School-based resilience interventions reduce adolescent tobacco, alcohol, and illicit substance use

This meta-analysis examined the effectiveness of school-based resilience interventions on adolescent substance use. The analysis included 13 studies on tobacco use, 14 on alcohol use, and 12 on illicit substance use, all conducted in school settings with students aged 6-18 years. The comparator was not explicitly reported in the input data.

The pooled results showed significant reductions associated with resilience interventions across all substance categories. For tobacco use, the odds ratio was 0.83 (95% CI = 0.73-0.93). For alcohol use, the OR was 0.81 (95% CI = 0.74-0.90). For illicit substance use, the OR was 0.80 (95% CI = 0.70-0.92). Absolute numbers of users and non-users were not reported. The analysis noted that multi-level interventions appeared to yield greater reductions, though specific subgroup effect sizes were not provided.

Safety and tolerability data were not reported. The evidence has important limitations: this was a meta-analysis of randomized and quasi-experimental studies showing association rather than causation, with moderate heterogeneity in the pooled results (I²: tobacco 61.0%, alcohol 57.1%, illicit substances 45.3%). Funding sources and conflicts of interest were not reported.

For practice, these findings suggest school-based resilience interventions may contribute to reduced substance use among adolescents. The analysis indicates that embedding sustained, multi-level approaches within whole-school prevention frameworks might strengthen effectiveness. However, clinicians should interpret these results cautiously given the observational nature of the evidence and lack of absolute risk reduction data.