The Long and Short Term Effects On Substance Use Behaviors of Keepin' It REAL Adapted for Mexico

Background and Purpose: Despite high rates of alcohol use in Mexico, only 43% of young adults report having ever been exposed to a substance use prevention program, and to our knowledge, very few substance use prevention program has been developed for and empirically tested specifically for Mexican youth.  In response, a linguistically adapted version of keepin’ it REAL, a SAMHSA model program, was pilot tested in Guadalajara, Mexico. keepin’ it REAL teaches youth culturally grounded drug resistance strategies (Refuse-Explain-Avoid-Leave), enabling them to successfully respond to substance offers in the US.  This paper examines changes in substance use following the implementation of keepin’ it REAL in Mexico.

Methods:  Students in two middle schools in Guadalajara, Mexico were recruited and randomized into a treatment (N=226) and control (N=206) condition (e.g. those receiving keepin’ it REAL compared to those receiving no substance use prevention programming). Students (mean age = 13) in both conditions completed a pre-test prior to implementation, a short-term post-test after the last lesson was delivered, and a long-term post-test 12 months later.  Substance use measures were 30-day amount and frequency of alcohol, cigarette, and marijuana use. Baseline adjusted OLS regression models predicted short-term outcomes, while growth curve models with missing data imputation examined program effects on trajectories of substance use.

Results: OLS regressions showed significant relative reductions in use of alcohol and cigarettes for youth participating in keepin’ it REAL compared to youth in the control group. Growth curve models indicated that over time the effects of keepin’ it REAL are gendered. Females in the treatment group drank alcohol significantly less frequently over time compared to females in the control school. Males in the treatment group, however, showed a relative reduction over time in the amount of marijuana used.

Conclusions: This pilot study provides support for the global applicability of efficacious substance use prevention programs originally developed in one country, but also the importance of assessing for cultural fit and adapting the programs to achieve maximum efficacy. The results indicate that keepin’ it REAL can be an effective tool in teaching drug resistance strategies and reducing substance use among adolescents in a major urban area in Mexico.  The findings also point to the possible impact of gendered cultural norms on the efficacy of prevention interventions in Mexico, and the need for these interventions to recognize gender differences in substance use patterns and their etiology. Although a more extensive cultural adaptation of keepin’ it REAL may be needed in Mexico to capture both male and female adolescents’ perspectives and reinforce cultural sources of resilience against substance use, the core components of keepin’ it REAL provides a promising foundation for creating an evidence-based substance use prevention curriculum for adolescents living in Mexico.