title: Understanding Psychosocial and High-Risk Sexual Behaviors Among Detained Juveniles: A Descriptive Study Protocol.
abstract: BACKGROUND
  African American women are disproportionately impacted by sexually transmitted infections (STIs), such as chlamydia and gonorrhea, which are known risk factors for human immunodeficiency virus (HIV) infection. STIs, particularly chlamydia and gonorrhea, are even more prevalent among young African American women with a juvenile detention history. The population with experiences with the criminal justice system has greater rates of STIs and is diagnosed more often with mental health issues, often related to sexual abuse or intimate partner violence, compared to peers who have not been detained by law enforcement. Psychosocial factors, especially those related to intimate relationships (ie, the imperativeness of being in a relationship and the power one has in their relationship), have emerged as important explanatory factors for acquiring STIs, including HIV, and a component of risk reduction interventions.
  
  
  OBJECTIVE
  To investigate more comprehensively the relationship between psychosocial risk factors and STIs, including HIV, as it relates to reduction and prevention of these diseases. The long-term goal is to improve the effectiveness of evidence-based interventions with a major focus on intimate relationship dynamics.
  
  
  METHODS
  This descriptive study surveys young women (ages 13-17) who have been detained (incarcerated) by a department of juvenile justice. In addition to being female and detained, eligibility criteria include being detained longer than 30 days and being free of cognitive impairments. This study will include young women from one juvenile detention center. The primary outcomes to be measured are STI knowledge, intimate relationship dynamics (ie, imperativeness and power), and high-risk sexual behaviors. High-risk sexual behaviors will be assessed using data extracted from health records.
  
  
  RESULTS
  Preliminarily, we have received assent from 26 primarily young African American women. The majority of participants (81%) had inadequate knowledge about STIs, 52% perceived a lack of power in their relationship, 56% were fearful of negotiating condom use, and 60% were not comfortable refusing sex. Interestingly, a majority of participants (68%) did not perceive a relationship as imperative.
  
  
  CONCLUSIONS
  When enrollment and data collection are completed, it is expected that the primary outcome of intimate relationship dynamics (ie, imperativeness and power) will be associated with high-risk sexual behaviors and having an STI. Further, the findings are expected to provide guidance in developing a risk reduction intervention, for the population in which psychosocial factors related to intimate relationships will be central.
authors.affiliation: Institute of Public and Preventive Health, Department of Family Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA, United States. mgates@gru.edu.
authors.forename: Madison L
authors.identifier: http://orcid.org/0000-0001-5677-6017
authors.initials: ML
authors.lastname: Gates
authors.forename: Michelle
authors.identifier: http://orcid.org/0000-0003-3271-3972
authors.initials: M
authors.lastname: Staples-Horne
authors.forename: Jeanne
authors.identifier: http://orcid.org/0000-0002-9944-188X
authors.initials: J
authors.lastname: Cartier
authors.forename: Candace
authors.identifier: http://orcid.org/0000-0003-0746-7394
authors.initials: C
authors.lastname: Best
authors.forename: Veronica
authors.identifier: http://orcid.org/0000-0002-9140-4419
authors.initials: V
authors.lastname: Walker
authors.forename: David
authors.identifier: http://orcid.org/0000-0003-4855-4590
authors.initials: D
authors.lastname: Schwartz
authors.forename: Wonsuk
authors.identifier: http://orcid.org/0000-0003-2414-2399
authors.initials: W
authors.lastname: Yoo
keywords: African Americans; HIV infections; adolescent; mental health; risk factors; risk reduction behavior; sexual behavior; sexually transmitted diseases; spouse abuse; unsafe sex