Abstract
Brody, G. H., Kogan, S. M., Chen, Y., & Murry, V. M. (2008). Long-term effects of the Strong African American Families Program on youths’ conduct problems. Journal of Adolescent Health, 43(5), 474–481.
The Strong African American Families Program (SAAF) is a 7-week program designed “to advance the well-being of African American families by strengthening family relationships, parenting processes and youth competencies” (http://www.cfr.uga.edu/order_saaf). It focuses on reducing risk factors and increasing protective factors with a goal to reduce alcohol and drug use and to postpone sexual involvement. This article describes the impact of SAAF on conduct problems at 29 months postintervention, hypothesizing that an alcohol use preventive intervention may also prevent the onset and escalation of conduct problems. The researchers concentrated on looking at protective factors that might be a common variable accounting for adolescent behavior. Those factors were “academic competence, self-esteem, future orientation, and negative attitudes about substance use and early-onset sexual activity” (p. 475).
The study sample included 667 African American primary caregivers and their 11-year-old children in nine rural Georgia counties. Eligible families were assigned to the intervention (n = 369) or the control group (n = 298). The SAAF included 7 weeks of hour-long separate and joint sessions for caregivers and youth in community locations that included family skill practice sessions. Caregivers learned nurturant-involved parenting, skills, and strategies for monitoring, controlling, communicating about sex and substance use, establishing clear expectations about substance use, and adaptive racial socialization. Three-person teams of African American leaders led the interventions. The intervention was followed at 6 months with a booster session. Control families received three mailed leaflets about early adolescent development, stress management, and adolescent fitness.
Measures were taken preintervention and 29 months postintervention. Responses related to the frequency of disruptive behavior involving theft, truancy, and school suspensions. Caregiver rating of youth distractibility, carelessness, and need for supervision indicated youth self-control. Caregiver measures included communication about behavioral expectations, use of child-management techniques, relationship building behaviors, and teaching youth to be proud of being African American. Protective factors were measured in terms of academic competence, self-esteem, goal setting, and negative attitudes toward drinking.
Findings indicated that the program was successful in reducing conduct problems with a stronger impact for youth with more risk factors such as affiliation with deviance-prone peers and low self-control. The intervention group had fewer conduct problems over time compared to the control group, and those youth who were more at risk seemed to benefit when protective factors were increased. The researchers claim that SAAF has public health implications because of the demonstrated efficacy, the specific design for rural African American youth, and the cost efficiency of the program. The methods used were “culturally and ecologically appropriate for rural African American youth” (p. 479). The use of community leaders and African American adults living in the community who led the program increased the success of the program because of their understanding of the community and ability to communicate with the participants.
TAKE-TO-WORK MESSAGE
The SAAF presents strategies for rural African American youth that can be considered by school nurses interested in developing programs in similar communities. The evidence that high-risk youth can benefit from such interventions can be brought to the attention of school intervention teams as a possible community and school effort to consider. School nurses can be instrumental in helping to foster the identification of community leaders who might be interested in helping to implement a program such as SAAF with the goal of reducing conduct problems in at-risk youth. Understanding the skills taught to the parents or caregivers can inspire school nurses to provide similar opportunities for parents or caregivers in schools where programs such as SAAF are not available.
Schaefer-McDaniel, N. (2009). Neighborhood stressors, perceived neighborhood quality, and child mental health in New York City. Health & Place,15(1), 148–155.
The purpose of this study was to examine youth perceptions of neighborhood in relation to various stressors and its impact on child mental health. The research took place in three disadvantaged New York City neighborhoods: one in Manhattan, and two in the Bronx. Participants (n = 126) were recruited from neighborhood after-school programs and were between the ages of 9–13 years with 63% having just completed sixth or seventh grade. Sixty percent were females, and the majority was Latino or Hispanic (58%), followed by African American (23%). In addition, 117 parents or primary caregivers were recruited.
The youth participants completed measures on neighborhood quality and depression, as well as describing on a map a five-block outline of their neighborhood. Adult participants completed surveys on their mental health and parenting practices. Two independent raters then observed the indicated neighborhoods using the Systematic Social Observations (SSO) inventory on warm and sunny weekdays. Stressors were organized according to the categories of parent stressors or neighborhood stressors of urban decay, drug/alcohol use, and loitering. According to the findings, 26% of the youth were not exposed to any of these stressors, and 37% were exposed to one of the stressors. The most commonly reported stressors were urban decay (40%), loitering/congregating (34%), and parent stressors (28%).
The only demographic variable related to depression was child race/ethnicity, with Hispanic youth having lower levels of depression than other groups. There did not appear to be any significant relationship between depression and loitering, neighborhood decay, or parent stressors. However, the presence of the drug/alcohol stressor was related to lower levels of depression. Children living in neighborhoods perceived as higher quality also reported lower levels of depression. When the analyses were concluded, it appeared that when a child perceived their neighborhood to be of good quality, the drug/alcohol stressor was no longer predictive of the level of depression. As a matter of fact, the researcher was unable to establish a relation, contrary to previous studies, between urban decay, loitering, or parenting and child depression. The researcher offered the following explanation for this finding: “Essentially, if public drug and alcohol use is condoned in a neighborhood and occurs in a non-threatening manner, children may equate these behaviors with indicators of safety or neighborhood cohesion since people are, more or less, socializing peacefully in the neighborhood. Further, the children may have become familiar with the people who hang out in the public space . . . and associate their presence with normal (“good”) neighborhood life, leading them to evaluate their neighborhood’s quality positively” (p. 153). In conclusion, the researcher emphasizes this counterintuitive finding indicates the need to take into consideration the perception of residents, specifically children, when understanding communities, rather than relying solely on physical characteristics and demographics of neighborhoods.
TAKE-TO-WORK MESSAGE
An implication of this study relates to the nurse’s role as a community health nurse in conducting windshield surveys and the importance of assessing more than what is apparent in a general “drive by” of a community. Understanding the neighborhood means understanding the risk factors as well as the protective factors, especially as perceived by the residents. As school nurses, we need to understand how students and other community members perceive their environment and how we can build more protective factors into their lives to reduce the risks they might be experiencing.
It is important to appreciate how children perceive their environment as a mediating factor despite disadvantages in their environment. The researcher suggests that having familiar adults in a neighborhood might provide a supportive environment versus a threatening environment for children. Helping children feel safe by recognizing safe adults might be a role that school nurses can promote. Helping parents identify adults in their community who are there on a regular basis in a non-threatening manner might be the beginning of a neighborhood watch program to further support children’s sense of safety and reduce the risk for depression.
Students have a need to find supportive figures in their environment. School nurses planning intervention programs, proposing research, or hoping to make changes for students are well advised to consider the important influences in a child’s life. The approach used in both of these studies emphasizes the holistic focus of nursing that requires attention and value to all aspects of our students’ lives.