eHealth Familias Unidas: Pilot Study of an Internet Adaptation of an Evidence-Based Family Intervention to Reduce Drug Use and Sexual Risk Behaviors Among Hispanic Adolescents.

This paper describes the Internet adaptation of an evidenced-based intervention for Hispanic families, eHealth Familias Unidas, and explores whether an Internet-based format is feasible and acceptable to Hispanic families. Core intervention components from the evidence-based intervention, Familias Unidas, were transposed into a video format and edited for content. Additionally, interactive exercises and a soap opera series were incorporated to reinforce intervention content and optimize participant engagement and retention. To understand the feasibility and acceptability of eHealth Familias Unidas, we conducted a pilot study and examined findings from: (1) session completion rates for both e-parent group sessions and family sessions (n = 23 families); and (2) qualitative data collected from Hispanic parents (n = 29) that received the eHealth intervention. Engagement and attendance in the intervention showed that 83% of families engaged in the intervention and that there was an overall session completion rate of 78%. Qualitative interviews were conducted mid and post intervention with a combined total of 29 participants. A general inductive approach was used to derive themes from the collected data. Overall, parents expressed positive feedback in regards to the intervention and stated that there were multiple lessons learned from participating in eHealth Familias Unidas. Findings indicate that an Internet-based family intervention is not only feasible and acceptable for Hispanic families, but also offers a viable option to ameliorate barriers to participation and implementation of preventive interventions.

Efficacy of a Brief Intervention to Reduce Substance Use and Human Immunodeficiency Virus Infection Risk Among Latino Youth.

PURPOSE: Familias Unidas is an efficacious and effective family-based intervention for preventing and reducing substance use and unsafe sexual behaviors among Latino youth. To facilitate its dissemination, Familias Unidas was shortened from a 12-week intervention to a 6-week intervention and evaluated. We hypothesized that brief Familias Unidas would be efficacious in reducing substance use and unsafe sexual behaviors relative to a comparison condition. METHODS: We randomized 160 ninth-grade Latino adolescents and their families to brief Familias Unidas or a community practice control condition. Adolescents were surveyed at baseline and 6, 12, and 24 months after baseline. RESULTS: At 24 months, youth randomized to brief Familias Unidas had a significantly lower sexual initiation rate (34.0%) relative to control (55.0%), p = .02. Brief Familias Unidas also increased positive parenting. Moderation analyses revealed that brief Familias Unidas was significantly associated with decreased substance use initiation among girls (30.4% vs. 64.0%, respectively; p = .02), but not boys (28.0% vs. 26.7%, respectively; p = .91). Brief Familias Unidas was also significantly associated with reduced unsafe sex among adolescents aged 15 years or less (p < .001), but not among older adolescents (p = .37). Moderating effects were also found for family-level variables. CONCLUSIONS: Brief Familias Unidas was efficacious in reducing sex initiation and improving positive parenting. Moderation analyses suggested that brief Familias Unidas was efficacious in reducing substance use initiation and unsafe sex for certain Hispanic adolescent subgroups, highlighting the importance of conducting moderation analyses, and of targeting interventions for specific subgroups.

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.

Mitigating flood exposure: Reducing disaster risk and trauma signature.

Introduction. In 2011, following heavy winter snowfall, two cities bordering two rivers in North Dakota, USA faced major flood threats. Flooding was foreseeable and predictable although the extent of risk was uncertain. One community, Fargo, situated in a shallow river basin, successfully mitigated and prevented flooding. For the other community, Minot, located in a deep river valley, prevention was not possible and downtown businesses and one-quarter of the homes were inundated, in the city's worst flood on record. We aimed at contrasting the respective hazards, vulnerabilities, stressors, psychological risk factors, psychosocial consequences, and disaster risk reduction strategies under conditions where flood prevention was, and was not, possible. Methods. We applied the "trauma signature analysis" (TSIG) approach to compare the hazard profiles, identify salient disaster stressors, document the key components of disaster risk reduction response, and examine indicators of community resilience. Results. Two demographically-comparable communities, Fargo and Minot, faced challenging river flood threats and exhibited effective coordination across community sectors. We examined the implementation of disaster risk reduction strategies in situations where coordinated citizen action was able to prevent disaster impact (hazard avoidance) compared to the more common scenario when unpreventable disaster strikes, causing destruction, harm, and distress. Across a range of indicators, it is clear that successful mitigation diminishes both physical and psychological impact, thereby reducing the trauma signature of the event. Conclusion. In contrast to experience of historic flooding in Minot, the city of Fargo succeeded in reducing the trauma signature by way of reducing risk through mitigation.

Trauma signature analysis of the great East Japan disaster: guidance for psychological consequences.

OBJECTIVES: On March 11, 2011, Japan experienced the largest earthquake in its history. The undersea earthquake launched a tsunami that inundated much of Japan's eastern coastline and damaged nuclear power plants, precipitating multiple reactor meltdowns. We examined open-source disaster situation reports, news accounts, and disaster-monitoring websites to gather event-specific data to conduct a trauma signature analysis of the event. METHODS: The trauma signature analysis included a review of disaster situation reports; the construction of a hazard profile for the earthquake, tsunami, and radiation threats; enumeration of disaster stressors by disaster phase; identification of salient evidence-based psychological risk factors; summation of the trauma signature based on exposure to hazards, loss, and change; and review of the mental health and psychosocial support responses in relation to the analysis. RESULTS: Exposure to this triple-hazard event resulted in extensive damage, significant loss of life, and massive population displacement. Many citizens were exposed to multiple hazards. The extremity of these exposures was partially mitigated by Japan's timely, expert-coordinated, and unified activation of an evidence-based mental health response. CONCLUSIONS: The eastern Japan disaster was notable for its unique constellation of compounding exposures. Examination of the trauma signature of this event provided insights and guidance regarding optimal mental health and psychosocial responses. Japan orchestrated a model response that reinforced community resilience.

The efficacy of Familias Unidas on drug and alcohol outcomes for Hispanic delinquent youth: main effects and interaction effects by parental stress and social support.

INTRODUCTION: Drug and alcohol use disproportionately affect Hispanic youth. Despite these disparities, few empirically supported preventive interventions are available to ameliorate this public health concern among Hispanic youth. This study examined the effects of Familias Unidas, relative to Community Practice, in reducing past 90-day substance use, alcohol and marijuana dependence, and having sex while under the influence of alcohol or drugs. Additionally, this study explored whether Familias Unidas' effects varied by environmental context, namely parental stress and social support for parents. METHODS: A total of 242 delinquent Hispanic youth aged 12-17 years and their primary caregivers were randomized to either Familias Unidas or Community Practice and assessed at three time points. RESULTS: Familias Unidas was efficacious in reducing past 90-day substance use, illicit drug use, and in reducing the proportion of youth with an alcohol dependence diagnosis, relative to Community Practice. Results also showed a reduction in the proportion of youth who reported having sex while under the influence of alcohol or drugs. No differences between conditions were observed in past 90-day alcohol use or marijuana dependence. Intervention effects on illicit drug use and alcohol dependence varied by environmental context. For example, Familias Unidas was most efficacious for adolescents with parents exhibiting high stress and lower levels of social support. CONCLUSIONS: Familias Unidas was efficacious in reducing some drug and alcohol related outcomes. The findings also support the concept of targeting family-based interventions, such as Familias Unidas, for adolescents with parents exhibiting high stress and low levels of social support.