Strong African American Families-Teen (SAAF-T)
- Need: There is a lack of interventions that addresses teenager behavioral problems, particularly for rural African American adolescents.
- Intervention: Rural, locally trained leaders administered five 2-hour meetings for teenagers and their primary caregivers. Trainings focused on reducing risks that prevent positive development, specifically sexual risk-taking that can lead to HIV and other STIs.
- Results: Teens reported reduced conduct problems, depressive symptoms, and substance abuse. Families were strengthened, and SAAF-T reduced unprotected intercourse and increased condom efficacy.
Effective (About evidence-level criteria)
Researchers supported by the National Institute on Drug Abuse (NIDA) created a family-centered prevention program to address the lack of interventions focused on decreasing behavioral and conduct problems in rural African American adolescents. Strong African American Families-Teen (SAAF-T) targets adolescents (ages 14-16) with the goal of preventing problem behaviors, particularly those most associated with HIV/AIDS risk, and promoting teens’ positive adjustment.
Dr. Gene Brody and colleagues at the Center for Family Research (CFR) - University of Georgia, developed SAAF-T, which was successfully tested and implemented in a rural Georgia.
In this randomized trial, 502 adolescents and primary caregivers were either placed in a group that attended SAAF-T meetings or a group that had the same structure as SAAF-T meetings but with a focus on proper nutrition, exercise, and informed consumer behavior.
In this video, parent and teen participants share how the SAAF-T program has helped strengthen their relationships.
CFR researchers created the SAAF-T content based on over 15 years of epidemiological research in rural Georgia.
SAAF-T teen sessions include content on:
- The importance of post-secondary education/training
- Financial responsibilities of being an adult
- Identifying goals for the future and possible barriers
- Strategies for accomplishing academic/occupational goals
- Strategies to resist personal temptation and peer pressure
- Strategies for effective communication about abstinence and sex
- The risks associated with sexual involvement (for example, STDs and pregnancy)
- How to use a condom properly
SAAF-T caregiver sessions include the following content:
- Adapting parenting styles as teens get older
- Consistently monitoring teens
- Helping teens deal with discrimination
- Offering teens academic support
- Promoting independence and community involvement
- Communicating with teenagers about peer pressure including alcohol, drugs, and sex
During the research study, teenagers and their primary caregivers were involved in five 2-hour SAAF-T meetings led by locally trained leaders. During the first hour, caregivers and teens met separately, convening during the last hour for additional discussions and family activities.
In this effective trial, teenagers who attended the SAAF-T meetings in 10th grade were interviewed again in 12th grade. In comparison to the nutrition/exercise group, the teens in the SAAF-T group reported:
- 36% fewer conduct problems
- 32% less frequent substance use
- 47% fewer substance use problems
- Reduced depressive symptoms
- Decreased frequency of unprotected intercourse
- Increased condom efficacy
The nutrition/exercise group was effective in the sense that its participants reported 14.5% more healthful behaviors at follow-up in comparison to the SAAF-T group.
From a cost-effectiveness standpoint, baseline and follow-up assessments revealed that of the 473 youth who participated:
- Incremental per participant costs were $168
- Incremental per participant effects prevented:
- 3.39 episodes of alcohol use
- 1.36 episodes of binge drinking
- Therefore, the SAAF-T Program cost:
- $50 per reduction in alcohol use episode
- $123 per reduction in binge drinking
At thresholds of $100 and $440, cost-effectiveness acceptability curves revealed that relative to the attention control intervention:
- 90% probability of cost-effectiveness for decreased alcohol use and instances of binge drinking
These findings suggest the SAAF-T intervention is a potentially cost-effective means for decreasing alcohol use and episodes of binge drinking in rural African American adolescents.
For more detailed results:
Brody, G., Chen, Y., Kogan, S., Yu, T., Molgaard, V., DiClemente, R., & Wingood, G. (2012, January). Family-Centered Program Deters Substance Use, Conduct Problems, and Depressive Symptoms in Black Adolescents. Pediatrics, 129(1): 108–115.
Ingels, J., Corso, P., Kogan, S., & Brody, G. (2013). Cost-effectiveness of the Strong African American Families-Teen Program: 1-Year Follow-up. Drug and Alcohol Dependence, 133(2):556-561.
Kogan, S., Brody, G., Molgaard, V., Grange, C., Oliver, D., Anderson, T., . . . Sperr, M. (2012). The Strong African American Families–Teen Trial: Rationale, Design, Engagement Processes, and Family-Specific Effects. Prevention Science, 13(2):206-217.
Kogan, S., Yu, T., Brody, G., Chen, Y., DiClemente, R., Wingood, G., Corso, P. (2011). Integrating Condom Skills Into Family-Centered Prevention: Efficacy of the Strong African American Families-Teen Program. Journal of Adolescent Health, 51(2):164-170.
The SAAF-T research trial was resource intensive as financial incentives and home-based engagement strategies were used to help yield high participation rates during the study. The use of financial incentives may have encouraged families to participate; however, research has shown that incentives alone are not sufficient to guarantee high attendance rates. Home-based engagement of participants is also resource intensive and may not be feasible for all agencies to implement.
Infrastructure building for the program can also be a financial challenge if a meal, transportation, and childcare are provided at each session. Agencies may need to consider a combination of present financial resources, community options, and donations as a way to provide for the infrastructure of the SAAF-T Program.
SAAF-T is a manualized, structured program which can be easily disseminated to public health agencies, schools, churches, boys’ and girls’ clubs, and other community agencies. The SAAF-T curriculum outlines each activity and the specific way in which it should be implemented with families. Agencies who implement SAAF-T will need to invest in the curriculum and the curriculum training and maintain a staff and/or volunteers who are trained on the curriculum.
Recruiting families for SAAF-T can be a challenge due to the demands on family life and competing activities in the community, school, and church. Agencies may need to find ways to overcome a teen’s lack of interest in family programming. Families can be recruited through a wide variety of community resources including local schools, nonprofit agencies, and churches as well as by word of mouth through agency contacts.
Maintaining a staff of individuals who have been trained on the SAAF-T Program is important for replication and sustainability of the program. A minimum of 5 agency representatives should be trained to ensure implementation feasibility and to account for staff/volunteer attrition. The SAAF-T training can accommodate up to 30 trainees.
Organizations that partner with other organizations are often most successful with implementation and sustainability. When organizations work together, they have more potential families to recruit from and more facilitators to work with because they come from the host and partnering organizations.
The CFR Dissemination office is equipped to support agencies that are interested in adopting the SAAF-T Program through training, ongoing technical assistance, and optional fidelity site visits. Agencies who purchase SAAF-T will receive a complete set of program materials as well as electronic access to the curriculum materials and two sets of the program DVDs. Agencies will also be provided with a Resource Manual that includes implementation and sustainability strategies and tips, as well as a Fidelity Manual to assist with monitoring curriculum adherence.
The SAAF-T brochure is used to education people about the program.
Children and youth
HIV and AIDS
Sexual and reproductive health
March 17, 2015
April 13, 2017
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.