keepin’ it REAL Efficacy Trial

Drug Resistance Strategies III

Principal Investigator: Flavio Marsiglia (Arizona component)

Funding: National Institutes of Health/ National Institute on Drug Abuse, award R01 DA14825 (1997-2001)

This study developed multiple versions of a culturally-grounded, middle school-based, universal prevention intervention designed to prevent, delay or reduce student substance use by influencing their drug use related knowledge, motivation (norms), and drug resistance skills in an ethnically sensitive manner. The relative efficacy of three versions of the intervention (Mexican American oriented, European American oriented, and a multicultural mixture of those two) was evaluated against a control group receiving their school's existing drug prevention curricula. The resulting keepin' it REAL intervention was created by, with, and for youth by involving them in the identification of effective examples of drug resistance skills (Refuse-Explain-Avoid-Leave, producing the REAL acronym) and the scripting and enactment of accompanying videos. A total of 35 schools and 6,035 students participated in a randomized trial utilizing a pretest and multiple post-test (2, 8 & 18 month follow-up) with control group design. Evidence was found for the intervention’s overall effectiveness, with statistically significant effects on gateway drug use as well as norms, attitudes, and resistance strategies. Specific analyses found the Mexican American and Multicultural versions impacted the most outcomes. The strong results of the efficacy of the multicultural version of the intervention led to its designation as a “Model Program” on the SAMHSA National Registry of Evidence-based Programs and Practices (

Gosin, M. N., Dustman, P. A., Drapeau, A. E., & Harthun, M. L. (2003). Participatory action research: Creating an effective prevention curriculum for adolescents in the Southwest. Health Education Research: Theory and Practice18, 363-379. doi: 10.1093/her/cyf026.

Gosin, M., Marsiglia, F. F., & Hecht, M. L. (2003). keepin' it R.E.A.L: A drug resistance curriculum tailored to the strengths and needs of preadolescents of the Southwest. Journal of Drug Education33, 119-142.

Harthun, M. L., Drapeau, A. E., Dustman, P. A., & Marsiglia, F. F. (2002). Implementing a prevention curriculum: An effective researcher-teacher partnership. Education and Urban Society34, 353-364.

Hecht, M. L., Marsiglia, F. F., Elek, E., Wagstaff, D. A., Kulis, S., & Dustman, P. A. (2003). Culturally-grounded substance use prevention: An evaluation of the keepin’ it REAL curriculum. Prevention Science4, 233-248.

Holleran, L., Reeves, L. J., Dustman, P. A., & Marsiglia, F. F. (2002). Creating culturally grounded videos for substance abuse prevention: A dual perspective on process. Journal of Social Work Practice in the Addictions2, 55-78.

Holley, L. C., Kulis, S., Marsiglia, F. F., Keith, V. M. (2006). Ethnicity versus ethnic identity: What predicts substance use norms and behaviors? Journal of Social Work Practice in the Addictions, 6, 53-79.

Kulis, S., Marsiglia, F. F., & Hurdle, D. E. (2003). Gender identity, ethnicity, acculturation and drug use: Exploring differences among adolescents in the Southwest. Journal of Community Psychology, 31, 1-22. doi: 1O.1002/jcop. Read full article PMCID: PMC3045088

Kulis, S., Napoli, M., & Marsiglia, F. F. (2002). Ethnic pride, biculturalism, and drug use norms of urban American Indian adolescents. Social Work Research, 26, 101-112. Read full article PMCID: PMC3051189.

Marsiglia, F. F., Kulis, S., Hecht, M. L., & Sills, S. (2004). Ethnicity and ethnic identity as predictors of drug norms and drug use among pre-adolescents in the Southwest. Substance Use and Misuse39, 1061-1094. doi: 10.1081/JA-120038030.

Marsiglia, F. F., Kulis, S., Hussaini, S. K., Nieri, T. A., & Becerra, D. (2010). Gender differences in the effect of linguistic acculturation on substance use among Mexican-origin youth in the Southwest U.S. Journal of Ethnicity in Substance Abuse, 9, 40-63. doi: 10.1080/15332640903539252 Read full article PMCID: PMC2903967

Marsiglia, F. F., Kulis, S., Nieri, T. A., & Parsai, M. (2005). God forbid! Substance use among religious and nonreligious youth. American Journal of Orthopsychiatry, 75, 585-598. doi: 10.1037/0002-9432.75.4.585. Read full article PMCID: PMC3043382

Marsiglia, F. F., Miles, B.W., Dustman, P. A., & Sills, S. (2003). Ties that protect: An ecological perspective on Latino/a urban pre-adolescent drug use. Journal of Ethnic and Cultural Diversity in Social Work11, 191-220.

Napoli, M., Marsiglia, F. F., & Kulis, S. (2003). Sense of belonging to school as a protective factor against drug use among urban Southwest Native American pre-adolescents. Journal of Social Work Practice in the Addictions, 3, 25-41. doi: 10.1300J160v03n02_03. Read full article PMCID: PMC3045112

Nieri, T. A., Kulis, S., Keith, V. M., & Hurdle, D. (2005). Body image, acculturation, and substance abuse among boys and girls in the Southwest. The American Journal of Drug and Alcohol Abuse, 31, 617-639. doi: 10.1081/ADA-200068418. Read full article PMCID: PMC3043457

Parsai, M., Marsiglia, F. F., & Kulis, S. (2010). Parental monitoring, religious involvement and drug use among Latino and non-Latino youth in the southwestern United States. British Journal of Social Work, 40, 100-114. doi: 10.1093/bjsw/bcn100. Read full article PMCID: PMC2799938

Parsai, M., Voisine, S., Marsiglia, F. F., Kulis, S., & Nieri, T. A. (2009). The protective and risk effects of parents and peers on substance use, attitudes and behaviors of Mexican heritage female and male adolescents. Youth & Society, 40, 353-376. Read full article PMCID: PMC2686611

Reeves, L.  J., Dustman, P. A., Holleran, L., & Marsiglia, F. F. (2008). Creating culturally-grounded prevention video: Defining moments in the journey to collaboration. Journal of Social Work Practice in the Addictions8, 65-94.

Voisine, S., Parsai, M., Marsiglia, F. F., Kulis, S., & Nieri, T. A. (2008). Effects of Parental Monitoring, Permissiveness, and Injunctive Norms on Substance Use Among Mexican and Mexican American Adolescents. Families in Society, 89, 264-273. Read full article PMCID: PMC 2910623

Warren, J. R., Hecht, M. L., Wagstaff, D. A., Elek, E., Ndiaya, K., Dustman, P. A., & Marsiglia, F. F. (2006). Communicating prevention: The effects of the keepin’ it REALclassroom videotapes and televised PSAs on middle-school students’ substance use. Journal of Applied Communication Research34, 210-228. doi: 10.1080/00909880600574153.

Related articles from the Drug Resistance Strategies II project:

Kulis, S., Marsiglia, F. F., & Hecht, M. L. (2002). Gender labels and gender identity as predictors of drug use among ethnically diverse middle school students. Youth and Society33, 442-475.

Marsiglia, F. F., Kulis, S., & Hecht, M. L. (2001). Ethnic labels and ethnic identity as predictors of drug use and drug exposure among middle school students in the Southwest. Journal of Research on Adolescence11, 21-48.