Culturally Grounded Substance Use Prevention: An Evaluation of the keepin' it R.E.A.L. Curriculum
Abstract
This paper reports on the evaluation of a culturally grounded prevention intervention targeting substance use among urban middle-school students. The curriculum consists of 10 lessons promoting antidrug norms and teaching resistance and other social skills, reinforced by booster activities and a media campaign. Three versions were delivered: Mexican American, combined African American and European American, and Multicultural. Thirty-five middle schools were randomly assigned to 1 of the 3 versions or the control. Students completed baseline and follow-up questionnaires over a 2-year period (total 6,035 respondents). Analyses utilizing a generalized estimating equations approach assessed the overall effectiveness of cultural grounding and the cultural matching hypothesis. Support was found for the intervention's overall effectiveness, with statistically significant effects on gateway drug use as well as norms, attitudes, and resistance strategies but with little support for the cultural matching hypothesis. Specific contrasts found the Mexican American and Multicultural versions impacted the most outcomes.
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Culturally targeted substance abuse interventions may impact initiation of substance use and help in the treatment of abuse.
“Culturally targeted substance abuse interventions may impact initiation of substance use and help in the treatment of abuse (Hetch et al., 2003; Unger, 2012).”
From National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999-2009. (2013) · cites this paper as Hetch et al., 2003
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Stigler, M. H., Neusel, E., & Perry, C. L. (2011) · Europe PMC (PubMed Central) · Cited by 83 · see citing works
Effects of a School-Based Prevention Program on European Adolescents' Patterns of Alcohol Use
Caria, M. P., Faggiano, F., Bellocco, R., & Galanti, M. R. (2010) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2010.06.003 · Cited by 82 · see citing works
School-Based Drug Prevention Programs: A Review of What Works
Soole, D. W., MAZEROLLE, L. G., & Rombouts, S. (2008) · Australian & New Zealand Journal of Criminology · doi:10.1375/acri.41.2.259 · Cited by 81 · see citing works
“…DeWit et al., 2000; Eisen, Zellman, Massett, & Murray, 2002; Eisen et al., 2003; Griffin, Botvin, Nichols, & Doyle, 2003; Hansen & Dusenbury, 2004; Hecht et al., 2003; McNeal, Hansen, Harrington, & Giles, 2004; Piper, Moberg & King, 2000; Scheier, Botvin, & Griffin, 2001; Schinke, Tepavac, &…”
Flay, B. R. (2009) · Tobacco Induced Diseases · doi:10.1186/1617-9625-5-7 · Cited by 79 · see citing works
Kulis, S., Hodge, D. R., Ayers, S. L., Brown, E. F., & Marsiglia, F. F. (2012) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2012.670338 · Cited by 78 · see citing works
Self-citationCaputi, T. L., & McLellan, A. T. (2016) · Drugs Education Prevention and Policy · doi:10.1080/09687637.2016.1208731 · Cited by 77 · see citing works
“The programme was developed specifically for a Hispanic audience (Gosin, Marsiglia, & Hecht, 2003; Hecht et al., 2003), and there is evidence that a Hispanic adaptation of KiR is effective with a predominantly Hispanic audience, as expected.”
BackgroundInfluentialElek, E., Wagstaff, D., & Hecht, M. (2010) · Journal of Drug Education · doi:10.2190/de.40.1.e · Cited by 69 · see citing works
“The positive substance use expectancies scale consisted of an average of three reverse-scored items adapted from Hansen and Graham (1991) and Hecht et al. (2003): “Drinking alcohol makes parties more fun,” “Smoking cigarettes makes people less nervous,” and “Smoking marijuana makes it easier to be…”
BackgroundMethodResultInfluentialSelf-citationAcculturation Status and Substance Use Prevention with Mexican and Mexican-American Youth
Marsiglia, F. F., Kulis, S., Wagstaff, D. A., Elek, E., & Dran, D. (2005) · Journal of Social Work Practice in the Addictions · doi:10.1300/j160v5n01_05 · Cited by 76 · see citing works
“…the pretest and posttest, students in the control condition participated in the existing substance use prevention programs chosen and instituted by their school or school district personnel to meet state mandates for prevention programming (see Hecht et al., 2003, for more detailed information).”
MethodSelf-citationPlanned Missing Data Designs in Educational Psychology Research
Rhemtulla, M., & Hancock, G. R. (2016) · Educational Psychologist · doi:10.1080/00461520.2016.1208094 · Cited by 75 · see citing works
“Several longitudinal studies have implemented multiform designs within one or more measurement occasions (e.g., Conrad-Hiebner, Schoemann, Counts, & Chang, 2015; Flay, Graumlich, Segawa, Burns, & Holliday, 2004; Hecht et al., 2003; Lin, Crnic, Luecken, & Gonzales, 2014).”
BackgroundCochrane Review: Universal school‐based prevention programs for alcohol misuse in young people
Foxcroft, D. R., & Tsertsvadze, A. (2012) · Evidence-Based Child Health: A Cochrane Review Journal · doi:10.1002/ebch.1829 · Cited by 87 · see citing works
Franklin, C., Kim, J. S., Beretvas, S. N., Zhang, A., Guz, S., Park, S., Montgomery, K. L., Chung, S., & Maynard, B. R. (2017) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-017-0235-4 · Cited by 73 · see citing works
Reducing substance use during adolescence: a translational framework for prevention
Stanis, J. J., & Andersen, S. L. (2014) · Psychopharmacology · doi:10.1007/s00213-013-3393-1 · Cited by 69 · see citing works
Primary Prevention of Cannabis Use: A Systematic Review of Randomized Controlled Trials
Norberg, M. M., Kezelman, S., & Lim-Howe, N. (2013) · PLoS ONE · doi:10.1371/journal.pone.0053187 · Cited by 68 · see citing works
Parsai, M., Castro, F. G., Marsiglia, F. F., Harthun, M. L., & Valdez, H. (2010) · Prevention Science · doi:10.1007/s11121-010-0188-z · Cited by 68 · see citing works
“However, despite demonstrated program efficacy (Hecht et al. 2003; Marsiglia et al. 2005), the Arizona-based developers in partnership with parents, students, teachers, and school principals and superintendents (community partners, stakeholders and key informants who participated in the development…”
BackgroundSelf-citationThe intersection of men's sexual violence perpetration and sexual risk behavior: A literature review
Davis, K. C., Neilson, E. C., Wegner, R., & Danube, C. L. (2018) · Aggression and Violent Behavior · doi:10.1016/j.avb.2018.04.001 · Cited by 68 · see citing works
“…program participants and stakeholders who can represent the community’s concerns be developed to ensure the mechanisms of action are delivered with fidelity and enhanced through adaptation to the needs of the community (Donovan, Daley, Brigham, Hodgkins, Perl, & Floyd, 2011; Hecht et al., 2003).”
BackgroundThe Cambridge Handbook of Substance and Behavioral Addictions
Sussman, S. Y. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591 · Cited by 63 · see citing works
Substance abuse prevention intervention research with Hispanic populations
Castro, F. G., Barrera, M., Pantin, H. M., Martínez, C. R., Félix‐Ortiz, M., Rios, R., López, V., & Lopez, C. (2006) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2006.05.005 · Cited by 64 · see citing works
How prevention curricula are taught under real‐world conditions
Miller-Day, M. A., Pettigrew, J., Hecht, M. L., Shin, Y., Graham, J., & Krieger, J. L. R. (2013) · Health Education · doi:10.1108/09654281311329259 · Cited by 66 · see citing works
“Indeed, many prevention programs are not developed with cultural diversity in mind (Hecht et al., 2003) and, so, may require adaptation for different cultural audiences.”
BackgroundSelf-citationParsai, M., Marsiglia, F. F., & Kulis, S. (2008) · The British Journal of Social Work · doi:10.1093/bjsw/bcn100 · Cited by 62 · see citing works
Self-citationDixon, A. L., Yabiku, S. T., Okamoto, S. K., Tann, S. S., Marsiglia, F. F., Kulis, S., & Burke, A. M. (2007) · The Journal of Primary Prevention · doi:10.1007/s10935-007-0114-8 · Cited by 62 · see citing works
“The cultural specificity of the program components is based on prior research, which found ethnic differences in common communication styles, competencies, and norms (Hecht and Ribeau 1984; Hecht et al. 1990) and drug use contexts (Gosin et al. 2003).”
BackgroundSelf-citationJumper-Reeves, L., Dustman, P. A., Harthun, M. L., Kulis, S., & Brown, E. F. (2014) · Prevention Science · doi:10.1007/s11121-012-0361-7 · Cited by 61 · see citing works
“The process utilized their expertise in a systematic cultural adaptation of an existing national model prevention curriculum, with the objective of increasing its applicability for Native adolescents (Hecht et al. 2003).”
MethodSelf-citationMarsiglia, F. F., Kulis, S., Yabiku, S. T., Nieri, T. A., & Coleman, E. (2010) · Prevention Science · doi:10.1007/s11121-010-0189-y · Cited by 59 · see citing works
“These findings confirm earlier findings on the effectiveness of keepin’ it REAL from its original RCT with middle school students (Hecht et al. 2003; Kulis et al. 2005).”
ResultSelf-citationParra‐Cardona, R., López‐Zerón, G., Leija, S. G., Maas, M. K., Villa, M., Zamudio, E., Arredondo, M., Yeh, H., & Domenech Rodríguez, M. M. (2019) · Family Process · doi:10.1111/famp.12381 · Cited by 60 · see citing works
“…these challenges, exemplar culturally relevant family-based prevention programs have been developed to benefit low-income Latino/a populations (Gonzales et al., 2012; Hecht et al., 2003; Kumpfer & Alvarado, 2003; Martinez & Eddy, 2005; Prado et al., 2007; Smokowski, David-Ferdon, & Bacallao, 2009).”
BackgroundBody Image, Acculturation, and Substance Abuse Among Boys and Girls in the Southwest
Nieri, T. A., Kulis, S., Keith, V. M., & Hurdle, D. E. (2005) · The American Journal of Drug and Alcohol Abuse · doi:10.1081/ada-200068418 · Cited by 60 · see citing works
“Data came from 3,563 eighth grade students completing the final wave of data collection (Spring 2000) in a 2-year, 4-wave drug prevention study in a large southwestern city (43).”
BackgroundSelf-citationHarthun, M. L., Dustman, P. A., Reeves, L. J., Marsiglia, F. F., & Hecht, M. L. (2009) · PubMed · Cited by 55 · see citing works
Self-citationPsychosocial Mediators of the Impact of Acculturation on Adolescent Substance Abuse
Saint‐Jean, G., Martínez, C. A. A., & Crandall, L. A. (2007) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-007-9060-z · Cited by 54 · see citing works
Liu, X., Guo, Y.-X., & Wang, X. (2023) · World Journal of Psychiatry · doi:10.5498/wjp.v13.i7.409 · Cited by 54 · see citing works
Cultural accommodation of the Strengthening Families Programme 10-14: UK Phase I study
Allen, D., Coombes, L., & FOXCROFT, D. R. (2006) · Health Education Research · doi:10.1093/her/cyl122 · Cited by 54 · see citing works
Voisine, S., Parsai, M., Marsiglia, F. F., Kulis, S., & Nieri, T. A. (2008) · Families in Society The Journal of Contemporary Social Services · doi:10.1606/1044-3894.3742 · Cited by 53 · see citing works
Self-citationLatent class analysis of substance use among adolescents presenting to urban primary care clinics
Bohnert, K. M., Walton, M. A., Resko, S. M., Barry, K., Chermack, S. T., Zucker, R. A., Zimmerman, M. A., Booth, B. M., & Blow, F. C. (2013) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2013.844821 · Cited by 53 · see citing works
Elek, E., Harris, S. L., Squire, C. M., Margolis, M. A., Weber, M. K., Dang, E. P., & Mitchell, B. (2013) · American Journal of Health Education · doi:10.1080/19325037.2013.768906 · Cited by 53 · see citing works
Self-citationWarren, J. R., Hecht, M. L., Wagstaff, D. A., Elek, E., Ndiaye, K., Dustman, P. A., & Marsiglia, F. F. (2006) · Journal of Applied Communication Research · doi:10.1080/00909880600574153 · Cited by 53 · see citing works
“Previous research has demonstrated its overall efficacy (Hecht et al., 2003).”
BackgroundMethodInfluentialSelf-citationHecht, M. L., Elek, E., Wagstaff, D. A., Kam, J. A., Marsiglia, F. F., Dustman, P. A., Reeves, L. J., & Harthun, M. L. (2008) · Journal of Drug Education · doi:10.2190/de.38.3.c · Cited by 51 · see citing works
“The analyses test the following hypothesis: When compared to students in the control condition, 5th grade students receiving the new keepin’ it REAL multicultural curriculum will experience: 1) a greater increase in refusal self-efficacy and the use of resistance strategies and decision-making skills; 2) less increase…”
BackgroundMethodInfluentialSelf-citationKulis, S., Yabiku, S. T., Marsiglia, F. F., Nieri, T. A., & Crossman, A. (2007) · Journal of Drug Education · doi:10.2190/c467-16t1-hv11-3v80 · Cited by 50 · see citing works
Self-citationReed, D. D., Naudé, G. P., Gelino, B. W., & Amlung, M. T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.011 · Cited by 48 · see citing works
Making Drug and Alcohol Prevention Relevant
Steiker, L. K. H. (2008) · Family & Community Health · doi:10.1097/01.fch.0000304018.13255.f6 · Cited by 48 · see citing works
A Meta-analysis of the Effectiveness of Interactive Middle School Cannabis Prevention Programs
Lize, S. E., Iachini, A. L., Tang, W., Tucker, J. A., Seay, K. D., Clone, S., DeHART, D. D., & Browne, T. A. (2016) · Prevention Science · doi:10.1007/s11121-016-0723-7 · Cited by 49 · see citing works
Strategic Directions in Preventive Intervention Research to Advance Health Equity
Boyd, R. C., Castro, F. G., Finigan‐Carr, N., Okamoto, S. K., Barlow, A., Kim, B. E., Lambert, S. F., Lloyd, J. J., Zhang, X., Barksdale, C. L., et al. (2022) · Prevention Science · doi:10.1007/s11121-022-01462-5 · Cited by 50 · see citing works
“The most established example is the original keepin’ it REAL drug use refusal skills training adapted for Mexican/ Mexican American youth in the Southwest (Hecht et al., 2003).”
BackgroundYabiku, S. T., Marsiglia, F. F., Kulis, S., Parsai, M., Becerra, D., & Del‐Colle, M. (2010) · Substance Use & Misuse · doi:10.3109/10826081003728256 · Cited by 48 · see citing works
“The dependent variables are measures of recent substance use that were developmentally appropriate for this age group as shown in other studies (Flannery, Vazsonyi, Torquati, and Fridrich, 1994; Hecht et al., 2003; Kandel and Wu, 1995).”
MethodSelf-citationSnijder, M., Stapinski, L. A., Lees, B., Ward, J. S., Conrod, P., Mushquash, C. J., Belone, L., Champion, K. E., Chapman, C., Teesson, M., et al. (2019) · Prevention Science · doi:10.1007/s11121-019-01038-w · Cited by 51 · see citing works
Kulis, S. S., Ayers, S. L., & Harthun, M. L. (2017) · The Journal of Primary Prevention · doi:10.1007/s10935-016-0461-4 · Cited by 47 · see citing works
“…with over 6000 middle school students demonstrated the efficacy of kiR in preventing substance use and strengthening antidrug norms and attitudes (Hecht et al., 2003; Kulis, Nieri, Yabiku, Stromwall, & Marsiglia, 2007; Kulis, Yabiku, Marsiglia, Nieri, & Crossman, 2007; Marsiglia, Kulis, Yabiku,…”
BackgroundMethodInfluentialSelf-citationThe Prevention and Treatment of Gambling Disorders: Some Art, Some Science
Derevensky, J. L. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.024 · Cited by 45 · see citing works
Okamoto, S. K., Helm, S., Pel, S., McClain, L. L., Hill, A. P., & Hayashida, J. K. P. (2012) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-012-9304-0 · Cited by 46 · see citing works
Okamoto, S. K., Kulis, S., Helm, S., Chin, S. K., Hata, J., Hata, E., & Lee, A. (2019) · Asian American Journal of Psychology · doi:10.1037/aap0000164 · Cited by 46 · see citing works
“For example, Hecht et al. (2003) found that alcohol, cigarette, and marijuana use increased in both the intervention and control Asian Am J Psychol.”
InfluentialSelf-citationConsidering the Overlap and Nonoverlap of Compulsivity, Impulsivity, and Addiction
Blum, A. W., & Grant, J. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.038 · Cited by 44 · see citing works
Neurobiological Foundations of Behavioral Addictions
Vaccaro, A. G., & Potenza, M. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.016 · Cited by 45 · see citing works
Neurobiology of Substance Addictions
Christie, N. C., & Bechara, A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.015 · Cited by 44 · see citing works
Sensitization of Incentive Salience and the Transition to Addiction
Warlow, S. M., Baumgartner, H. M., Freeland, C. M., Naffziger, E. E., Olney, J. J., Berridge, K. C., & Robinson, M. J. F. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.006 · Cited by 45 · see citing works
Marsiglia, F. F., Ayers, S. L., Baldwin‐White, A., & Booth, J. M. (2015) · Prevention Science · doi:10.1007/s11121-015-0574-7 · Cited by 45 · see citing works
“This can be compared with the original kiR study in which youth who participated in the intervention reported significantly less alcohol use at the end of 8th grade and less cigarette use at earlier waves when compared with the control group (Hecht et al. 2003; Kulis et al. 2005).”
InfluentialSelf-citationShin, Y., Miller-Day, M., Hecht, M., & Krieger, J. L. (2017) · Health Communication · doi:10.1080/10410236.2017.1321163 · Cited by 47 · see citing works
“The original version of kiR has proved to be effective in reducing substance use (Hecht et al., 2003; 2006).”
BackgroundSelf-citationMindfulness-Based Interventions Applied to Addiction Treatments
Kechter, A., & Black, D. S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.040 · Cited by 43 · see citing works
Multiple Memory Systems, Addiction, and Health Habits: New Routes for Translational Science
Stacy, A. W., Pike, J. R., & Lee, A. Y. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.017 · Cited by 43 · see citing works
Tanning as an Addiction: The State of the Research and Implications for Intervention
Miller, K. A., & Mays, D. M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.037 · Cited by 43 · see citing works
Schulte, E. M., Schiestl, E. T., & Gearhardt, A. N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.035 · Cited by 43 · see citing works
Behavioral Economics and Addictive Disorders
Jarmolowicz, D. P., & Schneider, T. D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.005 · Cited by 42 · see citing works
Prevention and Treatment of Compulsive Buying Disorder
Galimov, A., & Black, D. W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.027 · Cited by 42 · see citing works
Blum, K., Roy, A. K., Podesta, A., Modestino, E. J., Steinberg, B., Gondré-Lewis, M. C., Baron, D. A., Thanos, P. K., Lott, L., Badgaiyan, S., et al. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.031 · Cited by 42 · see citing works
Prevention and Treatment of “Food Addiction”
Davis, C., & Mason, A. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.023 · Cited by 42 · see citing works
Human Neurobiological Approaches to Hedonically Motivated Behaviors
Burger, K. S., Shearrer, G. E., & Sadler, J. R. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108632591.009 · Cited by 42 · see citing works
- Authors
- Hecht, M. L., Marsiglia, F. F., Elek, E., Wagstaff, D. A., Kulis, S., Dustman, P., & Miller-Day, M.
- Affiliations
- Pennsylvania State University (US)
- Arizona State University (US)
- Corresponding author
- Hecht, Michael L.
- Venue
- Prevention Science
- Published
- 2003-12
- Volume
- 4
- Issue
- 4
- Pages
- 233-248
- ISSN
- 1389-4986 (ISSN-L)
- 1573-6695
- OpenAlex
- W1577230560
- Cited by
- 383
- References
- 69
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 7 · 2023: 11 · 2022: 17 · 2021: 7 · 2020: 48 · 2019: 16 · 2018: 16 · 2017: 16 · 2016: 22 · 2015: 14 · 2014: 15 · 2013: 26 · 2012: 20
- FWCI
- 5.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Prevention Science (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention
- National Institute on Drug Abuse (R01 DA 05629, R01DA005629)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Demography › Youth, Drugs, and Violence
- Social Sciences › Sociology and Political Science › Crime Patterns and Interventions
- Keywords
- substance use prevention, cultural grounding, Mexican American students, African American students, European American students, junior high school students, resistance strategies, social skills, media campaigns, multicultural curriculum
- MeSH terms
- Adolescent, Culture, Curriculum, Ethnicity, Health Education, Humans, Surveys and Questionnaires, School Health Services, United States, Program Evaluation, Substance-Related Disorders, Self Efficacy
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