Culture plays an important role in all health message design, and school-based substance abuse prevention is no exception. Because most adolescent substance abuse prevention programs in the United States are delivered in schools, this is particularly important given the diversity of the students. Unfortunately, there is little theory to guide these programs and fewer programs that successfully achieve cultural competence. Using communication accommodation theory as a framework, this article articulates the principle of cultural grounding using the Drug Resistance Strategies Project as an exemplar. The article then describes a line of research describing youth, ethnic, and gender cultures leading to the development and evaluation of the keepin' it REAL curriculum. Results demonstrate the efficacy of a multicultural approach to prevention in controlling the onset of adolescent drug use
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