Hecht, M. L., Marsiglia, F. F., Elek, E., Wagstaff, D. A., Kulis, S., Dustman, P., & Miller-Day, M. (2003). Culturally grounded substance use prevention: An evaluation of the keepin' it REAL curriculum. Prevention Science, 4(4), 233-248. doi:10.1023/A:1026016131401

Type of Study: Randomized controlled trial
Number of Participants: 6,035

Population:

• Age — 11-18 years (Mean=12.53 years)
• Race/Ethnicity — 3,318 Mexican or Mexican American, 1,141 other Latino or multiethnic Latino origin (e.g., Mexican and White, Mexican and American Indian), 1,049 non-Hispanic White, and 527 African American
• Gender — 47% Female
• Status — Participants were low-income middle school students.

Location/Institution: Phoenix, AZ

Summary: (To include basic study design, measures, results, and notable limitations)
This paper reports on the evaluation of keepin' it REAL which targets substance use among urban middle-school students. Measures utilized the Focus Theory of Norms and included a questionnaire that addressed demographics, alcohol, cigarette, and marijuana use. Thirty-five middle schools were randomly assigned to 1 of the 3 keepin' it REAL versions: Mexican-American-centered version (Mexican American); non-Mexican-American-centered version (Black/White), Multicultural version, or to the services as usual control group. Results indicate students participating in any version of the keepin' it REAL intervention reported better behavioral and psychosocial outcomes related to substance use than did control students. Additionally, the Mexican American and Multicultural versions of the keepin' it REAL curriculum impacted the most outcomes. Limitations include differences in the drug resistance strategies between the three versions of keepin' it REAL, concerns about how well this Mexican American version will generalize to other Mexican American communities in the Southwest, the large amount of missing data, and the short length of post-intervention follow-up.

Length of controlled postintervention follow-up: 2 months after the end of the booster sessions.

Kulis, S., Marsiglia, F. F., Elek, E., Dustman, P., Wagstaff, D. A., & Hecht, M. L. (2005). Mexican/Mexican American adolescents and keepin' it REAL: An evidence-based substance use prevention program. Children & Schools, 27(3), 133-145. doi:10.1093/cs/27.3.133

Type of Study: Randomized controlled trial
Number of Participants: 3,402

Population:

• Age — 11-18 years (Mean=12.52 years)
• Race/Ethnicity — 100% Mexican, Mexican American, or Chicano
• Gender — 48.5% Female
• Status — Participants were low-income middle school students.

Location/Institution: 35 middle schools in Phoenix, Arizona

Summary: (To include basic study design, measures, results, and notable limitations)
This study utilizes the Mexican-American population from Hecht et al. (2003). This paper reports on the efficacy of three curriculum versions teaching drug resistance strategies of keepin' it REAL, one modeled on Mexican American culture; another modeled on European American and African American culture; and a multicultural version. Thirty-five middle schools were randomly assigned to 1 of the 3 versions: Mexican-American-centered version (Mexican American), non-Mexican-American-centered version (Black/White), Multicultural version, or to the services as usual control group. Measures utilized the Focus Theory of Norms and included a questionnaire that addressed demographics, alcohol, cigarette, and marijuana use. Results indicate that, compared with controls, Mexican-American students in the Latino version of keepin' it REAL reported less overall substance use and marijuana use, stronger intentions to refuse substances, greater confidence they could do so, and lower estimates of substance-using peers. Mexican-American students in the multicultural version reported less alcohol, marijuana, and overall substance use. Although program effects were confined to the Latino and multicultural versions, tests of their relative efficacy compared with the Black/White version found no significant differences. Limitations include the comparison of newly created program versions of keepin' it REAL to one another rather than to a standard keepin' it REAL version, dosage and attrition issues, and generalizability beyond the local cultural environments.

Length of controlled postintervention follow-up: 2 months after the end of the booster sessions

Hecht, M. L., Graham, J. W., & Elek, E. (2006). The drug resistance strategies intervention: Program effects on substance use. Health Communication, 20(3), 267-276. doi:10.1207/s15327027hc2003_6

Type of Study: Randomized controlled trial
Number of Participants: 6,298

Population:

• Age — 7th grade (approximately 11-13 years old)
• Race/Ethnicity — 65% Mexican/Mexican American, 24% White, 12% African American, 11% Hispanic (Puerto Rican, Cuban, etc.), 11% Native American, and 3% Asian or Pacific Islander
• Gender — 47% Female
• Status — Participants were economically disadvantaged 7th grade students.

Location/Institution: 35 middle schools in Phoenix, Arizona

Summary: (To include basic study design, measures, results, and notable limitations)
This study utilizes a population from Hecht et al. (2003). This study evaluates the Drug Resistance Strategies (DRS) project, keepin' it REAL. 35 participating metropolitan area Phoenix schools were randomly assigned according to enrollment and ethnicity (percentage Hispanic) to one of four conditions (Mexican and Mexican American version, 1,352 students; White and African American version, 1,180 students; multicultural version, 1,722 students; or control, 2,044 students). Measures utilized the Focus Theory of Norms and included a questionnaire that addressed demographics, alcohol, cigarette, and marijuana use. Results indicate when compared to a control group, the DRS keepin' it REAL intervention appeared to significantly limit the increase in the number of students reporting recent substance use, especially alcohol and marijuana use. The multicultural version of the curriculum proved most broadly effective, followed by the version targeting Mexican American youth. Limitations include concerns about how well this particular intervention will generalize to other Mexican American communities in the Southwest, high attrition rate, and that both experimental and control sites were exposed to the keepin' it REAL public service announcements and billboards.

Length of controlled postintervention follow-up: None.

Warren, J. R., Hecht, M. L., Wagstaff, D. A., Elek, E., Ndiaye, K., Dustman, P., & Marsiglia, F. F. (2006). Communicating prevention: The effects of the keepin' it REAL classroom videotapes and televised PSAs on middle-school students' substance use. Journal of Applied Communication Research, 34(2), 209-227. doi:10.1080/00909880600574153

Type of Study: Randomized controlled trial
Number of Participants: 4,734

Population:

• Age — Middle school age (approximately 10-14 years)
• Race/Ethnicity — 55% self-identified as Mexican American, Mexican, or Chicano; 17% as Other Latino (Puerto Rican, Cuban, etc.); 19% White, 9% African American
• Gender — 49% Female
• Status — Participants were economically disadvantaged middle school students.

Location/Institution: 35 middle schools in Phoenix, Arizona

Summary: (To include basic study design, measures, results, and notable limitations)
This study utilizes a population from Hecht et al. (2003). This study sought to determine if exposure to two communication-oriented activities (videotapes and public service announcements) accounts for changes in substance use among adolescents participating in the keepin' it REAL adolescent substance use prevention curriculum. Participating schools were randomly assigned to the following: 25 schools randomly assigned to one of three versions of keepin' it REAL and 10 schools to the services as usual control condition. Measures utilized the Focus Theory of Norms and included a questionnaire that addressed demographics, alcohol, cigarette, and marijuana use. Results indicate that keepin' it REAL students who saw four or five videos engaged in less substance use in the past month than did students who saw fewer videos. Having seen the PSAs one or more times did not predict the reported change in substance use. Limitations include the lack of randomization to view the videotapes and public service announcements, the relationship between school attendance and viewing of the materials, and possible inaccuracies in the students' self-reports of seeing the materials several months prior to the survey.

Length of controlled postintervention follow-up: 2 months after the end of the booster sessions.

Kulis, S., Yabiku, S. T., Marsiglia, F. F., Nieri, T., & Crossman, A. (2007). Differences by gender, ethnicity, and acculturation in the efficacy of the keepin' it REAL model prevention program. Journal of Drug Education, 37(2), 123-144. doi:10.2190/C467-16T1-HV11-3V80

Type of Study: Randomized controlled trial
Number of Participants: 4,622

Population:

• Age — Mean=12.52 years
• Race/Ethnicity — 55% Self-identified as Mexican American, Mexican, or Chicano; 17% as Other Latino (Puerto Rican, Cuban, etc.); 19% White, and 9% African American
• Gender — 49% Female
• Status — Participants were economically disadvantaged middle school students.

Location/Institution: 35 middle schools in Phoenix, Arizona

Summary: (To include basic study design, measures, results, and notable limitations)
This study utilizes a population from Hecht et al. (2003). This study examined whether the efficacy of keepin' it REAL was moderated by gender, ethnicity, and acculturation. The participating public schools were stratified according to enrollment size and ethnicity (the percentage of Latino students) and then assigned to treatment (keepin' it REAL) or control groups through block randomization. Measures utilized the Focus Theory of Norms and included a questionnaire that addressed demographics, alcohol, cigarette, and marijuana use. Results indicate that the total sample showed no gender differences in program effects on recent substance use, but the program was more effective in fostering boys' than girls' antidrug norms. Subgroup analyses demonstrated several more beneficial program effects for boys than girls (less alcohol and cigarette use and stronger antidrug norms), but only among less acculturated Latinos. There were no gender differences in program effects among more acculturated Latinos, nor among non-Latino whites. Limitations include that three versions of the keepin' it REAL were treated as a single intervention and the lack of longer follow-up.

Length of controlled postintervention follow-up: 2 months after the end of the intervention.

Kulis, S., Nieri, T., Yabiku, S., Stromwall, L. K., & Marsiglia, F. F. (2007). Promoting reduced and discontinued substance use among adolescent substance users: Effectiveness of a universal prevention program. Prevention Science, 8(1), 35-49. doi:10.1007/s11121-006-0052-3

Type of Study: Randomized controlled trial
Number of Participants: 1,364

Population:

• Age — 11-16 years (Mean=13 years)
• Race/Ethnicity — 95% Self-Identified as Mexican American, Mexican, or Chicano; 10% African American or Black, American Indian, and Asian or Pacific Islander
• Gender — 57% Male and 43% Female
• Status — Participants were economically disadvantaged middle school students.

Location/Institution: 35 middle schools in Phoenix, Arizona

Summary: (To include basic study design, measures, results, and notable limitations)
This study utilizes a population from Hecht et al. (2003). This study examined the effectiveness of keepin' it REAL in promoting reduced or recently discontinued alcohol, cigarette, and marijuana use. The participating public schools were stratified according to enrollment size and ethnicity (percentage of Latino students) and then assigned to treatment (program participation) or control groups through block randomization. Measures utilized the Focus Theory of Norms and included a questionnaire that addressed demographics, alcohol, cigarette, and marijuana use. Results indicated that prevention program participation influenced the rates of reduced and recently discontinued use only for alcohol, controlling for baseline use severity, age, grades, socioeconomic status, ethnicity, and gender. Among youth who reported use of alcohol in wave 1, the rate of reducing use for program participants was higher than the rate for control students. The rate of discontinuing use was higher than the rate for control students. Among youth who reported use of one or more of the three substances in wave 1), the rate of discontinuing all use was higher for program participants than for control students. Limitations include that three versions of the keepin' it REAL were treated as a single intervention, the manner in which reduction and discontinuation of substance use was measured, high attrition, and lack of longer follow-up.

Length of controlled postintervention follow-up: 2 months after the end of the intervention.

Marsiglia, F. F., Kulis, S., Yabiku, S. T., Nieri, T. A., & Coleman, E. (2011). When to intervene: Elementary school, middle school, or both? Effects of keepin' it REAL on substance use trajectories of Mexican heritage youth. Prevention Science, 12(1), 48-62. doi:10.1007/s11121-010-0189-y

Type of Study: Randomized controlled trial
Number of Participants: 1,670

Population:

• Age — 10-11 years (Mean=10.39 years)
• Race/Ethnicity — 84% Mexican, Mexican American, or Chicano
• Gender — Children: 50.4% Female and 49.6% Male
• Status — Participants were low-income elementary and middle school students.

Location/Institution: 29 middle schools in Phoenix, Arizona

Summary: (To include basic study design, measures, results, and notable limitations)
The study investigated the trajectory of recent substance use (alcohol, cigarettes, marijuana, inhalants) among Mexican heritage students participating in the keepin it REAL drug prevention program at different developmental periods: the elementary school (5th grade), middle school (7th grade), or both. Measures utilized the Focus Theory of Norms and included a questionnaire that addressed demographics, alcohol, cigarette, and marijuana use. Results indicate no evidence that intervening only in elementary school was effective in altering substance use trajectories from 5th to 8th grade, either for licit nor illicit substances. Implementing keepin' it REAL in middle school alone altered the trajectories of use of all four substances for Mexican heritage youth. A double dose of prevention, in elementary and middle school proved to be equally as effective as intervening in 7th grade only, and only for marijuana and inhalants. The decrease in use of marijuana and inhalants among students in the 7th-grade-only or the 5th- and 7th-grade interventions occurred just after students received the curriculum intervention in 7th grade. Limitations include failure to track some students successfully from elementary to middle school, and transfers of some students among study schools in different conditions, both experimental and control sites continued to offer their preexisting prevention activities, the impact of the keepin' it REAL intervention may not have been fully isolated from competing prevention messages, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Pettigrew, J., Miller-Day, M., Krieger, J., & Hecht, M. L. (2011). Alcohol and other drug resistance strategies employed by rural adolescents. Journal of Applied Communication Research, 39(2), 103-122. doi:10.1080/00909882.2011.556139

Type of Study: One-group pretest-posttest
Number of Participants: 113

Population:

• Age — Not Specified
• Race/Ethnicity — 85.8% White, 5.3% Latino/a, 0.9% Asian, and 6.2% Mixed Race
• Gender — 55% Male and 45% Female
• Status — Participants were economically disadvantaged middle school students.

Location/Institution: Appalachian schools in Pennsylvania and Ohio

Summary: (To include basic study design, measures, results, and notable limitations)
This study seeks to identify how rural adolescents make health decisions and utilize communication strategies to resist influence attempts in offers of alcohol, tobacco, and other drugs (ATOD) among students participating in the keepin' it REAL program. Measures utilized the Focus Theory of Norms and included a questionnaire that addressed demographics, alcohol, cigarette, and marijuana use. Results indicate rural adolescents from Pennsylvania and Ohio employed the same four primary resistance strategies - refuse, explain, avoid, and leave - identified in previous research among urban youth, but enacted resistance strategies in different ways than urban youth. The keepin' it REAL resistance typology appears to apply broadly across urban and rural youth samples in addition to spanning early adolescence into early adulthood. Limitations include nonrandomization of participants, lack of control group, and lack of follow-up.

Length of controlled postintervention follow-up: None.