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Study breakdown

School-based substance prevention programs showed mixed and sometimes counterproductive results

Cross SectionalModerate evidence
The takeaway

Public health engagement in school substance use prevention showed no overall effect on student use, and some collaborative approaches were associated with increased alcohol and cannabis use in low-use schools.

School health administrators, public health program designers, prevention researchers

Some prevention methods increased cannabis use in low-use schools

What the researchers found

Among 42,149 students in 84 schools, public health engagement in substance use prevention had no significant overall impact on student use. When public health agencies solved problems jointly with schools, odds of alcohol and cannabis use increased. Some methods decreased cannabis and cigarette use in high-use schools but increased alcohol and cannabis use in low-use schools.

Why it matters

Schools invest substantial resources in substance prevention programs. Finding that some approaches may backfire in low-use schools suggests that one-size-fits-all prevention strategies may be counterproductive.

The numbers in context

84 schools; 42,149 students; 70% of schools had public health engagement; joint problem-solving significantly increased odds of alcohol and cannabis use

How the study worked

Cross-sectional analysis of 2018/2019 COMPASS study data from 84 schools and 42,149 Canadian students. Multilevel logistic regression assessed associations between five methods of public health engagement and student substance use.

What this study cannot tell us

Cross-sectional design cannot establish causation. Public health engagement was measured at the school level, not the student level. Cannot account for quality or fidelity of specific program implementation.

How to read the evidence

Large sample with multilevel modeling, but cross-sectional design and inability to assess program quality limit conclusions.

When this study was published

Published 2023 using 2018-2019 data

The bigger picture

Prevention programs need to be tailored to school context. What works in a high-use school may not only fail in a low-use school but could potentially normalize substance use among students not previously at risk.

Questions still open

  • Why did joint problem-solving increase substance use in some schools? Would evidence-based program selection reduce the risk of iatrogenic effects?

Common questions

Do school substance prevention programs reduce cannabis use?
In this study of 42,149 Canadian students, public health engagement in prevention showed no overall effect. Some approaches reduced cannabis use in high-use schools but increased it in low-use schools.
Can prevention programs backfire?
Yes. When public health agencies solved problems jointly with schools, the odds of students using alcohol or cannabis significantly increased, suggesting some collaborative approaches may normalize substance use.

Read the original research

The association between public health engagement in school-based substance use prevention programs and student alcohol, cannabis, e-cigarette and cigarette use.

Canadian journal of public health = Revue canadienne de sante publique, 114(1), 94-103

Citation

Burnett, Trish; Battista, Kate; Butt, Michelle; Sherifali, Diana; Leatherdale, Scott T; Dobbins, Maureen. (2023). The association between public health engagement in school-based substance use prevention programs and student alcohol, cannabis, e-cigarette and cigarette use.. Canadian journal of public health = Revue canadienne de sante publique, 114(1), 94-103. https://doi.org/10.17269/s41997-022-00655-3

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