Abstract
Sharp increases in substance use rates among youth and the lack of evidence-based prevention interventions in Mexico are a major concern. A team of investigators from Mexico and the USA are actively addressing this gap by culturally adapting keepin’ it REAL (kiR)—a former US SAMHSA model program—for Mexico. This paper reports on the processes and outcomes of the cultural adaptation of kiR for adolescents in Mexico. Multiple forms of data informed this cultural adaptation, including focus groups with students about gendered and violence experiences with substance use, feedback from teachers who previously implemented the original versions of kiR, lesson fidelity observations, and external expert reviews. The culturally adapted version of kiR integrates Ecological Validity and Cultural Sensitivity Models in the adaptation process. The process encompassed surface structure adaptations, like updating language, graphics, and videos, as well as deep structure adaptation components including cultural norms, attitudes, and beliefs salient among Mexican adolescents. Youth reported receiving alcohol offers from family members, links between substance use and violence, and that shifting gender norms result in more females initiating substance use offers. In adapted kiR activities, students practice navigating substance use offers in these contexts. This approach to cultural adaptation led to a true collaborative between investigators in two countries. This study advances knowledge about how to undertake cultural adaptations of efficacious US-based prevention programs in international settings.
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Baker, J. A. (2013). Perception and intent define the reality, but criminal violence in Mexico has metastasize. Retrieved from http://blog.chron.com/bakerblog/2013/10/perception-and-intent-define-the-reality-but-criminal-violence-in-mexico-has-metastasized/.
Bender, M. S., & Clarke, M. J. (2011). Cultural adaptation for ethnic diversity: A review of obesity interventions for preschool children. Californian Journal of Health Promotion, 9, 40.
Berends, L., & Johnston, J. (2005). Using multiple coders to enhance qualitative analysis: The case of interviews with consumers of drug treatment. Addiction Research & Theory, 13, 373–381.
Bernal, G., Bonilla, J., & Bellido, C. (1995). Ecological validity and cultural sensitivity for outcome research: Issues for cultural adaptation and development of psychosocial treatments with Hispanics. Journal of Abnormal Child Psychology, 23, 67–82.
Bernal, G., Jiménez-Chafey, M. I., & Rodríguez, M. M. D. (2009). Cultural adaptation of treatments: A resource for considering culture in evidence-based practice. Professional Psychology: Research and Practice, 40, 361–368.
Calderón, L., Ferreira, O. R., & Shirk, D. A. (2018). Drug violence in Mexico: Data and analysis through 2018. San Diego, CA: University of San Diego.
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.
Cho, J. Y., & Lee, E. H. (2014). Reducing confusion about grounded theory and qualitative content analysis: Similarities and differences. The Qualitative Report, 19, 1–20.
Escoffery, C., Lebow-Skelley, E., Udelson, H., Böing, E., Wood, R., Fernandez, M., & Mullen, P. (2019). A scoping study of frameworks for adapting public health evidence-based interventions. Translational Behavioral Medicine, 9, 1–10.
Gosin, M., Marsiglia, F. F., & Hecht, M. L. (2003). Keepin’ it REAL: A drug resistance curriculum tailored to the strengths and needs of pre-adolescents of the southwest. Journal of Drug Education, 33, 119–142.
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 REAL curriculum. Prevention Science, 4, 233–248.
Instituto Nacional de Estadística y Geografía. (2014). Encuesta Nacional de la Dinámica Demográfica 2014. Table 1. Composición y estructura de la población. Retrieved from http://www.beta.inegi.org.mx/proyectos/enchogares/especiales/enadid/2014/default.html.
Instituto Nacional de Salud Pública. (2008). Encuesta Nacional de Adicciones 2008. México: Instituto Nacional de Salud Pública INSP, Consejo Nacional contra las Adicciones CONADIC, Instituto Nacional de Psiquiatría Ramón de la Fuente.
Kulis, S., & Brown, E. F. (2011). Preferred drug resistance strategies of urban American Indian youth of the Southwest. Journal of Drug Education, 41, 203–234.
Kulis, S., Marsiglia, F. F., Elek, E., Dustman, P., Wagstaff, D. A., & Hecht, M. L. (2005). Mexican/Mexican American adolescents and keepin'it REAL: An evidence-based substance use prevention program. Children & Schools, 27, 133–145.
Kulis, S., Marsiglia, F. F., Lingard, E. C., Nieri, T., & Nagoshi, J. (2008). Gender identity and substance use among students in two high schools in Monterrey, Mexico. Drug & Alcohol Dependence, 95, 258–268.
Marsiglia, F. F., & Hecht, M. L. (2005). Keepin’it REAL: An evidence-based program. Santa Cruz, CA: ETR Associates.
Marsiglia, F. F., Kulis, S., Rodriguez, G. M., Becerra, D., & Castillo, J. (2009). Culturally specific youth substance abuse resistance skills: Applicability across the U.S.—Mexico border. Research on Social Work Practice, 19, 152–164.
Marsiglia, F. F., Booth, J. M., Ayers, S. L., Nuño-Gutierrez, B. L., Kulis, S., & Hoffman, S. (2014). Short-term effects on substance use of the keepin’ it REAL pilot prevention program: Linguistically adapted for youth in Jalisco, Mexico. Prevention Science, 15, 694–704.
Marsiglia, F. F., Kulis, S., Booth, J. M., Nuño-Gutierrez, B. L., & Robbins, D. E. (2015). Long-term effects of the keepin’ it REAL model program in Mexico: Substance use trajectories of Guadalajara middle school students. The Journal of Primary Prevention, 36, 93–104.
Mayring, P. (2000). Qualitative content analysis. Forum: Qualitative Social Research [On-line Journal], 1(2), art. 20, http://nbnresolving.de/urn:nbn:de:0114-fqs0002204.
McKleroy, V. S., Galbraith, J. S., Cummings, B., Jones, P., Harshbarger, C., Collins, C., … & ADAPT Team. (2006). Adapting evidence–based behavioral interventions for new settings and target populations. AIDS Education & Prevention, 18(supp), 59–73.
Morse, J. M. (2015). Critical analysis of strategies for determining rigor in qualitative inquiry. Qualitative Health Research, 25, 1212–1222.
Parra-Cardona, R., Leijten, P., Lachman, J. M., Mejía, A., Baumann, A. A., Buenabad, N. G. A., … & Ward, C. L. (2018). Strengthening a culture of prevention in low-and middle-income countries: Balancing scientific expectations and contextual realities. Prevention Science, 1–11.
Resnicow, K., Baranowski, T., Ahluwalia, J. S., & Braithwaite, R. L. (1999). Cultural sensitivity in public health: Defined and demystified. Ethnicity & Disease, 9, 10–21.
Resnicow, K., Soler, R., Braithwaite, R. L., Ahluwalia, J. S., & Butler, J. (2000). Cultural sensitivity in substance use prevention. Journal of Community Psychology, 28, 271–290.
Sussman, S., Baezconde-Garbanati, L., Unger, J., Wipfli, H., & Palinkas, L. (2018). Translating health behavior interventions across nations. Research on Social Work Practice, 28, 546–557.
Tashakkori, A., & Teddlie, C. (Eds.). (2003). Handbook on mixed methods in the behavioral and social sciences. Thousand Oaks, CA: Sage.
Tobler, N. S., Roona, M. R., Ochshorn, P., Marshall, D. G., Streke, A. V., & Stackpole, K. M. (2000). School-based adolescent drug prevention programs: 1998 meta-analysis. Journal of Primary Prevention, 20, 275–336.
Acknowledgments
The authors thank Dr. Shiyou Wu for technical assistance and Gloria Quezada and Xóchitl Flores Gómez for assistance in data collection and cultural adaptation.
Funding
This research was supported by funding from the National Institutes of Health/National Institute of Drug Abuse (NIDA/NIH), award R01DA038657 (F. Marsiglia, P.I.).
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The authors declare no conflict of interest. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIDA or the NIH.
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All study procedures involving human participants were approved by the Arizona State University’s Institutional Review Board and in accordance with standards for ethical research practice, including the 1964 Helsinki declaration and its later amendments.
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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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Marsiglia, F.F., Medina-Mora, M.E., Gonzalvez, A. et al. Binational Cultural Adaptation of the keepin’ it REAL Substance Use Prevention Program for Adolescents in Mexico. Prev Sci 20, 1125–1135 (2019). https://doi.org/10.1007/s11121-019-01034-0
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DOI: https://doi.org/10.1007/s11121-019-01034-0