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Intervention Description
Intervention Package Information
Evaluation Study and Results
References and Contact Information
Intervention Description
Target Population
Incarcerated, male adolescent drug users
Goals of Intervention
- Eliminate or reduce HIV risk
behaviors
Brief Description
This intervention is a four-session,
small-group, interactive, AIDS education
program based on problem solving therapy
delivered to youth in jail. The
intervention is delivered to small
groups of 8 male inmates and focuses on
relevant health education issues,
emphasizing HIV/AIDS-related issues. The
Problem-Solving Therapy approach is used
to guide group discussions and includes
the following steps: problem
orientation, defining and formulating
the problem, generating alternative
solutions, decision-making, and
implementing a solution. As part of the
first step in the discussion – problem
orientation – participants share and
discuss facts and beliefs about HIV.
Then, participants define and formulate
the problem by identifying specific
attitudes or behaviors that need to be
modified in order to prevent against
HIV. For generating alternative
solutions, participants suggest and
compile possible courses of action.
During the decision-making step,
participants critique and evaluate the
alternative solutions. Finally,
participants engage in role-play and
rehearsal exercises to practice
implementing the solution. Topics
covered during the group discussions are
general HIV education information,
factors related to drug initiation or
drug use, the meaning and consequences
of sexual activity, and the relationship
between drug use and sexual activity and
HIV risk, and how to seek health care
services, social services, and drug
treatment. |
Theoretic Basis
None reported
Intervention Duration
Four 1-hour sessions delivered twice a week
over a 2-week period
Intervention Settings
New York City Department of Correction’s
Adolescent Reception and Detention Center,
Rikers Island
Deliverer
Male counselor
Delivery Methods
- Group Discussion
- Exercises
- Problem Solving Therapy
- Role Play
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Intervention Package Information
An intervention package is not available at this time. Please contact Dr.
Stephen Magura, Director of Science and Research, National Development and
Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY, 10010. email:
magura@ndri.org for details on intervention
materials.
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Evaluation Study and Results
The original evaluation was conducted at
the New York City Department of Correction’s
Adolescent Reception and Detention Center on
Rikers Island between 1991 and 1992.
Key Intervention Effects
Study Sample
The analytic study sample of 157 incarcerated adolescents is characterized
by the following:
- 66% African American, 33%
Hispanic, 2% White
- 100% Male
- 95% heterosexual, 5% homosexual
or bisexual
- Median age of 18 years, range:
16-19 years
- 41% attending school at time of
arrest
Recruitment Settings
New York City Department of Correction’s
Adolescent Reception and Detention Center on
Riker’s Island
Eligibility Criteria
Male adolescent inmates were eligible if
they were incarcerated in 11 dormitories at
the New York City Department of Correction’s
Adolescent Reception and Detention Center.
Assignment Method
Participants (N = 411) were assigned to 1 of
2 groups: Intensive AIDS Education
intervention (n = 110) or wait-list control
(n = 301). The assignment was based on a
convenience or logistical factor, that is,
youth who could not be offered the
intervention immediately after baseline were
assigned to the wait-list control
Comparison Group
The comparison was a wait-list control
group, where those who could not attend the
intervention immediately were placed on a
waiting list, but were later released from
jail or transferred before receiving the
intervention.
Relevant Outcomes Measured and Follow-up Time
- Sex behaviors measured during time
in the community since release from jail
were: having multiple sex partners,
having any high-risk sex partners,
having any anal sex, and frequency of
condom use during vaginal, oral, and
anal sex
- Outcomes were measured at a median
of 10 months after baseline, which was a
median of 5 months after release from
jail, indicating a follow-up of at least
5 months (but less than 10 months).
Participant Retention
- Overall study sample:
66% retained at the 5-month or
greater follow-up
- Intensive AIDS Education (retention
not reported):
≥ 60% retained at the 5-month or
greater follow-up (based on
calculation; see Considerations)
- Waitlist control (retention
not reported):
≥ 65% retained at the 5-month or
greater follow-up (based on
calculation; see Considerations)
Significant Findings
Intervention participants reported a
significantly greater frequency of condom
use during vaginal sex than the control
participants (p = .02, one-tailed test) at
the 5-month or greater follow-up.
Considerations
- This intervention fails to meet the best-evidence criteria due to a
potential small to moderate bias resulting from the assignment method, low
retention rates, and using a one-tailed test.
- Intervention participants reported significantly greater frequencies of
condom use during anal and oral sex (p= .04, one-sided test) and during
general (vaginal, anal, and oral) sex (p = .002, one-sided test) compared to
the control participants at the 5-month or greater follow-up.
- Intervention participants had significantly more favorable attitudes
towards condoms than control participants (p = .05, one-tailed test) at the
5-month or greater follow-up.
- The separate retention rates for the intervention and control groups
were not reported and the original data are no longer available. The author
conducted back-calculations to try to establish these follow-up rates.
Follow-up rates as low as 59% in either group would be inconsistent with the
published statistics; thus, the rate must have been greater than 59% for
both study groups. The author does not recall a follow-up rate of less than
60% for either group.
- The intervention and original research targeted male teens, including
mostly youth aged 16 to 18, but the study sample also included a few 19 year
olds who were in the detention center.
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References and Contact Information
- Magura, S., Kang, S. Y., & Shapiro,
J. L. (1994). Outcomes of intensive AIDS
education for male adolescent drug users
in jail. Journal of Adolescent Health,
15, 457-463.
Researcher: Dr. Stephen Magura,
Director of Science and Research,
National Development and Research
Institutes, 71 West 23rd Street, 8th
Floor, New York, NY 10010. email:
magura@ndri.org
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