eHealth Familias Unidas: Efficacy Trial of an Evidence-Based Intervention Adapted for Use on the Internet with Hispanic Families

Abstract

While substance use and sexual risk behaviors among Hispanic youth continue to be public health concerns, few evidence-based preventive interventions are developed for and implemented with Hispanic/Latino youth. The objective of this study was to evaluate the efficacy of eHealth Familias Unidas, an Internet adaptation of an evidence-based family intervention for Hispanics. A randomized controlled trial design (n = 230) was used to evaluate intervention effects on substance use and condomless sex among a sample of Hispanic eighth graders with behavioral problems. Participants were randomized to eHealth Familias Unidas (n = 113) or prevention as usual (n = 117) and assessed at baseline and 3 and 12 months post baseline. We trained mental health school personnel and community mental health professionals to recruit and deliver the Internet-based intervention with Hispanic families. It was hypothesized that, over time, eHealth Familias Unidas would be more efficacious than prevention as usual in reducing drug use (marijuana, cocaine, inhalants, and other drugs), prescription drug use, cigarette use, alcohol use, and condomless sex and that these changes would be mediated by family functioning. Significant intervention effects were found across time for drug use, prescription drug use, and cigarette use. While eHealth Familias Unidas positively affected family functioning, mediation effects were not found. This study demonstrated that family-based eHealth interventions can be efficacious among Hispanic populations when delivered in community settings.

Precision Strategies as a Timely and Unifying Framework for Ongoing Prevention Science Advances

“…Moreover, the technologies used to measure sympathetic nervous system and interactions leading to program outcomes both draw from and inform methods and program development (Type 1). Estrada et al (2018) tested an internet-delivered adaptation of the evidence-based Familias Unidas program to prevent behavioral problems in Hispanic adolescents by improving their families' functioning. This team's prior work on methods and program development (Type 1) resulted in efficacy for reduced drug use and cigarette use as well as improved family functioning (although family functioning did not statistically mediate the substance use outcomes of eHealth Familias Unidas).…”

“…This team's prior work on methods and program development (Type 1) resulted in efficacy for reduced drug use and cigarette use as well as improved family functioning (although family functioning did not statistically mediate the substance use outcomes of eHealth Familias Unidas). Discovery science may be needed to clarify the program's effects because the mediating mechanism(s) for eHealth Familias Unidas were not identified by Estrada et al (2018). Doing so may elucidate important insights for improving their intervention as well as other prevention strategies.…”

Moving Toward a Precision-Based, Personalized Framework for Prevention Science: Introduction to the Special Issue

“…The study by Estrada, Lee, Wagstaff, et al (2018) reports on the effectiveness of a particular intervention format – web-based– that has the capacity for far higher reach than traditional in-person interventions, and that ultimately could constitute one type of intervention format in an adaptive prevention trial. This study evaluated eHealth Familias Unidas , an online adaptation of a well-validated family intervention to prevent substance use and related risk behaviors in middle school students.…”

Rationale and design for eHealth Familias Unidas Primary Care: A drug use, sexual risk behavior, and STI preventive intervention for hispanic youth in pediatric primary care clinics

“…Our lead fidelity trainer also rates 25% of those cases rated by the independent rater to obtain inter-rater reliability. Inter-rater reliability has been > .75 in our prior efficacy studies (e.g., Prado et al, 2007; Estrada et al, in press) and effectiveness (Estrada et al, 2017a) trials. The clinical supervisor reviews fidelity ratings with the facilitators during group supervision sessions.…”