Abstract: Preventing Drug Use Among at-Risk Adolescents in Kazakhstan: Acceptability and Initial Evidence of Effects of a Family-Based Multi-Media Intervention (Society for Social Work and Research 20th Annual Conference - Grand Challenges for Social Work: Setting a Research Agenda for the Future)

Preventing Drug Use Among at-Risk Adolescents in Kazakhstan: Acceptability and Initial Evidence of Effects of a Family-Based Multi-Media Intervention

Schedule:
Sunday, January 17, 2016: 9:30 AM
Meeting Room Level-Meeting Room 14 (Renaissance Washington, DC Downtown Hotel)
* noted as presenting author
Leyla Ismayilova, PhD, Assistant Professor, University of Chicago, Chicago, IL
Assel Terlikbayeva, Regional Director, Global Health Research Center of Central Asia, Almaty, Kazakhstan
Elena Rozental, Project Coordinator, Global Health Research Center of Central Asia, Almaty, Kazakhstan
Introduction: Located on the major drug trafficking route from Afghanistan, Kazakhstan is experiencing one of the fastest growing rates of HIV infection in the world, disproportionately driven by injection drug use. The country’s HIV and drug abuse prevention efforts are limited to knowledge-based programs at schools that do not target at-risk adolescents and do not equip them with skills required to deal with situations of risk exposure. Parents or other family members, who represent a significant protective force in a family-oriented culture of Central Asia, are largely excluded from youth prevention efforts in Kazakhstan.

Methods: This NIDA-funded pilot RCT aims to develop and test the feasibility of a family-based multi-media intervention designed to reduce sexual and drug-related risks for HIV infection among at-risk 14-17 year old adolescents living in areas of Almaty, Kazakhstan highly affected by heroin trade and use. The intervention was culturally adapted through qualitative research and collaboration with youth and expert community advisory boards. The study included 180 adolescents recruited through police officers (‘inspectors’) from local schools, together with 180 of their caregivers. Eligible youth had to have at least one risk factor (i.e., substance-using friends or family members, parental criminal history). In addition to the standard school-based health education program on drug use and HIV, intervention arm adolescent-caregiver dyads received three 45-minute interactive multi-media sessions with avatars customized to participants’ gender covering risk reduction self-efficacy, resistance to peer pressure, and caregiver-adolescent communication, support and monitoring. Adolescents and caregivers completed ACASI surveys in Russian at baseline and 3-month follow-ups.

Results: About 63% of adolescents were boys and 48% of participants were ethnic Russians. About 26% of adolescents had a substance-using parent, 32% were offered to use or sell drugs, 9% had drug-using friends, 22% were in trouble with the police and 34% planned or tried to run away from home. In addition to parents--mothers (73%) and fathers (8%)--adolescents selected grandmothers and other relatives (aunts, cousins, adult siblings) to participate in the study, when primary caregivers were not available (e.g., due to substance addiction or imprisonment). About 99% of families completed all three sessions. The study discusses participants’ satisfaction, perceived usefulness and usability of the multi-media program. Changes were observed in key mediating factors: family conflicts about youths’ risk behaviors (p=.002), effective communication about risk behaviors (p=.05) and adolescents’ problem solving skills (p=.03). Changes in adolescents’ substance use and sexual risk behaviors will be assessed during the 6-month follow-ups.

Conclusions: The study offers strategies for adapting intervention content and delivery techniques to a new population and cultural milieu. The study findings improve scientific knowledge about the tailoring and delivery of culturally adapted drug prevention programs for at-risk youth in the context of a concentrated HIV epidemic driven by injection drug use. In middle-income and traditional countries like Kazakhstan, interventions that address the dual risk of HIV and substance use, combine empirically tested skills-based and family involvement approaches, involve extended family networks and utilize interactive technologies may represent a potentially engaging and cost-effective tool with high fidelity and easy scalability.