Long-Term Effects of Mantente Real (keepin’ it REAL) on Substance Use By Mexican Middle School Students

Background & Purpose: Adolescent substance use rates are increasing sharply in Mexico, yet few evidence-based universal prevention programs are offered in schools. A bi-national team of researchers from four universities sought to address this gap by culturally adapting the keepin’ it REAL (kiR) prevention intervention, and testing it in a randomized controlled trial in Mexico’s largest cities. KiR is an efficacious and cost-effective curriculum for middle school students shown to prevent substance use in several countries. A multiphase adaptation process expanded kiR’s core prevention elements —training in drug resistance, risk assessment, and communication skills—to address the gendered connection between violence and substance use in Mexico. This presentation focuses on tests of the long-term intervention effects of kiR among students with prior involvement in substance use.

Methods: Local research teams in Mexico City, Guadalajara, and Monterrey recruited a stratified probability sample of 36 middle schools, 12 in each city. We randomized schools to three conditions: Culturally adapted kiR (kiR-A), Original kiR translated into Spanish (kiR-O), and a Control condition with treatment as usual. Regular teachers were trained to implement the curricula over a 3-4 month period. All 7^th grade students with parental consent completed pretests in Fall 2017 (n=5,524), and three subsequent posttests: later in 7^th grade (T2), in 8^th (T3) and 9^th grade (T4). The relative effectiveness of kiR-A versus both kiR-O and Control was analyzed through auto-regressive path models in Mplus using FIML estimation to adjust for attrition and accounting for school and city-level random effects.

Results: kiR-A students who had used alcohol at baseline reported significantly lower odds of using alcohol over time compared to the Control students (T2: OR=.65, p=.003; T4: OR= .65, p=.019) and kiR-O students (T2: OR=.70, p=.074; T4: OR=0.64, p=.004). Short-term effects were also seen among users at baseline in the odds of using cigarettes between kiR-A students and Control students (T2: OR=0.54, p=.03). There were no significant differences between Control and kiR-O students in the odds of using alcohol or cigarettes over time.

Conclusions & Implications: For students with prior involvement in substance use, having a culturally adapted curriculum is efficacious for preventing subsequent alcohol use over time, the most commonly used substance in Mexico. The efficacious of a culturally adapted curriculum is above and beyond that of a linguistically adapted curriculum. For more at-risk adolescents, simply translating an efficacious prevention intervention from English into Spanish, may not enough to prevent and reduce substance use in contexts outside the United States.