Effective interventions for adolescents: Taking a structural approach

Adolescents comprise an increasingly larger proportion of those infected with HIV in the U.S. Even when targeted to adolescents, interventions typically have yielded only modest short-term HIV risk reductions. In general, such interventions have been delivered in a small group format, with minimal or no integration of ecological (e. g., contextual and environmental) factors. Intervening at an ecological level, however, necessitates the inclusion of community stakeholders, policy makers, and interdisciplinary teams. In this study, a sample of 363 adolescents were recruited from a juvenile detention center and a court-ordered treatment facility. Adolescents were randomized to either an HIV skills building group or a control group that targeted anger management skills. The outcome of the intervention revealed that, from pre-assessment to three months post-intervention, there were significant reductions in alcohol and marijuana use (F(1,202)=16.31, p<.001; F(1,201)=112.20, p<.001), as well as reduction in sexual activity (F(1,175)=51.99, p<.001), in both groups. While the results suggest that there may be factors common to both interventions that facilitated these changes they may also indicate the value of imparting skills to enable adolescents to better interface with the challenging structures of their lives, which may in turn smooth the uptake of protective behaviors. Social ecological skills training may be crucial to HIV risk reduction efforts, either in conjunction with or until more structural interventions are possible.