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Adaptations to interventions for specific settings or communities are critical for facilitating successful implementation. The Dynamic Adaptation Process model was applied to systematically assess the adaptation process made to an in-person parenting intervention (FPNG+) prior to its implementation online. This qualitative case study design included meeting notes and interviews completed with project team members. Meeting notes were analyzed using content analysis. Semi-structured interviews regarding project team members' roles on FPNG+ and processes and activities they identified as critical for the adaptation of FPNG+ to an online intervention were analyzed using a deductive-inductive approach. In the formative phase, three primary processes were identified: information gathering to determine if the environment existed for the implementation of an online program; considerations to support the facilitation process of FPNG+ to an online environment, and decision-making to support modifications to FPNG+. The pre-implementation phase consisted of three processes: information shared by the instructional designer to facilitate the delivery of the FPNG+ content online; modifications made to the format of the intervention to meet the cultural needs of Hispanic families and address contextual issues; and iterative efforts to tailor the intervention by the project team. This study used implementation science to distinguish the dynamic processes that occurred across different systems and multiple levels in the project team's effort to modify FPNG+ to an online intervention. The contribution of this study underscores the importance of identifying the processes that facilitate the modifications made to an intervention and the capacity to implement the modified intervention with Hispanic families.Adaptations to interventions for specific settings or communities are critical for facilitating successful implementation. The Dynamic Adaptation Process model was used to systematically assess the adaptation process made to an in-person parenting intervention (FPNG+) prior to its implementation online. Using a qualitative case study design, meeting notes were analyzed using content analysis; and semi-structured interviews were analyzed using a deductive-inductive approach. In the formative phase, three processes were identified: information gathering to determine if the environment existed for the implementation of an online program; considerations to support the facilitation process of FPNG+ to an online environment, and decision-making to support modifications to FPNG+. The pre-implementation phase consisted of three processes: information shared by the instructional designer to facilitate the delivery of the FPNG+ content online; modifications made to the format of the intervention to meet the cultural needs of Hispanic families and address contextual issues; and iterative efforts to tailor the intervention by the project team. The contribution of this study underscores the importance of identifying the processes that facilitate the changes made to an intervention and the capacity to implement the modified intervention with Hispanic families.

Studies focusing on the relevance or impact of a program, not just on its efficacy or effectiveness, can make important contributions to prevention science. This article documents the social validity (i.e., a construct encompassing feasibility, acceptability, and utility) of a universal substance use prevention program for early adolescents in Spain. The Mantente REAL (keepin’it REAL) program was culturally adapted to the Spanish context, implemented, and evaluated in six public middle schools in two regions of Spain. Participating teachers (N = 15), students (N = 354), and research team members (N = 6) reported on the feasibility, acceptability, and utility of the program implemented with first grade secondary school students. Qualitative and quantitative data about the program, its curriculum, and the implementation process were collected through teachers’ focus groups, students’ surveys, and observation forms completed by members of the research team. Mantente REAL was perceived to be a prevention program that was feasible for implementation in Spanish middle schools, although some logistics related to school structural constraints should be addressed in future implementations. The topics and activities in the curriculum were highly accepted by teachers and students, and they reported that the program was useful in teaching resistance strategies to cope with substance use and other risky situations. The findings support the social validity of the culturally adapted Mantente REAL program for early adolescents in Spain, and highlight how feedback from stakeholders involved in the implementation can improve the dissemination of effective prevention approaches.

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.

BACKGROUND: Prior studies have established that gender roles are predictive of substance use for Mexican and Mexican American adolescents, both living in the U.S. and in Mexico. OBJECTIVES: The moderating effects of gender and acculturation and the mediating effects of antisociality, depressive affect, and adaptive and avoidant coping on the gender role-alcohol use relationship were examined in a sample of Mexican American adolescents. METHODS: Secondary data analyses were conducted on a sample of 955 (450 boys, 505 girls) Mexican American 7th and 8th grade adolescents participating in a school-based substance use intervention. RESULTS: For boys, path analyses yielded significant direct paths from aggressive masculinity to alcohol use. Bootstrapped mediation tests also yielded significant indirect paths through antisociality from assertive masculinity, affective femininity, aggressive masculinity, and the interaction of linguistic acculturation by affective femininity to alcohol use. For girls, the relationship between aggressive masculinity with alcohol use and the negative relationship of affective femininity with alcohol use were also mediated by adaptive coping, which is predictive of decreased substance use. CONCLUSION/IMPORTANCE: The present analyses confirm the importance of gender roles, functional mediators, and their interaction with acculturation in predicting substance use in Mexican American adolescents, with implications for the design of interventions to reduce substance use within the Mexican American community.

Young adulthood is a time of increased substance use. To better understand the effects of potential protective factors, this study explores the relationship between four types of religious service attendance during emerging adulthood and six measures of young adult substance use. Study data were abstracted from waves I (time 1 [T1]) and IV (time 2 [T2]) of the National Longitudinal Study of Adolescent to Adult Health (Add Health) surveys (N = 14,800). Logistic regression was conducted to calculate the odds of using each substance with the results weighted to produce nationally representative estimates. Analysis revealed that service attendance was generally associated with a lower likelihood of lifetime and recent use across all measures examined at T2. Relative to the reference group (nonattenders at T1 and T2), the protective effects were largest for the consistent attendance group (attenders at T1 and T2), followed by the adult attendance group (nonattenders at T1, attenders at T2), and then the childhood attendance group (attenders at T1, nonattenders at T2). The results suggest that diverse attendance types may exert a protective influence on adult substance use. Practitioners might explore attendance options in clinical settings in a client-centered manner.

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: 267 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 (β = 0.02, p=.001) in Mexican children, and fewer steroid bursts (β= -0.41, p=.01) and better medication adherence (β = 0.02, 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.

This study documents the pivotal role that Community Health Workers (CHW) played while supporting underserved Latinx communities affected by COVID-19-related health inequities. With the support of CHWs' agencies historically serving three Latinx-dense counties in Arizona, we recruited CHWs who participated in a state-wide COVID-19 testing project. Using phenomenology and narrative qualitative research methods, five focus groups were facilitated in Spanish between August and November 2021. Bilingual research team members conducted the analysis of the Spanish verbatim transcripts and CHWs reviewed the results for validity. Three interconnected themes reflected the CHWs experiences: (1) CHWs as puentes/bridges with deep community embeddedness through shared experiences and social/cultural context, (2) CHWs as communication brokers and transformational agents, playing a pivotal role in responding to the health and socioeconomic challenges posed by the COVID-19 pandemic, (3) CHWs satisfaction and frustration due to their dual role as committed community members but unrecognized and undervalued frontline public health workers. These findings emphasize the CHWs' commitment towards supporting their communities, even amidst the stressors of the pandemic. It is important to continue to integrate the role of CHWs into the larger healthcare system as opposed to relegating them to short term engagements as was the case during the COVID-19 pandemic. This article provides a set of practice, policy, and future research recommendations, emphasizing the need to allocate greater budgetary and training resources in support of CHWs.

The COVID-19 pandemic and lockdown measures have had a profound impact on the emotions, anxiety, and mental health of affected communities. Despite this, there is a lack of knowledge about the possible generational and geographical differences in the effects on the mental health of individuals. This study examines the impact of COVID-19 related quarantine on symptoms of generalized anxiety disorders (GAD) among parents and children (N = 4503). It also compares the outcomes of residents from the initial COVID-19 epicenter of Wuhan to those in surrounding areas. Subgroup analyses were conducted by child and parent samples, and by Wuhan city and other cities in the Hubei province. Propensity score radius matching and ordinary least squares regressions were used to examine the relationship between quarantine and GAD symptoms. Results showed that quarantine had more psychological impact on parents than children, regardless of geographic location. Parents that experienced quarantine in Wuhan city, reported a significantly higher level of symptoms of GAD than those that did not. Parents from other cities showed no such difference. For both children and parents, interpersonal communication about COVID-19 and social media exposure to pandemic-related information were linked to GAD symptoms. Targeted policies and interventions are needed to address the psychological impacts of COVID-19 lockdown.

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”

Most studies on psychosocial stress among Hispanics have focused on risk factors. To better understand psychosocial stress among this population, this study aimed to examine components of bicultural identity integration and bicultural self-efficacy, that may be associated with lower psychosocial stress among Hispanic emerging adults (ages 18–25). This aim was tested on a cross-sectional sample of Hispanic emerging adults (M(age) = 21.30, SD = 2.09) that included 200 participants (Arizona n = 99, Florida n = 101). The sample included men (n = 98) and women (n = 102). Most participants were US-born (70%), college students (69.5%), and of Mexican heritage (44%). Standardized coefficients from a hierarchical multiple regression model indicate that higher levels of the bicultural harmony component of bicultural identity integration (β = −0.26, p < 0.001) and the social groundedness component of bicultural self-efficacy (β = −0.23, p < 0.01) were associated with lower levels of psychosocial stress. To our knowledge, this is the first study to examine components of bicultural identity integration and bicultural self-efficacy and their respective associations with psychosocial stress among any racial/ethnic group. Thus, more studies are needed to replicate our findings to determine if bicultural identity integration and bicultural self-efficacy should be considered in psychosocial stress interventions for Hispanics.

BACKGROUND: Experiencing acculturative stress burdens Latinx families in a variety of negative and deleterious ways. Using the Family Stress Model, this study aims to explore the patterns and experiences of acculturative stress in Latinx families, and how these experiences related to Latinx adolescent internalizing and externalizing behaviors. METHOD: Data came from baseline reports of three cohorts of parent-youth dyads (n = 532) participating in a longitudinal randomized control effectiveness trial testing a parenting intervention in southwestern U.S. area. RESULTS: Findings indicate that youth exhibited more depressive symptomology when both parent and child reported higher acculturative stress. While youths’ anti-social behaviors were only associated with their own acculturative stress and not their parents’ acculturative stress levels. DISCUSSION: This study advances new knowledge about the relationship between acculturative stress and youth behaviors, and provides recommendations for developing future interventions with Latinx youth to prevent the onset of internalizing and externalizing behaviors.

OBJECTIVE: A sociocultural stressor that has been understudied among racial/ethnic minorities is online ethnic discrimination. Accordingly, this study aimed to (1) examine associations of exposure to ethnic discrimination in social media with symptoms of depression and generalized anxiety, and (2) examine the extent to which gender moderates these respective associations. METHOD: 200 Hispanic emerging adults from Arizona (n=99) and Florida (n=101) completed a cross-sectional survey, and data were analyzed using hierarchical multiple regression and moderation analyses. RESULTS: Higher social media discrimination was associated with higher symptoms of depression and generalized anxiety. Moderation analyses indicated that higher social media discrimination was only associated with symptoms of depression and generalized anxiety among men, but not women. CONCLUSION: This is likely the first study on social media discrimination and mental health among emerging adults; thus, expanding this emerging field of research to a distinct developmental period.

Objective Hispanic immigrants exhibit more positive outcomes than U.S.-born Hispanics across educational, psychological, and physical health indices, a phenomenon called the immigrant paradox. We examined the immigrant paradox in relation to alcohol use severity among Hispanic young adults while considering both positive (optimism) and negative (depressive symptoms) processes. Method Among 200 immigrant and U.S.-born Hispanic young adults (Mage = 21.30; 49% male) in Arizona and Florida, we tested whether optimism and depressive symptoms statistically mediated the relationship between nativity and alcohol use severity. Specifically, we examined whether Hispanic immigrants reported greater optimism than their U.S.-born counterparts, and whether such optimism was, in turn, associated with less depressive symptoms and thus lower alcohol use severity. Results Indirect effects were significant in hypothesized directions (nativity → optimism → depressive symptoms → alcohol use severity). Conclusions Both positive and negative psychological processes are important to consider when accounting for the immigrant paradox vis-a-vis alcohol use severity among Hispanic young adults.

The rates of non-communicable diseases (NCD’s) such as diabetes and hypertension are reaching epidemic proportions in Asia. Behavioral conditions are frequently comorbid with NCD’s, contribute to poor clinical outcomes, and are under detected and untreated in many Asian nations. This article reports the findings of a study examining the level of behavioral and non-behavioral care integration in clinics and hospitals in China, Cambodia, Vietnam, and Thailand. It assessed providers’ ratings of patients’ prevalence of behavioral conditions, the need for behavioral health consultants, and patients’ self-reported health risk assessments (HRA) of their lifestyle and behavioral problems. The results show low levels of available behavioral care in the participating Asian countries in comparison with the United States. The HRA results showed high rates of patients’ reported tobacco use, high-risk levels for alcohol use in men, and low levels of healthy foods intake and physical activity for men and women. The provider survey results showed moderate perceived prevalence of lifestyle and behavioral conditions and moderate perceived need for integrated behavioral care. These results suggest a need to develop and evaluate integrated healthcare services in Asia in order to address the epidemic of NCD’s.

ObjectiveCOVID-19 burdens are disproportionally high in underserved and vulnerable groups in Arizona. As the pandemic progresses, it is unclear if the disparities have evolved. In this study, we aim to elicit the dynamic landscape of COVID-19 disparities at the community level and identify newly emerged vulnerable subpopulations.Materials and MethodsWe compiled biweekly COVID-19 case counts of 274 zip code tabulation areas (ZCTAs) in Arizona from October 21, 2020, to November 25, 2021, during which the COVID-19 growth rate has changed significantly. Within each growth period, we detected health disparities by testing associations between the growth rate of COVID-19 cases in a ZCTA and the population composition of race/ethnicity, income, employment, and age. We then compared the associations between periods to discover temporal patterns of health disparities.ResultsHigh percentage of Latinx or Black residents, high poverty rate, and young median age were risk factors of high cumulative COVID-19 case counts in a ZCTA. However, the impact of these factors on the growth rate of new COVID-19 cases varied. While high percentage of Black residents and young median age remained as risk factors of fast COVID-19 growth rate, high poverty rate became a protective factor. The association between the percentage of Latinx residents and the COVID-19 growth rate converted from positive to negative during summer 2021. The unemployment rate emerged as a new risk factor of fast COVID-19 growth rate after September 2021. Based on these findings, we identified 37 ZCTAs that are highly vulnerable to fast escalation of COVID-19 cases.Discussion and ConclusionAs the pandemic progresses, disadvantaged communities continue suffering from escalated risk of COVID-19 infection. But the vulnerabilities have evolved. While the disparities related to Latinx ethnicity improved gradually, those related to Black ethnicity and young communities aggravated. The struggle of financially disadvantaged communities continued, although the burden had shifted from those living under the poverty line to those with a high unemployment rate. It is necessary to adjust current resource allocations and design and deploy new interventions to address emerging needs.

The main objective of the current study is to analyze how the unique perspectives from both parents and children in regards to parental knowledge of the child's whereabouts, activities, and friendships are related to the adolescent's recent substance use four months later. Differences between parents and children, as well as between male and female adolescents are examined. Data come from a Latinx sample (mostly Mexican-origin) of 523 parent-adolescent dyads from Arizona (US) using a multi-informant approach (parent and adolescent reports). The results indicate that parents, especially mothers, report higher levels of parental knowledge than adolescents do. The structural equation modeling (SEM) results for the total sample indicate that both parents' and adolescents' unique perception of the level of parental knowledge is negatively related to the adolescents' recent alcohol and cannabis use four months later. Further, multi-group SEM results split by gender indicate that parents' unique perception of higher levels of parental knowledge is only marginally related to lower alcohol use for both males and females, whereas adolescents' unique perception is negatively related to alcohol and cannabis use (significantly) and tobacco use (marginally) for both males and females. No significant gender differences were found in the effects of parental knowledge on substance use. Findings suggest that parents' and adolescents' perceptions seem to be quite distinctive and independent from each other. Implications of these results regarding intervention programs for preventing substance use are discussed.El objetivo principal de este estudio es analizar cómo las perspectivas únicas de padres e hijos con respecto al conocimiento de los padres sobre el paradero, las actividades y las amistades de su hijo/a se relacionan con el consumo reciente de sustancias del adolescente cuatro meses después. Se examinan las diferencias entre padres e hijos, así como entre adolescentes chicas y chicos. Los datos provienen de una muestra de latinos (en su mayoría de origen mexicano) de 523 díadas de padres y adolescentes de Arizona (EE.UU.) utilizando un enfoque de múltiples informantes (informes de padres y adolescentes). Los resultados indican que los padres, especialmente las madres, reportan niveles más altos de conocimiento parental que los adolescentes. Los resultados del modelo de ecuaciones estructurales (SEM) para la muestra total indican que tanto la percepción única de los padres como la de los adolescentes del nivel de conocimiento parental está relacionada de forma negativa con el consumo reciente de alcohol y cannabis por parte de los adolescentes cuatro meses después. Además, los resultados de SEM multigrupo divididos por género indican que la percepción única de los padres de niveles más altos de conocimiento parental está únicamente relacionada de forma marginal con un menor consumo de alcohol, tanto para chicos como para chicas, mientras que la percepción única de los adolescentes está relacionada de forma negativa con el consumo de alcohol y cannabis (significativamente) y el consumo de tabaco (marginalmente), tanto en chicos como en chicas. No se encontraron diferencias de género significativas en los efectos del conocimiento parental sobre el uso de sustancias. Los resultados sugieren que las percepciones de padres y adolescentes parecen ser bastante distintas e independientes entre sí. Se discuten las implicaciones de estos resultados con respecto a los programas de intervención para prevenir el consumo de sustancias.

When testing longitudinal effects of parenting practices on adolescent adjustment, an integrated consideration of externalizing and internalizing behaviors is a gap in research. This study analyzed how parental support and parental knowledge directly and indirectly influence both antisocial behavior and emotional problems. The sample had 642 adolescents aged 12-15 (mean age = 12.49; 45.4% females) from Spain, who participated in a three-year long study. The results showed longitudinal bidirectional associations between parental support and parental knowledge. Only parental knowledge, however, directly predicted antisocial behavior and emotional problems. Parental support had an indirect effect on outcomes through the mediating effect of parental knowledge. This study has practical implications by indicating that increasing parental knowledge should be the target of educational-prevention programs.

Background Little research has been conducted that integrates, in one explanatory model, the multitude of factors potentially leading to disparities among Latino children. Purpose A longitudinal, observational study tested an explanatory model for disparities in asthma control between Mexican and Puerto Rican children with persistent asthma requiring daily controller medication use. Methods Mexican and Puerto Rican children aged 5–12 years (n = 267) and their caregivers (n = 267) were enrolled and completed interviews and child spirometry at baseline and 3, 6, 9, and 12 months postenrollment. A 12 month retrospective children’s medical record review was completed. Participants were recruited from two school-based health clinics and the Breathmobile in Phoenix, AZ, and two inner-city hospital asthma clinics in the Bronx, NY. Results Statistically significant differences in the social/contextual predictors of asthma illness representations (IRs) were noted between Mexican and Puerto Rican caregivers. The structural equation model results revealed differences in asthma control over time by ethnicity. This model accounted for 40%-48% of the variance in asthma control test scores over 12 months. Caregivers’ IRs aligned with the professional model of asthma management were associated with better children’s asthma control across 1 year. These results also supported the theoretical notion that IRs change over time impacting caregivers’ treatment decisions and children’s asthma control. Conclusions These findings extend a previous cross-sectional model test using a more comprehensive model and longitudinal data and highlight the importance of considering within-group differences for diagnosis and treatment of children coming from the vastly heterogeneous Latino umbrella group. Trial Registration Trial number NCT 01099800

Purpose The aim of the article was to examine national trends in adolescent participation in substance use prevention programming (SUPP). Methods We examine 15 years of cross-sectional data (2002–2016) from the National Survey on Drug Use and Health. Main outcomes were participation in past-year school and community-based SUPP (no/yes). Logistic regression was used to examine trends in the prevalence of participation. Results Participation in school-based SUPP decreased significantly from 48% among adolescents in 2002–2003 to 40% in 2015–2016, a 16.5% proportional decline. Significant declines for school-based participation were observed in all demographic and drug involvement subgroups examined. Youth participation in community-based SUPP also decreased significantly. However, this downward trend was significant only among younger teens, females, youth in very low ( Conclusions Participation in SUPP has decreased since the early 2000s, with noteworthy declines among Latino youth and youth from rural areas and socioeconomically disadvantaged backgrounds.

This article presents the effects of a synchronized Latino youth/parent intervention on adolescent inhalant use. The analytic sample included only Latino adolescents (N=487) between the ages of 12 and 14. Randomized at the school-level, the design included three possible conditions: 1) child and parent received the prevention interventions, 2) only the parent received the prevention intervention, 3) neither child or parent received the prevention interventions. Drawing from the ecodevelopmental perspective, the overall hypothesis was that youth randomly assigned to the condition with both interventions will report the strongest inhalant use prevention outcomes. Descriptive statistics and regression tests of significant group differences by treatment condition confirmed the overall hypothesis. Children receiving the youth intervention and whose parents received the synchronized parenting intervention reported the strongest desired inhalant prevention effects. The findings are interpreted from an ecodevelopmental perspective and implications for practice, policy and future research are discussed.

This article advances knowledge about the effectiveness of applying a community-based efficacious parenting intervention in parallel with an efficacious preadolescent intervention in changing substance abuse norms among preadolescent Latino youth. The study employed a longitudinal, randomized control group design comparing three groups: (1) Parent intervention combined with a Youth intervention: Parent/Youth; (2) Parent intervention without a Youth intervention: Parent Only; and (3) Treatment as usual: Comparison. In the comparison group, parents participated in a standard parenting program delivered by the community partner, and the youth received the usual drug use prevention programming offered in their schools. Data from both parents and youth at the19 participating schools were collected at pre-test, immediate post-test (4 months after pre-test), and two follow-up (8 & 20 months after the pre-test). The total sample includes 532 families (parent-child dyads). The parent-child dyads consisted of one parent and one youth ages 12–14. The retention rates for both parents and preadolescent were high across the different waves of data collection (79%–96%). Regression results of youth substance use norms were calculated based on three permutations of data: (a) original data, with no imputation and no propensity score matching; (b) imputed data but no propensity score matching; and (c) imputed data plus propensity score matching. Compared to the Comparison group, the Parent/Youth condition was the most effective in changing youth's norms, closely followed by the Parent Only condition. These findings make a significant contribution in advancing knowledge on family/youth substance use prevention for Latinos in a community environment. Although the study took place in a specific urban center in the Southwest US, its findings can be generalized to other urban communities of similar characteristics across the country.

Cyberbullying is a global and growing phenomenon, which affects the wellbeing of millions of adolescents around the world including Chinese adolescents. However, there is a lack of valid and reliable measures of cyberbullying behaviours in Chinese. To address this research gap, this study aims to adapt and validate a well-known, reliable and validated instrument: the European Cyberbullying Intervention Project Questionnaire (ECIPQ) among Chinese adolescents. A 14-item (seven for cyber aggression and seven for cyber victimisation) of the Chinese version of ECIPQ was developed based on its relevance and appropriateness to the Chinese culture. After its cultural and linguistic adaptation, the measure was norm with a sample of Chinese adolescents. A total sample of 452 adolescents was randomly split into two evenly subsamples for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The EFA results indicated that the Chinese version of ECIPQ had a good convergent validity and satisfactory discriminant validity, and a two-factor model was identified. CFA results showed a good fit of the measurement model in assessing cyber aggression and cyber victimisation. This adapted Chinese version of ECIPQ can be used to facilitate future research on cyberbullying screening, and that research may in turn promote proactive screening and better coordination of community responses for victims as well as perpetrators. Future comparative studies may use the validated scale to assess the prevalence of cyberbullying and the results of interventions to reduce cyberbullying among Chinese adolescents.

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.

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".

Mantente REAL is a school-based universal program to prevent drug use and other problematic behaviors specifically designed to be implemented in schools at the beginning of adolescence. This program, which is a culturally adapted version of the Keepin’ it REAL intervention, focuses on skills training for resisting social pressure to use drugs and improving psychosocial development. This study aims to evaluate the effectiveness of Mantente REAL on alcohol use in the Spanish context. The sample was composed of 755 adolescents from 12 state secondary schools in Spain, aged 11 to 15 (M = 12.24, SD = 0.56), 47.1% females. The 12 schools were randomly assigned to control and experimental groups, six to each condition. Pre-test and post-test questionnaires data were collected to evaluate the effectiveness of the program. The results indicated that a culturally adapted version of Mantente REAL was effective in preventing alcohol use among youth from northern and southern Spain. Students participating in the program demonstrated changes in the desired direction on alcohol frequency and intoxication episodes. Implications of these results regarding intervention programs aimed at preventing substance use in adolescence are discussed “Mantente REAL” es un programa universal que utiliza la escuela para prevenir el consumo de drogas y otras conductas problemáticas diseñado específicamente para ser implementado en las escuelas al comienzo de la adolescencia. Este programa, que es una versión culturalmente adaptada de la intervención Keepin’ it REAL, se centra en el entrenamiento de habilidades para resistir la presión social para consumir drogas y mejorar el desarrollo psicosocial. Este estudio tiene como objetivo evaluar la eficacia de “Mantente REAL” en el consumo de alcohol en el contexto español. La muestra estuvo compuesta por 755 adolescentes de 12 escuelas secundarias públicas en España, de 11 a 15 años (M = 12.24, DT = 0.56), el 47.1% mujeres. Las 12 escuelas fueron asignadas aleatoriamente a grupo control y experimental, seis en cada condición. Los datos se recopilaron a través de cuestionarios antes y después de la intervención para evaluar la eficacia del programa. Los resultados indicaron que la versión culturalmente adaptada de “Mantente REAL” fue eficaz para prevenir el consumo de alcohol entre los jóvenes del norte y sur de España. Los estudiantes que participaron en el programa demostraron cambios en la dirección deseada en la frecuencia del alcohol y los episodios de intoxicación. Se discuten las implicaciones de estos resultados con respecto a los programas de intervención destinados a prevenir el consumo de sustancias en la adolescencia This study was funded by the Global Center for Applied Health Research (Arizona State University) and supported by the Programa de Axudas á etapa posdoutoral da Xunta de Galicia (Consellería de Cultura, Educación e Ordenación Universitaria) and by FEDER/Ministerio de Ciencia, Innovación y Universidades – Agencia Estatal de Investigación (Grant PSI2015-65766-R) – under the Axuda para a consolidación e estruturación de unidades de investigación competitivas e outras accións de fomento nas universidades do SUG (GRC, 2018) SI

This chapter examines issues and challenges in the local and cultural adaptation of evidence-based interventions (EBIs) and empirically validated treatments (EVTs). We examined the prior Fidelity-Adaptation Dilemma from the contemporary perspective that regards both fidelity and adaptation as equally important intervention imperatives. This approach involves implementation fidelity in congruence with the theory-based and empirically validated core therapeutic thrust of the intervention, while also exercising flexibility in conducting planned adaptations that are responsive to the “real world,” needs of diverse cultural subgroups of clients. The need to develop pretreatment “integrative modules” is described as an innovative feature of contemporary EBI design, to aid in integrating the EBI for effective “function and fit” within various communities and health service delivery settings. The goal is to facilitate EBI widespread dissemination and implementation to thus improve the health and well-being of diverse clients and community residents. The implications for international dissemination and implementation across nations, cultures, and among diverse clients are described.

According to the theory of planned behavior (TPB), intentions to perform a specific behavior are the result of attitudes, norms, and perceived control, and in turn, intentions and perceived control are the main predictors of the behavior. This study aimed to test the applicability of TPB in predicting alcohol use in normative pre-adolescents. The sample was composed of 755 Spanish adolescents aged 11 to 15 (M = 12.24, SD = 0.56), 47.1% females, from 12 state secondary schools in Spain. The results of path analysis indicate that positive attitudes towards alcohol, favorable norms towards alcohol, and offer vulnerability (perceived control) are significantly positively related to intentions to use alcohol as well as negatively related to actual behavioral control (i.e., actual strategies to avoid alcohol use). In turn, intentions to use and actual control predict higher alcohol frequency and heavy drinking. Significant indirect effects of these antecedents were found on alcohol outcomes through the mediation of intentions and actual control. The findings suggest that the validity and applicability of the TPB in normative pre-adolescents depend on the severity of alcohol use and point to a need to consider negative social influence in decision making processes in early adolescence.

Background Understanding adolescent drug use mechanisms is critical for drug use prevention. Although some theories such as the gateway theory suggest that drug users gradually transition into using more addictive drugs, there is no consensus about such a hypothesis. One important factor that hinders the advancement of knowledge in this area is the scarcity of longitudinal studies examining the type of drugs adolescents initially use and the different pathways adolescents take to transition into using other drugs as they grow older. Methods Using the pooled sample of adolescent dug users (14–17 years old; n = 10,644) from the National Survey on Drug Use and Health (2015–2018), we constructed longitudinal data on adolescents’ illicit drug use history other than the use of tobacco and alcohol based on the age of drug initiation. This allowed us to investigate what drugs were initially used by adolescents, how the use of these drugs may have progressed into a new drug, and whether there were racial/ethnic differences in the initiation and progression. The retrospective longitudinal data analyses applied life table method and Cox regression models. Results Two thirds of the adolescent drug users initiated their drug use trajectories with marijuana, one quarter with inhalants, and the remaining with hallucinogens, prescription drugs, and hard drugs. Adolescent drug users who initiated with different drugs showed unique trajectories to the use of a new drug. By year 8, the probability of using a new drug was about 40% and 70% to 80% for adolescents who initiated with inhalants and other drugs, respectively. The probability of using a new drug for adolescents who initiated with marijuana and inhalants accumulated stably over time, and its difference with that of other drug users diminished over time. The multivariate Cox regression models suggest the observed discrepancies generally held after controlling for covariates. There were also racial/ethnic differences in adolescent drug use initiation and progression, with Black/African American adolescents being the least likely to switch to the use of a new drug. Conclusion Adolescents’ initial use of marijuana and inhalants may lead to substantial risks of using other drugs over time. It is therefore important to screen adolescent drug use comprehensively and provide early interventions to prevent an escalation to more detrimental drugs. The findings provide new evidence to support aspects of both the gateway and generalized risk drug use theories.

OBJECTIVES: The purpose of this study was to determine how closely parents and their adolescent children self-report family meal habits specific to types of food served and technology use. METHODS: Dyads (n = 100) of one parent (40.0 ± 7.1 years; 92.1% female) and one 6(th)-8(th) grade adolescent child (12.5 ± 0.9 years; 41.3% female) from primarily Hispanic families were recruited through middle schools in a Southwestern US metropolitan area. Parents and adolescents each completed surveys to self-report types of foods typically served at dinner (vegetables, 100% fruit juice, other fruit, milk, and sugar-sweetened beverages) and technology use allowed (television watching, use of hand-held games, talking on the phone, texting, listening to music with headphones) during family meals using identical questions. Answer choices were Never = 1, Sometimes = 2, Usually = 3, or Always = 4. Parents’ responses were compared to those of adolescents using paired samples T-tests. RESULTS: Relative to adolescent responses, parents reported greater family mealtime offering of vegetables (2.5 ± 0.9 vs. 1.8 ± 0.7), 100% fruit juice (2.0 ± 0.9 vs. 1.3 ± 1.0), other fruit (2.4 ± 1.0 vs. 1.3 ± 1.0), milk (2.9 ± 1.0 vs. 1.0 ± 1.0), and sugar-sweetened beverages (2.1 ± 0.8 vs 1.2 ± 0.9; P

Introduction: Adherence to dietary recommendations among Latinx adolescents is low, contributing to an increased risk for obesity and cardiometabolic disease. Parents play a crucial role in adolescents’ disease risk and diet quality due to their role in modeling healthful behaviors and providing food. However, information about how parental monitoring and eating-related parenting practices are associated to cardiovascular risk is scarce. Hypothesis: We hypothesized that unhealthful parenting practices would be associated with higher cardiometabolic risk factors among Latinx adolescents. Methods: We included 61 parent-adolescent (6 th -8 th grade) Latinx dyads. Parents self-reported information about parental monitoring, family eating habits (use of media during meals, inclusion of specific foods during dinner, fast food intake), parental feeding style, and parental energy index (whether parents have had conversations with their children regarding weight and healthful diet and physical activity behaviors). Adolescent cardiometabolic risk factors measured include blood pressure (BP), total cholesterol, and HbA1c. Age- and sex-adjusted BMI percentile (BMI%) and z-scores (BMIz) were calculated from weight and height measurements. Associations between parental practices and cardiometabolic risk factors were analyzed using linear regression (B) and correlation (r). Results: Adolescents’ measured risk factors were as follows: SBP=106±11 mm Hg, DBP=62±7 mm Hg, weight=61±15 kg, BMI%=83±20, BMIz=1.2±0.9, HbA1c=5.1±0.4 %, and total cholesterol=164±12 mg/dL. Use of media during meals (e.g., TV, electronic devices) was associated with higher adolescent weight (B=7.97; r=.31; p=.02) and BMIz (B=.37; r=.27, p=.05). Parental restrictive feeding style was associated with higher adolescent weight (B=5.54; r=.22; p=.03), BMI% (B=13.19; r=.52, p=.001) and diastolic BP (B=2.50; r=.27, p=.04). Adolescent children of parents reporting a greater parental energy index had a greater body weight (B=6.90; r=.46; p=.001) and BMI % (B=6.28; r=.33, p=.01). Parent-reported frequency of consuming family meals, frequency of fast food meals, importance of consuming family meals, and inclusion of vegetables, fruit and 100% juice, milk, and sugar-sweetened beverages during family meals were not associated with adolescents’ BMI or BP. Associations with other risk factors were not significant. Conclusions: Results suggest that unhealthful parenting practices such as restrictive feeding and allowing the use of media during meals may negatively influence cardiometabolic risk factors among Latinx adolescents. Parents of children with a greater BMI reported having more conversations about weight and healthful behaviors with their children. Future family-based behavioral interventions for this population should incorporate more parenting strategies as part of their curricula.

This study sought to identify variation by gender in the associations between religious service attendance from adolescence to young adulthood and seven measures of lifetime and short-term substance use. To conduct this nationally representative study, data from the Add Health Surveys was abstracted from Waves I and IV (N = 3,223) to construct four types of service attendance (non-attenders, attenders only as adolescents, attenders only in young adulthood, and consistent attenders). A series of logistic regressions were conducted to identify the independent effects of each pattern of service attendance on each substance among all black young adults, as well as male and female sub-samples. Analysis revealed consistent attenders were generally less likely to use substances, with the effects being strongest among females. Among young adult only attenders, males recorded lower odds across all three short-term measures whereas females reported lower odds only for monthly cigarette use. The protective effects of religious service attendance are more robust for African Americans who consistently attend in adolescence and young adulthood, especially among females.

Background Alcohol use among Chinese vocational school students is widespread and associated with many negative consequences. However, alcohol-specific antecedents for this population are understudied. Objectives The current study explored: (a) which alcohol-specific antecedents are the most salient predictors for alcohol use intentions, (b) whether any mediational relationships exist among these alcohol-specific antecedents, and (c) whether gender-based differences exist among these relationships. Methods This study analyzed data from 1,230 vocational school adolescents in three Chinese cities. Survey data were analyzed using dominance analysis and structural equation modeling. Results Personal norms were the most salient antecedents for alcohol use intentions, followed by injunctive norms from friends and parents, descriptive norms from friends and classmates, and positive belief about drinking. We observed a statistically significant mediational chain from descriptive norms to injunctive norms, and in turn to personal norms and positive beliefs, and finally to alcohol use intentions. Gender moderated some of the paths. Conclusions Alcohol use norms and beliefs among Chinese vocational school students have distinct predictive relationships with alcohol use intentions. Alcohol use prevention programs designed for this population need to address normative beliefs (descriptive, injunctive, and personal norms) and the perceived benefit of alcohol use.

Refugees frequently experience histories of trauma and stress of acculturation, which place them at a high risk for mental health and substance use problems. Although recently arrived forei...

Purposes Low socioeconomic status and limited social support may put older residents in subsidized housing at high risk for developing fears of Alzheimer’s disease or related dementias. This study examined the perceived threat of Alzheimer’s disease or related dementias among older Chinese Americans in subsidized housing facilities in Phoenix, Arizona of the United States, and focused on the effect of cultural beliefs (i.e., beliefs toward Alzheimer’s disease or related dementias, and beliefs toward intergenerational support) on the perceived threat of Alzheimer’s disease or related dementias. Method Analyses were based upon a survey of 207 Chinese American older adults (Mage = 75.37, SD = 7.47) living in subsidized housing facilities in the Phoenix metropolitan area. Standardized survey questionnaires were delivered through face-to-face interviews. Results Multivariate analyses suggest that fatalism related beliefs about Alzheimer’s disease or related dementias, rather than stigmatization, were related to higher levels of concerns for developing Alzheimer’s disease or related dementias, while beliefs in intergenerational support were related to lower levels of perceived threat of Alzheimer’s disease or related dementias. However, the protective effect of beliefs in intergenerational support tended to diminish in those living with higher levels of depressive symptoms. Discussion Cultural beliefs can entail both risks and strengths when low-income Chinese American elders attempt to comprehend the implications of Alzheimer’s disease or related dementias. Health education or intervention programs need to address their fatalism beliefs toward Alzheimer’s disease or related dementias, and facilitate the accessibility of intergenerational support for this group.

Cultural values are believed to influence perceptions of and solutions to elder mistreatment (EM) perpetrated by family members. This study aimed to understand the influence of family cohesion on EM reported by community-dwelling older Chinese Americans. A mixed-method approach consisting of a quantitative survey built on focus group interviews was utilized. Focus group interviews were conducted to ensure subsequent survey questions about EM were culturally and linguistically appropriate. The revised survey questionnaires were then administered to 266 Chinese American older adults to assess estimated EM prevalence and the effects of family cohesion. Survey findings indicate that 1 in 10 reported at least one occurrence of EM in the past year. Depressed Chinese older adults (OR= 1.14) and those reporting low levels of family cohesion (OR = .82) were more likely to experience EM. Multigenerational family interventions can be designed to reduce older adults’ depression levels and promote family cohesion.