Methodological characteristics of evaluative studies of drug prevention programs in Brazil: scoping review<sup/>

Schneider, Daniela Ribeiro; Thurow, Charlene Fernanda; Franzoloso, Tallita; Silva, Leila Gracieli da; Silva, Guilherme Gomes; Santos, Elaine Lucas dos; Domingues, Liz Paola; Anjos, Leila Pimentel dos; Lopes, Fernanda Machado; Noto, Ana Regina

doi:10.1590/1518-8345.7709.4578

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Review Article • Rev. Latino-Am. Enfermagem 33 • 2025 • https://doi.org/10.1590/1518-8345.7709.4578 linkcopy

Methodological characteristics of evaluative studies of drug prevention programs in Brazil: scoping review^*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: to map studies that have developed evaluation processes of prevention programs for the use of alcohol and other drugs in Brazil, analyzing their methodological characteristics.

Method: a scoping review guided by the Joanna Briggs Institute Manual and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. The searches were carried out in eight databases and a theses and dissertations database, screened with double-blind in Rayyan®, analyzed with a focus on the methodology of the evaluative studies and through qualitative synthesis.

Results: of the 56 publications included, the majority used an observational design, generally related to process evaluations (n = 26), followed by experimental (n = 23) and quasi-experimental (n = 8) analyses of results in terms of effectiveness and efficacy, respectively. Of the eleven actions analyzed, eight are universal prevention programs, one is selective prevention and two are a preventive strategy.

Conclusion: most of the programs evaluated are universal, aimed at adolescents, carried out in schools and focused on various drugs. It is recommended to focus on new groups, such as Indigenous populations and other risk conditions, and to develop selective programs in future government initiatives to prevent drug use in Brazil.

Descriptors:
Programs; Prevention; Review; Drug Abuse; Brazil; Public Policy

Highlights:

(1) Nine drug prevention programs with evaluation processes were found in Brazil. (2) Of the nine programs, eight are universal prevention programs and one is selective prevention. (3) Some programs have consistent evidence to support public policies. (4) PROERD has not demonstrated its effectiveness in prevention and needs to be remodeled. (5) There is a need to broaden the scope of preventive programs with evidence in Brazil.

Author, Year	Program (Original name)	Type of evaluation	Design/Participants	Target outcome assessment
Rocha, 2011 ( ¹³ )	Programa Mulheres	Result	Quasi-experimental, longitudinal Women (n* = 273)	Increased self-efficacy in women’s interpersonal relationships and reduced drug use.
Shamblen et al., 2014 ( ¹⁵ )	PROERD ^† (DARE ^‡ )	Result	Quasi-experimental, longitudinal Students, Adolescents (n* = 2995)	Harmless for effects on substance use, antisocial behavior and risk for substance use.
Horr, 2015 ( ¹⁶ )	#Tamojunto (Unplugged)	Process	Observational, Cross-sectional Students, Adolescents (n* = 353)	Positive satisfaction of the students when participating in the program, indicating good acceptability.
Peres, et al., 2015 ( ¹⁷ )	#Tamojunto (Unplugged)	Process	Observational, Cross-sectional Health professionals, teachers, program multipliers (n* = 19)	Implementation strengthened links between health and education. The program was highly acceptable to managers, coordinators, multipliers, health and education professionals and parents.
Sanchez, et al., 2016 ( ¹⁸ )	#Tamojunto (Unplugged)	Result	Quasi-Experimental (RCT ^§ ), Longitudinal Students, Adolescents (n* = 2459)	Decrease in recent marijuana use among students aged 13 to 15. There was no evidence of an effect on students aged 11 to 12.
Medeiros, et al., 2016 ( ¹⁹ )	#Tamojunto (Unplugged)	Process	Observational, Longitudinal Students, teachers, multipliers and managers (n* = 84)	The implementation and monitoring rates of the lessons reached 94%. The duration of the lessons was insufficient to cover all the proposed activities. Teachers and students were satisfied with the program.
Schneider, et al., 2016 ( ⁸ )	ELOS (Good Behavior Game)	Process	Observational, Longitudinal Teachers, School Pedagogical Staff, Coaches (n* = 43)	High acceptance by teachers and principals, attributed to its classroom management strategy. There were indications of the need for adaptations to reflect the Brazilian social and economic context.
Strelow, 2016 ( ²⁰ )	ELOS (Good Behavior Game)	Process	Observational, Cross-sectional Students, Adolescents(n* = 27)	Children showed high acceptability of ELOS and expressed the perceived results of increased collaboration with peers and a desire to continue the game.
Lopes, 2016 ( ¹⁴ )	#Tamojunto (Unplugged)	Process	Observational, Longitudinal Teachers (n* = 53)	Teachers gradually became more interested in the practice of prevention and the program. There was a change in discourse, from a moralistic and stigmatizing approach to a more understanding perspective.
Medeiros, 2016 ( ²¹ )	#Tamojunto (Unplugged)	Process	Observational, Longitudinal Students, Adolescents (n* = 1336)	94% of classes were implemented, but only 57% followed the manual. Some activities were excluded, there were difficulties in planning by teachers and a lack of support from administrators. They reported improvements in the classroom environment and in personal skills.
Martins, 2016 ( ²² )	#Tamojunto (Unplugged)	Result	Correlational, Cross-sectional Students, Adolescents (n* = 5007)	Analysis of the sample’s profile to understand possible moderators of the program’s effects identified a relationship between parenting styles and drug use.
Menezes, 2016 ( ¹² )	Famílias Fortes (Strengthening Families Program)	Process	Observational, Cross-sectional Health professionals, facilitators, program multipliers (n* = 41)	The cultural adaptation was carried out well. However, the program needs to be adapted to aspects related to social inequalities and the illiteracy of the population, which implies further adaptations.
Sanchez, et al., 2017 ( ²³ )	#Tamojunto (Unplugged)	Result	Experimental (RCT ^§ ), Longitudinal Students, Adolescents (n* = 4253)	Improved outcome: delayed first use of inhalants. Outcome that worsened: first use of alcohol.
Peres, et al., 2017 ( ²⁴ )	#Tamojunto (Unplugged)	Process	Observational, Cross-sectional Health professionals, education professionals (n* = 18)	Professionals’ positive perception of joint strategies for implementing the program and strengthening the connection between health and school. There were challenges in understanding intersectorality in practice.
Conegundes, 2017 ( ²⁵ )	#Tamojunto (Unplugged)	Result	Experimental (RCT ^§ ), Longitudinal Students, Adolescents (n* = 6387)	Students who participated in the intervention group and who did not live with their mothers had an increased chance of alcohol consumption when compared to the control group.
Pedroso, 2017 ( ²⁶ )	#Tamojunto (Unplugged)	Process	Observational, Longitudinal Teachers, Facilitators, Multipliers (n* = 671)	For the sustainability and dissemination of the program as a public policy, it is recommended to invest in a paradigmatic change in the approach to drugs by the implementers, increase the use of interactive methodologies, adapt class time and expand intersectoriality.
Sanchez, et al., 2018 ( ²⁷ )	#Tamojunto (Unplugged)	Result	Experimental (RCT§), Longitudinal Students, Adolescents (n* = 5007)	Results indicate that the program delayed the use of inhalants, but worsened the first use of alcohol among students who participated in the program.
Murta, et al., 2018 ( ²⁸ )	Famílias Fortes (Strengthening Families Program SFP 10-14-UK)	Process	Observational, Longitudinal Students, Adolescents, Parents, Facilitators, Program Multipliers (n* = 33)	Program perceived as culturally relevant and partially clear. Cultural adaptations should focus on linguistic aspects of materials and procedures, taking into account cultural, economic and educational differences of families, conducted in a participatory manner.
Medeiros, et al., 2018 ( ²⁹ )	#Tamojunto (Unplugged)	Process	Observational, Cross-sectional Students, adolescents, teachers, school staff (n* = 78)	Facilities for implementation include technical support, training, supervision and support from school administrators. The difficulties involved class time, obtaining support materials and complying with the regular curriculum. As a potentiality, improvements in coexistence were highlighted.
Gusmões 2018 ( ³⁰ )	#Tamojunto (Unplugged)	Result	Experimental (RCT ^§ ), Longitudinal Students, Adolescents (n* = 6637)	It reduced bullying in the first 9 months, but the effect was not maintained after 21 months. Risk factors for bullying included previous involvement in violence and use of alcohol and inhalants, mothers with drunken episodes.
D’Tôllis, 2018 ( ³¹ )	ELOS (Good Behavior Game)	Process	Observational, Longitudinal National managers (n* = 2)	Cultural adaptation was assessed as satisfactory. The aspects of implementation planning, cultural sensitivity, fidelity to the original program and evaluation and refinement processes were well developed.
Garcia, 2018 ( ³² )	ELOS (Good Behavior Game)	Process	Observational, Longitudinal Teachers, School Staff, Facilitators (n* = 60)	The evaluation of the fidelity of implementation was positive, but the results were partially inconclusive due to a problem in the return of the fidelity forms by teachers and multipliers.
Abdala, 2018 ( ³³ )	Famílias Fortes (Strengthening Families Program)	Process	Observational, Cross-sectional Program Facilitators, Multipliers (n* = 26)	The barriers to implementation pointed out by the facilitators included inadequate working conditions, weak municipal administration, insufficient training methodologies and low professional adherence.
Sanchez, et al., 2019 ( ³⁴ )	#Tamojunto (Unplugged)	Result	Experimental (RCT ^§ ), Longitudinal Students, Adolescents (6391)	The results suggest that there is no effect of the program on normative beliefs in relation to drug use.
Murta, et al., 2020 ( ⁷ )	Famílias Fortes (Strengthening Families Program)	Result	Pre-experimental, Longitudinal Students, Adolescents, Parents and Facilitators, Program Multipliers (n* = 126)	Increase in learning self-efficacy and decrease in absence from school without parental permission. No effect on alcohol consumption, binge drinking episodes and antisocial behavior in the last month.
Abdala, et al., 2020 ( ³⁵ )	Famílias Fortes (Strengthening Families Program)	Process	Observational, Cross-sectional Facilitators, Program Multipliers (n* = 26)	The barriers presented by the facilitators were working conditions, weak municipal administration, poor infrastructure, an inadequate group, methodologies for training facilitators, low adherence from managers and a lack of funding.
Valente, et al., 2020a ( ³⁶ )	#Tamojunto (Unplugged)	Result	Experimental (RCT ^§ ), Longitudinal Students, Adolescents (n* = 6391)	Results showed a reduction in decision-making skills and an increase in drug use and violence.
Valente, et al., 2020 ( ³⁷ )	#Tamojunto (Unplugged)	Result	Experimental (RCT ^§ ), Longitudinal Students, Adolescents (n* = 6391)	No potential “reinforcement” of parental behaviors regarding drug use was identified among those who received intervention. An association between lower parental demands and greater drug use by adolescents was identified.
Menezes, et al., 2020 ( ³⁸ )	Famílias Fortes (Strengthening Families Program)	Process	Observational, Cross-sectional Facilitators, Program Multipliers (n* = 42)	Regarding fidelity, half of the facilitators reported excluding items from the procedures and 73.2% of the interviewees reported having made one or more modifications when implementing the program.
Murta, et al., 2020 ( ³⁹ )	Famílias Fortes (Strengthening Families Program SFP 10-14-UK)	Process	Observational, Longitudinal Students, Adolescents, Parents (n* = 74)	Good levels of parental fidelity and involvement and moderate levels of adolescent involvement. The intervention is relevant and the procedures acceptable, but a need for cultural adaptations was identified to facilitate understanding for families with low levels of education.
Coelho and Monteiro, 2020 ( ⁴⁰ )	Jogo da Onda Digital (Digital Wave Game)	Process	Observational, Cross-sectional Students, Adolescents (n* = 12)	Perception of improved understanding of topics related to drug use. Participants valued the interactive and playful approach of the game, which stood out in comparison to traditional educational approaches.
Valente, 2020 ( ⁴¹ )	#Tamojunto (Unplugged)	Result	Experimental (RCT ^§ ), Longitudinal Students, Adolescents (n* = 6391)	The program changes decision-making skills, but in the opposite direction to that proposed by the program’s theoretical model. The intervention did not change drug use.
Amato et al., 2021 ( ⁶ )	Programa PERAE^\|\| (SHAHRP ^¶ )	Process	Observational, Longitudinal Students, Adolescents (n* = 348)	Implementation fidelity reached 66.8%. The percentage of complete classes implemented ranged from 62.5% to 87.5%. Students and teachers reported good acceptability of the program.
Murta, et al., 2021 ( ⁴² )	Famílias Fortes (Strengthening Families Program)	Process	Observational, Longitudinal Students, Adolescents, Parents, Facilitators (n* = 410)	It was assessed that satisfaction/acceptability resulted in increased viability. The program improved family cohesion but worsened facilitator overload.
Valente and Sanchez, 2021 ( ⁴³ )	PROERD ^† (DARE ^‡ Keepin’ it REAL)	Result	Experimental (RCT ^§ ), Longitudinal Students, Adolescents, (n* = 4030)	It improved the school experience, but worsened the intention to use drugs, decision-making skills, and skills in refusing drug offers.
Sanchez, et al., 2021 ( ⁴⁴ )	#Tamojunto 2.0 (Unplugged)	Result	Experimental (RCT ^§ ), Longitudinal Students, Adolescents (n* =5208)	Reduced the odds of 8th graders initiating alcohol use. No effects were found on any other drug initiation or prevalence of use/month.
Sanchez, et al., 2021 ( ⁴⁵ )	PROERD ^† (DARE ^‡ Keepin’ it REAL - kiR)	Result	Experimental (RCT ^§ ), Longitudinal Students, Adolescents (n* = 4030)	It presented a negative effect, indicating that 7th grade students who already practiced binge drinking before and attended the program were more likely to maintain this use.
Cogo-Moreira, et al., 2021 ( ⁴⁶ )	#Tamojunto (Unplugged)	Result	Experimental (RCT ^§ ), Longitudinal Students, Adolescents (n* = 6390)	The results indicated that early violent behavior predicts more drug use among adolescents and shows the lack of evidence that #Tamojunto changes the dynamics between drug use and bullying.
Pinheiro-Carozzo, et al., 2021 ( ⁴⁷ )	Famílias Fortes (Strengthening Families Program)	Result	Pre-experimental, Longitudinal Students, Adolescents, Parents (n* = 361)	It affects parenting dimensions differently depending on the initial parenting style and can help improve weaknesses in fulfilling parental duties in the short term.
Ferreira Junior, 2021 ( ⁴⁸ )	PROERD ^† (DARE ^‡ )	Result	Experimental (RCT§), Longitudinal Students, Adolescents (n* = 4045)	Alcohol use was associated with all types of bullying. Low academic performance was also strongly associated with bullying. Black/brown students were 3.35 times more likely to be highly victimized by bullying.
Mariano, et al., 2021 ( ⁴⁹ )	ELOS 2.0 (Good Behavior Game)	Result	Experimental (RCT§), Longitudinal No information	Effectiveness study protocol.
Machado, et al., 2021 ( ⁵⁰ )	Educação Sobre Drogas e Habilidades Sociais	Process	Observational, Longitudinal Students/Adolescents (n* = 145)	The majority of students approved of the program, favoring the possibility of continuing it in subsequent years.
Farias, 2021 ( ⁵¹ )	Famílias Fortes (Strengthening Families Program)	Process	Observational, Cross-sectional Managers (n* = 7)	Variables related to organizational capacity, program adaptation, political support, program evaluation and partnerships were cited as essential for program sustainability.
Gusmões et al., 2022 ( ⁵² )	PROERD ^† (DARE ^‡ Keepin’ it REAL - kiR)	Result	Experimental, Longitudinal Students, Adolescents and PROERD Instructors (n* = 4030)	The level of implementation fidelity had no influence on the program’s ability to reduce drug use among adolescents. However, the qualitative analysis revealed adaptations made by police instructors.
Melo, et al., 2022 ( ⁵³ )	#Tamojunto 2.0 (Unplugged)	Process	Observational, Longitudinal Teachers and Principals, Pedagogical Coordinators (n* = 21)	Low implementation fidelity, good quality in the application of the program and high student absenteeism.
Schneider, et al., 2022 ( ⁵⁴ )	ELOS (Good Behavior Game)	Result	Quasi-experimental, longitudinal Students, Adolescents (n* = 1731)	Decreased aggression and disruptiveness among boys. It didn’t have the same effect on girls.
Valente, et al., 2022 ( ⁵⁵ )	PROERD ^† (DARE ^‡ , Keepin’ it REAL - kiR)	Result	Experimental, Longitudinal Students, Adolescents (n* = 4300)	There is no evidence of the effects of changes in the pattern of drug use when comparing intervention with control in any of the PROERD curricula aimed at 5th and 7th grade students.
Garcia-Cerde, et al., 2022 ( ⁵⁶ )	#Tamojunto 2.0 (Unplugged)	Result	Experimental, Longitudinal Students, Adolescents (n* = 5208)	It increased knowledge about drugs and negative/non-positive beliefs about alcohol. No evidence was found on the effect of the program with marijuana.
Almeida, et al., 2023 ( ⁵⁷ )	#Tamojunto 2.0 (Unplugged)	Result	Experimental, Longitudinalz Students, Adolescents (n* = 5208)	Factors such as: being a girl, older age, previous drug use and greater presence of mental health symptoms were the main predictors of drug use at follow-up.
Gusmões, et al., 2023 ( ⁵⁸ )	PROERD ^† (DARE ^‡ , Keepin’ it REAL - kiR)	Process	Observational, Cross-sectional Military Police (n* = 19)	Most instructors adapt the program. The main extrinsic reasons for changes were the challenges arising from the cultural reality and the school performance of the students and the lack of support from the school. The intrinsic reason was the performance of the instructors.
Valente, et al., 2023 ( ⁵⁹ )	#Tamojunto 2.0 (Unplugged)	Result	Experimental, Longitudinal Students, Adolescents (n* = 5208)	It indirectly reduced bullying by reducing alcohol use. But the program was not directly effective in reducing the prevalence of bullying (victimization and perpetration).
Valente and Sanchez, 2023 ( ⁶⁰ )	PROERD ^† (DARE ^‡ , Keepin’ it REAL - kiR)	Result	Experimental, Longitudinal Students, Adolescents (n* = 4030)	It had no effect on decision-making skills, attitudes towards drugs, refusal skills and communication skills, as proposed by the theoretical model.
Garcia-Cerde, et al., 2023 ( ⁶¹ )	#Tamojunto 2.0 (Unplugged)	Result	Experimental, Longitudinal Students, Adolescents (n* = 5208)	It indirectly reduced lifetime alcohol use by increasing negative beliefs about alcohol. Although an indirect effect on decreasing binge drinking was observed, the direct effect on decreasing alcohol consumption was statistically significant.
Oliveira, et al., 2023 ( ⁶² )	Descolado	Process	Observational, Cross-sectional Program key informants (n* = 6)	The program can be evaluated. The results of the evaluation helped to organize and describe the program logically, as well as helping to improve its structure, indicating the need for adjustments to objectives, activities and resources.
Ferreira Junior, et al., 2023 ( ⁶³ )	PROERD ^† (DARE ^‡ , Keepin’ it REAL - kiR)	Result	Experimental, Longitudinal Students, Adolescents (n* = 4030)	Association between bullying outcomes, school violence, drug use patterns and socioeconomic descriptors.
Schneider, et al., 2023 ( ³⁴ )	ELOS (Good Behavior Game)	Result	Pre-experimental, Longitudinal Students, Children (n* = 624)	Classes that received the program with greater fidelity showed more positive results in reducing target behaviors. Classes with low fidelity showed innocuous or possibly iatrogenic results.

Program name	Type of evaluation	Type and category	Theoretical model	Intervention	Target outcome
#Tamojunto	Process (n=9) Result (n=10)	Universal Prevention Program	Social learning theory, life skills, health belief model and critical attitude-action theory	Classes / 45-60 min / 12 meetings / held by trained teachers, in public schools, with the support of facilitators	Delaying the onset and reducing the pattern of use of alcohol, tobacco, marijuana, inhalants, cocaine and crack cocaine
#Tamojunto 2.0	Process (n=1) Result (n=5)	Universal Prevention Program	Social learning theory, life skills, health belief model and critical attitude-action theory	Classes / 45-60 min / 12 meetings / held by trained teachers, in public schools, with the support of facilitators	Delaying the onset and reducing the pattern of use of alcohol, tobacco, marijuana, inhalants, cocaine and crack cocaine
Famílias Fortes	Process (n=8) Resultado (n=2)	Universal Prevention Program	Family systems theory, social cognition theory, resilience model and socio-ecological models	Workshops / 2 to 2 hours and 30 minutes / 7 to 11 meetings, with parents and teenagers (10-14 years old), held at CRAS ^† , by SUAS ^‡ professionals	Decrease adolescents’ use of alcohol and other drugs and modify parent-child relationship patterns and parenting styles
ELOS: Construindo Coletivos	Process (n=5) Result (n=1)	Universal Prevention Program	Life skills training, based on experimental behavior analysis	Pedagogical Strategy / 30 min. / varied frequency, usually 3 times a week	Modify aggressive and disruptive behavior and strengthen concentration on the task and collaboration among peers in children.
ELOS 2.0	Result (n*=1)	Universal Prevention Program	Life skills training, based on experimental behavior analysis	Pedagogical Strategy / 30 min. / varied frequency, usually 3 times a week	Modify aggressive and disruptive behavior and strengthen concentration on the task and collaboration among peers in children.
PROERD ^§	Process (n=2) Result (n=7)	Universal Prevention Program	Social-emotional learning theory, social skills and the social influence model of drug education	Lessons / 50 min. / 10 meetings	Change the pattern of alcohol and other drug use
Jogo da onda digital (Digital Wave Game)	Result (n*=1)	Universal Prevention Strategy	Psychoeducation strategy and normative beliefs about drug use	Game / 2h / 1 meeting or more	Change the pattern of alcohol and other drug use
PERAE ^\|\|	Process (n*=1)	Universal Prevention Program	Socio-emotional Learning and Harm Reduction	Lessons / 1 hour / 8 meetings	Change the pattern of alcohol use
ProgramaM ( M, de mulheres )	Result (n*=1)	Selective Prevention Program	Bandura’s self-efficacy, attitude change, critical knowledge and perception of risk behavior	Manual and group discussions: video exposure, social media campaign / 18 meetings	Strengthening self-efficacy in interpersonal relationships of women impacted by alcohol and other drug use
Descolado	Avaliabilility (n*=1)	Universal Prevention Program	Paulo Freire Pedagogy, Life Skills	Classes in schools by teachers on drug use, youth protagonism and the student’s Personal Promotion Plan (PPP)	Change the pattern of alcohol and other drug use
Educação Sobre Drogas e Habilidades Sociais	Process (n*=1)	Universal Prevention Strategy	Psychoeducation	10 thematic meetings on alcohol and other drugs and social skills in Physical Education classes	Change the pattern of alcohol and other drug use

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Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3387 / 3315-4407 - Ribeirão Preto - SP - Brazil
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[1] *n = Number of participants; ^†PROERD = Drug and Violence Resistance Education Program; ^‡DARE = Drug Abuse Resistance Education; ^§RCT = Randomized Clinical Trial; ^||PERAE = Program to Stimulate Health and Reduce Risks Associated with Alcohol Use Applied to the Educational Environment; ^¶SHAHRP = The School Health and Alcohol Harm Reduction Project

Methodological characteristics of evaluative studies of drug prevention programs in Brazil: scoping review*

Highlights:

Methodological characteristics of evaluative studies of drug prevention programs in Brazil: scoping review^*