Ecodevelopmental and intrapersonal moderators of a family based preventive intervention for Hispanic youth: a latent profile analysis.

Hispanic adolescents are disproportionately affected by externalizing disorders, substance use and HIV infection. Despite these health inequities, few interventions have been found to be efficacious for this population, and even fewer studies have examined whether the effects of such interventions vary as a function of ecodevelopmental and intrapersonal risk subgroups. The aim of this study was to determine whether and to what extent the effects of Familias Unidas, an evidence-based preventive intervention, vary by ecodevelopmental and intrapersonal risk subgroups. Data from 213 Hispanic adolescents (mean age = 13.8, SD = 0.76) who were enrolled in a randomized clinical trial evaluating the relative efficacy of Familias Unidas on externalizing disorders, substance use, and unprotected sexual behavior were analyzed. The results showed that Familias Unidas was efficacious over time, in terms of both externalizing disorders and substance use, for Hispanic youth with high family ecodevelopmental risk (e.g., poor parent-adolescent communication), but not with youth with moderate ecodevelopmental or low ecodevelopmental risk. The results suggest that classifying adolescents based on their family ecodevelopmental risk may be an especially effective strategy for examining moderators of family-based preventive interventions such as Familias Unidas. Moreover, these results suggest that Familias Unidas should potentially be targeted toward youth with high family ecodevelopmental risk. The utility of the methods presented in this article to other prevention scientists, including genetic, neurobiological and environmental scientists, is discussed.

Predicting condom use attitudes, norms, and control beliefs in Hispanic problem behavior youth: the effects of family functioning and parent-adolescent communication about sex on condom use.

Hispanic problem behavior youth are at an increased risk of engaging in HIV risk behaviors, including low condom use. However, relatively little research has examined factors that affect condom use in this population. Although research indicates that family processes, such as higher levels of family functioning and open parent-adolescent communication about sex, and condom use attitudes, norms, and control beliefs as depicted by the theory of planned behavior have an effect on condom use behaviors, the combination of the two factors has received minimal attention. The purpose of this study was to examine the effect of family functioning on condom use intentions and behaviors through communication about sex and condom use attitudes, parental norms, and control beliefs. A cross-sectional study of 171 predominately male (73.1%) sexually active Hispanic problem behavior adolescents (mean age = 14.88 years) was conducted. Structural equation modeling was used to test the study hypothesis. Findings largely support the overall model and suggest that family functioning had an indirect effect on condom use intention and behavior through communication about sex, condom use attitudes, and control beliefs. Family functioning, however, did not have an indirect effect on condom use intention and behavior through communication about sex and parental norms. Implications for prevention science and future research are discussed.

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 County's 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.

The long-term effects of childhood maltreatment experiences on subsequent illicit drug use and drug-related problems in young adulthood.

OBJECTIVES: The objective of this study was to examine the associations between (a) childhood maltreatment (i.e., physical abuse, sexual abuse, and neglect) and subsequent illicit drug use and (b) childhood maltreatment and drug-related problems in young adulthood. METHODS: Wave 1 and Wave 3 public-use data from the National Longitudinal Study of Adolescent Health were used. Logistic regressions, controlling for adolescent drug use and other important family and peer contextual processes, were estimated to determine the associations between (a) childhood maltreatment experiences and subsequent illicit drug use and (b) childhood maltreatment and drug-related problems in young adulthood. RESULTS: Among the participants, 31.9% reported some form of childhood maltreatment. Childhood physical abuse was associated with a 37% (OR=1.37; 95% CI=1.04, 1.80) increase in illicit drug use during the 30 days prior to the Wave 3 survey, a 48% (OR=1.48; 95% CI=1.16, 1.89) increase in illicit drug use during the year prior to the Wave 3 survey, and a 96% (OR=1.96; 95% CI=1.40, 2.76) increase in drug-related problems in young adulthood. The latter two associations persisted even after controlling for illicit drug use in adolescence. Neglect among females was associated with a higher likelihood of past year illicit drug use in young adulthood (OR=1.31; 95% CI=1.002, 1.71). However, this association was not significant once the effect of illicit drug use in adolescence was statistically controlled for. CONCLUSIONS: The present findings suggest that childhood maltreatment is related to subsequent illicit drug use and drug-related problems in young adulthood and that some of these associations differ by gender. Implications for preventive intervention are discussed.

The Role of Attitudes, Family, Peer and School on Alcohol Use, Rule Breaking and Aggressive Behavior in Hispanic Delinquent Adolescents.

OBJECTIVE: The purpose of this study was to examine ecodevelopmental risk factors associated with alcohol uses, rule breaking and aggressive behaviors among Hispanic delinquent adolescents. Specifically, this study tests the effect of attitudes, family, peer, and school bonding on alcohol use, rule breaking and aggressive behaviors in Hispanic delinquent youth. METHODS: A sample of 235 heterogeneous Hispanic delinquent adolescents was recruited through referrals from the Miami-Dade County's Department of Juvenile Services and from the Miami-Dade County Public School system. Logistic regression methods were utilized to examine the independent effect of each risk factor (attitudes, family, peer, school) and to determine the extent to which these factors are associated with alcohol use, rule breaking and aggressive behaviors. RESULTS: Family functioning was inversely and significantly related to past 90-day alcohol use in univariate regression (ß = -.24, p = .035) but was not significant in multiple regression (ß = -0.09, p = .556). Peer alcohol use (ß = 2.02, p<0.001) and poor alcohol attitudes (ß =0.59, p=0.006) were positively and significantly related to past 90-day alcohol use in the final model. Poor alcohol attitudes, family functioning, peer alcohol use, and school bonding were all significantly related to both rule breaking and aggressive behaviors in the final model. CONCLUSIONS: Findings highlight the importance of identifying risk factors at multiple levels to prevent/reduce alcohol use, rule breaking and aggressive behaviors among Hispanic delinquent youth.