Choices-TEEN: Phase I Trial to Assess a Gender-Specific Intervention to Reduce Bundled Health Risks Among Females in the Juvenile Justice System

Background/Purpose: Adolescent females in juvenile justice settings engage in multiple health risk behaviors that place them at risk for HIV and pregnancy affected by nicotine or alcohol. Specifically, they engage in frequent sexual risk behaviors, placing them at risk of unplanned pregnancy, STIs and HIV, while also drinking at risky levels and smoking, putting them at further risk of both tobacco- (TEP) and alcohol-exposed pregnancy (AEP). Despite the fact that females in the juvenile justice system present with unique, multiple health risks, few empirically supported gender specific interventions exist.

To address this need, this study assessed the feasibility and promise of an adapted CHOICES preconception intervention (CHOICES-TEEN) to reduce the risks of HIV, TEP, and AEP in adolescent females on intensive community probation. The original CHOICES intervention consisted of four sessions and was efficacious for adult women in reducing the risk of AEP in several high risk settings. A shorter, two-session bundled CHOICES intervention (CHOICES Plus) was efficacious in reducing both the risks of AEP and TEP. The current study posited that a two-session CHOICES intervention adapted to target multiple bundled health risks—AEP, TEP, and HIV—would be feasible, acceptable, and promising in reducing these risks for adolescent females on community-based probation.

Methods: Methods followed Stage Ia/Ib intervention development guidelines, and utilized a one group pretest-posttest design. CHOICES-TEEN consists of two counseling sessions with a master’s level clinician, referral to the Tobacco Cessation Quitline, a counseling session with a Pediatrician, and referral to a Health Clinic for further testing or medical care.

150 females aged 14-17 receiving specialized intensive community probation were screened for risk of HIV, TEP and AEP, and 37 (25%) were eligible. Those who assented and provided parental permission were enrolled in the study (N=28). Feasibility and acceptability were measured by assessing therapeutic alliance using the Working-Alliance Inventory Short Form, session retention, and treatment satisfaction using the Client Satisfaction Questionnaire (CSQ)-8.  Behavioral outcomes were measured using the Timeline Follow Back for all risk behaviors (alcohol use, smoking, sexual activity, condom use and effective contraception use) at baseline, posttest and 3 month follow-up.

Results: Participants’ mean age was 16 years old (SD=.95), 79% identified as Hispanic/Latina and 21% were Black Non-Hispanic. Client satisfaction was high overall, and therapists and clients rated their experience with the counseling sessions highly. Of those who completed the first intervention session, 92% also completed the second counseling session and the session with the Pediatrician. Ninety-one percent of participants reduced their risk of AEP at posttest and 71.5% remained at reduced risk at 3 months. Of those at risk of TEP at baseline, 72.2% reduced their risk at posttest and 50% at 3 months. Finally, 52.4% reduced risk of HIV at one month, and 28.6% at 3 months.

Implications: These results suggest that the CHOICES-TEEN intervention is feasible and promising for reducing overlapping, bundled health risks among high-risk adolescent females. The efficacy of this intervention should be assessed in a larger Stage II trial.