The keepin’ it REAL program is a video-enhanced intervention that uses a culturally grounded resiliency model to incorporate traditional ethnic values and practices that protect against drug use. The goal is to teach students how to resist substance use through practical, easy-to-remember and -use strategies that are embodied in the acronym REAL (Refuse, Explain, Avoid, Leave).
The curriculum was originally targeted at middle school adolescents in the urban Southwest who were considered at risk of substance use because of poverty and other factors such as immigration status, English acquisition, and acculturation stress. The program was designed to intervene with students before they began to engage in risky behaviors, such as alcohol and other drug experimentation. Although keepin’ it REAL was originally designed as a school-based prevention program for middle school students, it has been implemented with youths ages 11 through 18.
keepin’ it REAL is based on previous work demonstrating that teaching communication and life skills can combat the influence of negative peers and other negative influences (Tobler et al. 2000). The program extends resistance- and life-skills models by using a culturally based narrative and performance framework to enhance antidrug norms and attitudes and facilitate the development of risk assessment, decision-making, problem-solving, and resistance skills. The program is culturally grounded because earlier research shows that the most successful substance use prevention programs reflect aspects of the adolescent’s culture and learning style (Kandel 1995).
Key components of the program draw on numerous theoretical perspectives, including Communication Competence Theory, Narrative Theory, the Focus Theory of Norms, and Ecological Risk and Resiliency. These different perspectives are connected to cultural values and norms which provide a basis for the content and structure of the curriculum.
The program teaches youths to live drug-free lives by building on their existing cultural and communication strengths and the strengths of their families and communities. Using keepin’ it REAL strategies, students learn how to recognize risk, value their perceptions and feelings, embrace their cultural values (e.g., avoiding confrontation and conflict in favor of maintaining relationships and respect), and make choices that support them.
The curriculum includes 10 sequential lessons to be taught in class over a 2- to 3-month period. The curriculum has six core elements: 1) communication competence and ethnic variations thereof; 2) narrative-based knowledge to enhance identification with the prevention message; 3) different types of social norms (personal, injunctive, and descriptive) as motivators in substance use; 4) social learning of life skills and their key role in risk assessment and decision-making; 5) drug-resistance strategies most commonly and effectively employed by adolescents; and 6) the local social context.
Distinct Mexican American, non-Latino, and multicultural versions of keepin’ it REAL were developed so students could recognize themselves in the prevention message and see solutions that are sensitive to their unique cultural environments:
This culture-centered version was created with a concentration on Latino values such as familismo (family orientation), respeto (respect), personalismo (personal treatment), and simpatía (sympathy). For example, in lesson 1 of the Mexican American curriculum, the objective is for the student to recognize that what he or she does affects his or her community, group, and family and to differentiate between simple preference and “wise choice”—a choice that is honorable and can be respected.
This version is a mainstream curriculum, taking values such as goal orientation and individualism from white and African–American culture. For example, in lesson 1 of the black/white curriculum, the objective is for the student to recognize that what he or she does may have favorable or unfavorable consequences on his or her future goals and to differentiate between simple preference and wise choice.
This version was developed by incorporating five lessons from each of the Mexican American and non-Latino versions.
Although all four resistance strategies (Refuse, Explain, Avoid, and Leave) are taught in each version of the curriculum, some strategies receive more stress in one version than in the other. For example, “Explain” is stressed more in the Mexican American version, because explaining confirms cultural values about the importance of dealing with others in a respectful, nonconfrontational manner rather than outright refusal that may seem more disrespectful within the Mexican American culture.
11 to 18
Recent Substance Use
Hecht and colleagues (2003) found that over time the use of alcohol, cigarettes, and marijuana increased for both the intervention group who received the keepin’ it REAL curriculum and the control group. However, the increase was significantly less for intervention students. By wave 4 (14 months after the intervention), intervention group students were reporting significantly less use of alcohol and marijuana, but there was no significant difference in cigarette use.
At wave 2 (2 months after the intervention), intervention group students reported adopting more strategies used to resist marijuana and cigarettes than did control group students. However, by wave 4, no significant group differences emerged.
Intent to Accept and Self-Efficacy
The intervention had no significant impact on students’ intent to accept alcohol, tobacco, and other drug (ATOD) offers or on student confidence in resisting such offers (self-efficacy) at any of the follow-up periods.
The control group students reported significantly greater increases in positive expectations regarding alcohol, cigarette, and marijuana use at waves 3 and 4. This means that over time the control group students had more positive views of substance use, compared with the intervention students.
Overall, there were no significant differences in the degree of change in intervention and control group students’ reports of their parents’ or friends’ anti–ATOD injunctive norms over the follow-up periods. However, at waves 2 and 3, intervention students reported significantly less erosion in their attitudes against someone their age using substances (although this difference disappeared by wave 4). Also, across all three follow-up periods, intervention students reported perception of their peers’ substance experimentation and use increased significantly less than among control students (descriptive norms).
The Mexican American and multicultural versions of the curriculum both affected personal norms and alcohol and marijuana use. Students who received the Mexican American version performed significantly better than control students on cigarette use, self-efficacy, intentions to accept ATOD offers, and descriptive norms. Students who received the multicultural version performed significantly better on resistance strategies, positive substance use expectancies, and friend’s injunctive norms. However, the non-Latino (black/white) version of the curriculum had a significant impact only on students’ alcohol use and did not have an impact on any other measure.
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