This developmental (R21) study will address an unmet need among preteen youths and their African-American mothers who abuse crack cocaine. The strong link between adolescent substance use and high-risk sexual behaviors makes adolescent children of African-American drug abusers one of the highest risk groups for substance abuse and HIV. The social contexts of maternal drug use and its associations with potentially neglectful and aggressive parenting may lead to poor child outcomes through negative influence on family dynamics. Research shows that family factors influence substance use, HIV-related risk, and protective factors in the long term. Short-term effects of substance use and HIV risk-reduction interventions with youth may diminish over time because of the lack of family or parent involvement. Selective family-skills interventions that target drug-using mothers, their preadolescent children, and their dyadic interactions may be a more-durable approach to prevent youth drug abuse and HIV risk factors through adolescence and adulthood. To break potential intergenerational patterns of drug use and HIV risk among families with maternal drug use, there is a critical need to identify risks and protective mechanisms operating for the children of these families, and to adapt and test a family-skills intervention that targets these factors among youths at an especially vulnerable stage of pre-adolescence. Because target mothers and children are hard to reach and retain in interventions, the proposed study will be conducted in two phases: formative and experimental. The formative phase will adapt and refine recruitment and retention strategies and the intervention with community input; the experimental phase will examine the outcomes of the adapted family-skills intervention delivered in a multicomponent format (maternal, youth, and mother-child sessions) to prevent drug abuse and HIV among children (aged 10 to 14 years) of African-American mothers who abuse crack and are not in treatment.
The specific aims of the proposed developmental study are as follows:
Specific Aims : Formative Phase.
Aim 1) To develop and refine effective strategies to reach, recruit, and retain African-American mothers who use crack and their children (aged 10 to 14 years) in a multicomponent family-skills intervention to prevent youth drug abuse and HIV.
Aim 2) To revise, adapt, and tailor relevant family interventions to reduce risk factors for substance abuse and prevent HIV among the targeted preteen children (aged 10 to 14 years) of African-American mothers who use crack and are not in treatment.
Specific Aims : Experimental Phase.
Aim 3) To describe individual, maternal, and familial risk and protective factors in children (aged 10 to 14 years) of African-American mothers who use crack and are not in treatment.
Aim 4) To examine the outcomes (family environment, youth social skills and problem behaviors, substance use, and sexual risk) of a family-skills intervention adapted for drug abuse and HIV prevention among African-American mothers who use crack and their children relative to a no-intervention control group at 3- and 6-month follow-ups.
Aim 5) To explore mediating (e.g., maternal and adolescent self-efficacy, perceived risk, and maternal drug use) and moderating factors (youth age, gender, school performance, religiosity) of intervention effectiveness on substance use, sexual intentions and risk behaviors among children of African-American mothers who use crack and are not in treatment.
