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Program Profile: Sembrando Salud

Evidence Rating: No Effects - One study No Effects - One study

Date: This profile was posted on August 24, 2012

Program Summary

A culturally sensitive, community-based tobacco- and alcohol-use prevention program specifically adapted for migrant Hispanic adolescents and their families. The program is rated No Effects. The program made little impact on the measured outcomes of smoking and drinking or parent-child communication and attitudes.

Program Description

Program Goals/Target Population
Sembrando Salud is a culturally sensitive, community-based tobacco- and alcohol-use prevention program specifically adapted for migrant Hispanic adolescents and their families. The program is designed to improve parent–child communication skills as a way of improving and maintaining healthy decision-making. Designed for youths 11 to 16 years old, the 8-week curriculum for adolescents and their families is delivered by bilingual/bicultural college students in classrooms and meeting rooms in school-based settings during evening hours.

Program Components
Sembrando Salud is a mix of interactive teaching methods, including videos, demonstrations, skill practice, group discussions led by a leader, and role-playing. The program develops new behavioral skills, such as communicating with peers and adults and refusing alcohol and tobacco offers. The program includes three central components: 1) information about the health effects of using tobacco and drinking alcohol, 2) social influences on tobacco/alcohol use, and 3) training in refusal skills. Further, adolescents are exposed to how problems can be identified and analyzed, solutions generated, and decisions made, implemented, and evaluated. There is an additional emphasis on developing parental support for the healthy discussions and behaviors of adolescents through enhanced parent–child communications. Parental communication skills—such as listening, confirmation, and reassurance—also are developed.

The curriculum and group sessions were tailored to migrant Hispanic audiences. All sessions were taught by bilingual, bicultural Mexican American group leaders, who were sensitive to the values and norms of the cultures and could move between the languages during the presentation of the material for greater comprehension. Many of the role-plays were adapted from experiences common to migrant Hispanic adolescents living in the United States. For instance, issues of familismo and respeto were incorporated into the curriculum so adolescents could learn tobacco and alcohol refusal skills without disrespecting their elders.

Evaluation Outcomes

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Study 1
Overall, the results from the study by Elder and colleagues (2002) indicated that the Sembrando Salud program made little impact on the measured outcomes, except for measures of the perceived effects of tobacco use.

Thirty-Day Smoking
The rates of smoking in the past 30 days started low and remained low through the 2-year follow-up period. At baseline, 3.0 percent of the treatment group reported smoking in the past 30 days, compared with 3.1 percent of the attention-control group. By the 2-year follow-up, 2.9 percent of the treatment group and 3.5 percent of the attention-control group reported smoking in the past 30 days. There were no significant differences between the groups.

Susceptibility to Smoking
The number of youths in the treatment group who were considered susceptible to smoking dropped by nearly 50 percent from the immediate postintervention period to the 2-year follow-up period. The number of youths in the attention-control group susceptible to smoking also dropped 40 percent during this same period. The overall reduction in the number of youths considered susceptible to smoking was statistically significant. However, the difference between the groups was not statistically significant.

Thirty-Day Drinking
The rates of reported drinking in the past 30 days for the treatment and attention-control groups dropped from the baseline to the 2-year follow-up. The rates for drinking in the treatment group went from 7.9 percent to 6.8 percent, while the rates in the attention-control group went from 7.2 percent to 5.3 percent. Again, there were no significant differences between the groups, and the overall reduction was not statistically significant.

Susceptibility to Drinking
The number of youths in the treatment group who were considered susceptible to drinking dropped by about 25 percent from the baseline period to the 2-year follow-up period. In the attention-control group, the number of youths dropped by almost 50 percent during this same period. However, the overall reduction was not statistically significant, and there were no significant differences between the groups.

Parent–Child Communication and Attitudes
The results of communication with parents, tobacco peer norms, and tobacco self-standards were similar for the treatment and attention-control groups. The average scores on these measures tended to increase from baseline to the 2-year follow-up for both groups. There were no significant differences between the groups.

The program appeared to have short-term effects only on the perceived effects of tobacco use. The treatment group had significantly higher average scores on measures of the perceived effects of tobacco use, compared with the attention-control group, from the 1-year follow-up to the 2-year follow-up.
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Evaluation Methodology

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Study 1
Elder and colleagues (2002) used a randomized pretest–posttest control group study design to examine the effectiveness of the Sembrando Salud program compared with an attention-control condition. The study was conducted from January 1996 to December 1999. The Migrant Education Program in San Diego County, California, identified the participants. Twenty-five schools within 17 school districts were eligible to participate; ultimately, participating families came from 22 schools in 15 schools districts. (Two schools did not participate because of academic changes in the school calendar, and the third school was ineligible owing to its small number of migrant families. One district did not wish to share its rosters of migrant family names, and the other had an insufficient number of eligible families.)

Ultimately, 660 adolescents (49 percent females) and one of their adult caregivers agreed to participate in the study. The randomization of the schools resulted in 367 families assigned to the treatment condition and 293 families assigned to the attention-control condition. The participants were predominantly Mexican American. The average family income fell well below the poverty level.

Each condition was designed to be equivalent in all respects (except for the content) and included eight weekly, 2-hour sessions with parents attending three of the eight sessions jointly with their adolescent. Each week was formatted into small-group evening sessions held on school grounds or at a neighborhood community agency. The treatment group received the 8-week Sembrando Salud program. The attention-control condition was a first-aid/home-safety educational program concentrated on preparation for an emergency (such as assembling a first-aid kit). Participants were provided with information on first aid and wound care, bleeding and burn care, and home safety.

Data was collected through face-to-face surveys offered in English and Spanish. Baseline surveys were conducted before program implementation, with parents and adolescents assessed simultaneously in separate areas. The same survey was given to all participants following the completion of the group educational sessions and at 1-year and 2-year postintervention follow-ups. Attrition was similar across the treatment and attention-control condition groups at each follow-up period.

The project-developed survey incorporated previously developed scales and items translated into Spanish and “back translated.” The survey included 201 items and collected information on numerous domains. The primary outcomes of susceptibility to smoking and alcohol as well as 30-day drinking were measured by items developed for the California Tobacco Survey. Adolescents were coded as “susceptible” if 1) they were current smokers or drinkers, 2) they did not show firm resolve not to smoke or drink in the future, 3) they would accept a cigarette or drink from a friend, or 4) they intended to smoke in the next year. In addition, attitudes that were assessed included anticipated outcomes for use, intentions for use, and self-standards (in terms of whether the youth viewed himself or herself as tolerant of the identity of being a smoker). Finally, a six-item scale was used to assess parent–child communication.

Since randomization was based on schools, generalized estimating equations were used to account for the repeated measures and for the effects of clustering that resulted when intervention groups within schools were formed.

A major limitation to the study is that a no-treatment control group was not included. The treatment group was compared with a control group that participated in an intervention (although the content and the nature of the intervention was different from the Sembrando Salud program).
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Cost

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There is no cost information available for this program.
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Evidence-Base (Studies Reviewed)

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

Study 1
Elder, John P., Alan J. Litrownik, Donald J. Slymen, Nadia R. Campbell, Deborah Parra–Medina, Sunny Choe, Virginia Lee, and Guadalupe X. Ayala. 2002. “Tobacco and Alcohol Use–Prevention Program for Hispanic Migrant Adolescents.” American Journal of Preventive Medicine 23(4):269–75.
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Additional References

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

Litrownik, Alan J., John P. Elder, Nadia R. Campbell, Guadalupe X. Ayala, Donald J. Slymen, Deborah Parra–Medina, Francisco B. Zavala, and Chris Y. Lovato. 2000. “Evaluation of a Tobacco and Alcohol Use Prevention Program for Hispanic Migrant Adolescents: Promoting the Protective Factor of Parent–Child Communication.” Preventive Medicine 31:124–33.
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Program Snapshot

Age: 11 - 16

Gender: Both

Race/Ethnicity: Hispanic

Geography: Suburban, Urban

Setting (Delivery): School, Other Community Setting

Program Type: Classroom Curricula, Alcohol and Drug Prevention

Targeted Population: Families