Main and Moderating Effects of Familias Unidas in Preventing Adolescent Substance Use, HIV Risk Behaviors, and Externalizing Disorders

Introduction: Hispanic adolescents are disproportionately affected by substance use, HIV infection, and  externalizing disorders. Despite these health inequities, few interventions have been found to be efficacious for this population, and even fewer studies have examined whether the effects of such interventions vary as a function of ecodevelopmental and intrapersonal risk subgroups. This study examines the efficacy of Familias Unidas in preventing and reducing substance use, HIV risk behaviors, and externalizing disorders as well as whether and to what extent the effects of Familias Unidas on these outcomes vary as a function of ecodevelopmental and intrapersonal risk subgroups.

Methods: A total of 213 8th grade Hispanic adolescents with behavior problems and their primary caregivers were assigned randomly to one of two conditions: Familias Unidas or Community Control. Participants were assessed at baseline and at 6, 18, and 30 months post baseline. Substance use, HIV sexual risk behavior, and externalizing disorder data were collected from adolescent participants. Growth curve analyses and latent class analyses were conducted to examine main and moderating effects.

Results: Relative to a Community Control condition, Familias Unidas was efficacious in reducing substance use, in reducing unsafe sexual behavior, and in reducing externalizing symptoms. The results also showed that Familias Unidas was efficacious over time, in terms of both externalizing disorders and substance use, for Hispanic youth with high family ecodevelopmental risk (e.g., poor parent-adolescent communication), but not with youth with moderate ecodevelopmental or low ecodevelopmental risk.

Conclusions: The findings demonstrate the Familias Unidas has an overall effect on substance use, HIV sexual risk behaviors, and externalizing disorders. Furthermore, the results suggest that classifying adolescents based on their family ecodevelopmental risk may be an especially effective strategy for examining moderators of family-based preventive interventions such as Familias Unidas. Moreover, these results suggest that Familias Unidas should potentially be targeted towards youth with high family ecodevelopmental risk.