Exploring Change in Attitudinal and Behavioral Outcomes Using the Familia Adelante Program for Urban Latino High School Students

Exploring Change in Attitudinal and Behavioral Outcomes Using the Familia Adelante Program for Urban Latino High School Students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring Change in Attitudinal and Behavioral Outcomes Using the Familia Adelante Program for Urban Latino High School Students Richard Cervantes, Samantha Garcia, Cindy Keig, Jefferson Sa This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7014483/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Latinos are at increased risk of adverse health outcomes of substance use and risky sexual behaviors due in part due to sociodemographic and cultural barriers that reduce access to treatment. Culturally tailored and age-appropriate interventions aimed at reducing and preventing substance use and sexual behaviors are needed. Methods: Between October 2019 and October 2024, Familia Adelante, a school-based mental health prevention and early intervention program, was tailored to prevent substance use, risky sexual behaviors and increase risk perception of substance use. We used free latent growth curve models to assess our primary (change in alcohol, tobacco, and marijuana use) and secondary outcomes (binge alcohol use, risky sexual behavior, risk perception of substance use) over a 6-month period. Parsimonious models were then adjusted for significant sociodemographic variables. Results: Results showed marijuana use decreased, risk perception of substance use, and risk perceptions of sexual behavior increased over a 6-month period. Alcohol, binge alcohol, tobacco use, and sexual behavior did not significantly differ over time. Discussion: Culturally tailored school-based interventions may be an effective primary prevention tool at reducing some substance use disparities among Latino communities and increasing perceptions of risky behavior. Youth Alcohol Tobacco Marijuana Sex Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 BACKGROUND By 2050, the U.S. population will reflect more Latino than non-Latino white school-age children [1]. Alcohol and drug use among Latino adolescents is a persistent public health issue. It is imperative to better understand predictors of adolescent alcohol and drug use and to intervene with efficacious school-based strategies. In 2020, 12.7% of Latinos ages 12 and older had a substance use disorder, including alcohol use disorder. Approximately 95% of those who needed treatment in a facility or rehabilitation center did not receive such care [2]. Latinos often avoid treatment due to barriers stemming from stigma, lack of social support, cultural factors, access to treatment, employment, and family conflict [3]. While barriers may explain some of the disparity, others suggest there is a cultural mismatch between clinicians and clients, with some evidence indicating a clash in values, beliefs, and practices between Latinx cultural traditions and how treatment programs are structured [4]. Some national reports approximate 10% of Latino youth reported using marijuana [5], and over 14% of underage Latino youth were more likely to report using alcohol in the past month, with approximately 7% of Latino youth reported binge drinking [6]. Although California-based estimates of cannabis, alcohol use among Latino youth have been lower than national trends, Latinos are a heterogeneous group of individuals with varying environmental and social drivers of health behaviors. Marijuana use among Latino youth in underserved communities with high rates of poverty needs to be further explored. The acculturation process for Latino youth has become more turbulent in the last several years [8], leading to stressful experiences that come from immigration and discrimination [9]. These stressors, in turn, are exacerbated by the current sociopolitical climate, which is characterized by anti‐immigrant policies and rhetoric toward Latinx immigrants [10-11]. Latino youth and families experience cultural stressors such as language barriers, experiences of discrimination, racism, violence, and criminalization [12]. The physical and emotional demands of immigrating to the U.S. are well documented [13]. A 2022 study of children who have experienced migration-related trauma found significant barriers to receiving mental health care, including mental health stigma, distrust of service systems, and cultural and linguistic differences [14]. Immigration authorities encountered more than 152,000 unaccompanied minors at or near the U.S.-Mexico border in fiscal year 2022, an all-time high. Nearly 72% of all unaccompanied children in federal care were fifteen years of age or older, though authorities have also detained infants and toddlers [15]. Prior to migration, Latino youth may have experienced multiple traumas, including loss of loved ones, deprivation, exposure to violence, and displacement, each of which may affect subsequent resettlement and acculturative stressors [16]. In addition, parental deportation is an increasingly common hardship experienced by Latino youth. Most children of deported undocumented workers remained in the U.S. with the other parent or relative [17], leading to negative consequences on child wellbeing [18-21]. Children at high risk of substance use include those who witnessed their parents’ arrest, children separated from their parent longer than 30 days, and children whose primary caregiver was deported [22]. There is a lack of behavioral intervention strategies for Latino and immigrant youth to buffer the effects of substance abuse and risky sexual behaviors. One study included N=450 high-risk youth in an established, non-immigrant community setting. The prevention program included middle schools located in the disadvantaged neighborhoods in Phoenix, Arizona, with the highest enrollment of students of Mexican origin (ranging between 69% and 82% ) [23]. Substance abuse treatment interventions such as Brief Strategic Family Therapy and Culturally Informed Family Therapy for Adolescents address intra-familial stress in Latino families [24]. These programs have involved primarily Cuban or other Caribbean Latino samples, who differ from Mexican Latinos in a key criterion: they frequently hold refugee (Cuban) or citizen (Puerto Rican) standing. Randomized controlled trials suggest that strengthening the family system, rather than targeting specific health behaviors, is efficacious in preventing and reducing cigarette smoking, illicit drug use, and unsafe sex in Latino adolescents [25-26]. Unfortunately, this curriculum is parent-centered and requires prolonged involvement of highly trained (graduate degree or higher) bilingual intervention staff [27], an asset frequently lacking in new Latino settlement communities. Prior programs effective at reducing adolescents at risk for substance use, HIV, and behavioral health problems have not explored effectiveness among immigrant youth [28]. While past studies haveemphasized Mexican culture, they do not account for familial aspects. Other studies that do utilize a family component but do not take on the stressors of Mexican immigrant youth or families [29].Additionally, testing innovative programs for the rapidly growing Mexican immigrant population and their children is sorely needed. The Familia Adelante [FA] program, endorsed by SAMHSA and previously funded by NIH to incorporate HIV prevention modules, was originally developed for at-risk youth (age 10-15) and has demonstrated prior improvements in family and peer communication and reduction in youth substance abuse, HIV risks and high participant satisfaction [30, 31]. THEORETICAL FRAMEWORK Research indicates that stress partially mediates the relationship between acculturation and negative health behaviors. Stress impedes health by limiting access to salutogenic behaviors [32], and through maladaptive coping. Latinos under elevated stressor exposure are more likely to deny the stressor, or to use maladaptive coping behaviors such as risky sex and substance abuse [33]. Contemporary systemic transactional stress models have guided our approach to the development and initial testing of FA [34]. Using a psychoeducational approach, youth and parents are taught to identify culturally based stressors found to be related to substance use and develop healthy coping skills for these stressors. At the family level, FA addresses family-related risks, such as poor parent-child communication and inconsistent parenting approaches. Prevention strategies that address multiple risk behaviors, like FA, are increasingly desirable for cost-effective prevention programming and are beneficial for addressing the complex needs of hard-to-reach populations by reducing barriers to service access and utilization [35]. FA approaches each session topic from the perspective of Latino immigrants and U.S.-born youth, emphasizing challenges specific to immigrant families such as differential acculturation between parents and children, the potential of forced separation due to deportation, and the lack of familiarity with the U.S. educational system. The purpose of this study was to assess growth trajectories of alcohol use, tobacco use, marijuana use, sexual activity and risk perceptions of both sexual behavior and drug use throughout the implementation of the FA program and 3-months post intervention among a sample of older high school aged Latino students in an urban setting. We hypothesized that alcohol, tobacco use, marijuana use, binge alcohol drinking, and sexual activity would reduce over time. Additionally, we hypothesized that the perceived risk from alcohol and drugs, as well as the perceived risk of sexual activity, would increase among participants over time. Our sample included Latino immigrant students of various nationalities. METHODS Setting and Recruitment High school students were recruited from 2 urban Charter Schools located in South Los Angeles, California, with predominantly Latino students. Participation required students to be Latino origin and currently enrolled in a high school setting. Teachers and school counselors were informed about the nature of the FA study and were asked to identify youth with early behavioral or emotional difficulties, agreeable to receive the prevention and early intervention study, and were requested to recruit and refer students for participation. Academic counselors facilitated youth engagement and retention. The study began in 2019 and effectively ended in early 2024. This study was supported in part by SAMHSA (Grant #SP081494) and led by the Sunrise Community Counseling Center prevention staff. Informed consent procedures were used for each youth participant, and an intake interview was conducted to ensure eligibility for the study. Students with serious substance abuse or mental health issues, including severe depression, anxiety, and suicidality, were referred to additional intensive Services through the school counseling department. All informed consent procedures were reviewed by the Behavioral Assessment Incorporated Institutional Review Board (IRB00004925). Youth Survey Parents and youth completed a 36-question survey at baseline, the final session (3 months) and at 6-month post-intervention initiation. This survey tool was used as part of SAMHSA’s national cross-site evaluation and comprises questions to assess the cognitive and behavioral effects of FA on youth participants [36]. The youth survey included questions to capture: i) demographic information, ii) risk perception of substance use; iii) self-efficacy to decline participation in substances; iv) substance use; and v) sexual behavior. Procedures Following receipt of parental or caregiver consent, youth were assigned to a classroom where the trained FA facilitators met with students during school hours. The active intervention, FA was delivered over a 10-week period. The core components of FA are provided in Table 1. Each of the 10 sessions lasted approximately 90 minutes. FA approaches each of these topics from the perspective of Latino immigrants and U.S. born youth, emphasizing challenges specific to immigrant families like differential acculturation between parents and children, potential forced separation due to deportation, and a lack of familiarity with the U.S. educational system. The FA program is a selective prevention program that consists of twelve English or Spanish language, 90-minute modules, originally developed for at-risk youth (age 10-15) and their parents, and built on the fundamental premise that effective risk prevention strategies should incorporate family members. Measured Outcomes Alcohol, binge alcohol, tobacco, and marijuana use. Adolescent participants were asked, “Think back over the past 30 days and record on how many days, if any, you did any of the following activities: a) “smoke cigarettes?”; b) “Use other tobacco products?”; c) “Drink alcohol? (any use at all)”; d) “Binge drink?” (Binge drinking is five or more alcoholic beverages at the same time or within a couple of hours of each other for males; four or more for females); e) “Use marijuana or hashish?” Responses for a) and b) were then recoded as (1) any tobacco use, and (0) no tobacco use. Responses for c) were recoded as (1) any alcohol use, and (0) no alcohol use. Responses for d) were recoded as (1) binge drink, and (0) no binge drink. Responses for e) were recoded as (1) any tobacco use, and (0) no tobacco use. Sexual activity. Participants were asked, “During the past 3 months, how many people did you have sex with? Response categories were 0) 0 people; 1) 1 person; 2) 2 people; 3) 3 people; 4) 4 people; 5) 5 people; 6) 6 people or more people. Responses were recoded into 0) 0 people, and 1) 1 or more people. Risk perception of alcohol and drugs. Participants were asked six questions to assess perceived risk of harm when an individual engages in alcohol consumption or drugs. An example question was, “What level of risk do you think people have harming themselves physically or in other ways when they use tobacco once or twice a week?” Responses were 0) no risk, 1) slight risk, 3) moderate risk, 4) great risk 5) don’t know or can’t say. Individuals who indicated they didn’t know were imputed as missing. Responses of all six questions were summed up and averaged. Higher scores indicated higher perceived risk from alcohol and drugs. Risk perception of sex. Participants were asked “What level of risk do you think people have of harming themselves if they have sex without a condom?” to assess perceived risk of harm when an individual engages in sexual behavior. Responses were 0) no risk, 1) slight risk, 3) moderate risk, 4) great risk, 5) don’t know or can’t say. Responses of don’t know or can’t say were imputed as missing. Higher scores indicated higher perceived risk from sexual behavior. Covariates. Outcomes were assessed to determine if they significantly differed by age (continuous), sexual identity (1=male, 0= other), or living in the household with both parents (1= living with both parents, 0= not living with both parents). If the outcomes varied by age, sexual identity, or living with both parents, we then adjusted the model for significant covariates. Data Analysis Of the 257 students that were enrolled, 114 students were excluded as they did not identify with the ethnic group of Latino, and 15 were excluded if they had not yet been offered follow-up surveys. One participant age 21 was also excluded from the analysis, leaving n=127 for the analysis. Mplus 8 was used to perform descriptive statistics, frequencies, and latent class growth curve on the overall sample. Separate latent growth curve models were conducted on tobacco use, alcohol use, marijuana use, sexual activity, and perceived risk of alcohol and drugs and sex to assess changes across all assessment outcomes. Missing data was addressed using maximum likelihood estimation. Robust maximum likelihood estimation was used on all models to address non-normal data. Analyses were also conducted on non-imputed data to ensure consistency of findings. Root Mean Square Error [RMSEA]; Comparative Fit Index [CFI]; Tucker Lewis Index [TLI]; Standardized Root Mean Squared Residual [SRMR]; and Chi-square test of model fit were used to assess model fit of continuous outcome variables. Chi-square test of model fit was used to determine model fit of dichotomous outcome variables. RMSEA values below 0.08, CFI and TLI values above 0.90, SRMR values below 0.08 and chi-square test of model fit above 0.05 are considered to suggest appropriate model fit [36-39]. We then assessed and plotted growth trajectories separately. RESULTS Sample Characteristics A total of N=127 Latino youth were included in this analysis. Most participants were male (56%), lived with both parents at baseline (73%), never suspended from school for drugs or alcohol (96%), and not arrested in the past 30 days (92%). Average age was 17 years old (SD = 1.3) with a range between 13 and 20 years old. See Table 2 for additional demographics. Baseline past 30-day alcohol and tobacco use were (2%) and (12%), respectively. Approximately one-third of participants (32%) reported having sex within the past 30 days. See Table 3 for additional behaviors at baseline, 3-month and 6-month post-intervention. All models (Table 4) presented acceptable model fit. Behavioral Outcomes Alcohol and tobacco use varied by gender, with males reporting higher consumption of alcohol. While neither unadjusted nor adjusted free latent growth curve models of alcohol demonstrated significance in changes by slope, the adjusted model suggested a decrease over time ( B = -0.31). See Figure 1. Similarly, the tobacco use slope had a non-significant change in slope over time for unadjusted (B= -0.02) and adjusted ( B = 0.86) models. See Figure 2. Similarly, binge alcohol drinking and sexual activity slopes had a non-significant change in slope over time. Binge alcohol was unadjusted (B= 0.02) and adjusted ( B = 1.29) models when controlling for age and gender (see Figure 3). Sexual activity was unadjusted (B= -0.02) and adjusted ( B = 0.23) models when controlling for gender (See Figure 4). Marijuana use slope did significantly decrease over time, unadjusted (B= -1.36, p<0.05) and adjusted ( B = -1.44; p<0.01) models when controlling for gender (see Figure 5). Risk Perceptions Risk perceptions of sexual behavior and risk perceptions of alcohol and drug use did not differ by gender, age nor living with both parents. Both standardized models of risk perceptions of sexual behavior and risk perceptions of alcohol and drug use demonstrated an increase in slopes (B= 0.32, p<0.05 (Figure 6); B= -0.28, p<0.01 (Figure 7), respectively) DISCUSSION Our study comprised of N = 142 Latino high school youth between the ages of 13–20. Participants self-reported alcohol (2%), marijuana (7%), and tobacco (12%) use within the past 30 days at baseline. Notably, baseline marijuana and tobacco use among our sample was higher than recent California high school student estimates (4.5% and 7.3%) respectively yet were shown to have no significant increase over the 6 month study period. Participants in our study were sampled from low-income Latino urban communities in Los Angeles County. Previous literature has shown higher family income can be a protective factor in delay of tobacco initiation [ 41 ]. Thus, evidence-based interventions effective at reducing alcohol and substance use as well as risky sexual behavior among youth from low-income communities are essential to address health equity given the limited programming addressing acculturation stress among Latino youth [ 40 ]. Trends show FA was successful at reducing tobacco use and sexual activity from baseline to 6-month post-intervention. Additionally, participants perceived the risk of using alcohol and drugs increased as measured at 6-month post-intervention. Prior studies evaluating FA in younger youth (11–14 years old) of varying ethnicities found the intervention effective at sexual intercourse to be curvilinear, increasing slightly at posttest before declining at 6-month follow-up, and marijuana use to decrease at posttest and follow-up [ 42 ]. Our findings show that FA may be just as effective at targeting older Latino youth (13–20 years old). Study findings suggest youth-only services model may be and effective model to target older school-aged children. FA was built on the premise that family and acculturation stress could best be addressed if parents were active participants in the parent sessions. However, with some age-appropriate modifications to the original youth curriculum, when delivered to high school age student alone, this study shows positive changes in substance risk related attitudes and other risky behaviors. To address Latino health disparities (e.g., cancer, cardiovascular disease) attributed in part to alcohol and substance use) early prevention is key. Disparities in healthcare access and quality of care post-diagnosis further exacerbate inequities [ 43 ]. Effective high school behavioral interventions targeting at-risk older Latino youth, such as FA, are a valuable prevention strategy to reduce health risks of alcohol use, substance use and sexual activity. Strengths of this study include the use of a youth-only intervention and FA curriculum for older youth does not involve parent participation. While health behaviors and health disparities are heavily impacted by multilevel factors, including social and structural environments, a focus on individual behavior was sufficient to observe favorable trends in outcomes. Additionally, this study investigated Latino participants, a population which may be at higher risk of cardiovascular disease as a consequence of tobacco use, and cancers associated with risky sexual behavior [ 44 – 48 ]. Study limitations include the lack of randomized sampling, low rates of baseline substance use rates for comparing pre, exit, and follow-up outcomes, and lack of control of acculturation levels among youth participants. Declarations Author Contribution RC - Conducted the study with Dr. Sa and wrote the main manuscript and edited.SG - Wrote manuscript and prepared tables and figuresCK- Worked on main manuscript, table, references and submissionJS-PI for this study References Fry R, Gonzales F. One-in-five and growing fast: A profile of Hispanic public school students. Washington, DC: Pew Hispanic Center; 2008. Retrieved online 2025 May 22: https://files.eric.ed.gov/fulltext/ED502556.pdf Substance Abuse and Mental Health Services Administration (SAMHSA). 2020 National Survey on Drug Use and Health: Hispanics, Latino or Spanish Origin or Descent Retrieved online 2025 May 22: https://www.samhsa.gov/data/report/2020-nsduh-hispanics-latino-or-spanish-origin. Fish, J.N., Maier, C.A., Priest, J.B., Substance abuse treatment response in a Latino sample: The influence of family conflict. Journal of Substance Abuse Treatment 2015;49:27–34. https://doi.org/10.1016/j.jsat.2014.07.011. Alvarez, J., Jason, L. A., Olson, B. D., Ferrari, J. R., & Davis, M. I. Substance abuse prevalence and treatment among Latinos and Latinas. Journal of Ethnicity in Substance Abuse. 2007;6(2), 115–141. https://doi.org/10.1300/J233v06n02_08. Substance Abuse and Mental Health Services Administration (SAMHSA). 2019 National Survey on Drug Use and Health: Hispanics. Retrieved online: 2024 April 9. https://www.samhsa.gov/data/release/2019-national-survey-drug-use-and-health-nsduh-releases. Substance Abuse and Mental Health Services Administration (SAMHSA). 2021. National Survey on Drug Use and Health. Retrieved online 2024 April 9. https://www.samhsa.gov/data/release/2021-national-survey-drug-use-and-health-nsduh-releases. California Department of Education. California Healthy Kids Survey, 2019–2021. Sacramento (CA): CDE; Retrieved online: 2024 Sep 7. https://www.cde.ca.gov/ls/he/at/chks.asp. McCord, A. L., Draucker, C. B., Bigatti, S. Cultural stressors and depressive symptoms in Latino/a adolescents: An integrative review. Journal of the American Psychiatric Nurses Association . 2019.25(1), 49–65. https://doi.org/10.1177/1078390318778885. Cano, M.A., Schwartz, S.J., Castillo, L.G., Romero, A.J., Huang, S., Lorenzo-Blanco, E.I., Unger, J.B., Zamboanga, B.L., Des Rosiers, S.E., Baezconde-Garbanati,L., Lizzi, K.M., Soto, D.W., Oshri, A., Villamar, J.A., Pattarroyo, M., Szapocznik, J. Depressive symptoms and externalizing behaviors among Hispanic immigrant adolescents: Examining longitudinal effects of cultural stress. Journal of Adolescence . 2015. https://doi.org/10.1016/j.adolescence.2015.03.017. Finley, L., & Esposito, L. The immigrant as bogeyman: Examining Donald Trump and the right’s anti-immigrant, anti-pc rhetoric. Humanity & Society . 2020;44(2), 178-197. https://doi.org/10.1177/0160597619832627. Torres SA, Sosa SS, Flores Toussaint RJ, Jolie S, Bustos Y. Systems of oppression: The impact of discrimination on Latinx immigrant adolescents' well-being and development. Journal of Research on Adolescence . 2022;32(2):501-517. https://doi.org/10.1111/jora.12751. Lorenzo-Blanco; Elma I; Meca, A.; Unger, J.B.; Szapocznik, J.; Cano, M.A.; Des Rosiers, S. E.; Schwartz, S. J.; Cultural stress, emotional well-being, and health risk behaviors among recent immigrant Latinx families: The moderating role of perceived neighborhood characteristics . Journal of Youth and Adolescence. 2019 ; 48(1), 114-131. DOI: 10.1007/s10964-018-0907-5. Pew Research Center. Most Latinos say U.S. immigration system needs big changes. Washington, DC: Pew Research Center. 2021. Retrieved online 2025 May 22. https://www.pewresearch.org/short-reads/2021/04/20/most-latinos-say-u-s-immigration-system-needs-big-changes/. Miller, A. B., Davis, S. H., Mulder, L. A., Winer, J. P., Issa, O. M., Cardeli, E., Ellis, B. H. Leveraging community-based mental health services to reduce inequities for children and families living in United States who have experienced migration-related trauma. psychological trauma: Theory, research, practice, and policy. 2024. Retrieved online 2024 October. https://dx.doi.org/10.1037/tra0001392. Cheatham, Ameila & Roy, Diana. U.S. Detention of child migrants, Council on Foreign Relations 2023. Retrieved online April 10, 2024. https://www.cfr.org/backgrounder/us-detention-child-migrants. Cleary, S. D., Snead, R., Dietz-Chavez, D., Rivera, I., & Edberg, M. C. Immigrant trauma and mental health outcomes among Latino youth. Journal of Immigrant and Minority Health. 2018. 20(5), 1053–1059. https://doi.org/10.1007/s10903-017-0673-6. Chaudry A. Capps R. Pedroza J. Castañeda R. M. Santos R. Scott M., Facing our future: children in the aftermath of immigration enforcement. 2010. Washington, DC Urban Institute Report. https://files.eric.ed.gov/fulltext/ED508226.pdf. Capps, R., Castaneda, R. M., Chaudry, A., & Santos, R. Paying the price: The impact of Immigration raids on America's children. The Urban Institute and the National Council of La Raza Report. 2007. Retrieved online 2024. https://www.urban.org/research/publication/paying-price-impact-immigration-raids-americas-children. Chaudry, A., Fortuny, K., Capps, R., & Simms, M. Children of i mmigrants: National and state characteristics. 2009. Brief No. 9. Washington, DC. https://www.urban.org/sites/default/files/publication/32986/411939-Children-of-Immigrants-National-and-State-Characteristics.PDF. Hondagneu-Sotelo, P., and Ernestine A. I’m here, but I’m there: The meanings of Latina transnational motherhood. Gender and Society . 1997;11, no. 5, 548–71. http://www.jstor.org/stable/190339. Suárez-Orozco, C., Todorova, I. L. G., & 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. Chaudry A, Fortuny K. A comprehensive review of immigrant access to health and human services. Washington (DC): Urban Institute; 2011. Available from:https://www.urban.org/sites/default/files/publication/27651/412425-A-Comprehensive-Review-of-Immigrant-Access-to-Health-and-Human-Services.PDF. Varela, Ralph. Cultural Competent Prevention Program for At-Risk Chicano Youth . Substance Abuse Mental Health Services Administration/Center for Substance Abuse Prevention Report. U.S. Department of Health and Human Services. American Immigration Council Fact Sheet. U.S. Citizen Children Impacted by Immigration Enforcement 2001. https://nationalgangcenter.ojp.gov/spt/Programs/134#:~:text=Strengthening%20the%20Bonds%20of%20Chicano% 20Youth%20%28El%20Proyecto,Arizona%20who%20demonstrate%20high-risk%20characteristics%20of%20substance%20abuse. Santisteban, D. A., Coatsworth, J. D., Perez-Vidal, A., Kurtines, W., M., Schwartz, S. J., LaPerriere, A., & Szapocznik, J. Efficacy of brief strategic family therapy in modifying Hispanic adolescent behavior problems and substance use. Journal of Family Psychology. 2003;17(1), 121–133.https://doi.org/10.1037/0893-3200.17.1.121. Prado, G., Pantin, H., Briones, E., Schwartz, S. J., Feaster, D., Huang, S., Sullivan, S., Tapia, M. I., Sabillon, E., Lopez, B., Szapocznik, J. A randomized controlled trial of a parent-centered intervention in preventing substance use and HIV risk behaviors in Hispanic adolescents. Journal of Consulting Clinical Psychology . 2007; 75 (6),914-26. DOI:10.1037/0022-006X.75.6.914. Pantin, H., Prado, G., Lopez, B., Huang, S., Tapia, M. I., Schwartz, S. J., Branchini, J.A Randomized controlled trial of Familias Unidas for Hispanic adolescents with behavior problems. Psychosomatic Medicine. 2009;71, 987-995. DOI:10.1097/PSY.0b013e3181bb2913. Prado, G., Schwartz, S. J., Pattatucci-Aragón, A., Clatts, M., Pantin, H., Fernandez, M. I.,Lopez, B., Briones, E., Amaro, H., Szapocznik, J. The prevention of HIV transmission in Hispanic adolescents. Drug and Alcohol Dependence. 2006; 84(1),43-53. https://doi.org/10.1016/j.drugalcdep.2006.05.006. Nelson, A., Arthur, B. Storytelling for Empowerment: Decreasing At-Risk Youth's Alcohol and Marijuana Use. The Journal of Primary Prevention. 2003; 24,169–180. https://doi.org/10.1023/A:1025944412465. Varela, R., Cu ltural Competent Prevention Program for At-Risk Chicano Youth . Substance Abuse Mental Health Services Administration/Center For Substance Abuse Prevention Report. Washington, DC: U.S. Department of Health and Human Services. 2001. https://nationalgangcenter.ojp.gov/spt/Programs/134. Cervantes, R., Goldbach, J., & Santos, S. M. Familia Adelante: A multi-risk prevention intervention for Latino families. The Journal of Primary Prevention , 2011; 32 (3-4), 225–234. https://doi.org/10.1007/s10935-011-0251-y. [31] Dowling, J., & McCoy-Contreras, L. Annual evaluation report, Arizona governor’s office, parent commission grant program, 2017. Wellington Consulting Group, Ltd . https://www.juvenilejustice.az.gov/sites/default/files/meeting-documents/materials/parent_commission_evaluation_year_3_2022.pdf. [32] Wethington, E., Glanz K, Schwartz MD. Stress, coping, and health behavior. In: Glanz K, Rimer BK, Viswanath K, editors. Health behavior and health education: Theory, research, and practice . 4th ed. San Francisco: Jossey-Bass/Wiley ; 2015. p. 211–236. Worthman, C. M. The ecology of human development: Evolving models for cultural psychology. Journal of Cross-Cultural Psychology, 2010 . 41 (4), 546–562. https://doi.org/10.1177/0022022110362627 Ickovics, J. R. “Bundling” HIV prevention: Integrating services to promote synergistic gain. Preventative Medicine, 2008. 46 , 222-225. DOI:10.1016/j.ypmed.2007.09.006 Cervantes, R. C., & Goldbach, J. adapting evidence-based prevention approaches for Latino adolescents: the Familia Adelante Program – Revised. Journal of Psychosocial Intervention, 2012;21(3),281-290. https://doi.org/10.5093/in2012a25. Garnier-Villarreal, M., Jorgensen, T.D. Adapting fit indices for Bayesian structural equation modeling: comparison to maximum likelihood. Psychological Methods 2020; 25, 46–70. DOI:10.1037/met0000224. Bentler, P.M. Comparative fit indexes in structural models. Psychological Bulletin , 1990;107, 238–246. DOI:10.1037/0033-2909.107.2.238. Steiger, J.H. Structural model evaluation and modification: an interval estimation approach. Multivariate Behavioral Research , 1990; 25, 173–180. DOI:10.1207/s15327906mbr2502_4. Steiger JH, Lind JC, Statistically based tests for the number of common factors. The Annual Meeting of the Psychometric Society. 1980. Iowa City, IA. https://doi.org/10.1080/10705511.2016.1217487 Cervantes, R.C., Koutantos, E., Advances in substance abuse prevention practice and science for Hispanic/Latinos. Effective prevention and treatment of substance use disorders for racial and ethnic minorities. IntechOpen ; 2020. http://dx.doi.org/10.5772/intechopen.90399. Assari, S., Najand, B., & Sheikhattari, P. Household income and subsequent youth tobacco initiation: minorities’ diminished returns. 2024. Journal of medicine, surgery, and public health , 2 , 100063. DOI:10.1016/j.glmedi.2024.100063. Cervantes, R., Goldbach, J., & Santos, S. M. Familia Adelante: A multi-risk prevention intervention for Latino families. The Journal of Primary Prevention , 2011; 32 , 225-234. DOI:10.1007/s10935-011-0251-y. Guerrero, E. G., Marsh, J. C., Khachikian, T., Amaro, H., & Vega, W. A. Disparities in Latino substance use, service use, and treatment: Implications for culturally and evidence-based interventions under health care reform. Drug and Alcohol Dependence. 2013.133(3), 805-813.DOI: 10.1016/j.drugalcdep.2013.07.027 Sabado-Liwag, M., Zamora, M., & El-Toukhy, S. Current state of unhealthy living characteristics in Black/African American and Latino populations: Tobacco use. Progress in Cardiovascular Diseases , 2022; p 71 , 27-36. DOI:10.1016/j.pcad.2022.04.009 Gomez, S., Blumer, V., & Rodriguez, F. Unique cardiovascular disease risk factors in Hispanic individuals. Current Cardiovascular Risk Reports , 2022; 16(7), 53-61. DOI: 10.1007/s12170-022-00692-0.\ Mansur, A., Pompa, I. R., Goldberg, S. I., & Kamran, S. C. Disparities in penile cancer incidence, mortality, and place of death trends from 1999 to 2020. Clinical Genitourinary Cancer , 2024;22(5), 102156. DOI:10.1016/j.clgc.2024.102156. Villalona, S., Sukhdeo, S., Reinoso, D., Stroup, A., & Ferrante, J. M. Racial/ethnic disparities in HPV-associated anogenital cancers among males in the United States: a population-based retrospective cohort study. Cancer Health Disparities , 2022; 6 . https://doi.org/10.1200/JCO.2022.40.28_suppl.163. Perkins, R., & Mitchell, E. Cervical cancer disparities. Journal of the National Medical Association , 2023;115(2), S19-S25. DOI:10.1016/j.jnma.2023.02.006. Tables Table 1. Familia Adelante Program Overview Through coping and life skill enhancement, substance abuse education and academic skill building, Familia Adelante aims at: 1) Reducing overall levels of family stress; 2) Reducing youth’s behavioral problems; 3) Enhancing psychosocial coping and life skills in youth and young adults; 4) Enhancing academic achievement; 5) Decreasing the risk for later substance abuse, HIV risk and emotional problems in Hispanic youth and young adults. The Familia Adelante curriculum is administered once a week for 1.5 hours over a 12-week period. Concurrent groups of (10-12) parents and youth ages 10-14 participate in the program at any one time. YOUTH CURRICULUM OVERVIEW Activity Brief Description Session 1 Introduction & Assessment The purpose of the Familia Adelante Program. Session 2 Concept Building Enables youth to feel comfortable with staff and group members. Session 3 Feelings Introduces youth to physical and emotional feelings. Session 4 Stress Overview Defines what stress is and how it affects behaviors, and physical/emotional health. Session 5 Acculturation Stress Teaches youth about Hispanic acculturation stress. Session 6 School Related Stress Helps identify stressors related to school and how these stressors affect youth. Session 7 Negative Peer Pressure Introduces ways of coping with stress resulting from peer pressure and social media. Session 8 Family Stress Part I Teaches youth how to identify family stressors and ways in which they can cope with these stressors. Session 9 Gang Prevention Helps youth understand the importance of not becoming members of gangs. Session 10 Substance Use Education Teaches youth about the dangers of drug use. Session 11 Family Communication Teaches healthy communication among parents & Youth Session 12 Evaluation & Celebration Evaluates the effectiveness of the program and to celebrate the completion of the program. Table 2. Participant Characteristics ( N =127) Characteristic n (%) or Mean (SD) Participant Age 17 (1.6) Gender Male 71 (56) Female 53 (42) Transgender 3 (2) Lives with both parents Yes 90 (71) No 37 (29) Ever suspended from school because for drugs and alcohol use Yes 4 (3) No 123 (97) Number of times arrested in past 30 days 0 116 (91) 1 1 (1) 2 1 (1) Refused 5 (4) Don’t know 4 (3) Ever told HIV status Yes 31 (24) No 96 (76) Has a usual doctor’s office or clinic they visited Yes 95 (75) No 32 (25) Table 3. Participant Behavior ( N =127) Behavior Baseline n (%) or M(SD) 6-month n (%) or M(SD) 12-month n (%) or M(SD) Alcohol Use 11 (8.7%) 14 (11.0%) 11 (8.7%) Missing 3 (2.4%) 2 (1.5%) 0 Bing Alcohol 13 (10.2%) 12 (9.4%) 18 (14.2%) Missing 3 (2.4%) 2 (1.5%) 1 (0.8%) Tobacco Use 16 (12.6%) 18 (14.2%) 11 (8.7%) Missing 3 (2.3%) 2 (1.5%) 0 Marijuana Use 39 (30.7%) 29 (22.8%) 24 (18.8%) Missing 3 (2.4%) 2 (1.5%) 1 (0.8%) Sex in the past 30 days 43 (33.8%) 41 (32.2%) 51 (40.1%) Missing 0 0 0 Risk Perception of Sex 3.05 (0.92) 3.22 (0.85) 3.33 (0.84) Missing 7 (5.5%) 1 (0.8%) 1 (0.8%) Risk Perception of Drugs and Alcohol 3.06 (0.73) 3.21 (0.67) 3.22 (0.74) Missing 20 (15.7%) 8 (6.3%) 8 (6.3%) Table 4. Imputed Unstandardized and Standardized Model Results (N=127) Behavior Unadjusted Latent Growth Curve Estimate (SE) Adjusted Latent Growth Curve Estimate (SE) Unstandardized Alcohol Use a Intercept with slope -0.014(<0.05)* 0.51 Means Intercept 0.10* 0.00 Slope -0.007 -0.31 Standardized Alcohol Use Intercept with slope -0.42*** - Means Intercept 0.51** - Slope -0.04 - Unstandardized Binge Alcohol a,b Drinking Intercept with slope -0.02 -5.76 Means Intercept 0.10*** 0.00 Slope 0.02 1.29 Standardized Binge Alcohol Drinking Intercept with slope -0.71*** - Means Intercept .41** - Slope 0.12 - Unstandardized Tobacco Use a Intercept with slope -0.03** -7.11 Means Intercept 0.13*** 0.00 Slope -0.02 0.86 Standardized Tobacco Use Intercept with slope -0.7*** - Means Intercept 0.41* - Slope -0.13 - Unstandardized Marijuana Use a Intercept with slope -0.14 1.65 Means Intercept 0.00 0.00 Slope -1.36* -1.44** Standardized Marijuana Use Intercept with slope -0.02 - Means Intercept 0.00 - Slope -0.74*** - Unstandardized Any Sex a Intercept with slope -4.10 -4.45 Means Intercept 0.00 0.00 Slope -0.02 .23 Standardized Any Sex Intercept with slope -0.10 - Means Intercept 0.00 - Slope -0.004 - Unstandardized Risk Perception of Sex c Intercept with slope -0.27** - Means Intercept 3.05*** - Slope 0.14** - Standardized Risk Perception of Sex Intercept with slope -0.66** - Means Intercept 3.36*** - Slope 0.32* - Unstandardized Risk Perception of Drugs and Alcohol c Intercept with slope -0.12* - Means Intercept 3.06*** - Slope 0.09** - Standardized Risk Perception of Drugs and Alcohol Intercept with slope -0.57*** - Means Intercept 4.42*** - Slope 0.28** - *p <.05 ** p <.01 *** p <.001 a controlled for gender b controlled for age c did not vary by potential confounders Additional Declarations No competing interests reported. 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5","display":"","copyAsset":false,"role":"figure","size":101266,"visible":true,"origin":"","legend":"\u003cp\u003eLatent growth curve model of marijuana use (N=127)\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7014483/v1/6fa693cd24f80884266c8952.png"},{"id":86933674,"identity":"5131fce2-22d2-4a1e-96ab-1ad6d320beb8","added_by":"auto","created_at":"2025-07-17 10:16:03","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":79881,"visible":true,"origin":"","legend":"\u003cp\u003eLatent growth curve model of perceived risk of sexual behavior (N=127)\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-7014483/v1/c12f31bd9bac0ed3f8e7045e.png"},{"id":86935657,"identity":"bf80c19f-2124-4473-8721-30e8219b7215","added_by":"auto","created_at":"2025-07-17 10:40:04","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":77262,"visible":true,"origin":"","legend":"\u003cp\u003eLatent growth curve model of perceived risk of alcohol and drugs (N=127)\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-7014483/v1/148496d89801e661faa75d08.png"},{"id":104400351,"identity":"f1e6dfaf-cbd1-4822-8a31-bdce0276b623","added_by":"auto","created_at":"2026-03-11 12:09:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1683348,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7014483/v1/c6b8715c-a830-4e1f-9c2c-cceef9bc2eef.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring Change in Attitudinal and Behavioral Outcomes Using the Familia Adelante Program for Urban Latino High School Students","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eBy 2050, the U.S. population\u0026nbsp;will reflect more Latino than non-Latino white school-age children [1]. Alcohol and drug use among Latino adolescents is a persistent public health issue.\u0026nbsp;It is imperative to better understand predictors of adolescent alcohol and drug use and to intervene with efficacious school-based strategies. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn 2020, 12.7% of Latinos ages 12 and older had a substance use disorder, including alcohol use disorder. Approximately 95% of those who needed treatment in a facility or rehabilitation center did not receive such care [2]. Latinos often avoid treatment due to barriers stemming from stigma, lack of social support, cultural factors, access to treatment, employment, and family conflict [3]. While barriers may explain some of the disparity, others suggest there is a cultural mismatch between clinicians and clients, with some evidence indicating a clash in values, beliefs, and practices between Latinx cultural traditions and how treatment programs are structured [4]. Some national reports approximate 10% of Latino youth reported using marijuana [5], and\u0026nbsp;over 14% of underage Latino youth were more likely to report using alcohol in the past month, with approximately 7% of Latino youth reported binge drinking [6]. Although California-based estimates of cannabis, alcohol use among Latino youth have been lower than national trends,\u0026nbsp;Latinos are a heterogeneous group of individuals with varying environmental and social drivers of health behaviors. Marijuana use among Latino youth in underserved communities with high rates of poverty needs to be further explored.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe acculturation process for Latino youth has become more turbulent in the last several years\u0026nbsp;[8], leading to\u0026nbsp;stressful experiences that come from immigration and discrimination [9]. These stressors, in turn, are exacerbated by the current sociopolitical climate, which is characterized by anti‐immigrant policies and rhetoric toward Latinx immigrants [10-11]. Latino youth and families experience cultural stressors such as language barriers, experiences of discrimination, racism, violence, and criminalization\u0026nbsp;[12].\u0026nbsp;The physical and emotional demands of immigrating to the U.S. are well documented [13]. A 2022 study of children who have experienced migration-related trauma found significant barriers to receiving mental health care, including mental health stigma, distrust of service systems, and cultural and linguistic differences [14].\u0026nbsp;Immigration authorities encountered\u0026nbsp;more than 152,000 unaccompanied minors at or near the U.S.-Mexico border in fiscal year 2022, an all-time high. Nearly 72% of all unaccompanied children in federal care were fifteen years of age or older, though authorities have also detained infants and toddlers [15]. Prior to migration, Latino youth may have experienced multiple traumas, including loss of loved ones, deprivation, exposure to violence, and displacement, each of which may affect subsequent resettlement and acculturative stressors [16]. In addition, parental deportation is an increasingly common hardship experienced by Latino youth. Most children of deported undocumented workers remained in the U.S. with the other parent or relative [17], leading to negative consequences on child wellbeing [18-21]. Children at high risk of substance use include those who witnessed their parents\u0026rsquo; arrest, children separated from their parent longer than 30 days, and children whose primary caregiver was deported [22].\u003c/p\u003e\n\u003cp\u003eThere is a lack of behavioral intervention strategies for Latino and immigrant youth to buffer the effects of substance abuse and risky sexual behaviors. One study included N=450 high-risk youth in an established, non-immigrant community setting. The prevention program included middle schools located in the disadvantaged neighborhoods in Phoenix, Arizona, with the highest enrollment of students of Mexican origin (ranging between 69% and 82% ) [23].\u003c/p\u003e\n\u003cp\u003eSubstance abuse treatment interventions such as Brief Strategic Family Therapy and Culturally Informed Family Therapy for Adolescents address intra-familial stress in Latino families [24]. These programs have involved primarily Cuban or other Caribbean Latino samples, who differ from Mexican Latinos in a key criterion: they frequently hold refugee (Cuban) or citizen (Puerto Rican) standing. Randomized controlled trials suggest that strengthening the family system, rather than targeting specific health behaviors, is efficacious in preventing and reducing cigarette smoking, illicit drug use, and unsafe sex in\u0026nbsp;Latino\u0026nbsp;adolescents [25-26]. Unfortunately, this curriculum is parent-centered and requires prolonged involvement of highly trained (graduate degree or higher) bilingual intervention staff [27], an asset frequently lacking in new Latino settlement communities. Prior programs effective at reducing adolescents at risk for substance use, HIV, and behavioral health problems have not explored effectiveness among immigrant youth [28]. While past studies haveemphasized Mexican culture, they do not account for familial aspects. Other studies that do utilize a family component but do not take on the stressors of Mexican immigrant youth or families [29].Additionally, testing innovative programs for the rapidly growing Mexican immigrant population and their children is sorely needed. The Familia Adelante [FA] program, endorsed by SAMHSA and previously funded by NIH to incorporate HIV prevention modules, was originally developed for at-risk youth (age 10-15) and has demonstrated prior improvements in family and peer communication and reduction in youth substance abuse, HIV risks and high participant satisfaction [30, 31].\u003c/p\u003e"},{"header":"THEORETICAL FRAMEWORK ","content":"\u003cp\u003eResearch indicates that stress partially mediates the relationship between acculturation and negative health behaviors. Stress impedes health by limiting access to salutogenic behaviors [32], and through maladaptive coping. \u0026nbsp;Latinos under elevated stressor exposure are more likely to deny the stressor, or to use maladaptive coping behaviors such as risky sex and substance abuse [33].\u003c/p\u003e\n\u003cp\u003eContemporary systemic transactional stress models have guided our approach to the development and initial testing of FA [34]. Using a psychoeducational approach, youth and parents are taught to identify culturally based stressors found to be related to substance use and develop healthy coping skills for these stressors. At the family level, FA addresses family-related risks, such as poor parent-child communication and inconsistent parenting approaches. Prevention strategies that address multiple risk behaviors, like FA, are increasingly desirable for cost-effective prevention programming and are beneficial for addressing the complex needs of hard-to-reach populations by reducing barriers to service access and utilization\u0026nbsp;[35]. FA approaches each session topic from the perspective of Latino immigrants and U.S.-born youth, emphasizing challenges specific to immigrant families such as differential acculturation between parents and children, the potential of forced separation due to deportation, and the lack of familiarity with the U.S. educational system.\u003c/p\u003e\n\u003cp\u003eThe purpose of this study was to assess growth trajectories of alcohol use, tobacco use, marijuana use, sexual activity and risk perceptions of both sexual behavior and drug use throughout the implementation of the FA program and 3-months post intervention among a sample of older high school aged Latino students in an urban setting. We hypothesized that alcohol, tobacco use, marijuana use, binge alcohol drinking, and sexual activity would reduce over time. Additionally, we hypothesized that the perceived risk from alcohol and drugs, as well as the perceived risk of sexual activity, would increase among participants over time. Our sample included Latino immigrant students of various nationalities.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eSetting and Recruitment\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHigh school students were recruited from 2 urban Charter Schools located in South Los Angeles, California, with predominantly Latino students. Participation required students to be Latino origin and currently enrolled in a high school setting. Teachers and school counselors were informed about the nature of the \u003cem\u003eFA\u003c/em\u003e study and were asked to identify youth with early behavioral or emotional difficulties, agreeable to receive the prevention and early intervention study, and were requested to recruit and refer students for participation. Academic counselors facilitated youth engagement and retention. The study began in 2019 and effectively ended in early 2024. This study was supported in part by SAMHSA (Grant #SP081494) and led by the Sunrise Community Counseling Center prevention staff. Informed consent procedures were used for each youth participant, and an intake interview was conducted to ensure eligibility for the study. Students with serious substance abuse or mental health issues, including severe depression, anxiety, and suicidality, were referred to additional intensive Services through the school counseling department. All informed consent procedures were reviewed by the Behavioral Assessment Incorporated Institutional Review Board (IRB00004925).\u003c/p\u003e\n\u003cp\u003eYouth Survey\u003c/p\u003e\n\u003cp\u003eParents and youth completed\u0026nbsp;a 36-question survey at\u0026nbsp;baseline, the final session (3 months) and at 6-month post-intervention initiation.\u0026nbsp;This survey tool was used as part of SAMHSA\u0026rsquo;s national cross-site evaluation and comprises questions to assess the\u0026nbsp;cognitive and behavioral effects of FA on youth participants [36]. The youth survey included questions to capture: i) demographic information, ii) risk perception of substance use; iii) self-efficacy to decline participation in substances; iv) substance use; and v) sexual behavior.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedures\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing receipt of parental or caregiver consent, youth were assigned to a classroom where the trained FA facilitators met with students during school hours. \u0026nbsp;The active intervention, FA was delivered over a 10-week period. The core components of FA are provided in Table 1. Each of the 10 sessions lasted approximately 90 minutes.\u0026nbsp;FA approaches each of these topics from the perspective of Latino immigrants and U.S. born youth, emphasizing challenges specific to immigrant families like differential acculturation between parents and children, potential forced separation due to deportation, and a lack of familiarity with the U.S. educational system. The FA program is a selective prevention program that consists of twelve English or Spanish language, 90-minute modules, originally developed for at-risk youth (age 10-15) and their parents, and built on the fundamental premise that effective risk prevention strategies should incorporate family members.\u003c/p\u003e\n\u003cp\u003eMeasured Outcomes\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eAlcohol, binge alcohol, tobacco, and marijuana use.\u003c/u\u003e\u003c/em\u003e Adolescent participants were asked, \u0026ldquo;Think back over the past 30 days and record on how many days, if any, you did any of the following activities: a) \u0026ldquo;smoke cigarettes?\u0026rdquo;; b) \u0026ldquo;Use other tobacco products?\u0026rdquo;; c) \u0026ldquo;Drink alcohol? (any use at all)\u0026rdquo;; d) \u0026ldquo;Binge drink?\u0026rdquo; (Binge drinking is five or more alcoholic beverages at the same time or within a couple of hours of each other for males; four or more for females); e) \u0026ldquo;Use marijuana or hashish?\u0026rdquo; Responses for a) and b) were then recoded as (1) any tobacco use, and (0) no tobacco use. Responses for c) were recoded as (1) any alcohol use, and (0) no alcohol use. Responses for d) were recoded as (1) binge drink, and (0) no binge drink. Responses for e) were recoded as (1) any tobacco use, and (0) no tobacco use.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eSexual activity.\u003c/u\u003e\u003c/em\u003e Participants were asked, \u0026ldquo;During the past 3 months, how many people did you have sex with? Response categories were 0) 0 people; 1) 1 person; 2) 2 people; 3) 3 people; 4) 4 people; 5) 5 people; 6) 6 people or more people. Responses were recoded into 0) 0 people, and 1) 1 or more people.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eRisk perception of alcohol and drugs.\u003c/u\u003e\u003c/em\u003e Participants were asked six questions to assess perceived risk of harm when an individual engages in alcohol consumption or drugs. An example question was, \u0026ldquo;What level of risk do you think people have harming themselves physically or in other ways when they use tobacco once or twice a week?\u0026rdquo; Responses were 0) no risk, 1) slight risk, 3) moderate risk, 4) great risk 5) don\u0026rsquo;t know or can\u0026rsquo;t say. Individuals who indicated they didn\u0026rsquo;t know were imputed as missing. Responses of all six questions were summed up and averaged. Higher scores indicated higher perceived risk from alcohol and drugs.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cu\u003eRisk perception of sex.\u003c/u\u003e\u003c/em\u003e Participants were asked \u0026ldquo;What level of risk do you think people have of harming themselves if they have sex without a condom?\u0026rdquo; to assess perceived risk of harm when an individual engages in sexual behavior. Responses were 0) no risk, 1) slight risk, 3) moderate risk, 4) great risk, 5) don\u0026rsquo;t know or can\u0026rsquo;t say. Responses of don\u0026rsquo;t know or can\u0026rsquo;t say were imputed as missing. Higher scores indicated higher perceived risk from sexual behavior.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCovariates.\u003c/em\u003e Outcomes were assessed to determine if they significantly differed by age (continuous), sexual identity (1=male, 0= other), or living in the household with both parents (1= living with both parents, 0= not living with both parents). If the outcomes varied by age, sexual identity, or living with both parents, we then adjusted the model for significant covariates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u0026nbsp;\u003c/strong\u003eOf the 257 students that were enrolled, 114 students were excluded as they did not identify with the ethnic group of Latino, and 15 were excluded if they had not yet been offered follow-up surveys. One participant age 21 was also excluded from the analysis, leaving n=127 for the analysis. Mplus 8 was used to perform descriptive statistics, frequencies, and latent class growth curve on the overall sample. Separate latent growth curve models were conducted on tobacco use, alcohol use, marijuana use, sexual activity, and perceived risk of alcohol and drugs and sex to assess changes across all assessment outcomes. Missing data was addressed using maximum likelihood estimation. Robust maximum likelihood estimation was used on all models to address non-normal data. Analyses were also conducted on non-imputed data to ensure consistency of findings. Root Mean Square Error [RMSEA]; Comparative Fit Index [CFI]; Tucker Lewis Index [TLI]; Standardized Root Mean Squared Residual [SRMR]; and Chi-square test of model fit were used to assess model fit of continuous outcome variables. Chi-square test of model fit was used to determine model fit of dichotomous outcome variables. RMSEA values below 0.08, CFI and TLI values above 0.90, SRMR values below 0.08 and chi-square test of model fit above 0.05 are considered to suggest appropriate model fit [36-39]. We then assessed and plotted growth trajectories separately.\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cem\u003eSample Characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA total of N=127 Latino youth were included in this analysis. Most participants were male (56%), lived with both parents at baseline (73%), never suspended from school for drugs or alcohol (96%), and not arrested in the past 30 days (92%). Average age was 17 years old (SD = 1.3) with a range between 13 and 20 years old. See Table 2 for additional demographics. Baseline past 30-day alcohol and tobacco use were (2%) and (12%), respectively. Approximately one-third of participants (32%) reported having sex within the past 30 days. See Table 3 for additional behaviors at baseline, 3-month and 6-month post-intervention. All models (Table 4) presented acceptable model fit.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBehavioral Outcomes\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAlcohol and tobacco use varied by gender, with males reporting higher consumption of alcohol. While neither unadjusted nor adjusted free latent growth curve models of alcohol demonstrated significance in changes by slope, the adjusted model suggested a decrease over time (\u003cem\u003eB\u003c/em\u003e= -0.31). See Figure 1. Similarly, the tobacco use slope had a non-significant change in slope over time for unadjusted (B= -0.02) and adjusted (\u003cem\u003eB\u003c/em\u003e= 0.86) models. See Figure 2. Similarly, binge alcohol drinking and sexual activity slopes had a non-significant change in slope over time. Binge alcohol was unadjusted (B= 0.02) and adjusted (\u003cem\u003eB\u003c/em\u003e= 1.29) models when controlling for age and gender (see Figure 3). Sexual activity was unadjusted (B= -0.02) and adjusted (\u003cem\u003eB\u003c/em\u003e= 0.23) models when controlling for gender (See Figure 4). Marijuana use slope did significantly decrease over time, unadjusted (B= -1.36, p\u0026lt;0.05) and adjusted (\u003cem\u003eB\u003c/em\u003e= -1.44; p\u0026lt;0.01) models when controlling for gender (see Figure 5).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRisk Perceptions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eRisk perceptions of sexual behavior and risk perceptions of alcohol and drug use did not differ by gender, age nor living with both parents. Both standardized models of risk perceptions of sexual behavior and risk perceptions of alcohol and drug use demonstrated an increase in slopes (B= 0.32, p\u0026lt;0.05 (Figure 6); B= -0.28, p\u0026lt;0.01 (Figure 7), respectively)\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur study comprised of N\u0026thinsp;=\u0026thinsp;142 Latino high school youth between the ages of 13\u0026ndash;20. Participants self-reported alcohol (2%), marijuana (7%), and tobacco (12%) use within the past 30 days at baseline. Notably, baseline marijuana and tobacco use among our sample was higher than recent California high school student estimates (4.5% and 7.3%) respectively yet were shown to have no significant increase over the 6 month study period. Participants in our study were sampled from low-income Latino urban communities in Los Angeles County. Previous literature has shown higher family income can be a protective factor in delay of tobacco initiation [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Thus, evidence-based interventions effective at reducing alcohol and substance use as well as risky sexual behavior among youth from low-income communities are essential to address health equity given the limited programming addressing acculturation stress among Latino youth [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTrends show FA was successful at reducing tobacco use and sexual activity from baseline to 6-month post-intervention. Additionally, participants perceived the risk of using alcohol and drugs increased as measured at 6-month post-intervention. Prior studies evaluating FA in younger youth (11\u0026ndash;14 years old) of varying ethnicities found the intervention effective at sexual intercourse to be curvilinear, increasing slightly at posttest before declining at 6-month follow-up, and marijuana use to decrease at posttest and follow-up [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Our findings show that FA may be just as effective at targeting older Latino youth (13\u0026ndash;20 years old).\u003c/p\u003e\u003cp\u003eStudy findings suggest youth-only services model may be and effective model to target older school-aged children. FA was built on the premise that family and acculturation stress could best be addressed if parents were active participants in the parent sessions. However, with some age-appropriate modifications to the original youth curriculum, when delivered to high school age student alone, this study shows positive changes in substance risk related attitudes and other risky behaviors.\u003c/p\u003e\u003cp\u003eTo address Latino health disparities (e.g., cancer, cardiovascular disease) attributed in part to alcohol and substance use) early prevention is key. Disparities in healthcare access and quality of care post-diagnosis further exacerbate inequities [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Effective high school behavioral interventions targeting at-risk older Latino youth, such as FA, are a valuable prevention strategy to reduce health risks of alcohol use, substance use and sexual activity.\u003c/p\u003e\u003cp\u003eStrengths of this study include the use of a youth-only intervention and FA curriculum for older youth does not involve parent participation. While health behaviors and health disparities are heavily impacted by multilevel factors, including social and structural environments, a focus on individual behavior was sufficient to observe favorable trends in outcomes. Additionally, this study investigated Latino participants, a population which may be at higher risk of cardiovascular disease as a consequence of tobacco use, and cancers associated with risky sexual behavior [\u003cspan additionalcitationids=\"CR45 CR46 CR47\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStudy limitations include the lack of randomized sampling, low rates of baseline substance use rates for comparing pre, exit, and follow-up outcomes, and lack of control of acculturation levels among youth participants.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRC - Conducted the study with Dr. Sa and wrote the main manuscript and edited.SG - Wrote manuscript and prepared tables and figuresCK- Worked on main manuscript, table, references and submissionJS-PI for this study\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eFry R, Gonzales F.\u003c/strong\u003e One-in-five and growing fast: A profile of Hispanic public school students. Washington, DC: Pew Hispanic Center; 2008. Retrieved online 2025 May 22: https://files.eric.ed.gov/fulltext/ED502556.pdf\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSubstance Abuse and Mental Health Services Administration (SAMHSA).\u003c/strong\u003e 2020 National Survey on Drug Use and Health: Hispanics, Latino or Spanish Origin or Descent Retrieved online 2025 May 22: https://www.samhsa.gov/data/report/2020-nsduh-hispanics-latino-or-spanish-origin.\u003c/li\u003e\n \u003cli\u003eFish, J.N., Maier, C.A., Priest, J.B., Substance abuse treatment response in a Latino sample: The influence of family conflict. \u003cem\u003eJournal of Substance Abuse Treatment\u0026nbsp;\u003c/em\u003e2015;49:27\u0026ndash;34. https://doi.org/10.1016/j.jsat.2014.07.011.\u003c/li\u003e\n \u003cli\u003eAlvarez, J., Jason, L. A., Olson, B. D., Ferrari, J. R., \u0026amp; Davis, M. I. Substance abuse prevalence and treatment among Latinos and Latinas. \u003cem\u003eJournal of Ethnicity in Substance Abuse.\u003c/em\u003e 2007;6(2), 115\u0026ndash;141. https://doi.org/10.1300/J233v06n02_08.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSubstance Abuse and Mental Health Services Administration (SAMHSA). 2019\u0026nbsp;\u003c/strong\u003eNational Survey on Drug Use and Health: Hispanics. Retrieved online: 2024 April 9. https://www.samhsa.gov/data/release/2019-national-survey-drug-use-and-health-nsduh-releases.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSubstance Abuse and Mental Health Services Administration (SAMHSA). 2021.\u0026nbsp;\u003c/strong\u003eNational Survey on Drug Use and Health. Retrieved online 2024 April 9. https://www.samhsa.gov/data/release/2021-national-survey-drug-use-and-health-nsduh-releases.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eCalifornia Department of Education.\u003c/strong\u003e California Healthy Kids Survey, 2019\u0026ndash;2021. Sacramento (CA): CDE; Retrieved online: 2024 Sep 7. https://www.cde.ca.gov/ls/he/at/chks.asp.\u003c/li\u003e\n \u003cli\u003eMcCord, A. L., Draucker, C. B., Bigatti, S. Cultural stressors and depressive symptoms in Latino/a adolescents: An integrative review. \u003cem\u003eJournal of the American Psychiatric Nurses Association\u003c/em\u003e. 2019.25(1), 49\u0026ndash;65. https://doi.org/10.1177/1078390318778885.\u003c/li\u003e\n \u003cli\u003eCano, M.A., Schwartz, S.J., Castillo, L.G., Romero, A.J., Huang, S., Lorenzo-Blanco, E.I., Unger, J.B., Zamboanga, B.L., Des Rosiers, S.E., Baezconde-Garbanati,L., Lizzi, K.M., Soto, D.W., Oshri, A., Villamar, J.A., Pattarroyo, M., Szapocznik, J. Depressive symptoms and externalizing behaviors among Hispanic immigrant adolescents: Examining longitudinal effects of cultural stress. \u003cem\u003eJournal of Adolescence\u003c/em\u003e. 2015. https://doi.org/10.1016/j.adolescence.2015.03.017.\u003c/li\u003e\n \u003cli\u003eFinley, L., \u0026amp; Esposito, L. The immigrant as bogeyman: Examining Donald Trump and the right\u0026rsquo;s anti-immigrant, anti-pc rhetoric. \u003cem\u003eHumanity \u0026amp; Society\u003c/em\u003e. 2020;44(2), 178-197. https://doi.org/10.1177/0160597619832627.\u003c/li\u003e\n \u003cli\u003eTorres SA, Sosa SS, Flores Toussaint RJ, Jolie S, Bustos Y. Systems of oppression: The impact of discrimination on Latinx immigrant adolescents\u0026apos; well-being and development.\u003cem\u003e\u0026nbsp;Journal of Research on Adolescence\u003c/em\u003e. 2022;32(2):501-517. https://doi.org/10.1111/jora.12751.\u003c/li\u003e\n \u003cli\u003eLorenzo-Blanco; Elma I; Meca, A.; Unger, J.B.; Szapocznik, J.; Cano, M.A.; Des Rosiers, S. E.; Schwartz, S. J.; Cultural stress, emotional well-being, and health risk behaviors among recent immigrant Latinx families: The moderating role of perceived neighborhood characteristics . \u003cem\u003eJournal of Youth and Adolescence.\u003c/em\u003e2019\u003cem\u003e;\u003c/em\u003e48(1), 114-131. DOI: 10.1007/s10964-018-0907-5.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePew Research Center.\u003c/strong\u003e Most Latinos say U.S. immigration system needs big changes. Washington, DC: Pew Research Center. 2021. Retrieved online 2025 May 22. https://www.pewresearch.org/short-reads/2021/04/20/most-latinos-say-u-s-immigration-system-needs-big-changes/.\u003c/li\u003e\n \u003cli\u003eMiller, A. B., Davis, S. H., Mulder, L. A., Winer, J. P., Issa, O. M., Cardeli, E., Ellis, B. H. Leveraging community-based mental health services to reduce inequities for children and families living in United States who have experienced migration-related trauma. psychological trauma: Theory, research, practice, and policy. 2024. Retrieved online 2024 October. https://dx.doi.org/10.1037/tra0001392.\u003c/li\u003e\n \u003cli\u003eCheatham, Ameila \u0026amp; Roy, Diana. U.S. Detention of child migrants, Council on Foreign Relations 2023. Retrieved online April 10, 2024. https://www.cfr.org/backgrounder/us-detention-child-migrants.\u003c/li\u003e\n \u003cli\u003eCleary, S. D., Snead, R., Dietz-Chavez, D., Rivera, I., \u0026amp; Edberg, M. C. Immigrant trauma and mental health outcomes among Latino youth. \u003cem\u003eJournal of Immigrant and Minority Health.\u003c/em\u003e 2018. 20(5), 1053\u0026ndash;1059. https://doi.org/10.1007/s10903-017-0673-6.\u003c/li\u003e\n \u003cli\u003eChaudry A. Capps R. Pedroza J. Casta\u0026ntilde;eda R. M. Santos R. Scott M., Facing our future: children in the aftermath of immigration enforcement. 2010. Washington, DC Urban Institute Report. https://files.eric.ed.gov/fulltext/ED508226.pdf.\u003c/li\u003e\n \u003cli\u003eCapps, R., Castaneda, R. M., Chaudry, A., \u0026amp; Santos, R. Paying the price: The impact of Immigration raids on America\u0026apos;s children. The Urban Institute and the National Council of La Raza Report. 2007. Retrieved online 2024. https://www.urban.org/research/publication/paying-price-impact-immigration-raids-americas-children.\u003c/li\u003e\n \u003cli\u003eChaudry, A., Fortuny, K., Capps, R., \u0026amp; Simms, M. Children of \u003cu\u003ei\u003c/u\u003emmigrants: National and state characteristics. 2009. Brief No. 9. Washington, DC. https://www.urban.org/sites/default/files/publication/32986/411939-Children-of-Immigrants-National-and-State-Characteristics.PDF.\u003c/li\u003e\n \u003cli\u003eHondagneu-Sotelo, P., and Ernestine A. I\u0026rsquo;m here, but I\u0026rsquo;m there: The meanings of Latina transnational motherhood. \u003cem\u003eGender and Society\u003c/em\u003e. 1997;11, no. 5, 548\u0026ndash;71. http://www.jstor.org/stable/190339.\u003c/li\u003e\n \u003cli\u003eSu\u0026aacute;rez-Orozco, C., Todorova, I. L. G., \u0026amp; Louie, J. Making up for lost time: The experience of separation and reunification among immigrant families. \u003cem\u003eFamily Process\u003c/em\u003e. 2002; 41(4), 625-643. DOI: 10.1111/j.1545-5300.2002.00625.x.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eChaudry A, Fortuny K.\u003c/strong\u003e A comprehensive review of immigrant access to health and human services. Washington (DC): Urban Institute; 2011. Available from:https://www.urban.org/sites/default/files/publication/27651/412425-A-Comprehensive-Review-of-Immigrant-Access-to-Health-and-Human-Services.PDF.\u003c/li\u003e\n \u003cli\u003eVarela, Ralph.\u003ccite\u003eCultural Competent Prevention Program for At-Risk Chicano Youth\u003c/cite\u003e. Substance Abuse Mental Health Services Administration/Center for Substance Abuse Prevention Report. U.S. Department of Health and Human Services. American Immigration Council Fact Sheet.\u0026nbsp;\u003cbr\u003eU.S. Citizen Children Impacted by Immigration Enforcement 2001. https://nationalgangcenter.ojp.gov/spt/Programs/134#:~:text=Strengthening%20the%20Bonds%20of%20Chicano%\u003cbr\u003e20Youth%20%28El%20Proyecto,Arizona%20who%20demonstrate%20high-risk%20characteristics%20of%20substance%20abuse.\u003c/li\u003e\n \u003cli\u003eSantisteban, D. A., Coatsworth, J. D., Perez-Vidal, A., Kurtines, W., M., Schwartz, S. J., LaPerriere, A., \u0026amp; Szapocznik, J. Efficacy of brief strategic family therapy in modifying Hispanic adolescent behavior problems and substance use.\u003cem\u003eJournal of Family Psychology.\u0026nbsp;\u003c/em\u003e2003;17(1), 121\u0026ndash;133.https://doi.org/10.1037/0893-3200.17.1.121.\u003c/li\u003e\n \u003cli\u003ePrado, G., Pantin, H., Briones, E., Schwartz, S. J., Feaster, D., Huang, S., Sullivan, S., Tapia, M. I., Sabillon, E., Lopez, B., Szapocznik, J. A randomized controlled trial of a parent-centered intervention in preventing substance use and HIV risk behaviors in Hispanic adolescents.\u003cem\u003e\u0026nbsp;Journal of Consulting Clinical Psychology\u003c/em\u003e. 2007;\u003cem\u003e75\u003c/em\u003e(6),914-26. DOI:10.1037/0022-006X.75.6.914.\u003c/li\u003e\n \u003cli\u003ePantin, H., Prado, G., Lopez, B., Huang, S., Tapia, M. I., Schwartz, S. J., Branchini, J.A Randomized controlled trial of Familias Unidas for Hispanic adolescents with behavior problems. \u003cem\u003ePsychosomatic Medicine.\u003c/em\u003e2009;71, 987-995. DOI:10.1097/PSY.0b013e3181bb2913.\u003c/li\u003e\n \u003cli\u003ePrado, G., Schwartz, S. J., Pattatucci-Arag\u0026oacute;n, A., Clatts, M., Pantin, H., Fernandez, M. I.,Lopez, B., Briones, E., Amaro, H., Szapocznik, J. The prevention of HIV transmission in Hispanic adolescents.\u0026nbsp;\u003cem\u003eDrug and Alcohol Dependence.\u003c/em\u003e 2006; 84(1),43-53.\u003cbr\u003ehttps://doi.org/10.1016/j.drugalcdep.2006.05.006.\u003c/li\u003e\n \u003cli\u003eNelson, A., Arthur, B. Storytelling for Empowerment: Decreasing At-Risk Youth\u0026apos;s Alcohol and Marijuana Use. The Journal of Primary Prevention. 2003; 24,169\u0026ndash;180. https://doi.org/10.1023/A:1025944412465.\u003c/li\u003e\n \u003cli\u003eVarela, R., Cu\u003ccite\u003eltural Competent Prevention Program for At-Risk Chicano Youth\u003c/cite\u003e\u003cem\u003e.\u0026nbsp;\u003c/em\u003eSubstance Abuse Mental Health Services Administration/Center For Substance Abuse Prevention Report. Washington, DC: U.S. Department of Health and Human Services. 2001. https://nationalgangcenter.ojp.gov/spt/Programs/134.\u003c/li\u003e\n \u003cli\u003eCervantes, R., Goldbach, J., \u0026amp; Santos, S. M. Familia Adelante: A multi-risk prevention intervention for Latino families. \u003cem\u003eThe Journal of Primary Prevention\u003c/em\u003e, 2011; \u003cem\u003e32\u003c/em\u003e(3-4), 225\u0026ndash;234. https://doi.org/10.1007/s10935-011-0251-y.\u003c/li\u003e\n \u003cli\u003e[31] Dowling, J., \u0026amp; McCoy-Contreras, L. Annual evaluation report, Arizona governor\u0026rsquo;s office, parent commission grant program, 2017.\u003cem\u003eWellington Consulting Group, Ltd\u003c/em\u003e. https://www.juvenilejustice.az.gov/sites/default/files/meeting-documents/materials/parent_commission_evaluation_year_3_2022.pdf.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e[32] Wethington, E., Glanz K, Schwartz MD.\u0026nbsp;\u003c/strong\u003eStress, coping, and health behavior. In: Glanz K, Rimer BK, Viswanath K, editors. \u003cem\u003eHealth behavior and health education: Theory, research, and practice\u003c/em\u003e\u003cem\u003e.\u0026nbsp;\u003c/em\u003e4th ed. San Francisco: \u003cem\u003eJossey-Bass/Wiley\u003c/em\u003e; 2015. p. 211\u0026ndash;236.\u003c/li\u003e\n \u003cli\u003eWorthman, C. M. The ecology of human development: Evolving models for cultural psychology. \u003cem\u003eJournal of Cross-Cultural Psychology,\u0026nbsp;\u003c/em\u003e2010\u003cem\u003e. 41\u003c/em\u003e(4), 546\u0026ndash;562. https://doi.org/10.1177/0022022110362627\u003c/li\u003e\n \u003cli\u003eIckovics, J. R. \u0026ldquo;Bundling\u0026rdquo; HIV prevention: Integrating services to promote synergistic gain. \u003cem\u003ePreventative Medicine,\u0026nbsp;\u003c/em\u003e2008.\u003cem\u003e\u0026nbsp;46\u003c/em\u003e, 222-225. DOI:10.1016/j.ypmed.2007.09.006\u003c/li\u003e\n \u003cli\u003eCervantes, R. C., \u0026amp; Goldbach, J. adapting evidence-based prevention approaches for Latino adolescents: the Familia Adelante Program \u0026ndash; Revised. \u003cem\u003eJournal of Psychosocial Intervention,\u0026nbsp;\u003c/em\u003e2012;21(3),281-290. https://doi.org/10.5093/in2012a25.\u003c/li\u003e\n \u003cli\u003eGarnier-Villarreal, M., Jorgensen, T.D. Adapting fit indices for Bayesian structural equation modeling: comparison to maximum likelihood. \u003cem\u003ePsychological Methods\u003c/em\u003e 2020; 25, 46\u0026ndash;70. DOI:10.1037/met0000224.\u003c/li\u003e\n \u003cli\u003eBentler, P.M. Comparative fit indexes in structural models. \u003cem\u003ePsychological Bulletin\u003c/em\u003e, 1990;107, 238\u0026ndash;246. DOI:10.1037/0033-2909.107.2.238.\u003c/li\u003e\n \u003cli\u003eSteiger, J.H. Structural model evaluation and modification: an interval estimation approach. \u003cem\u003eMultivariate Behavioral Research\u003c/em\u003e, 1990; 25, 173\u0026ndash;180. DOI:10.1207/s15327906mbr2502_4.\u003c/li\u003e\n \u003cli\u003eSteiger JH, Lind JC, Statistically based tests for the number of common factors. The Annual Meeting of the Psychometric Society. 1980. Iowa City, IA. https://doi.org/10.1080/10705511.2016.1217487\u003c/li\u003e\n \u003cli\u003eCervantes, R.C., Koutantos, E., Advances in substance abuse prevention practice and science for Hispanic/Latinos. Effective prevention and treatment of substance use disorders for racial and ethnic minorities. \u003cem\u003eIntechOpen\u003c/em\u003e; 2020. http://dx.doi.org/10.5772/intechopen.90399.\u003c/li\u003e\n \u003cli\u003eAssari, S., Najand, B., \u0026amp; Sheikhattari, P. Household income and subsequent youth tobacco initiation: minorities\u0026rsquo; diminished returns. 2024. \u003cem\u003eJournal of medicine, surgery, and public health\u003c/em\u003e, \u003cem\u003e2\u003c/em\u003e, 100063. DOI:10.1016/j.glmedi.2024.100063.\u003c/li\u003e\n \u003cli\u003eCervantes, R., Goldbach, J., \u0026amp; Santos, S. M. Familia Adelante: A multi-risk prevention intervention for Latino families. \u003cem\u003eThe Journal of Primary Prevention\u003c/em\u003e, 2011;\u003cem\u003e32\u003c/em\u003e, 225-234. DOI:10.1007/s10935-011-0251-y.\u003c/li\u003e\n \u003cli\u003eGuerrero, E. G., Marsh, J. C., Khachikian, T., Amaro, H., \u0026amp; Vega, W. A. Disparities in Latino substance use, service use, and treatment:\u0026nbsp;\u003cbr\u003eImplications for culturally and evidence-based interventions under health care reform. \u003cem\u003eDrug and Alcohol Dependence.\u003c/em\u003e 2013.133(3), 805-813.DOI: 10.1016/j.drugalcdep.2013.07.027\u003c/li\u003e\n \u003cli\u003eSabado-Liwag, M., Zamora, M., \u0026amp; El-Toukhy, S. Current state of unhealthy living characteristics in Black/African American and Latino populations: Tobacco use. \u003cem\u003eProgress in Cardiovascular Diseases\u003c/em\u003e, 2022; p\u003cem\u003e71\u003c/em\u003e, 27-36. DOI:10.1016/j.pcad.2022.04.009\u003c/li\u003e\n \u003cli\u003eGomez, S., Blumer, V., \u0026amp; Rodriguez, F. Unique cardiovascular disease risk factors in Hispanic individuals. \u003cem\u003eCurrent Cardiovascular Risk Reports\u003c/em\u003e, 2022; 16(7), 53-61. DOI: 10.1007/s12170-022-00692-0.\\\u003c/li\u003e\n \u003cli\u003eMansur, A., Pompa, I. R., Goldberg, S. I., \u0026amp; Kamran, S. C. Disparities in penile cancer incidence, mortality, and place of death trends from 1999 to 2020. \u003cem\u003eClinical Genitourinary Cancer\u003c/em\u003e, 2024;22(5), 102156. DOI:10.1016/j.clgc.2024.102156.\u003c/li\u003e\n \u003cli\u003eVillalona, S., Sukhdeo, S., Reinoso, D., Stroup, A., \u0026amp; Ferrante, J. M. Racial/ethnic disparities in HPV-associated anogenital cancers among males in the United States: a population-based retrospective cohort study. \u003cem\u003eCancer Health Disparities\u003c/em\u003e, 2022; \u003cem\u003e6\u003c/em\u003e. https://doi.org/10.1200/JCO.2022.40.28_suppl.163.\u003c/li\u003e\n \u003cli\u003ePerkins, R., \u0026amp; Mitchell, E. Cervical cancer disparities. \u003cem\u003eJournal of the National Medical Association\u003c/em\u003e, 2023;115(2), S19-S25. DOI:10.1016/j.jnma.2023.02.006.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Familia Adelante Program Overview\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 636px;\"\u003e\n \u003cp\u003eThrough coping and life skill enhancement, substance abuse education and academic skill building, Familia Adelante aims at: 1) Reducing overall levels of family stress; 2) Reducing youth\u0026rsquo;s behavioral problems; 3) Enhancing psychosocial coping and life skills in youth and young adults; 4) Enhancing academic achievement; 5) Decreasing the risk for later substance abuse, HIV risk and emotional problems in Hispanic youth and young adults. The Familia Adelante curriculum is administered once a week for 1.5 hours over a 12-week period. Concurrent groups of (10-12) parents and youth ages 10-14 participate in the program at any one time.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 636px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYOUTH CURRICULUM OVERVIEW\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActivity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBrief Description\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSession 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eIntroduction \u0026amp; Assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eThe purpose of the Familia Adelante Program.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSession 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eConcept Building\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eEnables youth to feel comfortable with staff and group members.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSession 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eFeelings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eIntroduces youth to physical and emotional feelings.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSession 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eStress Overview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eDefines what stress is and how it affects behaviors, and physical/emotional health.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSession 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eAcculturation Stress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eTeaches youth about Hispanic acculturation stress.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSession 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eSchool Related Stress\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eHelps identify stressors related to school and how these stressors affect youth.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSession 7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eNegative Peer Pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eIntroduces ways of coping with stress resulting from peer pressure and social media.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSession 8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eFamily Stress Part I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eTeaches youth how to identify family stressors and ways in which they can cope with these stressors.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSession 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eGang Prevention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eHelps youth understand the importance of not becoming members of gangs.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSession 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eSubstance Use Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eTeaches youth about the dangers of drug use.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSession 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eFamily Communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eTeaches healthy communication among parents \u0026amp; Youth\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003eSession 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 210px;\"\u003e\n \u003cp\u003eEvaluation \u0026amp; Celebration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eEvaluates the effectiveness of the program and to celebrate the completion of the program.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Participant Characteristics (\u003cem\u003eN\u003c/em\u003e=127)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"577\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%) or Mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eParticipant\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e17 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e71 (56)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e53 (42)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Transgender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLives with both parents\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e90 (71)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e37 (29)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver suspended from school because for drugs and alcohol use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e4 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e123 (97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of times arrested in past 30 days\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e116 (91)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Refused\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e5 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Don\u0026rsquo;t know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e4 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver told HIV status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e31 (24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e96 (76)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHas a usual doctor\u0026rsquo;s office or clinic they visited\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;95 (75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e32 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Participant Behavior (\u003cem\u003eN\u003c/em\u003e=127)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"872\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBehavior\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%) or M(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6-month\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%) or M(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12-month\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003en\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%) or M(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003eAlcohol Use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e11 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e14 (11.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e11 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e2 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003eBing Alcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e13 (10.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e12 (9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e18 (14.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e2 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003eTobacco Use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e16 (12.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e18 (14.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e11 (8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e2 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003eMarijuana Use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e39 (30.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e29 (22.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e24 (18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3 (2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e2 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003eSex in the past 30 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e43 (33.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e41 (32.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e51 (40.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003eRisk Perception of Sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3.05 (0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3.22 (0.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3.33 (0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e7 (5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1 (0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003eRisk Perception of Drugs and Alcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3.06 (0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3.21 (0.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3.22 (0.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 430px;\"\u003e\n \u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e20 (15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e8 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e8 (6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 4. Imputed Unstandardized and Standardized Model Results (N=127)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"811\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBehavior\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnadjusted\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLatent Growth Curve\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eEstimate (SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLatent Growth Curve\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eEstimate (SE)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eUnstandardized Alcohol Use\u003csup\u003ea\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept with slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.014(\u0026lt;0.05)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeans\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.10*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eSlope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eStandardized Alcohol Use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept with slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.42***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeans\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.51**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eSlope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eUnstandardized Binge Alcohol\u003csup\u003ea,b\u0026nbsp;\u003c/sup\u003eDrinking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept with slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-5.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeans\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.10***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eSlope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eStandardized Binge Alcohol Drinking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept with slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.71***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeans\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e.41**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eSlope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eUnstandardized Tobacco Use\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept with slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.03**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-7.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeans\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.13***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eSlope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eStandardized Tobacco Use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept with slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.7***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeans\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.41*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eSlope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eUnstandardized Marijuana Use\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept with slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e1.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeans\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eSlope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-1.36*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-1.44**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eStandardized Marijuana Use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept with slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeans\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eSlope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.74***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003eUnstandardized Any Sex\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept with slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-4.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-4.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeans\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eSlope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e.23\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003eStandardized Any Sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept with slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeans\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eSlope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003eUnstandardized Risk Perception of Sex \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept with slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.27**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeans\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e3.05***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eSlope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.14**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003eStandardized Risk Perception of Sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept with slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.66**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeans\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e3.36***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 253px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eSlope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.32*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eUnstandardized Risk Perception of Drugs and Alcohol \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept with slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.12*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeans\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e3.06***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eSlope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.09**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003eStandardized Risk Perception of Drugs and Alcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept with slope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e-0.57***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003e\u003cem\u003eMeans\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eIntercept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e4.42***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 186px;\"\u003e\n \u003cp\u003eSlope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e0.28**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e*p\u003c/em\u003e\u0026lt;.05 ** \u003cem\u003ep\u003c/em\u003e\u0026lt;.01 ***\u003cem\u003e\u0026nbsp;p\u003c/em\u003e\u0026lt;.001\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003econtrolled for gender\u003c/p\u003e\n\u003cp\u003e\u003csup\u003eb\u003c/sup\u003e controlled for age\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ec\u003c/sup\u003e did not vary by potential confounders\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Youth, Alcohol, Tobacco, Marijuana, Sex","lastPublishedDoi":"10.21203/rs.3.rs-7014483/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7014483/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Latinos are at increased risk of adverse health outcomes of substance use and risky sexual behaviors due in part due to sociodemographic and cultural barriers that reduce access to treatment. Culturally tailored and age-appropriate interventions aimed at reducing and preventing substance use and sexual behaviors are needed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Between October 2019 and October 2024, Familia Adelante, a school-based mental health prevention and early intervention program, was tailored to prevent substance use, risky sexual behaviors and increase risk perception of substance use. We used free latent growth curve models to assess our primary (change in alcohol, tobacco, and marijuana use) and secondary outcomes (binge alcohol use, risky sexual behavior, risk perception of substance use) over a 6-month period. Parsimonious models were then adjusted for significant sociodemographic variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eResults showed marijuana use decreased, risk perception of substance use, and risk perceptions of sexual behavior increased over a 6-month period. Alcohol, binge alcohol, tobacco use, and sexual behavior did not significantly differ over time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion:\u003c/strong\u003e Culturally tailored school-based interventions may be an effective primary prevention tool at reducing some substance use disparities among Latino communities and increasing perceptions of risky behavior.\u003c/p\u003e","manuscriptTitle":"Exploring Change in Attitudinal and Behavioral Outcomes Using the Familia Adelante Program for Urban Latino High School Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-17 10:15:59","doi":"10.21203/rs.3.rs-7014483/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"06ad070b-74f7-4711-81f1-c963cf8f139b","owner":[],"postedDate":"July 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-03T01:39:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-17 10:15:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7014483","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7014483","identity":"rs-7014483","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}