Kulis Stephen S, Jager Justin, Marsiglia Flavio F, Campos Ana Paola, Medina-Mora Maria Elena
Global Center for Applied Health Research, Arizona State University, 411 North Central Avenue, Suite 720 (MC 4320), Phoenix, AZ 85004-0693, USA; School of Social and Family Dynamics, Arizona State University, PO Box 877203, Tempe, AZ 85287-7203, USA.
School of Social and Family Dynamics, Arizona State University, PO Box 877203, Tempe, AZ 85287-7203, USA.
Drug Alcohol Depend. 2025 Jun 1;271:112655. doi: 10.1016/j.drugalcdep.2025.112655. Epub 2025 Mar 13.
We tested effects of a culturally adapted version of the Keepin' it REAL (KiR) prevention program on longitudinal patterns of polysubstance use among Mexican adolescents.
A sample of 36 public middle schools in Mexico City, Guadalajara and Monterrey was randomized to: culturally adapted KiR, original KiR translated into Spanish, and treatment-as-usual controls. Regular teachers with training in KiR implemented curricula over 3-4 months. Seventh-grade students with parental consent completed pretests in Fall 2017 (n = 5522), and three posttests: later in 7th grade, in 8th and 9th grade. We analyzed patterns of recent use of five substances (alcohol, tobacco, inhalants, marijuana, other illicit drugs) and the efficacy of the two KiR versions using repeated measures latent class analysis (RM-LCA).
RM-LCA produced six classes: (A) non-use of substances across all time points; (B) initiating only licit substances; (C) initiating both licit and illicit substances; (D) declining use; (E) initiating inhalant and alcohol use; and (F) persisting polysubstance use. Adapted KiR students were more likely than controls to report declining substance use (class D), and less likely to initiate use (C and E). Adapted KiR students were overrepresented among those engaging in persisting polysubstance use, largely due to baseline differences. Un-adapted KiR showed no differences with controls.
Culturally adapted KiR for Mexico curbed initiation of especially harmful forms of illicit drug use, and prompted declines among those already engaging in use. Lack of evidence of efficacy of the un-adapted version of KiR suggests the need for cultural adaptation of efficacious interventions for new target populations.
我们测试了经过文化调适的“保持真实”（KiR）预防项目对墨西哥青少年多种物质使用纵向模式的影响。
从墨西哥城、瓜达拉哈拉和蒙特雷的36所公立中学抽取样本，随机分为：经过文化调适的KiR组、翻译成西班牙语的原始KiR组和常规治疗对照组。接受过KiR培训的普通教师在3 - 4个月内实施课程。获得家长同意的七年级学生于2017年秋季完成了预测试（n = 5522），并进行了三次后测试：七年级后期、八年级和九年级。我们使用重复测量潜在类别分析（RM-LCA）分析了五种物质（酒精、烟草、吸入剂、大麻、其他非法药物）的近期使用模式以及两个KiR版本的效果。
RM-LCA产生了六种类别：（A）在所有时间点都不使用物质；（B）仅开始使用合法物质；（C）开始使用合法和非法物质；（D）物质使用减少；（E）开始使用吸入剂和酒精；（F）持续使用多种物质。与对照组相比，接受调适版KiR的学生更有可能报告物质使用减少（D类），且开始使用物质的可能性较小（C类和E类）。在持续使用多种物质的学生中，接受调适版KiR的学生比例过高，这主要是由于基线差异。未调适版KiR与对照组没有差异。
针对墨西哥进行文化调适的KiR抑制了特别有害形式的非法药物使用的开始，并促使已经在使用药物的人减少使用。未调适版KiR缺乏有效性证据表明，针对新目标人群的有效干预措施需要进行文化调适。
