hip-hop to prevent substance use and hiv among african

J. DRUG EDUCATION, Vol. 38(4) 351-365, 2008
HIP-HOP TO PREVENT SUBSTANCE USE AND
HIV AMONG AFRICAN-AMERICAN YOUTH:
A PRELIMINARY INVESTIGATION*
JOCELYN O. TURNER-MUSA, PH.D.
Morgan State University
WARREN A. RHODES, PH.D.
Delaware State University
P. THANDI HICKS HARPER, PH.D.
Youth Popular Culture Institute, Inc., Clinton, Maryland
SYLVIA L. QUINTON, ESQ.
Strategic Community Services, Inc.
ABSTRACT
Substance use and HIV risk behaviors are increasing among AfricanAmerican youth. Interventions that incorporate youth values and beliefs are
needed to reduce this trajectory. Hip-hop plays an important role in the lives
of many African-American youth and provides a context within which to
prevent risky behaviors. The current study examines the efficacy of a hip-hop
based substance use and HIV preventive intervention that targets AfricanAmerican middle-school youth. The sample consists of 68 middle-school
students who completed baseline and 6-month follow-up assessments.
Findings suggest that students in the intervention group were significantly
more likely to have higher knowledge of perception of drug risk and more
knowledge about HIV/AIDS compared to students in the comparison group
at the 6-month post-intervention assessment. Discussion is centered on implications of hip-hop as a viable approach for preventing substance use and
HIV within a high-risk group.
*This study was funded by the Center for Substance Abuse Prevention (CSAP) Substance Use and
HIV Prevention in Minority Communities Grant #5H79SP10536.
351
Ó 2008, Baywood Publishing Co., Inc.
doi: 10.2190/DE.38.4.c
http://baywood.com
352 / TURNER-MUSA ET AL.
Substance use and abuse is a pervasive problem among adolescents in the United
States. Healthy People 2010 outlines 23 substance abuse reduction goals, with 8
that address adolescents (USDHHS, 2000). Recent national surveys indicate that
illicit substance use rates among youth continue to decline, over 23% between
2001-2006 (Johnston, O’Malley, Bachman, & Schulenberg, 2006). While
national surveys show that African-American youth report lower substance use
rates compared to white youth, there is still cause for concern. First, the negative
consequences of substance use continue to be more devastating for African
Americans than for whites (Gil, Wagner, & Tubman, 2004). Second, AfricanAmerican 8th-graders now report higher annual marijuana prevalence rates
than their white counterparts; and third African-American 10th-graders report
annual marijuana use prevalence rates nearly equal to those of white counterparts
(Johnston et al., 2006). Besides the fact that children who start using marijuana
at an early age are more likely to use cocaine and heroin and become drugdependent adults (Gfroerer, Wu, & Penne, 2002), these latter findings counter
past long-standing trends, which showed that African-American youth use
marijuana at lower rates than their white counterparts.
The consequences of substance use among adolescents are well known. For
instance, substance use is linked to increased risky sexual behavior (Leigh &
Stall, 1993; Malow, Devieux, Jennings, Lucenko, & Kalichman, 2001; Malow,
McMahon, Cremer, Lewis, & Alferi, 1997; Tapert, Aarons, Sedlar, & Brown,
2001) and risk of Human Immunodeficiency Virus (HIV). African Americans
are disproportionately infected with HIV and AIDS. In 2004, 50% of adults and
adolescents diagnosed with HIV were African American, though they account
for only 12% of the United States population. In 2002, HIV/AIDS was the
leading cause of death for African-American women age 25-34 and the second
leading cause of death for African-American men age 35-44. Furthermore,
African Americans account for 40% of all diagnosed AIDS cases since the
beginning of the epidemic and have much lower survival rates than do whites
and other ethnic groups. Of children under the age of 13 who were living with
AIDS in 2004, African Americans outnumber all racial groups combined. A
disproportionate number of newly diagnosed AIDS cases are African-American
adolescents, most of whom contracted the disease as a result of risky sexual
behavior (CDC, 2005). The Centers for Disease Control (CDC) has identified
several effective programs for prevention of HIV/AIDS in youth, some of
which specifically target African Americans (e.g., Jemmott, Jemmott, & Fong,
1992; Lyles, Kay, Crepaz, Herbst, Passin, Kim, et al., 2007; Staton, Li, Ricardo,
Gaibraith, Feigelman, & Kaljee, 1996).
HIV effective behavioral intervention programs include building personal skills
(decision-making, communication) and technical skills building (condom use)
and these were either demonstrated practices or role-played (Lyles et al., 2007).
According to Coyle et al. (1999), one reason that many prevention programs
are not effective is that they primarily focus on the individual behavior, when the
HIP-HOP TO PREVENT SUBSTANCE USE AND HIV /
353
family and school contexts are among the most important areas that may effect
risky behaviors. Researchers suggest that future studies should focus on testing
the generalizability of proven behavioral interventions to determine their effectiveness. Furthermore, it may be necessary to modify these proven strategies to
accommodate social, cultural, and contextual factors and evaluating these modifications using rigorous designs (Lyles et al., 2007). One social, cultural, and
contextual strategy for addressing substance use and HIV risk behaviors among
African-American youth is through hip-hop.
HIP-HOP—A CULTURAL EXPRESSION
Gaining considerable prominence in the late 1970s, hip-hop is approximately
30 years old and remains the dominant youth popular culture in America
(Hicks-Harper, 2004). The origins of hip-hop are found in ancient African traditions, although its contemporary presence evolved from the cultural expressions of
Black and Hispanic/Latino youth rapping and dancing in backyards and basements
in inner-city communities (Hicks-Harper, 2004). Hip-hop music is a ubiquitous
art form of unrivaled popularity that collectively voices the feelings of contemporary youth (Rhodes, Thomas, Harper, Leary, & Quinton, 2006). Among
African-American urban youth, popular music, such as hip-hop, has been shown
to play a significant role in decision-making and behavioral choices. Hip-hop is
a form of expression that, for many youth, is a way of life. It is a complex system
of values and ideas that include music, song, poetry, film, and fashion. At its
best, hip-hop is a “voice for the voiceless” and relates messages that reflect
real-life experiences for those growing up in impoverished or underpowered
environments. At its worst, hip-hop’s messages include lyrics and images that
demean women and promote violence, wanton sex, and substance use/abuse, as
well as escape from poverty by acquisition of material wealth by any means
necessary. Generally, hip-hop is associated with African-American and Latino
urban youth, but it has moved well beyond urban communities into “mainstream”
America. Hip-hop has been commercialized into a multi-billion dollar industry
with mass appeal (Stewart, 2005) and, while many features of hip-hop remain
controversial (Jones, 1997; Miranda & Claes, 2004; Peters, Kelder, Markham,
Yacoubian, Peters, & Ellis, 2003), researchers and educators suggest that the
potential of hip-hop for health promotion and disease prevention is unlimited
(Fitzgibbon et al., 1998; Harper, 2006; Stephens, 1998; Sussman, Parker, Lopes,
Crippens, Elder, & Scholl, 1995).
HIP-HOP AND HEALTH PROMOTION
Hip-hop music and culture are increasingly acknowledged as important
ingredients in strategies to reach out to African-American youth in interventions
aimed at promoting strength and resilience in the face of systemic social and
mental health problems (Harper, 2006). According to a recent survey of about
354 / TURNER-MUSA ET AL.
2,000 African-American urban youth ages 16-20, 45% indicated they listen to
the radio for 3 or more hours daily, are more likely to watch culturally-targeted
music videos, and prefer hip-hop/rap music (MEE, 2004). Many of the lyrics
and media images associated with hip-hop as depicted in mainstream media
include demeaning portrayals of African-American women, promote violence,
alcohol and drug use, and irresponsible sexual behavior (Durant, Rome, Rich,
Allred, Emans, & Woods, 1997; Forsyth, Barnard, & McKeganey, 1997). These
negative media messages have been associated with increased risky sexual
behavior among African-American adolescent girls (Wingood, DiClemente,
Bernhardt, Harrington, Davies, Robillard, et al., 2003), aggressive behaviors
(Anderson, Carnagey, & Eubanks, 2003; Baronagan & Hall, 1995), and increased
drug use (Forsyth et al., 1997). Such images are also likely to affect parents
and other adults such that expectations for youth are lowered and effective
communication may be hampered. Increasing parental monitoring has been
suggested to counteract these negative messages (American Academy of
Pediatrics, 1996). Further, positive aspects of hip-hop are oftentimes overlooked
in the mainstream media thereby possibly limiting its health promotion potential.
Consequently, hip-hop has yet to undergo the rigor of scientific scrutiny in the
substance use and HIV prevention arena.
A life course/social field theoretical orientation (Kellum & Rebok, 1992)
provides the contextual framework for the current study. The framework suggests
that success in responding to various social demands encountered during the
early life course is linked to the individual’s concurrent and later social and
psychological well-being. Accordingly, successful social adaptation is hypothesized to promote better adaptation to social demands across various social fields.
For adolescents these social fields include peers, family, and the school environment. Within a life course perspective, key transitional periods may increase
vulnerability to risky behaviors and poor adaptation. African-American urban
adolescents who are transitioning from the more sheltered elementary school
environment to middle school may be at greater risk for engagement in risky
behaviors (e.g., substance use) and associated negative outcomes (e.g., substance
abuse, HIV, violence). Among the risk factors associated with negative outcomes
for African-American urban youth are early drug use, poor parent/family/school
bonding, negative peer influences, and pro-drug attitudes.
PURPOSE
Research on substance use and HIV prevention among urban African-American
youth consistently shows a relationship between risk factors and substance
use/risky sexual behaviors, as well as mediation of these effects via the enhancement of protective factors such as skill-building. While researchers and educators have suggested that the potential of hip-hop for health promotion and
disease prevention is unlimited, we know of no experimental studies that have
HIP-HOP TO PREVENT SUBSTANCE USE AND HIV /
355
incorporated a hip-hop-based intervention to reduce risk factors for substance
use and HIV within a sample of urban African-American middle school youth.
The current study is designed to:
1. improve youth skills and knowledge about the dangers of substance use
and HIV;
2. create negative attitudes toward drug use and risky sexual behaviors; and
3. improve drug and sexual resistance skills.
We hypothesize that intervention group participants will have significantly
lower substance use rates, higher risk of harm when using alcohol or drugs,
more negative attitudes toward drugs, greater HIV/AIDS knowledge, and greater
sexual self-efficacy behaviors compared to a no-treatment comparison group
participants at 6-month follow-up.
METHOD
Participants
Participants included 23 boys and 45 girls who completed baseline and 6-month
assessments. The mean age of participants was 13 years (SD = .89). Ninety-one
percent of the participants were African American, 4% were Hispanic, and 5%
identified themselves as white or mixed-race. Sixty-two percent of the participants
were in 8th grade and 38% were in 7th grade.
Measures
An 88-item survey was administered to all program participants. The same
survey was administered to participants 6 months after completion of the
hip-hop-based curriculum (H2P) presentation. The survey consisted of several
scales designed to measure alcohol, tobacco, and drug use attitudes and beliefs
regarding drug use, decision-making skills, knowledge and attitudes about sex and
HIV/AIDS, sexual behaviors, and family and school bonding. For this study, the
35 items assessing substance use prevalence (12 items), substance use attitudes
and beliefs (4 items), HIV knowledge (10 items), sexual behaviors (5 items), and
drug risk behaviors (4 items) were examined. Mean scores were computed for
interval scales. Table 1 provides information on psychometric properties of each
construct and sample items.
Procedure
Participant Recruitment
Participants were recruited from a middle-school located in an urban community in the northeastern region of the United States. Recruitment procedures
included presenting information about the H2P intervention to students, parents,
4
4
4
Past 30-day usea
(Specific to use)
Attitudes toward drug use
(Specific to use)
Perceived harm/risk drug use
(Specific to use)
5
True, False, or Not sure
4-point scale
(No risk to Great risk)
4-point scale
(Not wrong at all to Very wrong)
7-point scale
(Not at all to 10-19 times)
Never—age of first use
4-point scale
(Never to regular)
Response format
Imagine that you or your boyfriend or girlfriend 4-point scale
have been going together, but you have not
(Very unsure to Very sure)
had sex. He or she really wants to have sex. Still,
you don’t feel ready. How sure are you that you
could keep from having sex until you feel ready?
Birth control pills protect a woman from HIV
How much do you think people risk harming
themselves (physically or in other ways) if
they try marijuana once or twice?
How wrong do you think it is for someone
your age to drink alcohol?
How frequently have you drank alcohol
during the past 30 days?
How old were you the first time you used
marijuana or hashish?
Have you ever smoked cigarettes?
Sample item
aRecoded to reflect whether the respondent did or did not use alcohol or drugs within a 30-day period.
Sexual self-efficacy:
Refusing sex
10
4
Age of first onset—ATOD
HIV knowledge
4
# of
items
Lifetime alcohol use
Construct
Table 1. Psychometric Properties of Assessment Scales
.93
.82
.87
.84
N/A
N/A
N/A
Cronbach
a
356 / TURNER-MUSA ET AL.
HIP-HOP TO PREVENT SUBSTANCE USE AND HIV /
357
and staff attending various school related events (e.g., Parent Teacher Association
meetings) at the beginning of the school year. Letters were sent to all students’
homes approximately 2 months after initial meetings inviting parents and students
to attend one of two intervention parent orientation dinner meetings where parents
and students would be fully informed about the program, have an opportunity to
register for the program, and provide written informed consent for participation.
Concurrently, posters and daily announcements at school reminded students about
the dinner meeting if they wanted to participate in H2P. If a family decided to
pursue program registration, they completed the parent/guardian informed consent
form and the minor child signed the assent form. The study was approved by the
school district’s Institutional Review Board.
One hundred thirty-five students and their parents or guardians completed all
program registration requirements and the baseline survey. Students were then
randomly assigned to the comparison group (n = 68) or intervention group (n = 67)
using a stratified randomization scheme. Participants were notified of their group
assignment and the H2P timetable via letters sent by program staff. Students
assigned to the comparison group completed the baseline and follow-up surveys.
Intervention group participants were divided into three instructional groups and
assigned to a 2-person teaching team; these groupings were maintained for the
entire program. To help maintain confidentiality for students having siblings in
the program, siblings were placed in different instructional groups. Six-months
after program completion, 68 students—26 comparison and 42 intervention—
completed the follow-up survey (60% retention rate). A review of the data
suggests that student attrition from baseline to the 6-month assessment reflected
those students who moved or graduated from middle school prior to the 6-month
assessment. No other systematic differences between these groups were
observed. All participants were offered a $15.00 gift certificate upon each
survey completion.
Program Description
H2P is a 10-session after-school substance abuse and HIV/AIDS prevention curriculum (Harper, 2005). H2P uses a contextual framework of youth
popular culture (i.e., hip-hop) exploration to present a prevention curriculum
that integrates substance abuse and HIV preventive intervention strategies.
H2P’s model is based on the cultural competence perspective (Resnicow,
Soler, Braithwaite, Ahluwalia, & Butler, 2000), risk and protective framework
(Hawkins, Catalano, & Miller, 1992), social learning theory (Akers, 1977),
social development theory (Catalano & Hawkins, 1996), and uses social learning
strategies as the foundation to promote effective behavioral change (Bandura,
1986). The prevention curriculum is based on two model programs: Project
SUCCESS (School Using Coordinated Community Efforts to Strengthen
358 / TURNER-MUSA ET AL.
Students), and BART (Becoming a Responsible Teen; Fisher & Fisher, 1992;
Morehouse & Tobler, 2000).
H2P is unique in that it is technology-driven and uses the characteristic original
art forms of dominant youth culture to effectively communicate prevention
messages. Faculty members from the host school were trained as H2P instructors.
Prior to implementation of the H2P curriculum, faculty and staff of the cooperating middle school participated in Hip-Hop 101, a 4-hour hip-hop workshop,
as a staff training experience during an in-service retreat for all teachers and
staff. The workshop was designed to increase faculty and administrator knowledge and understanding of hip-hop, and to explore ways that hip-hop could
enhance what these educators were already doing to increase student learning
in the classroom environment. Pre- vs. post-workshop survey findings indicated
that teachers demonstrated enhanced knowledge of hip-hop and reported a more
positive attitude toward the use of hip-hop as an educational and prevention
tool for their students.
H2P was implemented as a series of ten 2-hour sessions. Skills development for
self-efficacy, norms and belief clarification, conflict resolution, and resistance
occurs throughout the curriculum, since these skills are crucial to substance use
and HIV prevention. H2P Curriculum Components 1-4 were administered in and
around the multimedia center at the participating middle-school. Each session
provided participants with information about drugs, HIV/AIDS, healthy alternatives to sex and drugs, strategies for positive communication with peers,
parents, teachers, and information on how to distinguish between negative and
positive characteristics of hip-hop and how this can be used as a tool for peer
substance abuse intervention and HIV/AIDS prevention. Most of this information was acquired via interactive computer software and group activities facilitated by an adult program staff member.
H2P Curriculum Components 5-10 were implemented during a 3½-day stay
at a regional 4H Camp. The curriculum emphasized substance use prevention,
the synthesis of the curriculum’s positive lifestyle messages, resistance skills,
and information on sexual behavior. The weekend consisted of a balance of
classroom time and structured free time. The classroom time included an
opportunity for students to role-play drug and sex resistance self-efficacy
skills, create a “rap,” and participate in group discussions about drug use and
HIV prevention. During the free time sessions, participants played board games,
received instruction in arts and crafts, watched movies, and participated in
sports activities. The 4-H Camp staff facilitated the structured free-time activities,
allowing the H2P Instructors an opportunity to prepare for their presentations.
The initial post survey was administered to participants the week following
completion of the H2P Camp. Six months after program implementation, the
second post survey was administered to participants. Figure 1 provides a logic
model of the program.
HIP-HOP TO PREVENT SUBSTANCE USE AND HIV /
H2P
COMPONENTS
PROXIMAL
OUTCOMES
359
DISTAL
OUTCOMES
10-Session SAP/HIV
Prevention Curriculum
• Provide general
knowledge about
healthful practices &
harmful effects of
AOD via hip-hop
• Improve sub abuse
resistance skills
• Improve accuracy
in peer norms in
sub abuse
• Improve knowledge &
self-efficacy skills
• Norms clarification
• Accurate perception of
Decrease in
Substance Use
and HIV Risk
Behaviors
risk associated with SA
& inappropriate sexual
behaviors
• Negative attitudes toward
SA and risky sex
Proximal outcomes examined in current study.
Figure 1. Hip-hop to prevent substance abuse logic model.
RESULTS
Descriptive analyses were conducted to assess baseline characteristics of the
sample on key variables of interest. Findings suggest that alcohol and drug use
were very low in this sample. As shown in Table 2, the majority of participants
specified that they had never used alcohol in their lifetime (68%) or in the past
30 days (94%), or used marijuana in the past 30 days (97%). With regard to
perception of risk in drinking alcohol or using drugs, 67% perceived low to
moderate risk in using drugs. Conversely, most participants felt that drug use
was very wrong (75%). Twenty-five percent of the participants indicated that
they had sex at least once in their lifetime. Of the participants who had ever had
sex, 10% had engaged in risky sexual behavior (i.e., alcohol before sex). When
asked about knowledge of HIV/AIDS, only 38% of the sample had moderate to
high knowledge.
Given the reduction in sample size from baseline to 6-month post-assessment,
independent samples t-tests and chi square analyses were performed to examine
possible differences between those who were retained and those who were lost
to follow-up. No significant findings were observed on any of the demographic
or primary variables. Also, no significant differences were observed between
the intervention and comparison group on demographic and baseline variables
of interest.
360 / TURNER-MUSA ET AL.
Table 2. Baseline Scores on Key
Constructs (n = 68)
n
%
Ever used alcohol?
Yes
No
22
46
32
68
30-day alcohol use
Yes
No
4
64
6
94
30-day marijuana use
Yes
No
2
66
3
97
Perception of risk in drug use
Low/moderate risk
High risk
43
23
67
33
Attitude toward drugs
Very wrong
Wrong
A little wrong
51
15
2
75
22
3
Ever had sex
Yes
No
17
51
25
75
HIV/AIDS knowledge
Moderate/high (13-16)
Low (12/below)
26
42
38
62
Because there were no significant differences observed between the intervention and comparison groups, chi square analysis for 30-day drug use and
independent samples t-tests were computed to assess 6-month post assessment
differences between the intervention and comparison groups in 30-day drug use,
attitudes toward drugs, drug risk perception, HIV/AIDS knowledge, and sexual
self-efficacy. No significant differences were observed. While no significant
differences were found, mean differences for the intervention group were in
the hypothesized direction. To further explore this, paired samples t-tests were
performed to examine baseline to 6-month differences within each group. As
shown in Table 3, intervention group participants had greater mean differences
HIP-HOP TO PREVENT SUBSTANCE USE AND HIV /
361
Table 3. Mean Within-Group Differences for the H2P Intervention
and Comparison Group
Intervention
Baseline
6-month post
Measure
M
SD
M
SD
Drug risk
3.1
.78
3.3
Drug attitudes
3.7
.41
3.7
.34
HIV knowledge
10.6
Sexual self-efficacy
Comparison
4.3
12.5
3.05 1.0
3.2
Baseline
M
SD
M
SD
.59 2.06*
3.3
.71
3.1
.75 –1.30
.642
3.7
.43
3.6
.45
3.8 2.93** 10.0
4.5
11.3
3.1
1.1
3.1
.93
t(40)
6-month post
.68
5.1
.76
t(25)
–.79
1.76
.15
*p < .05; **p < .01.
from baseline to post-survey assessments in drug risk perception, t = 2.06 (38),
p < .05 and HIV/AIDS knowledge, t = 2.93 (38), p < .01. No mean differences
were shown for comparison group participants.
DISCUSSION
The current study sought to test the efficacy of a hip-hop-based intervention to
prevent alcohol and drug use and promote responsible sexual behavior. Baseline
findings suggest low substance use, greater negative attitudes toward drugs,
and low to moderate perceptions about drug risk. Substance abuse prevention
literature shows that high perceived risk levels are associated with decreased
substance use. In the current study, a high percentage of respondents reported
negative attitudes toward substance use at baseline, but a high percentage also
reported low to modest perceptions of negative consequences associated with
substance use. This may be indicative of a potential risk factor for the onset of
drug use. Those students who perceive lower negative consequences associated
with substance use may be at greater risk for experimenting with alcohol and
drugs. While there were no significant 6-month post-intervention differences
found between the comparison and intervention group on measures of substance
use, students participating in the H2P intervention, showed a significant increase
in their perception of risk associated with alcohol and drug use at 6-months
post-intervention. No such changes were observed in the comparison group.
Such findings underscore the need to implement preventive interventions at the
middle school level before substance use begins and reaches the frequency
and intensity observed later among African Americans (Gil, Wagner, &
Tubman, 2004).
362 / TURNER-MUSA ET AL.
With regard to risky sexual behaviors, most participants were not sexually
active. However, among those who were, a small percentage engaged in risky
sexual behavior. Further, when asked about knowledge pertaining to HIV/AIDS
at baseline, few participants reported having sufficient knowledge. This is particularly disturbing given the increase in HIV among African-American youth.
For those students who participated in the intervention group, HIV/AIDS knowledge at the 6-month post-assessment was significantly higher than their baseline
scores. Again, such findings justify the choice of middle school as an appropriate
venue for implementation of effective HIV preventive interventions.
While findings from this study are encouraging, there are some limitations
to consider. First, the small sample size due in part to participant attrition and
assessment of students at one school makes it difficult to generalize findings
beyond this population. With regard to participant attrition, examination of
possible differences between those who completed all study assessments and
those who did not revealed no significant difference. However, several students
moved or graduated and went on to high school and were lost to follow-up.
Nonetheless, a larger sample size may have yielded the additional power needed
to detect significant differences between the two study groups. Second, this
study is, to our knowledge, one of the first to examine the efficacy of hip-hop as
a substance use and HIV/AIDS preventive intervention among youth. As such
findings are preliminary at best. Third, given that students were recruited from
the same school, some program contamination may have occurred. Intervention
group participants may have unknowingly shared information about the intervention to comparison group participants. While this was not systematically
examined, the intervention effects may have been masked by this possibility.
Fourth, analyses utilized for this study did not control for variables that may
mediate or moderate the observed findings (e.g., gender). Fifth, a longer follow-up
period may have allowed for the opportunity to exam the long-term impact of
the intervention. However, the proximal findings observed do suggest that for
the intervention group, participants did have improved knowledge of substance
use and more of an accurate perception of risk associated with substance use
and inappropriate sexual behaviors.
Despite these limitations, findings suggest the need to develop and implement
culturally congruent interventions targeting at-risk groups. Consistent with
findings from similar prevention studies with a culturally-based emphasis (e.g.,
Belgrave, Reed, Plybon, & Corneille, 2004; Jemmott et al., 1992), findings from
this study suggest that a cognitive-based and culturally-focused intervention may
improve knowledge about alcohol and substance use risk as well as increase knowledge about HIV/AIDS in an African-American youth sample. Unlike previous
studies, this study employs hip-hop as a viable method for transmitting knowledge
and behavior change strategies to youth at risk for substance use and HIV/AIDS.
Future research should further explore the impact of this controversial yet culturally appropriate method of reaching and teaching young African Americans.
HIP-HOP TO PREVENT SUBSTANCE USE AND HIV /
363
ACKNOWLEDGMENTS
The authors wish to thank Dr. Gwen Allen (H2P Program Manager) and
Rosalind Hamilton and La Shaun Haynes who both served as H2P Program
Coordinators.
REFERENCES
Akers, L. (1977). Deviant behavior: A social learning approach (2nd ed.). Belmont, CA:
Wadsworth Press.
American Academy of Pediatrics (1996). Impact of music lyrics and music videos on
children and youth. Pediatrics, 98, 1219-1221.
Anderson, C., Carnagey, N., & Eubanks, J. (2003). Exposure to violent media: The
effects of songs with violent lyrics on aggressive thoughts and feelings. Journal of
Personality and Social Psychology, 84(5), 950-971.
Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory.
Englewood Cliffs, NJ: Prentice Hall.
Baronagan, C., & Hall, G. (1995). The influence of misogynous rap music on sexual
aggression against women. Psychology of Women Quarterly, 19, 195-207.
Belgrave, F., Reed, M., Plybon, L., & Corneille, M. (2004). The impact of a culturally
enhanced drug prevention program on drug and alcohol refusal efficacy among urban
African American girls. Journal of Drug Education, 34(3), 267-279.
Catalano, R., & Hawkins, D. (1996). The social developmental model: A theory of
antisocial behavior. In J. D. Hawkins (Ed.), Delinquency and crime: Current theories
(pp. 149-197). New York: Cambridge University Press.
Centers for Disease Control and Prevention (CDC). (2005). HIV/AIDS Surveillance Report,
(16). Atlanta: U.S. Department of Health and Human Services, CDC; –46.
Coyle, K., Basen-Engquist, K., Kirby, D., Parcel, G., Banspach, S., Harrist, R., et al.
(1999). Short-term impact of safer choices: A multicomponent, school-based HIV,
other STD, and pregnancy prevention program. Journal of School Health, 69(5),
181-188.
Durant, R., Rome, E., Rich, M., Allred, E., Emans, S., & Woods, E. (1997). Tobacco and
alcohol use behaviors portrayed in music videos: A content analysis. American
Journal of Public Health, 87, 1131-1135
Fisher, J., & Fisher, W. (1992). Changing AIDS risk behavior, Psychological Bulletin,
111, 455-474.
Fitzgibbon, M., Prewitt, E., Blackman, L., Simon, P., Luke, A., Keys, L., et al. (1998).
Quantitative assessment of recruitment efforts for prevention trials in two diverse
Black populations. Preventive Medicine: An International Journal Devoted to
Practice & Theory, 27(6), 838-845.
Fitzpatrick, K. (1997). Fighting among America’s youth: A risk and protective factors
approach. Journal of Health and Social Behavior, 38, 131-148.
Forsyth, A., Barnard, M., & McKeganey, N. (1997). Musical preference as an indicator
of adolescent drug use. Addiction, 92(1), 1317-1325.
Gfroerer, J., Wu, L., & Penne, M. (2002). Initiation of marijuana use: Trends, patterns,
and implications. (Analytic Series: A-17, DHHS Publication No. SMA 02-3711)
Rockville, MD: Substance Abuse and Mental Health Services Administration, Office
of Applied Studies.
364 / TURNER-MUSA ET AL.
Gil, A. G., Wagner, E. F., & Tubman, J. G. (2004). Associations between early-adolescent
substance use and subsequent young adult substance use disorders and psychiatric
disorders among a multiethnic male sample in South Florida. American Journal of
Public Health, 94, 1603-1609.
Harper, P. (2006). Hip-hop development: Exploring hip-hop culture as a youth engagement
tool for successful community building. Clinton, MD: Billo Communications, Inc.
and Youth Popular Culture Institute, Inc.
Harper, P. (2005). Hip Hop 2 Prevent Substance Abuse and HIV: A Youth Development
Curriculum 4 Adolescents. Clinton, MD: Billo Communications, Inc. and Youth
Popular Culture Institute, Inc. and Strategic Community Services, Inc.
Hawkins, J., Catalano, R., & Miller, J. (1992). Risk and protective factors for alcohol
and other drug problems in adolescence and early adulthood: Implications for
substance abuse prevention. Psychological Bulletin, 112(1), 64-105.
Jemmott, J., Jemmott, L., & Fong, G. (1992). Reductions in HIV risk-associated sexual
behaviors among black male adolescents: Effects of an AIDS prevention intervention.
American Journal of Public Health, 82(3), 372-377.
Jones, K. (1997). Are rap videos more violent? Style differences and the prevalence
of sex and violence in the age of MTV. Howard Journal of Communications, 8(4),
343-356.
Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2006). Monitoring the Future national results on adolescent drug use: Overview of key findings,
2005 (NIH Publication No. 06-5882). Bethesda, MD: National Institute on Drug
Abuse, 67.
Kellum, S., & Rebok, G. (1992). Building developmental and etiological theory through
epidemiologically based preventive intervention trials. In J. McCord & R. Tremblay
(Eds.), Preventing antisocial behavior: Interventions from birth through adolescence
(pp. 162-195). New York: Guilford Press.
Leigh, B., & Stall, R. (1993). Substance use and risky sexual behavior for exposure to
HIV: Issues in methodology, interpretation, and prevention. American Psychologist,
48, 1035-1045.
Lyles, C., Kay, L., Crepaz, N., Herbst, J., Passin, W., Kim, A., et al. (2007). Best-evidence
interventions: Findings from a systematic review of HIV behavioral intervention
for US populations at high risk, 2000-2004. American Journal of Public Health, 97(1),
133-143.
Malow, R., Devieux, J., Jennings, T., Lucenko, B., & Kalichman, S. (2001). Substanceabusing adolescents at varying levels, of HIV risk: Psychosocial characteristics, drug
use, and sexual behavior. Journal of Substance Abuse, 13(1-2), 103-107.
Malow, R., McMahon, R., Cremer, D., Lewis, J., & Alferi, S. (1997). Psychosocial
predictors of HIV risk among adolescent offenders who abuse drugs. Psychiatric
Services, 48(2), 185-187.
Miranda, D., & Claes, M. (2004). Rap music genres and deviant behaviors in FrenchCanadian adolescents. Journal of Youth & Adolescence, 33(2), 113-122.
Morehouse, E., & Tobler, N. (2000). Preventing and reducing substance use among
institutionalized adolescents. Adolescence, 35(137), 1-28.
Motivational Educational Entertainment (MEE). (2004). This is my reality: The price of
sex an inside look at black urban youth sexuality and the role of the media. A MEE
Productions Inc. Publication.
HIP-HOP TO PREVENT SUBSTANCE USE AND HIV /
365
Peters, R., Kelder, S., Markham, C., Yacoubian, G., Peters, L., & Ellis, A. (2003).
Beliefs and social norms about codeine and promethazine hydrochloride cough syrup
(CPHCS) onset and perceived addiction among urban Houstonian adolescents: An
addiction trend in the city of Lean. Journal of Drug Education, 33(4), 415-425.
Resnicow, K., Soler, R., Braithwaite, R., Ahluwalia, J., & Butler, J. (2000). Cultural
sensitivity in substance use prevention. Journal of Community Psychology, 28(3),
271-290.
Rhodes, W., Thomas, D., Harper, T., Leary, G., & Quinton, S. (2006). Promoting hip-hop
as a transformative tool in risk prevention. Unpublished manuscript. Adia Research
and Evaluation Associates, Dover, DE.
Staton, B., Li., X., Ricardo, I., Gaibraith, J., Feigelman, S., & Kaljee, L. (1996). A
randomized, controlled effectiveness trial of an AIDS prevention program for lowincome African-American youths. Archives of Pediatrics & Adolescent Medicine,
150(4), 363-372.
Stephens, T. (1998). Model for using hip-hop music for small HIV/AIDS prevention
counseling with African American adolescents and young adults. Patient Education &
Counseling, 35(2), 127-137.
Stewart, J. (2005). Message in the music: Political commentary in Black popular music from
rhythm and blues to early hip hop. The Journal of African American History, 196-225.
Sussman, S., Parker, V., Lopes, C., Crippens, D., Elder, P., & Scholl, D. (1995).
Empirical development of brief smoking prevention videotapes with AfricanAmerican adolescents. Substance Use and Misuse, 30(9), 1141-1164.
Tapert, S., Aarons, G., Sedlar, G., & Brown, S. (2001). Adolescent substance use and
sexual risk-taking behavior. Journal of Adolescent Health, 28(3), 181-191.
Wingood, G., DiClemente, R., Bernhardt, J., Harrington, K., Davies, S., Robillard, A., et al.
(2003). A prospective study of exposure to rap music videos and African-American
female adolescents’ health. American Journal of Public Health, 93, 437-439.
U.S. Department of Health and Human Services (USDHHS). (2000). Healthy People
2010. Washington, DC: U.S. Government Printing Office.
Direct reprint requests to:
Jocelyn Turner-Musa, PhD.
Morgan State University
Department of Psychology
1700 East Cold Spring Lane
Jenkins Room 410
Baltimore, MD 21251
e-mail: jocelyn.turnermusa@morgan.edu