Alida Bouris, Ph.D., MSW Assistant Professor University of Chicago School of Social Service Administration

1. Families Talking Together: The Feasibility and Efficacy of a Clinic-Based Parent Intervention to Prevent Unplanned Pregnancies, STIs and HIV among Latino Youth Alida Bouris, Ph.D., MSW Assistant Professor University of Chicago School of Social Service Administration National Hispanic Medical Association 15th Annual Conference Washington, DC March 19, 2011

2. Acknowledgments • Vincent Guilamo-Ramos, Ph.D., Professor, New York University Silver School of Social Work. Principal Investigator. • James Jaccard, Ph.D., Professor, Florida International University. • Bernardo Gonzalez, Project Coordinator, New York University Silver School of Social Work. Funded by: • Reducing Teen Sexual Behavior: A Clinic-Based Approach.National Institute of Mental Health: R34 MH078719-01A1. • A Community Clinic Partnership Demonstrating Social Workers’ Efficacy: A Clinic-Based Intervention. Subcontract with the Collaborative HIV-Prevention Research in Minority Communities Program, Center for AIDS Prevention Studies, University of California, San Francisco, funded by the National Institute of Child Health and Human Development: R25 HD045810-04.

3. Latino Adolescent Sexual Risk Behavior, Pregnancy, STIs and HIV Latino adolescents are sexually active: 49% of Latino high school students have had vaginal sexual intercourse. 45% did not use a condom at last sex. Highest teen pregnancy and birth rate in the U.S. Prevalence of Chlamydia per 100,000 people: 15-19 year olds: 1,866 among Latinos vs. 877 among Whites. Incidence of HIV per 100,000 people aged 13-29: Females: 14% among Latinas vs. 5% among Whites Males: 43% among Latinos vs. 18% among Whites. (CDC, 2008; 2010a; 2010b; NCTPUP, 2010)

4. Families Talking Together Parent-based intervention to prevent and reduce sexual risk behavior among Latino and African American middle school-aged adolescents. Delivered in a pediatric health clinic in the Bronx, NY High need and underserved population. Feasibility and efficacy research Focus groups Randomized controlled trial. (Bouris et al., 2010; Guilamo-Ramos, Bouris, et al., 2011)

5. Phase I: Feasibility Research • Focus groups with three groups of key stakeholders: • Healthcare providers (e.g., physicians and nurses) • African American and Latino mothers • African American and Latino adolescents. • Interested in identifying unique and common perspectives on how best to develop and implement a sexual risk reduction program. (Bouris et al., 2010)

6. Key Research Questions • Focused on four key areas: • Feasibility • Recruitment • Participation • Delivery Mechanism • Is a clinic-based parent intervention feasible? • How do we successfully involve mothers and youth? • How do we deliver the intervention in the context of the clinic? (Bouris et al., 2010)

7. Data Collection • Focus group with providers (N = 14) • Focus groups with mothers (N = 14) • 2 focus groups with Latino mothers: 1 English-speaking and 1 Spanish-speaking • 1 focus group with African American mothers • Focus groups with adolescents (N = 13) • 2 focus groups with Latino adolescents (all English-speaking) • 1 focus group with African American adolescents (Bouris et al., 2010)

8. Results • Across focus groups, salient themes on feasibility, participation and delivery were identified in four major areas: • Parent, adolescent and provider role expectations • Feasibility of the intervention • Participation in the intervention • Delivery of the intervention in the clinic setting (Bouris et al., 2010)

9. Results: Providers • View it as role to counsel youth on sex and reproductive health: • Busy: multiple roles and responsibilities. • Parents ask us to talk with adolescents about sex. • Tension between addressing general adolescent health vs. specific messages on sexual behavior. • Intervention and provider role cannot interfere with care or place additional burdens on provider: • Integrate intervention into routine delivery of health services. • Maximize provider influence by having provider endorse program. (Bouris et al., 2010)

10. Results: Adolescents • Believe a program is feasible and want information on dating, romantic relationships and sexual health. • Trust their providers: professional and expert. • Want provider to endorse the program. • Recruit mothers and youth in the waiting room: • Youth friendly posters, flyers, and pamphlets. • Highlight benefits: make program relevant to their life. • Include youth in recruitment efforts. • Be sensitive and respectful: don’t lecture. (Bouris et al., 2010)

11. Results: Adolescents • Want to talk with their mother about sexual health but recognize that mothers need additional support. • Adolescents want structured opportunities to implement a “family program and related activities.” • Get to know their parents better. • Learn more about their parent’s history. • Hear and learn about their parent’s thoughts and opinions. (Bouris et al., 2010)

12. Results: Mothers • Concerned about their children becoming sexually active and want to delay sexual activity. • Perceive it as within the provider role to talk to their children about reproductive health. • Mothers trust their adolescent’s provider: • Trustworthy and gives good advice • Feel comfortable talking to their adolescent’s provider • Providers are matter-of-fact and a source of good information and support for parents’ ongoing efforts to keep their child healthy. (Bouris et al., 2010)

13. Results: Mothers • Recruit parents in the waiting room: lost time. • Engage both mother and adolescent • Be respectful and helpful, not judgmental or preachy. • Package program as an extension of services offered to families as part of an ongoing partnership. • Focus on prevention AND let parents know it’s not too late if your child is already sexually active. • Deliver intervention when adolescent sees provider: • Have provider endorse program to mother and adolescent. • Follow up via telephone calls, e-mails, text messages. (Bouris et al., 2010)

14. Phase II: Pilot Randomized Controlled Trial of Families Talking Together • Purpose is to evaluate the preliminary efficacy of a brief parent-based intervention for healthcare settings designed to delay and/or reduce adolescent sexual behavior. Data provide preliminary evidence for subsequent larger scale RCT. • N = 264 mother-adolescent dyads • 133 randomized to experimental condition • 131 randomized to control condition (Guilamo-Ramos, Bouris, et al., 2011)

15. 326 Mother-Adolescent Dyads Assessed for Eligibility 62 Mother-Adolescent Dyads Excluded 55 Ineligible to participate 7 Refused to participate 264 Randomized 133 Allocated to Experimental Intervention 131 Allocated toControl Intervention 124 Delayed Follow-Up(9-Months from Baseline) 124 Provided data 3 Refused 6 Unable to track 126 Delayed Follow-Up(9-Months from Baseline) 126 Provided data 2 Refused 3 Unable to track 124 Included in Analysis 126 Included in Analysis Phase II: Families Talking Together (Guilamo-Ramos, Bouris, et al., 2011)

16. Phase II: Randomized Controlled Trial of Families Talking Together • Intervention delivered in pediatric health clinic by social work interventionist to parents when adolescents see pediatrician for routine health visits. • 30 minute face-to-face intervention coupled with focused homework assignments and parenting materials: • Interventionist reviews key intervention content and family activities. • Structured homework assignments. • Theoretically-driven communication materials. • Two booster calls via telephone.

17. Descriptive Statistics at Baseline for Total Sample

18. Analysis of Primary Outcomes *Statistically significant different at p < .05

19. Families Talking Together: A Parent-Based Intervention Delivered in a Pediatric Health Clinic (Guilamo-Ramos, Jaccard, & Dittus, 2003)

20. Additional Resources for Researchers and Practitioners

21. Practitioner-focused Materials Parent-adolescent communication about sex in Latino families: A guide for practitioners. National Campaign to Prevent Teen and Unplanned Pregnancy. Available at: http://www.thenationalcampaign.org/resources/pdf/pubs/Parent_AdolFINAL.pdf

22. Practitioner-focused Materials

23. Additional Resources

24. Primary Studies Bouris, A., Guilamo-Ramos, V., Jaccard, J., McCoy, W., Aranda, D., Pickard, A., & Boyer, C. (2010). The feasibility of a clinic-based parent intervention to prevent adolescent HIV infection, STIs, and unintended pregnancies. AIDS Patient Care and STDs, 24(6), 381-387. Guilamo-Ramos, V., Bouris, A., Jaccard, J., Gonzalez, B., McCoy, W., & Aranda, D. (2011). A parent-based intervention to reduce sexual risk behavior in early adolescence: Building alliances between physicians, social workers, and parents. Journal of Adolescent Health, 48(2), 159-163.

25. Additional Resources Bouris, A., Guilamo-Ramos, V., Pickard, A., Shiu, C., Loosier, P., Dittus, P., Gloppen, K., & Waldmiller, J. M. (2010). A systematic review of parental influences on the health and wellbeing of lesbian, gay and bisexual youth: Time for a new public health research and practice agenda. Journal of Primary Prevention, 31(5-6), 273-309. Guilamo-Ramos, V., & Bouris, A. (2008). Parent-adolescent communication about sex in Latino families: A guide for practitioners. National Campaign to Prevent Teen and Unplanned Pregnancy. Available at: http://www.thenationalcampaign.org/resources/pdf/pubs/Parent_AdolFINAL.pdf Guilamo-Ramos, V., Jaccard, J., & Dittus, P. (Eds.). (2010). Parental monitoring of adolescents. New York: Columbia University Press. Guilamo-Ramos, V., & Bouris, A. (2009). Working with parents to promote healthy adolescent sexual development. The Prevention Researcher, 16(4), 7-11.

26. References Centers for Disease Control and Prevention (CDC). (2010a). 2009 youth risk behavior survey. Available at: http://apps.nccd.cdc.gov/youthonline/App/Default.aspx Centers for Disease Control and Prevention (CDC). (2010b). Sexually transmitted disease surveillance 2009. Available at: http://www.cdc.gov/std/stats09/toc.htm. Guilamo-Ramos, V., Jaccard, J., & Dittus, P. (2004). Families Talking Together: A parent-based adolescent sexual risk reduction intervention. Authors. National Campaign to Prevent Teen and Unplanned Pregnancy. (2010). Summary of 2009 preliminary birth data from the National Center for Health Statistics. Washington, DC. Centers for Disease Control and Prevention. (2008). Subpopulation estimates from the HIV incidence surveillance system-United States, 2006. Morbidity and Mortality Weekly Reports, 58, 985-989.