Family-Centered Alcohol Use Prevention for African American Adolescents: A Randomized Clinical Trial

Abstract

Objective: The efficacy of the Strong African American Families (SAAF) alcohol use prevention program was tested. SAAF is a 7-session family skills training program offered in community settings. To overcome limitations of a past trial that used intent-to-treat (ITT) analyses, a Complier Average Causal Effect (CACE) analysis was used to estimate intervention effects and to determine the precise dosage of the intervention needed to achieve alcohol deterrence. Method: A sample of 472 African American youth and their caregivers were recruited randomly from public schools in 7 rural Georgia counties. Families were assigned randomly to receive SAAF or a no-treatment control. Youth provided data on their alcohol use during the past 3 months at 4 home visits, the final occurring 34 months after baseline and 28 months after the intervention. Results: Efficacy was tested with Poisson latent growth curve models. SAAF deterred growth in alcohol use in models using both ITT and CACE estimation. CACE analyses revealed that, among participants who received a full dose of the intervention (7 sessions), a large treatment effect on slowed growth in alcohol use emerged (beta = -.83, p < .001). Dose-response analyses in CACE models revealed a medium-sized effect (d [95% CI] = 1.51 [1.25, 1.75]) when participants attended at least 5 of the 7 sessions offered. Conclusions: Replication of SAAF in a second randomized prevention trial supports the robustness of program effects. It is critical, however, that participant engagement protocols he designed to encourage participation ill as at least 5 of the 7 sessions.