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 R.E.A.L curriculum. Prevention Science, 4(4), 233–248. https://doi.org/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/Mexican American, 1,141 Other Latino or Multiethnic Latino Origin, 1,049 Non-Hispanic White, and 527 African American
• Gender — 47% Female (Mexican or Mexican American), 50% Female (other Latino or multiethnic Latino origin), 48% (Non-Hispanic White), and 44% Female (African American)
• Status — Participants were low-income middle school students.

Location/Institution: Phoenix, AZ

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to report on the evaluation keepin’ it R.E.A.L. [now called keepin' it REAL (kiR)] which targets substance use among urban middle-school students. Participant schools were randomly assigned to 1 of 3 versions of keepin’ it R.E.A.L. (Mexican American, combined African American and European American, or Multicultural) or to the control. Measures utilized include the Focus Theory of Norms. Results indicate that students participating in any version of the keepin’ it R.E.A.L. 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 R.E.A.L. curriculum impacted the most outcomes. Limitations include differences in the drug resistance strategies between the three versions of keepin’ it R.E.A.L., concerns about how well the Mexican American version will generalize to other Mexican American communities in the Southwest, the large amount of missing data, and the short length of postintervention follow-up.

Length of controlled postintervention follow-up: 2 months.

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. https://doi.org/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/Chicano
• Gender — 49% Female
• Status — Participants were low-income middle school students.

Location/Institution: Thirty-five middle schools in Phoenix, Arizona

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Hecht et al. (2003). The purpose of the study was to report on the efficacy of three curriculum versions teaching drug resistance strategies of Keepin’ it REAL (kiR), one modeled on Mexican American culture; another modeled on European American and African American culture (Black/White); and a multicultural version. Participant schools were randomly assigned to 1 of the 3 versions, or to the services as usual control group. Measures utilized include the Focus Theory of Norms. Results indicate that, compared with controls, Mexican American students in the Latino version of kiR 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 kiR to one another rather than to a standard kiR version, dosage and attrition issues, only following a subsample of the original sample, lack of follow-up for other groups from the original study, and lack of generalizability beyond the local cultural environments.

Length of controlled postintervention follow-up: None.

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. https://doi.org/10.1207/s15327027hc2003_6

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

Population:

• Age — Not specified
• Race/Ethnicity — 65% Mexican/Mexican American, 24% White, 12% African American, 11% Hispanic,11% Native American, and 3% Asian or Pacific Islander
• Gender — 47% Female
• Status — Participants were economically disadvantaged 7th grade students.

Location/Institution: Thirty-five middle schools in Phoenix, Arizona

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Hecht et al. (2003). The purpose of the study was to evaluate the Drug Resistance Strategies (DRS) project, keepin’ it REAL (kiR). Participant schools were randomly assigned according to enrollment and ethnicity (percentage Hispanic) to one of four conditions (Mexican and Mexican American version; White and African American version; Multicultural version; or control). Measures utilized include the Focus Theory of Norms. Results indicate that when compared to a control group, the kiR 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 generalization to other Mexican American communities in the Southwest, the high attrition rate, only a subsample of the original sample received follow-up, and that both experimental and control sites were exposed to the kiR 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. https://doi.org/10.1080/00909880600574153

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

Population:

• Age — Not specified
• Race/Ethnicity — 55% Mexican American/Mexican/Chicano, 19% White, 17% Other Latino, and 9% African American
• Gender — 49% Female
• Status — Participants were economically disadvantaged middle school students.

Location/Institution: Thirty-five middle schools in Phoenix, Arizona

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Hecht et al. (2003). The purpose of the study was 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 (kiR) adolescent substance use prevention curriculum. Participating schools were randomly assigned to the following: 25 schools randomly assigned to one of three versions of kiR and 10 schools to the services as usual control condition. Measures utilized include the Focus Theory of Norms. Results indicate that kiR 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, only a subsample was followed, lack of follow-up for other groups from the original sample, and possible inaccuracies in the students’ self-reports of seeing the materials several months prior to the survey.

Length of controlled postintervention follow-up: None.

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. https://doi.org/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% Mexican American/Mexican/Chicano, 17% Other Latino, 19% White, and 9% African American
• Gender — 49% Female
• Status — Participants were economically disadvantaged middle school students.

Location/Institution: Thirty-five middle schools in Phoenix, Arizona

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Hecht et al. (2003). The purpose of the study was to examine whether the efficacy of keepin’ it REAL (kiR) was moderated by gender, ethnicity, and acculturation. Participating public schools were stratified according to enrollment size and ethnicity (the percentage of Latino students) and then assigned to treatment (kiR) or control groups through block randomization. Measures utilized include the Focus Theory of Norms. 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 male than female antidrug norms. Subgroup analyses demonstrated several more beneficial program effects for males than females (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 the three versions of kiR were treated as a single intervention, lack of follow-up for all groups, and only a subsample from the original sample received follow-up.

Length of controlled postintervention follow-up: None.

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. https://doi.org/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 — 77% Latino, 13% White/Anglo, 10% African American/Black, American Indian, and Asian or Pacific Islander
• Gender — 57% Male and 43% Female
• Status — Participants were economically disadvantaged middle school students.

Location/Institution: Thirty-five middle schools in Phoenix, Arizona

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Hecht et al. (2003). The purpose of the study was to examine the effectiveness of keepin’ it REAL (kiR) in promoting reduced or recently discontinued alcohol, cigarette, and marijuana use. Participant 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 include the Focus Theory of Norms. Results indicate 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 rates of both reducing and discontinuing use for program participants 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 the three versions of kiR were treated as a single intervention, the manner in which reduction and discontinuation of substance use was measured, high attrition, and only a subsample of the original sample received follow-up.

Length of controlled postintervention follow-up: 2 months.

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. https://doi.org/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/Chicano
• Gender — 50% Female and 50% Male
• Status — Participants were low-income elementary and middle school students.

Location/Institution: Twenty-nine middle schools in Phoenix, Arizona

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Hecht et al. (2003). The purpose of the study was to investigate the trajectory of recent substance use (alcohol, cigarettes, marijuana, inhalants) among Mexican heritage students participating in the keepin’ it REAL (kiR) drug prevention program at different developmental periods: elementary school (5th grade), middle school (7th grade), or both. Participant 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 include the Focus Theory of Norms. Results indicate that there was no evidence that intervening only in elementary school was effective in altering substance use trajectories from 5th to 8th grade, either for licit or illicit substances. Implementing kiR 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 kiR intervention may not have been fully isolated from competing prevention messages; and lack of follow-up.

Length of controlled postintervention follow-up: None.

Ayers, S. L., Kulis, S. S., Marsiglia, F. F., Campos, A. P., & Medina-Mora, M. E. (2023). Keepin’It REAL—Mantente REAL in Mexico: Longitudinal examination of youth drug resistance strategies and substance use among early adolescents. Journal of Adolescent Health, 73(3), 412–420. https://doi.org/10.1016/j.jadohealth.2023.05.009

Type of Study: Randomized controlled trial
Number of Participants: 5,522

Population:

• Age — 11–17 years
• Race/Ethnicity — 100% Mexican
• Gender — 49% Female
• Status — Participants were middle school students.

Location/Institution: Three metropolitan areas of Mexico: Mexico City, Guadalajara, and Monterrey.

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine if culturally and linguistically adapted versions of a US-developed adolescent substance use prevention intervention, keepin’ it REAL for Mexico increased the use of drug resistance strategies and if increased use of resistance strategies subsequently leads to a reduction in the frequency of substance use (i.e., alcohol, cigarette, marijuana, and inhalants). Participants were randomized into three conditions: (1) Mantente REAL (MREAL), the culturally adapted version, (2) kiREAL-S, the linguistically adapted version, and (3) Control. Measures utilized include study-developed questionnaires that recorded the frequency of use of alcohol, cigarettes, marijuana, and inhalants. Results indicate that at time point 2, the number of drug resistance strategies used by students increased in both MREAL and kiREAL-S compared to Control. However, only MREAL lead to less frequent use of alcohol, cigarettes, marijuana, and inhalants at time point 4, mediated through increased use of drug resistance strategies. Limitations include high attrition rate in the 9th grade, reliance on self-report measures, surveys neglecting to ask about e-cigarette use and vaping, and finally a natural disaster, an earthquake, occurred during the school year which delayed treatment completion for one metropolitan area and may have influenced the substance use rates.

Length of controlled postintervention follow-up: 4, 15, and 22 months.

The following studies were not included in rating kiR on the Scientific Rating Scale...

Marsiglia, F. F., Ayers, S. L., Baldwin-White, A., & Booth, J. (2016). Changing Latino adolescents’ substance use norms and behaviors: The effects of synchronized youth and parent drug use prevention interventions. Prevention Science, 17(1), 1–12. https://doi.org/10.1007/s11121-015-0574-7

The purpose of the study was to present the results on youth substance use when adding a culturally grounded parenting component, Familias Preparando la Nueva Generación (FPNG), to the existing classroom-based drug abuse prevention intervention, keepin’ it REAL (kiR). Participant schools were randomized into three conditions: parent and youth (PY), youth only (Y), and control (C), but only the PY and Y conditions are included in the analysis. Measures utilized include the Substance Use at W3 and Anti-drug Norms at W3. Results indicate that when FPNG and kiR are combined, youth had significantly lowered alcohol and cigarette use at the end of 8th grade, mediated through anti-drug norms when compared with youth who only participated in kiR without parental participation in FPNG. Limitations include lack of use of standardized measures, lack of generalizability due to the majority of adult participants being female and living in predominantly Latino neighborhoods, and lack of analysis on the control group. Note: This study was not used in the rating process due to significant adaptations that were made to the intervention.

Boyas, J. F., Villarreal-Otálora, T., & Marsiglia, F. F. (2019). Alcohol use among Latinx early adolescents: Exploring the role of the family. Journal of Alcohol and Drug Education, 63(2), 35–58. https://eric.ed.gov/?id=EJ1228056

The purpose of the study was to examine whether augmenting a culturally-based parent education program (Familias) would strengthen the effects of a youth intervention (keepin’ it REAL [kiR]) in reducing rates of alcohol consumption among Latinx adolescents. Participants were randomly assigned to one of three conditions: parent-youth (PY), youth-only (YO), or a control condition (C). Measures utilized include study-developed surveys. Results indicate that receiving the parental and youth curricula components and two other family practices were significantly associated with lower rates of alcohol consumption at Wave 2. Limitations include lack of standardized measures, lack of follow-up, lack of generalizability because most of the sample participants were of Mexican and Mexican American ancestry, dependence on self-report measures of alcohol use, and long-term causal inferences of the effectiveness of the intervention cannot be made. Note: This study was not used in the rating process due to the intervention being delivered in conjunction with another intervention and was not examined separately.

Marsiglia, F. F., Ayers, S. L., Han, S., & Weide, A. (2019). The role of culture of origin on the effectiveness of a parents-involved intervention to prevent substance use among Latino middle school youth: Results of a cluster randomized controlled trial. Prevention Science, 20(5), 643–654. https://doi-org.libproxy.sdsu.edu/10.1007/s11121-018-0968-4

The purpose of the study was to assess the combined effectiveness of a parenting intervention, Families Preparing the New Generation (FPNG), and a youth curriculum, keepin’ it REAL (kiR), on substance use prevention for middle school students in a large urban metro area of the Southwest USA. Participants were randomly assigned to three intervention conditions: parent-youth (PY), parent-only (PO), and comparison (C). Measures utilized include study-developed surveys. Results indicate that for alcohol use PO yielded better results than PY, and that PY outperformed C after 20 months. Further, PO showed a decreasing trajectory in any substance use over time since the implementation of the intervention. The effect sizes indicate small effects in any substance use and alcohol use for PO condition and smaller effects for the PY condition. Limitations include lack of standardized measures, relatively small sample size, all youth participated regardless of an indicated need for substance use prevention, lack of generalizability due to the participants in this study were majority immigrant families living in predominantly low socioeconomic status Latino neighborhoods in the Southwestern USA. Note: This study was not used in the rating process due to the intervention being delivered in conjunction with another intervention and was not examined separately.

Marsiglia, F. F., Ayers, S. L., Robbins, D., Nagoshi, J., Baldwin‐White, A., & Castro, F. G. (2019). The initial assessment of a community‐based intervention with Mexican‐heritage parents in boosting the effects of a substance use prevention intervention with youth. Journal of Community Psychology, 47(2), 195–209. https://doi.org/10.1002/jcop.21723

The purpose of the study was to examine if adding a parenting component, Families Preparing the New Generation (Familias Preparando la Nueva Generacion), to keepin’ it REAL (kiR), would boost the effects of the youth intervention in preventing substance use for middle school Mexican-heritage students. Participants were randomly assigned to 1 of 3 conditions: parent and youth, youth only (kiR), or control. Measures utilized include a study-developed survey measuring substance abuse. Results indicate that youth whose parents also participated in prevention programming exhibited significantly lower use of alcohol, cigarettes, marijuana, and inhalants compared to youth who received only kiR. Limitations include lack of standardized measures, lack of follow-up, did not assess parent’s knowledge of youth substance use prior to joining the intervention, the lack of representation of English-dominant Mexican American parents limits the generalizability of the findings, and reliance on self-reported substance use. Note: This study was not used in the rating process due to the intervention being delivered in conjunction with another intervention and was not examined separately.

Cutrín, O., Fadden, I. M., Marsiglia, F. F., & Kulis, S. S. (2023). Social validity in Spain of the Mantente REAL prevention program for early adolescents: Social validity of Mantente Real in Spain. Journal of Prevention, 44(2), 143–164. https://doi.org/10.1007/s10935-022-00701-3

The purpose of the study was to evaluate the culturally adapted version of, keepin’ it REAL, Mantente REAL for adolescents in Spain. Participant schools were randomized to either Mantente REAL or to a non-treatment control condition. Measures utilized include study-developed surveys, focus groups, and direct observations. Results indicate that the topics and activities in the curriculum were highly accepted by teachers and students, and they reported that the program was useful in teaching resistance strategies to cope with substance use and other risky situations. Limitations include lack of follow-up, concerns over acceptability in other regions of Spain, and reliance on self-report measures. Note: This study was not used for rating due to the significant cultural adaptations that were made to the intervention. The adapted program added extra culturally-adapted video components that were relevant for social validity for the target population.