Can life skills-based interventions mitigate the impact of adverse childhood experiences on adolescent substance use prevention outcomes? A quasi-experimental study

Adverse childhood experiences (ACEs) are associated with an increased risk of substance use during adolescence. However, most prevention efforts target youth with known childhood adversities who are receiving services in clinical or service programs, not in public settings such as schools. Moreover, research on the relationship between ACEs and substance use, as well as on the effectiveness of prevention strategies to mitigate the impact of ACEs on substance use, remains limited in East Asian countries, including Taiwan. This study aimed to address existing research gaps by examining the effects of a universal, school-based intervention on substance use outcomes among adolescents. Specifically, the study sought to examine the moderating effects that a life-skills intervention program, the Positive Interpersonal and Life Skills Training (PILOT), had on Taiwanese middle school adolescents with ACEs, assessing the program's impact on their level of substance use-related knowledge, attitudes, and skills. A total of 257 students from two middle schools in Taiwan participated in the study during the spring and fall of 2023. Of these, 139 students received the 8-module PILOT program integrated into their regular school curriculum, while 118 students received the standard curriculum. Participants completed pre-test and post-test questionnaires assessing ACEs and substance use prevention outcomes. The results indicate that ACEs were significantly associated with reduced substance-use-related knowledge among participants. The findings further confirmed the effectiveness of life skills-based interventions in enhancing substance use-related knowledge among Taiwanese middle school students. Notably, the PILOT program demonstrated a significant moderating effect, improving substance use-related knowledge among students with higher ACE exposure. In conclusion, life skills-based interventions can mitigate the negative impact of ACEs on adolescents' substance use prevention knowledge, which highlights the potential of universal, school-based life skills programs to serve as protective buffers for adolescents facing adversity.