Investigating public health unit engagement in secondary schools and student substance use over time

According to McLeroy's socio-ecological model, inter-organizational collaboration is important in shaping population health. This study aimed to investigate the association between public health unit (PHU) collaboration in secondary schools and student substance use over time.

Data from the Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking, and Sedentary behaviour (COMPASS) study were used to identify student-level substance use behaviours and school-level PHU engagement. Substance use was measured as self-reported use of alcohol, cannabis, cigarettes, and electronic cigarettes. Multilevel logistic regressions accounted for the hierarchical data structure.

This study included 16,575 students attending 68 Canadian schools from 2016/2017 to 2018/2019. Among these schools, 65% had PHU engagement in addressing alcohol and/or cannabis use, and 65% had PHU engagement in addressing cigarette and/or e-cigarette use. Provision of information/resources/programs was associated with lower odds of binge drinking (adjusted odds ratio [AOR], 0.77; 95% confidence interval [CI], 0.62-0.96) and e-cigarette use (AOR, 0.74; 95% CI, 0.59-0.94) in 2017/2018, but higher odds of cannabis use in 2018/2019 (AOR, 1.51; 95% CI, 1.08-2.11). Joint problem solving/program implementation was associated with higher odds of binge drinking, cannabis use, and e-cigarette use over time (p < 0.05), but was not associated with alcohol use overall. PHU-led prevention programs in schools were associated with reduced cigarette use (AOR, 0.67; 95% CI, 0.46-0.97).

Different methods of PHU-school collaboration may be differently associated with substance use behaviours. Further research is needed to understand how this partnership can better protect adolescent health at a critical time in their development.