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Designed Cultural Adaptation and Delivery Quality in Rural Substance Use Prevention: an Effectiveness Trial for the Keepin’ it REAL Curriculum

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Abstract

This study examined how cultural adaptation and delivery quality of the school-based intervention keepin’ it REAL (kiR) influenced adolescent substance use. The goal of the study was to compare the effectiveness of the multi-cultural, urban (non-adapted) kiR intervention, a re-grounded (adapted) rural version of the kiR intervention and control condition in a new, rural setting. A total of 39 middle schools in rural communities of two states in the USA were randomly assigned to one of three conditions (i.e., control, non-adapted urban kiR, and adapted rural kiR). Data included adolescent self-reported lifetime substance use and observers’ ratings of delivery quality from video recordings of lessons. Ratings of delivery quality were used to create four comparison groups (i.e., low/high delivery quality in non-adapted/urban kiR condition and low/high quality in adapted/rural kiR condition). Controlling for substance use in the 7th grade, findings compared 9th graders’ (N = 2781) lifetime alcohol, cigarette, marijuana, and chewing tobacco use. Mixed model analyses revealed that rural youth receiving the culturally adapted/rural curriculum reported significantly less cigarette use than rural youth in the control condition regardless of delivery quality. In the non-adapted/urban condition, youth receiving high delivery quality delivery reported less marijuana use than those receiving low delivery quality condition. However, substance use outcomes of youth receiving high and low delivery quality in the non-adapted intervention did not differ significantly from those the control group. Findings support the effectiveness of the culturally adapted/rural keepin’ it REAL curriculum for rural youth.

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Funding

This article was supported by Grant Number R01DA021670 from the National Institute on Drug Abuse to The Pennsylvania State University (Michael Hecht, Principal Investigator). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. REAL Prevention LLC, 130 Pearl Brook Drive, Clifton, NJ, 07013, USA

    Michael L. Hecht & Michelle Miller-Day

  2. Hugh Downs School of Human Communication, Arizona State University, Tempe, AZ, USA

    YoungJu Shin & Jonathan Pettigrew

  3. Department of Communication Studies, Chapman University, Orange, CA, 92866, USA

    Michelle Miller-Day

  4. STEM Translational Communication Center, University of Florida, Gainesville, FL, 32611, USA

    Janice L. Krieger

  5. Department of Advertising, University of Florida, Gainesville, FL, 32611, USA

    Janice L. Krieger

  6. Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, 32611, USA

    Janice L. Krieger

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  1. Michael L. Hecht
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  2. YoungJu Shin
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  3. Jonathan Pettigrew
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  4. Michelle Miller-Day
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  5. Janice L. Krieger
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Correspondence to Michael L. Hecht.

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Conflict of Interest

The authors declare a potential financial conflict of interest. Hecht and Miller-Day are co-founders of REAL Prevention, LLC—a business dedicated to training, research, and dissemination of keepin’ it REAL and other allied health promotion programs—and hold intellectual property rights to the keepin’ it REAL curriculum. Pettigrew is a part-time consultant with REAL Prevention but was not remunerated for involvement with this project.

Ethical Approval

All study procedures involving human participants were approved by the Penn State Institutional Review Board and in accordance with standards for ethical research practice, including the 1964 Helsinki declaration and its later amendments.

Informed Consent

Participants were informed of their rights and parental informed consent coupled with youth assent was obtained prior to any data collection.

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Hecht, M.L., Shin, Y., Pettigrew, J. et al. Designed Cultural Adaptation and Delivery Quality in Rural Substance Use Prevention: an Effectiveness Trial for the Keepin’ it REAL Curriculum. Prev Sci 19, 1008–1018 (2018). https://doi.org/10.1007/s11121-018-0937-y

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