School-Based Health Centers Help Prevent and Treat Substance Use
School-based health centers (SBHCs) are ideal places to identify these youth and provide evidence-based services that inform them about the health risks associated with alcohol and drug use, motivate them to change their behaviors, and support them in addressing the concerns that may be underlying their substance use.
At the same time, SBHCs are ideally positioned to address the underlying risks that contribute to substance use and strengthen protective factors by improving school climate and implementing trauma-informed practices.
School-based health centers (SBHCs) can also help prevent tobacco use in students through health education and are well-positioned to provide tobacco cessation services.
- One of the unique advantages of a SBHC is its ability to go beyond the provision of clinical medical services and engage in public health activities at the schoolwide level.
- SBHC staff provide health education in classrooms, conduct schoolwide screenings, hold youth and parent education groups, and work with school staff to identify high-risk students.
- This ability of SBHCs to fuse clinical care and public health makes them well-suited for many prevention activities, such as tobacco prevention and cessation.
Peer education programs have demonstrated effectiveness in preventing youth tobacco use.1
- Young people are more receptive to tobacco prevention messages delivered by their peers than those delivered by their teachers.2,3
- For the peer educators, providing tobacco prevention education to their friends provides an opportunity for positive youth development.3
- SBHCs who are already providing group education should consider peer programs as a way to enhance the effectiveness of their prevention education.
Youth Substance Use Impacts Long-Term Health Outcomes
School health providers are concerned about youth substance use because it impacts a student’s long-term health outcomes and their academic performance. Substance use is linked to lower grades, student absenteeism, and higher rates for high school dropout.4 Adolescent substance use is also highly predictive of adult substance abuse because the adolescent brain is still developing making it more susceptible to addiction. Nine out of ten people meeting the clinical criteria for a substance use disorder began using one or more addictive substances before the age of 18.5 Schools, school-based health programs, and school support services are ideally positioned to educate, prevent, and intervene early in youth substance use, preventing experimentation from escalating to misuse or addiction.
Nationwide, 14% of high school students have misused an opioid prescription.6 In California, 20% of 9th graders and 29% of 11th graders used alcohol or drugs at least once in the last month.7 Risk factors such as trauma, mental health conditions, and environmental factors can increase a young person’s likelihood of substance use.
Tobacco Use Is Still the Leading Cause of Preventable Death
Tobacco use continues to be the number one cause of preventable death in the United States and around the world. Tobacco killed one hundred million people worldwide in the 20th century and is on track to kill one billion people in the 21st century.8
In the US, tobacco use kills about 480,000 people per year — more than AIDS, alcohol, car accidents, illegal drugs, homicides, and suicides combined.9
Tobacco Use Is Typically Started & Established During Adolescence
- Approximately 90% of adult smokers tried their first cigarette before age 18 and nearly 700 children become regular smokers each day.10
- Each day in the United States, more than 3,800 youth aged 18 years or younger smoke their first cigarette, and an additional 2,100 youth and young adults become daily cigarette smokers.11
- E-cigarettes, including vapes, e-pens, e-pipes, and e-hookah, are known collectively as electronic nicotine delivery systems (ENDS). While cigarette use is on the decline, middle and high school students’ use of ENDS tripled from 2013 to 2014.12
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach to the screening and identification of individuals engaged in substance use, the delivery of early brief interventions in order to reduce use, and the referral to treatment for high-risk use. These quick guides give a brief overview of each “step” and implementation considerations for SBIRT within school-based health centers (SBHCs).
- Screening Quick Guide
- Brief Intervention Quick Guide
- Referral to Treatment Quick Guide
- Opioid Use Disorder Quick Guide
Frequently Asked Questions about Minor Consent for Substance Use Disorder Services in California has information on Family Code 6929.
CSHA’s School Discipline & Student Substance Use: A Guide for School-Based Health Providers
Many schools’ “zero tolerance” policies conflict with a public health approach to youth substance use that recognizes and addresses the underlying factors that contribute to substance use. This report highlights how – and why – schools should replace punitive discipline practices with recovery-focused approaches to student substance use. It also provides an overview of what is in California state law regarding discipline approaches to student substance use.
Alternatives to Suspension: Student Tobacco & Substance Use
This resource synthesizes some of the main points in the above report, with a specific lens to student tobacco use. It provides some helpful guidance, informed by best practices in the field, on how to create non-punitive discipline policies and important aspects to consider when implementing.&
Websites Recommended by Our Youth Board & School-Based Health Providers
Our Youth Board and school-based health providers reviewed existing youth-focused health education websites related to substance use prevention. They identified the following websites as relevant and impactful for school-based youth:
Tobacco Education Resources
The Stanford Tobacco Prevention Toolkit offers theory-based and evidence-informed resources created by educators, parents, and researchers aimed at preventing middle and high school students’ use of tobacco and nicotine.
Stanford University has additional resources, including the Vaping Prevention Toolkit, the Cannabis Prevention Toolkit, the Vaping Information, Solutions, and Interventions Toolkit (VISIT), and the Healthy Futures Curriculum, which is an alternative to suspensions education program for students caught using tobacco substances on campus.
The Centers for Disease Control and Prevention (CDC) has useful information about the negative health effects associated with tobacco including reports, fact sheets, and videos created by youth explaining the harmful effects of tobacco with suggestions on how to prevent young people from using tobacco.
The truth campaign has a website and media campaign geared toward youth and young adults.
Tobacco Cessation Resources
Smokefree Teen is a website for young people who are interested in quitting smoking. SmokefreeTXT is a mobile text messaging program that provides 24/7 tips, advice, and encouragement to help you quit smoking. You can see additional tools for quitting.
The California Smokers’ Helpline provides telephone counseling, a texting program, web-based referrals, and email support for those who are ready to quit smoking. Help is available in six languages and all services are free.
Resources for Parents
(1) Black, David R., Nancy S. Tobler, and John P. Sciacca. “Peer helping/involvement: an efficacious way to meet the challenge of reducing alcohol, tobacco, and other drug use among youth.” Journal of School Health 68.3 (1998): 87-93.
(2) Klepp, Knut‐Inge, Andrew Halper, and Cheryl L. Perry. “The efficacy of peer leaders in drug abuse prevention.” Journal of School Health 56.9 (1986): 407-411.
(3) Valente, Thomas W., et al. “Effects of a social-network method for group assignment strategies on peer-led tobacco prevention programs in schools.” American journal of public health 93.11 (2003): 1837-1843.
(4) D’Amico, E.J., et al. (2016). Alcohol and Marijuana Use Trajectories in a Diverse Longitudinal Sample of Adolescents: Examining Use Patterns from Age 11 to 17. Addiction, 111(10), 1825–1835; Engberg J., Morral A.R. (2006). Reducing substance use improves adolescents’ school attendance. Addiction, 101(12), 1741-1751.
(5) The National Center on Addiction and Substance Abuse (CASA) at Columbia University. (2011). Adolescent Substance Use: America’s #1 Public Health Problem. New York: CASA.
(6) Kann L., McManus T., Harris W. A., et al. (2018). Youth Risk Behavior Surveillance — United States, 2017. MMWR Surveill Summ 2018, 67(SS-8), 1–114. Retrieved from: http://dx.doi.org/10.15585/mmwr.ss6708a1.
(7) California Healthy Kids Survey. (2017). Alcohol/drug use in past month, by grade level [data file]. Retrieved from www.kidsdata.org.
(8) Campaign for Tobacco Free Kids. (2015).
(9) Ziedonis, Douglas M., et al. “Barriers and solutions to addressing tobacco dependence in addiction treatment programs.” (2007).
(10) US Department of Health and Human Services. “Preventing tobacco use among youth and young adults: a report of the Surgeon General.” Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health 3 (2012).
(11) US Department of Health and Human Services.
(12) Centers for Disease Control and Prevention. E-cigarette use triples among middle and high school students in just one year, MMWR. Morbidity and Mortality. (2015, April 16).