Longitudinal predictors of post-exposure prophylaxis awareness among latino sexual minority men in South Florida.

Biomedical tools for HIV prevention such as post-exposure prophylaxis (PEP) continue to be underutilized by subgroups experiencing significant HIV inequities. Specifically, factors associated with both PEP awareness and uptake both cross-sectionally and longitudinally are under-researched, despite PEP being a part of the United States' Plan for Ending the HIV Epidemic. The current study examined longitudinal predictors of PEP awareness among Latino sexual minority men (LSMM) living in South Florida. This current study (N = 290) employed hierarchal linear modeling across three timepoints (baseline, 4-months, 8-months) to assess within-person and between-person effects over time for several psychosocial and structural factors. Most participants (67.5%) reported little to no awareness of PEP at baseline with general PEP awareness growing slightly across the study (60.5% reporting little to no awareness of PEP at 8 months). Results of the final conditional model suggest significant within-person effects of PrEP knowledge (p = 0.02) and PrEP self-efficacy (p < 0.001), as well as a significant positive between-person effect of PrEP knowledge (p < 0.01) on PEP awareness. Between-person HIV knowledge was also a significant predictor in this model (p = 0.01). This longitudinal analysis of LSMM's PEP awareness indicates that more must be done to increase PEP awareness among this subgroup. Future studies should explore how to build on existing interventions focused on HIV and PrEP knowledge and PrEP self-efficacy to incorporate information about PEP to increase the reach of this effective biomedical HIV prevention tool.

Factors Associated with Antiretroviral Therapy Adherence Among a Community-Based Sample of Sexual Minority Older Adults with HIV.

Older sexual minorities (e.g., gay, bisexual) living with HIV are at risk for poor HIV outcomes due to their frequent experience with both psychosocial challenges and structural barriers to care. This study utilized a stochastic search variable selection (SVSS) approach to explore potential psychosocial and structural factors associated with HIV-related health outcomes among a community-based sample of older sexual minorities (N = 150) in South Florida, an U.S. HIV-epidemic epicenter. After SVSS, a forward entry regression approach suggested unstable housing, illicit substance use, current nicotine use, and depression were all associated with poorer ART adherence among older sexual minority adults living with HIV. No associations between potential correlates and biological measures of HIV disease severity were observed. Findings highlight a need to focus on multiple levels of intervention that target a combination of psychosocial and structural factors to improve HIV-care outcomes among older sexual minorities and achieve Ending the HIV Epidemic goals.

Minorías sexuales mayores (p.ej., gay, bisexual) que viven con VIH están en riesgo de resultados negativos de VIH debido a sus experiencias con desafíos psicosociales y barreras estructurales. Este estudio uso selección de variables de búsqueda estocástica (SVSS) para explorar factores psicosociales y estructurales asociadas con resultados de salud relacionado a VIH entre una muestra comunitaria de minorías sexuales mayores (N = 150) el la Sur de la Florida, un epicentro de la epidemia de VIH en EE. UU. Después de SVSS, una regresión de entrada directa sugirió que vivienda inestable, uso de sustancias ilícitas, consumo actual de nicotina, y depresión eran asociados con menos adherencia de terapias antirretroviral entre adultos mayores de minorías sexuales que viven con el VIH. No se encontraron asociaciones entre correlatos potenciales y medidas biológicas de VIH. Recomendaciones destacan una necesidad de concentrarse en múltiples niveles de intervención que apuntan una combinación de factores psicosociales y estructurales para mejorar resultados de VIH entre las minorías sexuales mayores y lograr las metas de Finalizando la Epidemia del VIH.

Barriers and facilitators to PrEP use and HIV testing for subgroups of Latino sexual minority men.

Pre-exposure prophylaxis (PrEP) and HIV testing inadequately reach Latino sexual minority men (LSMM), fueling HIV disparities. This study identified determinants of LSMM's PrEP use and HIV testing and examined differences across subgroups (i.e., age and immigration history). First, we identified the most to least endorsed barriers and facilitators of PrEP use and HIV testing among LSMM (1) over vs. under 40 years old, and (2) across immigration histories (U.S. born, recent immigrant, established immigrant). Next, we examined differences in barrier/facilitator ratings across these age and immigration status groups. Key overall determinants were cost, knowledge, and perceived benefit/need. However, there was variation in determinants across age groups (i.e., cost, affordability, navigation support, and normalization) and immigration statuses (i.e., language, immigration concerns, and HIV knowledge). There were also differences across service types; mistrust and concerns was a barrier related to PrEP but not HIV testing. We found unique and common multilevel factors across prevention services and subgroups. Language, cost, and clinic/system issues are key barriers in accessing HIV prevention that should be considered when developing implementation strategies to enhance the reach of these services to LSMM.

Engaging Latino sexual minority men in PrEP and behavioral health care: multilevel barriers, facilitators, and potential implementation strategies.

Latino sexual minority men (LSMM) are affected by HIV and behavioral health disparities. Evidence-based HIV-prevention and behavioral health (BH) services are not sufficiently scaled up to LSMM. The current study identified multilevel barriers and facilitators to LSMM's use of HIV-prevention and BH services. LSMM (N = 290) in South Florida, a US HIV epicenter, completed a battery of measures potentially associated with pre-exposure prophylaxis (PrEP) and BH treatment use. Stochastic search variable selection (SSVS) followed by multiple linear regression analyses identified variables associated with engagement in PrEP and BH treatment. Multilevel determinants of PrEP and BH treatment engagement were identified, with most identified determinants being at the relational level (e.g., stigma, discrimination based on income and immigration status, personal recommendation for treatment). Individual (e.g., knowledge, self-efficacy) and structural (e.g., financial stress) determinants were also identified. Accordingly, modifiable leverage points to enhance the reach of PrEP and BH treatment to LSMM include educating and enhancing the perceived relevance of services, de-stigmatizing and normalizing via peer examples, bolstering self-efficacy, and building trust.

Screening for Adolescent Risk Behaviors: Preliminary Evidence for a Family Functioning Tool.

BACKGROUND: Family functioning is associated with adolescent drug use, alcohol use, cigarette use, and sexual risk behaviors. Assessing adolescents for family functioning, commonly associated with multiple risk behaviors, may help identify adolescents at risk for adverse health outcomes. This study examined whether a latent family functioning construct, encompassing multiple dimensions of family functioning, was associated with adolescents' substance use and sexual risk behaviors. METHOD: This study used data harmonization with three intervention trials, including data from 1451 adolescents (M = 13.6, SD = 1.0), to perform a full-information item bifactor analysis on 46 family functioning items from five pre-existing family functioning measures. Regression analysis was used to examine the association between the identified subset of items and the following outcomes: cigarette use, alcohol use, drug use, and condom use. RESULTS: Bifactor analysis identified a 26-item latent family functioning construct. Regression analysis indicated that a 26-item latent family functioning construct was associated negatively with lifetime and past 90-day cigarette use, alcohol use, and drug use. CONCLUSION: In sum, the multi-dimensional latent family functioning construct may target specific barriers to risk screening in adolescent populations, including time constraint, hesitancy in discussing sensitive health topics, and use culturally appropriate and age-appropriate assessments.

The Role of Intervention Fidelity, Culture, and Individual-Level Factors on Health-Related Outcomes Among Hispanic Adolescents with Unhealthy Weight: Findings from a Longitudinal Intervention Trial.

Previous studies have suggested the impact of intervention fidelity on the management and prevention of chronic diseases; however, little is known about the effect of the contributing determinants (at multiple levels of influence) that can impact health-related interventions intending to improve the health status of Hispanic adolescents with overweight or obesity. The current study aimed to assess whether fidelity (i.e., dosage and quality of the program delivery), acculturation (i.e., orientation to the American culture, retention of Hispanic cultural values), and individual-level socio-demographic characteristics (i.e., income, education) predict changes in family processes (e.g., parent control), which in turn may affect adolescent health-related outcomes including body mass index (BMI), physical activity, dietary intake, and adolescents' health-related quality of life. A pathway analysis model was utilized to explore the study variables among 140 Hispanic parent-adolescent dyads randomized to Familias Unidas Health and Wellness (FUHW) intervention. Results indicated that fidelity was significantly associated with changes in parent-adolescent communication, parent monitoring, limit-setting, and control. Parents' education was associated with changes in parent limit-setting, and parent Hispanicism was associated with changes in parent limit-setting and discipline. The examination between family processes and adolescent health outcomes revealed that parents' higher discipline and improved communication with their adolescents were significantly associated with improved adolescents' quality of life, and parent control was positively associated with physical activity and negatively associated with BMI in adolescents. Our findings demonstrated the significant contribution of intervention fidelity and participants' characteristics in parenting strategies leading to adolescents' health outcomes to prevent obesity-related chronic diseases. Future research is needed to investigate the effect of environmental and organizational factors on the delivery of the intervention materials.

Impacts of Acculturative, Parenting, and Family Stress on US Born and Immigrant Latina/o/x Parent's Mental Health and Substance Use.

Latina/o/x face acculturative stressors which are unique to being an immigrant and/or racial/ethnic minority. Furthermore, Latina/o/x parents face an additional layer of stress related to parenting and family challenges. Little is known about how immigrant and non-immigrant parents cope with stress related to parenting and family stress and how these additional stressors impact parental mental health and substance use. The sample for this secondary data analysis included 1197 parents between 18 and 56 years of age. All analyses controlled for age, gender and number of persons living at home; for the immigrant subsample, we controlled for time in the USA and for the non-immigrant sample, we controlled for generational status. Analyses were conducted to examine the relationship between (1) acculturative stress and mental health and substance use and (2) parenting and family stress and mental health and substance use for immigrants and non-immigrants. Results of multivariate regression models revealed that acculturative stress was significantly associated with mental health, alcohol use, cigarette use, and other tobacco product use for both immigrant and non-immigrants. For both immigrants and non-immigrants, parenting stress and family stress were consistently associated with psychological distress. Parenting stress was associated with greater substance use, including cigarette, other tobacco use, and alcohol use. Given the different associations between acculturative, parenting, and family stress with mental health and substance use among immigrant and non-immigrant parents, family-based interventions should address these stressors to prevent poor health outcomes among Latina/o/x parents and their children.

Efficacy of a Family-Based Intervention for HIV Prevention with Hispanic Adolescents with Same Gender Sexual Behaviors.

Despite the availability of efficacious and effective family-based interventions, such interventions are scarce for sexual minority adolescents, particularly among ethnic/racial minorities. Prior to creating an entirely new intervention, a prudent first step may be to determine if existing interventions are efficacious in reducing risk behaviors in sexual minority adolescents. This study assesses the relative efficacy of a general, family-based intervention (Familias Unidas) on improving substance and condom use outcomes among Hispanic adolescents with same gender sexual behaviors (HASGB). Data across five distinct trials of Familias Unidas were synthesized. HASGB were randomized either to an intervention (n = 94) or control condition (n = 100). Mediation analyses tested for intervention efficacy on past 90-day substance (cigarette/alcohol/illicit drug) use and condomless sex at last intercourse in HASGB participants and whether family functioning indicators-parent-adolescent communication, positive parenting, and parental monitoring of peers-mediated the effects. Post hoc analyses explored the moderating role of study target population based on prior risk. Familias Unidas did not impact substance use but significantly reduced condomless sex postintervention relative to the control condition. Hypothesized mediators did not explain this effect. Post hoc analyses indicated that the effect was significant in studies that recruited based on prior risk but not studies that recruited universal samples. Our results suggest that a general, family-based intervention may have positive effects on condom use in HASGB, particularly those with prior indicated risk. Identifying intervention components that drive this effect in addition to developing tailored content for HASGB is needed.

Development of a family-based preventive intervention for Latinx sexual minority youth and their parents.

OBJECTIVE: Latinx sexual minority youth (LSMY) are disproportionately affected by adverse health outcomes, due to stigma and/or lack of family support. There are currently no family-based interventions for LSMY. This qualitative study describes the development of Familias con Orgullo (Families with Pride), a family-based intervention to prevent/reduce substance use, risky sexual behavior, and depressive symptoms in LSMY. METHOD: Familias con Orgullo was developed using an iterative, user-centered methodology across two study phases. A general inductive approach was used to analyze intervention development individual interviews (N = 24: n = 12 parents, n = 12 LSMY) and post-intervention focus groups (N = 4) to query participants about program components and enhancements to the developed program after delivery. Data were coded into 11 themes representative of program features for LSMY and their families. RESULTS: An intervention would need LSMY information delivered in a safe space and focused on communication, peer pressure, and mental health. Furthermore, participation would be dependent on parental level of acceptance. Informed by participants, we developed an intervention which addresses the multiple ecological levels of LSMY contexts within a cultural lens. Families gave positive feedback and indicated that additional content should focus on sexual health and intrapersonal topics. The intervention was modified and delivered to a new cohort of families; families felt the new intervention promoted inclusiveness; enriched relationships and communication between families; and enhanced lesbian, gay, bisexual, transgender, or queer (LGBTQ) knowledge. CONCLUSION: Familias con Orgullo begins to address the significant gap in intervention research with LSMY and their families. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Family-Based Healthy Lifestyle Intervention: Crossover Effects on Substance Use and Sexual Risk Behaviors.

This study examined the efficacy of a healthy lifestyle family-based intervention in reducing substance use and sexual risk behaviors compared with prevention as usual over 24 months in Hispanic adolescents. Participants were overweight/obese Hispanic adolescents (N = 280; M age 13.01; SD = .82) in the 7th/8th grade and their primary caregivers. Participants were randomized to either the healthy lifestyle family-based intervention or to the control condition (i.e., referral to community services offered for overweight and/or obese adolescents and their families). Outcomes included adolescent substance use and sexual risk behaviors among adolescents. Intervention effects were found for adolescent alcohol (b = - 0.37, 95% CI = [- 0.49, - 0.26]), marijuana (b = - 1.00, CI = [- 1.22, - 0.78]), and non-prescription drug use (b = - 3.77, CI = [- 6.49, - 1.05]) over 24 months. No significant intervention effects were found for adolescent sexual risk behaviors. Findings suggest that Familias Unidas for Health and Wellness reduces adolescent alcohol, marijuana, and non-prescription drug use across time. ClinicalTrials.gov Identifier: NCT03943628.

Understanding the Lived Experiences of Hispanic Sexual Minority Youth and their Parents.

Disclosure of sexual identity and/or gender orientation is difficult for youth and is associated with elevated adverse health risks, particularly when there is parental rejection. There are limited studies conducted with Hispanic sexual minority youth (HSMY) and their families to understand the disclosure process, how the family unit changes and adapts following disclosure, and the implications for preventive interventions for HSMY and their families. This paper explores the lived experiences of youth and parents throughout the disclosure process. A phenomenological approach was used to interview 15 parent-youth dyads (N = 30) to understand what it means for Hispanic youth to disclose their sexual identity and/or gender orientation. Three themes that best described the experience emerged from the participant interviews; the experience of disclosing included intrapersonal challenges, navigating disclosure, and conceptualizing acceptance. The authors highlight implications for preventive interventions that can help these families undergoing the unique process of disclosure.

La revelación de la identidad sexual o la orientación de género es difícil para los jóvenes y está asociada con riesgos adversos elevados para la salud, particularmente cuando existe rechazo por parte de los padres. Se han realizado pocos estudios con jóvenes de minorías sexuales hispanas y sus familias para comprender el proceso de revelación, cómo el núcleo familiar cambia y se adapta después de la revelación, y las consecuencias para las intervenciones preventivas orientadas a los jóvenes de minorías sexuales hispanas y sus familias. En este artículo se analizan las experiencias vividas de los jóvenes y sus padres a lo largo del proceso de revelación. Se utilizó un método fenomenológico para entrevistar a 15 díadas de padres y jóvenes (N = 30) a fin de comprender qué significa para los jóvenes hispanos revelar su identidad sexual o su orientación de género. De las entrevistas a los participantes surgieron tres temas que describieron mejor la experiencia; la experiencia de la revelación incluyó desafíos intrapersonales, el paso por la revelación y la conceptualización de la aceptación. Los autores destacan las implicancias para las intervenciones preventivas que pueden ayudar a estas familias a atravesar el proceso único de la revelación.

Refining Multilevel Barrier and Facilitator Measures for HIV Testing and PrEP Among Latino Sexual Minority Men.

PURPOSE: The purpose of this study is to refine and establish measures of multilevel barriers and facilitators to HIV testing and PrEP for Latino sexual minority men (LSMM). DESIGN: Cross-sectional measure validation. SETTING: Participants from Miami, FL. SUBJECTS: 290 LSMM from the DÍMELO study. MEASURES: Based on prior qualitative work, we developed two measures that evaluated multiple determinants (i.e., barriers and facilitators) to (1) HIV testing and (2) PrEP use. ANALYSIS: All measures included in this analysis assessed a set of theoretically distinct barriers and facilitators. We performed 11 exploratory factor analyses (EFA) to assess the dimensionality of theoretical groupings of items informed by prior qualitative work, including: knowledge, perceived need and benefit, mistrust and concerns, stigma and normalization, cultural competence, navigation support, provider demeanor, clinic and medical system issues, privacy concerns, cost, and language and immigration barriers. Based on EFA results, we conducted two confirmatory factor analyses (CFA), one for each measure. RESULTS: Within each measure, the 11 EFAs extracted 10 barrier factors and 7 facilitator factors. The CFAs for HIV testing and PrEP measures were consistent, such that all models retained the structures identified in the EFAs. CONCLUSION: Findings support the use of these measures with LSMM. These measures can inform multilevel implementation strategies for health promotion professionals to scale up and disseminate HIV prevention services to LSMM.

The Relationship Between Intersectional Oppression and Affirmation and Latino Sexual Minority Men's Mental Health.

Purpose: Latino sexual minority men (LSMM) may experience oppression based on their ethnicity, sexual orientation, and migratory status, yet scientific literature is only beginning to explore the intersection of these experiences. This study examined mental health (MH) in relation to LSMM's experiences of intersectional oppression and affirmation. Methods: We conducted a secondary analysis of baseline data from a cohort study examining LSMM's (n = 290) health care engagement in Miami, FL, from February to September 2020. Latent class analysis (LCA) identified classes based on self-reported multiple identity discrimination (e.g., race, ethnicity, and skin color), sexual orientation stigma/affirmation, and migration-related stress. Logistic and linear regressions examined associations between class membership and anxious, depressive, post-traumatic stress, somatic symptoms, and overall MH burden. Results: The LCA revealed a three-class solution: (1) affirmed LSMM (73.8%), (2) LSMM with intersectional oppression (21.7%), and (3) LSMM with immigration stress (4.5%). The three classes varied in terms of multiple identity discrimination, sexual orientation stigma/affirmation, and migration-related stress. Compared with Class 1, Class 2 had greater conditional probabilities of reporting clinically significant depressive (p = 0.033) and post-traumatic stress symptoms (p = 0.031), and at least one MH concern (p = 0.018). Greater depressive symptoms (p = 0.007), post-traumatic stress symptoms (p = 0.049), somatic symptoms (p = 0.024), and clinically significant MH concerns (p = 0.018) were found among Class 2 than among Class 1. Conclusion: Findings identified three groups of LSMM based on their experiences of intersectional oppression and affirmation. Discrimination at the intersection of multiple identities, sexual orientation stigma/affirmation, and migration-related stress were associated with LSMM's MH outcomes, particularly among immigrants.

Does Binge-Watching eHealth Intervention Content Impact Outcomes?

PURPOSE: Advancements in technology have made it possible to deliver parenting interventions online, known as eHealth interventions. Little is known about the rate at which parents participate in eHealth interventions, characteristics of parents who watch eHealth interventions at an accelerated pace (i.e., binge-watching), and if binge-watching impacts intervention outcomes. METHODS: The sample included 142 Hispanic parents who were randomly assigned to an eHealth family-based intervention and completed 100% of eight online, prerecorded and self-paced video group sessions delivered across 12 weeks. We examined baseline predictors (parent sociodemographic characteristics, report of child's externalizing behaviors, and family functioning) of watching group sessions in two weeks or less (n = 23, 16.2%). Using latent growth curve modeling, we tested the impact of binge-watching on the trajectory of adolescent drug use, condomless sex, and depressive symptoms across 36 months. We also examined the impact of binge-watching on changes in family functioning from baseline to 6 months postbaseline. RESULTS: Parents with high levels of education and of children with attention problems were more likely to binge-watch. Conversely, parents of children with conduct disorder symptoms were less likely to binge-watch. The trajectory of depressive symptoms increased for adolescents with parents who binge-watched the intervention, but the trajectory of condomless sex decreased. There was no impact on drug use. Binge-watching was also associated with decreases in parental monitoring. DISCUSSION: The findings of this study have implications for eHealth interventions; the pace that parents watch eHealth interventions may subsequently impact adolescent outcomes, such as condomless sex and depressive symptoms.

Trajectories of Drug Use and Depressive Symptoms among Latinx Youth and Sexual Minority Youth.

Drug use and depression co-occur and disproportionately affect Latinx sexual minority youth relative to their heterosexual Latinx peers. However, heterogeneity in co-occurring patterns of drug use and depressive symptoms is unknown. The objective of the current study was to identify patterns of drug use and depressive symptom trajectories and examine how these patterns varied between Latinx sexual minority youth and Latinx non-sexual minority youth. Latent class trajectory analysis identified distinct patterns of drug use and depressive symptom trajectories among 231 Latinx adolescents (Latinx sexual minority youth: n = 46, 21.4%; Latinx non-sexual minority youth: n = 169, 78.6%). After identifying class mean trajectories, we examined differences in mean trajectories across groups. A 3-class model was selected as the optimal class trajectory model for both groups, yet classes and trajectories differed. There were differences in initial levels of depression and drug use trajectories between both groups, as well as differences in patterns of drug use trajectories between both groups in two of the three classes. Given the variation in trajectory patterns, there is a need for practitioners to consider the unique needs of both groups to inform the development of preventive interventions for these two populations.

Measurement Invariance of Family Functioning Among Latina/o/x Sexual Minority Youth and Heterosexual Latina/o/x Youth.

Positive family functioning is negatively associated with drug use, sexual risk behaviors, and depression; however, existing measures of family functioning were not specifically developed for Latina/o/x sexual minority youth (LSMY). This study examined the factor structure of family functioning and whether it is invariant across sexual orientation (i.e., LSMY and heterosexual Latina/o/x youth). Participants included 454 Latina/o/x youth (LSMY: n = 115, 25.3%). Results yielded a higher-order family functioning factor consisting of parental involvement, positive parenting, parent-adolescent communication, and parental monitoring. The model fit for the sample was acceptable (CFI/RMSEA = .91/.04) and configural invariance indicated that the model fit the data adequately in both groups (CFI/RMSEA = .87/.05). Fit of the metric invariance model (∆χ2 (42) = 54.83, p = .09, ΔCFI, ΔRMSEA, ΔTLI < .001) was not significantly worse than the configural model, however, the scalar invariance model (∆χ2 (42) = 80.18, p < .001, ΔCFI = .01, ΔRMSEA, ΔTLI < .001) was significantly worse than the less constrained models, suggesting that family functioning was noninvariant with regard to sexual orientation. Noninvariance may be related to the unique experiences of LSMY related to sexual orientation that are not captured in existing measures of family functioning.

Familias con Orgullo: Study protocol for an efficacy study of a family-based intervention for Hispanic sexual minority youth.

This manuscript describes the rationale and design of a family-based, Hispanic sexual minority youth (HSMY) specific preventive intervention, Familias con Orgullo (Families with Pride). HSMY (N = 306) and their primary caregivers will be recruited in South Florida and be randomized to Familias con Orgullo or prevention as usual. The intervention will be delivered by trained study facilitators. Outcomes will be measured at baseline and 6-, 18-, and 30-months post-baseline. The goals of this study are to evaluate whether the Familias con Orgullo intervention, compared to community practice, is effective in reducing drug use and depressive symptoms through the improvement of parent support for the youth, parent acceptance, family functioning, youth stress, and sexual minority stress. Additionally, we will explore whether gender and baseline levels of parent support for the youth, parent acceptance, family functioning, youth stress, and sexual minority stress moderate intervention effects on the youth outcomes. ClinicalTrials.gov identifier: NCT06057337, First posted September 28, 2023.

Longitudinal findings of a U.S. preventive evidence-based family intervention tested among youth in Ecuador: Familias Unidas.

Interventions that address adolescent conduct problems are essential for decreasing negative risk behaviors and promoting positive protective factors among youth. Although interventions have been developed and tested in the United States, preventive evidence-based interventions (EBIs) are less available in Latin American countries such as Ecuador. Therefore, the purpose of this study was to evaluate the efficacy of an evidence-based, parent-centered intervention, Familias Unidas, in preventing/reducing conduct problems, across time, among youth in Guayaquil, Ecuador. Ecuadorian youth (ages 12 through 14) and their respective primary caregiver were recruited from two public schools and randomized to either Familias Unidas or Community Practice. A series of latent growth models were run to test for differences between Familias Unidas and Community Practice on conduct disorder symptoms across three timepoints covering 6 months. Ecuadorian mental health professionals were trained to deliver the evidence-based intervention. Findings indicate no direct relationship between condition and average change in conduct problems at 6 months post baseline. However, indirect effects favoring Familias Unidas over Community Practice were found through improvements in family functioning. Findings highlight that Familias Unidas was efficacious in an international setting and indicate the viability of successfully delivering preventive EBIs in Ecuador.

Acculturative Stress and Self-rated Health among Hispanic Emerging Adults: Examining the Moderating Effects of the Social Environment and Social Support.

Little is known about the impact of sociocultural stressors such as acculturative stress on self-rated health among Hispanics. We aimed to examine (a) associations between acculturative stress and self-rated health, and (b) the moderating effects of the community of settlement (i.e., Maricopa County, AZ and Miami-Dade County, FL) and social support on the association between acculturative stress and self-rated health. A hierarchical multiple regression model and moderation analyses were conducted using a cross-sectional sample of 200 Hispanic emerging adults from Arizona and Florida. Findings indicate that higher levels of pressure to acculturate are associated with lower levels of self-rated health. Community of settlement functioned as a moderator whereby pressure to acculturate was only associated with lower levels of self-rated health in Maricopa County. Lastly, a three-way interaction indicated that emotional social support mitigated the association between pressure to acculturate and self-rated health in Maricopa County. This study highlights the importance of accounting for community of settlement when examining associations between acculturative stress and health-related outcomes. A finding that may have implications for interventions is that social support may help to counteract the effects of acculturative stress.