Reducing Internalizing Symptoms Among High-Risk,Hispanic Adolescents: Mediators of a Preventive Family Intervention

Familias Unidas is a family-focused preventive intervention that has been found to reduce drug use and sexual risk behaviors among Hispanic adolescents. In some trials, Familias Unidas has also been found to be efficacious in reducing adolescent internalizing symptoms (i.e., depressive and anxiety symptoms), even though the intervention did not specifically target internalizing symptoms. This study examines potential mediators or mechanisms by which Familias Unidas influences internalizing symptoms, specifically the role of intervention-targeted improvements in parent-adolescent communication and reductions in youth externalizing behaviors. A total of 213 Hispanic eighth grade students with a history of externalizing behavior problems and their primary caregivers were recruited from the public school system. Participants, with a mean age of 13.8 years, were randomized into the Familias Unidas intervention or community practice control condition and assessed at baseline, 6, 18, and 30 months post-baseline. A cascading mediation model was tested in which the Familias Unidas intervention was hypothesized to decrease adolescent internalizing symptoms through two mediators: improvements in parent-adolescent communication leading to decreases in externalizing behaviors. Findings show that the intervention had significant direct effects on youth internalizing symptoms at 30 months post-baseline. In addition, the cascading mediation model was supported in which the Familias Unidas intervention predicted significant improvements in parent-adolescent communication at 6 months, subsequently decreasing externalizing behaviors at 18 months, and ultimately reducing youth internalizing symptoms at 30 months post-baseline. Implications for prevention interventions are discussed.     

Short-Term Effects on Family Communication and Adolescent Conduct Problems: Familias Unidas in Ecuador

Familias Unidas, a Hispanic/Latino-specific, parent-centered intervention, found to be efficacious in improving family functioning and reducing externalizing behaviors among youth in the USA, was recently adapted and tested for use in Ecuador. This study examined the short-term efficacy of Familias Unidas in Ecuador on parent-adolescent communication, parental monitoring of peers, and youth conduct problems. Two hundred thirty-nine youths (ages 12–14 years) and their primary care givers were randomized to either Familias Unidas or Community Practice and assessed pre- and post-intervention. There was a significant difference between Familias Unidas and Community Practice in conduct problems at 3 months (standardized β?=??.101, p?=?.001, effect size?=?.262). A significant indirect intervention effect was also detected, indicating that Familias Unidas predicted conduct problems at 3 months through parent-adolescent communication at 3 months (standardized β?=??.036, p?=?.016, CI 95% [?.066, ?.007], effect size?=?.265). Familias Unidas was efficacious in reducing conduct problems through improved parent-adolescent communication, relative to Community Practice. Future assessments will determine whether Familias Unidas also has an impact on substance use and sexual risk behaviors at later time points, as demonstrated in past Familias Unidas trials. The short-term effects of the intervention, family engagement, and facilitator skill in the Ecuadorian adaptation of Familias Unidas are promising. This study implies that an intervention developed for Hispanics/Latinos in the USA and culturally adapted and implemented for use by Hispanics/Latinos in a Latin American country can be efficacious in improving family functioning and reducing youth conduct problems. Trial registration: MSP-DIS-2015-0055-0, Ministry of Public Health (MSP), Ecuador     

Ecodevelopmental and Intrapersonal Moderators of a Family Based Preventive Intervention for Hispanic Youth: A Latent Profile Analysis

Hispanic adolescents are disproportionately affected by externalizing disorders, substance use and HIV infection. Despite these health inequities, few interventions have been found to be efficacious for this population, and even fewer studies have examined whether the effects of such interventions vary as a function of ecodevelopmental and intrapersonal risk subgroups. The aim of this study was to determine whether and to what extent the effects of Familias Unidas, an evidence-based preventive intervention, vary by ecodevelopmental and intrapersonal risk subgroups. Data from 213 Hispanic adolescents (mean age?=?13.8, SD?=?0.76) who were enrolled in a randomized clinical trial evaluating the relative efficacy of Familias Unidas on externalizing disorders, substance use, and unprotected sexual behavior were analyzed. The results showed that Familias Unidas was efficacious over time, in terms of both externalizing disorders and substance use, for Hispanic youth with high family ecodevelopmental risk (e.g., poor parent-adolescent communication), but not with youth with moderate ecodevelopmental or low ecodevelopmental risk. The results suggest that classifying adolescents based on their family ecodevelopmental risk may be an especially effective strategy for examining moderators of family-based preventive interventions such as Familias Unidas. Moreover, these results suggest that Familias Unidas should potentially be targeted toward youth with high family ecodevelopmental risk. The utility of the methods presented in this article to other prevention scientists, including genetic, neurobiological and environmental scientists, is discussed.     

Predictors of Participation in an <Emphasis Type="Italic">eHealth</Emphasis>, Family-Based Preventive Intervention for Hispanic Youth

The Familias Unidas intervention is an efficacious family-based preventive intervention for reducing substance use and other health risks among Hispanic youth. A current randomized controlled trial (RCT) is examining this intervention’s efficacy when delivered via the Internet (eHealth). eHealth interventions can overcome logistical barriers to participation, yet there is limited information about the feasibility of these interventions, especially among ethnic minorities. This paper examines participation and predictors of participation in the eHealth Familias Unidas intervention in a sample of 113 Hispanic families whose adolescent had behavioral problems. Analyses examined multidimensional ways of characterizing participation, including the following: (1) total intervention participation, (2) initial engagement (participating in at least one of the first three intervention sessions), (3) completing the pre-recorded, eHealth parent group sessions, and (4) participating in the live, facilitator-led, eHealth family sessions. Participation in this eHealth intervention was comparable to, and in most cases higher than, previous, face-to-face Familias Unidas interventions. High levels of baseline family stress were associated with lower initial engagement and lower family session participation. Greater parental Hispanicism was associated with more participation in eHealth parent group sessions and across the total intervention. Higher levels of baseline effective parenting, in other words less intervention need, were significantly associated with lower levels of total intervention participation and lower levels of family session participation. Implications for preventive interventions delivered via Internet are discussed.     

Preventing Youth Internalizing Symptoms Through the Familias Unidas Intervention: Examining Variation in Response

Prevention programs that strengthen parenting and family functioning have been found to reduce poor behavioral outcomes in adolescents, including substance use, HIV risk, externalizing and internalizing problems. However, there is evidence that not all youth benefit similarly from these programs. Familias Unidas is a family-focused intervention designed to prevent substance use and sexual risk among Hispanic youth and has recently demonstrated unanticipated reductions in internalizing symptoms for some youth. This paper examines variation in intervention response for internalizing symptoms using individual-level data pooled across four distinct Familias Unidas trials: (1) 266 eighth grade students recruited from the general school population; (2) 160 ninth grade students from the general school population; (3) 213 adolescents with conduct, aggression, and/or attention problems; and (4) 242 adolescents with a delinquency history. Causal inference growth mixture modeling suggests a three-class model. The two largest classes represent youth with low (60 %) and medium (27 %) internalizing symptoms at baseline, and both intervention and control participants show reductions in internalizing symptoms. The third class (13 %) represents youth with high levels of baseline internalizing symptoms who remain at steady levels of internalizing symptoms when exposed to the intervention, but who experience an increase in symptoms under the control condition. Female gender, low baseline levels of parent–adolescent communication, and older age were associated with membership in the high-risk class. These synthesis analyses involving a large sample of youth with varying initial risk levels represent a further step toward strengthening our knowledge of preventive intervention response and improving preventive interventions.     

Familias Unidas for Health and Wellness: Adapting an Evidence-Based Substance Use and Sexual Risk Behavior Intervention for Obesity Prevention in Hispanic Adolescents

We describe the adaptation of Familias Unidas, an evidence-based substance use and sexual risk behavior intervention, for obesity prevention in Hispanic adolescents. Intervention developers and experts in pediatric obesity, exercise physiology, dietetics, and the local parks system provided input for changes. Hispanic families also provided input through a series of 21 focus groups conducted before, during, and after an initial pilot test of the adapted intervention. After transcribing audiotaped sessions, we used a general inductive approach and Dedoose qualitative software to derive themes. Results indicated the need for improved health-related family functioning, enhanced nutrition education and skill building, increased family engagement in physical activity, and stronger links between family and environmental supports. Parents who participated in the pilot test expressed high enthusiasm for hands-on nutrition training and reported improvements in family functioning. Adolescents liked outdoor physical activities but wanted parents to be more engaged in joint physical activity sessions. The adapted intervention maintains fidelity to Familias Unidas’ core theoretical elements and overall structure, but also includes content focused on physical activity and nutrition, adolescent participation in physical activity sessions led by park coaches, and joint parent-adolescent participation in physical activity and nutrition skill-building activities.     

Preventing Youth Internalizing Symptoms Through the Familias Unidas Intervention: Examining Variation in Response

Prevention programs that strengthen parenting and family functioning have been found to reduce poor behavioral outcomes in adolescents, including substance use, HIV risk, externalizing and internalizing problems. However, there is evidence that not all youth benefit similarly from these programs. Familias Unidas is a family-focused intervention designed to prevent substance use and sexual risk among Hispanic youth and has recently demonstrated unanticipated reductions in internalizing symptoms for some youth. This paper examines variation in intervention response for internalizing symptoms using individual-level data pooled across four distinct Familias Unidas trials: (1) 266 eighth grade students recruited from the general school population; (2) 160 ninth grade students from the general school population; (3) 213 adolescents with conduct, aggression, and/or attention problems; and (4) 242 adolescents with a delinquency history. Causal inference growth mixture modeling suggests a three-class model. The two largest classes represent youth with low (60 %) and medium (27 %) internalizing symptoms at baseline, and both intervention and control participants show reductions in internalizing symptoms. The third class (13 %) represents youth with high levels of baseline internalizing symptoms who remain at steady levels of internalizing symptoms when exposed to the intervention, but who experience an increase in symptoms under the control condition. Female gender, low baseline levels of parent–adolescent communication, and older age were associated with membership in the high-risk class. These synthesis analyses involving a large sample of youth with varying initial risk levels represent a further step toward strengthening our knowledge of preventive intervention response and improving preventive interventions.

     

Preventing Internalizing Symptoms Among Hispanic Adolescents: A Synthesis Across Familias Unidas Trials

Studies document that there are efficacious interventions to prevent adolescent depression and internalizing symptoms, including several family-focused interventions. Questions remain about for whom interventions work (moderation) and by what mechanisms they work (mediation) to prevent internalizing symptoms. Unfortunately, single trials are often underpowered to address moderation and mediation, an issue addressed in this paper. This synthesis study combined individual-level, longitudinal data from 721 adolescents across 3 randomized clinical trials of Familias Unidas, a family-focused prevention intervention for Hispanic youth. Using integrative data analysis (IDA) methods applied to trials, the study examined intervention moderation and mediation effects on internalizing symptoms. Baseline internalizing symptoms were a significant moderator of the intervention’s effects on internalizing symptoms, while baseline externalizing symptoms did not moderate intervention effects. Baseline parent–adolescent communication, a modifiable risk factor and hypothesized mechanism by which the intervention works, significantly moderated the intervention’s effects. Specifically, the intervention was more efficacious in its impact on internalizing symptoms for youth with lower initial levels of parent–adolescent communication compared to those with higher communication levels. Moderated mediation analyses showed that parent–adolescent communication changes mediated the intervention’s effects on internalizing symptoms, with stronger effects for those with poorer baseline communication. Results suggest a potential benefit of identifying youth risks prior to interventions, and targeting specific modifiable mediators that lead to reductions of internalizing problems of adolescents. Findings also highlight advantages of utilizing data from combined trials and IDA for examining intervention moderators and mediators.     

Do Social and Behavioral Characteristics Targeted by Preventive Interventions Predict Standardized Test Scores and Grades?

This study assessed whether characteristics of individuals that are predictors of youth problem behavior such as substance use, delinquency, and violence also predict academic achievement. Longitudinal data from 576 students participating in the Raising Healthy Children (RHC) project were analyzed. The RHC project is a study of students recruited from a suburban Pacific Northwest school district. Tenth-grade academic achievement was measured by scores on a standardized test administered to students in Washington State (as part of compliance with the No Child Left Behind Act) and by student self-report of grades. Measures of social and behavioral characteristics at seventh grade were based on data from student, parent, and teacher surveys. Researchers assessed overall correlations between 7th-grade predictors and 10th-grade academic achievement as well as partial correlations adjusted for demographic characteristics and scores on an earlier achievement test, the Comprehensive Test of Basic Skills, in 4th grade. Results indicated that higher levels of school bonding and better social, emotional, and decision-making skills were related to higher test scores and higher grades. Lower test scores and lower grades were predicted by elevated levels of attention problems, negative behavior of peers, and disruptive and aggressive behavior. Lower test scores also were predicted by early use of alcohol and cigarettes. These findings support the premise that school-based social development interventions that address specific risk factors, curb early manifestations of antisocial behavior, and promote school bonding and social and emotional skills are likely to improve student academic achievement.     

Opportunity Costs and Financial Incentives for Hispanic Youth Participating in a Family-Based HIV and Substance Use Preventive Intervention

This paper presents results from a pilot study of the synergies between the opportunity costs incurred by research participants, participant compensation, and program attendance in a family-based substance use and HIV preventive intervention for Hispanic adolescents in Miami-Dade County, Florida. To estimate parent/caretaker cost per session and cost for the duration of the intervention, we administered the Caretaker Drug Abuse Treatment Cost Analysis Program to a random sample of 34 families who participated in a recent clinical trial of Familias Unidas. The total opportunity cost per parent/caretaker was under $40 per group session, under $30 per family session, and just over $570 for the duration of the intervention. Participants were compensated between $40 and $50 per session and attended more than 79 % of family and group sessions. Parents and caretakers incurred a cost of approximately $30–40 per intervention session for which they were adequately compensated. Attendance was very good overall for this group (>79 %) and significantly higher than attendance in a comparable uncompensated study group from another recent Familias Unidas trial that targeted similar youth. Findings suggest that incentives should be considered important for future implementations of Familias Unidas and similar family-based interventions that target minority and low-SES populations.     

Understanding the Links Among School Misbehavior,Academic Achievement,and Cigarette Use: A National Panel Study of Adolescents

Relations among academic achievement, school bonding, school misbehavior, and cigarette use from 8th to 12th grade were examined in two national panel samples of youth (n = 3056). A series of competing conceptual models developed a priori was tested using structural equation modeling (SEM). The findings suggest that during middle adolescence the predominant direction of influence is from school experiences to cigarette use. School misbehavior and low academic achievement contribute to increased cigarette use over time both directly and indirectly. Two-group SEM analyses involving two cohorts—gender and ethnicity—revealed that our findings are robust. In addition, comparisons between high school dropouts and nondropouts and between eighth-grade cigarette use initiators and nonusers revealed few differences in direction or magnitude of effects. Results suggest that prevention programs that attempt to reduce school misbehavior and academic failure, as well as to help students who misbehave and have difficulty in school constructively avoid negative school- and health-related outcomes, are likely to be effective in reducing adolescent cigarette use.     

Predictors of Participation in Parenting Workshops

Raising Healthy Children is a multi-year, experimental test of a school-based intervention that seeks to promote positive youth development and prevent problem behavior among children recruited into the project in the first or second grade of elementary school. The primary components of the intervention include staff development for teachers in classroom management and instruction, in-home services for high-risk children and their families, and parenting workshops for parents with students attending intervention schools. This paper examines predictors of attendance at parenting workshops. The study panel (n = 272) consists of families with a student who remained at an intervention school through the first five years of the project. Variables that were considered as predictors of parent attendance include social demographic characteristics, parent characteristics (at-risk behavior and smoking), and child characteristics (behavior problems and academic achievement). Parent education and parent's perception of their child's antisocial behavior both had positive and statistically significant bivariate associations with attendance. These two variables were also significantly positively associated with attendance in a multivariate model that included low-income and single-parent status, parent smoking and at-risk behavior, and parent rating of child's antisocial behavior and academic performance. Parents with at-risk behaviors were not significantly more or less likely to attend workshops.     

Early Elementary School Intervention to Reduce Conduct Problems: A Randomized Trial with Hispanic and Non-Hispanic Children

Children's aggressive behavior and reading difficulties during early elementary school years are risk factors for adolescent problem behaviors such as delinquency, academic failure, and substance use. This study determined if a comprehensive intervention that was designed to address both of these risk factors could affect teacher, parent, and observer measures of internalizing and externalizing problems. European American (n = 116) and Hispanic (n = 168) children from 3 communities who were selected for aggressiveness or reading difficulties were randomly assigned to an intervention or no-intervention control condition. Intervention families received parent training, and their children received social behavior interventions and supplementary reading instruction over a 2-year period. At the end of intervention, playground observations showed that treated children displayed less negative social behavior than controls. At the end of a 1-year follow-up, treated children showed less teacher-rated internalizing and less parent-rated coercive and antisocial behavior than controls. The study's limitations and implications for prevention are discussed.     

A Healthy Lifestyle Intervention for Hispanic Families: Moderating Effects of Education,Income, Nativity

ObjectiveTo explore the moderation effect of parental social determinant factors—educational attainment, income, and nativity—on intervention effects of a family-based lifestyle intervention, Familias Unidas for Health and Wellness (FUHW).DesignLongitudinal analysis across 6- and 24-months postbaseline of a randomized controlled trial.ParticipantsTwo-hundred and eighty primary caregivers.AnalysisModeration analysis was used to examine the interactive effects between intervention effects and social determinant factors.Main Outcome MeasuresParental body mass index, added sugar intake, sugar-sweetened beverage intake, and fruits and vegetable intake.ResultsFindings indicated that FUHW effects on added sugar intake were moderated by educational attainment (P = 0.006), income (P = 0.023), and nativity (P = 0.024). In addition, FUHW effects on sugar-sweetened beverage intake were moderated by parent education (P = 0.042).Conclusions and ImplicationsThis study suggests that FUHW may be helpful in reducing added sugar and sugar-sweetened beverage intake for Hispanic parents who face social determinant factors—educational attainment, income, and foreign-born status—that may influence their dietary behaviors. By including demographic information in intervention development, effects may be enhanced by ensuring that considerations related to participants’ socioeconomic and cultural status are incorporated into intervention components and help reduce overweight and obesity.     

同伴教育对青春期中小学生心理健康干预效果评价

了解同伴教育干预方式对改善青春期中小学生心理健康状况的效果,为促进青春期中小学生心理健康发展提供依据.方法 采用非随机对照试验的方法,在重庆某区选取2所小学和2所初中学校,将1所小学(四至五年级)和1所中学(七至八年级)作为同伴教育干预组,由接受培训的同伴教育者对学生进行干预;另1所小学和1所中学相同年级作为对照组,不采取任何干预措施.用《中学生心理健康自评量表》(Mental Health Inventroy of Middle-SchoolStudents,MMHI-60)和一般情况调查问卷进行基线调查和随访调查.结果 同伴教育干预校学生总心理健康状况、强迫症状、偏执、敌对、人际关系紧张与敏感、抑郁、焦虑、学习压力、情绪不平衡和心理不平衡问题检出率由干预前的39.9%,55.3%,38.8%,37.9%,43.9%,40.5%,42.7%,48.0%,52.5%,32.1%降低到干预后的36.8%,46.1%,36.6%,33.3%,37.2%,38.8%,40.9%,45.7%,49.2%,30.3%,干预后适应不良的检出率(39.8%)高于干预前(37.7%),差异均有统计学意义(P值均<0.05).二元Logistic回归分析结果显示,干预后干预校青春期中小学生的总心理健康、强迫症状、偏执、敌对、人际关系紧张与敏感、抑郁、焦虑和学习压力检出率分别是对照校学生的0.63(95%CI=0.49~0.81)、0.73(95% CI=0.58~ 0.91)、0.75(95%CI=0.60~0.95)、0.60(95%CI=0.47~0.76)、0.67(95%CI=0.53~ 0.86)、0.72(95% CI=0.56~0.91)、0.68(95%CI=0.54~0.86)和0.71 (95%CI=0.56~ 0.91)倍(P值均<0.05).结论 同伴教育能有效改善青春期中小学生的强迫症状、偏执、敌对、人际关系紧张与敏感、抑郁、焦虑和学习压力.     

The role of family factors and school achievement in the progression of adolescents to regular smoking

This study examines whether parental smoking and single parenting were related to adolescents' school achievement and anti-smoking parental practices as well as how these factors predicted later smoking. The sample comprised 1163 Finnish students in Grades 7 through 9. Results show that at the beginning of the seventh grade, parental smoking and single parenting were related to adolescents' lower levels of school achievement. Moreover, parental smoking had moderate association with lack of house smoking rules. At the beginning of the ninth grade, these associations were strengthened and lack of house smoking rules as well as loosened perceived parental punishment for smoking was related to both parental smoking and single parenting. The likelihood of ninth grade regular smoking was greater among adolescents whose parents smoked, who had no smoking rules in their homes and had substandard school achievement. These results suggest that smoking parents and single parents had similar anti-smoking regulations for their children at the baseline but once children became older smoking parents were not able to maintain these rules as successfully as non-smoking parents and families with two parents. Motivating parents to uphold these anti-smoking regulations offers a prospective intervention opportunity.     

The role of family,peers and school perceptions in predicting involvement in youth violence

This study explored the relative importance of family, peers and school in predicting youth violence. The analysis was done on a nationally representative sample included 8,394 students from grade 6th-10th in Israel. Measures of youth violence included bullying, physical fights and weapon carrying. The findings suggested that all three social systems had significant relations with youth violence, respectively. Variables found to predict violence were: Family-lack of parental support regarding school; Peers-Lack of social integration or too many evenings out with friends; School-feeling of school alienation, low academic achievement and perceptions of frequent acts of violence in school. School perceptions had the strongest predicting power. Findings emphasized the importance of focusing on improving the daily school experience in reducing youth violence.     

武汉市中等职业院校学生吸烟行为与家庭和同伴因素的关系

目的 了解家庭因素和同伴因素对武汉市中等职业院校学生吸烟行为的影响,为制定吸烟行为的预防干预策略提供依据。方法 采用立意抽样方法,从武汉市中等职业学校中抽取三所学校,对其中一、二年级的学生全部进行调查。结果 共2 354人接受问卷调查,武汉市中等职业院校学生尝试吸烟率为23.8%,现在吸烟率为18.6%,不同年龄和性别吸烟率差异有统计学意义（均有P<0.05）;单因素分析发现,平均月花费、父母监管、家庭冲突、亲近关系、家族中吸烟比例、朋友中吸烟比例、朋友对你吸烟态度等对吸烟行为均有影响（均有P<0.05）;多因素Logistic回归分析显示,吸烟行为与性别、年龄、平均学习成绩、平均月花费、父母监管、亲近关系、朋友中吸烟比例有关（均有P<0.05）。结论 中等职业院校学生控烟工作需要加强,提高父母监管技能,强化亲近关系和控制同伴影响有助于减少中等职业院校学生的吸烟行为。     

An Intervention to Address Interpersonal Violence Among Low-Income Midwestern Hispanic-American Teens

This paper reports pilot testing of “Familias En Nuestra Escuela”, an in-school interpersonal violence prevention intervention targeting Hispanic-American teens. The intervention, based on the hypothesis that the preservation and reinforcement of Hispanic cultural values can serve as a protective factor against violence, focused on the enhancement of ethnic pride. Researchers formed a partnership with a midwestern Hispanic community to test the feasibility, receptivity and preliminary impact of the intervention in a pre/post test, no control group design. Participants were low-income, predominantly first-generation Hispanic-American freshmen and sophomore students from one Hispanic-serving high school. Findings revealed a statistically significant increase in the intervention’s mediator, ethic pride. Changes in the desired direction occurred on measures of perceptions of self-efficacy for self-control, couple violence, and gender attitudes. The incidence of physical fighting and dating violence behaviors decreased over the course of an academic school year. Results provide preliminary evidence for the use of interventions based on ethnic and cultural pride as a violence prevention strategy among Hispanic-American teens, especially those who are first generation Americans.     

Character Education as a Prevention Strategy in School-Related Violence

Prevention education is seen as a key component in addressing school violence. Three hundred and three fourth grade students in 9 elementary schools in a predominantly rural community were provided a specialized program of character education as a prevention tool to reduce the potential for deviant behavior. Students in 3 schools were in the no treatment control condition. Students in the remaining 6 schools received a school-based and curriculum driven character education program; two of the schools were in the curriculum only condition while in four of the schools students were randomly selected to receive a protocol-driven summer academic (6 weeks) and experiential education/program. The intervention results suggest that the students who received the academic/camp intervention had the greatest increases in social competence, the largest gains in reading achievement, and the largest increase in parental interaction. Recommendations for prevention education are discussed at the primary, secondary and tertiary levels.