Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, 10th Floor (R-669), Miami, FL, 33136, USA.
George Washington University, Washington, DC, USA.
Prev Sci. 2018 Feb;19(Suppl 1):49-59. doi: 10.1007/s11121-016-0666-z.
Prevention programs that strengthen parenting and family functioning have been found to reduce poor behavioral outcomes in adolescents, including substance use, HIV risk, externalizing and internalizing problems. However, there is evidence that not all youth benefit similarly from these programs. Familias Unidas is a family-focused intervention designed to prevent substance use and sexual risk among Hispanic youth and has recently demonstrated unanticipated reductions in internalizing symptoms for some youth. This paper examines variation in intervention response for internalizing symptoms using individual-level data pooled across four distinct Familias Unidas trials: (1) 266 eighth grade students recruited from the general school population; (2) 160 ninth grade students from the general school population; (3) 213 adolescents with conduct, aggression, and/or attention problems; and (4) 242 adolescents with a delinquency history. Causal inference growth mixture modeling suggests a three-class model. The two largest classes represent youth with low (60 %) and medium (27 %) internalizing symptoms at baseline, and both intervention and control participants show reductions in internalizing symptoms. The third class (13 %) represents youth with high levels of baseline internalizing symptoms who remain at steady levels of internalizing symptoms when exposed to the intervention, but who experience an increase in symptoms under the control condition. Female gender, low baseline levels of parent-adolescent communication, and older age were associated with membership in the high-risk class. These synthesis analyses involving a large sample of youth with varying initial risk levels represent a further step toward strengthening our knowledge of preventive intervention response and improving preventive interventions.
预防项目，加强养育和家庭功能，已被发现减少青少年的不良行为结果，包括药物使用、艾滋病毒风险、外化和内化问题。然而，有证据表明，并非所有的年轻人都能从这些项目中获得同样的好处。Familias Unidas 是一个以家庭为中心的干预措施，旨在预防西班牙裔青少年的药物使用和性风险，最近已经证明，一些青少年的内化症状意外减少。本文使用跨四个不同 Familias Unidas 试验的个体水平数据，检查内化症状干预反应的变化：(1) 从一般学校人群中招募的 266 名八年级学生；(2) 来自一般学校人群的 160 名九年级学生；(3) 213 名有行为、攻击和/或注意力问题的青少年；(4) 242 名有犯罪史的青少年。因果推理增长混合建模表明存在一个三类别模型。两个最大的类别代表基线时内化症状低（60%）和中（27%）的青少年，干预组和对照组都表现出内化症状的减少。第三类（13%）代表基线时内化症状水平较高的青少年，他们在接触干预时保持内化症状的稳定水平，但在对照条件下，症状会增加。女性性别、基线时父母与青少年沟通水平低和年龄较大与高风险类别有关。这些涉及具有不同初始风险水平的大量青年的综合分析，进一步加强了我们对预防干预反应的认识，并改善了预防干预措施。
