An interactive educational program for African American parents and their early adolescent children living in rural communities that is designed to strengthen family relationships and help adolescents develop positive behaviors and respond effectively to the risks of substance use, delinquency, and sexual involvement.
Blueprints: Model
Crime Solutions: Effective
OJJDP Model Programs: Effective
SAMHSA : 3.6-3.8
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 (SAAF) program is a 7-week interactive educational program for African American parents and their early adolescent children living in rural communities. Early adolescence is the period in which children gain increasing control over their behavior, begin forming friendships based on similarities and common interests, and develop attitudes toward substances and substance use. The attitudes and behaviors that they develop during this time influence their achievement motivation, academic performance and friendship selections, which in turn lead them toward or away from substance use. The SAAF program is designed to strengthen positive family interactions and to enhance parents' efforts to help their children establish and reach positive goals during this critical transition between childhood and adolescence.
The Strong African American Families (SAAF) program is a 7-week interactive educational program for African American parents and their early adolescent children living in rural communities. Early adolescence is the period in which children gain increasing control over their behavior, begin forming friendships based on similarities and common interests, and develop attitudes toward substances and substance use. The attitudes and behaviors that they develop during this time influence their achievement motivation, academic performance and friendship selections, which in turn lead them toward or away from substance use. The SAAF program is designed to strengthen positive family interactions and to enhance parents' efforts to help their children establish and reach positive goals during this critical transition between childhood and adolescence.
The SAAF curriculum is based on data collected in two other studies, Families In It Together (FIIT) and the Family and Community Health Study (FACHS). These studies survey large numbers of African American families residing in rural areas about the kinds of things that parents and children do that foster competence. The SAAF program targets the following predictors of child competence: (1) family routines, parent-child relationship quality, no-nonsense discipline, monitoring and communication, parental involvement with the child's school, racial socialization; (2) goal setting, self-regulation, resistance skill development; and (3) the cognitive antecedents of adolescent risk behavior, including the formation of prototypes of drinking youths and willingness to drink in risk-conducive situations.
The SAAF includes a curriculum organized around seven sessions. Each session includes three modules - Caregiver, Youth, and Family. SAAF modules are an hour each. Parent and youth meet separately for their modules that occur simultaneously. During the second hour, everyone comes together for a group meeting with all of the families. Thus, all parents and youths receive a total of 14 hours of prevention training. All of the Caregiver modules, two of the Youth modules and one Family module utilize DVDs to facilitate content delivery. An optional component of the SAAF sessions includes the provision of meals prior to the start of each series of modules. This allows for a communal experience among families and rapport building between the facilitators and the families.
The SAAF curriculum is designed to help parents/caregivers learn nurturing skills that support their children; enhance parents' abilities to discipline their youth and promote independence as children transition to adolescence; give youth a healthy future orientation and an increased appreciation of their parents/caregivers; and to teach youth skills for dealing with temptation and peer pressure. Facilitators are African American community members who are trained to teach the SAAF curriculum. One facilitator leads the Parent/Caregiver Sessions, while two facilitators share the responsibility of leading the Youth Sessions. All three facilitators lead Family Sessions.
The aims of the program include (1) facilitating the development of a supportive and structured family environment that promotes positive parent-child relationships, (2) enhancing parental engagement in parenting that involves high levels of monitoring and support, strong communication about risk behavior such as substance use and sex, and racial socialization, and (3) preparing youth to resist substance use and other risk behavior by maintaining a future orientation, enhancing risk behavior resistance skills, and accepting parental influences.
Primary Evidence Base for Certification
Study 1
Brody et al. (2004) and five other reports found that relative to the control group, the intervention group had significantly:
Study 2
Brody et al. (2008, 2010) and eight other reports found that intervention youths relative to control youths reported significantly:
Study 4
Kogan et al. (2019) found that relative to the control group, the intervention group reported significantly:
Primary Evidence Base for Certification
Of the four studies Blueprints has reviewed, three studies (Studies 1, 2 and 4) meet Blueprints evidentiary standards (specificity, evaluation quality, impact, dissemination readiness). All studies were done by the developer; the first two have overlapping samples.
Study 1
Brody et al. (2004) and five other reports used a cluster randomized trial to examine 332 African American mothers and their 11-year-old children residing in eight rural county units in Georgia. The sample consisted of the first cohort of an ongoing project (see Study 2). The eight county units were randomly assigned to either the control or intervention conditions. Families in both groups completed a posttest (approximately three months after intervention end) and a 29-month follow-up with measures of parenting, youth protective factors, alcohol use, and sexual risk behavior.
Study 2
Brody et al. (2008, 2010) and eight other reports used a cluster randomized trial to examine 667 African American mothers and their 11-year-old children residing in eight rural county units in Georgia. The sample expanded upon that in Study 1 to include both the first and second cohorts. The eight county units were randomly assigned to either the control or intervention conditions. Families in both groups completed a posttest and four additional assessments through 65 months with measures of parenting, conduct problems, alcohol use, and sexual risk behavior. Subsamples ranging from 272-517 youth provided blood draws and survey measures at ages 19-25 (8-14 years after baseline).
Study 4
Kogan et al. (2019) used a randomized controlled trial to examine 472 families with an African American youth aged 11 or 12 years in seven rural Georgia counties. Families were randomized to either the intervention group (53%) or a control group (47%). Participants completed four assessments: baseline, posttest (10 months post-baseline), initial follow-up (22 months post-baseline) and final follow-up (34 months post-baseline). The main outcome measure was the frequency of alcohol use.
Study 1
Brody, G. H., Murry, V. M., Kogan, S. M., Brown, A. C., Anderson, T., Chen, Y., . . . Wills, T. A. (2006). The Strong African American Families program: A cluster-randomized prevention trial of long-term effects and a mediational model. Journal of Consulting and Clinical Psychology, 74, 356-366.
Brody, G., McBride-Murry, V., Gerrard, G., Gibbons, F., Molgaard, V., McNair, L., . . . Neubaum-Carlan, E. (2004). The Strong African American Families program: Translating research into prevention programming. Child Development, 75(3), 900-917.
Study 2
Brody, G., Kogan, S., Chen, Y., & McBride-Murry, V. (2008). Long-term effects of the Strong African American Families program on youths' conduct problems. Journal of Adolescent Health, 43, 474-481.
Study 4
Kogan, S. M., Bae, D., Lei, M. K., & Brody, G. H. (2019). Family-centered alcohol use prevention for African American adolescents: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 87(12), 1085-1092. doi:10.1037/ccp0000448
Individual: Early initiation of drug use, Favorable attitudes towards antisocial behavior, Favorable attitudes towards drug use*, Substance use
Peer: Interaction with antisocial peers, Peer substance use
Family: Family conflict/violence, Parental attitudes favorable to antisocial behavior, Parental attitudes favorable to drug use, Parent stress, Poor family management*
School: Low school commitment and attachment
Neighborhood/Community: Community disorganization, Extreme economic disadvantage, Laws and norms favorable to drug use/crime, Perceived availability of drugs
Individual: Clear standards for behavior*, Perceived risk of drug use, Problem solving skills, Prosocial behavior, Prosocial involvement, Refusal skills*
Family: 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 Program Logic Model (PDF)
Sample demographics including race, ethnicity, and gender for Blueprints-certified studies:
This program was developed for use among rural African American families.
Training for the Strong African American Families (SAAF) program includes three full days of in-depth training on the SAAF curriculum. During the three-day period, facilitators are trained on the 21 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 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 SAAF Agency Trainer certification process involves an individual's transition from Certified SAAF Facilitator to Certified Agency Trainer. The Certified Agency Trainer is limited to providing the SAAF training to individuals within their own agency/organization to implement SAAF through their organization. The cost associated with this training is $1,500 for the first person and $500 for each additional person.
To be eligible to go through this process, the Certified SAAF Facilitator must have implemented the full 7-week program at least 2 times as a parent/caregiver facilitator and 2 times as a youth facilitator.
Contact the CFR Dissemination Office for additional information regarding the TOT process and requirements.
Program Benefits (per individual):
$1,482
Program Costs (per individual):
$759
Net Present Value (Benefits minus Costs, per individual):
$723
Measured Risk (odds of a positive Net Present Value):
54%
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 (SAAF) Program Package, including initial training and curriculum, costs $8,000 for up to 30 trainees. Travel expenses for two SAAF trainers varies based on training location, but is estimated at an additional $3,000 ($1,500/trainer). Adopting organizations are responsible for printing the implementation manuals for the training participants. The Center for Family Research can print and ship the manuals for $35/manual.
Electronic access to all curriculum materials as well as one set of printed materials is included in SAAF Training and Program Package.
Included in SAAF Training and Program Package.
The purchase of supplemental supplies is estimated at $250 for the first implementation.
The purchase of supplemental supplies and printing costs for consumable curriculum materials is estimated to be $250 per group.
During the research trial, SAAF group facilitators were paid $15 per hour for leading 7 weekly groups per program cycle. Each weekly group required 6 hours for preparation, set-up, participating in the meal, leading the program and clean-up. Travel time was not included.
Unless it is provided by the sponsoring organization or donated, space may also need to be included in budget. It may also be necessary to budget for child care for siblings of youth participating in the program in order to promote caregiver participation. Adopting agencies should also consider transportation expenses.
Included in SAAF Program package. TA is available via tele- or video conferencing and email. A quality assurance site visit is also available for an additional cost of $2,000. During the visit, a SAAF Master Trainer is on-site to observe the implementation of a session. The trainer can also be available to meet with the adopting agency. The trainer will provide a written summary of his/her observations to the site with recommendations for future implementations.
Adopting organizations receive a fidelity manual as part of the purchase price. The manual includes an adherence checklist for each of the 21 modules in SAAF as well as a tool to evaluate competence.
None.
No information is available
No information is available
For this example, an organization in its first year of SAAF implementation will implement SAAF 3 times. Each implementation will include 10 families to yield 30 families for the year. Meals are provided at the cost of $20.00/family. Space is provided by the sponsoring organization at no added cost. The following costs can be projected for this example:
| Program Training Package and travel | $11,000.00 |
| Supplies and printing | $750.00 |
| Meals | $4,200.00 |
| Total One Year Cost | $15,950.00 |
To conduct three rotations and reach 30 families with the Strong African American Families program would cost $15,950 in Year One or $532 per family.
SAAF is a relatively inexpensive parent and adolescent education program that improves parent and youth relationships, communication, and perspective taking. It works to prepare youth to resist temptations and pressures for alcohol use, drug use, and sexual involvement. Public and private funding streams aimed at addressing substance abuse and preventing pregnancy and STDs can potentially support the program. Important streams include the federal Substance Abuse Prevention Block Grant, the federal Office of Juvenile Justice and Delinquency Prevention (OJJDP) Formula funds, and pregnancy prevention funds through the Office of Adolescent Health. In addition, SAAF was originally conceived and tested as a program targeted to rural African American families. Public and private funds focused on high need rural areas and African American families are also potential sources of support.
To the extent that programs already exist for substance abuse and teen pregnancy prevention that are not evidence-based, consideration can be given to re-directing the funds from those toward SAAF.
State and local funds for prevention programs can be allocated to SAAF. These would likely come from health-related initiatives. State Tobacco Settlement revenues have been used by some states for substance abuse prevention.
Formula Funds:
Discretionary Grants: Federal discretionary grants from the Substance Abuse and Mental Health Services Administration (SAMHSA) or the Office of Juvenile Justice and Delinquency Prevention may be available to support SAAF. 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.
Foundations, particularly those with a focus on pregnancy and substance abuse prevention can be a good source of funding for SAAF. Foundations with a particular interest in investing in African American communities and those who are interested in evidence-based interventions should also be considered.
Prevention programs such as SAAF can potentially be supported through state or local funding streams dedicated to prevention. 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. The program is so low cost that interested schools and communities could potentially consider community fundraising through local churches, or partnerships with local businesses and civic organizations as a means of raising dollars to support the initial training and curriculum purchases.
All information comes from the responses to a questionnaire submitted by the purveyor, the University of Georgia Center for Family Research, to the Annie E. Casey Foundation.
Gene H. Brody, PhD, RetiredUniversity of Georgia
An interactive educational program for African American parents and their early adolescent children living in rural communities that is designed to strengthen family relationships and help adolescents develop positive behaviors and respond effectively to the risks of substance use, delinquency, and sexual involvement.
African American parents living in rural areas and their early adolescent children, ages 11-12.
Sample demographics including race, ethnicity, and gender for Blueprints-certified studies:
This program was developed for use among rural African American families.
Risk Factors: Affiliating with deviant peers, increases in the rates of substance use in rural communities, limited recreational and occupational resources, limited access to mental health services.
Protective Factors: Negative attitudes about alcohol and sex, goal-directed future orientation, resistance efficacy, acceptance of parental influence and negative images of drinkers, and strong racial identity.
Individual: Early initiation of drug use, Favorable attitudes towards antisocial behavior, Favorable attitudes towards drug use*, Substance use
Peer: Interaction with antisocial peers, Peer substance use
Family: Family conflict/violence, Parental attitudes favorable to antisocial behavior, Parental attitudes favorable to drug use, Parent stress, Poor family management*
School: Low school commitment and attachment
Neighborhood/Community: Community disorganization, Extreme economic disadvantage, Laws and norms favorable to drug use/crime, Perceived availability of drugs
Individual: Clear standards for behavior*, Perceived risk of drug use, Problem solving skills, Prosocial behavior, Prosocial involvement, Refusal skills*
Family: 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 (SAAF) program is a 7-week interactive educational program for African American parents and their early adolescent children living in rural communities. Early adolescence is the period in which children gain increasing control over their behavior, begin forming friendships based on similarities and common interests, and develop attitudes toward substances and substance use. The attitudes and behaviors that they develop during this time influence their achievement motivation, academic performance and friendship selections, which in turn lead them toward or away from substance use. The SAAF program is designed to strengthen positive family interactions and to enhance parents' efforts to help their children establish and reach positive goals during this critical transition between childhood and adolescence.
The Strong African American Families (SAAF) program is a 7-week interactive educational program for African American parents and their early adolescent children living in rural communities. Early adolescence is the period in which children gain increasing control over their behavior, begin forming friendships based on similarities and common interests, and develop attitudes toward substances and substance use. The attitudes and behaviors that they develop during this time influence their achievement motivation, academic performance and friendship selections, which in turn lead them toward or away from substance use. The SAAF program is designed to strengthen positive family interactions and to enhance parents' efforts to help their children establish and reach positive goals during this critical transition between childhood and adolescence.
The SAAF curriculum is based on data collected in two other studies, Families In It Together (FIIT) and the Family and Community Health Study (FACHS). These studies survey large numbers of African American families residing in rural areas about the kinds of things that parents and children do that foster competence. The SAAF program targets the following predictors of child competence: (1) family routines, parent-child relationship quality, no-nonsense discipline, monitoring and communication, parental involvement with the child's school, racial socialization; (2) goal setting, self-regulation, resistance skill development; and (3) the cognitive antecedents of adolescent risk behavior, including the formation of prototypes of drinking youths and willingness to drink in risk-conducive situations.
The SAAF includes a curriculum organized around seven sessions. Each session includes three modules - Caregiver, Youth, and Family. SAAF modules are an hour each. Parent and youth meet separately for their modules that occur simultaneously. During the second hour, everyone comes together for a group meeting with all of the families. Thus, all parents and youths receive a total of 14 hours of prevention training. All of the Caregiver modules, two of the Youth modules and one Family module utilize DVDs to facilitate content delivery. An optional component of the SAAF sessions includes the provision of meals prior to the start of each series of modules. This allows for a communal experience among families and rapport building between the facilitators and the families.
The SAAF curriculum is designed to help parents/caregivers learn nurturing skills that support their children; enhance parents' abilities to discipline their youth and promote independence as children transition to adolescence; give youth a healthy future orientation and an increased appreciation of their parents/caregivers; and to teach youth skills for dealing with temptation and peer pressure. Facilitators are African American community members who are trained to teach the SAAF curriculum. One facilitator leads the Parent/Caregiver Sessions, while two facilitators share the responsibility of leading the Youth Sessions. All three facilitators lead Family Sessions.
The aims of the program include (1) facilitating the development of a supportive and structured family environment that promotes positive parent-child relationships, (2) enhancing parental engagement in parenting that involves high levels of monitoring and support, strong communication about risk behavior such as substance use and sex, and racial socialization, and (3) preparing youth to resist substance use and other risk behavior by maintaining a future orientation, enhancing risk behavior resistance skills, and accepting parental influences.
The Strong African American Families Program was conceived and designed using an approach that is consistent with recommendations presented in reports issued by the Institute of Medicine and the National Institute of Mental Health. Both reports described a three-phase preventive intervention cycle, which begins with the definition of a target problem. The second phase involves the review and application of developmental, epidemiological, and longitudinal research to derive an etiological model of the problem's development and the protective factors involved in that process. In the third phase the theoretical model for an intervention is constructed, preferably based on research conducted with populations similar to those who will receive the preventive intervention.
The SAAF program development followed many aspects of the reports, as well as building on other family-centered intervention programs (The Strengthening Families Program for Parents and Youth 10-14) that have been shown to enhance parent and youth competence and inhibit young people's use of alcohol and other substances, delinquent activity, and other problem behaviors. The basic premise of the SAAF 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); clearly articulated parental expectations for alcohol use (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 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
Of the four studies Blueprints has reviewed, three studies (Studies 1, 2 and 4) meet Blueprints evidentiary standards (specificity, evaluation quality, impact, dissemination readiness). All studies were done by the developer; the first two have overlapping samples.
Study 1
Brody et al. (2004) and five other reports used a cluster randomized trial to examine 332 African American mothers and their 11-year-old children residing in eight rural county units in Georgia. The sample consisted of the first cohort of an ongoing project (see Study 2). The eight county units were randomly assigned to either the control or intervention conditions. Families in both groups completed a posttest (approximately three months after intervention end) and a 29-month follow-up with measures of parenting, youth protective factors, alcohol use, and sexual risk behavior.
Study 2
Brody et al. (2008, 2010) and eight other reports used a cluster randomized trial to examine 667 African American mothers and their 11-year-old children residing in eight rural county units in Georgia. The sample expanded upon that in Study 1 to include both the first and second cohorts. The eight county units were randomly assigned to either the control or intervention conditions. Families in both groups completed a posttest and four additional assessments through 65 months with measures of parenting, conduct problems, alcohol use, and sexual risk behavior. Subsamples ranging from 272-517 youth provided blood draws and survey measures at ages 19-25 (8-14 years after baseline).
Study 4
Kogan et al. (2019) used a randomized controlled trial to examine 472 families with an African American youth aged 11 or 12 years in seven rural Georgia counties. Families were randomized to either the intervention group (53%) or a control group (47%). Participants completed four assessments: baseline, posttest (10 months post-baseline), initial follow-up (22 months post-baseline) and final follow-up (34 months post-baseline). The main outcome measure was the frequency of alcohol use.
Primary Evidence Base for Certification
Study 1
Brody et al. (2004) and five other reports found at posttest that intervention parents engaged in significantly more regulated, communicative parenting than parents in the control group. Intervention youths reported significantly higher levels of protective factors and lower levels of risk behavior than control youths. At long-term follow-up, intervention youths reported significantly fewer new alcohol users and significantly slower growth in alcohol use than the control group.
Study 2
Brody et al. (2008) found for a propensity-score matched subsample (n = 482) that intervention youths reported significantly fewer conduct problems than control youths at 29 months. Using the full randomized sample, Murry et al. (2014) found that the intervention was associated with significantly better parenting at posttest, and Brody et al. (2010) found lower rates of alcohol use initiation through 29 months, as well as a slower rate of increase in alcohol use over 65 months among intervention youths relative to control youths.
Using subsamples (n=272-517) of participants who provided blood draws and survey measures at ages 19-25, studies found that the intervention was associated with lower blood markers of inflammation, an indicator of likely chronic health problems (Miller et al., 2014), and lower blood cotinine levels, an indicator of smoking (Chen et al., 2017).
Many of the studies found no main effects of the program in young adulthood but also examined moderation effects. The results showed that the program was more effective for subsamples of participants with depressed parents (Brody et al., 2016), parents who had adverse childhood experiences (Brody et al., 2017), low teacher-reported self-control as children (Brody et al., 2020), and residence in disadvantaged neighborhoods (Brody et al., 2019).
Study 4
Kogan et al. (2019) found that relative to the control group, the intervention group had a significantly slower linear increase in alcohol use through 34 months.
Primary Evidence Base for Certification
Study 1
Brody et al. (2004) and five other reports found that relative to the control group, the intervention group had significantly:
Study 2
Brody et al. (2008, 2010) and eight other reports found that intervention youths relative to control youths reported significantly:
Study 4
Kogan et al. (2019) found that relative to the control group, the intervention group reported significantly:
Many of the reports in Studies 1 and 2 conducted mediation analyses or moderated-mediation analyses (i.e., mediation analyses for subgroups). Among the measures that significantly mediated the impact of the intervention on the varied outcomes were youth protective factors, early alcohol initiation, harsh parenting, and supportive parenting.
Study 1 (Brody et al., 2004; Murry et al., 2007) reported small-medium effect sizes (d = .39-.49) for parenting and youth protective factors.
Study 2 reported a large effect size for blood inflammation (d = -.90 in Miller et al., 2014), as well as a small effect size for a blood indicator of smoking (d = -.20 in Chen et al., 2017).
Study 4 (Kogan et al., 2019) reported a large effect size for growth in alcohol use (β = -.42).
Three studies meet Blueprints standards for high quality methods with strong evidence of program impact (i.e., "certified" by Blueprints): Study 1 (Brody et al., 2004, and additional reports), Study 2 (Brody et al., 2008, and additional reports), and Study 4 (Kogan et al., 2019). The samples for these studies included families in which most parents worked but were still below or near the poverty level.
Studies 1, 2, and 4 took place in rural counties of Georgia and compared the treatment group with either a no-treatment control group or a control group that received educational materials.
Additional Studies (not certified by Blueprints)
Study 3 (Futris & Kogan 2014; Kogan et al. 2016)
Futris, T. G., & Kogan, S. (2014). The Strong African American Families (SAAF) project: 2010-2014 program impact summary. Athens, GA: University of Georgia Extension.
Kogan, S. M., Lei, M., Brody, G. H., Futris, T. G., Sperr, M., & Anderson, T. (2016). Implementing family-centered prevention in rural African American communities: A randomized effectiveness trial of the Strong African American Families program. Prevention Science, 17, 248-258.
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: Model
Crime Solutions: Effective
OJJDP Model Programs: Effective
SAMHSA : 3.6-3.8
Western Tidewater Community Services Board
5268 Godwin Blvd.
Suffolk, VA 23434
(757)714-9670
Contact: Brandon Rodgers
brodgers@wtcsb.org
Amachi Pittsburgh
100 West Station Square Drive, Suite 621
Pittsburgh, PA 15219
(412)281-1288, ext. 208
Contact: Fred Hill
fhill@amachipgh.org
Evelyn K. Davis Center for Working Families
801 University Avenue, Unit 3
Des Moines, IA 50314
(515)697-7700
Contact: Jonathan R. Douglas, PhD
Jrdouglas3@dmacc.edu
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
Brody, G. H., Murry, V. M., Gerrard, M., Gibbons, F. X., McNair, L., Brown, A. C., . . . Chen, Y. (2006). The Strong African American Families program: Prevention of youths' high-risk behavior and a test of model change. Journal of Family Psychology, 20, 1-11.
Certified Brody, G. H., Murry, V. M., Kogan, S. M., Brown, A. C., Anderson, T., Chen, Y., . . . Wills, T. A. (2006). The Strong African American Families program: A cluster-randomized prevention trial of long-term effects and a mediational model. Journal of Consulting and Clinical Psychology, 74, 356-366.
Certified
Brody, G., McBride-Murry, V., Gerrard, G., Gibbons, F., Molgaard, V., McNair, L., . . . Neubaum-Carlan, E. (2004). The Strong African American Families program: Translating research into prevention programming. Child Development, 75(3), 900-917.
Gerrard, M., Gibbons, F. X., Brody, G. H., Murry, V. M., Cleveland, M. J., & Wills, T. A. (2006). A theory-based dual-focus alcohol intervention for preadolescents: The Strong African American Families program. Psychology of Addictive Behaviors, 20, 185-195.
Murry, V. M., Berkel, C., Brody, G. H., Gibbons, M., & Gibbons, F. X. (2007). The Strong African American Families program: Longitudinal pathways to sexual risk reduction. Journal of Adolescent Health, 41, 333-342.
Brody, G. H., McBride Murry, V., McNair, L., Chen, Y.-F., Gibbons, F. X., Gerrard, M., & Ashby Wills, T. (2005). Linking changes in parenting to parent-child relationship quality and youth self-control: The Strong African American Families program. Journal of Research on Adolescence, 15, 47-69.
Certified
Brody, G., Kogan, S., Chen, Y., & McBride-Murry, V. (2008). Long-term effects of the Strong African American Families program on youths' conduct problems. Journal of Adolescent Health, 43, 474-481.
Brody, G. H., Chen, Y.-F., Kogan, S. M., Murry, V. M., & Brown, A. C. (2010). Long-term effects of the Strong African American Families program on youths' alcohol use. Journal of Consulting and Clinical Psychology, 78, 281-285.
Miller, G. E., Brody, G. H., Yu, T., & Chen, E. (2014). A family-oriented psychosocial intervention reduces inflammation in low-SES African American youth. Proceedings of the National Academies of Science, 111(31), 11287-11292.
Murry, V. M., McNair, L. D., Myers, S. S., Chen, Y.-F., & Brody, G. H. (2014). Intervention induced changes in perceptions of parenting and risk opportunities among rural African Americans. Journal of Child and Family Studies, 23, 422-466.
Brody, G. H., Yu, T., Chen, E., Beach, S. R. H., & Miller, G. E. (2016). Family-centered prevention ameliorates the longitudinal association between risky family processes and epigenetic aging. Journal of Child Psychology and Psychiatry, 57(5), 566-574. doi:10.1111/jcpp.12495
Chen, Y. F., Yu, T., & Brody, G. H. (2017). Parenting intervention at age 11 and cotinine levels at age 20 among African American youth. Pediatrics, 140(1), 1-8. doi:10.1542/peds.2016-4162
Brody, G. H., Yu, T., Chen, E., & Miller, G. E. (2017). Family-centered prevention ameliorates the association between adverse childhood experiences and prediabetes status in young black adults. Preventive Medicine, 100, 117-122. doi:10.1016/j.ypmed.2017.04.017
Beach, S. R. H., Lei, M. K., Brody, G. H., & Philibert, R. A. (2018). Prevention of early substance use mediates, and variation at SLC6A4 moderates, SAAF intervention effects on OXTR methylation. Prevention Science, 19, 90-100. doi:10.1007/s11121-016-0709-5
Brody, G. H., Yu, T., Miller, G. E., Ehrlich, K. B., & Chen, E. (2019). Preventive parenting intervention during childhood and young black adults' unhealthful behaviors: A randomized controlled trial. Journal of Child Psychology and Psychiatry, 60(1), 63-71.
Brody, G. H., Yu, T., Miller, G. E., & Chen, E. (2020). A family‐centered prevention ameliorates the associations of low self‐control during childhood with employment income and poverty status in young African American adults. Journal of Child Psychology and Psychiatry, 61(4), 425-435.
Futris, T. G., & Kogan, S. (2014). The Strong African American Families (SAAF) project: 2010-2014 program impact summary. Athens, GA: University of Georgia Extension.
Kogan, S. M., Lei, M., Brody, G. H., Futris, T. G., Sperr, M., & Anderson, T. (2016). Implementing family-centered prevention in rural African American communities: A randomized effectiveness trial of the Strong African American Families program. Prevention Science, 17, 248-258.
Certified
Kogan, S. M., Bae, D., Lei, M. K., & Brody, G. H. (2019). Family-centered alcohol use prevention for African American adolescents: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 87(12), 1085-1092. doi:10.1037/ccp0000448
Kogan, S. M., Kwon, E., Brody, G. H., Azarmehr, R., Reck. A. J., Anderson, T., & Sperr, M. (2023). Family-centered prevention to reduce discrimination-related depressive symptoms among black adolescents: Secondary analysis of a randomized clinical trial. JAMA Network Open, 6(11): e2340567. doi:10.1001/jamanetworkopen.2023.40567
Study 1 examined the first cohort of a larger study that examined two cohorts.
Summary
Brody et al. (2004) and five other reports used a cluster randomized trial to examine 332 African American mothers and their 11-year-old children residing in eight rural county units in Georgia. The sample consisted of the first cohort of an ongoing project (see Study 2). The eight county units were randomly assigned to either the control or intervention conditions. Families in both groups completed a posttest (approximately three months after intervention end) and a 29-month follow-up with measures of parenting, youth protective factors, alcohol use, and sexual risk behavior.
Brody et al. (2004) and five other reports found that relative to the control group, the intervention group had significantly:
Evaluation Methodology
Design:
Recruitment: The study recruited African American mothers and their 11-year-old children from nine rural, high-poverty counties in Georgia, but two small contiguous counties were combined into one county unit. Schools in these eight units provided lists of 11-year-old students. The sample consisted of the first cohort of an ongoing project (see Study 2). A total of 521 families were selected randomly and 332 (64%) families were eligible and agreed to participate (note, however, that Brody, Murry, Kogan et al. [2006] list slightly different numbers in the CONSORT diagram).
Assignment: In a cluster randomized design, the eight county units were randomly assigned to the intervention condition (n = four schools, 182 families) or the control condition (n = four schools, 150 families). While the intervention families participated in the seven-week prevention program, the control families received three leaflets on adolescent development, stress management, and the importance of exercise. Consent followed random assignment of the counties, but Brody et al. (2004, p. 905) stated that "Families were initially recruited into the overall project but were informed that they could be assigned to an intervention condition." The statement may imply that participants were unaware of assignment when they consented and completed the pretest.
Assessments/Attrition: Assessments occurred at posttest (about seven months after pretest or three months after the program end) and at 29 months after pretest (about 24-25 months after the program end). Brody et al. (2004, 2005) and Brody, Murry, Gerrard et al. (2006) reported completion rates of 96% for both the pretest and posttest; Brody, Murry, Kogan et al. (2006) reported a completion rate of 92% at 29 months; Gerrard et al. (2006) used the 281 participants (85%) who completed the pretest, posttest, and 29-month follow-up; and Murry et al. (2007) used the 284 participants (86%) who provided data at all time points.
Sample: As reported in Brody et al. (2004), the families who completed the posttest had an average of 2.7 children. In 53.6% of these families, the target child was a girl. Of the mothers in the families, 33.1% were single, 23.0% were married and living with their husbands, 33.9% were married but separated from their husbands, and 7% were living with partners to whom they were not married. Of the two-parent families, 93.0% included both of the target child's biological parents. The mothers' mean age was 38.1 years, and the fathers' mean age was 39.4 years. A majority of the mothers, 78.7%, had completed high school. The families' median household income was $1,655.00 per month.
Measures:
The outcome measures came from parent and youth reports. African American university students and community members who were unaware of group assignment served as field researchers to collect data.
Regulated, Communicative Behaviors of Primary Caretaker: Four indicators of the primary caregivers' behaviors obtained from parent reports were combined into an index: involved-vigilant parenting, adaptive racial socialization, communication about sex, and clear communication of expectations about alcohol use. Alphas exceeded .70.
Youth Parenting Assessment: Youths reported on three variables: receipt of nurturant-involved parenting, racial socialization, and clear household rules from their primary caregivers. Alphas ranged from .61 to .85.
Youth Protective Factors: The measures consisted of youth-reported variables that were combined into an index: future-oriented goals, resistance efficacy, negative images of drinkers, acceptance of parental alcohol influences, and negative attitudes toward alcohol use and sexual activity. Alphas ranged from .62 to .81.
Youth Self-Control: Mothers assessed their child's self-control using scales for self-control (alphas = .79-.83) and lack of self-control (alphas = .59-.70). This parent-rated measure may not be independent.
Risk Behaviors: Risk behavior initiation was evaluated using the sum of three dichotomous items: ever drank alcohol, ever used marijuana, or ever had sexual intercourse.
Youth Alcohol Use: Brody, Murry, Kogan et al. (2006) used a youth-reported alcohol composite index measuring ever consumed an entire alcoholic drink, consumed an entire alcoholic drink during the past month, and ever drunk three or more alcoholic drinks at one time (binge drinking). The mean alpha across the three waves of data collection was .70.
Sexual Risk Behavior: Murry et al. (2007) used a nine-item measure of sexual risk (e.g., used a condom during last sex) that had an alpha of .67.
Mediators (Prototype Images and Similarity): Gerrard et al. (2006) measured judgements (popular, selfish, smart, cool, unattractive, and dull) of images of alcohol-drinking youths, parental monitoring of child behavior with parent reports on knowing "where your child is," frequency of parental involvement and inductive discipline, willingness to drink as shown in responses to hypothetical scenarios, and intentions to use alcohol in the next year.
Analysis: Most analyses used structural equation modeling, which controlled for measurement error and examined change over time with latent growth models (and thereby included the baseline outcomes). Exceptions included the analysis of alcohol use initiation, which examined differences in proportions.
The analyses did not adjust for clustering within the eight county units that were used for randomization because there were too few clusters for multilevel structural equation models. Brody et al. (2004) argued that intraclass correlations of .01 for communicative parenting and .04 for youth protective factors justified not adjusting for clustering. They also replicated the results using multilevel ANCOVA models. In addition, Brody, Murry, Kogan et al. (2006) reported that multilevel tests of county effects did not reveal any statistically significant differences.
Missing Data Strategy: The study used complete case analysis without imputation or FIML.
Intent-to-Treat: The analyses included all families in the intervention condition who completed all assessments regardless of the number of prevention sessions they attended.
Outcomes
Implementation Fidelity:
Brody et al. (2004) reported that 65% of the intervention families took part in five or more sessions, with 44% attending all seven. Coverage of the curriculum components exceeded .80 for the primary caregiver, target child, and family sessions.
Baseline Equivalence:
Using HLM because of the hierarchically nested structure of the data, tests for baseline equivalence found two significant differences across 13 measures (See Table 1, Brody et al., 2004). Scores were higher in the control group than in the prevention group on mothers' reports of communication about sex and youths' reports of negative attitudes toward alcohol and sexual activity. The researchers controlled for these measures in the analyses.
Differential Attrition:
Attrition was minimal (4%) at posttest (Brody et al., 2004, 2005; Brody, Murry, Gerrard et al., 2006). At 29 months, Brody, Murry, Kogan et al. (2006) reported that two-factor multivariate analyses of variance for each baseline measure revealed no significant condition-by-attrition interaction effects. Gerrard et al. (2006) stated that "There were no differences in refusal or attrition rates across groups." Murry et al. (2007) did not address differential attrition.
Posttest:
Posttest (Brody et al., 2004, 2005; Brody, Murry, Gerrard et al., 2006): Intervention parents reported significantly higher regulated communication about race, sex, and alcohol than control group parents (d = .47). Intervention youths reported significantly stronger protective factors (e.g., efficacy, attitudes) (d = .39) and significantly fewer risk behaviors (composite of drinking, marijuana use, and sexual intercourse) than the control youths.
Mediation tests found that changes in regulated, communicative parenting behaviors mediated the effect of treatment condition on changes in the other four outcomes of youth protective factors, youth assessments of parenting, youth risk behaviors, and youth self-control.
Long-Term:
29 Months (Brody, Murry, Kogan et al., 2006): Intervention youths reported significantly lower proportions of new alcohol users and a significantly slower rate of growth in alcohol use than control youths. Mediation tests found that intervention effects on changes in youth alcohol use through 29 months were mediated by improvements in youth protective processes from pretest to posttest.
29 Months (Gerrard et al., 2006): Youths in the intervention group reported significantly smaller increases in drinking between pretest and follow-up than did those in the control group. Mediation tests found that the effect of the intervention on change in alcohol consumption was mediated through decreases in children's willingness to drink (by making their images of drinkers less favorable) and intentions to drink.
29 Months (Murry et al., 2007): The intervention significantly improved parenting practices (d = .49) but did not affect sexual risk behaviors. Mediation tests found that intervention-induced changes in parenting behaviors were associated indirectly with sexual risk behavior through adolescent self-pride, peer orientation, and sexual intent.
Summary
Brody et al. (2008, 2010) and eight other reports used a cluster randomized trial to examine 667 African American mothers and their 11-year-old children residing in eight rural county units in Georgia. The sample expanded upon that in Study 1 to include both the first and second cohorts. The eight county units were randomly assigned to either the control or intervention conditions. Families in both groups completed a posttest and four additional assessments through 65 months with measures of parenting, conduct problems, alcohol use, and sexual risk behavior. Subsamples ranging from 272-517 youth provided blood draws and survey measures at ages 19-25 (8-14 years after baseline).
Brody et al. (2008, 2010) and eight other reports found that intervention youths relative to control youths reported significantly:
Evaluation Methodology
Design:
Recruitment: The study recruited African American mothers and their 11-year-old children (grade 5) from nine rural, high poverty counties in Georgia, but two small contiguous counties were combined into one county unit. Schools in these eight units provided lists of 11-year-old students. Of the families assessed, 667 (64%) met eligibility requirements and agreed to participate. The sample expanded upon that in Study 1 to include both the first and second cohorts.
When the youths had reached ages 19-20, a subgroup of 500 was randomly selected for continued study, as budget limitations prevented follow-up of all randomized participants.
Assignment: In a cluster randomized design, the eight county units were randomly assigned to the intervention condition (n = four county units, 369 families) or the control condition (n = four county units, 298 families). While the intervention families participated in the seven-week prevention program, control families received three leaflets on adolescent development, stress management, and the importance of exercise. As in Study 1, consent appeared to follow randomization of the counties, but participants may not have been aware of their assignment when consenting.
Some discrepancies in figures appeared across the studies. Miller et al. (2014) reported 372 families in the intervention condition and 295 families in the control condition, which indicates three more families in the intervention group and three fewer in the control group. Murry et al. (2014) reported 371 families in the intervention condition and 299 in the control group, which indicates a total sample of 670.
Assessments/Attrition: Brody et al. (2008) reported on assessments at posttest (about eight months after pretest and five months after the program end) and at long-term follow-up (about 29 months after pretest and 26 months after the program end). However, counting the booster session extends the program length to one year and defines a 17-month follow-up. About 91% completed both the posttest and the long-term follow-up.
Brody et al. (2010) reported on assessments at 9, 18, 29, 53, and 65 months after pretest. About 85% of the participating families completed the pretest, posttest, and four follow-up assessments. Murry et al. (2014) reported 95% completion at posttest and 85% completion at 65 months.
Studies of blood markers done 8-14 years after baseline included young adults at ages 19-25 but began with a randomly selected subsample of 500. After attrition, the studies ended up analyzing 272 at age 19 (Miller et al., 2014), 399 at age 20 (Brody et al., 2016), 424 at age 20 (Chen et al., 2017), 388 at age 20 (Beach et al., 2018), and 390 at age 25 (Brody et al., 2017).
Brody et al. (2019) provided somewhat different figures. They stated, "At age 19, a reduced sample of 520 young adults was randomly selected," and 517 "provided data on drug use and BMI during at least 1 year from ages 19 to 25." Further, "70.0% provided data at all four waves spanning ages 19-25, an additional 19.4% provided data at three waves, and the remaining 10.6% provided data at one or two waves. The data analyses were conducted with a sample of 517 young adults."
Brody et al. (2020) examined 381 individuals from the subsample of 500 (76%) who had both teacher reports of self-control at pretest and participant assessments at ages 19, 20, 21, and 25 years.
Sample: As presented in Brody et al. (2008), the families who completed the posttest had an average of 2.7 children. In 52.7% of these families, the target child was a girl. Of the mothers in the families, 54.0% were single, 36.2% were married and living with their husbands, 2.2% were married but separated from their husbands, and 7.1% were living with partners to whom they were not married. The mothers' mean age was 37.7 years, and the fathers' mean age was 39.8 years. A majority of the mothers, 80.0%, had completed high school. For the smaller sample in Brody et al. (2016), about 46% of the families lived below federal poverty standards.
Measures:
The outcome measures through the 65-month follow-up came from parent and youth reports. As noted in Brody et al. (2010), African American university students and community members who were unaware of group assignment served as field researchers to collect data. The outcome measures for young adults (ages 19-25) came from blood draws or youth self-reports.
Parenting: Parents completed four measures that were combined into a single index of regulated, communicative parenting. The four measures included communication about drugs, alcohol, and sex; consistent child management practices; positive affect in the parent-child relationship; and racial socialization. Alphas ranged from .69-.88. In addition, Miller et al. (2014) used a measure of parenting that combined measures of the frequency of nurturant-involved parenting and the frequency of harsh-inconsistent parenting. Chen et al. (2017) used a measure of parenting that combined measures of emotional support, youth management, and consistent non-harsh discipline (alphas = .81-.84). Brody et al. (2020) referred to measures of harsh parenting and supportive parenting.
Conduct Problems: Brody et al. (2008) examined a measure that counted the past year frequency of engaging in disruptive behaviors involving theft, truancy, and suspension from school.
Alcohol Use Frequency: Brody et al. (2010) measured if a youth ever drank alcohol and how many times over the past month a youth drank alcohol.
HIV-Related Risk Behavior: Murry et al. (2014) used a measure that summed three dichotomous items: ever had sex, sex in the last month, and use of a condom.
Blood Markers of Inflammation: Miller et al. (2014) reported on an outcome that combined six blood markers of inflammation (alpha = .93). Low-grade inflammation contributes to multiple health problems, including obesity, insulin resistance, high blood pressure, the early stages of coronary heart disease, and psychiatric conditions like depression, posttraumatic stress disorder, and substance abuse.
Blood Cotinine Marker of Smoking: Chen et al. (2017) used a measure of cotinine, a byproduct of nicotine exposure and an indicator of smoking.
Blood Marker of Epigenetic Aging: Brody et al. (2016) used a DNA measure to identify the disparity between an individual's biological and chronological ages. A high score indicates the undesirable outcome of premature or accelerated aging.
Blood Marker of Prediabetes: Brody et al. (2017) measured fasting glucose levels to identify participants with prediabetes.
Substance Use: Beach et al. (2018) examined a measure that combined alcohol use and marijuana use.
Drug Use: Brody et al. (2019) examined a measure that combined past-month cigarette use, excessive drinking, and marijuana use. This composite variable was averaged across ages 19-25 and log transformed to reduce skewness.
BMI: Brody et al. (2019) used each participant's weight and height to calculate the body mass index. Adjusting for pregnancy status did not affect the influence of the measure in the analyses.
Income and Poverty: Brody et al. (2020) measured self-reported average monthly gross personal income and poverty status based on federal poverty guidelines (0 = above 150% poverty, 1 = below 150% and above 100% poverty, and 2 = below 100% poverty).
Analysis:
The analyses mostly used structural equation models with controls for baseline outcomes but also used several types of regression models. The studies of blood markers (Miller et al., 2014; Brody et al., 2016, 2017; Chen et al., 2017; Beach et al., 2018) lacked baseline measures, as did the study of young adult BMI, drug use, and income (Brody et al., 2019, 2020). None of the analyses adjusted for clustering within counties - the unit of assignment. Brody et al. (2008) stated that "Tests of county effects on conduct problems, parenting factors, and youth protective factors [using HLM models] revealed no significant effects based on county membership. Accordingly, the study hypotheses were analyzed at the individual level." In examining a measure of neighborhood SES as a predictor, Brody et al. (2019) estimated models that accounted for non-independence of observations among participants from the same neighborhood.
Brody et al. (2008) adjusted for differences at baseline with a propensity-matched subsample of the randomized sample (n = 482 rather than 667). The propensity score model used "predictors of condition assignment plus key demographic variables to model the distribution of the treatment indicator variable."
Missing Data Strategy: The 10 reports appeared to use complete case analysis without imputation or FIML.
Intent-to-Treat: The 10 reports appeared to include all families in the intervention condition who completed the assessments regardless of the number of prevention sessions they actually attended. The analyses of outcomes at ages 19-26 were based on a randomly selected subsample to reduce follow-up costs, but they also used all participants with complete data regardless of program attendance.
Outcomes
Implementation Fidelity:
Brody et al. (2008) reported that mean attendance was 4.7 of seven total sessions and that mean adherence to intervention components was 90%.
Baseline Equivalence:
Of nine tests examined in Brody et al. (2008), three indicated significant baseline differences for the full randomized sample: per capita income, conduct problems, and youth protective processes. After selecting a propensity-matched subsample (n = 482), significant baseline differences remained for conduct problems and youth protective processes, which were controlled for in the analyses. The other nine studies examined baseline equivalence for their respective analysis samples, as described below.
Differential Attrition:
Brody et al. (2008) stated only that "No significant experimental condition x attrition interaction effects emerged." Brody et al. (2010) offered more details, stating: "A two-factor multivariate analysis of variance was conducted with the intervention and control groups at each wave of data collection for demographic characteristics (per capita income, maternal education and age, number of children in the household) and outcome measures (alcohol use initiation, frequency of past-month alcohol use). No significant Group x Attrition interaction effects emerged for any variable at any assessment." Murry et al. (2014) simply reported that all but one of the pretest measures were equivalent and that "No differential attrition effects were detected."
The studies of young adults that began with a randomly selected subsample of 500 had varied amounts of attrition and varied tests for differential attrition:
Posttest and Long-Term:
29 Months (Brody et al., 2008): Results for the propensity-matched subsample (n = 482) found that intervention youths reported significantly fewer conduct problems than control youths (see Table 2, Model 1). Moderation tests found stronger intervention effects for youths with low levels of self-control and numerous affiliations with deviance-prone peers than for their counterparts. Moderation-mediation tests found that youth protective factors partially mediated intervention effects on conduct problems for youth with lower self-control at baseline, while parenting partially mediated intervention effects on conduct problems for youth who associated with more deviance-prone peers.
65 Months (Brody et al., 2010): The results showed that the intervention youths reported a significantly slower rate of increase in alcohol use frequency than the control youths over the 65-month follow-up period. Mediation tests found that the program significantly reduced alcohol initiation at 29 months, which in turn significantly reduced the growth in alcohol use frequency from baseline to 65 months.
65 Months (Murry et al., 2014): The results focused only on mediation. The intervention group reported significantly improved parenting, which in turn improved youth perceptions of norms and expectations, which reduced youth opportunities for risk behavior, and which reduced youth risk behavior. However, the analysis did not test for the significance of indirect effects of the program on the sole behavioral outcome of risk behavior.
8 Years (Miller et al., 2014): Intervention participants had significantly lower blood markers of inflammation than control participants (d = -.90). Mediation tests found that the intervention effect was brought about in part by improved parenting at posttest. Moderation tests found stronger effects of the intervention on parenting and inflammation for youths from disadvantaged families.
9 Years (Brody et al., 2016): The study did not examine main effects of the intervention but found moderated and mediated effects. For moderation, the intervention had stronger effects on epigenetic aging for youths whose parents were depressed at baseline than for other youths. For moderated mediation, the intervention reduced harsh parenting among parents with baseline depression, which reduced epigenetic aging.
9 Years (Chen et al., 2017): Intervention participants had significantly lower levels of cotinine in the blood than control participants at age 20 (d = -.20). They also had significantly higher levels of supportive parenting at age 16 (d = .25). Mediation tests found that the intervention effect on cotinine levels was brought about by more supportive parenting at age 16.
9 Years (Beach et al., 2018): Results for a subsample with genotype information (n = 388) showed that intervention youths reported significantly lower substance use (i.e., alcohol and marijuana) initiation at age 13 than the control group. Moderation tests at nine years found that the intervention improved the genetic biomarkers related to regulation but only for those with a particular genetic allele.
14 Years (Brody et al., 2017): Results for the subsample with blood draws at age 25 (n = 390) examined the presence of prediabetes. There was no significant main effect, but tests found a moderation effect. The intervention had a stronger beneficial effect on prediabetes at age 25 for participants with parents having had adverse childhood experiences.
8-14 Years (Brody et al., 2019): Results across ages 19-25 years indicated no significant main effects of the intervention on BMI or drug use. Moderation tests for both neighborhood disadvantage at ages 11-16 and gender found that the intervention 1) significantly reduced the BMIs of women who lived in disadvantaged neighborhoods and 2) significantly reduced drug use among men who lived in disadvantaged neighborhoods. Moderation-mediation tests further showed that for the subgroup of men who had lived in a disadvantaged neighborhood, the effect of the intervention on drug use was mediated by improved parenting.
14 Years (Brody et al., 2020): Results at age 25 indicated no significant main effects of the intervention on employment income or poverty status. Moderation tests for self-control at age 11 found that the intervention significantly reduced both employment income and poverty status for young adults who had low levels of teacher-rated self-control at baseline (i.e., age 11). Moderation-mediation tests further showed that for the subgroup of participants with low baseline self-control, the effect of the intervention on employment income was mediated by enhanced supportive parenting.
Summary
Futris and Kogan (2014) and Kogan et al. (2016) used a randomized controlled trial to examine 465 African American fifth- and sixth-grade students and their primary caregivers residing in eight rural counties in Georgia. Families were randomly assigned to either the intervention condition or a waitlist control group. Families in both groups completed a pretest and posttest (approximately three months after intervention end) with measures of parenting, youth self-regulatory behavior, and risk behavior vulnerability.
Futris and Kogan (2014) and Kogan et al. (2016) found that relative to the control group, the intervention group had significantly greater improvements in:
Evaluation Methodology
Design:
Recruitment: Participants were recruited over the span of five years from school lists of African American fifth- and sixth- grade students in eight impoverished rural counties in Georgia. A total of 465 families were recruited during this time. Eligibility requirements for families included the presence of a youth 11 or 12 years of age at pretest who self-identified as African American; caregiver self-identification as African American was not required.
Assignment: Families were randomly assigned to either the intervention group (n=242) or a wait-list control group (n=223) that would receive the program after a 12-month waiting period.
Attrition: Assessments occurred at baseline and posttest, three months after program completion. At posttest there was an overall retention rate of 89.5%.
Sample:
Child participants ranged from 10-13 years in age, averaging 11.49 years at baseline, and were evenly split by gender (51% male). Primary caregivers were predominantly female (95.9%) and ranged in age from 22-81 years, with a baseline average of 37.11 years. Most caregivers were a biological parent of the participant child (89.9%) and most lived in a single-parent household (61.6). More than half were below the poverty line (57.4%).
Measures:
Assessments occurred at baseline and posttest (six months after pretest and three months after program completion).
Intervention-targeted parenting was assessed with both parent and youth reports on a nine-item involved/vigilant parenting scale, which assessed caregivers' use of monitoring, consistent discipline, and positive parenting practices. Internal consistency was relatively low (α=.62-.63). Parents and youth also completed a nine-item scale assessing parental discussion with youth regarding expectations about risky behavior such as alcohol use (α=.94-.95). Parents also reported on relationship harmony and distress (e.g., "your child is easy to get along with") using the Interaction Behavior Questionnaire (α=.90).
Intervention-targeted self-regulatory processes were assessed with youth self-reports on a four-item anger control scale (α=.84), a seven-item scale indexing behavioral self-control (α=.70), and a resistance efficacy measure that presents hypothetical scenarios where youth are offered alcohol, cigarettes, or marijuana to examine behavioral intentions (α=.72-.74).
Risk behavior vulnerability was assessed with the Tolerance for Deviance Scale (α=.86-.87), as well as a 13-item inventory on intentions to use substances and engage in sexual activity (α=.86-.88) and a 12-item measure assessing affiliations with risk-taking peers (α=.80-.81).
Parent-reported youth self-control was assessed by asking "how often does your child…work toward a goal, think ahead of time about the consequences of his/her actions."
Parent depressive symptoms were assessed with a 20-item depressive symptoms measure. Reliability was not reported.
Analysis:
The effects of the program at posttest were evaluated with structural equation models that controlled for baseline levels of risk behavior vulnerability, intervention-targeted parenting, and youth self-regulatory processes. Complier-average causal effect modeling was used to identify and compare latent groups of compliers within both conditions. Multilevel analysis was used to account for clustering by county.
Intent-to-Treat: All available data were used in analyses.
Outcomes
Implementation Fidelity:
All sessions were recorded and adherence checks were performed on six sessions (28%) for each seven-week program. Mean session coverage was 84.5% and did not vary significantly by site or implementation year.
Baseline Equivalence:
Families assigned to the intervention group were experiencing slightly (but significantly) more economic hardship than control group participants. Otherwise, the groups were equivalent on demographic and outcome measures.
Differential Attrition:
Tests revealed no significant differences between program completers and attriters, though baseline-by-condition attrition was not examined.
Posttest:
At posttest, compared to control participants, intervention youth showed significantly greater improvements in youth risk behavior vulnerability, youth self-regulatory processes, and parenting practices.
Long-Term:
Not examined.
Summary
Kogan et al. (2019) used a randomized controlled trial to examine 472 families with an African American youth aged 11 or 12 years in seven rural Georgia counties. Families were randomized to either the intervention group (53%) or a control group (47%). Participants completed four assessments: baseline, posttest (10 months post-baseline), initial follow-up (22 months post-baseline) and final follow-up (34 months post-baseline). The main outcome measure was the frequency of alcohol use.
Kogan et al. (2019) found that relative to the control group, the intervention group had a significantly:
Evaluation Methodology
Kogan et al. (2019) reported main effects and Kogan et al. (2023) reported moderation effects that tested whether the intervention attenuated the association of racial discrimination with adverse mental health outcomes among Black adolescents.
Design:
Recruitment: The sample of families was recruited from seven rural counties in Georgia. School districts provided lists of African American fifth-grade students, whose parents were contacted in random order to discuss participation. The sole eligibility requirement for families was the presence of a youth 11 or 12 years of age at pretest who self-identified as African American. Recruitment began on June 7, 2013, and data collection concluded on December 10, 2017. Of the 825 families screened for eligibility, 625 met the eligibility requirement and 472 enrolled (76%).
Assignment: After the baseline assessment, participants were assigned randomly, with an oversample of about 5% for the treatment group, to the intervention group (n = 252, 53%) or the control group (n = 220, 47%).
Assessments/Attrition: The four assessments occurred at baseline, posttest (10 months post-baseline), initial follow-up (16 months after program end or 22 months post-baseline), and final follow-up (28 months after program end or 34 months post-baseline). Retention from baseline to the final follow-up was 91.7%.
Sample:
Youths had a mean age of 11.61 years at baseline, and 50.8% were girls. The mean age of caregivers was 37.2 years. Of the caregivers, 18.2% had less than a high school education, 26.5% had completed high school or obtained a GED, and the remaining 55.3% had at least some college education. Most participating families, 64.4%, had family incomes below the federal poverty threshold.
Measures:
African American field researchers made home visits to collect data using audio computer-assisted self-interviews on laptop computers. In Kogan et al. (2019), the main outcome, the frequency with which the youths drank alcohol during the past three months, was measured on a scale from 0 (none) to 6 (> 30 times).
Analysis:
The analysis used growth curve models with Poisson distributions to represent changes in alcohol use over all four assessments. In addition, a Complier Average Causal Effect (CACE) model estimated intervention effects for those attending five or more sessions, those attending six or more sessions, and those attending all seven sessions. To estimate the CACE models, the analysis included youths' sex, age, tolerance for deviance, and academic orientation, as well as the family socioeconomic risk index and youth reports of protective parenting. The study reported one-tailed tests (excepting tests for baseline equivalence).
Kogan et al. (2023) conducted exploratory post hoc moderation analyses (group assignment × discrimination) with baseline adolescent gender and family socioeconomic disadvantage included as covariates.
Missing Data Method: The models used full information maximum likelihood estimation that included all available data. The authors noted that the attrition analysis, as described below, suggested that the data met the requirement of missing at random.
Intent-to-Treat: The intent-to-treat analysis used all available data with full information maximum likelihood (FIML) estimation. The CACE analysis, however, examined subsets of intervention participants based on high program dosage.
Outcomes
Implementation Fidelity:
Mean attendance was 4.5 of seven total sessions. Approximately 33% of those assigned to the intervention group attended all sessions, and approximately 20% attended no sessions. Adherence assessments indicated that coverage of the prevention curriculum exceeded 80% of manualized activities.
Baseline Equivalence:
Tests for six baseline sociodemographic and outcome measures using the full randomized sample (Table 1 of Kogan et al., 2019) found no significant differences.
Differential Attrition:
The attrition rates were 10% for the intervention group and 6% for the control group. The authors stated that attrition at the last follow-up "was not associated with experimental condition or baseline demographics, including youth gender, age, and family socioeconomic risk (e.g., parental education, family poverty status)."
Posttest and Long-Term:
The intent-to-treat analysis found that the linear increase in alcohol use over the study period was significantly slower for the intervention group than the control group (p = .02 for the one-tailed test remains significant at p < .05 for a two-tailed test).
The dose-response analysis using CACE models revealed a significant medium-sized intervention effect on growth in alcohol use (d = .51) when participants attended five of the seven offered sessions and a very large effect (d = 1.51) when participants attended all seven sessions.
In exploratory moderation analyses using two-tailed tests, Kogan et al. (2023) found that study condition significantly moderated the association between Black adolescents' experiences of racial discrimination and depressive symptoms 28 months after program end (p = .005). For the control group, racial discrimination was associated with increases in depressive symptoms (p < .001), whereas there was no association between racial discrimination and depressive symptoms for the intervention group (p = .09).