Strong African American Families-Teen Program

Evidence-level

Effective (About evidence-level criteria)

Description

Researchers supported by the National Institute on Drug Abuse (NIDA) created a family-centered prevention program to address the lack of interventions focused on decreasing behavioral and conduct problems in rural African American adolescents. Strong African American Families-Teen Program (SAAF-T) targets adolescents (ages 14-16) with the goal of preventing problem behaviors, particularly those most associated with HIV/AIDS risk, and promoting teens' positive adjustment.

Dr. Gene Brody and colleagues at the Center for Family Research (CFR) - University of Georgia, developed SAAF-T, which was successfully tested and implemented in rural Georgia. It is closely tied with the Strong African American Families Program.

In this randomized trial, 502 adolescents and primary caregivers were either placed in a group that attended SAAF-T meetings or a group that had the same structure as SAAF-T meetings but with a focus on proper nutrition, exercise, and informed consumer behavior.

Services offered

CFR researchers created the SAAF-T content based on over 15 years of epidemiological research in rural Georgia.

SAAF-T teen sessions include content on:

• The importance of post-secondary education/training
• Financial responsibilities of being an adult
• Identifying goals for the future and possible barriers
• Strategies for accomplishing academic/occupational goals
• Strategies to resist personal temptation and peer pressure
• Strategies for effective communication about abstinence and sex
• The risks associated with sexual involvement (for example, STDs and pregnancy)
• How to use a condom properly

SAAF-T caregiver sessions include the following content:

• Adapting parenting styles as teens get older
• Consistently monitoring teens
• Helping teens deal with discrimination
• Offering teens academic support
• Promoting independence and community involvement
• Communicating with teenagers about peer pressure including alcohol, drugs, and sex

During the research study, teenagers and their primary caregivers were involved in five 2-hour SAAF-T meetings led by locally trained leaders. During the first hour, caregivers and teens met separately, convening during the last hour for additional discussions and family activities.

Results

In this effective trial, teenagers who attended the SAAF-T meetings in 10th grade were interviewed again in 12th grade. In comparison to the nutrition/exercise group, the teens in the SAAF-T group reported:

• 36% fewer conduct problems
• 32% less frequent substance use
• 47% fewer substance use problems
• Reduced depressive symptoms
• Decreased frequency of unprotected intercourse
• Increased condom efficacy

The nutrition/exercise group was effective in the sense that its participants reported 14.5% more healthful behaviors at follow-up in comparison to the SAAF-T group.

From a cost-effectiveness standpoint, baseline and follow-up assessments revealed that of the 473 youth who participated:

• Incremental per participant costs were $168
• Incremental per participant effects prevented:
  • 3.39 episodes of alcohol use
  • 1.36 episodes of binge drinking
• Therefore, the SAAF-T Program cost:
  • $50 per reduction in alcohol use episode
  • $123 per reduction in binge drinking

At thresholds of $100 and $440, cost-effectiveness acceptability curves revealed that relative to the attention control intervention:

• 90% probability of cost-effectiveness for decreased alcohol use and instances of binge drinking

These findings suggest the SAAF-T intervention is a potentially cost-effective means for decreasing alcohol use and episodes of binge drinking in rural African American adolescents.

For more detailed results:

Brody, G., Yu, T., Chen, E., et al. (2021). Family-Centered Prevention Effects on the Association Between Racial Discrimination and Mental Health in Black Adolescents: Secondary Analysis of 2 Randomized Clinical Trials. JAMA Network Open, 4(3).

Brody et al (2014). Differential sensitivity to prevention programming: a dopaminergic polymorphism-enhanced prevention effect on protective parenting and adolescent substance use. Health Psychology, 33(2), 182-191.

Brody, G., Chen, Y., Kogan, S., Yu, T., Molgaard, V., DiClemente, R., & Wingood, G. (2012). Family-Centered Program Deters Substance Use, Conduct Problems, and Depressive Symptoms in Black Adolescents. Pediatrics, 129(1), 108–115.

Ingels, J., Corso, P., Kogan, S., & Brody, G. (2013). Cost-effectiveness of the Strong African American Families-Teen Program: 1-Year Follow-up. Drug and Alcohol Dependence, 133(2), 556-561.

Kogan et al. (2012). The Strong African American Families–Teen Trial: Rationale, Design, Engagement Processes, and Family-Specific Effects. Prevention Science, 13(2), 206-217.

Kogan, S., Yu, T., Brody, G., Chen, Y., DiClemente, R., Wingood, G., Corso, P. (2011). Integrating Condom Skills Into Family-Centered Prevention: Efficacy of the Strong African American Families-Teen Program. Journal of Adolescent Health, 51(2), 164-170.

Challenges

The SAAF-T research trial was resource intensive as financial incentives and home-based engagement strategies were used to help yield high participation rates during the study. The use of financial incentives may have encouraged families to participate; however, research has shown that incentives alone are not sufficient to guarantee high attendance rates. Home-based engagement of participants is also resource intensive and may not be feasible for all agencies to implement.

Infrastructure building for the program can also be a financial challenge if a meal, transportation, and childcare are provided at each session. Agencies may need to consider a combination of present financial resources, community options, and donations as a way to provide for the infrastructure of the SAAF-T Program.

Replication

SAAF-T is a manualized, structured program which can be easily disseminated to public health agencies, schools, churches, boys' and girls' clubs, and other community agencies.

The SAAF-T curriculum outlines each activity and the specific way in which it should be implemented with families. Agencies who implement SAAF-T will need to invest in the curriculum and the curriculum training and maintain a staff and/or volunteers who are trained on the curriculum.

Recruiting families for SAAF-T can be a challenge due to the demands on family life and competing activities in the community, school, and church. Agencies may need to find ways to overcome a teen's lack of interest in family programming. Families can be recruited through a wide variety of community resources including local schools, nonprofit agencies, and churches as well as by word of mouth through agency contacts.

Maintaining a staff of individuals who have been trained on the SAAF-T Program is important for replication and sustainability of the program. A minimum of 8 agency representatives should be trained to ensure implementation feasibility and to account for staff/volunteer attrition. The SAAF-T training can accommodate up to 20 trainees.

Organizations that partner with others are often most successful with implementation and sustainability. When organizations work together, they have more potential families to recruit from and more facilitators to work with because they come from the host and partnering organizations.

The CFR Dissemination office is equipped to support agencies that are interested in adopting the SAAF-T Program through training, coaching, quarterly TA calls, ongoing technical assistance, and optional fidelity site visits. Agencies who purchase SAAF-T will receive a complete set of program materials as well as electronic access to the curriculum materials, two sets of the program DVDs, and access to the video streaming site. Agencies will also have access to a Resource Manual that includes implementation and sustainability strategies and tips, as well as a Fidelity Manual to assist with monitoring curriculum adherence.

The SAAF-T brochure is used to education people about the program.

Contact Information

Gregory D. Rhodes, EdD, Dissemination Specialist
Center for Family Research
Strong African American Families-Teen Program
706.248.8422
gdrhodes@uga.edu