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J. DRUG EDUCATION, Vol. 33(2) 119-142, 2003
keepin’ it R.E.A.L.: A DRUG RESISTANCE CURRICULUM TAILORED TO THE STRENGTHS AND NEEDS OF
PRE-ADOLESCENTS OF THE SOUTHWEST
MONIKA GOSIN
University of California San Diego
FLAVIO FRANCISCO MARSIGLIA
Arizona State University
MICHAEL L. HECHT
The Pennsylvania State University
ABSTRACT
Research has shown that students respond more favorably to drug prevention
programs when they see their culture and themselves represented in the
prevention message. Additionally, studies highlight important ethnic differ-
ences in drug behaviors and attitudes, indicating that students’ ethnic culture
should be considered in the creation of prevention programs. Because there
are few effective, culturally grounded programs, new approaches are needed,
particularly among Mexican American youth. This need inspired the Drug
Resistance Strategies Project (DRS) to develop and test the keepin’ it R.E.A.L
curriculum serving ethnically diverse seventh grade students residing in
a large southwestern city. This article describes development of the keepin’
it R.E.A.L. curriculum, focusing on the methods used to ensure cultural
grounding. The article also reviews literature on cultural approaches in
prevention, presents a theoretical framework, summarizes key outcomes of
the curriculum evaluation, and concludes with recommendations for the
development of prevention programs for ethnically diverse youth.
119
� 2003, Baywood Publishing Co., Inc.
INTRODUCTION
Drug prevention research suggests that the most successful prevention models
for youth are those which incorporate norms, resistance, and other social skills,
and reflect the culture and learning styles of the target audience in the substance
and format of the intervention [1]. When youth are able to recognize themselves
in the scenarios presented, they are more likely to relate to and support the
prevention messages. Minority youth in particular have been found to respond
more favorably to programs in which the teachers or characters presented are
members of their own group [2, 3].
Many drug prevention programs, however, have neglected to consider the
importance of ethnicity and culture, assuming that a standardized curriculum will
be effective for students of all backgrounds. Standardized prevention messages
often enforce dominant cultural values that do not validate or utilize minority
children’s cultural experiences. Some programs have made positive attempts
to ground the curriculum in the culture of the children and communities they
serve. In some cases, those efforts have fallen short by relying on simplistic and
stereotypical representations of culture, and by using “ethnic glosses” or tar-
geting umbrella or broad aggregates of groups as if they were actual ethnic
groups [4, 5].
Culturally grounded programs are few, and further testing of their effective-
ness is needed. This need for more research on culturally-grounded approaches
inspired the current research by the Drug Resistance Strategies Project (DRS), a
partnership between Arizona State University and Pennsylvania State University
funded by a National Institute on Drug Abuse (NIDA) grant. DRS researchers
developed a curriculum specific to pre-adolescents of the Southwest called
keepin’ it R.E.A.L. R.E.A.L. is an acronym for the four resistance strategies
emphasized in the curriculum: Refuse, Explain, Avoid, and Leave. As in many
areas in the U.S. Southwest, Phoenix has a high percentage of Mexican/Mexican
American students, with Latinos constituting the numerical majority in many
of the schools [6]. Therefore, students’ ethnicity was central in the creation of
the prevention curriculum.
To reflect the ethnic culture of the students receiving the prevention messages,
the keepin’ it R.E.A.L. curriculum relies on the children’s cultural strengths and
communication styles. There are three versions of the curriculum: one targeting
Latino students (based on Mexican and Mexican American cultural values),
another targeting Non-Latino students (primarily European American and African
American), and a multicultural version (combining the Latino and Non-Latino
versions). The curriculum focuses on equipping students with the skills necessary
to resist drugs. Cultural values predominant (though not necessarily universal) in
each targeted cultural group are accentuated in the lessons. The curriculum further
reflects the students’ ethnic culture through videos, illustrating the application
of resistance skills in real life situations. The videos were scripted and filmed by
120 / GOSIN, MARSIGLIA AND HECHT
Phoenix high school students, therefore providing a visual manifestation of the
voice of Phoenix students.
The present article describes the keepin’ it R.E.A.L. curriculum and how
it strives to set norms and teach resistance and other social skills through a
culturally-grounded approach geared specifically toward a sample of ethnically
diverse seventh graders residing in the southwestern United States. Curriculum
development and content will be presented. In addition, curriculum evaluation
results will document the positive outcomes attained.
LITERATURE REVIEW
Skills-Based Prevention:
Social, Resistance, and Refusal Skills
Numerous school-based prevention strategies have been developed, with most
programs incorporating three components: information dissemination, affective
education, and social skill behavioral training [7-9]. “Information only” programs
have been found to be ineffective, as many teenagers choose to become substance
abusers each year despite their knowledge of drugs’ detrimental health, social, and
legal consequences [1]. As a result, over the past decade emphasis has shifted
to behavioral skills and normative training [9, 10]. While recent research has
raised questions about the uniform success of these programs [11, 12], the com-
bination of resistance and other social skills with normative influences provides
the most promising model of prevention [9, 10, 13, 14].
Botvin describes two social skills models fundamental to effective prevention
[1]. The first, called the Social Influence Model, “is designed to increase adoles-
cent’s ability to resist social influences to smoke, drink or use drugs” [1, p. 369].
The second, the Personal and Social Skills Model, teaches “relatively general
skills for coping with life that will have a broad application rather than a situation
specific or problem specific application” [1, p. 371]. These models aim not only
to teach adolescents to effectively resist drugs in specific situations but also to
enable adolescents to more effectively cope in their environment which in turn
will reduce their risk for drug use. Botvin’s Life Skills Training Program (LST),
a school-based approach designed to prevent alcohol, tobacco, and other drug
use (ATOD) among youth, is an example of an effective skills-based program.
It teaches skills for resisting social pressures to use drugs, helps students develop
social and self-management skills, and attempts to influence their knowledge
and attitudes about ATOD. Nearly two decades of extensive research on LST’s
effectiveness has shown the program to be successful in reducing drug use,
even among minority populations [15].
While Botvin’s LST program has been shown to be effective, Hermann and
McWhirther have found mixed results among other programs specifically using
refusal and resistance skills (RRS) [16]. In a selected review of the literature
keepin’ it R.E.A.L. / 121
assessing the relative efficacy of RRS on adolescent and child ATOD use and
sexual activity, Hermann and McWhirter found that generalization across
different RRS training programs is problematic because RRS strategies vary
in their content and application [16]. RRS programs appear to be successful in
reducing or delaying use of some substances or behaviors but not all. In addition,
they may increase student’s knowledge of RRS skills but not affect behavior [17].
Hermann and McWhirter suggest that while more research is needed to assess
the long-term effects of RRS on behavior, prevention curricula are likely to
benefit from including RRS training [16]. Researchers suggest, though, that efforts
should not be limited to training in refusal and resistance skills alone. Instead,
they should include a rationale for refusal since research indicates that “Just
say no” approaches are not effective [18]. Furthermore, RRS skill training should
be embedded in a comprehensive prevention curriculum [19] teaching RRS and
social skills and providing information about the actual behavior of a normative
group [16].
Drug Intervention during Early Adolescence
Because early adolescence is a vulnerable developmental period and early drug
use is associated with poorer outcomes, early drug intervention is important. Early
adolescence is also a period of emotional, physical, and social changes including
a shift in influence from parents to peers. Adolescents find themselves with
increasing amounts of unsupervised time and exposure to peers, factors that have
been related to higher levels of drug use and delinquent behavior [20, 21]. Early
adolescents who report drug use continue to use drugs in late adolescence [22].
Furthermore, since adolescent drug use often progresses from experimentation
with gateway drugs like tobacco or alcohol to serious abuse of hard drugs [23],
early adolescents experimenting with gateway drugs are likely to use other and
more serious drugs later. Therefore, intervention during early adolescence could
improve drug prevention and minimize negative health outcomes in later
years [24, 25].
Ethnic Differences in Youth Drug Use
Ethnic differences have been found for risk in using drugs [21, 26-30], the
degree of health risk associated with drug use [31], and the type of drugs most
commonly used [32]. Research also shows that early adolescents’ drug-related
attitudes and behaviors vary by ethnicity [33-35]. For example, white adolescents
report the least perceived amount of drug use risk and the least amount of friends’
disapproval of drug use [36, 37]. They also tend to be higher sensation seekers
[38], be at greatest risk when they have lower levels of family pride and involve-
ment [39, 40], and have peer models for hard liquor use [29]. African Americans
report the highest levels of perceived risk and friends’ disapproval of drug use [37]
but also tend to have peer models for beer and wine use [29]. Latino/a adolescents
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fall between whites and African Americans in the degree of perceived risk of
drug use and friends’ disapproval of use [37] but also have more peer models
for using pills like “uppers” than other ethnic groups [29].
The size of ethnic differences in adolescent drug use varies by substance
and type of measure. The Youth Risk Behavior Survey found large differences
in alcohol use, with 54 percent of white school age youth, 73 percent of
black youth, and 83 percent of Hispanic youth using alcohol in the past 30
days [41]. Current use of marijuana was about the same for all ethnic groups,
but differences appear for current cocaine, “crack,” or “freebase” use: 3 percent
of whites, less than 1 percent of African Americans, and 6 percent of
Hispanics. These ethnic differences in drug use, attitudes, and risk factors give
evidence for the need to consider ethnicity in the development of drug preven-
tion models.
Culture and Prevention
A key factor in school-based interventions is their relevance to youth and their
lives. This has been clear from the start when resistance skills training relied
heavily on social learning theory [42], which stresses the realisms of modeling.
The multicultural nature of many of our schools, particularly in large urban
and suburban areas, provides a challenge to this concept. If prevention materials
are derived from middle class, white culture, they may not be relevant to the
experience of minority youth.
Although culturally-oriented prevention messages have appeared successful
in limited testing [e.g., 14, 25, 43], few substance use prevention programs in
the United States take a culturally-grounded approach [44]. Instead, established
prevention programs originally created for and tested with non-Hispanic
white populations are modified for use with ethnic minority populations [14].
Yet, these modified or adapted programs may not be effective as they leave
intact the dominant cultural values and norms. This approach may invalidate
the day-to-day experiences of the African-American and Latino adolescents
they are intended to serve [45-48]. Yet, the degree of true cultural specificity
necessary for a successful prevention program is difficult to ascertain, especially
if the program is delivered to a culturally diverse audience [43, 47]. Further
research may deepen our understanding of cultural specificity’s impact on pre-
vention effectiveness.
Likewise, additional research on the efficacy of a multicultural intervention
is needed. Multiculturalism is predicated on inclusion [48], in this case the
inclusion of cultural values from all of the groups participating in the pre-
vention program. It assumes that participants prefer or accept inclusion rather
than separation in a targeted curriculum. Since many substance use prevention
programs make little effort to accurately and thoroughly represent the cultural
practices of either one or multiple ethnic/racial groups, further testing of the
keepin’ it R.E.A.L. / 123
effectiveness of both targeted (culturally-specific) and multicultural interven-
tions is needed.
In summary, ethnic differences in drug use, attitudes, and risk factors, early
adolescent vulnerability, and the need for resistance and other social skills and
norms development suggest the need for a culturally grounded prevention pro-
gram targeting earlier adolescents and teaching anti-drug norms and resistance
and life skills.
Theoretical Framework Guiding keepin’ it R.E.A.L.
keepin’ it R.E.A.L. was developed by incorporating several theoretical per-
spectives. Communication Competence Theory [49, 50] defines competence as a
relational phenomenon and identifies four necessary components: knowledge,
motivation, skills, and outcomes. Relational competence is the idea that any
conversation has outcomes for both parties and that communication optimizes
these mutual outcomes is maximally effective. When cast into a drug resistance
framework, this means that if Jack offers marijuana to Jim and Jim’s reply both
resists the offer and does not offend Jack, continued pressure is less likely,
resistance is successful, and the relationship is maintained. The components
of relational communication competence mirror elements of successful drug
prevention. Knowledge typically includes understanding the effects of drugs, the
context, and the topic. Motivation entails perceptions of peer norms, attitudes,
and consequences, and a desire to engage in resistance. Skills are the ability
to refuse drugs, manage stress, and interact effectively. Outcomes are the
consequences for self, others, and relationships. To competently resist offers
of drugs, teens need adequate knowledge, appropriate motivation, and skills to
produce desirable outcomes.
Research has demonstrated that there is a cultural basis of competence.
Members of various ethnic groups differ in their general communication com-
petencies and norms [51-55]; and styles [56, 57]. For example, Mexican American
communication is more concerned with relational solidarity, African American
communication more focused on power relationships and assertiveness, and
European American communication more future oriented and focused on
external rewards [53]. Mexican American norms are more focused on family
and the immediate circle of friends [51]. Therefore, cultural appropriateness
is essential to general effective communication effectiveness [58] and inter-
ventions [59].
Several other theories enabled us to specify each of the curriculum prevention
elements. Knowledge was guided by Narrative theory, which suggests that infor-
mation is best communicated through stories [13, 60, 61]. Motivation was guided
by the Focus Theory of Norms which distinguishes descriptive norms (what
people do in same or similar situations), injunctive norms (what ought to be
done), and personal norms (how an individual believes that s/he should act) [62].
124 / GOSIN, MARSIGLIA AND HECHT
Norms are viewed as an adolescent’s perception about drug use prevalence and
consciousness, and have been identified as a key factor in drug use and prevention
[63]. Skills was guided by Botvin’s models described above [1]. In addition, the
Ecological Risk and Resiliency approach [64-66] served as the theoretical basis
for recognizing culture as a strength promoting resiliency. This approach empha-
sizes multiple levels of influence on child development [67] and the complexity of
the child’s interaction with the environment [68-70]. Because of the importance
of environment, especially family and culture of origin, norms, and values from
family and culture that discourage drug use may increase the effectiveness of
prevention programs [62, 71].
Six core, interrelated conceptual elements were incorporated into the
intervention:
1. Ethnic variations in the nature of communication competence [49, 51, 72].
2. Narrative-based knowledge to enhance identification with the prevention
message [13, 60, 61].
3. An examination of the role of injunctive, personal, and descriptive norms
as motivators in substance use [62, 63].
4. Social learning of social skills and their key role in risk assessment and
decision making [42, 73, 74].
5. Drug resistance strategies most commonly and effectively employed by
adolescents [72, 75-77].
6. Grounding the prevention program in local social contextual risk and resili-
ency factors in substance use [64-66].
Figure 1 illustrates the conceptual framework and theoretical foundations
driving the research. The figure illustrates the environmental factors that influ-
ence a child to either make pro-drug or anti-drug choices and how the DRS
program intervenes to promote anti-drug choices. Box A represents the over-
arching theoretical framework and the child’s environment. Box B then presents
the theoretical components and structure of the intervention. Box B-1 and B-2,
components of the child’s environment, contain specific pro-drug (Box B-1) and
anti-drug (Box B-2) factors that may influence a child’s drug behaviors. Finally,
Box C includes curriculum outcomes: behaviors, attitudes, and norms. The level
of influence of environmental factors will dictate whether or not a child will
engage in drug use. The keepin’ it R.E.A.L intervention represented by Box B is
designed to intervene and disrupt the factors that would lead to the drug use
outcomes in Box C. The bold double-headed arrows from Box B and Boxes B-1
and B-2 demonstrate that the intervention relies on and reinforces the anti-drug use
(resiliency) factors already a part of the student’s environment while combating
pro-drug use risk factors (risk). At the same time, the arrow is double headed
because the effectiveness of the intervention is influenced by these risk and
resiliency factors.
keepin’ it R.E.A.L. / 125
Curriculum Development
Curriculum development proceeded from the theoretical model above with
the central principle of “from youth through youth to youth.” We started with
information from the adolescents themselves (i.e., their narratives) and involved
them in developing the intervention materials. The students’ stories were the main
vehicle for imparting new narrative knowledge. By feeding the adolescents’ own
stories back to them, they learned a new story of drugs, drug use, and drug users.
The new story, presented in narrative form (e.g., role plays and videos), provided
more accurate and conservative information about the number of peers using
drugs (descriptive norms) and peer attitudes (peer injunctive norms) and modeled
resistance and other social skills. By incorporating students’ voices and per-
spectives into the curriculum, we grounded the prevention message in the local
social, geographic, and cultural context of the participants.
126 / GOSIN, MARSIGLIA AND HECHT
Figure 1. Conceptual framework for the culturally-grounded
keepin’ it R.E.A.L. curriculum.
Ten classroom-based lessons were developed (see appendix for a list of lesson
titles). Five of these lessons included a video. The first video introduces the
curriculum while each of the other four models a specific resistance skill. Lesson
one provides an overview of the program, primarily through the introductory video
which shows the high school students producing the four core videos, students
discussing the video, and are given a homework assignment to observe media
advertisement. The remaining lessons follow a similar basic format. The teachers
and students cover a new topic. Students watch a video, conduct a role play,
or participate on some other activity (e.g., creation of a prevention rap song or
Public Service Announcement [PSA]). They discuss the video/activity, and are
assigned homework. Introductions and conclusions preview or summarize the
presented information (i.e., “What you are about to learn/or have learned . . .”).
Curriculum content was reinforced by a PSA on television, a billboard campaign
in local neighborhoods, and school-based booster activities, which repeated
elements of the 10 lessons.
The curriculum represents a comprehensive model of drug prevention [63],
covering the Communication Competence Theory components of knowledge
(drug information and narrative knowledge), motivation (descriptive, injunctive,
and personal norms), and skills (resistance and social skills) and utilizing a
performative style based on Narrative Theory. Lessons are designed to be inter-
active, incorporating active involvement, exchange of ideas, and sufficient prac-
tice time necessary for effective learning [73]. Furthermore, content is intended
to be delivered in a participatory style to encourage interaction among peers, a
particularly important pedagogical element for Latino and African American
youth [78].
Cultural Grounded Approach
To make the curriculum culturally-grounded, we utilized the youth’s own
narratives, which reflect the implicit assumptions of their local, youth, and ethnic
cultures. Our pilot research had identified ethnic differences in these narratives
[34, 35, 79], and, as a result, their use insured ethnic variation was incorporated
into the curriculum. For example, our work demonstrated that drugs typically are
offered to Mexican Americans, African Americans, and European Americans
in different contexts. The curriculum includes these contexts in the role-plays
and videos. Furthermore, the curriculum incorporates the cultural values of the
targeted group. The next section describes this incorporation in detail.
Ethnic Cultural Values Centered Approach
Although each ethnic group produces unique cultural artifacts, reliance on
stereotypes ignores the complexity of ethnicity and ethnic identity. For instance,
the notion that all Latinos are Catholic, for example, offers a narrow view of
Latinos and may fail to capture other cultural characteristics that influence norms
keepin’ it R.E.A.L. / 127
and behaviors. Researchers have suggested a more effective approach for infus-
ing culture into curricula is a values-centered approach [52]. Researchers have
identified cultural, relational, and communication norms and values that are
predominant, though not necessarily universal, within particular ethnic groups.
Affirming these values, influencing relational and communication norms [52],
can help students resist drugs in a manner to which they are already accustomed.
The keepin’ it R.E.A.L. curriculum emphasizes those family and cultural norms
which discourage behaviors such as drug use. It relies not on stereotypes but on
the predominant values in its target populations: Latinos, European Americans,
and African Americans (see Table 1). For example, pilot data [52] revealed that
unlike European Americans, Latinos are less likely to simply refuse a drug offer
(the refuse strategy), they view it as disrespectful to the offerer. Instead they are
more likely to give a reason or explain why a drug offer cannot be accepted (the
Explain strategy). The preference for “explain” is consistent with Latino cultural
values emphasizing the importance of respectful, non-confrontational interaction
manner [52], and as such was incorporated into the Mexican American version
of the curriculum.
The following are two expanded examples of the inclusion of cultural values
and norms into the curriculum.
Values Centered Approach Example #1:
Lesson Objectives
The learning objectives for each curriculum lesson were worded to reflect the
specific cultural values supporting the presented skill. By embedding the cultural
values into the lesson framework, teachers could effectively teach the curriculum
even if they were unfamiliar with a particular ethnic group’s values. The incor-
poration of culture-specific values into the objectives oriented the whole lesson
toward the targeted cultural group(s). For example, in the first lesson of the Latino
curriculum, the objectives are for the student to:
• Recognize that what he or she does affects his or her community, group, and
family; and
• Differentiate between simple preference and “wise choice”—a choice that
is honorable and can be respected.
In contrast, the objectives in the first lesson of the non-Latino version are for
the student to:
• Recognize that what he or she does may have favorable or unfavorable
consequences on his or her own future goals; and
• Differentiate between simple preference and “wise choice”—a choice that
helps the student to achieve his or her personal goals.
128 / GOSIN, MARSIGLIA AND HECHT
keepin’ it R.E.A.L. / 129
Table 1. Ethnic Values Identified as Predominant in Non-Latino
(Euro American), Latino, and African-American Culture
Non-Latino values Latino values African-American values
Individualism:
stress what people are able
to do for themselves as
honorable, honor individual
strengths, goals, victories
Planning and Goals:
having a purpose in life to
get ahead and setting
priorities accordingly
Respect:
valuing people’s boundaries
Directness in
Communication:
being assertive and sure of
one’s self in communication,
direct eye contact
Fair Game:
preference not to be singled
out, playing by the rules,
objectivity valued
(Adapted from J. H. Katz,
The sociopolitical
nature of counseling,
The Counseling
Psychologist, 13,
pp. 615-624, 1985; and
G. F. Cavanagh, American
Business Values,
Prentice-Hall, Englewood
Cliffs, New Jersey, 1990.)
Family Orientation
(familismo):
value in trusting entire
network; family/extended
family valued as center of
social support, solidarity;
family not limited to blood
relatives
Action Orientation:
emphasis on evidence of
one’s intentions through
their actions
Respect (respeto):
giving deference to persons
of status or acknowledging
their position, avoiding
humiliation of others or
direct public confrontation
Personal Treatment
(personalismo):
preference for being treated
on a personal basis rather
than according to
categories, rules, policy
Niceness (simpatia):
creating pleasure in others
by actions, kindness, and
grace in personal treatment,
regardless of persons
(Adapted from R. S. Mayers,
B. L. Kail, and T. D. Watts,
Hispanic Substance Abuse,
Springfield, Illinois: C. C.
Thomas, 1993.)
Communalism:
interdependence; strong
family orientation; role
flexibility, sacrificing or
adapting one’s own wishes/
agenda for the good of the
group or family;
inclusiveness
Purpose:
doing things for a reason;
value in hard work in
achieving a goal
Respect:
respecting the accomplish-
ments of others; honoring
the family and elders; taking
into account the feelings of
others, affective orientation
Endurance:
value in endurance and
persistence in the face of
adversity
Creativity:
expressing oneself through
music, dance, or other forms
of expressive presentation;
importance of the oral
tradition
(Adapted from R. W. Denby,
Resiliency and the African
American Family: A Model of
Family Preservation, The
Black Family, S. L. Logan
(ed.), Westview Press,
Boulder, Colorado,
pp. 144-163, 1996.)
In the Latino version, the student is instructed to consider his or her actions in the
light of how persons who are important to the student, such as family members,
would respond. This reflects the Latino value of familismo or family orientation.
The Non-Latino version places more emphasis on individualism, where the
consideration in making a choice is the student’s own goals. This affirms the
European American value of goal orientation. Thus, while both versions teach
the same skill of recognizing the consequences of choices and differentiating
between simple preference and “wise choice,” they present and justify the skill
through different cultural value frameworks.
Some values are present in multiple cultures. For example, concern for family is
a value for European American and African American cultures as well as Mexican
Americans, and, conversely, goal orientation is part of Mexican culture. The
difference is in the degree to which the curriculum version emphasizes these
values. The emphasis in the curriculum version matches the emphasis within the
targeted group’s culture. Therefore, a given curriculum version may appeal to
non-targeted groups.
Values Centered Approach Example #2: Videos
The curriculum’s videos were produced by youth and for youth. They offer
situational portrayals relevant to the targeted ethnic groups. The four resistance
skills videos, each focusing on a R.E.A.L. resistance strategy (Refuse, Explain,
Avoid, Leave), were written, acted, and produced by local high school students
[80]. The videos are based on middle school students’ stories of their drug offers
and responses. The videos feature youth that are similar to the curriculum partici-
pants in age and ethnicity, and were filmed locally. Consequently, participants are
able to recognize the places where the fictional scenarios take place and view
the videos as relevant and realistic to them.
Social Skills Based Prevention
The curriculum’s social skills component incorporates an interactive skill
development process, shown to be effective in other programs [81]. The process,
known as praxis [82], involves describing the skill to be learned, modeling the
skill, providing an opportunity to practice the skill, giving corrective feedback,
and requiring an application of the skill to natural settings through homework.
The Social Skills component also incorporates Social Influence and the Social
Skills Models [1], to provide students with skills to respond to their environment.
For example, each curriculum version highlights relationships between peers,
parents, and others and motivates participants to resist drugs using social skills
grounded in their ethnicity (e.g., respect, assertiveness, etc.). The curriculum
raises awareness about the social influences that promote substance use and
equips students with the skills to utilize their social support systems to effectively
resist drug offers. For example, each curriculum version contains an exercise in
130 / GOSIN, MARSIGLIA AND HECHT
which students examine their support network and identify who within that
network they can turn to when they have problems.
Communication competency is developed throughout the curriculum [83].
Participants explore the exchange of messages (offers and refusals), the relation-
ship between offerer and resister, and the knowledge, motivation, and skills of the
resister that are needed to achieve desirable outcomes. Through an exercise
entitled “R.E.A.L. in Real Life,” students learn to tailor their resistance to a drug
offer based on the person offering the drugs: family member, peer, or stranger.
Refusal and Resistance Skills:
R.E.A.L Strategies
Earlier ethnographic and other studies on students’ drug behaviors, resistance
strategies, and drug contexts revealed [49, 76] four resistance strategies that are
most used by students: Refuse, Explain, Avoid, and Leave (R.E.A.L). Therefore
keepin’ it R.E.A.L. teaches these strategies. Refuse strategies are straightforward,
verbal, or nonverbal refusals without explanation. Explain strategies include
verbal and non-verbal refusals accompanied by a reason or an excuse for not
accepting a drug offer. Avoid strategies include efforts to physically distance
oneself from situations where drugs may be offered or to avoid an offer once a
conversation has begun (e.g., by changing the topic). Leave strategies entail
physically removing oneself from a drug-related situation.
Influencing Normative Behavior
and Motivation
To cultivate anti-drug injunctive, descriptive, and personal norms the curric-
ulum encourages students to explore how drug use would negatively affect their
values and goals and whether members of their peer group or family would
negatively respond to drug use. It also works at dispelling the idea that drug
use is normative among the students’ peers. Anti-drug norms are presented in
consonance with specific cultural values and reinforced through the videos.
Previous studies suggest that video-based modeling of resistance strategies also
influences norms [58], perhaps through depicting peers who decide not to use
drugs when they are available.
In summary, keepin’ it R.E.A.L is a comprehensive drug prevention curriculum.
It offers skill building in drug resistance and social competence, development of
anti-drug norms, culturally grounded content and pedagogical materials, and a
youth centered approach. The curriculum builds on previous research indicating
the importance of culturally specific approaches to prevention and the ineffec-
tiveness of superficial modifications of standard curricula for ethnic minorities.
In addition, it permits the testing of culturally specific and multicultural drug
abuse interventions for adolescents. The next section presents a summary of the
results of field-testing and evaluation of the curriculum.
keepin’ it R.E.A.L. / 131
RESULTS
Field-Testing: Pre-Implementation Feedback
The curriculum was field-tested as it was developed. Field-testing helped to
ensure the cultural grounding and practical feasibility of the curriculum. Phoenix
teachers served as experts on classroom dynamics, and students served as experts
on the target population. Both provided feedback on individual lessons and the
curriculum as a whole. Greater detail on this method of participatory action
research is presented in Gosin, Dustman, Harthun, and Drapeau [84].
Teacher Feedback
Eight seventh grade teachers of various ethnic backgrounds and teaching
tenures and with Phoenix middle school experience, evaluated the curriculum and
gave suggestions for improvement. In addition to providing written feedback, they
also participated in focus groups where they discussed in-depth their reactions to
the curriculum. The teachers’ feedback offered valuable insight into how seventh
grade students would respond to the lessons and to the types of instruction and
materials that would be needed to help teachers effectively present the lessons.
For example, teachers expressed a need for bilingual materials to effectively
include their many monolingual Spanish students. Consequently, the in-class
worksheets, homework sheets, and overhead materials accompanying the lessons
were translated into Spanish and included in the curriculum.
Student Feedback
The curriculum was pilot tested in three seventh grade classrooms. One DRS
curriculum team member presented two lessons from the curriculum to each class
while another member observed student reactions. These classroom sessions gave
the DRS team a sense of the draft curriculum’s strengths and weaknesses, and
a realistic perspective on the logistical challenges involved in teaching any
lesson, such as working within the allotted time, maintaining students’ interest and
focus, and adapting lessons to students’ comprehension levels. For instance, some
lessons were initially too long to be conducted in the 40-45 minutes allotted to
the session. Consequently, lessons were shortened or activities were eliminated.
Outcome Evaluation Studies
An experimental design was used to evaluate the curriculum post-
implementation. Schools were randomly assigned to the experimental group
(with three subgroups by curriculum version) and the control group (schools
not receiving the curriculum). Classroom teachers taught the curriculum during
regularly scheduled seventh grade classes. PSAs, billboards, and boosters were
presented during the eighth grade. More information about the implementation
132 / GOSIN, MARSIGLIA AND HECHT
is presented in Harthun, Drapeau, Dustman, and Marsiglia [85]. All students
completed a pre-test survey (before curriculum implementation) and three post-
tests (once after the completion of the 10 lessons and twice during the booster
campaign). The results are encouraging. Students participating in any of the three
versions of the curriculum showed desired outcomes for drug use and anti-drug
norms. Table 2 summarizes program effects on key outcome variables for each
of the three curriculum versions and the control group.
As Table 2 shows, the major impact of the three versions of the intervention
were registered at the final post-test (wave 4) for recent (30 days) use of alcohol,
marijuana, and tobacco. The greatest difference was observed for alcohol, the
substance of choice of this sample, among students receiving any of the three
versions of the curriculum versus those in the control group, immediately after the
experimental group participation in the classroom based component (wave 2) and
in the booster campaign (wave 4). The Mexican American curriculum showed
the strongest desired results of any of the three versions of the intervention in
terms of the students’ self-reported use of the R.E.A.L. strategies, their perceived
self-efficacy to resist drugs, and their personal, injunctive, and descriptive
anti-drug norms. Clearly, culturally grounding through the infusion of cultural
elements and values appears to result in effective drug prevention. In an integrated
school system where Mexican American make up the numerical majority of
students, the evaluation found that a curriculum tailored to Mexican American
culture (Mexican American version) or reflective of Mexican American culture
(Multicultural version) reduced use and beneficially impacted a number of
other substance use related psychosocial variables. We conclude, therefore,
that keepin’ it R.E.A.L., a culturally-grounded, school-based intervention has
substantial significant effects on personal and descriptive norms, expectations of
substance and alcohol use, and some additional significant effects on self-efficacy
and injunctive norms.
CONCLUSION
The keepin’ it R.E.A.L curriculum is modeled on successful substance abuse
prevention programs. Its cultural grounding and use of Communication Com-
petence Theory set it apart, however, from some existing programs because it
is designed to reflect the ethnicity of the students it targets without resorting to
use of stereotypic representations of ethnic culture, and uses narratives, a broader
conceptualization of norms, and empirically-derived resistance strategies. By
involving the target population, students in the Southwest, in the creation of
the curriculum, DRS researchers capitalized on the students’ knowledge and
experiences to create a product that reflects their voice and their culture. Our data
demonstrate that the curriculum effectively teaches culturally relevant social
skills and drug resistance strategies while impacting drug norms and expectancies
to enable students to effectively refuse drugs in real life.
keepin’ it R.E.A.L. / 133
T a b
le 2
. M
e a n
D if fe
re n
c e s
a n
d S
ta n
d a rd
E rr
o rs
fo r
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a v io
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u tc
o m
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a n
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it h
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e (W
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134 / GOSIN, MARSIGLIA AND HECHT
S e lf -E
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keepin’ it R.E.A.L. / 135
A P
P E
N D
IX
L e
s s o
n T
it le
s in
O rd
e r
b y
V e
rs io
n o
f k e
e p
in ’ it
R .E
.A .L
. C
u rr
ic u
lu m
L e s s o
n N
u m
b e r
L a ti n
o N
o n
-L a ti n
o M
ix e d
1 2 3 4 5 6 7 8 9
1 0
O p
ti o
n s
a n
d C
h o
ic e s
(w it h
In tr
o d
u c
ti o
n V
id e o
)
R is
k s
C o
m m
u n
ic a ti o
n a n
d C
o n
fl ic
t
R e fu
s e
(v id
e o
: B
re a k in
’ B
a d
H a b
it s )
E x p
la in
(v id
e o
: ¿ P
o rq
u e
N o
? )
A v o
id
(v id
e o
: F ie
s ta
)
L e a v e
(v id
e o
: A
in ’t
N o
G a m
e )
V a lu
e s
F e e li n
g s
S u
p p
o rt
N e tw
o rk
s
O p
ti o
n s
a n
d C
h o
ic e s
(w it h
In tr
o d
u c
ti o
n V
id e o
)
R is
k s
C o
m m
u n
ic a ti o
n a n
d C
o n
fl ic
t
R e fu
s e
(v id
e o
: S
c h
o o
ly a rd
M e
n a c
e )
E x p
la in
(v id
e o
: W
h y
N o
t? )
A v o
id
(v id
e o
: D
re a m
T h
e m
e )
L e a v e
(v id
e o
: T h
e R
id e
)
V a lu
e s
F e e li n
g s
S u
p p
o rt
N e tw
o rk
s
O p
ti o
n s
a n
d C
h o
ic e s
(w it h
In tr
o d
u c
ti o
n V
id e o
)
R is
k s
C o
m m
u n
ic a ti o
n a n
d C
o n
fl ic
t
R e fu
s e
(v id
e o
: B
re a k in
’ B
a d
H a b
it s )
E x p
la in
(v id
e o
: W
h y
N o
t? )
A v o
id
(v id
e o
: D
re a m
T h
e m
e )
L e a v e
(v id
e o
: A
in ’t
N o
G a m
e )
V a lu
e s
F e e li n
g s
S u
p p
o rt
N e tw
o rk
s
136 / GOSIN, MARSIGLIA AND HECHT
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Direct reprint requests to:
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9500 Gilman Drive
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