Prevention of Substance Abuse Among Ethnic Minority Youth

A Kathleen Burlew, Tonya Hucks, Randi Burlew, Candace Johnson. Handbook of Racial & Ethnic Minority Psychology. Editor: Guillermo Bernai. Sage Publications. 2003.

Drug use among adolescents continues to be a national concern. The percentage of high school seniors who acknowledged that they had tried an illicit drug increased from 55% to 66% between 1975 and 1981 (Johnston, O’Malley, & Bachman, 2000). After a decline to a low of 41% by 1992, the rate rose again to 54% by 1997 and has remained at that level (Johnston et al., 2000). The specific drugs with the highest percentage of youth reporting lifetime use in 2000 are alcohol (80.3%), marijuana (48.8%), cigarettes (62.5%), smokeless tobacco (23.1%), and amphetamines (15.6%) (Johnston et al, 2000). Moreover, the age of first use is lowering. As many as 20% of sixth graders report that they have tried an illicit drug (Jani, 1999).

The use of alcohol and drugs at an early age has been shown to be associated with both immediate and long-term consequences. The immediate consequences include school failure (Ensminger & Slusarcick, 1992; Rhodes & Jason, 1990), increased delinquent activity (Ellickson, McGuligan, Adams, Bell, & Hays, 1996; Johnston et al, 2000), adolescent pregnancy, and other health risks (Dawkins & Dawkins, 1983; Emshoff, Avery, Raduka, Anderson, & Calvert, 1996; Segal & Stewart, 1996). The long-term consequences can include later unemployment and increased risk of participation in violent activities, including homicide (Dawkins & Dawkins, 1983; Emshoff et al, 1996; Segal & Stewart, 1996). Moreover, those adolescents who experiment early with substances are at greater risk for future drug (Anthony & Petronis, 1995; Hawkins, Catalano, & Miller, 1992; Robins & Przyeck, 1985) or alcohol problems (Grant & Dawson, 1997; Hawkins et al, 1997).

Until recently, much of the research on prevention focused on White adolescents. However, a growing body of literature has become available more recently on ethnic minority youth. The goal of this chapter is to review the body of prevention work on ethnic minority youth. Specifically, this review will focus on the following areas: (a) prevalence and consequences of drug and alcohol use; (b) theoretical issues useful for understanding drug use and prevention among ethnic minority youth; (c) the relation of ethnic identity to drug use; (d) promising approaches to prevention, including culturally tailored interventions; (e) methodological and analytical issues in conducting research on alcohol and drug use among ethnic minority youth; and (f) areas for future research.

Prevalence and Consequences of Drug Abuse Among Ethnic Youth

Two major national studies, the Monitoring the Future Study (MTF) (Johnston, O’Malley, & Bachman, 1998) and the National Household Survey on Drug Abuse (http://www.samhsa.gov/oas/NHSDA/1999/chapter2.htm), document the prevalence of drug abuse among adolescents. In particular, both studies provide information on the prevalence of drug abuse of ethnic minority groups.

The MTF is one of the most comprehensive sources for information on adolescent alcohol and drug abuse. The study began tracking the patterns of African American, Latino, and White 12th graders in 1975. In 1991, the survey expanded to collect information on drug abuse reported by 8th and 10th graders along with 12th graders. The MTF reported that, contrary to popular opinion, African American seniors (32.7%) reported lower rates of illicit drug use than White (42.8%) seniors. The rate for Latino (44.8%) seniors was very close to the rate for White seniors. Similarly, the 30-day prevalence rate for alcohol use among African American (30.0%) and Latino (51.2%) seniors was lower than the rate for White (55.1%) seniors. These findings from the MTF study are consistent with other findings that demonstrate that White children typically begin to use alcohol and other drugs earlier than Latino or African American youth (Swan, 1995).

Similar to the MTF study, the National Household Survey on Drug Abuse (http://www.samhsa.gov/oas/NHSDA/1999/chapter2.htm) has been collecting information on the prevalence of the abuse of alcohol and other drugs since 1971. This study collects data on nearly 70,000 individuals age 12 and older of African American, Latino, American Indian and Alaska Native, Asian American, biracial, and White backgrounds. In contrast to previous years, the 1999 survey provided information on the drug use trends according to age groups.

The NHSDA survey reported similar levels of drug use among Whites (10.9%) and African Americans (10.7%) between the ages of 12 and 17. Although 11.4% of Latino youth reported illicit drug use, this figure may not consider intragroup variations in the rate of drug abuse among various subgroups within the Latino community. For example, the Healthy People 2000 study suggested that Mexican American males consume larger amounts of alcohol than males in other Latino groups, such as Cuban Americans and Puerto Ricans (U.S. Department of Health and Human Services [DHHS], 2000).

The NHSDA survey reported that the highest rate of drug abuse was among American Indian and Alaska Native youth (19.6%). In a related study, Beauvais and Segal (1992) found that American Indian and Alaska Native youth had very high rates of drug abuse. Although this finding is consistent with previous research that suggests that American Indian and Alaska Native youth demonstrate more drug abuse and have an earlier initiation pattern into marijuana and tobacco than other groups (Beauvais, 1992a, 1992b, 1996), the drinking patterns among the 500+ tribes vary widely (Caetano, Clark, & Tam, 1998). For example, Stillner, Kraus, Leukefeld, and Hardenbergh (1999) reported that previous-month alcohol use was lower for Alaska Native parents between the ages of 26 and 34 in the Bering Sea than the 1995 national rate reported by the National Household Study.

The NHSDA survey reported that Asian Americans reported less illicit drug usage (8.4% in past 30 days) than any other group. However, previous research suggests that older males, particularly Japanese and Filipino men from a high social status, consume more alcohol than any other group of Asian Americans (DHHS, 2000). Moreover, the Healthy People 2000 report suggests that, as the number of Asian American immigrants continues to increase, so will the prevalence of alcohol use within that group.

Although drug and alcohol abuse may be less prevalent among certain ethnic/racial groups than their White counterparts (Bachman et al, 1991; Barnes & Welte, 1986; Johnston, O’Malley, & Bachman, 1995; Maddahian, Newcomb, & Bentler, 1988), the consequences associated with drug abuse may be even more pronounced among these groups than among Whites (Dawkins & Dawkins, 1983; Emshoff et al., 1996; Grace, 1992). For example, previous studies have suggested that substance abuse is associated with adolescent pregnancy, high unemployment rates, disruption of education and family life, violence and homicide, and suicide among African Americans (Dawkins & Dawkins, 1983; Emshoff et al, 1996). In addition, African American as well as Latino males have a high risk of developing acute and chronic alcohol-related diseases, such as heart disease and various cancers of the digestive tract (DHHS, 2000).

The consequences of substance abuse are high for American Indians and Alaska Natives as well. According to the Healthy People 2000 report, 4 out of 10 American Indian and Alaska Native deaths were alcohol related from 1978 to 1980 and again from 1983 to 1985. The same report also suggested that the high rate of fetal alcohol syndrome is another devastating consequence for American Indian and Alaska Natives. In addition, Beauvais (1992a, 1992b) suggested that drug abuse has led to unstable relationships with parents and peers among American Indian and Alaska Native youth.

Theoretical Perspectives on Drug Abuse Among Ethnic Youth

Various theoretical perspectives have been developed over the years to explain the substance use patterns described in the previous sections. Several of these seem especially applicable to understanding drug abuse among ethnic minorities. This section will focus on three of these theoretical perspectives—namely, risk and resilience, social ecology, and orthogonal cultural identification.

Risk and Resilience

One of the most promising models for understanding factors associated with drug use is a risk and resilience approach. Risk factors are factors that increase the likelihood that the youth will engage in substance abuse. Resilience factors promote healthy adaptation despite risk and adversity (Wolin & Wolin, 1995). In fact, it has been suggested that resilience factors act as a buffer between risk factors and outcome (Brook, Cohen, Whiteman, & Gordon, 1992; Newcomb & Felix-Ortiz, 1992; Stacy, Newcomb, & Bentler, 1992). For instance, positive family bonding (a resilience factor) may buffer the relationship between substance-abusing friends (a risk factor) and possible drug use (Johnson, 2001). Hawkins et al. (1992) suggested that risk factors might be categorized into the following four domains:

  • Personal/individual—uncontrollable (e.g., age and gender) and controllable personal characteristics (drug attitudes, perceptions of harm, impulsivity, hostility, alienation from the dominant values of the culture, and rebelliousness)
  • Family—includes poor family management, discipline and supervision, parental use of alcohol and drugs, and permissive drug attitudes among parents
  • Peer group—negative influence of peers, especially involvement with peers who use alcohol and drugs and who engage in other problem behaviors
  • Community—includes community norms that permit substance use, poverty, and cultural disenfranchisement
  • In addition, Hawkins et al. (1992) identified the following six categories of protective or resilience factors:
  • Personal/individual—These factors include temperament (e.g., emotional stability, positive sense of self) and social competence.
  • Family—Protective family characteristics include high levels of warmth, a basic sense of trust, high parental expectations, and clear rules and expectations for children.
  • School—The key school factors that promote resilience are a caring and supportive environment, clear standards and rules for appropriate behavior, and high expectations.
  • Peer group—The peer group characteristic that best promotes adaptation is an involvement in a peer group that promotes positive group activities and norms.
  • Community—The community factors that promote healthy adaptation are similar to the school factors, such as caring and support, high expectations for youth, and opportunities for youth to participate in community activities.
  • Society—The protective societal factors include the presence of media that promote strong antidrug messages and limited access to substance use.

Catalano et al. (1993) examined the relation of risk factors to drug use. The set of significant risk factors included poor family management styles and family bonding; early antisocial behavior, such as violent tendencies; accessibility and availability of drugs; and opportunities for involvement in school activities. No racial differences were evident in the relationship between these variables and the initiation of drug use. However, other studies have demonstrated racial differences in the extent to which the risk factors were present in their lives. For example, Hawkins et al. (1992) found that African American youth are exposed to more aggression than other youth; exposure to aggression is perceived as a risk factor for drug abuse. In other research, it has been suggested that the stress associated with acculturation may be a risk factor for Latino Americans (Rodriguez, 1995). For instance, the Healthy People 2000 (DHHS, 2000) report suggested that many Latino persons who immigrate to the United States quickly adopt the level of alcohol consumption of their American counterparts.

The Social Ecology Model

Another theoretical perspective on drug use among ethnic minorities is the social ecology model proposed by Kumpfer and Turner (1990-1991). This theory suggests that certain social settings and environments may serve as predictors of drug use for ethnic youth. The factors discussed in the model are family climate, school climate, school bonding and self-efficacy, and peer drug use. Similar to the risk and resilience theory, this theory hypothesizes that certain risk and protective factors predict an adolescent’s drug abuse patterns. For example, the presence of a caring adult and emotional support are family protective factors, whereas parental drug abuse and family stress are family risk factors (Kumpfer & Alvarado, 1995; Kumpfer & Bluth, in press).

Kumpfer (1994a, 1994b) used this model as a backdrop to develop the Strengthening Families Program (SFP) intervention. Research on the SFP program supports the link between family factors and adolescent drug abuse. Others have demonstrated the relationship of school (Rhodes & Jason, 1990) factors to drug outcomes. However, more research would be useful on the pattern of relationships suggested by the entire social ecology model.

Orthogonal Cultural Identification

The orthogonal cultural identification theory was based on work with American Indians and Alaska Natives along with Mexican American youth (Oetting & Beauvais, 1990). The theory suggests that identification with any culture or more than one culture is associated with better adjustment than alienation from all cultures. Moreover, cultural identification develops within the family. The theory has four assumptions: (a) Cultural identification can be assessed, (b) it is important to assess identification with any culture independently of assessing identification with any other culture, (c) identification with a culture may be a source of strength, and (d) cultural identification is strongly linked to culture-specific attitudes and behaviors (Oetting & Beauvais, 1990). Accordingly, identification with either one’s ethnic subculture or identification to mainstream society is associated with positive psychosocial characteristics. Youth who identify strongly with both their ethnic subculture and the mainstream culture have the highest self-esteem, whereas those youth who identify with neither culture have the lowest self-esteem. Moreover, youth with a strong identification with either the subculture or the mainstream culture are expected to abuse less alcohol, tobacco, and other drugs than youth with only a weak identification to any culture because of greater adaptability.

In a study by Weaver (1996), researchers found that many American Indian and Alaska Native youth identify with more than one culture. In addition, the study found a correlation between cultural identification with either culture and health scales, including tobacco use (Weaver, 1996). This finding supports the orthogonal cultural identification theory. The relationship between cultural identity and drug use is discussed in the next section.

Ethnic Identity and Drug Use

Ethnic/racial identity refers to one’s identity with a subgroup that shares a common ancestry and other characteristics such as culture, race, religion, language, kinship, or place of origin (Phinney, 2000). According to Phinney (2000), ethnic/racial identity is assumed to be a multidimensional construct that may include one or more of the following elements:

  • Ethnic self-identification (identifying oneself as a member of a particular ethnic group);
  • Affective components (i.e., attitudes and evaluations regarding one’s membership in an ethnic group such as pride and positive feelings about the group), along with a preference for ethnically related customs such as food choices or language;
  • Cognitive components (i.e., knowledge about the history, customs, and traditions of the group);
  • Value orientation (i.e., endorsement of the worldview of the group); and
  • Processes of change (i.e., a developmental process of internalizing a psychologically healthy identity regarding oneself as a member of a particular ethnic group).

Many assumed that ethnic/racial identity would lessen over time due to acculturation. However, perhaps due to social forces such as prejudice and immigration, ethnic/racial identity remains a salient force in the lives of ethnic minorities (Phinney, 2000). Still others assume that ethnic/racial identity is an undesirable characteristic perhaps because they mistakenly perceive ethnic/racial identity as a pseudonym for a militant or anti-White ideology. However, empirical research has revealed that ethnic/racial identity has numerous positive consequences for ethnic group members such as less vulnerability to adjustment difficulties, less psychological distress, greater levels of self-actualization, and greater levels of marital satisfaction (Burlew, 2000). The relationship between a healthy ethnic/ racial identity and positive drug-related outcomes for ethnic youth has been demonstrated in several studies.

Findings from studies examining the relationship between ethnic/racial identity and drug involvement among Latino populations have varied across subgroups. Some have suggested that acculturation (i.e., changes that individuals make to adapt to a new culture) plays a role. Specifically, they argue that as the level of acculturation increases, Latino youth are more likely to use drugs (Rodriguez, Recio, & De La Rosa, 1993). This relationship has been attributed to intergenerational family-adolescent conflicts (Szapocznik et al., 1986) and the stress associated with adapting to differences between the host culture and the culture of origin (Rodriguez, 1995).

Brook, Whiteman, Balka, Win, and Gursen (1998) examined the relationship between acculturation and drug use in a sample of 555 Puerto Rican males and females between the ages of 16 and 24. The youth were assigned to one of the following four categories based on their self-reported drug use: (a) no reported drug use, (b) used alcohol or tobacco only, (c) used marijuana but no other illicit drug, and (d) used illicit drugs other than marijuana. The findings revealed that those with no use or only alcohol/tobacco had higher levels of ethnic identity than those who reported more drug use. Moreover, in the same study, a strong sense of ethnic/racial identity ameliorated the effects of risk factors such as parental drug use or the availability of drug use on the adolescent’s own drug use. Other studies of Latino populations have demonstrated a similar relationship between cultural identity and decreased drug use (Burnam, Hough, Karno, Escobar, & Telles, 1987; Felix-Ortiz & Newcomb, 1995; Markides, Krause, & Mendes de Leon, 1988).

The relationship between ethnic/racial identity and drug use has also been demonstrated among African American youth. For example, Resnicow, Soler, Braithwaite, Selassie, and Smith (1999) found that the more the adolescents in their sample endorsed positive attitudes about being African American, the more anti-drug attitudes they reported. In this study, 346 low-income African American adolescents were given the Racial and Ethnic Identity (REI) Scale for African American youth as well as the Adolescent Survey of Black Life. They found that pro-Black beliefs were protective factors against many negative outcomes, including pro-drug attitudes. In contrast, anti-White attitudes were associated with increased drug use. These findings were consistent with others in the literature that have found a direct relationship between pro-Black beliefs and anti-drug attitudes.

Carlton Oler (1995) reported a similar finding in another sample of African American youth. In that study, 249 fourth, fifth, and sixth graders completed a measure of racial identity developed by Banks (1984) and the Botvin Alcohol and Drug Attitude Scale (Botvin, Baker, Dusenbury, Tortu, & Botvin, 1990). The results revealed that a strong racial identity was associated with positive (intolerant) attitudes about drug use. In a study of 100 African American second graders, Townsend and Belgrave (2000) found that a positive racial identity was related to anti-drug attitudes. Similar findings were reported by Belgrave, Townsend, Cherry, and Cunningham (1997) in a study of 189 African American fourth and fifth graders. In a study of American Indians and Alaska Natives, the relationship between ethnic/racial identity and alcohol involvement was not supported (Trimble, 1995). The sample included 621 American Indian and Alaska Native adolescents from five rural, reservation, and urban settings. That study was based on Trimble’s (1991) tripartite model of ethnic identification. Trimble found the following seven identity domains for American Indian self-identification: use of an American Indian or Alaska Native language, participation in American Indian or Native Alaskan traditions and ceremonies, affiliative patterns, self-identification, maternal identification, paternal identification, and acculturative status. A confirmatory factor model was performed using those domains, and the results were consistent with the Trimble tripartite model that includes natality, behavioral orientations, and subjective perceptions (Trimble, 1991). However, the findings did not reveal a relationship between ethnic identity and alcohol involvement in this sample of American Indians and Alaska Natives.

The drinking patterns of Asian Americans have been associated with both ethnicity and birthplace. Abstention rates among Asian Americans are higher among those born outside of the United States than among those born in the United States (Makimoto, 1998). This pattern is supported by the literature, which indicates that the drinking behaviors of Asian and Pacific Islanders living in the United States are more likely to reflect the adoption of the tolerant drug attitudes of the Western culture, whereas those Asians who live outside the United States may retain traditional views against drinking. The maintenance of traditional worldviews may reflect a higher level of ethnic identity.

In a study by James, Kim, and Moore (1997), alcohol use among Asian American youth was found to be related to the dynamics of adapting to Western culture. It was suggested that the transition to Western culture conflicted with the hierarchical nature of the Asian family structure, the interdependent nature of Asian family relationships, and the sense of self among young Asian Americans. The disruption of traditional family patterns and dynamics increases the risk of drug and alcohol use. The effect of acculturation on the family structure of Asian Americans is particularly noteworthy because the literature indicates that cultural identification and effective family management styles are associated with lower rates of alcohol use in Asian American youth (James, Kim, & Armijo, 2000).

The literature reviewed in this section argues for considering culture when designing prevention programs for ethnic minority youth. Some of the major approaches to prevention are described in the next section. Although the developers of these programs usually began with a generic version of the intervention, culture was later incorporated into the subsequent versions of several of these interventions. The section on culturally tailored interventions describes several efforts to include culture in prevention programming.

Approaches to Prevention

There is an ongoing effort to develop effective drug prevention programs for ethnic minority youth. Numerous prevention programs are being implemented throughout the United States. Although the objectives of these programs may differ with ethnicity, age, and risk factors, the common goal of drug prevention programs is to reduce the incidence of drug use and abuse (Botvin, 1995). Some prevention programs have been demonstrated to be more effective than others. Perhaps this finding supports the belief that some interventions are more closely tied than others to the empirical research on the etiology of drug use.

Drug prevention programs tend to fall into one of the following primary categories: comprehensive interventions, family-based interventions, and school-based interventions. The next few subsections will discuss each of these approaches to interventions and describe specific examples used with ethnic minorities. The three programs that are described—Project Northland, the Strengthening Families Program, and Life Skills Training—were all recently designated as exemplary programs by the U.S. Department of Education.

Comprehensive Programs

Numerous factors contribute to drug use among youth; therefore, some programs address drug use through multiple avenues of change. One comprehensive alcohol preventive intervention for youth has been fully tested (Perry & Williams, 1996). Project Northland, a community-wide research program, focuses on the prevention of alcohol use by using a multilevel, community-wide approach with youth. It was designed with primarily European youth from rural, lower-middle-class to middle-class communities. These communities were assumed to have the highest prevalence of alcohol-related problems in the state. For each year of the intervention, an overall theme was derived based on the developmental level of the group and the school organization. Social-behavioral curricula in schools, peer leadership, parental participation and education, and community-wide task force activities were all included in the intervention (Perry & Williams, 1996). The focus is on Grades 6 to 8. The objective for each grade level is different.

The objective of the sixth-grade program, “Slick Tracy,” is to facilitate communication between parents and adolescents about alcohol use. The seventh-grade curriculum, “Amazing Alternatives,” is aimed at enhancing refusal skills and building positive peer group influences. In the eighth grade, the youth are introduced to professional and political groups in the community that influence adolescent alcohol use. The eighth-grade curriculum is called “Powerlines.”

Peer leadership is also included in the intervention. Youth whom other adolescents like and respect are selected as peer leaders. Student leaders participate in a leadership training program called T.E.E.N.S. (The Exciting and Entertaining Northland Students). These student leaders plan alcohol-free activities for seventh graders. In the standard version, this component includes a 1-day leadership training session that focuses on methods to determine seventh graders’ favorite activities, budget planning for the activities, and publicizing the activities.

A community-wide task force is another component of Project Northland. In the original program, the community-wide task force activities included the passage of five alcohol-related ordinances, such as mandatory beverage service training to prevent illegal sales of alcohol to underaged youth. In addition, the task force collaborated with local businesses to establish a gold card system to provide discounts at selected businesses for youth who pledged to be alcohol and drug free.

Although this approach has proven to be successful, multilevel interventions, including both individual and environmental methods of change, are not frequently used in alcohol use prevention. Nevertheless, follow-up evaluations of this intervention demonstrate the utility of a comprehensive approach to reducing alcohol use (Perry & Williams, 1996).

Family-Based Interventions

A body of empirical literature has demonstrated the importance of family in fostering resilience (Hawkins et al., 1992; Kumpfer & Alvarado, 1995). Previous longitudinal and cross-sectional studies have demonstrated that parenting practices, such as clear no-use rules, monitoring, and limiting access to alcohol availability, play a significant role in preventing adolescent drinking. These relationships tend to be independent of race or ethnicity, yet some ethnic differences in alcohol use among youth may be attributed to variations in parenting practices (Barnes & Welte, 1986; Catalano et al, 1993).

As a result of findings linking family relationships to drug use, family-based interventions have also become an essential component in a group of drug prevention programs. Previous research has demonstrated that interventions that increase and encourage positive parenting practices can have a positive effect (Loveland-Cherry, Ross, & Kaufman, 1999; Spoth, Redmond, & Lepper, 1999). In addition to parenting practices, some researchers have postulated that family bonding may be a key social control mechanism that may lessen adolescents’ risk of alcohol abuse (Bahr, Marcos, & Maughan, 1995). Although the important role of parents in drug prevention has been acknowledged, program developers continue to struggle with achieving a high degree of parental participation (Botvin, 1995).

The Strengthening Families Program (SFP), developed by Karol Kumpfer, is an example of a family-based program. The Office of Juvenile Justice and Delinquency Prevention selected the Kumpfer SFP program as one in a set of “exemplary” family programs. The ultimate goal of the program is to increase personal resiliency to drug use. The program focuses on improving family relations by strengthening family communications, increasing parent-child time together, increasing parental empathy, and increasing family planning and organization (Kumpfer, 1994a, 1994b). The intervention is based on a strong body of research indicating that family factors such as parental support (Dishion, French, & Patterson, 1995; King, Beals, Manson, & Trimble, 1992), parental supervision (Hansen et al., 1987), family conflict and involvement (Bry, 1983; Mayer, 1995), and parenting practices (Szapocznik et al., 1988) are related to adolescent substance abuse and other problem behaviors. Moreover, parents in dysfunctional, antisocial, or drug-affected families may be limited in their capacity to respond appropriately to their children’s emotional and social cues (Hans, 1995; Kumpfer, 1994a, 1994b).

The SFP intervention consists of a multicomponent 14-session program. The parents receive training in effective parenting practices (i.e., reinforcement, limit setting). The children’s program is modeled after Spivack and Shure’s (1979) social skills training. The Family Skills Training Program provides an opportunity for parents and children to practice their skills (with trainer support) in a structured setting. SFP is unique in that it was developed “specifically for children of alcohol- and drug-abusing parents” (Kumpfer, 1994a, 1994b).

The SFP intervention has been evaluated in a number of settings with various ethnic groups. For example, in the Utah Community Youth Activity Project, the SFP was implemented in three counties and eight agencies. The sample consisted of 703 high-risk youth between the ages of 6 and 13 and their families. Of the sample, 69% was ethnic minority, including Asians (26%), Pacific Islanders (20%), Latinos (18%), and American Indians and Alaska Natives (5%). The results revealed a significant pretest-to-posttest reduction in externalizing (i.e., problem behaviors) and internalizing (i.e., depressive symptoms, anxiety symptoms) behaviors on the Child Behavior Checklist as well as reduced levels of family conflict and higher levels of family cohesion on the Family Environment Scale.

School-Based Interventions

A large percentage of drug prevention programs are school-based interventions (Ellickson, 1995). These school-based interventions focus on helping youth develop personal and social skills that will enhance their sense of competence and decrease the likelihood of yielding to pressures to use drugs (http://www.LifeSkillsTraining.com). The incorporation of social influence approaches and skills training into school-based interventions has demonstrated promising results in ethnic minority populations and in economically disadvantaged communities (Harrington & Donohew, 1997; Sussman, Dent, Stacy, & Craig, 1998). On the other hand, the minimal effect sizes raise the question of whether a school-based intervention alone is sufficient for significant and long-term changes in alcohol use by adolescents without broader environmental changes (Ellickson, 1995, Gorman, 1995, 1996; Johnson et al, 1990; Moscowitz, 1989).

The Life Skills Training (LST) program is an example of a school-based program. It was designed to prevent drug use among middle school or junior high students (Botvin, 1996). The 12 program units include sessions on self-image; decision making; myths and realities about smoking, alcohol, and marijuana; advertising; coping with anxiety; and communication, social, and assertiveness skills. Although the original program was tested on White children, the intervention was later evaluated using a Latino and an African American sample. The study testing the effectiveness of the LST intervention among Latino youth was conducted among 471 seventh graders attending eight public schools in the New York metropolitan area. Half of the schools were randomly assigned to receive the intervention, and the other half became the control group. The results revealed that the youth in the intervention reported less tobacco use and more knowledge about the consequences of smoking than the control group.

Culturally Tailored Interventions

The demonstrated link between racial/ ethnic identity and positive outcomes for youth was discussed earlier in the section on racial/ethnic identity and drug use. That body of work paved the way for research on the utility of culturally tailored interventions (Chipunga et al., 2000; Emshoff et al., 1996). Perhaps culturally tailored programs work because the activities are consistent with the cultural and risk characteristics of the targeted group (Chipunga et al., 2000).

Several alternative approaches exist for designing culturally tailored programs. We refer to these types as culturally enhanced (CE) and culturally based (CB) programs.

Culturally Enhanced Programs. CE programs modify a standard version to make it more culturally appropriate. These programs incorporate the same messages of the standard version but alter names, scenarios, stories, and other activities to be more culturally familiar.

The cultural version of the Botvin Life Skills Training program is an example of a CE program. Early research first documented the efficacy of the standard LST intervention with White middle-class youth (Botvin & Botvin, 1992). Later, a “culturally focused” version was developed for African Americans. This version differed from the universal version in several specific ways: (a) The materials were closely scrutinized to determine if the reading level was appropriate, (b) visual images were added to portray African American youth, and (c) the examples, role-play scenarios, and language were infused with themes consistent with the African American experience. However, the objective was to develop a “culturally focused” version that had the same messages as the universal version. Studies of the culturally tailored version of this program have shown that this approach is effective for African American youth (Botvin, Batson, et al, 1989).

Later, the materials were modified to increase their appropriateness for Latino students. Data gathered through focus groups as well as input from consultants, teachers, and students were used to make the program more culturally tailored for Latino youth (Botvin, Dusenbury, Baker, James-Ortiz, & Kerner, 1989). This time, the sample included 3,501 students from 47 public and parochial schools in New York City. Schools were assigned to either the intervention or the control condition. The results revealed a significant reduction in smoking among those Latino youth in the intervention relative to those in the control group at the end of the 7th grade. Moreover, the intervention group continued to demonstrate the efficacy of the program even during the 10th grade.

Culturally Based Programs. CB programs go beyond merely altering the manner in which the message of the generic program is presented to make it more culturally consistent. Specifically, CB programs develop curricula that incorporate cultural strengths. An underlying assumption in this second type of cultural tailoring is that it would be useful to incorporate some of the positive teachings (values) of a particular culture (cultural strengths) into the intervention. The SUPER STARS program (Emshoff et al., 1996) is an example of that form of cultural tailoring. The universal version of that intervention was modified to include activities to stress cultural pride and identity, exposure to important events in the history of African Americans, and exposure to cultural values expressed in cultural rituals (e.g., Nguzo Saba or the Seven Principles of Kwanzaa). After completing the culturally based program, youth reported both that they had more knowledge about drugs and that they were more likely to say no to drugs in the face of peer pressure (Carlyle & Emshoff, 1992). This type of cultural tailoring is more similar to the type of activities included in rites of passage and other culturally based interventions.

Our own program was a culturally based, Africentric program conducted with African American youth. The youth were sixth graders when they entered our program. Interested youth and their families attended a social gathering that served as an orientation to the program. At that session, the participants were randomly assigned to participate in either the intervention or the control group. For approximately 10 to 12 weeks, the participants attended three separate sessions. The drug education/prevention curriculum provided information about the consequences of drug use. However, several of the sessions included discussions on the incongruency between African American belief systems and drug use. The second session each week was aimed at promoting self-esteem through cultural awareness. The SETCLAE (Self-Esteem Through Culture Leads to Academic Achievement) curriculum developed by Jawanza Kunjufu was used for this session. The Saturday enrichment sessions included arts and crafts, plays, skits, storytelling, field trips, and community projects. Relative to the control group, the program participants reported more favorable school bonding, racial/cultural pride, and resistance to peer pressure to use drugs. In addition, male participants, relative to male members of the control group, had better school attendance and reported more favorable self-discipline and fewer problem behaviors.

CSAP Model Programs

The Center for Substance Abuse Prevention (CSAP) plays a critical role in the development, evaluation, and dissemination of research on prevention programs. CSAP funding has made it possible for researchers throughout the country to develop and evaluate numerous prevention programs that have demonstrated positive outcomes for both short- and long-term periods. The heterogeneity of these programs indicates the need for programming that meets the needs of diverse groups.

To date, CSAP has identified 20 interventions as model programs. To be considered a “model” program, a program must be rated acceptable on several criteria, including the incorporation of theory, the fidelity of the implementation of the intervention, quality of the process evaluation, the adequacy of the sampling strategy and implementation, low attrition, positive outcomes, appropriate treatment of missing data, outcome data collection, analysis, the use of designs that eliminate other plausible threats to validity (excluding attrition), integrity, utility, replications, dissemination, and cultural and age appropriateness (Substance Abuse and Mental Health Services Administration [SAMHSA], 2001). The wide range of techniques used to target particular populations has contributed to the success of these prevention programs. For example, the Dare to Be You program in Colorado addresses resilience factors rather than substance abuse itself (SAMHSA, 2001). The Keep a Clear Mind program is aimed at strengthening parent-child communication (SAMHSA, 2001). These two CSAP model programs are described below.

Dare to Be You

The Dare to Be You program was designed by Colorado State University for the parents of children between the ages of 2 and 5. It was implemented in four ethnically diverse settings, including the Ute Mountain Ute community (95% American Indian and Alaska Native), the San Luis Valley (64% Hispanic), Colorado Springs (53% White), and Montezuma County (84% White). The aim of the program was to strengthen resiliency factors in children by (a) promoting self-concept, satisfaction with the parenting role, internal locus of control, and satisfaction with the social support network among parents while enhancing their relationship with children and the knowledge of child development; (b) training parents to replace harsh punishment with more appropriate control techniques; and (c) improving behavior, interactions with parents, and developmental milestones for preschool children at risk for alcohol and drug use.

The parent training program consists of 24 hours of weekly training over a 3- to 4-month period aimed at increasing parental knowledge of child development, personal sense of worth, effective discipline strategies, personal and parental efficacy, and appropriate child-rearing practices. Separately, the children participate in activities to bolster self-worth and self-responsibility while improving communication, problem-solving, and reasoning skills. A follow-up workshop series is added to reinforce the skills obtained during the intervention phase. When the program was implemented in Colorado, the retention was amazingly high. More than 95% of the participants completed all program components during the first year, and more than 75% completed yearly follow-up surveys. The results also revealed significant and lasting increases in parental competence and parental role satisfaction.

Keep a Clear Mind

The Keep a Clear Mind (KACM) program was developed by the University of Arkansas with a grant from the U.S. Department of Education. This home-based prevention program was developed for fourth- to sixth-grade children and their families. Both home activities and school activities were used in the implementation of this program. Home activities were sent to the families, including weekly newsletters that provided parents with information on various drugs, strategies for communicating with their children about drugs, and suggestions for helping children avoid drugs. The home activities addressed the primary goals of increasing parent-child communications related to substance use prevention and encouraging the youth to develop refusal skills for gateway drug use (SAMHSA, 2001). The classroom component included activities that focus on reducing susceptibility to peer pressure for drug experimentation. This prevention program posits that individual, family, peer, protective, and risk factors need to be addressed. Follow-up evaluations revealed that KACM participants had a higher frequency of endorsing a no-use position and a more realistic view of drug use consequences than non-KACM participants. The evaluation also revealed that the parents of these participants also had a more realistic view of drug use among youth and its harmful consequences.

Research Issues

The growing numbers of available prevention programs for ethnic minority and other youth summon the need to evaluate the efficacy of various types of intervention. To conduct effective evaluations, researchers must develop methodology sound enough for them to feel confident in interpreting the results. A major concern regarding the research on ethnic minorities in general and prevention programs in particular is the assumption of the universality of the American mainstream experience. That supposition too often leads researchers to assume incorrectly that the theories, procedures, measures, and analytical strategies used to conduct evaluations of White samples can be blindly applied to the evaluations of ethnic minorities. A comprehensive discussion of this issue is beyond the scope of this chapter. However, this issue is discussed more fully in the chapter titled “Research With Ethnic Minorities: Conceptual, Methodological, and Analytical Issues”. Various conceptual issues associated with the universality assumption have been discussed throughout this chapter, such as the utility of designing intervention programs that are consistent with prevalence rates along with the specific risk and resilience factors associated with specific ethnic/racial groups. However, in this section, methodological and analytical issues and areas for future research will be discussed.

Methodological Issues

Several methodological issues pose challenges for the prevention researcher. These include recruitment, measurement, sampling, the validity of self-report, and within-group heterogeneity. Although these are certainly issues when conducting research on White youth as well, the issues themselves are slightly different in samples of ethnic minorities.

Recruitment and Retention

The NIH Revitalization Act of 1993 (P.L. 103-43) {Federal Register, 199A) mandated the recruitment of women and minorities in clinical research and especially clinical trials. One outgrowth of that act was the development of a document titled “Outreach Notebook for the NIH Guidelines for the Inclusion of Women and Minorities as Subjects in Clinical Research.” Perhaps one explanation for the difficulty of including ethnic minorities is the skepticism of ethnic minority communities about the value of research in their lives (Call, Otto, & Spenner, 1982). The poor relationships that the research community has fostered with ethnic minority communities may be a source of this skepticism. For example, one explanation for the skepticism among American Indian and Alaska Native tribes is that the tribes have rarely been invited to participate in anything other than the data collection process. Consequently, ethnic minorities may be reluctant to participate in studies in which the results are likely to be interpreted by outsiders using theories that are not always consistent with American Indian and Alaska Native culture (Baldwin, 1999).

Measurement

The tendency to assume that measures developed and standardized on other subgroups are appropriate for research on ethnic minorities is another example of the assumption of the universality of the American mainstream. Several issues may affect whether a measure is equivalent in different cultural contexts. If the group to which the scale is to be applied does not speak the same language as the group on whom the scale was developed, researchers run the risk of failing to achieve what Brislin (1993) called translation equivalence. In addition, researchers must also consider whether a scale has metric equivalence for a given minority group. Reliability and validity measures may change from one group to another. Finally, conceptual equivalence refers to whether the underlying trait is the same in the two groups (Allen & Walsh, 2000).

Several strategies have been proposed to assess whether a measure is appropriate for a given ethnic group. Assessing internal consistency is a common method used by researchers to assess whether a measure is reliable in a different group. However, other analyses need to be conducted to ensure that the traits being measured in the original and the new group are equivalent. These include factor analysis, regression, and item response theory (Allen & Walsh, 2000).

Increasing the Accuracy of Self-Report

Self-report is the most common method of collecting social behavioral research on drug use. However, the validity of self-report is a concern for prevention research for all groups, not just ethnic minorities. Strategies that may improve the accuracy of self-report of sensitive information have been examined. These strategies include anonymity, the use of a self-generated identification code, and the bogus pipeline technique.

A self-generated identification code is an anonymous code generated from information available to the participant but not to the researcher (Kearney, Hopkins, Mauss, & Warheith, 1984). Specifically, each participant is requested to use the same instructions to create the same confidential identification code at each data collection. For example, the first letter of the mother’s maiden name might be used to generate the first digit. The next digit might be based on the respondent’s birthplace. Using that information, the participant can generate a code that the researcher cannot use to identify the respondent. However, when that participant uses those same instructions to generate the same code at a second data collection, the researcher can match the data collected at the two time points. If the same instructions are provided at the beginning and end of an intervention, the researcher can match a participant’s data at the two data points and still provide the participants with anonymity.

Evans, Hansen, and Mittlemark (1977) developed a procedure called the bogus pipeline (BPL) in which the participant is led to believe the information that she or he provides about drug use will be verified by a biochemical test. In reality, the information is not verified. That explains why it is called a “bogus” pipeline. The utility of the bogus pipeline has been widely discussed elsewhere (Aguinis, Pierce, & Quigley, 1995; Roese & Jamieson, 1993). Previous research has demonstrated that the BPL has improved the accuracy of the information provided on both alcohol and marijuana use (Hingson et al., 1986; Lowe, Windsor, Adams, Morris, & Reese, 1986). However, little research is available on the utility of these strategies among ethnic minorities.

Within-Group Heterogeneity

The heterogeneity within specific ethnic minority groups is another issue that should be considered when developing a sampling plan. For example, past research often treated American Indians and Alaska Natives as a heterogeneous group (Baldwin, 1999). However, the American Indian and Alaska Native community consists of more than 500 tribes who speak more than 200 languages. Although they are often studied as a group, drinking patterns among the different tribes vary significantly (Caetano et al., 1998). For example, the Navajo tribes view alcohol consumption as acceptable, whereas the Hopi consider drinking to be irresponsible.

The Problem with Race Comparison Analyses

A common strategy for analyzing research with ethnic minority youth and children is to use a race comparison approach (Graham, 1992; McLoyd, 1998; McLoyd & Randolph, 1985). In race comparison studies, race (or ethnicity) is the independent variable, and the objective is to compare ethnic groups on one or more dependent variables. The pitfalls of this strategy include the failure to consider that sociodemographic variables may account for some differences that masquerade as ethnic group differences. A second pitfall is the faulty assumption that mean differences reflect actual differences and not methodological errors.

Such problems have led several researchers to conclude that race comparison research is inappropriate except in a small number of specific situations (Azibo, 1988; Steinberg & Fletcher, 1998). Nevertheless, the issue of whether a specific intervention has a differential impact across ethnic/racial groups is certainly a valid concern. Assuming one has addressed the issues associated with measurement equivalence, Steinberg and Fletcher (1998) suggested that one appropriate use of race in multiethnic prevention studies is to include race as a moderator of the relationship between an independent (i.e., assignment to the intervention or the comparison group) and a dependent variable (i.e., drug outcomes). In this case, one is addressing whether the impact of the intervention on the outcome variables differs according to race/ethnicity (moderator).

The need to address the within-group heterogeneity in the sampling plan was mentioned earlier. However, within-group heterogeneity also requires attention at the analysis stage. Specifically, if a researcher has successfully recruited a heterogeneous sample of a specific ethnic group, then the analyses should consider whether the outcomes differ for different subgroups.

Areas for Future Research

Too often, the research for the ethnic minority community reflects the research agenda for White youth. However, a number of issues unique to the ethnic minority community warrant further attention. First, the underutilization of available services among ethnic minorities is an issue that has been documented elsewhere (Makimoto, 1998). Although the factors that may influence utilization rates are complex, providing prevention services in a culturally consistent manner may be related to utilization. For example, Makimoto (1998) reported that participation rates increase significantly if bilingual and bicultural staff persons are available to provide services to Asian Americans.

Little research is available on the dynamics of why culturally tailored interventions may improve outcomes. Such research is crucial for designing future programs that effectively incorporate culture. One possibility is that adolescents who have more positive perceptions regarding their own ethnic group are more likely to hold positive opinions about themselves and, ultimately, to avoid drug use because they take their futures more seriously. However, an alternative explanation is that the efficacy of culturally tailored programs is due to the inculcation of a specific set of positive cultural values. The first explanation argues for prevention programming that showcases the accomplishments of the African American community. However, the second explanation would suggest the development of programs that provide more socialization to a set of important values. More research is necessary to address issues such as these.

A number of other topics warrant further research for understanding the etiology of substance abuse among ethnic minority youth. A sample of these topics include the relation of ethnic/racial identity to substance abuse and the impact of the concentration of liquor stores in ethnic minority communities. These are topics that may not be critical for understanding drug use among White youth but demand more research for understanding the drug behaviors of ethnic minorities. However, future research aimed at determining the best way to collect substance abuse information from youth will be useful for future research with all adolescents, not just ethnic minority youth.

Conclusions

This chapter has highlighted some of the important issues related to studying and understanding ethnic minority drug use. The prevalence rates vary across ethnic minority groups. Contrary to popular belief, studies have demonstrated that the prevalence of drug abuse among ethnic minorities is similar to or less than the rate for their White counterparts. However, the consequences of drug abuse appear to be more pronounced among ethnic minority groups than White youth.

Several theoretical perspectives have been used to explain drug abuse among ethnic minorities. Some have focused on the risk and resilience factors associated with drug use, such as social settings and environments, whereas other perspectives have asserted that drug use may be related to cultural identification.

As our understanding of drug-related issues continues to increase, there is an ongoing effort to make this knowledge practical through the development of various prevention programs. The major types of prevention programs include family-based, school-based, and comprehensive programs, which incorporate the community in prevention efforts. Several prevention programs have been recognized as “model programs” because of their success in the prevention of drug use among various ethnic groups. The continued success of these model programs and future prevention programs will require researchers and program developers to address the various methodological issues that surface when conducting research on ethnic minorities.