Systematic Review: Culturally Tailored Digital Substance Use Prevention Interventions for Black Adolescents.

Objective: Black adolescents differ from adolescents of other racial/ethnic groups in prevalence, patterns, risk and protective factors, and consequences of substance use, underscoring the need for culturally tailored interventions. Black adolescents also experience unique barriers in access to interventions that may be amenable to digital interventions. However, based on available literature, no systematic review has examined the efficacy of culturally tailored digital interventions for substance use prevention among Black adolescents. Here, existing culturally tailored digital interventions for substance use prevention among Black adolescents were systematically reviewed, and their efficacy in preventing substance use was examined. Method: A systematic search of biomedical research databases was conducted. Search terms included controlled vocabulary terms and free text terms for concepts of digital interventions, substance use, and clinical trials. Randomized controlled trials comparing a culturally tailored intervention for Black adolescents with a control intervention were included. The level of cultural tailoring (surface- vs deep-level tailoring) was determined, and the impact of interventions on substance use outcomes was assessed. The quality of studies was evaluated using the National Institutes of Health tool for quality assessment of controlled intervention studies. A narrative synthesis summarizing results by study characteristics, intervention characteristics, and study outcomes/findings was also conducted. Results: Eleven articles comprising 6 studies testing 6 interventions met inclusion criteria. The proportion of Black adolescents varied among studies from 41% to 100% (n = 109-421). Four interventions significantly improved overall substance use outcomes with effect sizes ranging from 0.002 to 1.5 for alcohol use, 0.11 to 1.57 for marijuana use, 0.002 to 0.64 for tobacco use, and 0.009 to 0.35 for other drugs. Five interventions also improved antecedents to substance use (eg, self-efficacy, intentions to use drugs, parental monitoring). Effects persisted at long-term follow-up (≥12 months) among 75% of interventions that examined these outcomes. Cultural tailoring varied widely among interventions, with 4 studies reporting surface-level adaptations, 1 study reporting deep-level adaptations, and 1 study reporting both surface- and deep-level adaptations. Cultural tailoring largely focused on intervention content, with only 2 studies describing additional tailoring at the implementation level. One study assessed the impact of cultural tailoring on intervention outcomes. Interventions were tested in various settings, including community (2 studies), home (1 study), school (1 study), emergency department (1 study), and primary care (1 study); were delivered using a CD-ROM/computer (5 studies) or videotape (1 study); and comprised different types of interventions, including universal (4 studies), selective (1 study), and indicated (1 study). Conclusion: Although the number of available studies is limited, culturally tailored digital interventions appear to be effective at improving substance use outcomes among Black adolescents and have been tested across various settings. However, the impact of cultural tailoring is challenging to isolate, given the wide variability in the description of culturally tailored content, the lack of homogeneity in the study samples, and the lack of evaluation of the effect of cultural tailoring on intervention outcomes. Given rapid advances in digital technologies and the pressing need to curtail the rise in substance use among Black adolescents, it is imperative to design, test, and implement digital interventions that meet the needs of Black adolescents. Study registration information: Culturally adapted digital substance use interventions for black adolescents: a systematic review; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023452522.