Mar 16, 2007


Keepin’ it R.E.A.L. is a school-based prevention program designed to reduce substance use and promote anti-drug attitudes and norms among middle school students. In an effort to increase effectiveness, the program incorporates the predominant cultural values and beliefs of the student population. The program consists of a 10-session classroom curriculum. The curriculum is reinforced by a series of culturally driven videos and a local media campaign. Thirty-five schools were randomly assigned, and more than 6,000 students were followed over two years. Three parallel versions were implemented-Mexican American, Black/White, and Multicultural-along with a control group. Although no significant effects were found for cultural matching at the individual level, the overall intervention was effective in reducing the use of gateway drugs and showed significant impacts on norms, attitudes and resistance strategies.


Target population: Keepin’ it R.E.A.L. was implemented in 1998-1999 among 7th grade students in 35 Phoenix, Arizona public schools.

Keepin’ it R.E.A.L. strives to develop drug resistance strategies, encourage conservative substance use attitudes and ultimately reduce substance abuse among students. The program consists of a culturally driven classroom curriculum that spans 10 sessions and is taught by regular classroom teachers. In these sessions students are taught the core resistance strategies that make up the program’s name: Refuse, Explain, Avoid, Leave (R.E.A.L.). Five of the sessions are dedicated to videos that reinforce these strategies. The videos are made by nearby high schools and incorporate students’ stories and narratives reflecting their own experiences with alcohol and drugs. Class time is spent devising strategies and practicing responses to the situations portrayed in the videos. Television, public service ads on the radio, and billboard ads accompany the lessons. During the 8th grade follow-up year, students receive in-school booster sessions to reinforce lessons learned the previous year. Based on the population in Phoenix, Arizona, where Keepin’ it R.E.A.L. is implemented, students in the evaluation study were assigned to one of three cultural versions of the program: the Mexican-American, combined African American and European American (Black/White), or Multicultural program.


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), 233-247.

Evaluated population: The final sample included 6,035 participants. Of those students, 3,318 were Mexican American, 1,141 were Latino, 1,049 were non-Hispanic, White and 527 were African American. Students from each ethnic group were represented in all of the intervention and control groups and gender was distributed more or less equally among each ethnic group. Approximately 84 percent of the participants received free or reduced price lunches at school.

Approach: The evaluation took place over a 48-month period. During the first year, 35 public middle schools were randomly assigned to one of four groups. Eight schools taught the Mexican American curriculum, nine schools taught the Black/white version, eight schools taught the Multicultural version, and ten schools served as the control group. Those schools in the control group continued with their existing substance abuse programs. American Indian, Asian, and Pacific Islanders represented only 4 percent of the student population and were therefore not included in the evaluation.

In Year 2, pre-intervention questionnaires were issued to all students and the program was implemented among the twenty-five treatment schools. This data, collected in the Fall of 1998, represents Wave 1 baseline data. In the Spring of 1999, students were issued a follow-up questionnaire (Wave 2 data). The media campaign was implemented during the Summer of 1999.

During Year 3, students in the treatment schools received 8th grade booster activities approximately once a month. Booster activities consisted of assemblies, poster projects, murals, and essay contests. The data collected in the Fall of 1999 constitutes Wave 3. By the Spring of 2000, all boosters had been completed, another evaluation was conducted, and Wave 4 data were collected.

In order to gauge the impact of the program, it is important to note participation and consistency. 91 percent of students in the treatment groups saw at least one R.E.A.L. video during the 7th grade curriculum, while 30 percent saw all five videos. On the other hand, 57 percent of students in the treatment groups saw at least one public service ad whereas only 30 percent in the control group did. Only 10 percent of treatment students saw a public service ad more than five times. Furthermore, 70 percent of participants attended at least one booster activity during their 8th grade year. Lastly, forty-nine teachers implemented the Keepin’ it R.E.A.L. curriculum and of those, thirty-seven were observed. When rated on the “appropriateness of conveying the curriculum”, the average teacher received a 5.8 on a scale of 1 to 7.

Although attrition was a factor in the evaluation, it did not differ significantly among ethnic groups. Missing data usually resulted from low response rates, transfers, inadequate demographic information and school participation rates. 16 percent of students transferred from each school during the 7th grade year, whereas an additional 19 percent transferred in the 8th grade. Overall, data decreased by 7 percent in Wave 2; by 12 percent in Wave 3; and by 16 percent in Wave 4.

The questionnaires collected demographic information, and information on alcohol and drug use, antidrug personal norms, norms and intention to accept substances offered. Questionnaires also asked about resistance strategies adolescents had used to decline drugs and alcohol. Trained proctors administered the surveys during school hours, and students had the option of completing them in English or Spanish.

Results: The intervention was evaluated on three different levels. One analysis compared the overall intervention, which included all three versions, to the control group. Another compared outcomes across the three cultural groups and lastly, the evaluation assessed the program’s impact on an individual level. The first analysis combined the Mexican American, Black/white, and Multicultural units into one intervention group. In comparison with the control group, the intervention group reported better behavioral outcomes. Although both groups showed an increase in the use of substances, the increase was significantly less among intervention group students as was their perception of peer use. Students in the intervention group tended to adopt more resistance strategies than the control group and this may have contributed to better outcomes.

When evaluators looked at the intervention groups separately, a variety of differences appeared. Overall, the Mexican American and Multicultural curricula resulted in more significant outcomes than the Black/white group. Students in the Mexican American program showed the smallest increase in overall substance use; lower increases in intent to accept offers; less erosion in attitudes against someone using substances and a lower perception of substance use prevalence among peers.

Students receiving the Multicultural curriculum reported significantly more resistance strategies, smaller increases in positive expectancies toward substance use and less erosion in attitudes against someone using substances.

Students in the Black/white group demonstrated the lowest level of significant outcomes. They did, however, report significantly more resistance strategies.

Finally, evaluators believed that students randomly assigned to the cultural treatment group that matched their own ethnic background (matched) would produce the greatest results. Students whose background did not match the treatment group were categorized as mismatched and students in the Multicultural group were labeled as mixed. There were very few significant differences and no substantial evidence that those students assigned to their matching cultural treatment group had more significant results.


Link to program curriculum:


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), 233-247.

KEYWORDS: School-Based, Substance Use, Middle School, Community/Media Campaign, Hispanic or Latino, Black or African American, White or Caucasian, Alcohol Use, Illicit Drug Use, Behavioral Problems, Physical Health, Social/Emotional Health and Development, Adolescence (12-17), Adolescent.

Program information last updated 3/16/07