Tanya Nieri, PhD Jennifer L. Matjasko, PhD - PowerPoint Presentation

Slide1

Tanya Nieri, PhDJennifer L. Matjasko, PhDKirk R. Williams, PhDNancy Guerra, Phd

Public Health Intervention and High Risk Populations

Funding for the Southern California Academic Center of Excellence on Youth Violence Prevention at UC

Riverside (ACE-UCR)

is provided by a cooperative agreement with the Centers for Disease Control (Grant # 5U49CE000734).Slide2

Our presentationProvides an overview and examples of public health interventionsPresents case studies of public health intervention with high risk populations: two delinquency interventions

Reviews contemporary questions and ideas for future researchSlide3

Public Health InterventionsFocus on:The health of the populationPrevention through health promotion

Using:

Data driven/evidence-based approaches

Comprehensive, multi-level approachesSlide4

Public Health and the Social Ecological Model

Individual

Relationship

Community

Society

Societal

Community

Relationship

IndividualSlide5

The Public Health Approach to Prevention

3. Develop

and Test

Prevention

Strategies

4. Assure

Widespread Adoption

2. Identify

Risk

and Protective

Factors

1. Define

the

ProblemSlide6

1. Define the ProblemWho is being affected?Are rates are increasing or decreasing?

How do the data compare across communities and time?Slide7

Example: Surveillance data from Santa Ana, CA

Demographics:

Santa Ana (Citywide)

Total population

61,363

(337,977)

African American

522

( 5,749)

Latino

56,464

(257,097)

Asian

897

( 29,778)

White Non Latino

3,224

( 41,984)

Native American

67

( 4,014)

Other Pac Islander

199

( 1,160)

Youth under 18

46,203

(115,507)Slide8

Example: Surveillance data from Santa Ana, CA

Education

level

:

(for 25 years and over)

Santa Ana (Citywide)

Less than 9

th

48.1%

(36.3%)

9

th

to 12

th

21.7%

(20.5%)

High School Graduate

12.6%

(16.0%)

Some College

9.3%

(13.9%)

Associate Degree

2.8%

( 4.1%)

Bachelor’s Degree

3.6%

( 6.4%)

Graduate or Professional Degree

2.0%

( 2.8%)Slide9

Example: Surveillance data from Santa Ana, CAWell Being:

Santa

Ana (Citywide)

Median household income

$33,728

($43,412)Slide10

Example: Surveillance data from Santa Ana, CA

Risk factors

Santa Ana (Citywide)

Female Headed Household with Children

10.4%

( 7.6%)

Foreign Born

59.5%

(53.3%)

Unemployed

5.6%

( 4.7%)

Families under the poverty level

26.4%

(16.1%)Slide11

Example: Surveillance data from Santa Ana, CA

2003 Youth crime:

(counts)

Santa Ana (Citywide)

All crime

574

(1,028)

Homicide

2

( 3)

Rape

9

( 16)

Robbery

26

( 35)

Assault

42

( 63)

Drug Crimes

98

( 197)

Misdemeanors

397

( 714)

Child abuse reports

1,455

(3,957)Slide12

2. Identify Risk and Protective FactorsWhat protects youth/what increases their risk?What prevents youth from/what increases their risk of perpetrating violence?

Which factors (i.e. attitudes and behaviors, policies) are modifiable?

Which groups (i.e. age, gender, ethnicity, income, location) are most at risk?Slide13

Example: Youth problem behaviorIdentified risk and protective factors:Poor emotional and behavioral regulationPoor decision-making skillsLack of concern about fairness, justice, integrity, responsibility and the welfare of others

Self esteemSelf efficacy

Social relationships characterized by caring and trustSlide14

3. Develop and Test Prevention StrategiesEfficacy versus effectiveness trialsEntire programs to smaller components

Content

Scope

AudienceSlide15

Social Ecological ModelSocietal

Community

Family/Peer

IndividualSlide16

Example: Individual-level InterventionPositive Life Choices: Building Core Competencies for YouthDeveloper: Nancy GuerraCognitive-behavioral mindfulness program for adolescents (aged 14-21) in schools or alternative settingsPromotes core competencies of youth development and prevention of problem behaviors: positive sense of self, self control, moral system of belief, pro-social connectedness, decision-making skills

Three components (10 lessons each) can be delivered separately or togetherSlide17

Social Ecological ModelSocietal

Community

Family/Peer

IndividualSlide18

Example: Family-level InterventionTriple P: Positive Parenting ProgramDeveloper: Matthew R. Sanders Aims to prevent social, emotional and behavioral problems in childhood, prevent child maltreatment, and strengthen parenting and parental confidenceDraws on social learning, cognitive-behavioral and developmental theory and research into risk and protective factors associated with the development of children’s social and behavioral problems

Multi-level and organized for population dissemination

Can be tailored to family needs through flexible formats and delivery Slide19

Social Ecological ModelSocietal

Community

Family/Peer

IndividualSlide20

Example: Community-level InterventionPrevention of HIV in Women and Infants Demonstration Project s (WIDP)Developers: B. Person , J. Adams, M. Stark, & J. L. LaubyAims to increase positive community norms, attitudes, and behaviors concerning condom use among women at risk for HIV infection

Activities: development & distribution of HIV prevention materials, mobilization of peer network of community volunteers & network of community orgs and businesses that supported the project, & delivery of prevention messages by trained outreach specialists thru individual contacts and small groupsSlide21

Good public health interventions are…Based on “Theory of Change” that outlines mechanisms thru which program has effects and targets risk/protective factors, mediating mechanisms, and behavioral outcomesAdaptable to individuals’/groups’ needs

Matched to target population

Implemented by/in communities ready for themSlide22

Case Studies: Delinquency InterventionsAn illustration of public health interventions that affect delinquency Efforts of the Academic Center of Excellence on Youth Violence Prevention at UC Riverside, (http://www.stopyouthviolence.ucr.edu

) Families and Schools Together (FAST)

Arlanza

Neighborhood InitiativeSlide23

Families and Schools Together (FAST)Santa Ana, CASAMHSA model program developed by L. McDonald, adapted by investigators for local community

Promotes healthy youth development by jointly engaging students, families and schools

Connects parents and kids to their schools & communities

Promotes community service & voluntary participation (

promotora

model)

Guides parents in building their kids’ personal success assets and in remaining their kids’ primary agents of protection

Builds skills & changes attitudes thru experiential learning

Preserves classroom time through school-focused, extracurricular parental involvement and after-school programming for kidsSlide24

FAST DesignQuasi-experimental effectiveness trial4 communities in Santa Ana, CA (2 Tx, 2 C)

Implementation at Latino Health Access

Surveys of parents and children: pretest, 3-month and 9-month posttests

Evaluation focus groups with parents & promotoras

240 low-income immigrant Latino parents & their elementary school-aged childrenSlide25

FAST Survey Results-ParentsMeans (Standard Deviations)

Time 1

Time 2

Time 3

Collective efficacy

Intervention

Control

Support from neighbors

Intervention

Control

Social support

Intervention

ControlSlide26

FAST Survey Results-ParentsMeans (Standard Deviations)

Time 1

Time 2

Time 3

Collective efficacy

Intervention

Control

19.09

(6.33)

18.99 (6.62)

20.84 (5.89)

19.39 (6.68)

21.01 (5.88)

20.57 (6.65)

Support from neighbors Intervention Control

2.04 (1.02)2.14 (1.12)2.37 (1.02)

2.39 (1.04)2.60 (1.05)2.25 (1.00)Social support

Intervention Control

31.18 (11.20)32.43 (11.16)35.40 (9.84)34.38 (11.19)

36.10 (10.03)34.15 (10.49)Slide27

FAST Survey Results-ParentsMeans (Standard Deviations)

Time 1

Time 2

Time 3

Collective efficacy

Intervention

Control

19.09

(6.33)

18.99 (6.62)

20.84 (5.89)

19.39 (6.68)

21.01 (5.88)

20.57 (6.65)

Support from neighbors Intervention

Control2.04 (1.02)2.14 (1.12)

2.37 (1.02)2.39 (1.04)2.60 (1.05)2.25 (1.00)

Social support Intervention Control

31.18 (11.20)32.43 (11.16)35.40 (9.84)34.38 (11.19)

36.10 (10.03)34.15 (10.49)Slide28

FAST Survey Results-ChildrenMeans (Standard Deviations)

Time 1

Time 2

Time 3

Social cohesion

Intervention

Control

Problem solving

Intervention

Control

Victimization

Intervention

Control

Bullying

Intervention

ControlSlide29

FAST Survey Results-ChildrenMeans (Standard Deviations)

Time 1

Time 2

Time 3

Social cohesion

Intervention

Control

30.43

(

6.47)

30.14 (7.19)

32.89 (6.64)

32.16

(6.69)

32.89 (6.71)

32.06

(7.13)

Problem solving Intervention Control

14.91 (4.37)16.15 (4.01)16.36 (3.88)16.32 (4.06)

15.76 (4.99)15.25 (4.53)

Victimization Intervention Control

5.03 (3.03)

4.58 (3.92)

4.34 (3.39)

4.01 (3.10)

3.55 (3.16)

3.87 (3.32)

Bullying

Intervention

Control

1.88 (2.36)

1.80 (2.39)

1.46 (2.36)

1.33 (2.12)

1.55 (2.35)

1.58 (3.1)Slide30

FAST Survey Results-ChildrenMeans (Standard Deviations)

Time 1

Time 2

Time 3

Social cohesion

Intervention

Control

30.43

(

6.47)

30.14 (7.19)

32.89 (6.64)

32.16

(6.69)

32.89 (6.71)

32.06

(7.13)

Problem solving Intervention Control

14.91 (4.37)16.15 (4.01)16.36 (3.88)16.32 (4.06)

15.76 (4.99)15.25 (4.53)

Victimization Intervention Control

5.03 (3.03)

4.58 (3.92)

4.34 (3.39)

4.01 (3.10)

3.55 (3.16)

3.87 (3.32)

Bullying

Intervention

Control

1.88 (2.36)

1.80 (2.39)

1.46 (2.36)

1.33 (2.12)

1.55 (2.35)

1.58 (3.1)Slide31

FAST Focus Group ResultsIntervention cultivated social support

“Social capital. It is very important because here, you feel alone, don’t have your extended family to rely on, that you could leave your kids with or things like that. So if you have a group of friends that you can trust…. If you would see the stories that the moms tell us…, as A told me the other day, one of the moms lose her kid (kid got lost) and all of the mothers that lived there and that had attended FAST helped her find her kid. So imagine, you don’t feel you are alone anymore. At least you know that you can go to your neighbor or the one 3 buildings away and you can count on them. So you don’t feel as lonely as when you arrived to this country….”Slide32

FAST Focus Group ResultsIntervention culturally appropriate

“What a mom from FAST comment me is that the FAST team speaks their own language: Spanish, that you can be touched (they can touch you, rub your back), that they feel welcome. So it’s not just somebody talking to them behind a desk (podium). It’s a very fraternal contact with them. ‘

Don’t worry; we are here. Don’t worry; we are here’.”Slide33

FAST Focus Group ResultsIntervention promoted father involvement in family“So with FAST I told him the same as I told my daughter. ‘Go and see if you like it. I will not force you to go.’ So he tried to attend the meetings even if it was late. Like the other day that my high school daughter got a D, I made the appointment with the counselor on a Saturday to force him to go because he always tells me that he has to work, and my daughter was very proud that her father went. So I want him to get involved because when my daughter is receiving her doctors degree, he will then want to go and I won’t let him!

(laughing)

”Slide34

FAST Focus Group ResultsIntervention taught specific helpful strategies – e.g., 15 Minutes

“She got into a fight with her daughter …and it was a big one. So she started shouting at her daughter, and her daughter calmed down and said to her, ‘

Mami

, so soon did you forgot to give me my 15 minutes?’ So the mom said that when her daughter told her that, everything inside her got removed. Everything that she was told in the program. ‘So I stopped what I was doing, left my other kid with someone, and gave to my daughter her 15 minutes.’ They were talking, and the daughter said, ‘You have to continue in the program even if it’s over. You have to continue doing what you learned in FAST.’ So that daughter had seen that those 15 minutes that she shared with her mother made a huge difference. So when they graduated and all that and the first situation that showed up that she lost control and that her daughter remind her, she doesn’t forget. She says it’s an experience she will not forget.”Slide35

FAST Focus Group ResultsIntervention facilitators also benefitted“Many things of the FAST program I’ve taken (applied) into my personal life. What’s more difficult for me is to coach, because while I’m talking to them, is as if I would be talking to my interior (to myself). Many things I have told the parents have helped me. So I say to myself, if that program that I’m helping to implement has helped me, and when I listen to the parents experiences, it’s worth it to be here! ”Slide36

FAST Summary & CommentsNo effects on youth behaviorExplained by intervention timing: Implementation during high stress period due to ICE raidsHowever, significant effects on collective efficacy and social cohesion among parents and childrenIntervention effectively connected parents and children to community and reduced isolation, two factors influencing juvenile delinquency

Intervention facilitated resilience

Implications?

Evidence-based program with marginal effects – why?Slide37

Arlanza Neighborhood InitiativeRiverside, CANeighborhood-level intervention to promote well-being of children aged 0-5

Neighborhood mobilization to build social capitalBackground: neighborhood decline in 90s when industry replaced residential areas and neighborhood turnover increased due to loss of major employerSlide38

Arlanza InterventionMapped institutional assetsFormed Riverside Youth Violence Prevention Policy BoardEstablished Eric M. Solander

Arlanza Youth and Family Resource CenterProvided services through the Center:

Child care, gang prevention, WIC nutritional and health services, counseling services, community meeting space, parenting classes

Formed

Arlanza

Area Clergy Team (neighborhood engagement and beautification)

Formed English Learning Advisory Committee (for monolingual parents to engage in schools)Slide39

Arlanza Results Participation15 agencies involved in BoardEvidence of collective and collaborative action

Services providedChildcare provided to 300/352 eligible families WIC services provided to 3,883 women, infants, and children

Delinquency reduction

Juvenile arrests in neighborhood dropped by 41% post intervention

Outcome evaluation under way, using 2008 crime dataSlide40

4: Assure Widespread AdoptionIdentification of effective programsDissemination

Replication

e.g., ACE-UCR’s use of FASTSlide41

Contemporary Questions/Future ResearchNeed to assess effects of public health interventions Across time

Across ecological levelsAcross outcomes

Across subgroupsSlide42

Contemporary Questions/Future ResearchAcross time – examine the life courseMultiple points of interventione.g., FAST age-specific versions

Multiple points of assessmente.g. Good Behavior Game (see Drug and Alcohol Dependence, Volume 95 Supplement, June 2008)

Need longitudinal data – multiple,

long-term

time pointsSlide43

Contemporary Questions/Future ResearchAcross levels of the social ecology Assess outcomes beyond individual level … family, community, aggregate individual, etc.Effects: More than just the sum of individual units!Challenge: statistical power for community-level interventions effectiveness analyses

Recognize difference between assessing outcomes and intervening at each level of social contextSlide44

Contemporary Questions/Future ResearchAcross outcomesAssess whether program effects crossover to other outcomes e.g. Botkin’s LifeSkills

Training

Assess program effects on syndromes

Considering multiple outcomes simultaneously (e.g. using cluster analysis)Slide45

Contemporary Questions/Future ResearchAcross subgroups – effective for whom?Risk statuse.g. keepin’ it REAL youth substance use prevention intervention - effects moderated by prior substance use (Kulis et al., 2007)

Ethnicity/acculturation

e.g.

keepin

’ it REAL - effects moderated by acculturation (Marsiglia et al., 2005)

Intervention responsiveness

Cluster analysis – what participant profile is associated with highest responsiveness?Slide46

ConclusionPublic health interventions & high risk populationsWe’ve come along way

Know lots re: intervention efficacy & effectiveness Have many evidence-based interventions to employ

Recognize need to link research, policy, & practice

We still face challenges

Lots ineffective or not-yet-proven effective interventions in use (and funded!)

Evidence-based programs sometimes don’t work

We must move forward

Study how interventions perform across time, ecological levels, outcomes, & subgroups

Study how to better translate research in to policy and practiceSlide47

Thank youTanya Nieri, PhDAssistant Professor, Sociology

Academic Center of Excellence on Youth Violence Prevention

Presley Center for Crime and Justice Studies

University of California, Riverside

tanyan@ucr.edu

Jennifer L . Matjasko, PhD

Behavioral Scientist

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Jmatjasko@cdc.gov