Preventing Health Disparities in Hispantic Youth: Changing trajectories

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The proposed study is submitted as part of a P60 entitled "NCMHD Center for Culturally-Tailored Hispanic Health Disparities Research", in response to the NIH RFA-MD-06-002: Establishing Comprehensive NCMHD Research Centers of Excellence (El Centra). This study seeks to investigate the efficacy and mechanisms of a highly promising and culturally informed family-based intervention for preventing the emergence of two important health disparities in Hispanic youth - drug use and HIV/STIs. Indicated prevention of these specific disparities will be accomplished by identifying youth who already show serious child psychiatric, behavioral, and family risk factors (i.e., conduct disorder, attention deficit hyperactivity disorder, depressive disorders, and maladaptive family functioning) for these disparities and providing treatment to significantly modify these problems. In Hispanic youth and families we will also target the acculturation-related stressors that have been shown to place youth at risk for deteriorating health. The Culturally Informed Family Treatment for Adolescents (CIFTA) model to be tested integrates cultural and individually-based enhancements (e.g., modules on immigration stressors and individual skills development) with family treatment, to better address the youth and family's treatment needs. The culture-based enhancements are critical because the stresses of acculturation and discrimination compound the typical risk factors and family disruptions that can contribute to the deteriorating behavior in Hispanic youth. The flexible manual design is also innovative and helps to tailor interventions to the needs of Hispanic youth and families. This study will: 1) refine/adapt the CIFTA treatment manual to the unique clinical and developmental characteristics of youth 11-14 years of age, 2) implement a randomized clinical trial with 200 Hispanic youth, testing the efficacy of CIFTA compared to a community treatment as usual condition in reducing symptoms of CD, ADHD, DD, and family risk factors, 3) investigate the relationship of CIFTA's hypothesized mechanisms of treatment change to outcome, 4) test the ability of CIFTA to prevent health disparities over a period of 20 months post baseline, and 5) empirically identify subtypes of profiles on acculturation and immigration-related factors and link these to treatment outcomes. The results of this study have the potential to advance the knowledge base relevant to Hispanics by providing data from a fully Hispanic sample, on such important issues as outcome findings, mechanisms of change, and sub-types of culturally-related profiles that can impact treatment response.