Transcript D.R.S. Presentation

CULTURAL ADAPTATION OF
SUBSTANCE USE PREVENTION
INTERVENTIONS FOR LATINOS IN THE
SOUTHWEST
Michael L. Hecht
The Pennsylvania State University
Presentation to the School of Communication
The Ohio State University
Funding Provided by NIDA Grant R01 DA005629
PI: Michael Hecht
Conceptual/Theoretical
Framework
Cultural
Ecology
&
Environmental
Risk &
Resiliency
Factors
Communication
Competence
Theory
Knowledge
Motivation
Skills
Relationships
Culture
Keepin’ it
REAL
Norms
Narrative
Knowledge
Attitudes
Norms
Intentions
Refusal
Skills
Expectations
Decision
Making
Risk
Assessment
Cultural
Grounding
Communication
Competency
Substance
Use
Approaches to Cultural
“Sensitivity”
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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
–
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Convergence, Divergence, Maintenance
Over-accommodation
(Gallois, Ogay, & Giles, 2005)
Drug Resistance Strategies
Project
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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
Ethnic Differences
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
simple offer
How Offered
Where Offered
How Resisted
party
park
friend’s home or street
explain
(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
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Target Group “Stories”
–
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From Kids – Through Kids – To Kids Approach
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”
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Peer narratives as the source material for
the curriculum.
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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

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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
American
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PRO-DRUG USE:
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
White/
MultiBlack
Cultural
Versus
Versus
Versus
Control
Control
Control
T2 T3 T4 T2 T3 T4
T2 T3 T4
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(Hecht, M.L., Marsiglia, F.F., Elek, E., Wagstaff, D. A., Kulis, S., Dustman, P., & MillerDay, 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:
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Limiting increases in substance use.
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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
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3,402 Mexican heritage students
Multi-level regression using Stata
For Mexican American version:
–
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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
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Discrete-time event history analysis using multilevel 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