities), particularly among youth. Teens in juvenile justice are disproportionately AA, and compared to the general population, juvenile offenders (JO) report more risky sexual behavior, drug and alcohol use, and psychiatric disorders, and are more likely to test positive for STIs. Still, few empirically-supported, theoretically-driven programs exist to address their negative health outcomes. This proposal addresses these health disparities by testing an innovative and uniquely tailored HIV/AIDS/STI, mental health, and substance use program designed for and pilot tested with recently arrested 13 - 17 year-old urban males and females (85% African American, 14% Latino/a) released on probation (PHAT Life; R34MH075628). PHAT Life was derived from a carefully staged process that included an active, diverse, multi-disciplinary advisory board, a youth advisory board, focus groups, two pilot tests, extensive feedback, and a series of curriculum revisions over three years. The R34 established feasibility and acceptability, revealed positive youth and stakeholder feedback, and yielded good preliminary outcomes at 3-month follow-up (e.g., increased condom use) to justify an efficacy trial. This application proposes a 2-arm randomized controlled trial to test PHAT Life versus a health promotion program with recently arrested 13-17 year-old male and female, mostly ethnic minority JO (as representative of Cook County) on probation in Chicago. We will use the procedures and methods established in the developmental study to recruit, enroll, assess, track, and intervene with teens. We will randomly assign youth to PHAT Life (N=150) or a health promotion control group (N=150), and we will deliver the interventions in single sex groups of 5 - 7 teens at Evening Reporting Centers. Assessments will occur at baseline, 6-, and 12-months post-treatment, and we will screen youth for three common STIs (Chlamydia, Gonorrhea, Trichamonas) at baseline and 12-month follow-up. All youth who test positive for an STI will receive single dose antibiotic treatment free of charge. Using an intent-to-treat analysis, we will test and compare PHAT Life to the health promotion control group on adolescent risky sexual behavior, substance use, and theoretical mediators. This proposal answers a compelling need for innovative prevention programs that address the intersecting health disparities of mental illness and HIV/AIDS/STIs among youth in juvenile justice. Without intervention, these teens continue to engage in risk behaviors post-release, amplifying their own and their partner's risk for HIV/AIDS/STIs.26, 27 The lasting effects on community well-being, individual employment prospects, and neighborhood health28 are profound, but effective programs can alter the negative developmental trajectories of this very high-risk population29, 30 and begin to redress existing health disparities. PUBLIC HEALTH RELEVANCE: This application has significant long-term implications for redressing serious health disparities. Juvenile offenders, the vast majority of whom are ethnic minorities, are disproportionately overburdened by HIV/AIDS/STIs, mental illness, and substance use. Few empirically-validated, theoretically-based programs exist for teens in juvenile justice, especially offenders who return to their communities immediately post-arrest, and none address the full range of impairment in these youth. High rates of co-morbid substance use and mental health problems present unique challenges for HIV/AIDS/STI prevention. Unfortunately, most JO return to their communities with undiagnosed and untreated STIs, and these youth continue to engage in risk behaviors post-release, amplifying their own risk, increasing the chances of infecting their partners, placing their neighborhoods at risk, and further fueling well-known health disparities. These negative outcomes have profound long-term effects on community well-being, individual employment prospects, and neighborhood health and safety. This study will begin to redress these concerns; empowered with the right tools, JO will be better equipped to make safer decisions that reduce their risk taking, thereby curbing the spread of HIV/AIDS/STIs in their communities.