Foundations for School-based Alcohol Education in India: A Multi-stakeholder Qualitative Needs Assessment

Background: Adolescent alcohol use is a growing public health concern in India, yet school-based alcohol education remains awareness-oriented, fragmented, and insufficiently differentiated from broader substance use prevention. This multi-stakeholder needs assessment aimed to evaluate the provision, content, and delivery of school-based alcohol education; identify barriers and enablers to implementation; and characterize adolescent perspectives on alcohol use and preferred program approaches. Methods: A qualitative design was employed, guided by the Social-Ecological Model, Social Norm Theory, and Social Learning Theory. Data were collected between August and December 2025 in Chandigarh and the Delhi National Capital Region (NCR) through key informant interviews with two education sector staff, in-depth interviews with 12 school-based teachers and counselors, and four focus group discussions with 21 students across one private and three government secondary schools. Data were analyzed using a framework of thematic analysis. Results: Seven cross-cutting themes were identified: barriers to alcohol education (curriculum overload, lack of teacher training, resource constraints); enablers and facilitators; current content; delivery formats; social-ecological influences on adolescent alcohol use; social learning processes; and social norms and outcome expectancies. Participant-specific themes addressed decision-making, teacher training, and suggestions for program development. An integrative framework mapping determinants of adolescent alcohol use and conditions for effective school-based education across four ecological levels was developed. Conclusions: Our study supported the need, context, and preconditions of school-based alcohol education in India. The next phase should involve multi-stakeholder co-design of a pilot program, followed by testing with fidelity monitoring and evaluation using validated behavioral outcome measures.