Substance Use

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.

  • 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 Graph

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

Resources for Practice

(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:
(7) California Healthy Kids Survey. (2017). Alcohol/drug use in past month, by grade level [data file]. Retrieved from
(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).