Prenatal care programs in a clinic based center in El Paso, Texas: Evaluating outcomes among Hispanic women

Early prenatal care has been found to improve pregnancy and birth outcomes by reducing the risk of low birth weight and preterm births. Statistics point to lower utilization rates of prenatal care in El Paso, Texas and increasing rates of low birth weight. This study was a secondary data analysis, which explored the perceived benefits and barriers known to influence the utilization of prenatal care, and the birth outcomes among participating subjects attending three different prenatal care programs offered at the Centro San Vincent Clinic during the period of December 2006 to February 2008. A survey was used to collect data on demographics and assess perceived benefits and barriers regarding early prenatal care and self-efficacy of the participants. Post-partum birth records were used to gather data about the participant's newborns to include birth weight, gestational age, and the type of delivery (i.e. vaginal versus Cesarean birth). Chi square analysis was conducted to test for significant differences and associations. The sample of women in the study had high risk factors for inadequate utilization of prenatal care. In spite of high demographic risk factors, these women had higher perceived benefits, lower perceived barriers and high self-efficacy associated with prenatal care utilization. The perceived benefits and barriers to prenatal care were associated with place of birth and language preferred, with women from Mexico and who preferred Spanish having higher perceived benefits and lower barriers. There was no significant difference in birth outcomes among the women in different prenatal care programs. The findings of this study suggest that of all participants in the study, those born in Mexico demonstrated higher rates of perceived benefits of early prenatal care. The analysis also suggested that healthy birth outcomes were evenly distributed among women participating in one of the three prenatal care programs. ^

Effect of a lifestyle physical activity intervention on transtheoretical model variables

Purpose. To determine the effect a stage-based, lifestyle physical activity intervention has on Transtheoretical Model variables in a population of breast cancer survivors. ^ Methods. Sedentary breast cancer survivors (N=60) were randomized to either a standard care study condition or to a 6-month, 21-session intervention. The Transtheoretical Model variables stage of change, self-efficacy, decisional balance (pros and cons to exercise), and processes of change were measured at baseline, 3 months, and 6 months. ^ Results. Women in the lifestyle group had significantly higher self-efficacy than women in the standard care group (F=9.55, p=0.003). Although there was not a significant difference between the two groups for perceived pros of exercise, there was a significant difference between the groups for perceived cons of exercise. Women in the lifestyle group perceived significantly fewer cons of exercise at both 3 and 6 months compared with women in the standard care condition (F=5.416, p=0.025). Between baseline and the 6 month assessment, the intervention also had an effect on three of the processes of change, while seven of the processes were not significantly affected by the intervention. ^ Conclusions. Data from the pilot study suggest that a stage-based, lifestyle physical activity intervention has an effect on Transtheoretical Model variables, which have been shown to facilitate exercise adoption, and should be tested in a larger trial. ^

Houston police officer attitudes towards the mentally ill: CIT trained and non-CIT trained

The purpose of this study was to develop a better understanding of police officer attitudes towards the mentally ill and what impact that might have on their behavior. Focused on the effects of Crisis Intervention Team (CIT) training on Houston police officers, this research wanted to determine if CIT training decreases attitudes of authoritarianism and increases attitudes of self-efficacy in dealing with the mentally ill—other factors assessed were age, years of service, ethnicity, and gender. Results confirmed that CIT training had an effect on an officer's attitudes with CIT officers being less authoritarian and having more self-efficacy with respect to dealing with the mentally ill as compared to non-CIT officers. Because of these results, this study could offer support in tailoring training programs to have successful officer-mentally ill person interactions. ^

Healthy relationships: An HIV intervention for positives

The present study assessed Community Prevention Intervention Unit clients participating in Healthy Relationships in December of 2005 to December of 2006. Healthy Relationships was formulated from Social Cognitive Theory-based HIV prevention. This 5-week intervention integrates skills building, self-efficacy, and positive expectations about new behaviors in addition to stress reduction and sexual risk reduction techniques to elicit a behavior change. The study was undertaken to evaluate differences in attitudes, beliefs and behaviors regarding one's HIV status and participation in Healthy Relationships. Gender differences among participants in Healthy Relationships were also measured. Subjects were evaluated utilizing pre- and post-questionnaires. Analyses revealed that there were significant differences in some risk behaviors, beliefs and attitudes. However, men and women did differ with regard to significant differences among disclosure. ^

Defining barriers in caring for seriously-ill children in a resource-limited setting: An observational study of 2 children's hospitals in Haiti

Background. According to the WHO 2007 country report, Haiti lags behind the Millennium Development Goal of reducing child mortality and maintains the highest under-5 mortality rate in the Western hemisphere. 3 Overall, few studies exist that seek to better grasp barriers in caring for a seriously ill child in a resource-limited setting and only a handful propose sustainable, effective interventions. ^ Objectives. The objectives of this study are to describe the prevalence of serious illnesses among children hospitalized at 2 children's hospitals in Port au Prince, to determine the barriers faced when caring for seriously ill children, and to report hospital outcomes of children admitted with serious illnesses. ^ Methods. Data were gathered from 2 major children's hospitals in Port au Prince, Haiti (Grace Children's Hospital [GCH] and Hopital d l'Universite d'Etat d'Haiti [HUEH]) using a triangulated approach of focus group discussions, physician questionnaires, and retrospective chart review. 23 pediatric physicians participated in focus group discussions and completed a self-administered questionnaire evaluating healthcare provider knowledge, self-efficacy, and perceived barriers relating to the care of seriously ill children in a resource-limited setting. A sample of 240 patient charts meeting eligibility criteria was abstracted for pertinent elements including sociodemographics, documentation, treatment strategies, and outcomes. Factors associated with mortality were analyzed using χ2 test and Fisher exact test [Minitab v.15]. ^ Results. The most common primary diagnoses at admission were gastroenteritis with moderate dehydration (35.5%), severe malnutrition (25.8%), and pneumonia (19.3%) for GCH, and severe malnutrition (32.6%), sepsis (24.7%), and severe respiratory distress (18%) for HUEH. Overall, 12.9% and 27% of seriously ill patients presented with shock to GCH and HUEH, respectively. ^ Shortage of necessary materials and equipment represented the most commonly reported limitation (18/23 respondents). According to chart data, 9.4% of children presenting with shock did not receive a fluid bolus, and only 8% of patients presenting with altered mental status or seizures received a glucose check. 65% of patients with meningitis did not receive a lumbar puncture due to lack of materials. ^ Hospital mortality rates did not differ by gender or by institution. Children who died were more likely to have a history of prematurity (OR 4.97 [95% CI 1.32-18.80]), an incomplete vaccination record (OR 4.05 [95% CI 1.68-9.74]), or a weight for age ≤3rd percentile (OR 6.1 [95% CI 2.49-14.93]. Case-fatality rates were significantly higher among those who presented with signs of shock compared with those who did not (23.1% vs. 10.7%, RR=2.16, p=0.03). Caregivers did not achieve shock reversal in 21% of patients and did not document shock reversal in 50% of patients. ^ Conclusions. Many challenges face those who seek to optimize care for seriously ill children in resource-limited settings. Specifically, in Haiti, qualitative and quantitative data suggest major issues with lack of supplies, pre-hospital factors, including malnutrition as a comorbidity, and early recognition and management of shock. A tailored intervention designed to address these issues is needed in order to prospectively evaluate improvements in child mortality in a high-risk population.^

Psychosocial variables associated with sexual risk behavior among an urban seventh grade population

This dissertation examines the psychosocial factors associated with sexual risk behavior among low socio-economic, minority middle school students in a large urban school district in Houston, Texas and is presented in the form of three articles. Article One examines the association between knowledge, perceived risk of HIV/STD, and self-reported lifetime engagement in vaginal sex among seventh grade students. The purpose of Article Two is to examine the association between knowledge about condoms, condom use attitudes, perceived peer norms about condom use, condom use negotiation self-efficacy, condom use self-efficacy, condom use intentions and actual condom use among seventh grade middle school adolescents. Finally, Article Three examines the association between attitudes, perceived peer norms, refusal self-efficacy about sex, sexual and abstinence intentions among seventh grade adolescents. By providing a better understanding of factors influencing sexual intentions and sexual behaviors among this population, these articles will enable practitioners to develop effective evidence-based interventions to delay sexual initiation and prevent youth from engaging in risky sexual behaviors, including risk of HIV/STDs and unintended pregnancy.^

Cross-cultural equivalence and associations among food insecurity and parental influences of children's fruit and vegetable consumption

Over the past several decades, the prevalence of obesity has dramatically increased. Cause for concern has increased because overweight and obesity are major contributors to morbidity and mortality. Intervention research aimed at reducing the prevalence of obesity has identified the family, specifically the parent, as a key component of the home environment. However, findings from dietary behavior change interventions have been disheartening because few studies have reported meaningful change, suggesting methodological and/or measurement issues within the intervention process. A lack of appropriate mediators and cross-cultural equivalence may partially explain the reason for little change.^ The study aims were to (1) evaluate the psychometric properties and assess the cross cultural equivalence of the Food Insecurity Scale (paper 1) and the modified Parent Feeding Practices Questionnaire (paper 2) and to assess the overall relationships among food insecurity, parent mediators, and parent behaviors towards children's dietary behavior (paper 3) through structural equation modeling and tests of invariance. The study aims were accomplished through conducting secondary analyses using baseline data from English- and Spanish-speaking Hispanic women who participated in the Healthy Families: Step by Step (BHF) study.^ Results indicated that although the FIS and the mPFPQ exhibited sound psychometric properties, the instruments exhibited a lack of invariance across language spoken groups. The lack of invariance was more pronounced in the FIS. Results also supported the theoretical framework identifying parent's perceived barriers and self-efficacy as mediators of parent's behaviors toward improving children's health eating. Results did not suggest that the relationships were moderated by food insecurity.^ In conclusion, the identification of differential item functioning in food insecurity and parent feeding practices may be beneficial in enhancing tailored interventions through the incorporation of cultural differences into the change mechanisms. However, future research needs to be conducted to determine if the lack of invariance demonstrates the existence of item bias or if it is a reflection of true difference among the language spoken groups. Additionally, obesity intervention studies targeting parent/family barriers and parent self-efficacy to provide/encourage healthy diets may result in an increase in parent behaviors which promote healthy eating behaviors among children. Future research should also examine a more complete causal pathway to determine whether parental changes in the mediators ultimately lead to an increase in healthy dietary behavior among children.^

Physician's adherence to CDC standards for physical activity counseling of older women in a cardiology practice in Texas---An exploratory study

Physical activity is an important health-promoting behavior to prevent and control chronic disease. Interventions to increase physical activity are vitally needed. Women are not meeting the recommended goals for physical activity - a behavior that has been shown to effectively reduce the incidence of chronic disease and the medical costs associated with treating it. Among many factors predicting physical activity and the different forms of interventions that have been applied, physician counseling is one potentially cost-effective approach that may produce at least modest effects on women's behavior. The Centers for Disease Control and Prevention has published standards for physician counseling of patients regarding physical activity. This study used a short questionnaire to assess the degree to which a group practice of cardiology physicians in Texas queried and discussed physical activity recommendations to older women that they treat and whether they are meeting the physical activity counseling goals of the Centers for Disease Control and Prevention. The majority of this group of physicians counseled patients without benefit of exploring patient behavior. Although these physicians "agreed" that physical activity delayed or prevented disease, the outcome suggests that low self-efficacy hampered efforts to counsel older women on this. Physicians' perceptions that counseling may be ineffective could explain the lower rate of physical activity counseling that does not meet the goals of the Centers for Disease Control and Prevention. ^

Psychosocial measures reported by parents in studies of skin cancer prevention

Background. Because it is important to minimize children's sun exposure to reduce skin cancer risk, much of the extensive skin cancer prevention literature consists of studies of children's sun protection, sun avoidance and ultraviolet radiation (UVR) exposure. Little attention has been focused on the measurement of psychosocial constructs in these studies. Identification of the psychosocial correlates or determinants of children's skin cancer risk or risk-reduction behavior is critical to more fully understand and predict behavior. Furthermore, psychosocial variables may be influenced by interventions to reduce risk. Thus, it is important to examine the psychosocial measures used in studies of children's skin cancer prevention. Information on the validity and reliability of psychosocial measures may increase confidence in study findings based on these measures. In particular, self-efficacy and barriers are key constructs in several major theoretical frameworks and parental measures have been associated with children's sun protection. However, there is conceptual overlap of self-efficacy and barriers measures and little is known about the psychometric properties of these measures.^ Study Aims and Methods. The overall goal of this dissertation was to examine the measurement of psychosocial constructs relevant to children's skin cancer prevention. Because children depend primarily on their parents for skin cancer prevention, measures of parents' psychosocial constructs are the focus. Study 1 was a systematic review of parental psychosocial measures used in studies of children's sun protection, sun avoidance and UVR exposure. The specific aims of Study 1 were to (1) describe psychosocial measures reported by parents, including available information on the psychometric properties of these measures and their use in analyses and (2) provide recommendations for the development, refinement and standardized reporting of measures. ^ Study 2 examined the psychometric properties of measures of parental self-efficacy and barriers regarding children's sun protection. Melanoma patients (N=205) who were parents of children ≤ 12 years of age completed a telephone interview that included self-efficacy and barriers measures specific to sunscreen, clothing, shade and limiting time outdoors. The specific aims of Study 2 were to (1) use a confirmatory factor analytic approach to examine the factorial validity of parental self-efficacy and barriers measures, (2) examine the convergent and discriminant validity of behavior-specific measures of self-efficacy and barriers and (3) assess the reliability of item and scale measures.^ Results. In Study 1, a search of standard databases yielded 48 eligible studies. Most studies assessed only one or two psychosocial constructs. Knowledge was measured most frequently. There was little discussion of measure source, development, theoretical background or psychometric properties, besides internal consistency reliability. There was conceptual overlap of some measures. In Study 2, confirmatory factor analytic findings supported the factorial validity of the self-efficacy and barriers measures. When all eight self-efficacy and barriers measures were included in the same model, a modified eight-factor model adequately fit the data, providing preliminary evidence that the measures are distinct. Measure associations supported the convergent validity of all measures and the discriminant validity of most measures. The self-efficacy and barriers measures were reliable.^ Conclusions. Recommendations based on the literature review include developing and refining psychosocial measures based on theory. Describing a measure's theoretical basis and psychometric properties would facilitate critical evaluation. Standardized reporting of source, development, theory, construct, items and analytic role would facilitate comparison of findings, continual refinement and future applications of measures. In the validation study, self-efficacy and barriers measures were examined in a sample of parents with a personal history of melanoma. Findings suggested that these measures are valid and reliable for use in studies of children's sun protection. There was preliminary evidence that these measures are distinct but additional study is needed. ^

Determining the feasibility and acceptability of a garden-based nutrition curriculum for preschoolers

Obesity rates around the nation have risen to epidemic proportions. Rates of childhood obesity are at very high levels with 24.4% of preschool-aged children in the U.S. currently considered as overweight or obese. The percentage of childhood obesity is much higher in the southern part of the United States as compared to the rest of the nation. Minority populations, especially African American and Hispanic, are affected more than other ethnic groups. Obesity prevention programs are needed targeting young children <6 years of age from minority populations. Currently, there are few obesity prevention programs that have been implemented and evaluated in children <6 years of age. Gardening programs have been successful in improving the health status of elementary school children by increasing fruit and vegetable intake and increasing preferences for healthier food choices. However, there is no evidence of the feasibility and acceptability of a garden-based obesity prevention program among preschoolers. This pretest study, a classroom-based gardening curriculum program with 16 lesson plans and coordinating activities for preschool age children (3-5 years old) enrolled in Head Start, provides the opportunity to address this need. The study included 103 preschoolers from two centers and 9 teachers or teachers' aides. Qualitative data on feasibility and acceptability was collected from process evaluation forms of individual lesson plans and focus groups with teachers. Teacher questionnaires assessed individual teacher characteristics and provided feedback regarding the curriculum. Quantitative measures of teachers' self-efficacy, attitudes, and knowledge pertaining to nutrition were analyzed from pre and post-test surveys. Results revealed this preschool garden-based nutrition curriculum was both feasible and acceptable. The program improved teacher's self-efficacy, knowledge, and attitudes about nutrition, with teacher's confidence in ability to teach a gardening curriculum increasing from a mean score of 2.14 to 3.00 from pre to post test (P value = 0.0046). These results indicate implementing garden-based nutrition lessons within preschools is achievable. Employing garden-based nutrition lessons in the classroom is the first step in teaching children about nutrition and gardening concepts. Constructing gardening beds for more hands-on learning is the next proposed step in the larger parent study of this program.^

A dose-response analysis of a school-based nutrition intervention in middle school children

Childhood obesity in the US has reached epidemic proportions. Minority children are affected the most by this epidemic. Although there is no clear relationship between obesity and fruits and vegetables consumption, studies suggest that eating fruits and vegetables could be helpful in preventing childhood obesity. A few school-based interventions targeting youth have been effective at increasing fruits and vegetables intake.^ In Austin, Texas, the Sustainable Food Center delivered the Sprouting Healthy Kids (SHK) program that targeted low socio-economic status children in four intervention middle schools. The SHK program delivered six intervention components. This school-based intervention included: a cafeteria component, in-class lessons, an after-school garden program, a field trip to a local farm, food tasting, and farmers' visits to schools. This study aimed to determine the effects of the SHK intervention in middle school students' preferences, motivation, knowledge, and self-efficacy towards fruits and vegetables intake, as well as the actual fruits and vegetables intake. The study also aimed to determine the effects of exposure to different doses of the SHK intervention on participants' fruits and vegetable intake.^ The SHK was delivered during Spring 2009. A total of 214 students completed the pre-and-posttest surveys measuring self-report fruits and vegetables intake as well as intrapersonal factors. The results showed that the school cafeteria, the food tasting, the after school program, and the farmers' visits had a positive effect on the participants' motivation, knowledge, and self-efficacy towards fruits and vegetables intake. The farmers' visits and the food tasting components increased participants' fruits and vegetables intake. Exposure to two or more intervention components increased participants' fruits and vegetables intake. The statistically significant dose-response effect size was .352, which suggests that each intervention component increased participants' fruits and vegetables consumption this amount. Certain intervention components were more effective than others. Food tasting and farmers visits increased participants fruits and vegetables intake, therefore these components should be offered in an ongoing basis. This study suggests that exposure to multiple intervention components increased behaviors and attitudes towards fruits and vegetables consumption. Findings are consistent that SHK can influence behaviors of middle school students.^

Social cognitive theory and factors associated with Mexican-American parents' beliefs, attitudes and practices regarding communication with their adolescent children about sex

Latinos have the highest teen birth rate nationally. Cameron County, Texas is primarily Latino (Mexican-American). This mixed-method study (n=43) examines Mexican-American parents of adolescents' beliefs, attitudes and practices regarding communication with their adolescent children about sex. Social Cognitive Theory (SCT) constructs self-efficacy, behavioral determinism, environment, outcome expectations and reciprocal determinism can be influences on frequency and quality of parent-adolescent sex communication.^ This study describes Mexican-American parents' of adolescents recollections of their own experiences associated with learning about sexuality. It also examines the attitudes and practices regarding communication about sex and the self-efficacy and behavioral capability of participants to teach their adolescent children about sex and sexually transmitted infections. ^ Negative childhood experiences (shame, lies and trauma) of the parents in this study played a key role in terms of their desire to communicate more comprehensively about sexuality with their own children than did their parents. While participants' reported low self-efficacy and behavioral capability to communicate with their adolescent children about sex, they reported relatively high frequency and quality of communication, with 75% of participants receiving a high quality score and over 44% reporting frequent communication with their adolescent children about sex. A Chi square analysis and Fisher's Exact Score revealed no association between acculturation status, gender or having a child who has mothered/fathered a baby and the frequency or quality of communication about sex with adolescent children. Study participants also gave specific recommendations for method, content and setting of sex education for their children and themselves. Promotora delivery of information and education in a comfortable, culturally appropriate neighborhood setting, as well as parent –child learning sessions were identified as possible approaches to address improve self-efficacy and behavioral capability of parents communicating with their adolescent children about sex.^ The results of this analysis provide public health practitioners and interested community entities data to identify and develop interventions that use a theoretical, evidence-based framework for culturally appropriate interventions to encourage and equip Mexican-American parents to effectively communicate with their adolescent children about sexuality, and ultimately to address the high rates of teen pregnancy in this U.S.-Mexico border community. ^

Perceived gender relations and sexual relations among undergraduate female students in the Mekong Delta of Vietnam

Background. Literature worldwide has documented associations between gender-based relationship inequity, sexual communication self-efficacy, and actual use of condoms and contraceptives among young women. However studies that have rigorously tested these associations in southern Vietnam are extremely rare. This study aimed to examine these associations and other current sexual practices among undergraduate female students in the Mekong Delta. Method. A qualitative study was conducted to examine the operationalization of the Theory of Gender and Power and to obtain salient and culture-relevant dimensions of perceived gender relations in the Mekong Delta of Vietnam. Sixty-four undergraduate female students from two universities participated in eight group discussions focusing on their viewpoints regarding national and local gender equity issues. A subsequent cross-sectional survey consisting of 1181 third-year female students from Can Tho University and An Giang University was conducted. Latent variable modeling and logistic regression were employed to examine the hypothesized associations. Results. Dimensions of perceived gender relations were attributable to theoretical structures of labor, power, and cathexis. Perceptions about gender inequities were comparable to findings from several reports, in which women were still viewed as inferior and subordinate to men. Among students who had ever had a boyfriend(s) (72.4%), 44.8% indicated that their boyfriend had ever asked for sex, 13% had ever had penile-vaginal sex, and 10.3% had ever had oral sex. For those who had ever had penile-vaginal sex, 33% did not use any contraceptive method at first sex. The greater a student’s perception that women were subordinate to men, the lower her self-efficacy for sexual communication and the lower her actual frequencies of asking for contraceptive or condom use. Sexual communication self-efficacy was marginally associated with actual contraceptive use (p=.039) and condom use (p=.092) at first sex. Conclusion. Sexual health promotion strategies should address the influence of perceived unequal gender relations on young women’s sexual communication self-efficacy and the subsequent impact on actual contraceptive and condom use.^

"Teens talk healthy weight": A video technology project

Purpose. The purpose of this study was to investigate the impact of a motivational weight management DVD on knowledge of obesity related diseases, readiness, motivation, and self-efficacy to lose weight, connectedness to their care provider, and patients return to clinic. Design. A randomized control trial was conducted in which 40 overweight/obese adolescents and their parents/caregivers were randomly assigned to standard care alone or standard care plus DVD. Subjects completed a set of pre- and post-questionnaire measures. A group of 22 patients was also formed as a historical control group in order to account for the potential effect of extra attention given to subjects prospectively enrolled. Methods. The adolescents and their parent/caregiver were placed into a patient room. Consent was obtained and a set of written pre-questionnaires were given to both the parent and the adolescent. Standard care was provided to all patients by the Registered Dietitian and physician; the DVD was shown in addition to standard care among the intervention group. A set of post-questionnaires were given and compensation was provided. Analysis. Groups were compared to determine equivalence at baseline. Analysis of covariance was used to evaluate changes over time, while controlling for pre-test scores and race/ethnicity. Results. Parents who viewed the DVD experienced greater changes in correct knowledge as compared to parents who did not view the DVD. Conclusion. Our study found only one substantial benefit of the DVD beyond standard clinical practices. This is an important area for change as it increased awareness of obesity as a serious disease and has future clinical implications.^

Process evaluation of intervention program for prevention of early sexual activity and alcohol use among Hispanic teenagers

Hispanic teens are a high-risk population for initiation of early sexual activity and alcohol use which in turn has numerous social and health consequences. One strategy to address prevention of these behaviors is to implement a capacity building intervention that promotes parent child communication, encompasses their cultural values and community participation. This study describes the process evaluation of a pilot intervention program amongst Hispanic teens and their families living along the Texas-Mexico border. “Girls Lets Talk” is a small group intervention with 10-14 year old teens and their female adult family members that involves education regarding effects of alcohol use and sexual activity as well as activities for monitoring and refusal skills to prevent risky behaviors. Two waves of the program each consisting of at least seven mother daughter dyads were conducted. During the designing process, community advisory board meetings and focus groups were held to review course materials and ensure they were appropriate to the Mexican American culture. Parent and adolescent surveys were administered at the beginning and end of the intervention to assess for psychosocial outcome variables. All sessions received high mean satisfactory scores (mean of 4.00 or better on a five point scale) for both adult and adolescent participants. Qualitative feedback was obtained via debriefing sessions to evaluate experience as well as alter recruitment strategies. A Wilcoxon Sign Rank analysis of the pre and post intervention surveys was done that showed significant changes in some outcome variables such as intentions and confidence for monitoring behaviors for adults and beliefs regarding sexual activity. “Girls Lets Talk” is a promising example of how a process evaluation plan can help develop a theory based health promotion program using the community based participatory research approach. The intervention may also be effective in altering intentions and enhancing self-efficacy among parents and teens in order to decrease risky behaviors such as early sexual activity and alcohol use.^