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降低涉法青少年危险行为的随机试验。

Randomized Trial to Reduce Risky Sexual Behavior Among Justice-Involved Adolescents.

作者信息

Schmiege Sarah J, Magnan Renee E, Yeater Elizabeth A, Feldstein Ewing Sarah W, Bryan Angela D

机构信息

Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

Department of Psychology, Washington State University Vancouver, Vancouver, Washington.

出版信息

Am J Prev Med. 2021 Jan;60(1):47-56. doi: 10.1016/j.amepre.2020.07.009.

Abstract

INTRODUCTION

Justice-involved adolescents are at high risk for sexually transmitted infections; one primary reason is co-occurring substance use. This study investigates the additive benefit of including alcohol and cannabis use content in a theory-based sexual risk reduction intervention, delivered using group-based motivational enhancement therapy.

STUDY DESIGN

This study had a cluster randomized design, with randomization of single-sex clusters to 1 of 3 interventions.

SETTING/PARTICIPANTS: Participants were male and female justice-involved adolescents (N=460) residing in youth detention facilities. Data were collected from 2010 to 2014; analyses were completed in 2018-2019.

INTERVENTION

Adolescents were randomized to 1 of 3 motivational enhancement therapy interventions: sexual risk reduction intervention, sexual risk reduction intervention with alcohol content, or sexual risk reduction intervention with alcohol and cannabis content.

MAIN OUTCOME MEASURES

The primary outcome was risky sexual behavior (aggregation of condom use and frequency of intercourse), measured every 3 months for 1 year. Secondary outcomes were theoretical mechanisms on which the intervention was based (condom use attitudes, self-efficacy, peer norms, and behavioral intentions), collected at baseline and post-test.

RESULTS

Risky sexual behavior significantly decreased from baseline to 3-month follow-up (t=10.59, p<0.001) and this decrease was maintained 1 year later (t=9.04, p<0.001). Intervention was associated with improved values on all theoretical mechanisms. Although all outcomes improved over time, changes did not differ by intervention condition (p>0.29 for all). Comparisons to a historical, information-only, sexual risk reduction control arm conducted with a similar juvenile justice sample confirm the effectiveness of all 3 motivational enhancement therapy-based interventions.

CONCLUSIONS

All 3 interventions were associated with decreased sexual risk up to 1 year later, suggesting that the intervention modality (motivational enhancement therapy) may resonate with this population beyond the specific substance use content. This single-session manualized intervention can be readily disseminated to juvenile justice settings.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT01170260.

摘要

引言

涉司法青少年感染性传播感染的风险很高;一个主要原因是同时存在物质使用问题。本研究调查了在基于理论的性风险降低干预措施中纳入酒精和大麻使用内容的附加益处,该干预措施采用基于小组的动机增强疗法实施。

研究设计

本研究采用整群随机设计,将单性别群组随机分配到三种干预措施之一。

设置/参与者:参与者为居住在青少年拘留设施中的涉司法青少年男性和女性(N = 460)。数据收集时间为2010年至2014年;分析于2018 - 2019年完成。

干预措施

青少年被随机分配到三种动机增强疗法干预措施之一:性风险降低干预、含酒精内容的性风险降低干预或含酒精和大麻内容的性风险降低干预。

主要结局指标

主要结局是危险性性行为(避孕套使用和性交频率汇总),在1年时间内每3个月测量一次。次要结局是干预措施所基于的理论机制(避孕套使用态度、自我效能感、同伴规范和行为意图),在基线和测试后收集。

结果

从基线到3个月随访时,危险性性行为显著下降(t = 10.59,p < 0.001),1年后这种下降仍持续(t = 9.04,p < 0.001)。干预措施与所有理论机制的改善值相关联。尽管所有结局随时间推移都有所改善,但不同干预条件下的变化并无差异(所有p > 0.29)。与使用类似青少年司法样本进行的仅提供信息的历史性性风险降低对照组进行比较证实了所有三种基于动机增强疗法的干预措施的有效性。

结论

所有三种干预措施在长达1年后都与性风险降低相关联,这表明干预方式(动机增强疗法)可能对该人群产生共鸣,而不仅仅局限于特定物质使用内容。这种单节次的手册化干预措施可以很容易地推广到青少年司法环境中。

试验注册

本研究已在www.clinicaltrials.gov上注册NCT01170260。

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