Preventing Youth Substance Use and Dependency: The Long-Term Effects of Keepin It REAL in Guadalajara, Mexico

Despite high rates of substance use in Mexico, only 43% of young adults report receiving a substance use prevention program. In response, keepin’it REAL (Manténte REAL), a substance prevention program developed in the US for Mexican American youth, was implemented in central Mexico by a bi-national team of investigators. Two middle schools in Guadalajara, Mexico, were randomized into a treatment (N=226) and control (N=206) condition. Students completed a pre-test prior to implementation, a short-term post-test after the last lesson, and a long-term post-test 12 months later.  Substance use measures were 30-day amount and frequency of alcohol, cigarette, and marijuana use. Baseline adjusted OLS regression models predicted short-term outcomes, while growth curve models with missing data imputation examined program effects on trajectories of substance use. OLS regressions showed significant relative reductions in use of alcohol and cigarettes for youth participating in keepin’ it REAL compared to youth in the control group. Growth curve models indicated that over time the effects of keepin’ it REAL are gendered. Females in the treatment group drank alcohol significantly less frequently over time. Males in the treatment group, however, showed a relative reduction over time in the amount of marijuana used. This pilot study provides support for the global applicability of efficacious substance use prevention programs originally developed in one country, but also the importance of assessing for cultural fit and adapting the programs to achieve maximum efficacy. The results indicate that keepin’ it REAL can be an effective tool in teaching drug resistance strategies and reducing substance use and dependency among adolescents in a major urban area in Mexico.