School Substance Use Research Articles

Combined prevention for substance use, depression, and anxiety in adolescence: a cluster-randomised controlled trial of a digital online intervention

Substance use, depression, and anxiety in adolescence are major public health problems requiring new scalable prevention strategies. We aimed to assess the effectiveness of a combined online universal (ie, delivered to all pupils) school-based preventive intervention targeting substance use, depression, and anxiety in adolescence. We did a multicentre, cluster-randomised controlled trial in secondary schools in Australia, with pupils in year 8 or 9 (aged 13-14 years). Participating schools were randomly assigned (1:1:1:1) to one of four intervention conditions: (1) Climate Schools-Substance Use, focusing on substance use only; (2) Climate Schools-Mental Health, focusing on depression and anxiety only; (3) Climate Schools-Combined, focusing on the prevention of substance use, depression, and anxiety; or (4) active control. The interventions were delivered in school classrooms in an online delivery format and used a mixture of peer cartoon storyboards and classroom activities that were focused on alcohol, cannabis, anxiety, and depression. The interventions were delivered for 2 years and primary outcomes were knowledge related to alcohol, cannabis, and mental health; alcohol use, including heavy episodic drinking; and depression and anxiety symptoms at 12, 24, and 30 months after baseline. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12613000723785) and an extended follow-up is underway. Between Sept 1, 2013, and Feb 28, 2014, we recruited 88 schools (12 391 pupils), of whom 71 schools and 6386 (51·5%) pupils were analysed (17 schools dropped out and 1308 pupils declined to participate). We allocated 18 schools (1739 [27·25%] pupils; 1690 [97·2%] completed at least one follow-up) to the substance use condition, 18 schools (1594 [25·0%] pupils; 1560 [97·9%] completed at least one follow-up) to the mental health condition, 16 schools (1497 [23·4%] pupils; 1443 [96·4%] completed at least one follow-up) to the combined condition, and 19 schools (1556 [23·4%] pupils; 1513 [97·2%] completed at least one follow-up) to the control condition. Compared with controls, the combined intervention group had increased knowledge related to alcohol and cannabis at 12, 24, and 30 months (standardised mean difference [SMD] for alcohol 0·26 [95% CI 0·14 to 0·39] and for cannabis 0·17 [0·06 to 0·28] at 30 months), increased knowledge related to mental health at 24 months (0·17 [0·08 to 0·27]), reduced growth in their odds of drinking and heavy episodic drinking at 12, 24, and 30 months (odds ratio for drinking 0·25 [95% CI 0·12 to 0·51], and for heavy episodic drinking 0·15 [0·04 to 0·58] at 30 months), and reduced increases in anxiety symptoms at 12 and 30 months (SMD -0·12 [95% CI -0·22 to -0·01] at 30 months). We found no difference in symptoms or probable diagnosis of depression. The combined intervention group also showed improvement in alcohol use outcomes compared with the substance use and mental health interventions and improvements in anxiety outcomes when compared with the mental health intervention only. Combined online prevention of substance use, depression, and anxiety led to increased knowledge of alcohol, cannabis, and mental health, reduced increase in the odds of any drinking and heavy episodic drinking, and reduced symptoms of anxiety over a 30-month period. These findings provide the first evidence of the effectiveness of an online universal school-based preventive intervention targeting substance use, depression, and anxiety in adolescence. Australian National Health and Medical Research Council.

Using polytomous latent class analysis to compare patterns of substance use and co-occurring health-risk behaviors between students in alternative and mainstream high schools

IntroductionAlternative high school (AHS) students, an understudied and underserved population, experience educational, social, and health disparities relative to students in mainstream high schools. Disparities in single types of substance use are particularly high, yet no known studies have compared patterns of substance use or relationships between these patterns and other health-risk behaviors between AHS and mainstream high schools. MethodsUsing data from the Texas Alternative School Health Survey (n = 515; mean age 17.1 years, 49% male, 59% Hispanic, 23% White, 15% Black) and the Texas Youth Risk Behavior Survey (n = 2,113; mean age 16 years, 47% male, 64% Hispanic, 22% White, 7% Black), we used latent class analyses to compare patterns of substance use in AHSs and mainstream high schools. We used latent class regression to examine relationships between patterns of substance use and involvement in other health-risk behaviors in each school setting. ResultsStudents in AHSs and mainstream high schools had similar patterns of substance use, and youth in higher risk categories engaged in higher levels of other health-risk behaviors. A substantially greater proportion of AHS students, however, fell into the moderate and high use categories, in support of continuing disparities for AHS students. ConclusionsAdditional support is needed in AHSs to address the prevalence of high-risk patterns of substance use and associated health-risk behaviors. For example, ongoing public health surveillance is needed in AHSs, just as is done in mainstream high schools, to monitor trends in substance use and impact of policies and interventions.

Correlates of Substance Use Abstinence and Non-Abstinence Among High School Seniors: Results From the 2014 Monitoring the Future Survey

Several risk and protective factors are influential in predicting who uses or abstains from illicit substances during the high school years. The 2014 national cohort data from the Monitoring the Future survey shows the demographics, psychosocial factors, and attitudes regarding substance use that predict abstention by twelfth-graders (versus those who report any lifetime use of any illicit drugs). Being older, having a higher rate of sensation-seeking behaviors, perceiving drugs as easy to obtain, and participation of some social activities were associated with a lower rate of abstention. In contrast, being optimistic, involvement in school activities, perceiving drug and alcohol use as high risk, believing their peers disapprove of substance use, and personally disapproving of substance use were associated with greater abstention from lifetime substance use. A similar model including negative attitudes and experiences (nonuse-related) with marijuana was associated with a greater likelihood to abstain from substances. We examine possible explanations and prevention implications of these findings and discuss the role of abstention in post-high school substance use risks.

Children, Substance Abuse and the Role of Social Work

The study determined children’s experiences of and views on substance abuse, and the role of social work practice. It adopted a quantitative approach using a descriptive survey design. Data were collected using structured questionnaires with a total of 100 randomly selected students from the Tshwaragano Junior Secondary School in Botswana. The data were coded and quantitatively analysed using SPSS. A research permit and permission to enter the school were obtained from the Institutional Review Board of the University of Botswana, and the Ministry of Education and Skills Development. Furthermore, parental or guardian informed consent was obtained before the data collection. The findings reveal that various illegal substances widely used by students manifested in psychosocial issues. Moreover, it was also affirmed that despite government programme interventions designed to end substance use in schools, the situation remained unabated. This paper recommends that social workers contribute to this area in order to play a greater role in advocating for their clientele to receive the most effective interventions so that they can fight substance abuse. The paper concludes that generating reliable empirical data will increase awareness on the subject with the aim of making schools a conducive and better environment for students.

Psychoactive substance use profile and risk factors in TRNC risky regions: Surlarici ve Maras primary school sample

Objective: The aim of the study is to examine the profile of psychoactive substance users in 5th grade primary school students in Nicosia/Surlarici (Walled City) and Famagusta/Maras regions, which are defined as special regions in TRNC. Methods: The study was conducted between May and June 2019 among 267 primary school students in 20 state primary schools affiliated to the Ministry of National Education and Culture in TRNC. In the study, the US Ministry of Education ‘California Healthy Children Questionnaire was adapted to Turkish and used. Results: Cigarette, alcohol and other psychoactive substance (OPS) use rates were found to be high in primary schools in private regions. In this study, lifetime prevalence of tobacco use was found to be 17.0%, alcohol use prevalence was 27.6% and OPS use prevalence was 8.6%. Conclusion: DPM usage is higher in primary schools which are in special regions compared to primary schools in TRNC regions. Sociodemographic characteristics such as low socioeconomic level, low level of family education and migration of the family have an effect on substance use in primary schools in Surlarici and Maras.

Assessing the association between the strength of state policies on school drug prevention and substance use disorders

Background: Adolescent substance use has been linked to numerous adverse health, social, and educational outcomes. While there have been intensive resources placed in school-based prevention programs, the association of these policies on prevention outcomes is still unclear. State variation in policies provides an opportunity to assess the influence of school-based prevention programs. Objectives: To examine the association between the strength of state high school-based prevention programing and the prevalence of substance use disorders among adolescents ages 14–17 in the United States. Methods: National Survey on Drug Use and Health (NSDUH) data with state-level identifiers were merged with National Association of State Boards of Education (NASBE) information on school-based prevention policy strength, categorized into “required,” “recommended,” and “no policy.” Unadjusted comparisons and multilevel random intercept linear regression models were estimated to assess the change in rates of substance abuse or dependence from pre- to post- policy implementation, accounting for the nesting of individuals within states. Results: Rates of alcohol and tobacco abuse/dependence were significantly lower in states that required an alcohol prevention curriculum. After covariate adjustment, rates of alcohol abuse/dependence remained significantly lower in those states. Conclusions: Reinforcing alcohol prevention messaging in school appears to have a modest association with decreased rates of adolescent alcohol use disorders, possibly in part due to a different approach to the curriculum. For other substances, policy requirements appear to be less effective in reducing the prevalence of adolescent substance use disorders, suggesting that more targeted messaging with higher-risk students may be required.

Substance use off and on school grounds: A California statewide comparison between different groups of homeless students and nonhomeless students

About 1.3 million homeless students attend schools across the US, yet little is known about their substance use patterns, especially substance use on school grounds. The objectives of this study were to examine differences in substance use on and off school grounds between nonsheltered homeless, sheltered homeless, and nonhomeless public school students, and to examine the relationship between homelessness and substance use in school. Data were from a statewide representative sample from the California Healthy Kids Survey collected in 2011–2013, (n = 390,028). Bivariate and multivariate analyses were applied. Findings show that compared to nonhomeless students, homeless students, both sheltered and nonsheltered, reported higher rates of age at first time of use under the age of 10, and recent substance use, for an array of substances, indulging alcohol, cigarettes, marijuana and other illegal drugs. Additionally about 50% of nonsheltered homeless students, and 15% of sheltered homeless students reported having used substances in school in the past 30 days. Results from logistic regressions indicate that homelessness is associated with substance use in school. Particularly, nonsheltered homeless students were 17.41, 12.09, 11.36 and 17.59 times more likely to report smoking cigarettes, drinking alcohol, using marijuana and using other illegal drugs (respectively) in school in the past 30 days, compared to nonhomeless students. Sheltered homeless students were also more likely to use substances in school compared to nonhomeless students, but less likely compared to nonsheltered students. Findings highlight the need to develop differentiated school-based responses to each homeless subgroup and have conceptual, scientific and policy implications.

Predicting Substance Use and Deviant Behavior from Prosociality and Sociability in Adolescents.

Social competence is commonly considered an important factor that impedes maladaptive development because individuals who lack adequate competence to direct or control their behaviors in social situations are likely to display problems. Despite the belief that social competence may be a multi-dimensional construct, existing research has not explored the unique contributions of its different aspects to development. The present two-wave longitudinal study examined relations of prosociality and sociability, two major aspects of social competence, with problem behaviors in a sample of adolescents. Peer assessment data on prosociality and sociability and self-report data on substance use and deviant behavior were obtained from a sample of adolescents in middle (N = 657, mean age = 13 years) and high (N = 675, mean age = 16 years) schools in China. The results showed that prosociality negatively predicted later problem behaviors, whereas sociability positively predicted later problem behaviors. In addition, gender and grade moderated the associations between sociability and problem behaviors. More specifically, the positive association between sociability and later substance use was significant for boys, but not for girls. Sociability was also more strongly associated with later substance use in middle school than in high school. The results indicate that prosociality and sociability may have different functional meanings in adolescent development and have implications for practical work with adolescents who display problem behaviors.

Epidemiology of adolescent substance use in Norfolk schools.

The pattern of alcohol and substance use is changing, with the introduction of novel psychoactive substances, the internet as a means of acquisition and variations in drug purity and price. Alcohol and substance use among adolescents is associated with behavioural, mental health, health and social difficulties; arising at a vulnerable period in their development. Little is known about adolescent substance use in the UK, especially in rural areas. To investigate the prevalence of substance use amongst young people, aged 16-21 years, in Norfolk schools. Cross sectional questionnaire survey. Pupils from two, sixth form colleges in Norfolk answered a self-report questionnaire designed to measure prevalence, age of onset and frequency of use for alcohol, tobacco, illicit substances including new psychoactive substances as well as demographic data. A total of 482 students completed the survey (68% participation rate). Life-time use of alcohol was reported by 442 (91.7%) students and over half the pupils had tried tobacco (52.5%, n=253). About 40.7% reported cannabis use and nearly one-fifth (18.9%, n=91) reported using 3,4-methylenedioxymethamphetamine (MDMA); 41.1% (n=198) students reported using 'any drug' and 23.2% (n=112) 'using an illicit drug other than cannabis' and 8.7% (n=42) reported the use of a novel psychoactive substance. The most widely used substances were alcohol, tobaccos and cannabis; in keeping with European trends. Over the past decade a decline in alcohol and drug use by adolescents has been seen in the UK. However, since 2010 this decline has slowed with an increase in substance use noted in the past 2 years. This study provides evidence to support this trend. The findings demonstrate differences between the use of substances by pupils in this Norfolk sample compared to national surveys and more urbanized areas. These regional differences can be used to assist the development of local interventions targeting substance use among adolescents.

Peer influence processes as mediators of effects of a middle school substance use prevention program

BackgroundPeer influence processes have been linked to escalation in substance use during the middle school years, particularly among at-risk youth. In this study, we report on an approach to prevention that attempts to counteract peer influence by interrupting the process of deviant peer clustering, in which socially marginalized youth self-aggregate and reinforce delinquent behavior, including substance use. We aimed to interrupt this process by implementing collaborative, group-based learning activities in school (i.e., cooperative learning). MethodsIn a cluster randomized trial in the Pacific Northwest (N = 1460 7th-grade students in 15 schools), we tested whether cooperative learning can reduce alcohol and tobacco use, and whether these effects are mediated by reductions in the amount of alcohol and tobacco use among one's friends. Intervention schools were provided with training in cooperative learning, and data were collected in September/October 2016 (baseline) and March 2017 (follow-up). ResultsResults indicated that cooperative learning significantly lowered rates of growth in alcohol (β = −0.60 [−0.36|−0.84]; p < .001) and tobacco use (β = −0.58 [−0.21|−0.94]; p = .01) between baseline and follow-up in intervention schools as compared to control schools. These effects were mediated by reductions in the prevalence of alcohol and tobacco use, respectively, among self-selected friends. ConclusionsCooperative learning was able to significantly reduce the prevalence of both alcohol and tobacco use in friendship networks during the school year. The lower prevalence of alcohol and tobacco use among friends, in turn, reduced individual use at follow-up.This study was registered as trial NCT03119415 in ClinicalTrials.gov.

Locus of Control and College Students’ Use of Alcohol, Cigarettes and Drugs

Past studies have shown that an external locus of control (LOC) is associated with health-threatening behaviors, such as the use of alcohol, cigarettes and drugs, Results of research on the relationship between perceived control and substance use in high school and college students have been mixed and inconclusive. 32 male and 98 females undergraduates, ages 17-25, who volunteered (with informed consent) to take part in the study were given the Dimension (Physical, Psychological, Social, Moral) X Outcome LOC Inventory and a questionnaire assessing use of alcohol, cigarettes, drugs and demographic information. Results indicated that 84% of the participants reported use of alcohol, 22% cigarettes and 17% drugs. No differential effects were found for cigarette or drug use. There were significant positive relationships between alcohol use and Physical and Psychological LOC, especially for males. Heavier alcohol use was associated with a more external LOC. There were no significant differential effects for participants over the legal age limit. (&gt;21) For “underage” participants, there was a significant positive relationship between alcohol use and Psychological LOC. Demographically, a higher Economic level was associated with heavier alcohol use for males, females and underage participants. For participants &gt;21, a strong religious belief was associated with less use of alcohol. Past inconsistent findings can be attributed to differences in substance in question, gender, demographics (age, economic level and strength of religious belief) and the measure and dimension of perceived control.

Locus of Control and College Students’ Use of Alcohol, Cigarettes and Drugs

Past studies have shown that an external locus of control (LOC) is associated with health-threatening behaviors, such as the use of alcohol, cigarettes and drugs, Results of research on the relationship between perceived control and substance use in high school and college students have been mixed and inconclusive. 32 male and 98 females undergraduates, ages 17-25, who volunteered (with informed consent) to take part in the study were given the Dimension (Physical, Psychological, Social, Moral) X Outcome LOC Inventory and a questionnaire assessing use of alcohol, cigarettes, drugs and demographic information. Results indicated that 84% of the participants reported use of alcohol, 22% cigarettes and 17% drugs. No differential effects were found for cigarette or drug use. There were significant positive relationships between alcohol use and Physical and Psychological LOC, especially for males. Heavier alcohol use was associated with a more external LOC. There were no significant differential effects for participants over the legal age limit. (&gt;21) For “underage” participants, there was a significant positive relationship between alcohol use and Psychological LOC. Demographically, a higher Economic level was associated with heavier alcohol use for males, females and underage participants. For participants &gt;21, a strong religious belief was associated with less use of alcohol. Past inconsistent findings can be attributed to differences in substance in question, gender, demographics (age, economic level and strength of religious belief) and the measure and dimension of perceived control.

84 - Mental Health, Sexual Health and Substance Use in Same, Opposite and Both-Sex Attracted Adolescents Attending School Based Health Centers

Purpose: There is evidence that sexual minority youth have an increased vulnerability to mental health issues. Less research has been conducted broadly examining multiple health risk behaviors among sexual minority youth, particularly in both-sex attracted youth. Understanding if these youth are at increased risk for behaviors detrimental to their health can inform resources needed to serve them. This study aimed to examine health risk behaviors in the domains of substance use, mental and sexual health across sexual attraction groups.

Relationships between parent–child social media interactions and health behaviors

ABSTRACTSocial media use by both teens and adults has become increasingly common. This frequency of interaction can be capitalized upon by researchers looking to design programs to limit youth substance use. This study serves as a first step in this area of research, examining how parent–child social media exchanges (specifically on Facebook) may be related to youth risk behavior. In a sample of 252 college students, results indicated that roughly 63% of youth reported being friends with their parents on Facebook while in high school. A minority (27%) reported they blocked their parents from seeing certain material on their Facebook page, and most youth reported their parents discussed information from their Facebook page with some regularity (65%). Logistic regression analyses indicated that, when accounting for demographics, parental solicitation, and parental control efforts, youth who were friends with their parents on Facebook and did not block any materials from them had a decreased likelihood of alcohol and/or marijuana use in high school relative to those who were not friends with their parents on Facebook or who blocked materials from their parents. These findings imply that efforts to encourage parent–child interactions via social media may help prevent substance use in high school.

Findings from a Large-Scale Empirical Research on Substance Abuse Prevention in Greece

Research indicates that combined psychosocial interventions aiming at reducing or postponing substance use and abuse in schools can be effective. Confronted with a rising number of both young and adult drug users successive geek governments have established an extensive network of prevention centers all over the country end especially in Attica where most citizens live. Our own empirical study –the first of its kind in Greece and with such a large number of both providers and receivers who participated in the research project- has taken a detailed look at both the inner workings of those centers and the actual effects of the psychosocial interventions that aim to reduce substance problems in youth as perceived by both implementers and receivers at school level. Our findings suggest that the majority of the students who participated in the psychosocial interventions expressed the views that they have been taught new coping mechanisms and have enjoyed the whole experience. Proposals are made for the role of policy makers and those involved in planning, implementing and evaluating prevention programs along with the need for more systematic research into methodological issues in the performance stages of substance prevention programs in Greece.

Education, substance use, and HIV risk among orphaned adolescents in Eastern Zimbabwe

ABSTRACTThere is a growing interest in education as a means to reduce HIV infection in vulnerable children in sub-Saharan Africa; however, the mechanisms by which education reduces HIV infection remain uncertain. Substance use has been associated with high-risk sexual behaviour and could lie on the causal pathway between education and HIV risk. Therefore, we used multivariable regression to measure associations between: (i) orphanhood and substance use (alcohol, recreational drugs, and smoking), (ii) substance use and sexual risk behaviours, and (iii) school enrolment and substance use, in adolescents aged 15–19 years, in Eastern Zimbabwe. We found substance use to be low overall (6.4%, 3.2%, and 0.9% of males reported alcohol, drug, and cigarette use; <1% of females reported any substance use), but was more common in male maternal and double orphans than non-orphans. Substance use was positively associated with early sexual debut, number of sexual partners, and engaging in transactional sex, while school enrolment was associated with lower substance use in males. We conclude that education may reduce sexual risk behaviours and HIV infection rates among male adolescents in sub-Saharan Africa, in part, by reducing substance abuse.

Perceived Teacher Encouragement as Buffer to Substance Use in Urban African American Adolescents: Implications for Disconnected Youth

The variety of experiences of African American adolescents is still misunderstood and neglected. Empirical and lay reports consistently report that drug use is rampant within African American communities despite the fact that national statistics show that African Americans engage in substance use less than their White counterparts. Thus, the current study investigates the relations between African American adolescents’ school encouragement, academic future expectations (AFE), and substance use engagement. The participants are 206 African American adolescents (females = 65.7%), mean age 15.78 ( SD = 1.18), who reside in a southern, urban city. The regression results indicated that there was an inverse, trend level relation between school encouragement and the global substance use assessment (β = −.05, p &lt; .10; Δ R2 = .02). AFE moderated the relation between school encouragement and all of the substance use variables except alcohol. Simple slopes analyses revealed that AFE only significantly moderated the relation between school encouragement and substance use for students who reported low levels of AFE, indicating that increased school encouragement may serve as a protective factor against substance use engagement for those students who may be disconnected from academic achievement.

Perceived parent–child communication and well-being among Ethiopian adolescents

This study examines the relationship between perceived parent–child communication and four children well-being measures (depression, self-esteem, substance use and school adjustment). The participants consisted of 809 adolescents, mostly male (52.9%), and had a mean age of 16.8 years (SD = 1.58). The children completed a battery of instruments that measured perceived communication, depression symptoms, school adjustment problems, substance use and self-esteem. Correlations, regression and t-tests were used to address the objectives of the study. We found that female participants perceived the nature of communication with both parents as more open than boys did. We also found significant associations between children’s perception of communication with both parents and their subjective well-being. Findings of this study point to the importance of open parent–child communication to adolescents’ well-being.

Drug use in adolescents in relation to social support and reactive and proactive aggressive behavior.

Aggressive behavior in adolescents, along with drug use, has become one of the great issues in education in recent years, among other things, due to its relationship with school failure and delinquency. The purpose of this paper was to find out whether social support fulfils a basic role in decision-making on drug use and the behavior of adolescents. 822 high school students participated in the study (M = 14.84, SD = 0.87). Data were collected with the Peer Conflict Scale and the Multidimensional Scale of Perceived Social Support, and an ad hoc questionnaire on drug use. The results show that drug use is significantly related to reactive and proactive aggressive behavior. It was also observed that higher use is significantly related to perceived social support by the peer group, and less support by family. It was shown that substance use is related to perceived social support by the adolescent&rsquo;s peer group and to aggressive behavior. It is therefore necessary to intervene in both respects to avoid the presence of substance use in schools.

School Substance Use Norms and Racial Composition Moderate Parental and Peer Influences on Adolescent Substance Use.

Parental and peer influences on adolescent substance use have been well demonstrated. However, limited research has examined how parental and peer influences vary across school contexts. This study used a multilevel approach to examine the effects of school substance use norms and school racial composition in predicting adolescent substance use (a composite measure of alcohol, tobacco, and marijuana use) and in moderating parental and peer influences on adolescent substance use. A total of 14,346 adolescents from 34 schools in a mid-western county completed surveys electronically at school. Analyses were conducted using hierarchical linear modeling. Results indicated that school-level disapproval against substance use and percentage of minority students at school were negatively associated with adolescent substance use. School-level disapproval moderated the association between peer substance use and adolescent substance use, with the association being stronger when school-level disapproval was lower. School racial composition moderated the influence of parental disapproval and peer substance use on adolescent substance use. Specifically, both the association between parental disapproval and adolescent substance use and the association between peer substance use and adolescent substance use were weaker for adolescents who attended schools with higher percentages of minority students. Findings highlighted the importance of considering the role of school contexts, in conjunction with parental and peer influences, in understanding adolescent substance use.