Cultural Adaptation of Substance Abuse Interventions: A Review of the Literature

CATEGORY/THEME: Social and Environmental Determinants of Health

TITLE: Cultural adaptation of substance abuse interventions: A review of the literature

ABSTRACT BODY:

Introduction: Adolescent substance abuse is a global problem (Botkin & Griffin, 2007). Educators have sought to address this issue through school-based preventive education (Hecht & Krieger, 2006). Prior research recommends interventions which are culturally sensitive (Barrera, Castro, Strycker, & Toobert, 2012). Such interventions have been shown to enhance both student engagement and adolescent behaviors (Griffin & Miller, 2007). However, more research should be done in order to clarify the cultural components in prevention as they pertain to specific health topics, such as substance abuse (Barrera, Castro, & Holleran-Steiker, 2011). Thus, the purpose of this review is to a) identify the cultural variables used in the adaptation of substance abuse interventions and b) to evaluate whether the inclusion of such variables enhance program outcomes.

Methods: This literature review utilized systematic search procedures: database searches using applicable search terms (e.g., Academic Search Premier, ERIC), consultation of prior literature reviews, and reverse citation searches. The resulting studies were screened according to inclusion criteria (e.g. peer-reviewed, evaluated the cultural adaptation of a school-based prevention intervention, school-based, and specifically addressed substance abuse). The selected 57 articles were organized into a table which described the study design, results, and cultural variables involved. The cultural variables were categorized according to the model of cultural sensitivity which contains two dimensions: surface structure variables (e.g., language, character names) and deep structure variables (e.g., normative beliefs, motivational factors), (Resnicow, Soler, Braithwaite, Ahluwalia, & Butler, 2000).

Results*: Some of the cultural variables reviewed and shown to be empirically validated included language, communication preferences, level of individualism, family orientation, religiosity, norms regarding substance use, gender, ethnic identity, and environmental accessibility. Overall, moderate effects sizes revealed variations in these variables may improve program effectiveness.

Conclusions: This review highlights the need to incorporate deep structure variables (as well as surface structure variables) in future adaptations. Also, there is a need for more rigorous research that operationalizes some of the cultural constructs relevant to substance abuse and analyzes the impact of those constructs on program effectiveness.   

*This review is currently being updated in order to include relevant studies from 2012, and thus the results may be affected.