1. Pilot Implementation of the “Communities That Care” Prevention System in Brazil -- Florianopolis and São Paulo, Brazil (Collaboration with the University of Santa Catarina and University of São Paulo)
Abstract:
Communities That Care (CTC) is one of the most widely used prevention systems in the world. Based on the public health model, it employs the use of epidemiological assessments of risk and protective factors specific to the target community, as well as surveys of community knowledge, objectives and norms, which serve as the basis for the definition of preventive programs that best suit the identified needs. The field of Community Prevention in Brazil is nascent and has not received much investment despite the extensive implementation of community interventions throughout the country. Therefore, the experience with the CTC may enhance existing prevention initiatives that have been developed for use in Brazil, as well as contribute to the consolidation of Prevention Science in the country.
This project aims to establish the partnership and establish a tripartite collaboration between the Center for Research in Clinical Psychosocial Care (PSICLIN-UFSC), the Center for Research on Health and Substance Use (NEPSIS-UNIFESP), both from Brazil, and the Prevention Education and Research in Latin America (PERLA-UM) group, USA, to execute a research project for the cultural adaptation and implementation of the "Communities That Care" (CTC) Prevention System in two communities in Brazil. Specific elements of the project include:
- Cultural adaptation of CTC evaluation and training materials to Brazilian Portuguese and the Brazilian reality.
- Training of national CTC facilitators, community leaders and coalition members in the selected communities.
- Collection and analysis of community readiness and coalition functioning data.
- Collection of youth risk and protection data (pre-test and post-test using the CTCYS instrument), to be used in the community diagnosis process before the start and at the end of CTC implementation in the selected communities.
- Registering, selecting and implementing evidence-based programs, according to the needs identified in the community diagnosis and the availability of such programs in Brazil.
- Publication of research results and development of the knowledge base for prevention science and prevention policies in Brazil.
2. Development and Implementation of the “Businesses That Care” prevention system in Zacatecas, Mexico (Working with the University Autónoma de Zacatecas)
Abstract
As part of the Global Smart Drinking Goals campaign launched in 2018 in 6 “City Pilots” around the world, the Businesses That Care (BTC; Empresas Que se Cuidan in Spanish) prevention system was developed and implemented in Zacatecas, Mexico. BTC is private business sector adaptation of the Communities That Care prevention system. BTC is designed to address underage alcohol use through a combination of a company-led prevention system, an adapted family-based prevention program with parents employed at participating companies, and environmental prevention strategies for company employees. BTC was designed to be congruent with other health and safety efforts in the region (e.g., media campaign, road safety, and school prevention efforts). This study presents the feasibility and adoption of the BTC system in Zacatecas.
Process implementation measures indicated successful participant recruitment, retention, and adherence to intervention protocols. The first 4 stages of BTC implementation were completed within 14 months, with Stage 5 being interrupted by the COVID-19 pandemic. BTC Prevention Committee members, made up of employees from BTC participating companies, received 9 out of 10 BTC trainings/workshops during this time. Results provide evidence of the acceptability and feasibility for private companies to implement a prevention system approach for reducing youth alcohol use. The project has been extended to run through the end of 2021.
See BusinessesThatCareZacatecaswebsite: https://www.empresasquesecuidan.org/
3. Testing “Tomando Buenas Decisiones:” A Family-based Youth Alcohol Prevention Program in Mexico – Zacatecas, Mexico (Working with the University Autónoma de Zacatecas)
Abstract
Alcohol use represents a global health problem, especially for Latin American youth. As part of the 2015 Global Smart Drinking Goals campaign, we adapted and pilot tested a family preventive intervention in Zacatecas Mexico, called Tomando Buenas Decisiones, which was based on an existing evidence-based program (Guiding Good Choices). This study explored (a) the malleability and session-specific mean level changes in protective and risk factors targeted by the adapted family-based intervention for preventing underage alcohol use and abuse; (b) whether baseline individual, familial, and cultural factors predict participants’ engagement and attendance in the adapted family-based program for preventing underage alcohol use and abuse; and (c) effects of the TBD program on reducing family risk for youth alcohol use through a quasi-experimental design.
The sample consisted of 177 to 268 parents of children between 8 to 16 years, from four private local companies participating in the Businesses That Care prevention system. Data were collected before and after each program session. Linear mixed-effects models were used to examine growth trajectories and session-specific differences of selected etiologic factors. Latent growth curve modelling was used to analyze (a) change in engagement, (b) predictors of engagement, and (c) predictors of attendance. Latent growth curve modeling also was used to analyze the intervention impact on three risk factors and a construct for general family risk at baseline, post-intervention and 3-months post-intervention.
Results showed significant (p < .05) upward trends for protective factors and downward trends for risk factors were found. Among protective factors, clear standards for youth showed the biggest linear increase over time and the biggest immediate session-specific increase. The biggest linear decrease in risk was observed for family conflict, which also showed the biggest pre-post reduction. Results indicated that perceived program engagement had a significant linear increase throughout the intervention. Participants’ perceptions of family as referents and family support at baseline predicted both average engagement and change in engagement; familial obligation also predicted change in engagement. Program attendance was predicted negatively by perceived familial obligations, perceived stress, and poor family management. Additionally, the TBD program was efficacious in reducing past positive attitudes for drug use, family conflict, poor family management, and in reducing general family risk levels, relative to wait-listed controls. No differences between conditions were observed in positive attitudes for drug use at 3-months follow-up (19 weeks after baseline). Overall, the TBD program was efficacious in reducing risk levels for underage drinking in Mexican families from Zacatecas.
Our findings suggested that the adapted program helped families develop protection against, and reduce risk for, alcohol use in their adolescent children. Our findings have important implications for the conceptualization of program engagement and attendance in family-based preventive interventions for underage drinking in Hispanic families. Researchers interested in implementing interventions in Latin America can use these findings to better comprehend how and for whom parent-centered interventions work after their adaptation. Results from this provide support for further evaluation and dissemination of the adapted family-based intervention for Latinx families. Moreover, findings from this project will help inform prevention efforts to reduce youth alcohol use-related harms such as road traffic accidents and domestic violence experienced by Mexican adolescent populations.
4. Community-based Youth Alcohol Prevention in Brasilia – Ceilândia, Brazil (Working with Grupo Tellus International)
Abstract
Our research lab has been working with Grupo Tellus International in the effort to prevention youth alcohol use and misuse in the community of Ceilândia, Brazil. This effort is also part of the 2015 Global Smart Drinking Goals campaign, with Brasilia being one of the six international City Pilots selected for a comprehensive set of prevention initiatives. In partnership with Grupo Tellus and the Corporación Nuevos Rumbos, we support the development, implementation, and analysis of data from the “youth pillar” of this initiative. Three preventive interventions were/are part of this effort: Strengthening Families Program (SFP), Brief Intervention through Motivational Interviewing (BIMI), and a new social-skills based program currently under development by Grupo Tellus. Unfortunately, implementation and evaluation of these interventions were interrupted by the COVID-19 pandemic, with resumption planned for 2021.
5. Measuring Perceptions of Family and Community Risk from Youth and Their Parents – Bogota, Colombia (Working with Corporación Nuevos Rumbos).
Abstract
The “community diagnostic model” (Feinberg, 2021) suggests that epidemiological surveys of risk and protective factors can be used to assess the needs for tailored prevention programming in a community. Several community-based prevention systems (e.g., Communities That Care) using this model as a guide in determining the domains for preventive intervention (e.g. school, workplace, family, peers) and the specific programs that should be implemented in these domains. To date, however, this process has relied exclusively on youth reports of risk and protective factors. While youth certainly have a unique perspective on risk and protection for adverse health outcomes such as alcohol, tobacco, and other drug use; parents may have a different picture of risk and protection—especially as they relate to family, workplace, and community domains.
In this project, we collect pilot data to assess the correspondence (convergent and discriminant validity) of risk and protective factors that are commonly used as diagnostic data for prevention programming, from both youths and their parents. The degree to which risk and protective factor measures provide overlapping and unique information is currently unknown and is highly important to community prevention science. This is especially true in prevention systems that focus on both adult and youth populations as in the case of the Businesses that Care Model. We are collaborating with our research partners at the Corporación Nuevos Rumbos in Bogotá, Colombia, which is the next anticipated site for implementation of the BTC model, and collect data on a target sample of 500 child-parent dyads of approximately 12 validated risk and protective factors from both youth between the ages of 12 and 17, and their parents. The statistical approach will consist of a dyadic confirmatory factor analyses that will indicate the degree of shared and unique variance between the two raters. These findings will provide preliminary data for future grant applications to do similar (but larger) studies of this type in the United States and elsewhere.
6. Identifying Youth Alcohol, Tobacco, and Other Drug Prevention Programs in Latin America and the Caribbean – (Funded by the Organization of American States – Inter-American Drug Control Commission)
Abstract
Consistently high rates of alcohol, tobacco, and other drug (ATOD) use by youth in Latin American and the Caribbean have called for the identification and proliferation of preventive interventions in the region to address the growing threat to the region’s public health. In response, the Organization of American States’ Inter-American Drug Abuse Control Commission (CICAD) contracted with the PERLA lab to do a systematic scoping review of the literature and data collection effort through key informant interviews with prevention leaders throughout the Americas to identify active preventive interventions (i.e., programs, strategies/practices, and implementation/community mobilization systems) that address youth and young adults (ages 6 to 21) ATOD use in Latin America and the Caribbean (LAC).
From an original pool of 6,685 peer-reviewed published articles in English, French, Spanish, or Brazilian Portuguese that met a comprehensive search criteria in one of multiple literature platforms. Despite the large number of articles that met the initial search criteria, only 22 articles contained information on youth ATOD preventive interventions with 18 unique youth ATOD preventive interventions being used across 25 LAC countries and overseas territories.
Key informant surveys with 32 LAC prevention leaders in the field relied on existing prevention science related professional networks and a “snowball” sampling approach to identify additional youth ATOD preventive interventions that were in use throughout the region but not yet disseminated or, at best, were residing in the “grey literature.” Results of the key informant surveys yielded an additional 31 youth ATOD preventive interventions, across 29 LAC countries.
Results of the combined strategies for identifying youth ATOD preventive interventions yielded a total registry of 55 unique youth ATOD preventive interventions currently available for use (n=17 from the scoping literature review, n=31 from the key informant interviews, and n=7 interventions that are pending interviews). Thirty-five interventions were developed locally in Latin America and the Caribbean, and 20 were adapted from European or US-developed interventions. The majority of the interventions either adopted a universal prevention approach (n=30) or a health promotion approach (n=22). In terms of setting, most were implemented in schools (n=36) or in the community (n=17), one of which was implemented in both. Twenty-eight interventions used a pretest-posttest design to assess effects, 6 of which were experimental and 10 quasi-experimental.
Results of this investigation indicate a paradox between the availability of youth ATOD preventive interventions and data that suggest that rates of ATOD use have not changed (and even have increased) in LACs. Our findings call into question the efficacy of the interventions and the attention to implementation fidelity of interventions that moderate the interventions’ ability to effect behavioral change. The changing panorama of ATOD availability and use among youth (e.g., from traditional alcohol use to pre-mixed caffeinated alcoholic beverage use; from traditional cigarette use to e-cigarette use, hookah use, and vaping; and with the expansion of legal recreational marijuana use) calls for immediate attention to these questions; specifically with regard to existing deficits in prevention science knowledge, funding for prevention efforts, and maximal dissemination of available preventive interventions throughout the region. To this end, this project provides a thorough review of available preventive interventions with the caveat that the number and types of preventive interventions are constantly in flux and updates are continuously warranted.
