Familias Unidas: Preventing Substance Abuse in Hispanic Youth

Substance use (including cigarette and illicit drug use) and HIV represent major public
health problems facing America's youth (CDC, 2007; Johnston, O'Malley, Bachman, &
Schulenberg, 2007). Hispanic adolescents report higher use across all drug categories (with
the exception of amphetamines) and higher cigarette use than non-Hispanic White and African
American adolescents (Johnston et al., 2007). Hispanic youth also engage in higher rates of
unprotected sexual behavior at last sexual intercourse than non-Hispanic White and African
American adolescents (CDC, 2007). Compared to non-Hispanic Whites, Hispanics are also
disproportionately represented among HIV/AIDS cases, accounting for 18% if all such cases in
the United States (CDC, 2006). These disparities are especially disconcerting because
Hispanics are the largest and fastest growing minority group in the United States (Marotta &
Garcia, 2003). Preventing substance use and HIV in Hispanic adolescents is therefore if
vital importance.

Familias Unidas is delivered through family-centered, multi-parent groups that place parents
in the change agent role and through family visits. Each parenting skill is discussed and
role-played in parent-group sessions and is then enacted with the parent and the adolescent
in a family visit. During the group sessions, the facilitator offers support for parents and
gently corrects maladaptive interactions between parents and adolescents (during the
group-session role plays, the role of adolescent is played by another parent). During family
visits, facilitators assist families in practicing skills and restructuring family
interactions. The parent group sessions focus on parental investment in the adolescent's
worlds (e.g., peer and school worlds), family communication, family support, behavior
management/positive parenting, parental monitoring, adolescent substance use, and adolescent
unsafe sex and HIV. Consistent with our prior Familias Unidas efficacy studies, all parent
group sessions and all family visits will be conducted in Spanish and will take place in the
evenings and on Saturdays at the school or at a community site that is preferred by the
families.

The proposed study will be guided by four aims. AIM 1 is to evaluate the effectiveness of
Familias Unidas, relative to Community Practice (i.e., standard prevention services), in
preventing illicit drug use in a community sample of Hispanic adolescents; AIM 2 is to
evaluate the effectiveness of Familias Unidas, relative to Community Practice in preventing
cigarette use in a community sample of Hispanic adolescents; AIM 3 is to evaluate the
effectiveness of Familias Unidas, relative to Community Practice, in preventing unsafe
sexual behavior in a community sample of Hispanic adolescents; and AIM 4 is to assess the
extent to which family functioning mediates the effects of the intervention on illicit drug
use, cigarette use, and unprotected sexual behavior.

Hypothesis 1. Familias Unidas will be more effective than Community Practice in reducing
adolescent illicit drug use (defined as frequency of illicit drug use in the past 90 days)
over time.

Hypothesis 1a. The effect of Familias Unidas on illicit drug use will be partially mediated
by improvements in family functioning, defined as parental involvement, parental monitoring
of peers, parent-adolescent communication, social support, and positive parenting.

Hypothesis 2. Familias Unidas will be more effective than Community Practice in reducing
cigarette use (defined as frequency of cigarette use in the past 90 days) over time.

Hypothesis 2a. The effect of Familias Unidas on cigarette use will be partially mediated by
improvements in family functioning, defined as parental involvement, parental monitoring of
peers, parent-adolescent communication, family support, and positive parenting.

Hypothesis 3. Familias Unidas will be more effective than Community Practice in reducing
unsafe sexual behavior (defined as unprotected sexual behavior at last sexual intercourse)
over time.

Hypothesis 3a. The effect of Familias Unidas on unsafe sexual behavior will be partially
mediated by improvement in family functioning, defined as parental involvement, parental
monitoring of peers, parent-adolescent communication, family support, and positive
parenting.

Inclusion/Exclusion criteria

a) Female and male adolescents of Hispanic origin, defined as self-identified Hispanic by
the Primary caregiver.

(b) Adolescents attending 8th grade at baseline

(c) Adolescents living with an adult primary caregiver who is willing to participate

(d) At baseline, families must live within the catchment areas of the 24 participating
middle schools

Inclusion Criteria:

- Female and male adolescents of Hispanic immigrant origin, defined by the Primary
caregiver as Self-identified Hispanic.

- Adolescents attending 8th grade at baseline

- Adolescents living with an adult primary caregiver who is willing to participate

- At baseline, families must live within the catchment areas of the 24 participating
middle schools