Feasibility, Acceptability, and Utility of the Keepin' It REAL Program for Preventing Adolescent Substance Use in Nigeria.

Adolescent substance use remains a pressing public health concern, particularly in low- and middle-income countries (LMICs) where prevention infrastructures are limited. This mixed-methods study evaluated the feasibility, acceptability, utility, and preliminary efficacy of a linguistically adapted version of the keepin' it REAL (KiR) substance use prevention curriculum for junior secondary school students in Lagos, Nigeria. Participants included 532 students (age 11-13) from eight public schools randomly assigned to intervention or control conditions and the teachers implementing KiR (N = 9). Quantitative surveys assessed implementation outcomes and proximal behavioral indicators (e.g., personal anti-drug norms, resistance strategies, intentions to use substances), while qualitative interviews and open-ended responses captured implementation experiences. Results showed high feasibility (e.g., strong student participation and consistent curriculum delivery) and acceptability across sites, as reflected in student interest and high satisfaction ratings despite infrastructural challenges. Students reported meaningful learning, especially regarding REAL resistance strategies. Regression analyses indicated that participation in KiR significantly predicted stronger anti-drug norms (p = .01) and greater use of resistance strategies (p < .001) at post-test. Findings suggest that KiR can be feasibly implemented in Nigerian schools with some adaptation to the context, offering promise as a culturally responsive strategy to reduce adolescent substance use in West African settings.