What is it:

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PERAE is a school-based prevention program that can reduce alcohol use problems and first consumption among young people if implemented as recommended. It is a preventive program that was built on two main pillars: the experience of young people and scientific evidence.

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The project was developed in Australia by researchers from the National Drug Research Institute at Curtin University, where it is known as SHAHRP (School Health and Alcohol Harm Reduction Project). The SHAHRP was adapted for Brazil by NEPSIS researchers. The Brazilian version of the program was named PERAE (Program to Stimulate Health and Reduce Risks Associated with the Use of Alcohol Applied in an Educational Setting).

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The first phase of the program is suitable for students in the 8th year of Elementary School II (12/13 years) and the second phase for the 9th grade students (13/14 years). The material is composed by interactive activities that brings to the classroom a discussion about alcohol consumption among young people. It is noteworthy that only the first phase of the program for 8th grade students was implemented and researched in Brazil.

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It is the world first program in assessing the behavioural impact of a harm reduction approach to alcohol education in schools. The program was adapted to private schools of the São Paulo city through a research protocol, since a cross-cultural adaptation is essential for its feasibility in other countries. The research was extremely relevant to the  adequacy of the material to Brazilian context.

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PERAE PROJECT: adaptation research of SHAHRP to Brazil

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Study 1: aimed at translate and adapt Phase I of the SHAHRP program to the context of private schools in São Paulo; to verify the opinion of Brazilian experts in drug education ​​and to adapt the program content to the students' experiences.

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The material has been translated into Portuguese with adaptations in graphic design. Situations reported by Brazilian students were collected through focus groups on alcohol consumption and were included in the material. Brazilian specialists made suggestions for the adequacy of the vocabulary and graphical presentation of the material. They criticized the short time to do the activities during a Brazilian class time and the amount of written activities. They also pointed out the innovative potential of prevention practices due to the logical integration among activities, the didactic to teach alcohol education and the building of knowledge based on students experience.

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Study 2: aimed at verifying the acceptance of Phase I of the PERAE program by students and teachers and the feasibility of implementing the program in the school curriculum.

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The first phase of the program was implemented in four private schools, three in São Paulo and one in the interior of the state. The program was applied by teachers of mathematics, Portuguese, sciences, physical education and by educational advisors (psychologists). Each school has adopted an implementation strategy: to use each week one class of different disciplines without overloading none, to insert in the timetable of sciences (whose content is already part of the curriculum), to insert in the classes of physical education or in the classes from Portuguese. All possibilities were feasible, however inclusion in physical education classes was criticized by the students. It was possible to implement 70% of the activities as instructed in the teacher's material, in eight classes, 40-50 min per week.

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The students considered that useful knowledge was transmitted through the activities, they liked the interactive dynamics of the classes and the exchange of opinions among the students. As the experts pointed out, students enjoyed less written and individual activities. They suggested including more time for the program, including activities on other drugs and on emergency situations and more severe cases. However, most students would keep the program unchanged.

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Teachers also indicated the short time for the classes an obstacle to the completion of all activities indicated for a class. They said that they had to interrupt important discussions and the ideal would be to do in more than eight classes or to extend the time of one lesson.

 

About the risk reduction approach, teachers found that students became more critical about situations involving alcohol consumption. They reported that students felt more respected and absorbed content better because the program gives the student the possibility to think and to analyze the situation together. The teachers themselves indicated that the program should be done by a teacher trained in the risk reduction approach, who is interested in applying the activities and has identification with the program proposal. The students said that the most appropriate teacher is one who cares about the students beyond the content of the classes and understands the current issues of their generation.

 

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Why focus on alcohol? 

 

In Brazil, it is estimated that 25% of students have consumed any drug other than alcohol and tobacco. The prevalence for alcohol use is 60%, being the drug of earlier use and the most consumed among adolescents from different countries. The binge drinking is associated with many risks and harms, despite being the most culturally accepted drug in the country. The age of onset is close to 12 years old, but the legal age for alcohol use in Brazil is 18, when more than 80% of the young people have already drunk at least once. The risk of harms associated with alcohol use is greater with increasing frequency of consumption and the number of doses. It is estimated that 30% of high school students consume at least once a month 5 doses in few hours. Among those who drink at any level, about 30% reported some problem caused by consumption. The binge drinkers have chance of fights increased by 4 times, the chance of having unprotected intercourse increases by almost 5 times and the chance of going to school under the effect of alcohol increases by 6 times. The more frequent the consumption, the greater the risks.

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The PERAE is composed by:

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Teacher Training: It is recommended that the training be held just before the program beginning. Teachers are presented with an overview of the study of behavioral changes, the scientific basis of the program, and the interactive model of all activities. The program is recommended for teachers who have experience with interactive activities.

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Teacher's Manual: The manual works as a guide for teachers. It contains the detailed planning, with issues to facilitate discussion, tips to help manage activities and information on alcohol. Throughout some activities were included situations reported by the youth themselves, which facilitate a realistic discussion on strategies to remain more secure.

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Student material: student material is intended to stimulate student interest and participation, provide information, encourage students to explore more questions, has space to record what they have learned, and also serve as a tool to consolidate practical activities.