Combining an intervention to reduce cannabis use with interventions for reducing sexually risky behavior and alcohol use proved effective at cutting the incidence of sexually transmitted infections (STI), according to a trial done in the juvenile justice system.
At 12-month follow-up, positive diagnosis of STI occurred in 3.9% of participants who received all three interventions (cannabis, sexual risk, and alcohol) versus 10.2% of those who received sexual risk reduction plus alcohol-focused content delivery (OR 0.36, 95% CI 0.12-1.05) and 12.4% of those receiving sexual risk reduction only (OR 0.29, 95% CI 0.10-0.84), albeit with extremely wide confidence intervals, according to Angela D. Bryan, PhD, of the University of Colorado in Boulder, and colleagues.
Adolescents involved in the juvenile justice system are at increased risk for STI, and “behavioral change interventions,” which are based on behavioral science theory, are more efficacious than those not based on behavioral science theory, they wrote in JAMA Pediatrics.
They found a “didactic, theory-based, sexual risk-reduction intervention” that included a segment on alcohol-focused content delivered as motivational enhancement therapy that resulted in both lower rates of sexual risk behavior and higher rates of condom use. Given this, they decided that incorporating cannabis-focused content is “well supported empirically and from a policy perspective given recent changes in the legislation of cannabis, decreased perception of its risks and high rates of use among adolescents.”
For this cluster randomized trial, the researchers examined adolescents living at a juvenile detention facility that were tested and treated for STIs, both before being randomized and 12 months after the intervention. Participants had to speak English, be ages 14-18, have a remaining detention term of less than 1 month, and sign a release to grant access to results of their STI tests. They were also paid for their participation, and received more money if they completed the intervention and did the follow-up.
Urine testing was used to diagnose Chlamydia trachomatis and Neisseria gonorrhoeae.
Interventions were in same-sex groups conducted by clinicians. They took place in a 3-hour session approximately 2 weeks before the participants were released from the detention facility. The authors explained that these interventions had the same focus — “establishing common definitions and hearing the stories of the youths themselves; provision of norms; bolstering of self-affirmation; exploration of high-risk situations; and exploration of how one might change if one wanted to.”
Participants were randomized to one of three interventions:
- Sexual risk reduction intervention (focusing entirely on condom use)
- Sexual risk reduction intervention plus alcohol-focused content delivery (condom use plus the role of the youth and their partner’s alcohol use in sexually risky behavior)
- Sexual risk reduction intervention plus alcohol-focused plus cannabis-focused content delivery (condom use plus the role of the youth and their partner’s alcohol and cannabis use in sexually risky behavior)
Overall, 460 participants (mean age 15.8) were randomized. Three-quarters were boys and over half were of Hispanic ethnicity. Almost 80% of participants contributed STI diagnosis data at their 12-month follow-up. Chlamydia was the most common STI both at baseline (of the 44 participants with an STI, 35 had chlamydia) and at follow-up (of the 31 participants with an STI, 28 had chlamydia).
“Consistent with epidemiologic data from the Centers for Disease Control and Prevention showing that chlamydia is 3 to 4 times more prevalent than gonorrhea, chlamydia was more prevalent than gonorrhea in our sample,” the authors noted.
Study limitations included the lack of a no-treatment control group. Also, the generalizability of the findings may be limited as participants were from a juvenile detention facility.
“Our results suggest that intervention effects are not linked solely to mode of delivery; instead, substance-use content may play a role in reducing sexual risk among this vulnerable population,” the authors concluded. “This cost-effective, easily disseminated intervention has real-world value for juvenile justice agencies.”
The study was partially supported by the National Institute on Alcohol Abuse and Alcoholism.
Bryan and co-authors disclosed that biological testing for STI was included as an outcome of the trial after review, but before a decision by a NIH council regarding funding.
Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner