Preventing drug use and sexual risk behaviors and promoting wellness among Latinx adolescents through eHealth interventions

When Yannine Estrada, PhD, set out to develop the prototype for a mobile app to help prevent Latinx teen substance use and risky sexual behaviors, she envisioned two modules focusing on drug use and sexual health.

“We wanted to create an individually-based prevention intervention that’s easy for kids to access and that can be widely disseminated,” said Estrada, a research assistant professor at the University of Miami’s School of Nursing and Health Studies (UM-SONHS). “An app that could be used as a preventive tool to help decrease existing health disparities among Latinx youth.”

Yannine Estrada, PhD

But Estrada, who also serves as director of research for the long-running “Familias Unidas” studies that now make their home at the UM-SONHS, knew that a sound methodology meant first asking teens and their parents what they needed and wanted from an app.

Supported by a two-year pilot study award from the NIH-funded Center for Latino Health Research Opportunities (CLaRO), Estrada worked closely with her mentor, UM-SONHS professor and associate dean for research and CLaRO principal investigator Victoria Behar-Zusman, Ph.D., to develop a prototype they called SEEK (Socio-Emotional Efficacy and Knowledge).

Estrada conducted focus groups with 20 parents and 45 adolescents over the course of the study. During phase one, she asked participants what they wanted to see in the mobile app, with the aim of using this information to create the initial SEEK prototype.

But after talking with teens and their parents, Estrada realized SEEK would need to expand beyond its original two-module structure. The team developed three additional modules designed to address concerns identified by the focus groups: effective communication with parents and peers, depression, and mindfulness. 

“The adolescents thought that depression was an underlying cause of these risk behaviors, and that it was important for an app to talk about and help kids to manage their depression,” said Estrada. “The depression module answers questions like ‘what is depression?’ and ‘what can you do about depression?’ and provides the teens with resources.”

The team also developed a module to promote wellness behaviors among the adolescents.

“I felt it was important to give them something they could use right away,” said Estrada, “so we developed a module on mindfulness that includes meditation and breathing activities kids can do on their own.”

With the five-module design in place, Estrada’s research team got to work developing the SEEK prototype. In phase two of the study, they sought additional feedback from the teens and modified the prototype based on their input.

“One thing the kids wanted was incentives, so we introduced a game that allows them to choose an avatar – a cute puppy or kitten,” said Estrada. “As they work their way through the app’s content, they can earn points to buy food and toys for their pet. The game is a way to engage them and keep them coming back.”

Finally, in phase three of the study, they asked the teens to comment on the look and design of the revised prototype, as well as its content. Because the actual app had not yet been developed, the teens critiqued images that simulated what the app screens would eventually look like.

Ultimately, the pilot study led to an app design that proactively addresses prevention needs identified by the teens.

“Our pilot study findings helped us understand the needs for the mobile app and what design and content would motivate teens to use it,” she said. “The prototype we developed is not only a tool to reduce risk – it also promotes wellbeing.”

What’s next for Estrada? Applying for R34 funding to develop and test the actual app – possibly through a SMART (Sequential Multiple Assignment Randomized Trial) design – using the prototype to guide intervention development and testing.

“It might be a tailored intervention that lets kids choose which modules to complete, and in what order,” said Estrada. “We would look at outcomes like communication, self-efficacy, and knowledge.”

The app is just one of many projects Estrada envisions. She hopes to develop prevention interventions for Latinx youth that are easily available and accessible, such as trauma-informed interventions to help prevent post-traumatic stress disorder (PTSD) symptoms.

And she’s well on her way.

CLaRO: Building an enduring community of health disparities scholars

Estrada is already working on disseminating and building on her findings – submitting to the Society for Prevention Research for its 2022 conference, preparing a manuscript for publication, working on grant proposals – and she’s also presented at CLaRO meetings and as a guest lecturer for UM-SONHS students. She credits CLaRO for providing opportunities for professional development beyond the pilot study.

“CLaRO is a great support system that has been instrumental in getting our grant proposal submissions out the door,” she said. “They’ve created a sense of community and family. It’s good to know you’re not alone, that there are others with you on this journey.”

Even though her pilot study has concluded, Estrada continues to be mentored by Behar-Zusman.

“Vicky is so knowledgeable – it helps to have her perspective on things I didn’t think about, helping me to see beyond,” she said. “If I have a concern, I can always talk to her and get a professional point of view.” 

The admiration and appreciation goes both ways – Behar-Zusman is eager to praise Estrada’s many gifts. “Dr. Estrada has the rare combination of skill sets that are so important to the future of health disparities science: clinical know-how, methodology for intervention development and clinical trials, and how to deliver accessible and culturally-informed interventions to Latino families through the use of media and technology.”

Estrada has also participated in two of CLaRO’s research training institutes.

“The institute is an exceptional opportunity to network and meet leaders in the field in an intimate setting – it’s not overwhelming like a conference,” said Estrada. “The speakers are phenomenal, we learn about how they’re applying methodologies and how we could use them to go in new directions. We get the sense that if they were able to do it, we can too. It’s very inspiring.”

Other opportunities CLaRO has provided Estrada include collaborations with fellow pilot study grantees on manuscripts and grant proposals, as well as involvement in the study CLaRO is conducting as part of NIH’s Community Engagement Alliance Against COVID-19 Disparities (CEAL) project to address vaccine hesitancy among Latinx communities in South Florida.

“I’m really grateful, because to this day CLaRO has continued to be supportive – they’re not getting rid of me, and I’m not getting rid of them,” she laughs. “They’re helping us launch our careers, but they’re always there as a safe place to land.”