Abstract
BACKGROUND: Resilience is a key protective factor in mitigating substance use behaviors in adolescence, but the effectiveness of school-based resilience interventions remains unclear. METHODS: Randomized and quasi-experimental studies evaluating school-based resilience interventions for tobacco, alcohol, or illicit substance use among students aged 6-18 years were identified. Pooled effect sizes were estimated using random-effects meta-analysis, with subgroup and meta-regression analyses. RESULTS: From 3504 records, 13 studies on tobacco, 14 on alcohol, and 12 on illicit substances met the inclusion criteria. The pooled results showed significant reductions in tobacco (OR = 0.83, 95% CI = 0.73-0.93, I(2) = 61.0%), alcohol use (OR = 0.81, 95% CI = 0.74-0.90, I(2) = 57.1%), and illicit substance use (OR = 0.80, 95% CI = 0.70-0.92, I(2) = 45.3%). Subgroup analysis revealed that multi-level interventions yielded a greater reduction. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: School-based resilience interventions reduce adolescent substance use, providing insight into how resilience strategies operate across ecological domains. Embedding sustained, multi-level approaches within whole-school prevention frameworks may strengthen effectiveness and promote equity in school health. CONCLUSIONS: School-based resilience interventions are effective in reducing adolescent substance use, underscoring the need for multi-level intervention strategies.