Globally, a significant proportion of people, including those in Australia, are at risk of harm from smoking, alcohol misuse or illicit drug use [1, 2]. Of all age groups, young people report the greatest prevalence of such substance use . The younger the age of initiation of substance use, the greater the likelihood of ongoing use, dependence and harm in later life . As such, primary prevention efforts focusing on preventing initiation of substance use by young people have been recommended .
Schools provide an appropriate setting for improving the immediate and long term health of young people as adolescents [6–8], however there is limited evidence that school-based programs are effective [5, 9, 10]. A recent review of school-based programs targeting alcohol however has reported that interventions that aimed to develop the psychological or social skills of young people had the most promise [5, 9]. The findings of these reviews are consistent with a World Health Organisation review that concluded that programs that promote young people’s mental well-being were most likely to be effective . The same World Health Organisation review suggests that school-based interventions that address the school curriculum, school environment and community were the most likely to achieve a beneficial outcome, a method known as the Health Promoting Schools approach .
Resilience theory, which has arisen from the study of risk factors for, and their impact on, positive youth development represents one approach to improving adolescent mental or psychosocial well-being [12–18]. Whilst there is variation in the definition of resilience, it is generally agreed that both individual (internal) as well as environmental (external) characteristics contribute to individual resilience and are critical for positive youth development and the avoidance of risk behaviours [19–21]. An inverse association has been found to exist between adolescent resilience characteristics and substance use [22–24].
Although a number of school-based studies have reported targeting some aspect of adolescent resilience as a basis for intervention, none have applied the approach in a comprehensive manner nor have they demonstrated consistent effect [25–30]. In a number of such studies, the researchers have concluded that inadequate intervention dose and fidelity may have contributed to the limited outcomes . A number of barriers to intervention adoption have been cited including: a lack of financial resources for planning, training, and teacher release; inadequate levels of professional development; inadequate program resources; failure to adopt a ‘whole of school’ approach to implementation and monitoring; and inadequate support by school executives .
A pilot study of a comprehensive intervention addressing both internal and external adolescent resilience factors in a convenience sample of three socio-economically disadvantaged secondary schools has recently been reported. The intervention was delivered using the Health Promoting Schools approach , and included explicit strategies to enhance intervention adoption such as adoption support staff, resource provision and staff training. The evaluation suggested significant increases across all three schools in internal and external resilience scores, and significant decreases across all three schools in prevalence of student smoking, alcohol consumption and marijuana use . Such positive outcomes were demonstrated for all grades and genders, and exceeded declining temporal trends in the broader population .
Whilst the findings of the pilot study were positive, a more rigorous study design is required to confirm the potential of such a comprehensive resilience enhancing approach. A cluster randomized controlled trial is planned to examine the efficacy of a comprehensive resilience intervention, inclusive of intervention adoption strategies, in decreasing the tobacco, alcohol and illicit drug use of adolescents attending secondary schools in a socio-economically disadvantaged region.