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The keepin’ it R.E.A.L. (Refuse, Explain, Avoid, Leave) program is a video-enhanced intervention that uses a culturally grounded resiliency model that incorporates traditional ethnic values and practices that protect against drug use. A school-based prevention originally designed for middle-school students, the program has been implemented with youths ages 10 through 17.
keepin’ it R.E.A.L. is based on previous work demonstrating that teaching communication and life skills can combat negative peers and other influences. The program extends resistance- and life-skills models by using a culturally based narrative and performance framework to enhance antidrug norms and attitudes and facilitate the development of risk assessment, decision-making, problem-solving, and resistance skills.
The program teaches youths to live drugfree lives by building on their existing cultural and communication strengths and the strengths of their families and communities. Students are taught how to resist substance use through practical, easy-to-remember and -use strategies that are embodied in the acronym REAL (Refuse, Explain, Avoid, Leave). Using keepin’ it R.E.A.L. strategies, students learn how to recognize risk, value their perceptions and feelings, embrace their cultural values (e.g., avoiding confrontation and conflict in favor of maintaining relationships and respect), and make choices that support them.
Distinct Mexican-American, African-American/Non-Latino, and multicultural versions of keepin’ it R.E.A.L. were developed so students could recognize themselves in the prevention message and see solutions that are sensitive to their unique cultural environments:
Mexican-American
This culture-centered version was created with a concentration on Latino values such as familismo (family orientation), respeto (respect), personalismo (personal treatment), and simpatía (sympathy). For example, in lesson 1 of the Mexican-American curriculum, the objective is 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.
Non-Latino
This version is a mainstream curriculum, taking values such as goal orientation and individualism from white and African–American culture. For example, in lesson 1 of the black/white curriculum, the objective is for the student to recognize that what he or she does may have favorable or unfavorable consequences on his or her future goals and differentiate between simple preference and wise choice.
Multicultural
This version was developed by incorporating five lessons from each of the Mexican-American and non-Latino versions. For a large sample of Phoenix, Ariz., middle school students, the multicultural version had the widest appeal and the highest level of effectiveness of the three versions.
One monthly booster session during the 8 months after completing the classroom-based intervention is recommended. In addition, while this is not a core component, at several replication sites program prevention messages and resistance strategies were reinforced in the community through television and radio public service announcements (PSAs) and billboards.
The initial keepin’ it R.E.A.L. evaluation was conducted over 48 months. The study sample consisted of 3,318 Mexican or Mexican-American students (47 percent female), 1,141 students of other Latino or multiethnic Latino origin (e.g., Mexican and white, Mexican and American Indian; 50 percent female), 1,049 non-Hispanic white students (48 percent female), and 527 African-American students (44 percent female). Eighty-six percent of the Mexican/Mexican-American respondents, 78 percent of the African-American respondents, 73 percent of the multiethnic Latino and other Latino origin respondents, and 36 percent of the non-Hispanic white respondents qualified for free lunch under the Federal program for low-income students. Students ranged in age from 11 to 18, with an average of 12.53 years of age at wave 1. A large proportion of the students spoke Spanish as their native language. In fact, about 10 percent of all participating students chose to complete the study questionnaire in Spanish, about 10 percent specified they speak mostly Spanish with their friends, and 13 percent stated they speak mostly or only Spanish with their families.
Year 1 of the evaluation stratified 35 sample middle schools by enrollment and ethnicity and used block randomization to assign to one of four conditions: Mexican American, black/white, multicultural, or control.
Year 2 administered a preintervention questionnaire to all participants (wave 1), implemented the curriculum in seventh grade classes in treatment schools, and followed this with a wave 2 postintervention questionnaire. Teachers used English or Spanish materials (or both), available with each version. During the summer, a bilingual television PSA and outdoor billboard campaign was conducted.
Year 3 delivered school-based booster sessions with students in the treatment schools and administered follow-up questionnaires (wave 3) and final questionnaires (wave 4) to students in all schools.
Wave 2, 3, and 4 questionnaires were administered 2, 8, and 14 months, respectively, after complete program implementation. The questionnaires used a three-form design that employed planned “missingness” to limit the number of items each individual student received in the questionnaire, while maximizing the total number of items included for analysis. At each wave, students responded to the items used to obtain information about demographic characteristics: recent alcohol, cigarette, and marijuana use; antidrug personal norms; descriptive norms; and intentions to accept substances.
The evaluation findings suggest that keepin’ it R.E.A.L. succeeded in decreasing substance use, in reducing negative attitudes/behaviors, and in improving positive attitudes/behaviors. The data showed a 32 percent to 44 percent reduction in marijuana, tobacco, and alcohol use; a 29 percent to 34 percent decrease in intent to accept substances; and a reduction and cessation of substance use. Improvements in antidrug attitudes/behaviors were apparent in the 30–38 percent increase in knowledge about and negative attitude toward drug use, increased repertoire of resistance skills, more frequent use of those skills, and increased adoption of strategies to resist using alcohol, cigarettes, and marijuana. Other types of outcomes included significantly less substance use (especially alcohol), retention of unfavorable attitudes against someone their age using substances, and perception that their peers’ increase in substance use experimentation was significantly less than previously believed.
Hecht, Michael L., John W. Graham, Elvira Elek–Fisk, Flavio F. Marsiglia, Stephen Kulis, Michelle Miller–Day, and Patricia A. Dustman. 2002. “The Drug Resistance Strategies Intervention: Program Effects on Growth of Substance Use.” Society for Prevention Research annual meeting. Seattle, Wash., June 1.
Hecht, Michael L., Flavio F. Marsiglia, Elvira Elek–Fisk, David A. Wagstaff, Stephen Kulis, and Patricia A. Dustman. 2003. “Culturally Grounded Substance Use Prevention: An Evaluation of the keepin’ it R.E.A.L.” Prevention Science 4(4):233–48.
Patricia Dustman, Ed.D.
Southwest Interdisciplinary Research Center
Arizona State University-Downtown Phoenix Campus
411 N. Central Avenue, Suite 720, Mail Code 4320
Phoenix, AZ 85004-0693
Phone: (602) 496-0700
Fax: (602) 496-0958
E-mail: patricia.dustman@asu.edu
Web site: http://keepinitreal.asu.edu
Patricia Dustman, Ed.D.
Southwest Interdisciplinary Research Center
Arizona State University-Downtown Phoenix Campus
411 N. Central Avenue, Suite 720, Mail Code 4320
Phoenix, AZ 85004-0693
Phone: (602) 496-0700
Fax: (602) 496-0958
E-mail: patricia.dustman@asu.edu
Web site: http://keepinitreal.asu.edu
