‘The right guidance can help change communities and people’s choices’

Growing up in Miami’s inner city, Guillermo “Willy” Prado, Ph.D., M.S., didn’t need to look beyond his own family to see how good parenting influenced one’s life trajectory.

His home was a loving sanctuary amid the chaos of a crime-ridden neighborhood, where his family was once held at gunpoint in their own living room. His parents never let their environment interfere with the family’s tight bond and nurturing support that would later shape Prado into the top public health expert he is today and inspire the structure for the Familias Unidas initiative.

“The right guidance can help change communities and people’s choices,” said Prado, a Leonard M. Miller Professor of Public Health Sciences and Director of the Division of Prevention Science and Community Health. “That’s why I’m passionate about what I do. If we give parents the tools to be effective, kids can grow up healthy in any environment.”

Since 2000, Prado has been on the frontlines of preventing sexual risk behaviors, substance use and obesity among Hispanics in Miami-Dade County. One of his greatest accomplishments is making a difference at his former middle school and high school where some of his old teachers still remember him.

The beloved educator, avid dancer and local public health figure chats with Medical Communications to discuss his vision for preventive health mechanisms, his goal to train future preventive health scientists in the Miller School of Medicine’s new public health doctoral degree program, and his recent work to expand Familias Unidas in Ecuador, Chile and Colombia.

Tell us about your background.
I was born in Mexico but my mom was from Cuba. She left when the Castro regime came to power. My mom was very vocal and my grandmother was afraid that she was going to be arrested or get killed, so she forced her to emigrate to Mexico where she would later meet my father, who was from Yrapuato. We left Mexico for New Jersey when I was 2 and moved to Miami when I was 5, and I’ve called Miami my home ever since.

I came from very modest roots. My older brother and I always shared a room. My parents worked in blue-collar jobs at restaurants, pastry-shops, and liquor stores, but there was always a clear expectation that we would go to college. Like many Hispanics, I moved away for college but not too far from my family.

What attracted you to public health?
I attended the University of Florida in Gainesville, where I started off as pre-med but after my last freshman chemistry class I decided that it wasn’t my passion. I then pursued math, which I’d always been pretty good at, but I also liked statistics because it was more applied. I later returned to Miami where I enrolled in UM’s graduate statistics program. I was very fortunate to meet Dr. Daniel Feaster, who at the time needed a graduate student to analyze data for a treatment study with HIV-positive people. He asked me, ‘Have you done this before?’ I said no, but I thought that I could absolutely try. That’s how I really got engaged in the research world.

While I enjoyed working on the HIV treatment study, my thoughts were focused on prevention. Then I learned about an HIV family prevention study that was the perfect match for my interests. I started working on that study with Dr. Hilda Pantin in 2000 and I’ve been working in this area ever since. In 2003, I went on to pursue my Ph.D. in epidemiology. Though it’s rare that a graduate student would be allowed to directly apply for funding from the National Institutes of Health, I applied and was awarded funding to examine which prevention mechanisms were effective for various Hispanic subpopulations. I was so enthusiastic about starting my own projects that I finished the Ph.D. program in a little over a year and a half. I really wanted to make a difference.

How did your upbringing influence your work?

I lived in neighborhoods where drugs were being exchanged and in heavy use. It was tough growing up in a risky environment, but my parents were so effective at raising us that engaging in delinquent behavior or drugs never crossed my mind or my older brother’s. The right guidance can help change communities and people’s choices. That’s why I’m so passionate about what I do. If we give parents the tools to be effective, kids can grow up healthy in any environment. This was the basis for Familias Unidas, which we started in 2000. The main goal is to give parents and families, particularly those like mine with little resources, the right tools for communication, discipline, social peer monitoring and other areas so that they can offset risks within their children’s environment.

What led you to focus the program on substance use, sexual risk behaviors and obesity?

I was always very interested in working with Hispanic populations. I also grew up with kids who were substance users, and I wanted to empower others to make better choices. The focus on sexual risk behaviors stemmed from the prevention project that I had worked on, so it was a natural carryover. My parents were both heavyweight, and I was a very obese child growing up and even until college. We’ve observed how a child’s eating habits and level of physical activity mirror the parents’ behaviors. So in general, I’m interested in promoting physical and emotional health among Hispanic populations and adolescents in general. Many of these risky behaviors can lead to increased death rates among youth and it’s been great putting interventions in place.

What role does preventive health play in an academic medical setting?

While traditional medicine deals with outcomes, prevention aims to reach people before they experience health failures. That can be a difficult task since preventive medicine lacks the funding it needs. But now is the right time for it. With the Affordable Health Care Act and other national prevention strategies promoted by the president, we’re starting to see a shift from a model of sick care to a model of well care.

Preventive health, similar to public health, requires us to be out in the community instead of the office. We have to do a lot of listening and getting to know people. A lot of times we spend eight hours a day in the community trying to assess their needs and determine what works for them. You can’t do public health work if you don’t go where the people are.

What impact has Familias Unidas had on the community?
We’ve worked with 40 to 50 middle and high schools in the Miami-Dade County school district and have served thousands of Hispanic students and their families. We’ve seen substantial decreases over two to three years in families in our program. Cigarette use has decreased by 88 percent, drug use by 30 percent and the outreach has increased condom use by 50 percent. We established great relationships and partnerships with the school district, and we couldn’t have done it without this collaboration. It’s been wonderful, because we get to work with schools of lower socio-economic status and have a positive impact.

Describe some of the most memorable moments with your work.

I’ve had the unique fortune of being able to do work in schools that I attended, such as Kinloch Park Middle School. I get emotional even walking through the halls, and it’s such a great way to give back. The nostalgia is remarkable, and I can see part of myself in the students. Some of the same teachers are still at the school and they even remember me by name.

Tell us about Familias Unidas’ international endeavors?

Familias Unidas has expanded to Latin America in the past year. We started a satellite program in Ecuador at the end of 2014 and more recently in Chile. We will soon be in Colombia. These are adapted versions of our program that are tailored to the needs of those populations. We’ve trained the various program administrators to deliver research studies and evaluate and assess their versions of the program. There are some subtle differences from the Miami program, such as dialects, youth experiences and the age at which youth are targeted. For example, the risk of drug use, especially marijuana, starts at a younger age in Ecuador. Our long-term vision is to reach all of Latin America.

What’s the role of community partners?

They are essential. The work doesn’t happen without the community partners. They know what’s going on in their communities and best recognize the most prevalent risk factors and the prevention strategies that will work. And certainly, our UM team is able to guide with evidence-based expertise, so it’s really a great marriage.

What are your goals for Familias Unidas?

We’re looking at working more closely with primary care doctors to integrate the program into their practices. We’re starting with some of our pediatric doctors at UM and also plan to work with doctors in the community. The model would be an adapted, web-based version of the program that in addition to the medical care the children receive, connects the families to a behavioral health specialist who will deliver parenting sessions via the Web. We’re waiting for a grant. If we receive it, we plan to start in December. Our vision is to do this in a way that’s sustainable so that when we complete the study, the doctors will continue providing the services. We’re also working with the U.S. Preventive Task Force and giving them the evidence they need to recommend physician reimbursement for these parenting programs.

What are your hopes for the Miller School’s new Ph.D. program in Prevention Science and Community Health?

My goal with the program is to train the next generation of prevention science leaders so that they can disseminate the best evidence-based practices in our field. The aim is for them to do innovative research and learn how to adopt these practices. I really am so excited about this program. Our first cohort of stellar students includes two Hispanics, a Haitian and a Brazilian. This diverse group of students will bring so much to the program. Some of them have already spearheaded programs in their respective countries or communities in Miami.

Another goal is to get the most effective public health interventions to the masses. Unlike medicine, which disseminates evidence-based treatments, public health and prevention in particular does not do the same. Our field needs more collective effects to implement the very best prevention models in the communities that need them. The populations are getting some type of help, but unfortunately the programs are not evidence-based. For this reason, another major goal of mine is to launch a center focused on prevention innovations. By creating such a center, we will have the opportunity to improve the lives of youth through the development of new prevention strategies and methods, dissemination of evidence-based preventive strategies on a global scale, and training the best and brightest prevention scientists.

What are your hobbies?
I love to travel the world every chance that I get. I like to see what other communities look like and meet new people. I also love going out and dancing, jogging and working out in the wellness center. One thing that I’m known for is pulling pranks on people.

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