School-based Substance Use Research Articles

Co-occurring experiences of traumatic events and substance use among young people

ObjectiveHarmful substance use among young people is concerningly prevalent. Substance use disorder (SUD) and post-traumatic stress disorder (PTSD) frequently co-occur in treatment settings and are well researched among adults but lacking among young community cohorts. The aim of this study was to explore the prevalence and relationship between substance use, SUD, trauma, and PTSD among a community sample of young people in Australia. MethodA cross-sectional examination of data collected from participants (n = 1007, 48.9 % male) aged 18–22 years (M = 20 years, SD = 0.44), who took part in the 7-year follow-up of a cluster RCT of school-based substance use prevention interventions: The Climate and Preventure (CAP) study. A series of regressions were conducted to examine the relationship between trauma-related variables and substance use outcomes. Results48.3 % experienced a traumatic event (median = 2, range = 1–11) and of those 10.9 % met a probable PTSD diagnosis. Median age of first trauma exposure was 14 years (range = 0–21). 89.9 % used substances; 73.1 % reported binge drinking, and 35.6 % met a probable diagnosis of SUD (alcohol/cannabis). Those who experienced any traumatic event had almost 1.5 times greater odds of binge drinking. Cannabis use was significantly associated with most trauma-related variables. Sexual trauma exposure was the only trauma type significantly associated with all substance use variables. ConclusionsThis study demonstrated that substance use/SUD and experiences of trauma/PTSD are prevalent among a community sample of young people. Importantly, substance use among young people is associated with experiencing a traumatic event, particularly sexual and physical types of traumatic events, and developing PTSD.

Effects of a school-based substance use prevention education on psychoactive substance knowledge, attitudes and behaviours among young people

Effects of a school-based substance use prevention education on psychoactive substance knowledge, attitudes and behaviours among young people

School-based interventions targeting substance use among young people in low-and-middle-income countries: A scoping review.

Globally, harmful substance use is among the leading causes of premature deaths in the general population, and most of these behaviours are initiated during pre-adolescence to young adulthood. Preventing the onset or reducing the prevalence of substance use among young people is thus a global health priority. Diverse school-based interventions have been implemented in low-and-middle-income countries (LMICs); however, evidence regarding their theoretical underpinnings and core components is lacking. The aim of this scoping review was to identify the underlying (social/behavioural) theories, models or frameworks (TMF) and core (practical) components of school-based interventions in LMICs aimed at preventing the onset or reducing the prevalence of substance use among young people. Using the Joanna Briggs Institute (JBI) guidance for conducting scoping reviews, we searched scientific literature databases for articles published from 1995 to 2022. A further search was conducted using the reference lists of included articles. We selected randomized and non-randomized trials of school-based interventions in LMICs that aimed at preventing the onset or reducing the prevalence of substance use among young people. We used Covidence software to screen titles and abstracts, as well as full texts. We then extracted the data and analysed it using a descriptive content analysis approach. Two reviewers conducted the screening, extraction and data analysis and discussed discrepancies, and clarified doubts and uncertainties through consultation with the other team members. A total of 58 articles were included in the review. Most articles (63.8%) used either a single or combination of two or more TMFs to inform their interventions. The most widely used TMF was social learning theory followed by theory of planned behaviour. We identified six core components of substance use prevention interventions: education, school environment, school policy, parental involvement, peer engagement and counselling. This scoping review outlines the core components of school-based substance use prevention interventions used in low-and-middle-income countries and the common theories, models or frameworks that underpin the design of those interventions.

Youth participation in substance use prevention: A national profile, 2011–2019

PurposePrevention efforts are critical to avoid the negative consequences of substance use in adolescents. This study aimed to examine national trends and sociodemographic differences in adolescents' participation in school-based substance use prevention (SUP) education, community-based SUP programs, as well as family conversations about substance use. MethodsPublicly available data for adolescents aged 12–17 from the annual cross-sectional surveys of the National Survey on Drug Use and Health 2011–2019 were analyzed. ResultsAcross the survey years, up to 74.9%, 12.2%, and 58.1% of adolescents reported having participated in school-based SUP education, community-based SUP programs, and family conversations about the danger of substance use in the past-year, respectively. From 2011 to 2019, statistically significant decreases were observed in adolescents' participation in school-based SUP education (OR = 0.97, 95% CI: 0.96, 0.98, p < 0.001) and community-based SUP programs (OR = 0.98, 95% CI: 0.97, 0.99, p < 0.001). Meanwhile, no significant changes were observed in adolescents' participation in family conversations about the dangers of substance use. Overall, lower levels of participation in school-based and community-based SUP programs were found in adolescents aged 16–17. Adolescents living in rural areas showed lower levels of participation in school-based SUP programs and family conversations about SUP. Racial/ethnic minority adolescents overall were less likely to participate in conversations with parents about SUP than Whites. ConclusionsFurther development and implementation of developmentally appropriate, gender-specific, culturally sensitive, and contextually informed SUP programs at school, community, and family levels are needed.

Universal School-Based Substance Use Prevention Using Technology-Supported Cooperative Learning.

Substance use in adolescence is a significant public health issue, particularly in early-to-mid adolescence, which represents a window of risk in the etiology of substance abuse and dependence. Substance use during this development period often results from affiliation with deviant peers, who model, facilitate, and reinforce use. Existing school-based substance use prevention programs have historically aimed to build adolescent knowledge regarding the dangers of substance use and/or enhance peer refusal skills. Research finds that these programs have had some success in reducing substance use, but meta-analyses report that average effect sizes are small. In a small one-year cluster randomized trial (12 middle and high schools; N = 813 students; ClinicalTrials.gov: NCT04478240), cooperative learning (CL) was implemented with the support of specialized technology and evaluated for its ability to reduce deviant peer affiliation and, in turn, reduce substance use. CL is a structured approach to small-group learning that provides at-risk youth with the opportunity to build friendships with more prosocial youth, interrupting the process of deviant peer clustering. Multi-level modeling revealed intervention effects for deviant peer affiliation and alcohol use across the sample, while tobacco use was significantly reduced among non-White students; intervention effects for marijuana use were only marginally significant. Effects for dosage were found for all outcomes, suggesting that every lesson taught had a significant impact. We conclude that CL, delivered with the aid of specialized technology, represents a viable option for universal substance use prevention. Future research should attempt to combine this approach with evidence-based prevention curricula.

194. Effectiveness of Interactive School-Based Substance Use Prevention Education among Adolescents

194. Effectiveness of Interactive School-Based Substance Use Prevention Education among Adolescents

Unmet Need for School-Based Substance Use Prevention Strategies Among Secondary Schools in Orlu, Imo State

Abstract: Background. In Nigeria, the use of psychoactive substances has reached an epidemic proportion while substance use prevention remains inadequate or unavailable. Methods. Cross-sectional data from 300 Junior Secondary School students in Imo state were analyzed to evaluate the unmet need for school-based substance use prevention strategies among secondary school students in Orlu, Imo state. Information was collected using a structured questionnaire. Results. Substance use was common with easy access to psychoactive substances for young people. There was a perceived need for substance use prevention strategies in their school with most students lacking access to basic preventive strategies. Conclusion. Though there was a high need for preventive strategies for substance abuse among secondary school students in Orlu, few strategies were in place to meet the needs of the students.

86.1 Community and School-Based Substance Use Prevention Interventions

86.1 Community and School-Based Substance Use Prevention Interventions

A pragmatic clinical effectiveness trial of a novel alternative to punishment for school-based substance use infractions: study protocol for the iDECIDE curriculum.

Adolescents who use alcohol and other drugs on school campuses are at heightened risk for adverse consequences to their health and wellbeing. Schools have historically turned to punitive approaches as a first-line response to substance use. However, punishment is an ineffective deterrent for substance use and may cause harm and increase inequities. iDECIDE (Drug Education Curriculum: Intervention, Diversion, and Empowerment) was developed as a scalable and youth-centered drug education and diversion program that can be used as a skills-based alternative to punishment. We aim to evaluate the effectiveness of the iDECIDE curriculum as an alternative to punishment (ATP) for school-based substance use infractions in the context of a large pragmatic clinical effectiveness study. We will conduct a Type 1, hybrid effectiveness-implementation trial. Using a stepped wedge design with approximately 90 middle and high schools in Massachusetts, we will randomly allocate the timing of implementation of the iDECIDE curriculum compared to standard disciplinary response over approximately 36 months. We will test the overarching hypothesis that student-level outcomes (knowledge of drug effects and attitudes about substance use; frequency of substance use; school connectedness) improve over time as schools transition from a standard disciplinary response to having access to iDECIDE. The secondary aims of this trial are to (1) explore whether change in student-level outcomes vary according to baseline substance use, number of peers who use alcohol or other drugs, age, gender, and school urbanicity, and (2) determine the acceptability and feasibility of the iDECIDE curriculum through qualitative stakeholder interviews. Substance use continues to be a major and rapidly evolving problem in schools. The importance of moving away from punishment to more restorative approaches is widely accepted; however, scalable alternatives have not yet been identified. This will be the first study to our knowledge to systematically evaluate an ATP for students who violate the school substance use policy and is well poised to have important implications for policy making.

Does Narrative Quality Matter During Implementation of a School-Based Prevention Intervention? A Test of Narrative Engagement Theory

Narratives play a powerful role in sharing meaning and making sense of experiences. Specifically, health narratives convey storylines, characters, and messages about health-related behaviors and provide audiences with models for healthy behaviors, prompting audiences’ health-related reflections and decision-making. Narrative engagement theory (NET) explains how personal narratives can be integrated into interventions to promote health. This study utilizes NET to test direct and indirect effects of teachers’ narrative quality on adolescent outcomes during a school-based substance use prevention intervention that includes narrative pedagogy and an implementation strategy. Observational coding of teacher narratives in video-recorded lessons along with self-report student surveys (N = 1,683) were subjected to path analysis. Findings showed significant direct effects of narrative quality on student engagement, norms (i.e. personal, best-friend injunctive, and descriptive norms), and substance use behavior. The analysis also yielded support for indirect effects of narrative quality on adolescent substance use behavior via student engagement, personal norms, and descriptive norms. Findings highlight important issues related to teacher-student interaction during implementation and contributes implications for adolescent substance use prevention research.

Public Health Implications: A Scoping Review of Opioid Prevention Programs Among Adolescents

Opioid misuse and its attendant negative consequences remain a public health challenge. This is true among all sectors of the population, and, in the U.S., it has impacted adolescent health in sometimes fatal ways. As a result, the public health sector has sought mechanisms for preventing opioid misuse, with school-based interventions emerging as one of the most viable options for intervening early and effectively. School-based substance use interventions have proven effective when implemented using a repertoire of effective strategies, however, it is unclear if those strategies have been equally effective in combatting adolescent opioid misuse. This scoping review explores school- and community- based intervention programs as well as national public awareness initiatives that support adolescent opioid education. Identification of Evidence-Based Programs (EAP) that target opioid education for adolescents has proven to be most elusive; it is our belief that no such EAP exists. Therefore, it is critical to evaluate current opioid prevention efforts in hopes to determine whether we have the appropriate tools to combat this public health issue.

Updated systematic review of Australian school-based prevention programmes for alcohol and other drugs: a review protocol

IntroductionAdolescent onset substance use is associated with neurodevelopmental, social and psychological harms. Thus, alcohol and other drug prevention programmes are essential to promote health and well-being during this period. Schools...

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

ObjectiveThis study examined the associations between public health engagement (PHE) in school-based substance use prevention programs and student substance use. For the purposes of this study, PHE refers to any form of collaboration between the local government public health agency and the school to promote the physical and mental health of students.MethodsData for this study were collected from the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking and Sedentary behaviour (COMPASS) study during the 2018/2019 data collection year. Multilevel logistic regression was used to analyze the associations between PHE and student substance use.ResultsData from 84 schools and 42,149 students were included; 70% of schools had PHE in substance use prevention programs. PHE in substance use prevention appears to have had no significant impact on student substance use in our models. When PHE was divided into five methods of engagement, it was found that when public health solved problems jointly with schools, the odds of a student using alcohol or cannabis significantly increased. When schools were split into low- and high-use schools for each substance measured, some methods of PHE significantly decreased the odds of cannabis and cigarette use in high-use schools and significantly increased the odds of alcohol and cannabis use in low-use schools.ConclusionThis study highlights the need to develop better partnerships and collaborations between public health and schools, and the importance of ensuring that school-based substance use prevention programs are evidence-based and tailored to the specific needs of schools and students.

Youth gun carrying and household firearm ownership in 22 US states.

Youth gun carrying is associated with a range of adverse outcomes, including increased risks for homicide, suicide, school disciplinary problems, and criminal legal involvement. In this study we examined the association between state-level household firearm ownership rates and the odds of past-year gun carrying among high-school-aged youth. Using survey-weighted multivariable logistic regression models, results showed that each 1% point increase in state-level gun ownership was associated with a 2.7% (95% confidence interval [CI] = [1.1%, 4.2%], p = 0.001) increased odds of youth gun carrying, controlling for histories of school-based victimization, physical fighting, and substance use. Among a subset of weapon-carrying youth, state-level firearm availability was a significant factor in determining whether the weapon carried was a gun or a less lethal (i.e., nonfirearm) weapon (odds ratio = 1.021, 95% CI = [1.005, 1.038], p = 0.01). These findings show that firearm availability confers additional risk for youth gun carrying beyond the psychosocial risks emphasized in prior research and efforts to restrict youth access to firearms might be particularly important, especially in communities with high levels of household gun ownership.

The Unplugged program in Chile (\u201cYo S\xe9 Lo Que Quiero\u201d) for substance use prevention among early adolescents: study protocol for a randomized controlled trial

BackgroundSubstance use is among the main contributors to disease among children and adolescents in the Americas region. The call for effective prevention of substance use among adolescents has resulted in numerous school-based programs, and particularly the Unplugged program has been proved to be successful in reducing the prevalence of different substances in seven European countries. The purpose of this study is to test the effectiveness of the Unplugged program in Chile (“Yo Sé Lo Que Quiero”).MethodsThis is a cluster randomized controlled trial, parallel-group type, where “Yo Sé Lo Que Quiero” is compared to standard school preventive curricula in control schools. A total of 70 schools and 8400 adolescents are expected to be randomized with 1:1 allocation. During formative work, the Unplugged program was culturally adapted to Chile, and the instrument to assess the primary and secondary outcomes was validated. The effectiveness of this program will be assessed using the European Drug Addiction Prevention Trial Questionnaire (EU-Dap), measuring substance use prevalence and risk and protective factors in baseline, post-intervention, and four months after the end of the intervention.DiscussionThe proposed study will be the first to test the effectiveness of a school-based substance use prevention program in Chile in a cluster randomized control trial and the first study evaluating the Unplugged program in Spanish-speaking Latin America. A model for disseminating the Unplugged program inside Europe already exists and has been implemented successfully in several countries. Thus, if the effects of the program are positive, wide implementation in Chile and Latin American countries is possible soon.Trial registrationClinicalTrials.govNCT04236999. Registered on January 17, 2020.

Effectiveness of a school-based substance use prevention program taught by police officers in Brazil: Two cluster randomized controlled trials of the PROERD

The Drug and Violence Resistance Educational Program (PROERD) is widely disseminated and implemented as a public policy in Brazil. PROERD's current curricula are the translation of the North American program DARE-Keepin'it REAL, based on the theories of socio-emotional learning and resistance training. The present study aims to evaluate the effectiveness of PROERD in the prevention of drug use. Two PROERD curricula were analyzed through two cluster randomized controlled trials conducted with 4030 students (1727 5th graders and 2303 7th graders) in 30 public schools in São Paulo. The intervention group received ten PROERD classes delivered by trained police officers, and the control group received no intervention. Data collection was performed using self-administered questionnaires on smartphones at two points in time (baseline pre-intervention and nine months follow-up). The outcomes evaluated were initiation and recent drug use. Two different paradigms were used in a multilevel analysis: an analysis of complete cases (CC) and an intention to treat missing data through full information maximum likelihood and selection model. We found no evidence of the effectiveness of PROERD as an intervention for the prevention of drug use. For the conditional transition analysis, we found that 7th graders in the PROERD group who were already binge drinking at baseline had a significantly higher chance of maintaining this consumption pattern when compared to the control group. The lack of preventive effects found here suggests that a process evaluation may address concrete implementation and cultural adaptation issues.

Effects of the "Unplugged" school-based substance use prevention program in Nigeria: A cluster randomized controlled trial

BackgroundSchool-based programs are the most convenient interventions to tackle substance use among youth. “Unplugged” is a Social Influence universal school curriculum developed and tested in the “EU-Dap” project. In 2015, Nigeria implemented a large-scale project to promote healthy lifestyles in schools, families and communities. Within the project, the effectiveness of “Unplugged” was evaluated through a cluster randomized controlled trial. MethodsThe program was adapted to the Nigerian context, assembling suggestions from monitoring forms and interviews, and performing fidelity checks on content and method. Thirty-two secondary schools were extracted from a list provided by the Federal Ministry of Education, and randomly allocated to intervention and control arms. A self-completed anonymous questionnaire was used for baseline and follow-up surveys. The analysis sample finally included 2685 pupils (mean age 14.2 years). Multilevel models were run to estimate program effects on prevalence of self-reported cigarettes, alcohol, and marijuana use. Mediation analysis was performed to identify possible mediators of program effect on alcohol use. ResultsUnplugged significantly reduced the prevalence of recent alcohol use in intervention vs control pupils. The effect on prevalence of cigarette and marijuana use was not statistically significant. The program prevented progress and encouraged regress across stages of intensity of alcohol use. Negative beliefs, risk perceptions, and class climate mediated the effect of Unplugged on alcohol use. ConclusionsUnplugged was effective in preventing alcohol use improving beliefs, class climate and risk perceptions among Nigerian students. The implementation of the program at a larger scale in the country should be supported.

Policy Makers' Priorities for Addressing Youth Substance Use and Factors That Influence Priorities.

Understanding public policy makers' priorities for addressing youth substance use and the factors that influence these priorities can inform the dissemination and implementation of strategies that promote evidence-based decision making. This study characterized the priorities of policy makers in substance use agencies of U.S. states and counties for addressing youth substance use, the factors that influenced these priorities, and the differences in priorities and influences between state and county policy makers. In 2020, a total of 122 substance use agency policy makers from 35 states completed a Web-based survey (response rate=22%). Respondents rated the priority of 14 issues related to youth substance use and the extent to which nine factors influenced these priorities. Data were analyzed as dichotomous and continuous variables and for state and county policy makers together and separately. The highest priorities for youth substance use were social determinants of substance use (87%), adverse childhood experiences and childhood trauma (85%), and increasing access to school-based substance use programs (82%). The lowest priorities were increasing access to naloxone for youths (49%), increasing access to medications for opioid use disorder among youths (49%), and deimplementing non-evidence-based youth substance use programs (41%). The factors that most influenced priorities were budget issues (80%) and state legislature (69%), federal (67%), and governor priorities (65%). Issues related to program implementation and deimplementation were significantly higher priorities for state than for county policy makers. These findings can inform the tailoring of dissemination and implementation strategies to account for the inner- and outer-setting contexts of substance use agencies.

Frequency and importance of interpersonal communication about a school-based intervention with parents, peers, and teachers: application of social interface model

ABSTRACT Social interface model (SIM) explicates the important roles of family, peer, and school microsystems in intervention research. The present study used surveys to explore how Nicaraguan adolescents who participated in a school-based substance use and violence prevention intervention communicated about the intervention with parents, peers, and teachers. Latent class analysis was run to identify distinctive typologies of interfaces characterized by occurrence and importance of conversations. Five latent classes (N = 109) were discovered: optimal transference (21%), neutral transference (17%), limited positive transference (17%), negligible neutral interface (28%), and negligible adverse interface (16%). The optimal transference and neutral transference groups reported having conversations with all three microsystems (i.e. their mother, father, best friend, and teachers) and that those conversations resulted in seeing the curriculum the same way or as more important. The negligible neutral interface and negligible adverse interface groups reported minimal or no conversation across microsystems, which resulted in viewing the curriculum as not important or less important. The limited positive transference group reported selective conversations mostly with their mother and teachers, which was evaluated as important and/or neutral. Findings discuss the application of SIM in prevention research and provide a more nuanced understanding of how intervention messages are recalled and processed post-delivery.

Erratum: Erratum for “Differential Nonenrollment of Taiwanese Children in School-Based Substance Use Prevention Studies: A Multilevel Analysis”

"Erratum: Erratum for “Differential Nonenrollment of Taiwanese Children in School-Based Substance Use Prevention Studies: A Multilevel Analysis”" Journal of Studies on Alcohol and Drugs, 82(3), p. 439