Local Public Health Efforts in Schools May Not Work

Efforts to prevent and curb substance use in schools through public health engagement (PHE) appear to be effective where use of cigarettes and cannabis is high but had the opposite impact in schools where use of alcohol and cannabis is low, according to a cross-sectional study published in the Canadian Journal of Public Health.

The study investigated the links between PHE (defined as collaboration between local government public health units and local schools), in-school–based substance use prevention programs, and student substance use, explained Trish Burnett, RN, MSN, who conducted this study as part of her master’s degree in the School of Nursing at McMaster University in Hamilton, Ontario, Canada. She added that researchers used the dataset from the Cannabis Obesity, Mental health, Physical activity, Alcohol use, Smoking and Sedentary behavior (COMPASS) study, collected in 2018 and 2019.

“We know that substance use in adolescence can have long-term negative health consequences and therefore it is an important issue we need to address. We need to be thinking about how we can help reduce or prevent substance use in adolescence,” said Burnett in an interview with Medscape Medical News. “That spurred this study.”

Trish Burnett, RN, MSN

Burnett and co-investigators included data from 84 schools, eight from British Columbia, 15 from Alberta, and 61 from Ontario, which represented 42,149 students. The student response rate was 80.2% and fewer than 5% of students had missing data.

A total of 70% of schools offered PHE in substance use prevention programs. They divided PHE into five types of engagement and looked at effects on binge drinking, alcohol drinking, cannabis use, cigarette use, and e-cigarette use.

The study noted that school administrators were asked this question: “During the past 12 months, what role did your local Public Health Unit play when working with your school on addressing [specific health behavior] for students?”

There were four possible responses to this question: no contact with local public health unit; provided information resources/programs; solved problems jointly; and developed/implemented program activities jointly.

Burnett and co-investigators found that the impact of PHE was different depending on the level of substance use at a school. Though PHE in substance use prevention overall did not have a statistically significant effect on substance use, there was a positive effect observed with some forms of PHE in schools that had high rates of cannabis and cigarette use. This was not the case in schools with low use of alcohol and cannabis, where there were some forms of PHE.

For example, a student from a high-use school where public health developed and implemented program activities had lower odds of cannabis use (adjusted odds ratio [aOR], 0.82), and in cases where public health provided information, resources, or programs, a student from a high-use school had lower odds of cigarette use (aOR, 0.74).

In low-use schools, however, where public health solved problems jointly with the school, students had higher odds of binge drinking (aOR, 1.61) and drinking (aOR, 1.59). Similarly, students in low-use schools had higher odds of cannabis use (aOR, 1.26), where public health developed and implemented program activities.

The study supports the need for greater investigation into PHE to determine the content and effectiveness of substance use prevention programs implemented at schools and how best to work with schools to deliver the programs, according to Burnett.

“We did also look at public health engagement across multiple health domains,” said the researcher. “And we found that 13% of schools had no engagement with public health and, of the schools with engagement, only 34% had public health engagement across all health domains. There is an opportunity for more engagement between schools and public health (units). I think this study shows there is also opportunity for more research and more surveillance of health promotion programming in schools and the role of public health in that programming.”

Michael Chaiton PhD, senior scientist, Centre for Addiction and Mental Health, Toronto, Canada, pointed out that the study revealed where resources should and should not be dedicated to curb and prevent substance use among adolescent youth.

“The really interesting part of this study is that providing that kind of prevention programming in low prevalence schools can be counterproductive,” said Dr Chaiton, reacting to the study’s findings.

Michael Chaiton, PhD

“This study shows PHE has the potential for increasing risk among populations where there isn’t much exposure to illicit substances like cannabis and alcohol. It’s not that useful to give prevention programming to youth who are not at high risk of abusing substances.”

One of the strengths of the analysis is that the sample was large and diverse, and another is that a specific question was posed to respondents, added Dr Chaiton. “There was a specific question asked, and the responses were analyzed appropriately,” said Dr Chaiton.

A limitation of the study is that the schools that were included in the study selected themselves, noted Dr Chaiton. “Technically that is a bias (self-selection), but that is the real world,” he said. “This represents what actually happens.”

Trish Burnett had no financial disclosures. Dr Chaiton had no financial disclosures.

Canadian Journal of Public Health. Published online July 21, 2022. Full text

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