Michelle Miller-Day

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.

Influences of Personal, Injunctive, and Descriptive Norms on Early Adolescent Substance use

Social norms play an important role in adolescent substance use. Norm focus theory (Cialdini, Reno, & Kallgren, 1990) distinguishes three types of norms: injunctive, descriptive, and personal. This study examines the relative influences of these three norms, as well as the moderating effects of gender and ethnicity, on the concurrent substance use of 2,245 Mexican or Mexican-American students, 676 students of other Latino or multiethnic Latino origin, 756 non-Hispanic White students, and 353 African- American students. Personal norms appear to be the strongest significant predictor of substance use. Descriptive, parental injunctive, and friend injunctive norms also demonstrate significant, though weaker influences. Controlling for intentions reduces the predictive ability of each type of norm, especially personal norms. Gender moderates the relationship between norms and substance use with the relationships generally stronger for males. Personal norms act as stronger predictors of some types of substance use for Mexican/Mexican Americans.

Researching the researcher-as-instrument: an exercise in interviewer self-reflexivity.

Because the researcher is the instrument in semistructured or unstructured qualitative interviews, unique researcher characteristics have the potential to influence the collection of empirical materials. This concept, although widely acknowledged, has garnered little systematic investigation. This article discusses the interviewer characteristics of three different interviewers who are part of a qualitative research team. The researcher/interviewers – and authors of this article – reflect on their own and each other’s interviews and explore the ways in which individual interview practices create unique conversational spaces. The results suggest that certain interviewer characteristics may be more effective than others in eliciting detailed narratives from respondents depending on the perceived sensitivity of the topic, but that variation in interviewer characteristics may benefit rather than detract from the goals of team-based qualitative inquiry. The authors call for the inclusion of enhanced self-reflexivity in interviewer training and development activities and argue against standardization of interviewer practices in qualitative research teams.

Parent-Adolescent Communication about Alcohol, Tobacco, and Other Druguse

For this study, 67 adolescent African American and Caucasian adolescents were interviewed about their parent-adolescent conversations regarding alcohol, tobacco, and other drug (ATOD) use. Analyses indicated that fewer than half of the youth had engaged in a conversation with one or more parent about ATOD use and that significantly more adolescents felt closest to and preferred talking with their mothers about risky topics than to other family members. Moreover, the results suggested that parental antidrug messages were part of the ongoing discourse of family life rather than structured in an isolated “drug talk,” as is advocated in contemporary media. This article argues for a clearer definition of the parent-adolescent conversation, discusses implications for targeting mothers as prevention agents, and introduces risksocialization theory.

More Than Just Openness: Developing and Validating a Measure of Targeted Parent–Child Communication About Alcohol

Research addressing parent–child communication on the topic of alcohol use relies heavily on assessing frequency of discussions and general assessments of openness in parent–child communication, ignoring the complexity of this communication phenomenon. This study adds to the literature by articulating a conceptualization and developing a measurement of parent–child communication—targeted parent–child communication about alcohol—and comparing the efficacy of targeted parent–child communication about alcohol in predicting positive expectancies of alcohol use and recent alcohol use. The predictive power of general openness in parent–child communication and frequency of communication about alcohol also were assessed. Students in fifth and sixth grade (N = 1,407) from 29 public schools completed surveys. Targeted parent–child communication about alcohol was negatively associated with both outcomes. Frequency and general openness were only negatively associated with positive expectancies regarding alcohol. Implications of these findings for the etiology and prevention of substance use are discussed.

Toward a Descriptive Model of Parent–Offspring Communication about Alcohol and Other Drugs

This study examined the narratives of 75 parent–offspring pairs who were asked to relate their shared drug prevention conversations. A descriptive model of parent–offspring drug talks (PODT) was developed to address the form, content, and function of parent–offspring discourse about drugs and drug use. Additionally, two temporal approaches to socializing conservative drug use norms were identified – targeted socialization and integrated socialization. Over two-thirds of the respondents reported integrating ongoing socialization efforts into the fabric of their everyday lives in contrast to more targeted one-shot ‘drug talks.’

Upward turning points and positive rapport-development across time in researcher—participant relationships:

Some of the first, and potentially most important, steps that researchers must take in the field are those related to rapport development with their participants. Both novice and experienced field researchers negotiate the difficulties and mysteries of establishing and maintaining this rapport. In this research, it was our intention to disentangle the often puzzling rapport-building process. We contacted 16 field researchers with varying degrees of experience and asked them to detail their relational turning points with select participants. Using the Retrospective Interview Technique (RIT) as a narrative prompt we uncovered a pattern of rapport-building that took the shape of five semipermeable phases of researcher—participant rapport: Other-Orientation, Self-in-Relation to Other, Self-and-Other Linking, Interpersonal Connection, and Partnership. In this article we propose a preliminary stage model of rapport-building trajectories, and offer implications such a model might have for field researchers.

Using Positive Deviance for Determining Successful Weight-Control Practices

Based on positive deviance (examining the practices of successful individuals), we identified five primary themes from 36 strategies that help to maintain long-term weight loss (weight control) in 61 people. We conducted in-depth interviews to determine what successful individuals did and/or thought about regularly to control their weight. The themes included weight-control practices related to (a) nutrition: increase water, fruit, and vegetable intake, and consistent meal timing and content; (b) physical activity: follow and track an exercise routine at least 3x/week; (c) restraint: practice restraint by limiting and/or avoiding unhealthy foods; (d) self-monitor: plan meals, and track calories/weight progress; and (e) motivation: participate in motivational programs and cognitive processes that affect weight-control behavior. Using the extensive data involving both the practices and practice implementation, we used positive deviance to create a comprehensive list of practices to develop interventions for individuals to control their weight.

The Patient Centered Medical Home: Mental Models and Practice Culture Driving the Transformation Process

ABSTRACTBACKGROUNDThe Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. The PCMH model is a departure from more traditional models of healthcare delivery and requires significant transformation to be realized.OBJECTIVETo describe factors shaping mental models and practice culture driving the PCMH transformation process in a large multi-payer PCMH demonstration project.DESIGNIndividual interviews were conducted at 17 primary care practices in South Eastern Pennsylvania.PARTICIPANTSA total of 118 individual interviews were conducted with clinicians (N = 47), patient educators (N = 4), office administrators (N = 12), medical assistants (N = 26), front office staff (N = 7), nurses (N = 4), care managers (N = 11), social workers (N = 4), and other stakeholders (N = 3). A multi-disciplinary research team used a grounded theory approach to develop the key constructs describing factors shaping successful practice transformation.KEY RESULTSThree central themes emerged from the data related to changes in practice culture and mental models necessary for PCMH practice transformation: 1) shifting practice perspectives towards proactive, population-oriented care based in practice–patient partnerships; 2) creating a culture of self-examination; and 3) challenges to developing new roles within the practice through distribution of responsibilities and team-based care. The most tension in shifting the required mental models was displayed between clinician and medical assistant participants, revealing significant barriers towards moving away from clinician-centric care.CONCLUSIONSKey factors driving the PCMH transformation process require shifting mental models at the individual level and culture change at the practice level. Transformation is based upon structural and process changes that support orientation of practice mental models towards perceptions of population health, self-assessment, and the development of shared decision-making. Staff buy-in to the new roles and responsibilities driving PCMH transformation was described as central to making sustainable change at the practice level; however, key barriers related to clinician autonomy appeared to interfere with the formation of team-based care.

Adapting School-Based Substance Use Prevention Curriculum Through Cultural Grounding: A Review and Exemplar of Adaptation Processes for Rural Schools

A central challenge facing twenty-first century community-based researchers and prevention scientists is curriculum adaptation processes. While early prevention efforts sought to develop effective programs, taking programs to scale implies that they will be adapted, especially as programs are implemented with populations other than those with whom they were developed or tested. The principle of cultural grounding, which argues that health message adaptation should be informed by knowledge of the target population and by cultural insiders, provides a theoretical rational for cultural regrounding and presents an illustrative case of methods used to reground the keepin’ it REAL substance use prevention curriculum for a rural adolescent population. We argue that adaptation processes like those presented should be incorporated into the design and dissemination of prevention interventions.