Flavio F. Marsiglia

Culturally Grounded Substance Use Prevention: An Evaluation of the keepin' it R.E.A.L. Curriculum

This paper reports on the evaluation of a culturally grounded prevention intervention targeting substance use among urban middle-school students. The curriculum consists of 10 lessons promoting antidrug norms and teaching resistance and other social skills, reinforced by booster activities and a media campaign. Three versions were delivered: Mexican American, combined African American and European American, and Multicultural. Thirty-five middle schools were randomly assigned to 1 of the 3 versions or the control. Students completed baseline and follow-up questionnaires over a 2-year period (total 6,035 respondents). Analyses utilizing a generalized estimating equations approach assessed the overall effectiveness of cultural grounding and the cultural matching hypothesis. Support was found for the interventions overall effectiveness, with statistically significant effects on gateway drug use as well as norms, attitudes, and resistance strategies but with little support for the cultural matching hypothesis. Specific contrasts found the Mexican American and Multicultural versions impacted the most outcomes.

Ethnic Labels and Ethnic Identity as Predictors of Drug Use among Middle School Students in the Southwest

This article explores differences in the self-reported drug use and exposure to drugs of an ethnically diverse group of 408 seventh-grade students from a large city in the southwest. We contrast the explanatory power of ethnic labels (African American, non-Hispanic White, Mexican American, and mixed ethnicity) and two dimensions of ethnic identity in predicting drug use. One dimension focuses on perceived ethnically consistent behavior, speech, and looks, while the other gauges a sense of ethnic pride. Ethnic labels were found to be somewhat useful in identifying differences in drug use, but the two ethnic identity measures, by themselves, did not generally help to explain differences in drug use. In conjunction, however, ethnic labels and ethnic identity measures explained far more of the differences in drug use than either did alone. The findings indicate that the two dimensions of ethnic identity predict drug outcomes in opposite ways, and these relations are different for minority students and non-Hispanic White students. Generally, African American, Mexican American, and mixed-ethnicity students with a strong sense of ethnic pride reported less drug use and exposure, while ethnically proud White students reported more. Ethnic minority students who viewed their behavior, speech, and looks as consistent with their ethnic group reported more drug use and exposure, while their White counterparts reported less. These findings are discussed, and recommendations for future research are provided.

God Forbid! Substance Use Among Religious and Nonreligious Youth

Among a predominantly Mexican and Mexican American sample of preadolescents, religiosity protected against lifetime alcohol, cigarette, and marijuana use and recent alcohol and cigarette use when religious affiliation was controlled. When religiosity was controlled, however, adolescents with no religious affiliation and adolescents who were religiously affiliated reported similar substance use outcomes. Interaction effects demonstrated that the protective effect of greater religiosity operated more strongly in some religions than in others for selected outcomes. Overall, the impact of religiosity on reported drug use did not differ significantly for more and less acculturated Latino youth.

Ethnicity and Ethnic Identity as Predictors of Drug Norms and Drug Use Among Preadolescents in the US Southwest

This article reports the results of research exploring how ethnicity and ethnic identity may “protect” adolescents against drug use and help them form antidrug use norms. This study was conducted in 1998 and is based on a sample of 4364 mostly Mexican American seventh graders residing in a large southwestern city of diverse acculturation statuses. It aims at testing existing findings by conducting the research within the unique geographic and ethnic context of the Southwest region of the United States. This research examines how strength of ethnic identity plays a distinctive role in drug use behavior among the various ethnic groups represented in the sample: Mexican Americans, other Latinos, American Indians, African Americans, non-Hispanic Whites, and those of mixed ethnic backgrounds. Positive ethnic identity (i.e., strong ethnic affiliation, attachment, and pride) was associated with less substance use and stronger antidrug norms in the sample overall. Unexpectedly, the apparently protective effects of positive ethnic identity were generally stronger for non-Hispanic White respondents (a numerical minority group in this sample) than for members of ethnic minority groups. Implications for prevention programs tailored for Mexican/Mexican American students are discussed.

The protective and risk effects of parents and peers on substance use, attitudes and behaviors of Mexican and Mexican American female and male adolescents.

This study explores the extent to which parental and peer behaviors and norms may affect substance use, personal antidrug norms, and intentions to use drugs in a group of Mexican heritage preadolescents in the Southwest United States, and whether these parental and peer influences differ according to gender. Secondary data from a randomized trial of a drug prevention program were used. The sample consisted of 2,733 adolescents. The outcomes were recent alcohol, cigarette, and marijuana use, personal antidrug norms, and intentions to use drugs. In this study, peer variables were more consistently related to the outcomes than parent variables, with the exception of parental injunctive norms, which were the most predictive parent factor. Recommendations are provided to further study the protective processes that are maintained through the transition into adolescence and acculturation as a foundation for the design of resiliency-focused prevention interventions.

Perceived Ethnic Discrimination versus Acculturation Stress: Influences on Substance Use among Latino Youth in the Southwest∗:

Using a predominately Mexican-origin Latino sample of 5th grade students from the Southwestern United States, this study examined the relative effects of perceived discrimination and acculturation stress on substance use, and it assessed whether these effects were moderated by linguistic acculturation or time in the United States. Although rates of substance use were generally low in the sample, given the young age of the participants, over half (59%) of the sample perceived some discrimination, and almost half (47%) experienced some acculturation stress. Spanish-dominant and bilingual youth perceived more discrimination than English-dominant youth, whereas youth who have been in the United States five or fewer years perceived more discrimination than youth with more time in the United States. Youth who were Spanish-dominant or were recent arrivals experienced the most acculturation stress, with levels declining as linguistic acculturation and time in the United States increased. Multiple regression estimates indicated that perceived discrimination was associated with larger amounts and higher frequency of recent substance use and an array of substance use attitudes, such as stronger intentions to use substances, espousal of pro-drug norms, more positive substance use expectancies, and peer approval of substance use. Although acculturation stress was not associated with substance use, it was positively associated with several substance use attitudes, which are known antecedents of actual use. With a few exceptions, linguistic acculturation and time in the United States did not moderate the effects of perceived discrimination or acculturation stress.

Effects of Familism and Family Cohesion on Problem Behaviors among Adolescents in Mexican Immigrant Families in the Southwest U.S

This study used baseline data from the Southwest sample of the Latino Acculturation and Health Project to examine whether familism and cohesion are related to problem behaviors in a sample of Mexican and Mexican-American adolescents in the Southwest United States. This study is important to practitioners and prevention and intervention researchers because it examines buffers to problem behaviors among an increasingly at-risk population. The results confirm that familism is a powerful protective factor against aggressive behavior, conduct problems, and rule-breaking in this sample. The results draw attention to the importance of family among Mexican and Mexican-American families. Family cohesion, however, was found to be protective against conduct problems and rule-breaking but not aggressive behavior. Possible explanations for this result are discussed. Additional findings suggest that adolescents who have the ability to navigate between culture of origin and mainstream culture are also protected against some problem behaviors.

Boys Must Be Men, and Men Must Have Sex With Women: A Qualitative CBPR Study to Explore Sexual Risk Among African American, Latino, and White Gay Men and MSM

Men who have sex with men (MSM) continue to be disproportionately affected by HIV and sexually transmitted diseases. This study was designed to explore sexual risk among MSM using community-based participatory research (CBPR). An academic—community partnership conducted nine focus groups with 88 MSM. Participants self-identified as African American/Black (n = 28), Hispanic/Latino (n = 33), White (n = 21), and biracial/ethnic (n = 6). The mean age was 27 years (range = 18-60 years). Grounded theory was used. Twelve themes related to HIV risk emerged, including low knowledge of HIV and sexually transmitted diseases, particularly among Latino MSM and MSM who use the Internet for sexual networking; stereotyping of African American MSM as sexually “dominant” and Latino MSM as less likely to be HIV infected; and the eroticization of “barebacking.” Twelve intervention approaches also were identified, including developing culturally congruent programming using community-identified assets, harnessing social media used by informal networks of MSM, and promoting protection within the context of intimate relationships. A community forum was held to develop recommendations and move these themes to action.

Promoting Healthy Lifestyles in High School Adolescents: A Randomized Controlled Trial

BACKGROUND Although obesity and mental health disorders are two major public health problems in adolescents that affect academic performance, few rigorously designed experimental studies have been conducted in high schools. PURPOSE The goal of the study was to test the efficacy of the COPE (Creating Opportunities for Personal Empowerment) Healthy Lifestyles TEEN (Thinking, Emotions, Exercise, Nutrition) Program, versus an attention control program (Healthy Teens) on: healthy lifestyle behaviors, BMI, mental health, social skills, and academic performance of high school adolescents immediately after and at 6 months post-intervention. DESIGN A cluster RCT was conducted. Data were collected from January 2010 to May of 2012 and analyzed in 2012-2013. SETTING/PARTICIPANTS A total of 779 culturally diverse adolescents in the U.S. Southwest participated in the trial. INTERVENTION COPE was a cognitive-behavioral skills-building intervention with 20 minutes of physical activity integrated into a health course, taught by teachers once a week for 15 weeks. The attention control program was a 15-session, 15-week program that covered common health topics. MAIN OUTCOME MEASURES Primary outcomes assessed immediately after and 6 months post-intervention were healthy lifestyle behaviors and BMI. Secondary outcomes included mental health, alcohol and drug use, social skills, and academic performance. RESULTS Post-intervention, COPE teens had a greater number of steps per day (p=0.03) and a lower BMI (p=0.01) than did those in Healthy Teens, and higher average scores on all Social Skills Rating System subscales (p-values <0.05). Teens in the COPE group with extremely elevated depression scores at pre-intervention had significantly lower depression scores than the Healthy Teens group (p=0.02). Alcohol use was 12.96% in the COPE group and 19.94% in the Healthy Teens group (p=0.04). COPE teens had higher health course grades than did control teens. At 6 months post-intervention, COPE teens had a lower mean BMI than teens in Healthy Teens (COPE=24.72, Healthy Teens=25.05, adjusted M=-0.34, 95% CI=-0.56, -0.11). The proportion of those overweight was significantly different from pre-intervention to 6-month follow-up (chi-square=4.69, p=0.03), with COPE decreasing the proportion of overweight teens, versus an increase in overweight in control adolescents. There also was a trend for COPE Teens to report less alcohol use at 6 months (p=0.06). CONCLUSIONS COPE can improve short- and more long-term outcomes in high school teens. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01704768.

Neighborhood Effects on Youth Substance Use in a Southwestern City

This study examines neighborhood influences on alcohol, cigarette, and marijuana use among a predominantly Latino middle school sample. Drawing on theories of immigrant adaptation and segmented assimilation, the authors test whether neighborhood immigrant, ethnic, and socioeconomic composition, violent crime, residential instability, and family structure have differential effects on substance use among youth from different ethnic and acculturation backgrounds. Data are drawn from self-reports from 3,721 seventh-grade students attending thirty-five Phoenix, Arizona, middle schools. Analysis was restricted to the two largest ethnic groups, Latino students of Mexican heritage and non-Hispanic Whites. After adjusting for individual-level characteristics and school-level random effects, only one neighborhood effect was found for the sample overall, an undesirable impact of neighborhood residential instability on recent cigarette use. Subgroup analyses by individual ethnicity and acculturation showed more patterned neighborhood effects. Living in neighborhoods with high proportions of recent immigrants was protective against alcohol, cigarette, and marijuana use for Latino students at different acculturation levels, whereas living in predominantly Mexican heritage neighborhoods (mostly nonimmigrants) was a risk factor for alcohol and marijuana use for less acculturated Latinos. There were scattered effects of neighborhood poverty and crime, which predicted more cigarette and alcohol use, respectively, but only among more acculturated Latinos. Inconsistent effects confined to bilingual and more acculturated Latinos were found for the neighborhoods proportion of single-mother families and its residential instability. No neighborhood effects emerged for non-Hispanic White students. Results suggested that disadvantaged neighborhoods increase substance use among some ethnic minority youth, but immigrant enclaves appear to provide countervailing protections.