Decision-making skills as a mediator of the #Tamojunto school-based prevention program: Indirect effects for drug use and school violence of a cluster-randomized trial

The Indirect Effect of #Tamojunto2.0 Program on Bullying Through Reduction of Alcohol Use Initiation

PURPOSE

The Brazilian version of the prevention program Unplugged, #Tamojunto, has had a positive effect on bullying prevention. However, the curriculum has recently been revised, owing to its negative effects on alcohol outcomes. This study evaluated the effect of the new version, #Tamojunto2.0, on bullying. For adolescents exposed to the school-based program #Tamojunto2.0, we investigated (1) whether the prevalence of bullying victimization and perpetration was reduced, (2) whether this reduction was moderated by gender, and (3) whether the program's effect on bullying was mediated by adolescents' alcohol use.

METHODS

A cluster randomized controlled trial was conducted using 5,208 eighth-grade students from 73 Brazilian public schools. Baseline data were collected before program implementation, and follow-up data were collected nine months later. We used a multilevel mixed-effects model to examine the effect of #Tamojunto2.0 on bullying, and a moderation model to test the moderating effect of gender on program outcomes. A mediation analysis was performed to determine lifetime alcohol use as a mediator of the intervention effect on bullying.

RESULTS

We found that the positive effect of #Tamojunto2.0 on bullying victimization (β = -0.019, 95% confidence interval = -0.035; -0.002) and perpetration (β = -0.027, 95% confidence interval = -0.051; -0.004) was mediated by a decrease in alcohol use, but not moderated by gender.

DISCUSSION

#Tamojunto2.0 program can be indirectly effective in the prevention of bullying by decreasing adolescents' alcohol use. Moreover, alcohol and drug use prevention programs might also affect bullying outcomes through mediation, and we suggest that future studies consider this.

Changes in alcohol beliefs mediate the effects of a school-based prevention program on alcohol use among Brazilian adolescents

OBJECTIVE

To investigate the mechanisms of the #Tamojunto2.0 program that mediated the prevention of lifetime alcohol and drug use, including drug knowledge, behavioral beliefs, attitudes, decision-making skills, and refusal skills.

METHODS

A cluster-randomized controlled trial was conducted in 73 public middle schools in three Brazilian cities. The sample included 5208 students (49.4 % girls; M_age = 13.2 years). The intervention group attended twelve #Tamojunto2.0 lessons conducted by their previously trained teachers. The control group did not receive any intervention. Data were collected pre-intervention and at the 9-months follow-up. We performed multiple mediation models (for the whole sample, users, and non-users) with a post-estimation adjustment to standard errors to account for nesting. We analyzed all available mediators simultaneously according to each drug: alcohol, binge drinking, tobacco, marijuana, and inhalant lifetime use. To handle missing data, we used the "full-information maximum-likelihood" paradigm.

RESULTS

Outcomes in the whole sample and among non-users showed that #Tamojunto2.0 indirectly prevented lifetime alcohol use and binge drinking by increasing negative and non-positive alcohol beliefs. Only the direct effect on decreasing lifetime alcohol consumption was statistically significant. However, an indirect increase in binge drinking was observed through knowledge about alcohol, but the direct effect was not statistically significant. No effects were reported for marijuana, tobacco, or inhalants. Among users, no statistically significant effects were found for alcohol or drug use.

CONCLUSIONS

The results suggest that the #Tamojunto2.0 program was only effective in delaying alcohol consumption via increasing negative and non-positive alcohol beliefs. It seems that mediating mechanisms vary depending on contextual characteristics, differences in socializing among adolescents, features of the educational systems, psychosocial conditions, or, fidelity issues of program implementation.

Short-Term Secondary Effects of a School-Based Drug Prevention Program: Cluster-Randomized Controlled Trial of the Brazilian Version of DARE's Keepin' it REAL

This study aimed to evaluate the effectiveness of the drug and violence resistance educational program (PROERD) on short-term secondary outcomes, such as intentions to use drugs, attitudes toward drugs, school experience, and life skills (refusal, decision-making, and communication). Two cluster-randomized controlled trials were conducted in 30 public schools in the city of São Paulo (Brazil) with 4030 students (1727 fifth and 2303 seventh graders). The intervention group attended 10 PROERD classes conducted by trained police officers, whereas the control group received no intervention. PROERD is a Brazilian adaptation of the North American Drug Abuse Resistance Education (DARE) program Keepin' it REAL. Data were collected at two time points: pre-intervention and at 9-month follow-up. Two different paradigms were used in the multilevel analysis, complete case (CC), and intention-to-treat (ITT) analyses, using full information maximum likelihood (FIML). We found mixed results. Although the seventh-year curriculum seems to have positive effects on school experience (coef = 0.093; 95% CI: 0.001, -0.185), it also increases the intention to use cigarettes in the future (OR = 1.93, 95% CI: 1.109, 3.379) and the chances of accepting marijuana (OR = 1.62, 95% CI: 1.03, 2.53), and it appears to slightly reduce decision-making skills among fifth graders (coef = -0.078; 95% CI: -0.131, -0.025). Our results suggest that PROERD implementation and cultural adaptation should be reevaluated to understand why the program does not achieve the expected preventive goals and produces potential iatrogenic effects.