School-based Substance Abuse Prevention Research Articles

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.

Effectiveness of Digital Health Tools to Prevent Bullying among Middle School Students

Bullying is a widespread public health problem with significant behavioral and mental health consequences. The current study tested the effectiveness of combining interactive digital material for students, educators, and parents with class sessions to prevent bullying among middle school students. Fourteen middle schools were randomly assigned to intervention and comparison conditions. Both conditions received a classroom-based drug and violence prevention program that taught social skills, self-management skills, and social resistance skills. The intervention condition included class material on bullying and an educational video game for students that reinforced the classroom program; it also included digital material on bullying for parents and school staff. All students completed online pre- and post-test surveys to assess bullying-related behavior, knowledge, and life skills. Results indicated that students in the intervention schools reported significantly less bullying and cyberbullying perpetration and increased life skills knowledge relative to comparison schools. This study provides evidence that a school-based drug abuse and violence prevention program, when enhanced with a set of digital tools for students, parents, and school staff, holds considerable potential for addressing bullying among middle school adolescents.

Life skills education: a coping strategy against substance abuse

Substance abuse has been a topic of discussion for healthcare professionals. It involves using harmful or hazardous psychoactive substances that, if administered into one's system, can affect the mental processes. Consumption of these substances leads to societal as well as health problems among its users there by indirectly affecting their families too. These substances mainly include alcohol, tobacco, opiates, cocaine, amphetamines, hallucinogens, prescription and over-the-counter drug abuse.1,2 According to the world drug report 2020 by United Nations Office on Drugs and Crime (UNODC), there are about 35 million people who suffer from drug use disorders and require treatment services globally.2 In India, the substance abuse epidemic in the younger generation has increased rapidly. The crucial factors which lead to these problems involve familial, social as well as individual problems. Familial issues may involve childhood maltreatment or familial substance abuse. Similarly, social issues involves deviant peer pressure and association with popular groups in order to prevent from being bullied. Individual factors which might lead to substance abuse includes depression and attention deficit hyperactivity disorder (ADHD).3 Its prevalence at the national level varies for different substance abuse forms, accompanied by drastic regional variations. Issues regarding treatment access and adherence concerning substance user disorders (SUD) already existed. Due to the current COVID-19 situation, drastic social and economic changes have further worsened the situation. So in this regard, newer strategies have to be brought up in place.4 It has been found that life skills education is one of the most influential activities in school-based substance abuse prevention.

GÉNERO Y PREVENCIÓN DE DROGODEPENDENCIAS: EVALUACIÓN DEL PROGRAMA ESCOLAR "JUEGO DE LLAVES"

El consumo de drogas en menores es una realidad preocupante, especialmente el de sustancias legales. Una de las principales medidas emprendidas para hacer frente a esta situación es el desarrollo de programas de prevención escolar dirigidos a favorecer la adquisición de actitudes y estilos de vida saludable. El objetivo de este artículo es comprobar si existen diferencias en el efecto de este tipo de programas en función del género. Para ello se lleva a cabo un análisis de los datos obtenidos en la evaluación del programa escolar “Juego de Llaves” realizada en el curso escolar 2016-2017 con una muestra de 4.195 estudiantes de Educación Secundaria de 32 centros educativos. Los resultados muestran diferencias ligadas al género previas a la implantación del programa en temas como el ocio, interacción social, gestión emocional, valores e información sobre drogas, que se mantienen una vez realizado. La aplicación del programa consigue un efecto diferencial en la autoestima que se incrementa en el grupo de las adolescentes. Se concluye recomendando que cualquier programa preventivo debe analizar las desigualdades observadas y las situaciones de vulnerabilidad específicas y proponer la definición de indicadores de género que permitan medir la efectividad de los programas en ambos sexos.

Quality of life and its related factors in women with substance use disorders referring to substance abuse treatment centers

BackgroundSubstance-Related Disorders are among the most common social problems caused by using legal and illegal substances. Therefore, this study aimed at determining the quality of life (QoL) and its related factors among women with substance use disorders referring to substance abuse treatment centers in Hamadan, west of Iran.MethodsThis cross-sectional study was carried out on 120 Iranian female substance users recruited through the census sampling method in 2018. Data collection tools consisted of demographic characteristics and QoL assessment (SF-36). Data were analyzed using SPSS-16 via one-way analysis of variance (ANOVA) and chi-square tests.ResultsThe mean age of the participants was 33.2 ± 12.1 years and the mean score of their total QoL was 35.35 ± 13.5. The results of multiple linear regression analysis indicated that using methamphetamine (β = − 6.62) was the predictor of QoL in women. Moreover, there was a significant association between QoL and age (p < 0.001), educational level (p = 0.011), and age at first use (p < 0.001).ConclusionAccording to the results, the participants’ QoL was found to be at an unsatisfactory level. So, it is essential to implement educational help-seeking behavior for treatment and effectiveness educational, as well as holding mental health intervention, school-based substance abuse prevention, and harm reduction programs of substance use. This is especially important in adolescents, young, low-educated, early drug use, and methamphetamine user women, as it may increase the QoL

Javanese Traditional Songs for Early Childhood Character Education

&#x0D; &#x0D; &#x0D; Character education in early childhood is not new, and character education is also not just a transfer of knowledge, but something that needs to be built early on through various stimula- tions. This study aims to develop the character of early childhood through audio-visual media with traditional Javanese songs. Using educational design-based research to develop audio-visual media from traditional songs, this media was tested in the field with an experimental design with a control group. Respondents involved 71 kindergarten students from one experimental class in one control class. The data revealed that character education in children shows the average value of the experi- mental class is higher than the control group, this means character education in children can be built through traditional songs. Further research can be done to improve the character of early childhood through a variety of media that interests children.&#x0D; Keywords: Early Childhood, Character Education, Javanese Traditional Songs Media&#x0D;

Increasing Implementation Fidelity for School-Based Drug Abuse Prevention: Effectiveness of Enhanced Training and Technical Assistance

Objective: A substantial barrier to translating prevention science into practice is the potential for low implementation fidelity when evidence-based interventions are delivered in real-world settings. This study tested the extent to which enhanced training and technical assistance can improve implementation fidelity of LifeSkills Training, an evidence-based drug abuse prevention program. Method: We recruited and randomly assigned middle schools (N = 34) to either a standard provider training condition or a fidelity-enhancement (FE) condition. Teachers in both conditions participated in a standard 1-day training session led by a certified trainer. Teachers in the FE condition received supplemental training and technical assistance (TA), which included planning workbooks, interactive DVD training tools, just-in-time e-mail reminders, and access to TA via the Internet and telephone. Trained coders rated videotapes of classroom teachers implementing curriculum sessions. An intent-to-treat analysis included all videotapes received, including sessions that were only partially implemented or videotaped. Results: Teachers in the FE condition covered significantly more curriculum points and objectives, taught longer sessions, and spent more time using facilitated group discussion and skills practice than teachers in the standard condition. Conclusions: Findings suggest that providing program providers with planning tools and telephone, e-mail and Internet-based TA can significantly enhance implementation fidelity.

Independent Evaluation of Middle School-Based Drug Prevention Curricula: A Systematic Review.

Lack of robust program evaluation has hindered the effectiveness of school-based drug abuse prevention curricula overall. Independently evaluated randomized controlled trials (RCTs) of universal, middle school-based drug abuse prevention curricula are the most useful indicators of whether such programs are effective or ineffective. To conduct a systematic review identifying independently evaluated RCTs of universal, middle school-based drug abuse prevention curricula; extract data on study quality and substance use outcomes; and assess evidence of program effectiveness. PsycInfo, Educational Resources Information Center, Science Citation Index, Social Science Citation Index, Cumulative Index to Nursing and Allied Health Literature, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched between January 1, 1984, and March 15, 2015. Search terms included variations of drug, alcohol, tobacco, and marijuana use, as well as school, prevention, and effectiveness. Studies included in the review were RCTs carried out by independent evaluators of universal school-based drug prevention curricula available for dissemination in the United States that reported alcohol, tobacco, marijuana, or other drug use outcomes. Two researchers extracted data on study quality and outcomes independently using a data extraction form and met to resolve disagreements. A total of 5071 publications were reviewed, with 13 articles meeting final inclusion criteria. Of the 13 articles, 6 RCTs of 4 distinct school-based curricula were identified for inclusion. Outcomes were reported for 42 single-drug measures in the independent RCTs, with just 3 presenting statistically significant (P < .05) differences between the intervention group and the control group. One program revealed statistically significant positive effects at final follow-up (Lions-Quest Skills for Adolescence). The results of our review demonstrate the dearth of independent research that appropriately evaluates the effectiveness of universal, middle school-based drug prevention curricula. Independent evaluations show little evidence of effectiveness for widely used programs. New methods may be necessary to approach school-based adolescent drug prevention.

Neutralization and glorification: Cannabis culture-related beliefs predict cannabis use initiation

Addressing specific pro-cannabis attitudes may be a viable adjunct to school-based substance abuse prevention programs. To study the predictive value of cannabis culture-related beliefs in relation to initiation of cannabis use, a prospective cohort study of 1223 students attending high school or equivalent education programs in Denmark were administered a questionnaire containing demographic information, questions about cannabis use, normative perception and personal beliefs in relation to two dimensions of cannabis culture-related beliefs: (1) beliefs about the negative consequences of cannabis use (neutralization) and (2) beliefs about positive aspects of cannabis use (glorification). Normative perception and glorification were both robustly associated with incidence of cannabis use at the 6- and 12-month follow-up. Neutralization was associated with initiated cannabis use only at the 12-month follow-up. These findings suggest that beliefs about the benefits of cannabis use may be as important in targeted programs to prevent cannabis use as beliefs about whether cannabis use is common or harmful.

A large-scale initiative to disseminate an evidence-based drug abuse prevention program in Italy: Lessons learned for practitioners and researchers

Across developed countries, experimentation with alcohol, tobacco, and other drugs often begins in the early adolescent years. Several evidence-based programs have been developed to prevent adolescent substance use. Many of the most rigorously tested and empirically supported prevention programs were initially developed and tested in the United States. Increasingly, these interventions are being adopted for use in Europe and throughout the world. This paper reports on a large-scale comprehensive initiative designed to select, adapt, implement, and sustain an evidence-based drug abuse prevention program in Italy. As part of a large-scale regionally funded collaboration in the Lombardy region of Italy, we report on processes through which a team of stakeholders selected, translated and culturally adapted, planned, implemented and evaluated the Life Skills Training (LST) school-based drug abuse prevention program, an evidence-based intervention developed in the United States. We discuss several challenges and lessons learned and implications for prevention practitioners and researchers attempting to undertake similar international dissemination projects. We review several published conceptual models designed to promote the replication and widespread dissemination of effective programs, and discuss their strengths and limitations in the context of planning and implementing a complex, large-scale real-world dissemination effort.

Long-Term Effects of the keepin’ it REAL Model Program in Mexico: Substance Use Trajectories of Guadalajara Middle School Students

In the face of rising rates of substance use among Mexican youth and rapidly narrowing gender differences in use, substance use prevention is an increasingly urgent priority for Mexico. Prevention interventions have been implemented in Mexico but few have been rigorously evaluated for effectiveness. This article presents the long term effects of a Mexico-based pilot study to test the feasibility of a linguistically specific (Mexican Spanish) adapted version of keepin' it REAL, a school-based substance abuse prevention model program. University affiliated researchers from Mexico and the US collaborated on the study design, program implementation, data collection, and analysis. Students and their teachers from two middle schools (secundarias) in Guadalajara participated in this field trial of Mantente REAL (translated to Spanish). The schools were randomly assigned to treatment and control conditions. The sample of 431 students reported last 30day substance use at three times (one pretest and two posttests). Changes in substance use behaviors over time were examined using growth curve models. Long term desired intervention effects were found for alcohol and marijuana use but not for cigarettes. The intervention effects were greater for girls than for boys in slowing the typical developmental increase over time in alcohol use. Marijuana effects were based on small numbers of users and indicate a need for larger scale studies. These findings suggest that keepin' it REAL is a promising foundation for cultural program adaptation efforts to create efficacious school-based universal prevention interventions for middle school students in Mexico.

Partnership, Knowledge Translation, and Substance Abuse Prevention With a First Nations Community

Partnership, Knowledge Translation, and Substance Abuse Prevention With a First Nations Community Lola Baydala, Fay Fletcher, Stephanie Worrell, Tania Kajner, Sherry Letendre, Liz Letendre, and Carmen Rasmussen What Is the Purpose of This Study? • To understand the benefits of culturally adapting and implementing a 3-year, school-based, drug and alcohol prevention program for First Nation children and youth. What Is the Problem? • Substance abuse is a significant area of concern within Aboriginal communities across Canada. However, effective school-based substance abuse prevention programs are not typically available to the majority of First Nations schools. • Prevention programs that are available often fail to integrate the cultural beliefs and values of individuals outside of the dominant culture. • More research is required on the benefits of culturally appropriate drug and alcohol prevention programs that incorporate the beliefs, values, language, and visual images of the community. What Are the Findings? • Qualitative measures revealed a positive effect of the culturally adapted program on youth. • Elders and community members observed positive changes in student’s cultural knowledge and cited observed behavioral changes as evidence of the adapted program’s success. • The culturally adapted program is seen as surpassing the original in terms of embodying the values of the community. • Positive community developments occurred as a result of the program adaptation process, which followed a community-based participatory research approach. • Results of the quantitative measures were mixed, in part as a result of inconsistent and unpredictable student school attendance. Who Should Care Most? • Educators, school officials, and health care providers working in First Nations communities. • Policymakers in the areas of health and education. • Community members and leaders. • Substance abuse, public health, and youth program providers. [End Page 139] Recommendations for Action • Highly effective, evidence-based substance abuse prevention programs for school-aged children can be successfully adapted to incorporate the cultural beliefs, values, language, and visual images of the community where the program is delivered. • Community Elders are the keepers of the Nation’s oral traditions and knowledge and their input and guidance is an important and necessary part of program adaptation, implementation, and evaluation. • Culture, language, history, and spirituality are the foundations of Aboriginal identity and are essential components of program adaptation. • Cultural adaptations should go beyond surface level cultural markers to include Aboriginal worldviews and ways of knowing, as well as recognition of historical impacts on health and education. • A community-based participatory research approach is a catalyst for community development and an important component of program sustainability. • Attention to both community capacity building and academic capacity building is important to ensure a successful project. [End Page 140] Lola Baydala University of Alberta Fay Fletcher University of Alberta Stephanie Worrell University of Alberta Tania Kajner University of Alberta Sherry Letendre University of Alberta Liz Letendre Alexis Heritage Program, Alexis Nakota Institute Carmen Rasmussen University of Alberta Copyright © 2014 The Johns Hopkins University Press

Advancing school-based interventions through economic analysis.

Commentators interested in school-based prevention programs point to the importance of economic issues for the future of prevention efforts. Many of the processes and aims of prevention science are dependent upon prevention resources. Although economic analysis is an essential tool for assessing resource use, the attention given economic analysis within school-based prevention remains cursory. Largely, economic analyses of school-based prevention efforts are undertaken as secondary research. This limits these efforts to data that have been collected previously as part of epidemiological and outcomes research. Therefore, economic analyses suffer from gaps in the knowledge generated by these studies. This chapter addresses the importance of economic analysis for the future of school-based substance abuse prevention programs and highlights the role of prevention research in the development of knowledge that can be used for economic analysis.

Public commitment, resistance to advertising, and leisure promotion in a school-based drug abuse prevention program: a component dismantling study.

The objective of the present study was to examine the contribution of three intervention components (public commitment, resistance to advertising, and leisure promotion) on alcohol and protective variables in a school-based substance use prevention program. Participants included 480 Spanish students aged from 14 to 16 who received the Saluda prevention program in one of the following five experimental conditions: complete program, program minus public commitment, program minus resistance to advertising, program minus leisure promotion, and a waiting-list control. The students completed self-report surveys at pretest, posttest, and 6-month follow-up assessments. When excluding the healthy leisure promotion component, the Saluda program showed no loss of efficacy neither on alcohol use nor on other substance-related variables, while public commitment and resistance to advertising improved the aforementioned program's efficacy.

Alcohol as a Gateway Drug: A Study of US 12th Graders

The Gateway Drug Theory suggests that licit drugs, such as tobacco and alcohol, serve as a "gateway" toward the use of other, illicit drugs. However, there remains some discrepancy regarding which drug-alcohol, tobacco, or even marijuana-serves as the initial "gateway" drug subsequently leading to the use of illicit drugs such as cocaine and heroin. The purpose of this investigation was to determine which drug (alcohol, tobacco, or marijuana) was the actual "gateway" drug leading to additional substance use among a nationally representative sample of high school seniors. This investigation conducted a secondary analysis of the 2008 Monitoring the Future 12th-grade data. Initiation into alcohol, tobacco, and other drug use was analyzed using a Guttman scale. Coefficients of reliability and scalability were calculated to evaluate scale fit. Subsequent cross tabulations and chi-square test for independence were conducted to better understand the relationship between the identified gateway drug and other substances' use. Results from the Guttman scale indicated that alcohol represented the "gateway" drug, leading to the use of tobacco, marijuana, and other illicit substances. Moreover, students who used alcohol exhibited a significantly greater likelihood of using both licit and illicit drugs. The findings from this investigation support that alcohol should receive primary attention in school-based substance abuse prevention programming, as the use of other substances could be impacted by delaying or preventing alcohol use. Therefore, it seems prudent for school and public health officials to focus prevention efforts, policies, and monies, on addressing adolescent alcohol use.

Boosting a Teen Substance Use Prevention Program with Motivational Interviewing

A brief motivational interviewing (MI) intervention may be a viable adjunct to school-based substance abuse prevention programs. This article describes the development and implementation of a brief MI intervention with 573 adolescents (mean age 16.8; 40.3% female, 68% Latino) enrolled in eight continuation high schools in Southern California. Study participants were assigned to the MI condition in a randomized controlled trial of Project Toward No Drug Abuse. Data are provided on dosage, topics discussed, and quality of MI determined with the Motivational Interviewing Skill Code (MISC). Results suggest that the protocol was feasible and implemented with adequate fidelity. The study's limitations are noted.

Effects of a School-Based Prevention Program on European Adolescents' Patterns of Alcohol Use

School-based substance abuse prevention programs are widespread but are rarely evaluated in Europe. We aimed to evaluate the effect of a new school-based prevention program against substance use on the frequency of alcohol consumption and alcohol-related problem behaviors among European students. During the school year 2004-2005, a total of 7,079 students aged 12-14 years from 143 schools in seven European countries participated in this cluster randomized controlled trial. Schools were randomly assigned to either control (65 schools, 3,532 students) or to a 12-session standardized program based on the comprehensive social influence model (78 schools, 3,547 students). Alcohol use and frequency of alcohol-related problem behaviors were investigated through a self-completed anonymous questionnaire at baseline and 18 months thereafter. The association between intervention and changes in alcohol-related outcomes was expressed as odds ratio (OR), estimated by multilevel regression model. The preventive program was associated with a decreased risk of reporting alcohol-related problems (OR = .78, 95% confidence intervals [CI] = .63-.98), although this reduction was not statistically significant in the subgroup of 743 current drinkers at baseline. The risk for alcohol consumption was not modified by exposure to the program (OR = .93, 95% CI = .79-1.09). In the intervention group, nondrinkers and occasional drinkers at baseline progressed toward frequent drinking less often than in the control group. School curricula based on the comprehensive social-influence model can delay progression to frequent drinking and reduce occurrence of alcohol-related behavioral problems in European students. These results, albeit moderate, have potentially useful implications at the population level.

School Disrepair and Substance Use Among Regular and Alternative High School Students

The physical environment influences adolescent health behavior and personal development. This article examines the relationship between level of school disrepair and substance use among students attending regular high school (RHS) and alternative high school (AHS). Data were collected from students (N = 7058) participating in 2 randomized controlled trials of a school-based substance abuse prevention program implemented across the United States. Students provided substance use and demographic information on a self-reported survey. Data for the physical disrepair of schools were collected from individual rater observations of each school environment. We hypothesized that school disrepair would be positively associated with substance use controlling for individual characteristics and a socioeconomic status proxy. Multilevel mixed modeling was used to test the hypothesized association and accounted for students nested within schools. Findings indicated that students attending AHS with greater school disrepair were more likely to report the use of marijuana and other illicit drugs (ie, cocaine, heroin). Students attending RHS with greater school disrepair were less likely to report smoking cigarettes. Differences in findings between RHS and AHS students are discussed, and implications for substance use prevention programming are offered. Students attending AHS with greater school disrepair may require more substance abuse prevention programming, particularly to prevent illicit substance use.

Negative Reflected Appraisal, Negative Self-Perception, and Drug Use Intentions in a Sample of Suburban High School Students

Drawing on theories of symbolic interaction, some researchers have suggested that negative reflected appraisal imposes a “delinquent” identity on adolescents whom adults and peers perceive as delinquent, creating ego identity discomfort that these adolescents seek to mitigate through association with drug-using peers for whom the delinquent label is evaluated more positively. On the other hand, research on reflected appraisal and delinquency has suggested that negative reflected appraisal is more salient for adolescents who are or desire to be part of high-status peer groups than for adolescents who are uninterested in such peer groups. This article reports results of a secondary analysis of evaluation data from a federally sponsored school-based substance abuse prevention project testing whether reflected appraisal is associated with subsequent intention to use marijuana, whether this association is mediated by negative self-concept, and whether it is moderated by ethnicity and gender. Results indicate that reflected appraisal is associated with marijuana use intentions and that negative self-concept mediates this association. It also indicates that the association between negative reflected appraisal and negative self-concept is weaker for African Americans and males, and that the association between negative reflected appraisal and marijuana use intentions is less salient for Hispanics.

The effectiveness of a school-based substance abuse prevention program: 18-Month follow-up of the EU-Dap cluster randomized controlled trial

Aim To evaluate the effectiveness of a school-based substance abuse prevention program developed in the EU-Dap study (EUropean Drug Addiction Prevention trial). Materials and methods Cluster Randomized Controlled Trial. Seven European countries participated in the study; 170 schools (7079 pupils 12–14 years of age) were randomly assigned to one of three experimental conditions or to a control condition during the school year 2004/2005. The program consisted of a 12-h curriculum based on a comprehensive social influence approach. A pre-test survey assessing past and current substance use was conducted before the implementation of the program, while a post-test survey was carried out about 18 months after the pre-test. The association between program condition and change in substance use at post-test was expressed as adjusted prevalence odds ratio (POR), estimated by multilevel regression models. Results Persisting beneficial program effects were found for episodes of drunkenness (any, POR = 0.80; 0.67–0.97; frequent, POR = 0.62; 0.47–0.81) and for frequent cannabis use in the past 30 days (POR = 0.74; 0.53–1.00), whereas daily cigarette smoking was not affected by the program as it was at the short-term follow-up. Baseline non-smokers that participated in the program progressed in tobacco consumption to a lower extent than those in the control condition, but no difference was detected in the proportion of quitters or reducers among baseline daily smokers. Conclusion The experimental evaluation of an innovative school curriculum based on a comprehensive social influence approach, indicated persistent positive effects over 18 months for alcohol abuse and for cannabis use, but not for cigarette smoking.