Predictors of Engagement and Retention into a Parent-Centered, Ecodevelopmental HIV Preventive Intervention for Hispanic Adolescents and their Families

Predictors of Engagement and Retention into a Parent-Centered, Ecodevelopmental HIV Preventive Intervention for Hispanic Adolescents and their Families Guillermo Prado,1 PHD, Hilda Pantin,2 PHD, Seth J. Schwartz,2 PHD, Nichole S. Lupei,2 BS, and José Szapocznik,2 PHD 1 Stempel School of Public Health, Department of Epidemiology and Biostatistics, Florida International University and 2Department of Psychiatry and Behavioral Sciences, Center for Family Studies, Miller School of Medicine, University of Miami Objective This study examined predictors of engagement and retention into a parentcentered, ecodevelopmental HIV preventive intervention for Hispanic adolescents and their families. The influence of retention on changes in adolescent HIV-risk attitudes was also examined. Methods Participants in this study were 91 Hispanic adolescents and their primary parents. Structural equation modeling was used to identify (a) predictors of initial engagement, (b) the effects of group processes on retention, and (c) the effects of retention on change HIV-risk attitudes in adolescents. Results Although some participant characteristics predicted engagement, the parent–facilitator relationship quality at the initial contact was found to be the strongest predictor of engagement. Furthermore, within-group processes such as group cohesion positively predicted retention. Finally, parent retention predicted decreases in adolescent HIV-risk attitudes. Conclusions The results may have important implications for engagement and retention in parent-centered interventions, as well as for reducing risks for HIV transmission in Hispanic adolescents. Implications for services research are also discussed. Key words HIV; prevention; Hispanic; parent-centered; engagement; retention. HIV and AIDS represent a major public health problem facing today’s young people. Globally, it is estimated that 50% of all new HIV infections occur among young people aged 10–24, and that 30% of the approximately 40 million people living with HIV are adolescents or young adults aged 15–24 [World Health Organization (WHO), 2003]. The AIDS pandemic has also had a considerable impact on adolescents and young adults in the United States. Although epidemiological data indicate that the number of HIV cases (between 2000 and 2003) and AIDS cases (between 1999 and 2001) has remained steady in many age groups, the number of HIV and AIDS cases among adolescents and young adults aged 15–24 in the United States is increasing [Centers for Disease Control and Prevention (CDC-P), 2004a]. The HIV epidemic has disproportionately affected minorities in the United States, especially Hispanics and African Americans (CDC-P, 2004b). Hispanics, who are the largest and fastest growing minority group in the United States (Ramírez & de la Cruz, 2003), represent 13% of the population but account for 19% of all HIV/ AIDS cases (CDC-P, 2004b). Moreover, more than one third of all U.S. Hispanics are children or adolescents (Ramírez & de la Cruz, 2003). As a result, preventing problem outcomes such as HIV in Hispanic adolescents is a primary public health concern. This is especially true because, compared with non-Hispanic White adolescents, All correspondence concerning this article should be addressed to Guillermo Prado, Ph.D, Stempel School of Public Health, Department of Epidemiology and Biostatistics, Florida International University, 11200 SW 8th St. HLS 597 Miami, FL 33199. E-mail: . Journal of Pediatric Psychology 31(9) pp. 874–890, 2006 doi:10.1093/jpepsy/jsj046 Advance Access publication July 27, 2005 Journal of Pediatric Psychology vol. 31 no. 9 © The Author 2005. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: Predictors of Engagement and Retention Hispanic adolescents are more likely to initiate sexual activity before age 13, less likely to use condoms, and more likely to report multiple sexual partners (CDC-P, 2004b). Perhaps, as a result, Hispanics are disproportionately represented among new HIV cases (CDC-P, 2002), trailing only African Americans. Therefore, improving the efficacy of HIV prevention interventions for Hispanic adolescents, especially those that target specific risk processes associated with HIV contraction, is an important public health priority. To combat the increasing number of HIV cases in this age group, a number of preventive intervention efforts have been designed and implemented. For example, cognitive behavioral (Jemmott, Jemmott, Fong, & McCaffree, 1999) and psychoeducational (Ebreo, FeistPrice, Siewe, & Zimmerman, 2002) interventions have been found to decrease risk factors associated with HIV transmission in adolescents. These interventions have tended to involve working directly with adolescents to change attitudes, beliefs, and intentions regarding sexual risk taking. Parent-centered preventive interventions, however, which work directly with parents and place them in the role of primary change agent by strengthening their sense of responsibility and control over the lives of their adolescents, may be more efficacious than interventions aimed directly toward adolescents (Tobler et al., 1998). Such interventions may be particularly well suited for preventing and reducing risk behaviors for HIV/AIDS (Krauss et al., 2000; Pantin, Schwartz, Sullivan, Prado, & Szapocznik, 2004). Because of its focus on family, an ecodevelopmental framework (Szapocznik & Coatsworth, 1999) may be an especially appropriate platform for designing parent-centered interventions (Pantin et al., 2004). Ecodevelopmental theory consists of three overlapping components: (a) a social–ecological framework, based on the work of Bronfenbrenner (1979), that incorporates four levels of social context; (b) a developmental perspective emphasizing the changing nature of youth and families across time as a function not only of the current social context but also of changing conditions in the social context over time; and (c) a focus on social interactions between and among individuals in the youth’s and family’s social context. Parent-centered interventions guided by an ecodevelopmental framework target the naturally occurring interactions among risk and protective factors at various levels of the adolescent’s social environment. An important problem in implementing parentcentered interventions, however, is that engagement and participation rates are often less than optimal (DeMarsh & Kumpfer, 1986; Kazdin, 1993; Perrino, Coatsworth, Briones, Pantin, & Szapocznik, 2001). Participants who do not engage or are not retained in intervention programs are unlikely to receive the full benefits of participation, and the efficacy of the intervention itself may be underestimated when sufficient numbers of participants do not complete a full dosage of intervention activities. Thus, failing to engage and retain participants may interfere with attainment (...truncated)