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

 描述(由申请者提供)：墨西哥年轻人的物质使用率急剧上升是一个主要问题，无论是在墨西哥还是美国。尽管墨西哥政府已将预防药物滥用提升为国家优先事项，但很少有以学校为基础的全民预防计划可供选择，这些计划有文化基础，经过经验检验，并被证明有效。这项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(KIR)预防干预措施来解决这一差距。KIR是美国国家有效计划和实践登记处针对中学生的示范计划，在减少美国多种族和墨西哥裔美国人大样本中的物质使用方面被证明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方面的专门知识，并建立在墨西哥各地一系列可行性研究的基础上，这些研究表明KIR的核心要素在墨西哥是适用的。然而，证据也表明，需要进一步的适应，以增强干预的文化契合度。在拟议研究的第一阶段，三所学校的学生和教师实施者--每个城市一所--将提供关于原始课程的反馈，并根据文化和背景确定 相关的场景和例子。两国研究团队-包括最初的KIR课程设计师-将合作确保墨西哥的文化适用性和对KIR核心元素的忠诚度。在第二阶段，与原始版本的KIR和对照条件相比，经过文化适应的墨西哥版本KIR的疗效将通过随机对照试验进行内部治疗分析，对象为27所中学的4,050名7年级学生，每所城市9名。这项研究将调查并将墨西哥背景下可能影响青少年使用药物风险及其对预防计划的反应性的特定性别提供毒品的经验和适当的耐药性战略纳入课程。鉴于墨西哥不断上升的暴力，这项研究的第二个目的是调查年轻人实施、受害和目击暴力的行为如何可能削弱墨西哥KIR的疗效。这项研究将为美墨边境两侧的墨西哥传统青年创造与有效预防方法相关的知识。通过了解受文化影响的性别角色规范如何影响物质使用的提供、态度和行为，以及普遍预防计划的成功，将促进预防科学的发展。此外，这项研究将增加关于如何进行协作性、跨国家、转化性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.