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, 2005). Compared to the general adolescent population, justice-involved adolescents 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 suggests that key brain regions integral for making decisions about behavior in high risk situations are still developing during adolescence. Unfortunately, at present, many of the best-supported sexual risk prevention programming rely on well-developed cognitive control systems (e.g., motivational interviewing; MI), which may be less accessible for adolescents at this stage of neurodevelopment. Thus, the goal of the proposed study is to build on our previous successful work with this population (1R01 AA017390-01) to test two different types of theory-based interventions; one that relies upon well-developed control systems (MI) versus one that relies on a more basic behavioral approach (Behavioral Skills Training; BST). Through this innovative, integrative approach, we hope to build upon our prior work to: (1) demonstrate associations between risky sexual behavior with the reward and control networks in the brain, (2) understand whether variability in neurocognitive activation associated with the control and reward systems predicts the effectiveness of these two intervention approaches to reduce risky sexual behavior among justice- involved adolescents at high risk for HIV/STDs, and (3) examine the correlation between neurocognitive responses to the fMRI-based tasks to a parallel set of cognitive tasks that are easily administered outside of the scanner to assess the potential for the translation of neurocognitive findings into real-world application. The proposed research is expected to provide critical data that will improve HIV/STD risk reduction programming with high risk adolescents.
Justice-involved adolescents 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 greater rates of unintended pregnancy and STDs including HIV/AIDS. Research supports that specific brain regions are critical in decision-making about risky situations. However, many of these areas are still developing during adolescence, and this may contribute to the high level of sexual risk seen at this stage of development. Individual differences in the development of these areas in adolescents may result in differential responses to various intervention approaches. This study explicitly links the basic biological science of developmental cognitive neuroscience, neurocognitive models of impulsive and risky decision making, and psychosocial sexual risk prevention interventions to evaluate how best to prevent sexual risk behavior in this highly vulnerable population.
