Culturally sensitive risk behavior prevention programs for African American adolescents: a systematic analysis

Systematic review of family-based interventions integrating cultural and family resilience components to improve Black adolescent health outcomes

BACKGROUND

Past reviews have shown that culturally salient resilience interventions buffer the negative effects of racial discrimination on psychological and behavioral outcomes among Black youth. However, these prior reviews neglect to integrate trials targeting physical health and/or health-promoting outcomes, synthesize trials based on methodological rigor, or systematically assess efficacy or resilience intervention components.

PURPOSE

This systematic review expands on past research by (1) providing an up to-date literature review on family-based cultural resilience interventions across a range of health-related outcomes (physical health, health behaviors, health risk-taking behaviors, and psychological), (2) evaluating the rigor of these interventions, (3) analyzing the efficacy of rigorous interventions, and (4) describing the resilience intervention components of rigorous interventions.

METHODS

Using the PRISMA guidelines, a systematic search was conducted from 1992 to 2022. Studies were included if they were family-based resilience interventions targeting health-related outcomes among Black adolescents ages 10-17 years.

RESULTS

Fifteen studies met inclusion criteria, 10 of which were not included in past reviews. Overall, 10 trials demonstrated high methodological rigor, 9 of which were efficacious. Most rigorous, efficacious trials targeted health risk-taking behaviors outcomes (~66%), whereas none targeted health promotion behaviors (physical activity, diet). Resilience components of rigorous efficacious interventions included racial socialization (racial coping, cultural pride) and family resilience (communication, routine), with fewer integrating racial identity (self-concept, role models) and cultural assets (spirituality, communalism).

CONCLUSIONS

These findings suggest the need to replicate existing rigorous strengths-based resilience interventions and address broader outcomes, including health-promoting behaviors, in the future.

Justice-Involved Youth: Support for Community and Family Interventions

Justice-involved youth have high rates of mental health symptoms and diagnoses. Unaddressed mental health needs are associated with exposure to adversity and trauma, as well as unidentified or mislabeled symptoms that may be present early in life. Justice-involved youth disproportionately come from low-income families and minoritized populations. Community-based interventions that address family and community factors associated with justice involvement are key to improving mental health and life trajectory outcomes for youth. Policies and interventions that address unmet educational needs, support families, and promote early identification of youth in need of social, educational, and mental health services are reviewed.

Experience of Family Members of Relatives With Substance Use Disorders: An Integrative Literature Review

Background: Substance use disorders (SUDs) present substantial challenges for family members living with or supporting relatives with SUDs. This review explores existing literature on family members' experiences with relatives with SUDs and their support needs. Method: An integrative review was conducted by searching literature in the Cumulative Index of Nursing and Allied Health, PubMed, PsycINFO, ProQuest, and Scopus databases. Results: Five themes were generated based on analysis of 26 empirical studies: (a) family members' and caregivers' experiences of SUDs; (b) impact of SUDs-related aggressive/violent behaviors on families; (c) dilemmas faced by family members; (d) culture and family stigma related to SUDs; and (e) factors contributing to SUDs, challenges, and support needs. The review highlighted barriers to seeking support due to stigma and guilt, underscoring the need for structured support programs. Conclusions: This review sheds light on the challenges faced by family members with relatives suffering from SUDs and emphasizes the crucial need for structured support programs. The findings provide insights for developing initiatives to address the social and trauma-induced needs of family members and to establish support resources for them.

Black Moms Matter: A Qualitative Approach to Understanding Barriers to Service Utilization at a Children's Advocacy Center Following Childhood Abuse

Black families are significantly less likely to receive evidence-based trauma treatment services; however, little is known about factors impacting engagement, particularly at Children's Advocacy Centers (CACs). The goal of this study is to better understand barriers and facilitators of service utilization for Black caregivers of CAC referred youth. Participants (n = 15) were randomly selected Black maternal caregivers (ages 26-42) recruited from a pool of individuals who were referred to receive CAC services. Black maternal caregivers reported barriers to accessing services at CACs including a lack of assistance and information in the referral and onboarding process, transportation issues, childcare, employment hours, system mistrust, stigma associated with the service system, and outside stressors such as stressors related to parenting. Maternal caregivers also shared suggestions for improving services at CACs including increasing the length, breadth, and clarity of investigations conducted by child protection services and law enforcement (LE) agencies, providing case management services, and having more diverse staff and discussing racial stressors. We conclude by identifying specific barriers to the initiation and engagement in services for Black families, and we provide suggestions for CACs seeking to improve engagement of Black families referred for trauma-related mental health services.

Patient-Provider Health Communication Strategies: Enhancing HPV Vaccine Uptake among Adolescents of Color

Cervical cancer remains a public health issue in the United States, particularly among stigmatized racial and ethnic populations. The human papillomavirus (HPV) vaccine has been clinically proven to prevent cervical cancers, and other HPV-associated cancers, among men and women. However, HPV vaccine uptake is suboptimal; only 55% of adolescents complete the two-dose series by age 15. Past research has shown that provider HPV vaccine communication for people of marginalized races/ethnicities is subpar. This article focuses on provider communication strategies to promote HPV vaccine uptake effectively and equitably. The authors reviewed the literature on evidence-based patient-provider HPV vaccine communication techniques to create a set of communication language providers could use and avoid using to enhance HPV vaccine acceptance and uptake among adolescents of marginalized racial and ethnic groups. Evidence has shown that information and the manner of dissemination are critical for influencing HPV vaccine uptake. These communication strategies must be suited to the context of the targeted population, and the message content can be broadly categorized into source, content, and modality. Strategies to improve patient-provider communication among adolescents of color using source, modality, and content include the following: (1) Source: increase provider self-efficacy to provide the recommendation, building rapport between providers and parents; (2) Content: persistent, forceful language with minimal acquiescence should be employed, reframing the conversation focus from sex to cancer; and (3) Modality: use multiple vaccine reminder modalities, and work with the community to culturally adapt the vaccination language. Utilizing effective behavior-change communication adapted for adolescents of color can reduce missed opportunities for HPV prevention, potentially decreasing racial and ethnic disparities in HPV-related morbidity and mortality.

Educational and Training Interventions Aimed at Healthcare Workers in the Detection and Management of People With Mental Health Conditions in South and South-East Asia: A Systematic Review

Background: To bridge significant mental health treatment gaps, it is essential that the healthcare workforce is able to detect and manage mental health conditions. We aim to synthesise evidence of effective educational and training interventions aimed at healthcare workers to increase their ability to detect and manage mental health conditions in South and South-East Asia. Methods: Systematic review of six electronic academic databases from January 2000 to August 2020 was performed. All primary research studies were eligible if conducted among healthcare workers in South and South-East Asia and reported education and training interventions to improve detection and management of mental health conditions. Quality of studies were assessed using Modified Cochrane Collaboration, ROBINS-I, and Mixed Methods Appraisal Tools and data synthesised by narrative synthesis. Results are reported according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A review protocol was registered with the PROSPERO database (CRD42020203955). Findings: We included 48 of 3,654 screened articles. Thirty-six reported improvements in knowledge and skills in the detection and management of mental health conditions. Training was predominantly delivered to community and primary care health workers to identify and manage common mental health disorders. Commonly used training included the World Health Organization's mhGAP guidelines (n = 9) and Cognitive Behavioural Therapy (n = 8) and were successfully tailored and delivered to healthcare workers. Digitally delivered training was found to be acceptable and effective. Only one study analysed cost effectiveness. Few targeted severe mental illnesses and upskilling mental health specialists or offered long-term follow-up or supervision. We found 21 studies were appraised as low/moderate and 19 as high/critical risk of bias. Interpretation: In low resource country settings, upskilling and capacity building of primary care and community healthcare workers can lead to better detection and management of people with mental health disorders and help reduce the treatment gap. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42020203955.

Leveraging Technology and Cultural Adaptations to Increase Access and Engagement Among Trauma-Exposed African American Youth: Exploratory Study of School-Based Telehealth Delivery of Trauma-Focused Cognitive Behavioral Therapy

African American youth are disproportionately represented among trauma-exposed youth; yet, they are significantly less likely to access and complete mental health services. Research suggests that barriers to accessing and engaging in trauma-focused treatment include both logistical factors and engagement factors. This multiple case study sought to illustrate the initial feasibility and acceptability of delivering culturally tailored, trauma-focused cognitive behavioral therapy (TF-CBT) via telehealth in a school setting with three African American youth presenting with multiple barriers to accessing treatment. Barriers to treatment, telehealth modifications, and cultural tailoring are described for each participant. The UCLA Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) was completed at pretreatment and posttreatment. Results demonstrated significant decreases in symptoms of posttraumatic stress, as evidenced by a reduction in total UCLA PTSD-RI scores to nonclinical levels for all participants at posttreatment (UCLA scores posttreatment = 8-12). In addition, at posttreatment no participants met diagnostic criteria for PTSD or adjustment disorder. This multiple case study provides preliminary support for school-based, culturally tailored TF-CBT delivered via telehealth with African American youth.

Sexual Health Programs for Latinx Adolescents: A Meta-analysis

CONTEXT

Latinx adolescents are at risk for negative sexual health outcomes, and many interventions have been developed to reduce this risk.

OBJECTIVE

In this meta-analysis, we synthesized the literature on sexual health interventions for Latinx adolescents and examined intervention effects on 3 behavioral outcomes (abstinence, condom use, number of sex partners) and 3 psychological outcomes (safer sex knowledge, intentions, self-efficacy). Moderators of intervention success were explored.

DATA SOURCES

A systematic search of studies published through January 2019 was conducted by using PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature databases.

STUDY SELECTION

All studies included a US-based sample of Latinx adolescents, evaluated sexual health intervention by using an experimental or quasiexperimental design, included a behavioral outcome, and were in English.

DATA EXTRACTION

Standardized mean difference (d) and 95% confidence intervals (CIs) were meta-analyzed by using random-effects models.

RESULTS

Effect sizes from 12 studies, sampling 4673 adolescents, were synthesized. Sexual health interventions improved abstinence (d = 0.15, 95% CI: 0.02 to 0.28), condom use (d = 0.44, 95% CI: 0.18 to 0.70), number of sex partners (d = -0.19, 95% CI: -0.37 to -0.001), and sexual health knowledge (d = 0.40, 95% CI: 0.10 to 0.70), compared with control conditions. Effects were consistent across a number of demographic and clinical characteristics, although culturally tailored interventions produced greater change in condom use than nontailored interventions.

LIMITATIONS

There was variation across studies in measures of sexual behavior, and some elements of individual study quality were unclear.

CONCLUSIONS

Sexual health interventions have a small but significant impact on improving safer sexual behavior among Latinx adolescents. Health educators should consider the importance of cultural tailoring to program success.

Association of Sexual Health Interventions With Sexual Health Outcomes in Black Adolescents: A Systematic Review and Meta-analysis

IMPORTANCE

Black adolescents are at increased risk of contracting HIV and other sexually transmitted infections (STIs) and experiencing unplanned pregnancy. Although sexual health interventions aimed at decreasing these risks exist, evidence of the association between sexual health interventions and the sexual behavior of black adolescents has not been synthesized to our knowledge.

OBJECTIVE

To examine the associations between sexual health interventions and behavioral, biological, and psychological outcomes.

DATA SOURCES

For this systematic review and meta-analysis, a systematic search was conducted of studies published through January 31, 2019, using the PubMed, PsycINFO, and CINAHL databases and relevant review articles. The following key words were used: youth, adolesc* or teen*; sexual health or safe* sex or sexually transmitted disease or sexually transmitted infection or STD or STI or HIV or AIDS or pregnancy or reproductive health or condom* or contracept* or unprotected sex or abstinence; intervention or program or education or prevention or promotion or trial; latino* or latina* or latinx* or minorit* or ethnic* or hispanic or african american* or black* or race or racial or biracial.

STUDY SELECTION

Studies were included if they included a US-based sample of black adolescents, evaluated a sexual health intervention using experimental or quasi-experimental designs, included a behavioral outcome, and were published in English.

DATA EXTRACTION AND SYNTHESIS

Standardized mean differences and 95% CIs were extracted and meta-analyzed using random-effects models.

MAIN OUTCOMES AND MEASURES

Behavioral outcomes were abstinence, condom use, and number of sex partners. Biological outcomes were pregnancy and STI contraction. Psychological outcomes were sexual health intentions, knowledge, and self-efficacy.

RESULTS

Across 29 studies including 11 918 black adolescents (weighted mean age, 12.43 years), there was a significant weighted mean association of sexual health interventions with improvements in abstinence (Cohen d = 0.14; 95% CI, 0.05-0.24) and condom use (Cohen d = 0.25; 95% CI, 0.11-0.39). No significant mean association of these interventions with number of sex partners, pregnancy, or STI contraction was found. Sexual health interventions were significantly associated with improvements in psychological outcomes: sexual health intentions (Cohen d = 0.17; 95% CI, 0.05-0.30), knowledge (Cohen d = 0.46; 95% CI, 0.30-0.63), and self-efficacy (Cohen d = 0.19; 95% CI, 0.09-0.28). Intervention effect sizes were consistent across factors, such as participant sex and age and intervention dose.

CONCLUSIONS AND RELEVANCE

The findings suggest that sexual health interventions are associated with improvements in sexual well-being among black adolescents. There appears to be a need for wide-scale dissemination of these programs to address racial disparities in sexual health across the US.

Cultural sensitivity in paediatric nursing care: a concept analysis using the Hybrid method

BACKGROUND

Cultural sensitivity is a core concept to establish awareness and knowledge about various ethnicities, cultures, genders and additional diversity characteristics to understand individual's requests and respond appropriately to them. A need for further development of the concept is warranted, especially in the context of paediatric nursing.

AIMS

The purpose of this paper was to determine the main elements of cultural sensitivity in the context of paediatric nursing in Iran.

METHODS

The Hybrid method was implemented consisting of three phases: theoretical, fieldwork and final analysis. In the theoretical phase, articles from 2007 to 2017 were reviewed for relevance. In the phase of fieldwork, 25 nurses and nine parents were interviewed to explore the aspects of cultural sensitivity in paediatric nursing. The interviews were transcribed, and content analysis was conducted. In the final phase, an overall analysis of the two previous phases was performed.

RESULTS

In the theoretical phase, the following attributes were determined: cultural encounter and awareness, acceptance of cultural diversity and designing programmes in accordance with family culture. The fieldwork phase explored three themes of intercultural encounters, intercultural communication and adapting the care plan with family culture. The final synthesis yielded that sensitivity to family requests and beliefs, effective intercultural communication and integration of family culture with the care plan are the main elements of cultural sensitivity in Iranian paediatric nursing.

CONCLUSION

With a deeper understanding of the term cultural sensitivity, nurses will have a foundation to improve paediatric nursing care and align the care plan with the patient's culture to provide trust, child/parent participation, secure care, effective communication and satisfaction. Since the concepts are the building blocks that underpin theory, the present concepts identified can help to serve as the foundation for the development of a theoretical model.

Dimensions of ethnic identity as protective factors for substance use and sexual risk behaviors in African American college students

OBJECTIVE

To examine ethnic identity and ethnic socialization as potential protective factors for risk behaviors among US college students.

PARTICIPANTS

Participants were 398 African American and Afro-Caribbean students recruited from 30 colleges and universities during September 2008-October 2009.

METHODS

Data on hazardous alcohol use, substance use, sexual behaviors, ethnic identity, and ethnic/racial socialization were collected. Hierarchical linear and negative binomial regression analyses were conducted to determine the degree to which ethnic identity and ethnic/racial socialization predicted the risk behaviors.

RESULTS

Ethnic Identity affirmation, belonging, and commitment (EI-ABC) significantly predicted lower substance use and hazardous alcohol use. Ethnic/racial socialization was not a significant predictor of substance use or sexual risk behaviors.

CONCLUSIONS

Components of ethnic identity are potentially protective against alcohol and substance use behaviors. Additional research is recommended to determine effective intervention strategies.

Glucocorticoid Receptor (NR3C1) Gene Polymorphism Moderate Intervention Effects on the Developmental Trajectory of African-American Adolescent Alcohol Abuse

Accumulative evidence from recent genotype × intervention studies suggests that individuals carrying susceptible genotypes benefit more from intervention and provides one avenue to identify subgroups that respond differentially to intervention. This study examined the moderation by glucocorticoid receptor (NR3C1) gene variants of intervention effects on the developmental trajectories of alcohol abuse through adolescence. Participants were randomized into Fast Track intervention and control groups self-reported past-year alcohol abuse annually from grade 7 through 2 years post-high school and provided genotype data at age 21 (69% males; European Americans [EAs] = 270, African-Americans [AAs] = 282). Latent growth curve models were fit to examine developmental trajectories of alcohol abuse. The interactions of 10 single nucleotide polymorphisms (SNPs) in NR3C1 with intervention were examined separately. Both EAs and AAs showed significant increases in past-year alcohol abuse with substantial inter-individual differences in rates of linear growth. AAs showed lower general levels and slower rates of linear growth than EAs. Adjusting for multiple tests, one NR3C1 SNP (rs12655166) significantly moderated intervention effects on the developmental trajectories of alcohol abuse among AAs. Intervention effects on the rates of linear growth were stronger among AAs carrying minor alleles than those not carrying minor alleles. The findings highlight the importance of taking a developmental perspective on adolescent alcohol use and have implications for future intervention design and evaluation by identifying subgroups that could disproportionally benefit from intervention.

Racial-Ethnic Protective Factors and Mechanisms in Psychosocial Prevention and Intervention Programs for Black Youth

Extending previous reviews related to cultural responsiveness in the treatment of ethnic minority youth, the current review provides a critical assessment and synthesis of both basic and applied research on the integration of three racial-ethnic protective factors (racial identity, racial socialization, Africentric worldview) in psychosocial prevention and intervention programs for Black children and adolescents. Seventeen programs meeting inclusion and exclusion criteria were evaluated for the extent to which racial-ethnic protective factors and related mechanisms were integrated, applied, and tested in such programs. A systematic assessment of these programs revealed that several prevention and intervention programs drew upon the three factors, particularly Africentric worldview. In addition, a number of studies hypothesized and assessed mechanisms, both those previously identified in conceptual literature and those that emerged from the interventions themselves. A set of recommendations encouraging the implementation of these factors into future prevention and intervention programs, examples of how clinicians can infuse these factors into psychotherapy, and areas for future research are discussed.

Evaluating Teach One Reach One-An STI/HIV Risk-Reduction Intervention to Enhance Adult-Youth Communication About Sex and Reduce the Burden of HIV/STI

PURPOSE

Parents and caregivers play an important role in sexual socialization of youth, often serving as the primary source of information about sex. For African American rural youth who experience disparate rates of HIV/sexually transmitted infection, improving caregiver-youth communication about sexual topics may help to reduce risky behaviors. This study assessed the impact of an intervention to improve sexual topic communication.

DESIGN

A Preintervention-postintervention, quasi-experimental, controlled, and community-based trial.

SETTING

Intervention was in 2 rural North Carolina counties with comparison group in 3 adjacent counties.

SUBJECTS

Participants (n = 249) were parents, caregivers, or parental figures for African American youth aged 10 to 14.

INTERVENTION

Twelve-session curriculum for participating dyads.

MEASURES

Audio computer-assisted self-interview to assess changes at 9 months from baseline in communication about general and sensitive sex topics and overall communication about sex.

ANALYSIS

Multivariable models were used to examine the differences between the changes in mean of scores for intervention and comparison groups.

RESULTS

Statistically significant differences in changes in mean scores for communication about general sex topics ( P < .0001), communication about sensitive sex topics ( P < .0001), and overall communication about sex ( P < .0001) existed. Differences in change in mean scores remained significant after adjusting baseline scores and other variables in the multivariate models.

CONCLUSIONS

In Teach One Reach One intervention, adult participants reported improved communication about sex, an important element to support risk reduction among youth in high-prevalence areas.

Future Directions in Research on Racism-Related Stress and Racial-Ethnic Protective Factors for Black Youth

Research on racism-related stress and racial-ethnic protective factors represents an important enterprise for optimizing the mental health of African American and other racial and ethnic minority youth. However, there has been a relative dearth of work on these factors in the clinical psychology research literature, and more work is needed in outlets such as these. To this end, the current article adopts a developmental psychopathology framework and uses recent empirical findings to outline our current understanding of racism-related stress and racial-ethnic protective factors (i.e., racial identity, racial socialization, Africentric worldview) for African American youth. We then provide nine recommendations-across basic, applied, and broader/cross-cutting research lines-that we prioritize as essential to advancing the future scientific investigation of this crucial research agenda. Within and across these recommendations, we issue a charge to researchers and clinicians alike, with the ultimate goal of alleviating the negative mental health impact that racism-related stress can have on the well-being and mental health of African American and other racial and ethnic minority youth.