keepin' it REAL in Mexico: An Adaptation and Multisite RCT
Early adolescents (7th grade) in major metropolitan areas of Mexico.
Principal Investigators: Flavio F. Marsiglia and Maria Elena Medina Mora. Co-Investigators: Stephen S. Kulis, Stephanie L. Ayers
Sharp increases in substance use rates among youth in Mexico are a major concern, both in México and in the US. Although substance abuse prevention is a national priority, Mexico has few school-based universal prevention programs that are culturally grounded, empirically tested, and shown to be efficacious. Along with our partners in Mexico, GCAHR addressed this gap by culturally adapting, implementing, and testing a Spanish-language version of the keepin' it REAL (kiREAL) prevention program in Mexico's three largest cities. Translated to Spanish the adapted prevention program is entitled Mantente REAL (MREAL). The acronym REAL – Refuse, Explain, Avoid, and Leave – represents four strategies commonly used by youth who do not use substances: refuse substance offers with a direct no, explain why you decline, avoid substance offer situations, or leave them.
Frequency and amount of use of alcohol, tobacco, marijuana and other drugs; non-permissive attitudes towards drug use; violence perpetration and victimization.
In Phase I of the project, our bi-national research team, including the original kiR curriculum designers, collaborated to ensure cultural applicability in Mexico and fidelity to core elements of kiREAL. The cultural adaptation of MREAL addressed neighborhood, school and family violence that often accompanies substance use offers for Mexican adolescents, such as threats of violence and intimidation. The adaptations represented gender-specific scenarios where Mexican adolescents confront drug offers, people offering substances aggressively, alternatives to responding in kind in an angry or violent way, and the ability to assess and leave situations when threatened. In Phase 2, we tested the efficacy of the culturally adapted MREAL, relative to the original version of kiREAL and to a control condition, in a randomized controlled trial with 5,523 7th grade students in 36 public middle schools.
The adapted MREAL version for Mexico showed numerous desired outcomes in areas deliberately targeted in the cultural adaptation. Compared to students receiving the unadapted version of kiREAL and to students in control schools, MREAL students had relatively more desirable outcomes in recent use of alcohol, cigarettes, “hard drugs”, heavy episodic drinking and intoxication. MREAL students reported relatively less violence victimization and perpetration of bullying, and relatively more use of three of the intervention’s REAL drug resistance strategies (Explain, Avoid, Leave).
Medina-Mora, M. E., Kulis, S. S., Real, T., Nuño-Gutiérrez, B. L., Corona, M. D., Cutrín, O., & Marsiglia, F. F. (2023). The impact of major earthquakes on students’ emotional distress and internalizing symptoms, externalizing behaviors, and coping during the implementation of keepin’ it REAL-Mexico. Prevention Science. Advance online publication. https://doi.org/10.1007/s11121-023-01542-0
Ayers, S. L., Kulis, S. S., Marsiglia, F. F., Campos, A. P., & Medina-Mora, M. M. (2023). Keepin’ It REAL – Mantente REAL in Mexico: Longitudinal panel analysis examining youth drug resistance strategies and substance use frequency. Journal of Adolescent Health, 73(3), 412-420. https://doi.org/10.1016/j.jadohealth.2023.05.009
Cutrín, O., Arévalo Avalos, M., Corona, D., Nuño-Gutiérrez, B. L., Medina-Mora, M. E., Real, T., Mendoza-Meléndez, M. A., Lara-Valencia, F., Ayers, S. L., Kulis, S. S., & Marsiglia, F. F. (2022). Use of violence as a strategy of early adolescents for rejecting drug offers in Mexican cities. Revista Mexicana de Psicología, 39(1), 18-30. [PubMed: PMC9450683]
Marsiglia, F. F., Kulis, S. S., Cutrín, O., Medina-Mora, M. E., Real, T., Nuño-Gutiérrez, B. L., Corona, M. D., Mendoza-Meléndez, M. A., Gresenz, K., & Alcala-Calvillo, D. (2022). The feasibility, acceptability, and utility of Mantente REAL: the culturally adapted version of keepin’ it REAL for Mexico. Prevention Science, 23, 1483-1494. https://doi.org/10.1007/s11121-022-01409-w
Cutrín, O., Kulis, S. S., Maneiro, L., MacFadden, I., Navas, M. P., Alarcón, D., Gómez-Fraguela, J. Villalba, C., & Marsiglia, F. F. (2021). Effectiveness of the Mantente REAL program for preventing alcohol use in Spanish adolescents. Psychosocial Intervention, 30(3), 113-122. https\\doi.org:10.5093/pi2020a19
Kulis, S. S., Marsiglia, F. F., Medina-Mora, M. E., Nuño-Gutiérrez, B. L., Corona, M. D., & Ayers, S. L. (2021). Keepin’ it REAL – Mantente REAL in Mexico: A cluster randomized controlled trial of a culturally adapted substance use prevention curriculum for early adolescents. Prevention Science, 22(5), 645-657. https\\doi.org:10.1007/s11121-021-01217-8
Marsiglia, F.F., Medina-Mora, M. E., Gonzalvez, A., Alderson, G., Harthun, M. L., Ayers, S. L., Nuño-Gutiérrez, B. L., Corona, M. D., Mendoza-Meléndez, M. A., & Kulis, S. S. (2019). A binational cultural adaptation of the keepin’ it REAL substance use prevention program for adolescents in Mexico. Prevention Science, 20(7), 1125-1135. https\\doi.org:10.1007/s11121-019-01034-0 [PubMed: PMC6721982]
Kulis, S. S., & Marsiglia, F. F. (2023, May-June). Evaluating the efficacy of the Mexican version of keepin’ it REAL using repeated measures latent class analysis. “Abstract of Distinction” paper presentation at the Society for Prevention Research annual meeting. Washington, DC.
Campos, A. P., Ayers, S. L., Kulis, S. S., Marsiglia, F. F., & Medina-Mora, M. E. (2023, May-June). Keepin’ it REAL – Mantente REAL in Mexico: Longitudinal panel analysis examining youth drug resistance strategies and substance use frequency. Poster presentation at the Society for Prevention Research annual meeting. Washington, DC.
Marsiglia, F. F., Ayers, S. L., & Kulis, S. S. (2023, January). Long-term effects of Mantente REAL (keepin’ it REAL) on substance use by Mexican middle school students. Paper presentation at the Society for Social Work and Research annual conference, Phoenix, AZ.
Kulis, S. S., Marsiglia, F. F., & Ayers, S. L. (2022, September). Long-term effects of Mantente REAL (keepin’ it REAL) on Mexican middle school students’ alcohol use mediated by drug resistance training. Poster presentation at the European Society for Prevention Research annual conference, Tallinn, Estonia.
Marsiglia, F. F., Kulis, S. S., Cutrín, O., & Medina-Mora, M. E. (2022, June). Feasibility, acceptability, and utility of Mantente Real (keepin’ it REAL): A culturally adapted school-based substance use prevention program for Mexico. Paper presentation at the Society for Prevention research annual meeting. Seattle, WA.
Marsiglia, F. F., Kulis, S. S., & Cutrín, O. (2022, January). Assessing the feasibility, acceptability, and utility of Mantente REAL (keepin’ it REAL), a school-based substance use prevention program culturally adapted for Mexico. Poster presentation at the Society for Social Work and Research annual meeting, Washington, DC.
Marsiglia, F. F., Kulis, S. S., & Cutrín, O. (2021, January). Mantente Real (keepin' it REAL) in Mexico: Gender differences in effects of a culturally adapted substance use prevention program for middle schools. Paper presentation at the Society for Social Work and Research annual meeting (virtual).
Real, T., Medina Mora, M. E., Marsiglia, F. F., Kulis, S. S., Ayers, S. L., & Palafox, G. (2020, October). Implementation of keepin' it REAL in schools on Mexico-USA border. Poster presentation at the National Hispanic Science Network annual meeting (virtual).
Kulis, S. S., Marsiglia, F. F., Medina-Mora, M. E., Ayers, S. L., Nuño-Gutierrez, B. L., Corona-Lozano, D., & Mendoza-Meléndez, M. A. (2020, July). keepin’ it REAL (Mantente REAL) in Mexico: Gender differences in effects of a USA substance use prevention program culturally adapted for middle schools in Mexico. Paper presentation at the Society for Prevention Research annual meeting (virtual).
Marsiglia, F. F., Medina-Mora, M. E., Ayers, S. L., Nuño-Gutiérrez, B. L., Corona-Lozano, D., Mendoza-Meléndez, M. A., & Kulis, S. S. (2020, July). Exploring the process of a bicultural, bilingual, binational adaptation of an adolescent substance use prevention program. Paper presentation at the Society for Prevention Research annual meeting (virtual).
Kulis, S. S., Marsiglia, F. F., Medina-Mora, M. E., Ayers, S. L., Nuño-Gutiérrez, B. L., Corona-Lozano, D., & Mendoza-Meléndez, M. A. (2020, January). Keepin’ it REAL in Mexico: A randomized controlled trial of a substance use prevention program for middle schools in Mexico’s largest cities. Paper presentation at the Society for Social Work and Research annual meeting, Washington, DC.
Marsiglia, F. F., Medina-Mora, M. E., Ayers, S. L., Nuño-Gutiérrez, B. L., Corona-Lozano, D., Mendoza-Meléndez, M. A., & Kulis, S. S. (2020, January). Binational cultural adaptation of the keepin’ it REAL substance use prevention program for adolescents in Mexico. Poster presentation at the Society for Social Work and Research annual meeting, Washington, DC.
Kulis, S. S., Marsiglia, F. F., Medina-Mora, M. E., Nuño-Gutiérrez, B. L., Corona-Lozano, D., & Mendoza-Meléndez, M. A. (2019, September). Keepin’ it REAL in Mexico: A randomized controlled trial of a substance use prevention program for middle schools in Mexico’s largest cities. Paper presentation at the European Society for Prevention Research annual meeting, Ghent, Belgium.
Marsiglia, F. F., Medina-Mora, M. E., Ayers, S. L., Nuño-Gutiérrez, B. L., Corona-Lozano, D., Mendoza-Meléndez, M. A., & Kulis, S. S. (2019, September). Binational collaboration to culturally adapt the keepin’ it REAL substance use prevention program for adolescents in Mexico. Paper presentation at the European Society for Prevention Research annual meeting, Ghent, Belgium.
Marsiglia, F. F., Kulis, S. S., Ayers, S. L., Medina-Mora, M. E., Nuño-Gutiérrez, B. L., Corona-Lozano, D., & Mendoza-Meléndez, M. A. (2019, May). Keepin’ it REAL (Mantente REAL) in Mexico: Short-term RCT effects of a USA substance use prevention program culturally adapted for middle schools in Mexico’s three largest cities. Paper presentation at the Society for Prevention Research annual meeting, San Francisco, CA.
Marsiglia, F. F., Medina-Mora, M. E., Alderson, G., Nuño Gutiérrez, B. L., Corona, M. D., Mendoza-Meléndez, M. A., Quezada, G., Flores, X. G., Harthun, M. L., Kulis, S. S., Ayers, S. L., & Gonzalvez, A. (2018, June). A binational cultural adaptation of the substance use prevention program, keepin’ it REAL, for adolescents in Mexico. Poster presentation at the NIDA International Forum, San Diego, CA.
Kulis, S. S., Marsiglia, F. F., Nuño-Gutiérrez, B. L., Corona, M. D., Medina-Mora, M. E., & Ayers, S. L. (2018, May-June). Traditional gender roles and the narrowing gender gap in substance use among urban early adolescents in Mexico: Implications for prevention. Poster presentation at the Society for Prevention Research annual meeting, Washington, DC.
Marsiglia, F. F., Medina-Mora, M. E., Alderson, G., Nuño Gutiérrez, B. L., Corona, M. D., Mendoza-Meléndez, M. A. M., Quezada, G., Flores, X. G., Harthun, M. L., Kulis, S., S., Ayers, S. L. & Gonzalvez, A., (2018, May-June). A binational cultural adaptation of the substance use prevention program, keepin’ it REAL, for adolescents in Mexico. Poster presentation at the Society for Prevention Research annual meeting, Washington, DC.
Marsiglia, F. F., Medina-Mora, M. E., Alderson, G., Nuño Gutiérrez, B. L., Corona, M. D., Mendoza-Meléndez, M. A. M., Quezada, G., Flores, X. G., Harthun, M. L., Gonzalvez, A., Kulis, S., S., & Ayers, S. L. (2018, June). The binational cultural adaptation process of keepin’ it REAL for use in Mexico: Processes and lessons learned. Poster presentation at the Society for Prevention Research annual meeting, Washington, DC.
Marsiglia, F. F., Gonzalvez, A., Medina-Mora, M. E., Nuño Gutiérrez, B. L., Corona, M. D., Quezada, G., Flores, X. G., Harthun, M. L., Alderson, G., Kulis, S., S., & Ayers, S. L. (2018, May-June). A binational approach to cultural adaptation of the substance use prevention program, Mantente REAL, for adolescents in Mexico: Products developed. Poster presentation at the Society for Prevention Research annual meeting, Washington, DC.