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Culturally sensitive programs integrate positive youth development factors such as future orientation, problem-solving, communication, decision-making, and emotional regulation with specific cultural or ethnic factors related to socialisation, identity, and acculturation. Culturally sensitive prevention programs for substance use were assessed in a systematic review and meta-analysis (Bo et al., 2023, 30 studies) and found a small yet significant effect in:

• Preventing and reducing substance use (Hedges’s g = - 0.20, 95% CI = [-0.24, -0.16])

A systematic review with meta-analysis (Tinner et al., 2022, 66 studies) assessed the effects of individual-, family- and school-based interventions to prevent multiple risk behaviours relating to alcohol, tobacco and drug use in young people aged 8-25 years. Results found that:

• for targeted school-level interventions, there was low quality evidence of no or a small short-term benefit: alcohol use (OR 0.90, 95% CI: 0.74-1.09), tobacco use (OR 0.86, 95% CI: 0.66, 1.11), cannabis use (OR 0.84, 95% CI: 0.66-1.07) and other illicit drug use (OR 0.79, 95% CI 0.62-1.02).

A systematic review with meta-analysis (Tinner et al., 2022, 66 studies) assessed the effects of individual-, family- and school-based interventions to prevent multiple risk behaviours relating to alcohol, tobacco and drug use in young people aged 8-25 years. Results show that:

• universal school-based interventions are likely to have little or no short-term benefit (up to 12 months) in relation to alcohol use (OR 0.94, 95% CI: 0.84, 1.04), tobacco use (OR 0.98, 95% CI: 0.83, 1.15), cannabis use (OR 1.06, 95% CI: 0.86, 1.31) and other illicit drug use (OR 1.09, 95% CI: 0.85, 1.39)

School-based multicomponent positive psychology interventions aim at increasing well-being indicators of mental health (i.e., subjective and psychological well-being) and reducing the most common psychological distress indicators (i.e., depression, anxiety, and stress) in adolescents. Positive psychology interventions originated as scientifically-based interventions that focus on strengthening positive emotions, thoughts, and behaviors through activities that can be easily implemented in daily routines. Multicomponent positive psychology interventions are based on a variety of individual exercises targeting two or more theoretically relevant well-being components and are conducted within an integral program, decreasing the risk of relapse and increasing the probability of spill-over effects and synergy between activities, thus being more likely to provide long-term effects.

School-based multicomponent positive psychology interventions were found in a systematic review with meta-analysis (Tejada-Gallardo et al., 2020, 9 studies, N= 4 898) to be effective in improving:

• subjective well-being (g = 0.24, 95% CI 0.11–0.38, p = 0.000),
• psychological wellbeing (g = 0.25, 95% CI 0.01–0.51, p <0.05),
• and depression symptoms (g = 0.28, 95% CI 0.13–0.43, p = 0.000).

Removing low-quality studies led to a slight decrease in the effect sizes for subjective well-being and a considerable increase for psychological well-being and depression symptoms.

A review of 29 reviews (McGrath et al., 2006) found evidence that booster sessions or similar extra components that aimed to reinforce the effects of a programme have a positive impact on the pre-specified outcomes. However, since the relationship between booster sessions and programme outcomes was not statistically examined, the link should be treated as hypothetical.

Mass-media campaign in combination with school-based, community-based or national programmes were found in a systematic review (Carson et al., 2017, 8 studies, N= 17 385) to be inconclusive regarding:

• reduced smoking behaviour of young people (3 studies (n = 17,385) found some evidence but the remaining 5 studies (n = 72,740) did not detect a significant effect on smoking behaviour)

Multi-component programmes, with both family and schools interventions, for preventing smoking by children and adolescents were found in a systematic review (Thomas et.al., 2015, 27 RCTs), to be more effective than school-only intervention in:

• reducing smokng in adolescents who never smoked at baseline (2 RCTs, N = 2 301)  (RR = 0.85, 95 % CI 0.75–0.96)
• reducing smoking in adolescents who were smokers at baseline (1 RCT, N = 1 096)  (RR = 0.60, 95 % CI 0.38–0.94)

Multi-component prevention programs (intervention delivered in more than one setting) have shown in a systematic review (Foxcroft et al., 2011) of 20 RCTs to be effective in:

• reducing alcohol misuse in adolescents (12 of the 20 trials showed some evidence of effectiveness).

Comprehensive approaches involving community and school, were found effective in a systematic review (Jones et al., 2006, 222 studies - 14 systematic reviews; 103 RCTs; 52 Controlled non-randomized studies; 18 CBA; 35 BA) at preventing/delaying/reducing:

• all substances when compared with community-only programmes and school-community programmes targeting high-risk youth (SMD = 0.38 and 0.36 respectively), and in high-risk individuals when compared with low-risk individuals (SMD = 0.42 and 0.08);
• tobacco when compared with community-only programmes and school-community programmes targeting high-risk youth (SMD = 0.46 and 0.48), and in high-risk individuals when compared with low-risk individuals (SMD = 0.49 and 0.03);
• alcohol when compared with community-only programmes and school-community programmes targeting high-risk youth (SMD = 0.49 and 0.49), and in high-risk individuals when compared with low-risk individuals (SMD = 0.56 and 0.05);
• cannabis when compared with community-only programmes and school-community programmes targeting high-risk youth (SMD = 0.82 and 0.79), and in high-risk individuals when compared with low-risk individuals (SMD = 0.84 and 0.22);
• all illicit drugs when compared with community-only programmes and school-community programmes targeting high-risk youth (SMD = 0.56 and 0.54), and in high-risk individuals when compared with low-risk individuals (SMD = 0.65 and 0.05).

There was no difference in effectiveness between ‘school-community’ programmes and ‘community-only’ programmes. Moreover, low risk population effect sizes were significantly greater across all types of interventions (‘comprehensive’, ‘school-community’, ‘community-only’) for tobacco (SMD = 0.05, SMD = 0.13); and cannabis (SMD = 0.04, SMD = 0.10). No other significant differences were reported.

There is evidence from a narrative review including results of one RCT (N=326) (Velleman 2009) that specific training given to young people in order to make them influence each other is not effective in:

• reducing alcohol and tobacco use;
• increasing knowledge and attitudes towards alcohol and tobacco