Integrating Primary and Secondary Prevention in U.S. School-Based Substance Use Programs: A Scoping Review from...

Area of Science:

• Public Health
• Adolescent Health
• Substance Use Prevention

Background:

• Traditional school-based substance use prevention in the U.S. primarily focuses on primary prevention.
• Existing programs often fail to address students already engaging in substance use.
• There's a growing need for secondary prevention strategies due to rising youth mental health issues and polysubstance use.

Purpose of the Study:

• To systematically review the integration of secondary prevention components within U.S. school-based substance use prevention programs.
• To assess the incorporation of resource-oriented strategies like harm reduction and help-seeking.
• To identify gaps and limitations in current school-based prevention efforts.

Main Methods:

• Systematic literature search using PRISMA-ScR guidelines across EBSCOHOST, PubMed, and Google Scholar (July 2025).
• Included peer-reviewed articles from 2000-2025 evaluating U.S. middle and high school programs.
• Excluded non-U.S. programs, elementary/college interventions, and grey literature.

Main Results:

• Out of 24 studies, 16 focused on primary prevention (e.g., refusal skills), while 8 integrated secondary prevention (harm reduction, help-seeking).
• Theoretical grounding was inconsistent; 3 studies lacked an explicit framework.
• Most programs were teacher-led, peer-enhanced, and targeted universal populations, with limited tailoring for high-risk groups or cultural adaptation.

Conclusions:

• School substance use programs predominantly use universal, peer-focused strategies, with limited secondary prevention integration.
• Methodological limitations include inconsistent theoretical frameworks and lack of cultural adaptation.
• Future research should prioritize rigorous evaluation, theoretical clarity, cultural tailoring, and hybrid models for equitable prevention across diverse adolescent populations.