A family-centered group program for African-American teens living in rural communities that fosters skills for parenting, strengthens family relationships, and helps youth develop the self-regulation needed to respond effectively to risks of substance use and unsafe sexual behavior.
Blueprints: Promising
Gregory Rhodes, EdD
SAAF Programs Dissemination Specialist
Phone: 706-248-8422
Email: gdrhodes@uga.edu
Tracy N. Anderson, PhD
Assistant Director
Email: tnander@uga.edu
The Center for Family Research
University of Georgia
1095 College Station Road
Athens, GA 30602-4527
Website: www.cfr.uga.edu
Gene H. Brody, PhD, Retired
University of Georgia
The Strong African American Families - Teen (SAAF-T) intervention is a preventive intervention for African-American teens living in rural communities and entering high school. It integrates individual youth skills building, parenting skills training, and family interaction training. SAAF-T involves five group sessions using DVDs where narrators address specific content and actors present family scenarios depicting program-targeted interactions and behaviors. Each meeting includes separate one-hour concurrent training for caregivers and youth, followed by a one-hour conjoint session during which families practice the skills they learned in their separate sessions. The program provides parents and youth with skills that nurture adolescent self-regulation, achievement orientation, and negative attitudes toward substance use and other risk behaviors. The program is interactive involving role-playing activities, guided discussions, and question answering.
The Strong African American Families - Teen (SAAF-T) intervention is a preventive intervention for African-American teens living in rural communities and entering high school. It integrates individual youth skills building, parenting skills training, and family interaction training. SAAF-T involves five group sessions using DVDs where narrators address specific content and actors present family scenarios depicting program-targeted interactions and behaviors. Each meeting includes separate one-hour concurrent training for caregivers and youth, followed by a one-hour conjoint session during which families practice the skills they learned in their separate sessions. The program provides parents and youth with skills that nurture adolescent self-regulation, achievement orientation, and negative attitudes toward substance use and other risk behaviors. The program is interactive involving role-playing activities, guided discussions, and question answering.
More specifically, caregivers are taught consistent use of monitoring and control practices, adaptive racial socialization approaches (including guidance for dealing with discrimination), approaches to communicate expectations about risky behaviors including substance use and sexual involvement, establishment of norms around provision of academic support, and cooperative caregiver-adolescent problem solving. Adolescents are taught the importance of academic success, goal formation, strategies to counteract racism, resisting peer pressure, and strategies to attain educational and occupational goals.
The fourth session includes a sexual health focus adapted from the "Sisters Informing Healing Living and Empowering" program for African American adolescent women. This session provides general sexual health information and skills for abstaining from sexual activity. The caregiver sessions address communication about risk behavior and common misconceptions regarding condom education. After session 4, there is an optional, with parent consent only, mini session. In this 30-minute session, the teens learn skills for talking to their partner about using condoms, they see a video-based demonstration of condom skills and have the opportunity to learn how to correctly use a condom by placing a condom on a penis model (this occurs in gender-segregated groups).
Primary Evidence Base for Certification
Study 1
Brody et al. (2012), Kogan, Brody et al. (2012), Kogan, Yu et al. (2012), and Ingels et al. (2013) found that, relative to the control group, the program significantly improved self-reported youth:
Risk and protective factors:
Primary Evidence Base for Certification
The one study Blueprints has reviewed meets Blueprints evidentiary standards (specificity, evaluation quality, impact, dissemination readiness). The study was done by the developer.
Study 1
Brody et al. (2012), Kogan, Brody et al. (2012), Kogan, Yu et al. (2012), and Ingels et al. (2013) conducted a randomized controlled trial to examine 502 African American families with a youth aged 15-16 and residing in six rural counties in Georgia. The families were randomized to intervention and control groups. Assessment of self-reported parent management skills occurred at pretest and posttest (two months after the intervention ended), and assessment of self-reported youth outcomes occurred at pretest and an average of 22 months after baseline.
Study 1
Brody, G. H., Chen, Y., Kogan, S. M., Yu, T., Molgaard, V. K., DiClemente, R. J., & Wingood, G. M. (2012). Family-centered program deters substance use, conduct problems, and depressive symptoms in black adolescents. Pediatrics, 129, 108-115.
Individual: Favorable attitudes towards antisocial behavior, Favorable attitudes towards drug use
Family: Parental attitudes favorable to antisocial behavior, Parental attitudes favorable to drug use, Poor family management*, Unplanned pregnancy
Individual: Problem solving skills, Prosocial involvement
Peer: Interaction with prosocial peers
Family: Attachment to parents, Opportunities for prosocial involvement with parents, Parental involvement in education, Parent social support
*
Risk/Protective Factor was significantly impacted by the program
See also: Strong African American Families - Teen Logic Model (PDF)
Subgroup differences in program effects by race, ethnicity, or gender (coded in binary terms as male/female) or program effects for a sample of a specific racial, ethnic, or gender group:
Study 1 (Brody et al., 2012; Kogan, Brody et al., 2012; Kogan, Yu et al., 2012; Ingels et al., 2013) tested for subgroup effects by using a homogenous sample of all African American youth. In addition, Kogan, Yu et al. (2012) tested for subgroup effects by gender and found equal benefits for males and females.
Sample demographics including race, ethnicity, and gender for Blueprints-certified studies:
Study 1 (Brody et al., 2012; Kogan, Brody et al., 2012; Kogan, Yu et al., 2012; Ingels et al., 2013) examined a sample consisting of self-identified African Americans (55.8% girls).
Training for the Strong African American Families - Teen (SAAF-T) program includes three full days of in-depth training on the SAAF-T curriculum. During the three-day period, facilitators are trained on 24 hours of program content via curriculum review, role plays and open discussion regarding the applicability of program content to the local community. The third day of training requires that training participants present an assigned segment of the curriculum to the group as though implementing those activities with families. Facilitators must complete the full three-day training, in order to become a certified SAAF-T Facilitator. Technical assistance is available during all phases of program adoption (e.g., organizing the training) and implementation (e.g., recruitment, evaluation) to ensure program success.
The Strong African American Families Teen (SAAF-T) Training and Program Package, which includes the initial training and curriculum, costs $8,000 for up to 30 trainees. The cost includes the 3-day training, 2 sets of the SAAF-T Program DVDs, electronic files of the curriculum materials and curriculum manuals, plus one complete set of printed materials for the first implementation, resource materials and technical assistance. Travel for two SAAF-T trainers are estimated at $2,662.
The CFR Dissemination Office has developed a process by which Certified SAAF-T Facilitators who meet certain criteria and requirements can participate in a training that will allow them to become a Certified Agency Trainer. The Certified Agency Trainer is limited to providing the SAAF-T training to individuals within their own agency. They are not authorized to train individuals from other agencies or SAAF Sites. The cost associated with this training is $1500 for the first person and $500 for each additional person. Contact CFR for further information.
Certified Agency Trainer
A viable candidate for Agency Trainer is a Certified SAAF-T Facilitator who meets the following minimum criteria:
Program Benefits (per individual):
$1,709
Program Costs (per individual):
$562
Net Present Value (Benefits minus Costs, per individual):
$1,147
Measured Risk (odds of a positive Net Present Value):
59%
Source: Washington State Institute for Public Policy
All benefit-cost ratios are the most recent estimates published by The Washington State Institute for Public Policy for Blueprint programs implemented in Washington State. These ratios are based on a) meta-analysis estimates of effect size and b) monetized benefits and calculated costs for programs as delivered in the State of Washington. Caution is recommended in applying these estimates of the benefit-cost ratio to any other state or local area. They are provided as an illustration of the benefit-cost ratio found in one specific state. When feasible, local costs and monetized benefits should be used to calculate expected local benefit-cost ratios. The formula for this calculation can be found on the WSIPP website.
The Strong African American Families Teen (SAAF-T) Training and Program Package, which includes the initial training and curriculum, costs $8,000 for up to 30 trainees. The package includes the 3-day training, 2 sets of the SAAF-T Program DVDs, electronic files of the curriculum materials and curriculum manuals, plus one complete set of printed materials for the first implementation, resource materials and technical assistance.
Travel expenses for two trainers are estimated at $2,662 and will vary by location of training.
Agencies may host the training at their site or opt to rent a space which will be needed from 7:15 a.m. to 5:30 p.m. on training days. Rental fees should be considered for the 3-day training. Ideally trainers have access to set up the training space the afternoon before training begins.
Note: The ideal training space can accommodate up to 30 training participants and 2 trainers. Preferably, the room can be arranged in a U-shape with chairs and tables. Trainers will need access to equipment to show program DVDs and a PowerPoint presentation each day of the training.
Curriculum: Included in the SAAF-T Program Package
Materials: $200 for supplemental materials (e.g., scissors, glue sticks, markers, etc.)
Included in the SAAF-T Program Package.
Ensure funding is available for program needs (e.g., incentives, childcare, meals/refreshments and payments/honoraria for facilitators) as allowed by the funding source.
Consumable curriculum and supplemental materials: $100 per implementation
Agencies should have a SAAF-T Site Coordinator who is responsible for coordinating the implementation of the program. Agencies need to consider if a portion of the staff member's salary should be supplemented by funds designated for the SAAF-T program implementation.
It is recommended that a team of 3 facilitators implement each program session. Two facilitators work together to implement the teen session and one facilitator works with the caregivers. All 3 then work together to implement the family session. A minimum of 2 facilitators are needed to conduct teen, caregiver and then family sessions.
SAAF-T group facilitators are paid between $15 and $20 per hour for running the 5 sessions for 12 families per program implementation. Each weekly session requires 6 hours for preparation, set-up, participation in the meal, the program, and clean-up. Travel time is not included.
Additionally, materials prep is a time-intensive part of preparing to implement the program. Agencies may want to consider compensation for part-time or full-time staff to help with getting materials ready.
Transportation: Agencies may offer transportation to families who attend the program sessions. CFR recommends a budget of $30.00 per session per family although it is likely that not all families will need transportation. If agencies are able to provide the transportation directly rather than contracting with someone else that will also be a cost saving.
Facility: As a standard practice, organizations are likely to consider convenience and accessibility for program participants when selecting a program facility to implement SAAF-T. Another consideration for implementation is the actual space within the facility. At minimum, the facility should have two rooms so that the Caregiver and Teen Sessions can run concurrently. Additionally, one of the rooms should be large enough to accommodate the Family Session - when caregivers and teens come together for activities. As a rule of thumb, during the concurrent sessions, the Teens should use the larger room to accommodate the activities that require more space. Note: If organizations are able to provide childcare, the facility should have a separate and secure space to accommodate this service.
If the adopting agency needs to consider renting a space, local agencies such as recreation departments, senior centers, churches and other community organizations could be contacted. Ideally agencies can find a place to host the program for little or no cost.
Recruitment: Some funding should be designated for the recruitment of families to the program to pay for any mailings or flyers that are created to help promote the program among community members and community partners.
Retention: Agencies may want to consider funding for retention efforts to compensate staff who might oversee these efforts or to pay for any reminder mailings or other contacts (e.g., text messages and emails) to keep families engaged throughout the 5-session program.
Technical assistance is included in the program fee.
Assessing fidelity is done by having an observer(s) watch the SAAF-T session and code the adherence by using the corresponding fidelity forms. The most common procedure for assessing fidelity is having the observer visit a session and rate fidelity based on in-session observations. Another option, if resources are available, is to record the sessions and have the observer rate the session by watching the video recording.
Agencies should consider compensation for program staff who complete the fidelity process.
No information is available
No information is available
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For this example, an organization uses an existing staff person to coordinate the SAAF-T program but hires program facilitators. In the first year, the program is implemented 4 times with each implementation including 12 families. Meals, childcare, and transportation are provided. Space is provided by the sponsoring organization at no added cost. The following costs can be projected for this example:
| Training and Program Package | $8,000.00 |
| Trainer Travel | $2,662.00 |
| Facilitators - 3 x $20/hr x 6 hr/session x 5 sessions/round x 4 rounds | $7,200.00 |
| Supplies and Printing Materials - Initial and 3 replacement | $500.00 |
| Meals - $20/person x 2 person/family x 12 families x 5 sessions/round x 4 rounds | $9,600.00 |
| Childcare - $30/session x 5 sessions/round x 4 rounds | $600.00 |
| Transportation - $30/session/family x 12 families x 5 sessions/round x 4 rounds | $7,200.00 |
| Incentives - $20/family x 12 families/round x 4 rounds | $960.00 |
| Total One Year Cost | $36,722.00 |
In the first year, with 4 rounds of implementation, 48 families are served by the SAAF-T program. Thus the total Year 1 cost is $36,772 or $765.04 per family.
The above provisions are highly recommended for program success; however, an agency may consider cost reductions by reducing meal expenses, omitting childcare, transportation or incentives, or using existing staff for facilitation.
No information is available
Prevention programs such as SAAF-T can potentially be supported through state or local funding streams dedicated to prevention (e.g., the Pennsylvania Commission on Crime and Delinquency). Sin taxes, such as those that target alcohol and tobacco use, have been established by some states to support tobacco and substance abuse prevention programs (e.g., Senate Bill 94 in Colorado).
Formula Funds:
Substance Abuse and Mental Health Block Grants - mandated by Congress, SAMHSA's block grants are non-competitive grants that provide funding for substance abuse and mental health services.
Office of Juvenile Justice and Delinquency Prevention (OJJDP) Formula Funds support a variety of delinquency prevention programs in states. Evidence-based programs are an explicit priority for these funds, which are awarded competitively by state agencies to community based programs.
Discretionary Grants: Federal discretionary grants from the SAMHSA and OJJDP may be available to support SAAF-T. In addition, relevant discretionary grants include grants focused on pregnancy prevention that are administered by the Department of Health and Human Services Office of Adolescent Health (OAH) and Family and Youth Services Bureau (FYSB); and the Centers for Disease Control grants for replication of evidence-based programs for teen pregnancy prevention.
Entitlement Funds: The Children's Bureau (an Office of the Administration for Children and Families in the U.S. Department of Health and Human Services) uses a competitive peer review process to award discretionary grants for research and program development to state, tribal and local agencies; faith- and community-based organizations; and other non-profit groups.
Foundations, particularly those with a focus on pregnancy and substance abuse prevention can be a good source of funding for SAAF-T. Foundations with a particular interest in investing in African American communities and those who are interested in evidence-based interventions should also be considered.
Interested organizations may consider community fundraising and partnership with the faith-based community, local businesses and civic organizations as a means of raising dollars to support the initial training and curriculum purchases.
Possible in-kind support from local businesses include meals/refreshments, space for implementation, the provision of childcare or transportation, or gift cards/door prizes as incentives for participants.
Gene H. Brody, PhD, RetiredUniversity of Georgia
A family-centered group program for African-American teens living in rural communities that fosters skills for parenting, strengthens family relationships, and helps youth develop the self-regulation needed to respond effectively to risks of substance use and unsafe sexual behavior.
African American adolescents living in rural areas and entering high school, ages 14-16.
Subgroup differences in program effects by race, ethnicity, or gender (coded in binary terms as male/female) or program effects for a sample of a specific racial, ethnic, or gender group:
Study 1 (Brody et al., 2012; Kogan, Brody et al., 2012; Kogan, Yu et al., 2012; Ingels et al., 2013) tested for subgroup effects by using a homogenous sample of all African American youth. In addition, Kogan, Yu et al. (2012) tested for subgroup effects by gender and found equal benefits for males and females.
Sample demographics including race, ethnicity, and gender for Blueprints-certified studies:
Study 1 (Brody et al., 2012; Kogan, Brody et al., 2012; Kogan, Yu et al., 2012; Ingels et al., 2013) examined a sample consisting of self-identified African Americans (55.8% girls).
Individual: Favorable attitudes towards antisocial behavior, Favorable attitudes towards drug use
Family: Parental attitudes favorable to antisocial behavior, Parental attitudes favorable to drug use, Poor family management*, Unplanned pregnancy
Individual: Problem solving skills, Prosocial involvement
Peer: Interaction with prosocial peers
Family: Attachment to parents, Opportunities for prosocial involvement with parents, Parental involvement in education, Parent social support
*Risk/Protective Factor was significantly impacted by the program
The Strong African American Families - Teen (SAAF-T) intervention is a preventive intervention for African-American teens living in rural communities and entering high school. It integrates individual youth skills building, parenting skills training, and family interaction training. SAAF-T involves five group sessions using DVDs where narrators address specific content and actors present family scenarios depicting program-targeted interactions and behaviors. Each meeting includes separate one-hour concurrent training for caregivers and youth, followed by a one-hour conjoint session during which families practice the skills they learned in their separate sessions. The program provides parents and youth with skills that nurture adolescent self-regulation, achievement orientation, and negative attitudes toward substance use and other risk behaviors. The program is interactive involving role-playing activities, guided discussions, and question answering.
The Strong African American Families - Teen (SAAF-T) intervention is a preventive intervention for African-American teens living in rural communities and entering high school. It integrates individual youth skills building, parenting skills training, and family interaction training. SAAF-T involves five group sessions using DVDs where narrators address specific content and actors present family scenarios depicting program-targeted interactions and behaviors. Each meeting includes separate one-hour concurrent training for caregivers and youth, followed by a one-hour conjoint session during which families practice the skills they learned in their separate sessions. The program provides parents and youth with skills that nurture adolescent self-regulation, achievement orientation, and negative attitudes toward substance use and other risk behaviors. The program is interactive involving role-playing activities, guided discussions, and question answering.
More specifically, caregivers are taught consistent use of monitoring and control practices, adaptive racial socialization approaches (including guidance for dealing with discrimination), approaches to communicate expectations about risky behaviors including substance use and sexual involvement, establishment of norms around provision of academic support, and cooperative caregiver-adolescent problem solving. Adolescents are taught the importance of academic success, goal formation, strategies to counteract racism, resisting peer pressure, and strategies to attain educational and occupational goals.
The fourth session includes a sexual health focus adapted from the "Sisters Informing Healing Living and Empowering" program for African American adolescent women. This session provides general sexual health information and skills for abstaining from sexual activity. The caregiver sessions address communication about risk behavior and common misconceptions regarding condom education. After session 4, there is an optional, with parent consent only, mini session. In this 30-minute session, the teens learn skills for talking to their partner about using condoms, they see a video-based demonstration of condom skills and have the opportunity to learn how to correctly use a condom by placing a condom on a penis model (this occurs in gender-segregated groups).
The basic premise of the SAAF-T program is that regulated, communicative home environments are characterized by four practices: involved-vigilant parenting (high levels of monitoring and control as well as high levels of emotional and instrumental support); parental communication about risky behaviors including expectations for substance use and sexual involvement (this creates a parent-child relationship that promotes discussions about these types of issues); communication about sex (provides information to the youth and promotes the youths' internalization of their parents' norms regarding sexual behavior) and racial socialization (included as previous research suggests that racism contributes to substance use and compromises psychological functioning among African American youth). The theories relevant to the SAAF-T program are social control theory; social development theory; problem behavior theory; the prototype/willingness model of adolescent risk behavior and self-control theory.
Primary Evidence Base for Certification
The one study Blueprints has reviewed meets Blueprints evidentiary standards (specificity, evaluation quality, impact, dissemination readiness). The study was done by the developer.
Study 1
Brody et al. (2012), Kogan, Brody et al. (2012), Kogan, Yu et al. (2012), and Ingels et al. (2013) conducted a randomized controlled trial to examine 502 African American families with a youth aged 15-16 and residing in six rural counties in Georgia. The families were randomized to intervention and control groups. Assessment of self-reported parent management skills occurred at pretest and posttest (two months after the intervention ended), and assessment of self-reported youth outcomes occurred at pretest and an average of 22 months after baseline.
Primary Evidence Base for Certification
Study 1
Brody et al. (2012), Kogan, Brody et al. (2012), Kogan, Yu et al. (2012), and Ingels et al. (2013) found a small but significant beneficial program effect on parent-reported family management skills at posttest relative to the control group. The program also had significant effects on the frequency of self-reported conduct problems, substance use, substance use problems, alcohol use, and depression. For the subsample attending the optional session on sexual health, the program significantly reduced unprotected intercourse and condom efficacy.
Primary Evidence Base for Certification
Study 1
Brody et al. (2012), Kogan, Brody et al. (2012), Kogan, Yu et al. (2012), and Ingels et al. (2013) found that, relative to the control group, the program significantly improved self-reported youth:
Risk and protective factors:
Study 1 (Brody et al., 2012; Kogan, Brody et al., 2012; Kogan, Yu et al., 2012; Ingels et al., 2013) reported a small effect size for parent management skills (beta = .10).
One study meets Blueprints standards for high-quality methods with strong evidence of program impact (i.e., "certified" by Blueprints): Study 1 (Brody et al., 2012; Kogan, Brody et al., 2012; Kogan, Yu et al., 2012; Ingels et al., 2013). The sample for the study included African American youths aged 15-16.
Study 1 took place in six rural counties in Georgia and compared the treatment group to an alternate-treatment control group.
As an upstream preventive intervention, this program targets and reduces problem behaviors that are associated with increased risk of developing substance use disorder or opioid use disorder later in life.
Blueprints: Promising
Gregory Rhodes, EdD
SAAF Programs Dissemination Specialist
Phone: 706-248-8422
Email: gdrhodes@uga.edu
Tracy N. Anderson, PhD
Assistant Director
Email: tnander@uga.edu
The Center for Family Research
University of Georgia
1095 College Station Road
Athens, GA 30602-4527
Website: www.cfr.uga.edu
Certified Brody, G. H., Chen, Y., Kogan, S. M., Yu, T., Molgaard, V. K., DiClemente, R. J., & Wingood, G. M. (2012). Family-centered program deters substance use, conduct problems, and depressive symptoms in black adolescents. Pediatrics, 129, 108-115.
Kogan, S. M., Brody, G. H., Molgaard, V. K., Grange, C. M., Oliver, D. A. H., Anderson, T. N., . . . Sperr, M. C. (2012). The Strong African American Families-Teen trial: Rationale, design, engagement processes, and family-specific effects. Prevention Science, 13, 206-217.
Kogan, S. M., Yu, T., Brody, G. H., Chen, Y., DiClemente, R. J., Wingood, G. M., & Corso, P. S. (2012). Integrating condom skills into family-centered prevention: Efficacy of the Strong African American Families-Teen program. Journal of Adolescent Health, 51, 164-170.
Ingels, J. B., Corso, P. S., Kogan, S. M., & Brody, G. H. (2013). Cost-effectiveness of the Strong African American Families-Teen program: 1-year follow-up. Drug and Alcohol Dependence, 133(2), 556-561. doi:10.1016/j.drugalcdep.2013.07.036
Summary
Brody et al. (2012), Kogan, Brody et al. (2012), Kogan, Yu et al. (2012), and Ingels et al. (2013) conducted a randomized controlled trial to examine 502 African American families with a youth aged 15-16 and residing in six rural counties in Georgia. The families were randomized to intervention and control groups. Assessment of self-reported parent management skills occurred at pretest and posttest (two months after the intervention ended), and assessment of self-reported youth outcomes occurred at pretest and an average of 22 months after baseline.
Brody et al. (2012), Kogan, Brody et al. (2012), Kogan, Yu et al. (2012), and Ingels et al. (2013) found that, relative to the control group, the program significantly improved self-reported youth:
Risk and protective factors:
Evaluation Methodology
Design:
Recruitment: Participating families residing in six rural counties in Georgia were recruited from lists of 10th graders provided by public high schools. Eligibility requirements included having a youth aged 15-16 and self-identification as African American. Of the 692 families screened, 632 (91%) were eligible to participate and 502 (79%) of those eligible agreed to take part in the study. The statement (Kogan, Brody et al., 2012, p. 211) that "refusal rates were similar across conditions" implies consent came after assignment to conditions, but the participant flow diagram shows assignment after agreement to participate. Data collection began in 2007 and ended in February 2010.
Assignment: The study randomly assigned the 502 families to the intervention (N = 252) and control (N = 250) groups. The control group consisted of an alternative treatment call Fuel for Families, which was identical to SAAF-T in duration, format, and use of videotaped presentations and interactive components. The control treatment, however, focused on health promotion topics that, unlike the intervention, did not include content about substance use or sexual risk reduction and did not target family relationships. The design thus controlled for non-specific attention factors that can influence outcomes.
Attrition: Families provided data at pretest, 5-month posttest administered 2 months after the intervention ended, and 22-month (on average) follow-up (about 1.5 years after the program ended). Of the 502 randomized families, 482 (96%) completed the posttest (Kogan, Brody et al., 2012), and 478 (95%) completed the long-term follow-up (Brody et al., 2012). Ingels et al. (2013) included 473 participants (94%) "who completed baseline and follow-up assessments."
Sample: The mean age was 16.0 years for the youth and 43.1 for the primary caregivers. In 55.8% of the families, the target youth was a girl. Single mothers headed 55.5% of the families. A majority of the primary caregivers, 74.6%, had completed high school or earned a GED; 25.4% did not complete high school. With mean household monthly gross income of $1,482, approximately 64% of study families lived below the poverty threshold. They had an average of 2.5 children. As most caregivers worked, they can be described as working poor.
Measures: Self-report questionnaires were administered at posttest to a primary caregiver and the target youth via audio computer-assisted self-interviewing technology on laptop computers. Researchers assisting in data collection were blind to condition.
The posttest study (Kogan, Brody et al., 2012) measured parent-reported protective family management skills as a single latent construct with four component scales:
The follow-up study of youth (Brody et al., 2012) measured four self-reported outcomes. The measures had been used previously, but the study reported little information on validity or reliability.
In the study of sexual risk behavior, Kogan, Yu et al. (2012) examined unprotected intercourse and condom efficacy. Youth reported the number of times they had sexual intercourse during the past 3 months and the number of times condoms were used. Subtracting protected episodes from total episodes yielded a count of unprotected episodes. Condom efficacy was assessed using a 6-item scale (e.g., "How much of a problem would it be for you to unroll a condom down correctly on the first try?"), with Cronbach's alpha ranging from .87 to .90.
Ingels et al. (2013) measured two outcomes over the previous three months: the number of times having consumed at least one drink of alcohol and the number of times having consumed three or more drinks at one time.
Analysis: In the analysis of family management skills, Kogan, Brody et al. (2012) used structural equation models with full information likelihood estimation to deal with missing data and control for the pretest outcome. Effect sizes were reported as standardized betas.
In the analysis of long-term youth outcomes, Brody et al. (2012) used zero-inflated Poisson regression models for count measures; the models present coefficients for both a binary yes/no indicator and the frequency of occurrence. Ordinary least squares was used for the logarithm of depressive symptoms. All models controlled for baseline outcomes.
In the analysis of sexual risk behavior, Kogan, Yu et al. (2012) used complier average causal effect models to "provide unbiased estimates of causal effects for a full dose of an intervention while accounting for self-selection factors that would bias 'as-treated' analyses." The models used full information likelihood estimation for all available data to identify a group of compliers in the intervention condition and an equivalent group of compliers in the attention-control condition. In each model, intervention dose was included as a covariate to increase the precision of the model estimates.
The complier average causal effect models used zero-inflated Poisson estimation for any unprotected sex (yes/no) and for the count of unprotected sex. Ordinary least squares regression was used for the logarithm of condom efficacy. All models included the baseline outcome as a covariate.
Ingels et al. (2013) used interval regression for the two ordinal outcome measures of episodes of alcohol use and binge drinking. The regressions included pretest measures of alcohol use or binge drinking as covariates. The authors checked for clustering within sites, which differed by the county and day of the week of the sessions. They found "no significant intra-class correlation among the participants" and did not adjust for clustering.
Intent-to-Treat: The analysis of parents in Kogan, Brody et al. (2012) used all randomized subjects. Brody et al. (2012) dropped only the 5% without follow-up data, with one exception. Ingels et al. (2013) used all participants with complete data at baseline and follow-up. The analysis of substance use problems excluded subjects who had not used substances at baseline. In the evaluation of the optional unit on sexual health, Kogan, Yu et al. (2012) used the complier average causal effect analysis of attenders to adjust for not having an intent-to-treat sample.
Outcomes
Implementation Fidelity: All sessions were videotaped and used to provide constructive feedback to group leaders. Coverage of the curriculum components exceeded 80% for both intervention and control sessions. Mean attendance was approximately four of five sessions; only 32 families (6.3%) declined to attend any intervention sessions.
Of the 252 intervention families, 175 (69.4%) participated in the optional condom skills unit.
Baseline Equivalence: Kogan, Brody et al. (2012, p. 212) found no significant differences on three sociodemographic and four outcome measures (Table 2). Brody et al. (2012) reported finding no condition differences on baseline variables, including socioeconomic risk, gender, and five outcomes. Kogan, Yu et al. (2012) examined baseline equivalence for the complier intervention and control samples. These groups did not differ significantly on eight background and outcome measures.
Differential Attrition: Attrition was low (4-5%), and no differences emerged on study variables or demographic characteristics based on attrition status at posttest (Kogan, Brody et al., 2012) or follow-up (Brody et al., 2012; Kogan, Yu et al., 2012). In Ingels et al. (2013), the 6% without both baseline and follow-up data did not differ on baseline alcohol use or demographic variables from those with complete data.
Posttest: In Kogan, Brody et al. (2012), the program significantly improved parent-reported family management skills at posttest relative to the attention-intervention control group. The program effect was small (beta = .10).
Long-Term: In Brody et al. (2012), the results for long-term youth outcomes showed significant effects on the count portion of the zero-inflated Poisson regression analyses for self-reported conduct problems, substance use, and substance use problems. Participation in the program was associated with a 36% decrease in the frequency of conduct problems, a 32% decrease in substance use, and a 47% decrease in substance use problems (among those having used substances at baseline). However, the program did not affect the binary outcomes of having a conduct problem, using substances, or having substance use problems. In a regression analysis, intervention subjects reported significantly fewer depressive symptoms (4.5%) than the control group.
A validity check of the results examined program effects on a measure of healthful behaviors not related to program content. That the control group did significantly better on this outcome suggests that the attention-control group served as an effective comparison.
The sexual behavior results for the complier analysis showed a significant reduction in the frequency of unprotected intercourse but not in the binary (yes, no) outcome. They also showed a significant positive effect on condom efficacy. No gender interactions emerged, suggesting that the intervention worked equally well for male and female youth.
Ingels et al. (2013) found that intervention adolescents reported significantly fewer episodes of alcohol use and binge drinking than control adolescents.