'keepin' It REAL in Mexico: An Adaptation and Multisite RCT

 描述（由申请人提供）：墨西哥青年中药物使用率的急剧增加是墨西哥和美国的一个主要问题。虽然墨西哥政府已将预防药物滥用提升为国家优先事项，但很少有基于学校的普遍预防方案可供选择，这些方案具有文化基础，经过经验检验，并证明是有效的。本研究旨在通过在墨西哥三个最大的城市：墨西哥城、瓜达拉哈拉和蒙特雷调整、实施和测试“保持真实的（kiR）预防干预措施来解决这一差距。kiR是美国国家有效方案和实践登记处的中学生示范方案，在美国大量多种族和墨西哥裔美国人样本中，证明在减少物质使用方面是有效和具有成本效益的。拟议的研究将利用两国研究小组在开发和调整kiR方面的专业知识，并建立在墨西哥各地的一系列可行性研究的基础上，这些研究表明kiR的核心要素适用于墨西哥。然而，证据也表明，需要进一步调整，以提高干预的文化适应。在拟议的研究的第一阶段，三所学校的学生和教师实施者-每个城市一所-将提供有关原始课程的反馈，并在文化和背景上进行识别 相关场景和例子。两国研究团队-包括原始kiR课程设计者-将合作，以确保在墨西哥的文化适用性和保真度kiR的核心要素。在第2阶段，将通过随机对照试验中的意向治疗分析来测试文化适应的墨西哥版kiR相对于原始版本kiR和对照条件的疗效，该试验涉及27所中学的4，050名7年级学生，每个城市9名。这项研究将调查并将在墨西哥背景下与毒品供应和适当的耐药战略有关的性别具体经验纳入课程，这可能会影响青年人使用药物的风险及其对预防方案的反应。鉴于墨西哥的暴力事件不断增加，这项研究的第二个目的是调查青少年的犯罪，受害和目睹暴力如何可能缓和kiR在墨西哥的功效。这项研究将为美墨边境两侧的墨西哥裔青年创造与有效预防方法相关的知识。预防科学将通过了解文化影响的性别角色规范如何影响物质使用提供，态度和行为，以及普遍预防计划的成功来推进。此外，该研究将增加关于如何执行合作，跨国，转化预防干预研究的知识。

 DESCRIPTION (provided by applicant): Sharp increases in substance use rates among youth in Mexico are a major concern, both in Mexico and the US. Although the Mexican government has elevated substance abuse prevention as a national priority, there are few school-based universal prevention programs to choose from that are culturally grounded, empirically tested, and shown to be efficacious. This study aims to address this gap by adapting, implementing, and testing the keepin' it REAL (kiR) prevention intervention in Mexico's three largest cities: Mexico City, Guadalajara, and Monterrey. kiR is a model program for middle school students on the US National Registry of Effective Programs and Practices, shown to be efficacious and cost-effective in reducing substance use among large multi-ethnic and Mexican American samples in the US. The proposed study will leverage the bi-national research team's expertise in developing and adapting kiR and build upon a series of feasibility studies across Mexico which showed that kiR's core elements are applicable there. However, evidence also suggested that further adaptation is needed to enhance the intervention's cultural fit. During the proposed study's Phase 1, students and teacher-implementers in three schools-one from each of the cities-will provide feedback about the original curriculum and identify culturally and contextually relevant scenarios and examples. The bi-national research team-including original kiR curriculum designers-will collaborate to ensure cultural applicability in Mexico and fidelity to core elements of kiR. In Phase 2, the efficacy of the culturally adapted Mexican version of kiR, relative to the original version of kiR and to a control condition, will be tested through an inten-to-treat analysis in a randomized controlled trial with 4,050 7th grade students in 27 middle schools, 9 from each city. The study will investigate and incorporate into the curriculum gender specific experiences with drug offers and appropriate drug resistance strategies in the Mexican context that may impact the youths' risk of substance use and their responsiveness to prevention programs. In light of rising violence in Mexico, a secondary aim of the study is to investigate how youths' perpetration, victimization, and witnessing of violence may moderate the efficacy of kiR in Mexico. The study will create knowledge relevant to efficacious prevention approaches for Mexican-heritage youth on both sides of the US-Mexico border. Prevention science will be advanced by understanding how culturally influenced gender role norms affect substance use offers, attitudes, and behaviors, as well as the success of universal prevention programs. In addition, the study will add to knowledge on how to execute collaborative, cross-national, translational prevention intervention research.