Charles R. Martinez

The Cultural Adaptation of Prevention Interventions: Resolving Tensions Between Fidelity and Fit

A dynamic tension has developed in prevention science regarding two imperatives: (a) fidelity of implementation—the delivery of a manualized prevention intervention program as prescribed by the program developer, and (b) program adaptation—the modification of program content to accommodate the needs of a specific consumer group. This paper examines this complex programmatic issue from a community-based participatory research approach for program adaptation that emphasizes motivating community participation to enhance program outcomes. Several issues, key concepts, and implementation strategies are presented under a strategic approach to address issues of fidelity and adaptation. Despite the noted tension between fidelity and adaptation, both are essential elements of prevention intervention program design and they are best addressed by a planned, organized, and systematic approach. Towards this aim, an innovative program design strategy is to develop hybrid prevention programs that “build in” adaptation to enhance program fit while also maximizing fidelity of implementation and program effectiveness.

Promoting Academic Success Among Latino Youths

This article describes results from the Oregon Latino Youth Survey, which was designed to identify factors that promote or hinder academic success for Latino middle school and high school youngsters. The study samples included a total of 564 Latino and non-Latino students and parents. Analyses showed that Latino students reported a high frequency of discriminatory experiences and institutional barriers at school, and Latino students and their parents were more likely to experience institutional barriers compared to non-Latinos. Furthermore, Latino students and parents reported that they and/or their youngsters were more likely to drop out of school compared to non-Latinos. Path models showed that lower acculturation and more institutional barriers were related to less academic success for Latino students. More parent academic encouragement and staff extracurricular encouragement were associated with better academic outcomes for Latino students. Finally, family socioeconomic disadvantage had an indirect effect on Latino youngster academic success, through effects on parent monitoring and school involvement.

Effects of Culturally Adapted Parent Management Training on Latino Youth Behavioral Health Outcomes.

A randomized experimental test of the implementation feasibility and the efficacy of a culturally adapted Parent Management Training intervention was conducted with a sample of 73 Spanish-speaking Latino parents with middle-school-aged youth at risk for problem behaviors. Intervention feasibility was evaluated through weekly parent satisfaction ratings, intervention participation and attendance, and overall program satisfaction. Intervention effects were evaluated by examining changes in parenting and youth adjustment for the intervention and control groups between baseline and intervention termination approximately 5 months later. Findings provided strong evidence for the feasibility of delivering the intervention in a larger community context. The intervention produced benefits in both parenting outcomes (i.e., general parenting, skill encouragement, overall effective parenting) and youth outcomes (i.e., aggression, externalizing, likelihood of smoking and use of alcohol, marijuana, and other drugs). Differential effects of the intervention were based on youth nativity status.

Recruitment and Retention of Latino Immigrant Families in Prevention Research

The development and testing of culturally competent interventions relies on the recruitment and retention of ethnic minority populations. Minority immigrants are a population of keen interest given their widespread growth, needs, and contributions to communities in which they settle, and particularly recent immigrants from Mexico and Central and South American countries. However, recruitment and retention strategies for entirely immigrant samples are rarely discussed in the literature. The current article describes lessons learned from two family-focused longitudinal prevention research studies of Latino immigrants in Oregon—the Adolescent Latino Acculturation Study (ALAS) and the Latino Youth and Family Empowerment Project-II (LYFE-II). Social, legal, economic, and political contexts are considered that shape Latino immigrants’ experiences in their home countries as well as in the United States. The implications of these contexts for effective recruitment and retention strategies are discussed.

Development of a multisystemic parent management training intervention for incarcerated parents, their children and families

The majority of men and women prison inmates are parents. Many lived with children prior to incarceration, and most have at least some contact with their children and families while serving their sentences. As prison populations have increased in the United States, there has been a renewed interest in finding ways not only to reduce recidivism, but also to prevent incarceration in the first place, particularly amongst the children of incarcerated parents. Positive family interaction is related to both issues. The ongoing development of a multisystemic intervention designed to increase positive family interaction for parents and families involved in the criminal justice system is described. The intervention package currently includes a prison-based parent management training program called Parenting Inside Out (PIO); a prison-based therapeutic visitation program; and complimentary versions of PIO designed for jail and probation and parole settings. Work on other components designed for justice-involved parents, children and for caregivers during reunification from prison is ongoing. Program development has occurred within the context of strong support from the state department of corrections and other key governmental and non-profit sector groups, and support systems have been established to help maintain the interventions as well as to develop complimentary interventions, policies and procedures.

Time in U.S. Residency and the Social, Behavioral, and Emotional Adjustment of Latino Immigrant Families

Little is known about contributors to positive social, behavioral, and emotional adjustment among foreign-born youth at different stages of adapting to life in the United States. Using baseline data from the Adolescent Latino Acculturation Study (N = 217), this article examines the effects of time in residency on parent adjustment, family stress, parenting practices, and youth behavioral and socioemotional outcomes among Latino immigrant parents and youth (Grades 6 to 10) who have lived in the United States between 1 and 12 years. Results of cross-sectional analyses show that immigrant families with less time in residency may experience higher levels of distress that diminish in intensity over time and that youth problem behaviors increase and academic outcomes worsen with increased exposure to life in U.S. society. Time in residency, parent adjustment, and parenting practices each demonstrated unique and unmediated effects on youth outcomes. Results highlight specific vulnerabilities for families in states with emerging immigrant populations that often have few supports for the successful integration of recent immigrant families.

Stress, Place, and Allostatic Load Among Mexican Immigrant Farmworkers in Oregon

Cumulative exposure to chronic stressors has been shown to contribute to immigrants’ deteriorating health with more time in US residence. Few studies, however, have examined links among common psychosocial stressors for immigrants (e.g., acculturation-related) and contexts of immigrant settlement for physical health. The study investigated relationships among social stressors, stress buffers (e.g., family support), and allostatic load (AL)—a summary measure of physiological “wear and tear”—among 126 adult Mexican immigrant farm workers. Analyses examined social contributors to AL in two locales: (1) White, English-speaking majority sites, and (2) a Mexican immigrant enclave. Our six-point AL scale incorporated immune, cardiovascular, and metabolic measures. Among men and women, older age predicted higher AL. Among women, lower family support related to higher AL in White majority communities only. Findings suggest that Latino immigrants’ cumulative experiences in the US significantly compromise their health, with important differences by community context.

Child and Adolescent Affective and Behavioral Distress and Elevated Adult Body Mass Index.

Obesity rates throughout the world have risen rapidly in recent decades, and are now a leading cause of morbidity and mortality. Several studies indicate that behavioral and affective distress in childhood may be linked to elevated adult body mass index (BMI). The present study utilizes data from a 20-year longitudinal study to examine the relations between symptoms of conduct disorder, attention-deficit/hyperactivity disorder, and depression during late childhood and mid-adolescence and BMI during emerging adulthood. Data were analyzed using multiple regression. Results suggest that childhood and adolescent problems may influence adult BMI through direct impacts on adolescent overweight, a condition which then persists into adulthood.

Diurnal cortisol rhythms among Latino immigrants in Oregon, USA

One of the most commonly used stress biomarkers is cortisol, a glucocorticoid hormone released by the adrenal glands that is central to the physiological stress response. Free cortisol can be measured in saliva and has been the biomarker of choice in stress studies measuring the function of the hypothalamic-pituitary-adrenal axis. Chronic psychosocial stress can lead to dysregulation of hypothalamic-pituitary-adrenal axis function and results in an abnormal diurnal cortisol profile. Little is known about objectively measured stress and health in Latino populations in the United States, yet this is likely an important factor in understanding health disparities that exist between Latinos and whites. The present study was designed to measure cortisol profiles among Latino immigrant farmworkers in Oregon (USA), and to compare quantitative and qualitative measures of stress in this population. Our results indicate that there were no sex differences in average cortisol AUCg (area under the curve with respect to the ground) over two days (AvgAUCg; males = 1.38, females = 1.60; P = 0.415). AUCg1 (Day 1 AUCg) and AvgAUCg were significantly negatively associated with age in men (P<0.05). AUCg1 was negatively associated with weight (P<0.05), waist circumference (P<0.01) and waist-to-stature ratio (P<0.05) in women, which is opposite of the expected relationship between cortisol and waist-to-stature ratio, possibly indicating hypothalamic-pituitary-adrenal axis dysregulation. Among men, more time in the United States and immigration to the United States at older ages predicted greater AvgAUCg. Among women, higher lifestyle incongruity was significantly related to greater AvgAUCg. Although preliminary, these results suggest that chronic psychosocial stress plays an important role in health risk in this population.

Associations Among Mother–Child Contact, Parenting Stress, and Mother and Child Adjustment Related to Incarceration

Contact between incarcerated parents and their children has received increased attention due to potential effects of contact on adult adjustment, adults’ ability to parent their children effectively, and children’s adjustment during and after incarceration. This pilot investigation incorporated self-report and biological measures of stress to examine associations between various forms of mother-child contact, mothers’ cortisol levels derived from hair samples, self-reported parenting stress, and maternal and child adjustment (i.e., emotion dysregulation, depressive and other mental health symptoms). The sample comprised 47 incarcerated mothers with a child between the ages of 4 and 12 years. Mothers were assessed at T1 in prison, at T2 before release, and at T3 6 months after release to examine change and stability over time in mothers’ cortisol and adjustment, associations between mothers’ cortisol and adjustment, and associations between mother-child contact and mothers’ cortisol, adjustment, and recidivism. Caregivers provided reports on children at T1 and T3 to investigate associations among child adjustment, mother-child contact, and maternal stress and adjustment. Mothers’ cortisol levels remained stable in prison and increased significantly after release, which was in contrast to other aspects of mothers’ adjustment such as depressive and mental health symptoms that decreased before release and remained stable after prison. More frequent mother-child contact appeared to be beneficial for maternal stress. In contrast, more mother-child contact was associated with higher child internalizing behavior. Mother-child contact was also related to recidivism. Living with their children before and after incarceration, and more frequent contact after release were associated with a decreased likelihood of detention after release among mothers. At T3 after reunification, higher maternal parenting stress was related to children’s higher internalizing and emotion dysregulation. The implications of the findings are discussed.