Testing the keepin’ it REAL Substance Use Prevention Curriculum Among Early Adolescents in Guatemala City

  • Stephen S. KulisEmail author
  • Flavio F. Marsiglia
  • Maria Porta
  • Marvyn R. Arévalo Avalos
  • Stephanie L. Ayers


This article describes a test in Guatemala City of Mantente REAL, a linguistically adapted version of the keepin’ it REAL universal substance use prevention curriculum for early adolescents that teaches culturally grounded drug resistance, risk assessment, and decision making skills. Academic researchers collaborated with a local non-profit to recruit and randomize 12 elementary schools in Guatemala City to intervention and comparison conditions. Regular classroom teachers were trained to deliver the ten-lesson Mantente REAL (MR) manualized curriculum to sixth-grade students. Parents provided passive consent and students gave active assent for data collection, which occurred between February 2013 and September 2014. Two academic year cohorts of students participated (n = 676; 53% male; M age = 12.2). All students completed a pretest questionnaire before the curriculum lessons began in intervention schools and a posttest (87% matched) 4 months later, 1 month after the final lesson. We assessed the MR intervention with paired t tests, effect sizes (Cohen’s d), and general linear models adjusted for baseline, attrition, non-linear distributions, and school-level clustering. Results indicated that MR can be an effective school-based prevention approach in Guatemala. The MR participants reported pretest-to-posttest changes in desirable directions on substance use behaviors, attitudinal antecedents of substance use, and acquisition of drug resistance skills. The comparison group generally changed in undesirable directions. In linear models, the MR participants, relative to the comparison group, reported less cigarette and marijuana use, less positive drug use expectancies, and greater use of drug resistance skills. Intervention effect sizes were between .2 and .3.


Adolescents Substance use Prevention Guatemala Drug resistance skills 



This study was funded through a research grant from the Global Center for Applied Health Research at Arizona State University.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and later amendments or comparable ethical standards.

Informed Consent

Informed consent or assent was obtained from all individual participants in the study.


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Copyright information

© Society for Prevention Research 2018

Authors and Affiliations

  1. 1.Global Center for Applied Health ResearchArizona State UniversityPhoenixUSA
  2. 2.U Yum CapGuatemalaGuatemala

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