Randomized Trial to Reduce Risky Sexual Behavior Among Justice-Involved Adolescents

Abstract

Justice-involved adolescents are at high risk for sexually transmitted infections; one primary reason is co-occurring substance use. This study investigates the additive benefit of including alcohol and cannabis use content in a theory-based sexual risk reduction intervention, delivered using group-based motivational enhancement therapy. This study had a cluster randomized design, with randomization of single-sex clusters to 1 of 3 interventions. Participants were male and female justice-involved adolescents (N=460) residing in youth detention facilities. Data were collected from 2010 to 2014; analyses were completed in 2018-2019. Adolescents were randomized to 1 of 3 motivational enhancement therapy interventions: sexual risk reduction intervention, sexual risk reduction intervention with alcohol content, or sexual risk reduction intervention with alcohol and cannabis content. The primary outcome was risky sexual behavior (aggregation of condom use and frequency of intercourse), measured every 3 months for 1 year. Secondary outcomes were theoretical mechanisms on which the intervention was based (condom use attitudes, self-efficacy, peer norms, and behavioral intentions), collected at baseline and post-test. Risky sexual behavior significantly decreased from baseline to 3-month follow-up (t=10.59, p<0.001) and this decrease was maintained 1 year later (t=9.04, p<0.001). Intervention was associated with improved values on all theoretical mechanisms. Although all outcomes improved over time, changes did not differ by intervention condition (p>0.29 for all). Comparisons to a historical, information-only, sexual risk reduction control arm conducted with a similar juvenile justice sample confirm the effectiveness of all 3 motivational enhancement therapy-based interventions. All 3 interventions were associated with decreased sexual risk up to 1 year later, suggesting that the intervention modality (motivational enhancement therapy) may resonate with this population beyond the specific substance use content. This single-session manualized intervention can be readily disseminated to juvenile justice settings. This study is registered at www.clinicaltrials.gov NCT01170260.