Effects of a Preventive Intervention for Mexican Origin Adolescents

描述(由申请人提供)：该项目是对516名墨西哥裔(MO)青少年及其照顾者的跟踪调查，这些青少年和他们的照顾者在7年级参与了一项名为Bridges to High School Program/Puentes a la Secundaria(Puentes)的实验试验。Puentes是一种文化上有能力的、以家庭为重点的干预措施，以几个假定的调解人为目标，基于经验证据，这些调解人解释了MO青年在心理健康和物质使用障碍方面的显著差异。从4所中学的学校花名册中招募家庭，接受为期9周的普恩特斯计划或1节控制组研讨会。分层招募被用来为该项目的不同英语和西班牙语版本随机选择样本。该计划是以高水平的保真度实施的，多报告评估被用于后测和一年计划效果(8年级)。作为近端调节因素的个人和家庭能力以及一些远端调节因素，包括物质使用、学校行为混乱和父母报告内化和外化行为，假设用于预测高中后期和成年初生(EA)诊断的障碍的长期计划效果，都发现了积极的后测效应。方案效果受到基线功能水平的影响，表明对在基线水平上功能较差的青少年和家庭的影响普遍较强，并受到语言的影响，表明在家庭文化适应的基础上存在不同的影响。测验后近端调节因子的变化导致8年级物质使用、偏离同伴联系、内化和外化显著减少。目前的申请建议在5年和7年后进行两次评估，以解决以下具体目标：1)检查普恩特斯对心理健康和物质使用轨迹和障碍的影响；2)检查普恩特斯对危险行为(例如，危险的性行为、辍学)和EA适应功能成功的影响；3)检查计划效果是否由干预目标的假定中介因素调节；以及4)检查计划效果是否受到基线风险水平、青少年性别和家庭语言适应水平的影响。将使用协方差分析、混合模型方差分析、Logistic回归和潜在增长曲线建模来检验目标。这项拟议的继续研究通过测试在青春期早期提供的以家庭为中心的干预措施是否可以预防高中后期和成年初期的精神健康和物质使用障碍，从而解决了预防科学和健康差距研究中的重大差距，这些障碍对美国的MOS具有重大的公共卫生负担。拟议的研究具有重要的公共卫生意义，并与2010年健康人目标、消除少数族裔健康差距的目标(DHHS，2005)以及NIMH制定文化上适当和有效的预防干预措施的优先事项(NIMH，1998)相一致。

DESCRIPTION (provided by applicant): The proposed project is a follow-up of 516 Mexican origin (MO) adolescents and their caregivers who participated in an experimental trial of the Bridges to High School Program / Puentes a la Secundaria (Puentes) in 7th grade. Puentes is a culturally competent, family-focused intervention that targeted several putative mediators based on empirical evidence that they account for significant disparities in mental health and substance use disorders for MO youth. Families were recruited from school rosters at 4 middle schools to receive the 9-week Puentes program or a 1-session control group workshop. Stratified recruitment was used to select random samples for separate English and Spanish versions of the program. The program was implemented with high levels of fidelity and multiple-reporter assessments were used to posttest and one-year program effects (8th grade). Positive posttest effects were found for each of the individual and family competencies targeted as proximal mediators and for a number of distal mediators, including substance use, school disorderly conduct, and parent report of internalizing and externalizing behaviors, hypothesized to predict long-term program effects on diagnosed disorders in late high school and emerging adulthood (EA). Program effects were moderated by baseline levels of functioning indicating generally stronger effects for adolescents and families with worse functioning at baseline, and by language, indicating differential effects on the basis of family acculturation. Posttest changes on proximal mediators led to significant reductions in substance use, deviant peer association, internalizing and externalizing in 8th grade. The current application proposes two assessments at 5 and 7 years posttest to address the following specific aims: 1) Examine Puentes effects on mental health and substance use trajectories and disorders; 2) Examine Puentes effects on risky behaviors (e.g., risky sexual behavior, school dropout) and success in EA adaptive functioning; 3) Examine whether program effects are mediated by the putative mediators targeted in the intervention; and 4) Examine whether program effects are moderated by baseline levels of risk, adolescent gender, and family linguistic acculturation. Analysis of covariance, mixed-model analysis of variance, logistic regression and latent growth curve modeling will be used to test the aims. The proposed continuation addresses a significant gap in prevention science and health disparities research by testing whether a family-focused intervention delivered in early adolescence can prevent mental health and substance use disorders in late high school and emerging adulthood that have significant public health burden for MOs in the U.S. The proposed research has important public health significance and is consistent with the goal of Healthy People 2010, to eliminate minority health disparities (DHHS, 2005) and with NIMH priorities to develop culturally appropriate and effective preventive interventions (NIMH, 1998).