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by Allie Nicodemo
August 11, 2016
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Locally tailored programs put peer pressure in its place

Madison Placencio is a 13-year-old eighth-grader in San Tan Valley, Arizona. She’s at the age when peer pressure becomes increasingly common and tougher to resist. But Placencio handles it with finesse.

For example, one time her friends tried to convince her to go to a party she didn’t want to go to. She already had plans that day for an outing with her family.

“I was like, ‘no, I’d rather go with my family,’” Placencio says. “I just explained to them why I couldn’t go.”

It might sound simple, but for a middle school student, having the confidence to say “no” is critical—and not always easy. A 2014 survey found that 11 percent of eighth-graders in the United States had used marijuana and nine percent had used alcohol. These substances are particularly dangerous for children because their brains are still developing.

“It’s not healthy for a young person to use a substance, legal or illegal. Their brain cannot tell them when to stop yet, so they reach addiction very quickly,” says Flavio Marsiglia, a Regents’ Professor in Arizona State University’s School of Social Work and director of ASU’s Southwest Interdisciplinary Research Center (SIRC).

SIRC is a national Exploratory Center of Excellence on minority health and health disparities. Researchers at the center develop interventions to prevent and reduce health problems such as substance abuse, diabetes, cardiovascular disease, asthma and sexually transmitted diseases. They work among disadvantaged groups including Latinos, American Indians, African-Americans, Asian-Americans, Somali refugees, women and juvenile offenders.

For the past two decades, Marsiglia has been working to develop culturally relevant health interventions for youth.

The good news is that most middle school students, like Placencio, choose not to use alcohol or other drugs. Marsiglia and his colleagues wanted to find out what strategies these kids use to evade peer pressure. They interviewed hundreds of Phoenix middle school students and identified four main tactics: refuse, explain, avoid and leave.

“Refuse” can be a simple “no” or a gesture, like shaking the head. “Explain” also involves saying “no” but includes a reason why. “It gives me a headache,” “my parents will be upset,” “I don’t believe in that,” and “I don’t need it to have fun” are all examples Marsiglia has heard from kids. “Avoid” could mean staying away from a party where drugs and alcohol are likely to be present. “Leave” is a tactic used by kids who are already at the party when trouble shows up.

With funding from the National Institute on Drug Abuse, Marsiglia and his team developed a program based on their research called “keepin’ it REAL”—an acronym of the four strategies. The intervention was evaluated in central and south Phoenix with the participation of more than 7,000 middle school students and their teachers.

The keepin’ it REAL intervention includes manuals and videos for teachers to use in the classroom. Placencio has been participating in keepin’ it REAL at her school for three years, and says that she looks forward to it each week. The program is so effective that it has been adopted by schools in 48 states and nine countries outside the U.S.


Madison Placencio

The perfect social laboratory 

Keepin’ it REAL was designed with Phoenix demographics in mind. The city is home to the third-largest population of Native Americans, and more than 40 percent of the population is Hispanic or Latino, according to the 2010 U.S. Census. There are also many elderly people in the Phoenix metro area, as well as young Latinos. This mirrors the expected future population of the whole country, Marsiglia says, making Phoenix the “perfect social laboratory.”

Because ASU is embedded in these diverse communities, researchers have the opportunity to develop interventions that are culturally grounded. The keepin’ it REAL program was created with input from the local children it is intended to serve. It has also been tweaked to represent a multicultural audience. That way, kids from different ethnic backgrounds can relate to characters in the workbooks and videos. This sets keepin’ in REAL apart from previous interventions that have failed.

“If the child doesn’t identify with the intervention—nobody in the video looks like them, speaks like them or dresses like them—they will say, ‘oh this isn’t about me, this is about somebody else,’” Marsiglia says.

After creating different versions of keepin’ it REAL, researchers found the multicultural adaptation to be the most effective. Students of all ethnic backgrounds who received this version were more likely to employ the REAL techniques.

The Native American population in Arizona has a unique set of needs and challenges. A SIRC team led by ASU Professor Stephen Kulis, in partnership with the Phoenix Indian Center, developed an intervention called Living in Two Worlds, designed for Native American children living in urban settings. The program is based on keepin’ it REAL, but Living in Two Worlds emphasizes cultural identity much more.

“We found that American-Indian kids in the city sometimes don’t know who they are,” Marsiglia says.

Learning more about their cultural history, and the tribe they come from, helps kids develop a stronger sense of identity, which protects them from risky behaviors.

“That inspires them,” Marsiglia says. “They can be leaders in their community and learn not to be ashamed of who they are.”


Posters made by students in the keepin' it REAL program

Parenting in Two Worlds

Living in two worlds can be a challenge for Native American children. Researchers have found that it’s difficult for their parents, too. As a result, many of the interventions that Marsiglia and his colleagues develop include companion programs for parents.

Parenting in Two Worlds was designed with and for Native American parents living in urban Phoenix. These parents face the complex challenge of being part of their tribal cultures, but also living day-to-day immersed in a different culture. Parenting in Two Worlds is the only program of its kind in the nation. The project is funded by the National Institute on Minority Health and Health Disparities.

“Now we’re getting calls from other urban American Indian communities and tribal communities,” Marsiglia says. He is hoping to test the program in partnership with Indian reservations and in other urban centers besides Phoenix, so that it can be adapted for other parts of the country.

The keepin’ it REAL program provides training for parents as well. This is especially useful for parents and guardians from different ethnic backgrounds who are trying to assimilate in the U.S. Children tend to adapt to new cultures and learn new languages faster than adults. This can make children feel power over their parents, changing the relationship dynamic and creating conflict.

“Language is power,” Marsiglia says. “There is a role reversal, and that creates a problem when the parents need to set boundaries and set limits and assert their authority.”

The parenting program for keepin’ it REAL, called Families Preparing the New Generation, equips parents with effective communication tools. It also allows them to share tips and strategies with one another.

Some parents benefited from the program in other unintended ways. Marsiglia’s research found that some parents were dealing with substance abuse issues of their own—particularly binge drinking. After completing the program, the parents reported a significant decrease in that behavior.

“Through a prevention program that was not intended to treat them, they got some help,” Marsiglia says. This suggests that before the program, parents may not have had access to treatment resources.

“That’s an example of the unique things that happen in Arizona, and that maybe happen in other places, but here you can see it,” Marsiglia says. “Everything is a little bit more raw. It’s right in front of you.”

After the widespread success of keepin’ it REAL, researchers at ASU are now working to adapt the intervention for other countries. The National Institutes of Health recently awarded Marsiglia’s team and their Mexican collaborators a five-year grant to implement a nationwide adaptation and evaluation of keepin’ it REAL in Mexico. In addition, Marsiglia is working with colleagues in Seville, Spain, to create a prevention intervention aimed at the Roma people, also known as the Gypsy community.

“They are a very oppressed, misunderstood, stigmatized community with a lot of substance abuse issues,” Marsiglia says.

The team will develop an intervention that is grounded in their culture, just as the keepin’ it REAL program was designed for local communities in the U.S.

Placencio is a testament to the program’s success. She uses the REAL strategies in real situations and says they have served her well.

“I don’t know where I’d be if I didn’t have them—I’d probably be stuck in a bad situation,” she says.  

Instead, she is thriving. Her favorite subject in school is science, and she wants to be a movie director one day.

“And I want to go to ASU,” she says. “I’ve always wanted to go to ASU.”

At Placencio’s school, keepin’ it REAL is funded by the Arizona Parents Commission on Drug Education and Prevention, administered by the Governor’s Office of Youth, Faith and Family.

The National Institute on Drug Abuse and the National Institute on Minority Health and Health Disparities are part of the National Institutes of Health.