Cultural sensitivity in substance use prevention

The rationale for targeted and tailored substance use prevention programs d erives from essentially three observations: 1) differences in substance use prevalence rates across racial/ethnic groups; 2) differences in the preval ence of the risk factors for substance use across racial/ethnic groups; and 3) differences in the predictors of substance use across groups. This arti cle provides a model for understanding cultural sensitivity as it pertains to substance use prevention. Cultural sensitivity is defined by two dimensi ons, surface and deep structure. Surface structure involves matching interv ention materials and messages to observable, "superficial" characteristics of a target population. This may involve using people places, language, pro duct brands, music, food, locations, and clothing familiar to, and preferre d by, the target audience. Surface structure refers to how well interventio ns fit within a specific culture. Deep structure involves incorporating the cultural, social, historical, environmental, and psychologic forces that i nfluence the target health behavior in the proposed target population. For example, peer influences may exert a greater influence on substance use ini tiation among White and Hispanic than among African American youth, while p arental influences may be stronger among African Americans. Whereas surface structure generally increases the "receptivity" or "accepta nce" of messages, deep, structure conveys salience. Techniques for developi ng culturally sensitive interventions, borrowed from social marketing and h ealth communication theory, are described. (C) 2000 John Wiley & Sons, Inc.