Evaluating the Effectiveness of an eHealth EBI for Latino Youth in Primary Care

美国的西班牙裔青少年经历了显著的健康差距，特别是在与毒品有关的方面 使用、不安全性行为和性传播感染(STI)。尽管存在这些差距，但仍有少数人 许多针对西班牙裔青少年的有效预防干预措施，甚至更少被传播 广泛(国际移民组织/国家研究中心，2009年)。鉴于初级保健设置越来越多地成为通过 哪些父母给青少年带来了行为健康方面的担忧，青少年初级保健环境是理想的， 但未得到充分利用，这是传播循证预防干预措施的环境。预防性的 以家庭内的风险和保护因素为目标的干预措施，最近的和最基本的 影响人类行为的社会制度被发现是最有效的干预措施之一 预防和减少吸毒和性危险行为。 Familas Unidas是一种专门针对西班牙裔的、以家庭为基础的干预措施，被发现在 预防和减少药物使用、性危险行为和自我报告的性传播感染。Unidas一直以来都很熟悉 被医学研究所关于年轻人的预防、情绪和行为的报告引用为 已做好广泛传播的准备(国际移民组织/核研究中心，2009年)。然而，迄今为止，仅对Familias Unidas进行了测试 在学校的效力和效力，还没有对初级保健的效力/效力进行评估。我们 调整和评估了Familias Unidas的在线交付；成功地保留了80%的西班牙裔 家长和他们的青年(从学校招募)在网上，电子健康适应家庭联盟。我们有 还证明了在初级保健中提供eHealth Familas Unidas的可行性和可接受性。 评估针对西班牙裔青年的创新性电子健康家庭干预措施的可行性和 在初级保健环境中建立可接受性是及时的，具有很高的公共卫生意义。因此， 拟议的研究的总体目标是评估eHealth的相对有效性和成本效益 与国家药物滥用研究所(NIDA)在线信息页面的转介相比， 针对西班牙裔青少年的父母(以下简称NIDA在线信息)。为了测试……的有效性 电子健康家庭Unidas初级保健在预防吸毒、无保护的性行为和性传播感染方面的作用 西班牙裔青年的普遍样本，这项研究将随机选择456名西班牙裔青年及其父母参加eHealth Familas Unidas或NIDA在线信息。参与者将在基线、6、12、24和36岁时进行评估 基线后几个月。研究假设是：1)eHealth Familias Unidas相对于NIDA将是有效的 在线信息，在预防/减少吸毒、无保护的性行为和性传播感染发病率方面 随着时间的推移，西班牙裔青少年的干预效果将部分地通过家庭功能来调节 性传播感染的药物使用和无保护性行为以及家庭功能和无保护性行为 发病率。还将评估eHealth Familias Unidas在三年后续行动中的成本效益。

Hispanic adolescents in the U.S. experience significant health disparities, particularly as it relates to drug use, unsafe sexual behaviors and sexually transmitted infections (STIs). In spite of these disparities, a paucity of effective preventive interventions exist for Hispanic adolescents, and even fewer have been disseminated widely (IOM/NRC, 2009). Given that primary care settings are increasingly becoming the entry-point through which parents bring youth with behavioral health concerns, adolescent primary care settings represent ideal, yet underutilized, settings in which to disseminate evidence-based preventive interventions. Preventive interventions which target risk and protective factors within the family, the most proximal and fundamental social system influencing human behavior, have been found to be among the most efficacious interventions in preventing and reducing drug use and sexual risk behaviors. Familias Unidas is a Hispanic-specific, family-based intervention found to be efficacious and effective in preventing and reducing drug use, sexual risk behaviors, and self-reported STIs. Familias Unidas has been cited by the Institute of Medicine report on Preventing, Emotional, and Behavioral among Young People as ready for broad dissemination (IOM/NRC, 2009). To date, however, Familias Unidas has been only tested for efficacy and effectiveness in schools and has not been evaluated for efficacy/effectiveness in primary care. We have adapted and evaluated Familias Unidas for online delivery; successfully retaining 80% of Hispanic parents and their youth (recruited from schools) in the online, eHealth adaptation of Familias Unidas. We have also demonstrated the feasibility and acceptability of delivering eHealth Familas Unidas in primary care. Evaluating innovative eHealth family-based interventions for Hispanic youth whose feasibility and acceptability is established in primary care settings is timely and of high public health significance. Therefore, the proposed study's overarching aim is to evaluate the relative effectiveness and cost effectiveness of eHealth Familias Unidas, compared to a referral to the National Institute Drug Abuse’s (NIDA) online information page for parents of Hispanic youth (referred hereafter as NIDA Online Information). To test the effectiveness of eHealth Familias Unidas Primary Care in preventing drug use, unprotected sexual behavior, and STIs in a universal sample of Hispanic youth, this study will randomize 456 Hispanic youth and their parents to eHealth Familias Unidas or to NIDA Online Information. Participants will be assessed at baseline, 6, 12, 24, and 36 months post baseline. Study hypotheses are that: 1) eHealth Familias Unidas will be effective, relative to NIDA Online Information, in preventing/reducing drug use, unprotected sexual behavior, and STI incidence in Hispanic adolescents over time and 2) Intervention effects will be partially mediated by family functioning for drug use and unprotected sexual behavior and by family functioning and unprotected sexual behavior for STI incidence. The cost effectiveness of eHealth Familias Unidas over a three year follow up will also be estimated.