Reducing alcohol use among adolescents through a community-based, multicomponent intervention: an implementation research approach

Alcohol consumption is one of several causes of non-communicable diseases such as cardiovascular diseases, diabetes substance abuse disorders, and several types of cancer. According to the World Health Organization (WHO), the harmful use of alcohol is considered one of the four most important risk factors responsible for the worldwide increase in such diseases. Development and implementation of measures aimed at reducing alcohol use among young people is complex since drinking behavior is influenced by risk factors at several different levels, such as individual factors, the influence of parents and peers as well as alcohol policy. One of the most effective strategies for reducing alcohol consumption and the damage later in life is therefore to postpone alcohol use among young people through various research-based measures. Research shows that structural, community-related measures have a greater impact on reducing alcohol use among young people than individual measures. The aim of the project is to evaluate already established programs that aim to prevent alcohol use among young people in Brazil and to adapt to Mozambique. An implementation survey will be carried out with a hybrid design, that is, considering the implementation-effectiveness dyad and has the following steps: Phase 1- Identification of an appropriate intervention; Phase 2- Adaptation and pilot of the intervention; Phase 3- Implementation and evaluation of the intervention; Phase 4- Expansion, describing how the knowledge will be translated, disseminated, and sustained with quality in the studied community and in similar communities. This project was funded through an international joint call on a life course approach to common NCD risk factor prevention and reduction organized by the Global Alliance for Chronic Diseases and has the partners Federal University of Sao Paulo (Brazil) and the National Institute of Health of Mozambique.

Alcohol is a major component cause of non-communicable diseases (NCDs) like cancer, cardiovascular diseases, diabetes, and substance use disorders. Harmful alcohol use is a key risk factor for the rise of NCDs globally. To reduce the NCD burden, preventing and reducing harmful alcohol consumption is crucial. Delaying alcohol use among adolescents through evidence-based interventions is effective, especially community-based initiatives with school and family programs, and environmental strategies. In Brazil, UNODC and the Ministry of Health adapted proven programs like "Unplugged" (Tamojunto 2.0) and "Strengthening Families Programme 10-14" (Familias Fortes). However, these programs were discontinued due to a lack of "know-how" and stakeholder involvement. In Mozambique, no study or program aiming to reduce or prevent alcohol consumption in this target group has been conducted thus far. There is a gap in Brazilian and Mozambican alcohol prevention policy for a community-based multicomponent intervention integrating existing programs and environmental strategies, with stakeholder participation. A hybrid implementation research study will be conducted, following WHO's framework with four phases: identification, adaptation, implementation and evaluation (including reach, adoption, fidelity), and scale-up. The study will assess readiness, appropriateness, acceptability, feasibility, fidelity, adoption, reach, sustainability, and effectiveness. Two small municipalities in São Paulo (Cordeirópolis and Iracemapolis) and two big cities in Mozambique (Maputo and Nampula) will be involved, with engagement from the executive and legislative branches. The aim is to translate and disseminate knowledge, ensuring sustained quality implementation. This research aims to improve alcohol prevention public policies in Brazil and Mozambique.