Associate Professor and Director Division of Prevention ... · PDF fileCommunication Family Support ... Group participatory learning/ discussion, parent role-plays ... Slide 1 Author:

Guillermo (Willy) Prado
Associate Professor and Director
Division of Prevention Science and Community Health
Department of Public Health Sciences
University of Miami Miller School of Medicine
Council on Contemporary Families
16th Annual Conference
April 5 6, 2013

HIV incidence among Hispanics in the U.S. has decreased by about 4% annually since 2006 (Espinoza et al., - JAIDS, 2012) Good news or bad news?

0
5
10
15
20
25
30
35
40
45
50
Illicit Drugs Alcohol Cigarettes
White
Black
Hispanic
Per
cen
t
Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2013). Monitoring the
Future national survey results on drug use, 2012: Overview of Key Findings on Adolescent
Drug Use. Ann Arbor: Institute for Social Research, the University of Michigan

Past Month Substance Use among Hispanics Aged 12 to 17, by Nativity Status
Nativity
Alcohol
Use
Cigarette
Use
Marijuana
Use
Nonmedical
Use
of
Prescription-
Type Drugs
Born in the United States 16.6% 8.6% 7.1% 3.0%
Not Born in the United
States
12.3% 5.7% 3.6% 2.6%
NSDUH Report, 2011

(Szapocznik & Coatsworth, 1999; Prado et al., 2009)
Social-Cultural Context
Family Microsystem
Positive Parenting Communication about sex
Communication Family Support
Parental Involvement
Peers
Substance use w/ friends
Peer sexual risk
behaviors
School
School Bonding
Academic Achievement
Family-School
Mesosystem
Parental involvement
in school
Family-Peer Mesosystem
Parental monitoring of
peers
Parental Resources/Stressors
Parents Social Support/Collective Efficacy
Parents Stress
Culture
Immigration
Policy Poverty
Language
Problems

Three month preventive intervention Parent-centered Parent groups and family visits Participatory

Parent Support Network
Goals: Enhance social support, change parental beliefs and attitudes, build parenting skills
Strategies: Group participatory learning/ discussion, parent role-plays
Parent-School
Goals: Highlight importance of school involvement.
Increase parental involvement in school.
Strategies: Parent-teacher/counselor meetings
Parent-Peer
Goals: Highlight importance of parental monitoring
of peers. Build relations with peers parents
Strategies: Supervised peer activities
Individual Adolescent Development
Prevent: Substance Use (alcohol, cigarette, and illicit drug use), delinquency, unsafe sexual behavior, HIV infection
School
Goals: Educate parents and adolescent
about the risks of poor academic
achievement and poor school
bonding.
Strategies: Group participatory learning/
discussion, family visits.
Peer
Goals: Educate parents and adolescent
about positive peer relations.
Strategies: Group participatory learning/
discussion, family visits.
Cultural Influences
Goals: Increase parental knowledge about American society and enhance parental skills to protect adolescents from risks
Strategies: Group participatory learning/ discussion, parent role-plays
Family
Goals: Build family cohesion, improve
parenting strategies and parent-
adolescent communication, and
increase parental support for the
adolescent
Strategies: Group visits (role-plays),
family visits, skill building
activities
Exosystem
Mesosystem
Microsystem
Macrosystem

Basic Science/ Etiology
Implementation Effectiveness Efficacy
Community Based Participatory Research
Advanced Statistical Methodology

Intervention conditions
Familias Unidas
HIV Prevention
Health Promotion
Proposed mediator
Family functioning
Outcomes
Cigarette use
Illicit drug use
Alcohol use
Unprotected sexual behavior
Prado, G., Pantin, H., Briones, E., Schwartz, S., Feaster, D., Huang, S., Sullivan, S., Tapia, M., Sabillon, E., Lopez, B., &
Szapocznik, J. (2007). A randomized controlled trial of a parent-centered intervention in preventing substance use and
HIV risk behaviors in Hispanic adolescents. Journal of Consulting and Clinical Psychology, 75, 914-926.
Study Hypotheses:

Baseline
Assessment
Recruitment and
Screening
Randomization
(n = 266)
Familias Unidas
(n=91)
HIV Prevention
(n=84)
Health
Promotion
(n=91)
6, 12, 24,
and 36 months-post
baseline assessments

127 males, 139 females
Mean age = 13.5 (SD = 0.73).
58% of the participants had a family income below the poverty line
Over 60% of youth were foreign born

0
2
4
6
8
10
12
14
16
baseline 6 12 24 36
Months
%
Familias Unidas
HIV Prevention
Health Promotion
Good
Familias Unidas vs HIV Prevention, p

0
5
10
15
20
25
30
35
40
Baseline 36
Months
Low to Moderate Family Risk
%
Familias Unidas
HIV Prevention
Health Promotion
0
5
10
15
20
25
30
35
40
Baseline 36
Months
High Family Risk %
Familias Unidas
HIV Prevention
Health Promotion
Prado, G., Schwartz, S., Maldonado-Molina, M., Huang, S., Pantin, H., Lopez, B., & Szapocznik, J. (2008). Ecodevelopmental x intrapersonal risk: Substance use and sexual behavior in Hispanic adolescents. Health Education & Behavior: 1 17.

-0.2
-0.15
-0.1
-0.05
0
0.05
0.1
0.15
0.2
0.25
baseline 6 12
Months
Mean
Familias Unidas
HIV Prevention
Health Promotion
Good
Familias Unidas vs HIV Prevention, p

0
5
10
15
20
25
30
35
40
45
Familias Unidas HIV Prevention Health Promotion
% Reporting Unprotected Sex
Unprotected Sex at Last Encounter
p

Intervention conditions
Familias Unidas
Community Practice
Proposed mediator
Family functioning
Outcomes
Illicit Drug Use
Alcohol Use
Alcohol Dependence
Marijuana Dependence
Unsafe Sex while Under
the Influence
Study Hypotheses:
Prado, G., Cordova, D., Huang, S., Estrada, Y., Rosen, A., Bacio, G.A., Jimenez, G.L., Pantin, H., Brown, C. H., Velazquez, M.R.,
Villamar, J., Freitas, D., Tapia, M.I., & McCollister, K. The efficacy of Familias Unidas on drug and alcohol outcomes for Hispanic
delinquent youth: Main Effects and Effects by Environmental Context, Drug & Alcohol Dependence, In Press

Figure 1: Flow of Study participants
446 youth and their primary caregivers screened
136 (30.5%) Not Eligible 8 not Hispanic 53 moving out of area 25 adolescents not between 12-17
years of age 50 adolescents did not meet studys
definition of delinquency 68 (15.2%) Eligible but Refused
242 randomized
120 Assigned to Familias Unidas 122 Assigned to Community Practice
113 Completed 6-Month Follow-up and used in the analysis
Declined to Continue = 3

0
5
10
15
20
25
30
0 2 4 6 8 10 12
Months
Perc
ent
report
ing a
lcohol d
ependence
dia
gnosi
s Condition
Community Control
Familias Unidas

0
10
20
30
40
50
0 2 4 6 8 10 12
Months
Perc
ent
report
ing h
ad s
exu
al i
nte
rcours
e w
hile
under
the in
fluence
of
alc
ohol o
r dru
gs
Condition
Community Control
Familias Unidas

Intervention effect on alcohol use for U.S.-born adolescents
(Cordova et al., 2012)
0%
10%
20%
30%
40%
50%
60%
baseline 6 18 30
% R
ep
ort
ion
g a
lco
ho
l is
e in
th
e p
as
t 9
0 d
ays
Months
Familias Unidas
Community PracticeControl
b=-0.425, p=0.017

Intervention effect on parent monitoring of peer for U.S.-born adolescents
10
11
12
13
14
15
16
17
18
Baseline 6 18

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Associate Professor and Director Division of Prevention ... · PDF fileCommunication Family Support ... Group participatory learning/ discussion, parent role-plays ... Slide 1 Author: