Staci Leon Morris

Treatment Process Predictors of Program Completion or Dropout among Minority Adolescents Enrolled in a Brief Motivational Substance Abuse Intervention

This study documents significant differences in alliance in a predominantly Latino sample of adolescents who either completed or dropped out of a Guided Self-Change treatment program. Therapeutic alliance, working alliance, and patient involvement were assessed via ratings of audio-recorded segments of participants’ counseling sessions. Descriptive discriminant function analysis identified working alliance goals, patient participation, and therapist warmth and friendliness variables as significantly predictive of completion status. These results were confirmed via follow-up logistic regression analyses. The use of brief clinical tools to monitor and manage alliance among adolescents receiving treatment who are at risk for dropout is discussed.

Pathways to drinking among Hispanic/Latino adolescents: perceived discrimination, ethnic identity, and peer affiliations

We examined whether discrimination experienced by Hispanic/Latino adolescents is associated (a) directly with adolescent alcohol use or (b) indirectly with adolescent alcohol use via mediation by ethnic identity and/or peer associations. Data were drawn from an NIAAA-funded randomized controlled trial evaluating the efficacy of a Guided-Self Change intervention for Hispanic/Latino youth with alcohol and interpersonal violence problems (R01 AA12180; see Wagner et al., 2014). The current sample included 371 Hispanic/Latino teenagers (mean age = 16.3 years [SD = 1.37]; 38% female). Using structural equation modeling (SEM), results revealed that perceived discrimination was indirectly related to alcohol consumption through positive (non-drinking) peer affiliations. Additionally, ethnic identity was found to moderate the relationship between discrimination and positive peer affiliation. These findings further our understanding about how discrimination and ethnic identity interact, as well as provide directions for how the effectiveness of prevention models may be enhanced for reducing underage drinking among Hispanic/Latino adolescents.

A Randomized Controlled Trial of Guided Self-Change with Minority Adolescents

OBJECTIVE Adolescent substance use and abuse is a pressing public health problem and is strongly related to interpersonal aggression. Such problems disproportionately impact minority youth, who have limited access to evidence-based interventions such as ecological family therapies, brief motivational interventions (BMIs), and cognitive behavioral therapies (CBTs). With a predominantly minority sample, our objective was to rigorously evaluate the efficacy of a school-based BMI/CBT, Guided Self-Change (GSC), for addressing substance use and aggressive behavior. METHOD We conducted a school-based randomized, controlled trial with 514 high school students (mean age 16.24 years, 41% female, 80% minority) reporting using substances and perpetrating aggression. We used structural equation modeling to compare participants randomly assigned to receive GSC or standard care (SC; education/assessment/referral-only) at posttreatment and at 3 and 6 months posttreatment on alcohol use, drug use, and interpersonal aggression outcomes as assessed by the Timeline Follow-Back. RESULTS Compared with SC participants, GSC participants showed significant reductions (p < .05) in total number of alcohol use days (Cohens d = 0.45 at posttreatment and 0.20 at 3 months posttreatment), drug use days (Cohens d = 0.22 at posttreatment and 0.20 at 3 months posttreatment), and aggressive behavior incidents (Cohens d = 0.23 at posttreatment). Moreover, treatment effects did not vary by gender or ethnicity. CONCLUSIONS With minority youth experiencing mild to moderate problems with substance use and aggressive behavior, GSC holds promise as an early intervention approach that can be implemented with success in schools.

Developing an SMS Intervention for the Prevention of Underage Drinking: Results From Focus Groups

ABSTRACT Background: There is growing evidence that text messaging—”short message service” (SMS)—is useful for health promotion and behavior change. SMS has become a preferred channel of communication among adolescents. Despite burgeoning interest, there remains a critical need for formative research regarding developmentally and culturally appropriate SMS-based health promotion with teenagers. Objectives. The primary objective was to develop SMS message protocols and procedures effective for reducing underage drinking among Hispanic teens. Using focus groups, we sought our target populations perspectives on SMS parameters including scheduling, frequency, content, themes, and confirmation-of-receipt. Method: We conducted, recorded, and transcribed six mixed-gender focus groups (20 adolescents, 4–5 per group) recruited from the Division of Adolescent Medicine at Miami Childrens Hospital. Alcohol-related and “attention control” text messages were assembled from two sources (http://www.mobilehealth4youth.org and the existing literature); these SMSs, along with SMS procedures, were the focus of discussion. The recordings and transcription were reviewed by two researchers who employed a qualitative iterative process analytical approach. Results: Findings revealed distinct preferences among teenagers about the scheduling, frequency, content, themes, and confirmation-of-receipt of SMSs. Moreover, teens were most enthusiastic about SMSs that addressed alcohol-related knowledge, self-efficacy, social support, or future orientation. Conclusion/Importance: Seeking our target populations perspectives on SMS parameters was essential for developing SMS message protocols and procedures with potential effectiveness for reducing underage drinking among Hispanic teens. It is strongly recommended that researchers or clinicians considering SMS-based interventions conduct a similar formative process prior to implementation.

Mechanisms of Association between Paternal Alcoholism and Abuse of Alcohol and Other Illicit Drugs among Adolescents.

The current study examines the effect of paternal alcohol problems on adolescent use of alcohol and other illicit drugs as a function of maternal communication, as well as adolescent social and coping skills (N = 145). Structural equation modeling (SEM) analyses indicated that adolescents with a paternal history of alcohol problems reported higher levels of problematic communication with their mothers than did adolescents with fathers who were light drinkers or who were non-drinkers. Moreover, problematic maternal communication functioned as a partial mediator for both adolescent negative social skills and self-blame coping skills. Adolescents who reported using self-blame coping skills more frequently also tended to use alcohol more frequently. Findings suggest that these high-risk adolescents might need more intensive and targeted social and psychological services in their schools and communities.

Factors associated with alcohol use among minority female adolescents receiving preventive text messaging for underage drinking

Background There is a high prevalence of alcohol use among adolescents, especially among Hispanic teens in middle adolescence. This emphasizes the need for developmentally appropriate and culturally sensitive underage drinking brief interventions. Texting (i.e. SMS) is extremely popular among U.S. teenagers, and its advantages as a brief intervention includes wide reach, low cost, easy standardization, automation of health message delivery, and the ability to include multiple recipients concurrently.

Hispanic Students’ Perceptions About HIV/STI Testing and Prevention: A Mixed-Methods Study in a Hispanic-Serving University

Hispanic young adults in the United States are disproportionately affected by HIV and should be considered a priority for prevention efforts. The purpose of this study was to explore perceptions and beliefs of English-speaking students (aged 18-24 years) at a Hispanic-serving university about HIV/sexually transmitted infection (STI) testing and prevention to increase acceptance and adoption of services. Four major themes emerged from four qualitative focus groups (n = 30 students) and were corroborated by an optional anonymous survey (n = 24 surveys): (a) preferences for HIV/STI testing services, (b) essential HIV/STI testing information, (c) preferred delivery method of HIV/STI testing information, and (d) culturally appropriate message design with Hispanic young adults. Findings suggest that Hispanic young adults perceive accessible testing to be important to their community and view normalization of these services as a necessary component of successful adoption and adherence. Although flyers were reported as a practical means for distributing on-campus testing and service information, social media was endorsed as one of the most effective ways to reach young adults. Among participants, there was less consensus regarding the need for cultural tailoring. Results provide practical insights into the development and application of health promotion strategies with an ethnic minority group and demonstrate how a mixed-methods approach can be employed to inform health promotional efforts.