Randomized trial of group interventions to reduce HIV/STD risk and change theoretical mediators among detained adolescents

Abstract

Criminally involved adolescents engage in high levels of risky sexual behavior and alcohol use, and alcohol use may contribute to lack of condom use. Detained adolescents (n = 484) were randomized to (1) a theory-based sexual risk reduction intervention (GPI), (2) the GPI condition with a group-based alcohol risk reduction motivational enhancement therapy component (GPI + GMET), or (3) an information-only control (INFO). All interventions were presented in same-sex groups in single sessions lasting from 2 to 4 hr. Changes to putative theoretical mediators (attitudes, perceived norms, self-efficacy, and intentions) were measured immediately following intervention administration. The primary outcomes were risky sexual behavior and sexual behavior while drinking measured 3 months later (65.1% retention). The GPI + GMET intervention demonstrated superiority over both other conditions in influencing theoretical mediators and over the INFO control in reducing risky sexual behavior. Self-efficacy and intentions were significant mediators between condition and later risky sexual behavior. This study contributes to an understanding of harm reduction among high-risk adolescents and has implications for understanding circumstances in which the inclusion of GMET components may be effective.

Figures

Figure 1

Diagram of participant flow through the study by condition. INFO = information-only control; GPI = theory-based sexual risk reduction intervention; GPI + GMET = the GPI condition with a group-based alcohol risk reduction motivational enhancement therapy component.

Figure 2

Mediational model examining psychosocial constructs as mediators between condition and risky sexual behavior at 3-month follow-up. All parameter estimates are standardized. INFO = information-only control; GPI = theory-based sexual risk reduction intervention; GPI + GMET = the GPI condition with a group-based alcohol risk reduction motivational enhancement therapy component. * p < .05. ** p < .01. *** p < .001.