Building Competencies to Prevent Youth Substance Use in Kazakhstan: Mixed Methods Findings From a Pilot Family-Focused Multimedia Trial

Abstract

Purpose: The knowledge-based approach to substance use and HIV prevention, commonly used in Central Asia, does not equip at-risk adolescents with risk reduction skills. This pilot study aims to adapt and test the feasibility and estimate the effect size parameters of a skill-based and family-focused intervention for at-risk adolescents from communities affected by heroin trade and use in Kazakhstan, located on the major drug trafficking route from Afghanistan. Methods: This National Institute on Drug Abuse-funded pilot trial used a mixed-methods approach and included 181 adolescents (ages 14–17) that reported at least one risk factor (e.g., substance-using family members or friends and parental criminal history). In addition to the school-based health education program, intervention-arm adolescent-caregiver dyads received three computerized pilot sessions focusing on risk reduction self-efficacy, resistance to peer pressure, and strengthening of family relationships. Adolescents completed baseline, 3- and 6-month Audio Computer-Assisted Self-Interview surveys in Russian and treatment group adolescents (n = 12) also participated in postintervention focus groups. Results: Small size effects were observed for youth-level theoretical mediators associated with lower substance use. Compared to the control group, intervention-arm adolescents showed improvement in personal and social competencies such as assertiveness (Cohen’s d = .21) and self-esteem (d = .22) at 3 months and increased engagement in prosocial activities at 6 months (d = .41). Adolescents from the intervention group also reported improved self-control skills helping alleviate emotional distress (an increase in anger and tension management d = .30 at 3 months and a reduction in temper d = .27 at 6 months) along with a lower likelihood of binge drinking at 6 months (odds ratio = .18, p = .023). Conclusions: In middle-income countries like Kazakhstan, an intervention that utilizes interactive technologies and combines an empirically tested skills-based approach with family involvement may be an engaging, acceptable, and culturally appropriate tool for preventing substance use among at-risk youth.

Longitudinal Associations Between Sexual Victimization and Substance Misuse Among High School Youth in Colorado

“…Finally, due to IRB restrictions, we inquired about the likelihood to use substances as a proxy measure for reported current use. However, this measure has been used in several other adolescent- and school-based samples, and where substance use questions must be administered sensitively given potential disciplinary or familial implications (Foster et al, 2018; Ismayilova & Terlikbayeva, 2018; Jones et al, 2019; Maddahian et al, 1988). In previous work, intentions to use are highly correlated with current substance misuse behaviors, making it a reasonable gauge, given ethical and practical limitations associated with youth samples (Foster et al, 2018; Ismayilova & Terlikbayeva, 2018; Jones et al, 2019; Maddahian et al, 1988).…”

Computerized intervention to prevent drug use among at-risk adolescents in Central Asia: Preliminary family-level findings from a pilot mixed methods trial

“…Additionally, the moderation analysis suggested that stronger changes were observed among adolescent boys, compared to girls. The study revealed that girls may experience more complex pathways to risk exposure situations and drug use (Ismayilova & Terlikbayeva, 2018) and, therefore, the future tailoring of this intervention should incorporate trauma-informed and gender-responsive content addressing issues related to dating and interpersonal violence and childhood abuse (Covington, 2008; Goodman, 2017).…”

“…Final scripts for each session were programmed to include storylines, skill demonstrations, exercises, quizzes, and games. A more detailed description of the adaptation process is provided elsewhere (Ismayilova & Terlikbayeva, 2018). The multimedia program was saved on a flash drive and was available offline, which was essential for areas with weak internet connectivity.…”

“…The program also permitted youths and caregivers to assume each others’ roles in interactions, allowing each to experience the challenges faced by the other and creating teachable moments (see screenshots and video in Appendix). A more detailed description of the intervention is provided elsewhere (Ismayilova & Terlikbayeva, 2018).…”

“…Using a mixed methods approach, the aims of this paper are: 1) to obtain preliminary estimates of the effect sizes of the Usual Care Plus Kazakhstani Families Together (KFT) intervention compared to the Usual Care Alone on family-level theoretical mediating variables (youth-parent relationship quality, risk behavior communication, and parenting practices) associated with sexual and substance use-related outcomes at 3- and 6-month follow-ups; 2) to estimate potential moderators of intervention effects; and 3) to explore participants’ experiences with the pilot intervention using qualitative interviews. The preliminary effects on youth-level mediators (e.g., coping skills, impulse management, social competences) and substance use outcomes are described elsewhere (Ismayilova & Terlikbayeva, 2018).…”