Redução de riscos relacionados ao uso de álcool entre adolescentes: um estudo de viabilidade do programa SHAHRP em escolas brasileiras

Amato, Tatiana de Castro; Opaleye, Emérita Sátiro; McBride, Nyanda; Noto, Ana Regina

doi:10.1590/1413-81232021268.13472020

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Sumário

ARTICLE • Ciênc. saúde coletiva 26 (08) • Ago 2021 • https://doi.org/10.1590/1413-81232021268.13472020 copiar

Redução de riscos relacionados ao uso de álcool entre adolescentes: um estudo de viabilidade do programa SHAHRP em escolas brasileiras

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

O programa SHAHRP foi eficaz na Austrália, mas precisa de adaptação transcultural para replicação em outro país. Este estudo teve como objetivo avaliar a viabilidade do SHAHRP no Brasil com base na sua implementação e aceitação. Utilizou-se métodos mistos: quantitativo para a implementação do programa e da avaliação e qualitativo para aceitação. O desenho quantitativo foi o piloto de um estudo clínico randomizado. Participaram escolas particulares: quatro intervenções (n = 160) e quatro controles (n = 188). Os alunos tinham 12,7 anos em média. A fidelidade da implementação e possíveis medidas de resultados foram avaliadas. Os dados qualitativos sobre aceitação foram relatados por alunos e professores. A fidelidade de implementação variou de 62,5% a 87,5%. Comportamentos como danos causados pelo uso de álcool precisam de uma amostra maior e de mais tempo para avaliação. A abordagem de redução de riscos e as atividades do programa foram bem aceitas por alunos e professores. Os resultados quantitativos e qualitativos sobre conhecimento e tomada de decisão indicaram possível melhora nas escolas-intervenção. O programa é viável e bem aceito no cenário brasileiro, abrindo caminho para avaliação e disseminação mais abrangentes.

Palavras-chave:
Consumo de bebidas alcoólicas; Adolescente; Prevenção; Redução do dano; Educação

	Programme Dosage			Fidelity of Implementation
Sessions	Total of planned activities (n)	Incomplete activities (n)	Not performed activities (n)	Complete lessons (%)	Activity full delivered (%)	Attendance (n)	Reach (%)
1	40	6	6	70,0%	1 (87.5), 2 (87.5), 3 (75), 4 (75), 5 (25)	202	85,6
2	16	2	0	87,5%	1 (87.5), 2 (87.5)	203	86,0
3	24	8	3	54,2%	1 (75), 2 (62.5), 3 (25)	205	86,9
4	40	8	8	60,0%	1 (75), 2 (87.5), 3 (75), 4 (50), 5 (12.5)	205	86,9
5	24	8	0	66,7%	1 (87.5), 2 (62.5), 3 (50)	206	87,3
6	16	3	1	75,0%	1 (87.5), 2 (62.5)	205	86,9
7	24	8	2	58,3%	1 (50), 2 (75), 3 (50)	193	81,8
8	24	2	7	62,5%	1 (87.5), 2 (50), 3 (50)	155	65,7

			Control (n = 188)		PERAE (n = 160)		p
			T0	T1	T0	T1
Alcohol
	Ever used		n (%)	n (%)	n (%)	n (%)
		No	61 (32.4)	54 (28.9)	36 (22.5)	33 (21.0)	0.039*
		Yes	127 (67.6)	133 (71.1)	124 (77.5)	124 (79)
	Use in the last 6 months
		No	106 (58.6)	104 (55.6)	76 (49.4)	70 (45.5)	>0.050^b
		Yes	75 (41.4)	83 (44.4)	78 (50.6)	84 (54.5)
			Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)
	Number of drinks in the last 6 months		2.0 (9)	2.2 (6.6)	3.0 (11.3)	4.1 (15.5)	0.930
Knowledge level			19.5 (4.9)	20.0 (6.0)	18.2 (5.5)	22.0 (6)	0.000 **
Decision making skills			46.6 (10.1)	44.2 (9.6)	45.0 (11.4)	47.2 (11.3)	0.003 **
Beliefs about consequences
	Positive		9.3 (5.2)	10.3 (5.4)	10.0 (4.9)	10.6 (6.0)	0.583
	Negative		18.0 (8.4)	15.8 (8.0)	16.2 (7.8)	15.2 (8.3)	0.358
Harm due to own consumption			0.5 (3.2)	0.6 (3.1)	0.8 (2.7)	1.4 (3.8)	0.242
Harm due to the consumption of others			1.5 (2.5)	1.5 (2.9)	1.6 (2.5)	1.7 (2.6)	0.868

Theme 1 What I liked	Theme 2 What I did not like	Theme 3 What else I suggest including
Useful knowledge	Repetitive content	More time per class and more classes
"The knowledge of the harm that drink can do not only to me but also to other people" "I learned to make the right decisions (not that I wanted to smoke or drink)"	"The repetitive subject of all the classes" "Too fast, too few lessons"	"More classes for us to learn more" "More time for activities"
Alcohol content and standard drinks	Boring Lessons	More practical activities
"Knowing how much is a standard drink and being able to warn people who are going to drive" "Interesting things, myths, facts, alcohol content, amount of standard drink" "Getting more knowledge and learning about moderate alcohol consumption"	"Not having enough “practical” classes such as measuring the quantity of alcohol in each drink" "Individual written ctivities" "Some classes were boring and tiring"	"They could have more fun activities to help us to learn" "More games about situations that happen to those who drink" "Situations of people who drank alcohol and who did not, to learn more about this"
Classes dynamics	Program in physical education classes	Knowing about subjects not addressed
"Discussing situations related to alcoholic drinks with friends, knowing each other's opinion" "Different games and ways to understand this" "Games, activities, videos, discussions" "Groups, collective activities" "Calculating the alcohol content in bottles"	"The class is good but I did not like missing my physical education classes"	"About illegal drugs" "More about varying individual alcohol metabolism" "A role-play about accidents" "Know about alcohol content of other alcoholic drinks" "How to treat your friends in extreme cases"

Theme 1 Lack of time	Theme 2 Risk reduction	Theme 3 Program aproach
Solution "I think increasing the number of classes from 8 to 10 could dilute some activities within that class."	"Wow, I don’t know if I will be able to do this. But they saw that at no time did I say, “don’t drink”. I felt that the students became more critical about alcohol consumption"	"In the program (...) at the beginning, the teacher makes an agreement with the students. (...) Look, what we say here is going to stay inside this room, it doesn’t matter to us to know who did what or why, we will just discuss and think about the stories that come up. So that, at least in our school, this gave us a good openness and the students made use of it"
"We had the opportunity in the last session do a double lesson, so I spent 100 minutes with them. That was great..."	"It's a gamble that they can make good decisions, isn’t it? I think the school, in general, has a hard time believing they are able to"	"It motivated discussion about the subject, and the material helped to make a good, interesting class that they liked, which I think is the main point, right?"
Difficulty “Time was really the most difficult factor. Sometimes you needed to stop the activity because you could not finish it, although you could see that the students wanted to continue"	"(...) I know other programs that just say, ‘no, you can do that’. That’s why young people feel more respected when you talk about risk reduction! ‘Look, I'm giving you the option to think. I believe you are able to consider this.’ (...) Students feel more respected and I think that's why it gets through better"

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[1] Collaborations

TC Amato did the data collection, the analysis and wrote the first version of the article. ES Opaleye, N McBride and AR Noto participated actively in the research design, analysis and discussion of the results. All authors participated in the review and approval of the final version of the paper.