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Updated: Sep 9, 2025

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Examining Racial Differences in the Effects of the Brazilian State-Level Police Substance Use Prevention Program in

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  • 1Section of Epidemiology and Biostatistics, Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, 4Th Floor, Vila Clementino, São Paulo, SP, CEP: 04023-062, Brazil. aasmenezes@unifesp.br.

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A school-based prevention program did not reduce adolescent alcohol and tobacco use across racial groups in Brazil. Black seventh-graders showed a higher risk of initiating substance use compared to White students.

Keywords:
Effect heterogeneityPreventionSchoolsSmokeUnderage drinking

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Area of Science:

  • Public Health
  • Adolescent Health
  • Substance Use Prevention

Background:

  • Adolescent alcohol and tobacco use pose significant health risks, including cognitive and developmental impairments.
  • Minority youth experience unique vulnerabilities, such as discrimination, increasing stress and substance use risk.
  • School-based programs are a common strategy for adolescent substance use prevention.

Purpose of the Study:

  • To evaluate the effectiveness of the PROERD program in preventing adolescent alcohol and tobacco use.
  • To examine differences in program effectiveness across racial groups in Brazil.
  • To identify disparities in substance use initiation among minority adolescents.

Main Methods:

  • Analysis of data from two cluster-randomized controlled trials in São Paulo public schools (2019).
  • Inclusion of fifth- and seventh-grade students, assessing alcohol and tobacco use.
  • Racial classification based on self-identification (White, Black, Others) according to Brazilian census.

Main Results:

  • No significant preventive effect of the PROERD program on alcohol or tobacco use was found in any racial group or grade level.
  • Black seventh-grade students demonstrated a higher risk of initiating alcohol and tobacco use compared to White students after nine months.
  • Program did not mitigate disparities in substance use initiation among racial minority adolescents.

Conclusions:

  • Current school-based prevention strategies, like PROERD, may not adequately address racial disparities in adolescent substance use.
  • Culturally sensitive and comprehensive prevention approaches are needed to target specific risk factors for minority youth.
  • Promoting health equity requires tailored interventions that consider the impact of racism and discrimination on adolescent substance use.