keepin' it REAL /Mantente REAL: A Feasibility Trial in Mexico's Three Largest Cities

Location(s): Latin America, Mexico, México City, Guadalajara, and Monterrey
Target Population: 
Early adolescents (7th grade) in major metropolitan areas of Mexico
Project Team: 

Flavio F. Marsiglia, PhD; Stephen S. Kulis, PhD; Bertha L. Nuño-Gutiérrez, PhD; María Dolores Corona Lozano, PhD, Miguel Ángel Mendoza Meléndez, MD

Project Status: 
GCAHR International Initiatives

The project was a collaboration between GCAHR investigators and substance use researchers at the National Autonomous University of Mexico (Mexico City), University of Guadalajara, and Autonomous University of Nuevo León (Monterrey). The objective was to assess the applicability and need for cultural adaptation in Mexico of the keepin' it REAL substance use prevention program for middle school students.

Primary Health Outcome

Substance use behaviors, attitudes, and exposure; violence victimization, perpetration and witnessing


The sample of seventh-grade students (n=4,932) attended 26 public schools in Mexico City, Guadalajara, or Monterrey in 2014. Schools were randomized to receive the keepin' it REAL curriculum, translated into Mexican Spanish and renamed Mantente REAL, or to serve as a treatment as usual control/comparison group. Regular teachers were trained to deliver Mantente REAL, and students completed pretests and two post-tests.

Key Findings

The study highlighted the importance of addressing both the closing gender gap in adolescent substance use in Mexico, as well as gender differences in the factors that lead to vulnerability to substance use. One analysis tested whether alcohol use and violence perpetration are temporally related, whether the influence is unidirectional or reciprocal and whether it differs by gender and the type of violence. For both males and females, more frequent alcohol use predicted subsequent criminally violent behavior, and bullying predicted later alcohol use. Alcohol use was reciprocally linked to criminally violent behavior among males only and reciprocally linked to bullying among females alone.
The study also investigated associations between traditional gender roles (TGRs) and substance use. The hypothesis was that TGRs for males encourage risky behaviors in males, but TGRs for females discourage substance use. As expected, among males TGRs were consistently linked to a higher risk of substance use in contrast, but among females, there was no evidence that TGRs were associated with desirable outcomes. Contrary to expectations, TGRs predicted poorer outcomes for both females and males, and to equivalent degrees.