Evidence-Based Substance Use Prevention With Adolescents in Sub-Saharan Africa: Challenges and Opportunities

This commentary article examines the landscape of youth substance use prevention efforts in sub-Saharan Africa over the past decade (2014-2024), highlighting both the progress made and the challenges that remain. It reviews current evidence-based prevention programs, including Keepin' it REAL and the Unplugged Program, discussing their implementation, cultural adaptation, and effectiveness. The article also acknowledges other promising prevention initiatives and capacity-building efforts across the region. The review concludes that the region's great diversity is also reflected in the state of prevention science in different countries. There is, however, a shared need for more access to evidence-based prevention interventions and a need to strengthen local capacity to lead the efforts. We introduce the Global Center for Applied Health Research's African Initiative as a specific approach to strengthening local capacity, conducting feasibility studies, and culturally adapting evidence-based interventions. The model emphasizes sustainability, cultural congruence, and community-based participatory research approaches. We discuss the implications for future research, stressing the need for culturally adapted, evidence-based interventions that address the complex socio-cultural, economic, and political landscapes of sub-Saharan Africa. The article calls for greater involvement of local researchers and youth in the design and implementation of prevention programs, as well as an increase in funding for prevention science research to inform policy changes. This commentary proposes a specific strategy in support of in-country researchers, policymakers, educators, and health professionals as they work toward reducing substance use among youth in sub-Saharan Africa. The article concludes by advocating for a multilevel approach to prevention science that goes beyond studying proximal risk factors to consider broader structural determinants.