Abstract This study focused on how a non-targeted group minority youth might or might not benefit from a prevention intervention focused on other cultural groups. The study specifically evaluated the effects of an evidence-based drug prevention curriculum with a sample of urban American Indian youth in the southwest U. S. , most of whom self-reported multi-ethnic heritages. This research examined the developmental trajectory of drug use for these youth, and compared it with the trajectory of youth from other racial/ethnic groups at pre-intervention, post-intervention, and two follow up time periods.
Results indicated that alcohol and marijuana use increased from pre-intervention across subsequent time periods for all youth. The drug use of the American Indian youth in the treatment group increased on certain measures. They reported a steeper trajectory in the amount and frequency of alcohol and marijuana use compared to the youths in the treatment groups with other racial/ethnic identifications. Implications of these findings for the development of culturally grounded prevention programs for multi-ethnic, urban American Indian youth are discussed.
Culturally specific, school-based drug prevention programs have been receiving increased attention in recent years. These programs are based on the premise that infusing youths’ culture into the content and format of the prevention message will reduce adolescent drug use (Kandel 1995). One such program, Keepin’ it R. E. A. L. , has achieved this by creating the curriculum from the developmental and cultural realities of Mexican American youth from the southwest United States (Gosin et al. 2003).
To date, the program has been developed for and evaluated with primarily Mexican American youth (Kulis et al. 2005). Research has assessed the differences in program effectiveness by acculturation level among Mexican/Mexican Americans (Marsiglia et al. 2005) but has not closely examined the residual effects of this program among other minority youth populations (i. e. , the program’s effects on non-targeted minority youth populations). In what ways might this program impact the drug use of minority youth who are not Mexican American?
How might these effects compare with the treatment effects of the program for Mexican American and European American youth? Drug Prevention Programming for American Indian Youth There have been substantial efforts in recent years toward the development of drug prevention programs focused on American Indian youth. For example, Marlatt et al. (2003) described the development of the Journeys of the Circle Project, which is a culturally congruent life skills course targeted toward Northwestern American Indian youth. Similarly, Schinke et al.
(2000) implemented and evaluated a culturally tailored life skills intervention with American Indian youth from 10 reservations in North and South Dakota, Idaho, Montana, and Oklahoma. Aside from the research conducted by Schinke and colleagues, however, the majority of prevention efforts with American Indian youth have not been rigorously evaluated for efficacy (Beauvais and Trimble 2003; Hawkins et al. 2004). Beauvais and Trimble stated that most of the prevention research with American Indian youth has focused largely on “commentary and recommendations and not on the science of prevention” (p. 397).
However, while there are relatively few evaluation studies focused specifically on drug use and American Indian youth, there have been ongoing efforts related to culturally specific drug prevention programs for minority youth in general. Related to this research is the debate as to whether prevention programs need to be culturally “grounded,” that is, developed from the cultural values and variability inherent within each culture, or if they can be culturally “adapted,” that is, modified from universal prevention programs originally developed for non-Hispanic European American populations (Hecht et al.2003).
Each of these approaches has implications toward the fidelity and fit of prevention interventions (Castro et al. 2004). Further, culturally focused prevention curricula range in ethnic specificity; some are highly specific (e. g. , Hecht et al. 2003) while others are more broadly targeted for “minority” youth (e. g. , Botvin et al. 1997). In sum, there is much left to learn about the degree of cultural specificity required for positive prevention effects with minority youth.
The Keepin’ it R. E. A. L. Curriculum Keepin’ it R. E. A. L. is a culturally grounded, video-enhanced prevention intervention that was developed and normed from the narratives of Latino, African American, and Euro American youth (Gosin et al. 2003), and validated with teacher and student feedback (Gosin et al. 2003. ; Harthun et al. 2002). It has been identified as a “Model Program” by Substance Abuse and Mental Health Services Administration (SAMHSA; U. S. Department of Health and Human Services [DHHS] n. d. ), which is a designation given by the organization to effective programs that have been evaluated using “rigorous” standards of research.
The 10-lesson curriculum was designed for use with middle school students (6th, 7th, and 8th graders), and draws from a variety of theoretical frameworks, such as communication competence theory (Spitzberg and Cupach 1984) and ecological risk and resiliency theory (Bogenschneider 1996). The curriculum situates these frameworks within the unique geographic and cultural contexts of Latino, African American, and European American youth in the southwest United States. The primary focus of the program is on teaching drug resistance skills using four strategies: refuse, explain, avoid, and leave (Hecht et al.2003).
“Refuse” consists of statements of saying “no” to substance use offers, while “explain” consists of more elaborate reasons for refusing these offers. “Avoid” refers to avoiding situations where drugs and alcohol might be present, and “leave” refers to leaving the environment once the youth encounters substance use (Hecht et al. 2003). 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).
Based on this research, three versions of the curriculum have been developed: 1) A Latino version, which primarily reflects Mexican American and Mexican values (e. g. , familismo, or family orientation), 2) A Non-Latino version, grounded primarily in European American and African American values, and 3) A Multicultural version, which combines half of the lessons from the Latino version and half of the lessons from the non-Latino version (Hecht et al.2003; Kulis et al. 2005).
An example of an objective from the Latino version of the curriculum is for the student to “recognize what he/she does affects his/her community, group, and family,” while an objective from the Non-Latino version is for the student to “recognize what he/she does may have favorable or unfavorable consequences on his/her own future goals” (Gosin et al. 2003, p. 128).
The in-class curriculum was supplemented with a media campaign, consisting of television, radio, and billboard advertisements that reinforced the four strategies (refuse, explain, avoid, and leave) and follow-up booster activities such as school assemblies, poster projects, murals, and essay contests (Kulis et al. 2005). Research evaluating the curriculum found that the use of alcohol, cigarettes, and marijuana increased over time for students who received any version of the intervention and students in the control group; however, the increase was significantly less for students in the intervention group (Hecht et al.
2003). This effect was particularly salient for alcohol use (Gosin et al. 2003; Hecht et al. 2003). Further, the intervention students perceived significantly smaller increases in their peers’ substance use compared with those in the control group (DHHS n. d. ; Hecht et al. 2003). Past research suggests differential effects of each version of the program, with the Latino and Multicultural versions of the intervention providing more benefits to Mexican/Mexican American students (Gosin et al.2003; Kulis et al. 2005) and the overall sample (Hecht et al. 2003).
However, while versions of the curriculum that incorporated aspects of culture (the Latino and Multicultural Versions) were found to impact a wider array of substance use and attitudinal outcomes in the desirable direction than did the Non-Latino version, tests of strict cultural matching of program content with the students’ racial/ethnic backgrounds did not produce statistically significant differences (Hecht et al.2003; Kulis et al. 2005).
In other words, these studies did not find that Mexican/Mexican American students receiving the Latino version of the curriculum demonstrated better overall outcomes than those receiving other versions of the curriculum. This finding is significant, because it provides support for prevention programs that broadly target “minority” youth, rather than those that are ethnic-specific.
Subsequently, the strength of culturally grounded prevention programs may lie in their ability to reflect regionally-specific multicultural environments, rather than specific ethnic groups. In order to examine this hypothesis, we chose to examine the program’s efficacy with another predominant minority cultural group in the southwest U. S. To date, no studies of Keepin’ it R. E. A. L. have examined the residual effects of the program among youth who were not Latino, African American, or Euro American.
Perhaps this program’s strength lies in its ability to integrate multiculturalism into drug prevention, defined as the inclusion of cultural values from all groups participating in the prevention program (Green 1999), rather than its cultural specificity related to drug use prevention. Therefore, the purpose of this study was to examine the impact of the curriculum on urban American Indian youth of the southwest in order to examine this hypothesis more closely. The study presented here involved a reanalysis of data that was previously reported (Gosin et al.2003; Hecht et al. 2003; Kulis, et al. 2005; Marsiglia et al. 2005).
However, this study differs from previous studies because it tests the generalizability of the culturally enhanced versions of the curriculum with American Indian youth. This is accomplished through the use of growth curve modeling to examine the developmental trajectory of drug use among youth who participated in Keepin’ it R. E. A. L. While previous evaluations of the Keepin’ it R. E. A. L. curriculum support its efficacy with specific groups of racial/ethnic adolescents (Hecht et al. 2003; Kulis et al.2005; Marsiglia et al. 2005), the current study suggests that the program may have limited effectiveness in curbing the drug use of American Indian youth.
Despite the current study’s limitations, our findings have implications for the development of culturally grounded prevention programs in schools, reservation, and non-reservation communities for American Indian youth and for other minority youth populations. Our findings suggest that American Indian youth may require drug prevention curricula that are specific to their developmental and cultural realities.
In order to effectively address drug use among American Indian youth, prevention researchers and specialists may need to focus on creating and/or modifying drug prevention programs in order to address the daily traditions, cultures, and values of American Indian youth. References 1. Beauvais, F. , & Trimble, J. E. (Beauvais, F. , & Trimble, J. E. (2003). The effectiveness of alcohol and drug abuse prevention among American-Indian youth. In Z. Sloboda & W. J. Bukoski (Eds. ), Handbook of drug abuse prevention: Theory, science, and practice (pp. 393-410). New York: Kluwer. 2. Botvin, G. J. , Epstein, J. A. , Baker, E., Diaz, T. , & Ifill-Williams, M. (1997).
School-based drug abuse prevention with inner-city minority youth. Journal of Child & Adolescent Substance Abuse, 6, 5-19. 3. Castro, F. G. , Barrera, M. , & Martinez, C. R. (2004). The cultural adaptation of prevention interventions: Resolving tensions between fidelity and fit. Prevention Science, 5, 41-45. 4. Hecht, M. L. , Marsiglia, F. F. , Elek, E. , Wagstaff, D. A. , Kulis, S. , Dustman, P. , & Miller-Day, M. (2003). Culturally grounded substance use prevention: An evaluation of the keepin’ it R. E. A. L. curriculum. Prevention Science, 4, 233-248. 5. Kandel, D. B. (1995).
Ethnic differences in drug use: Patterns, paradoxes. In G. J. Botvin, S. Schinke, & M. A. Orlandi (Eds. ), Drug abuse prevention with multiethnic youth (pp. 81-104). Thousand Oaks: Sage. 6. Gosin, M. , Marsiglia, F. F. , & Hecht, M. L. (2003). keepin’it R. E. A. L. : A drug resistance curriculum tailored to the strengths and needs of pre-adolescents of the southwest. Journal of Drug Education, 33, 119-142. 7. Kulis, S. , Marsiglia, F. F. , Elek, E. , Dustman, P. , Wagstaff, D. A. , & Hecht, M. L. (2005). Mexican/Mexican American adolescents and keepin’ in R. E. A. L. : An evidence-based, substance use prevention program.
Children and Schools, 27, 133-145. 8. Marlatt, G. A. , Larimer, M. E. , Mail, P. D. , Hawkins, E. H. , Cummins, L. H. , Blume, A. W. , et al. (2003). Journeys of the circle: A culturally congruent life skills intervention for adolescent Indian drinking. Alcoholism: Clinical and Experimental Research, 27, 1-3. 9. Schinke, S. P. , Orlandi, M. A. , Botvin, G. J. , Gilchrist, L. D. , Trimble, J. E. , & Locklear, V. S. (1988). Preventing substance abuse among American Indian adolescents: A bicultural competence skills approach. Journal of Counseling Psychology, 35, 87-90. 1. 1. Beauvais, F. , & Trimble, J. E.
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