Ethnic discrimination, acculturative stress, and sexual risk among Latinx emerging adults: Examining moderation effects of familism support and ethnic identity

OBJECTIVES

Ethnic discrimination and acculturative stress play an important role in sexual risk behaviors for Latinx emerging adults, who are at disproportionate risk for sexually transmitted infections. Factors such as familism support and ethnic identity may be protective, yet research is limited. This study is guided by a culturally adapted stress and coping framework to examine associations of ethnic discrimination and acculturative stress with sexual risk behaviors (i.e., multiple sex partners, alcohol or drug use before sex, and condomless sex with a primary or casual partner), and examine the moderating roles of familism support and ethnic identity among Latinx emerging adults.

METHOD

Participants were recruited from Arizona and Florida and were primarily female (51.3%) with a mean age of 21.48 years (SD = 2.06). Using cross-sectional data from 158 sexually active Latinx emerging adults, this study employed multiple logistic regression and moderation analyses.

RESULTS

Higher levels of ethnic discrimination and pressure to acculturate were associated with fewer sex partners, and higher levels of pressure against acculturation were associated with increased condomless sex with a casual partner. The moderation effect of higher levels of familism support on pressure to acculturate was associated with fewer sex partners, and the moderation effect of higher levels of ethnic identity on pressure against acculturation was associated with decreased condomless sex with casual partners.

CONCLUSIONS

Examining the results within a culturally informed theoretical framework supports that protective factors may help mitigate sexual risk factors among Latinx emerging adults experiencing acculturative stress. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Efficacy of a Digital Health Preventive Intervention for Adolescents With HIV or Sexually Transmitted Infections and Substance Use Disorder: Protocol for a Randomized Controlled Trial

BACKGROUND

HIV or sexually transmitted infections remain a significant public health concern in the United States, with adolescents affected disproportionately. Adolescents engage in HIV/STI risk behaviors, including drug use and condomless sex, which increase the risk for HIV/STIs. At-risk adolescents, many of whom are racial minorities, experience HIV/STI disparities. Although at-risk adolescents are disproportionately affected by HIV/STI risk behaviors and infections and although the Centers for Disease Control and Prevention recommends routine HIV/STI testing for adolescents, relatively few adolescents report having ever been tested for HIV/STI. With expected increases in health clinic visits as a result of the Affordable Care Act combined with technological advances, health clinics and mobile health (mHealth), including apps, provide innovative contexts and tools to engage at-risk adolescents in HIV/STI prevention programs. Yet, there is a dearth of efficacious mHealth interventions in health clinics to prevent and reduce both condomless sex and drug use and increase HIV/STI testing for at-risk adolescents.

OBJECTIVE

To address this gap in knowledge, we developed a theory-driven, culturally congruent mHealth intervention (hereon referred to as S4E [Storytelling 4 Empowerment]) that has demonstrated feasibility and acceptability in a clinical setting. The next step is to examine the preliminary efficacy of S4E on adolescent HIV/STI testing and risk behaviors. This goal will be accomplished by 2 aims: the first aim is to develop a cross-platform and universal version of S4E. The cross-platform and universal version of S4E will be compatible with both iOS and Android operating systems and multiple mobile devices, aimed at providing adolescents with ongoing access to the intervention once they leave the clinic, and the second aim is to evaluate the preliminary efficacy of S4E, relative to usual care control condition, in preventing or reducing drug use and condomless sex and increasing HIV/STI testing in a clinical sample of at-risk adolescents aged 14-21 years living in Southeast Michigan.

METHODS

In this study, 100 adolescents recruited from a youth-centered community health clinic will be randomized via blocked randomization with random sequences of block sizes to one of the 2 conditions: S4E mHealth intervention or usual care. Theory-driven and culturally congruent, S4E is an mHealth adaptation of face-to-face storytelling for empowerment, which is registered with the Substance Abuse and Mental Health Services Administration's National Registry of Evidence-Based Programs and Practices.

RESULTS

This paper describes the protocol of our study. The recruitment began on May 1, 2018. This study was registered on December 11, 2017, in ClinicalTrials.gov. All participants have been recruited. Data analysis will be complete by the end of March 2024, with study findings available by December 2024.

CONCLUSIONS

This study has the potential to improve public health by preventing HIV/STI and substance use disorders.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03368456; https://clinicaltrials.gov/study/NCT03368456.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47216.

A Community-Academic Approach to Preventing Substance Use Disorders

BACKGROUND

The coronavirus disease 2019 pandemic and activism against structural racism heightened awareness of racial-ethnic disparities and disproportionate burden among the underserved. The opioid crisis further compounds these phenomena, increasing vulnerability for substance use disorders (SUD). Community-based participatory research can facilitate multidisciplinary collaboration, yet literature on these approaches to prevent and reduce SUD and associated stigma remains limited.

OBJECTIVE

Discrimination, stigma, and multiple crises with health care and systemic barriers increasingly marginalize the underserved, specifically around SUD. The Detroit Area Mental Health Leadership Team (DAMHLT, since 2015), aims to optimize SUD prevention, enhance resiliency and advocacy to advance knowledge on SUD research and influence community-level research and practice.

LESSONS LEARNED

DAMHLT's approach on bidirectionality, community level access to real-time epidemiological data, advocacy (i.e., institutional responsiveness) and dissemination may be translational to other partnerships.

CONCLUSIONS

As we move through an ever-changing pandemic, DAMHLT's lessons learned can inform partnership dynamics and public health strategies such as hesitancy on public health response.

Pilot Study of a Multilevel Mobile Health App for Substance Use, Sexual Risk Behaviors, and Testing for Sexually Transmitted Infections and HIV Among Youth: Randomized Controlled Trial

BACKGROUND

Preventing and reducing substance use disorders, sexually transmitted infections (STIs)/HIV, and teen pregnancy, and the associated risk behaviors (ie, substance use and sexual risk behaviors) among youth remain public health priorities in the United States. Equally important is improving the uptake of STI/HIV testing among the youth. Mobile health (mHealth) apps may be a solution to ameliorate these public health concerns; however, few mHealth preventive interventions have demonstrated efficacy in reducing substance use or sexual risk behaviors or improving the uptake of STI/HIV testing among the youth, particularly in clinic settings.

OBJECTIVE

This small-scale study aimed to examine the feasibility of conducting a pilot randomized controlled trial (RCT). We evaluated the effects of Storytelling 4 Empowerment (S4E), relative to enhanced usual practice, on the potential mechanisms by which behavior change occurs, namely clinician-youth risk communication, prevention knowledge, and substance use and sexual risk refusal self-efficacy. We also assessed the ability to measure targeted outcomes of past 30-day substance use (ie, alcohol, tobacco, and other drug use), condomless sex, and alcohol or drug use before sex, as well as the uptake of STI/HIV testing.

METHODS

Employing community-based participatory research principles, 50 youths aged 13 to 21 years were recruited from a youth-centered community health clinic in Southeast Michigan, randomized sequentially to either S4E or enhanced usual practice, and assessed at baseline, immediately postintervention, and 30 days postintervention. S4E consists of 3 modules, including alcohol and drug use, tobacco, and STI/HIV.

RESULTS

Relative to youth in the enhanced usual practice group, S4E participants demonstrated higher youth-clinician risk communication (mean 3.22, SD 1.67) and increases in prevention knowledge (∆ score mean 0.36, SD 0.51) and self-efficacy (∆ score mean 0.16, SD 0.47). In addition, youth in the S4E group showed reductions in the proportions of past 30-day overall substance use (Cohen h=0.71, 95% CI 0.15 to 1.27), as well as past 30-day alcohol (Cohen h=0.71, 95% CI 0.15 to 1.27), tobacco (Cohen h=0.17, 95% CI -0.39 to 0.73), and drug use (Cohen h=1.28, 95% CI 0.72 to 1.84). The results also suggest a reduction in the proportion of youths who reported past 30-day condomless sex (Cohen h=0.18, 95% CI -0.38 to 0.74) and alcohol use before sex (Cohen h=0.44, 95% CI -0.12 to 1.00). Finally, the findings also demonstrated an increase in the proportion of youths who reported STI/HIV testing over time (Cohen h=0.16, 95% CI -0.39 to 0.72).

CONCLUSIONS

The findings suggest the feasibility of a small-scale pilot RCT. S4E demonstrated shifts in the hypothesized direction, reducing substance use, sexual risk behaviors, and improving the uptake of STI/HIV testing among youth in a clinic setting. The findings suggest that a larger RCT may be warranted.

TRIAL REGISTRATION

ClinicalTrails.gov NCT03855410, https://clinicaltrials.gov/ct2/show/NCT03855410.

A multilevel mHealth drug abuse and STI/HIV preventive intervention for clinic settings in the United States: A feasibility and acceptability study

BACKGROUND

Drug abuse and sexually transmitted infections (STIs), including the human immunodeficiency virus (HIV), remain significant public health concerns in the United States. Youth are at disproportionate risk of drug use and STIs/HIV, yet interventions aimed at improving STI and HIV testing and reducing STI/HIV risk behaviors through technology-based engagement in clinic settings are limited. The purpose of this study was to examine the feasibility and acceptability of Storytelling 4 Empowerment (S4E), a multilevel mobile-health drug abuse and STI/HIV preventive application (app) for clinic settings. We also explored uptake of STI/HIV testing among youth immediately post-intervention.

METHOD

Employing community-based participatory research principles and a multi-method research design, we developed a clinician-facing app, and examined the feasibility and acceptability of S4E among clinicians (n = 6) and youth (n = 20) in an urban youth-centered community health clinic. S4E aimed to improve clinician-youth risk communication and youths' drug use and STI/HIV knowledge, self-efficacy, and refusal skills. We also explored youths' uptake of STI and HIV testing. Quantitative data were analyzed by computing mean scores and proportions, and qualitative analyses followed the tenets of content analysis.

RESULTS

Among eligible participants, 86.9% of youth and 85.7% of clinicians enrolled in the study, suggesting the feasibility of recruiting participants from the targeted clinic. Most clinicians identified as non-Hispanic white (83%) and female (66.7%). Among the youth, 70% identified as non-Hispanic white, followed by 30% African American, and 50% identified as female with a mean age of 19.6 (SD = 1.5, Range = 16-21). The quantitative findings suggest that the acceptability of S4E is high, as indicated by the Client Satisfaction Questionnaire (mean score = 25.2, SD: 4.8). Immediately post-intervention, all youth who reported past 90-day condomless sex or having never been tested for STIs or HIV in their lifetime, were tested for both STIs and HIV. Qualitative themes revealed four overarching themes, including S4E: (1) faciliated timely, targeted, and tailored prevention and risk reduction strategies; (2) shaped clinician and youth communication and interaction during the clinic visit; (3) may have improved uptake of STI/HIV testing and increased STI/HIV knowledge and self-efficacy; and (4) had high feasibiliy and acceptability among youth and clninicans.

CONCLUSIONS

Findings suggest the feasibility and acceptability of S4E in an urban community-based health clinic setting. A next important step is to examine the efficacy of S4E in a randomized controlled trial design.

Development of the Brief Social Capital for Youth Sexual and Reproductive Health Scale: Exploratory and Confirmatory Factor Analysis

Social capital plays an important role in sexual and reproductive health among youth, yet few measures to assess this concept have been developed and tested for this population. We developed and examined the factor structure of the Brief Social Capital for Youth Sexual and Reproductive Health Scale. Drawing on the empirical literature, we identified item content to assess an overall construct of social capital in relationship to youth's sexual and reproductive health, including condom self-efficacy, civic engagement, and adult and community support. We conducted exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) with a sample of 200 youth, predominately low-income and ethnic minority in Denver, Colorado. EFA with geomax rotation yielded a three-factor solution. CFA provided an adequate model fit with acceptable standardized factor loadings. This study provides a validated measure for future research to further examine social capital and youth sexual and reproductive health.

The Usability and Acceptability of an Adolescent mHealth HIV/STI and Drug Abuse Preventive Intervention in Primary Care

Human Immunodeficiency Virus (HIV)/sexually transmitted infection (STI) risk behaviors among adolescents remain significant public health concerns. Shifts in policy and advances in technology provide opportunities for researchers and clinicians to deliver and evaluate mobile-health (mHealth) prevention programs in primary care, however, research is limited. This study assessed the usability and acceptability of Storytelling 4 Empowerment-a mHealth HIV/STI and drug abuse preventive intervention app-among adolescents in primary care. Informed by principles of community-based participatory research, we recruited a purposive sample of 30 adolescents from a youth-centered community health care clinic in Southeast Michigan. The study sample is primarily African American and female. Adolescents who participated in the Storytelling 4 Empowerment intervention assessed its usability and acceptability, and self-reported their HIV/STI risk behaviors. We used a multiple-methods approach. Adolescents reported high acceptability of the content, process, and format of Storytelling 4 Empowerment, as evidenced by qualitative data and mean scores from the Session Evaluation Form for the HIV/STI and Alcohol/Drug content, overall Storytelling 4 Empowerment intervention, and Client Satisfaction Questionnaire-8. Findings indicate that Storytelling 4 Empowerment is acceptable among adolescents in primary care. A next step is to examine the effect of Storytelling 4 Empowerment on adolescent sexual risk and drug use behaviors and HIV/STI testing.

A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study

Background

Despite ongoing prevention efforts, HIV and other sexually transmitted infections (HIV/STIs) and drug use remain public health concerns. Urban adolescents, many of whom are underserved and racial minorities, are disproportionately affected. Recent changes in policy, including the Affordable Care Act, and advances in technology provide HIV/STI and drug abuse prevention scientists with unique opportunities to deliver mobile health (mHealth) preventive interventions in primary care.

Objectives

The purpose of this community-engaged study was to develop an mHealth version of the Storytelling for Empowerment preventive intervention for primary care (hereinafter referred to as “S4E”).

Methods

A total of 29 adolescents were recruited from a youth-centered primary care clinic in Southeast, Michigan, to participate in qualitative interviews. Participants were predominantly African American (n=19, 65.5%) and female (n=21, 72.4%) with a mean age of 16.23 (SD 2.09). The principles of community-based participatory research (CBPR), in conjunction with agile software development and the recommended core prevention principles of the National Institute on Drug Abuse (NIDA) were employed during S4E development. CBPR principles are aimed at improving the effectiveness of research by addressing locally relevant health problems, working with community strengths, and translating basic science into applied research. Complementing this approach, the NIDA prevention principles are derived from decades of drug abuse prevention research aimed at increasing the effectiveness and uptake of programs, through the development of culturally specific interventions and ensuring the structure, content, and delivery of the intervention fit the needs of the community. Data were analyzed using thematic analysis.

Results

A total of 5 themes emerged from the data: (1) acceptability of the mHealth app to adolescents in primary care, (2) inclusion of a risk assessment to improve clinician-adolescent HIV/STI and drug use communication, (3) incorporation of culturally specific HIV/STI and drug use content, (4) incorporation of interactive aspects in the app to engage youth, and (5) perspectives on the appearance of the app.

Conclusions

There is a dearth of mHealth HIV/STI and drug abuse preventive interventions for primary care. Incorporating the principles of CBPR in conjunction with agile software development and NIDA-recommended core prevention principles may be helpful in developing culturally specific mHealth interventions. An important next step in this program of research is to examine the feasibility, acceptability, and efficacy of S4E on adolescent sexual risk and drug use behaviors, and HIV/STI testing. Implications for prevention research and primary care practice are discussed in the context of the Affordable Care Act and technological advances.

Transitions in Current Substance Use from Adolescence to Early-Adulthood

Substance use behaviors do not occur in isolation of one another and are not static over time. As adolescents age into early adulthood, there may be dynamic changes in their substance use behaviors, and these changes may be influenced by family and school factors. The current study uses Latent Transition Analysis to examine these changes by measuring transitions among different substance use profiles based on past 30-day alcohol, tobacco and marijuana use, and by estimating associations with demographic, family and school factors. Data were from youth (n = 850; 80% African American, 17% white, 3% mixed race, 50% female and 50% male) in grade 10 (Time 1), with 24- (Time 2) and 48-month (Time 3) follow-ups. Substance use profiles included Non-users (54%), Alcohol and Marijuana Users (20%), and Alcohol, Tobacco and Marijuana Users (26%). There were considerable transitions among profiles from Time 1 to Time 2, and fewer transitions from Time 2 to Time 3. At Time 1, African American race and positive school attitudes were negatively associated with being an Alcohol and Marijuana User, and being an Alcohol, Tobacco and Marijuana User. Family conflict, parental school involvement, female gender and African American race were associated with transitions among substance use profiles. Implications are discussed for a better understanding of transitions in substance use profiles, and for promoting maintenance of non-use and transitions from substance using profiles to non-use.

Storytelling for Empowerment for Latino Teens

Latino adolescents are disproportionately impacted by HIV, but researchers have documented few programs to prevent and reduce HIV risk. The Storytelling for Empowerment (SFE) HIV StoryBook was designed with an innovative ecodevelopment approach combining empowerment, family communication, and positive cultural identity. A mixed method design used both a randomized control group design, as well as grounded theory coding of semi-structured focus group interviews. For the quantitative method, a total of 96 adolescents (85% Latino, M age = 12.2) were randomized to either the SFE HIV StoryBook condition or a control condition and then tested at baseline and at 4 months post-baseline. Study findings indicated that teens who participated in the HIV StoryBook condition maintained sexual abstinence, increased their ability to communicate about sex, increased their intention to stop sexual advances, and increased their HIV prevention knowledge. For the qualitative method, seven focus groups of 38 participants, including staff, madres, teen participants, and graduates created rich description. Axial coding produced emergent themes, including an appreciation for the culturally affirming curriculum, increased family communication, and the embodiment by teens resulting in restraint and integrity. Results indicate that SFE has promise to stem HIV infections.

Crime and Violence among MDMA Users in the United States

The question of whether MDMA use is associated with increased crime and violence has not been adequately explored especially in nationally representative samples. This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to assess the association between MDMA use and violent and non-violent antisocial behavior while controlling for sociodemographic variables, lifetime psychiatric, alcohol and drug use disorders, and family history of antisocial behavior. MDMA users, both male and female, were involved in a number of crimes in acts of violence including drunk driving, shoplifting, theft, intimate partner violence, and fighting. Notably, female MDMA users were more antisocial than male non-MDMA users. Although adjusting the results for numerous confounds attenuated the relationships, MDMA users were still at significantly greater odds of engaging in violent and nonviolent crime than non-MDMA users. Although MDMA has been considered a facilitator of empathy and closeness, the current study suggests a dark side as MDMA is associated with a broad array of crimes and transgressions. Additional tests of the MDMA-crime link are needed to properly inform policy.

Family functioning and parent support trajectories and substance use and misuse among minority urban adolescents: a latent class growth analysis

We sought to examine latent classes of family functioning and parent support trajectories during high school and whether these trajectories are associated with an increased risk of substance use and misuse among urban youth. A total of 850 adolescents (Mage = 15.1 years) were included in this study, assessed at baseline, 12-, 24-, and 36-months postbaseline, and completed self-report measures on past 30-day alcohol and marijuana use, binge drinking, and measures of family functioning and parent support. Latent class growth analysis revealed that trajectories of high family functioning and parent support are associated with a decreased risk of marijuana use. Findings may be helpful to inform family-based preventive interventions.

Exploring Culturally Based Intrafamilial Stressors Among Latino Adolescents

Despite the profound impact that intrafamilial stressors, including parent - adolescent acculturation discrepancies, may have on Latino adolescent behavioral and mental health, this line of research remains underdeveloped. The purpose of this study is to obtain rich descriptions from Latino adolescents of the most salient intrafamilial stressors. The authors employ focus group methodology with a grounded theory approach. A total of 25 focus groups were conducted with 170 Latino adolescents in the Northeast and Southwest United States. Findings indicate that Latino adolescents experience significant stressors related to parent - adolescent acculturation discrepancies. From this qualitative study the authors derive a series of testable hypotheses aimed at fully understanding the role of parent - adolescent acculturation discrepancies on Latino adolescent behavioral and mental health and informing the development of culturally responsive preventive interventions for this population.

Do parent-adolescent discrepancies in family functioning increase the risk of Hispanic adolescent HIV risk behaviors?

In the family-based prevention science literature, family functioning, defined as positive parenting, parental involvement, family cohesion, family communication, parental monitoring of peers, and parent-adolescent communication, has been shown to ameliorate HIV risk behaviors in Hispanic youth. However, the majority of studies have relied solely on parent or adolescent reports and we know very little about parent-adolescent family functioning discrepancies. Therefore, the purpose of this study was to examine whether and to what extent parent-adolescent discrepancies in family functioning increased the risk of HIV risk behaviors, including substance use and sexual risk behaviors, and whether these associations vary as a function of acculturation and youth gender. A total of 746 Hispanic 8th grade youth and their primary caregivers were included in the study. Structural equation modeling findings indicate that parent-adolescent family functioning discrepancies are associated with an increased risk of Hispanic adolescent HIV risk behaviors, including lifetime and past 90-day alcohol and illicit drug use, and early sex initiation. In addition, study findings indicate that results vary by acculturation and youth gender. Findings are discussed in the context of existing family-based research and practice in preventing and reducing HIV risk behaviors among Hispanic youth and their families.

An application of the Complier Average Causal Effect analysis to examine the effects of a family intervention in reducing illicit drug use among high-risk Hispanic adolescents

The Complier Average Causal Effect (CACE) method has been increasingly used in prevention research to provide more accurate causal intervention effect estimates in the presence of noncompliance. The purpose of this study was to provide an applied demonstration of the CACE analytic approach to evaluate the relative effects of a family-based prevention intervention, Familias Unidas, in preventing/reducing illicit drug use for those participants who received the intended dosage. This study is a secondary data analysis of a randomized controlled trial designed to evaluate the relative efficacy of Familias Unidas with high-risk Hispanic youth. A total of 242 high-risk Hispanic youth aged 12-17 years and their primary caregivers were randomized to either Familias Unidas or Community Practice and assessed at baseline, 6 months and 12 months postbaseline. CACE models were estimated with a finite growth mixture model. Predictors of engagement were included in the CACE model. Findings indicate that, relative to the intent-to-treat (ITT) analytic approach, the CACE analytic approach yielded stronger intervention effects among both initially engaged and overall engaged participants. The CACE analytic approach may be particularly helpful for studies involving parent/family-centered interventions given that participants may not receive the intended dosage. Future studies should consider implementing the CACE analysis in addition to ITT analysis when examining the effects of family-based prevention programs to determine whether, and the extent to which, the CACE analysis has more power to uncover intervention effects.

The Role of Intrapersonal and Ecodevelopmental Factors in the Lives of Latino Alternative High School Youth

Despite efforts aimed at achieving health equity, Latino youth continue to experience significant health and mental health disparities. The purpose of this investigation was to explore the role of intrapersonal and ecodevelopmental factors, including family, peer, school, and community, in the lives of Latino alternative high school youth residing in the Southwest, United States. Five focus groups were implemented with a total of 19 participants. Study findings are indicative of an ecology characterized by multiple challenges that have a significant impact on the lives of Latino alternative high school youth. Findings from this study reinforce that there remains a great need to fully understand the scope and influence of intrapersonal and ecodevelopmental factors among Latino alternative high school youth to inform the development of culturally-responsive social work preventive intervention programs.

'They don't look at what affects us': the role of ecodevelopmental factors on alcohol and drug use among Latinos with physical disabilities

Objectives. Latinos with disabilities disproportionately report substance use, including binge drinking and drug use. Ecodevelopmental factors, including socioeconomic patterning of poverty, social exclusion, and post-colonial racism, have been shown to impact alcohol and drug use. However, this line of research remains underdeveloped among Latinos with disabilities. The purpose of this study was to obtain rich descriptions of the role of ecodevelopmental factors, including family and community, on alcohol and drug use among Latinos with physical disabilities. Methods. We utilized a community-based participatory research design, in conjunction with an innovative methodology referred to as photovoice. Three rounds of photography and focus group interviews were conducted with a total of 17 focus groups. Reflections in each focus group interview were aloud and digitally audiotaped. A total of 28 participants 19-35 years of age (mean age = 27.65, SD = 5.48) participated in each round of photography and focus group interviews. Data analyses followed the tenets of descriptive phenomenology. Results. Findings highlight ecodevelopmental family and community risk and protective factors. At the family level, participants reflected on the ways in which family functioning, including family support, communication, and cohesion, can serve as risk and promotive factors for alcohol and drug use. Additionally, participants described in detail how experiences of poverty, stigma and discrimination, violence, accessibility to alcohol and drugs, accessibility for persons with disabilities, transportation, community support and cohesion, and access to health and mental health services constitute risk and promotive factors at the community level. Conclusion. Findings are suggestive of how ecodevelopmental family and community factors might increase the risk of alcohol and drug use among Latinos with physical disabilities. From this qualitative research, we derive a series of testable hypotheses. For example, future studies should examine the impact of family functioning on alcohol and drug use among Latinos with physical disabilities over time. Study findings may have great utility to inform the development of preventive interventions for this at-risk group.

The role of acculturation and family functioning in predicting HIV risk behaviors among Hispanic delinquent youth

The present study examined the relationship between Berry's acculturation typology and HIV risk behaviors and whether family functioning mediated any such effects. A total of 235 high risk Hispanic adolescents were categorized into one of Berry's four acculturation typologies through the use of cut-off scores on measures of Hispanicism and Americanism. Structural equation modeling was used to examine the effects of acculturation typology on HIV risk behaviors and the indirect effects of acculturation typology on HIV risk behaviors through family functioning. Acculturation typology was related to HIV risk behaviors. Family functioning partially mediated the effects of acculturation typology on the HIV risk behavior outcomes. These findings suggest that both Americanism and Hispanicism play an important role in the etiology of HIV risk behaviors among Hispanic youth and that both, along with family functioning, are important to consider when designing preventive interventions for this population.

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.

The Role of Intrapersonal Factors on Alcohol and Drug Use Among Latinos With Physical Disabilities

Persons with disabilities are disproportionately impacted by alcohol and drug use. Social work best practice approaches require an understanding of the effects of intrapersonal factors on alcohol and drug use, yet the theoretical and empirical literature remain underdeveloped, especially among ethnic minority populations. We sought to obtain a detailed description of the role of intrapersonal factors, including perceptions and life experiences, on alcohol and drug use among Latinos with physical disabilities. We employed community-based participatory research in conjunction with photovoice. A total of 17 focus group interviews were completed. Three rounds of photography and focus group interviews occurred with a total of 28 participants who participated in each round. Data analyses followed the tenets of descriptive phenomenology. Results highlight intrapersonal risk and protective factors to inform social work practice and work toward developing and evaluating alcohol and drug use preventive interventions for this overlooked and vulnerable population.

The role of acculturation and family functioning in predicting HIV risk behaviors among Hispanic delinquent youth

The present study examined the relationship between Berry's acculturation typology and HIV risk behaviors and whether family functioning mediated any such effects. A total of 235 high risk Hispanic adolescents were categorized into one of Berry's four acculturation typologies through the use of cut-off scores on measures of Hispanicism and Americanism. Structural equation modeling was used to examine the effects of acculturation typology on HIV risk behaviors and the indirect effects of acculturation typology on HIV risk behaviors through family functioning. Acculturation typology was related to HIV risk behaviors. Family functioning partially mediated the effects of acculturation typology on the HIV risk behavior outcomes. These findings suggest that both Americanism and Hispanicism play an important role in the etiology of HIV risk behaviors among Hispanic youth and that both, along with family functioning, are important to consider when designing preventive interventions for this population.

The role of perceived peer prejudice and teacher discrimination on adolescent substance use: a social determinants approach

Although Black adolescents have reported a lower prevalence of substance use relative to non-Hispanic Whites, Black youth are disproportionately affected by adverse social outcomes. Social scientists have highlighted that using a framework that includes perceived peer prejudice and teacher discrimination as social determinants of adolescent risk behaviors is essential to fully understanding substance use behaviors in adolescents. However, this area of research remains underdeveloped. This study examined whether and to what extent perceived peer prejudice and teacher discrimination affect binge drinking and marijuana use by Black (n = 514) and non-Hispanic White (n = 2,818) adolescents using data from the National Longitudinal Study of Adolescent Health, Wave 2, Public Use dataset. Findings suggest that peer prejudice increased the risk of substance use in non-Hispanic White youth only, whereas experiences of teacher discrimination increased the risk of substance use in both Black and non-Hispanic White youth. The study's limitations are noted, and implications for future research are discussed.

Do the effects of a family intervention on alcohol and drug use vary by nativity status?

To examine whether the intervention effects of Familias Unidas, compared to community practice, on Hispanic adolescent alcohol and drug use varies by nativity status (i.e., U.S.-born and foreign-born). A total of 213 eighth grade Hispanic adolescents with behavior problems and their primary caregivers were assigned randomly to one of two conditions: Familias Unidas or Community Control. Participants were assessed at baseline and at 6, 18, and 30 months post baseline. Results showed that, the effects of Familias Unidas on alcohol use was moderated by nativity status. Specifically, Familias Unidas was efficacious in preventing/reducing alcohol use for U.S.-born youth, but not foreign-born. No moderating effects were found for drug use. These findings suggest that prevention interventions may be more efficacious in preventing/reducing alcohol use among certain Hispanic adolescent subgroups.

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.

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 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 (β = -.24, p = .035) but was not significant in multiple regression (β = -0.09, p = .556). Peer alcohol use (β = 2.02, p<0.001) and poor alcohol attitudes (β =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.

Spatiotemporal calcium signaling in a Drosophila melanogaster cell line stably expressing a Drosophila muscarinic acetylcholine receptor

A muscarinic acetylcholine receptor (mAChR), DM1, expressed in the nervous system of Drosophila melanogaster, has been stably expressed in a Drosophila S2 cell line (S2-DM1) and used to investigate spatiotemporal calcium changes following agonist activation. Carbamylcholine (CCh) and oxotremorine are potent agonists, whereas application of the vertebrate M1 mAChR agonist, McN-A-343, results in a weak response. Activation of S2-DM1 receptors using CCh resulted in an increase in intracellular calcium ([Ca(2+)](i)) that was biphasic. Two distinct calcium sources were found to contribute to calcium signaling: (1) internal stores that are sensitive to both thapsigargin and 2-aminoethoxydiphenyl borate and (2) capacitative calcium entry. Spatiotemporal imaging of individual S2-DM1 cells showed that the CCh-induced [Ca(2+)](i) transient resulted from a homogeneous calcium increase throughout the cell, indicative of calcium release from internal stores. In contrast, ionomycin induced the formation of a "calcium ring" at the cell periphery, consistent with external calcium influx.

GSTT1 and GSTM1 null genotypes and the risk of gastric cancer: a case-control study in a Chinese population

Glutathione S-transferase (GST) enzymes are involved in detoxification of many potentially carcinogenic compounds. The homozygous deletions or null genotypes of GSTT1 (theta class) and GSTM1 (mu class) genes may be associated with an increased risk of cancer. Few studies have evaluated the relationship between GSTT1, GSTM1 and the risk of gastric cancer, as well as the potential interactions between these genetic markers and other risk factors of gastric cancer in the Chinese population. We conducted a case-control study with 143 cases with gastric cancer, 166 chronic gastritis (CG) cases and 433 cancer-free population controls from Yangzhong County, China. The epidemiological data were collected by a standard questionnaire for all of the subjects, and blood samples were obtained from 91 gastric cancer cases, 146 CG cases, and 429 controls. GSTT1 and GSTM1 genotypes were assayed by the PCR method, and Helicobacter pylori infection was measured by the ELISA method. Using logistic regression model in SAS, we assessed the independent effects of GSTT1 and GSTM1 null genotypes on the risk of gastric cancer and their potential interactions with other factors. The prevalence of GSTM1 null genotype was 48% in gastric cancer cases, 60% in CG patients, and 51% in controls. The prevalence of GSTT1 null genotype was 54% in gastric cancer cases, 48% in CG patients, and 46% in controls. After controlling for age, gender, education, pack-years of smoking, alcohol drinking, body mass index, H. pylori infection, and fruit and salt intake, the adjusted odds ratio (OR) for GSTT1 and gastric cancer was 2.50 (95% confidence interval (CI), 1.01-6.22). When gastric cancer cases were compared with CG patients, the adjusted OR for GSTT1 was 2.33 (95% CI, 0.75-7.25). However, GSTT1 null genotype was not associated with the risk of CG when using population controls. No obvious association was found between GSTM1 and the risk of both gastric cancer and CG. Our results suggest that GSTT1 null genotype may be associated with an increased risk of gastric cancer in a Chinese population.

Polycyclic dinitriles: a novel class of potent GABAergic insecticides provides a new radioligand, [3H]BIDN

The polycyclic dinitriles are a potent class of insecticides which are non-competitive GABA (gamma-aminobutyric acid) antagonists acting at the convulsant site. Comparison with other classes of GABA convulsant site ligands using molecular modelling has shown significant structural similarities. We have developed a pharmacophore model which unifies this class and some previous classes of GABA convulsants. Key pharmacophore elements are a polarizable functionality separated by a fixed distance from two H-bond accepting elements. This model is based on information from X-ray crystal structures and Sybyl using the Tripos force field. Using this pharmacophore model, numerous structural modifications were explored to enhance understanding of structure-activity relationships at the GABA receptor convulsant site of insects and mammals. A radiolabelled bicyclic dinitrile, [3H]BIDN [3H]3,3-bis-trifluoromethyl-bicyclo[2,2,1]heptane-2,2-dicarbonitrile+ ++), was prepared from this area of chemistry and was used as a probe for the interaction of polycyclic dinitriles at the target site.

Effects of [3H]-BIDN, a novel bicyclic dinitrile radioligand for GABA-gated chloride channels of insects and vertebrates

1. The radiolabelled bicyclic dinitrile, [3H]-3,3-bis-trifluoromethyl-bicyclo[2.2.1]heptane-2,2-dicarbonitrile ([3H]-BIDN), exhibited, specific binding of high affinity to membranes of the southern corn rootworm (Diabrotica undecimpunctata howardi) and other insects. A variety of gamma-aminobutyric acid (GABA) receptor convulsants, including the insecticides heptachlor (IC50, 35 +/- 3 nM) and dieldrin (IC50, 93 +/- 7 nM), displaced [3H]-BIDN from rootworm membranes. When tested at 100 microM, 1-(4-ethynylphenyl)-4-n-propyl-2,6,7-trioxabicyclo[2.2.2]oct ane(EBOB), 4-t-butyl-2,6,7-trioxa-1-phosphabicy-clo[2.2.2]octane-1-thio ne (TBPS), 1-phenyl-4-t-butyl-2,6,7-trioxabicyclo[2.2.2]octane (TBOB) and picrotoxin failed to displace 50% of [3H]-BIDN binding to rootworm membranes indicating that the bicyclic dinitrile radioligand probes a site distinct from those identified by other convulsant radioligands. 2. Dissociation studies showed that dieldrin, ketoendrin, toxaphene, heptachlor epoxide and alpha and beta endosulphan displace bound [3H]-BIDN from rootworm membranes by a competitive mechanism. 3. Rat brain membranes were also shown to possess a population of saturable, specific [3H]-BIDN binding sites, though of lower affinity than in rootworm and with a different pharmacological profile. Of the insecticidal GABAergic convulsants that displaced [3H]-BIDN from rootworm, cockroach (Periplaneta americana) and rat brain membranes, many were more effective in rootworm. 4. Functional GABA-gated chloride channels of rootworm nervous system and of cockroach nerve and muscle were blocked by BIDN, whereas cockroach neuronal GABA(B) receptors were unaffected. 5. Expression in Xenopus oocytes of either rat brain mRNA, or cDNA-derived RNA encoding a GABA receptor subunit (Rdl) that is expressed widely in the nervous system of Drosophila melanogaster resulted in functional, homo-oligomeric GABA receptors that were blocked by BIDN. Thus, BIDN probes a novel site on GABA-gated Cl- channels to which a number of insecticidally-active molecules bind.

A process model for competency-based education

This article describes a process model for design and development of curricula. The model is based on learning theories of competency-based education. It is suggested that curricula so designed will, in conjunction with accreditation and credntialing, provide an additional mechanism for ensuring quality in professional practice.