What’s Known On This Subject:
Conduct problems, substance use, substance use problems, and depressive symptoms increase as black adolescents enter high school. Although family-centered prevention programs deter these problems during middle school, no such programs have been developed and evaluated for black high school students.
What This Study Adds:
This study demonstrates that participation in a family-centered preventive intervention reduces conduct problems, substance use, and substance use problems among black adolescents by more than 30% compared with adolescents in an attention control condition across nearly 2 years.
More than 15 million black families live in the rural southern coastal plain that stretches from South Carolina to Louisiana, one of the most economically disadvantaged areas in the United States,1
in which tax bases are low. Consequently, few pediatric mental health, substance use, or prevention services are available in this area.2
Historically, residence in these rural communities has protected black adolescents from developing the levels of conduct problems, depressive symptoms, and substance use problems that are prevalent in urban areas. Epidemiologic data, however, indicate that black adolescents in rural areas now display rates of these problems that equal or exceed those among adolescents in densely populated inner cities.3
These circumstances and the need they produce for prevention programs designed for this population led to the development of the Strong African American Families–Teen (SAAF–T) program; its primary objective is to deter substance use, conduct problems, and depressive symptoms across adolescence. The purpose of this study was to test empirically the efficacy of SAAF–T in preventing increases in conduct problems, substance use, substance use problems, and depressive symptoms among rural black adolescents.
SAAF–T builds on other family-centered intervention programs that have been found to enhance parent and youth competence while inhibiting children’s and preadolescents’ substance use, delinquent activity, and other co-occurring problems among youth in elementary school and middle school.4–6
For broad public health impact, however, family-centered prevention programs must be available for youth at all developmental stages. Unfortunately, no family-centered prevention programs for adolescents have been developed and tested, despite epidemiologic research that highlights the emergence and escalation of substance use, conduct problems, and depressive symptoms around the time of high school entry.7,8
The development of these problems could be addressed with timely intervention. The development and evaluation of SAAF–T was designed to meet the need for family-centered prevention programs for adolescents in general and for black adolescents in particular.
SAAF–T was developed according to the recommendations set forth by the Institute of Medicine8,9
that longitudinal, epidemiologic research with the target population should guide the selection of malleable protective factors—those that can be modified—to be targeted in prevention programs. Data that we gathered from more than 1000 rural black adolescents and their families for more than a decade were used to identify such factors in the adolescents’ immediate family contexts. In this research, we identified powerful caregiving practices that nurtured the development of adolescent self-regulation, achievement orientation, and negative attitudes toward substance use and other risk behaviors. All of these characteristics were negatively associated with the development of problem behaviors across adolescence.10
Protective caregiving practices include setting limits, monitoring adolescents’ whereabouts and knowing their friends, instilling a sense of racial pride, teaching strategies for dealing with discrimination, monitoring and supporting academic achievement, and solving problems cooperatively. These practices, along with the promotion of adolescent self-regulation, were targeted in SAAF–T.
Adolescents and their families were randomly assigned to either SAAF–T or an attention control program. The use of an attention control group is unique in evaluations of the efficacy of family-centered interventions. Typically, control groups in such evaluations receive either no treatment or minimal information; these designs do not control for nonspecific factors, such as social support from intervention trainers and other group members, which arguably could be responsible for observed intervention effects. To provide a more stringent efficacy evaluation, all families, whether assigned to SAAF–T or the attention control condition, attended a 5-session, 10-hour group prevention program. The control program was designed to promote good nutrition, exercise, and informed consumer behavior among adolescents. The attention control program included no content that referred to or provided information about the protective processes targeted in SAAF–T. We hypothesized that adolescents participating in SAAF–T would manifest lower levels of conduct problems, substance use, substance use problems, and depressive symptoms than would those in the attention control condition across the 22 months that separated the pretest and long-term follow-up assessments.