Unplanned pregnancies (pregnancies that are either mistimed or unwanted) and sexually transmitted infections (STIs) are important and costly public health problems in the United States resulting from unprotected sexual activity. Currently, 80% of teen pregnancies are unplanned and are the result of no or improper use of contraceptives.23,24 Teenage girls involved in the justice system are at increased risk for these problems given the high rates of substance abuse and commercial sex work in this population. Unplanned pregnancies can be prevented through highly effective (less than 2% annual failure rate with typical use) reversible contraceptive methods which are readily available through Title X clinics. The long-term objectives of this research are to develop effective treatments to reduce unplanned pregnancy and STIs for a highly under-served population in great need. This proposal will evaluate a Motivational Interviewing (MI) intervention designed to improve contraceptive use and decrease STIs for girls involved with the justice system for both those who do and do not want a pregnancy. Those interested in becoming pregnant will be counseled in the risks associated with teen pregnancy and what it means to have a healthy pregnancy and raise a child. We will utilize Title X programs in Rhode Island to provide reproductive health services in the community. Building upon program experience and prior evaluations, we have adapted Computer Assisted Motivational Interviewing (CAMI25), and plan to implement and evaluate CAMI for increasing the initiation and continuation of highly effective contraceptive methods among girls at risk for an unplanned pregnancy or STI. We will recruit 250 girls from juvenile probation and randomize them to two interventions: two sessions of personalized CAMI combined with one session of skill building or three sessions of Didactic Educational Counseling (DEC), both delivered individually by trained counselors. CAMI is based on the principles of the Transtheoretical Model (TTM) and on MI4,an empirically supported counseling technique designed to enhance readiness to change targeted behaviors. The DEC provides didactic information about contraception, STI prevention and abstinence, and is intended to control for the effects of assessment and attention. The proposal is consistent with the agency's mission to promote healthy and wanted pregnancy, reduce harmful reproductive processes, and support children in achieving healthy and productive lives.

Public Health Relevance

The proposed study builds on past trials implementing a computer assisted motivational intervention (CAMI) for pregnancy and STI's among incarcerated women. We now seek to include adolescent girls on probation as a way of beginning the discussion at an earlier phase both in terms of pregnancy and STI risk and contact with the criminal justice system. The CAMI has been piloted successfully by this research team and has shown promising results for reducing STI's and pregnancy in high risk female populations. There is a paucity of knowledge on treatment for adolescent females involved in the justice system in general and even more in terms of their reproductive health, this study addresses this gap.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
Project #
Application #
Study Section
Nursing and Related Clinical Sciences Study Section (NRCS)
Program Officer
Newcomer, Susan
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Rhode Island
Internal Medicine/Medicine
Schools of Arts and Sciences
United States
Zip Code
Hill, Danielle C; Stein, L A R; Rossi, Joseph S et al. (2018) Intimate violence as it relates to risky sexual behavior among at-risk females. Psychol Trauma 10:619-627
Noska, Amanda J; Roberts, Mary B; Sufrin, Carolyn et al. (2016) History of Sex Exchange in Women with a History of Incarceration. J Health Care Poor Underserved 27:149-62
Gold, Melanie A; Tzilos, Golfo K; Stein, L A R et al. (2016) A Randomized Controlled Trial to Compare Computer-assisted Motivational Intervention with Didactic Educational Counseling to Reduce Unprotected Sex in Female Adolescents. J Pediatr Adolesc Gynecol 29:26-32
Stein, L A R; Clair, Mary; Soenksen, Shayna et al. (2015) Studying Process and Proximal Outcomes of Supervision for Motivational Interviewing. Train Educ Prof Psychol 9:175-182