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ObjectivesWe examined the prevalence of sexting, related motivations, demographics, and association with behavioral health problems among justice-involved adolescents.HypothesesWe hypothesized positive associations between sexting and sexual risk, substance use, delinquency, and mental health problems.MethodsParticipants were 307 community-supervised justice-involved adolescents with a first-time offense (Mage =14.50 years, 44.6% female) and their caregivers. Adolescents answered questions on technology use and sexting by sending, receiving, or forwarding sexually suggestive text messages and images (pictures or videos). They also completed measures of recent (past 4-month) sexual activity, unprotected sex, cigarette, alcohol, marijuana, and other drug use, and delinquency; current trauma symptoms, internalizing problems, and adaptive functioning.ResultsPrevalence of sexting were 37.7% (lifetime overall; 17.0% sent texts; 17.4% sent images) and 29.5% (past-year overall; 12.8% sent texts; 13.6% sent images). Sexts were commonly sent as presents to partners, in response to sexts received, or to have fun. "Sexters" were older than "non-sexters" and more likely to identify as lesbian, gay, bisexual, or questioning. Past-year sexting was significantly associated with recent sexual activity; unprotected sex; alcohol use and days of use; marijuana and other drug use; delinquency and variety of delinquent acts; and elevated trauma symptoms and internalizing problems.ConclusionsSexting is prevalent among adolescents with a first-time offense and co-occurs with multiple behavioral health needs. Intervention for this population may be informed by routinely assessing sexting in community settings. Familiarity with local reporting laws could help clinicians navigate the legal implications of sexting among adolescents with existing justice-system involvement.

BackgroundGirls have unique developmental pathways to substance use and justice system involvement, warranting gender-responsive intervention. We tested the efficacy of VOICES (a 12-session, weekly trauma-informed, gender-responsive substance use intervention) in reducing substance use and HIV/STI risk behaviors among justice- and school-referred girls.MethodsParticipants were 113 girls (Mage = 15.7 years, SD = 1.4; 12 % White, 19 % Black, 15 % multi-racial; 42 % Latinx) with a history of substance use referred from juvenile justice (29 %) and school systems (71 %). Study assessments were completed at baseline, 3-, 6- and 9-months follow-up. Primary outcomes included substance use and HIV/STI risk behaviors; secondary outcomes included psychiatric symptoms (including posttraumatic stress) and delinquent acts. We hypothesized that girls randomized to the VOICES (n = 51) versus GirlHealth (attention control; n = 62) condition would report reduced alcohol, cannabis and other substance use, HIV/STI risk behaviors, psychiatric symptoms, and delinquent acts.ResultsGirls randomized to VOICES reported significantly less cannabis use over 9-month follow-up relative to the control condition (time by intervention, p < .01), but there were no between group differences over time in HIV/STI risk behavior. Girls in both conditions reported fewer psychiatric symptoms and delinquent acts over time.ConclusionsData support the use of a trauma-informed, gender-responsive intervention to reduce cannabis use among girls with a substance use history and legal involvement; reducing cannabis use in this population has implications for preventing future justice involvement and improving public health outcomes for girls and young women, who are at disproportionate health and legal risk relative to their male counterparts.

BackgroundJustice-involved youth use cannabis at higher rates than their same-aged peers increasing likelihood of adverse behavioral health consequences and continued legal involvement. This study examined individual level predictors of early onset use cannabis use (

Court-involved youth exhibit high rates of psychiatric symptoms, substance use, and delinquency, yet little is known about the contributing roles of caregiver and family factors. The current study examined whether family functioning and parental monitoring mediate the relationship between caregiver and youth psychiatric symptoms (at first court contact) and youth substance use and delinquency (two years later). Participants were 400 first-time offending court-involved youth (Mage = 14.5 years; 57.3% male; 45.6% non-Latinx White, 42.0% Latinx) and an involved caregiver (Mage = 41.0 years; 87.2% female; 53.0% non-Latinx White, 33.8% Latinx). Structural equation modeling revealed that caregiver and youth psychiatric symptoms were prospectively associated with worse family functioning, which was in turn related to higher levels of youth delinquency and greater likelihood of substance use. The results support the notion of addressing the needs of justice-involved youth and families holistically rather than treating youth as "the problem" in isolation.

This study examines substance use, emotional/behavioral symptoms and sexual risk among first-time offending, court-involved, non-incarcerated (FTO-CINI) youth. Youth and caregivers (N=423) completed tablet-based assessments. By time of first justice contact (average 14.5 years old), 49% used substances, 40% were sexually active and 33% reported both. Youth with co-occurring substance use and sexual risk had more emotional/behavioral symptoms; youth with delinquent offenses and females had greater co-occurring risk. Time of first offense is a critical period to intervene upon high rates of mental health need for those with co-occurring substance use and sexual risk to prevent poor health and legal outcomes.

Court-involved youth engage in risky sex behaviors at higher rates than non-offending peers and are at particular risk for adverse sexual health outcomes. Parenting practices, such as parent-child sexual communication and parental monitoring, may protect court-involved youth from engaging in risky sexual behavior. Parent psychological distress and family dysfunction may, however, compromise parenting practices for court-involved youth. This study examined associations among parent mental health symptoms, family functioning, and parenting practices within 157 parent-youth dyads who were court-referred for mental health treatment. Results revealed that greater parent mental health symptoms were directly related to greater family dysfunction and indirectly associated with poorer parental monitoring through worse family functioning. Findings suggest that directly addressing parent mental health needs in family-based adolescent sexual health programming for court-involved youth may be effective in improving parent-child relationships and family processes that support long term sexual health outcomes for adolescents.

Multiple assessment studies demonstrate that juvenile offenders are at increased risk for contracting HIV and other STIs relative to their non-offending counterparts. Such data are used to support the implementation of adolescent HIV prevention interventions within the juvenile justice system. Despite the compelling data related to high rates of unprotected sexual activity, pregnancy, STIs, substance use and psychiatric symptoms, there are very few empirically supported HIV prevention interventions for this adolescent subgroup. Using our experience conducting HIV prevention research studies with court-involved, non-incarcerated (CINI) youth we identify salient and unique challenges to consider when conducting HIV prevention intervention research with this population. Obstacles to consider include lack of "buy-in" and engagement from justice staff and families about the need for youth sexual health promotion and HIV prevention services and logistical barriers (time, transportation, space) related to conducting intervention research with a community-based sample of justice-involved youth. We consider these various challenges and provide recommendations for researchers on how to overcome barriers to continue to develop evidence-based HIV prevention services for communities of youth in need.

Given the continued increases in proportion of young girls entering the juvenile justice system, identifying factors to incorporate into gender responsive programming for these youth is of paramount importance to improving their behavioral health and legal outcomes. Psychiatric factors, including sexual abuse, marijuana use and HIV/STI sexual risk behaviors have been studied, but among detained youth. With increased emphasis on diverting young girls from incarceration, informing prevention and intervention programs about girls' psychiatric symptom profile and co-occurring risk behavior while in the community, but court-involved is of timely relevance. Therefore preliminary associations, by gender, between psychiatric symptoms, history of sexual abuse, substance use and HIV/STI sexual risk behavior among a pilot sample (N=60) of court-involved, non-incarcerated (CINI) youth were explored. Results from chi-square and t-test analysis indicate important gender differences. Girls have higher rates of depression and trauma symptoms, report higher rates sexual abuse and sexual risk behavior. These results provide some initial data related to risk factors for community supervised samples that can be used to begin to inform gender-specific juvenile justice programming.

Approximately 80% of all arrested youth are diverted from detention and supervised in the community through probation, specialty courts and other community-based diversion efforts. Justice-involved youth have greater psychiatric impairment, substance use and sexual risk behaviors than their non-justice-involved peers. Family-based interventions to address mental health, substance use and recidivism have been successful in improving these youth outcomes; but the lack of integration of HIV/STI prevention is notable given the co-occurrence of substance use, delinquency and sexual risk-taking behaviors among justice-involved youth. Moreover, emotion dysregulation may be an important and understudied underlying construct of these co-occurring risk behaviors for justice-involved youth. Study participants were 47 caregiver-youth dyads enrolled in a juvenile drug court program. As part of a pilot efficacy trial, dyads were randomized to a 5-session family-based integrated substance use and HIV/STI prevention intervention that relied on affect management strategies for risk reduction or an adolescent-only psychoeducation condition matched for time and attention. Data collected at baseline and 3months post-intervention suggest that a family-based integrated affect management substance use and HIV prevention pilot intervention may lead to justice-involved youths' enhanced motivation to change their marijuana use, decreased marijuana use and decreased risky sexual behavior over time. Future research is required to replicate these pilot trial findings and should also examine family-level mediators and moderators of treatment response, particularly with respect to HIV prevention efforts for these youth.

Juvenile offenders are a subgroup of adolescents at particular risk for HIV/STI infection. Although HIV prevalence among these youth is low (

Background: Health promotion/education strive to promote healthful conditions that improve quality of life based on the perceptions of those whose lives are affected Though health promotion/education might have instrumental value in reducing risks for premature morbidity and mortality, their ultimate value lies in contributions to quality of life. Life satisfaction (LS) has been defined as an individual's assessment of their quality of life based upon personal criteria and linked to adolescent health risk behaviors and developmental assets. Purpose: We investigated the psychometrics of the Brief Multidimensional Students' Life Satisfaction Scale [BMSLSS] with an adolescent sample of African Americans (N = 1,658) from four mid-sized cities in the United States. Reliability and validity of the BMSLSS has not been determined for samples of exclusively African American adolescents. Methods: Data analysis included calculating mean ratings, standard deviations and effect sizes (Cohen's d) and inspecting the scale's internal structure, reliability, and relationships to other variables. Results: Evidence of internal structure, internal consistency reliability, and hypothesized relationships to other variables for participants were determined. Translation to Health Education Practice: The BMSLSS is a useful indicator of LS for research and health education assessment purposes among African American adolescents where brevity of psychometric measures is imperative.

Young female offenders represent a growing number of young offenders. Studies have shown that youth in the juvenile justice system, particularly young females, report higher rates of lifetime sexual abuse than their nonoffending peers. The aim of this study was to examine gender differences in risk factors for recidivism, including a history of sexual abuse, among a juvenile court clinic sample. Findings suggest that, even after accounting for previously identified risk factors for recidivism such as prior legal involvement and conduct problems, a history of sexual abuse is the most salient predictor of recidivism for young female offenders, but not for males. The development of gender-responsive interventions to reduce juvenile recidivism and continued legal involvement into adulthood may be warranted.

Juvenile offenders have disproportionately high rates of psychiatric and substance use disorders relative to their nonoffending counterparts. Less is known about the impact of psychiatric and substance use disorders on repeat juvenile justice involvement among juveniles specifically referred for forensic mental health evaluations. We describe the demographic, psychiatric, and legal history background of 404 juveniles who underwent a court clinic forensic mental health evaluation, and we examine the association between these factors and detention rates of 20 percent over a 12-month post-evaluation period. After accounting for known predictors of reoffending, such as prior offense history and externalizing disorders, dual diagnosis (i.e., co-occurring psychiatric and substance use disorders) remained a salient predictor of future detention. Consistent with prior literature on juvenile offending, substance use may greatly enhance the likelihood of subsequent detention.

The acquisition of affect regulation skills is often impaired or delayed in youth with mental health problems but the relationship between affect dysregulation and risk behaviors has not been well studied. Baseline data from adolescents (N = 417; ages 13-19) recruited from therapeutic school settings examined the relationship between affect dysregulation, substance use, self-cutting, and sexual risk behavior. Analyses of covariance demonstrated that adolescents who did not use condoms at last sex, ever self-cut, attempted suicide, used alcohol and other drugs and reported less condom use self-efficacy when emotionally aroused were significantly more likely (p < .01) to report greater difficulty with affect regulation than peers who did not exhibit these behaviors. General patterns of difficulty with affect regulation may be linked to HIV risk behavior, including condom use at last sex. HIV prevention strategies for youth in mental health treatment should target affect regulation in relation to multiple risk behaviors.

BackgroundIn the United States, young minority men who have sex with men (MSM) are the most likely to become infected with HIV. Pre-exposure prophylaxis (PrEP) is an efficacious and promising prevention strategy. However, PrEP’s safety and effectiveness can be greatly compromised by suboptimal adherence to treatment. To maximize the positive impact of PrEP, it is necessary to combine its prescription with cost-effective behavioral interventions that promote adherence and decrease HIV risk behaviors. In this project, we developed a theoretically informed app/gaming intervention to engage young MSM in learning information, practicing behaviors, and improving motivation for HIV preventative behaviors and PrEP adherence. ObjectiveThe goal of this project was to develop and test a cutting-edge, engaging, and entertaining app/gaming intervention for improving adherence to PrEP and building HIV prevention knowledge, skills, and behavior. MethodsThis study was conducted in two phases. In the developmental phase, we conducted qualitative interviews with young MSM (n=20) to guide the development of the gaming intervention. In the randomized controlled trial, we tested the preliminary efficacy of the gaming intervention compared to a comparison condition among young MSM. Subjects were recruited from the University of Mississippi Medical Center HIV/STI testing clinics (n=60). ResultsInstitutional review board approval was received in February 2015. Research activities began in June 2015 and are still ongoing. ConclusionsThis app/gaming intervention aimed to improve PrEP adherence and HIV preventative behaviors in young MSM. Engaging young MSM in learning information, practicing behaviors, and improving motivation for increased adherence to PrEP has the potential to decrease HIV seroconversion. It is important to develop interventions that are enjoyable, engaging, and easily incorporated into clinical settings. Trial RegistrationClinicalTrials.gov RCT02611362; https://tinyurl.com/y65gkuwr International Registered Report Identifier (IRRID)DERR1-10.2196/18640

Background: Schools in the United States are increasingly being urged to address the problem of adolescent dating violence (DV) with their students. Given the limited time available to implement prevention programming during the school day, brief programs are needed. The purpose of this study was to test the efficacy of a widely disseminated, brief community-based DV prevention program in partnership with a nonprofit community agency. Methods: We conducted a randomized waitlist control trial of a 5-session DV prevention program (active condition) compared to health class as usual (waitlist control condition). Participants were 225 10th-grade students with a recent dating history in a large public school in New England. Surveys were administered at baseline, end of program, and 3 months postintervention. Results: After completing the program, students in the active condition reported significantly lower approval of aggression, healthier dating attitudes, and more DV knowledge. These effects were sustained at 3-month follow-up. In addition, students in the active condition reported significantly less emotional/verbal and total DV perpetration and victimization at 3-month follow-up. Conclusions: These findings suggest that a brief, community-based DV prevention curriculum can promote change in behaviors, attitudes, and knowledge among high school students.