Caregiver Social Capital and Supportive Relationships are Associated with Better Child Social-Emotional Development.

This study examined how different domains of social capital and of social support among caregivers are associated with social-emotional development in children ages 4-6 and how caregiver depressive symptoms modify these associations. Using a stratified random sample of preschools, data included a cross-sectional study of 1147 child-caregiver pairs (543 girls) in a low-income municipality in Brazil. Crude and adjusted linear regression models revealed that all domains of social support and two domains of social capital were associated with less social-emotional development delay in children. Given a significant proportion of children in low- and middle-income countries do not meet developmental milestones, strengthening caregiver social capital and support in these settings may have the potential to improve child social-emotional development.

Are Social Vulnerability and Family Social Support Associated with Children's Psychiatric Symptoms?

Social influence can shape early childhood at different levels. We explored the association between social vulnerability and lifetime caregiver alcohol use with children's psychiatric symptoms. Multivariable logistic regression assessed the association between child psychiatric symptoms and social vulnerability among 1275 preschool child-caregiver pairs with lifetime caregiver alcohol used as a control variable. Of the children, 15.78% (95% CI 15.17-16.42) had internalizing symptoms, 2.49% (95% CI 2.19-2.83) had externalizing symptoms, and 9.36% (95% CI 8.88-9.86) had internalizing/externalizing symptoms. High social vulnerability was positively correlated with internalizing (aRRR 1.54; 95% CI 1.41-1.68) and internalizing/externalizing symptoms (aRRR 1.77; 95% CI 1.58-2.00). Low family support was strongly associated with internalizing/externalizing symptoms (aRRR 2.60; 95% CI 2.20-3.10). Lifetime caregiver alcohol use was positively correlated with all three psychiatric symptoms (aRRR 1.33; 95% CI 1.18-1.51; aRRR 1.13; 95% CI 1.06-1.59; and aRRR 1.26; 95% CI 1.12-1.42). Their association with children's mental health outcomes calls for social policy changes at the macrosystem level.

Being bullied and using drugs are associate with eating disorder symptoms in Brazilian students.

OBJECTIVE: This study's main purpose is to evaluate factors associated with eating disorder (ED) symptoms among Brazilian adolescents. METHOD: The sample consisted of 5,213 students, mean age 13.24 (SD ±0.01), in the eighth grade of 93 public schools from three Brazilian cities. Data were collected through an anonymous self-report questionnaire, assessing: sociodemographics, use of alcohol, tobacco, illicit drugs, binge drinking, bullying, and ED symptoms. We used confirmatory factor analysis and multivariate linear regression. RESULTS: We found that high levels of bullying victimization, binge drinking and the use of unprescribed weight-loss substances were associated with higher levels of ED symptoms to both genders. However, only among girls, the higher age (ß = .10; 95% CI = 0.02; 0.17) and the use of illicit drugs (ß = .21; 95% CI = 0.094; 0.34) were associated with increase in the ED symptoms. DISCUSSION: We demonstrate a significant association of ED symptoms with drug use and bullying, highlighting the importance of addressing these factors in the development of ED prevention strategies.

Child and adolescent psychiatry training in Brazil, Argentina, Uruguay and Chile: current panorama and future challenges.

Mental disorders affect approximately 10-15% of children and adolescents worldwide. In South America these numbers are probably higher due to poverty and adverse life events that frequently affect this region. The availability of qualified services and well-trained professionals to care for those children are by far insufficient. The aim of this study was to assess and describe child and adolescent psychiatry (CAP) training in Brazil, Argentina, Uruguay, and Chile, to support the development and strengthen training standards. The coordinators of CAP residency programs in Brazil, Argentina, Uruguay, and Chile were invited to answer an online questionnaire about the characteristics of their training programs. Twelve programs from Brazil, three programs from Chile, two from Argentina, and one from Uruguay completed the questionnaires. In the last three countries, CAP is recognized as an independent specialty, while in Brazil it is considered a subspecialty of psychiatry. None of the countries have a national guideline for CAP residency training. Recently, there has been an increase in the number of professionals interested in pursuing a formal CAP training. This is the first study aiming to evaluate the current scenario of CAP training in South America. The results point to a great potential in the evaluated programs, but also to the need for homogeneous criteria for CAP training and evaluation of residents. A more efficient communication among programs would be an enriching strategy for their development, which may be facilitated by the results of this study.

Effectiveness evaluation of the school-based drug prevention program #Tamojunto2.0: protocol of a cluster randomized controlled trial.

BACKGROUND: The European school-based drug addiction prevention program Unplugged was adapted to the Brazilian context by the Ministry of Health and renamed #Tamojunto. Its first implementations, in the form of a public policy in Brazil, showed contradictory and different effects from those observed in Europe. Adaptations were made to #Tamojunto in 2018 to reintroduce the essential content of the original program. METHODS: A parallel, two-arm, randomized controlled trial (RCT) will be conducted to evaluate the effectiveness of the new version of the school-based government program #Tamojunto2.0 for the prevention of drug use among 8th grade middle school students from 70 public schools in three Brazilian cities, totaling approximately 6.300 participating students distributed in 210 classes. For intervention, the experimental group will receive the 12 lessons of the #Tamojunto2.0 program under the supervision of a Brazilian Ministry of Health team. The control group will not receive any intervention. Information will be collected from the students at three time points: preintervention and 9 and 18 months postintervention. Multilevel analyses will be performed using the Gllamm Stata program to assess simultaneous differences in prevalence, in time and among groups for the outcomes of interest. Structural equation modeling will be used to evaluate the effectiveness of the intervention in changing the behavioral patterns of the adolescents through latent transition analysis. The effect of the mediators involved in the program effectiveness outcomes will also be analyzed. The program doses applied in all classes of the intervention group will be collected using a form completed by the teacher at the end of each lesson, indicating the activities taught and not taught in each lesson. DISCUSSION: This study will show whether the #Tamojunto2.0 program can be expanded as a public policy for all schools with the aim of preventing drug use among Brazilian students. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (RBR-8cnkwq) under the name "Avaliação do Efeito do Programa de Prevenção Escolar ao Uso de Drogas #Tamojunto2.0, Versão 2018", on August 30th, 2018 ( http://www.ensaiosclinicos.gov.br/rg/RBR-8cnkwq/ ).

The association of psychiatric symptomatology with patterns of alcohol, tobacco, and marijuana use among Brazilian high school students.

BACKGROUND AND OBJECTIVES: Studies have highlighted psychosocial factors associated with drug use among adolescents. Association of specific psychiatric comorbidity with substance use has not been properly established in Brazil. This study aimed to investigate alcohol, tobacco, and marijuana use by 15-18-year-old high school Brazilian students and to estimate associations with psychiatric symptoms. METHODS: A cross-sectional survey of 4,034 students from 128 public and private schools in São Paulo State was carried out using a two-step probability sample. Data were collected through self-report standardized questionnaires including questions on substance use patterns and the Strengths and Difficulties Questionnaire (SDQ). Key outcome variables were past-month use and past-month frequent use of alcohol, tobacco and marijuana. Questionnaires with missing information were excluded, resulting in a final sample of 2,532 adolescents. Weighted data was analyzed through logistic regressions, adjusted by gender and by socio-economic status (SES). RESULTS: Regarding SDQ total score, 43.6% of students had no psychiatric symptoms, 7.9% had subclinical symptoms and 48.5% presented clinically significant symptoms. Respondents with a clinically significant SDQ score were more likely to be past month alcohol (aOR = 1.51; 95%CI 1.22-1.88), tobacco (aOR = 1.82; 95%CI 1.25-2.66), and marijuana (aOR = 1.79; 95%CI 1.21-2.64) users as compared to those with no symptomatology. DISCUSSION AND CONCLUSIONS: Psychopathological symptoms were associated with alcohol, tobacco and marijuana use by 15-18-year-old adolescents. These associations should also be considered when planning public policies of mental health promotion. SCIENTIFIC SIGNIFICANCE: This study discusses the importance of the association between psychopathological symptoms and substance use in a middle-income country, with high level of social inequalities, in a state representative sample. (Am J Addict 2016;25:416-425).

Impulsivity in children and adolescents with mood disorders and unaffected offspring of bipolar parents.

OBJECTIVE: Increased impulsivity seems to be present across all phases of bipolar disorder (BD). Impulsivity may therefore represent an endophenotype for BD, if it is also found among normal individuals at high genetic risk for mood disorders. In this study, we assessed impulsivity across four different groups of children and adolescents: patients with BD, major depressive disorder (MDD) patients, unaffected offspring of bipolar parents (UO), and healthy controls (HC). SUBJECTS AND METHODS: 52 patients with BD, 31 with MDD, 20 UO, and 45 HC completed the Barratt Impulsiveness Scale (BIS-11), an instrument designed to measure trait impulsivity. RESULTS: UO displayed significantly higher total BIS-11 impulsivity scores than HC (p=0.02) but lower scores than BD patients (F=27.12, p<0.01). Multiple comparison analysis revealed higher BIS-11 total scores among BD patients when compared to HC (p<0.01) and UO (p<0.01). MDD patients had higher BIS-11 scores when compared to HC (p<0.01). Differences between MDD patients and UO, as well as between MDD and BD patients, were not statistically significant. CONCLUSION: Our findings suggest that trait impulsivity is increased among children and adolescents with mood disorders, as well as in unaffected individuals at high genetic risk for BD.

Prosocial behavior in children involved in peer violence.

INTRODUCTION: Peer violence is a serious type of school violence that is associated with emotional and behavioral problems. OBJECTIVE: To analyze violence between peers associated with students' social skills. METHODS: We used a cross sectional survey nested in a cluster randomized controlled trial to evaluate peer violence among elementary school students and its association with prosocial behaviors and mental problems. Teachers answered an adapted version of the Revised Olweus Bully/Victim Questionnaire and the Brazilian adaptation of the Teacher Observation of Classroom Adaptation-Checklist (TOCA-C) scale for each student. Children completed a sociodemographic questionnaire. The participants were 1,152 5-14-year-old children from Brazilian public schools; 79.70% reported being involved in violent situations. RESULTS: Children who had both committed and suffered violence were less likely to exhibit prosocial behaviors. Children who committed and suffered violence and those who only committed were more likely to experience concentration problems and disruptive behaviors. DISCUSSION: This study suggests that peer violence is associated with lower prosocial behaviors and more behavioral problems. Thus, more specialized mental health care is required for children involved in peer violence, in addition to the possibility of implementing and maintaining programs to prevent and reduce violence and to develop prosocial behaviors in schools.

Short-term effects of the strengthening families Program (SFP 10-14) in Brazil: a cluster randomized controlled trial.

INTRODUCTION: This study reports the evaluation of the short-term effects of the Strengthening Families Program (SFP 10-14), adapted as Famílias Fortes (Strong Families) in Brazil, on preventing adolescent drug use and improving parenting behaviors. METHODS: A two-arm, parallel cluster randomized controlled trial was conducted in 60 Social Assistance Reference Centers (SARC) from 12 Brazilian municipalities. In each city, the SARC were randomly assigned to the intervention or control group. A total of 805 families participated in the study, each contributing data from one parent or legal guardian and one adolescent totaling 1,610 participants. Data collection occurred before intervention implementation and 6 months after baseline collection. Data were analyzed using multilevel mixed-effects modeling with repeated measures in two different paradigms: Intention to Treat (ITT) and Per protocol (PP). The study was registered in the Brazilian Ministry of Health Register of Clinical Trials (REBEC), under protocol no. RBR-5hz9g6z. RESULTS: Considering the ITT paradigm, the program reduced the chance of parents and legal guardians being classified as negligent by 60% (95%CI 0.21; 0.78), increased the use of nonviolent discipline by caregivers (Coef 0.33, 95%CI 0.01; 0.64) and decreased the chance of adults exposing adolescents to their drunken episodes by 80% (95%CI 0.06; 0.54). No program effects were observed on outcomes related to adolescent drug use. Similar results were found for the PP paradigm. CONCLUSION: The positive effects on family outcomes suggest preventive potential of the program among the Brazilian population. Long-term evaluations are necessary to verify if the program can also achieve the drug use reduction goals not observed in the short term.

Temperament and character traits in children and adolescents with major depressive disorder: a case-control study.

OBJECTIVES: To evaluate temperament and character traits using the Junior Temperament and Character Inventory (JTCI) in children and adolescents with major depressive disorder (MDD) in comparison with healthy control subjects (HC), and to verify if comorbidity with disruptive behavioral disorders and being currently depressed influence JTCI scores. METHODS: A case-control study comprising 41 MDD children/adolescents matched to 40 HC by gender and age (8-17years). All participants were assessed diagnostically with the Kiddie Schedule for Affective Disorders and Schizophrenia - Present and Lifetime (K-SADS-PL). Temperament and character traits were measured with the parent and child versions of JTCI, and depression was evaluated with the Children's Depression Rating Scale (CDRS). RESULTS: According to child and parent data, MDD subjects had significantly higher scores on harm avoidance and novelty seeking, and lower scores on reward dependence, persistence, self-directedness and cooperativeness compared with HC. According to parent data only, MDD subjects significantly differed from HC on self-transcendence (lower spirituality scores and higher fantasy scores). Comorbidity with disruptive behavioral disorders exerted influence on almost all dimensions, in general increasing the mean differences between MDD and HC subjects. Also, being currently depressed did not influence the results, except for reward dependence according to parent data. LIMITATIONS: The cross-sectional nature of the study and its limited sample size. CONCLUSIONS: MDD children/adolescents have a different temperament and character profile compared to HC subjects. This study supports previous findings of trait-like characteristics of harm avoidance and self-directedness.

Dysfunctional family environment in affected versus unaffected offspring of parents with bipolar disorder.

OBJECTIVE: Children of parents with bipolar disorder (BD) are at heightened risk for developing mood and other psychiatric disorders. We proposed to evaluate the environment of families with at least one parent with BD type I (BDF) with affected offspring (aBDF) and unaffected offspring (uBDF) compared with control families without a history of DSM-IV Axis I disorder (CF). METHOD: We used the Family Environment Scale (FES) to evaluate 47 BDF (aBDF + uBDF) and 30 CF. Parents were assessed through the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Diagnosis of the offspring was determined through the Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL) interview. RESULTS: There were statistically significant differences between aBDF, uBDF and CF in cohesion (p = 0.003), intellectual-cultural orientation (p = 0.01), active-recreational orientation (p = 0.007), conflict (p = 0.001), control (p = 0.01), moral-religious emphasis (p = 0.01) and organization (p = 0.001). The aBDF showed higher levels of control (p = 0.02) when compared to the uBDF. CONCLUSIONS: Families with a BD parent presented more dysfunctional interactions among members. Moreover, the presence of BD or other psychiatric disorders in the offspring of parents with BD is associated with higher levels of control. These results highlight the relevance of psychosocial interventions to improve resilience and family interactions.

Behavioral self-regulation in pediatric bipolar disorder and healthy offspring of bipolar patients.

OBJECTIVES: This study investigated behavioral self-regulation problems using the Children's Hostility Inventory (CHI) in pediatric bipolar disorder (PBD), healthy offspring of bipolar disorder patients (HOBD), and healthy controls (HC) without previous history of psychiatric disorders. METHODS: The CHI was administered to 41 consecutive children and adolescents diagnosed with PBD, to 16 HOBD, and to 22 HC. The inventory assessed irritability, expression, hostility, and aggression and was completed by the children with the help of their mothers. Adolescents and their respective parents were interviewed separately using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). RESULTS: All subscales of the CHI presented statistically significant differences, except for the subscale assessing feelings of suspicion. Pairwise comparisons revealed consistently significant differences between the PBD group and controls, indicating more self-regulation difficulties in the PBD group, represented by high levels of hostility and aggressive behavior. There were no significant differences between the PBD and HOBD groups. CONCLUSIONS: Future studies should further investigate if such behavior is state-dependent or a trait of bipolar juvenile expression. Expression of hostility and irritability should be considered relevant targets in psychosocial approaches addressing this population.

Self-regulation in youth with bipolar disorder.

OBJECTIVES: To examine the composition of self-regulation in pediatric bipolar disorder (PBD) through the relationship between executive functions, emotion processing, and family environmental factors. METHODS: 58 participants (36 with PBD and 22 controls), ages 12-17, were assessed using the Barratt Impulsiveness Scale (BIS), Conners' Continuous Performance Test (CPT-II), Wisconsin Cards Sorting Test (WCST), Computerized Neurocognitive Battery Emotion Recognition Test-Facial Emotion Recognition Test (PENNCNB ER-40), and Expressed Emotion Adjective Checklist Questionnaire (EEAC). RESULTS: Adolescents with PBD displayed significant deficits in all three spheres when compared to the control group. Emotion processing correlated negatively with inhibition and attention, and correlated positively with mental flexibility/working memory. Family environmental factors correlated negatively with mental flexibility/working memory and emotion processing, and positively with attention and inhibition. These correlations indicate that better inhibitory control, attention, and mental flexibility/working memory are associated with greater emotion processing and a fitter family environment. CONCLUSION: This study is the first to investigate all of the components of self-regulation deficits simultaneously in patients with PBD. Results suggest that self-regulation is essential for a comprehensive perspective of PBD and should be assessed in an integrative and multifaceted way. Understanding that self-regulation is impacted by the abovementioned factors should influence treatment and improve the functional impairments of daily life observed in this population.

The Impact of Family Stress and Resilience on Child Development: a scope review.

INTRODUCTION: Children grow up spending most of their time within the family social environment, where they can experience stressful situations such as marital conflict, a non-cohesive environment, parental alcohol use disorder, parental depression, and other parental mental health issues. All these factors are associated with children's developmental delays. OBJECTIVE: We aimed to conduct a scoping review on family stress and family resilience associated with child development delays to examine familial conditions associated with child development. METHODS: We conducted a scoping review of observational studies published between January 2000 to July 2023, indexed in MEDLINE and LILACS databases. We included observational studies that evaluated the history of exposure to violence, and behavioral or emotional symptoms, or mental health problems among children aged 4-12. Data were independently extracted using a structured form. RESULTS: Database searches identified 12,990 different records. A total of 43 articles were included in the review. Three main findings emerged: (1) parental mental health problems, especially depressive symptoms in mothers, were associated with child developmental delays and mental health problems; (2) better parenting practices and cohesive home environment were positively associated with child development, and (3) Vulnerable social environments (e.g., poverty and housing insecurity) may be linked to child mental health problems. CONCLUSIONS: Studies reviewed show that promoting better family dynamics and increasing family cohesion, as well as parenting abilities, are beneficial to a child's socio-emotional development and prevention of child mental health problems. Moreover, increasing family and children's resilience improves the quality of life within family units.

Profile of Service Use and Barriers to Access to Care among Brazilian Children and Adolescents with Autism Spectrum Disorders.

Delayed diagnosis and a lack of adequate care for people with autism spectrum disorder (ASD) are related to worse outcomes and quality of life. This study aimed to identify the profile of service use, barriers to access care, and factors related to those barriers in Brazilian families with children with ASD. A total of 927 families with children with ASD (3-17 years) from five Brazilian regions completed an online version of the Caregivers Needs Survey. Results showed that the most used services were behavioral interventions and pharmacotherapy, while the most used professionals were neurologists, nutritionists, speech therapists, psychiatrists, psychologists, and pediatricians. The main barriers included waiting lists, costs, and the absence of services or treatment. Service use varied according to age, the region of residence, type of health care system used, and the parents/caregivers' education. Access to behavioral interventions was more frequent among users of the private system/health insurance and families whose caregivers had higher education. The absence of specialized services/treatments was less frequent among residents of state capitals and families whose caregivers had higher levels of education. This study highlights how families with children/adolescents with ASD in Brazil face significant barriers to access care related to sociodemographic factors.

Effectiveness of a school-based substance use prevention program taught by police officers in Brazil: Two cluster randomized controlled trials of the PROERD.

BACKGROUND: The Drug and Violence Resistance Educational Program (PROERD) is widely disseminated and implemented as a public policy in Brazil. PROERD's current curricula are the translation of the North American program DARE-Keepin'it REAL, based on the theories of socio-emotional learning and resistance training. The present study aims to evaluate the effectiveness of PROERD in the prevention of drug use. METHOD: Two PROERD curricula were analyzed through two cluster randomized controlled trials conducted with 4030 students (1727 5th graders and 2303 7th graders) in 30 public schools in São Paulo. The intervention group received ten PROERD classes delivered by trained police officers, and the control group received no intervention. Data collection was performed using self-administered questionnaires on smartphones at two points in time (baseline pre-intervention and nine months follow-up). The outcomes evaluated were initiation and recent drug use. Two different paradigms were used in a multilevel analysis: an analysis of complete cases (CC) and an intention to treat missing data through full information maximum likelihood and selection model. RESULTS: We found no evidence of the effectiveness of PROERD as an intervention for the prevention of drug use. For the conditional transition analysis, we found that 7th graders in the PROERD group who were already binge drinking at baseline had a significantly higher chance of maintaining this consumption pattern when compared to the control group. CONCLUSION: The lack of preventive effects found here suggests that a process evaluation may address concrete implementation and cultural adaptation issues.

Maternal Pregnancy Intention and Developmental Outcomes in Brazilian Preschool-Aged Children.

OBJECTIVE: This study aims to characterize the association between maternal pregnancy intention and socioemotional developmental outcomes in a Brazilian sample of preschool-aged children. METHODS: Data from children aged 4 to 5 years and their primary caregivers in Embu das Artes, a Brazilian municipality in the state of São Paulo, were collected in 2016. Maternal pregnancy intention was defined as intended or unintended, which was then further stratified as mistimed or unwanted. Outcomes included socioemotional developmental delay, internalizing and externalizing behaviors, and school readiness. We estimated risk ratios (RRs) for unadjusted and inverse-probability-weighted regression adjustment (IPWRA) analyses using 2-level (intended vs unintended) and 3-level (intended vs mistimed vs unwanted) exposure definitions. RESULTS: Of 1,034 total mothers, 40.7% reported their pregnancy as intended, 46.0% as mistimed, and 13.4% as unwanted. In both unadjusted and IPWRA analyses comparing intended and unintended pregnancies, all associations failed to reach statistical significance. In the IPWRA analysis using the 3-level exposure definition, unwanted pregnancies were associated with higher risk of socioemotional developmental delay (RR = 1.14; 95% confidence interval [CI], 1.01-1.28) and co-occurring internalizing and externalizing behaviors (RR = 1.11, 95% CI, 1.00-1.22), compared with intended pregnancies. CONCLUSION: There was higher risk of poor child outcomes among unwanted compared with intended pregnancies, whereas mistimed pregnancies were not associated with poor outcomes. Further research using standardized definitions of pregnancy intention along with targeted interventions that increase access to family planning services and counseling for parents of children born after unintended pregnancies is needed.

Callosal abnormalities, altered cortisol levels, and neurocognitive deficits associated with early maltreatment among adolescents: A voxel-based diffusion-tensor imaging study.

INTRODUCTION: Neuroimaging studies have shown callosal abnormalities among maltreated subjects, but little is known about the functional and neurobiological correlates of these supposed developmental alterations. The aim of this study was to investigate childhood maltreatment (CM), neurocognitive functioning, cortisol levels, and corpus callosum (CC) integrity among adolescents. METHODS: One hundred and seven subjects underwent magnetic resonance imaging (MRI) with voxel-based diffusion-tensor imaging (DTI) and the Crossed Finger Localization Test (CFLT). Psychopathology was investigated with the Schedule for Affective Disorders and Schizophrenia (K-SADS-PL); CM was detailed by the Childhood Trauma Questionnaire (CTQ), and salivary cortisol levels were measured by immunoassay. RESULTS: Higher levels of CM were associated with current lower CFLT scores, mainly in the CROSSED condition, involving interhemispheric communication of sensorimotor information (p < .05) and with reduced fractional anisotropy (FA) in the splenium of the CC (p < .01). Deficits in the CFLT were also associated with higher cortisol levels (p < .05). CONCLUSION: The association among CM, neuropsychological abnormalities, callosal microstructure alterations, and cortisol levels suggests an altered pattern of brain interhemispheric connectivity among maltreated adolescents. Further studies are needed to investigate the extent to which these sensorimotor deficits and abnormal cortisol levels may be possible mediators of negative neurodevelopmental trajectories and adult psychopathology.

Validation of a Tool to Evaluate Drug Prevention Programs Among Students.

Background: School-based prevention programs have been implemented worldwide with the intention of reducing or delaying the onset of alcohol and drug use among adolescents. However, their effects need to be evaluated, being essential to use validated and reliable questionnaires for this purpose. This study aimed to verify the semantic validity and reliability of an instrument developed to evaluate the results of a government drug prevention program for schoolchildren called #Tamojunto2.0. Methods: This is a mixed methods study with quantitative (test-retest, confirmatory factor analysis and non-response evaluation) and qualitative analyses (focus group and field cards). The self-administered questionnaires were used for a sample of 262 eighth-grade students (elementary school II) in 11 classes of four public schools in the city of São Paulo. Results: The level of agreement was substantial (Kappa 0.60-0.79) or almost perfect (Kappa > 0.8) for almost all questions about the use of marijuana, alcohol, cigarettes, cocaine, crack, and binge drinking. The model fit indices, for almost all secondary outcomes, indicated that the modls underlying each scale, constituted by observed and latent variables, had a good fit adjustument. The focus groups and field cards provided high-quality information that helped the researchers identify the main difficulties in applying and understanding the questions. Conclusion: The questionnaire showed high factorial validity, reliability and understanding by adolescents. After the necessary changes, identified in this study, the questionnaire will be suitable to evaluate the results of the #Tamojunto2.0 program in a randomized controlled trial.

Effectiveness of the Elos 2.0 prevention programme for the reduction of problem behaviours and promotion of social skills in schoolchildren: study protocol for a cluster-randomized controlled trial.

BACKGROUND: Early interventions benefit the mental health, academic performance and productivity of children and adolescents throughout their life. The present study protocol will evaluate the effectiveness of the Elos 2.0 Programme, which is a version adapted for Brazil by the Ministry of Health, in reducing problem behaviours (e.g., disruptiveness, aggressivity and shyness) and promoting social skills in the school context in children 6 to 10 years of age. The Elos Programme is based on the Good Behaviour Game, which is widely used and prevents and/or reduces students' disruptive behaviours by establishing cooperation contingencies. METHOD: A cluster-randomized controlled trial will be performed in 30 schools in three cities (15 controls and 15 in the experimental group), with a total of 3800 children participating in the test (1900 in the control group and 1900 in the intervention group). Data will be collected by having teachers in the control and experimental classes complete the Teacher Observation of Classroom Adaptation (TOCA) questionnaire, which is an instrument used to observe children's behaviour in the classroom. We will collect data before and after the intervention period in the same year. Due to the hierarchical structure of the data, multilevel analysis will be performed to detect simultaneous differences in prevalence over time and across groups to control for sociodemographic variables. DISCUSSION: The current study will examine the effectiveness of the Elos 2.0 Programme in reducing problem behaviours (e.g., disruptiveness, aggressivity and shyness) and promoting social skills in the school context. The findings of this school-based prevention programme for children will influence the development and implementation of similar programmes for schools and educational policymakers by identifying mechanisms that are central to achieving positive outcomes for participants. TRIAL REGISTRATION: Registry of Clinical Trials of the Ministry of Health RBR-86c6jp . Registered February 2, 2019.