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
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.
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)
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)
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)
Key Research Questions

Focused on four key areas:
1. Feasibility
2. Recruitment
3. Participation
4. 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)
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 Englishspeaking)
 1 focus group with African American adolescents
(Bouris et al., 2010)
Results

Across focus groups, salient themes on feasibility,
participation and delivery were identified in four major
areas:
1. Parent, adolescent and provider role expectations
2. Feasibility of the intervention
3. Participation in the intervention
4. Delivery of the intervention in the clinic setting
(Bouris et al., 2010)
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)
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)
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)
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)
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)
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)
Phase II: Families Talking Together
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 to
Control Intervention
124 Delayed Follow-Up
(9-Months from Baseline)
126 Delayed Follow-Up
(9-Months from Baseline)
124 Provided data
3 Refused
6 Unable to track
124 Included in Analysis
126 Provided data
2 Refused
3 Unable to track
126 Included in Analysis
(Guilamo-Ramos, Bouris, et al., 2011)
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.
Descriptive Statistics at Baseline
for Total Sample
Sample Size
N = 264
Parents
Adolescents
Mean age
40.7
Percent Latino
84.5
Mean age
12.9
Percent African American
15.5
Percent male
47.7
28.0
Percent mostly speak
Spanish in the home
63.1
Percent completed high
school (modal education)
Percent Catholic
56.5
Percent born in the US 71.2
Percent mostly speak
Spanish in the home
72.6
Percent had vaginal
sex
Percent born in the US
22.7
Percent single head of
household
44.6
6.4
Analysis of Primary Outcomes
Adolescent Report
Percent engaged in vaginal
sexual intercourse
Intervention Control
Baseline
6
6
9-month Follow-up
6*
22*
Adolescent Report
Frequency of sexual
intercourse in past 30 days
Intervention Control
9-month Follow-up
Adolescent Report
Percent have given or
received oral sex
1.08*
1.53*
Intervention Control
Baseline
3
3
9-month Follow-up
4*
10*
*Statistically significant different at p < .05
Families Talking Together:
A Parent-Based Intervention Delivered in a
Pediatric Health Clinic
(Guilamo-Ramos, Jaccard, & Dittus, 2003)
Additional Resources for
Researchers and Practitioners
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/reso
urces/pdf/pubs/Parent_AdolFINAL.pdf
Practitioner-focused Materials
Additional Resources
Primary Studies
Bouris, A., Guilamo-Ramos, V., Jaccard, J., McCoy, W., Aranda,
D., Pickard, A., & Boyer, C. (2010). The feasibility of a clinicbased 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.
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.
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.