Adolescents are at great risk for sexually transmitted diseases (STDs) including HIV/AIDS, and are one of few HIV risk groups for whom HIV/AIDS incidence is not declining (CDC, 2005a). Compared to the general adolescent population, adolescents involved with the criminal justice system are younger at first intercourse, have a greater number of sex partners, and lower rates of condom use, resulting in higher rates of unintended pregnancy and STDs (e.g., Teplin, Mericle, McClelland &Abram, 2003). Data from our previous research efforts suggests that it is heavy alcohol use in concert with sexual activity, rather than heavy alcohol use generally, that is most strongly related to lack of condom use (Bryan, Ray, &Cooper, in press). Further, we have demonstrated initially higher rates of condom use at follow-up among adolescents who participated in a combined sexual risk reduction + alcohol risk reduction intervention as compared to a sexual risk reduction only intervention and an information only control intervention in our prior NIAAA-supported randomized controlled intervention with incarcerated adolescents, (R01 AA013844-01;Schmiege, Broaddus, Bryan, et al., 2008). The goal of the proposed study is to build on those successful findings, and on our ongoing work (RO1 DA019139-01) and that of others (Lebeau-Craven et al., 2003;Kingree &Betz, 2003) which suggests that marijuana use is more prevalent than alcohol use generally and during sex than is alcohol use among criminally-involved adolescents. In addition, NIDA has noted that marijuana is a specific drug of abuse that may be an emerging risk factor for HIV and STDs, but one for which there is little basic or intervention research. In this continuation, we propose to conduct a second randomized controlled trial to compare an expanded sexual risk reduction intervention that includes both an alcohol component and a marijuana component, to a sexual risk reduction intervention that includes only an alcohol component, and a sexual risk reduction only condition. Each of these interventions includes a standard theory-based didactic presentation of sexual reduction intervention material and a group motivational enhancement therapy component focused on alcohol and marijuana, alcohol use only, or sexual risk behavior only. We hope to show that: 1) combining both substances into one intervention further increases its efficacy at decreasing sexual risk behavior because of its broad coverage of the three most highly prevalent risk behaviors (alcohol, marijuana, and unprotected sex) in this population, 2) it is the substance use content, and not the group MET modality that is responsible for this increased efficacy, and 3) the intervention exerts its effects through theoretically-based mediators. The relative success of these interventions will have implications for HIV/STD risk reduction programming for high risk adolescents in the criminal justice system.

Public Health Relevance

Adolescents involved with the criminal justice system are younger at first intercourse, have a greater number of sex partners, and lower rates of condom use than their non criminally-involved counterparts. This high level of sexual risk results in higher rates of unintended pregnancy and STDs including HIV/AIDS. These young people also have extraordinarily high rates of alcohol and marijuana use, and many have demonstrated that substance use plays a causal role in sexual risk. This research is designed to implement and carefully evaluate new intervention technologies that have the goal of decrease alcohol- and marijuana-related sexual risk behavior in this population of highly vulnerable young people.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
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Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
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Bryant, Kendall
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University of New Mexico
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Ewing, Sarah W Feldstein; Schmiege, Sarah J; Bryan, Angela D (2014) Continued detention involvement and adolescent marijuana use trajectories. J Correct Health Care 20:31-44
Dealy, Bern C; Horn, Brady P; Callahan, Tiffany J et al. (2013) The economic impact of project MARS (motivating adolescents to reduce sexual risk). Health Psychol 32:1003-12
Callahan, Tiffany J; Montanaro, Erika; Magnan, Renee E et al. (2013) Project MARS: Design of a Multi-Behavior Intervention Trial for Justice-Involved Youth. Transl Behav Med 3:122-130
Schmiege, Sarah J; Feldstein Ewing, Sarah W; Hendershot, Christian S et al. (2011) Positive outlook as a moderator of the effectiveness of an HIV/STI intervention with adolescents in detention. Health Educ Res 26:432-42
Bryan, Angela D; Schmiege, Sarah J; Broaddus, Michelle R (2009) HIV risk reduction among detained adolescents: a randomized, controlled trial. Pediatrics 124:e1180-8
Schmiege, Sarah J; Broaddus, Michelle R; Levin, Michael et al. (2009) Randomized trial of group interventions to reduce HIV/STD risk and change theoretical mediators among detained adolescents. J Consult Clin Psychol 77:38-50
Schmiege, Sarah J; Levin, Michael E; Bryan, Angela D (2009) Regression mixture models of alcohol use and risky sexual behavior among criminally-involved adolescents. Prev Sci 10:335-44
Broaddus, Michelle R; Bryan, Angela (2008) Consistent condom use among juvenile detainees: the role of individual differences, social bonding, and health beliefs. AIDS Behav 12:59-67
Bryan, Angela; Schmiege, Sarah J; Broaddus, Michelle R (2007) Mediational analysis in HIV/AIDS research: estimating multivariate path analytic models in a structural equation modeling framework. AIDS Behav 11:365-83