{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T04:18:21Z","timestamp":1787890701079,"version":"build-2784847793"},"reference-count":35,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behav. Sci.","Behavioral Sciences"],"abstract":"<jats:p>School-based prevention programs increasingly incorporate mental health-related components to prevent substance use among adolescents. This study aimed to evaluate the effectiveness of integrated school-based mental health and substance use prevention programs for adolescents through a systematic review and meta-analysis. A systematic literature search was conducted across 12 electronic databases for studies published between January 2016 and April 2026. Randomized controlled trials (RCTs) and cluster randomized controlled trials evaluating school-based integrated prevention programs for adolescents were included. Random-effects meta-analyses were performed for substance-use outcomes, including alcohol-related outcomes and binge drinking, using pooled odds ratios (ORs) and 95% confidence intervals (CIs). Mental health and psychosocial outcomes were synthesized narratively because heterogeneity in outcome definitions, measurement instruments, and assessment periods precluded meaningful quantitative pooling. A total of 16 reports representing 10 independent trials were included in the systematic review, and five independent trial comparisons were included in the primary meta-analysis. Integrated prevention programs significantly reduced alcohol-related behaviors among adolescents compared to control groups (OR = 0.56, 95% CI = 0.37\u20130.86, p = 0.008). Significant preventive effects were also observed for binge drinking outcomes (OR = 0.32, 95% CI = 0.16\u20130.64, p = 0.001). Most interventions incorporated emotional regulation, resilience enhancement, coping skills, stress management, and help-seeking promotion. Digital and online approaches were frequently used. Narrative findings suggested potential benefits for selected psychosocial and mental health-related outcomes; however, these outcomes were not quantitatively pooled and were not consistently sustained across follow-up periods. Integrated school-based prevention programs incorporating mental health-related components demonstrated beneficial effects on alcohol-related behaviors and binge drinking among adolescents. Evidence regarding mental health and psychosocial outcomes was based on narrative synthesis and remains less conclusive. These findings support the importance of integrated prevention approaches that simultaneously address substance use and mental health in school settings. However, additional large-scale RCTs with standardized outcome measures and long-term follow-up are needed to strengthen the current evidence base.<\/jats:p>","DOI":"10.3390\/bs16091498","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:04:32Z","timestamp":1787756672000},"page":"1498","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of School-Based Integrated Mental Health and Substance Use Prevention Programs for Adolescents: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9035-6451","authenticated-orcid":false,"given":"Jihye","family":"Shin","sequence":"first","affiliation":[{"name":"College of Nursing, Eulji University, Uijeongbu 34824, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8175-3961","authenticated-orcid":false,"given":"Kyung-Young","family":"Hong","sequence":"additional","affiliation":[{"name":"College of Nursing, Eulji University, Uijeongbu 34824, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Beckman, L., Svensson, M., Geidne, S., and Eriksson, C. (2017). Effects on alcohol use of a Swedish school-based prevention program for early adolescents: A longitudinal study. BMC Public Health, 17.","DOI":"10.1186\/s12889-016-3947-3"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e45216","DOI":"10.2196\/45216","article-title":"Evaluating a peer-support mobile app for mental health and substance use among adolescents over 12 months during the COVID-19 pandemic: Randomized controlled trial","volume":"25","author":"Birrell","year":"2023","journal-title":"Journal of Medical Internet Research"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s10964-016-0513-3","article-title":"Evaluation of yoga for preventing adolescent substance use risk factors in a middle school setting: A preliminary group-randomized controlled trial","volume":"46","author":"Butzer","year":"2017","journal-title":"Journal of Youth and Adolescence"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e276","DOI":"10.1016\/S2589-7500(23)00028-6","article-title":"Health4Life eHealth intervention to modify multiple lifestyle risk behaviours among adolescent students in Australia: A cluster-randomised controlled trial","volume":"5","author":"Champion","year":"2023","journal-title":"The Lancet Digital Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1111\/add.13345","article-title":"Effectiveness of a universal internet-based prevention program for ecstasy and new psychoactive substances: A cluster randomized controlled trial","volume":"111","author":"Champion","year":"2016","journal-title":"Addiction"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e020433","DOI":"10.1136\/bmjopen-2017-020433","article-title":"Cluster randomised controlled trial of an online intervention to prevent ecstasy and new psychoactive substance use among adolescents: Final results and implications for implementation","volume":"8","author":"Champion","year":"2018","journal-title":"BMJ Open"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"101706","DOI":"10.1016\/j.pmedr.2022.101706","article-title":"Effectiveness of a neuroscience-based, harm reduction program for older adolescents: A cluster randomised controlled trial of the Illicit Project","volume":"26","author":"Debenham","year":"2022","journal-title":"Preventive Medicine Reports"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"106794","DOI":"10.1016\/j.ypmed.2021.106794","article-title":"Personality-targeted prevention for adolescent tobacco use: Three-year outcomes for a randomised trial in Australia","volume":"153","author":"Debenham","year":"2021","journal-title":"Preventive Medicine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1111\/acer.14016","article-title":"The effect of contextual risk factors on the effectiveness of brief personality-targeted interventions for adolescent alcohol use and misuse: A cluster-randomized trial","volume":"43","author":"Edalati","year":"2019","journal-title":"Alcoholism: Clinical and Experimental Research"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1016\/j.addbeh.2012.05.023","article-title":"Sex specific trajectories in cigarette smoking behaviours among students participating in the unplugged school-based randomized control trial for substance use prevention","volume":"37","author":"Gabrhelik","year":"2012","journal-title":"Addictive Behaviors"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s10802-022-00978-2","article-title":"Substance use screening and prevention for adolescents in pediatric primary care: A randomized clinical trial using the family check-up","volume":"51","author":"Shaw","year":"2023","journal-title":"Research on Child and Adolescent Psychopathology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"107522","DOI":"10.1016\/j.addbeh.2022.107522","article-title":"Changes in alcohol beliefs mediate the effects of a school-based prevention program on alcohol use among Brazilian adolescents","volume":"137","author":"Valente","year":"2023","journal-title":"Addictive Behaviors"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e682","DOI":"10.1016\/S2468-2667(25)00145-8","article-title":"The OurFutures vaping eHealth intervention to prevent e-cigarette use among adolescent students in Australia: A cluster randomised controlled trial","volume":"10","author":"Gardner","year":"2025","journal-title":"The Lancet Public Health"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Griffin, K. W., Williams, C., Sousa, M. M., and Botvin, G. J. (2026). Impact of a hybrid prevention program for high school students on prescription drug misuse outcomes. Behavioral Sciences, 16, (1).","DOI":"10.3390\/bs16010154"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4725","DOI":"10.1017\/S0033291724002897","article-title":"Do school-based prevention programs impact co-occurring alcohol use and psychological distress during adolescence?","volume":"54","author":"Halladay","year":"2024","journal-title":"Psychological Medicine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e26951","DOI":"10.2196\/26951","article-title":"A mobile phone-based life-skills training program for substance use prevention among adolescents: Cluster-randomized controlled trial","volume":"9","author":"Haug","year":"2021","journal-title":"JMIR mHealth and uHealth"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e016060","DOI":"10.1136\/bmjopen-2017-016060","article-title":"Effectiveness of a pragmatic school-based universal resilience intervention in reducing tobacco, alcohol and illicit substance use in a population of adolescents: Cluster-randomised controlled trial","volume":"7","author":"Hodder","year":"2017","journal-title":"BMJ Open"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1007\/s10935-016-0461-4","article-title":"Substance use prevention for urban American Indian youth: An efficacy trial of the culturally adapted living in 2 worlds program","volume":"38","author":"Kulis","year":"2017","journal-title":"The Journal of Primary Prevention"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"112655","DOI":"10.1016\/j.drugalcdep.2025.112655","article-title":"Efficacy of the Mexican version of the keepin\u2019 it REAL school-based prevention program in addressing multi-substance use from early to mid-adolescence","volume":"271","author":"Kulis","year":"2025","journal-title":"Drug and Alcohol Dependence"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1007\/s11121-018-0956-8","article-title":"Testing the keepin\u2019 it REAL substance use prevention curriculum among early adolescents in Guatemala city","volume":"20","author":"Kulis","year":"2019","journal-title":"Prevention Science"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.addbeh.2017.02.030","article-title":"Effectiveness of a selective alcohol prevention program targeting personality risk factors: Results of interaction analyses","volume":"71","author":"Lammers","year":"2017","journal-title":"Addictive Behaviors"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2917","DOI":"10.1017\/S0033291724000989","article-title":"The long-term effectiveness of a personality-targeted substance use prevention program on aggression from adolescence to early adulthood","volume":"54","author":"Lawler","year":"2024","journal-title":"Psychological Medicine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"100225","DOI":"10.1016\/j.eclinm.2019.11.018","article-title":"Twelve-month outcomes of MAKINGtheLINK: A cluster randomized controlled trial of a school-based program to facilitate help-seeking for substance use and mental health problems","volume":"18","author":"Lubman","year":"2020","journal-title":"EClinicalMedicine"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"209523","DOI":"10.1016\/j.josat.2024.209523","article-title":"Effects on alcohol and substance use of a school-based training intervention for adolescents with ADHD","volume":"168","author":"Margherio","year":"2025","journal-title":"Journal of Substance Use and Addiction Treatment"},{"key":"ref_25","first-page":"882","article-title":"Examining racial differences in the effects of the Brazilian state-level police substance use prevention program in schools: A cluster-randomized controlled trial","volume":"12","author":"Menezes","year":"2025","journal-title":"Journal of Racial and Ethnic Health Disparities"},{"key":"ref_26","first-page":"e18487","article-title":"Evaluating the effectiveness of a web-based program (POP4Teens) to prevent prescription opioid misuse among adolescents: Randomized controlled trial","volume":"22","author":"Moore","year":"2020","journal-title":"Journal of Medical Internet Research"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3433","DOI":"10.1017\/S0033291720001919","article-title":"A national effectiveness trial of an eHealth program to prevent alcohol and cannabis misuse: Responding to the replication crisis","volume":"52","author":"Newton","year":"2022a","journal-title":"Psychological Medicine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1177\/0004867419877948","article-title":"Evaluating the differential effectiveness of social influence and personality-targeted alcohol prevention on mental health outcomes among high-risk youth: A novel cluster randomised controlled factorial design trial","volume":"54","author":"Newton","year":"2020","journal-title":"Australian & New Zealand Journal of Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.jaac.2021.10.023","article-title":"The 7-year effectiveness of school-based alcohol use prevention from adolescence to early adulthood: A randomized controlled trial of universal, selective, and combined interventions","volume":"61","author":"Newton","year":"2022b","journal-title":"Journal of the American Academy of Child & Adolescent Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s13011-018-0171-4","article-title":"Universal cannabis outcomes from the Climate and Preventure (CAP) study: A cluster randomised controlled trial","volume":"13","author":"Newton","year":"2018","journal-title":"Substance Abuse Treatment, Prevention, and Policy"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"100648","DOI":"10.1016\/j.invent.2023.100648","article-title":"24-month outcomes of an eHealth universal program for students and parents to prevent adolescent alcohol use: A cluster randomized controlled trial in schools","volume":"33","author":"Slade","year":"2023","journal-title":"Internet Interventions"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e334","DOI":"10.1016\/S2589-7500(24)00046-3","article-title":"Effectiveness of a universal, school-based, online programme for the prevention of anxiety, depression, and substance misuse among adolescents in Australia: 72-month outcomes from a cluster-randomised controlled trial","volume":"6","author":"Teesson","year":"2024","journal-title":"The Lancet Digital Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1017\/S0033291717000198","article-title":"Combined universal and selective prevention for adolescent alcohol use: A cluster randomized controlled trial","volume":"47","author":"Teesson","year":"2017","journal-title":"Psychological Medicine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e74","DOI":"10.1016\/S2589-7500(19)30213-4","article-title":"Combined prevention for substance use, depression, and anxiety in adolescence: A cluster-randomised controlled trial of a digital online intervention","volume":"2","author":"Teesson","year":"2020","journal-title":"The Lancet Digital Health"}],"container-title":["Behavioral 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