Efficacy of an HIV/STI sexual risk-reduction intervention for African American adolescent girls in juvenile detention centers: a randomized controlled trial.

Few HIV/STI interventions exist for African American adolescent girls in juvenile detention. The objective was to evaluate the efficacy of an intervention to reduce incident STIs, improve HIV-preventive behaviors, and enhance psychosocial outcomes. We conducted a randomized controlled trial among African American adolescent girls (13-17 years, N = 188) in juvenile detention from March 2011 to May 2012. Assessments occurred at baseline and 3- and 6-months post-randomization and included: audio computer-assisted self-interview, condom skills assessment, and self-collected vaginal swab to detect Chlamydia and gonorrhea. The Imara intervention included three individual-level sessions and four phone sessions; expedited partner therapy was offered to STI-positive adolescents. The comparison group received the usual care provided by the detention center: STI testing, treatment, and counseling. At the 6-month assessment (3-months post-intervention), Imara participants reported higher condom use self-efficacy (p < 0.001), HIV/STI knowledge (p < 0.001), and condom use skills (p < 0.001) compared to control participants. No significant differences were observed between trial conditions in incident Chlamydia or gonorrhea infections, condom use, or number of vaginal sex partners. Imara for detained African American adolescent girls can improve condom use skills and psychosocial outcomes; however, a critical need for interventions to reduce sexual risk remains.

Screening for sexually transmitted diseases in short-term correctional institutions: summary of evidence reviewed for the 2010 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines.

Young persons entering US jails and youth detention facilities have high rates of sexually transmitted diseases (STDs). The Centers for Disease Control and Prevention added STD screening guidelines specific to correctional settings to the 2010 STD Treatment Guidelines. This article summarizes published evidence from 1990 to 2009 used to develop the recommendations. The literature supports routine screening of adolescents and young women (aged ≤35 years, or on the basis of local institutional prevalence data) for chlamydia and gonorrhea because of high prevalence and the subsequent risk of adverse reproductive outcomes. Chlamydia positivity among young women (aged <20 years) in juvenile detention facilities and adult facilities is more than 14%. Men in correctional settings are also at high risk for chlamydia and gonorrhea. Among boys in juvenile detention facilities, chlamydia positivity is estimated at 6.6%; among young men in adult facilities, positivity is 16.6%. Screening men (to reduce sequelae among women) should be considered based on local epidemiology and resource availability. Syphilis screening is not strongly supported in published literature because of low prevalence and is not routinely recommended; however, some screening may be warranted based on local prevalence. Although there is a great diversity in the organization of correctional facilities, implementation of screening recommendations is possible owing to improvements in test technology (urine specimens) and through integration of a standard screening protocol. Based on the high burden of disease and substantial opportunities to reach a high-risk population, correctional facilities are important venues to target efforts to control STDs.

Condom misuse among adjudicated girls: associations with laboratory-confirmed chlamydia and gonorrhea.

OBJECTIVES: To identify the prevalence of condom use errors among detained female teens and to test two inter-related hypotheses concerning condom failure. METHODS: A cross-sectional survey of 134 female teens recruited within eight detention facilities. Measures were collected using audio-computer assisted self-interviewing. Assessment for the presence of C. trachomatis and N. gonorrhoeae was also conducted. RESULTS: Five forms of condom use errors/problems were common: not discussing condom use with the partner (34.3%), not having a condom when one was desired (48.5%), starting sex before application (21.6%), removing condoms before sex concludes (26.9%), and breakage (32.8%). Significant, associations were found between condom errors/problems and drug/alcohol use. Errors/problems with condom use were significantly higher among teens diagnosed with an sexually transmitted disease (STD) (P = 0.039 for an index measure; P = 0.022 for a single-item measure). CONCLUSIONS: Findings suggest that detained female teens may have experienced multiple condom use error and problems thereby increasing their vulnerability to STD acquisition.

Witnessing community violence and health-risk behaviors among detained adolescents.

This study examines whether witnessing community violence, in the 12 months prior to juvenile detention, is related and health-related outcomes in the 2 months prior to being detained among 550 youth. Participants answered survey questions using audio-computer assisted self-interviewing procedures, which assessed demographic, problem, and drug and sexual risk behaviors. Multiple logistic regression analyses, controlling for significant covariates, indicated that adolescents, in the last 12 months, who reported witnessing community violence, relative to their peer witnessing no violence, were in the last 2 months prior to being detained, twice more likely to have suicidal threats, 2 times more likely to use marijuana and alcohol, 2 times more likely to get high on alcohol or other drugs during sexual intercourse, and 2 times more likely to have sex with a partner who was high on alcohol or other drugs. Finding suggest that detained youth, many of whom may not access traditional health care, should be offered prevention and intervention services during detention, which provides a critical window of opportunity for needed services.

Substance Use Disorders and Related Health Problems in an Aging Offender Population.

Substance use disorders (SUD), including alcohol and tobacco, have been associated with chronic, infectious diseases, and mental health disorders. Few studies have examined associations between SUD and health issues for aging offenders (≥ 45 years old), who may have been long-term users. This study investigated associations between SUD and health problems in a prison population (men and women). We included 10,988 offenders, of whom 26.8% were aging. Aging offenders were more likely than younger peers to have health problems, such as cardiovascular diseases and hypertension, (80.8% compared with 63.6%). We found that aging African Americans with SUD had greater odds for being diagnosed with chronic conditions than White peers (p <.0001). Controlling for SUD, cardiovascular disease emerged as the most significant and frequently associated health problem for aging offenders. Results suggest a need to focus on the health of aging offenders with a history of SUD, particularly African Americans.

Associations among Substance Use, Mental Health Disorders, and Self-Harm in a Prison Population: Examining Group Risk for Suicide Attempt.

Substance use disorders (SUD) and mental health disorders are significant public health issues that co-occur and are associated with high risk for suicide attempts. SUD and mental health disorders are more prevalent among offenders (i.e., prisoners or inmates) than the non-imprisoned population, raising concerns about the risk of self-harm. This cross-sectional study examined the population of a state prison system (10,988 out of 13,079) to identify associations among SUD (alcohol, cannabis, intravenous drugs, narcotics, and tobacco smoking), mental health disorders (anxiety, bipolar, depression, and psychotic disorders), and suicide attempts. The primary aim was to determine which groups (SUD, mental health disorders, and co-occurrences) were strongly association with suicide attempts. Groups with a documented SUD or mental health disorders compared to peers without these issues had 2.0 and 9.2 greater odds, respectively, for attempting suicide, which was significant at p < 0.0001 for both conditions. There were also significant differences within SUD and mental health disorders groups in regard to suicide attempts. Groups with the greatest odds for suicide attempts were offenders with comorbid bipolar comorbid and anxiety, alcohol combined with depression, and cannabis co-occurring with depression. Documentation of suicide attempts during imprisonment indicates awareness, but also suggest a need to continue enhancing screening and evaluating environmental settings.

The Benefits of Community and Juvenile Justice Involvement in Organizational Research.

The Juvenile Justice (JJ) system has a number of local behavioral health service community linkages for substance abuse, mental health, and HIV services. However, there have only been a few systemic studies that examine and seek to improve these community behavioral health linkages for justice-involved youth. Implementation research is a way of identifying, testing, and understanding effective strategies for translating evidence-based treatment and prevention approaches into service delivery. This article explores benefits and challenges of participatory research within the context of the National Institute on Drug Abuse (NIDA)'s Juvenile Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) implementation behavioral health study. The JJ-TRIALS study has involved JJ partners (representatives from state-level JJ agencies) throughout the study development, design, and implementation. Proponents of participatory research argue that such participation strengthens relations between the community and academia; ensures the relevancy of research questions; increases the capacity of data collection; and enhances program recruitment, sustainability, and extension. The extent of the impact that JJ partners have had on the JJ-TRIALS study will be discussed, as well as the benefits local JJ agencies can derive from both short- and long-term participation. Issues associated with the site selection, participation, and implementation of evidence-based practices also will be discussed.

A Call to Develop Evidence-based Interventions to Reduce Sexually Transmitted Infections in Juvenile Justice Populations.

Sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) risk, are a significant health issue for young women (ages 16-21), especially African Americans with a juvenile justice history. Studies have found that 44% of young African American women have had at least one STI compared to 24.1% for all young women. The rate of STIs among young women with juvenile justice histories, particularly African Americans, is likely much higher than their non-detained peers. Yet, there are few evidence-based interventions (EBIs) designed specifically for the detained population. In 2014, the Centers for Disease Control and Prevention's Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention listed few programs that comprehensively included components related to mental health, intimate relationships and high risk sexual behaviors that would be salient for a detained population. Further, many EBIs have had limited or no long-term protective effect. We propose that interrelated factors (mental health, substance use, trauma and intimate relationships) can effectively decrease risk and increase protective behaviors for the detained population most at risk.

Understanding Psychosocial and High-Risk Sexual Behaviors Among Detained Juveniles: A Descriptive Study Protocol.

BACKGROUND: African American women are disproportionately impacted by sexually transmitted infections (STIs), such as chlamydia and gonorrhea, which are known risk factors for human immunodeficiency virus (HIV) infection. STIs, particularly chlamydia and gonorrhea, are even more prevalent among young African American women with a juvenile detention history. The population with experiences with the criminal justice system has greater rates of STIs and is diagnosed more often with mental health issues, often related to sexual abuse or intimate partner violence, compared to peers who have not been detained by law enforcement. Psychosocial factors, especially those related to intimate relationships (ie, the imperativeness of being in a relationship and the power one has in their relationship), have emerged as important explanatory factors for acquiring STIs, including HIV, and a component of risk reduction interventions. OBJECTIVE: To investigate more comprehensively the relationship between psychosocial risk factors and STIs, including HIV, as it relates to reduction and prevention of these diseases. The long-term goal is to improve the effectiveness of evidence-based interventions with a major focus on intimate relationship dynamics. METHODS: This descriptive study surveys young women (ages 13-17) who have been detained (incarcerated) by a department of juvenile justice. In addition to being female and detained, eligibility criteria include being detained longer than 30 days and being free of cognitive impairments. This study will include young women from one juvenile detention center. The primary outcomes to be measured are STI knowledge, intimate relationship dynamics (ie, imperativeness and power), and high-risk sexual behaviors. High-risk sexual behaviors will be assessed using data extracted from health records. RESULTS: Preliminarily, we have received assent from 26 primarily young African American women. The majority of participants (81%) had inadequate knowledge about STIs, 52% perceived a lack of power in their relationship, 56% were fearful of negotiating condom use, and 60% were not comfortable refusing sex. Interestingly, a majority of participants (68%) did not perceive a relationship as imperative. CONCLUSIONS: When enrollment and data collection are completed, it is expected that the primary outcome of intimate relationship dynamics (ie, imperativeness and power) will be associated with high-risk sexual behaviors and having an STI. Further, the findings are expected to provide guidance in developing a risk reduction intervention, for the population in which psychosocial factors related to intimate relationships will be central.

Health risk factors among detained adolescent females.

OBJECTIVES: To identify the prevalence of health risk factors among a sample of detained adolescent females and determine whether there are racial/ethnic differences. DESIGN AND SETTING: A cross-sectional survey of 197 adolescent females (aged 14 to 18 years) recruited within eight detention facilities. OUTCOME MEASURES: Thirty-five measures, comprising four domains, were assessed. Domains were sex-related risk factors, violence-related risk factors, selected mental health issues, and substance abuse behaviors. Measures were collected using audio-computer-assisted self-interviewing. A biological assessment for the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis was also conducted. RESULTS: Several health risk factors were especially prominent. Mean age of sexual debut was 13 years. The mean number of sex partners (lifetime) was 8.8. Twenty percent tested positive for an STD, and 32.2% had ever been pregnant. Of those reporting sexual activity, 33.9% had not used any form of contraception in the past 2 months and about 40% reported having recent sex with a casual partner. More than 40% reported that a friend had been beaten, attacked, or hurt by others in the past year. More than one half had witnessed violence (past year) and nearly 30% had ever belonged to a gang. Forty percent had thought about committing suicide in the past 2 months, with 35% informing someone of their intent, and 25% attempting suicide. Recent use of illegal substances was common. Correlations between the four domains were significant (p < 0.03), but weak. With some notable exceptions (STD prevalence, trading sex for money, witnessing violence), no difference was found between minority and nonminority adolescents with respect to risk factors. After creating an index of all the risk factors, a normal distribution was obtained (mean number of factors, 10.3; standard deviation, 5.0). CONCLUSIONS: Preventive medicine programs for adolescent females within detention facilities are warranted. Our evidence suggests that health risk behaviors in this population may be quite diverse; therefore, these programs should be broad in scope and that depth of the programs should vary as a function of risk level.

Teacher connectedness and health-related outcomes among detained adolescents.

PURPOSE: Data were collected from a convenience sample of 550 detained adolescents (ages 14-18 years) to explore the association between adolescents' perception of teacher connectedness and a range of health risk behaviors, such as gang membership, use of in alcohol, drugs, and tobacco, and engagement in sexual risk behaviors prior to detainment. METHODS: Participants answered survey questions using audio-computer assisted self-interviewing procedures that assessed demographic, pro-social, problem, and drug and sexual risk behaviors. RESULTS: Multiple logistic regression analyses controlling for demographic and socioeconomic status, truancy, number of days in the detention center, and family factors indicated that adolescents who reported low teacher connectedness, relative to their peers reporting high teacher connectedness, were twice as likely to use marijuana and amphetamines, and twice as likely to be sexually active, have sex while high on alcohol or drugs, have a partner who was high on alcohol or other drugs during sex, and have multiple sexual partners. CONCLUSIONS: The association between teacher connectedness and adolescents' health risk behaviors prior to detainment suggests that school-based interventions that enhance the school environment, particularly teachers' skills and training to enhance and maximize the effectiveness of their student interactions, may be one strategy for reducing health risk behaviors and their associated adverse health outcomes among youth at high risk.

Accounting for failures may improve precision: evidence supporting improved validity of self-reported condom use.

OBJECTIVES: To determine whether a measure of unprotected vaginal sex that is adjusted for condom failures would produce improved accuracy in predicting biologically confirmed STDs (chlamydia and gonorrhea) among female teens. METHODS: Self-reported measures were collected using audio-computer-assisted self-interviewing. DNA amplification for the presence of Chlamydia trachomatis and Neisseria gonorrhoeae was conducted. RESULTS: The unadjusted measure of unprotected vaginal sex was not significantly associated with biologically confirmed prevalence of STDs (prevalence ratio [PR] = 1.51; 95% CI = 0.71-3.21; P = 0.28). Alternatively, the adjusted measure achieved significance (PR = 3.59; 95% CI = 1.13-11.38; P = 0.014). More than one quarter (25.6%) of teens using condoms inconsistently and/or incorrectly tested positive for an STD compared to 7.1% among those reporting the consistent and correct use of condoms. CONCLUSION: Findings demonstrate that studies of condom effectiveness should use an adjusted measure of condom use to achieve precision and rigor.