Translating Effective Drug Use Prevention Approaches for Societies in Transition: Lessons from Latin America in Cultural Program Adaptation

In recent decades a steadily advancing “science of prevention” has spurred the development of a lengthening list of evidence-based interventions designed to reduce risk behaviors and promote better health among vulnerable populations. A growing body of evidence from longitudinal randomized controlled trials in the United States, Canada and Europe has identified key program elements that improve outcomes for at-risk children and families. Still, many Type II translational research challenges remain in efforts to bring prevention programs—mostly created for developed countries in highly controlled settings—into new international settings. The challenges include aligning the prevention programs with diverse sociocultural, historical and structural contexts, differing definitions and priorities regarding behavioral health and prevention strategies, and varying systems and infrastructure for delivering prevention. Drawing from our experience in adapting and testing the U.S. middle school-based drug prevention program “keepin’ it REAL” for use in Mexico, Guatemala, and Uruguay, this presentation will review strategies for assessing local needs and institutional capacity for school-based drug prevention programs, methods for cultural adaptation, and lessons learned in dissemination.  Implementation of evidence based prevention programs in international settings is far more than a technical matter. The more daunting and fundamental challenges include gaining an understanding of social, cultural and historical factors influencing youth drug use; how educational, social and service systems operate to address it; and the factors determining community readiness for prevention efforts and their uptake. Our cultural adaptation approach includes systematic methods for determining how to transform the intervention model to be more valid within particular ecological contexts by modifying elements of the intervention, without compromising its effectiveness, in order to enhance the fit between the intervention and community cultural values, preferences, and norms.