Sembrando Salud

Migrant farm children appear to be at higher risk for health problems and earlier death than the general population. Most migrant farm worker families are at or below poverty level, and they report low use of health-related services in public programs. The process of becoming acclimated to a new culture and the stresses that come from being a migrant appear to increase health risk behaviors such as tobacco and alcohol use.

Sembrando Salud, literally translated as, "sowing the seeds of health," is a bilingual, 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 facilitating and maintaining healthy youth decision-making. Sembrando Salud includes a school and family curriculum delivered by bilingual/bicultural college students. Through presentation of information, modeling, and behavioral rehearsal, adolescents are exposed to how problems can be identified and analyzed, solutions generated, and decisions made, implemented, and evaluated.

Another component of this program is the specific focus on developing parental support for the healthy decisions and behaviors of the adolescents through enhanced parent-child communication. Parental communication skills such as listening (for example, verbal and non-verbal attention), confirmation (for example, accepting messages), and reassurance (for example, expressing care and concern) are developed and reinforced through behavioral methods of modeling, role playing, and behavior rehearsal.

The program includes information about tobacco and alcohol effects, social skills training, and the specific development of parent-child communication skills to support healthy youth decisions. The specific tobacco/alcohol sessions include listening skills, communication skills, health effects of smoking and peer pressure, health effects of alcohol and decision making, societal influences, refusal skills, media and adult influences, and review.

Presentation methods for the core content of each session vary; however, each curriculum uses a similar mix of teaching methods including group leader-led discussions, videos, demonstrations, skill practice, and role-playing. For the sessions jointly attended by parents and adolescents, separate parent- and adolescent-only breakout groups are held in addition to combined parent-adolescent groups in an effort to facilitate discussions relevant to each group.

The program produced positive findings that demonstrate the efficacy of the program in enhancing parent-child communication. Please note: Sembrando Salud is intended to increase parent-child communication to prevent tobacco use. This program is not intended to directly change tobacco use behavior.

The program requires that adolescents attend 8 weekly, 2-hour sessions, and that parents attend 3 sessions jointly with their adolescents.

The study focused on adolescents between the ages of 11 and 16 years and their families. The participants were identified through the Migrant Education Program in San Diego County and were predominantly oriented toward the Mexican culture. Most were Mexican-born, living in Spanish-speaking households.

The intervention is suitable for school-based settings.

The Sembrando Salud Curriculum is required. The program developer has determined that, although recommended, the additional materials that are referenced in this program are not required for successful implementation and so these additional materials have not been made available to EBCCP. The following information is provided to assist in obtaining the materials, if desired:

• Video "Building Self-Confidence" can be obtained from Sunburst Communications, Pleasantville, NY 10570. Toll free 1-800-431-1934 or http://www.sunburst-store.com/cgi-bin/sunburst.storefront/EN/Catalog/1134. Product number is 2303.
• Videos "The Subject is Smoking" and "El Sueño de Elias" were developed by the Los Angeles Regional Family Planning Council, Inc., 3600 Wilshire Blvd, Suite 600, Los Angeles, CA 90010. Telephone 213-386-5614.

Results of the study indicate the following:

• The children of migrant workers included in this study exhibited unexpectedly low levels of risk for use of tobacco and alcohol. Nevertheless, youth who attended more sessions were less susceptible to using tobacco and alcohol.
• Parents and youth who participated in the tobacco/alcohol intervention reported better communication in their family than did those in the control group. Smaller families were found to have benefited more than larger families.
• Thirty-day smoking and drinking rates remained at very low levels. Those considered susceptible to smoking dropped by nearly 40% in the attention-control and by 50% in the intervention from baseline to final follow-up.
• Sembrando Salud appears to make short-term changes to smokers' perceived effects of tobacco use.