Culturally Grounded Substance Abuse Prevention with High Risk Youth in Community Settings

Purpose: This NIDA-funded K01 consisted of mentored research in the area of culturally grounded substance abuse prevention with high risk youth in community settings (homeless youth, youth in alternative schools, GLBTQ youth at a drop-in center, incarcerated youth in day programs, and youth on the U.S.-Mexico border). This K01 research fills a gap by examining how culturally adapted curricula improve evidence-based practice and how the adaptation processes effect the participating youth. This study examined a broad definition of culture (i.e., peer, popular, and agency culture in unique settings) as it impacts drug prevention curricula. Methods: In this project, high risk youth adapted the evidence-based “Keepin' it REAL” curriculum for their peers in unique settings and cultures. The design allowed for the establishment of systematic procedures for having drug-initiated older youth adapt the curriculum (i.e. rewriting workbook scenarios and remaking videos) for their community or setting without changing the curriculum core. Results: The study process (n = 422 youth) found that by involving youth as drug and alcohol experts in the context of their culture, a prevention curriculum can be systematically tailored to include true-to-life experiences of the participating youth, making it culturally relevant and effective for their peers. In Phase II the analysis included youth (N=144) at pretest, posttest, and 1 and 3 month follow ups. Multivariate ANOVAs were performed with the Acceptance outcomes of beer/wine, liquor, and marijuana, and for the Past Month Use outcomes of beer, wine, liquor, and marijuana. Significant multivariate time*group interaction were found, Wilks' F(12, 365) = 1.93, p < .05, with significant univariate follow-up interactions for acceptance of beer/wine, F(4, 140) = 3.28, p < .05, and liquor, F(4, 140) = 2.49, p < .01. The study demonstrated a significant decrease in use for youth in the group receiving the adapted curriculum vs the no curriculum group. Follow-up pairwise comparisons showed that the original group vacillated over time, the comparison group stayed stable, and the adapted group decreased in use of wine and liquor. The past-month use analysis (which also included a significant effect of age) resulted in a significant multivariate interaction between time and group, Wilks' F(16, 116) = 2.92, p < .001, with significant univariate follow-ups for all 4 dependent variables: beer F(3.98, 129.35) = 3.95, p < .001; wine F(4.00, 130.00) = 3.82, p < .01; liquor F(3.89, 126.33) = 3.38, p < .05; marijuana F(3.17, 102.90) = 3.10, p < .05). Follow-up tests showed that, of the three groups, only the adapted group displayed consistent decreases in acceptance across all three time points. This group showed significant drops in wine and liquor, but not in beer and marijuana. The study's focus groups qualitatively supported adaptation processes to improve the curriculum. Conclusions: The act of adapting the evidence-based program for others shifts attitudes and behaviors regarding drugs and alcohol. The youth engaged in the curriculum adaptation process, serendipitously reported changes in attitudes towards drugs and alcohol and substance use. Implications of this work is discussed for substance abuse prevention.