Youth First Supports Adolescent Wellbeing: A Longitudinal Cluster Randomized Controlled Trial of a Teacher-Delivered School-Based Program in India

Globally, adolescents are facing a “polycrisis” of intersecting challenges that place them at heightened risk for poor mental health outcomes, particularly in low- and middle-income countries (LMICs), where 90% of the world’s adolescents live. School-based wellbeing programs offer a promising, cost-effective prevention strategy, yet evidence from large-scale, government-delivered interventions with longer-term follow-ups remains limited. This study evaluates the effectiveness of Youth First, a teacher-delivered, in-school wellbeing program, as conducted in Bihar, India, via government systems, addressing key evidence gaps relevant to LMIC government adoption.We conducted secondary analysis of data from a cluster-randomized controlled trial across 69 government schools in Bihar, India, enrolling 5,445 Grade 7–8 students. Schools were randomized to Youth First or control (standard education). Data were collected at baseline, 8 months, and 20 months. Outcomes measured included physical and mental wellbeing, psychosocial assets, gender attitudes, empowerment, and tobacco use. Analyses followed an intention-to-treat framework using mixed-effects difference-in-differences models with random intercepts for schools and students.Youth First led to statistically significant improvements in social and peer support across multiple time points and cohorts. Additional significant effects were observed for self-efficacy, empowerment, internalizing symptoms, psychological wellbeing, and tobacco use, with patterns varying by grade and exposure duration. Notably, several effects persisted or intensified one year post-intervention, including for psychological wellbeing and self-efficacy.This longitudinal cluster-randomized controlled trial demonstrates that a scalable, government-delivered school wellbeing program can produce meaningful and sustained benefits across multiple priority outcomes for adolescents in an LMIC setting.