Brief Report: The Adaptation of Project Northland for Urban Youth

Journal of Pediatric Psychology () pp. –, doi:./jpepsy/jsh

Journal of Pediatric Psychology vol. no. © Society of Pediatric Psychology ; all rights reserved.

Brief Report: The Adaptation of Project Northland for Urban Youth

Kelli A. Komro, MPH, PHD, Cheryl L. Perry, PHD, Sara Veblen-Mortenson, MSW, MPH, Linda M. Bosma, MA, Bonnie S. Dudovitz, MED, Carolyn L. Williams, PHD, Rhonda Jones-Webb, DRPH, and Traci L. Toomey, MPH, PHDDivision of Epidemiology, School of Public Health, University of Minnesota

Objective Summarizes the research and intervention design of a new trial to evaluate an adapta-

tion of Project Northland, a multicomponent, community-wide alcohol prevention program for

culturally diverse youth living in a large city. The original Project Northland was successful in

reducing alcohol use among a sample of mostly White, rural adolescents. Methods We high-

light the steps taken to adapt the intervention strategies for culturally diverse inner-city

youth, families, and neighborhoods. The research design is a randomized controlled trial to

evaluate the effectiveness of the adapted Project Northland for reducing the early onset and

prevalence of alcohol use among young urban adolescents. Conclusion The information

gained from this trial, including the process of adaptation of prevention strategies, will be

beneficial for alcohol-use prevention efforts within diverse urban communities across the

country.

Key words adolescents; alcohol; prevention; cultural adaptation.

Early-onset drinking among youth is risky for a varietyof health and social reasons, including its associationwith illicit drugs, violence, stealing, driving under theinfluence, academic problems, feeling depressed, anddeliberately trying to hurt or kill oneself (Greenblatt,2000). All young people, regardless of race or place ofresidence, are at high risk for early-onset drinking(Komro, Hu, & Flay, 1997). In the high school sampleof the Youth Risk Behavior Survey, 28% of White andAfrican American youth reported drinking alcoholbefore age 13, compared with 34% of Hispanic youth(Grunbaum et al., 2002). Place of residence (i.e., centralcity, suburban, rural) does not play a significant role inrates of alcohol use among high school students (Komroet al., 1997). Clearly, delaying the initiation of alcoholuse among all adolescents is an important public healthgoal. Unfortunately, the early onset of alcohol use hasbeen one of the most difficult social behaviors to prevent(Komro & Toomey, 2002). Among existing alcohol pre-vention programs, few have successfully targeted raciallyand ethnically diverse youth living in central city areas.

Current research suggests that significant, long-term reductions in adolescent alcohol use requiremultiple-component, community-wide efforts focus-ing on demand- and supply-reduction strategies—thatis, to reduce the adolescents’ desire to use alcohol aswell as their means to access it (Komro & Toomey,2002; Pentz, Bonnie, & Shopland, 1996). Supplystrategies may be especially salient in minority andlow-income neighborhoods, where alcohol outletsproliferate and where high alcohol content beveragesare readily available and heavily marketed to inner-city youth (Alaniz & Wilkes, 1998; Altman, Schooler,& Basil, 1991; Brown-Taylor, 2000; LaVeist & Wallace,2000).

Project Northland is a multiple-component,community-wide preventive intervention that wasdesigned during the 1990s to prevent early-onsetalcohol use among young adolescents living in ruralareas of Minnesota (Perry et al., 1993). Project North-land’s original intervention, for sixth- through eighth-grade students, includes 3 years of

All correspondence should be sent to Kelli A. Komro, PhD, University of Minnesota—Epidemiology, 1300 S. 2nd St., Suite 300, Minneapolis, MN 55454. E-mail: [email protected].

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1. social–behavioral curricula,2. peer leadership and extracurricular social

opportunities,3. parental involvement and education, and4. community-wide task forces (Komro et al., 2001;

Perry et al., 1993; Perry et al., 1996).

The intervention was evaluated using a community trialdesign that included 24 school districts and their adjoin-ing communities in northeastern Minnesota (Perry et al.,1996). The northeastern part of Minnesota is primarilyrural and Caucasian in population but has high rates ofalcohol use and alcohol-related problems (NationalInstitute of Alcohol Abuse and Alcoholism [NIAAA],1991; Perry et al., 1993). The 24 school districts wereblocked by size and randomly assigned to interventionand control conditions. The study cohort was in sixthgrade when the intervention began. At the end of 3 years,a significantly smaller percentage of eighth-grade studentsin the intervention communities reported drinking orbeginning to drink than students in the reference com-munities (Perry et al., 1996), a finding primarily due tochanges in peer norms and role models, functionalmeanings around alcohol, and parent–child communica-tion (Komro et al., 2001). Among students who reportednever having drank alcohol at the beginning of the sixthgrade, students in the intervention group were not onlyless likely to drink 3 years later but also had lower ratesof cigarette and marijuana use (Perry et al., 1996).

Project Northland is recommended as a modelprogram by the Center for Substance Abuse Preventionand as an exemplary program of the United StatesDepartment of Education (http://modelprograms.samhsa.gov/matrix_all.cfm). Project Northland is being dissemi-nated by Hazelden Publishing and Educational Servicesand is being implemented in over 1,500 schools aroundthe country (A. Standing, personal communication, Sep-tember 12, 2003). Because of the positive significant out-comes achieved in the original trial, the substantial interestin replicating Project Northland in other parts of the coun-try, and the high rates of early alcohol initiation amongsome minority youth living in inner cities, it seemed criticaland timely to evaluate the effects of Project Northland in anurban environment with ethnically diverse youth.

The aims of this article are twofold: first, to describethe research and intervention design of a new random-ized controlled trial to evaluate an adaptation of ProjectNorthland for urban youth; and second, to describe howthe intervention was adapted to be more salient andrelevant for urban youth within an ethnically andracially diverse population.

Project Northland: Chicago Action for Healthy YouthResearch Design

The adapted and enhanced Project Northland for Chicagois being evaluated using a randomized trial of schoolsand surrounding neighborhoods in Chicago. Throughan extensive, year-long process, 61 schools wererecruited, signed on to participate, and randomlyassigned to an intervention or control condition. Thecontrol group is actually a delayed program; it willreceive program materials and training after the activestudy phase, in 2005. The intervention group will beexposed to 3 years of the adapted Project Northlandcurricula, family interventions, youth-planned extra-curricular activities, and community organizing. The inter-ventions will be evaluated with a cohort of sixth gradersbeginning in the 2002–2003 academic school year. Atbaseline, the Chicago study sample of sixth-gradestudents (N = 4,164) is culturally diverse, with 42% Afri-can American, 30% Hispanic, 14% White, 5% Asian, 2%Native American, and 7% of mixed race and ethnicity.The cohort will be followed through the end of theireighth-grade year. Outcomes will be measured via sur-veys of students, parents, and neighborhood leaders; alco-hol purchase attempts; and direct observations ofalcohol advertising near schools. Process evaluationmeasures will assess teacher compliance and feedback;peer, parent, and community participation; and trackstrategies implemented in the community-organizingprocess.

Intervention Design

The Project Northland Chicago intervention includes

1. implementation of 3 years of peer-led classroom curricula,

2. parental involvement and education,3. peer leadership and youth-planned extra-

curricular activities, and4. community organizing and environmental

neighborhood change.

Project Northland Chicago aims to change the personal,social, and environmental factors that support alcoholuse among young adolescents (see Figure 1). The theoryof triadic influence (Flay & Petraitis, 1994; Komro et al.,1997) and Perry’s (1999) planning model for adolescenthealth promotion programs integrate these factors fromseveral social behavioral theories, and they are used toguide the adaptation and enhancement of Project North-land Chicago.

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The Project Northland Chicago intervention periodis designed to be implemented consecutively from sixthto eighth grade. Each year of intervention involvesschool, family, and community components. Table Isummarizes the intervention strategies and the level ofmodifications made for urban and multiethnic youth,families, and neighborhoods. Figures 2 and 3 provideexamples of some of the adapted materials.

Cultural Adaptation Process

The original Project Northland interventions are beingadapted to be culturally relevant and salient for a multi-ethnic population using the two dimensions of surfaceand deep structures described by Resnicow, Baranowski,Ahluwalia, and Braithwaite (1999). Surface structureinvolves matching intervention materials and messagesto observable characteristics of a population. Deep structure

involves incorporating the cultural, social, historical,environmental, and psychological forces that influencehealth behaviors in the particular population. Examplesof surface-structure changes include adaptations toaudiovisual materials to involve people, language, music,locations, and clothing familiar to (and preferred by) thetarget populations (Resnicow et al., 1999). Both surface-and deep-structure changes are generally achieved throughinvolvement of the target population in interventiondevelopment (Resnicow et al., 1999). We have involvedyouth, parents, guardians, teachers, and communitymembers throughout the stages of the adaptation process.

In the next section, we highlight the steps we havetaken, and are currently taking, to adapt the ProjectNorthland prevention strategies. Table I provides a sum-mary of adaptations made to each component of theintervention.

Figure 1. Conceptual model for Project Northland: Chicago Action for Healthy Youth.

EnvironmentalFactors

InterpersonalFactors

• Increase healthful role models

• Provide social support for non-use

• Create alcohol-free norms

Social Context

• Increase barriers

• Increase health promoting

messages

• Reducing advertising

• Provide alternatives/opportunities

• Increase knowledge

• Change value and beliefs

• Influence attitudes

• Enhance social skills

• Increase resistance skills and self-efficacy

CommunityOrganizing

Extracurricular Activities

Parent Education and Involvement

School Curriculum

PreventReduceAlcoholUse

Figure 2. Example of adaptations to the Slick Tracy Home Team comic books (scene from Week 2—Project Northland: Chicago).

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Table I. Project Northland Chicago Intervention Components by Grade

Intervention Components Grade 6 (2002–2003) Grade 7 (2003–2004) Grade 8 (2004–2005)

Classroom curricula Slick Tracy Amazing Alternatives! PowerLines

Format • Six 30-min sessions • Nine 45-min sessions • Eight 45-min sessions

• Comic activity books • Peer-led activities • Group projects

• Peer-led activities • Audiotape vignettes • Peer leaders alternate by activity

• Four homework assignments • Group discussions

• Creation of posters by student pairs • Problem solving

• Role plays

Topics • Facts and myths about alcohol • Skills to identify and resist • Community influences

• Influence of advertising influences to use alcohol • Skills

• Peer pressure • Promotion of alcohol-free • Positive role models

• Consequences alternatives

Adaptations • Extensive visual adaptations • Creation of new culturally and • Significant adaptations to

to comic books regionally appropriate role-play reflect an urban environment

• Slight modifications to comics scenarios and audiotape vignettes and community structure

and activities so more relevant • Retaping of audiotapes with • Enhance exposure to

to urban-life situations African American and positive role models

Hispanic actors • More skills building and

• Enhanced and modified normative education

curriculum activities

Parental education

and involvement Slick Tracy Amazing Alternatives! PowerLines

Format • Four 30-min homework • Four 30-min homework • Four home sessions with

assignments included in the comic assignments interactive activities for child and

activity books • Two 10-min interactive parents

• Two 10-min interactive activities activities per assignment

for parents and child to work on

together

Topics • Communication • Family connection • Family bonding

• Family rules about alcohol use • Supervision • Communication

• Influences to use alcohol and skills to • Media literacy • Supervision

resist negative influences • Creation of family rules • Parenting skills

• Parental monitoring

• Parents as role models

Adaptations • Extensive visual adaptations to comic • Incorporated as a homework • New program added to enhance

Books assignment instead of pamphlets parental skills and family bonding

• Slight modifications to comics and mailed directly to parents

activities to be more relevant to urban- • Simplification and

family life situations enhancement of original

materials

Amazing Alternatives!

Slick Tracy Poster Fair Family Fun Event Parent forum

Format • Event held at each school for students • Event held at school or other • Event held at school or other

to display their alcohol-related posters community setting community setting

Topics • Knowledge and awareness of alcohol- • Model a fun alcohol-free event • Family bonding

related issues for families • Communication

• Opportunity for parents to • Supervision

discuss alcohol-related issues • Parenting skills

• Positive messages to

adolescents and parents about

being alcohol-free

Adaptation • Activities held during the day instead • Minor modifications to games • New program added to enhance

of at night to update them parental skills and family bonding

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• Projects modified to reflect urban life • Incorporation of a fun modern

and acknowledge more fully cultural dance activity

considerations, such as extended family

network

Parent postcards Parent postcards

Format • Five postcards mailed directly • Five postcards mailed directly to

to parents parents

Topics • Introduction/community • Positive Parenting Norms

involvement • Monitoring

• Awareness/setting rules • Family Connections

• Communication • Positive Community Involvement

• Access in home • Role Models

• Supervision

Adaptations • Replace more dense format of • Replace more dense format of the

the original “Northland Notes original “Northland Notes for

for Parents” newsletters Parents” newsletters

• Postcards are more colorful, • Postcards are more colorful, eye-

eye-catching, and larger catching, and larger

• Offer brief behavioral tips for • Offer brief behavioral tips for

parents parents

Student-planned

extracurricular

activities 7th-grade activities 8th-grade activities

Format • Students will plan two social or • Students will plan one community

community service projects project during their eighth-grade

• Open to their entire class year

• Open to their entire class

Topics • Skills building • Skills building

• Healthy norms • Healthy norms

• Positive relations • Positive relations

Adaptation • Emphasize community service • Emphasize community service to

to provide positive community provide positive community

interactions interactions

Community

organization 1st year 2nd year 3rd year

Format • 10 community organizers in Chicago • Continuation of community • Continuation of community

• Each organizer establishes organizing activities organizing activities

neighborhood action teams

Topics • Action teams focus on environmental

factors that influence young adolescent

alcohol use

Adaptations • More resources devoted to community

Organizing

• Strategies relevant to urban neighborhoods

Adaptation Steps for All Intervention Strategies

As a first step, a review of the literature was accom-plished regarding ethnicity, alcohol use, and prevention.Two of the major groups involved with this study areAfrican American and Hispanic youth and families.Resnicow et al. (1999) suggested core cultural valuesthat should be considered when developing programsfor African Americans, including such values as commu-

nalism; expressiveness and respect for verbal communi-cation skills; commitment to family; and reliance onintuition and experience versus that of empiricism. ForHispanics, core cultural values include family, respect forelders, and the importance of positive social interactions(Resnicow et al., 1999). Although many of these import-ant cultural values are similar to those found in ruralMinnesota, values such as respect for elders and the

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importance of the extended family have been incorpor-ated into the adapted version of the Project Northlandprograms, with particular attention to how the familyprograms are delivered. Sensitivity to the importance ofintuition and experience versus that of empiricisminfluenced adaptations to written materials for parentsand community materials, which now emphasize exam-ples of personal experiences over the presentation ofresearch results.

According to the research literature, there seems tobe similarity and substantial overlap of risk factors foralcohol use, regardless of race or ethnicity (Botvin,Baker, Dusenbury, Botvin, & Diaz, 1995; Collins, 1995;Epstein, Botvin, Diaz, & Schinke, 1995; Griffin, Scheier,Botvin, & Diaz, 2000; Newcomb, 1995), a finding thatsupports the generalizability of prevention programs formultiethnic populations. The generalizability of preven-tion approaches was supported by the positive outcomesachieved with Botvin’s Life Skills Training classroomcurriculum with multiethnic inner-city youth (Botvin,1995). However, some risk and protective factors maybe unique to particular minority groups or may havedifferential influence, whereas other forces may operateacross ethnic groups (Griffin et al., 2000; Newcomb, 1995).For example, one study found that African Americanyouth were more concerned than their Caucasian peersabout their parents’ disapproval of drinking, whereasWhite youth were more concerned than African Americanyouth about their friends’ disapproval (Ringwalt & Palmer,1990). This finding suggests that family programs maybe even more salient for African American populations.Another important study found that protective factors,including positive youth and adult role models, wereespecially important and salient among inner-city minorityyouth (Griffin et al., 2000). Etiological and prevention

research that has included multiethnic inner-city youthprovides support for the relevance of the original theo-retical model of Project Northland, with adaptationsincluding additional emphasis placed on the larger socialenvironment, positive role models, and the importanceof family interactions (Figure 1).

Community Advisory CommitteeA community advisory committee was created to providethe research team with cultural and logistical advice inadapting and implementing the intervention and evalu-ation components. Previous drug-prevention scientistshave emphasized the importance of including communitymembers in the process of intervention development formultiethnic communities (Dusenbury & Diaz, 1995).Representatives of the communities can make importantcontributions by helping to determine the types of strat-egies that are likely to be acceptable, by providing theresearch team with credibility in the community, and byhelping to identify ways the community can benefit byparticipation (Dusenbury & Diaz, 1995).

Original members of the Project Northland ChicagoCommunity Advisory Committee include a ChicagoPublic Schools teacher who has extensive preventionresearch experience, the manager of the Safe and Drug-Free Schools and Communities Program for the ChicagoPublic Schools, the executive director of a community-based health care organization serving a primarilyHispanic population, and the special assistant to thecommissioner for Hispanic affairs at the ChicagoDepartment of Public Health. Two formal meetings wereheld with the community advisory committee during thefirst year of the study. During these meetings the com-mittee members provided feedback on programs andprotocols. Additional communication occurs through

Figure 3. Example of parent postcard.

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e-mail or by telephone throughout the development andstudy phases. Formal meetings are held annually.

Familiarity With ChicagoAn initial important step for the research team and theproject’s local community organizers was to develop afamiliarity with political and community structures,schools, and organizations in Chicago and the studyneighborhoods. Initial contacts involved members ofthe community advisory committee and contacts withinthe Chicago Public Schools. In addition, the director ofthe community organization component introduced theproject to key community contacts, developed relation-ships with key stakeholders, and began the process ofunderstanding more about community dynamics specificto Chicago. The Chicago-based community organizersspent their initial months of employment assessing theneighborhoods in which they would be working, byattending community meetings and by conducting hun-dreds of one-on-one meetings with local residents.

TranslationSome participants in the project include parents andcommunity members who do not read or speak English.The primary foreign languages include Spanish, Polish,and Chinese. Therefore, program materials are translatedinto these languages. We have employed a variety ofpeople to conduct translations; most have been Chicago-based translators working in the study schools andcommunities. In addition, community members orschool staff serve as interpreters at community meetings.We hired Spanish-speaking community organizers towork with schools and community areas that have ahigh percentage of Spanish-speaking parents andresidents.

Adaptation Steps for School and Family ProgramsWhen developing school and family programs, we offeror suggest information that includes choices for familiesto make. This process is designed to convey respect andto avoid making overarching assumptions regardingfamily values. The program activities provide a frame-work that facilitates parents’ or guardians’ reflections oftheir own family environment and what might supporttheir children’s health. Participant involvement—including students, parents, guardians, and teachers—inthe development process is key to this process. Weemploy a series of steps to incorporate participantinvolvement and feedback, as described in this section.

Focus GroupsAn initial step in the revision process was to recruittwo schools with multiethnic student populations to serve

as pilot schools. One school has a primarily AfricanAmerican student body, and the other has an ethnicallyand racially diverse student body with a sizable Hispanicpopulation. Focus groups are conducted with youthbefore the adaptation process and after participation in apilot implementation of the revised program. Focusgroups are conducted with four classrooms of studentsin the relevant grade from the two pilot schools (n range= 80–120 students) before the adaptation process. Weask students about young people’s habits regarding popculture, their favorite hangout spots, activities that theyshare with their parents or caregivers; and we seek feed-back about the original program materials, activities,and characters. A team of six trained research staff con-duct focus groups in each classroom, dividing eachclassroom into three small groups with one focus groupleader and one notetaker. Detailed notes are taken foreach focus group question. Analyses of focus groupsinclude a summary of response patterns within andacross the focus groups. Information is deemed mostimportant and is thus incorporated into program adapta-tion if at least one-third of the students within a focusgroup respond similarly and if there is consistencyacross the majority of focus groups in specific responses.The initial focus groups confirmed that a comic bookmotif would be appropriate and attractive to this popu-lation, that students were confident and interested inworking on homework assignments with their parents,and that the comic book characters were appealing.

Pilot Test With Direct Observations and FeedbackA pilot test of each of the revised classroom and home-based programs are conducted in the two pilot schools.Teachers and peer leaders are trained to conduct theprogram in the classrooms. Direct classroom observa-tions of each session are conducted by trained study staffto evaluate the level of implementation fidelity, timing,and logistics. After completion of the pilot, teacherscomplete evaluations of the program; focus groups areconducted with student participants; and in-depth inter-views are conducted with a small group of parent–care-giver participants. Focus groups are conducted with thestudent participants in a classroom setting during theschool day. Primary topics of the focus groups includedetails about the acceptability and completion of theclassroom and home-based components. In addition,questions are asked about the acceptance and identi-fication with program characters and messages. In-depthtelephone interviews with a small group of parentparticipants (n range = 5–10) are conducted after com-pletion in the pilot family programs. Questions areasked regarding the relevance, appropriateness, and use

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of program materials and messages. To date, resultsfrom focus groups, teacher feedback, classroom observa-tions, and parent interviews have indicated that therevised intervention materials have been well received.Teachers have rated the majority of session activities as“very effective.” They also rated student level of partici-pation and interest as “high” for the majority of sessions.One teacher commented, “Some students who rarelyparticipate in classroom activities did take part.” Duringpostimplementation focus groups, students were positiveabout the programs and could recite the main messagesof the programs. Students offered minor recommenda-tions for changes in the visuals of the programs.

The program materials and activities have beendesigned to have universal appeal, with the ability offamilies to tailor the messages and activities to their ownfamily culture. Feedback from parents has indicated thatthe program materials and activities are relevant andsalient. The majority of parents thought the programswere easy to complete. All parents believed the pro-grams to be culturally appropriate and able to addressissues around alcohol that they believed were importantfor young people. Parents were quoted as saying that theprograms “created more open conversation” and that“this project is interesting; my family enjoyed it.”

Adaptation of the Community Strategy

The adapted Project Northland for Chicago will expandthe concept of community task forces used in the originalstudy by using a direct-action community-organizingmodel (Forster et al., 1998; Perry et al., 2000; Veblen-Mortenson et al., 1999; Wagenaar et al., 1999, 2000).Direct-action community organizing has been success-fully conducted in diverse, multiethnic inner-cityneighborhoods (Levinton, Snell, & McGinnis, 2000).Low-income neighborhoods may be especially receptiveto community organizing around alcohol issues (Lenk,Toomey, Wagenaar, Bosma, & Vessey, 2002). Ten full-time, ethnically and racially matched community organ-izers were hired to work with schools, youth, families,and community members. Community organizers wererequired to demonstrate culturally competent skillsthrough their past work experience with racially andethnically diverse populations and through their under-standing of, and identity with, their own culture (Alkon,Tschaun, Ruane, Wolff, & Hittner, 2001). In addition,the organizers demonstrated open-mindedness, respectfulattitudes toward others, and excellent communicationskills. The city of Chicago recognizes 77 distinct com-munity areas; the Project Northland Chicago organizersare working within 20 such areas.

To adapt the community-organizing design, infor-mation was gathered through numerous meetings withChicago professionals working in public health, lawenforcement, prevention, and substance-use policy. Inaddition, advice was sought from current and past com-munity organizers in Chicago. This input was used toadvertise and promote the community-organizing jobpositions throughout the city so that the project couldrecruit a diverse team with previous organizing experi-ence. Current liquor laws and ordinances were reviewed,and information was gathered on previous communityefforts. Rather than address city ordinances as in theoriginal Project Northland, community action teams inChicago will focus on neighborhood-based institutionaland informal policies to reduce youth access to alcoholand marketing of alcohol to youth.

Each community organizer conducted a communityassessment to become familiar with their assigned com-munities’ alcohol issues, identified resources, and keyorganizations. The organizers began with outreachactivities by attending community meetings and by con-ducting one-on-one meetings with hundreds of commu-nity residents. Through this process, the organizersformed an understanding of specific community con-cerns and identified key community members to inviteto join their action teams. The organizers have workedespecially hard to identify parents with whom to involvein the community action teams. Action teams have beenformed in each intervention community to addressneighborhood and schoolwide issues related to youngadolescents access to, and use of, alcohol. The commu-nity organizers have held action team meetings and areengaged in actively involving community members inthis process. Teams are identifying major access andadvertising issues that are relevant to their specific com-munities. Several teams are beginning to take on actionsin the community, with community members engagedin monitoring and observing activities in parks and atcommunity events where youth drink. Several teamshave begun to visit alcohol retailers to ask them to signpledges committing to not sell alcohol to underage persons.In some cases, the community organizers work with othersin the community to raise awareness of the seriousness ofyouth alcohol use and how it is associated with otherserious community issues, such as youth violence.

In summary, the adaptation process employed in thisstudy provides a guideline for others in the development ofmultiple-component, community-wide prevention strat-egies for multiethnic communities. This investigation isa critical and timely evaluation of an adapted andenhanced Project Northland for urban and multiethnic

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youth, families, and neighborhoods. Chicago, the thirdlargest city in the United States, with a culturally diversepopulation, provides an excellent setting to evaluate thisadaptation process. Its strong evaluation design, with arandomized design and with multiple levels of measures,should provide insight into how, if, and why the adaptedProject Northland Chicago intervention is successful.The information gained from this trial, including theprocess of adaptation of prevention strategies, will bebeneficial for alcohol-use prevention efforts withindiverse urban communities across the country.

Acknowledgment

This research was funded by a grant from the NationalInstitute on Alcohol Abuse and Alcoholism, awarded toKelli A. Komro, PhD, PI.

Received June 20, 2003; revisions received September 30,2003, and December 12, 2003; accepted January 4, 2004

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