Program reduces alcohol consumption by 20% among adolescents

Brazilian researchers are adapting methodology developed in Australia for use in schools.

By Karina Toledo

Agência FAPESP – Australian researchers have managed to reduce alcohol consumption among adolescents through a program that seeks to raise awareness among youth in a fun manner that is attuned to their perceptions about the risks associated with excessive drinking. Universidade Federal de São Paulo (Unifesp) researchers are adapting this methodology for use in Brazilian schools.

According to Ana Regina Noto, coordinator of the Health and Substance Abuse Center (Nepsis) at Unifesp’s Psychobiology Department, the idea of developing the Brazilian version of the School Health and Alcohol Harm Reduction Project (SHAHRP), which was successfully implemented in Australia, emerged after the conclusion of a 2010 study conducted by her group, which revealed alarming rates of alcohol consumption among 8th and 9th grade students.

According to the study, 40% of the 5,226 students interviewed at private São Paulo schools had consumed alcohol in the month prior to the survey, and 33% of these students had consumed amounts considered to represent harmful ‘binge drinking’ – four or more units of alcohol for women and five or more for men in a single session.

“What’s different about this project is the fact that it is betting on the adolescent’s ability to make safer choices when encouraged to do so. The program encourages students to reach their own conclusions instead of simply attempting to say “no” as a pre-established option. Perhaps for this reason, SHAHRP has shown better results when compared to many other programs of its type,” said Noto.

Based on the scientific evidence, added Noto, the program operates from the premise that alcohol use among adolescents occurs, often with the permission of their families, although the sale of beverages to people younger than 18 is prohibited. “For this reason, we create a space for conversation about these situations,” he said.

“Previous research shows that approaches based simply on convincing youths not to drink were flawed. Many times, they even had a negative impact, causing an increase in consumption instead of a reduction. We decided to try something different,” explained Nyanda McBride a researcher at Australia’s National Drug Research Institute and one of the proponents of SHAHRP.

Before developing the methodology, McBride interviewed professors and specialists in prevention and spoke with students. The objective was to discover where, how and with whom they normally consumed alcohol as well as the risk situations to which they were exposed.

“If you tell us not to drink, we will simply tune out because that is what we have been accustomed to hearing all our lives, the youths told us,” said the Australian researcher.

McBride then developed a two-phase intervention strategy to be applied in schools. In the first phase, focused on students aged 12 and 13 who are just beginning to have contact with alcohol, eight one-hour sessions were held. The second phase, applied a year later, had four one-hour sessions.

In addition to passing on information, the mission of the instructors was to help the youths through games and interactive activities to develop their own strategies to reduce the risks associated with alcohol consumption. The methodology was applied in a group of approximately 2,500 students, half of whom were part of the control group and were submitted to a regular drug prevention program.

The youths were then monitored for 32 months and were evaluated for their knowledge and attitudes regarding alcohol, the total quantity of alcohol consumed, and consumption standards as well as the adverse consequences they faced.

The total alcohol consumption in the group that received the intervention was 20% lower than in to the control group. Furthermore, the rate of binge drinking in this group was 19.5% lower, and the youths had 10% more knowledge about alcohol and experienced 33% fewer adverse consequences related to sexual issues, violence and problems with the law, family or school.

“We continued measuring for one year after the end of the program, and we observed that the behavioral impact persisted. The methodology was replicated in schools in Northern Ireland with similar results. One of the keys is the inclusion of real experiences from participants. Our objective is to make these experiences more secure,” explained McBride.

Process of adaptation

SHAHRP is being adapted to the Brazilian culture in conjunction with FAPESP fellow and doctoral student Tatiana de Castro Amato’s dissertation project under the guidance of Noto.

“We have been conducting interviews with adolescents since 2012 and also with professors and pedagogic coordinators to understand the perceptions they have about alcohol consumption and the associated problems as well as to attempt to define the ideal class load and identify the best teacher for classroom activities,” explained Noto.

The first Brazilian version of the program was split into eight one-hour sessions and is being tested as a pilot program in four private schools, three of which are located in the capital city. An additional four schools are participating as control groups.

“The first session offers information but with an invitation for reflection. Half of the following program is presented as risk situations, and adolescents have to develop strategies to deal with problems,” explained Noto.

The age range of 12 to 13 was chosen because Brazilian epidemiological studies indicate that the first contact with alcohol occurs within this age range. “Consumption in this range is still low, but there is a natural tendency to increase as they age. We hope that the group that receives the interventions will have lower consumption within 6 to 12 months compared to the control group,” said Noto. According to the researcher, private schools were initially selected because according to scientific evidence, the greater the buying power is, the greater the alcohol consumption.

“The program has been well received by students, and some schools are already thinking about incorporating it into their curricula. We also have invitations to adapt it for public schools in Minas Gerais and, in the future, to attempt to introduce it in São Paulo for youths in other contexts,” he explained.