RESUMO
This article describes a community-academic partnership designed and implemented to address disparities in accessing COVID-19 testing in Arizona, from November 2020 through March 2023. An equitable community-academic partnership, the involvement of local leaders, and the engagement of community health workers were critical for the success of the intervention. More than 5000 previously underserved patients were tested and received COVID-19 related services. A profile comparison with a matched group documents the success of the program in reaching the targeted population. (Am J Public Health. 2024;114(S5):S388-S391. https://doi.org/10.2105/AJPH.2024.307684).
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COVID-19 , Área Carente de Assistência Médica , Populações Vulneráveis , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Arizona , Feminino , Masculino , Adulto , SARS-CoV-2 , Relações Comunidade-Instituição , Pessoa de Meia-Idade , Agentes Comunitários de Saúde/organização & administração , Disparidades em Assistência à Saúde , Idoso , Teste para COVID-19 , Acessibilidade aos Serviços de Saúde/organização & administraçãoRESUMO
The COVID-19 pandemic highlighted deep-rooted health disparities, particularly among Latinx immigrants living on the Mexico-US border. This article investigates differences between populations and adherence to COVID-19 preventive measures. This study investigated whether there are differences between Latinx recent immigrants, non-Latinx Whites, and English-speaking Latinx in their attitudes and adherence to COVID-19 preventive measures. Data came from 302 participants who received a free COVID-19 test at one of the project sites between March and July 2021. Participants lived in communities with poorer access to COVID-19 testing. Choosing to complete the baseline survey in Spanish was a proxy for being a recent immigrant. Survey measures included the PhenX Toolkit, COVID-19 mitigating behaviors, attitudes toward COVID-19 risk behaviors and mask wearing, and economic challenges during the COVID-19 pandemic. With multiple imputation, ordinary least squares (OLS) regression was used to analyze between-group differences in mitigating attitudes and behaviors toward COVID-19 risk. Adjusted OLS regression analyses showed that Latinx surveyed in Spanish perceived COVID-19 risk behaviors as more unsafe (b = 0.38, p = .001) and had stronger positive attitudes toward mask wearing (b = 0.58, p = .016), as compared to non-Latinx Whites. No significant differences emerged between Latinx surveyed in English and non-Latinx Whites (p > .05). Despite facing major structural, economic, and systemic disadvantages, recent Latinx immigrants showed more positive attitudes toward public health COVID-19 mitigating measures than other groups. The findings have implications for future prevention research about community resilience, practice, and policy.
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Teste para COVID-19 , COVID-19 , Humanos , Pandemias , Comportamentos Relacionados com a Saúde , Hispânico ou LatinoRESUMO
For decades, human ecosystem disruptions (HEDs), including pandemics, natural disasters, and socio-economic crises, have shaped national and international responses affecting everyday life. These disruptions present challenges and opportunities for prevention science to address emerging behavioral and mental health research questions, intervention strategies, methodologies, analyses, and research collaboration. This paper introduces a special issue that aims to document examples of how prevention science research teams had (1) globally improved health and well-being through swift, scientifically based responses during HED events and (2) advanced our understanding of the conduct and outcomes of prevention intervention research during crises such as pandemics, natural disasters, and socio-economic crises. The issue presents six research studies conducted in over ten different countries (e.g., Australia, Mexico, China). This issue includes original empirical and descriptive work that addressed HED implications for preventive interventions at within-country and cross-national levels. The findings hold potential applications for responses during current and future pandemics and natural disasters. Participants reflected on methodological and contextual considerations during HEDs, such as navigating travel restrictions, adapting ongoing research efforts to accommodate scientific learning during disruptions, and assessing the impact of policies redistributing preventive resources during and after a HED.
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Ecossistema , Pandemias , Humanos , Pandemias/prevenção & controle , Saúde Mental , Pesquisa sobre Serviços de Saúde , AustráliaRESUMO
This article reports on effects of two earthquakes in Mexico on adolescents attending middle school. The earthquakes struck in close succession during the implementation of a school-based prevention program, providing an opportunity to assess emotional distress due to the earthquakes and whether the life skills taught in the program affected how students coped with the natural disaster. The objectives were to (1) evaluate the earthquakes' impact on students' distress; (2) assess if distress is associated with internalizing symptomology and externalizing behaviors; and (3) investigate if students receiving the original and adapted versions of the intervention coped better with the events. A Mexico-US research team culturally adapted keepin' it REAL to address connections between substance use among early adolescents in Mexico and exposure to violence. A random sample of public middle schools from three cities (Mexico City, Guadalajara, and Monterrey), stratified by whether they held morning or afternoon sessions, was selected. A total of 5522 7th grade students from 36 schools participated in the study. Students answered pretest and posttest questionnaires; the latter assessed earthquake-related distress and coping strategies. Earthquake-related distress was associated with all measures of undesired internalizing symptomology and externalizing behaviors. Compared to controls, students in the adapted intervention reported less aggressive and rule-breaking externalizing behavior and less violence perpetration. However, these intervention effects were not moderated by the level of earthquake-related distress, and they were not mediated by positive or negative coping. The findings have implications for prevention intervention research and policy as natural and human-made disasters occur more often.
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Terremotos , Angústia Psicológica , Adolescente , Humanos , México , Capacidades de Enfrentamento , EstudantesRESUMO
This study documents the pivotal role that Community Health Workers (CHW) played while supporting underserved Latinx communities affected by COVID-19-related health inequities. With the support of CHWs' agencies historically serving three Latinx-dense counties in Arizona, we recruited CHWs who participated in a state-wide COVID-19 testing project. Using phenomenology and narrative qualitative research methods, five focus groups were facilitated in Spanish between August and November 2021. Bilingual research team members conducted the analysis of the Spanish verbatim transcripts and CHWs reviewed the results for validity. Three interconnected themes reflected the CHWs experiences: (1) CHWs as puentes/bridges with deep community embeddedness through shared experiences and social/cultural context, (2) CHWs as communication brokers and transformational agents, playing a pivotal role in responding to the health and socioeconomic challenges posed by the COVID-19 pandemic, (3) CHWs satisfaction and frustration due to their dual role as committed community members but unrecognized and undervalued frontline public health workers. These findings emphasize the CHWs' commitment towards supporting their communities, even amidst the stressors of the pandemic. It is important to continue to integrate the role of CHWs into the larger healthcare system as opposed to relegating them to short term engagements as was the case during the COVID-19 pandemic. This article provides a set of practice, policy, and future research recommendations, emphasizing the need to allocate greater budgetary and training resources in support of CHWs.
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COVID-19 , Equidade em Saúde , Humanos , Pesquisa Qualitativa , Agentes Comunitários de Saúde/educação , Teste para COVID-19 , Pandemias , COVID-19/epidemiologia , Arizona/epidemiologia , Hispânico ou LatinoRESUMO
OBJECTIVE: Examine whether caregiver depressive symptoms at baseline predict longitudinal child asthma outcomes in the two populations with the largest asthma disparities: Mexicans and Puerto Ricans. METHODS: Two hundred and sixty-seven Hispanic caregiver-child dyads (Mexican = 188, Puerto Rican = 79; children 5-12 years) were recruited from clinics and hospitals in Phoenix, AZ and the Bronx, NY. The Center for Epidemiological Studies Depression Scale assessed caregiver depressive symptoms; higher scores indicate greater depressive symptomology. Medical records verified child asthma diagnosis. Assessments for outcome variables occurred at baseline, 3, 6, 9, and 12-month follow-ups. Pulmonary function was measured by spirometry, asthma control was measured by the Asthma Control Test, steroid bursts and acute healthcare utilization were assessed by caregiver report and medical records, and adherence was measured by doser devices on controller medications. Structural equation modeling analyzed baseline caregiver depressive symptoms as a predictor of longitudinal child asthma outcomes, and differences between subgroups. RESULTS: Higher caregiver depressive symptoms predicted better pulmonary function (ß = .02, p = .001) in Mexican children, and fewer steroid bursts (ß = -.41, p = .01) and better medication adherence (ß = .02, p = .07) in Puerto Rican children. Caregiver depressive symptoms did not predict pediatric asthma control or acute healthcare utilization in either subgroup. CONCLUSIONS: Caregiver depressive symptomology had unexpected effects on child asthma outcomes. Results may be explained by the Hispanic paradox, caregiver resilience, acculturation, and the study's longitudinal nature. Further research is needed on social determinants of health that may influence differences in child asthma outcomes in heterogeneous Hispanic communities.
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Asma , Asma/tratamento farmacológico , Cuidadores , Criança , Depressão/epidemiologia , Hispânico ou Latino , Humanos , Porto Rico/epidemiologiaRESUMO
A binational team of investigators culturally adapted, implemented, and tested the efficacy in Mexico of keepin' it REAL, a US-designed prevention intervention for youth. This article reports on the social validity of the adapted intervention by assessing its feasibility, acceptability, and utility, as perceived by participating middle school students, teachers/implementers, and school administrators. Middle schools (N = 36) were randomly assigned to (1) the culturally adapted version for Mexico (Mantente REAL), (2) the original intervention from the USA (keepin' it REAL) translated into Spanish, or (3) a control condition (treatment as usual). Adult and child feedback about the adapted and original versions of the intervention indicate that both are feasible to implement in the Mexican context. Implementation fidelity was equally high for both versions of the manualized intervention. Students, however, were more satisfied with the culturally adapted version than with the non-adapted version. They reported gaining more knowledge, finding it more acceptable, applicable, and authentic, and they reported discussing the program with their family and friends more often. The findings support the feasibility of engaging classroom teachers to implement manualized prevention programs in Mexico. These findings also advance prevention science by documenting the importance of cultural adaptation as a means to increase students' identification with and acceptability of efficacious school-based interventions. The article discusses the practice, policy, and future prevention research implications of the findings for Mexico and their potential generalizability to other middle- and lower-income countries.
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Transtornos Relacionados ao Uso de Substâncias , Adolescente , Criança , Humanos , Estudos de Viabilidade , México , Instituições Acadêmicas , Estudantes , Transtornos Relacionados ao Uso de Substâncias/prevenção & controleRESUMO
When testing longitudinal effects of parenting practices on adolescent adjustment, an integrated consideration of externalizing and internalizing behaviors is a gap in research. This study analyzed how parental support and parental knowledge directly and indirectly influence both antisocial behavior and emotional problems. The sample had 642 adolescents aged 12-15 (mean age = 12.49; 45.4% females) from Spain, who participated in a three-year long study. The results showed longitudinal bidirectional associations between parental support and parental knowledge. Only parental knowledge, however, directly predicted antisocial behavior and emotional problems. Parental support had an indirect effect on outcomes through the mediating effect of parental knowledge. This study has practical implications by indicating that increasing parental knowledge should be the target of educational-prevention programs.
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Comportamento do Adolescente , Transtornos do Comportamento Infantil , Adolescente , Comportamento do Adolescente/psicologia , Criança , Transtornos do Comportamento Infantil/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Relações Pais-Filho , Poder Familiar/psicologia , Pais/psicologia , EspanhaRESUMO
BACKGROUND: Prior studies have established that gender roles are predictive of substance use for Mexican and Mexican American adolescents, both living in the U.S. and in Mexico. Objectives: The moderating effects of gender and acculturation and the mediating effects of antisociality, depressive affect, and adaptive and avoidant coping on the gender role-alcohol use relationship were examined in a sample of Mexican American adolescents. METHODS: Secondary data analyses were conducted on a sample of 955 (450 boys, 505 girls) Mexican American 7th and 8th grade adolescents participating in a school-based substance use intervention. RESULTS: For boys, path analyses yielded significant direct paths from aggressive masculinity to alcohol use. Bootstrapped mediation tests also yielded significant indirect paths through antisociality from assertive masculinity, affective femininity, aggressive masculinity, and the interaction of linguistic acculturation by affective femininity to alcohol use. For girls, the relationship between aggressive masculinity with alcohol use and the negative relationship of affective femininity with alcohol use were also mediated by adaptive coping, which is predictive of decreased substance use. CONCLUSION/IMPORTANCE: The present analyses confirm the importance of gender roles, functional mediators, and their interaction with acculturation in predicting substance use in Mexican American adolescents, with implications for the design of interventions to reduce substance use within the Mexican American community.
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Aculturação , Transtornos Relacionados ao Uso de Substâncias , Adaptação Psicológica , Adolescente , Depressão , Feminino , Papel de Gênero , Humanos , Linguística , Masculino , Americanos Mexicanos/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologiaRESUMO
BACKGROUND: Minority stress may lead to poorer mental health for sexual and gender minority adolescents, yet no interventions have been tested through an RCT to address these concerns. METHODS: We report on an RCT of an intervention-Proud & Empowered-with four high schools. Measures assess the intervention's impact on mental health symptoms. RESULTS: Compared to the control, participants in the treatment condition reported significant differences in minority stress, anxiety, and depressive symptoms. Moderation analyses showed that the intervention significantly moderated the relationship between minority stress and PTSD (b = -1.28, p = .032), depression (b = -0.79, p = .023), and suicidality (b = 0.14, p = .012) symptoms; those in the intervention condition had mitigated relationships between measures of stress and health outcomes compared to those in the control condition. CONCLUSIONS: Results suggest that Proud & Empowered help reduce mental health symptoms and exposure to minority stressors and build coping strategies. TRIAL REGISTRATION: The intervention was registered on clinicaltrials.gov on August 1, 2019 under Trial # NCT04041414 .
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Transtornos de Ansiedade , Minorias Sexuais e de Gênero , Adolescente , Transtornos de Ansiedade/psicologia , Sintomas Comportamentais , Depressão , Humanos , Saúde Mental , Ideação SuicidaRESUMO
PURPOSE: This study sought to identify variation by gender in the associations between religious service attendance from adolescence to young adulthood and seven measures of lifetime and short-term substance use. METHODS: To conduct this nationally representative study, data from the Add Health Surveys was abstracted from Waves I and IV (N = 3,223) to construct four types of service attendance (non-attenders, attenders only as adolescents, attenders only in young adulthood, and consistent attenders). A series of logistic regressions were conducted to identify the independent effects of each pattern of service attendance on each substance among all black young adults, as well as male and female sub-samples. RESULTS: Analysis revealed consistent attenders were generally less likely to use substances, with the effects being strongest among females. Among young adult only attenders, males recorded lower odds across all three short-term measures whereas females reported lower odds only for monthly cigarette use. CONCLUSION: The protective effects of religious service attendance are more robust for African Americans who consistently attend in adolescence and young adulthood, especially among females.
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Negro ou Afro-Americano , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Religião , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto JovemRESUMO
This study assesses the efficacy of a version of the keepin' it REAL (kiREAL) substance use prevention curriculum for middle school students that was culturally adapted for Mexico, renamed Mantente REAL (MREAL), and tested in a cluster randomized controlled trial in Mexico's three largest cities. Student participants were in 7th grade in public middle schools (N = 5523, 49% female, mean age = 11.9). A representative sample of 12 schools from each city, stratified by whether they held morning or afternoon sessions, was randomized to three conditions: culturally adapted MREAL, original kiREAL translated into Spanish, or a treatment-as-usual control group. Regular classroom teachers were trained to deliver the adapted MREAL or the kiREAL manualized curricula. Students with active parental consent completed pretest and post-test questionnaires, 7-8 months apart, at the beginning and end of the 2017-2018 academic year. We assessed the MREAL intervention, relative to kiREAL and controls, with general linear models adjusted for baseline, attrition (24%), non-normal distributions, stratification by city, and school-level clustering. Among students already using the substance more often at pretest, MREAL students had relatively more desirable outcomes, compared to kiREAL and/or to controls, in recent use of alcohol, cigarettes, "hard drugs," heavy episodic drinking, and intoxication. MREAL students reported relatively less violence victimization and perpetration of bullying and relatively more use of three of the intervention's REAL drug resistance strategies (Explain, Avoid, Leave). The adapted version of kiREAL for Mexico showed numerous desired outcomes in areas deliberately targeted in the cultural adaptation. Full protocol can be accessed through Clinical Trials.gov. ID: NCT03233386, "'Keepin' It REAL in Mexico: An adaptation and multisite RCT".
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Transtornos Relacionados ao Uso de Substâncias , Adolescente , Criança , Currículo , Feminino , Humanos , Masculino , México , Instituições Acadêmicas , Estudantes , Transtornos Relacionados ao Uso de Substâncias/prevenção & controleRESUMO
Background: This article reports on a test of a youth substance use prevention program conducted in Nogales-Sonora, a Mexican city on the US border. Objective: The study tested the efficacy of a version of the keepin' it REAL curriculum for middle school students that was culturally adapted for Mexico and renamed Mantente REAL. Methods: Students in 7th grade classrooms in four public schools participated in the study (N = 1,418, 49% female, mean age = 11.9). Using a clustered randomized design, two schools received the intervention and two served as a treatment-as-usual control group. Regular classroom teachers were trained to deliver the twelve-lesson Mantente REAL manualized curriculum. Parents provided active consent and students gave written assent to collect pretest and posttest questionnaire data, 7 months apart, at the beginning and end of the 2017-2018 academic year. We assessed the Mantente REAL intervention with general linear models adjusted for baseline, attrition, non-linear distributions, and school-level clustering. Results: Students who participated in Mantente REAL reported relatively less frequent use of alcohol and illicit drugs other than marijuana, compared to students in control schools. Males alone reported desirable intervention effects for marijuana use. These desirable effects were especially strong among students who reported higher initial levels of involvement in risky behaviors. Among students more at risk, both females and males receiving the program reported relative reductions in the frequency of use of alcohol and illicit drugs. Conclusions: These promising results within the Mexico-US border context support a further dissemination of the intervention and additional youth prevention research in the region.
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Fumar Maconha , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Criança , Currículo , Feminino , Humanos , Masculino , México , Instituições Acadêmicas , Estudantes , Transtornos Relacionados ao Uso de Substâncias/prevenção & controleRESUMO
METHOD: Two hundred Hispanic emerging adults from Arizona (n = 99) and Florida (n = 101) completed a cross-sectional survey, and data were analyzed using hierarchical multiple regression and moderation analyses. RESULTS: Higher social media discrimination was associated with higher symptoms of depression and generalized anxiety. Moderation analyses indicated that higher social media discrimination was only associated with symptoms of depression and generalized anxiety among men, but not women. CONCLUSION: This is likely the first study on social media discrimination and mental health among emerging adults; thus, expanding this emerging field of research to a distinct developmental period.
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Ansiedade/psicologia , Depressão/psicologia , Hispânico ou Latino/psicologia , Racismo/psicologia , Mídias Sociais , Ansiedade/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Fatores Sexuais , Adulto JovemRESUMO
BACKGROUND: Little research has been conducted that integrates, in one explanatory model, the multitude of factors potentially leading to disparities among Latino children. PURPOSE: A longitudinal, observational study tested an explanatory model for disparities in asthma control between Mexican and Puerto Rican children with persistent asthma requiring daily controller medication use. METHODS: Mexican and Puerto Rican children aged 5-12 years (n = 267) and their caregivers (n = 267) were enrolled and completed interviews and child spirometry at baseline and 3, 6, 9, and 12 months postenrollment. A 12 month retrospective children's medical record review was completed. Participants were recruited from two school-based health clinics and the Breathmobile in Phoenix, AZ, and two inner-city hospital asthma clinics in the Bronx, NY. RESULTS: Statistically significant differences in the social/contextual predictors of asthma illness representations (IRs) were noted between Mexican and Puerto Rican caregivers. The structural equation model results revealed differences in asthma control over time by ethnicity. This model accounted for 40%-48% of the variance in asthma control test scores over 12 months. Caregivers' IRs aligned with the professional model of asthma management were associated with better children's asthma control across 1 year. These results also supported the theoretical notion that IRs change over time impacting caregivers' treatment decisions and children's asthma control. CONCLUSIONS: These findings extend a previous cross-sectional model test using a more comprehensive model and longitudinal data and highlight the importance of considering within-group differences for diagnosis and treatment of children coming from the vastly heterogeneous Latino umbrella group. TRIAL REGISTRATION: Trial number NCT01099800.
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Asma/etnologia , Asma/enfermagem , Cuidadores/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Hispânico ou Latino/estatística & dados numéricos , Arizona/etnologia , Criança , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Masculino , Americanos Mexicanos/estatística & dados numéricos , Modelos Estatísticos , Cidade de Nova Iorque/etnologia , Porto Rico/etnologia , Estudos RetrospectivosRESUMO
OBJECTIVE: Hispanic immigrants exhibit more positive outcomes than U.S.-born Hispanics across educational, psychological, and physical health indices, a phenomenon called the immigrant paradox. We examined the immigrant paradox in relation to alcohol use severity among Hispanic young adults while considering both positive (optimism) and negative (depressive symptoms) processes. METHOD: Among 200 immigrant and U.S.-born Hispanic young adults (Mage = 21.30; 49% male) in Arizona and Florida, we tested whether optimism and depressive symptoms statistically mediated the relationship between nativity and alcohol use severity. Specifically, we examined whether Hispanic immigrants reported greater optimism than their U.S.-born counterparts, and whether such optimism was, in turn, associated with less depressive symptoms and thus lower alcohol use severity. RESULTS: Indirect effects were significant in hypothesized directions (nativity â optimism â depressive symptoms â alcohol use severity). CONCLUSIONS: Both positive and negative psychological processes are important to consider when accounting for the immigrant paradox vis-à-vis alcohol use severity among Hispanic young adults.
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Consumo de Bebidas Alcoólicas/etnologia , Depressão/etnologia , Emigrantes e Imigrantes/psicologia , Hispânico ou Latino/psicologia , Otimismo/psicologia , Consumo de Bebidas Alcoólicas/psicologia , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Modelos Psicológicos , Índice de Gravidade de Doença , Estados Unidos , Adulto JovemRESUMO
OBJECTIVE: To examine baseline measures of illness-specific panic-fear (ie, the level of anxiety experienced specifically during asthma exacerbations) as a protective factor in pediatric asthma outcomes over a 1-year period. STUDY DESIGN: The sample comprised 267 children (Mexican, n = 188; Puerto Rican, n = 79; age 5-12 years) from a longitudinal observational study conducted in Phoenix, AZ and Bronx, NY. Assessments were done at baseline and 3, 6, 9, and 12 months. The Childhood Asthma Symptom Checklist was administered at baseline to children and caregivers to assess children's illness-specific panic-fear. Asthma outcome variables quantified longitudinally included pulmonary function, the Asthma Control Test, acute healthcare utilization, and medication adherence, measured by devices attached to inhaled corticosteroids. RESULTS: Child report of illness-specific panic-fear at baseline predicted higher forced expiratory volume in 1 second (FEV1) % across 1-year follow-up in Mexican children (ß = 0.17, P = .02), better asthma control in Puerto Rican children (ß = 0.45, P = .007), and less acute healthcare utilization for asthma in both groups (Mexicans: ß = -0.39, P = .03; Puerto Ricans: ß = -0.47, P = .02). Caregiver report of child panic-fear predicted higher FEV1% in Mexican (ß = 0.30; P = .02) and Puerto Rican (ß = 0.19; P = .05) children. Panic-fear was not related to medication adherence. CONCLUSIONS: Illness-specific panic-fear had beneficial effects on asthma outcomes in both groups of Latino children. The heightened vigilance associated with illness-specific panic-fear may lead children to be more aware of their asthma symptoms and lead to better strategies for asthma management.
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Adaptação Psicológica , Asma/psicologia , Medo/psicologia , Hispânico ou Latino , Americanos Mexicanos , Transtorno de Pânico/etnologia , Medição de Risco/métodos , Asma/complicações , Asma/etnologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Masculino , Transtorno de Pânico/etiologia , Transtorno de Pânico/psicologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologiaRESUMO
The purpose of this study was to assess the combined effectiveness of a parenting intervention, Families Preparing the New Generation (FPNG), and a youth curriculum, keepin' it REAL (kiR), on substance use prevention for middle school students in a large urban metro area of the southwest USA. The study aimed to generate usable knowledge on what works in adolescent substance use prevention and how it works best-a combined parent and youth programming or parent-only programming. A total of 532 adolescents in the 7th grade from 19 participating middle schools were randomly assigned into three intervention conditions: parent-youth (PY), parent-only (PO), and comparison (C). This article focuses on the comparison between PY and PO in order to determine which intervention strategy works best to reduce adolescent substance use including alcohol, inhalant, cigarette, and marijuana uses. A generalized estimating equation (GEE) model examined the longitudinal data. The results for alcohol use show that PO yielded better results than PY and that PY outperformed C after 20 months. Further, PO showed a decreasing trajectory in any substance use over time since the implementation of the intervention. The effect sizes based on Cohen's h indicate small effects in any substance use and alcohol use for PO condition and smaller effects for the PY condition. These findings have implications for the design of future culturally specific parenting and youth prevention interventions with Latino families.
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Características Culturais , Hispânico ou Latino , Relações Pais-Filho , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adolescente , Análise por Conglomerados , Humanos , Estados UnidosRESUMO
This article describes a test in Guatemala City of Mantente REAL, a linguistically adapted version of the keepin' it REAL universal substance use prevention curriculum for early adolescents that teaches culturally grounded drug resistance, risk assessment, and decision making skills. Academic researchers collaborated with a local non-profit to recruit and randomize 12 elementary schools in Guatemala City to intervention and comparison conditions. Regular classroom teachers were trained to deliver the ten-lesson Mantente REAL (MR) manualized curriculum to sixth-grade students. Parents provided passive consent and students gave active assent for data collection, which occurred between February 2013 and September 2014. Two academic year cohorts of students participated (n = 676; 53% male; M age = 12.2). All students completed a pretest questionnaire before the curriculum lessons began in intervention schools and a posttest (87% matched) 4 months later, 1 month after the final lesson. We assessed the MR intervention with paired t tests, effect sizes (Cohen's d), and general linear models adjusted for baseline, attrition, non-linear distributions, and school-level clustering. Results indicated that MR can be an effective school-based prevention approach in Guatemala. The MR participants reported pretest-to-posttest changes in desirable directions on substance use behaviors, attitudinal antecedents of substance use, and acquisition of drug resistance skills. The comparison group generally changed in undesirable directions. In linear models, the MR participants, relative to the comparison group, reported less cigarette and marijuana use, less positive drug use expectancies, and greater use of drug resistance skills. Intervention effect sizes were between .2 and .3.
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Currículo , Serviços de Saúde Escolar , Estudantes , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Criança , Feminino , Guatemala , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Inquéritos e QuestionáriosRESUMO
Sharp increases in substance use rates among youth and the lack of evidence-based prevention interventions in Mexico are a major concern. A team of investigators from Mexico and the USA are actively addressing this gap by culturally adapting keepin' it REAL (kiR)-a former US SAMHSA model program-for Mexico. This paper reports on the processes and outcomes of the cultural adaptation of kiR for adolescents in Mexico. Multiple forms of data informed this cultural adaptation, including focus groups with students about gendered and violence experiences with substance use, feedback from teachers who previously implemented the original versions of kiR, lesson fidelity observations, and external expert reviews. The culturally adapted version of kiR integrates Ecological Validity and Cultural Sensitivity Models in the adaptation process. The process encompassed surface structure adaptations, like updating language, graphics, and videos, as well as deep structure adaptation components including cultural norms, attitudes, and beliefs salient among Mexican adolescents. Youth reported receiving alcohol offers from family members, links between substance use and violence, and that shifting gender norms result in more females initiating substance use offers. In adapted kiR activities, students practice navigating substance use offers in these contexts. This approach to cultural adaptation led to a true collaborative between investigators in two countries. This study advances knowledge about how to undertake cultural adaptations of efficacious US-based prevention programs in international settings.