Tae Kyoung Lee

Predictors of Participation in an eHealth, Family-Based Preventive Intervention for Hispanic Youth

The Familias Unidas intervention is an efficacious family-based preventive intervention for reducing substance use and other health risks among Hispanic youth. A current randomized controlled trial (RCT) is examining this intervention’s efficacy when delivered via the Internet (eHealth). eHealth interventions can overcome logistical barriers to participation, yet there is limited information about the feasibility of these interventions, especially among ethnic minorities. This paper examines participation and predictors of participation in the eHealth Familias Unidas intervention in a sample of 113 Hispanic families whose adolescent had behavioral problems. Analyses examined multidimensional ways of characterizing participation, including the following: (1) total intervention participation, (2) initial engagement (participating in at least one of the first three intervention sessions), (3) completing the pre-recorded, eHealth parent group sessions, and (4) participating in the live, facilitator-led, eHealth family sessions. Participation in this eHealth intervention was comparable to, and in most cases higher than, previous, face-to-face Familias Unidas interventions. High levels of baseline family stress were associated with lower initial engagement and lower family session participation. Greater parental Hispanicism was associated with more participation in eHealth parent group sessions and across the total intervention. Higher levels of baseline effective parenting, in other words less intervention need, were significantly associated with lower levels of total intervention participation and lower levels of family session participation. Implications for preventive interventions delivered via Internet are discussed.

Personal Identity Development in Hispanic Immigrant Adolescents: Links with Positive Psychosocial Functioning, Depressive Symptoms, and Externalizing Problems.

The present study was designed to examine trajectories of personal identity coherence and confusion among Hispanic recent-immigrant adolescents, as well as the effects of these trajectories on psychosocial and risk-taking outcomes. Personal identity is extremely important in anchoring young immigrants during a time of acute cultural change. A sample of 302 recently immigrated (5 years or less in the United States at baseline) Hispanic adolescents (Mage = 14.51 years at baseline; SD = 0.88 years, range 14–17) from Miami and Los Angeles (47 % girls) completed measures of personal identity coherence and confusion at the first five waves of a six-wave longitudinal study; and reported on positive psychosocial functioning, depressive symptoms, and externalizing problems at baseline and at Time 6. Results indicated that identity coherence increased linearly across time, but that there were no significant changes in confusion over time and no individual differences in confusion trajectories. Higher baseline levels of, and improvements in, coherence predicted higher levels of self-esteem, optimism, and prosocial behavior at the final study timepoint. Higher baseline levels of confusion predicted lower self-esteem, greater depressive symptoms, more aggressive behavior, and more rule breaking at the final study timepoint. These results are discussed in terms of the importance of personal identity for Hispanic immigrant adolescents, and in terms of implications for intervention.

Familias Unidas' crossover effects on suicidal behaviors among Hispanic adolescents: results from an effectiveness trial

The long-term impact of Familias Unidas on suicidal behaviors among Hispanic 8th graders (N = 746) was examined along with parent-adolescent communication as a moderator of intervention effectiveness. At baseline, 9.2% (95% CI = 7.3%-11.6%) of adolescents reported suicide ideation and 5.7% (95% CI = 4.1%-7.7%) reported a past year suicide attempt. There were no significant intervention effects on suicidal behaviors; however, parent-adolescent communication was a moderator of suicide attempts in the past year, across the intervention (b = -.01, p = .01). Results suggest that Familias Unidas reduces suicidal behaviors among Hispanic adolescents with low levels of parent-adolescent communication despite no suicide-specific intervention content. Implications of these findings are discussed.

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.

Social stratification of general psychopathology trajectories and young adult social outcomes: A second-order growth mixture analysis over the early life course

BACKGROUND Research has documented heterogeneous developmental trajectories of specific symptoms, such as anxiety and depression, in late childhood and adolescence. Few studies, however, have examined the heterogeneity of general psychopathology (GPP) trajectories considering symptoms of anxiety, depression, and hostility in adolescence simultaneously. Identifying antecedents for distinct trajectory groups of GPP, and their respective consequences, may provide insight into the etiological underpinnings of social antecedents of different symptoms and inform the targets and timing of intervention. METHODS European American target adolescents (N=444, 53% female) evaluated three domain specific symptoms (i.e., symptoms of anxiety, depression, and hostility) as well as psychosocial risks and social consequences over 10 years (from 1990 [Wave 2] to 2001 [Wave 13]). First- and second-order growth mixture models (SOGMMs) were used to identify trajectories of GPP and specific symptoms from mid-adolescence through young adulthood, as well as their predictors and consequences. RESULTS A three-class model consisting of high and escalating (10.1%), high and decreasing (23.2%), and consistently low (66.7%) GPP emerged as the preferred solution. More predictors and outcomes were associated with membership in both the high and escalating and the high and declining classes of GPP compared to corresponding classes of the specific symptoms trajectories. LIMITATIONS Self-reported information regarding three symptoms may be a source of bias within the current study. CONCLUSION Our findings suggest that unified interventions and/or prevention efforts are needed to not only assess specific symptoms, but also to treat GPP in adolescence.

Identifying diverse life transition patterns from adolescence to young adulthood: The influence of early socioeconomic context

The purposes of the present study are to investigate: (1) the heterogeneity in life transition patterns of youth from adolescence to young adulthood (ages 18-30) involving the timing and sequence of four transition events (college graduation, full-time employment, marriage, and parenthood), (2) the influence of early socioeconomic adversity on life transition patterns from adolescence to young adulthood, and (3) the influence of gender and race/ethnicity on these transition patterns. Using a multivariate discrete-time mixture survival model with a sample of 14,503 adolescents from the National Longitudinal Study of Adolescent to Adult Health (Add Health), the study identified four life transition patterns and found that early socioeconomic adversity shapes disrupted life transition patterns from adolescence to young adulthood. Gender and race/ethnicity differences are discussed. These results highlight the need for prevention and intervention programs that selectively target at-risk youth beginning in adolescence and continuing through subsequent transition periods.

Effects of parent-adolescent reported family functioning discrepancy on physical activity and diet among Hispanic youth.

Research has shown that family functioning has been positively associated with physical activity and dietary intake, both of which are obesity-related risk factors. The most widely practiced methodological approach to assessing this construct in empirical studies relies on either parent or adolescent report. Yet, discrepancy in parent and adolescent report of family functioning may provide a fuller understanding of the effects of this construct on obesity-related health outcomes. This is especially important among Hispanics, a population that suffers from disproportionately high rates of obesity and its health-related consequences. The purpose of this study was to examine whether, and to what extent, parent-adolescent discrepancies in family functioning are associated with physical activity, and fruit and vegetable and added sugar intake. We estimated discrepancy scores between parents and adolescents (n = 280 dyads) in family functioning. Then, using structural equation modeling, we tested the effect of family functioning discrepancy on adolescent reports of physical activity, fruits and vegetables intake, and added sugar intake. After controlling for adolescent’s gender and BMI, family functioning discrepancy was significantly associated with reduced physical activity (&bgr; = −.14*, 95% CI ([−.26, −.05]) and fruits and vegetables intake (&bgr; = −.22*, 95% CI [−.38, −.09]) such that the larger the discrepancy between parent and youth reported family functioning, the fewer days of adolescent physical activity and the poorer the fruits and vegetables intake. Our findings provide insight for the role of the family in Hispanic adolescent health outcomes and rationale for capturing rich data to better understand that role.

Early socioeconomic adversity and cardiometabolic risk in young adults: mediating roles of risky health lifestyle and depressive symptoms

The study examined the mediating roles of risky health lifestyle and depressive symptoms in relation to childhood/adolescence adversity and young adult cardiometabolic risk with data from the National Longitudinal Study of Adolescent to Adult Health (n = 9421). Four classes of youth emerged from a latent class analysis with varying early adversity patterns: (a) both low disadvantaged SES and stressful experience (54.8%), (b) high disadvantaged SES and low stressful experience (31.0%), (c) low disadvantaged SES and high stressful experience (10.9%), and (d) both high disadvantaged SES and stressful experience (3.3%). Early adversity had multiple direct and indirect effects on CM risk for those experiencing SES-related adversities. Instead, early adversity generated mediational processes between adversity and CM risks through risky health lifestyle and depressive symptoms for those experiencing stressful experience. Implications for intervention when dealing with youths who have experienced multiple forms of early adversity are discussed.

Predictors of Participant Attendance Patterns in a Family-Based Intervention for Overweight and Obese Hispanic Adolescents

This study examined participant attendance patterns and individual (e.g., income), family dynamics (e.g., communication), and cultural (i.e., Americanism, Hispanicism) predictors of these patterns among Hispanic families enrolled in a 12-week family-based intervention, Familias Unidas for Health and Wellness. Hispanic adolescents (n = 140, 49% female, 13.04 ± 0.87 years old, 36% overweight, 64% obese, 39% immigrants) and their parents (87% female, 42.09 ± 6.30 years old, BMI 30.99 ± 6.14 kg/m2, 90% immigrants) were randomized to the intervention condition. A repeated measures latent class analysis that included 12 binary variables (yes/no) of attendance identified three subgroups of attendance patterns: consistently high, moderate and decreasing, and consistently low. An ANOVA was then conducted to examine whether the identified attendance patterns differed by individual, family dynamics, and cultural characteristics at baseline. Parents in the consistently high attendance group had lower Americanism than those in either of the other attendance groups. Adolescents in the consistently high attendance group had lower Hispanicism than those in either of the other attendance groups. No other variables significantly discriminated between attendance groups. Sustained attendance in the Familias Unidas for Health and Wellness intervention may be driven by Hispanic parents’ desire to better understand their host culture, connect with other culturally similar parents, and reconnect adolescents with their heritage culture.