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Predictors of Change in HIV Risk Factors for Adolescents Admitted to Substance Abuse Treatment

Predictors of Change in HIV Risk Factors for Adolescents Admitted to Substance Abuse Treatment. Passetti, L. L., Garner, B. R., Funk, R., Godley, S. H., & Godley, M. D. Chestnut Health Systems JMATE 2008. Acknowledgements.

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Predictors of Change in HIV Risk Factors for Adolescents Admitted to Substance Abuse Treatment

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  1. Predictors of Change in HIV Risk Factors for Adolescents Admitted to Substance Abuse Treatment Passetti, L. L., Garner, B. R., Funk, R., Godley, S. H., & Godley, M. D. Chestnut Health Systems JMATE 2008

  2. Acknowledgements Preparation of this presentation was supported by funding from the following sources: • Center for Substance Abuse Treatment (Strengthening Communities-Youth project grant no. TI 13356) • National Institute on Drug Abuse (grant no. DA 018183) • National Institute on Alcohol Abuse and Alcoholism (grant no. AA 010368).

  3. HIV Infection in Adolescents • Estimated 5,322 adolescents living with AIDS in the U.S. • 46.7% increase since 2001 (CDC, 2005) • Average of 10 years from HIV infection to development of AIDS • Many young adults likely infected as teenagers (National Institute of Allergy and Infectious Disease, 2000)

  4. HIV Risk in Adolescents Presenting to Substance Abuse Treatment • (Ammon et al., 2005; Deas-Nesmith et al., 1999; Jainchill et al., 1999; Malow et al., 2001; Tapert et al., 2001)

  5. Purpose • For adolescents admitted to substance abuse treatment, identify variables that most strongly predict the transition from: Presence of any HIV risk factor Absence of HIV risk factors Follow-up Interview Next Follow-up Interview

  6. Sample • 283 adolescents • Strengthening Communities - Youth (SCY) • n=113 • Admitted to outpatient substance abuse treatment • Assertive Continuing Care (ACC-2) • n=170 • Admitted to residential substance abuse treatment

  7. Average Age: 16 Caucasian: 70% Male: 65% Main substances of choice: marijuana, alcohol Average years of education: 9 In school: 83% Employed: 39% Involved with criminal justice system: 78% Participant Characteristics at Intake (n=283)

  8. Measurement • Global Appraisal of Individual Needs (GAIN) • Administered at intake and quarterly follow-up intervals • 3, 6, 9, and 12 months post-intake for SCY • 3, 6, 9, and 12 months post-discharge for ACC-2 • Follow-up rates ranged from 90% to 96%

  9. Analysis • Step One - Univariate logistic regression • Identify variables that predict the transition from: (i.e., from 3 to 6 months, 6 to 9 months, 9 to 12 months) Presence of any HIV risk factor Absence of HIV risk factors Follow-up Interview Next Follow-up Interview

  10. Analysis • Step Two - Multivariate mixed nominal regression • Identify strongest predictors of transition • Enter significant predictors from univariate analysis simultaneously

  11. Unit of Analysis • 283 adolescents • 477 observations in which adolescents reported at least one risk factor for HIV infection

  12. Predictors • Intake Variables • Age • Gender • Minority (Yes/No) • Years of education • Symptoms of internalizing disorder (Yes/No) • Symptoms of externalizing disorder (Yes/No)

  13. Predictors • Follow-up Variables (During the past 90 days) • In school (Yes/No) • Employed (Yes/No) • Involved with the criminal justice system (Yes/No) • Substance Frequency Scale (SFS) – 8 items • Substance Problem Scale (SPS) – 16 items • Recovery Environment Risk Index (RERI) – 13 items

  14. Predictors • Follow-up Variables (During the past 90 days) • Social Risk Index (SRI) – 6 items • Treatment Motivation Index (TMI) – 5 items • Treatment Resistance Index (TRI) – 4 items • Problem Orientation Scale (POS) – 5 items • Weeks in substance abuse treatment • Weeks in mental health treatment • Weeks in a controlled environment

  15. Outcome Measure • HIV Risk Status (Yes/No) • Endorsed any of the following HIV risk factors during the past 90 days: • Needle use • Sex with a needle user • Sex while adolescent or partner was high on alcohol or drugs • Unprotected sex • Multiple sex partners (two or more) • Trading sex for drugs/money • Victimized (sexually, physically, or emotionally)

  16. Transition Period: 3 to 6 months Presence 67% Presence (n = 117) Absence 33% HIV Risk Status: 3 Months HIV Risk Status: 6 Months

  17. Transition Period: 6 to 9 months Presence 71% Presence (n = 174) Absence 29% HIV Risk Status: 6 Months HIV Risk Status: 9 Months

  18. Transition Period: 9 to 12 months Presence 61% Presence (n = 186) Absence 39% HIV Risk Status: 9 Months HIV Risk Status: 12 Months

  19. ResultsUnivariate Logistic Regression

  20. ResultsUnivariate Logistic Regression

  21. ResultsUnivariate Logistic Regression

  22. Results Multivariate Mixed Nominal Regression

  23. Conclusions • In this sample, the strongest predictors of transitioning to the absence of any HIV risk factors were: • Younger age • Lower recovery environment risk • Lower treatment resistance

  24. Strengths • Few studies examining change in HIV risk factors over time • Adolescents in OP and residential treatment • High follow-up rates

  25. Limitations • Self-report • No measure of HIV risk interventions received during or after treatment

  26. Implications • Interventions with this population may be developed and tested that are tailored by: • Age • Level of risk in the recovery environment • Level of treatment resistance

  27. Implications • While 1/3 of the analyzed transitions demonstrated improvement in HIV risk, 2/3 represented the same or greater levels of risk • Longer and/or repeated assessments and interventions may be required to initiate and sustain a reduction in HIV risk

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