Drug Prevention for Adolescents in Violent Urban Settings: Implementation and Evaluation of Keepin' It Real in a Northern Mexican Border City

Background & Purpose: Cities provide a unique educational, cultural, and economic context for adolescents to develop socially and psychologically. However, cities may also have a negative impact on their mental health and well-being, particularly when youth are exposed to settings with high levels of drug-trafficking related violence, substance abuse, and pervasive poverty. Northern border states in Mexico have been at the national and international center of attention due to the violence related to organized crime and drug trafficking, and this region is often characterized as a permissive area for the use of alcohol and drugs. The northern border state of Sonora, Mexico reports a larger prevalence of alcohol use among adolescents (12-17 years) than the country as a whole, however information about the efficacy of substance use prevention programs at the state and municipality level is scarce. This study reports on the findings of a pilot study to explore the efficacy of keepin’ it REAL in an U.S.-Mexico border city of Nogales, Mexico. KiR is a prevention program for middle school students shown to be efficacious and cost-effective in reducing substance use in the USA.

Methods: For this pilot study, four middle schools in Nogales, Sonora, Mexico were invited to participate. Two schools were randomized into the intervention group (e.g., receiving kiR) and two schools served as the control group (e.g., treatment as usual). In total, 47 classrooms participated in the pilot study - 21 in the control group and 26 in the intervention group. All students (M_age = 11.9 years old) with parental consent completed pretest and posttest questionnaires during the 2017-2018 school year (n=1,418 at pretest). The relative effectiveness of kiR versus the control group was analyzed through baseline adjusted regression models in Mplus using FIML estimation to adjust for attrition (14.5%) and accounting for school-level random effects.

Results: In general, reductions in substance use were see among the students who were most at-risk for substance use at pretest. Among those studes most at-risk, youth receiving kiR reported relatively larger decreases in the frequency of recent alcohol, marijuana, and hard drug use when compared to youth in the Control group. These results were particularly salient for at-risk males. There were no significant interevntion effects for cigarette or inhalant use.

Conclusions & Implications:  Findings from this pilot study in Nogales, Sonora, Mexico suggest that in conexts with high violence, substance abuse, and poverty, those who respond most favorably to substance use prevention interventions are those adolescents most at-risk. Substance use and violence have the potential to negatively impact youth psychosocial development and integration into their families and communities. The presentation provides recommendations for drug prevention interventions in violent urban settings that build on individual, family, and community strengths to promote the mental health and well-being of children. Findings can be applied to other Mexico-USA border cities as well as to other countries with similar issues.