The Impact of Parental Suicide Stigma on Youth Suicide Stigma in Mexico.

Suicide negatively impacts societies worldwide. A particular area of concern is the prevalence of suicide among Latinx youth, as research indicates that suicide behaviors among Latinx in the United States and youth in Latin America have increased drastically over the last decade. Reducing suicide stigma is a key factor in promoting youth help-seeking behaviors regarding suicidality. Previous research suggests that a relationship with a trusted adult may influence the likelihood of an adolescent contacting a suicide crisis line. Our study seeks to further the research of how parents can influence youth perceptions of suicide by studying the relationship between parent and child suicide stigma. Data were collected from parent-child dyads throughout Mexico. The Stigma of Suicide Scale Short Form was used to measure suicide stigma among adult and youth participants independently. Results suggest that parent suicide stigma was a significant predictor of youth suicide stigma, that male youth in our sample had higher suicide stigma than female youth, and that access to healthcare services was associated with lower suicide stigma. Results are discussed considering unique cultural factors in Mexico such as familismo. If future research reinforces the findings of this study, suicide stigma programs might be more effective if targeted at the entire family unit rather than just adolescents.

Exploring the Association between Educational Aspirations and Intentions to Migrate among Youth in Central Mexico by Gender.

We assessed the association between educational aspirations and the intention to migrate among 1,446 adolescents aged 11-17 years, living in semi-urban/rural communities in Jalisco, Mexico. Analyses rely on survey data from the Family Migration and Early Life Outcomes study. The outcome variable was the intention to migrate, a three-category variable coded as no intention to migrate, intention to migrate within Mexico, and intention to migrate internationally. The main independent variable was the adolescents' educational aspirations, conceptualized as the intention to achieve higher education. Multinomial logistic regression models were used to examine associations. We found an association between educational aspirations and intentions to migrate, and it was moderated by gender. Girls with the highest educational aspirations intended to migrate internationally, while higher educational aspirations were not a driver for boys' migration intentions. The study findings have implications for education and migration policies and future research.

Parent-child conflict and adolescent health literacy in Mexico: Results from a nationwide dyad study in Mexico.

Research suggests that health literacy (HL) is critical in preventing and managing health problems. However, over half of adults in Mexico report having inadequate health literacy. Research suggests the parent-child relationship can be a key predictor of developmental competencies; however, little research has examined how dyadic family interactions relate to HL. This study examined whether parent-child relationship conflict was associated with adolescent health literacy among families living in Mexico. Data from a parent-child dyads in Mexico were gathered using online surveys (N = 746, 373 parent-child dyads). Our findings suggested that child-reported family conflict-but not parent-reported family conflict - was associated with lower adolescent health literacy. Researchers and practitioners should consider how parent-child conflict may impact adolescent health outcomes, and prioritise child reports in data collection.

The Impact of Major Earthquakes on Students' Emotional Distress and Internalizing Symptoms, Externalizing Behaviors, and Coping During the Implementation of keepin' it REAL-Mexico.

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.

Construir una cultura de paz en el noroeste de México: el caso del programa de prevención Mantente REAL / Building a culture of peace in northern Mexico: the case of the Mantente REAL prevention program

Resumen Introducción: Por décadas, la frontera norte de México ha sido el centro de atención nacional e internacional debido al nivel de violencia generado por el tráfico de personas y las actividades ilícitas vinculadas al tráfico de sustancias adictivas. El impacto económico y social de la inseguridad demanda el diseño de acciones educativas que promuevan la construcción de una cultura de seguridad y paz en personas adolescentes. Este estudio analiza el rol del programa Mantente REAL en el establecimiento de normas y valores que fomentan la convivencia escolar inclusiva y la resolución de conflictos, orientadas al cuidado individual y al bien común. Metodología: Se analiza información cualitativa recopilada en 2018 dentro del programa de prevención de uso de sustancias Mantente REAL. Los datos fueron extraídos de 10 grupos focales, con estudiantes (n = 8) y profesores (n = 2), quienes participaron en el programa. Resultados: Los hallazgos indican que el aprendizaje de habilidades de vida y el uso de las estrategias del acrónimo REAL (Rechaza, Explica, Aléjate y Levántate) ayudan a crear la paz y la ciudadanía en población estudiantil. Conclusiones: Los participantes construyeron metas individuales y colectivas para evitar problemas como el uso de sustancias, el acoso escolar y otras formas de violencia.

Abstract Introduction: For decades, Mexico's northern border has been the center of national and international attention for the level of violence generated by organized crime, human trafficking and illicit activities linked to drug trafficking. Due to the economic and social impact of insecurity and violence, there is a need to develop educational actions that promote the construction of a culture of security and peace among adolescents. This study analyzes the role of Mantente REAL in the construction of norms and values that promote inclusive school relationships, conflict resolution, values oriented to selfcare, and the common good among students. Methodology: This study analyzes qualitative information that was collected in 2018 in the context of the implementation of the substance use prevention program Mantente REAL. Information from 10 focus groups with students (n=8) and teachers (n=2) who participated in the program was analyzed. Result: Findings indicate that learning life skills, and using the strategies of the acronym REAL -Refuse, Explain, Avoid and Leave- foster peace and citizenship students participating in the program. Conclusions: Participants engaged in individual and collective efforts to prevent problems such as substance use, bullying and other forms of violence. Recommendations highlight the need to investigate further the potential benefits of implementing school-based interventions with multiple outcomes.

Keepin' It REAL-Mantente REAL in Mexico: Longitudinal Examination of Youth Drug Resistance Strategies and Substance Use Among Early Adolescents.

PURPOSE: This study examined if culturally and linguistically adapted versions of a US-developed adolescent substance use prevention intervention, keepin' it REAL (kiREAL), for Mexico increases the use of drug resistance strategies and if increased use of resistance strategies subsequently leads to a reduction in the frequency of substance use (i.e., alcohol, cigarette, marijuana, and inhalants). METHODS: Students (N = 5,522, 49% female, age range = 11-17) in 36 middle schools across three cities in Mexico were randomized into three conditions: (1) Mantente REAL (MREAL), the culturally adapted version, (2) kiREAL-S, the linguistically adapted version, and (3) Control. Using survey data collected at four time points, random intercept cross-lagged path analyses tested the direct and indirect effects of MREAL and kiREAL-S compared to Control. RESULTS: At time 2, the number of drug resistance strategies used by students increased in both MREAL (ß = 0.103, p = .001) and kiREAL-S (ß = 0.064, p = .002) compared to Control. However, only MREAL lead to less frequent use of alcohol (ß = -0.001, p = .038), cigarettes (ß = -0.001, p = .019), marijuana (ß = -0.002, p = .030), and inhalants (ß = -0.001, p = .021) at time 4, mediated through increased use of drug resistance strategies. DISCUSSION: This study provides evidence that MREAL and kiREAL-S are successful in spurring use of the drug resistance strategies that are the core component of the intervention. Only MREAL achieved long-term effects on substance use behaviors, the ultimate objective of these interventions. These findings provide support for the value and importance of rigorous cultural adaptation of efficacious prevention programs as a necessary condition for enhancing prevention benefits for participating youth.

Migration Intentions and Alcohol Use Among Adolescents in West-Central Mexico.

This study explores the association between migration intentions and alcohol use among west-central Mexico adolescents living in high migration communities. This study used the baseline data from the Family Migration and Early Life Outcomes (FAMELO) project (N = 1286), collected in 2018. We used multiple imputations to address missingness and propensity score matching to reduce the selection bias. We also conducted subgroup analyses to compare gender difference (i.e., boys vs. girls) on the relationship between migration intention and alcohol use. The findings show that for the whole sample, youth with migration intentions had significant higher odds (OR = 1.78; p = .010) of having a lifetime drinking experience when compared to youth who reported no interest in living abroad, but this association remained significant only for boys (OR = 2.14; p = .010). This study makes an important contribution to our understanding of the etiology of migration intentions and alcohol use for adolescents living in sending migration communities. The findings have specific alcohol prevention, policy, and future research implications in Mexico and the U.S.

Urban Violence, Migration and Alcohol, Tobacco, and Marijuana Use among Transnational Students in Northern Mexico.

This article reports on the findings of a study of the relationship between transnational experiences in the United States (US) and the use of alcohol, tobacco, and marijuana among 7th grade students (n = 1418). The study was guided by a cross-national framework for research on immigrant health and assessed the accumulation of risk factors for transnational adolescents. Data came from a survey conducted in 2017 in Nogales, Mexico. In this study, the last 30-day prevalence of use of alcohol, tobacco, and marijuana among students was 21.7%, 8.3%, and 2.4%, respectively. Most students were born in Nogales (69.6%), while 10.5% were born in the US, 7.5% attended school in the US, and 3.6% engaged in health-related risk behaviors while living in or visiting the US. Students with transnational experiences, such as attending school in the US, reported the highest 30-day prevalence of tobacco (13.3%) and marijuana (9.5%) use. After adjusting for family, school, access to substances and neighborhood violence variables, students who engaged in health-related risk behavior in the US had significantly increased odds of alcohol and marijuana use while later attending school in Mexico. The article discusses the findings from a prevention science perspective and provides implications for policy, practice, and future research on the Mexico-US border region.

Use of Violence as a Strategy of Early Adolescents for Rejecting Drug Offers in Mexican Cities.

Drug use and violence are two interconnected problems in violent urban contexts, leading to coercive drug offers. In this study, relationships between drug use, use of violence as a strategy for rejecting drug offers, and exposure to neighborhood violence were analyzed in Mexican students. Data were obtained through a self-report survey and focus groups with lower secondary students in three Mexican metropolitan areas. Both quantitative and qualitative results indicated that students who had used or would use violence as a strategy for rejecting drug offers presented a more problematic psychosocial profile, with exposure to neighborhood violence as the main predictor. These results suggest that Mexican students in violent cities may resort to violence as a strategy for rejecting drug offers.

El consumo de drogas y la violencia son dos problemas interconectados en contextos urbanos violentos y generan ofrecimientos de drogas coercitivos. En este estudio se analizaron las relaciones entre el consumo de drogas, el uso de violencia como una estrategia para resistir ofrecimientos de drogas y la exposición a violencia en el barrio entre estudiantes mexicanos. Se obtuvieron los datos mediante una encuesta de autoinforme y grupos de discusión centrada con estudiantes de educación secundaria en tres áreas metropolitanas de México. Tanto los resultados cuantitativos como los cualitativos indicaron que aquellos estudiantes que habían usado o usarían violencia como una estrategia para resistir ofrecimientos de drogas presentaban un perfil psicosocial más problemático, con la exposición a violencia en el barrio como el principal predictor. Estos resultados sugieren que los estudiantes mexicanos en ciudades violentas pueden recurrir a la violencia como una estrategia para resistir ofrecimientos de drogas.

The Feasibility, Acceptability, and Utility of Mantente REAL: the Culturally Adapted Version of keepin' it REAL for Mexico.

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.

Impact of caregiver depression on child asthma outcomes in Mexicans and Puerto Ricans.

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.

Keepin' It REAL-Mantente REAL in Mexico: a Cluster Randomized Controlled Trial of a Culturally Adapted Substance Use Prevention Curriculum for Early Adolescents.

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".

Testing a Culturally Adapted Youth Substance Use Prevention Program in a Mexican Border City: Mantente REAL.

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.

Binational Cultural Adaptation of the keepin' it REAL Substance Use Prevention Program for Adolescents in Mexico.

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.

The Adaptive Effect of Illness-Specific Panic-Fear on Asthma Outcomes in Mexican and Puerto Rican Children.

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.

Reciprocal Effects of Alcohol Use and Violence Perpetration Among Early Adolescents in Mexico: A Gendered Analysis.

Although substance use and violent behaviors often emerge together in adolescence, and both have similar widely cited causes and negative consequences for development, it remains unclear whether and how they may be linked causally. This study of early adolescents in Mexico's three largest cities tested whether alcohol use and violence perpetration are temporally related, whether their relationship is unidirectional or reciprocal, and whether the relationship differs by gender and the type of violence. The study employed longitudinal data from seventh grade students (N = 4830; M age = 12.0, range 11-15; 49% female) in 18 public middle schools in Mexico City, Guadalajara and Monterrey. Students completed questionnaires at the beginning, middle, and end of the 2014-2015 academic year. Students' responses to a multi-dimensional violence assessment emerged in two distinct patterns: criminally violent acts, and bullying/aggression. Although males engaged in both types of violence more frequently than females at all three time points, they used alcohol more frequently than females only at the first survey, after which the gender gap disappeared. Cross-lagged multi-group path models showed that, for both males and females, more frequent alcohol use predicted subsequent increases in criminally violent behavior, and bullying/aggression predicted later increases in alcohol use. Reciprocal associations varied by gender and type of violence: Alcohol use was reciprocally linked to criminally violent behavior among males only, and reciprocally linked to bullying-aggression among females alone. The results are interpreted in the context of sharply increasing rates of violence in Mexico and changing gender norms, with implications for youth prevention programs.

THE INITIAL ASSESSMENT OF A COMMUNITY-BASED INTERVENTION WITH MEXICAN-HERITAGE PARENTS IN BOOSTING THE EFFECTS OF A SUBSTANCE USE PREVENTION INTERVENTION WITH YOUTH.

Drawing from an ecodevelopmental framework, this article examines if adding a parenting component, Families Preparing the New Generation (Familias Preparando la Nueva Generación), to an efficacious classroom-based drug abuse prevention intervention, keepin'it REAL, will boost the effects of the youth intervention in preventing substance use for middle school Mexican-heritage students. Youth attending schools in a large urban area in the Southwestern U.S. (N = 462) were randomly assigned to 1 of 3 conditions: parent and youth, youth only, or control. Using ordinary least squares regression, changes in youth substance use outcomes were examined. Results indicate that youth whose parents also participated in prevention programming exhibited significantly lower use of alcohol, cigarettes, marijuana, and inhalants compared to youth who received only keepin'it REAL. These initial effects indicate that involving parents in prevention efforts can strengthen the overall efficacy of a youth prevention intervention. This article discusses specific implications for the design of prevention interventions, policy, and future research.

Testing the keepin' it REAL Substance Use Prevention Curriculum Among Early Adolescents in Guatemala City.

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.

Traditional gender roles and substance-use behaviors, attitudes, exposure, and resistance among early adolescents in large cities of Mexico.

This study investigated the associations between traditional gender roles (TGRs) and substance use among early adolescents in Mexico's largest cities. The sample of seventh grade students (n = 4,932) attended 26 public schools in Mexico City, Guadalajara, or Monterrey in 2014. Outcomes included recent alcohol, binge drinking, cigarette and marijuana use, and lifetime poly-substance use; substance-use intentions, norms, attitudes, and expectancies; and substance-use exposure (peer use, offers) and resistance (refusal confidence, refusal skills, and decision-making skills). A TGR scale assessed endorsement of a polarized gender division of family labor and power. As hypothesized, among males, TGRs were consistently associated with poorer outcomes, and this association was usually stronger for males than for females. In contrast, among females there was no evidence that TGRs were associated with desirable outcomes. Contrary to expectations, TGRs predicted poorer outcomes for both females and males, and to equivalent degrees, for binge drinking, cigarette use, positive substance-use expectancies, and friends' approval of substance use, and they predicted poorer outcomes for females but not for males on parental disapproval of substance use and drug-resistance skills. Interpretations highlight the persisting aspects of TGRs in the family and conflicting messages for females as Mexico undergoes changes in its gender order.

Health Literacy among Youth in Guatemala City.

Health literacy (HL) is recognized as an important health construct that is correlated with various health-related outcomes, but outside of the United States there is limited HL research available, particularly among youth. This study looked at the HL and harmful health behavior (i.e., substance use) of 210 youth across 10 schools in Guatemala City. Based on results from the Newest Vital Sign (NVS) HL assessment, fewer than one third of youth sampled had adequate HL. Training/education to improve adolescent HL is needed in Guatemala City, and the unique skillset of social workers could be an idea method of reaching at-risk youth.