Drug abuse has increasingly become a major public health concern worldwide, with its onset age gradually shifting to younger populations [1]. Traditionally viewed as a problem affecting older adolescents and adults, recent epidemiological data highlight a worrying trend in which drug abuse, including prescription medication abuse and illicit substance use, has extended into younger school-aged children. In Korea, national health insurance records and government surveys reveal that drug abuse among adolescents has risen steadily over the past decade [2]. The increasing accessibility of drugs through online markets, social media platforms, and peer networks has further exacerbated this trend, creating a new and urgent challenge for educators, clinicians, and policymakers.

The consequences of early exposure to drugs are profound. On an individual level, drug abuse in childhood can disrupt normal neurodevelopmental processes, impair cognitive function, and hinder academic achievement [3]. Early substance use has also been associated with emotional dysregulation, impulsivity, and impaired decision-making, all of which can persist into adolescence and adulthood [4]. From a psychosocial perspective, drug misuse or abuse can disrupt peer relationships, family dynamics, and the overall trajectory of healthy social development [5]. On a broader scale, the rise in drug misuse among youth places a considerable economic and social burden on society, contributing to increased healthcare costs, school absenteeism, family stress, and legal consequences [6]. As such, addressing drug misuse at its earliest stages is not only a matter of individual health but also a critical social priority.

In Korea, the urgency for early drug prevention is underscored by recent statistics showing that the number of teenage drug offenders has nearly quadrupled over the past five years [7]. According to the National Health Insurance Service, the number of adolescents receiving medical treatment for drug abuse-related issues surged by 41.4% in just one year, rising from 1,187 cases in 2020 to 1,678 cases in 2021 [8]. Furthermore, the increasing accessibility of illicit substances through social media and dark web platforms has made adolescents increasingly vulnerable to drug exposure [9]. In response, the Ministry of Education’s Second National Student Health Promotion Plan (2024-2028) now mandates that drug prevention education be implemented starting from the elementary level, emphasizing early intervention before maladaptive behaviors become entrenched [10].

Nonetheless, prevention programs targeting Korean elementary school students remain limited in scope and effectiveness. Existing programs are typically delivered as one-time lectures that emphasize the dangers of drugs or only focused on alcohol or tobacco. Moreover, participation rates remain low, with national surveys showing that less than 10% of students received structured drug education programs in the past several years [11]. This gap is particularly concerning given that research consistently demonstrates the importance of interactive, multi-session, and developmentally tailored approaches to prevention [12].

In the United States, there are well-known evidence-based strategies for early drug prevention. LifeSkills Training (LST) has demonstrated long-term effectiveness in reducing youth tobacco, alcohol, and illicit drug use across diverse populations, supported by multiple randomized controlled trials and meta-analyses [13]. Drug Abuse Resistance Education (D.A.R.E.), and the revised Keepin’ it REAL model have demonstrated measurable benefits in delaying the onset of substance use, improving social-emotional competencies, and strengthening resilience against peer pressure [14]. These interventions are grounded in theories of Social and Emotional Learning (SEL), which emphasize the cultivation of self-awareness, responsible decision-making, emotional regulation, and positive peer relationships. Importantly, such programs are interactive, utilizing role-play, group discussions, and experiential learning to engage students in meaningful ways. However, while these programs have shown success globally, their direct application in Korea is limited by differences in the educational system and cultural norms. There is a critical need for research that bridges the gap by culturally and developmentally adapting the core components of SEL—such as responsible decisionmaking and peer pressure resistance—specifically for the Korean elementary school context.

The purpose of the present study was to develop a culturally tailored, developmentally appropriate, drug abuse prevention program specifically for Korean elementary school children. We conducted a pilot study to examine the feasibility of the program in a school setting.

A total of 194 (male, 47.47%) elementary school students—45, 2nd graders; 40, 3rd graders; 39, 5th graders; 60, 6th graders—participated in the pilot program. Students had not previously participated in structured drug prevention programs.

Facilitators who implemented the program reported that conducting the program using the manual and presentation slides was non-challenging. Also, they reported that program content was generally appropriate for the student’s developmental level and was well understood. They reported that students were attentive and actively participated in interactive activities such as role-play and group discussions. They suggested that the student workbooks should be used only as supplementary materials, so that students would not be overly occupied with writing tasks.

The results of the satisfaction surveys administered at the end of the program are presented in Figures 1 and 2. Among lower elementary students, 82.4% rated the program as “interesting,” and 81.1% reported that they understood it well. Among upper elementary students, 87.9% rated the program as “interesting,” and 87.9% reported that they understood it well. Also, 84.8% of the lower elementary students and 87.1% of upper elementary students reported that they learned about making healthy and responsible choices.

Pre- and post-program surveys from the upper elementary students demonstrated that the mean Rosenberg Self-Esteem Scale score increased from 27.3±4.2 at baseline to 28.2±3.9 post-intervention, yielding a small effect size (Cohen’s d=0.21). The attitude toward drug abuse questionnaire showed that the score (higher scores indicating stronger rejection to drug abuse) increased from 15.2±2.3 to 15.6±3.1 (Cohen’s d=0.14). While these changes were not statistically significant (p>0.5), they indicate a positive direction in the program’s preliminary impact.

The present study represents one of the first attempts to develop a culturally tailored drug abuse prevention program for elementary school students in Korea. By grounding the program in the framework of SEL and using evidence-based international models such as LST and D.A.R.E. as references, the program sought to bridge the gap between global best practices and the Korean educational context. The findings provide preliminary evidence the program is feasible and applicable in targeted population.

The findings of this pilot study provide preliminary but promising quantitative evidence for the program’s impact. Specifically, the increase in self-esteem scores (d=0.21) and drug-rejecting attitudes (d=0.14), while not statistically significant, align with the outcomes of established international models like LST in their early implementation phases [18]. Pilot studies of prevention programs often yield small effect sizes due to brief intervention periods and small sample sizes [19]. These results suggest that even brief SEL interventions can initiate meaningful shifts in the psychological protective factors of Korean youth, providing a foundation for long-term behavioral change.

One of the most significant contributions of this study lies in its focus on early intervention. Previous research has consistently demonstrated that delaying the onset of drug use reduces the likelihood of long-term dependence and associated negative outcomes [20]. Elementary school students represent a critical population for preventive intervention, as their cognitive, emotional, and social skills are still forming. By introducing prevention content during this developmental period, the program may foster resilience against peer pressure and unhealthy decision-making that typically emerge during adolescence. We aimed our program to not only prevent drug abuse but also enhance general psychosocial well-being. By embedding SEL principles into the program, we not only addressed drug abuse but also promoted broader competencies such as stress management and responsible decision-making, which are highly relevant for Korean youth. Teachers and experts noted that these elements increased the likelihood of program acceptance and sustainability in school settings.

The program’s reliance on interactive teaching strategies is another noteworthy strength. Unlike traditional lecture-style prevention efforts commonly used in Korea, the sessions incorporated role-play, group discussions, and scenario-based learning. Students responded positively to these methods, which likely contributed to their high engagement and the observed outcomes. Experts also highlighted the developmental appropriateness of the program, noting that younger students benefited from visual aids and storytelling, while older students were able to critically engage with more complex discussions. This tailoring of content to age-specific developmental stages underscores the importance of differentiated approaches in prevention science.

Despite its promising results, the reasons why significant improvements were not observed in self-esteem scores and attitudes toward substance abuse can be considered as follows: First, the sample size was too small, since only 99 upper elementary students completed the surveys. The limited sample size likely constrained the ability to detect pre-post intervention effects. Second, the primary goal of this program was to prevent drug abuse by enhancing social skills such as making safe and responsible decisions. Thus, the self-esteem scale used may not have adequately captured the specific outcomes targeted by the intervention. Accordingly, the development and application of more suitable measures are needed to more accurately evaluate program effectiveness. Third, due to practical constraints in school schedule, the pilot program was delivered as two consecutive sessions per day. This scheduling may have negatively affected students’ attention and engagement, thereby diminishing the expected educational effect. Indeed, in the program satisfaction survey, relatively low ratings were reported regarding the length of the sessions. Therefore, limitations in session allocation and timing may have contributed to the absence of significant changes in substance misuse attitudes. Future implementation should follow the manual’s recommended format of conducting one session per week before evaluating changes in outcomes.

In conclusion, this study demonstrated that a culturally tailored, SEL-based prevention program is both feasible and potentially effective in improving protective factors against drug abuse among Korean elementary school students. While further research is required, these findings highlight the importance of early, developmentally appropriate interventions and provide a strong foundation for future policy and practice in youth drug prevention. Future directions for this line of research should include larger scale studies across multiple regions with better suitable measures to accurately evaluate program effectiveness.