A Primary Care E-Health Family Intervention for Risk Behaviors in Hispanic Youths: A Randomized Clinical Trial.

Importance: Culturally tailored, evidence-based family interventions that can be effectively delivered within pediatric primary care settings may provide a scalable approach for preventing risk behaviors among Hispanic adolescents. Objective: To evaluate whether the online eHealth Familias Unidas Primary Care (eHealth FUPC) program reduced drug use and increased condom use in Hispanic youth and to examine family functioning as a mediator. Design, Setting, and Participants: This randomized clinical trial included 5 follow-up visits across 36 months from April 18, 2017, to December 18, 2022, at 15 pediatric primary care clinics. Participants included Hispanic youth aged 12 to 16 years and a legal guardian. Data were analyzed from January 31, 2023, to August 21, 2024. Intervention: Participants were randomized 1:1 to the intervention, consisting of 8 video group sessions for parents and 4 online, facilitator-guided family sessions for parents and adolescents for a total intervention duration of approximately 12 weeks. Interventionists included pediatric primary care personnel. Main Outcomes and Measures: The co-primary outcomes were past 90-day drug use, condom use, and sexually transmitted infections (STIs). Secondary outcomes included initiation of alcohol use, initiation of hard drug use (ie, lysergic acid diethylamide, phencyclidine, ecstasy [MDMA], psilocybin mushrooms), and family functioning. STI was changed to a secondary outcome after data collection was discontinued because of the COVID-19 pandemic. Results: A total of 456 dyads of adolescents (mean [SD] age, 13.9 [1.4] years; 241 [52.9%] female) and parents or caregivers (mean [SD] age, 43.2 [6.6] years; 424 [93.0%] female) were included in the primary intention-to-treat analyses (225 in the eHealth FUPC intervention and 231 in treatment as usual). A total of 356 families (78.1%) completed the final assessment. eHealth FUPC effects were found for past 90-day drug use trajectories (unstandardized b [SE] = -0.70 [0.70]; incidence rate ratio, 0.47; 95% CI, -0.84 to -0.55; P < .001), alcohol initiation (χ21 = 3.85; P = .05; Cramer V = 0.10), and hard drug use (χ21 = 4.14; P = .04; Cramer V = 0.10), with less initiation for eHealth FUPC. Intervention effects were not found for condom use, condom use trajectory, or family functioning. Conclusions and Relevance: In this randomized clinical trial of the eHealth FUPC intervention, compared with treatment as usual, the experimental condition showed reduced drug use across time and prevented youths from initiating alcohol and hard drug use. No intervention effects were found for condom use. Whether behavioral preventive evidence-based interventions such as eHealth FUPC can be maintained in organizations such as primary care clinics should be further researched. Trial Registration: ClinicalTrials.gov Identifier: NCT03009539.