cultural adaptation of substance use prevention interventions for latinos in the southwest michael...
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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 -- Videos
Videos created by high school students
- Written
- Directed
- Performed
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