Scaling Out Evidence-Based Interventions Outside the U.S. Mainland: Social Justice or Trojan Horse?

Global health disparities continue to widen as professional standards for effectiveness of mental health services provision become more precise and difficult to achieve across varied economic and social contexts. Within the U.S., health disparities are evident in Latinx populations. Globally, the health disparities are also evident in Latin America as compared to the U.S. and other economically affluent nations. The diversification of psychology in content and persons has led to a unique opportunity to build bridges that can help reduce disparities in- and outside of the U.S. mainland. Collaborations can be of great use in addressing health disparities internationally but also are of critical importance in testing the ecological validity of existing interventions. It is imperative that researchers approach these exchanges as truly collaborative and power even, as researchers in all locations stand to learn and grow from the partnership, otherwise U.S.-based researchers can unwittingly engage intellectual colonization and advance cultural imperialism. U.S.-based researchers must be particularly thoughtful about disparities in both resources and consequences for success and failures in research contexts. We discuss specific failures, recoveries, and successes that may be useful to other researchers engaged, or seeking to engage in, international collaborations

The Influence of Perceived Parenting on Substance Initiation Among Mexican Children

Parents shape their children\u27s behaviors and impact their developmental trajectories. Despite this, few studies have examined the potential relationship between child reported parenting factors and lifetime substance use and use intentions. The current study examined the potential impact of parenting factors (i.e., positive parenting, supervision, parental illicit substance use, substance-specific communication) on early substance use and intentions among Latinx children. Data for the present study utilized a representative sample of Mexican children (n = 52,171; 5th and 6th grades) who participated in a national survey on substance use. Children reported their demographics, lifetime substance use/intentions, and perceived parenting characteristic and practices. Child reported parental (i.e., individual or both parents) illicit substance use was associated with the largest increases in risk for reporting lifetime use of all substances examined. Higher levels of positive parenting were consistently associated with reductions in risk for reporting intentions for and use of all substances examined. Parent-child substance specific communication was not significantly related to child reported lifetime use or use intentions, with the exception of a minor decrease in the odds of reporting lifetime inhalant use. Supervision was associated with small to modest increase in risk. Substance use prevention efforts targeting Latinx populations may benefit from promoting positive parenting and direct supervision during childhood. Targeted prevention efforts may be needed for Latinx children exposed to parental illicit substance use, as they may be especially at risk for early substance initiation

Parenting programs for underserved populations: Issues of scientific integrity and social justice

Research suggests that parenting programs are effective for preventing behavioral and emotional difficulties in children, but a lot more attention needs to be paid to issues of context and culture during the development, testing, and implementation of these interventions. The views and needs of underserved and disenfranchised communities in the USA and the Global South are often not taken into account for the development and testing of interventions. The successful implementation of evidence-based interventions for vulnerable children and families in underserved and marginalized communities requires careful consideration of how existing paradigms of prevention, evaluation, and implementation science impact issues of social justice and equity. This paper will describe how a team of parenting program researchers has been collaborating with their partners globally in generating local knowledge by balancing the need for rigorous scientific methods with issues of power. Authors from the USA, Latin America, Africa, and Southeast Asia draw on their experiences regarding challenges and successes with issues regarding study design and measurement, the transferability and adaptation of interventions, and the dissemination and implementation of different parenting interventions while placing communities at the center of their efforts through participatory methods. We describe innovative approaches that span the continuum of intervention development, adaptation, optimization, evaluation, implementation, and scale-up of different parenting programs for vulnerable children and families across the world. We conclude by offering specific and pragmatic recommendations to increase access of culturally relevant and effective parenting programs in these communities

Strengthening a culture of prevention in low- and middle-income countries: Balancing scientific expectations and contextual realities

Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central México, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed

Early Adolescent Substance Use in a National Sample of Mexican Youths: Demographic Characteristics that Predict Use of Alcohol, Tobacco, and Others Drugs

The United States and Mexico have seen significant increases in the prevalence of substance use among Latinx adolescents in the last 20 years. Research is needed to address rising national rates of substances use to inform the development of policies and intervention programs targeting Latinx youth. Our primary aim was to identify demographic factors associated with substance initiation and use among elementary age Latinx youth. Data for the present study include 52,171 elementary students in 5th and 6th grades, who participated in the National Survey of Drug Use Among Students (ENCODE) in Mexico. Youths reported demographic information, rates of substance use for alcohol, tobacco, marijuana, inhalant, and other substances, or intention for first time substance use. Findings suggest that Latinx youth who were boys, of indigenous heritage, nonreligious, and overage for their grade were especially at risk for reporting lifetime alcohol, tobacco, marijuana, inhalant, and other substance use. Boys and youth with indigenous heritage were more likely to report intentions to try alcohol, tobacco, and other substances for the first time. High subjective economic status was associated with lower risk for reporting lifetime tobacco use and substance use intentions in general. Efforts are needed to disseminate accessible substance use prevention programs during early adolescence to encourage positive developmental trajectories among Latinx youths at an elevated risk for substance initiation and use. Clinical and research implications are discussed

Parent Characteristics and Practices Classify Lifetime Substance Use Among Mexican Children

The objective of this study is to determine whether parent characteristics and practices differentiate between substance using and non-using children in Mexico. Data consisted of 52,171 children (i.e., 5th and 6th grade) who participated in the National Survey of Drug Use Among Students. The relative importance of student reported parenting factors in classifying lifetime substance use were assessed across outcomes with a logistic regression algorithm. Machine learning algorithms utilizing parent characteristics and practices classifed tobacco, marijuana, inhalants, and other substance use. Parenting factors were poor classifers of lifetime alcohol use. The algorithm generally selected important classifers broadly associated with parental illicit substance use and monitoring practices across child substance use outcomes. Findings suggest that leveraging parental infuences during childhood may be a high value point of intervention for preventing non-alcoholic substance use. Important classifers identifed by the current study represent potential targets for childhood substance use prevention efforts

Strengthening a culture of prevention in low- and middle-income countries: Balancing scientific expectations and contextual realities

Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central Mexico, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate the following: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed

Innovative Identification of Substance Use Predictors: Machine Learning in a National Sample of Mexican Children

Machine learning provides a method of identifying factors that discriminate between substance users and non-users potentially improving our ability to match need with available prevention services within context with limited resources. Our aim was to utilize machine learning to identify high impact factors that best discriminate between substance users and non-users among a national sample (N = 52,171) of Mexican children (i.e., 5th, 6th grade; Mage = 10.40, SDage = 0.82). Participants reported information on individual factors (e.g., gender, grade, religiosity, sensation seeking, self-esteem, perceived risk of substance use), socioecological factors (e.g., neighborhood quality, community type, peer influences, parenting), and lifetime substance use (i.e., alcohol, tobacco, marijuana, inhalant). Findings suggest that best friend and father illicit substance use (i.e., drugs other than tobacco or alcohol) and respondent sex (i.e., boys) were consistent and important discriminators between children who tried substances and those that did not. Friend cigarette use was a strong predictor of lifetime use of alcohol, tobacco, and marijuana. Friend alcohol use was specifically predictive of lifetime alcohol and tobacco use. Perceived danger of engaging in frequent alcohol and inhalant use predicted lifetime alcohol and inhalant use. Overall, findings suggest that best friend and father illicit substance use and respondent’s sex appear to be high impact screening questions associated with substance initiation during childhood for Mexican youths. These data help practitioners narrow prevention efforts by helping identify youth at highest risk

Strengthening a Culture of Prevention in Low- and Middle-Income Countries: Balancing Scientific Expectations and Contextual Realities

Relevant initiatives are being implemented in low- and middle-income countries (LMICs) aimed at strengthening a culture of prevention. However, cumulative contextual factors constitute significant barriers for implementing rigorous prevention science in these contexts, as defined by guidelines from high-income countries (HICs). Specifically, disseminating a culture of prevention in LMICs can be impacted by political instability, limited health coverage, insecurity, limited rule of law, and scarcity of specialized professionals. This manuscript offers a contribution focused on strengthening a culture of prevention in LMICs. Specifically, four case studies are presented illustrating the gradual development of contrasting prevention initiatives in northern and central Mexico, Panamá, and Sub-Saharan Africa. The initiatives share the common goal of strengthening a culture of prevention in LMICs through the dissemination of efficacious parenting programs, aimed at reducing child maltreatment and improving parental and child mental health. Together, these initiatives illustrate the following: (a) the relevance of adopting a definition of culture of prevention characterized by national commitments with expected shared contributions by governments and civil society, (b) the need to carefully consider the impact of context when promoting prevention initiatives in LMICs, (c) the iterative, non-linear, and multi-faceted nature of promoting a culture of prevention in LMICs, and (d) the importance of committing to cultural competence and shared leadership with local communities for the advancement of prevention science in LMICs. Implications for expanding a culture of prevention in LMICs are discussed