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

描述（由申请人提供）：青少年司法机构中被拘留或缓刑的青少年女性从事多种健康风险行为，这些行为使她们面临感染艾滋病毒和受尼古丁或酒精影响的怀孕的风险。具体来说，他们经常从事危险的性行为，使他们面临意外怀孕，性传播感染和艾滋病毒的风险，同时吸烟和从事高风险饮酒，使他们面临尼古丁和酒精暴露怀孕的风险。拟议研究的长期目标是开发和测试捆绑（针对一种以上的行为）干预措施，以减少青少年司法系统中女性的艾滋病毒传播和怀孕暴露于尼古丁和酒精的风险。捆绑有效地汇集了服务，以促进在干预高风险人群时的“协同增益”。本研究的总体目标是评估可行性和承诺 一个适应性的选择孕前干预（选择-青少年）在减少艾滋病毒的风险，尼古丁暴露怀孕（NEP），酒精暴露怀孕（AEP）在密集的社区缓刑的青少年女性。最初的选择干预包括四个阶段，在几个高风险环境中，对成年女性有效降低AEP的风险。考虑到吸烟和危险饮酒的合并症，以及完成两个疗程的患者与本疗效试验中完成四个疗程的患者的结局相似，正在哈里斯县医院区诊所对成年女性进行的随机临床试验中测试一种更短的两个疗程捆绑式选择干预，以降低AEP和NEP风险。为此，目前的研究假设，两届会议的选择干预适应于多个捆绑的健康风险AEP，NEP和艾滋病毒将是可行的，可接受的，并有希望在减少这些风险的女性社区为基础的少年缓刑。本研究将：目的1：修改有效的选择孕前干预，以预防艾滋病毒，AEP和NEP。结果将是一个两个会话的个人干预（选择-青少年）和伴随的治疗手册的基础上跨理论模型（TTM）和动机访谈。目标2：对少年司法系统中的女性进行单组可行性试验，以评估“青少年选择”的前景。这项试点研究将：1）证明在少年司法环境中与硕士水平的心理健康专业人员一起提供CHOICES-TEEN的可行性; 2）确定CHOICES-TEEN的接受程度，通过客户依从性，保留率和治疗满意度来衡量;以及3）在3个月随访时评估客户的改善（例如，降低HIV、NEP和AEP的风险）。这项研究将为后续的II/III期行为干预研究提供信息，并有助于知识库中缺失的基本要素-进一步了解在高危青少年中针对捆绑健康风险的可行性，以及针对该人群的性别特异性干预的潜在前景。 公共卫生相关性：在少年司法环境中被拘留或缓刑的少女有着独特的健康风险，包括感染艾滋病毒的风险。该项目将调查针对这一高危人群的多种健康风险的性别特异性“捆绑式”简短干预的可行性和前景。调查结果将为这一弱势群体的循证预防规划提供信息，其中许多人是处于不成比例风险中的少数民族。

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.