Schools Study of 6,000 Indian Teens Finds Moderation May Matter Most in Preventing Substance Use

A sweeping survey of more than 6,000 school-going adolescents across India has delivered a finding that upends a common assumption in prevention science: when it comes to psychological resources that guard against substance use, more may not always be better. The multicentre cross-sectional study, published in BMC Psychology, analyzed baseline data from 6,168 young people aged 10 to 19 enrolled in 108 schools across six geographically diverse regions of India, and found that moderate levels of protective factors and coping mechanisms were associated with the lowest odds of current substance use, while the highest categories showed weaker and less precise associations.

The research team, led by U. Venkatesh of the All India Institute of Medical Sciences in Gorakhpur, together with colleagues from AIIMS campuses in Nagpur, Rajkot, Deoghar and Guwahati as well as JIPMER in Puducherry, set out to address a persistent gap in the literature. Most research on adolescent substance use has concentrated on risk factors such as peer pressure, family conflict and easy access to psychoactive substances. Far less attention has been paid to the psychosocial assets that may buffer young people against initiation and continued use, and the evidence that does exist comes disproportionately from high-income countries. For low- and middle-income settings, where the majority of the world’s adolescents live, robust data on protective resources have been scarce.

The study defined current substance use as the self-reported use of at least one assessed psychoactive substance during the preceding three months. Complete information on this outcome was available for 4,848 of the 6,168 enrolled adolescents, a response coverage of 78.6 percent. Within this analytic sample, 545 adolescents, or 11.2 percent, reported current substance use. Rather than singling out one substance, the researchers cast a wide net across the psychoactive substances commonly assessed in adolescent health surveys, capturing the full spectrum of use from tobacco and alcohol to other substances.

Methodologically, the investigators constructed study-specific composite scores for three domains: protective factors, coping mechanisms, and social engagement. Each score was assembled from questionnaire items embedded in the parent multicentre study and then categorized as low, moderate, or high using cut-offs derived from the interquartile range of the score distributions. This approach allowed the team to examine whether associations with substance use differed across the spectrum of psychosocial resources rather than treating these constructs as continuous variables, an important design choice given that the relationship between psychological resources and behavior is not always linear.

The headline result concerned protective factors. Compared with adolescents in the low category, those with moderate protective-factor scores had 40 percent lower odds of current substance use, an adjusted odds ratio of 0.60 with a 95 percent confidence interval of 0.47 to 0.76, which excludes the null value and therefore reaches conventional statistical significance. Strikingly, the estimate for adolescents with high protective-factor scores was weaker and less precise, at 0.78 with a confidence interval of 0.59 to 1.02, a range that includes the null. The same pattern emerged for coping mechanisms: moderate coping scores were associated with 35 percent lower odds of current use, an adjusted odds ratio of 0.65 with a confidence interval of 0.51 to 0.82, while high coping scores yielded a weaker estimate of 0.81 with a confidence interval of 0.60 to 1.10 that crosses the null.

Social engagement told a different and more equivocal story. The moderate category showed essentially no independent association with substance use, with an adjusted odds ratio of 0.98 and a confidence interval spanning 0.77 to 1.25. The high-category estimate, at 2.27 with a very wide confidence interval of 0.71 to 7.24, was highly imprecise and cannot support any firm conclusion about whether greater social engagement raises, lowers, or leaves unchanged the odds of adolescent substance use. The researchers also conducted exploratory interaction analyses to test whether peer norms modified these relationships, finding only limited evidence of such effect modification.

To probe the overall direction of the associations, the team performed adjusted ordinal analyses examining trends across increasing categories of each psychosocial measure. These analyses indicated overall inverse ordinal trends, meaning that, on average, higher categories of protective factors and coping were associated with lower substance use. However, the authors are emphatic that the category-specific estimates did not consistently demonstrate monotonic patterns. Because the moderate categories showed stronger associations than the high categories, the findings should not be interpreted as evidence of dose-response relationships, in which each incremental rise in psychosocial resources produces a corresponding drop in substance use. This distinction matters both for statistical interpretation and for the practical design of interventions.

The statistical models were carefully adjusted for a battery of potential confounders, including age, sex, household economic status, living arrangement, the amount of pocket money available to the adolescent, peer norms, and study site. This adjustment is critical because older adolescents, boys, those with more disposable income, and those in permissive peer environments are known to differ systematically in both psychosocial resources and substance use. By holding these factors constant, the analysis isolates the association between the psychosocial composites and substance use, though it cannot eliminate confounding by unmeasured variables.

The authors are equally candid about the limits of what a cross-sectional design can establish. Because exposure and outcome were measured at the same point in time, the study cannot determine whether lower protective factors and coping capacity preceded substance use or, conversely, whether substance use eroded those resources. Temporality and causality remain unresolved questions. The composite scores, while constructed systematically from study questionnaire items, were not validated instruments, which introduces the possibility of measurement error. The authors call explicitly for longitudinal studies using validated psychosocial measures to clarify these associations over time.

Even with these caveats, the study carries significant implications for adolescent health programming in India and comparable settings. The work is embedded in a larger research effort funded by the Indian Council of Medical Research under an Extramural Research Grant, part of a cluster randomized controlled trial evaluating a community-based peer-led intervention to prevent substance use among adolescents within the school health programme under Ayushman Bharat, India’s national health initiative. If subsequent longitudinal research confirms that moderate psychosocial resources confer the greatest protection, school-based programmes may need to look beyond simply maximizing every student’s resilience scores and instead focus on ensuring that no adolescent falls below a functional threshold of protective resources. The ethical scaffolding of the study was rigorous: approvals were obtained from the institutional ethics committees of all six participating institutions, informed consent was secured from all adolescents, written parental or guardian consent was obtained for participants under 18, participation was voluntary, and confidentiality was strictly maintained, in accordance with the Declaration of Helsinki. As substance use during adolescence remains a pressing public health concern with consequences that ripple across the life course, this large, multi-regional analysis offers policymakers a data-driven starting point, and a caution against linear thinking, in designing prevention strategies for the world’s largest adolescent population.

Subject of Research: Psychosocial protective factors, coping mechanisms and social engagement associated with current substance use among school-going adolescents in India

Article Title: Protective factors, coping mechanisms and social engagement associated with current substance use among adolescents from 108 schools in India: a multicentre cross-sectional study

Article References: Venkatesh, U., Gandhi, A. P., Joshi, K., Bhattacharya, S., Agarwalla, R., Chinnakali, P., & Hossain, M. (2026). Protective factors, coping mechanisms and social engagement associated with current substance use among adolescents from 108 schools in India: a multicentre cross-sectional study. BMC Psychology. https://doi.org/10.1186/s40359-026-05658-0

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05658-0

Keywords: adolescents, substance use, protective factors, coping mechanisms, social engagement, India, school health, psychosocial resources, cross-sectional study, public health, BMC Psychology, prevention