Hilda Pantin

The Role of Families in Adolescent HIV Prevention: A Review

Recent research has highlighted the significant contribution families make in the prevention of HIV risk behaviors among adolescents. As the most proximal and fundamental social system influencing child development, families provide many of the factors that protect adolescents from engaging in sexual risk behaviors. Among these are positive family relations, effective communication about sexuality and safer sexual behaviors, enhancement and support of academic functioning, and monitoring of peer activities. HIV risk behaviors occur in a social context, and it is becoming clear that the earliest and most effective way to intervene is in the context where one initially learns about relationships and behavior—the family. Both the Centers for Disease Control and Prevention and the National Institute for Mental Health have taken steps to support and emphasize research that will further elucidate our understanding of the role of families in HIV prevention. This article uses Ecodevelopmental Theory to guide and organize the findings of this promising research area. Within this context, and with special attention to the comorbidity of adolescent problem behaviors, this article reviews empirical research on the role of families in HIV prevention, discusses current intervention efforts that involve families and ecosystems, and addresses prospects and implications for future research and interventions.

A Randomized Controlled Trial of a Parent-Centered Intervention in Preventing Substance Use and HIV Risk Behaviors in Hispanic Adolescents

The present study evaluated the efficacy of Familias Unidas + Parent-Preadolescent Training for HIV Prevention (PATH), a Hispanic-specific, parent-centered intervention, in preventing adolescent substance use and unsafe sexual behavior. Two hundred sixty-six 8th-grade Hispanic adolescents and their primary caregivers were randomly assigned to 1 of 3 conditions: Familias Unidas + PATH, English for Speakers of Other Languages (ESOL) + PATH, and ESOL + HeartPower! for Hispanics (HEART). Participants were assessed at baseline and at 6, 12, 24, and 36 months postbaseline. Results showed that (a) Familias Unidas + PATH was efficacious in preventing and reducing cigarette use relative to both control conditions; (b) Familias Unidas + PATH was efficacious, relative to ESOL + HEART, in reducing illicit drug use; and (c) Familias Unidas + PATH was efficacious, relative to ESOL + PATH, in reducing unsafe sexual behavior. The effects of Familias Unidas + PATH on these distal outcomes were partially mediated by improvements in family functioning. These findings suggest that strengthening the family system, rather than targeting specific health behaviors, may be most efficacious in preventing and/or reducing cigarette smoking, illicit drug use, and unsafe sex in Hispanic adolescents.

Familias Unidas: A Family-Centered Ecodevelopmental Intervention to Reduce Risk for Problem Behavior among Hispanic Adolescents

This paper describes the theoretical and empirical foundations of Familias Unidas, a multilevel, family-centered intervention designed to prevent problem behavior in Hispanic adolescents. The main theoretical tenets for the intervention model; an ecological-developmental perspective, the centrality of ethnic and cultural themes, application of empowerment principles, and a family focus are reviewed. The literature on the risk and protective factors that provided the justification for the interventions targeted mediators and the core clinical applications that are intended to alter them are discussed. Familias Unidas engages Hispanic immigrant parents into an empowerment process in which they first build a strong parent-support network and then use the network to increase knowledge of culturally relevant parenting, strengthen parenting skills, and then apply these new skills in a series of activities designed to reduce risks frequently found in poor, urban environments. The available evidence supporting the efficacy of Familias Unidas is summarized, as are future goals and a current, second-generation application of the intervention.

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.

Nativity and Years in the Receiving Culture as Markers of Acculturation in Ethnic Enclaves

The current study was conducted to ascertain the validity of two commonly used markers of acculturation (nativity and years in the receiving culture) in an enclave context. Relationships between these markers and a bidimensional measure of acculturation were examined in a convenience sample of Hispanic immigrant adolescents and their caregivers in Miami. Nativity was examined using adolescent-reported data; approximately half of the youth were U.S.-born and half foreign-born, but all of the caregivers were foreign-born. Years in the receiving culture was examined using both adolescent and caregiver data. Results indicated that nativity was significantly associated with adoption of receiving-culture practices, with a small to moderate effect size. Years in the receiving culture was significantly associated with adoption of receiving-culture practices only for adolescent girls and for female caregivers who immigrated as youth. Neither nativity nor years in the receiving culture explained even moderate amounts of variance in retention or loss of culture-of-origin practices.

A randomized controlled trial of Familias Unidas for Hispanic adolescents with behavior problems.

Objective: To evaluate the efficacy of Familias Unidas, a Hispanic-specific, parent-centered intervention, in preventing/reducing adolescent substance use, unsafe sexual behavior, and externalizing disorders. Methods: A total of 213 8th grade Hispanic adolescents with behavior problems and their primary caregivers were assigned randomly to one of two conditions: Familias Unidas or Community Control. Participants were assessed at baseline and at 6, 18, and 30 months post baseline. Results: Results showed that, relative to a Community Control condition, Familias Unidas was efficacious in preventing or reducing externalizing disorders, preventing and reducing substance use, and in reducing unsafe sexual behavior. The effects of Familias Unidas on these outcomes were partially mediated by improvements in family functioning. Conclusions: These findings suggest that parent-centered intervention is an efficacious strategy for preventing/reducing specific health risk behaviors in Hispanic adolescents with behavior problems.

Initial Engagement in Parent-Centered Preventive Interventions: A Family Systems Perspective.

This article examines factors predicting participant engagement in a parent-centered, substance abuse preventive intervention. One hundred forty-three families assigned to the experimental condition were identified as either “initially engaged” (having attended at least one of the first three sessions) or “not initially engaged.” The groups were compared on demographics, family need for the intervention, barriers to participation, and family systems level variables. Results from hierarchical logistic regression analyses indicate that caregiver need for the intervention and family systems variables significantly predicted initial engagement in the intervention, while demographic variables, stressful life circumstances, and family stress failed to significantly influence engagement. Family systems variables were the strongest predictors of engagement within the full model. Furthermore, ethnic and racial background significantly moderated the effects of family systems variables on engagement in the intervention. For instance, African American families with low levels of family organization were less likely to be engaged than those with high levels of organization. This effect was not as strong for Hispanic caregivers. Implications for recruitment and engagement strategies are discussed.

Ecodevelopmental HIV Prevention Programs for Hispanic Adolescents

The purpose of this article is to illustrate how an ecodevelopmental perspective on risk and protection can be applied to the study and prevention of unsafe sexual behavior in Hispanic immigrant adolescents. Special attention is given to culturally based ecodevelopmental risk and protective processes that may influence unsafe sexual behavior among Hispanic adolescents. Principles for designing prevention programs to offset these risks are offered on the basis of an ecodevelopmental HIV prevention program that has been developed and is currently being tested.

Family Functioning, Identity, and Problem Behavior in Hispanic Immigrant Early Adolescents

The present study investigated the role of identity in the relationship between family functioning and behavior problems in a sample of Hispanic immigrant early adolescents and their families. The sample consisted of 181 Hispanic immigrant adolescents (92 males, 89 females) and their participating caregivers (who were mostly mothers). Identity was measured using adolescent reports, whereas family functioning and early adolescent behavior problems were measured using both adolescent and parent reports. Correlational analyses indicated that previously obtained relationships among family functioning, identity, and behavior problems were replicated in the present sample. Structural equation models indicated that 20% of the relationship between family functioning and behavior problems operated indirectly through identity, and identity confusion partially mediates the relationship between family functioning and early adolescent behavior problems. Implications for intervention are discussed.

What Accounts for Differences in Substance Use Among U.S.-Born and Immigrant Hispanic Adolescents?: Results from a Longitudinal Prospective Cohort Study

PURPOSE The current study was conducted to ascertain whether the effects of nativity (i.e., U.S. born vs. immigrant) on Hispanic adolescent substance use is mediated by ecological processes such as family functioning, school connectedness, and perceived peer substance use. METHODS The effects of family, peer, and school processes on adolescent substance use were examined in a nationally representative sample of 742 (358 male, 384 female) Hispanic youth (mean age = 15.9; SD = 1.8). RESULTS Results from a structural equation model indicated that the higher rates of substance use among U.S.-born Hispanics (compared with foreign-born Hispanics) are partially mediated by perceived peer substance use (as measured by the adolescent). The results also showed that perceived peer substance use and school connectedness mediate the relationship between family processes and substance use, suggesting that family processes may offset some of the deleterious effects of negative peer selection on adolescent substance use. CONCLUSION These findings imply that public health behavioral interventions to prevent substance use among both U.S.-born and foreign-born Hispanics may need to attend to multiple ecological processes, including family, school, and peers.