The #Tamojunto Drug Prevention Program in Brazilian Schools: a Randomized Controlled Trial

Abstract

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.

Belief patterns and drug use in a sample of Brazilian youth: an exploratory latent class analysis

“…Our survey weighting took the wide variation in sample sizes (São Paulo had the largest sample and Tubarão the smallest) into account. 15 The cities were chosen by the Brazilian Ministry of Health based on previous political pacts with the state and municipal secretary of health: São Paulo and São Bernardo do Campo are located in the state of São Paulo (southeast region); Florianópolis and Tubarão are in the state of Santa Catarina (southern region); Fortaleza is in the state of Ceará (northeast region); and Brasília is in the state of Goiânia (midwest region). Considering that our sample was not calculated to be representative of each city, a stratified analysis at this level would not be adequate.…”

“…Because evidence suggests that initiation of substance use can begin as early as 12-14 years of age in Brazilian youth, the target population for this program was children in the seventh and eighth grades. 12,15 Based on results from a previously conducted pilot study and on school absence data, we chose to increase the sample size by 50% over conservative estimates (knowing that between 20-25% of enrolled students will not be present on the day the survey is applied) to account for expected data loss and significant intra-class correlation. Thus, final sample size calculations suggested a total of 4,253 subjects in each arm.…”

“…7,8 This disproportionate focus on wealthy European and North American countries is particularly relevant, given that many lower-income countries experience a significant, if not greater, burden of disease from substance use than wealthier countries. 9 Brazil, an upper-middle-income country, experiences a high prevalence of youth substance use, alcohol use in particular, with nearly 60.3% of [13][14][15] year old and 27.9% of 10-12 year old public school students reporting lifetime alcohol consumption. Additionally, roughly 40.3% of the older age group and 14.1% of the younger reported pastyear alcohol use.…”

“…The Brazilian adapted version, eventually renamed #Tamojunto in 2014, was also shown to produce marginal positive effects among seventh and eighth graders in a 2013 quasi-randomized study. 14,15 This paper utilizes data from the baseline survey responses collected during the 2014 six-city randomized controlled trial, prior to randomization and program implementation.…”

Mental health conditions among adolescents of substance dependent parents

“…[24][25][26] To use for problem solving or management purposes, these techniques mainly focus on interpersonal skills, such as, drug refusal skills, sticking to anti-drug norms, general social skills, by enhancing personal self-management skills, social, emotional, behavioral, cognitive and more competencies, building self-efficacy, involving adolescents as leadership role and improving social relationships. [24][25][26] However, effectiveness of these methods in relation to the social and cultural context, we need evidence based information. Unfortunately in our context, the foci of empirical studies with substance dependency are not on understanding these vulnerable children's psychological problems, which in fact were always keeping us away from the fact-based knowledge on their (young people) contemporary and future conditions and probable effective management.…”