High rates of mental illness, HIV/AIDS/STI, and incarceration among African Americans (AA) reflect significant health disparities (NIH 2001 strategic plan to eliminate health disparities), particularly among youth. Teens in juvenile justice are disproportionately AA, and compared to the general population, juvenile offenders (JO) report more risky sexual behavior, drug and alcohol use, and psychiatric disorders, and are more likely to test positive for STIs. Still, few empirically-supported, theoretically-driven programs exist to address their negative health outcomes. This proposal addresses these health disparities by testing an innovative and uniquely tailored HIV/AIDS/STI, mental health, and substance use program designed for and pilot tested with recently arrested 13 - 17 year-old urban males and females (85% African American, 14% Latino/a) released on probation (PHAT Life;R34MH075628). PHAT Life was derived from a carefully staged process that included an active, diverse, multi-disciplinary advisory board, a youth advisory board, focus groups, two pilot tests, extensive feedback, and a series of curriculum revisions over three years. The R34 established feasibility and acceptability, revealed positive youth and stakeholder feedback, and yielded good preliminary outcomes at 3-month follow-up (e.g., increased condom use) to justify an efficacy trial. This application proposes a 2-arm randomized controlled trial to test PHAT Life versus a health promotion program with recently arrested 13-17 year-old male and female, mostly ethnic minority JO (as representative of Cook County) on probation in Chicago. We will use the procedures and methods established in the developmental study to recruit, enroll, assess, track, and intervene with teens. We will randomly assign youth to PHAT Life (N=150) or a health promotion control group (N=150), and we will deliver the interventions in single sex groups of 5 - 7 teens at Evening Reporting Centers. Assessments will occur at baseline, 6-, and 12-months post-treatment, and we will screen youth for three common STIs (Chlamydia, Gonorrhea, Trichamonas) at baseline and 12-month follow-up. All youth who test positive for an STI will receive single dose antibiotic treatment free of charge. Using an intent-to-treat analysis, we will test and compare PHAT Life to the health promotion control group on adolescent risky sexual behavior, substance use, and theoretical mediators. This proposal answers a compelling need for innovative prevention programs that address the intersecting health disparities of mental illness and HIV/AIDS/STIs among youth in juvenile justice. Without intervention, these teens continue to engage in risk behaviors post-release, amplifying their own and their partner's risk for HIV/AIDS/STIs.26, 27 The lasting effects on community well-being, individual employment prospects, and neighborhood health28 are profound, but effective programs can alter the negative developmental trajectories of this very high-risk population29, 30 and begin to redress existing health disparities.
This application has significant long-term implications for redressing serious health disparities. Juvenile offenders, the vast majority of whom are ethnic minorities, are disproportionately overburdened by HIV/AIDS/STIs, mental illness, and substance use. Few empirically-validated, theoretically-based programs exist for teens in juvenile justice, especially offenders who return to their communities immediately post-arrest, and none address the full range of impairment in these youth. High rates of co-morbid substance use and mental health problems present unique challenges for HIV/AIDS/STI prevention. Unfortunately, most JO return to their communities with undiagnosed and untreated STIs, and these youth continue to engage in risk behaviors post-release, amplifying their own risk, increasing the chances of infecting their partners, placing their neighborhoods at risk, and further fueling well-known health disparities. These negative outcomes have profound long-term effects on community well-being, individual employment prospects, and neighborhood health and safety. This study will begin to redress these concerns;empowered with the right tools, JO will be better equipped to make safer decisions that reduce their risk taking, thereby curbing the spread of HIV/AIDS/STIs in their communities.