Maria I. Tapia

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.

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.

Effects of a family intervention in reducing HIV risk behaviors among high-risk Hispanic adolescents: A randomized controlled trial

OBJECTIVE To determine the efficacy of a family intervention in reducing human immunodeficiency virus (HIV) risk behaviors among Hispanic delinquent adolescents. DESIGN Randomized controlled trial. SETTING Miami-Dade County Public School System and Miami-Dade Countys Department of Juvenile Services, Florida. PARTICIPANTS A total of 242 Hispanic delinquent youth aged 12 to 17 years and their primary caregivers completed outcome assessments at baseline and 3 months after intervention. INTERVENTION Participants were randomized to either Familias Unidas (120 participants), a Hispanic-specific, family intervention designed to reduce HIV risk behaviors among Hispanic youth, or a community practice control condition (122 participants). MAIN OUTCOME MEASURES Self-reported measures included unprotected sexual behavior, engaging in sex while under the influence of alcohol and/or drugs, number of sexual partners, and incidence of sexually transmitted diseases. Family functioning (eg, parent-adolescent communication, positive parenting, and parental monitoring) was also assessed via self-report measures. RESULTS Compared with community practice, Familias Unidas was efficacious in increasing condom use during vaginal and anal sex during the past 90 days, reducing the number of days adolescents were under the influence of drugs or alcohol and had sex without a condom, reducing sexual partners, and preventing unprotected anal sex at the last sexual intercourse. Familias Unidas was also efficacious, relative to community practice, in increasing family functioning and most notably in increasing parent-adolescent communication and positive parenting. CONCLUSION These results suggest that culturally tailored, family-centered prevention interventions may be appropriate and efficacious in reducing HIV risk behaviors among Hispanic delinquent adolescents. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01257022.

Parent-centered intervention: A practical approach for preventing drug abuse in hispanic adolescents

Objective: The objective of the present article is to review and discuss Familias Unidas, an empirically supported, family-based, culturally specific drug abuse and HIV prevention intervention for Hispanic immigrant adolescents and their families. Method: The authors focus on engagement and retention as well as on intervention delivery. Conclusions: The present article serves as a guide for social workers and mental health practitioners in carrying out effective family-based adolescent substance use and HIV preventive interventions. Recommendations for and challenges to implementing the intervention in practice-based settings are discussed.

Blending Qualitative and Computational Linguistics Methods for Fidelity Assessment: Experience with the Familias Unidas Preventive Intervention.

AbstractCareful fidelity monitoring and feedback are critical to implementing effective interventions. A wide range of procedures exist to assess fidelity; most are derived from observational assessments (Schoenwald and Garland, Psycholog Assess 25:146–156, 2013). However, these fidelity measures are resource intensive for research teams in efficacy/effectiveness trials, and are often unattainable or unmanageable for the host organization to rate when the program is implemented on a large scale. We present a first step towards automated processing of linguistic patterns in fidelity monitoring of a behavioral intervention using an innovative mixed methods approach to fidelity assessment that uses rule-based, computational linguistics to overcome major resource burdens. Data come from an effectiveness trial of the Familias Unidas intervention, an evidence-based, family-centered preventive intervention found to be efficacious in reducing conduct problems, substance use and HIV sexual risk behaviors among Hispanic youth. This computational approach focuses on “joining,” which measures the quality of the working alliance of the facilitator with the family. Quantitative assessments of reliability are provided. Kappa scores between a human rater and a machine rater for the new method for measuring joining reached 0.83. Early findings suggest that this approach can reduce the high cost of fidelity measurement and the time delay between fidelity assessment and feedback to facilitators; it also has the potential for improving the quality of intervention fidelity ratings.

Parent-Centered Prevention of Risky Behaviors Among Hispanic Youths in Florida

Objectives To evaluate the effectiveness of an evidence-based, parent-centered intervention, Familias Unidas, delivered by nonresearch personnel, in preventing substance use (alcohol, illicit drugs) and sex without a condom among Hispanic adolescents. Methods A randomized controlled trial (n = 746) evaluated the effectiveness of Familias Unidas among Hispanic eighth graders (age range = 12-16 years), relative to prevention as usual, within a public school system. School personnel, including social workers and mental health counselors, were trained to deliver the evidence-based intervention. Participant recruitment, intervention delivery, and follow-up ran from September 2010 through June 2014 in Miami-Dade County, Florida. Results Familias Unidas was effective in preventing drug use from increasing and prevented greater increases in sex without a condom 30 months after baseline, relative to prevention as usual. Familias Unidas also had a positive impact on family functioning and parental monitoring of peers at 6 months after baseline. Conclusions This study demonstrated the effectiveness of a parent-centered preventive intervention program in preventing risky behaviors among Hispanic youths. Findings highlight the feasibility of training nonresearch personnel on effectively delivering a manualized intervention in a real-world setting.

Familias Unidas for high risk adolescents: Study design of a cultural adaptation and randomized controlled trial of a U.S. drug and sexual risk behavior intervention in Ecuador.

BACKGROUND Developing, testing and implementing evidence-based prevention interventions are important in decreasing substance use and sexual risk behavior among adolescents. This process requires research expertise, infrastructure, resources and decades of research testing, which might not always be feasible for low resource countries. Adapting and testing interventions proven to be efficacious in similar cultures might circumvent the time and costs of implementing evidence-based interventions in new settings. This paper describes the two-phase study, including training and development of the research infrastructure in the Ecuadorian university necessary to implement a randomized controlled trial. METHODS/DESIGN Familias Unidas is a multilevel parent-centered intervention designed in the U.S. to prevent drug use and sexual risk behaviors in Hispanic adolescents. The current study consisted of Phase 1 feasibility study (n=38) which adapted the intervention and study procedures within a single-site school setting in an area with a high prevalence of drug use and unprotected sexual behavior among adolescents in Ecuador, and Phase 2 randomized controlled trial of the adapted intervention in two public high schools with a target population of families with adolescents from 12 to 14 years old. DISCUSSION The trial is currently in Phase 2. Study recruitment was completed with 239 parent-youth dyads enrolling. The intervention phase and the first follow-up assessment have been completed. The second and third follow-up assessments will be completed in 2016. This project has the potential of benefitting a large population of families in areas of Ecuador that are disproportionally affected by drug trafficking and its consequences. TRIAL REGISTRATION MSP-DIS-2015-0055-0, Ministry of Public Health (MSP), Quito, Ecuador.

The Role of Settings in Family Based Prevention of HIV/STDs

This chapter provides a broad overview of the role of setting in family based prevention. This chapter has several related goals: First, we provide a brief overview of the ecodevelopmental model. Second, we explore the existing empirical literature providing evidence to support how specific settings may present risk or protection for HIV/STDs for individuals within a family, using the framework of the ecodevelopmental model. The settings to be explored in this chapter include the home, school, neighborhood, church, and substance abuse treatment settings. Finally, for each setting we provide examples illustrating which aspects of settings may be most important for conducting HIV/STD family based preventive interventions.

eHealth Familias Unidas: Pilot Study of an Internet Adaptation of an Evidence-Based Family Intervention to Reduce Drug Use and Sexual Risk Behaviors Among Hispanic Adolescents

This paper describes the Internet adaptation of an evidenced-based intervention for Hispanic families, eHealth Familias Unidas, and explores whether an Internet-based format is feasible and acceptable to Hispanic families. Core intervention components from the evidence-based intervention, Familias Unidas, were transposed into a video format and edited for content. Additionally, interactive exercises and a soap opera series were incorporated to reinforce intervention content and optimize participant engagement and retention. To understand the feasibility and acceptability of eHealth Familias Unidas, we conducted a pilot study and examined findings from: (1) session completion rates for both e-parent group sessions and family sessions (n = 23 families); and (2) qualitative data collected from Hispanic parents (n = 29) that received the eHealth intervention. Engagement and attendance in the intervention showed that 83% of families engaged in the intervention and that there was an overall session completion rate of 78%. Qualitative interviews were conducted mid and post intervention with a combined total of 29 participants. A general inductive approach was used to derive themes from the collected data. Overall, parents expressed positive feedback in regards to the intervention and stated that there were multiple lessons learned from participating in eHealth Familias Unidas. Findings indicate that an Internet-based family intervention is not only feasible and acceptable for Hispanic families, but also offers a viable option to ameliorate barriers to participation and implementation of 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.