Despite the diversity of our communities, adolescent alcohol and other drug use is a serious health concern across the United States. According to National Survey on Drug Use and Health (NSDUH)1 an estimated 22 million people aged 12 and older were categorized in the 2002 NSDUH as abusers of alcohol and/or drugs requiring treatment (3 million on both alcohol and drugs; 4 million on illicit drugs only; and, 15 million on alcohol only). About half was considered dependent (11.5 million); yet, only about 3.5 million of those who abused or were dependent actually received treatment.

The 2002 NSDUH also reveals a continued disparity among ethnic groups in drug use prevalence, reporting that the rate of illicit drug use was highest among American Indians/Alaska Natives (10.1 percent) and persons reporting two or more races (11.4 percent). Rates were 8.5 percent for whites, 7.2 percent for Hispanics, and 9.7 percent for blacks. Asians had the lowest rate at 3.5 percent. When looking at these data more closely, however, they reveal that whites were more likely than any other racial/ethnic group to report abuse of alcohol in 2002. An estimated 55 percent of whites reported past month abuse, the next highest rate was for persons reporting two or more races (49.9 percent), 44.7 percent for American Indians/Alaska Natives, 42.8 percent for Hispanics, 39.9 percent for blacks, and 37.1 percent for Asians. Other research shows that in some regions of the country and for some substances such as alcohol, Latino eighth-grade students exhibit the highest prevalence of use (Marsiglia, Kulis, & Hecht, 2001).

Substance use and abuse affects all ethnic groups in the United States. A “one size fits all” approach to prevention programming is no longer feasible given multicultural communities across the country. A singular cultural approach to substance abuse prevention cannot possibly address the needs of all communities. In a report to Congress, the National Institute on Drug Abuse (2001) described key drug prevention principles for the 21st century. Among those principles were:

• Prevention programming should be adapted to address the specific nature of drug use problems in the local community.
• Prevention programs should be culturally grounded.

Prevention efforts are moving toward more community identification of prevention and treatment needs particular to their community and adapting prevention efforts to fit those needs, while assuring sensitivity to the different cultural backgrounds of those in the community. Implicit in this movement is the assumption that individuals identify with a particular ethnic culture.

Ethnic identity
According to researchers, ethnic identification entails a sense of belonging to a particular group, to the extent that one labels oneself as belonging to this group, and refers to a sense of collective identity based on one’s perception that he or she shares a common heritage with a particular ethnic group (Hecht, Jackson, & Ribeau, 2003). Ethnic identification may be a significant predictor of drug attitudes, use, and abuse (Hecht, Trost, Bator, & McKinnon, 1997; Marsiglia, Kulis, & Hecht, 2001; Moon, Hecht, Jackson, & Spellers, 1999), therefore we cannot ignore its importance in prevention. In order to develop the culturally grounded prevention programs advocated by national substance abuse prevention agencies, researchers and practitioners at the community level need to know if this cultural grounding approach works and how they might best adapt current prevention programming for their own communities. The Drug Resistance Strategies project is a prevention program located in Arizona that is doing just that — assessing cultural approaches to prevention in its “keepin’ it REAL” curriculum.

keepin’ it REAL
The keepin’ it REAL curriculum is a school-based program consisting of 10 lessons that promote antidrug norms and attitudes, change expectations, and teach risk assessment, decisions making, resistance and other social skills. The lessons are reinforced by booster activities and a media campaign consisting of radio and TV PSAs and billboards. The curriculum was developed from the perspective of the experiences of the youth in the target community thereby grounding the intervention in their ethnic and youth culture (Gosin, Marsiglia, & Hecht, 2003; Gosin, Dustman, Harthun, & Drapeau, 2003; Miller, Alberts, Hecht, Trost, & Krizek, 2000).

This grounding was accomplished by utilizing adolescents’ own narratives about drug offers and refusals as the core of the program and incorporating traditional ethnic values and cultural resiliency practices that promote protection against drug use (Castro et al., 1999; Huff & Kline, 1999). The intervention was developed from the “ground up” by starting with the stories and experiences of the adolescents in the target community of Phoenix, Arizona, which consisted of Mexican or Mexican-American, African-American, and European-American youth. The curriculum developers identified culturally grounded prevention messages from the youth’s own experiences, integrating them with values commonly cited as fundamental to Mexican-American, African-American, and European-American cultures (Hecht et al., 2003).

This process led to the development of prevention messages tied to particular cultural values and experiences. These prevention messages were incorporated into classroom activities, videos, public service announcement, and billboards placed around the city. They also promoted anti-drug use norms and taught social and resistance skills in ways familiar to the youth in each cultural group, heightening identification and engagement with the messages. Three versions of the curriculum were created. One was geared to Mexican-American culture, that largest group in the schools. A second was geared to European-American and African-American cultures, the two next largest groups. The third version was multicultural, developed from all three of these groups.

In the intervention trial, 35 middle schools in Phoenix were randomly assigned to either a control condition, which continued receiving whatever prevention program they had been using, or one of the three culturally grounded versions of the curriculum. A total of 6,035 students completed baseline and follow-up questionnaires over a 2-year period spanning 7th and 8th grades. The researchers conducting this program predicted that schools receiving the curriculum would see lower alcohol and other drug use rates than the schools not receiving the curriculum. Additionally, they wondered if cultural matching between program content and student background (for example, a Mexican-American youth matched with the Mexican-American program content) or a multicultural approach would have the stronger effects on reducing alcohol, tobacco, and other drug use.

What they discovered was that some prevention programming was better than no prevention at all and that while both the Mexican-American and multicultural versions were effective in reducing alcohol, tobacco, and marijuana use, the multicultural version had the broadest range of effects over the 2-year period. The most substantive effects across time were for adolescent alcohol use. Significant effects were also found changing perceptions of drug use norms, attitudes, and resistance strategy knowledge and skill.

Why did the multicultural approach work the best? Hecht and colleagues (2003) suspect that perhaps in schools that are culturally diverse it may not be necessary to ethnically segregate students into narrowly tailored programs to gain effectiveness. Rather, the process of incorporating a representative level of relevant cultural elements into the prevention message is critical. That way, the program is inclusive rather than exclusive, sensitive to cultural differences across the representative ethnic cultures, but not privileging any.

These results clearly support the assumptions of multiculturalism — that representation and inclusion constitute key elements in successful intervention (Hecht et al., 2003). In a country where racially integrated schools are more and more common, especially in urban areas, this is a particularly promising area for prevention science and practice.

Developing a program in your community
How can you replicate such a program in your community? Even without the resources necessary to develop billboards, public service announcement, or video programs — schools, churches, and service agencies can work toward building their own multicultural prevention messages by listening to the youth in their communities, youth who may be abstinent, using, abusing, or recovering from alcohol or other drug use. And, what can you do with these narratives? We have found that both live performances as well as videotapes are useful in drug abuse prevention. A local high school or community drama group may be able to take these stories and create a performance script. It is important that these scripts stick to the story without moralizing about drugs.

We find that adolescents do not want to be preached to, preferring to hear one other’s stories. Using indigenous experiences and integrating cultural values across the cultural groups in your community, it is possible to build on existing work and “customize” a culturally sensitive prevention program in your community.2 More about the development of keepin’ it REAL and techniques for creating this type of program for your own community can be found in Miller et al. (2000), Gosin, Marsiglia, and Hecht (2003) and in Gosin, Dustman, Harthun, and Drapeau (2003).

More information on the keepin’ it REAL curriculum in English or Spanish can be found at http://cas.la.psu.edu/drsp/drsp.htm and http://keepinitreal.asu.edu.

Michelle Miller-Day, PhD ( This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ) is a professor of communication arts and sciences at Penn State University. Her work focuses on interpersonal communication, substance use, and suicide.

Michael L. Hecht, PhD ( This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ) is a professor of communication arts and sciences at Penn State University. His work focuses on ethnicity, communication, and adolescent drug use and prevention.

Footnotes
1 The National Survey on Drug Use and Health is a national survey that serves as the primary source of information on the prevalence, patterns, and consequences of drug and alcohol use and abuse in the general U.S. civilian non-institutionalized population, age 12 and older. This survey obtains drug use data from approximately 70,000 persons per year.
2 For some specific steps on “how to” develop your customized prevention programming based on local experiences see Miller, Alberts, Hecht, Trost, & Krizek (2000).

References
Castro, F. G., Proescholdbell, R. J., Abeita, L., & Rodriguez, D. (1999). Ethnic and cultural minority groups. In B. S. McCrady & E. E. Epstein (Eds.), Addictions: A comprehensive guidebook (pp. 499-526). New York: Oxford Press.
Cavanagh, G. F. (1990). American business values. Englewood Cliffs, NJ: Prentice-Hall.
Denby, R. W. (1996). Resiliency and the African American family: A model of family preservation. In S. L. Logan (Ed.), The Black family (pp. 144-163). Boulder, CO: Westview Press.
Gosin, M., Marsiglia, F.F., & Hecht, M.L. (2003). Keepin’ it REAL: A drug resistance curriculum tailored to the strengths and needs of pre-adolescents of the Southwest. The Journal of Drug Education, 33(2), 119-142.
Gosin, M.N., Dustman, P.A., Harthun, M.L. & Drapeau, A.E. (2003). Participatory action research: Creating an effective prevention curriculum for adolescents in the Southwest. Health Education Research: Theory & Practice, 18(3): 363-379.
Hecht, M.L., Jackson, R.L., & , & Ribeau, S. (2003). African American Communication: Exploring Identity and Culture (2nd edition). Mahwah, NJ: Lawrence Erlbaum Associate, Inc.
Hecht, M. L., Marsiglia, F. F., Elek-Fisk, E., Wagstaff, D. A, Kulis, S., Dustman, P., & Miller-Day, M. (2003). Culturally-grounded substance use prevention: An evaluation of the keeping it REAL curriculum. Prevention Science, 4, 233-248.
Hecht, M., Trost, M., Bator, R., & MacKinnon, D. (1997). Ethnicity and gender similarities and differences in drug resistance. Journal of Applied Communication Research, 25, 1-23.
Huff, R. M., & Kline, M. V. (Eds.). (1999). Promoting health in multicultural populations: A handbook for practitioners. Thousand Oaks, CA: Sage.
Katz, J. H. (1985). The sociopolitical nature of counseling. The Counseling Psychologist, 13, 615-624.
Marsiglia, F.F., Kulis, S.& Hecht, M.L. (2001). Ethnic labels and ethnic identity as predictors of drug use and drug exposure among middle school students in the Southwest. Journal of Research on Adolescence, 11, 1, 21-48.
Mayers, R. S., Kail, B. L., &Watts, T. D. (1993). Hispanic substance abuse. Springfield, IL: Thomas.
Miller, M., Alberts, J.K., Hecht, M.L., Krizek, R.L., & Trost, M. (2000). Adolescent relationships and drug abuse. NY: Erlbaum Publications.
Moon, D.G., Hecht, M.L., Jackson, K.M., & Spellers, R. (1999). Ethnic and gender differences and similarities in adolescent drug use and the drug resistance process. Substance Use and Misuse, 34, 1059-1083.
National Institute on Drug Abuse. (1999). Drug abuse and addiction research: 25 years of discovery to advance the health of the public. The sixth triennial report to Congress. Washington, DC: National Institutes of Health.
Additional research articles
Napoli, M., Marsiglia, F.F., & Kulis, S. (2003). Sense of belonging in school as a protective factor against drug abuse among Native American urban adolescents in the Southwest. Journal of Social Work Practice in the Addictions, 3,2,25-41.
Kulis, S., Marsiglia, F.F., & Hurdle, D. (2003). Gender identity, ethnicity, acculturation and drug use: Exploring differences among adolescents in the Southwest. Journal of Community Psychology , 31, 2, 167-188.
Marsiglia, F.F., & Waller, M. (2002).”Language preference and drug use among Southwestern Mexican American middle school students.” Children & Schools, 25, 3, 145-158.
Holleran, L., Dustman, P., Reeves, L., & Marsiglia, F.F. (2002) “Creating culturally grounded videos for substance abuse prevention: A dual perspective on process.” Journal of Social Work Practice in the Addictions, 2, 1, 55-78.
Harthun, M.L., Drapeau, A.E., Dustman, P.A., & Marsiglia, F.F. (2002) “Implementing a prevention curriculum: An effective researcher-teacher partnership.” Education and Urban Society, 34, 3, 353-364.
Marsiglia, F.F., & Daley, J.M. (2002). “Latinos participating in multiethnic coalitions to prevent substance abuse: A case study.” Journal of Human Behavior in the Social Environment, 5, 3/4, 97-121.
Kulis, S., Marsiglia, F.F., & Hecht, M.L. (2002). “Gender labels and gender identity as predictors of drug use among ethnically diverse middle school students.” Youth and Society, 33, 3, 442-475.
Daley, J.M., & Marsiglia, F.F. (2001). “Social diversity within nonprofit boards: Members’ Views on status and issues.” Journal of the Community Development Society, 32, 2, 290-309.
Marsiglia, F.F., Kulis, S., & Hecht, M.L. (2001). “Ethnic labels and ethnic identity as predictors of drug use and drug exposure among middle school students in the Southwest.” Journal of Research on Adolescence, 11, 1, 21-48.

This article is published in Counselor,The Magazine for Addiction Professionals, August 2004, v.5, n.4, pp. 33-36.

Comments

Add New Search RSS

Write comment
Name:
Email:	do not notifynotify
Title:
	Please input the anti-spam code that you can read in the image.

Powered by !JoomlaComment 3.26

3.26 Copyright (C) 2008 Compojoom.com / Copyright (C) 2007 Alain Georgette / Copyright (C) 2006 Frantisek Hliva. All rights reserved."

---