A randomized controlled trial was conducted in 2014 with 7th and 8th grade students from 72 public schools in 6 Brazilian cities. This trial aimed to evaluate the effects of an adapted European school-based drug prevention program Unplugged, called #Tamojunto in Brazil, which was implemented by the Ministry of Health as part of public policy. The experimental group (n = 3340) attended 12 classes in the #Tamojunto program, and the control group (n = 3318) did not receive a school prevention program. Baseline data were collected prior to program implementation, and follow-up data were collected 9 months later, allowing a matching of 4213 adolescents in both waves. The substances examined were alcohol, tobacco, marijuana, inhalants, cocaine, and crack. Multilevel analyses were used to evaluate the changes in consumption of each drug between time points and between groups. The intervention and control groups had similar baseline characteristics. The mean age of the adolescents was 12.5 ± 0.7 years, and 51.3% were female. The program seemed to increase alcohol use initiation (first alcohol use); students in the experimental group had a 30% increased risk of initiating alcohol use during the 9-month follow-up (aRR = 1.30, 95% confidence interval (95%CI) 1.13-1.49, p < 0.001) compared to the control group. The opposite was found for the first inhalant use: the risk of using inhalants for the first time after baseline was lower in the experimental group (aRR = 0.78, 95%CI 0.63-0.96, p = 0.021) than the control group. The results of the #Tamojunto program suggest that the content and lessons regarding alcohol may enhance curiosity about its use among adolescents. We suggest a re-evaluation of the expansion of the #Tamojunto program in schools while analyzing why the program's effects were inconsistent with those of previous European studies.

OBJECTIVE:Alcohol and other drug use appears to reduce decision-making ability and increase the risk of unsafe sex, leading to possible unplanned pregnancies, sexually transmitted diseases/human immunodeficiency virus/HIV transmission, and multiple sexual partners. This study aimed to test the hypothesis that risky sexual behaviors among adolescents are associated with legal and illegal drug use.METHODS:A national cross-sectional survey of 17,371 high-school students was conducted in 2010. Students were selected from 789 public and private schools in each of the 27 Brazilian state capitals by a multistage probabilistic sampling method and answered a self-report questionnaire. Weighted data were analyzed through basic contingency tables and logistic regressions testing for differences in condom use among adolescents who were sexually active during the past month.RESULTS:Approximately one third of the high school students had engaged in sexual intercourse in the month prior to the survey, and nearly half of these respondents had not used a condom. While overall sexual intercourse was more prevalent among boys, unsafe sexual intercourse was more prevalent among girls. Furthermore, a lower socioeconomic status was directly associated with non-condom use, while binge drinking and illegal drug use were independently associated with unsafe sexual intercourse.CONCLUSION:Adolescent alcohol and drug use were associated with unsafe sexual practices. School prevention programs must include drug use and sexuality topics simultaneously because both risk-taking behaviors occur simultaneously.

BackgroundMost Brazilian schools do not have a continuous program for drug use prevention. To address this gap, the Ministry of Health adapted the European evidence-based program Unplugged to improve the drug use prevention efforts of Brazilian public schools. The aim of this study was to evaluate the process of program implementation in three Brazilian cities among middle school students between 6th and 9th grade (11 to 14 years old).MethodsMixed methods were used in this process evaluation study, including focus groups, fidelity forms, and satisfaction questionnaires. Study participants included 36 teachers, 11 school administrators, 6 coaches, 16 stakeholders, and 1267 students from 62 classes in 8 schools.ResultsThe 12 Unplugged lessons were all implemented in 94 % of the classes. However, only 57 % of the classes were completed as described in the program's manual. The decision to exclude activities because of time constraints was made without a common rationale. Teachers reported difficulties due to the amount of time necessary to plan the lessons and implement the activities. In addition, they mentioned that the lack of support from school administrators was an obstacle to proper program implementation. The majority of students and teachers responded positively to the program, reporting changes in the classroom environment and in personal skills or knowledge.ConclusionsThe Unplugged program can be feasibly implemented in Brazilian public schools. However, it is necessary to reduce the number of activities per class and to restructure the format of the standard teaching schedule to ensure that the normal academic content is still taught while Unplugged is being implemented.

The low efficacy of crack cocaine addiction treatment available in Brazil has led Brazilian users to find alternatives to reduce drug consumption or even to reach abstinence. One of them is the use of entheogenic substances, like ayahuasca, an infusion obtained from two native plant species from the Amazon. The present report aimed to understand how crack cocaine users recover from drug addiction by consuming ayahuasca tea in a religious context. This is a qualitative study with a purposeful sample of 40 crack cocaine users, based on in-depth, semi-structured interviews. Participants reported that ayahuasca allowed them to access a consciousness dimension which enabled them to solve problems and traumas and reduce crack cocaine consumption. The religious ceremony increased the user's spirituality and the reception from the community gave them a sense of self-esteem, strengthening them in an emotional and social way. That positive experience has been incorporated into the daily routine of most participants. Findings indicate that ayahuasca, in a religious context, may have therapeutic value for crack cocaine dependence treatment.

Abstract:The article discusses the pilot implementation of the evidence-based preventive program Good Behavior Game (GBG) in public schools in four Brazilian cities. GBG is a method for classroom behavior management by teachers, which aims at developing sociability among elementary school students between 6 and 10 years old. The objective of this study was to evaluate the program implementation process, focusing on the acceptability and perceived results by the professionals involved. Mixed methods were used, and data analysis was conducted using triangulation, including questionnaires and semi-structured interviews with 28 teachers, 9 school administrators, and 6 coaches. Data analysis was performed through descriptive and inferential statistics and content analysis, according to the nature of data. GBG had a high acceptance among teachers and school administrators. Professionals highlighted the importance of stimulating teamwork, the systematic use of rewards, and the objectivity of classroom rules. Acceptability was attributed, in large part, to the effectiveness of the strategy for classroom management. Nevertheless, this study highlighted the need of adaptations to better reflect the Brazilian societal and economic context. Keywords: Prevention, Process Evaluation, Children, Drug Abuse. Avaliação da implementação em escolas brasileiras de um programa preventivo para criançasResumo: O artigo discute a implementação piloto do programa preventivo baseado em evidência Good Behavior Game (GBG) em escolas públicas de quatro cidades brasileiras. O GBG é considerado um método para o professor de manejo de comportamentos em sala de aula, visando a construção de sociabilidade entre os estudantes, direcionado para turmas do ensino fundamental, com crianças entre seis e 10 anos. O objetivo deste estudo foi a avaliação do processo de implementação com foco na aceitabilidade e percepção de resultados pelos profissionais envolvidos. Foram utilizados métodos mistos na investigação e triangulação de dados na análise, com base na aplicação de questionários e entrevistas semiestruturadas com 28 professores, nove diretores e seis multiplicadoras do programa. Os dados foram analisados através de estatística descritiva e inferencial ou análise de conteúdo, conforme a natureza do dado. O GBG obteve uma alta aceitação entre professores e diretores. Destacou-se a importância do estímulo ao trabalho em grupo, o uso de elogios como reforçadores, a objetividade das regras assumidas coletivamente. A aceitabilidade foi atribuída, em boa parte, à eficácia de sua estratégia de manejo de sala de aula. Houve indicações da necessidade de adaptações que reflitam o contexto social e econômico brasileiro. Palavras-chaves: Prevenção, Avaliação de Programa, Avaliação de Processo, Criança, Abuso de Drogas. 509Schneider D. R.; Pereira A. P. D.; Cruz J. I.; Strelow M.; Chan G.; Kurki A.; Sanchez Z. M. (2016).Evaluation of a Preventive Program for Children.

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Background: Although available treatments may reduce the severity of crack cocaine use-related problems, a significant percentage of users resume drug abuse within a relatively short time after treatment. This relapse process is the return to the condition of pre-treatment drug consumption conditions. Crack cocaine users appear to be particularly prone to this dynamic, making relapse one of the biggest challenges for treating crack cocaine dependents. However, in the midst of this disheartening setting regarding the high relapse potential, a negligible part of the population of users remains in abstinence, not following this pattern of relapse, although they belong to contexts similar to relapsing users. This study aimed to identify the main characteristics of crack cocaine users, which protect them from relapse in the first six months after treatment. Methods: This is a study with 700 participants recruited through treatment institutions. Initially, data were analyzed descriptively and the existence of associations was verified by Chi-Square test or Fisher’s exact test. The Student t-test for independent samples was employed to compare the means between two groups. Logistic regressions were used to simultaneously evaluate the effects of demographic characteristics, history of use of crack cocaine on the occurrence of non-relapse. Results: The results of this work returned the following crack cocaine user’s main protective factors for relapse: being single but with a steady partner, or being separated or divorced, Catholic, not living in the streets or “Cracolândia”, not developing binge, withdrawal, dependence, abstinence (more than ten days) and drug late onset. Conclusion: Among these factors, not being abstinent is a protective factor for relapse that deserves attention, considering that the conventional treatment options available in Brazil consider abstinence as the only possible outcome.

The Elos Program resulted from a Brazilian cultural adaptation of the Good Behavior Game, a preventive strategy for classroom management to reduce aggressive and disruptive behaviors. The goal is to discuss the Elos Program’s efficacy during its implementation in 16 elementary Brazilian public schools in two cities in 2016. The design was a non-randomized controlled trial with 80 classes in each group, experimental and control, involving 1,731 students. The study used the Generalized Estimating Equation model to verify the program's effect. Elos seemed to be effective in reducing aggressiveness and disruptive behavior in boys. These results are aligned with others GBG international studies and suggest that, after a randomized trial, the program would be ready to be disseminated in Brazil.