Exploring Cultural Adaptations: A Scoping Review on Adolescent Mental Health and Substance Use Prevention Programs

Vol:.(1234567890) Prevention Science (2025) 26:204–221 https://doi.org/10.1007/s11121-025-01779-x Exploring Cultural Adaptations: AScoping Review onAdolescent Mental Health andSubstance Use Prevention Programs ClaudiaCorpus‑Espinosa1· IsottaMacFadden3· MaríadelCarmenTorrejón‑Guirado1,2· MartaLima‑Serrano1,2 Accepted: 20 January 2025 / Published online: 31 January 2025 © The Author(s) 2025 Abstract Adolescence is a critical period for developing risk behaviors such as substance use, which can impact health in adulthood. Culturally adapted evidence-based programs (EBPs) are promising for prevention. This review explores the processes for culturally adapting EBPs targeting alcohol, tobacco, or cannabis use, and/or anxiety or depression in adolescents. We searched multiple databases, grey literature, and relevant websites for studies detailing the cultural adaptation process of EBPs. We then categorized common adaptation steps, classified adaptations using the cultural sensitivity model, identified prevalent adaptation techniques, and determined effectiveness assessment methods. We reviewed the cultural adaptation processes of 43 EBPs. These programs were implemented in schools (51%), followed by family settings (30%), community settings (14%), and multi-component settings (5%). Eleven key steps were identified across the documents: local needs assessment, program selection, understanding of the program's curriculum, advisory group establishment, first draft of initial adaptation changes, staff selection and training, pilot study, enhanced cultural adaptation, implementation, evaluation and monitoring, and dissemination. Most programs integrated both surface (e.g., use of local images, material translation) and deep adaptations (e.g., incorporation of cultural values like "familismo"). Despite the common use of the cultural sensitivity model, detailed adaptation frameworks were often lacking. The field has advanced, but clearer documentation is needed to improve research and practical application. Keywords Cultural adaptation· Adolescence· Evidence-based interventions· Mental health promotion· Substance use Introduction Throughout life, etiological factors—risk and protective— can emerge at various stages; however, those arising during critical developmental periods, such as childhood and adolescence, are particularly impactful (Reiner etal., 2019). During these key stages, the emergence of risk behaviors, such as substance use, can severely affect the quality of life, contributing to the development of chronic diseases and posing significant risks to mental health (Valenzuela-Mujica etal., 2013). These behaviors are often influenced by various risk factors, including peer pressure, unstable family environments, and lack of opportunities. However, protective factors, such as high self-esteem and parental supervision, can play a crucial role in counteracting these risks and promoting healthier developmental outcomes (Nawi etal., 2021). In adolescence, substance use—particularly involving alcohol, tobacco, and cannabis—becomes a prevalent risk behavior with significant health consequences (Nebhinani * Isotta Mac Fadden macf[email protected] Claudia Corpus-Espinosa ccor[email protected] María del Carmen Torrejón-Guirado [email protected] Marta Lima-Serrano [email protected] 1 Faculty ofNursing, Physiotherapy, andPodiatry, Department ofNursing, Universidad de Sevilla, Avenzoar Street, 6, 41009Seville, Spain 2 Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC, Universidad de Sevilla, Seville, Spain 3 Social Sciences Faculty, Department ofSociology, Universidad de Salamanca, Francisco Tomás y Valiente Avenue, no.,37071Salamanca, Spain 205Prevention Science (2025) 26:204–221 etal., 2022). In 2021, the leading global disease burden, measured in Disability-Adjusted Life Years (DALYs), was attributed to behavioral risks, with alcohol use and smoking being the top contributors among adolescents (Brauer etal., 2024). Research highlights a bidirectional relationship between mental health issues and substance use, where mental health problems can heighten the risk of substance use, and substance use can exacerbate mental health issues, with shared etiological factors and social determinants of health driving both (National Institutes of Health, 2024). The World Health Organization (WHO) (2022) defines mental health as “mental health is a state of mental wellbeing that allows people to cope with life's stressful moments, develop all their abilities, learn and work adequately, and contribute to the improvement of their community.” Mental health is shaped by individual, social, and structural factors that can either protect or negatively influence it. Globally, approximately 14% of individuals aged 10 to 19 are affected by depression and anxiety(WHO, 2021), conditions commonly classified as "common mental health disorders," which rank among the leading causes of illness and disability (WHO, 2017). To address this, implementing evidence-based interventions (EBIs) is crucial, especially in vulnerable contexts (Marsiglia etal., 2019). EBIs —defined as programs, practices, processes, policies, and guidelines with proven efficacy or effectiveness in a specific population and context (Rabin etal., 2008)—offer a cost-effective means to engage youth in preventive education (Marsiglia etal., 2022). More specifically, an evidence-based program (EBP) is a set of coordinated activities that demonstrate effectiveness on some desired outcomes and have been rigorously evaluated (Mihalic & Elliot, 2015). Developing a new program from scratch requires significant resources, therefore, culturally adapted programs can enhance engagement and optimize resources by building upon proven programs (Marsiglia etal., 2019). Culturally adapting programs involve systematically modifying a program, including deletions or additions, changes in manner or intensity, and modifications to cultural aspects to fit and address the cultural beliefs, values, and practices of a specific population to ensure cultural relevance adoption, and acceptability of programs, which in turn increases participant engagement and attendance (Barrera, 2013). Several models have been proposed to guide the cultural adaptation of EBPs. These models can be divided into two categories: those focusing on the content of adaptations and those guiding the adaptation process. Frameworks describing the content include Bernal’s (1995) Ecological Validity Model (EVM), which identifies eight dimensions to better meet the needs of the target population. The Cultural Sensitivity model by Resnicow etal. (1999) also emphasizes content, distinguishing between surface structure (enhancing acceptability through cultural elements) and deep structure (considering cultural, social, historical, and environmental, factors affecting health behavior). Another framework is the Psychotherapy Adaptation and Modification Framework (PAMF; Hwang, 2006), which outlines six domains for EBPs adaptation. Frameworks describing the process of cultural adaptation include the following: Kumpfer etal. (2008) developed a model based on their experiences with the Strengthening Families Program, which consists of nine steps. Barrera and Castro (2006) introduced the Heuristic framework for the cultural adaptation of interventions, outlining several steps. Additionally, the ADAPT-ITT model also offers guidance (Montero-Zamora etal., 2021a), among others. Overall, current initiatives have made significant strides in cultural adaptation; however, many existing frameworks exhibit inconsistencies and ambiguities, suggesting they may not fully encompass all the components of the adaptation process (Chu & Leino, 2017). A clearer understanding of these aspects would enhance study comparisons and enable a more comprehensive examination of the impact of adaptations. Furthermore, the literature highlights the importance of applying culturally adapted EBPs to prevent adolescent substance use and promote mental health (Chu & Leino, 2017; Lee etal., 2024). A scoping review is a systematic type of knowledge to synthesize an existing or emerging body of literature on a specific topic, making it ideal for exploring the cultural adaptation of EBPs due to its broad coverage of diverse literature, which makes it optimal for topics with a heterogeneous research landscape and allows for the identification of knowledge gaps. This approach facilitates a comprehensive understanding of the adaptation processes while providing a foundation for future research in the field (Alves-Apóstolo, 2017). The research questions were: 1) What frameworks are employed in effecting cultural adaptations and what procedural steps do they have in common? 2) What types of adaptations are made? 3) What techniques are used to adapt the programs? and 4) How do authors evaluate whether the adaptation was successful or not? This scoping review marks one of the first attempts to explore cultural adaptations on a global scale for EBPs aimed at preventing substance use and common mental health problems among culturally diverse communities. Methods Study Design The research questions were addressed using the scoping review methodology, following guidelines from the Joanna 206 Prevention Science (2025) 26:204–221 Briggs Institute (JBI) and PRISMA-ScR (Peters etal., 2015; Tricco etal., 2018). The protocol was registered with the Open Science Framework on 20/06/2023 (https:// osf. io/ 5n37e/). Eligibility Criteria The PCC (Participants, Concept, Context) eligibility criteria are as follows (Peters etal., 2015): • Population: The study focused on adolescents (10– 19years old) (WHO, 2023a). To broaden the scope, the search strategy also included keywords "children" and "preadolescents," using thesaurus headings and relevant scientific article keywords. • Concept: The study concentrated on methodologies or models for culturally adapting EBPs targeting the prevention of common mental health disorders (specifically: anxiety and depression) and substance use (specifically: alcohol, tobacco, or cannabis) whether individually or collectively. • Context: The context was considered as the setting where the program was implemented, i.e., at school, family, or community level. We included documents employing qualitative, quantitative, and mixed methodologies if they provided details on the adaptation process or if such information was retrievable. Studies were included regardless of publication period, language, or source type. Exclusion criteria included papers lacking explicitly stating that the program was evidence-based. To verify the original and adapted programs' based on evidence, we applied the JBI levels of evidence for effectiveness. These levels establish a hierarchy for assessing the quality of evidence regarding the effectiveness of programs, with higher levels indicating stronger evidence (JBI, 2013). Additionally, papers lacking details on the cultural adaptation process or methodology were excluded. Information Sources Literature research was conducted from February 2023 to October 2024 across various bibliographic databases, including PubMed, Scopus, PsycINFO, Embase, Web of Science, CINAHL, Cochrane, OpenGrey, and websites such as WHO, Pan American Health Organization (PAHO), Substance Abuse and Mental Health Services Administration (SAMHSA), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Search strategies were developed using MeSH and DeCS terms, CINAHL subject headings, and free-text terms. Strategies were refined with librarian guidance and team discussions. Reference lists of included articles, systematic reviews, and scoping reviews were also examined for additional papers. No filters were applied during database searches. Final search strategies for Scopus, as an example, can be found in Online resource 1. Study Selection andData Extraction The search results were exported to Zotero (Cohen etal., 2023) for reference management, and duplicate entries were removed. Titles, abstracts, and keywords of identified documents were examined, and those not meeting inclusion criteria were excluded. One researcher (CACE) conducted initial screening, with subsequent reviews and verifications by two reviewers (IMF and MLS). Consensus was sought to resolve disagreements. Documents passing initial screening were transferred to the collaborative platform "rayyan" (Ouzzani etal., n.d.) for two independent reviewers to examine them (MCTG and CACE); the consensus was sought to resolve disagreements (MLS). Those not meeting inclusion criteria were excluded. A data-charting form was developed collaboratively in Excel by the researchers to extract variables. This form included details such as the name of the EBP, adapted program, home and adaptation countries, program objectives, target population, facilitators, context, cultural adaptation framework, theoretical foundation, key adaptation steps, types of adaptations, techniques used, and adaptation effectiveness. One researcher charted the data (CACE), with two reviewers (IMF and MLS) validating the results through discussions and seeking consensus in case of disagreements. The form underwent continuous updating iteratively. To address the interrogations posed above, we examined the frameworks or methodologies documented in the studies for culturally adapting the programs, the steps entailed by these methodologies or models, the nature of adaptations implemented, whether superficial or deep, the techniques employed for adapting the EBP´s, and the evaluations conducted to assess the effectiveness of the adapted program. Synthesis ofResults The articles were linked based on several factors: authorship, where the content of each document was examined for connections; retrospective references, where, if an evaluation article of an adapted program was identified, citation and reference searches were conducted to link related articles comprehensively; and prospective references, where, if an adaptation article was found, the authors were checked for any mention of ongoing evaluation studies or related work. Regardless of whether such studies were mentioned, The program name was searched in the previously mentioned 207Prevention Science (2025) 26:204–221 databases without applying filters. This linking process was initially conducted by one researcher (CACE) and subsequently reviewed by two additional researchers (MFI and MLS). In cases of disagreement, consensus was reached. In this review, which included multiple study designs, a segregated design was employed following the methodology described by Marshall etal. (2021). This approach allowed qualitative and quantitative data to be considered separately, yet in a complementary manner, to address the research questions. Qualitative data were used to explore the cultural adaptation processes and the social validity of the programs, where applicable, as part of the reported outcomes from each adapted program in the included documents. Meanwhile, in response to the fourth research question of this scoping review, and considering the diverse nature of the documents, quantitative data were examined to summarize the outcomes, based on the authors’ reported results. These health-related outcomes varied by program and included measures such as attitudes, knowledge, skills, and behaviors, all reported as part of the program results. Data from this review were synthesized and presented narratively to condense and elucidate the key findings. A content analysis approach was used, guided by two frameworks for adapting EBPs (Barrera & Castro, 2006; Kumpfer etal., 2008), to identify common program adaptation steps. Descriptions for each step were developed based on theauthors' accounts. The frequency of each step's inclusion and the use of frameworks were determined. A final table was compiled and cross-verified by two reviewers (MLS and IMF). Program adaptation types were categorized as superficial or deep using Resnicow etal.'s model. Surface adaptations involve adjusting materials and messages to the target population's observable characteristics (e.g., language, food, music, locations), while deep adaptations focus on understanding the cultural, social, historical, environmental, and psychological factors influencing the target health behavior. Additionally, two literature reviews that classify cultural adaptations based on this model were utilized to guide the classification process (Marshall etal., 2021). Based on this, adaptations were classified as superficial when they involved modifications of elements such as language, places, music, food, games, images, or symbols that make the program more familiar or culturally recognizable. They were classified as deep when they addressed cultural constructs, such as values, beliefs, or social norms that influence behavior. This includes adaptations that consider gender roles, family structures, or community practices that are deeply embedded in the culture of the target population. One researcher (CACE) classified each adaptation, and subsequently, two additional researchers evaluated this classification (MFI and MLS). In cases of disagreement, consensus was sought. The most utilized techniques (focus groups, interviews, etc.) for program adaptation or evaluation were identified. Lastly, the assessment of program effectiveness was determined. Results Study Selection A total of 2,361 studies were compiled, and after removing duplicates and excluding citations marked as ineligible by automated tools, 1,936 remained. Following the screening of titles and abstracts, 143 full-text articles were assessed, with 66 excluded based on the criteria outlined in Fig.1. One study was excluded due to unavailability. Ultimately, 76 studies were included in the review (Fig.1). A full list of the studies included for review can be found in Online Resource 2. Program Characteristics The included articles describe 43 adapted programs, the majority of which originated in the USA (33), followed by the UK (6), Australia (1), Puerto Rico (1), Europe (1), and the Netherlands (1). Most programs were implemented in school settings (n = 22), followed by family settings (n = 13), community settings (n = 6), and two multi-component settings involving school, family, and community. As seen in Fig.2, most of the adaptation processes were conducted within the USA, with shifts in target populations, such as from urban to rural areas or from American to Latino populations. Similar processes were observed more frequently in European countries. However, there were fewer reported instances of culturally adapted programs in lowermiddle-income countries. Additional characteristics of these programs are provided in Online resource 2. The attributes were chosen based on findings reported in consulted studies (Escoffery etal., 2018; Movsisyan etal., 2021). Cultural Adaptation Frameworks In Prevention Programs The process of culturally adapting the programs has been variable; as shown in Table1 while some programs use a single framework (CATCH-IT, EMAS, Familias Fuertes, Familias Fuertes Brazil, GGC, ITC, Jóvenes Fuertes, KiR Pennsylvania and Ohio, KiR 5th grade version, L2W, NTC, RAD-PAL, SFP 10–14 Italy and Poland, SFP 12–16, Slick Tracy Home, TALKnTIME), others use two to complement the cultural adaptation (Bacanísimo, CURB, Entre Parceros, MREAL Mexico, RISE, TG, UTC), and in some cases, even 208 Prevention Science (2025) 26:204–221 three (PN). Nevertheless, among the 43 EBPs, 18 studies did not mention whether they employed a specific model or not (Alerta Alcohol, ASPIRE, Familias que funcionan Spain, Familien stärken, Entrenamiento en Habilidades de Vida, KiR LGBT + community, KiR Texas, LST, MREAL Spain, PERAE, Preventure, Project EX, PN Croatia, SFP 10–14 Greece, Sweden and UK, SFP France, #Tamojunto). The most commonly used methodology was the cultural sensitivity model reported 5 times (KiR Pennsylvania and Ohio, MREAL Mexico, PN, RISE, and Slick Tracy Home), followed by the ecological validity model (EMAS, Jóvenes Fuertes, MREAL Mexico) and the third most employed were the Community Based Participatory Research (CBPR) (KiR 5th grade version, L2W, RISE, UTC), and the SFP´s recommendations for cultural adaptations (Familias Fuertes Brazil, SFP 10–14 Italy and Poland, and SFP 12–16). Frameworks that were also reported for adapting the EBPs include: Participatory Action Qualitative Research (PAQR) for the TALKnTIME program, The Look, Think, Act action research cycle for UTC, the Circular Model of Cultural Tailoring for ITC and NTC, the PEN-3 cultural model for CATCH-IT and CURB, in the latter, also used the Strategies for Enhancing Cultural Appropriateness, the MOST approach and a Community Engaged Process to adapt TG, the Heuristic framework for the cultural adaptation of interventions and FRAME for Entre Parceros and Bacanísimo, the ADAPT-ITT framework for RAD-PAL and GGC, the Guidelines for Balancing Program Fidelity/ Adaptation for Familias Fuertes and The theory of triadic influence and Perry´s planning model for adolescent health promotion programs for PN. The review highlighted significant variability in how adaptation processes were documented. While all studies provided information on their adaptation process, the level of detail varied considerably. Documents focused on program adaptation, such as Familias Fuertes Brazil, MREAL Fig. 1 PRISMA flow diagram 209Prevention Science (2025) 26:204–221 in Mexico, GGC, SFP 10–14 Poland, L2W, and PN, provided more comprehensive details of the processes followed. In contrast, documents focused on evaluation, like MREAL Spain, KiR Texas, and Project X, presented the adaptation steps in a more summarized manner. This discrepancy suggests that reported steps may not fully reflect actual practices. Greater transparency in future research is needed to ensure clear and thorough documentation of methodologies. Cultural Adaptation Stages andProcess Description The cultural adaptation processes comprised distinct yet occasionally overlapping steps. We delineated 11 steps in the adaptation of programs, which we classified into the following categories (Fig.3). The analysis revealed that a crucial step emphasized in multiple studies is understanding participants' characteristics, preferences, and values, commonly known as “local needs assessment” (Table1). This assessment influences outcomes such as receptivity, adherence, and overall effectiveness, and it also addresses risk and protective factors as well as psychosocial challenges related to substance use and mental health. As shown in Fig.2, only 56% of the reviewed studies reported conducting this assessment before adaptation. Some programs implemented regular reviews and updates to maintain the relevance and effectiveness of their programs, underscoring the importance of continuous refinement to meet emerging needs and enhance overall impact. This step was executed by: Alerta Alcohol, Bacanísimo, CATCH-IT, CURB, Entre Parceros, Familias Fuertes Brazil, GGC, ITC, KiR LGBT + community, L2W, MREAL Mexico and Spain KiR Pennsylvania and Ohio, KiR Texas, KiR 5th grade version, NTC, Preventure, PN, PN Croatia, RAD-PAL, SFP 10–14 Italy and Poland, SFP 12–16 and UTC. Another step documented by only a few programs is “program selection” (35%), which involves collecting information on existing EBPs and selecting those that align with the community’s needs and context. For example, Familias Fuertes Brazil, MREAL Mexico and Spain, NTC, PN, PN Croatia, SFP 10–14 Italy and Poland, SFP 12–16, were among those that followed this step (Table1). An additional aspect that received limited attention in the studies included in this review was “understanding the program's curriculum,” with only 40% addressingit. This is concerning since comprehending the theoretical foundations of the program and its core components is crucial to avoid potential impacts on the program's effectiveness. This action was performed by: Alerta Alcohol, Entrenamiento en Habilidades de Vida, Familias Fuertes, Familias Fuertes Brazil, KiR LGBT + community, KiR Pennsylvania and Ohio, KiR Texas, KiR 5th grade version, L2W, MREAL Mexico and Spain, among others (Table1). The most prevalent step in all adaptation processes (100%) was the “advisory group establishment”, typically composed of a mix of experts and members from the target Fig. 2 Cultural adaptation processes distribution 210 Prevention Science (2025) 26:204–221 Table 1 Cultural adaptations of included evidence-based programs N° Program Reported steps Reported framework Effectiveness evaluation 1 Alerta Alcohol (Lima-Serrano etal., 2018;Martínez-Montilla etal., 2022 ; Martínez-Montilla, 2020;Vargas-Martínez etal., 2023) Netherlands (Dutch) → Spain (Spanish) 1.Local needs assessment 2.Program selection 3. Understanding the curriculum 4.Advisory group 7. Pilot 8.Enhanced cultural adaptation 9. Implementation 10. Evaluation N/A Cluster RCT 2 ASPIRE (Tamí-Maury etal., 2019) USA (Spanish) → Colombia/Mexico (standard Spanish) 4.Advisory group 5.Initial adaptation 7.Pilot 8.Enhanced cultural adaptation 10. Evaluation N/A Pre-posttest design 3 Bacanísimo (Sánchez-Franco etal., 2021) UK (English) → Colombia (Spanish) 1.Local needs assessment 4.Advisory group 5.Initial adaptation 6. Training 7. Pilot 8.Enhanced cultural adaptation 10. Evaluation Heuristic framework FRAME Pre-posttest design 4 CATCH-IT (Abuwalla etal., 2019) USA (English) → Arab Countries (An Arabic dialect) 1.Local needs assessment 4.Advisory group (experts) 5.Initial adaptation PEN-3 cultural model N/A 5 CURB (Bansa etal., 2018; Saulsberry etal., 2013) USA (English) → Chicago, USA (adolescents in English parents in Spanish) 1.Local needs assessment 4.Advisory group (target population) 5.Initial adaptation PEN-3 cultural model Strategies for enhancing cultural appropriateness RCT with wait-list 6 EMAS (Sáez-Santiago etal., 2017) Puerto Rico (Spanish) → Puerto Rico (Spanish) 4.Advisory group 5.Initial adaptation 6. Training 7. Pilot 8.Enhanced cultural adaptation 10. Evaluation Ecological validity model Pilot study 7 Entrenamiento en Habilidades de Vida (De los Ángeles Luengo Martín etal., 1999) USA (English) → Spain (Spanish) 2.Program selection 3. Understanding the curriculum 4.Advisory group 5.Initial adaptation 6. Training 7. Pilot 8.Enhanced cultural adaptation 9.Implementation 10. Evaluation N/AcQuasi-experimental design 8 Entre Parceros (Sánchez-Franco etal., 2021) UK (English) → Colombia (Spanish) 1.Local needs assessment 4.Advisory group 5.Initial adaptation 6. Training 7.Pilot 8.Enhanced cultural adaptation 10. Evaluation Heuristic framework FRAME Pre-posttest design 9 Familias Fuertes Brazil(Abreu etal., 2021; Murta etal., 2018, 2020, 2021; Sanchez etal., 2024) UK (English) → Brazil (Portuguese) 1.Local needs assessment 2.Program selection 3. Understanding the curriculum 4.Advisory group 5.Initial adaptation 6. Training 7. Pilot 8.Enhanced cultural adaptation 9.Implementation 10. Evaluation 11. Dissemination SFP's cultural adaptation recommendations Cluster RCT 211Prevention Science (2025) 26:204–221 Table 1 (continued) N° Program Reported steps Reported framework Effectiveness evaluation 10 Familias Fuertes Latin American immigrant (Azziz-Baumgartner C & Wilson, 2009; Orpinas etal., 2014) USA (English) → USA (adolescents in English parents in Spanish) 3. Understanding the curriculum 4.Advisory group 5.Initial adaptation 6. Training 9. Implementation 10. Evaluation Guidelines for Balancing Program Fidelity/Adaptation N/A 11 Familias que funcionan Spain (Pérez etal., 2010) USA (English) → Spain (Spanish) 4.Advisory group (experts) 5.Initial adaptation 7.Pilot 8.Enhanced cultural adaptation 10. Evaluation N/A Longitudinal analysis at 1 and 2years 12 Familien stärken (Baldus etal., 2016; Bröning etal., 2014; Stolle etal., 2011) USA (English) → Germany (English) 4.Advisory group 6. Training 7.Pilot 10. Evaluation N/A Multi-center RCT 13 GGC (Montero-Zamora etal., 2021a, 2021b, 2022) USA (English) → Mexico (Spanish) 1.Local needs assessment 2.Program selection 4.Advisory group 5.Initial adaptation 6. Training 7.Pilot 8.Enhanced cultural adaptation 10. Evaluation ADAPT-IT Quasi-experimental pilot design 14 ITC (Baldwin etal., 2021, Lowe, 2024) USA (Tribal language) → USA (Tribal language) 1.Local needs assessment 4.Advisory group 6. Training 8.Enhanced cultural adaptation 9.Implementation 10.Evaluation Circular Model of Cultural Tailoring Quasi-experimental study 15 Jóvenes Fuertes (Castro-Olivo & Merrell, 2012) USA (English) → USA, Latino Immigrant (Spanish) 4.Advisory group 7.Pilot 8.Enhanced cultural adaptation 10. Evaluation Ecological validity model Pre-posttest design 16 KiR LGBT + community (Goldbach & Holleran Steiker, 2011) USA (English) → USA (English) 1.Local needs assessment 3.Understanding the curriculum 4.Advisory group (target population) 5.Initial adaptation 6. Training 7.Pilot 8.Enhanced cultural adaptation N/A N/A 17 KiR Pennsylvania and Ohio (Colby etal., 2013; Hecht etal., 2018) USA (English) → USA (English) 1.Local needs assessment 3. Understanding the curriculum 4.Advisory group 5.Initial adaptation 6. Training 7.Pilot 8.Enhanced cultural adaptation 9. Implementation 10. Evaluation Cultural sensitivity model RCT 18 KiR Texas (Holleran Steiker etal., 2014) USA (English) → USA (English) 1.Local needs assessment 3. Understanding the curriculum 4.Advisory group (target population) 5.Initial adaptation 6. Training 7.Pilot 8.Enhanced cultural adaptation 10. Evaluation N/A Quasi-experimental design 212 Prevention Science (2025) 26:204–221 Table 1 (continued) N° Program Reported steps Reported framework Effectiveness evaluation 19 KiR 5th grade version (Harthun etal., 2009; Hecht etal., 2008) USA (English) → USA (English) 1.Local needs assessment 3. Understanding the curriculum 4.Advisory group 5.Initial adaptation 6. Training 7.Pilot 8.Enhanced cultural adaptation 10. Evaluation CBPR Longitudinal RCT 20 LST (Velasco etal., 2015, 2017) USA (English) → Italy (Italian) 2.Program selection 4.Advisory group 5.Initial adaptation 6. Training 7.Pilot 8.Enhanced cultural adaptation 9.Implementation 10. Evaluation 11. Dissemination N/A Quasi-experimental design 21 L2W (Jumper-Reeves etal., 2013; Kulis etal., 2016) USA (English) → USA (N/A) 1.Local needs assessment 3. Understanding the curriculum 4.Advisory group 5.Initial adaptation 6. Training 7.Pilot 8.Enhanced cultural adaptation 9. Implementation 10. Evaluation CBPR RCT 22 MREAL Mexico (Kulis etal., 2021; Marsiglia etal., 2019, 2022) USA (English) → Mexico (Spanish) 1.Local needs assessment 2.Program selection 3. Understanding the curriculum 4.Advisory group 5.Initial adaptation 6. Training 7.Pilot 8.Enhanced cultural adaptation 9.Implementation 10. Evaluation Ecological validity model Cultural sensitivity model Cluster RCT 23 MREAL Spain (Cutrín etal., 2021; Cutrín etal., 2022) Mexico (Spanish) → Spain (Spanish) 1.Local needs assessment 2.Program selection 3. Understanding the curriculum 4.Advisory group 5.Initial adaptation 6. Training 7.Pilot 8.Enhanced cultural adaptation 9.Implementation 10. Evaluation N/A RCT 24 NTC (Patchell, 2011) USA (Tribal language) → USA (Tribal language) 1.Local needs assessment 2.Program selection 3. Understanding the curriculum 4.Advisory group 6. Training 8.Enhanced cultural adaptation 10. Evaluation Circular Model of Cultural Tailoring Pre-posttest design 25 PERAE (Amato etal., 2021; De Castro-Amato, 2015) Australia (English) → Brazil (Portuguese) 4.Advisory group 5.Initial adaptation 6. Training 7.Pilot 8.Enhanced cultural adaptation 10. Evaluation N/A Pilot RCT 26 Preventure (Barrett etal., 2015; Debenham etal., 2021) UK (English) → Australia (English) 1.Local needs assessment 4.Advisory group 5.Initial adaptation 8.Enhanced cultural adaptation 10. Evaluation N/A Cluster RCT 27 Project Ex (Espada etal., 2014) USA (English) → Spain (Spanish) 3. Understanding the curriculum 4.Advisory group 5.Initial adaptation 6. Training 10. Evaluation N/A RCT 219Prevention Science (2025) 26:204–221 of EBPs. Finally, thequality assessment of the studies was omitted as per JBI guidelines for scoping reviews. Future systematic reviews might prioritize high-evidence studies to assess adapted programs´ efficacy. Future research should explore the complexities of adapting and implementing EBPs for the prevention of substance use, depression, and anxiety, particularly in the context of marginalized adolescents. This focus is essential for addressing health inequities and enhancing engagement, program uptake, and health outcomes. Marginalized youth, especially those growing up in poverty, experience mental health issues at rates 2–3 times higher than the general population. (United Nations Office on Drugs and Crime, 2022). This review serves multiple purposes. Firstly, it documents the most commonly reported steps in the cultural adaptation process found in the literature. Secondly, it presents various methodological models, program adaptation techniques, assessment methods, and EBPs aimed at preventing substance use, depression, and anxiety in adolescents across different contexts, including face-to-face and web-based programs. Furthermore, it identifies gaps in knowledge, highlighting areas for further research. Conclusion This review has identified eleven common steps across various adaptation processes (local needs assessment, program selection, understanding program´s curriculum, advisory group establishment, first draft of initial adaptation changes., staff selection and training, pilot study, enhanced cultural adaptation, implementation, evaluation and monitoring and dissemination). However, there remains a need for more meticulous reporting, systematization, and detail of the adaptation process. Subsequent research efforts could benefit from the development of an adaptation model to systematically guide this process. Additionally, the findings underscore the importance of documenting the adaptation of programs for both research and practical applications. Finally, further investigation is needed into culturally adapted EBPs addressing substance use and common mental health disorders in adolescents from vulnerable communities. These insights will inform the next steps of developing a methodological framework to adapt EBPs focused on preventing common mental health disorders and substance use in adolescents living in vulnerable areas. Supplementary Information The online version contains supplementary material available at https:// doi. or g/ 10. 1007/ s1112102501779-x. Authors Contribution Claudia Corpus-Espinosa: Conceptualization, Methodology, Validation, Formal analysis, Investigation, WritingOriginal Draft, Writing-Review & Editing, Visualization. Isotta Mac Fadden: Conceptualization, Methodology, Validation, Investigation, Writing-Review & Editing, Visualization, Supervision, Project administration. María del Carmen Torrejón-Guirado: Validation, Writing-Review & Editing. Marta Lima-Serrano: Conceptualization, Methodology, Validation, Investigation, Writing-Review & Editing, Visualization, Supervision, Project administration. Funding Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. The first author acknowledges the support of the National Council of Humanities, Sciences, and Technologies (CONAHCyT) for the scholarship N° CVU 1007341. Declarations Ethics Approval Not applicable. Consent to Participate Not applicable. Conflict Of Interest The authors have no competing interests to declare. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. 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