Historically, growing-up in rural communities in the southern United States has protected African American preadolescents and adolescents from the use of alcohol and other drugs. Recent epidemiological data, however, indicate that African American youths in rural areas use substances at rates equal to or exceeding those of youths in densely populated inner cities.
Prevention programs designed to deter alcohol and drug use are scarce in the rural South. These circumstances, and the need for prevention programming led the Center for Family Research to develop the Strong African American Families (SAAF) program for preadolescents, the Strong African American Families-Teen (SAAF-T) program for adolescents, and the Adults in the Making (AIM) program for emerging adults. These family-centered prevention programs were developed, implemented, and tested in randomized prevention trials. Evaluations of these programs confirmed their efficacy in preventing the use of alcohol and other drugs years after participation in the prevention programs. The SAAF and SAAF-T programs are reaching African American families in communities around the nation.
The Strong African American Families (SAAF) Program is a 7 session program designed for youth aged 10–14 and their caregivers.
The Strong African American Families – Teen Program (SAAF-T) is a 5 session program designed for teens aged 14–16 and their caregivers.
Adults in the Making (AIM) is a 6 session program for youth age 17-19 years and their caregivers.
The programs are designed to accommodate groups of 8 to 13 families. Caregivers and youth attend weekly 2- hour meetings: seven meetings for SAAF, six meetings for AIM, and five meeting for SAAF-T. In the first hour, caregivers and youths meet separately; in the second hour families practice skills they learned in their separate sessions in a joint caregiver-youth session. The caregiver sessions focus on enhancing developmentally appropriate protective caregiving that features providing emotional support, setting limits, day-to-day parenting, helping youth succeed at school, encouraging racial pride and developing strategies for dealing with racial discrimination, and staying connected. The youth sessions include setting goals for the future and how to reach them, handling peer pressure, dealing with unfair situations like racial discrimination, and making good choices.
Because each program is highly structured, a detailed curriculum manual is used and all activities are timed. Program content for the caregivers’ sessions is delivered by narrators on video presentations that also depict family interactions illustrating targeted behaviors. Video presentations are used in some youth sessions, showing age-appropriate models discussing typical high-risk situations and ways of dealing with temptation and peer pressure issues. Structured activities, games, role-playing, and group discussions are also part of the youth sessions. Trained group leaders guide and facilitate all of these activities. This carefully structured approach standardizes the content and staging of each session facilitating fidelity in implementation.
What the SAAF Prevention Trial Continues to Teach Us about the Long-term Benefits of Family Centered Drug Use Prevention Programs
We have been able to track and collect data on the families in the SAAF trial since the youth were 11 years old. The young people in the SAAF trial are now 29 years old. Along the way, we wanted to learn:(1) if SAAF program effects were durable over time, (2) if SAAF participation was associated with employment income and poverty status during young adulthood, and (3) whether participation in SAAF had health benefits. Below we present brief snapshots of some of the findings.
How Durable Is SAAF?
Sixty-five months after the pretest, youths who participated in SAAF reported drinking alcohol half as often during the previous month than did those in the control condition. When the participants were age 25 we followed-up to see whether participation in SAAF 14 years earlier reduced drug use and body mass index.
We focused on drug use and BMI because many youth cope with stressful circumstances by using substances ( tobacco, alcohol, or illicit substances) or eating comfort foods. The available data suggests that during young adulthood, Black men report increases in drug use and black women report weight gain. Young male adults in the control group evinced the highest levels of drug use and women in the control group showed higher levels of BMI. The results showed that exposure to SAAF at age 11 could have lasting protective effects on self-medicating behaviors such as drug use and excessive eating.
Can Participation in SAAF Protect Children with Low levels of Self-control from Earning Lower Wages and Living in Poverty during Young Adulthood?
Self-control involves planning, persistence, and a future goal orientation. Studies that follow children into adulthood show self-control presage favorable life outcomes. Children who exhibit greater self-control go on to find jobs and remain stably employed, save more money, and are less likely to live in poverty. Against this backdrop, we found among children in the control group, lower levels of self-control at age 11 predicted lower employment income and greater likelihood of living in poverty at age 25. In contrast, among children who participated in SAAF, no relationship was found between low self-control at age 11 and age 25 employment income or poverty status. This finding shows that SAAF, which is designed to enhance parenting and strengthen families, can buffer the long-term economic consequences of low self-control.
Does Participation in SAAF Have Health Benefits in Young Adulthood?
Black children in the rural South are vulnerable to a variety of health problems in adulthood. Studies hint that protective caregiving may offset these health risks, but it is unclear whether these findings reflect a causal process and have clinical utility. We wondered whether SAAF, which sought to improve protective caregiving, could shield youth from poor health outcomes during young adulthood. To test the potential health benefits of SAAF, we collected biomarkers to determine whether SAAF reduced risk factors for heart disease, diabetes, stroke, and altered brain development. The biomarkers were obtained from blood draws and MRI brain scans during the young adult years. The endpoints of these studies were inflammation (a precursor of heart disease, diabetes, and stroke), metabolic syndrome (a precursor of heart disease and diabetes), accelerated cellular aging( a precursor of mortality), and brain development. Years after the intervention, youth who participated in SAAF had significantly fewer health risks than controls; in addition, participation in SAAF ameliorated the association of years lived in poverty with brain development.