Family-centered Intervention Effectively Reduces Risky Behavior Among Hispanic Youth
Posted by admin
A family-centered program that improves parent-child dynamics and family functioning is more effective at discouraging Hispanic youth from engaging in risky behavior than programs that target specific behaviors, according to a study published in the December 2007 issue of the Journal of Consulting and Clinical Psychology.
Hispanic adolescents are at higher risk for substance abuse and risky sexual behavior than other ethnic groups, according to the U.S. Centers for Disease Control and Prevention. And while they represent 14 percent of the U.S. population, they account for a disproportionate 18 percent of all HIV/AIDS cases in the nation.1
Several types of interventions exist that aim to reduce or prevent risky behavior like substance use and unsafe sexual behavior among non-Hispanic white youth, but no studies have been conducted to determine the relative effectiveness of similar programs targeted to Hispanic youth. Guillermo Prado, Ph.D., of the University of Miami, and colleagues randomly assigned 266 eighth-grade Hispanic youth and their primary caregivers (usually the mother) to one of three interventions:
- Familias Unidas plus Parent-Preadolescent Training for HIV Prevention (PATH)
- English for Speakers of Other Languages (ESOL) plus PATH
- ESOL plus HeartPower for Hispanics, an American Heart Association program
Familias Unidas plus PATH was designed to promote positive adolescent development by increasing parental involvement and teaching more effective parental communication techniques. The program was designed to be more consistent with Hispanic cultural expectations, in which life is family-centered and vital to an individual’s emotional support. PATH is designed to specifically increase parent-adolescent communication about sexual behavior and HIV risks, but it does not target family dynamics specifically. HeartPower for Hispanics is designed to encourage healthier behaviors among Hispanic youth to reduce obesity and heart disease risks.
The interventions were conducted over one year, and researchers followed up with participants at one and two years after the intervention ended. They found that the Familias Unidas plus PATH intervention was much more effective than the other two interventions in reducing cigarette use, and moderately more effective in reducing illicit drug use and unsafe sexual behavior among the adolescents.
“It is noteworthy that Familias Unidas + PATH produced favorable outcomes among the youth, even though most sessions in this group were conducted only with the parents.” said Dr. Prado. “The findings also suggest that targeting specific health behaviors such as cigarette smoking and risky sexual behavior within the context of strengthening the family may be the most effective approach for Hispanic adolescents.”
The majority of Hurricane Katrina survivors who developed mental disorders after the disaster are not receiving the mental health services they need, and many who were receiving mental health care prior to the hurricane were not able to continue with treatment, according to an NIMH-funded study published online ahead of print December 17, 2007, in the American Journal of Psychiatry.
Philip Wang, M.D., Dr.P.H., formerly of Harvard University, and now director of the NIMH Division of Services and Intervention Research, and colleagues conducted telephone surveys in early 2006 with 1,043 adults who had been affected by the hurricane in Alabama, Mississippi and the New Orleans metropolitan area. Respondents were asked if they had a diagnosed mental disorder, such as depression or anxiety, prior to the hurricane for which they received professional treatment. Those who did not have a pre-existing disorder were asked if they had developed and been treated for a mental disorder since the hurricane struck. Treatment included medication and/or psychotherapy from mental health professionals, general medical providers, religious or spiritual advisors, or complementary and alternative medicine professionals.
Nineteen percent of people surveyed said they had developed a mental disorder after the hurricane. Among them, only 18.5 percent were receiving any treatment. Among the 21 percent of respondents who said they had been in treatment for a mental disorder prior to the hurricane, 23 percent were having difficulty maintaining treatment after the storm, and were receiving reduced treatment or no treatment at all.
Respondents with pre-hurricane mental disorders cited loss of financial resources, such as unemployment and loss of insurance, as a significant barrier to maintaining treatment. In addition, they noted that many mental health care facilities and personnel were lost after the hurricane, especially in the New Orleans area. Those who were identified as having a post-hurricane mental disorder commonly indicated they felt no need to seek treatment. The majority of the respondents who did get treatment after the hurricane received it from general medical providers. Many of these respondents received medication, but few had access to psychotherapy.
The researchers note that their study sample likely underrepresented those who were most disadvantaged or ill because people unreachable by phone were excluded. Wang and colleagues conclude that future disaster management plans should anticipate the mental health care needs of people with pre-existing disorders who need to maintain treatment, as well as survivors who may be vulnerable to emotional difficulties and mental disorders triggered by the disaster itself.
Discovery could lead to better medications for depression, other mental illnesses
NIMH-funded scientists have a major new clue as to where the long-pursued binding site for commonly used antidepressants – potentially the site that triggers the medications’ effects – may be on brain cells. The finding could lead to better medications for depression, but also has important implications for other mental illnesses because it addresses a biological flaw that a number of them share.
The flaw involves a molecular mechanism that maintains the balance of key brain chemicals called neurotransmitters. The mechanism acts as a pump by transporting neurotransmitters into brain cells when needed, a process in which correct amount and timing are essential for parts of the brain to communicate with each other. However, the pumps are dysfunctional in depression and some other mental illnesses, including autism and obsessive-compulsive disorder.
Medications called tricyclic antidepressants help offset an imbalance in the neurotransmitters serotonin and norepinephrine by shutting the pumps. This stops the neurotransmitters from flooding back into the brain cells that emit them, making more available to other cells – thus helping to relieve depression. However, it was not known how the medications shut the pumps at the molecular level.
The new study is the first to pinpoint a molecular mechanism that could provide an explanation. Results were published by Satinder Singh, PhD, Atsuko Yamashita, PhD, and Eric Gouaux, PhD, in the August 23 issue of Nature.
Rather than looking at the pump for these neurotransmitters, the researchers used a model in their experiments: a similar pump found in bacteria. Both are in a family of pumps called sodium-coupled transporters. The bacterial pump operates virtually identically to the one in brain cells, but changes in its molecular structure are easier to analyze.
Experiments showed that tricyclic antidepressants latch onto the bacterial pump, changing its molecular structure in a way that effectively plugs it. Could the medications be affecting similar pumps for serotonin and norepinephrine on human brain cells in the same way? The researchers are cautious about drawing a direct comparison; the two kinds of pumps are related, but somewhat different.
But now that scientists know that plugging these kinds of pumps is one way to reduce their activity, researchers may be able to develop medications that target them more directly and efficiently. This could result in more effective antidepressants with fewer side effects. The findings may also extend to development of medications for other mental illnesses in which pump dysfunction plays a role.