Program Profile: Adults in the Making (AIM)

This is a family-centered intervention designed to deter alcohol and substance use and reduce risk-taking behaviors of youth. The program is rated Effective. Treatment group participants reported statistically significantly greater reduction in risk behaviors and greater reduced impact of life stress on risk behaviors, compared with comparison group participants. However, there was no statistically significant impact on alcohol use, substance use, or cognitive susceptibility.

An Effective rating implies that implementing the program is likely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals

Adults in the Making (AIM) was a family-centered preventive intervention designed to enhance the family protective process and self-regulatory competence to deter escalation of alcohol use and development of substance use problems. AIM sought to safeguard against the negative impact of life stressors on African American youth while also preventing engagement in risky behavior, by focusing on family protective factors (such as emotional and instrument support), coaching and advocacy, and racial socialization. The AIM program also focused on enhancing youths’ ability to self-regulate, which included the ability to set goals, problem-solve—especially in settings where racial discrimination was present—and anticipate the consequences of their choices. It was believed that through enhancing these skills, African American youths would be less likely to use alcohol or other substances and would develop a greater interest in their education or career (Brody et al. 2012).

Target Population

The transition from adolescence to young adulthood is usually filled with increased risk of juvenile problem behavior such as alcohol use (Brody et al. 2010). Moreover, African American youths located in rural communities face other risk factors that could lead to high levels of conflict, deviant affiliations, and racial discrimination. As a result, the AIM program targeted African American youths in their last 2 years of secondary school who resided in rural counties in Georgia. Six counties were chosen as target sites, as the poverty rates in these counties were among the highest in the nation and unemployment rates were above the national average.

Program Theory

The AIM program used the stress-coping theory and social cognitive theory as its framework. The stress-coping theory argues that substance abuse and risky sexual behavior are consequences of life stress and negative life events (Brody et al. 2010). The social cognitive theory suggests that supportive and positive family relationships foster the ability to develop problem-solving skills (Brody et al. 2010). In using both theories, the AIM program sought to promote positive family relationships so that African American youths were better suited to handle life stressors and therefore less inclined to engage in risky behaviors.

Program Components

The AIM program consisted of six weekly group meetings at a community facility. The curriculum included separate skill-building courses for parents and youth, followed by a joint parent–youth session, where parents were able to exhibit the skills they learned in their separate training. Each training session lasted 1 hour, resulting in each participant receiving 12 hours of AIM training.

During the parent training sessions, the curriculum focused on ensuring that parents had the skills and understanding to provide developmentally appropriate emotional and instrumental support to youths. Other topics included racial socialization (which included strategies for dealing with discrimination), assistance with providing both occupational and educational mentoring to youths, the importance of taking responsibility for ones’ actions, and promoting responsible decisions. In addition to video instruction, the sessions included role-playing activities, group discussions, and question and answer pieces that were led by African American group leaders.

During the youth sessions, the curriculum concentrated on providing youths the tools to develop a plan for the future, set goals, identify individuals who could help them meet their goals, cope with barriers and racial discrimination, and develop self-care strategies. Similar to the parent training sessions, the youth sessions were delivered by video and included activities, role-playing, and group discussions.

Study

Similar to the 2010 study, Brody and colleagues (2012) used a randomized field trial to determine the preventative impact of Adults in the Making (AIM). The same sample was used in the 2010 and 2012 studies, and in both studies participant age within the AIM program and control groups varied at all waves of data collection.

Families provided data for the 4 data-collection periods: pretest (2.5 months preintervention), posttest (6.4 months after pretest), and two long-term follow-up periods (16.6 months and 27.5 months after pretest). The CrimeSolutions review of this study focused on the difference between the treatment condition and comparison condition at the 27.5-month follow-up. Field researchers made home visits to all participants at each data collection point. Self-report questionnaires were administered to caregivers and youths during the home visits. The interviews were private, in that no other family members were present.

The following outcomes were measured at each time period: alcohol use, substance use problems, risk taking, and susceptibility cognitions. Alcohol use was measured through youth self-report. Youths were asked to report on a scale ranging from 1 (zero) to 7 (40 or more) the number of times in the past 3 months they drank alcohol. Substance use problems were measured through the 10-item Minnesota Survey of Substance Use Problems, where youths were asked to report the number of times in the past 6 months they had experienced problems with substance use. Substance use problems included using substances in hazardous situations, legal problems, use in the face of social/interpersonal problems, and failure to fulfill obligations.

Risk taking was measured through Eysenck’s Risk-Taking Scale. The scale includes six items, such as “I enjoy taking risks” and “I would do almost anything on a dare.” Youths were asked to rank the items on a scale of 1 (not at all true) to 5 (very true). Finally, susceptibility cognitions included youths’ behaviors and intentions to use alcohol or other substances, as well as prototypes of peers who use alcohol and other substances.

Youths’ behaviors and intentions were measured through presenting a scenario where the youth would have to choose whether to engage in alcohol or drug use and answering questions related to their willingness to participate. Youths’ behavior and intentions were also measured through an eight-item scale related to their intention to use alcohol and drugs in the future. Prototype of peers was measured through youths’ rating on a scale of 1 (not at all) to 4 (very) their perceptions (cool, smart, popular) of those who use drugs or drink alcohol. Youths were also asked to indicate whether they considered themselves similar to those who use drugs or drink alcohol.

These outcomes were compared against the contextual risk factor index, which was assessed at baseline and composed of parent–child conflict, deviant peers, and perceived racial discrimination. Parent–child conflict was measured on two scales: the Ineffective Arguing Inventory, where youths responded to statements about any conflicts they had with their parents on a scale of 0 to 4; and the Discussion Quality Scale, where youths reported how frequently they argued with their parents regarding their choice of friends, school, job, alcohol, drugs, or sex. The scale ranged from 1 (never) to 4 (always).

The deviant peers’ index was measured through youth responses on two scales. One of the scales included youths reporting the number of their friends who engaged in 15 deviant behaviors. Youths were asked to respond on a scale of 0 (none) to 2 (all). Youths were also asked to report on how often their current or last romantic partners engaged in a similar set of risky behaviors on a scale of 1 (never) to 3 (often). Finally, perceived racial discrimination was assessed using the Racist Hassles Questionnaire, which included nine items related to racial discrimination. The youths were asked to respond to the number of times they experienced the items within the past 6 months on a scale of 0 (never happened) to 2 (happened a lot). The authors conducted subgroup analyses to examine the difference in outcomes for participants identified as having high contextual risk and low contextual risk.

Study

Brody and colleagues (2010) used a randomized field trial to determine the preventative impact of Adults in the Making (AIM). Participants were recruited from schools in six rural counties in Georgia. To be eligible to participate, youths had to be in the last 2 years of secondary school. Of the 560 eligible families, 347 agreed to participate. Willingness to participate was determined through phone calls to families. One-hundred seventy-four families were assigned to the treatment condition, while 173 were assigned to the comparison condition. The average age of youths in the sample was 17.7, which was 58.5 percent female, and 63.6 percent of the youths lived in single-mother homes. About 42.0 percent of the families lived below the poverty standards.

Three data points were used in the 2010 study: 1) pretest, 2) posttest, and 3) follow-up. Data was collected for each time period during 2-hour home visits with families. Life stress (defined as negative life events and perceived racial discrimination) and risk behaviors were measured to determine AIM’s impact. Life stress was measured through a 12-item checklist, which included negative stressful events. Youths were asked to indicate whether any of the events had occurred during the previous 6 months.

Perceived racial discrimination was measured through the Racist Hassles Questionnaire, an eight-item questionnaire that listed discriminatory experiences. Youths were asked to indicate the number of times they had similar experiences in the past 6 months. Risk behaviors were measured through self-report. Youths were asked to report the number of times in the previous month they had used marijuana or drank three or more alcoholic beverages at one time. Youths were also asked to indicate the number of times they had been high, drunk, or had sex in the past month. No subgroup analysis was conducted.

Field researchers received 12 hours of training in administering the protocol. Instruments and procedures were developed with the help of 40 African American community members who were representative of the population. Adults in the Making (AIM) group leaders who led the youth and parent training sessions were instructed during three training sessions over a 4-day period. The trainers were mainly African American women in the education, social work, and homemaking fields (Brody et al. 2010).

Subgroup Analysis

Brody and colleagues (2012) conducted subgroup analyses to examine the difference in outcomes for participants identified as having high contextual risk and low contextual risk. Participants with high contextual risk factors in the Adults in the Making treatment group were less likely to report alcohol use, substance use problems, risk taking, or susceptibility cognitions, compared with participants with high contextual risk factors in the comparison group. These differences were all statistically significant. However, there were no statistically significant differences between participants with low contextual risk factors in the treatment group and participants with low contextual risk factors in the comparison group in any of the outcome measures.

These sources were used in the development of the program profile: