University of Chicago, School of Social Service Administration, Chicago, Illinois.
Global Health Research Center of Central Asia, Almaty, Kazakhstan.
J Adolesc Health. 2018 Sep;63(3):301-312. doi: 10.1016/j.jadohealth.2018.04.005. Epub 2018 Jul 10.
The knowledge-based approach to substance use and HIV prevention, commonly used in Central Asia, does not equip at-risk adolescents with risk reduction skills. This pilot study aims to adapt and test the feasibility and estimate the effect size parameters of a skill-based and family-focused intervention for at-risk adolescents from communities affected by heroin trade and use in Kazakhstan, located on the major drug trafficking route from Afghanistan.
This National Institute on Drug Abuse-funded pilot trial used a mixed-methods approach and included 181 adolescents (ages 14-17) that reported at least one risk factor (e.g., substance-using family members or friends and parental criminal history). In addition to the school-based health education program, intervention-arm adolescent-caregiver dyads received three computerized pilot sessions focusing on risk reduction self-efficacy, resistance to peer pressure, and strengthening of family relationships. Adolescents completed baseline, 3- and 6-month Audio Computer-Assisted Self-Interview surveys in Russian and treatment group adolescents (n = 12) also participated in postintervention focus groups.
Small size effects were observed for youth-level theoretical mediators associated with lower substance use. Compared to the control group, intervention-arm adolescents showed improvement in personal and social competencies such as assertiveness (Cohen's d = .21) and self-esteem (d = .22) at 3 months and increased engagement in prosocial activities at 6 months (d = .41). Adolescents from the intervention group also reported improved self-control skills helping alleviate emotional distress (an increase in anger and tension management d = .30 at 3 months and a reduction in temper d = -.27 at 6 months) along with a lower likelihood of binge drinking at 6 months (odds ratio = .18, p = .023).
In middle-income countries like Kazakhstan, an intervention that utilizes interactive technologies and combines an empirically tested skills-based approach with family involvement may be an engaging, acceptable, and culturally appropriate tool for preventing substance use among at-risk youth.
中亚地区常用的基于知识的物质使用和 HIV 预防方法并未使处于危险中的青少年掌握减少风险的技能。本试点研究旨在调整和测试一种基于技能和以家庭为重点的干预措施的可行性，并估计该措施对哈萨克斯坦受海洛因交易和使用影响社区中处于危险中的青少年的效果大小参数，这些社区位于从阿富汗到主要贩毒路线上。
这项由美国国立药物滥用研究所资助的试点试验采用混合方法，纳入了 181 名（年龄在 14-17 岁之间）报告至少存在一个风险因素（例如，有滥用药物的家庭成员或朋友以及父母的犯罪记录）的青少年。除了学校的健康教育计划外，干预组的青少年和照顾者二人组还接受了三个计算机化的试点课程，重点是增强减少风险的自信、抵制同伴压力以及加强家庭关系。青少年以俄语完成了基线、3 个月和 6 个月的音频计算机辅助自我访谈调查，而干预组的青少年（n=12）还参加了干预后的焦点小组。
与对照组相比，与较低物质使用相关的青少年层面的理论中介变量出现了较小的效果。与对照组相比，干预组的青少年在个人和社交能力方面有所提高，例如自信（Cohen's d=0.21）和自尊（d=0.22）在 3 个月时，在 6 个月时增加了参与亲社会活动（d=0.41）。干预组的青少年还报告说，他们的自我控制技能有所提高，有助于减轻情绪困扰（愤怒和紧张管理的增加 d=0.30，3 个月，脾气的减少 d=0.27，6 个月），同时在 6 个月时暴饮的可能性降低（优势比=0.18，p=0.023）。
在像哈萨克斯坦这样的中等收入国家，利用互动技术并结合经过实证检验的基于技能的方法与家庭参与的干预措施可能是一种引人入胜、可接受且文化适宜的工具，可以预防处于危险中的青少年使用物质。
