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Articles   |    
Project STYLE: A Multisite RCT for HIV Prevention Among Youths in Mental Health Treatment
Larry K. Brown, M.D.; Wendy Hadley, Ph.D.; Geri R. Donenberg, Ph.D.; Ralph J. DiClemente, Ph.D.; Celia Lescano, Ph.D.; Delia M. Lang, Ph.D.; Richard Crosby, Ph.D.; David Barker, Ph.D.; Danielle Oster, B.S.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300095
View Author and Article Information

Dr. Brown, Dr. Hadley, Dr. Barker, and Ms. Oster are with the Department of Psychiatry, Rhode Island Hospital, Providence (e-mail: lkbrown@lifespan.org). Dr. Donenberg is with the Department of Psychiatry, University of Illinois at Chicago. Dr. DiClemente and Dr. Lang are with the Rollins School of Public Health, Emory University, Atlanta. Dr. Lescano is with the Department of Psychiatry, University of South Florida, Tampa. Dr. Crosby is with the College of Public Health, University of Kentucky, Lexington.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  The study examined the efficacy of family-based and adolescent-only HIV prevention programs in decreasing HIV risk and improving parental monitoring and sexual communication among youths in mental health treatment.

Methods  A randomized controlled trial (RCT) with 721 adolescents (ages 13–18 years) and their caregivers from mental health settings in three U.S. cities were randomly assigned to one of three theory-based, structured group interventions: family-based HIV prevention, adolescent-only HIV prevention, and adolescent-only health promotion. Interventions were delivered during an all-day workshop. Assessments were completed at baseline and three months postintervention.

Results  Compared with those in the health intervention, adolescents in the HIV prevention interventions reported fewer unsafe sex acts (adjusted rate ratio=.49, p=.01), greater condom use (adjusted relative change=59%, p=.01), and greater likelihood of avoiding sex (adjusted odds ratio=1.44, p=.05). They also showed improved HIV knowledge (p<.01) and self-efficacy (p<.05). The family-based intervention, compared with the other interventions, produced significant improvements in parent-teen sexual communication (p<.01), parental monitoring (p<.01), and parental permissiveness (p=.05).

Conclusions  This RCT found that the HIV prevention interventions reduced sexual risk behavior over three months in a large, diverse sample of youths in mental health treatment and that the family-based intervention improved parental monitoring and communication with teens about sex. These interventions show promise.

Abstract Teaser
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Table 1Risk behaviors reported by adolescents before and after a one-day intervention programa
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a HIV prevention included an intervention for adolescents only or for parent and teen; the control condition was a general health intervention for adolescents only. Percentages are based on the number of valid cases for each measure.

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b Adjusted for baseline measurements

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c Reported for adolescents who were sexually active by the 3-month assessment

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d Reported for adolescents who reported sexual activity during the past 90 days

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Table 2Risk incidence reported by adolescents before and after a one-day intervention programa
Table Footer Note

a HIV prevention included an intervention for adolescents only or for parent and teen; the control condition was a general health intervention for adolescents only.

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b Sexual risk outcomes were reported for those who reported sexual activity during the past 90 days.

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c Rate ratio, adjusted for baseline measurements

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Table 3Family scale scores after the family intervention and other interventions (adolescent only and general health promotion)
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a (Adjusted mean difference/adjusted comparison condition mean) × 100%. Relative change scores were adjusted for baseline measurements.

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b Possible scores range from 6 to 42, with higher scores indicating greater communication.

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c Possible scores range from 1 to 20, with higher scores indicating greater perceived parental monitoring or permissiveness.

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d Possible scores range from 1 to 27, with higher scores indicating greater perceived knowledge about HIV.

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