An HIV risk-reduction intervention in an adolescent correctional facility: lessons learned

A "Triple Threat" to Research Protocols and Logistics: Adolescents, Sexual Health, and Poverty

The purpose of this article is to discuss lessons learned from conducting research with urban communities. A brief overview of the Health Improvement Project for Teens (HIPTeens) will be provided. It will be followed by several suggestions concerning recruitment and retention of participants, challenges related to working in impoverished environments, hiring and training of research teams, interacting with administration and community, and strategies for doing research in diverse settings.

Obstacles to research in residential juvenile justice facilities: recommendations for researchers

Federal, state, and local initiatives to improve the treatment and outcomes for young people in the juvenile justice system prompt the need for additional research. Despite the call for empirical data, researchers encounter numerous obstacles when initiating and conducting studies in detention and post-adjudication facilities. These obstacles are often only briefly mentioned in publications, but they can interfere with researchers' desires and abilities to conduct studies in these settings. This paper reviews legal, ethical, and methodological challenges to successfully conducting research in detention and residential post-adjudication placements, including selecting and accessing appropriate facilities, obtaining institutional review board approval, seeking parental permission and youth assent, reporting child abuse and neglect, responding to participants' threats to harm self or others, working effectively with facilities, juvenile justice system-related attrition, and the dissemination of research findings. Recommendations are presented to help investigators anticipate obstacles when designing and executing research protocols to prevent interference and to encourage ethical responses and successful study completion.

An expanded model of the temporal stability of condom use intentions: gender-specific predictors among high-risk adolescents

BACKGROUND

Adolescents involved with the criminal justice system are at particularly high-risk for the Human Immunodeficiency Virus and sexually transmitted infections.

PURPOSE

The purpose of this study was to longitudinally examine gender-specific models of condom use, incorporating temporal stability of intentions.

METHODS

Adolescents on probation (N=728) were recruited to complete longitudinal surveys including measures of Theory of Planned Behavior and gender-specific constructs, relationship length, and condom use.

RESULTS

Gender-specific models of condom use behavior suggested by previous research were mostly replicated. For young women, the effect of baseline intentions on subsequent condom use behavior was stronger when intentions were either stable or increasing. For young men, more stable, increasing intentions were directly associated with more condom use. There was preliminary evidence to suggest an association between temporal stability of intentions and decreasing condom use in stable relationships.

CONCLUSIONS

Intervention efforts should be tailored by gender and aim to forestall decreasing intentions and condom use over time by addressing difficulties in maintaining condom use.

Preliminary efficacy of a comprehensive HIV prevention intervention for abstinent adolescent girls: pilot study findings

We developed and pilot-tested a comprehensive HIV prevention/sexual risk reduction intervention with 54 sexually abstinent girls and estimated the effect of the intervention on three antecedents of sexual risk behavior: information, motivation, and behavioral skills. Girls ages 14-18 were randomized into either (a) an AbsPlus intervention or (b) a structurally equivalent control group. Assessments were obtained at baseline and 3 months follow-up using audio computer assisted self-interview. The intervention resulted in a large effect for information (d = 1.11); small to large effects for the motivational measures (d = .34-.88), and a moderate effect for a measure of behavioral skills (d = .67). The results indicate that antecedents of sexual risk behavior change were improved by a gender-specific theoretically guided intervention.

Adapting an HIV prevention intervention for high-risk, incarcerated adolescents

This study examined the effectiveness of an adapted 4-session HIV prevention program. Participants included 490 adolescents who participated in either the 8- or the adapted 4-session HIVEd program. Analyses to identify mean changes in HIV-related knowledge, attitudes, self-efficacy, and behavioral intentions between participants in either the 4- (n = 274) or 8-session (n = 216) programs were completed. Findings indicate participants in both programs had positive changes at post interview across all study outcomes. No significant differences in changes between participants in the 4- and 8-session programs were found except that male adolescents in the 4-session program had significantly higher mean changes in condom knowledge (p < .01). The adaptation of the 8-session HIVEd program was undertaken to better reach and accommodate the needs of a high risk incarcerated adolescent population. Findings demonstrate that HIV prevention interventions for high risk populations may be successfully adapted and condensed when based on rigorously evaluated and theoretically driven programs.

A human immunodeficiency virus risk reduction intervention for incarcerated youth: a randomized controlled trial

PURPOSE

To evaluate, by gender, the impact of a structured, comprehensive risk reduction intervention with and without boosters on human immunodeficiency virus (HIV) knowledge, attitudes and behaviors in incarcerated youth; and to determine predictors of increasing HIV knowledge and reducing high-risk attitudes and behaviors.

METHODS

This randomized controlled trial involved participants completing structured interviews at 1, 3, and 6 months. Repeated measures analysis of variance was used to analyze changes over time. The study was conducted in secure custody facilities and in the community. The study sample comprising 391 incarcerated youth, 102 female and 289 male aged 12-18, formed the voluntary sample. Participants were randomly assigned to one of three conditions: education intervention; education intervention with booster; or no systematic intervention. The outcome and predictor measures included the Rosenberg Self-Esteem Scale, Youth Self Report, Drug Use Inventory, and HIV Knowledge, Attitudes and Behavior Scale.

RESULTS

The 6-month retention rate was 59.6%. At 6 months, males in the education and booster groups sustained increases in knowledge scores (p < 0.001). Females in these groups sustained increased condom attitude scores (p = 0.004). Males in the booster group sustained increased prevention attitude scores (p = 0.017). Females in the booster group reported more consistent condom use (odds ratio [OR] = 4.20; 95% confidence interval [CI] = 1.81, 9.77). Age, gender, drug use, and psychological profiles were predictive of outcome.

CONCLUSIONS

The intervention and boosters led to gender-specific improvements in knowledge, attitudes, and condom use. Result variations by gender underline the importance of gender issues in prevention interventions. Predictors of success were identified to inform future HIV education interventions.

Understanding sexual abstinence in urban adolescent girls

OBJECTIVES

To gain insight into the context of sexual abstinence and identify potential determinants of abstinence in this population.

DESIGN

Four focus groups.

PARTICIPANTS AND SETTING

Twenty-four, predominantly African American (88%) girls aged 14 to 19 years were recruited from urban health centers and youth development programs in Rochester, New York, between September and December 2006.

DATA ANALYSIS

Content analysis was used to analyze the four verbatim transcripts. Using analytic induction, groups were compared and contrasted at the micro (within-group) and macro (between-group) levels to identify themes.

RESULTS

Four themes were identified that provided insight into how and why these girls remain abstinent despite being in sexually active social climates. They focused on the following: self-respect (I'm worth it), impact of mothers (Mama says ... think before you let it go), influence of boys and other peers (Boys will be boys), and potential negative consequences of sex (Hold on, there's a catch).

CONCLUSIONS

Developing interventions to maintain abstinence, delay onset of sexual activity, and promote protected first and subsequent sexual contact in abstinent girls are key to decreasing future sexual risk. These findings suggest opportunities to develop HIV prevention strategies tailored to the needs of abstinent girls.

Neurological function and HIV risk behaviors of female prison inmates

The purpose of this study was to explain relationships between neurological dysfunction, HIV serological status, and HIV risk behaviors that have not been well understood. A secondary analysis was conducted on data from 117 female prison inmates. Another 18 female inmates from the same prison were further evaluated with more specific neurological, neuropsychological, and HIV risk behavior Risk Assessment Battery (RAB) measures. Neurological function, defined by valid, reliable quantitative measures of cognition, behavior/mood, cranial nerves, motor, reflexes, and sensation, was significantly correlated with HIV RAB scores (.743, p = .006), and RAB scale scores (.824, p = .001) in HIV-negative, but not HIV-positive, inmates. Specifically, the reflex deficits subscale correlated with RAB scores (.779, p = .003) and RAB scale scores (.682, p = .015) in the HIV-negative group. These findings combined with subjects' histories suggest cerebral dysfunction possibly contributes to HIV risk behaviors in certain high-risk female inmates predating HIV infection. These findings further suggest that HIV risk reduction should target neurologically impaired females as a high-risk group. Larger studies are needed to validate these findings.

Group-based HIV risk reduction intervention for adolescent girls: evidence of feasibility and efficacy

The purposes of this pilot study were (a) to assess the feasibility of a community-based, small group HIV risk reduction intervention with adolescent girls, and (b) to obtain preliminary evidence of the efficacy of this theoretically-guided intervention using a controlled design. The feasibility of the intervention was demonstrated by successfully implementing it with 33 sexually-active, single girls. Preliminary evidence of the efficacy of the intervention was obtained using a randomized trial with 62 sexually-active, single girls. Data obtained at a 3-month follow-up assessment showed that girls who received the HIV-related intervention improved their HIV-related knowledge and enhanced their motivation for risk reduction compared to girls who received a control (health promotion) intervention. Effect sizes suggest that the HIV intervention also reduced several risk behaviors (e.g., vaginal sex without a condom, giving oral sex, and alcohol and drug use before sex). Challenges to implementation and suggestions for intervention enhancement are discussed.

A Comparison of African American and Cuban American Adolescent Juvenile Offenders: Risky Sexual and Drug Use Behaviors

Racial and ethnic disparities exist in HIV seroconversion rates, with African American and Hispanic youth in the 13-19-year-old age group representing 61% and 21% of new AIDS cases, respectively. The aim of this study was to examine sexual and drug use behaviors among a sample of 138 African American and Cuban American juvenile offenders. Cuban American adolescents showed higher levels of unprotected sex, higher levels of sex while using drugs, and higher levels of drug/alcohol use in the three and six months prior to confinement. These differences may be explained by multiple factors, including differences in acculturation levels among the Cuban American adolescents, differences in health messages targeted at the two groups, and family mores and norms.