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.     

Familias Unidas Prevents Youth Internalizing Symptoms: a Baseline Target Moderated Mediation (BTMM) Study

Prevention Science - Family-based preventive interventions have been found to prevent youth internalizing symptoms, yet they operate through diverse mechanisms with heterogeneous effects for...     

Familias Unidas: The Efficacy of an Intervention to Promote Parental Investment in Hispanic Immigrant Families

This paper reports a test of the efficacy of Familias Unidas, a Hispanic-specific, ecologically focused, parent-centered preventive intervention, in promoting protection against and reducing risk for adolescent behavior problems. Specifically, the intervention was designed to foster parental investment, reduce adolescent behavior problems, and promote adolescent school bonding/academic achievement, all protective factors against drug abuse and delinquency. One-hundred sixty seven Hispanic families of 6th and 7th grade students from three South Florida public schools were stratified by grade within school and randomly assigned to intervention and no-intervention control conditions. Results indicated that Familias Unidas was efficacious in increasing parental investment and decreasing adolescent behavior problems, but that it did not significantly impact adolescent school bonding/academic achievement. Summer-vacation rates of adolescent behavior problems were six times higher in the control condition than in the intervention condition. Furthermore, change in parental investment during the intervention was predictive of subsequent levels of adolescent behavior problems. The findings suggest that Familias Unidas is efficacious in promoting protection and reducing risk for adolescent problem behaviors in poor immigrant Hispanic families.     

eHealth Familias Unidas: Efficacy Trial of an Evidence-Based Intervention Adapted for Use on the Internet with Hispanic Families

Prevention Science - While substance use and sexual risk behaviors among Hispanic youth continue to be public health concerns, few evidence-based preventive interventions are developed for and...     

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     

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.     

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.     

Adolescents' Cortisol Reactivity and Subjective Distress in Response to Family Conflict: The Moderating Role of Internalizing Symptoms

Purpose

Internalizing symptoms have been associated with both higher and blunted cortisol responses in adolescents. Little attention has been paid to subjective experiences of distress in conjunction with internalizing symptoms in hypothalamic–pituitary–adrenal axis responses to laboratory stressors. The present study examines whether adolescents' internalizing symptoms moderate the association between cortisol responses and distress in response to a common stressor in adolescence: family conflict. Differences are also examined between adolescents with current, past only, and no history of internalizing symptoms.

Methods

Adolescents (N = 70) discussed areas of conflict with their parents and subsequently reported on distress experienced during the discussion. Baseline and five poststressor saliva samples were collected. Adolescents' internalizing symptoms were assessed concurrently with the discussion and at three previous time-points.

Results

Internalizing symptoms moderated the association between distress reported by the adolescents and cortisol reactivity in response to family conflict. Adolescents with current and past internalizing symptoms had a blunted cortisol response, whereas adolescents with no history of internalizing symptoms showed greater cortisol reactivity when reporting greater distress.

Conclusions

This study expands the understanding of how current and remitted internalizing symptoms are related to adolescents' responses to everyday family conflicts. Adolescents with current and past internalizing symptoms demonstrated a lack of correspondence between psychological and physiological stress, whereas adolescents with no history of internalizing symptoms showed the anticipated correspondence. This study has important implications for understanding the link between internalizing symptoms and adolescents' hypothalamic–pituitary–adrenal functioning in response to common social stressors.     

Preventing Internalizing and Externalizing Problems in Girls in Foster Care as They Enter Middle School: Impact of an Intervention

Girls in foster care have been shown to be at risk for emotional and behavioral problems, especially during the preadolescent and adolescent years. Based on these findings and on the lack of research-based preventive interventions for such youths, the current study examined the impact of an intervention targeting the prevention of internalizing and externalizing problems for girls in foster care prior to middle school entry. Study participants included 100 girls in state-supported foster homes who were randomly assigned to an intervention condition or to a control condition (foster care services as usual). The intervention girls were hypothesized to have fewer internalizing problems, fewer externalizing problems, and more prosocial behavior at 6-months post-baseline compared to the control girls. The results confirmed the hypotheses for internalizing and externalizing problems, but not for prosocial behavior. Limitations and future directions are discussed.     

Contextual Fit of a Family Evidence-Based Intervention for Preventing Youth Alcohol Use in Mexico

Reducing youth alcohol use is a public health priority that can be addressed by implementing evidence-based preventive interventions (EBPIs) with high fidelity. However, when EBPIs are delivered in a new geographical setting, lack of contextual fit might interfere with expected effects. The purpose of our study was to understand the contextual fit of the family preventive program, Guiding Good Choices (GGC), to inform its future adaptation in Zacatecas, Mexico. Four focus groups were conducted with parents of children aged 9–14 years (N?=?43) from four private companies. After transcribing audiotaped sessions, we used a general inductive approach to obtain codes and derive themes. Parents expressed a high level of interest in program content, highlighting its potential to decrease underage drinking in Mexico. Surface-structure modifications of program audiovisual materials (e.g., new videos with Mexican actors and locations) and delivery methods were recommended by parents to maximize participant acceptability and engagement. Participant definitions of family and perception of family dynamics both support the cultural relevance of the program modules and activities related to this content. Underage drinking was acknowledged by parents as a major problem in Zacatecas. Our findings suggest a need for incorporating an extra session that focuses on addressing low alcohol literacy levels and parents’ positive alcohol expectancies. Machismo was not considered a cultural factor that could affect attendance and program activities. In fact, we observed an opportunity to use local masculinity to ensure practice of parental skills at home. Due to the needs expressed by participants and the apparent compatibility and fit of the curriculum contents with the new context, we conclude that GGC could be an adequate EBPI for preventing underage drinking in Mexico.

     

A Prospective Comparison of Moderating Relationships among Stressors, Hopelessness, and Internalizing Symptoms in Low-Income Urban Youth with Asthma

There are many risk factors associated with the development of internalizing symptoms in low-income urban youth, and youth with asthma appear to be at greater risk for experiencing stressors in multiple domains. The purpose of the current study was to examine stressors, hopelessness, and the interaction between them, as predictors of trajectories of anxious/depressed and withdrawn symptoms over a 4-year period of adolescence. Participating in the study were 53 youth from Chicago public schools, the majority of whom identified themselves as African American or Latino. Multi-level modeling was used to examine major life events, daily hassles, exposure to violence, poverty, and hopelessness as predictors of both types of symptoms. Major life events and exposure to violence predicted anxious/depressed symptoms but not withdrawn symptoms. Hopelessness predicted both types of symptoms and further interacted with major life events to predict both anxious/depressed and withdrawn symptoms. Hopelessness also moderated the effects of daily hassles on anxious/depressed symptoms and poverty on withdrawn symptoms. Results of this study provide insight into the psychosocial risk factors associated with the experience of asthma in urban adolescents.     

Exploring Identities Through the Internet: Youth Experiences Online

How do youth experience their online interactions? This article presents youth voices talking about their online experiences and how they perceive these interactions to have influenced their lives highlighting three themes: the notion of “wowness” experiences of freedom, power, and connectedness; and expanding notions of self and identities. It explores how parameters of the Internet (anonymity, interactivity, and connectivity) assist in enabling powerful relations and interactions that benefit some youth very positively. Virtual interactions and online spaces are seen as further sites of interaction in which youth can explore their identities and sense of themselves.     

Examining the Cultural Context of Youth Mentoring: A Systematic Review

While research in youth mentoring is extensive in the U.S., little research has explored its effectiveness in New Zealand, despite its growth in the past 20?years. While arguments have been raised that overseas models may not fit all cultural contexts within New Zealand, there appears to be limited evidence supporting this contention. Further, little is known about associations between effectiveness and the cultural appropriateness of programs and research. This systematic review of youth mentoring programs in New Zealand is based on 26 studies that met inclusion criteria. Of those, 14 had a significant proportion (15% or more) of indigenous Māori youth and six had a significant proportion of Pasifika (Pacific Islander) youth. While almost all programs and associated research were culturally appropriate to the overall New Zealand context, they tended to be less culturally appropriate for programs working with Māori and Pasifika youth. Further, there was a negative association between cultural appropriateness and program effectiveness.     

Building Self-Esteem Through Social Skills Training and Cultural Awareness: A Community-Based Approach for Preventing Violence Among African American Youth

In West Tennessee, the Juvenile Court Report indicated that African American male youths were six times as likely to be referred on aggravated assault charges, and were taken into protective custody four times as often as their white counterparts. This study aimed to help lessen the likelihood of African American male youths' involvement with the juvenile justice system by: (a) assisting them in developing positive self-esteem; (b) teaching them decision-making and conflict resolution skills; and (c) exposing them to their culture and heritage. A sample of 122 African American male students were drawn from public schools in West Tennessee. The Stephan-Rosenfield Racial Attitude Scale and Banks Attitude Scale were used to assess students' level of self-esteem. Findings revealed that the mean scores on participants' concept of their physical characteristics and ethnic identity improved at post-program, whereas attitudes toward their neighborhood and school did not. Only students within the age range 10–11 years showed an improvement in their mean scores for physical self-concept and attitude towards African Americans relative to those in 8–9 and 12–14 age categories. Lessons learned and implications for violence prevention programs for at-risk populations are discussed.     

Preventing Risk for Significant Behavior Problems Through a Cognitive-Behavioral Intervention: Effects of the Tools for Getting Along Curriculum at One-Year Follow-Up

Efficient and effective social-emotional learning programs increase the likelihood of success in school for all students, and particularly for those who may develop emotional or behavior problems. In this study, we followed a sub-sample of students 1 year after their participation in a randomized controlled trial of the effects of the Tools for Getting Along (TFGA) curriculum. TFGA is a universally delivered, preventive cognitive-behavioral curricular intervention designed to improve upper elementary school students’ emotional and behavioral self-regulation. To determine effects at 1-year follow-up, we assessed 720 out of the 1,296 original students across TFGA and control conditions on measures of curricular knowledge, teacher-rated executive function and behavior, and student-reported anger and social problem solving. Findings indicated a continued positive effect on curricular knowledge for students taught TFGA relative to controls. We also found significant pretest by condition interaction effects on teacher reports of skills associated with executive function, including inhibitory control and shift (cognitive flexibility), and on teacher reported internalizing and externalizing behavior. Specifically, students with poorer scores on these measures at pretest benefited from TFGA at follow-up relative to comparable students in the control condition. Finally, we found marginally significant pretest by condition interaction effects on proactive aggression, outward expressions of anger, and the executive function related skills of initiating activities and using working memory. Counter to expectations, we found negative TFGA effects on student-reported trait anger and anger control.     

Preventing Substance Use in High Risk Youth: Evaluation Challenges and Solutions

Programs to prevent substance use among high risk youth can pose numerous challenges for program evaluators including FEASIBILITY ISSUES such as Participant Recruitment and Retention, Identifying High Risk Youth, and Obtaining a Control/Comparison Group; MEASUREMENT ISSUES such as Social Desirability Bias and Instrument Reliability; METHODOLOGIC ISSUES such as Attrition (both selective and differential), Inadequate Implementation and Variable Dose, Low Statistical Power, Contamination of Comparison Groups, and Low Literacy Skills of Participants. For each of these challenges specific solutions are offered for researchers and practitioners. In general the solutions relate to three themes; 1) incorporate evaluation early into program design; 2) develop a strong partnership with program staff; and 3) be flexible. Also addressed are the need to acknowledge possible bias toward documenting positive outcomes as well as the need to customize evaluation designs for different settings and populations.     

Associations Between the Prenatal Environment and Cardiovascular Risk Factors in Adolescent Girls: Internalizing and Externalizing Behavior Symptoms as Mediators

This longitudinal study examines links among adolescent internalizing and externalizing symptoms, the prenatal environment (e.g., nicotine exposure) and pre/perinatal maternal health, and cardiovascular risk factors. Girls (N = 262) ages 11–17 reported internalizing and externalizing behaviors and mothers reported about the prenatal environment and maternal health during pregnancy and 3 months post-pregnancy. Adolescent cardiovascular risk included adiposity, smoking, blood pressure, and salivary C-reactive protein. Internalizing symptoms mediated relations between prenatal exposures/maternal health and adiposity; externalizing symptoms mediated relations between prenatal exposures and adolescent smoking. Health care providers who attend to internalizing and externalizing symptoms in girls may ultimately influence cardiovascular health, especially among those with pre/perinatal risk factors.     

Impact of Garden-Based Youth Nutrition Intervention Programs: A Review

Garden-based nutrition-education programs for youth are gaining in popularity and are viewed by many as a promising strategy for increasing preferences and improving dietary intake of fruits and vegetables. This review examines the scientific literature on garden-based youth nutrition intervention programs and the impact on nutrition-related outcomes. Studies published between 1990 and 2007 were identified through a library search of databases and an examination of reference lists of relevant publications. Studies were included if they involved children and adolescents in the United States and examined the impact of garden-based nutrition education on fruit and/or vegetable intake, willingness to taste fruits and vegetables, preferences for fruits and vegetables, or other nutrition-related outcomes. Only articles published in peer-reviewed journals in English were included in the review. Eleven studies were reviewed. Five studies took place on school grounds and were integrated into the school curriculum, three studies were conducted as part of an afterschool program, and three studies were conducted within the community. Studies included youth ranging in age from 5 to 15 years. Findings from this review suggest that garden-based nutrition intervention programs may have the potential to promote increased fruit and vegetable intake among youth and increased willingness to taste fruits and vegetables among younger children; however, empirical evidence in this area is relatively scant. Therefore, there is a need for well-designed, evidenced-based, peer-reviewed studies to determine program effectiveness and impact. Suggestions for future research directions, including intervention planning, study design, evaluation, and sustainability are provided.