Effect of Including Alcohol and Cannabis Content in a Sexual Risk-Reduction Intervention on the Incidence of Sexually Transmitted Infections in Adolescents

Abstract

IMPORTANCE Adolescents in the juvenile justice system are at high risk for sexually transmitted infections (STIs). Concurrent use of alcohol and cannabis increase this risk. OBJECTIVE To determine whether a theory-based sexual risk-reduction intervention that included alcohol-and cannabis-focused content resulted in greater reductions in STIs than an intervention that included alcohol-related content only and an intervention that did not include substance use content. DESIGN, SETTING, AND PARTICIPANTS Cluster randomized clinical trial with 3 conditions. Between July 1, 2010, and December 10, 2014, adolescents living at a juvenile detention facility in the southwestern United States were tested and treated for STI before randomization and again 12 months after the intervention. Data analyses were conducted in July and August 2017. Eligibility criteria included (1) being aged 14 to 18 years, (2) able to speak English, (3) having a remaining detention term of less than 1 month, and (4) signing a release granting access to STI results if tested at intake. Six hundred ninety-three adolescents were assessed for eligibility. Of these, 460 completed baseline assessments and were randomized to 1 of 3 intervention conditions. Data analysis was by intent-to-treat. INTERVENTIONS There were 3 intervention conditions: sexual risk reduction intervention (SRRI); SRRI plus alcohol content (SRRI + ETOH); and SRRI + ETOH plus cannabis content (SRRI + ETOH + THC). Interventions were conducted in same-sex groups by trained clinicians and included video presentations with discussion, group activities, and active feedback by participants, consistent with the principles of motivational enhancement therapy. MAIN OUTCOMES AND MEASURES Although not the outcome on which the study was originally powered, the main outcome variable presented herein is STI incidence (Chlamydia trachomatis and/or Neisseria gonorrhoeae) 12 months after the intervention. RESULTS Of the 460 participants randomized, mean (SD) age was 15.8 (1.1) years, 347 participants (75.4%) were male, and 57.0% were of Hispanic ethnicity. Among the participants, 143 were randomized to SSRI, 155 to SRRI + ETOH, and 162 to SRRI + ETOH + THC. Attrition at 12-month follow-up was 99 (21.5%) for the STI outcome variable. Participants in the SRRI + ETOH + THC intervention had lower incidence of STI at follow-up (3.9%) than those in either the SRRI (12.4%; odds ratio, 0.29; 95% CI, 0.10-0.84) or the SRRI + ETOH (10.2%; odds ratio, 0.36; 95% CI, 0.12-1.05) interventions. CONCLUSIONS AND RELEVANCE An intervention delivered in a motivational enhancement therapy format that includes theory-based sexual risk reduction combined with alcohol-and cannabis-focused elements is effective at reducing STI incidence among justice-involved adolescents. This 1-session manualized intervention can be delivered in the context of short-term detention and is easily disseminated to juvenile justice agencies. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01170260

Improving the sexual health of young people (under 25) in high-risk populations: a systematic review and meta-analysis of behavioural and psychosocial interventions.

“…We identi ed six papers reporting trials that targeted justice-involved youth (27,28,(31)(32)(33)(34). Four of the six trials took place in detention centres or prisons, while one (32) was conducted in foster care homes adolescents had been placed in as part of their 'treatment'.…”

“…The papers mostly reported behavioural outcomes such as condom use, pregnancy and STI incidence. One study (27) reported the reduction in STI incidence as a result of their sexual risk reduction group with additional content on alcohol and cannabis use. Kerr and colleagues (32), in a trial with girls aged 13-17, found multidimensional treatment foster care reduced the odds of pregnancy over the subsequent 24 months.…”

“…Five other papers identi ed in this review included young people with substance use problems as secondary groupings, given the commonality of comorbidities between these at-risk groups (Juvenile Justice and Homelessness groups) (27)(28)(29)(30)(31). These will be discussed under their primary grouping.…”

Adolescent Male Couples-Based HIV Testing Intervention (We Test): Protocol for a Type 1, Hybrid Implementation-Effectiveness Trial

“…As their communication skills are still very much in development [29], particularly in the relationship context [30,31], youth may need added support to effectively identify sexual goals and to learn to communicate them carefully and productively. Youth may need the support of additional communication and skills practice, both modeled (such as in assertive communication training, CT) or as shaped through actual role plays [32] to successfully convey their sexual and relationship goals to their likely, relatively new relationship partner.…”

“…Motivational interviewing (MI) has empirical support for its success in reducing adolescent risky sex and sexually transmitted infections (STIs) [32,45-47], including earlier iterations of MI for adolescent HIV risk reduction that are now recognized as empirically supported programs by the Office of Adolescent Health [48]. In line with this team’s prior work in this area [30,32], this intervention has been updated to enhance communication development, particularly for young adolescents who are new to the relationship context. Thus, new developments to this intervention specifically target enhancing nascent communication around HIV risk reduction within young dyads.…”