Family-based Prevention Programs Research Articles

Adolescent Peer Networks and the Potential for the Diffusion of Intervention Effects

Many evaluation studies assess the direct effect of an intervention on individuals, but there is an increasing interest in clarifying how interventions can impact larger social settings. One process that can lead to these setting-level effects is diffusion, in which intervention effects spread from participants to non-participants. Diffusion may be particularly important when intervention participation rates are low, as they often are in universal family based prevention programs. We drew on socialization and diffusion theories to articulate how features of peer networks may promote the diffusion of intervention effects. Then, we tested the measurement properties of ten social network analytic (SNA) measures of diffusion potential. Data were from 42 networks (n = 5,784 students) involved in the PROSPER intervention trial. All families of sixth-grade students were invited to participate in a family based substance use prevention program, and 17 % of the families attended at least one session. We identified two dimensions of network structure--social integration and location of intervention participants in their peer network--that might promote diffusion. Analyses demonstrated that these SNA measures varied across networks and were distinct from traditional analytic measures that do not require social network analysis (i.e., participation rate, how representative participants are of the broader population). Importantly, several SNA measures and the global network index predicted diffusion over and above the effect of participation rate and representativeness. We conclude by recommending which SNA measures may be the most promising for studying how networks promote the diffusion of intervention effects and lead to setting-level effects.

The Influence of Parental, Peer, and School Factors on Marijuana Use Among Native American Adolescents

ABSTRACT Marijuana use among Native American (NA) adolescents continues to be an ongoing concern and is often cited as the most critical health issue facing this population. Despite this recognition, few studies have examined the roles played by parental monitoring and school relationships among NA youth. This cross-sectional study used secondary data from the 2010 National Survey in Drug Use and Health to examine the combined influence of parental, peer, and school indicators on marijuana use among NA adolescents aged 12 to 17 years old (N = 287). The results of structural equation modeling suggest that peer factors and parental monitoring were significantly associated with marijuana use. In fact, the peer network was the most influential predictor. However, a significant relationship was not found between school relationships and marijuana use. Given the insignificance of school relationships, further research should examine the influence of peer interactions on marijuana use and the development of family-based prevention and intervention programs.

Determinants of Nutritional Status in Children living in Mashhad, Iran

Introduction: Children are one of the most vulnerable groups to sub-optimal nutritional intake in most societies. We have investigated some of the potential determinants of malnutrition in children of 2-5 years of age. Methods and Materials: A cross sectional study was conducted to determine the relationship between nutritional status (weight for age, height for age and weight for height) and dietary and socioeconomic factors in 671 children (24-59 months of age) from selected health centers in Mashhad city, Iran. Children were assessed for weight and height and the care givers were interviewed and a questionnaire was completed by the interviewers. The data were analyzed using SPSS13 software and the Z-scores were calculated using the WHO anthropometric software package. Results: The study showed that 24.4% of children were mildly underweight, 4.3% were underweight, 13% were mildly stunted, 23.6% of children were mildly wasted and 3.1% were stunted. Educational attainment, whether the children had been breast feed, average daily consumption of milk, feeding practices and type of first food were found to be the main factors determining nutritional status in our study. Conclusion: A higher daily consumption of milk, lower age at which first solid food was started; lower age for consumption of meat and good feeding practices may resolve malnutrition in this population. These findings support the need for a family-based prevention program that focus on guiding parents to foster appropriate feeding practices as well as to promote healthy food intake in the children. Future research should determine the cost-effectiveness of both short- and long-term interventions for child malnutrition.

Two-year outcomes of a randomized, family-based substance use prevention trial for Asian American adolescent girls.

Asian Americans have been largely ignored in the prevention outcome literature. In this study, we tested a parent-child program with a sample of Asian American adolescent girls and their mothers, and evaluated the program's efficacy on decreasing girls' substance use and modifying risk and protective factors at individual, family, and peer levels. A total of 108 Asian American mother-daughter dyads recruited through online advertisements and from community service agencies were randomly assigned to an intervention arm (n = 56) or to a test-only control arm (n = 52). The intervention consisted of a nine-session substance abuse prevention program, delivered entirely online. Guided by family interaction theory, the prevention program aimed to strengthen the quality of girls' relationships with their mothers while increasing girls' resilience to resist substance use. Intent-to-treat analyses showed that at 2-year follow-up, intervention-arm dyads had significantly higher levels of mother-daughter closeness, mother-daughter communication, maternal monitoring, and family rules against substance use compared with the control-arm dyads. Intervention-arm girls also showed sustained improvement in self-efficacy and refusal skills and had lower intentions to use substances in the future. Most important, intervention-arm girls reported fewer instances of alcohol and marijuana use and prescription drug misuse relative to the control-arm girls. The study suggests that a culturally generic, family-based prevention program was efficacious in enhancing parent-child relationships, improving girls' resiliency, and preventing substance use behaviors among Asian American girls.

Evaluation des familienbasierten Programms Familien stärken zur Prävention von Sucht- und Verhaltensproblemen bei Jugendlichen

The Strengthening Families Program was developed in the USA and is regarded as an effective family-based prevention programme for youth. The evaluation of an adapted German version was carried out as a randomised-controlled multicentre trial. 292 families were recruited, 150 followed the intervention, and 142 received a minimal intervention. Acceptance from families and programme facilitators was high. Results about the effectiveness will be reported as soon as follow-up assessments are completed.

Six-Week Latino Family Prevention Pilot Program Effectively Promotes Healthy Behaviors and Reduces Obesogenic Behaviors

To test the effectiveness of a 6-week family-based healthy eating pilot program aimed to reduce obesogenic behaviors among Latino parents and children. A 6-week healthy eating pilot program focused on dietary changes within Latino families witha 6- to 13-year-old child. A 1-group, pre-posttest design with 2-month follow-up examining fruit, vegetable, and sugar-sweetened beverage consumption. The program was effective at increasing parent-report of child fruit consumption, (P < .001, effect size = .26), vegetable consumption, (P = .001, effect size = .20), and decreasing sugar-sweetened beverage consumption, (P = .002, effect size = .16). This family-based prevention program was effective at improving healthy eating in Latino families, especially for children. The curriculum can be used in future prevention programs for Latino families with a 6- to 13-year-old child.

Intervention Induced Changes in Perceptions of Parenting and Risk Opportunities Among Rural African American

A randomized prevention trial was conducted contrasting families who took part in the Strong African American Families Program (SAAF), a preventive intervention for rural African American parents and their 11-year-olds, with control families. The trial, which included 671 families, indicated that intervention-induced changes occurred in intervention-targeted parenting and youth behavior, as well as youth initiation of alcohol use and sexual activity. Four waves of data collected were obtained at pretest, 3-month post-test, 29 month long-term follow up; and 65 month long-term follow up. Three data points were selected and analyzed in the current study: pretest, post-test, and 65 month long-term follow up to capture the sustainability of SAAF during three critical developmental stages—middle childhood, early adolescence, and late adolescence. Intervention-induced changes in parenting mediated the effect of intervention-group influences on changes in the onset and escalation of alcohol use and sexual activity over 65 months through its positive influence on youths’ perceptions and internalization of parental norms and resistance to engaging in risk opportunities. These findings highlight the potential for family-based prevention programs to enhance positive developmental outcomes to reduce HIV-related risk behaviors among rural African American youth.

Participación parental en intervenciones familiares para prevenir drogodependencias: una revisión empírica

Substance use andmisuse are very common in adolescence. Parents play an important part in substance use, both through inducing risk or promoting protection and resilience. Family-based interventions have proven to be a useful approach to prevent adolescent substance use and other youth problem behaviors. However, low participation rates are an important threat to the validity of family-based preventive interventions. It has long been recognized that one of the major problems in implementing familybased preventive interventions has been the recruitment, retention and participation of parents. Besides, the benefits of increased parent participation in preventive parent training are associated with a lasting effect on adolescent behavior. Identify specific determinants of participant engagement in family-based prevention programs is of utmost importance, as the level of parental engagement can be a predictor of program effectiveness. There has recently been increased attention to understanding how individual, contextual and intervention factors can predict parental participation in family-based drug prevention interventions. Research on predictors of participation is helpful in the way it can identify those individuals who may be at highest risk for drop out. In this paper we provide an overview of the more recent developments of the several predictors of family participation in preventive substance use and other problems family-based programs. Keeping inmind the specific dynamic determinants of participation examined in this review, we finally suggest a theoretical framework of family participation that includes four basic components: (1) family interaction patterns; (2) parent cognitions and attributions about child’s behavior problems; (3) parent psychological variables; and; (4) parent perceptions about the preventive intervention.

HIV/STD prevention interventions for couples and families: A review and introduction to the Special Issue.

While tremendous progress has been made in the prevention and treatment of HIV, individuals continue to be at risk of acquiring HIV. There is increased recognition that interventions need to target couples and families in at-risk populations. This article provides an introduction to this special issue on couples, families, and HIV and a review of research on couple and family interventions for prevention of HIV. The section on couples focuses on prevention programs for heterosexual couples while the section on families focuses on family based prevention programs for adolescents. This review demonstrates the efficacy of couple and family interventions to reduce HIV risk behavior and to increase other HIV-related behaviors in couples and to prevent HIV risk behaviors in families. Implementation of these evidenced-based interventions in couple and family practice are discussed.

A Comparison of Maternal Outcomes From an Alcohol, Tobacco, and Other Drug Prevention Program for Mothers Choosing an Intervention Versus Being Randomized

Self-determination theory and substantial research findings suggest that more desirable outcomes may occur when participants are able to choose their prevention or treatment interventions, as having a choice may lead to greater motivation and feelings of self-efficacy. The present study examined the influence of having a choice of family-based prevention programs for youth alcohol, tobacco, and other drug use on mothers' communication outcomes. Families (N = 496) were those with an 11- to 12-year-old enrolled in Kaiser Permanente medical centers at one of four locations. Results from multivariate repeated measures analyses supported the importance of having a choice for improved communication outcomes. As compared with families who were randomly assigned to a program, those allowed to choose showed improved tobacco-specific and peer pressure communication, with marginally improved alcohol communication. No differences were found between the groups for general communication. Results suggest that allowing mothers to participate in decisions about health-related interventions for their teens may lead to better outcomes.

Universal family-based prevention programs for alcohol misuse in young people

Alcohol misuse in young people is a cause of concern for health services, policy makers, prevention workers, and criminal justice system, youth workers, teachers, and parents. To systematically review evidence on the effectiveness of universal family-based prevention programs in preventing alcohol misuse in school-aged children up to 18 years of age. To update a part of a previously published Cochrane systematic review. Relevant evidence (up to 2002) was selected from the previous Cochrane review. Later studies, to July 2010, were identified from MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Project CORK, and PsycINFO. Randomized trials evaluating universal family-based prevention programs and reporting outcomes for alcohol use in students 18 years of age or younger were included. Two reviewers screened titles/abstracts and full text of identified records. Two reviewers extracted relevant data independently using ana prioridefined extraction form. Risk of bias was assessed. 12 parallel-group trials were included. The reporting quality of trials was poor, only 20% of them reporting adequate method of randomisation and program allocation concealment. Incomplete data was adequately addressed in about half of the trials and this information was unclear for about 30% of the trials. Due to extensive heterogeneity across interventions, populations, and outcomes, the results were summarized only qualitatively.9 of the 12 trials showed some evidence of effectiveness compared to a control or other intervention group, with persistence of effects over the medium and longer-term. Four of these effective interventions were gender-specific, focusing on young females. One study with a small sample size showed positive effects that were not statistically significant, and two studies with larger sample sizes reported no significant effects of the family-based intervention for reducing alcohol misuse. In conclusion, in this Cochrane systematic review we found that that the effects of family-based prevention interventions are small but generally consistent and also persistent into the medium- to longer-term.

Mental health functioning among children and adolescents with perinatal HIV infection and perinatal HIV exposure

Mental health problems (MHPs) among children with perinatal HIV infection have been described prior to and during the highly active antiretroviral therapy (HAART) era. Yet child, caregiver and socio-demographic factors associated with MHPs are not fully understood. We examined the prevalence of MHPs among older children and adolescents with perinatal HIV exposure, including both perinatally HIV-infected (PHIV + ) and perinatally HIV-exposed but uninfected (PHEU) youth. Our aims were to identify the impact of HIV infection by comparing PHIV+ and PHEU youth and to delineate risk factors associated with MHPs, in order to inform development of appropriate prevention and intervention strategies. Youth and their caregivers were interviewed with the Behavior Assessment System for Children, 2nd edition (BASC-2) to estimate rates of at-risk and clinically significant MHPs, including caregiver-reported behavioral problems and youth-reported emotional problems. The prevalence of MHPs at the time of study entry was calculated for the group overall, as well as by HIV status and by demographic, child health, and caregiver characteristics. Logistic regression models were used to identify factors associated with youth MHPs. Among 416 youth enrolled between March 2007 and July 2009 (295 PHIV+, 121 PHEU), the overall prevalence of MHPs at entry was 29% and greater than expected based on recent national surveys of the general population. MHPs were more likely among PHEU than among PHIV+ children (38% versus 25%, p<0.01). Factors associated with higher odds of MHPs at p<0.10 included caregiver characteristics (psychiatric disorder, limit-setting problems, health-related functional limitations) and child characteristics (younger age and lower IQ). These findings suggest that PHEU children are at high risk for MHPs, yet current models of care for these youth may not support early diagnosis and treatment. Family-based prevention and intervention programs for HIV affected youth and their caregivers may minimize long-term consequences of MHPs.

Neighborhood perceptions and parent outcomes in family based prevention programs for Thai adolescents: the role of program engagement.

Due to concerns over Thai adolescent risky behaviors, effective prevention strategies are needed. Determining the role neighborhood context plays in program engagement and outcomes may inform these strategies. This study includes 170 mother-adolescent pairs (M = 13.44, SD = .52) in Bangkok, Thailand in a prevention program for adolescent substance use and sexual risk. Neighborhoods were related to engagement, which was critical to outcomes. Neighborhood disorganization was related to confidence in program effects and program completion. Completion was related to increased ATOD communication. Neighborhood cohesion was related to less program enjoyment, while neighborhood social control was related to more enjoyment. Enjoyment was related to increased ATOD communication and formation and monitoring of alcohol rules. Prevention strategies should focus on neighborhood contexts and enhancing engagement.

Family-based prevention against substance abuse and behavioral problems: culture-sensitive adaptation process for the modification of the US-American Strengthening Families Program 10–14 to German conditions

Aim The Strengthening Families Program 10–14 (SFP 10–14) was developed in 1993 at the Iowa State University as a universal family-based prevention program against substance abuse and behavioral problems in youth aged 10 to 14 years. Its effectiveness in delaying the initiation of tobacco, alcohol and cannabis use, in decreasing the average amount consumed and in reducing adolescents’ problem behavior in school and at home has been repeatedly evaluated in randomized-controlled studies in the US. While there is a well-established system of school- and community-based prevention in Germany, there is a lack of family-based prevention. This situation would be improved by the cultural adaptation and evaluation of SFP 10–14 in Germany.

College Teaching and Community Outreaching

Background: Service learning can enrich students' knowledge, skills and commitment to occupational goals while positively affecting communities. Undergraduate students in a course on obesity engaged in service learning by assisting with a family-based obesity prevention program, Getting Into Fitness Together (GIFT). Purpose: The impact of GIFT on students and family participants was evaluated. Methods: Students (N=33) completed surveys assessing their perceptions of the course and its service learning component. Eighteen of 21 families who participated in GIFT completed questionnaires and interviews about their experience nearly six months after the program ended. Results: Students evaluated both the course and service learning very favorably; a consistent theme was that the opportunity to apply classroom learning to a real-world experience was invaluable. GIFT participants described strong satisfaction with the program (retention rate = 90%), and most (89%) reported tangible behavioral changes in physical activity or eating patterns. Discussion: Service learning in obesity prevention offered benefits for college students and participants. Especially notable aspects of the program include its emphases on full-family involvement, physical activity and family mentoring. Translation to Health Education Practice: Service learning may offer an especially influential means of introducing future health educators to the critically important topic of obesity.

Efficacy of a Self-Administered Home-Based Parent Intervention on Parenting Behaviors for Preventing Adolescent Substance Use.

A growing body of literature suggests that parenting practices characterized by careful monitoring, firm and consistent limit setting, and nurturing communication patterns with children are protective against adolescent substance use and other problem behaviors. Family-based prevention programs that promote these behaviors can be an effective way to prevent adolescent substance use. However, low participation rates remain problematic for many such programs, particularly programs that require parents to attend scheduled meetings outside the home. The purpose of this study was to determine the efficacy of a newly developed substance use prevention program when self-administered at home by parents of middle school students. As part of a randomized trial, 338 parents of middle school students either received the parent prevention program or served as control group participants. Parents completed self-report surveys at home that assessed parenting behaviors at pre-test, post-test, and one-year follow-up time points. A series of mixed model ANCOVAs were conducted, examining the post-test and one-year follow-up means for the parent outcomes, controlling for pre-test levels on these outcomes. Analyses showed that at the post-test assessment, intervention parents reported significant increases relative to controls in appropriate role modeling, disciplinary practices, family communication, and parental monitoring skills. At the one-year follow-up assessment, intervention effects on family communication skills remained significant and effects on parental role modeling were marginally significant. This study shows that a theoretically rich prevention program can be effectively self-administered by parents at home and improve key parenting skills that have been shown to prevent adolescent substance use.

Implementation fidelity in adolescent family-based prevention programs: relationship to family engagement

Reliability and validity of intervention studies are impossible without adequate program fidelity, as it ensures that the intervention was implemented as designed and allows for accurate conclusions about effectiveness (Bellg AJ, Borrelli B, Resnick B et al. Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH behavior change consortium. Health Psychol 2004; 23: 443-51). This study examines the relation between program fidelity with family engagement (i.e. satisfaction and participation) in family-based prevention programs for adolescent alcohol, tobacco or other drug use. Families (n = 381) were those with an 11- to 12-year-old child enrolled in Kaiser Permanente in the San Francisco area. Families participated in one of two programs: Strengthening Families Program: For Parents and Youth 10-14 (SFP) (Spoth R, Redmond C, Lepper H. Alcohol initiation outcomes of universal family-focused preventive interventions: one- and two-year follow-ups of a controlled study. J Stud Alcohol Suppl 1999; 13: 103-11) or Family Matters (FM) (Bauman KE, Ennett ST. On the importance of peer influence for adolescent drug use: commonly neglected considerations. Addiction 1996; 91: 185-98). Fidelity was assessed by: (i) adherence to the program manual and (ii) quality of implementation. No relationships were found for FM, a self-directed program. For SFP, higher quality scores were related to higher parent satisfaction. Higher adherence scores were related to higher satisfaction for youth, yet surprisingly to lower satisfaction for parents. Parent sessions involve much discussion, and to obtain high adherence scores, health educators were often required to limit this to implement all program activities. Findings highlight a delivery challenge in covering all activities while allowing parents to engage in mutually supportive behavior.

Nurse-coordinated multidisciplinary, family-based cardiovascular disease prevention programme (EUROACTION) for patients with coronary heart disease and asympto matic individuals at high risk of cardiovascular disease: a paired, cluster-randomised controlled trial

Ongeveer een op de drie Nederlanders sterft aan hart- en vaatziekten. Door vergrijzing van onze bevolking zal dit aantal nog verder gaan toenemen. Preventie van hart- en vaatziekten krijgt dan ook hoge prioriteit van overheid en hulpverleners. De Europese multidisciplinaire richtlijn voor preventie van hart- en vaatziekten is grotendeels gebaseerd op wetenschappelijk bewijs

In This Issue

In This Issue

Limitations of Scientific Rigorous Recommendations for Prevention Programs “at Practice” – Recollecting the Experience with the Family-based Prevention Program FAST in Germany

Limitations of Scientific Rigorous Recommendations for Prevention Programs “at Practice” – Recollecting the Experience with the Family-based Prevention Program FAST in Germany