Behavioral interventions in a motivational enhancement therapy (MET) format that include sexual risk reduction combined with alcohol- and cannabis-focused elements are effective in reducing sexually transmitted infection (STI) incidence among justice-involved adolescents, according to a study published in JAMA Pediatrics.
Angela D. Bryan, PhD, from the Department of Psychology and Neuroscience at the University of Colorado, Boulder, and colleagues conducted a randomized trial of 460 adolescents residing at a detention facility at the time of recruitment. Eligibility criteria included those who were aged 14 to 18 years and English-speaking and those who had a remaining detention term of less than 1 month and who signed a release granting access to STI results. Data were collected between July 1, 2010, and December 10, 2014, and analyses were conducted in July and August 2017.
Urine testing for men and women was used to diagnose Chlamydia trachomatis and Neisseria gonorrhoeae. Participants with laboratory-confirmed chlamydia and/or gonorrhea were treated according to the Centers for Disease Control and Prevention’s 2010 STD Treatment Guidelines. The 3 intervention conditions included sexual risk reduction intervention (SRRI); SRRI plus alcohol content (SRRI + ETOH); and SRRI plus ETOH plus cannabis content (SRRI + ETOH + THC).
Of the 460 participants randomized, the mean age was 15.8 years, 347 (75.4%) were male, and 262 (57.0%) were of Hispanic ethnicity. The adolescents were sexually experienced, with high levels of alcohol and cannabis use. Conditions were equivalent at baseline, with the exception of more Hispanic participants in the SRRI + ETOH group than in the SRRI + ETOH + THC group. A total of 361 participants (78.5%) contributed STI diagnosis data at the 12-month follow-up.
Among the participants, 143 were randomized to SSRI, 155 to SRRI + ETOH, and 162 to SRRI + ETOH + THC. Attrition at 12-month follow-up was 99 (21.5%) for the STI outcome variable. Participants in the SRRI + ETOH + THC intervention had a lower incidence of STI at follow-up (3.9%) than those in either the SRRI (12.4%; odds ratio, 0.29) or the SRRI + ETOH (10.2%; odds ratio, 0.36) interventions.
“A MET-based intervention including theory-based sexual risk-reduction and alcohol- and cannabis-related content was more effective at reducing STI incidence among justice-involved adolescents than an intervention using a similar format that did not include substance use content,” the authors concluded.
Bryan AD, Magnan RE, Gillman AS, et al. Effect of including alcohol and cannabis content in a sexual risk-reduction intervention on the incidence of sexually transmitted infections in adolescents: a cluster randomized clinical trial. JAMA Pediatr. 2018 Feb 12:e175621. doi: 10.1001/jamapediatrics.2017.5621