School effects on young people's drug use: a systematic review of intervention and observational studies

J Adolesc Health. 2008 Mar;42(3):209-20. doi: 10.1016/j.jadohealth.2007.09.020. Epub 2007 Dec 26.


Purpose: This systematic review examined the hypothesis that school institutional factors influence young people's use of drugs. We aimed to (1) identify the effect of school-level changes on drug use and (2) explore the possible mechanisms by which school-level influences on individual drug use might occur.

Methods: Systematic review. Experimental/quasi-experimental studies of "whole-school" drug prevention interventions and longitudinal observational studies on the association between school-level and individual-level school-related exposures and drug use were included. Experimental studies were included because they are the most reliable available source of evidence about causation. Observational studies of school-level and individual-level school-related exposures were included with the aim of providing evidence about a wider range of possible school-level effects and how school-level influences might be mediated by individual-level factors.

Results: Experimental studies suggested that changes to the school social environment that increase student participation, improve relationships and promote a positive school ethos may be associated with reduced drug use. School-level and individual-level observational studies consistently reported that disengagement and poor teacher-student relationships were associated with drug use and other risky health behaviors.

Conclusions: There is evidence of school effects on young people's drug use. Interventions that promote a positive school ethos and reduce student disaffection may be an effective complement to drug prevention interventions addressing individual knowledge, skills, and peer norms. Such approaches should now be piloted in a wider range of settings. Further research is also needed to explore mechanisms by which schools may influence young people's drug use.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adolescent Behavior*
  • Age Distribution
  • Alcohol Drinking / epidemiology
  • Alcohol Drinking / prevention & control
  • Australia / epidemiology
  • Child
  • Educational Status
  • Faculty
  • Female
  • Health Behavior
  • Humans
  • Interpersonal Relations
  • Longitudinal Studies
  • Male
  • Netherlands / epidemiology
  • Observation
  • Risk Factors
  • Schools / statistics & numerical data*
  • Smoking / epidemiology
  • Smoking Prevention
  • Social Conditions*
  • Substance-Related Disorders / epidemiology*
  • Substance-Related Disorders / prevention & control
  • United States / epidemiology