Caregiver Involvement in Sexual Risk Reduction with Substance Using Juvenile Delinquents: Overview and Preliminary Outcomes of a Randomized Trial

Responsible Behavior With Younger Children: Results From a Pilot Randomized Evaluation of a School-Based Child Sexual Abuse Perpetration Prevention Program

Many efforts to prevent child sexual abuse (CSA) aim to teach children strategies for recognizing, resisting, and reporting victimization. There is limited evidence that victimization-focused efforts actually prevent CSA. Moreover, these efforts often overlook the fact that many children and adolescents engage in problem sexual behavior against younger children. Responsible Behavior with Younger Children (RBYC) is a novel universal school-based perpetration-focused intervention that aims to prevent the onset of inappropriate, harmful, or illegal sexual behavior by adolescents against younger children.1 Responsible behavior with younger children was designed to provide adolescents and their parents with the knowledge and tools to help adolescents interact appropriately with younger children and avoid CSA behaviors. In this paper we describe intervention development, summarize lessons learned from implementing RBYC in four urban schools, and report results from our pilot randomized waitlist-controlled trial (RCT) with 160 6th and 7th grade students. Results indicate RBYC was associated with increased accuracy in youth knowledge about CSA and CSA-related laws, and with increased behavioral intention to avoid or prevent CSA with younger children and peer sexual harassment. Although the sample was small and the effects were relatively modest, the findings do suggest that RBYC holds promise for preventing the onset of problem sexual behavior.

Contingency Management: Using Incentives to Improve Outcomes for Adolescent Substance Use Disorders

Multiple interventions for treating adolescents with substance use disorders have demonstrated efficacy, but most teens do not show an enduring positive response to these treatments. Contingency management (CM)-based strategies provide a promising alternative, and clinical research focused on the development and testing of innovative CM models continues to grow. This article provides information on the principles that underlie CM interventions, key metrics that define their development and implementation, a brief review of studies that have tested these approaches, and some clinical CM tools. As with other interventions to help youth with substance use problems, there is much to learn about CM approaches.

Assessment of Parent-Based Interventions for Adolescent Sexual Health: A Systematic Review and Meta-analysis

IMPORTANCE

Parent-based sexual health interventions have received considerable attention as one factor that can increase safer sexual behavior among youth; however, to our knowledge, the evidence linking parent-based interventions to youth sexual behaviors has not been empirically synthesized.

OBJECTIVE

To examine the association of parent-based sexual health interventions with 3 primary youth outcomes-delayed sexual activity, condom use, and parent-child sexual communication-as well as several secondary outcomes. We also explored potential moderators of intervention effectiveness.

DATA SOURCES

A systematic search was conducted of studies published through March 2018 using MEDLINE, PsycINFO, Communication Source, and CINAHL databases and relevant review articles.

STUDY SELECTION

Studies were included if they: (1) sampled adolescents (mean age, ≤18 years), (2) included parents in a key intervention component, (3) evaluated program effects with experimental/quasi-experimental designs, (4) included an adolescent-reported behavioral outcome, (5) consisted of a US-based sample, and (6) were published in English.

DATA EXTRACTION AND SYNTHESIS

Standardized mean difference (d) and 95% confidence intervals were computed from studies and meta-analyzed using random-effects models. A secondary analysis evaluated potential moderating variables.

MAIN OUTCOMES AND MEASURES

The primary outcomes were delayed sexual activity, condom use, and sexual communication.

RESULTS

Independent findings from 31 articles reporting on 12 464 adolescents (mean age = 12.3 years) were synthesized. Across studies, there was a significant association of parent-based interventions with improved condom use (d = 0.32; 95% CI, 0.13-0.51; P = .001) and parent-child sexual communication (d = 0.27; 95% CI, 0.19-0.35; P = .001). No significant differences between parent-based interventions and control programs were found for delaying sexual activity (d = -0.06; 95% CI, -0.14 to 0.02; P = .16). The associations for condom use were heterogeneous. Moderation analyses revealed larger associations for interventions that focused on younger, compared with older, adolescents; targeted black or Hispanic youth compared with mixed race/ethnicity samples; targeted parents and teens equally compared with emphasizing parents only; and included a program dose of 10 hours or more compared with a lower dose.

CONCLUSIONS AND RELEVANCE

Parent-based sexual health programs can promote safer sex behavior and cognitions in adolescents, although the findings in this analysis were generally modest. Moderation analyses indicated several areas where future programs could place additional attention to improve potential effectiveness.

Substance Use and HIV Among Justice-Involved Youth: Intersecting Risks

PURPOSE OF REVIEW

This review discusses recent advances in research on the intersection of HIV prevention and substance use among youth involved with the justice system. We discuss current themes of recent findings and provide guidance for researchers, policymakers, and clinicians on the next steps in advancing work in this nascent area.

RECENT FINDINGS

Of the 46 studies that measured HIV risk and substance use among justice-involved youth, 56% were cross-sectional designs, 22% were intervention trials, and 22% were longitudinal designs. Cross-sectional studies suggested that substance use is highly associated with HIV risk behaviors. Longitudinal analyses underscored the importance of understanding contextual risk factors, such as trauma and violence. Intervention trials demonstrated improved scientific rigor of behavioral approaches. Despite recent advances, research in this field remains limited. Future directions include longer follow-up periods, consideration of biomedical HIV-prevention interventions, and a focus on dissemination and implementation science of efficacious interventions.

Association of Mental Health Symptoms and Peer Behaviors with Risk for Substance Use and Condomless Sex among Youth in Juvenile Drug Court

Juvenile drug courts are a growing response to adolescent substance use, but a better understanding of modifiable risk factors is needed to improve program outcomes. Youth's mental health symptoms and peers' activities may impede the effectiveness of these "therapeutic" courts. In a unique longitudinal sample of 105 adolescents involved in juvenile drug court, we find elevated internalizing symptoms and deviant behavior of peers were each associated with increased risk of alcohol and marijuana use. Similar effects were seen on risk for condomless sex. Mental health and peer behaviors should be intervention targets for evidence-based juvenile drug court programming.

Parent and Youth Engagement in Court-Mandated Substance Use Disorder Treatment

While juvenile drug courts (JDCs) require treatment participation, youth and parent engagement in treatment cannot be mandated. We compared youths' and parents' self-reports of engagement in Risk Reduction Therapy for Adolescents (RRTA) and Treatment as Usual (TAU) in JDCs. Parents and youth receiving RRTA were more likely than those receiving TAU to report high engagement in treatment. High parent engagement in RRTA early in treatment predicted fewer missed appointments and lower youth substance use at 3 months. Emphasizing therapeutic techniques that increase parent engagement, as utilized in RRTA, could lead to improved participation and clinical outcomes in court-mandated treatment settings.

A Randomized Trial of the Effectiveness of Using Incentives to Reinforce Parolee Attendance in Community Addiction Treatment

This study was a randomized effectiveness trial of the use of incentives to improve treatment retention and post-treatment outcomes among parolees in community treatment. Parolees entering community treatment were randomized to incentives ( N = 104) or brief education ( N = 98). It was hypothesized that the use of incentives to increase treatment retention would result in improved post-treatment outcomes (i.e., arrest, employment, and drug use), but at 18 months post-intake, there were no group differences for any outcome. In secondary analyses, rearrest by 18 months post-intake was predicted by substance use, greater number or severity of psychological symptoms, treatment non-completion, unemployment, and younger age. Contrary to expectations, results indicated that participants who received incentives for attendance had arrest, employment, and drug use outcomes similar to those who received a brief education session. Our findings, in concert with those of several other researchers, suggest that there may be certain populations or settings where incentives may not be effective.

Contingency Management Approaches for Adolescent Substance Use Disorders

Multiple interventions for treating adolescents with substance use disorders have demonstrated efficacy, but a majority of teens do not show an enduring positive response to these treatments. Contingency management (CM)-based strategies provide a promising alternative, and clinical research focused on the development and testing of innovative CM models continues to grow. This article provides an updated review on the progress made in this area. It is important to continue to search for more effective models, focus on post-treatment maintenance (reduce relapse), and strive for high levels of integrity and fidelity during dissemination efforts to optimize outcomes.

First Evaluation of a Contingency Management Intervention Addressing Adolescent Substance Use and Sexual Risk Behaviors: Risk Reduction Therapy for Adolescents

There is a need for interventions that comprehensively address youth substance use disorders (SUD) and sexual risk behaviors. Risk Reduction Therapy for Adolescents (RRTA) adapts a validated family-focused intervention for youth SUD to include sexual risk reduction components in a single intervention. In this first evaluation of RRTA, drug court involved youth were randomly assigned to RRTA (N=45) or usual services (US; N=60) and followed through 12-months post-baseline. RRTA included weekly cognitive behavior therapy and behavior management training and contingency-contracting with a point earning system managed by caregivers targeting drug use and sexual risk antecedents. Longitudinal models estimated within-group change and between-group differences through 6- and 12-month follow-up on outcomes for substance use, sexual risk behaviors, and protective HIV behaviors. Robust effects of the intervention were not detected under conditions of the study that included potent background interventions by the juvenile drug court. Considerations about future development and testing of sexual risk reduction therapy for youth are discussed, including the potential role of contingency management in future interventions.

Effectiveness of Using Incentives to Improve Parolee Admission and Attendance in Community Addiction Treatment

This study is a randomized effectiveness trial of the use of incentives to improve treatment utilization among parolees in community treatment. In prison, Admission phase parolees were randomized to Admission Incentive (N=31) or Education (N=29). Attendance phase parolees entering community treatment were randomized to Attendance Incentive (N=104) or Education (N=98). There was no main effect for incentives in either study phase. Neither admission to community treatment (Incentive 60%, Education 64%; p =.74), nor intervention completion (Incentive 22%; Education 27%; p =.46) appeared to be impacted. Time-in-treatment was predicted by age, first arrest age, and type of parole status (Cox regression p<.05), but not by treatment group. Providing incentives did not increase the likelihood that parolees enrolled in or stayed in community treatment. In light of this finding, criminal justice practitioners who are considering incentives to increase admission or retention should be aware that they may not produce the desired outcomes.

Gambling and sexual behaviors in African-American adolescents

OBJECTIVES

Late adolescence represents a developmental risk period when many youth become involved in multiple forms of high-risk behaviors with adverse consequences. This study assessed the degree to which two such behaviors, adolescent sexual behaviors and gambling, were associated in a community-based sample with a large African-American presence.

STUDY DESIGN

Data are derived from a cohort study. This study focuses on 427 African-American participants with complete information on gambling and sexual behaviors by age 18 (72% of original cohort). Gambling involvement and related problems were based on responses to the South Oaks Gambling Screen - Revised for Adolescents. Several questions assessed sexual behaviors, including age of initiation. Multivariable logistic regression models adjusted for demographics, intervention status, impulsivity, depressive and anxiety symptoms, and alcohol and illegal drug use.

RESULTS

Almost half of the sample (49%, n=211) had gambled at least once before age 18. More gamblers than non-gamblers had initiated sexual intercourse by age 18 (aOR: 2.29 [1.16, 4.52]). Among those who had initiated sexual activity, more gamblers than non-gamblers with high impulsivity levels at age 13 (vs. low impulsivity levels) had become pregnant or had impregnated someone. Among those who had initiated sexual activity by age 18, more male gamblers had impregnated someone by age 18 as compared to female gamblers becoming pregnant.

CONCLUSIONS

Gambling and sexual behaviors often co-occur among adolescents. Such findings prompt the need for the inclusion of gambling, an often overlooked risky behavior, in behavioral prevention/intervention programs targeting adolescents.