**5. Protective effects of family and social support**

Protective factors are those personal and environmental conditions and experiences that can counteract risk factors for substance use. For example, emphasis on family life is a central core value to most Hispanics and essential for their resilience in achieving normative life aims in the face of adverse social and environmental barriers. The concept of *familismo/*familism is a core value and belief in the centrality of family in the life of Hispanics. It highlights family loyalty, interdependence over independence, and cooperation over competition. Hispanic cultural values (i.e., *familismo*, *simpatia*, power distance, personal space, present time orientation, traditional gender roles) may impact health outcomes and diminish during the acculturation process. Embracing familism as a value contributes to a familial stability, which is linked to better physical health behaviors,


**Table 1.**

*Protective factors and resilience strategies.*

higher likelihood of seeking medical help, better psychological health, and lower perceived burden of stress.

Familism and the highly involved parenting practices that often come with familism have been linked to fewer behavior problems in children. The work by Perreira and colleagues has pointed to specific resiliency strategies utilized by Hispanic immigrant parents. These include (1) emphasizing with and respecting adolescents/children (i.e., developing a deep understanding of what they are going through in an unfamiliar context and admiring the strength shown by children in that difficult context); (2) seeking help and fostering social support (i.e., connecting to other Hispanics and building community); (3) developing bicultural coping skills (including teaching children about their heritage and American culture); and (4) improving communication with their children (e.g., speaking honestly about difficult situations and being attentive to the child's needs). *Familismo*, the orientation towards putting the needs of the family above that of the individual, family cohesiveness, reciprocity, and honor is a core value in Hispanic/Latino culture [45–49]. Most studies of psychosocial outcomes related to *familismo* find favorable psychosocial results for Hispanic children and adolescents [50–55]. Incorporating Hispanic/ Latino family values into early intervention and prevention programs can buffer the impact of weakening connection to traditional family protective factors [56].

Other forms of resilience can be found among Hispanic/Latino youth and families. These resources can be "mobilized" as part of any culturally focused prevention strategy. In one qualitative study of family resilience, Cervantes and Santisteban [57] reported specific, contextual resilience strategies mentioned by Hispanic/ Latino families in confronting acculturation stressors (**Table 1**).

#### **6. Research on behavioral intervention strategies for Hispanic/Latino youth**

Evidence-based drug prevention programming for Hispanic/Latinos does exist, although the number or programs is small. Familias Unidas, Familia Adelante, Strengthening the Bonds of Chicano Youth, and other similar programs will be highlighted here. The *Familias Unidas* intervention research has been undertaken with various Hispanic/Latino population groups including a study of predominantly Cuban (39%), Central and South Americans (29 and 17%, respectively), and a small proportion of Puerto Rican/Dominican (5%) participants [58]. A more recent study of *Familias Unidas* included adolescent participants who were predominantly US-born (56.1%) as well as adolescent immigrants from Honduras (26.9%), Cuba (20.4%), and Nicaragua (16.1%) [59]. A study of *Strengthening the Bonds of Chicano Youth* (El Proyecto de Nuestra Juventud) included 450 high-risk youth in an established, nonimmigrant community setting [60]. Results were generally positive in reducing risk factors for substance use.

*Familias Preparando la Nueva Generación* (FPNG) is a synchronized culturally grounded parenting component program which involves Latino youth substance abuse prevention [61]. FPNG serves as an addition to the already proven efficacious classroom-based drug abuse prevention intervention, Keepin' it Real (KIR). One study showed that anti-drug norms were stronger in participants who were enrolled in KIR whose parents also participated in FPNG than in participants who were enrolled in KIR alone. Along with these stronger anti-drug norms, participants whose parents were in FPNG also showed reduced use of cigarettes and alcohol. The findings have shown that adolescent normative beliefs and related behaviors can be changed through synchronized culturally grounded parent and youth interventions.

*Advances in Substance Abuse Prevention Practice and Science for Hispanic/Latinos DOI: http://dx.doi.org/10.5772/intechopen.90399*

REAL Groups is a small-group intervention designed to complement the schoolbased Keepin' it Real (KIR) prevention program [62]. REAL Groups intervention is the result of a partnership with predominantly Mexican-American schools located in the central city neighborhoods of a southwestern US metropolitan area. The REAL Groups approach was designed as a companion to the larger KIR intervention and takes place over 10 weeks specifically targeting Latino, Hispanic, and Mexican-American children that appear to be more vulnerable to using drugs before entering adolescence. However, the outcomes of the REAL Groups intervention have been mixed and inconclusive, mainly due to the participants of the study being in the fifth grade with low drug use rates.

The mother/daughter intervention (MDI) approach is another program that involves substance abuse prevention strategies for youth [63]. This approach consists of 10 sessions via the internet which are to be completed at a rate of one session per week. In one study the MDI targeted young Black and Latina girls between the ages of 10 and 13 and their mothers. The outcome of the MDI showed that the girls who received the intervention reported lower levels of depression and higher levels of self-efficacy about their ability to avoid cigarette smoking, alcohol consumption, and drug use.

Substance abuse treatment and prevention interventions also exist to address intrafamilial stress in Hispanic families, such as brief strategic family therapy (BSFT) and more recently culturally informed family therapy for adolescents (CIFTA) [64, 65]. Again, these studies have included predominately Cuban or other Caribbean Latino samples yet may prove beneficial when applied to other Hispanic/ Latino groups.

#### **7. Integrating acculturation stress into prevention efforts**

As an example of the expanding set of innovative research-based prevention programs for Hispanic/Latino youth, Familia Adelante will be will be discussed in some detail to exemplify one recently developed, culturally focused program. Familia Adelante is a drug prevention program that incorporates *promotores* as facilitators for this curriculum-based drug prevention program. The first iteration of the *Familia Adelante* (*FA*) curriculum showed reductions in family stress



#### **Table 2.**

*Familia adelante session summary.*

and youth behavior problems, enhancing academic and psychosocial coping and decreasing substance use patterns in Latino youth [66]. FA was also tested through in the SAMHSA-funded Blythe Street Prevention Project (BSPP) with youth and their parents, and that study found significant improvements in drug knowledge and drug resistance skills in both youth and parents [67]. *FA* was then evaluated in 2006 with six cohorts of families in a school-based setting. Findings were positive showing that family and peer communication improved and perceptions of substance use harm increased while social norms around sexual behavior and past-30-day use of marijuana and illegal drugs were reduced [68]. The developers also conducted NIH-supported work to infuse the *FA* curriculum with reproductive health education and HIV prevention messaging. Based on focus group data, new content was identified by participating youth that was not included in the original *FA* curriculum (i.e., content on eating disorders) (**Table 2**).

#### **8. Adapting evidence-based programs**

Given the lack of prevention programs that have used a grounded cultural theory or that have incorporated culturally relevant risk and protective factors, there is oftentimes a need to use other evidence-based prevention practices and approaches and to adapt those to the needs of local Hispanic/Latino community. In one literature review comparing cultural adaptations to either no treatment or unadapted treatments, researchers found that cultural adaptations can be more effective than either of these other conditions, especially for clients with a diagnosed mental health disorder [69]. When examined as a whole, the scientific literature on cultural adaptations shows treatment effects to be significant and moderate in size on average [69–75]. Still, researchers caution that conclusions about the need for cultural adaptations should be reserved until more studies that directly compare adapted and unadapted EBPPs are conducted.

Adapted interventions that address the powerful, everyday stressors experienced by Hispanic/Latino clients are likely to be perceived as more relevant and attractive to clients. Enhancing content of existing EBPPs to reflect the values (e.g.,

#### *Advances in Substance Abuse Prevention Practice and Science for Hispanic/Latinos DOI: http://dx.doi.org/10.5772/intechopen.90399*

family, religion) and world views of Latino clients will also increase the cultural relevance of the intervention [69, 76]. Finally, there are a number of agency- and provider-level characteristics that must be considered before a decision to adapt an EBP is made. First and foremost is the capacity of a provider organization to systematically undertake an adaptation. Agency capacity refers to the financial and human capital resources, skills, knowledge, and in-kind support that are needed to take on each step of the adaptation process (outlined below). For example, an initial needs assessment may include conducting consumer, staff, and other stakeholder interviews or focus groups. Thus, an agency should be prepared to cover costs related to staffing of these additional activities, paying incentives for participants, offering childcare, providing food and providing transportation for participants, transcription of focus group data, data management, data analysis, and reporting.

### **9. Conclusions and recommendations for future research**

Drug prevention science and practice continues to expand, and to some extent the field has made positive impact in the Hispanic/Latino community. Based on the research to date, sufficient evidence exists about culturally specific risk and protective factors associated with the onset of substance use [3, 42]. Additionally, the momentum is gathering for the development and study of culturally focused prevention interventions. Acculturation and related stressors have been shown to precipitate behavioral health problems, and the body of research on acculturation stress can serve as theoretical underpinnings for the development of additional contemporary, culturally sensitive programming. As prevention programming and the evidence base for Hispanic/Latino practices continues to expand, core theoretical considerations will drive effective prevention programming. Latino and other scholars agree that concepts of acculturation, acculturation stress, familismo, *respeto*, and *comunidad* (community) must be inherent components, if not core components of prevention strategies for this growing population. Reinforcing positive family and youth identity that incorporates, embraces, and honors cultural history and traditions appears to have most promise.

In addition, there is growing evidence that factors such as acculturation stress, parent–child acculturation gaps, and prolonged discrimination (measured by allostatic load) may all play a role in the development of SUD among Hispanic/Latino youth. Programs such as Familia Adelante, which can be considered a culturally grounded model, address many of the acculturation and stress-related issues that resonate with many Hispanic/Latino youth. The development of prevention service approaches that include family and parent involvement is necessary, not only for the purpose of recruiting and retaining families but also as a way to promote and reinforce *familismo*. Future research on the impact of immigration policy and enforcement is needed particularly related to how family separations, childhood trauma associated with immigration, and deportation experiences lead to the development of behavioral health problems. The testing of prevention programs that are specific to new immigrants and refugee populations will be needed to address the uncertainties that these youth and families experience and that may not be addressed in existing prevention models.

Finally, we have outlined issues related to adapting existing EPBs for use in Hispanic/Latino communities. Research is fairly conclusive that adapting an EBP to the language and cultural characteristics of a particular ethnic community is better than not doing the adaption. Yet, the skills, capacity, and resources available to do good program adaptation must be in place. More specific research on program adaptations of generic prevention programs for Hispanic/Latino communities is needed.

*Effective Prevention and Treatment of Substance Use Disorders for Racial and Ethnic Minorities*

### **Author details**

Richard C. Cervantes\* and Elias Koutantos Behavioral Assessment Inc., Los Angeles, California, USA

\*Address all correspondence to: rccbeth@aol.com

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*Advances in Substance Abuse Prevention Practice and Science for Hispanic/Latinos DOI: http://dx.doi.org/10.5772/intechopen.90399*

### **References**

[1] US Census Bureau. The Hispanic Population in the United States: 2014. The United States Census Bureau. Available from: https://www.census. gov/data/tables/2014/demo/hispanicorigin/2014-cps.html. Published August 23 2017. Accessed [December 10 2019]

[2] Cuijpers P. Three decades of drug prevention research. Drugs: Education, Prevention and Policy. 2003;**10**(1):7-20. DOI: 10.1080/0968763021000018900

[3] Releases IOM. Report on preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Journal of Child and Adolescent Psychiatric Nursing. 2010;**23**(2):118-118. DOI: 10.1111/j.1744-6171.2010.00231.x

[4] Johnston L, Miech R, Omalley P, Bachman J, Schulenberg J, Patrick M. Monitoring the Future national survey results on drug use, 1975-2017: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, University of Michigan; 2018. DOI: 10.3998/2027.42/148123

[5] Pemberton MR, Colliver JD, Robbins TM, Gfroerer JC. Underage alcohol use: Findings from the 2002- 2006 national surveys on drug use and health. PsycEXTRA Dataset. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies; 2008. DOI: 10.1037/ e474852008-001. DHHS Publication No. SMA 08-4333, Analytic Series A-30

[6] Youth Risk Behavior Surveillance. United States: Centers for Disease Control and Prevention; 2011. Available from: https://www.cdc.gov/mmwr/ preview/mmwrhtml/ss6104a1.htm?s\_ cid=ss6104a1\_w. Accessed [December 12 2019]

[7] Martin JA, Hamilton BE, Ventura SJ, Osterman MJK, Matthews TJ. Births:

Final Data for 2011. Centers for Disease Control and Prevention. Available from: https://stacks.cdc.gov/view/cdc/23435. Published June 28 2013. Accessed [December 12 2019]

[8] Volk K. Teen Prescription Drug Misuse and Abuse. SAMHSA. 2019. Available from: https://www.samhsa. gov/homelessness-programs-resources/ hpr-resources/teen-prescription-drugmisuse-abuse [Accessed: October 21, 2019]

[9] U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General-Executive Summary. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2016

[10] Cardoso JB, Goldbach JT, Cervantes RC, Swank P. Stress and multiple substance use behaviors among Hispanic adolescents. Prevention Science. 2015;**17**(2):208-217. DOI: 10.1007/s11121-015-0603-6

[11] McCubbin HI, Thompson AI, McCubbin MA. Family Assessment: Resiliency, Coping and Adaptation: Inventories for Research and Practice. Madison, WI: University of Wisconsin Publishers; 1997

[12] Patten E. The Nation's Latino Population Is Defined by Its Youth. Pew Research Center's Hispanic Trends Project. 2016. Available from: https://www.pewresearch.org/ hispanic/2016/04/20/the-nationslatino-population-is-defined-by-itsyouth/ [Accessed: October 11, 2019]

[13] Krogstad JM, Keegan M. 15 States with the Highest Share of Immigrants in Their Population. Pew Research Center. 2014. Available from: https://www.pewresearch.org/ fact-tank/2014/05/14/15-states-withthe-highest-share-of-immigrants-intheir-population/ [Accessed: October 21, 2019]

[14] Chaudry A, Capps R, Pedroza JM, Castaneda RM, Santos R, Scott MM. Facing our future: Children in the aftermath of immigration enforcement. Research Report. Urban Institute. 2010. DOI: 10.1037/ e726272011-001

[15] Capps R. Paying the Price: The Impact of Immigration Raids on Americas Children. National Council of La Raza: Washington, D.C; 2007

[16] Fortuny K, Capps R, Simms M, Chaudry A. Children of immigrants: National and state characteristics. Research Report. Urban Institute. 2009. DOI: 10.1037/e724062011-001

[17] Hondagneu-Sotelo P, Avila E. Im here, but Im there. Gender and Society. 1997;**11**(5):548-571. DOI: 10.1177/089124397011005003

[18] Suarez-Orozco C, Todorova IL, Louie J. Making up for lost time: The experience of separation and reunification among immigrant families. Family Process. 2002;**41**(4):625-643. DOI: 10.1111/j.1545-5300.2002.00625.x

[19] Fortuny K, Chaudry A. A Comprehensive Review of Immigrant Access to Health and Human Services. 2011. Available from: https://www. urban.org/research/publication/ comprehensive-review-immigrantaccess-health-and-human-services/ view/full\_report

[20] Cervantes RC, Castro FG. Stress, coping, and Mexican American

mental health: A systematic review. Hispanic Journal of Behavioral Sciences. 1985;**7**(1):1-73. DOI: 10.1177/07399863850071001

[21] Araújo BY, Borrell LN. Understanding the link between discrimination, mental health outcomes, and life chances among Latinos. Hispanic Journal of Behavioral Sciences. 2006;**28**(2):245-266. DOI: 10.1177/0739986305285825

[22] Torres L, Driscoll MW, Voell M. Discrimination, acculturation, acculturative stress, and Latino psychological distress: A moderated mediational model. Cultural Diversity & Ethnic Minority Psychology. 2012;**18**(1):17-25. DOI: 10.1037/ a0026710

[23] Lazarus RS, Folkman S. Stress, Appraisal, and Coping. New York: Springer Pub. Co.; 1984

[24] Ensel WM. "important" life events and depression among older adults. Journal of Aging and Health. 1991;**3**(4):546-566. DOI: 10.1177/089826439100300407

[25] Pearlin LI. The sociological study of stress. Journal of Health and Social Behavior. 1989;**30**(3):241. DOI: 10.2307/2136956

[26] Hunt LM, Schneider S, Comer B. Should "acculturation" be a variable in health research? A critical review of research on US Hispanics. Social Science & Medicine. 2004;**59**(5):973-986. DOI: 10.1016/j.socscimed.2003.12.009

[27] Lara M, Gamboa C, Kahramanian MI, Morales LS, Bautista DEH. Acculturation and Latino health in the United States: A review of the literature and its sociopolitical context. Annual Review of Public Health. 2005;**26**(1):367-397.

*Advances in Substance Abuse Prevention Practice and Science for Hispanic/Latinos DOI: http://dx.doi.org/10.5772/intechopen.90399*

DOI: 10.1146/annurev. publhealth.26.021304.144615

[28] Martinez-Tyson D, Pathak EB, Soler-Vila H, Flores AM. Looking under the Hispanic umbrella: Cancer mortality among Cubans, Mexicans, Puerto Ricans and other Hispanics in Florida. Journal of Immigrant and Minority Health. 2008;**11**(4):249-257. DOI: 10.1007/s10903-008-9152-4

[29] Arroyo-Johnson C, Mincey KD, Ackermann N, Milam L, Goodman MS, Colditz GA. Racial and ethnic heterogeneity in self-reported diabetes prevalence trends across Hispanic subgroups, national health interview survey, 1997-2012. Preventing Chronic Disease. 2016;**13**. Available from: http:// dx.doi.org/ 10.5888/pcd13.150260. Published January 21 2016. [Accessed: December 12 2019]

[30] Pabon-Nau LP, Cohen A, Meigs JB, Grant RW. Hypertension and diabetes prevalence among U.S. Hispanics by country of origin: The national health interview survey 2000-2005. Journal of General Internal Medicine. 2010;**25**(8):847-852. DOI: 10.1007/ s11606-010-1335-8

[31] Alegria M, Canino G, Stinson FS, Grant BF. Nativity and DSM-IV psychiatric disorders among Puerto Ricans, Cuban Americans, and non-Latino whites in the United States. The Journal of Clinical Psychiatry. 2006;**67**(1):56-65. DOI: 10.4088/jcp. v67n0109

[32] Alegría M, Canino G, Shrout PE, et al. Prevalence of mental illness in immigrant and non-immigrant U.S. Latino groups. The American Journal of Psychiatry. 2008;**165**(3):359-369. DOI: 10.1176/appi.ajp.2007.07040704

[33] Fuligni AJ, Eccles JS, Barber BL, Clements P. Early adolescent peer orientation and adjustment during

high school. Developmental Psychology. 2001;**37**(1):28-36. DOI: 10.1037//0012-1649.37.1.28

[34] Carola S-O, Suárez-Orozco Marcelo M. Children of Immigration. Cambridge: Harvard University Press; 2001

[35] Portes A, Rumbaut Rubén G. Legacies: The Story of the Immigrant Second Generation. Berkeley, CA: University of California Press;

[36] Vega WA, Rodriguez MA, Gruskin E. Health disparities in the Latino population. Epidemiologic Reviews. 2009;**31**(1):99-112. DOI: 10.1093/epirev/mxp008

[37] Allen JD, Caspi C, Yang M, Leyva B, Stoddard AM, Tamers S, et al. Pathways between acculturation and health behaviors among residents of lowincome housing: The mediating role of social and contextual factors. Social Science & Medicine. 2014;**123**:26-36. DOI: 10.1016/j.socscimed.2014.10.034

[38] Perez SM, Gavin JK, Diaz VA. Stressors and coping mechanisms associated with perceived stress in Latinos. Ethnicity & Disease. 2015;**25**(1):78-82

[39] Cummings AM, Gonzalez-Guarda RM, Sandoval MF. Intimate partner violence among Hispanics: A review of the literature. Journal of Family Violence. 2012;**28**(2):153-171. DOI: 10.1007/s10896-012-9478-5

[40] Martinez CR. Effects of differential family acculturation on Latino adolescent substance use. Family Relations. 2006;**55**(3):306-317. DOI: 10.1111/j.1741-3729.2006.00404.x

[41] Levy V, Page-Shafer K, Evans J, et al. HIV-related risk behavior among Hispanic immigrant men in a population-based household survey in low-income neighborhoods of northern California. Sexually Transmitted Diseases. 2005;**32**(8):487-490. DOI: 10.1097/01.olq.0000161185.06387.94

[42] Cervantes RC, Fisher DG, Córdova D, Napper LE. The Hispanic stress inventory—Adolescent version: A culturally informed psychosocial assessment. Psychological Assessment. 2012;**24**(1):187-196. DOI: 10.1037/ a0025280

[43] Cervantes RC, Fisher DG, Padilla AM, Napper LE. The Hispanic stress inventory version 2: Improving the assessment of acculturation stress. Psychological Assessment. 2016;**28**(5):509-522. DOI: 10.1037/ pas0000200

[44] Birman D, Trickett E, Buchanan RM. A tale of two cities: Replication of a study on the acculturation and adaptation of immigrant adolescents from the former Soviet Union in a different community context. American Journal of Community Psychology. 2005;**35**(1-2):83-101. DOI: 10.1007/ s10464-005-1891-y

[45] Steidel AGL, Contreras JM. A new familism scale for use with Latino populations. Hispanic Journal of Behavioral Sciences. 2003;**25**(3):312- 330. DOI: 10.1177/0739986303256912

[46] Marin G, Sabogal F, Marin BV, Otero-Sabogal R, Perez-Stable EJ. Development of a short acculturation scale for Hispanics. Hispanic Journal of Behavioral Sciences. 1987;**9**(2):183-205. DOI: 10.1177/07399863870092005

[47] Zinn MB. Chicano men and masculinity. Journal of Ethnic Studies. 1982;**10**(2):29-44

[48] Comeau JA. Race/ethnicity and family contact. Hispanic Journal of Behavioral Sciences. 2012;**34**(2):251- 268. DOI: 10.1177/0739986311435899 [49] Falicov CJ. Working with transnational immigrants: Expanding meanings of family, community, and culture. Family Process. 2007;**46**(2):157-171. DOI: 10.1111/j.1545-5300.2007.00201.x

[50] Calderón-Tena CO, Knight GP, Carlo G. The socialization of prosocial behavioral tendencies among Mexican American adolescents: The role of familism values. Cultural Diversity & Ethnic Minority Psychology. 2011;**17**(1):98-106. DOI: 10.1037/ a0021825

[51] Morcillo C, Duarte CS, Shen S, Blanco C, Canino G, Bird HR. Parental familism and antisocial behaviors: Development, gender, and potential mechanisms. Journal of the American Academy of Child and Adolescent Psychiatry. 2011;**50**(5):471-479. DOI: 10.1016/j.jaac.2011.01.014

[52] Esparza P, Sánchez B. The role of attitudinal familism in academic outcomes: A study of urban, Latino high school seniors. Cultural Diversity & Ethnic Minority Psychology. 2008;**14**(3):193-200. DOI: 10.1037/1099-9809.14.3.193

[53] Germán M, Gonzales NA, Dumka L. Familism values as a protective factor for Mexican-origin adolescents exposed to deviant peers. The Journal of Early Adolescence. 2008;**29**(1):16-42. DOI: 10.1177/0272431608324475

[54] Kuperminc GP, Wilkins NJ, Jurkovic GJ, Perilla JL. Filial responsibility, perceived fairness, and psychological functioning of Latino youth from immigrant families. Journal of Family Psychology. 2013;**27**(2):173- 182. DOI: 10.1037/a0031880

[55] Marsiglia FF, Parsai M, Kulis S. Effects of familism and family cohesion on problem behaviors among adolescents in Mexican immigrant families in the Southwest United States. *Advances in Substance Abuse Prevention Practice and Science for Hispanic/Latinos DOI: http://dx.doi.org/10.5772/intechopen.90399*

Journal of Ethnic and Cultural Diversity in Social Work. 2009;**18**(3):203-220. DOI: 10.1080/15313200903070965

[56] Castro FG, Barrera JM, Martinez JCR. The Cultural Adaptation of Prevention Interventions: Resolving Tensions Between Fidelity and Fit. Prevention Science. 2004;**5**(1):41-45. DOI:10.1023/ b:prev.0000013980.12412.cd

[57] Cervantes RC, Santisteban DS. Enhancing family resilience among at risk Latinos panel presentation. In: Presented at the Society for Prevention Research Annual Conference, San Francisco, CA. 2016

[58] Pantin H, Schwartz SJ, Sullivan S, Coatsworth JD, Szapocznik J. Preventing substance abuse in Hispanic immigrant adolescents: An ecodevelopmental, parent-centered approach. Hispanic Journal of Behavioral Sciences. 2003;**25**(4):469-500. DOI: 10.1177/0739986303259355

[59] Pantin H, Prado G, Lopez B, et al. A randomized controlled trial of familias unidas for Hispanic adolescents with behavior problems. Psychosomatic Medicine. 2009;**71**(9):987-995. DOI: 10.1097/psy.0b013e3181bb2913

[60] Varela R. Cultural Competent Prevention Program for At-Risk Chicano Youth. Substance Abuse Mental Health Services Administration/ Center for Substance Abuse Prevention (SAMHSA/CSAP) Report. Washington, DC: Samhsa, Csap, U.S. Department of Health and Human Services; 2001

[61] Marsiglia FF, Ayers SL, Baldwin-White A, Booth J. Changing Latino adolescents' substance use norms and behaviors: The effects of synchronized youth and parent drug use prevention interventions. Prevention Science. 2015;**17**(1):1-12. DOI: 10.1007/ s11121-015-0574-7

[62] Marsiglia FF, Peña V, Nieri T, Nagoshi JL. Real groups: The design and immediate effects of a prevention intervention for Latino children. Social Work With Groups. 2010;**33**(2-3):103- 121. DOI: 10.1080/01609510903366202

[63] Schinke SP, Fang L, Cole KC, Cohen-Cutler S. Preventing substance use among black and Hispanic adolescent girls: Results from a computer-delivered, mother–daughter intervention approach. Substance Use & Misuse. 2010;**46**(1):35-45. DOI: 10.3109/10826084.2011.521074

[64] Santisteban DA, Coatsworth JD, Perez-Vidal A, et al. Efficacy of brief strategic family therapy in modifying Hispanic adolescent behavior problems and substance use. Journal of Family Psychology. 2003;**17**(1):121-133. DOI: 10.1037//0893-3200.17.1.121

[65] Santisteban DA, Mena MP, Mccabe BE. Preliminary results for an adaptive family treatment for drug abuse in Hispanic youth. Journal of Family Psychology. 2011;**25**(4):610-614. DOI: 10.1037/a0024016

[66] Cervantes R, Goldbach J, Santos SM. Familia adelante: A multirisk prevention intervention for Latino families. The Journal of Primary Prevention. 2011;**32**(3-4):225-234. DOI: 10.1007/s10935-011-0251-y

[67] Cervantes RC, Pena C. Evaluating Hispanic/Latino programs. Alcoholism Treatment Quarterly. 1998;**16**(1-2):109- 131. DOI: 10.1300/j020v16n01\_07

[68] Bernal G, Adames C. Cultural adaptations: Conceptual, ethical, contextual, and methodological issues for working with ethnocultural and majority-world populations. Prevention Science. 2017;**18**(6):681-688. DOI: 10.1007/s11121-017-0806-0

[69] Hall GCN, Ibaraki AY, Huang ER, Marti CN, Stice E. A meta-analysis of cultural adaptations of psychological interventions. Behavior Therapy.

2016;**47**(6):993-1014. DOI: 10.1016/j. beth.2016.09.005

[70] Benish SG, Quintana S, Wampold BE. Culturally adapted psychotherapy and the legitimacy of myth: A direct-comparison metaanalysis. Journal of Counseling Psychology. 2011;**58**(3):279-289. DOI: 10.1037/a0023626

[71] Griner D, Smith TB. Culturally adapted mental health intervention: A meta-analytic review. Psychotherapy: Theory, Research, Practice, Training. 2006;**43**(4):531-548. DOI: 10.1037/0033-3204.43.4.531

[72] Huey SJ, Polo AJ. Evidencebased psychosocial treatments for ethnic minority youth. Journal of Clinical Child and Adolescent Psychology. 2008;**37**(1):262-301. DOI: 10.1080/15374410701820174

[73] Smith TB, Rodríguez MD, Bernal G. Culture. Journal of Clinical Psychology. 2010;**67**(2):166-175. DOI: 10.1002/jclp.20757

[74] Smith TB, Trimble JE. Foundations of Multicultural Psychology: Research to Inform Effective Practice. Washington, DC: American Psychological Association; 2016

[75] Loon AV, Schaik AV, Dekker J, Beekman A. Bridging the gap for ethnic minority adult outpatients with depression and anxiety disorders by culturally adapted treatments. Journal of Affective Disorders. 2013;**147**(1-3): 9-16. DOI: 10.1016/j.jad.2012.12.014

[76] Ulibarri M, Calzada E, Cervantes RC, Santisteban DS, Bernal G. Make Your program work: The value of cultural adaptations for Latino-serving substance use treatment organizations. In: National Hispanic and Latino Addiction Technology Transfer Center ATTC. Los Angeles, CA; 2018

Section 3

Treatment

## **Chapter 3**
