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Low-income urban youth of color are frequently confronted by a wide variety of challenges and hardships that are not experienced by young people in other areas. They are more likely to drop out of high school (Harvard Civil Rights Project 2004), more likely to be unemployed (Danziger et.al. 1994), more likely to experience poverty and be denied access to basic social services (Rothstein 2003), and more likely to become pregnant during adolescence (Luker 1998).
The prevalence of the hardships faced by these youth has contributed to the notion that this group is by their very nature “at-risk”, and promotes stereotypes that result in them being seen as irresponsible, anti-social and even dangerous. In some cases, social scientists have contributed to this discourse by suggesting that urban youth are products of a pathological “culture of poverty” that render them incapable of overcoming environmental hardships (Murray 1984). Wide acceptance of such views among policy makers and the media have given rise to a broad set of punitive policies aimed at controlling the behavior of urban youth through security, law enforcement and incarceration (Polakow 2001). Such measures reflect a broader societal tendency to overlook the environmental factors that place urban youth at risk (i.e. joblessness, de-industrialization, environmental degradation, school failure, etc.) that shape the lives and opportunities available to urban youth of color.
This comes at a time when this nation’s demographics is rapidly and dramatically changing. Minority and foreign-born populations constitute the fastest growing segment of the school-age population (Suarez-Orozco & Suarez-Orozco, 2000). Census projections indicate that the number of first- and second-generation immigrant youth will continue to expand due to the ongoing influx of immigrants, with the largest number of these arriving from Mexico, Asia and Latin America.
In this chapter, an alternative program strategy is posited -- one that places diversity with respect to culture, class and environment, at the center of prevention efforts. Such an approach it is argued is not only more effective in appealing to the sensibilities of urban youth but also in altering their behavior. We believe this strategy is, in fact, appropriate for most youth programs attempting to serve the needs of low-income youth of color.
About Substance Abuse and Prevention
For most individuals, initiation into drug and alcohol use occurs during adolescence or early adulthood (Kandel & Logan, 1984). For many, early use is little more than a form of experimentation, but for a small but significant segment of the population, early use is often the start to a long-term pattern of substance abuse. Understanding what might be done to reduce and prevent substance abuse among adolescents is increasingly recognized as an essential component of any comprehensive national prevention strategy.
While the potential benefits prevention programs are clear, many schools and community-based organizations have had difficulty designing programs that meet the needs of diverse student population.
Many initiatives to curtail drug and alcohol use are ineffective because they have not been tailored to meet the cultural sensibilities of diverse adolescent populations. The messages and strategies adopted by most substance abuse prevention programs have been designed for a White, middle class recipient population and often are not effective in reaching student populations that are diverse with respect to race, language, culture and socio-economic status (Kumpfer, Alvarado, Smith, & Bellamy, 2002). Kumpfer et al. explain why cultural mismatch is endemic to the design of many prevention programs: “The theoretical constructs, definitions of protective or risk factors, appropriate interventions of strategies, and research evaluation strategies have all been influenced by mainstream American values” (Kumpfer et al., 2002, p.242). In most conventional programs cultural variables receive superficial coverage, and these “mainstream” programs often reflect an ignorance of the cultural perspectives of racial/ethnic minority recipients (Castro & Alarcon, 2002). For this reason, traditional prevention programs are generally less effective with low-income and ethnically/racially diverse populations (Terrell, 1993).
This chapter draws upon the findings from research conducted by Goldstein and Nogurea carried out on an urban high school located in the center of a large metropolitan area, with student population that was 96.9% non-White (2002-2003 Annual Report). More than two-thirds of the students were either first or second-generation immigrants; 8.5% had come to the United States within the last three years. Additionally, more than two-thirds came from homes where English was not the language spoken. Despite the diversity of the student population, educators at the school implemented a standard “mainstream” substance abuse prevention program that was being used with high school students throughout the country.
The goal of the research was to illuminate why such approaches to substance abuse prevention are ineffective, and to make the case for greater attention to the need for cultural tailoring in the materials used with diverse student populations. Below, we describe the concepts of cultural tailoring in the context of prevention programs and offer recommendations we believe will be useful to prevention programs and other programs seeking to engage and improve the outcomes for low-income youth of color
Cultural Tailoring: Surface Level
Research has shown that cultural tailoring must be reflected in the surface structure of a prevention program so that interventions are matched to the observable social and behavioral characteristics of the target groups (Rensnicow, Soler, Braithwaite, Ahluwalia, & Butler, 2000). According to Pasick, D'Onofrio, and Otero-Sabogal (1996), cultural tailoring is “The process of creating culturally sensitive interventions, often involves the adaptation of existing materials and programs for racial/ethnic populations.” Cultural tailoring is a strategy that has been used to enhance the cultural relevance of educational materials in order to heighten receptivity to prevention messages. Without cultural tailoring (discussed in detail below), Castro and Alarcon warn that the messages of a prevention program may be ineffective for diverse groups of learners (Castro & Alarcon, 2002).
Successful cultural tailoring results in surface structures that are more likely to increase receptivity, comprehension, and acceptance of messages (Rensnicow et al, 2000). A critical component of surface-level cultural tailoring is to provide instruction and information in a language and idiom that recipients understand. This entails more than merely a translation of text-based information. It may also require that materials be modified in ways that are appealing and relevant to the cultural codes and social norms of adolescents. At the school where this research was carried out, 17.1 percent of students were identified as English Language Learners (2002-2003 Annual Report), but remarkably, prevention materials were only available in English.
Surface tailoring requires more than an understanding of the heritage and language of the target population. It is equally important that an understanding of students’ daily lives - the challenges they face outside of school, the way they interact within school, and their typical patterns of behavior - be incorporated into the design of programs and into the training of those who will implement the prevention program. For substance abuse prevention, this also entails knowing the types of alcohol or drugs commonly used by the student population.
Surface tailoring should also recognize typical concerns of a target recipient group. For high school students, daily concerns often relate to social pressures; alcohol and drug use may be driven by peer pressure and a desire to fit in. For example, Velez and Ungemack (1995) found that peer modeling was the strongest predictor of drug involvement among Puerto Rican youth. To minimize substance use risks, a prevention program must encourage students to talk about pressures they perceive in their environment and the ways in which patterns of substance use may be normalized within their environment. Such conversations are essential to facilitate the development of refusal skills and resiliency to enable students to resist perceived peer pressure. Because different ethnic/racial groups may have different perceptions of peer pressure and different methods to deal with social influences, a prevention program must be adaptive to accommodate diverse student needs.
In economically depressed areas, the need to address the pressures students may experience to sell drugs as a source of income may be as important as the threat posed by consumption and abuse. Research has shown that where poverty is concentrated and options for employment are limited, the lure of drug trafficking may be powerful and difficult to resist (Wilson, 1987; Williams, 1988). In such areas, the informal sector of the economy where illegal transactions in goods and services occur may provide a greater portion of the income to residents than the formal, legal sector (Skolnick & Curry). Under such circumstances prevention campaigns that encourage young people to “just say no,” or even the threat of long prison sentences for dealers, may not be enough to deter young people from entering the drug trade. For this reason, to succeed in preventing young people from selling drugs school-based prevention programs may also have to address the economic incentives that make it attractive.
Finally, research suggests that efforts to culturally tailor a prevention program with respect to its surface structure should incorporate members of the recipient group in program planning, development, and delivery. Hecht, Marsiglia, Elek, Wagstaff, Kulus, and Dustman (2003) found that minority youth were more responsive to programs in which their input was encouraged. They also tended to respond favorably to teachers delivering the prevention program who were familiar with the challenges they faced in their community or were members of their own ethnic/racial group.
Cultural Tailoring: Deep Level
Research has shown that cultural tailoring must also entail deep-level program adaptations, which reflect how cultural, social, psychological, environmental, and historical factors influence an individual’s health behaviors (Resnicow et al., 2000). As with surface structure, there are several ways to make a substance abuse prevention program culturally relevant at the deep structural level. Stemming from Frye’s (1995) research involving Vietnamese, Cambodian, and Hmong refugees, the author recommends integrating cultural themes into health promotion messages and strategies. Specifically, Frye found that kinship solidarity and the search for equilibrium were dominant cultural themes that could be linked with health messages (Frye, 1995). In a similar vein, Gloria & Peregoy (1996) found that salient Latino values such as simpatia (sympathy), personalismo (personalism), familismo (familial ties), machismo (masculinity) and hembrismo (brotherhood), verguenza (pride), and espiritismo (spiritualism), could be incorporated into the structure of prevention programs. Finally, Wong and Piran (1995) found that, in contrast to the Western culture’s emphasis on the need to be independent and develop an internal locus of control, Chinese culture stresses interdependence, collectivity, and an external locus. Such findings suggest that programs that reflect recognition of students’ cultural values, norms and sensibilities, can increase the receptivity of adolescents to underlying prevention messages.
To accomplish deep structural tailoring, research suggests that program implementers must acknowledge differences in attitudes toward substance usage among and between ethnically/racially diverse student groups. Research has identified consistent correlations between one’s cultural identification and his/her perspectives on health issues, receptivity to messages, and substance use behaviors. Orlandi (1992) explains, “An ethnic or racial group’s shared norms, beliefs, and expectations regarding alcohol and its effects shape the group members’ drinking habits, the ways in which the members behave while drinking, and their perceptions of personal and collective responsibility for the outcomes of drinking.”
Attitudes towards illicit drug use also tend to vary across cultures in predictable ways. Indian culture, for example, considers drug use a moral problem that brings dishonor to one’s community and can cause a family to lose prestige and pride (Bhattacharya, 2002). In Haiti and Cambodia, however, some narcotics are used for medicinal purposes (Amodeo & Jones, 1997); this practice may cause some immigrants from these countries to be more accepting of drug use in some circumstances. Additionally, it has been known for many years that there is variance in the age at which adolescents may be regarded as adults (Findsen, 2003), and therefore allowed to make independent decisions regarding important issues such as marriage, childbirth, and the use of controlled substances. Attention to cultural perspectives and norms increases the likelihood that students will be receptive to a program’s messages.
Deep-level cultural tailoring also requires an understanding of students’ family child rearing norms, which also have been found to vary across cultures. Shakib, Mouttapa, Johnson, Ritt-Olson, Trinidad, Gallaher, & Unger (2003) explain that there is ethnic variation in parenting characteristics and child rearing practices, including parental expectations of parent-child relationship, reliance on authority and control, discipline and parental monitoring. Relative to middle class and affluent Whites, research has found that African Americans, Hispanics and working class Whites are more likely to exhibit authoritative parenting styles (Shakib et al., 2003). Catalano, Morrison, Wells, Gillmore, Iritani, & Hawkins (1992) found that African-American parents tend to be proactive in setting rules and monitoring their child’s behavior during pre-adolescence, but tend to lessen the exercise of authority over their children as they grow older. This type of monitoring has been found to be a protective factor that prevents early substance use initiation but less effective at deterring use during the riskier teen years.
Additionally, factors related to immigration and the subsequent process of assimilation/acculturation have been linked to increased risk of substance abuse and should therefore be reflected in the deep-structural tailoring of a prevention program (Bhattacharya, 2002). Rumbaut (2004) found that as acculturation progresses with greater exposure to the cultural norms prevalent in the United States, immigrant youth experience a noticeable decline in overall health and wellbeing and greater propensity to engage in a variety of risk behaviors. Similarly, a study described by Velez & Ungemack (1995) showed that drug use systematically increased with the number of years in which immigrants reported living in New York City. Finally, a SAMHSA study revealed that, while recent immigrants were less likely to engage in substance use than the U.S.-born population, immigrants who had been in the United States for ten years or longer reported drug use that was not significantly different from that of the native population (SAMHSA, 2004). This research suggests that the vulnerability of adolescent immigrants may be directly related to the stress resulting from acculturation to new societal norms and the concomitant transformation in social identity that adolescents experience during this period (Amodeo & Jones, 1997). Blake, Ledsky, Goodenow, and O’Donnell (2001a) remind us that, “As immigrants acculturate, they adopt norms, health, and risk behavior of their immediate social reference groups and racial/ethnic peers.”
For all of the reasons previously cited, the literature suggests that a culturally competent substance abuse prevention program requires educators to have a thorough grasp of the language, values, belief systems and challenges faced by the targeted recipient population. One may argue that it would be impossible for one program to reflect the unique cultural perspective of each student in highly diverse environments. However, Hecht et al. (2003) found that programs do not need to be narrowly tailored for each cultural/ethic group. Rather, they should incorporate a representative level of relevant cultural elements and draw upon images and themes from popular culture that are likely to resonate with a wide variety of young people. By offering a broad range of culturally relevant material, and by allowing students to bring their own cultural perspectives into class discussions, a program can achieve cultural competency.
Implications and Conclusions
Our research findings have potential implications for improving the prevention programs, some of which may be of value can program seeking to serve the needs of older youth of color. To minimize students’ risks, prevention programs should devote increased attention to informing students about the actual prevalence of adolescent substance use, which is lower than students typically perceive. Furthermore, the program should acknowledge potential ethnic/racial differences in students’ perceptions about peer substance use. Study findings suggest that African American and U.S.-born students may be at higher immediate risk for initiating substance use. Since adolescents tend to conform to what they perceive as normal peer behavior (Stacy, A. W., Sussman, S., Dent, C. W., Burton, D., & Flay, B. R., 1992; Musher-Eizenman, Holub, & Arnett M, 2003), the higher estimates of peer drug use may indicate their heightened risk for using substances.
It is possible that, with increased time in the United States, immigrants’ social norms perceptions will change and become more closely matched to those reported by U.S.-born students. Over time, these changes may result in actual substance use increases among the immigrant student groups. To combat this risk, prevention programs should take advantage of the “window of opportunity” (Blake, 2001b), during which time immigrants are highly receptive to prevention education. The program may benefit from promoting resiliency and refusal skills among immigrant youth. These skills may help these students resist perceived peer pressure during the acculturation process, a period during which Bhattacharya (2002) and other researchers revealed that immigrants often initiate substance use.
Survey findings related to perceptions of social pressure also suggest that the prevention program should encourage students to communicate with each other openly in facilitated workshops about pressures that exist within their school environment. The availability of positive peer role models may provide students with the opportunity to disengage from a peer cluster that may put them at high risk for substance abuse. An obvious way a school can foster student communication is by engaging students in program development and implementation. Research attests to the success of peer-based strategies (Tobler, 1986).
The following is a summary of recommendations for how prevention programs focus on substance use and other issues can improve the program on a surface level:
- Provide translated text-based information. Insure that translation services are available to program providers in order to make the prevention program accessible to English Language Learners;
- Integrate students’ everyday terminology into instructional materials;
- Incorporate cultural images and elements into instructional materials to appeal to the diverse recipient group;
- Convey an awareness of the types of substances and other high-risk behaviors students are most likely to engage in;
- Recruit the input and participation of a culturally/racially diverse group of individuals, including a diverse group of instructors, peers, parents, community members, and graduate students.
The following recommendations should be taken to support deep structural tailoring:
- Incorporate diverse cultural themes into its prevention messages;
- Acknowledge potential culture-based differences in students’ substance abuse attitudes and behaviors.
- Increase sensitivity to diverse family structures and parent-child relationships; this can be achieved by incorporating more diverse depictions of family into role-play scenarios;
- Revamp the written curriculum, incorporating settings and role-play scenarios with which more students may identify; recruit students’ help with this process;
- Acknowledge and directly address the influences of peer pressure. By instituting a Peer Helper Program, students would have a forum in which they can be encouraged to talk about pressures they perceive in their environments;
- Devote increased attention to the potential influence of immigrant status on students’ beliefs, behaviors, and substance abuse and other risk behaviors.
- Identify immigrant youth who may be experiencing culture shock, ethnic identity confusion, or family separation, since these students may be at higher risk during acculturation.
Developing strategies to better integrate the realities faced by low-income urban youth of color into prevention and youth development programs is essential to effectively offsetting the wide variety of risks they face. As this study has shown, such strategies are more likely to be effective if they take diversity with respect to language, culture, class and environment into account in development and implementation. While such programs cannot counter the structural factors (i.e. economic marginalization, housing and job shortages, etc.) that place large number of urban youth at risk, they can help in promoting resilience and relief from some of the hardships urban youth endureReferences:
Amodeo, M., & Jones, L.K. (1997). Viewing alcohol and other drug use cross culturally: a cultural framework for clinical practice.
Catalano, R.F., Morrison, D.M, Wells, E.A., Gillmore, M.R., Iritani, B., & Hawkins, J.D. (1992). Ethnic differences in family factors related to early drug initiation. Journal of Studies on Alcohol, 53; 208-217.
Castro, F.G., & Alarcon, E.H. (2002). Integrating cultural variables into drug abuse prevention and treatment with racial/ethnic minorities. Journal of Drug Issues, 32(3); 783-810.
Findsen, B. (2003). Older adults' communities of learning and practice. Communities of learning: Communities of practice: Proceedings of the 43rd National Conference of Adult Learning Australia. [Online]. Sydney: Adult Learning Australia. pp. 180-197. Information retrieved online June 24, 2005 from: www.ala.asn.au/conf/2003/findsen.pdf
Gloria, A.M., & Peregoy, J.J. (1996). Couseling Latino alcohol and other substance users/abusers. Cultural considerations for counselors. Cultural consideration for counselors. Journal of Substance Abuse Treatment, 13; 119-126.
Published in In Motion Magazine March 25, 2006.
