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

Abstract

Background: The rapidly growing rates of HIV infection in Kazakhstan are largely driven by injection drug use. The study adapts a family-focused evidence-based HIV and substance use prevention intervention for at-risk adolescents from communities in Almaty that have been greatly affected by heroin trade and use. Methods: This NIDA-funded pilot feasibility trial included 181 at-risk adolescents (ages 14–17) recruited through local schools and 181 of their parents or other adult family members. To be eligible, youth had to reside in city areas with high drug exposure and have at least one personal or family risk factor (e.g., substance-using family members or friends, parental criminal history). In addition to the standard school-based health education program on drug use and HIV, intervention arm adolescent–caregiver dyads received three pilot computerized sessions focused on caregiver-adolescent communication, support and monitoring. Adolescents and caregivers completed ACASI surveys in Russian at baseline, 3- and 6-month follow-ups and a subsample from the treatment group (n = 24 dyads) also participated in post-intervention focus group interviews. Results: At 6-month follow-up, small effect sizes were detected for parenting practices as the key theoretical mediating variable. Intervention arm participants reported a reduction in harsh discipline practices (Cohen’s d = −.35, p = .026), an increase in positive and supportive parenting (d = 0.26, p = .042), and a decline in poor monitoring (according to caregivers d = −0.23, p = .137 and adolescents d = −0.25, p = .113). Post-intervention focus groups provided examples of how the intervention content allowed caregivers to reconnect with their children and get more involved in each other’s lives. Conclusion: In middle-income countries like Kazakhstan, interventions that integrate family involvement approaches and utilize interactive technologies may represent an engaging and potentially effective tool with high fidelity and easy scalability to reduce substance use and other risk-taking behaviors among at-risk youth.

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

“…The intervention-arm adolescents also demonstrated a greater involvement in prosocial activities at home and at school, an important achievement for at-risk youth who are often marginalized. Responses from caregivers, described in a separate manuscript, showed less frequent use of harsh discipline practices, improved supportive parenting, and reduced family conflicts [16]; thus, a more positive family environment could potentially explain promising improvements in youth’s temper and anger management. All these potential changes are essential as youth with low self-esteem, history of violence, psychological distress, and low level of family support are more like to engage in risk behaviors [27].…”

“…It was designed to test the feasibility and obtain preliminary estimates of the effect size parameters of the adapted intervention compared to the standard care on: (1) youth-level theoretically relevant mediating variables (youth’s personal and social competences such as assertiveness, self-esteem, self-control, and coping skills; refusal skills and resistance to peer pressure; and risk reduction self-efficacy) and (2) substance use intentions and behaviors. The estimates of effect size parameters on caregiver youth–mediators are described else where and incorporate youth’s and caregivers’ quantitative and qualitative responses [16]. …”

“…The aim of this pilot study was to adapt and test feasibility of a youth drug prevention intervention called Kazakhstani Family Together (KFT) that engages youths’ caregivers and utilizes a multimedia approach [16]. Computerized interventions are known for high fidelity, scalability, and inexpensive dissemination [17,18], but their use has not been tested in a middle-income country like Kazakhstan.…”

A Systematic Literature Review of Substance-Use Prevention Programs Amongst Refugee Youth

“…This evidence is supported by social bond theory, which postulates that commitment to conventional values of one’s family, religion, and school act to prevent deviant responses (Nijdam-Jones et al, 2015 ). Similarly, the Family Interaction Theory suggests that social learning, parent attachment, and intrapersonal characteristics equally discourage youth risk-taking behaviours (Ismayilova et al, 2019 ). The evidence appeared in several substance use prevention programs (Huang et al, 2014 ; Ishaak et al, 2015 ; Liddle et al, 2006 ).…”