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Culturally Grounded Drug Abuse Prevention Research

Culturally Grounded Drug Abuse Prevention Research. Flavio F. Marsiglia, Ph.D., Director Southwest Interdisciplinary Research Consortium (SIRC) School of Social Work - Arizona State University Substance Abuse Research Development Program School of Social Work University of Texas – Austin

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Culturally Grounded Drug Abuse Prevention Research

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  1. Culturally GroundedDrug Abuse Prevention Research Flavio F. Marsiglia, Ph.D., Director Southwest Interdisciplinary Research Consortium (SIRC) School of Social Work - Arizona State University Substance Abuse Research Development Program School of Social Work University of Texas – Austin February 21, 2003

  2. keepin’itR.E.A.L. Keepin’it R.E.A.L. is a product of the Drug Resistance Strategies project, a collaboration between Arizona State University & Pennsylvania State University Funded by the National Institutes of Health/ National Institute on Drug Abuse

  3. keepin’it R.E.A.L. • Context & Rationale • Conceptual Foundations • Implementation of the Program • Methodology and Study Design • Results & Follow-up Research • Infrastructure development

  4. Context: The State of Arizona • Demographic profile • The borderlands • Immigration • Tribal communities (N=21) • Demographic explosion California Phoenix, AZ Mexico

  5. Context: 30% Latino • Immigration • South-Central Phoenix • Residential segregation • Acculturation

  6. ProgramRationale Builds a prevention program around the cultural strengths & communication styles of youth who do not use drugs • Importance of culture in youth substance use and prevention models should reflect culture and learning styles of the students • An alternative to standard prevention messages enforcing dominant cultural values and relying on stereotypical representations of culture and ethnicity

  7. Theoretical Foundation • Ecological risk and resiliency approach to prevention and intervention (Bogenschneider) • Beyond medical and socioeconomic conceptions of risk • Ethnicity and culture as important social contexts that moderate risk behaviors and build resiliency against them • Communication competencey theory. Knowledge+motivation+skills needed to resist social influence • Narrative theory Narratives as primary means of sense making, frame for moral choices, organizing principle for human behavior • Demonstrated success as basis for youth prevention (Botvin)

  8. keepin’ it R.E.A.L. • Drug Resistance Strategies Project, Phoenix middle schools • Relies on cultural strengths & communication styles of youth • Videos scripted and filmed by Phoenix high school students • Three interventions: Mexican American, White/African American, & Multicultural • Uses narrative and performance framework to teach life skills • 10 lessons over 10 weeks illustrate drug resistance skills and motives based on specific cultural norms

  9. Resistance Strategies (R.E.A.L.) Refuse Explain Avoid Leave

  10. Goals of keepin’it R.E.A.L. • Enhance identification with models of drug resistance • Reduce substance use (alcohol, cigarettes, marijuana) • Promote more conservative drug norms and attitudes • Develop effective drug resistance decision making and communication skills

  11. Sampling Design • 35 Phoenix middle schools stratified based on size and ethnicity (% Latino); 10 different school districts across city • Schools randomly assigned to 4 conditions: Mexican American, White/African American, Multicultural,Control • Respondents of all ethnicities from schools in each condition • All 7th grade classes completed questionnaires in Fall 1998 (pretest)

  12. keepin’itR.E.A.L. timetable

  13. Respondents Profile at T-1 • 53% Mexican American • 18% Non-Hispanic White • 8% African American • 16% Multi-ethnic or Other Latino • 49% female • Average age: 12.5 • SES: 73% received free and • 9% reduced price school lunch

  14. 4 waves of survey data collection • Pre-Test (T1) 4,224 7th Graders (Nov. 1998) • Curriculum Implementation: January-March 1999 • 1st (immediate) Post-test (T2) 3,986 7th Graders (April 1999) • 2nd (6 month) Post-test (T3) 3,742 8th Graders (Nov. 1999) • 3rd (12 month) Post-Test (T4) 3,980 8th Graders (Apr. 2000) • Analysis uses students matched at T1T2, T1T3, and T1T4 (match rates of 58%-62%) • Current analysis uses only Mexican American, non-Hispanic White, and African American respondents (2001-2003).

  15. Research Design • Fall Spring Fall Spring • 1998 1999 1999 2000 • Mexican O1 X1 O2 B O3 B O4 • White/Af.Am. O1 X2 O2 B O3 B O4 • Multicultural O1 X3 O2 B O3 B O4 • Control O1 O2 O3 O4 • Key: O = Observations; X = Treatment; B = Boosters • O1 = Pretest; X1 = Mexican Version; O2-4 = Posttests • X2 = White/African Am. Version X3 = Multicultural Version

  16. Program Effectiveness:Key Hypotheses • Compared to control group, students experiencing the drug resistance curriculum will report less current substance use and stronger anti-drug norms and intentions. • Program will be most effective for students receiving the drug resistance curriculum specifically developed for their cultural group (cultural matching).

  17. Methodology • Longitudinal design: students matched in pre-test before curriculum (T1), to post-tests immediately after curriculum(T2), 6 months later (T3), and 12 months (T4) • Students participating in 3 versions of curriculum (Mexican, White/African Am., Multicultural) contrasted withControls • Assessed level of substance use and strength of anti-drug norms at each post-test controlling for level reported at T1. Mixed models adjust for school level effects (SAS Proc Mixed) • Missing data estimated through multiple imputation using an EM algorithm (NORM software) • Ethnographic component: semi-structured interviews and school-based participant observation

  18. Outcomes: Substance Use and Anti-Drug Norms • Recent substance use (alcohol, cigarettes, marijuana) last month • Use of R.E.A.L.drug resistance strategies • Injunctive norms (parents angry at / friends reject R’s drug use) • Personal norms: disapproval of substance use • Descriptive norms: perceived extent of classmates / friends using drugs • Self-efficacy: confidence in ability to refuse drugs • Personal intentions: intent to resist using drugs in future • Positive drug expectancies (e.g., alcohol enlivens parties)

  19. Contrasts between R.E.A.L.Intervention and Control Group, Accounting for Pre-intervention Differences

  20. Summary Results: (significant effects) • MexicanWhite/Multi- Culturally • AmericanAfr. Am.Cultural Matched VersusVersusVersus Versus • ControlControlControlMismatched • PRO-DRUG USE:T2 T3 T4T2 T3 T4T2 T3 T4 T2 T3 T4 • Recent Alcohol Use       • Recent Cigarette Use   • Recent Marijuana Use  • Descriptive Norms        • Positive Drug Expectancy       • ANTI-DRUG: • Use of R.E.A.L.Strat.         • Injunctive Norms: Parent  • Injunctive Norms: Friends        • Personal Norms       • Self Efficacy      • Personal Intentions

  21. Slowing-down drug use

  22. Program Effectiveness: Summary (I) Over time, both Mexican American and Multicultural versions had similar desired impacts Mexican American version had largest initial impact: lower alcohol use; stronger anti-drug norms; more frequent use of R.E.A.L.strategies; most effects persisted after 6 and 12 months

  23. Program Effectiveness: Summary (II) Multicultural version particularly effective 12 months after implementation: lower alcohol and marijuana use; more use of R.E.A.L.strategies to resist alcohol; stronger anti-drug norms; lowered positive substance use expectancies.

  24. Test of cultural matching between curriculum and student’s ethnicity... • ...more use of R.E.A.L. alcohol resistance strategies • ...strengthened injunctive norms (friends) • ...lowered perceptions of friends’/peers’ substance use • ...increased self efficacy (confidence to resist drugs) • But effects small, scattered, inconsistent across waves • Effectiveness of Multicultural version after 12 months suggests cultural inclusiveness may be as important as ethnic matching

  25. GENDER IDENTITY

  26. RELIGIOUS AFFILIATION

  27. Implementation: Lessons Learned • Importance of partnerships • Increased cultural awareness by teachers and principals • Professional development • Participatory Action Research

  28. Conclusions • Promising results • Significant program effects on drug norms, and use of alcohol, marijuana and tobacco • Prevention messages that are grounded on the culture of the client are more likely to have a positive impact • SAMSHA assessed it as effective and in the process of becoming a Model Program

  29. Follow-up Research • Focus on acculturation status & acculturation stress • Developmental issues: earlier implementation (5th grade) • Sequencing 5th v. 7th grade; 5th v. 5th & 7th • Ethnic and gender identity • The Monterrey-Mexico pilot

  30. Continuing Research… The Next Generation • N.I.H./N.I.D.A. R-01 grant 2001--2003 • Contextual analysis of DRS3 results • Impact on program effectiveness of… • School & neighborhood ethnic composition • Matches between teacher/implementer ethnicity ...and student ethnicity ...and curriculum version

  31. Next Generation: Influence of proportion of recent immigrants on program effectiveness: • Lower neighborhood stability (with many newcomers)? • Lower SES of neighborhood? • Stronger Mexican culture in neighborhood (traditional drug use patterns, norms)? • More family closeness, respect for parents?

  32. DRS-The Next Generation How does neighborhood “disadvantage” influence the effectiveness of a prevention curriculum? Neighborhood Disadvantage: does it act as a “sponge…” …So that those most disadvantaged “soak up” the curriculum best? OR, does it act as a “brick wall…” …“blocking” the effect of the curriculum?

  33. Next Generation: Ways that neighborhood ethnic composition might influence program effectiveness • Cultural match between predominant ethnicity of neighborhood and curriculum reinforces anti-drug-use learning. • Cultural clash between curriculum and neighborhood ethnicity fails to support anti-drug-use learning.

  34. More alcohol use reported by middle school students in neighborhoods with… • High violent crime rates (esp. among more acculturated Latinos) • Low concentrations of recent immigrants • High residential mobility rates • High concentrations of Mexican heritage residents • Last 3 especially strong for less acculturated Latinos • The neighborhood’s family structure (proportion of families headed by single mothers) has no effect

  35. INFRASTRUCTURE DEVELOPMENT: • N.I.H./N.I.D.A. R-24 grant 2002—2007 • Research support for faculty – Research Grants • 24 ASU faculty (Social Work, Sociology, Psychology, Nursing, Education, Just. Studies) • Graduate student assistantships • Mentorship, collaboration, grant development • Community partnerships • Dissemination

  36. RESEARCH AREAS: • American Indian Youth: Promoting Social Competence and Resiliency • Family Reunification Project – Drug Court • Co-occurring conditions • Homelessness drug research • Mexico/U.S.A. comparative studies

  37. Whom we serve • Arizona youth and their families • Ethnic communities of the Southwest • Community based social service agencies • Schools

  38. Thank You! For more information, visit us at: http://sirc.asu.edu

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