Adolescents as Ambassadors in Substance Abuse Awareness Programs: Interpersonal and Intrapersonal Effects

Abstract

This study explores an adolescent ambassador program that promotes substance abuse awareness in rural villages, and studies its effects on self-esteem, peer influence, and family communication. This school-based intervention was part of a larger program that mentored adolescent youth as change agents to promote health and social awareness in rural communities in India, in alignment with UN Sustainable Development Goal 3 (good health and wellbeing). One hundred and forty-three ambassadors between 8 and 18 years of age, representing rural communities in 23 economically challenged villages across 11 states of India, participated in the study. Adolescents were mentored to implement substance abuse awareness programs among their peers and the village community. During the training, the ambassadors used a variety of didactic, creative, and technological modalities. Pre- and post-analyses assessed ambassadors’ self-esteem, personal substance use, perceptions of peer substance abuse, comfort with discussing substance abuse, and perceptions of social support. Ambassadors’ self-esteem increased significantly. In addition, positive changes related to the perception of parents’ and friends’ attention, as well as comfort in addressing substance abuse topics with others, were observed.

1. Introduction

Negative effects of alcohol and other psychoactive substances are clear, particularly in underdeveloped and developing countries and among youth and adolescents worldwide. The UN’s Sustainable Development Goal (SDG) 3.5 recognizes alcohol use as a development issue due to its impact on social and economic aspects, in addition to its health repercussions [1]. The World Drug Report 2012 states that approximately one in every 100 deaths among adults is attributed to illicit drug use [2].

In India, studies have shown that males in lower economic, rural areas tend to be the heaviest consumers of alcohol [3], though alcoholism among males in urban areas is also high. According to the National Family Health Survey-5 (NFHS) 2021, nearly 150 million adults (aged 15 and above) in India drink alcohol, with 1.3% of adult women and 18.8% of adult men consuming alcohol [4]. The SDG National Indicator Framework 2021 published by the Government of India identifies the states of Chhattisgarh and Telangana as having among the highest rates of alcoholism in the country, with over fifty percent of males regularly consuming alcohol. In the states of Jharkhand, Odisha, Uttarakhand, and Andhra Pradesh, more than thirty-five percent of men consume alcohol regularly [5]. These statistics highlight the significant impact of alcohol consumption in India and the need for effective prevention and intervention efforts.

Alcohol consumption is becoming a major public health problem in India [6]. In rural India, easy access to psychoactive substances, particularly unregulated substances, is a major challenge. For example, approximately two-thirds of the alcohol consumed in India is locally brewed and unregulated [7], making it easily accessible to adolescents and children. Additionally, adulterating locally brewed alcohol with toxic substances, such as battery fluid, has had a significant impact, particularly on rural and indigenous people [8]. It is important to address these issues to reduce the negative consequences of alcohol and substance abuse in India.

Substance abuse among adolescents in India is a particular concern due to the critical developmental stage adolescents are in, during which specific brain areas responsible for emotions, memory, and drives are developing [9,10]. Adolescents are particularly vulnerable and easily influenced during this time [11]. Substance abuse during adolescence increases the risk of severe psychological disorders, such as memory loss and schizophrenia [12,13]. Substance abuse and dependence can have a range of negative impacts on physical, cognitive, psychological, social, and moral functioning. Heavy alcohol use has been linked to mental disorders such as depression, anxiety, and an increased risk of suicide. Alcohol abuse can also affect the immune system and contribute to health problems such as heart disease, cancer, and liver cirrhosis [14]. Tobacco has similar negative effects on adolescent health, whether through first or second-hand smoking [15]. It is important to address substance abuse among adolescents to prevent these negative consequences and promote healthy development.

Parental communication, peer influence, and extended societal and cultural environments can have a significant impact on cognitive development and IQ and play a major role in shaping adolescent behaviour [16]. Research has identified several risk factors that may lead to alcohol and substance abuse during adolescence and later life, including drug use among friends and family and peer group influences [17,18]. Substance abuse is often associated with social disorders in families and affects children [19].

Positive influences can support an adolescent’s life during this critical developmental phase. Community-based awareness and preventive care programs targeted towards at-risk populations and people of impressionable age, such as adolescents, can significantly reduce addiction and problems related to substance abuse [20].

Studies have shown that children tend to be more successful when the family and community support education and there is a strong presence of parental involvement, such as volunteering at school, parent–teacher communication, and school–community interactions [21]. According to authors such as [22], close family links, a strong bond, and family support aid in preventing delinquent behaviour among adolescents. Family cohesion has been positively related to psychological wellbeing [23]. Consequently, good family communication can prevent mental health and behavioural problems and be a protective factor in substance abuse, especially during adolescence [24,25,26,27,28]

Studies indicate that preventive interventions against substance abuse among adolescents may benefit from targeting self-esteem [29,30]. Regardless of the type of drug, recent users were found to have the lowest self-esteem scores [31]. Therefore, a program to raise adolescents’ self-esteem could decrease drug and alcohol abuse [32].

A major risk factor for adolescent substance use is peer influence [33]. Modern intervention programs for substance abuse often employ social influence models and focus on building behaviour-change skills such as resistance and assertiveness. These programs are typically interactive, developmentally appropriate, and involve peer mediation and sharing, as well as training teachers to recognize deviations and strategies to influence student behaviour [34,35]. One example of such a program is Project Northland, which was adopted as a model program by the Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the U.S. Department of Health and Human Services [34]. Project Northland targeted adolescents and included interventions such as peer involvement and leadership, school programs, and parental and community-wide involvement [34,36,37]. These types of programs can be effective in addressing substance abuse among adolescents and promoting healthy behaviours.

Rural India, however, calls for somewhat different and more diverse strategies of sensitization owing to the prevalence of different regional cultures and languages [38]. While awareness campaigns to sensitize youth about the dangers of substance abuse are relatively common in urban India, they are rare in rural India, where existing programs have focussed less on prevention and more on treatment and rehabilitation camps [3]. The Indian Ministry of Social Justice has a program for the prevention, counselling, de-addiction, and rehabilitation of substance users [39]. The Indian Ministry of Tribal Affairs maintains a performance dashboard to visualize and monitor the development program status to support tribal development [40]. Although rural India often requires different and more diverse strategies for addressing substance abuse due to the prevalence of different regional cultures and languages, some of the SAMHSA strategies, especially those related to social influence and peer mediation, may work well in India, as well.

While awareness campaigns to educate youth about the dangers of substance abuse are relatively common in urban India, they are rare in rural India, where existing programs have typically focused less on prevention and more on treatment and rehabilitation camps [3]. This paper discusses a prevention-focused substance abuse approach, the Adolescent Awareness Ambassadors (AAA) Program, which may be appropriate for rural India.

The AAA program aims to promote health-oriented awareness in rural India through community involvement and a peer-reinforcement model, considering the diversity of terrain, language, and culture in these areas. Aligned with SDG 3 (Good Health and Well-Being), the AAA program uses a school-based, community-centred approach to promote broadly defined goals that support a sustainable lifestyle, human rights, and a culture of peace and nonviolence [5]. In this study, the AAA program focused on addressing substance abuse issues and attempting to influence prosocial and healthy attitudes in target villages by training adolescent student ambassadors from local high schools. These ambassadors then motivated and recruited their peers and village youth to participate in health promotion activities through didactic and creative means such as thematic street plays. Village teachers and coordinators also provide support and monitor progress [41].

This intervention strategy is supported by research indicating that increased resilience capacity in adolescents is associated with several factors, including family support, peer relationships, and school community involvement [42]. Previous studies have demonstrated the benefits of using mobile apps and educational software for educational support [40,43] and of a digital literacy framework for low-literate and rural settings [44].

In addition to enhancing specific community-level health-related goals, the AAA program contributes to several United Nations Sustainable Development Goals (SDGs). While it is most directly related to SDG 3 (ensuring healthy lives and promoting wellbeing for all ages), it also indirectly contributes to several other SDGs. According to the World Health Organization (WHO) [42], “Action to reduce the harmful use of alcohol will contribute to many other WHO goals and targets...Almost all of the other 16 SDGs are directly related to health or will contribute to health indirectly” including (but not limited to) “sustaining economic growth (SDG 8), ending poverty (SDG 1), reducing inequalities between and within countries (SDG 10), and achieving gender equality (SDG 5).” This highlights the far-reaching impact of addressing substance abuse and the importance of considering its relationship to other global development goals.

Student ambassadors in the AAA program receive training in various topics, including substance abuse, communication skills, and program implementation skills, which help build confidence in speaking with their peers and communities [45]. These activities can promote a sense of community and create social capital [38] and influence their peers by teaching them to communicate effectively about substance abuse. It considers the perceived prevalence of substance abuse among the local youth [46]. The AAA program involves teachers from each village trained in these specific topics and awareness education. This enables them to support student ambassadors not only during the program but also during follow-up programs conducted by the local student ambassadors. This helps to ensure that the program continues even after the research study ends in the village if the participants are motivated and empowered [47].

The research questions asked in this study are

RQ1: Does participating as an ambassador in the AAA program affect self-esteem?

RQ2: Does participating as an ambassador in the AAA program affect peer influence?

RQ3: Does participating as an ambassador in the AAA program affect family communication?

The outline of the paper is as follows. Section 2 outlines the material and methods and describes the program design, the study area, participants, the program implementation, the design of the study, and the statistical methods. Section 3 describes the results. The paper ends with a discussion and conclusion in Section 4 and Section 5.

2. Materials and Methods

2.1. Program Design

The research team for the AAA program visited village schools, conducted an initial introductory session, and then selected and trained student ambassadors. After training, the adolescent ambassadors implemented programming to increase awareness about substance abuse among their peers, primary schools, and their village communities through activities such as street plays, mobile interactive games, visual media, and other activities. The ambassadors completed a questionnaire before and after the training and implementation of the program.

2.2. Settings

The AAA program was conducted between August 2015 and November 2018. After an initial pilot program was implemented in two remote tribal villages in the Wayanad and Idukki districts of Kerala (KL) in 2015, the program was refined and expanded. Over the next two years, the program was implemented in 11 additional states: Telangana, Chhattisgarh, Andhra Pradesh, Bihar, Himachal Pradesh, Madhya Pradesh, Rajasthan, Orissa, Uttarakhand, Jharkhand, and West Bengal, reaching populations in 23 villages. The participants in the intervention were from economically challenged backgrounds and lived in remote rural villages. The villages selected for the program were those where the research team had previously conducted outreach activities, such as tutoring and skilling centres, and the ambassadors were selected from local schools. As some program adjustments were made after the Kerala pilot program, data from Kerala was not included in the analysis.

2.3. Participants

Data was collected from 143 ambassadors between the ages of 8 and 18 through pre- and post-surveys. These 143 ambassadors represent the complete sample of all trained ambassadors between August 2015 and November 2018. The inclusion criteria for selecting ambassadors included being from the local community and attending a local government school, being in grades 7, 8, 9, or 11 (as students in grades 10 and 12 are typically preparing for board exams) and maintaining a balance of equal numbers of girls and boys. Of the ambassadors, 74 (fifty-two percent) were male, and 69 (forty-eight percent) were female. All ambassadors were trained and mentored by zonal coordinators and faculty researchers. The ambassadors completed a total number of 107 sessions, directly teaching 5106 students in schools. Programs were conducted regularly over a six-month intervention period. The parents of the participants provided written consent.

2.4. Program Phases

The program is divided into four phases, as shown in Figure 1.

2.4.1. Phase 1: Selection of Ambassadors

This initial program module includes a video in the local language about substance abuse, a discussion, and an icebreaker activity. After the introductory program, presenters invited interested students to participate as ambassadors. Up to twelve students are selected from the school to act as ambassadors. Figure 2A shows the steps in Phase 1.

2.4.2. Phase 2: Training of Ambassadors

In the second phase of the program, only students who volunteered to act as ambassadors were included. This phase began with the ambassadors completing a 20-item questionnaire (described below). The training of the ambassadors included didactic, experiential, and creative elements and was conducted in a collaborative learning style. The trainers encouraged and supported the ambassadors in expressing their ideas about the dangers of alcohol and other substances in a creative manner, such as creating scripts, costumes, and folk music for street plays to take the message to village people. The training also emphasized practicing assertive behaviour and included activities to build self-esteem and family and community support, which are known to build adolescent resilience. In addition, the training included presentation skills using digital aids, public speaking, voice modulation, expressing ideas through visual arts, saying no to negative peer pressure, and actively conveying the message to family and friends. Figure 2B shows the skills learned through the different components of the program in Phase 2.

2.4.3. Phase 3: Dissemination to School Community

During the third phase of the AAA program, the trained ambassadors addressed village students in groups and led awareness classes to disseminate knowledge about substance abuse, engaging students through discussion, activities, tablet exercises, street plays, and other creative expressions.

2.4.4. Phase 4: Extension to Village Community

In the fourth phase of the AAA program, the ambassadors expand their activities beyond the school environment to actively engage with the village and extended community through participatory learning methods. This typically involves inviting parents and other village members to attend a meeting where the ambassadors present street plays and other activities designed to raise awareness about substance abuse issues in an engaging way. These activities may include visual media, lively presentations, and role-plays, followed by discussions. The aim is to engage the village and extended community in this process and help promote a culture of awareness and prevention around substance abuse.

2.5. Educational Modalities

Various topics are covered to help students understand the dangers of substance abuse and how to avoid it. These topics include the health impacts of substance abuse, such as the effects of alcohol on the body and the diseases it can cause. Legal aspects, such as age limits and penalties for substance-related abuse, are also covered. Social aspects, such as how to avoid peer pressure and where to seek support, are addressed. Training modalities include presentation slides, videos, and software prepared in the local language, game-based learning (GBL) activities, quiz contests, and short films that are age-appropriate and designed to build awareness about substance abuse. Group games are also conducted. In addition, print media messages against substance abuse, such as posters and pocket calendars, are distributed among the students

2.6. Follow-Up Programs

Following the initial training and program implementation activities, monthly follow-up programs ensured that ongoing support and a steady stream of information and knowledge were communicated to ambassadors, students, and village communities. Researchers remained actively involved for an entire year in implementing programs, after which participating teachers continued the programming. Furthermore, the student ambassadors themselves were empowered to take the program forward in their school with the help of these local teachers.

2.7. Survey Instrument

The pre-intervention questionnaire for ambassadors consisted of the ten Rosenberg self-esteem scale (RSES) questions and ten additional items [48]. RSES is a validated instrument used to measure self-esteem. Additional items included two questions regarding social support from parents, teachers, or other adults, self-assessment of one’s substance use; two items about their perception of other students’ substance use; two items about comfort level in discussing substance abuse with others (your family, your friends); two questions regarding whether the student expected to be listened to by others (family, friends); and one item asking what the student would do if invited to drink with a friend. One reason ambassadors were asked for perceptions related to others’ substance use was to address the possible effects of social desirability bias. This bias, possibly related to fear of social stigma, trouble with the law for illegal consumption, and repercussions at school and within the family, may have prompted students to give untruthful accounts of their usage. Thus, this additional question was included regarding information from them about the habits of classmates or friends.

The post-intervention questionnaire consisted of the same 20 questions plus six additional items to assess ambassadors’ preferences regarding the training content and effectiveness.

2.8. Statistical Methods

Quantitative variables are described by means and standard deviations and are visualized using mosaic plots. RSES reliability was determined using Cronbach’s alpha [49]. Paired t-tests were used to analyse change between the pre- and post-survey Likert scale questions and for changes in self-esteem. Qualitative variables are described by percentage and are visualized by dot charts. Prevalence of substance use stratified by state and village, and gender. The relationship between pre-survey questions and the post-attitude towards the program was quantified by Spearman’s correlation and assessed for significance using rank tests.

3. Results

3.1. Substance Abuse Prevalence Estimates

Table 1. Estimated prevalence of substance abuse as reported by ambassadors in different states of India.

State	Boys				Girls
	All	>50%	<50%	None	All	>50%	<50%	None
AP	0	0	100	0	0	0	0	100
BH	0	0	33	67	0	0	17	83
CT	0	0	64	36	0	0	0	100
HP	0	0	100	0	0	0	0	100
JH	0	0	10	90	0	0	0	100
MP	0	0	44	56	0	0	0	100
OR	0	38	24	38	0	5	10	86
RJ	0	62	12	25	0	38	0	62
TS	0	0	0	100	0	0	0	100
UT	59	29	12	0	71	18	12	0
WB	0	0	55	45	0	0	0	100

identifies the estimated prevalence of substance use as reported by ambassadors stratified by state and gender, based on the questions “how many boys in your age group use substances” and “how many girls in your age group use substances” reported in the pre-intervention survey. State abbreviations: AP—Andhra Pradesh, BH—Bihar, CT—Chhattisgarh, HP—Himachal Pradesh, JH—Jharkhand, MP—Madhya Pradesh, OR—Orissa, RJ—Rajasthan, TS—Telangana, UT—Uttarakhand, WB—West Bengal. The table shows, for each state, the percentage of boys and girls, respectively, that say either (1) all their peers drink; (2) more than fifty percent drink; (3) less than fifty percent drink; or (4) none of them drink.

3.2. Self-Esteem

Figure 3A shows pre- and post-Rosenberg self-esteem scale scores stratified by sex, and Figure 3B shows the scales stratified by state. Self-esteem increases significantly from the pre- to post-survey (p = 0.013).

3.3. Self-Esteem and Social Support Perceptions

Pre- and post-responses were quantified using Spearman’s correlation and assessed for significance using rank tests.

Table 2. Rank correlation between pre-survey questions and as to whether ambassadors liked being in the program and an ambassador.

	Rank Correlation	p Value
Self-esteem	0.195	0.027
Having at least one teacher I can talk to	0.337	<0.001
There is at least one adult or parent that I had to talk to	0.218	0.016
Using chewing tobacco	0.146	0.098
Using other substances	−0.139	0.116
Boys in the village are using alcohol or other substances	−0.279	0.001
Girls in the village are using alcohol or other substances	0.008	0.924

shows the rank correlation between pre-survey questions and the Likert scale answer at the post-survey regarding whether ambassadors felt positive about their participation in the program and being an ambassador.

Ninety-six percent of students reported increased self-esteem when involved in the AAA program [6]. Apart from being an indicator of program success, students’ participation in the program is also positively correlated with family support. This, combined with the high number of students who welcomed parental influence, also indicates the importance of raising family and community awareness and involvement in adolescent life.

3.4. Peer and Social Influence

An examination of pre- and post-training/implementation responses indicates several significant differences including whether the ambassadors thought their parents listened to them when they talked about substance abuse (p = 0.001), level of comfort when talking about substance abuse with their friends (p < 0.001), and the perception that their friends are very likely to listen to them when they talk about substance abuse (p < 0.001). In addition, there was a slight indication of a change in how comfortable ambassadors feel talking to their families about substance abuse (p = 0.083). The ambassadors agreed unanimously that the program helped them interact with their families more openly on substance abuse.

Ambassadors said that all students indicated that if their friends avoided substances, it would help them stay away. The combined findings suggest that peer influence is perhaps the most powerful factor in helping adolescents avoid substance abuse.

After completing the program, ambassadors were asked to rate their family’s reactions to their involvement in the AAA project. Of the total, 88.2% said that their family was “very happy”, while 6% responded that they were “somewhat happy”; the remaining 5.8% chose “neutral”. Assuming that these ambassador perceptions are accurate, this suggests that the community appreciated the program and was aware of its positive influence on their children. When asked if they felt they could continue influencing their family’s opinion, they were positive that they could influence their family’s opinion about substance abuse.

3.5. Learning Methods and Perceived Prevalence

In the post-training/intervention questionnaire, ambassadors were asked to rate which training approaches they found most compelling. Their responses were almost evenly divided between learning through peer interaction in the collaborative learning style and learning through visual and interactive media on the tablets, as shown in Figure 3C.

The ambassadors agreed that the AAA participatory learning model helped them learn more about the dangers of substance abuse. When asked about the program’s success, sixty-six percent felt that more than 20 of their classmates were positively influenced by it (Figure 4A).

Figure 4B shows how students reacted to being asked about their classmates. Only one student out of the 91 surveyed admitted to using alcohol personally in the past six months.

4. Discussion

This study focused primarily on the student ambassadors and how the program influenced their self-esteem and perceptions of social support. This study grew from a recognition that substance abuse is an ongoing issue with serious ramifications within rural communities in India [50]. This study is important for youth, given the neurodevelopmental effects of substance use on the adolescent brain, and has implications related to the Sustainable Development Goals related to health and wellbeing and social development.

The results of this multi-state study support the success of community intervention programs against substance abuse for adolescents in rural and indigenous areas. Empowering local adolescent ambassadors in rural settings, with support from community-wide stakeholders, and executed consistently over a sustained period, suggests the potential to mitigate substance abuse [51]. Meta-analyses have found that school-based peer-led programs are effective interventions [52]. Ambassadors indicated positive individual effects, such as enhanced self-esteem and improvements in actual substance use and social and familial relationships.

Results suggest that participation in the Ambassador program indeed has positive effects on the student participants and likely on the broader community, as well. Overall awareness of the dangers of substance abuse increased significantly, and ninety-four percent of the ambassadors surveyed said that awareness provided by AAA is adequate to make students stay away from substances. These findings may contribute to a further understanding of the development of social capital. Villages may gain social capital by improving family communication, peer influence, and community participation in programs [38]. Building social capital is required to address imbalances in socioeconomic structures and opportunities [53].

4.1. Change in Ambassador’s Self-Esteem

Self-esteem and self-confidence are important indicators for successfully preventing substance abuse [54]. Like other findings that adolescents trained in problem-solving skills experience improvements in social confidence [55], we found that both the self-esteem and self-confidence of the mentored ambassadors increased. Measures of self-esteem showed clear improvement, while self-confidence was inferred from the increased comfort ambassadors felt when talking about substance abuse with their friends and family members. There was a significant improvement in whether the ambassadors thought their parents listened to them. In addition, there was a significant increase in their belief that their friends and family are likely to listen to them while talking about substance abuse. Studies show that extending their voice to families and communities empowers students and increases self-confidence [56].

4.2. Peer Influence

As corroborated by other studies, peer influence is a powerful factor in preventing and reducing substance abuse, even in culturally diverse, remote rural areas [57]. Ambassadors were more likely to pay attention to peers regarding avoidance of psychoactive substances (Figure 4). Just as peer pressure can negatively impact adolescent substance abuse, peer influence can also be channelled positively [58].

4.3. Family Communication

The program resulted in improved communication between parents and adolescents and, similar to Uemura’s findings, a change in behaviour and understanding of substance abuse [54]. Like adult literacy programs involving students as home facilitators [59], we found that the program was effective for parents with low literacy rates. Supporting such an approach are studies showing that an adolescent’s resilience capacity depends on several contributors such as family support, peer relationships, school community, family communication, community support, and so forth [43,60,61].

4.4. Sustainability, Replicability, and Scalability

The AAA program is designed to be sustainable and scalable as it mentors a few ambassadors who work with peers and friends to communicate awareness to entire schools and communities. The program employs teachers from the village and trains them in these specific topics and awareness education to support the follow-up programs conducted by local students as ambassadors. Hence, the program is sustainable as a preventive solution to rural India’s health and social issues. As the local people continue follow-up programs, the program is low-cost [62]. The multi-level program against adolescent substance abuse is replicable, as it mentors community ambassadors to use the participatory learning methodology.

5. Conclusions

Alcohol use and substance abuse are not only critical issues for individual and community wellbeing but are global concerns and constitute UN SDG3 development issues with social, health, and economic repercussions [63,64]. Our focus on SDG3 is consistent with the recent studies that map research topics to various SDGs [64,65].

This study’s results emphasize the power of peer and parental influence in adolescent life and stress the importance of raising family and community involvement. Most drug and alcohol programs in India focus on rehabilitation and treatment and tend to occur in urban settings. To prevent substance abuse, there is a need to spread awareness among the youth about the negative consequences of substance abuse through sensitization [6]. Programs in remote, rural India that systematically involve adolescent students to educate peers and address prevention are less common.

The AAA program evaluated in this article involves adolescents in spreading awareness to peers, their parents, and villagers who, findings indicate, are a strong influence in their lives. The activity-based, collaborative, and participatory learning styles were novel to the village scenario and were received with interest and enthusiasm. Channelling the creative energy of youth into a positive cause was beneficial, with the ambassadors benefiting significantly. The pedagogy included digital, collaborative, participatory, and activity-based learning.

The primary focus was on influencing prevalent social and healthy attitudes in adolescent ambassadors and mentoring them to train, motivate and work with peer students and village youth. Supporting such an approach are studies showing that an adolescent’s resilience capacity is dependent on several contributors, such as family support, peer relationships, school community, and so forth [41]. Ambassadors who previously reported some exposure to substances reported a gradual reduction in substance use over the six months of their involvement.

Future research will include longitudinal analysis and long-term effects in preventing and reducing substance abuse through ongoing mentoring. Additional research could examine the effectiveness of extending the AAA model to other community challenges in addition to (or related to) substance abuse, such as domestic violence. Policy implications could include government, school, and civil agencies that empower women to break out of the victim cycle and resist the violence resulting from substance abuse. They could seek financial independence when faced with substance abuse in their homes and teach life skills that empower them to resist secondary abuse and domestic violence.

Schools and civil societies can adopt the AAA framework as it is both effective and sustainable. It fosters community empowerment by mentoring select adolescents as change agents while improving self-esteem and self-confidence. Our findings suggest that empowering adolescent ambassadors with awareness training using multimodal learning activities, involving family and community, and leveraging peer influence are powerful factors in substance abuse prevention and early intervention. Due to community members being empowered, the model is scalable and sustainable.

Limitations

While some of the ambassadors had consumed alcohol, none of them were daily consumers or addicted to any substance. Thus, this study is not about de-addiction but is limited to the prevention of youth becoming addicted to substances through participation in substance abuse awareness building. The prevalence of substance use is limited to the perception of the students about substance use among their friends.