Decision-making skills as a mediator of the #Tamojunto school-based prevention program: Indirect effects for drug use and school violence of a cluster-randomized trial

Author(s)

Valente, Juliana Y. ^[1] ; Cogo-Moreira, Hugo ^{[2, 3]} ; Sanchez, Zila M. ^[1]

Affiliation

^[1] Univ Fed Sao Paulo, Dept Prevent Med, Sao Paulo - Brazil

^[2] Univ Fed Sao Paulo, Dept Psychiat, Sao Paulo - Brazil

^[3] Free Univ Berlin, Dept Psychol & Educ, Berlin - Germany

• Document type: Journal article
• Source: DRUG AND ALCOHOL DEPENDENCE; v. 206, JAN 1 2020.
• Web of Science Citations: 0

Abstract

Background: The aim of the present study was to evaluate a formal mediation analysis effect of the \#Tamojunto program on adolescents' drug use and violent behavior in schools through decision-making skills using a potential outcomes approach. Methods: An in-cluster randomized controlled trial was conducted in 2014-2015 with 6691 7th- and 8th-grade students in 72 public schools in 6 Brazilian cities to evaluate the effects of the European drug prevention program Unplugged, called \#Tamojunto in Brazil. Baseline data were collected prior to program implementation, and follow-up data were collected 9 and 21 months later. Mediation analysis using a potential outcomes approach, in which counterfactuals are modeled if positivity is met, was used to evaluate the indirect effects of the program \#Tamojunto on the third-wave of drug use (alcohol, tobacco, marijuana, inhalants, and binge drinking) and school violence (bullying or physical, verbal and sexual aggression) assessment through decision-making skills. Results: When controlling for all covariates, the Total Natural Indirect Effect (TNIE) was significant only for pastyear drug use (TNIE = 0.003, 95%CI = 0.001; 0.007). In the adjusted models, 37.5% of the effect of the intervention on drug use was mediated by decision-making skills. Conclusions: The \#Tamojunto program increased drug use through decreasing decision-making skills. The findings demonstrate that this program changes decision-making skills but in the opposite direction proposed by the theoretical model of the program, suggesting that modifications are needed to produce the intended effect of the program. (AU)

• FAPESP's process: 16/11971-5 - Influence of Parenting Styles on the Effectiveness of Prevention program of Drug Use #Tamojunto
• Grantee: Juliana Yurgel Valente
• Support Opportunities: Scholarships in Brazil - Doctorate