Association between Public Health Unit Engagement in Secondary Schools and Per Capita  Public Health Spending and Adolescent Substance Use
Creators: Rai, Urvi
Publisher: name: University of Alberta Library
Year: 2023

<p>BackgroundBased on the socio-ecological model of health, government institutions have an important role in shaping adolescent health. Public health units (PHUs) are one such institution. PHU decisions on community collaboration and resource allocation may have important downstream consequences on population health. Although studies are sparse, descriptive and cross-sectional studies suggest that PHU engagement in secondary schools may benefit adolescent health. The first objective of this study was to investigate the association between PHU engagement in secondary schools and adolescent substance use over time. Additionally, PHU spending has been shown to be associated with population health outcomes. Although the evidence is mixed, several studies find that greater PHU spending is associated with improved population health. The second objective of this study was to investigate the association between per capita PHU spending and self-reported substance use among Canadian adolescents. MethodsTo investigate the association between PHU engagement and adolescent substance use, a longitudinal analysis was completed using data from the Cannabis, Obesity, Mental Health, Physical Activity, Alcohol Use, Smoking, and Sedentary Behaviour (COMPASS) study, which was conducted in Ontario, Alberta and British Columbia. 16,575 students in grades 9-12 in 68 schools who participated in year 5 of the COMPASS study (2016/17) were followed until year 7 (2018/19). Students answered survey questions on demographics and on their substance use behaviour. School representatives answered survey questions about school-level engagement by their local PHU in addressing substance use. To investigate the association between PHU spending and adolescent substance use, a cross-sectional analysis was conducted using data from year 7 (2018/19) of the COMPASS study as well as PHU per capita spending information from the Ontario Public Health Information Database (OPHID). Statistical analyses were conducted for a sample of 29,056 students in grades 9-12 in 61 schools across Ontario. Substance use was measured as the self-reported use of alcohol overall, alcohol binge drinking, cannabis use, cigarette use and e-cigarette use, at least once per month on average. ResultsApproximately 50% of the study samples were female and the majority identified as being White. In 2016/17, 65% of schools reported PHU engagement in addressing substance use. Methods of PHU engagement ranged from the provision of informational resources to leading prevention programs. With respect to PHU spending, the distribution of expenditure values was right-skewed. Per capita spending ranged from $54.07 to $224.95, with a median spending amount of $89.62 and a mean of $95.96. As an overall measure fixed at baseline, PHU engagement was not associated with adolescent substance use. However, different methods of PHU engagement were associated over time with different types of substance use. For example, adolescents exposed to PHU-school joint problem solving/program implementation had lower odds of cannabis and e-cigarette use at baseline (adjusted odds ratio (AOR): 0.43; 95% CI: 0.25, 0.76 and AOR: 0.38; 95% CI: 0.20, 0.72, respectively), but a larger increase in the odds of cannabis and e-cigarette over time (AOR of interaction terms: 1.80; 95% CI: 1.13, 2.86 and 2.58; 95% CI: 1.69, 3.96, respectively), compared to adolescents exposed to no PHU engagement. Adolescents exposed to PHU-led programs had a smaller increase in cigarette use over time compared to those not exposed, suggesting a protective association (AOR of interaction term: 0.67; 95% CI: 0.46, 0.97). With respect to PHU spending, the highest quartile of expenditure compared to the lowest quartile was significantly associated with higher odds for alcohol use (AOR: 1.41, 95% CI: 1.04, 1.91), alcohol binge drinking (AOR: 1.71, 95% CI: 1.18, 2.48), and cigarette use (AOR: 2.19, 95% CI: 1.23, 3.91), while the second highest quartile was associated with lower e-cigarette use (AOR: 0.74, 95% CI: 0.56, 0.98).Conclusion PHUs have potential to address adolescent substance use through evidence-informed engagement at secondary schools, however further research is required to examine how different methods of engagement may impact students differently. The highest quartile of PHU spending was associated with higher alcohol and cigarette use in this study. Further research is needed to explore the direction of this association and potential pathways where intervention can occur. </p>