OBJECTIVE The Adelante intervention, implemented between 2013 and 2018, addressed an important syndemic health disparity for Central American immigrant youth approaching or in high school-the co-occurrence of substance abuse, sex risk (pregnancy, sexually transmitted infections, HIV), and interpersonal violence. Adelante was implemented and evaluated by the Avance Center for the Advancement of Immigrant/Refugee Health, which built on a university-community partnership that has been in place since 2005. Using a tailored, ecological positive youth development (PYD) approach, Adelante employed intervention strategies across ecological levels, including individual, family, peer, and community levels, with the use of social marketing and digital media strategies to link activities under one aspirational identity and support community engagement. METHOD Using a Community Based Participatory Research approach with multiple community partners involved in the effort, the research assessed changes in co-occurring behavioral outcomes and tested hypotheses concerning relationships between PYD mediators and these outcomes. Multiple methods were used in collaboration with partners to assess intervention inputs and outcomes-detailed implementation process records; prepost surveys to assess changes in PYD assets, risk behavior knowledge, and prevention skills; a community survey in the intervention and comparison communities (total N = 3,600) at baseline and two follow-up waves; surveys of a high risk cohort (n = 238) at baseline and follow-up; and social marketing campaign surveys (n = 1,549) at baseline with 2 follow-up waves. RESULTS Analysis showed multiple improvements in PYD mediators and risk behavior outcomes, including an overall 70% increase in knowledge and a 15% increase in prevention skills. Preliminary analysis of risk behavior outcomes demonstrated, for example, a significant, inverse effect on reported sexual activity (past 3 months) for both Adelante intervention community and cohort samples. In addition, self-reported exposure to the social marketing campaign was associated with positive effects on multiple outcomes, including drug use risk and violence attitudes, and improvement in violence/sexual risk behavior outcomes in the intervention versus comparison community. CONCLUSION There are few models in the literature that provide a roadmap for how to address multiple, related health conditions in marginalized, immigrant communities, even as most health disparities are associated with complex social ecologies. The Adelante intervention adds a useful model of this nature to the evidence base, and provides support for the ecological approach to PYD with respect to such communities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

中文翻译：

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Adelante 项目：解决中美洲移民青年健康差异的现实、挑战和成功。


目标 2013 年至 2018 年间实施的 Adelante 干预措施解决了中美洲移民青年面临的一个重要的流行病健康差异，即药物滥用、性风险（怀孕、性传播感染、艾滋病毒）和人际交往的同时发生。暴力。 Adelante 由 Avance 移民/难民健康促进中心实施和评估，该中心建立在自 2005 年以来建立的大学与社区伙伴关系的基础上。Adelante 采用量身定制的生态积极青年发展 (PYD) 方法，采用了干预措施跨生态层面（包括个人、家庭、同伴和社区层面）的战略，利用社会营销和数字媒体战略将同一个理想身份下的活动联系起来并支持社区参与。方法 该研究采用基于社区的参与式研究方法，多个社区合作伙伴参与其中，评估了同时发生的行为结果的变化，并测试了有关 PYD 调解者与这些结果之间关系的假设。与合作伙伴合作使用多种方法来评估干预投入和结果——详细的实施过程记录；事前调查，评估 PYD 资产、风险行为知识和预防技能的变化；在基线和两次后续波中对干预社区和比较社区（总 N = 3,600）进行社区调查；在基线和随访时对高风险人群（n = 238）进行的调查；以及基线时的社会营销活动调查（n = 1,549）以及 2 次后续波次。 结果 分析显示 PYD 中介因素和风险行为结果有多项改善，包括知识总体增加 70%，预防技能增加 15%。例如，对风险行为结果的初步分析表明，Adelante 干预社区和队列样本对报告的性活动（过去 3 个月）存在显着的反向影响。此外，自我报告的社会营销活动接触与多种结果的积极影响相关，包括吸毒风险和暴力态度，以及干预社区与比较社区中暴力/性风险行为结果的改善。结论 尽管大多数健康差异与复杂的社会生态有关，但文献中很少有模型为如何解决边缘化移民社区的多种相关健康状况提供路线图。 Adelante 干预措施在证据基础上添加了这种性质的有用模型，并为针对此类社区的 PYD 生态方法提供了支持。 （PsycInfo 数据库记录 (c) 2022 APA，保留所有权利）。