Culturally sensitive interventions and substance use: A meta-analytic review of outcomes among minority youths

This study assessed the effectiveness of culturally sensitive interventions (CSIs) (N = 10) designed to address substance use among minority youths. Study methods consisted of systematic search procedures, quality of study ratings, and recta-analytic techniques to gauge effects and evaluate publication bias. The results, across all measures and time frames, reveal small effects (Hedges's g = .118, 95% confidence interval [CI] = 0.004 to 0.232). For recent alcohol use, the effects were small (Hedges's g = .225, 95% CI = 0.015 to 0.435). For recent marijuana use, the effects failed to achieve significance (Hedges's g = .610, 95% CI = -0.256 to 1.476). Suggestions for enhancing the effectiveness of CSIs are discussed along with the benefits and limitations of using meta-analyses versus narrative reviews to assess intervention effectiveness in emerging areas of research. KEY WORDS: culturally sensitive interventions; substance use ********** To address substance use among youths from minority cultures, the importance of culturally sensitive interventions (CSIs) is often emphasized (Gil, Wagner, & Tubman, 2004). CSIs can be understood as interventions that incorporate a target population's culture (norms, beliefs, and values) (Resnicow, Soler, Braithwaite, Ahluwalia, & Butler, 2000). Resnicow et al. distinguish between surface structure and deep structure CSIs. The former involves tailoring interventions to conform to observable social and behavioral characteristics of the population. This entails use of people, language, clothing, settings, music, and exemplars that resonate with the population. The latter involves construction of interventions that reflect the social, historical, psychological, and cultural forces related to health and wellness in that population. With African Americans, for example, such a deep structural intervention might incorporate the values of spirituality, communalism, expressiveness, family, and storytelling. The prevention program developed by Flay, Graumlich, Segawa, Burns, and Holliday (2004) represents one example of an intervention that incorporates a similar set of Afro-centric values and uses a mix of surface and deep structural strategies. Some content was adapted from exiting substance use prevention programs, whereas other, more Afro-centric content was developed specifically for the CSI. The intervention was pilot tested and then refined to enhance its level of cultural congruence. Although CSIs have garnered considerable philosophical support, debate exists about their effectiveness (Hall, 2001). Proponents noted that interventions are typically designed, developed, and tested in environments that are predominately European American (Sue & Sue, 2008). Such interventions often reflect majority-culture beliefs and values and, consequently, may have limited utility with minority groups who affirm different cultural norms. Alternatively, others have questioned the effectiveness of CSIs, arguing that contemporary society is increasingly characterized by a blended, post-ethnic youth culture in which norms, beliefs, and values are widely shared across cultural groups (Elliott & Mihalic, 2004). In addition, basic developmental needs are understood to be similar across cultural groups. Adapting proven evidence-based interventions to reflect more locally based cultural norms may undermine their effectiveness and even engender detrimental outcomes. Despite such debates, little research on effectiveness exists (Hecht et al., 2008). This represents a significant oversight given the growing size of the minority youth population, which is projected to grow from 44% of the nation's children and adolescents to 62% in 2050 (U.S. Census Bureau, 2008). Accordingly, research is needed to determine the effectiveness of currently operationalized CSIs designed to address substance use. ASSESSING EFFECTIVENESS: NARRATIVE REVIEWS VERSUS META-ANALYSES Two types of systematic reviews are commonly used to assess intervention effectiveness: narrative reviews and meta-analyses (Borenstein, 2005; Littell, Corcoran, & Pillai, 2008). …