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Investigating the association between school substance programs and student substance use: accounting for informative
Aya A Mitani1, Yushu Zou1, Scott T Leatherdale2
1Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Epidemiologic Methods
|August 27, 2025
Summary
School-based programs for adolescent substance use may show different results depending on school size. Multivariate analysis accounting for informative cluster size (ICS) is crucial for accurate findings on student substance behaviors.
Area of Science:
- Public Health
- Biostatistics
- Adolescent Health
Background:
- Adolescent substance use is a growing public health concern in Canada.
- School-based programs are implemented to address student substance use, but their effectiveness is not definitively established.
- Polysubstance use data from schools may be affected by informative cluster size (ICS).
Purpose of the Study:
- To determine if multivariate analysis, accounting for ICS, yields different conclusions compared to univariate analyses.
- To compare analytical approaches for estimating associations between school substance programs and adolescent substance use behaviors.
- To investigate the impact of informative cluster size on the analysis of student polysubstance use data.
Main Methods:
- Utilized data from the 2018/2019 Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary Behaviour (COMPASS) study.
- Compared four analytical approaches: univariate generalized estimating equations (GEE), univariate cluster-weighted GEE (CWGEE), multivariate GEE, and multivariate CWGEE.
- Examined associations between school substance programs and binge drinking, cannabis, e-cigarette, and cigarette use.
Main Results:
- Student substance use was higher in smaller schools and lower in larger schools.
- Univariate and multivariate analyses generally produced comparable results, but differences emerged between CWGEE and GEE.
- Multivariate CWGEE indicated a significant association between a cannabis program and reduced substance use (OR 0.83; 95% CI 0.73, 0.95), while GEE showed a null association (OR 0.92; 95% CI 0.79, 1.07).
Conclusions:
- Informative cluster size (ICS) in clustered school data can lead to differing results between weighted and unweighted analyses.
- Careful consideration of the relationship between cluster size and outcomes, along with appropriate analytical methods, is necessary.
- Multivariate approaches are essential for studying adolescent substance use, as school programs may impact multiple substance behaviors.
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