CULTURAL ADAPTATION OF SUBSTANCE USE PREVENTION INTERVENTIONS FOR

LATINOS IN THE SOUTHWEST

Michael L. HechtThe Pennsylvania State University

Presentation to the School of CommunicationThe Ohio State University

Funding Provided by NIDA Grant R01 DA005629PI: Michael Hecht

Conceptual/Theoretical Framework

Cultural Ecology

&Environmental

Risk &Resiliency

Factors

Communication Competence

Theory

KnowledgeMotivation

SkillsRelationships

Culture

Keepin’ it REAL

Narrative Knowledge

Norms

Refusal Skills

Decision Making

RiskAssessment

Cultural Grounding

Norms

Attitudes

Intentions

Expectations

CommunicationCompetency

SubstanceUse

Approaches to Cultural “Sensitivity”

Peripheral Strategies – packaging Evidential Strategies – evidence of effects on

group Linguistic Strategies – language accessibility Constituent-involving Strategies Sociocultural Strategies

(Kreuter et al., 2003)

Principle of Cultural Grounding

• Starts with culture, rather than just adding culture to existing materials

● Active participation of cultural group members in message construction

● Culture as identity groups – broader than just race/ethnicity (e.g., age, geography, gender, SES)

● Considers both surface and deep structures (Resnicow, et al., 1999)

(Hecht, M.L., & Krieger, J.K. (2006). The principle of cultural grounding in school-based substance use prevention: The Drug Resistance Strategies Project. Journal of Language and Social Psychology, 25, 301-319. Hecht, M.L., & Miller-Day, M. (in press). The Drug Resistance Strategies Project:  A communication approach to preventing adolescent drug use. In L. Frey & K. Cissna (Eds.), Handbook of Applied Communication)

Guidelines for Culturally Grounded Adaptation

1) Begin with “insider” perspectives

2) Focus on “stories” of target groups

3) Include expert input on cultural values and developmental needs

4) Include input from other community members

Guidelines for Culturally Grounded Adaptation II

5) Include cognitive, affective-motivational, and environmental factors (Castro, Barrera & Martinez, 2004)

Develop and modify the curriculum with assistance of target groups

7) Evaluate the curriculum

Communication Accommodation Theory

Strategies of Accommodation– Convergence, Divergence, Maintenance– Over-accommodation

(Gallois, Ogay, & Giles, 2005)

Drug Resistance Strategies Project

Example of cultural grounding process

16 years of research about why youth use alcohol, tobacco, and other drugs and how youth resist related offers.– Youth culture in Phoenix metropolitan area– Similarities and differences across age, ethnic

group, and gender (membership and identification)

4 year process of program development and evaluation sponsored by NIDA (National Institute of Drug Abuse).

Partners: PSU, ASU, and middle and high schools in Phoenix, Arizona

Mexican

Americans

African

Americans

European

Americans

Substance most use/ youngest use: alcohol, pot, hard drugs, inhalants

least use cigarettes

Who Offered peer family members (brother, sister, cousin)

boyfriend/ girlfriend, parent

male or female acquaintance

How Offered simple offer

Where Offered party park friend’s home or street

How Resisted explain

Ethnic Differences

(Hecht et al. (1997); Moon, Hecht, Jackson, & Spellers (1999). Substance Use and Misuse, 34, 1059-1083)

Research Question

● What is the optimal level of accommodation/convergence?

● Do we need to exclusively ground the prevention program in the culture of one group or is inclusion enough?

DRS and Cultural Grounding

“Insider” Perspectives- From Kids – Through Kids – To Kids Approach

Target Group “Stories”– Narrative interviews, focus groups and surveys

Expert Input– Values – Latino, African American, European American

DRS and Cultural Grounding

Community Member Input– Participatory Action Research with teacher focus

groups and individual input

Modify Curriculum with target group input

Target Group Input

● “From kids through kids to kids”

● Peer narratives as the source material for the curriculum.

● Used language (slang, etc.) of the target students

● Set in the contexts in which substance use occurs.

Target Group Input

● Students helped developed title and logo:

Target Group Input -- Videos

Videos created by high school students

- Written

- Directed

- Performed

Regional Emmy Award Presentation

Evaluating keepin’ it REAL

Missing data estimated through multiple imputation and serial correlations (NORM software)

Overall Evaluation– Generalized estimating equations (GEE) adjust for

school level effects (STATA Xtgee module) – Growth modeling analysis

Subgroup analyses– Event history analysis with previous substance users– Mexican Americans subsample with multi-level regression using

Stata Program Components

– Analysis of covariance model

Overall Evaluation.1 Mexican White/ Multi-

American Black Cultural Versus Versus Versus

Control Control Control • PRO-DRUG USE: T2 T3 T4 T2 T3 T4 T2 T3 T4 • Recent Alcohol Use • Recent Cigarette Use • Recent Marijuana Use • Descriptive Norms • Positive Drug Expectancy • Personal Intentions • ANTI-DRUG:• Use of R.E.A.L. Strategies • Injunctive Norms: Parent • Injunctive Norms: Friends • Personal Norms • Self Efficacy

(Hecht, M.L., Marsiglia, F.F., Elek, E., Wagstaff, D. A., Kulis, S., Dustman, P., & Miller-Day, M. (2003). Culturally-grounded substance use prevention: An evaluation of the keepin’ it R.E.A.L. curriculum. Prevention Science, 4, 233-248)

Program Effectiveness

The Mexican American version proved effective in:– Limiting increases in substance use.

– Developing stronger anti-drug norms and refusal self-efficacy.

– Slowing the increase in intentions to accept offers.

Program Effectiveness

The Multicultural version proved effective in:

– Limiting increases in substance use.

– Developing stronger anti-drug norms.

– Slowing the increase in positive substance use expectancies.

Ethnic Matching

No support found for an ethnic matching hypothesis – that students matched to the cultural focus of the version of the intervention would demonstrate better outcomes than mismatched students

Program Effectiveness.2

Growth modeling analysis (SEM, multilevel)– Model 1: pretest substance use as covariate– Model 2: growth over all waves of the study

Intervention significantly limited the increase in recent substance use, especially alcohol and marijuana.

Multicultural intervention had the broadest range of effects.

(Hecht, M.L., Graham, J.W. & Elek, E. (in press). The Drug Resistance Strategies Intervention: Program Effects on Substance Use. Health Communication)

Outcomes for Mexican American Students

3,402 Mexican heritage students Multi-level regression using Stata For Mexican American version:

– Smaller increases in marijuana use, stronger intentions to refuse and refusal confidence, and perceptions of less peer use at the end of the study

For Multicultural version:– Smaller increases in recent alcohol and marijuana use at

end of the study

(Kulis, S., Marsiglia, F.F., Elek, E., Dustman, P., Wagstaff, D.A., & Hecht, M. (2005). Mexican/Mexican American Adolescents and keepin’ it REAL: An Evidenced-based, Substance Use Prevention Program. Children and Schools, 27, 133-145)

Outcomes for Adolescent Substance Users

Data was from subsample of 1,364 middle school students who had previously used substances

Discrete-time event history analysis using multi-level models

Participation in program influenced reduced and recently discontinued alcohol use

(Kulis, S., Nieri, T., Tabiku, S. Stromwall, L.K., & Marsiglia, F.F. (in press). Promoting reduced and discontinued substance use among adolescent substance users: Effectiveness of a universal prevention program. Prevention Science)

Program Components: In class videos and PSAs

Data were from the entire sample

Analysis of covariance model was fit separately for each substance use outcome

At posttest, students who saw 4-5 of the videos engaged in less substance use in the past month

Having seen PSAs one or more times did not influence substance use

(Warren, J.R., Hecht, M.L., Wagstaff, D.A., Elek, E., Ndiaye, K., Dustman, P., & Marsiglia, F.F. (2006). Communicating Prevention: The Effects of the keepin’ it REAL Classroom Videotapes and Televised PSAs on Middle-School Students’ Substance Use. Journal of Applied Communication Research, 34, 209-227)

Conclusions

Appropriate degree of accommodation – Inclusion rather than Exclusion (multiculturalism)

Go beyond surface structures

Address the complexity of culture (ethnicity, geography, age, gender, etc.)

Narrative approach can contribute to accomplishing all three

DRS Website Information

http://drugresistance.la.psu.edu/index.html