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Can Entertainment Education be Used to Prevent Alcohol and Drug Use by Young People?
Last registered on July 22, 2019

Pre-Trial

Trial Information
General Information
Title
Can Entertainment Education be Used to Prevent Alcohol and Drug Use by Young People?
RCT ID
AEARCTR-0002922
Initial registration date
April 24, 2018
Last updated
July 22, 2019 9:46 PM EDT
Location(s)

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Primary Investigator
Affiliation
World Bank
Other Primary Investigator(s)
PI Affiliation
World Bank
PI Affiliation
American University
Additional Trial Information
Status
On going
Start date
2018-04-25
End date
2020-04-30
Secondary IDs
Abstract
Latin America has high rates of drug and alcohol consumption by young people (Inter-American Drug Abuse Control Commission, 2015), with rates rapidly increasing during the adolescent years. In Mexico, the 2014 National Survey of Drug Use among Students (n=191,880; Villatoro et al, 2015) revealed that the prevalence of drug use increases exponentially from primary (3.3%) to middle (10.9%) and high school (26.2%). The same pattern is observed for alcohol binging (defined as 5 or more drinks in one sitting) in the last year: prevalence was 2.4% in primary, 8.9% in middle and 27.3% in high school. The social costs of addictions continue into adulthood. For example, according to the Addiction Attention and Prevention Institute (2012), four out of every five crimes in Mexico are committed under the influence of alcohol.
Governments have commonly sought to address this problem through primary prevention programs delivered in the school setting. The evidence of these programs’ effectiveness, mostly from developed countries, is mixed. Faggiano et al (2014) provide a comprehensive overview of various types of programs and a systematic review and meta-analysis of impacts measured through 51 RCTs. They find improvements in knowledge and small effects on behavior, though not always statistically significant. Moreover, these programs are generally quite resource intensive (most involve between 10 to 20 sessions), and for this reason, they cannot be easily scaled up in developing countries.

Many behavior change interventions are based on rational behavior models that greatly assume the provision of information should be sufficient to motivate individuals to adopt healthier behaviors. Rational and individual-centered models are increasingly being enriched with insights from the psychology and sociology literatures (DellaVigna 2007, World Bank World Development report “Mind, Society and Behavior” 2015). Decisions are often driven by emotions, systematic biases, and by an individual’s perception of social norms, or what others do or approve of. Mass media programs can support behavior change campaigns by targeting these non-rational components. Entertainment education (or edutainment) is a type of media that incorporates educational messages into an entertaining format with the end goal of improving knowledge, shifting attitudes and social norms and changing behavior (Singhal and Rogers, 2004). Entertainment education traces its theoretical foundations to Albert Bandura's (1976) social learning theory, which posits that individuals learn by observing others, especially if these are role models that observers can relate to. Narratives are inherently easier to observe, understand and remember than abstract concepts that lack a storyline to connect them (Fisher 1987). Pioneered by Mexican TV producer Miguel Sabido in the 70s, entertainment education has been used to address public policy issues primarily related to health, and increasingly in other areas as well.

The entertainment education production that is the focus of this evaluation, "Addicted to Life" (A2L), has been designed to prevent the consumption of psychoactive substances by young people. A2L was created by Life Changing Experiences, an Israeli company, with the help of national and international behavior specialists, and incorporates local content to make it more relevant and appealing to Mexican audiences. Screenings of A2L will be complemented by interventions organized in schools the following week: a workshop with students and a session with parents.

CinemaPark, the study’s implementation partner, distributes it in Mexico in Cinépolis movie theaters and in schools. Proof of concept evaluations have been conducted for A2L in the US, Israel and Mexico. However, these studies were based on exit surveys collected immediately after program exposure, so they only measured intended, and not realized, behavior change. The objective of this evaluation is to measure impacts on knowledge, attitudes and behaviors related to drug and alcohol use after six months of program exposure.

This study will investigate the potential role of an entertainment education production as a tool to prevent and reduce the use of alcohol and drugs among middle school students in Mexico City. The participants will be students in the second year (12-14 year-olds) of middle school. The selection of the target group is motivated by consumption patterns as measured by the 2012 Survey of Drug Use among Students in Mexico City. This survey revealed that students start experimenting with alcohol and drugs in the second and third year of middle school, hence the importance of implementing a prevention program with this group. We chose students in the second year to be able to measure effects in the following academic year (those in the third year would have already moved on to high school).

The study will employ a cluster randomized controlled trial design where schools will be randomly assigned to one of three groups: screenings of “Addicted to Life” in the movie theater plus complementary school based interventions (Treatment 1), screenings of “Addicted to Life” in schools plus complementary school based interventions (Treatment 2), and a comparison group that will participate in screenings of “Addicted to Life” only after the follow-up survey. This evaluation is part of the Narrating Behavior Change research program of the World Bank’s Development Impact Evaluation (DIME) Unit. In its first phase, this research program is launching randomized controlled trials in the entertainment hubs of Brazil, India, Mexico, and Nigeria.

The study aims to answer the following research questions:
1. Does the intervention lead to changes in knowledge about the effects of drugs, perceptions of risk, self-efficacy to resist peer pressure, beliefs about the consumption of peers?
2. Does the intervention lead to a reduction in or a delayed onset of alcohol and drug use?
3. Does the mode of delivery for the edutainment production matter: do screenings in movie theaters and in schools have similar effects?
4. Do the effects differ by gender?
5. Are there heterogeneous effects on youth at higher risk of consumption ex ante?
External Link(s)
Registration Citation
Citation
Costica, Laura Elena, Jessica Leight and Victor Orozco. 2019. "Can Entertainment Education be Used to Prevent Alcohol and Drug Use by Young People? ." AEA RCT Registry. July 22. https://doi.org/10.1257/rct.2922-3.0.
Former Citation
Costica, Laura Elena, Jessica Leight and Victor Orozco. 2019. "Can Entertainment Education be Used to Prevent Alcohol and Drug Use by Young People? ." AEA RCT Registry. July 22. https://www.socialscienceregistry.org/trials/2922/history/50490.
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Experimental Details
Interventions
Intervention(s)
The entertainment education production that is the focus of this evaluation, "Addicted to Life" (A2L), has been designed to prevent the consumption of psychoactive substances by young people . A2L was created by Life Changing Experiences, an Israeli company, with the help of national and international behavior specialists, and incorporates local content to make it more relevant and appealing to Mexican audiences. A2L is an educational multi-sensorial and interactive production intended to promote a drug free life. It shows dramas of teenagers who suffered negative health consequences after consuming drugs or were involved in a car crash due alcohol abuse. The show also includes 3D videos about how the different drugs and their natural equivalent, dopamine “highs” from say, running or engaging in intellectual endeavors, affect the brain and ultimately youths’ behaviors. It has a total duration of 1.5 hours.

Screenings of A2L will be complemented by interventions organized in schools the following week: a workshop with students and a session with parents. Both will been designed and carried by an external organization specialized in organizing activities for the prevention of alcohol and drug use among youth. The workshop with students will have a duration of 1.5 hours and will center around three key messages that can be traced back to specific theoretical mechanisms underlying entertainment education : (1) I can resist peer pressure to consume and can support others when they are being pressured (self-efficacy channel), (2) drugs generate only temporary happiness by affecting our central nervous system, and real happiness is to be found is each one of us (information channel) (3) drug and alcohol use is not very common among young people (social norms channel). Through open discussion and role playing, students will be encouraged to reflect upon these messages and consider their relevance to their own lives. The sessions with parents, also lasting for 1.5 hours, will provide information about “Addicted to life” and will encourage them to talk to their children about the use of drugs and alcohol.
Intervention Start Date
2018-05-08
Intervention End Date
2018-07-10
Primary Outcomes
Primary Outcomes (end points)
Knowledge about the effects of drugs
Attitudes: Perceptions of risk, self-efficacy to resist peer pressure, beliefs about the consumption of peers, and behavior intentions
Behaviors: Alcohol and drug use throughout life, in the last 6 months, in the last 30 days; alcohol binging
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
The evaluation will be a cluster randomized trial implemented in 150 middle schools in Mexico City. Since spillovers may occur within the same school, we opted for a design where schools, and not individuals, will be randomly assigned to receive the intervention or not. To ensure that there is no systematic difference between control and treatment schools beyond the provided interventions, the invitation to schools will be delivered in an identical manner and the randomization will be stratified by school size and type (technical or regular). Schools who sign up to participate will be randomly allocated to one of three groups: screenings of “Addicted to Life” in the movie theatre plus complementary school based interventions (Treatment 1), screenings of “Addicted to Life” on school premises plus complementary school based interventions (Treatment 2), a comparison group that will participate in screenings of “Addicted to Life” after the follow-up survey (Control).
Experimental Design Details
Not available
Randomization Method
Randomization done in office by a computer
Randomization Unit
Schools, then classrooms within schools
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
250 schools
Sample size: planned number of observations
7500
Sample size (or number of clusters) by treatment arms
2500
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
We conducted power calculations using data from the 2012 Survey of Drug Use among Students in Mexico City, shared with the research team by the National Institute of Psychiatry of Mexico. Assuming a power of 80%, a significance level of 5% and performing two-sided tests, we calculated that 50 students in each school or a total of 7,500 students will result in minimum detectable effect sizes of 0.8-0.9 standard deviations for outcomes measuring consumption of a series of drugs, alcohol use, alcohol binging and perceptions of risk. Assuming an equal gender distribution, minimum detectable effect sizes for the same outcomes measured on males are 0.11-0.12 standard deviations and on females 0.11-0.14 standard deviations.
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
Solutions IRB
IRB Approval Date
2018-04-23
IRB Approval Number
#2018/04/13
Analysis Plan
Analysis Plan Documents
Pre-analysis Plan: Can Entertainment Education be Used to Prevent Alcohol and Drug Use by Young People

MD5: e7c6062806a0efb9461f79868044c73b

SHA1: 5e05734614110bf4f24a79cd28221f2dd8d5a3b4

Uploaded At: July 22, 2019