Zambia presents a stark backdrop for this research. A recent systematic review and meta-analysis documented an overall alcohol use disorder prevalence of 7.7 percent among adolescents in sub-Saharan Africa, and Zambia reported the highest weighted past-6-month prevalence of adolescent alcohol use at 80.6 percent, alongside the highest prevalence of alcohol dependence. Much of this consumption involves inexpensive, unregulated non-industrial alcohol, which carries a heavy burden of disease and injury. The consequences ripple outward: unsafe sexual behavior that raises HIV risk, fetal alcohol spectrum disorder, injuries, gender-based violence, and mental health disorders. Against this landscape, the United Nations has called for strengthened prevention under Sustainable Development Goal 3.5, and the African Union has urged evidence-based, community-integrated prevention activities.

The GROW-HFLS curriculum emerged from an earlier success. In 2017, researchers culturally adapted the original Global Resilience Oral Workshops for Zambian primary school students aged 10 to 13, and a cluster-randomized trial of 543 children in Lusaka showed increased hope and resilience alongside decreased alcohol use. Parents, school staff, and community leaders then pushed for an expanded program targeting older adolescents, whose risk of substance use initiation is even greater. The result is a 12-month curriculum delivered in 36 weekly 90-minute after-school sessions, combining a character strengths and resilience component called GROW Strong with a substance use prevention module called GROW Free.

Technically, the intervention draws on the Values in Action framework of 24 character strengths identified by Peterson and Seligman, teaching each through Bible stories chosen from scriptures respected by both Christians and Muslims, including the five books of Moses, Psalms, and the gospels. Sessions weave in evidence-based positive psychology exercises: song and dance, positive self-affirmation, drama, active constructive responding, brainstorming, goal setting, meditation, role modeling, and gratitude practices. The GROW Free component then concentrates on five strengths previously linked to lower alcohol use—forgiveness, hope, self-regulation, spirituality, and prudence—while teaching media literacy, alcohol refusal skills, strategies for avoiding risk-promoting social networks, and coping with negative emotions without substances. Homework booklets reinforce each week’s goals through memorization, meditation practice, gratitude walks, and peer sharing.

Crucially, the program was not delivered by credentialed clinicians but by trained community members. Fifty-four lay candidates were recruited through Zambian pastors, teachers, and addiction specialists, screened for compassionate character and interpersonal skill, and given four days of interactive training. Senior trainers selected four coaches and fifteen group leaders, each group led by one man and one woman. Fidelity was monitored through detailed checklists covering all fifteen activities in every session, with weekly submissions and regular field visits. A three-day Child Protection Protocol workshop equipped the team to identify psychosocial distress and refer at-risk students to a clinical social worker. When five staff members withdrew early due to competing school job demands, a pre-trained replacement pool filled the gaps without interrupting delivery.

The trial enrolled 460 eighth-grade students aged 13 to 17 from eight schools, cluster-randomized in a 1:1 ratio to the intervention or a waitlist control. Researchers measured character strengths, resilience, substance use, sexual risk behaviors, and quality of life using computerized audio-assisted self-report questionnaires at baseline, 6 months, and 12 months, with sensitive sections administered through headphones to protect privacy. School records provided attendance percentages and final exam scores in five core subjects across successive spring terms. Analyses used generalized estimating equations and mixed effects modeling adjusted for the cluster design and baseline differences in age, sex, and meal frequency.

Feasibility results were striking. Ninety-eight percent of intervention students attended at least one session, and 70 percent completed the program by attending 30 or more of the 36 classes. The median attendance was 34 sessions, with no decline between the first and second halves of the year. Rural participants attended even more faithfully, with a median of 35 sessions and a 75.4 percent completion rate compared to 61.5 percent in urban schools. Follow-up survey completion rates exceeded 80 percent in both arms at both timepoints, and qualitative feedback from parents, students, and leaders confirmed strong acceptability.

The efficacy signals were equally compelling. Intervention students showed significantly greater increases than controls in hope, self-regulation, psychological resilience, and perceived self-efficacy to refuse alcohol when others are drinking. School attendance rose from 94.8 to 97.0 percent in the intervention group while falling from 94.3 to 90.8 percent among controls, a highly significant group-by-time interaction. Exam scores climbed from 49.0 to 52.4 percent in the intervention arm versus a smaller gain from 40.4 to 41.8 percent among controls, with the effect concentrated in rural schools. Urban participants, meanwhile, showed stronger gains in hope, resilience, self-regulation, and quality of life measures, suggesting the program’s benefits may manifest differently across settings.

Substance use outcomes were promising but statistically inconclusive. Past-6-month alcohol use fell from 9.9 to 3.7 percent in the intervention group between 6 and 12 months, while remaining flat around 5.6 percent in controls. Adjusted relative risk ratios favored the intervention for alcohol use (0.57), other substance use (0.45), and any sexual partners (0.43), but all confidence intervals were wide and included 1.0, likely because baseline use was far lower than the 42.6 percent reported in earlier Zambian surveys. Notably, the rural subgroup showed a significant effect on sexual partners at 12 months, with 5.9 percent of intervention students versus 23.5 percent of controls reporting any partner—a finding with potential implications for HIV prevention in a country where prevalence remains 8.0 percent among men and 13.9 percent among women.

The study’s limitations temper enthusiasm. Self-reported substance use was not confirmed with biomarkers, social desirability bias may have suppressed reporting, and the power analysis did not account for cluster sampling. Participants knew the program’s goals, introducing possible performance bias, and the sample’s limited religious diversity restricts generalizability. Those lost to follow-up were more likely male, older, and to have reported lifetime alcohol use at baseline. Still, the authors argue that GROW-HFLS demonstrates a feasible, culturally adaptable, and scalable model that aligns with the African Union’s call for community-involved prevention. By training lay community members rather than relying on scarce professionals, the program sidesteps a chronic barrier in low- and middle-income countries, and its tangible academic benefits—attendance and exam gains linked to lifelong health and earning potential—may accelerate adoption by education ministries. Larger trials with longer follow-up, biomarker verification, and more religiously diverse samples are the logical next steps, but for now, a curriculum built on hope, storytelling, and community ownership has shown it can move the needle on some of the most stubborn determinants of adolescent wellbeing in sub-Saharan Africa.

Subject of Research: A pilot cluster-randomized trial of a school-based character strengths and substance use prevention intervention for Zambian adolescents

Article Title: Feasibility, acceptability, and preliminary effects of the GROW Hopes for Life-Schools intervention on character strengths, resilience, substance use, risky sexual behavior, and school attendance and performance among Zambian adolescents: results of a pilot cluster-randomized controlled trial

Article References: Feasibility, acceptability, and preliminary effects of the GROW Hopes for Life-Schools intervention on character strengths, resilience, substance use, risky sexual behavior, and school attendance and performance among Zambian adolescents: results of a pilot cluster-randomized controlled trial. (n.d.). https://doi.org/10.3389/fradm.2026.1739068

Image Credits: AI Generated

DOI: 10.3389/fradm.2026.1739068

Keywords: adolescent health, Zambia, character strengths, positive psychology, substance use prevention, resilience, school attendance, cluster-randomized trial, community health workers, alcohol prevention, risky sexual behavior, positive youth development