School effects on young people's drug use: a systematic review of intervention and observational studies.
OBJECTIVE
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.
Fletcher
Adam
A
The Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, United Kingdom. adam.fletcher@lshtm.ac.uk
Bonell
Chris
C
Hargreaves
James
J
D000293:Adolescent; D000294:Adolescent Behavior; D017677:Age Distribution; D000428:Alcohol Drinking / Q000453:epidemiology / Q000517:prevention & control; D001315:Australia / Q000453:epidemiology; D002648:Child; D004522:Educational Status; D005178:Faculty; D005260:Female; D015438:Health Behavior; D006801:Humans; D007398:Interpersonal Relations; D008137:Longitudinal Studies; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D019370:Observation; D012307:Risk Factors; D012574:Schools / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology; D000074606:Smoking Prevention; D012924:Social Conditions; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control; D014481:United States / Q000453:epidemiology