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Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes. [ABSTRACT FROM AUTHOR]

Machine learning provides a method of identifying factors that discriminate between substance users and non-users potentially improving our ability to match need with available prevention services within context with limited resources. Our aim was to utilize machine learning to identify high impact factors that best discriminate between substance users and non-users among a national sample (N = 52,171) of Mexican children (i.e., 5th, 6th grade; Mage = 10.40, SDage = 0.82). Participants reported information on individual factors (e.g., gender, grade, religiosity, sensation seeking, self-esteem, perceived risk of substance use), socioecological factors (e.g., neighborhood quality, community type, peer influences, parenting), and lifetime substance use (i.e., alcohol, tobacco, marijuana, inhalant). Findings suggest that best friend and father illicit substance use (i.e., drugs other than tobacco or alcohol) and respondent sex (i.e., boys) were consistent and important discriminators between children who tried substances and those that did not. Friend cigarette use was a strong predictor of lifetime use of alcohol, tobacco, and marijuana. Friend alcohol use was specifically predictive of lifetime alcohol and tobacco use. Perceived danger of engaging in frequent alcohol and inhalant use predicted lifetime alcohol and inhalant use. Overall, findings suggest that best friend and father illicit substance use and respondent's sex appear to be high impact screening questions associated with substance initiation during childhood for Mexican youths. These data help practitioners narrow prevention efforts by helping identify youth at highest risk. [ABSTRACT FROM AUTHOR]