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CULTURAL ADAPTATION OF SUBSTANCE USE PREVENTION INTERVENTIONS FOR LATINOS IN THE SOUTHWEST

CULTURAL ADAPTATION OF SUBSTANCE USE PREVENTION INTERVENTIONS FOR LATINOS IN THE SOUTHWEST. Michael L. Hecht The Pennsylvania State University Presentation to the School of C ommunication The Ohio State University Funding Provided by NIDA Grant R01 DA005629 PI: Michael Hecht.

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CULTURAL ADAPTATION OF SUBSTANCE USE PREVENTION INTERVENTIONS FOR LATINOS IN THE SOUTHWEST

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  1. CULTURAL ADAPTATION OF SUBSTANCE USE PREVENTION INTERVENTIONS FOR LATINOS IN THE SOUTHWEST Michael L. Hecht The Pennsylvania StateUniversity Presentation to the School ofCommunication The Ohio State University Funding Provided by NIDA GrantR01 DA005629 PI: Michael Hecht

  2. Conceptual/Theoretical Framework Keepin’ it REAL Narrative Knowledge Norms Refusal Skills Decision Making Risk Assessment Cultural Grounding Cultural Ecology & Environmental Risk & Resiliency Factors Norms Attitudes Intentions Expectations Communication Competency Substance Use Communication Competence Theory Knowledge Motivation Skills Relationships Culture

  3. 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)

  4. 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)

  5. Guidelines for Culturally Grounded Adaptation • Begin with “insider” perspectives • Focus on “stories” of target groups • Include expert input on cultural values and developmental needs • Include input from other community members

  6. Guidelines for Culturally Grounded Adaptation II • Include cognitive, affective-motivational, and environmental factors (Castro, Barrera & Martinez, 2004) • Develop and modify the curriculum with assistance of target groups • Evaluate the curriculum

  7. Communication Accommodation Theory • Strategies of Accommodation • Convergence, Divergence, Maintenance • Over-accommodation (Gallois, Ogay, & Giles, 2005)

  8. 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

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

  10. 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?

  11. 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

  12. DRS and Cultural Grounding • Community Member Input • Participatory Action Research with teacher focus groups and individual input • Modify Curriculum with target group input

  13. 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.

  14. Target Group Input • Students helped developed title and logo:

  15. Target Group Input -- Videos • Videos created by high school students - Written - Directed - Performed

  16. Regional Emmy Award Presentation

  17. 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

  18. Overall Evaluation.1 MexicanWhite/Multi- AmericanBlackCulturalVersusVersusVersus ControlControlControl • PRO-DRUG USE:T2 T3 T4T2 T3 T4T2 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)

  19. 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.

  20. 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.

  21. 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

  22. 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)

  23. 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)

  24. 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)

  25. 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 REALClassroom Videotapes and Televised PSAs on Middle-School Students’ Substance Use. Journal of Applied Communication Research, 34, 209-227)

  26. 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

  27. DRS Website Informationhttp://drugresistance.la.psu.edu/index.html

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