Background: Substance use can have lifelong consequences for adolescents and the rates of substance use in Canadian adolescents are increasing. This is a serious public health issue which needs to be addressed. The purpose of this study is to determine the impact of public health unit (PHU) engagement in school-based substance use prevention programs on student substance use. Methods: Data was collected from the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking and Sedentary behaviour (COMPASS) study over the 2018/19 data collection year. A multi-level logistic regression was used to analyze the associations between PHU engagement and student substance use. Results: The analyses found that 70% of schools had PHU engagement in substance use prevention programs. Overall, PHU engagement made no difference on student substance use. However, when PHU engagement was divided into five levels of engagement (with zero being no engagement and five being the highest level of engagement) it was found that students from schools where PHUs solved problems jointly (level two) had statistically significantly greater odds of binge drinking, alcohol use and cannabis use. Schools were also divided into low and high-use schools for each substance. It was found that students in low-use schools had statistically significantly greater odds of binge drinking, alcohol and cannabis use with some levels of PHU engagement and students from high-use schools had statistically significantly lower odds of cannabis and cigarette use with some levels of PHU engagement compared to a similar student from a school without PHU engagement. Conclusions: Our findings show that there is opportunity for greater PHU engagement with schools in substance use prevention programming. Furthermore, it is important that PHUs are working with schools to ensure school-based substance use prevention programs are evidence-based and tailored to the specific needs and risk-levels of the students. / Thesis / Master of Science in Nursing (MSN) / The purpose of this study is to determine the impact of public health unit (PHU) engagement in school-based substance use prevention programs on student substance use. Data for this study was collected from the Cannabis, Obesity, Mental health, Physical activity, Alcohol use, Smoking and Sedentary behaviour (COMPASS) study. The results show that 70% of schools had PHU engagement in substance use prevention programs. Across all schools, when PHUs and schools solved problems jointly an increase in student binge drinking, alcohol and cannabis use was found. When schools were divided into low and high-use schools, similar results were found when PHUs engaged with low-use schools whereas when PHUs engaged in high-use schools a reduced odds of student cannabis and cigarette use was found in some situations. These findings highlight the importance for PHUs to consider the specific needs and risk-levels of the students and schools they are engaging with.

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