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Multilevel population-based cross-sectional study examining school substance-misuse policy and the use of cannabis, mephedrone and novel psychoactive substances among students aged 11–16 years in schools in Wales
  1. Luke S Midgley1,2,
  2. Simon Murphy1,
  3. Graham Moore1,
  4. Gillian Hewitt1,
  5. James White2
  1. 1 School of Social Sciences, Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
  2. 2 School of Medicine, Centre for Trials Research, Cardiff University, Cardiff, UK
  1. Correspondence to Mr Luke S Midgley; MidgleyLS{at}


Objectives To examine whether young peoples’ risk of cannabis, mephedrone and novel psychoactive substances (NPS) use is associated with school substance-misuse policy.

Design A cross-sectional survey of secondary school students combined with a School Environment Questionnaire and independently coded school substance-misuse policies (2015/6).

Setting 66 secondary schools in Wales.

Participants Students aged 11–16 years (n=18 939).

Results The prevalence of lifetime, past 30-day and daily cannabis use was 4.8%, 2.6% and 0.7%, respectively; lifetime prevalence of mephedrone use was 1.1% and NPS use was 1.5%. Across 66 schools, 95.5% (n=63) reported having a substance-misuse policy, 93.9% (n=62) reported having a referral pathway for drug using students, such that we were insufficiently powered to undertake an analysis. We found little evidence of a beneficial association between lifetime cannabis use and involving students in policy development including student council consultation (OR=1.24, 95% CI 0.89 to 1.73), other student consultation (OR=1.42, 95% CI 0.94 to 2.14) or with the use of isolation (OR=0.98, 95% CI 0.67 to 1.43), with similar results for cannabis use in past 30 days, daily and the lifetime use of mephedrone and NPS. The School Environment Questionnaires found that 39.4% (n=26) schools reported no student involvement in policy development, 42.4% (n=28) reported student council consultation, 18.2% (n=12) used other student consultations and 9.7% (n=3) mentioned isolation. The independently coded content of policies found that no school policy recommended abstinence, one mentioned methods on harm minimisation, 16.1% (n=5) policies mentioned student involvement and 9.7% (n=3) mentioned isolation.

Conclusions Policy development involving students is widely recommended, but we found no beneficial associations between student involvement in policy development and student drug use. This paper has highlighted the need for further contextual understanding around the policy-development process and how schools manage drug misuse.

  • public health
  • substance misuse
  • school health
  • health policy

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  • Contributors LSM and JW wrote the first draft of the manuscript which was reviewed and amended by all authors. GM, GH and LSM led the development of drug-related questions in the School Health Research Network survey. SM, GH and GM designed and manage the School Health Research Network in Wales, including the collection of survey data reported in this study. All authors approved the final manuscript.

  • Funding The lead author Luke S Midgley is supported by an ESRC-funded PhD Studentship (AE30105159). The School Health Research Network is a partnership between DECIPHer, Welsh Government, Public Health Wales and Cancer Research UK, funded by Health and Care Research Wales via the National Centre for Health and Wellbeing Research. The work was undertaken with the support of the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Cardiff University School of Social Sciences Research Ethics Committee (SREC/1530).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Details on data access to the School Health Research Network survey can be found by contacting SHRN:

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