Culturally Sensitive Prevention Programs for Substance Use Outcomes Among Youth of Color: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background and Purpose: Due to discrimination and acculturative stress, people of color tend to suffer from more severe substance use-related consequences. To date, most substance use prevention programs have not been designed specifically for youth of color and do not address key cultural factors such as racial and ethnic identity, pride, acculturation, discrimination, racial socialization, and cultural values. The effects of culturally sensitive prevention programs on substance use among youth of color are unclear, including what factors moderate intervention effects. The present study uses an antiracist lens and aims to (1) synthesize the intervention effects of culturally sensitive prevention programs evaluated in randomized control trials (RCT) that examined substance use outcomes among U.S. youth of color, and (2) explore whether the treatment effects vary by participants’ characteristics and intervention characteristics.

Methods: A university librarian searched the following electronic bibliographic databases in September 2020: the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, Embase, CINAHL, Social Services Abstracts, Web of Science, and ProQuest Dissertations and Theses. The first author also searched ClinicalTrials.gov and several evidence-based practice registries. Inclusion criteria included RCTs investigating the efficacy or effectiveness of any culturally sensitive prevention programs that examined substance use outcomes (i.e., alcohol use, cigarette smoking, marijuana use, illicit drug use, and unspecified substance use) among U.S. youth of color (Asian, Black, Latinx, Multiracial, Native American Indian) adolescents between the ages of 11 and 18. Two reviewers independently conducted screening, data extraction, and risk of bias assessment (based on Cochrane’s RoB 2). Robust variance estimation in meta-regression was used to analyze treatment effect size estimates and to conduct moderator analysis.

Results: Electronic bibliographic database searching yielded 2473 records from 8 databases, and grey literature search yielded 184 additional records. After screening, 31 articles and reports representing 25 unique studies were included in the systematic review and meta-analysis. Most of the included studies had non-active control groups. Sample sizes of the included comparisons ranged from 31 to 2212. The mean age of the included studies’ participants ranged from 10.8 to 17.7. The average treatment effect size across all substance use outcomes, with 169 effect sizes from 25 studies, was d = −0.20 with a 95% confidence interval [−0.25, −0.15]. The average treatment effect size was statistically significant among programs targeting Latinx youth (d = -0.21, 95% CI = -0.26, -0.15) and Black youth (d = -0.24, 95% CI = -0.37, -0.11), but non-significant among Native American Indian youth (d = -0.12, 95% CI = -0.41, 0.16). Meta-regression found that culturally sensitive prevention programs have larger mean effect sizes on cigarette smoking than drinking outcomes (b = -0.12, SE = 0.05).

Conclusions and Implications: This meta-analysis found evidence of culturally sensitive prevention programs’ efficacy in preventing or reducing substance use outcomes among Black and Latinx youth. Findings suggest that researchers and interventionists should consider culturally sensitive approaches in substance use prevention interventions with Black and Latinx youth. More culturally sensitive substance use prevention programs and studies are needed for Asian American, Multiracial, and Native American youth.