Characteristics of school-based drug prevention programs in Brazil

Pereira, Ana Paula Dias; Sanchez, Zila M

doi:10.1590/1413-81232020258.28632018

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ARTICLE • Ciênc. saúde coletiva 25 (8) • Aug 2020 • https://doi.org/10.1590/1413-81232020258.28632018 copy

Characteristics of school-based drug prevention programs in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The aim of this study was to identify the main characteristics of school-based drug prevention programs in Brazil and verify whether these interventions apply the prevention principles suggested by the National Institute on Drug Abuse (NIDA). A cross-sectional study was conducted using a random national sample of 1,151 public and private school managers. The data were collected using an online questionnaire. Poisson regression was used to identify factors associated with the application of a greater number of prevention principles in the programs. The findings showed that programs were generally sporadic, had an average duration of one semester, incorporated different program models, and primarily directed at students. The most active organization in the delivery of programs was the Military Police. Private schools were shown to be 14% more likely to apply more good practice principles than public schools. Furthermore, programs delivered by school staff, health institutions, or departments of education were more likely to apply more prevention principles. Efforts are needed to improve drug prevention practice in Brazilian schools. Our findings show that, overall, school-based drug prevention programs do not apply the NIDA prevention principles.

Key words
Prevention; Drugs; Programs; School Health

Variables	Total
	n = 1,151
	n	%	95%IC
Respondent characteristics
Sex
Female	855	74.4	71.8 - 76.9
Male	294	25.6	23.1 - 28.2
Age
20 - 29 years	55	4.8	3.6 - 6.2
30 - 39 years	343	29.8	27.2 - 32.5
40 - 49 years	471	40.9	38.1 - 43.8
50 - 59 years	239	20.8	18.4 - 23.2
60 - 69 years	43	3.7	2.7 - 5.0
Education level
High school	29	2.5	1.7 - 3.6
Higher education	259	22.5	20.1 - 25.0
Postgraduate (Specialization)	773	67.2	64.4 - 69.9
Postgraduate (Masters/PhD)	89	7.7	6.3 - 9.4
Position
Principal	505	51.2	48.0 - 54.3
Education coordinator	397	40.2	37.1 - 43.3
Prevention program coordinator	60	6.1	4.7 - 7.7
Other	25	2.5	1.6 - 3.7
Has completed a course on drug education	739	65.1	62.2 - 67.8
School characteristics
Type
Public	893	77.6	75.1 - 80.0
Private	258	22.4	20.0 - 24.9
Region
Southeast	524	45.5	42.6 - 48.4
South	163	14.2	12.2 - 16.3
Northeast	287	24.9	22.5 - 27.5
North	77	6.7	5.3 - 8.3
Center-West	100	8.7	7.1 - 10.5
Size^* * Small (up to 800 students); Medium (between 801 and 1,600 students); Large (more than 1,600 students).
Small	809	70.3	67.5 - 72.9
Medium	281	24.4	22.0 - 27.0
Large	61	5.3	4.1 - 6.8
Location
Non-capital	908	79.6	77.2 - 81.9
Capital	232	20.4	18.0 - 22.8

Variables	Total
	n = 580¹ 1 Total number of schools answering that they had a drug prevention program.
	n	%	95%IC
Frequency of activities
Sporadic (irregular)	340	58.6	54.5 - 62.7
Systematic (regular)	240	41.4	37.3 - 45.5
Duration
One year	65	11.6	9.1 - 14.5
One semester	116	20.7	17.4 - 24.3
One trimester	321	57.2	53.0 - 61.4
One month	26	4.6	3.0 - 6.7
Less than a month	33	5.9	4.1 - 8.2
Target audience
Students	555	97.4	95.7 - 98.5
Teachers	267	46.8	42.7 - 51.0
Parents	230	40.4	36.3 - 44.5
Community	180	31.6	27.8 - 35.6
Non-teaching staff	184	32.3	28.5 - 36.3
Grades
Elementary	195	33.6	29.8 - 37.6
Middle school	380	65.5	61.5 - 69.4
High school	253	43.6	39.5 - 47.8
Organizations conducting programs
Military Police	411	73.4	69.5 - 77.0
School staff	238	42.5	38.4 - 46.7
Health institution	176	31.4	27.6 - 35.4
Department of education	101	18.0	14.9 - 21.5
Religious group	55	9.8	7.5 - 12.6
Non-religious NGO	35	6.3	4.4 - 8.6
Drug prevention program model
Health education	515	90.5	87.8 - 92.8
Affective education	501	88.5	85.6 - 91.0
Scientific knowledge	461	81.3	77.8 - 84.4
Provision of alternatives	389	69.1	65.1 - 72.9
Personal and social skills	386	68.1	64.1 - 71.9
Drug resistance training	383	67.1	63.0 - 70.9
Scare tactics	253	45.1	40.9 - 49.3
Positive group pressure	159	28.4	24.7 - 32.4
Drug prevention activities developed in the schools
Presentations with invited guests	505	87.7	84.7 - 90.2
School assignments	496	86.7	83.6 - 89.4
Films	463	81.2	77.8 - 84.3
Group activities	340	70.0	65.7 - 74.0
Educational material	392	69.0	65.0 - 72.8
Special events	344	60.1	56.0 - 64.2
Multidisciplinary projects	339	59.3	55.1 - 63.3
Theater	273	56.6	52.1 - 61.1
Presentations by former drug users	235	42.0	37.8 - 46.2
Project linked to a specific subject	229	40.0	36.0 - 44.2
Curricular classes	196	34.3	30.4 - 38.3
Questionnaires about drugs	169	35.4	31.1 - 39.9

Prevention principles	Total
	n = 382
	N	%	95% IC
Risk and protective factors	362	94.8	92.0 - 96.8
Address all types of drugs	349	92.6	89.4 - 95.0
Tailored to the age/characteristics of the students	284	76.3	71.7 - 80.6
For elementary school children, focus on training skills	240	64.5	59.4 - 69.4
Employ interactive techniques	229	61.7	56.6 - 66.7
Continuous and long-term	221	59.4	54.2 - 64.4
Family participation	192	51.3	46.1 - 56.5
Combine two or more domains of prevention (school, family, and community-based programs)	184	50.8	45.5 - 56.1
For high school students: drug resistance skills	164	46.9	41.5 - 52.2
Preschool (address aggressive behavior, poor social skills, and academic difficulties)	172	46.4	41.2 - 51.6
Address the type of drug abuse problems in the school	160	43.0	37.9 - 48.2
Community participation	144	38.7	33.7 - 43.9
Adapted from research-based interventions	137	37.7	32.7 - 42.9
Teacher training	119	32.2	27.4 - 37.2
Reinforce the program at key transition points	115	32.1	27.3 - 37.2

Variables	Univariate regression			Multivariate regression
Variables	IRR	95%IC	p-value	IRR	95%IC	p-value
School characteristics
Type
Public	1.00	--	--	1.00	--	--
Private	1.11	1.01 - 1.21	0.030	1.14	1.03 - 1.25	0.008
Region
Southeast	1.00	--	--	--	--	--
South	0.97	0.88 - 1.08	0.645	--	--	--
Northeast	1.01	0.90 - 1.12	0.907	--	--	--
North	0.98	0.83 - 1.15	0.793	--	--	--
Center-West	1.04	0.90 - 1.19	0.623	--	--	--
Size
Small	1.00	--	--	--	--	--
Medium	1.10	1.01 - 1.20	0.031	--	--	--
Large	1.16	0.98 - 1.38	0.074	--	--	--
Location
Capital	1.00	--	--	--	--	--
Non-capital	1.04	0.94 - 1.14	0.471	--	--	--
Organizations conducting programs
Military Police (Proerd)¹ 1 The reference is "No".	0.93	0.86 - 1.01	0.092	--	--	--
School staff¹ 1 The reference is "No".	1.22	1.13 - 1.32	<0.001	1.17	1.08 - 1.27	<0.001
Health institution¹ 1 The reference is "No".	1.17	1.08 - 1.27	<0.001	1.09	1.00 - 1.19	0.048
Department of education¹ 1 The reference is "No".	1.21	1.10 - 1.32	<0.001	1.20	1.09 - 1.33	<0.001
Non-religious NGO¹ 1 The reference is "No".	1.12	0.98 - 1.28	0.096	--	--	--
Religious group¹ 1 The reference is "No".	1.09	0.96 - 1.24	0.201	--	--	--

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[1] Collaborations

APD Pereira participated in study conception, data collection and analysis, and in drafting this article. ZM Sanchez was responsible for study design, the supervision of data analysis, and the revision of this article.