A school-based screening and brief intervention (SBI) program was associated with a smaller increase in cannabis and e-cigarette use among middle schoolers as well as girls attending middle or high school. These findings were published in JAMA Network Open.
This study was conducted by the Boston Children’s Hospital during the 2017-2018 and 2018-2019 school years. A total of 22 schools with expenditures of $13,000-$24,000 per pupil participated in this study. Students were screened in a private location using the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) questionnaire which indicated potential for a substantial problem with substance use. A total of 2393 students received the SBI intervention and 2194 served as the control group. The primary outcomes were self-reported substance and alcohol use at follow-up.
A total of 2866 students were middle school students in grades 7 and 8, and 1721 were high school students in grades 9 and 10. The middle and high school groups included students with mean age of 12.8 (SD, 0.7) and 14.9 (SD, 0.8) years, respectively; 48.4% and 48.7% were girls, respectively; 62.1% and 68.0% were White, respectively; 79.3% and 74.4% lived in a 2-parent household, respectively; 15.1% and 25.6% had depression according to the 2-item Patient Health Questionnaire (PHQ-2) instrument, respectively, and 11.2% and 20.9% had anxiety according to the 2-item Generalized Anxiety Disorder (GAD-2) instrument, respectively.
At baseline, no differences were observed in alcohol, cannabis, and e-cigarette use behaviors or intention to use in the next 3 months between the intervention and control cohorts for either the middle or high school students.
Overall, cannabis use increased in the middle (marginal estimated probability [MEP], 0.73 vs 2.01) and high (MEP, 2.86 vs 3.10) school SBI and middle (MEP, 0.24 vs 3.38) and high (MEP, 1.30 vs 1.72) school control cohorts at follow-up compared with baseline, respectively. Similar trends were observed for e-cigarette use.
Among the middle school cohort, at follow-up SBI was associated with a lower rate of increase in cannabis (adjusted rate ratio [aRR], 0.19; 95% CI, 0.04-0.86) and e-cigarette (aRR, 0.36; 95% CI, 0.08-1.59) use in the previous 3 months. No effects were observed for the high school group.
The SBI program did not have effects on substance use knowledge, perceived risk for substance use, or perceived adult support.
Stratified by gender, the increased rate of cannabis (aRR, 0.17 vs 1.17) and e-cigarette (aRR, 0.16 vs 2.50) use among girls was lower than among boys, respectively.
Staff members viewed student participation in the SBI as positive but were concerned about the lack of adequate time and space to implement the intervention and questioned the honesty of student responses.
The major limitation of this study was the reliance on self-reported behaviors.
Study authors concluded, “In this quality improvement study, exposure to a school- based SBI program was associated with a significantly smaller increase in the rate of cannabis use among middle school students and significantly smaller increases in the rates of cannabis and e-cigarette use among all female students, with no associated harms identified.”
Levy S, Wisk LE, Minegishi M, et al. Association of screening and brief intervention with substance use in Massachusetts middle and high schools. JAMA Netw Open. 2022;5(8):e2226886. doi:10.1001/jamanetworkopen.2022.26886