School-based Prevention Programs Research Articles

Feasibility study of the e-learning version of the “Journey of the Brave:” a universal anxiety-prevention program based on cognitive behavioral therapy

BackgroundSchool-based cognitive behavioral therapy (CBT) programs could contribute toward preventing anxiety disorders in children. However, setting aside class time for such programs is difficult. Internet-based CBT (I-CBT) is an efficient way to provide CBT. However, studies on I-CBT for anxiety prevention remain scarce, including I-CBT for school-based universal prevention programs. Therefore, we developed an e-learning version of a school-based anxiety-prevention CBT program, “Journey of the Brave,” which was effective in Japan, to make it more flexible and accessible. This study evaluated its feasibility.MethodsWe conducted a single-arm study based on 44 parents and children. Children aged 10–12 years took the e-learning program at home. Parents and children responded to a questionnaire three times: before the learning (Pre), after the learning (Post), and three months later (FU: Follow-up). Feasibility was comprehensively evaluated through dropout rates, satisfaction and learning records, and changes in scores on psychological scales assessing anxiety symptoms, emotion-regulation skills, and children’s emotional and behavioral problems.ResultsOf the 44 children, 42 started the e-learning, and 32 continued it (dropout rate of 23.8%). Furthermore, 83.9% of the children and 96.8% of the parents responded “agree” or “somewhat agree” regarding overall satisfaction. The parent-rated Spence Children’s Anxiety Scale(SCAS) (SCAS-P) showed a significant decrease between Pre and FU (p = 0.014, 95% CI = (-9.22, -0.84)); however, the child-rated SCAS (SCAS-C) reduction was not significant (p = 0.08). The Emotion‑Regulation Skills Questionnaire (ERSQ) also increased significantly between Pre and FU (p = 0.045, 95% CI = (0.18, 18.31)). The Total Difficulties Score of the Strengths and Difficulties Questionnaire(SDQ) decreased significantly from Pre to Post (p = 0.025, 95% CI = (-3.62, -0.19)); however, it was not significantly different between Pre and FU (p = 0.67).ConclusionThe e-learning version showed low dropout rates and high satisfaction ratings from parents and children. Moreover, this study did not rule out the possibility that the program reduced children’s anxiety and improved their emotional-regulation skills. Therefore, its potential and feasibility were indicated.Trial registrationUMIN, UMIN000049182, Registered 11 October 2022.

Effect of a multicomponent school-based intervention with parental involvement on socioeconomic inequalities in smoking initiation: equity impact analysis of the TOPAS study

BackgroundAs prevalence of tobacco use falls, socioeconomic inequalities in tobacco use are increasing in many high-income countries. Evidence is lacking on the effect of preventive interventions on socioeconomic inequalities in...

Caries Incidence in School-Based Prevention Programs in the Presence of Interval Censoring.

School-based caries prevention can increase access to critical dental services and reduce oral health inequities. However, little is known regarding the incidence of dental caries in children participating in school caries prevention, and caries diagnosis is often interval censored. In this paper, we used data from a longitudinal, school-based, randomized clinical trial of minimally invasive treatments for dental caries to estimate the per-visit incidence rate and compare the hazard of dental caries in children receiving either silver diamine fluoride or glass ionomer dental sealants. To account for interval censoring, we used semiparametric transformation models for univariate failure time data and imputed caries incidence using G-imputation. There were 3040 children that met inclusion criteria for analysis, 1516 (49.9%) of which were randomly assigned to receive silver diamine fluoride and 1524 (50.1%) were assigned to receive glass ionomer dental sealants and atraumatic restorations. There were no differences in the hazard of caries between treatments (HR = 0.99, 95% CI = 0.72, 1.24), while children with caries at baseline had a significant increase in the hazard of new caries (HR = 2.54, 95% CI = 2.26, 2.83) compared to those that were caries free. The per-visit caries incidence ranged from 4.8 to 11.1 at the individual level and increased with each successive study observation. School-based caries prevention can positively affect caries incidence, and the results can be used to inform future program design and implementation.

School-based eating disorder prevention programmes and their impact on adolescent mental health: systematic review.

Growing evidence indicates an association between disordered eating and a range of mental health problems, including anxiety, depression and emotional dysregulation. This study aimed to explore whether reducing risk factors for eating disorders, such as body dissatisfaction and low self-esteem, through school-based programmes can enhance adolescent mental health. We searched PubMed, PsycINFO, EMBASE and Web of Science from the date of inception to 15 October 2023. Data were synthesised by using a systematic narrative synthesis framework, and formal assessments were conducted to assess the quality of the included studies. After title/abstract screening and full-text assessment, 13 articles met the pre-specified inclusion criteria, comprising a total of 14 studies (n = 5853). Notably, three studies encompassed multiple programmes, leading to the identification of 17 eating disorder prevention programmes. Among these programmes, seven (41%) employed dissonance-based approaches. Topics covered in the programmes included psychoeducation, body acceptance, sociocultural issues, nutrition and physical activities, self-esteem and stress coping. Ten (59%) of the programmes were effective in improving adolescent mental health. Six of the 14 studies (43%) did not specify follow-up time, and quality assessments found the majority to be of either high (five studies, 36%) or fair (eight studies, 57%) quality. The findings from the ten effective programmes consistently support the use of body acceptance strategies in improving the mental health of adolescent students. Brief interventions delivered by trained, non-licensed facilitators appear good for the sustainable implementation of in-school psychological services to support well-being among adolescents.

Telehealth-delivered depression prevention: Short-term outcomes from a school-based randomized controlled trial.

To examine short-term (i.e., postintervention) outcomes from a randomized controlled trial comparing a school-based telehealth-delivered depression prevention program, Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), to services as usual (SAU). We expected IPT-AST would be acceptable and feasible and that IPT-AST adolescents would experience greater reductions in depression symptoms, anxiety symptoms, and impairment compared with SAU. Adolescents (N = 242; Mage = 14.80 years, SD = 0.70; 65% female; 21% Black; 13% Hispanic/Latinx) with elevated scores on the Center for Epidemiologic Studies Depression Scale (Radloff, 1977) at screening provided data at baseline, 2-month (midpoint of IPT-AST), and 3-month (postintervention) assessments. They reported depression symptoms on the Center for Epidemiologic Studies Depression Scale, anxiety symptoms on the Screen for Child Anxiety Related Emotional Disorders (Birmaher et al., 1997), and impairment on the Columbia Impairment Scale (Bird et al., 1993). Baseline depression diagnosis was examined as a moderator. Hierarchical linear models showed that adolescents reported significant reductions in depression symptoms and impairment across conditions. IPT-AST adolescents reported significantly greater reductions in anxiety symptoms than SAU adolescents, d = .39, 95% CI [.05, .72], p = .003. Depression diagnosis moderated outcomes (ds = .33-.34, ps ≤ .05), such that IPT-AST adolescents without a diagnosis at baseline showed greater improvements in depression and anxiety symptoms than SAU adolescents. Adolescents in SAU with a depression diagnosis at baseline showed greater improvements in impairment compared with IPT-AST. Attendance and satisfaction data demonstrated the feasibility and acceptability of telehealth-delivered IPT-AST. Results support telehealth-delivered IPT-AST as a promising intervention for improving short-term outcomes among adolescents with depression symptoms but without a depression diagnosis. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Could We Prevent Tobacco Products in Young Populations?

The well-documented detrimental effects of tobacco on children and adolescents make it imperative to prevent tobacco use in young populations, which is a critical public health objective. Youth are particularly susceptible to nicotine’s addictive properties, and they are more susceptible to developing an addiction to tobacco products if they begin using them at a young age, according to research. The reduction of tobacco use among young people can be achieved by implementing evidence-based strategies, including increasing the minimum legal age for purchasing tobacco products, increasing taxation on these products, restricting marketing aimed at youth, and facilitating comprehensive school-based prevention programs, etc. Furthermore, prevention initiatives may be further bolstered by initiatives to encourage smoke-free environments and offer access to smoking cessation resources. In order to effectively prevent tobacco use in young populations and promote healthier outcomes for future generations, it is necessary to target various levels of intervention and involve multiple sectors, including healthcare professionals, educators, policymakers, and community leaders.

Comparative Outcomes of Three School-Based Cognitive-Behavioral Interventions for Adolescent Suicide Prevention in Hong Kong.

Background/Objectives: This study assessed the effectiveness of a school-based suicide prevention program in Hong Kong. Methods: 105 secondary school students aged 14-16, identified as having high levels of depression and suicidal ideation. Participants were divided into three intervention groups: one for adolescents only, another for adolescents with peers, and a third for adolescents with parental involvement. All groups engaged in weekly online exercises. Repeated measures ANOVA was used to analyze the within-group and between-group differences in the levels of adolescents' suicidal ideation, depression and anxiety. Results: The results indicated a statistically significant reduction in suicidal ideation, depression and anxiety levels after participation in all three groups. No statistically significant between-group differences were identified, meaning the effects of the three interventions on the measured outcomes were similar. Conclusions: This study demonstrates the promise of implementing school-based suicide prevention programs in the Hong Kong context.

The Impact of School-Based Caries Prevention Programs on DMFT Scores and Oral Health Behaviors in School Children

Oral health promotion is recognized as one of the fundamental components of health-promoting schools. However, few studies have demonstrated the efficacy of supportive school environments for school children’s Oral health. This systematic review evaluates the impact of school-based caries prevention programs on DMFT scores and Oral health behaviours in school children. Objective: To evaluate the impact of school-based caries prevention programs on DMFT Scores and Oral Health Behaviors in school children. Methods: Databases like PubMed, Google Scholar, Cochrane Library, Springer, and Science Direct were searched from January 2009 to February 2024. Prisma guidelines were followed; 1, 950 studies were identified on the first search, titles, and abstracts of 500 papers were screened, 500 full-text papers were screened for eligibility, and 25 studies meeting the inclusion criteria were evaluated, relevant information was extracted, and a systematic review was conducted. Twenty-five studies were included in the systematic review. Results: These results indicate the significant role of SCPP among school-going children. Children with school-based caries prevention programs compared to those with no school-based caries prevention programs showed improved DMFT scores, reduced caries increment, healthy oral health behaviours, consistent Oral health hygienic habits, frequent use of flossing, fluoride toothpaste and mouth rinsing, and increased caries prevention knowledge. Conclusions: It was concluded that based on the pooled results, school-based caries prevention programs provide better, easily accessible, and sustainable caries prevention activities to school children to improve DMFT scores and Oral health behaviours.

Problematic use of social media in adolescents or excessive social gratification? The mediating role of nomophobia

The term problematic social media use (PSMU) refers to the interference produced by social networks in everyday life, where online participation is perceived as rewarding and continues despite negative consequences. The constant gratification (peer connection, instant notifications, scrolling, and variable rewards) has negative consequences for the well-being of adolescents, from the fear of not being connected to developing negative moods. Recent studies of uses and gratifications theory suggest that user preferences, such as the search for friendships and maintaining social relations, are related to PSMU. Based on that theory, this study analyzes the mediating role of nomophobia in the link between social use (social gratification) and problematic social media use among adolescents in Madrid (Spain). The research was conducted in 2022 with adolescents aged 14–17 (N = 820), who self-reported the use of social media, nomophobia, and problematic social media use (Adolescent Risk of Addiction to Social Networks and the Internet Questionnaire; ERA-RSI). The data were analyzed using structural equation modeling (SEM) with partial least squares (PLS). The gratification-oriented social use offered by social networks in interactions with other people and nomophobia were explanatory variables for problematic use in adolescent participants. As predicted, nomophobia mediates the link between social use and PSMU. Social use and nomophobia were positively and significantly related, with a medium effect size. The preference for online social interaction and fear of losing this connection contribute significantly to PSMU. The results revealed the need for school-based prevention and intervention programs for digital well-being.

Testing an Organizational Implementation Process Model Related to Teachers' Implementation-Related Attitudes and Behaviors: a Multilevel Mediation Analysis.

The effectiveness of school-based universal prevention programs is frequently diminished due to low-quality implementation. Organizational factors support high-quality implementation because of their broad influence across implementers. Conceptually, implementation leadership (i.e., behaviors that prioritize, reward, and support evidence-based practice [EBP] implementation) works to embed a favorable implementation climate (i.e., implementers' collective perceptions that their organization prioritizes, rewards, and support EBP implementation) leading to improved implementation citizenship behavior and attitudes toward EBP. This organizational implementation process model has some empirical support but has not been tested in a multilevel framework or related to hypothesized attitudinal and behavioral outcomes. The sample included 319 teachers across 39 US public elementary schools; all were implementing Schoolwide Positive Behavior Interventions and Supports. Multilevel mediation (level 1 = teacher, level 2 = school) was used to test the indirect association of implementation leadership on implementation-related attitudes and behaviors via implementation climate across two time points (fall and spring). At the school level, the organizational implementation process model was validated related to implementation citizenship behavior, but not attitudes toward EBP. At the teacher level, the process model was validated related to both outcomes, and there was a significant direct effect of implementation leadership on attitudes toward EBP. Developing strong leaders for implementation seems key to achieving high-quality EBP implementation. Implications for schools, principal training, and research are discussed.

52281 Stopping Skin Cancer: Evaluating the effectiveness of a school-based skin cancer prevention program in changing adolescents’ behaviors

52281 Stopping Skin Cancer: Evaluating the effectiveness of a school-based skin cancer prevention program in changing adolescents’ behaviors

Refining the Universal, School-Based OurFutures Mental Health Program to Be Trauma Informed, Gender and Sexuality Diversity Affirmative, and Adherent to Proportionate Universalism: Mixed Methods Participatory Design Process.

Mental disorders are the leading cause of disease burden among youth. Effective prevention of mental disorders during adolescence is a critical public health strategy to reduce both individual and societal harms. Schools are an important setting for prevention; however, existing universal school-based mental health interventions have shown null, and occasionally iatrogenic, effects in preventing symptoms of common disorders, such as depression and anxiety. This study aims to report the adaptation process of an established, universal, school-based prevention program for depression and anxiety, OurFutures Mental Health. Using a 4-stage process; triangulating quantitative, qualitative, and evidence syntheses; and centering the voices of young people, the revised program is trauma-informed; lesbian, gay, bisexual, transgender, nonbinary, queer, questioning, and otherwise gender and sexuality diverse (LGBTQA+) affirmative; relevant to contemporary youth; and designed to tailor intervention dosage to those who need it most (proportionate universalism). Program adaptation occurred from April 2022 to July 2023 and involved 4 stages. Stage 1 comprised mixed methods analysis of student evaluation data (n=762; mean age 13.5, SD 0.62 y), collected immediately after delivering the OurFutures Mental Health program in a previous trial. Stage 2 consisted of 3 focus groups with high school students (n=39); regular meetings with a purpose-built, 8-member LGBTQA+ youth advisory committee; and 2 individual semistructured, in-depth interviews with LGBTQA+ young people via Zoom (Zoom Video Communications) or WhatsApp (Meta) text message. Stage 3 involved a clinical psychologist providing an in-depth review of all program materials with the view of enhancing readability, improving utility, and normalizing emotions while retaining key cognitive behavioral therapy elements. Finally, stage 4 involved fortnightly consultations among researchers and clinicians on the intervention adaptation, drawing on the latest evidence from existing literature in school-based prevention interventions, trauma-informed practice, and adolescent mental health. Drawing on feedback from youth, clinical psychologists, and expert youth mental health researchers, sourced from stages 1 to 4, a series of adaptations were made to the storylines, characters, and delivery of therapeutic content contained in the weekly manualized program content, classroom activities, and weekly student and teacher lesson summaries. The updated OurFutures Mental Health program is a trauma-informed, LBGTQA+ affirmative program aligned with the principles of proportionate universalism. The program adaptation responds to recent mixed findings on universal school-based mental health prevention programs, which include null, small beneficial, and small iatrogenic effects. The efficacy of the refined OurFutures Mental Health program is currently being tested through a cluster randomized controlled trial with up to 1400 students in 14 schools across Australia. It is hoped that the refined program will advance the current stalemate in universal school-based prevention of common mental disorders and ultimately improve the mental health and well-being of young people in schools.

Could school programs based on social-emotional learning prevent substance abuse among adolescents?

In this editorial, we comment on the article Adolescent suicide risk factors and the integration of social-emotional skills in school-based prevention programs by Liu et al . While the article focused on the issue of suicide and social-emotional learning programs as a possible intervention, we here discuss evidence of other reported outcomes and if it could be an effective way to prevent substance abuse among adolescents.

Two universal school-based prevention programs for depression and anxiety: 24-Month follow-up of an RCT

Background and objectivesTransdiagnostic approaches have been promoted as a means of maximising preventative effects across multiple problems with depression and anxiety suitable targets as they appear to have highly interconnected systems in pathology development and maintenance. This study investigated long-term effects of two universal school-based programs, Emotion Regulation (ER) and Behavioral Activation (BA), that sought to prevent depression and anxiety by targeting worry (a transdiagnostic feature) to promote resilience. MethodsThis follow-up study captured data from 162 of 316 initial students (aged 8–13; 52.2% female), from six Australian schools. The original study design cluster randomised students by school into BA, ER, or a usual class control. Intervention conditions consisted of 8 × 50-min weekly sessions. This study measured the effects of these interventions after 24 months on resilience, worry, depression, and anxiety. Resilience was also examined as a potential mediator. ResultsAt 24-month follow-up, there was no significant effect of either intervention on depression, anxiety, worry, or resilience levels. Significantly fewer participants in ER and BA met clinical thresholds for separation anxiety disorder (SAD) and obsessive-compulsive disorder (OCD) in the 24-month follow-up compared with baseline. No mediation effects were found. LimitationsAlthough self-report measures are common in universal, school-based research, this represents a study limitation. ConclusionsBoth interventions may provide limited long-term protective effects on SAD and OCD symptoms, which appear to have a shelf-life shorter than 24 months. To maintain program effects, refresher sessions at shorter intervals may be a consideration for future research.

Factors influencing the overall satisfaction of teachers participating in a nationwide school-based smoking prevention program in Korea.

Numerous studies of school-based smoking prevention programs (SSPPs) exist; however, most have been conducted from the students' perspective, and insufficient research has explored teachers' perceptions. Our study aimed to identify factors affecting overall satisfaction and operational status from the perspective of teachers participating in the SSPP. This is a cross-sectional study analyzing data from a survey regarding the operation of an SSPP conducted by the Korea Health Promotion Institute in 2022. The study sample comprised 669 teachers involved in the SSPP: 215 from elementary schools, 212 from middle schools, and 242 from high schools. To identify factors influencing teachers' overall satisfaction, independent variables were categorized into three types of factors: personal, school, and teacher perceptions. Multiple linear regression analysis was performed for each factor to test the independent association. For elementary school teachers, as the necessity of smoking prevention and cessation education (β=0.292; 95% CI: 0.182-0.382) increased, the overall satisfaction with the operation of the SSPP significantly improved. Similarly, for middle school teachers, as the necessity of smoking prevention and cessation education (β=0.231; 95% CI: 0.104-0.336) increased, the overall satisfaction significantly improved. Conversely, for high school teachers, the effectiveness (β=0.347; 95% CI: 0.184-0.520) was the variable that significantly improved overall satisfaction with the SSPP operation. The variables affecting teacher satisfaction across all school levels were the necessity of smoking prevention and cessation education, the effectiveness of the SSPP, and its impact on smoking cessation among smoking students, all of which belonged to the teacher perceptions factor. Smoking education in schools requires teachers to play a crucial role. Among participating teachers, overall satisfaction with SSPP operations and the influencing factors differed according to school level, highlighting the importance of careful consideration to establish a more effective operational environment tailored to each school level.

Sense of School Belonging as a Mediator of the Relationship between Witnessing Bullying and Internalizing Symptoms.

Bullying is a significant public health concern associated with mental health risks. Negative bullying outcomes extend beyond targets, with students who witness bullying reporting negative associated mental health consequences. Because bullying often occurs within the school setting, understanding the relationship between witnessing bullying and internalizing symptoms within the school environment can help shape school-based bullying prevention. The purpose of this study was to examine sense of school belonging as a mediator of the relationship between witnessing bullying and internalizing symptoms. We conducted two studies with middle school students (N = 130; N = 147) in which we used structural equation modeling (SEM) to test the mediational model. Results from Study 1 and Study 2 supported the mediational model, indicating that one explanation for the relationship between witnessing bullying and internalizing symptoms is that witnessing bullying negatively impacts students' sense of school belonging, which in turn increases internalizing symptoms. Results from this study provide support for the importance of students' perceptions of school climate in the development of internalizing symptoms related to witnessing bullying. Implications for school-based bullying prevention programs are discussed.

School-based tobacco prevention and cessation program using psycho-education and counselling: a mixed method

Introduction. In Malaysia, tobacco-related causes of death have claimed an estimated 27,400 lives annually, and that number is anticipated to climb in the coming years. Despite laws in Malaysia banning smoking in public areas, restrictions on tobacco sponsorship, promotion, and advertising in all media, as well as Graphic Warning Labels (GWLs) on cigarette packets and restricting the legal smoking age to 18 years, it is well-known that children and teenagers are involved and youth tobacco usage is rising. As there is a rise in the prevalence of tobacco use so is the call for effective school-based tobacco prevention and cessation program for children and teenagers. The study set out to understand the current level of knowledge, attitude, and behaviour of children and teenagers towards tobacco use and possible change through psycho-education and counselling towards prevention and cessation. Study participants and methods. This study adopted a pre and post Mixed Method Triangulation Design: Convergence Model. There was an independent and concurrent collection of quantitative and qualitative data from school children ages 11 to 18 years and 7 to 10 years respectively. A one-day four-module school-based prevention and cessation program was developed and carried out in five approved schools and data were collected before and after the program. The mean age for the quantitative study was 13 years, 66% were males and 34% were females. For the qualitative study, the mean age was 9 years, 54% were male and 46% were female A grand total of 131 students participated in the study. The data was analyzed using descriptive statistics, paired samples t-test thematic analysis. Results. The quantitative analysis showed a significant difference between knowledge test scores before psychoeducation intervention (M=.803; SD=.1793) and Knowledge test scores after the psycho-education intervention (M=.895; SD=.1193); [t (108) = -4.596, p = .000], attitude and behavior were insignificant Results from the thematic analysis on the qualitative results showed that the psychoeducation and counselling intervention had a significant impact only on knowledge. The children report on attitude and behaviour towards tobacco did not significantly change from before to after the program. The timing between the program and postdata may be a contributing factor but irrespective of the data collection method the outcome was similar for both children and teenagers. Practical Significance. Through psycho-education and counselling towards prevention and cessation the study set out to understand the current level of knowledge, attitude, and behaviour of children and teenagers towards tobacco use and possible change through psycho-education and counselling towards prevention and cessation. Therefore, intervention programme should include psychoeducation and counselling to improve the knowledge of students in school-based interventions.

Challenges in Type 2 Diabetes Prevention among Senior High School Students: A Qualitative Study.

Schools, a place where students spend much more time than home, play an important role in preventing the nation's future generation from type 2 diabetes mellitus (T2DM). This study aimed to explore challenges in T2DM prevention among senior high school students. The study was conducted in Riau Province, Indonesia, from June to August 2023 using a qualitative content analysis. 31 respondents, determined by data saturation, were recruited using purposeful sampling. They were public senior high schools' principals, vice principals, school health services staff, school canteen tenants, students, parents, and primary health care personnel in six districts. Data were collected through semi-structured face-to-face interviews and document review. Graneheim and Lundman's content analysis method was used to analyze the data in Nvivo version 11 software. The Lincoln and Guba Qualitative research criteria for trustworthiness were used to ensure the rigor of the study. The main concepts obtained from the data were classified into three themes entitled, "Nonoptimal existing diabetes prevention programs in schools", "Inadequate knowledge of school community on T2DM", and "Inadequate policies to prevent diabetes in schools". An evidence-based, well-organized, and systematic school-based diabetes prevention program is fundamental to help overcome challenges and prevent future T2DM incidence. It requires relevant stakeholders' high level of awareness, strong collaborations with the school community, and effective school policies.

A Universal Program to Improve Mental Health among Youth from Low-Income Predominantly Minority Communities: Implementation of Advocates 4 ALL Youth (ALLY).

Disparities in mental health care and access to care disproportionately affect youth from minoritized and low-income communities. School-based prevention programs have the potential to offer a non-stigmatized approach to mental health care as well as the ability to reach many students simultaneously. Advocates 4 All Youth (ALLY) is a program developed for 5-6th grade students aimed at improving self-efficacy and resilience via individualized sessions with a trusted adult (ALLYs). The feasibility of delivering ALLY in a racially and minoritized low-income community is discussed and modifications required to implement the program documented. Students completed questionnaires and sessions with an ALLY. Aspects of program delivery deemed feasible included training ALLYs to delivery program, stakeholder buy-in regarding missing class time, and students attending the sessions. Further modifications included adjustments to materials due to lower reading level and health literacy related-educational needs. Programs designed in one demographic setting may not work in a different setting.

Effectiveness of School-based Substance abuse Prevention Programme (SSPP) on awareness, attitude, peer pressure, and life skills among adolescents in selected public schools of Pokhara, Nepal–A cluster randomized trial protocol

ObjectiveEarly substance use has been linked to various adverse outcomes and escalates quickly during adolescence. Delaying the onset of substance use among adolescents is a primary public priority as it is associated with severe effects. The objective of the study is to develop and determine the effectiveness of a School-based Substance Abuse Prevention Programme (SSPP) on awareness, attitude, peer pressure, and life skills towards preventing substance abuse among adolescents. MethodPhase I of the study is a qualitative approach, where a focus group discussion (FGD) will be conducted among different stakeholders to explore their perceptions regarding the prevention of substance use among adolescents. The anticipated sample size is 38. Thematic analysis will be done by using ATLAS.ti software. The inputs given by the stakeholders will be incorporated in developing the intervention (SSPP). Phase II is a cluster randomized controlled trial. A minimum of 210 adolescents (105 each in the intervention and control groups) between the age group of 13 to 15 years from 8th and 9th grade will be recruited for the study. In this study, the school will be the cluster and will be randomly assigned either to an intervention or control arm. The data will be collected at pre, post, 3-month, and 6-month intervals. The ethical approval was obtained from the Nepal Health Research Council Committee, Nepal (NHRC 276/2023). The trial was also registered under the Clinical Trial Registry of USA-Clinical Trials.gov (CTRI 06004726/2023/08/22/). Descriptive and inferential statistics will be used to analyze the data. Expected resultsImplementation of the SSPP module will improve the awareness, attitude, peer pressure, and life skills of adolescents toward preventing substance use behavior. Overall, the study aims to achieve Sustainable Development Goal (SDG) 3.5- ‘Good Health and Well-being; strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.’ ConclusionThe present study protocol will help to develop a unique training module (SSPP) focused on preventing substance use behaviour among adolescents in Nepal.