Table 3.
Outcome trials of culturally adapted interventions.
| Authors (year) |
Sex/ gender |
Age | Sample n (% Mexican) |
% monolingual | Target/diagnosis | Control condition |
Cultural construct measured |
Outcome measure |
Outcome |
|---|---|---|---|---|---|---|---|---|---|
| Treatment RCTs | |||||||||
| Burrow-Sanchez and Wrona (2012) | 94% male | M = 15.49 | N = 35; majority parents Mexican born (74% mothers; 88% fathers) | 72–73 Spanish spoken at home; eligibility had to be bilingual; excluded if monolingual adolescent | Diagnosis of drug abuse or dependence DSM-IV-TR | Standard cognitive-behavioral treatment | Acculturation; ethnic identity; average familism of parent and adolescent | Percentage days used any substance (excluding tobacco) | Time effects significant; treatment effect nonsignificant; moderators significant at 3-month outcome (ethnic identity and familism significant moderators) |
| Burrow-Sánchez et al. (2015) * | 90% male | M = 15.2 | N = 70 | Excluded monolingual; parents mostly born in Mexico (74.3% mothers; 81.4% fathers) | Diagnosis alcohol or drug abuse or dependence DSM-IV-TR | Group-based cognitive-behavioral treatment | Acculturation; ethnic identity; parental familism | Number of days substances including alcohol but excluding tobacco were used in past 90 days | Time effects significant; Treatment effect nonsignificant; Ethnic identity and familism significant moderators at 3 months. Low ethnic identity predicted best outcomes in standard CBT and worst outcomes in A-CBT. High ethnic identity did better in A-CBT. For low parental familism, youth did best in S-CBT; for high parental familism, youth did best in A-CBT |
| Burrow-Sánchez et al. (2019) * | 90% male | M = 15.2 | N = 70 | Excluded monolingual; parents mostly born in Mexico (74.3% mothers; 81.4% fathers) | Diagnosis alcohol or drug abuse or dependence DSM-IV-TR | Group-based cognitive-behavioral treatment | Acculturation; ethnic identity; parental familism | Number of days substances including alcohol but excluding tobacco were used in past 90 days | Time effects significant; Treatment effect significant at 12-month timepoint; Moderator (parental familism) significant at 12-month timepoint. Those in the A-CBT had the lowest use of substances with no differences between those with parents high or low in familism. Those with low parental familism in A-CBT did better than those with low parental familism in S-CBT. Similarly, those with high parental familism did better in A-CBT than those with high familism in S-CBT, who had the worst outcomes. |
| Lee et al. (2013) | 56% male | M = 34.9 | N = 58 | Had to be English proficient (conversationally) | Hazardous drinking | Unadapted MI | Acculturation | Drinking days/month; heaving drinking days/month; drinking consequences at 2- and 6-month follow up | Time effects significant for all 3 outcomes; treatment effect significant for negative consequences (Impulse subscale). |
| Lee et al. (2019) | 63% male | M = 41 | N = 296; 1.4% Mexican-Am; 45% Puerto Rican | 32% received intervention in Spanish | 2 or more heavy drinking episodes in past month and not in SUD treatment | Unadapted MI | Acculturation; discrimination | Percent heavy drinking days and negative consequences; moderators acculturation and discrimination | Time effects significant: percent heavy drinking days and for negative consequences. Treatment effects not significant. Acculturation and discrimination each significant moderators |
| Lee et al. (2020) ** | 63% male | M = 41 | N = 296; 1.4% Mexican-Am; 45% Puerto Rican | 32% received intervention in Spanish | 2 or more heavy drinking episodes in past month and not in SUD treatment | Unadapted MI | Acculturation; discrimination | Secondary outcome measures: depression symptoms; anxiety symptoms | Time effects significant for both depression and anxiety; treatment effect not significant, Discrimination moderated depression outcome but not anxiety; acculturation not a significant mediator |
| Muroff et al. (2019) | 88.6% male | M = 41.1 | N = 79 | 100% (all Spanish Speaking-fluent, not sure if monolingual) | Substance use after successful completion of residential treatment | Not an RCT; single group | None | ASI substance use; “rates of use” alcohol use, illegal drugs, same day alcohol and drug use, cocaine, marijuana, heroin. | Rates of use for each substance remained stable and did not differ significantly from baseline to 6 months (prevention of “relapse” focused, so good). “Treatment completers” did significantly better than those who discontinued treatment (use of illegal drugs, cocaine & heroin).. |
| Ornelas et al. (2019) | 100% male | M = 47.8 | N = 121 (65.3% Mexico country of origin) | 28.9% (only Spanish for reading and speaking) | At risk drinking (AUDIT 6+) | Referral to services | None | Total AUDIT score and AUDIT Q3 (frequency of heavy episodic drinking); number of drinks per drinking day (from TLFB past 2 weeks) | Time effect significant; treatment effect nonsignificant. Effect sizes between intervention groups at baseline, 2- and 8-week follow-ups for drinks per drinking day ranged from 0.35–0.67 (at 8 week); number of drinking days in past 14 days. |
| Paris et al. (2018) | 32.6% female | Mean = 42.9 (11.5) | N = 92 (9% Mexican origin) (72% Puerto Rican – majority) | 100% Spanish “primary language” | Any substance use – 36 reported their primary substance was marijuana, 35% reported alcohol, and 25% reported cocaine; the remainder reported opioids (3%) or benzodiazepines (1%)” | Standard outpatient treatment | Level of acculturation | Substance use calendar (“similar to TLFB”); self-reported, days of substance use by week | Significant time effects, significant treatment effect CBT4CBT yielded greater reductions in primary substance used. |
| Prevention trials | |||||||||
| Estrada et al. (2019) | 63% male | 8th grade M = 13.6 yrs | N = 230; 56.6% born in the U.S. (no % of Mexican Am given) | Unclear | Sample exhibiting behavioral problems | Prevention as usual | None | Frequency of drug use; prescription drug use; alcohol use; cigarette use; condomless sex | Intervention effects significant; EFamilias superior to PAU for drug use, prescription drug use, cigarette use; no significant mediation. Regarding drug use, post hoc tests showed EFamilias youth decreased use of marijuana, prescription drugs, and cigarette use and had stable inhalant use and alcohol use while PAU increased on all 4. Secondary outcome: EFamilias resulted in improved family function at 3 months but did not significantly mediate outcomes. |
| Hecht et al. (2003) | 47% female | 7th grade at Wave 1 with a 2 year follow-up | N = 6035 reported on (N = 4234 Wave 1), n = 3318 Mexican or Mexican-American | “Substantial proportion of Spanish speaking students, so teachers delivered in English and Spanish: 10% chose to complete questionnaires in Spanish 10% said they spoke mostly or only Spanish and 13% said they spoke mostly Spanish with their families” | Prevent alcohol, cigarettes, and marijuana | Substance use prevention programs provided by their school district/personnel | None | Quantity and frequency of alcohol, cigarettes, and marijuana in past 30 days (Likert scales) | Comparing control to combined intervention arms: both time and treatment effects significant, increase in alcohol use significantly less than in control group; Mexican American and Multicultural versions more effective than the Black/White version. Each intervention arm evidenced significantly less increase in alcohol than control group at Wave 2 and less alcohol and all substances at Wave 4. Students in Mex-American and Multicultural arm had less increase in marijuana than in control group; the Mexican American group had smaller increases in overall substance use at Wave 2 and 3 and less cigarette use at Wave 3. |
| Komro et al. (2008) | 50% male | 6th graders wave 1, 7th graders wave 2, 8th graders wave 3 | N = 61 schools; 4259 students at baseline | 74% said English primary language spoken at home | Universal prevention of alcohol, cigarette, and cannabis use | Prevention as usual | None | Alcohol use (summed 5 items about alcohol use), intention to use alcohol (summed 4 items), and multiple drug use - alcohol, cigarette, and marijuana (alcohol measured by Monitoring the Future questions) | ITT analyses: no treatment effects at any time point; Project Northland; secondary analyses revealed superior outcomes for home-based delivery |
| Kulis et al (2005) | 48.5% female | 12.52 yrs. at baseline | N = 3402 (100% Mexican heritage with 63% of those endorsing only Mexican heritage) | 8% completed in Spanish, 14% spoke mostly or only Spanish with friends 31% spoke only or mostly Spanish with family | Delaying or reducing substance use and promoting antidrug attitudes and norms | Substance use prevention programs provided by their school district/personnel | None | Quantity and frequency of alcohol, cigarettes, and marijuana in past 30 days (Likert scales) and averaged these for measure of overall substance use | Time effects significant with increases in substance use. No treatment effects compared to non-Latino version; Latinx version group vs controls had less overall substance use, less marijuana use, stronger intentions to refuse; greater confidence they could refuse drugs, and lower estimates of their peers' drug use; in multicultural version vs controls, they had less overall substance use, less marijuana substance use, and less alcohol use; |
| Marsiglia, Ayers, et al. (2019) | 46.7% youth female; 91% parents female | M = 12.6 | N = 532 dyads (parents and youth); 19.9% youth foreign born; 97% parents foreign born; 98% parents Latino | Majority of parent groups conducted in Spanish only (no number) | Use of alcohol, cigarettes, and Marijuana | Curriculum designed by the community partner without an alcohol and other drug prevention focus | None | Dichotomized use vs no use of alcohol, cigarettes, and marijuana in past 30 days | Time effect: control significantly increased use wave 1 to wave 4; PO (parent only, and this is Families Preparing the New Generation - not KiR) sig increased W 1–2 but then significant decrease W2-W4; no significant difference PY (parent and youth) over time (use stable). Treatment effect significant at W4 PO youth used significantly less than control youth. Alcohol and Inhalants seemed to drive the “any substance use” findings. For alcohol only, there was a treatment effect between PO and PY at Wave 4 such that PO outperformed PY. But for inhalants, inhalant use was higher in the PO vs PY at Wave 2 |
| Martinez and Eddy (2005) | 56% male youth; 44% female youth | M = 12.74; mothers M = 36.38; fathers M = 39.29 | N = 73 families; 90% of families of Mexican heritage | Recruited Spanish Speakers, so 100% Spanish-speaking Latino parents | Universal prevention of alcohol, cigarette, and cannabis use, and other drugs | No project related services | None | 3 or 4 questions on how likely youth was to use alcohol, tobacco, marijuana, and other drugs in next year if offered by a best friend. (also: decrease internalizing behaviors and improvement academics). Also interested in feasibility and parenting practices | Youth outcomes: treatment effect for tobacco intentions to use also treatment effects for youth aggression and externalizing behaviors with better outcomes for intervention; parental outcomes evidenced a treatment effect on 3 outcomes in favor of the intervention |
Note:
*
indicates that both articles (Burrow-Sánchez et al., 2015; 2019) are from the same RCT.
**
indicates that both articles (Lee et al., 2019, 2020) contain data from the same RCT; CBT = cognitive behavioral therapy; A-CBT = culturally accommodated CBT; S-CBT = standard CBT; ASI = Addiction Severity Index; PAU = prevention as usual; W = wave.