Reducing alcohol-related risks among adolescents: a feasibility study of the SHAHRP program in Brazilian schools

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

doi:10.1590/1413-81232021268.13472020

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

Reducing alcohol-related risks among adolescents: a feasibility study of the SHAHRP program in Brazilian schools

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The SHAHRP program was effective reducing drinking and alcohol - harms in Australia, but cross-cultural adaptation is required before replication. This study aimed at assessing the feasibility of SHAHRP in Brazil focused on implementation and acceptability. A mixed-methodsdesign was used: quantitative for implementing the program and evaluation and qualitative for acceptability. The quantitative design was a pilot of a randomized controlled trial. Private schools were randomly divided into four intervention (n=160) and four control (n=188) schools. Student’s mean age was 12.7 years. The fidelity of implementation and likely outcome measures were assessed. Qualitative data on acceptability were provided by students and teachers. The percentage of implementation varied from 62.5% to 87.5%. Behaviours such as alcohol-harms requires a larger cohort and longer follow-up to be adequately evaluated. The risk reduction approach and activities had good acceptability from students and teachers. Quantitative and qualitative outcomes on knowledge and decision-making indicated possible improvement in SHAHRP schools. The program is feasible and well accepted in a Brazilian setting, opening the way for a more comprehensive evaluation and dissemination.

Key words:
Alcohol drinking; Adolescent; Prevention; Risk reduction; Education

	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.