Intersectoral Interventions in School to Develop Strategies to Prevent the Use of Alcohol and Other Drugs: A Scoping Review

It is important to prioritize intersectoral action at schools to prevent the use of alcohol and other drugs. This strategic act should be organized with multidisciplinary learning characteristics and with the involvement of different stakeholders. The aim of a recent scoping review was to identify the factors that benefit and hinder intersectoral actions at school resulting from the elaboration of policies to prevent drug use. It seems like the research study was a scoping review that used the P-population, C-context, and C-concept structure. The study searched for information in various databases like Embase, Proquest, Lilacs, Medline via Pubmed, PsycInfo, WHO-Iris, and PAHO-Iris on April 17, 2023. According to the results, there were 5 studies that were eligible to answer the research question. One of the advantages of intersectoral actions is the role of schools in creating a support network with different social actors, particularly with family involvement. On the other hand, one of the challenges is inconsistencies in legal regulations, which do not provide enough guidance to schools on how to prevent alcohol and drug use. While public and private schools may be affected differently by social and economic factors, it is essential to invest in developing policies that focus on drug prevention for children and adolescents who are learning in schools.


Introduction
The importance of public policies to combat drug consumption is closely related to the social, economic, and cultural model outlined by the State (Höfling, 2001).It is crucial to involve young people in the formulation of these policies, given that education plays a fundamental role in their development.Schools are an excellent place for preventive actions against drug use since they provide an environment that reinforces scientific thinking and its practical application in the community (Takeiti & Vicentin, 2015).Adolescence is a time when there is a higher retention rate in school, and it is also when a large number of drug experimentation cases occur.Therefore, schools have a significant role to play in instilling critical thinking and reflection on values that can help reduce risk factors and reinforce protective factors regarding drug use (Novaes, 2009).
Intersectoral action in schools involves a strategic management process in primary care that incorporates the principles of territory, regionalization, and comprehensive healthcare.It should be organized in collaboration with education, health, and other sectors, considering the complexity of drug use and its impact as a public health issue.Intersectoral actions in schools are crucial for developing policies that prevent the use of alcohol and other drugs.They are structured through integrated management and applied to the exchange of collective knowledge, practices, and languages (Csete, 2016).This approach encompasses diverse knowledge and planning and has multidisciplinary learning characteristics that improve specific policy performance issues.Intersectoral actions at school are crucial for developing policies to prevent the use of alcohol and other drugs.These actions are structured through integrated management and involve collective exchange of knowledge, practices, and languages (Csete, 2016).
The development of health promotion with a health education interface should be based on the principle of intersectoral and social participation.It is essential to give priority to health conditions and determinants to coordinate concrete actions by policymakers to achieve effective health responses in the context of alcohol and drug abuse, and to promote healthy lifestyles.It's worth mentioning that sociodemographic and economic factors such as gender, income, age group, race/color, and housing play a crucial role in drug use and abuse and have significant physical, psychological, and social implications (Teixeira, 2017).
As per the World Health Organization (WHO), addiction to alcohol and other drugs is a chronic ailment (WHO, 2010).Therefore, it is necessary to adopt an inclusive approach towards drug prevention that involves health education promotion by the government, civil societies, Non-Governmental Organizations (NGOs), managers, health professionals, education, social assistance, public security, and representatives of people who use drugs.This approach will ensure cooperation not only in the prevention of drug use but also in providing support, mutual help, treatment, and recovery for social reintegration (Teixeira, 2015).
Intersectoral actions at school that involve alcohol and other drug prevention policies should be consolidated in a guiding way for decision-making.This is important because the health-illness process can interfere with various aspects of formulating intersectoral actions at school.Therefore, it is necessary to establish co-participation in school management, improve health service techniques, and provide a better quality of life for people who use alcohol and other drugs (Petersen, 2016).
Preventing the use of alcohol and other drugs is a challenging policy that requires collaboration from different sectors and areas.It is aimed at providing care through practical and theoretical foundations in the fields of education and health promotion, without any stigma, prejudice or prohibitionist or coercive preventive approaches (Abdel-Baki, 2019).The main objective of the study is to identify the factors that hinder or benefit intersectoral actions at school for developing policies to prevent the use of alcohol and other drugs.

Study Design
This is a scoping review that aims to comprehensively map scientific literature and synthesize findings related to policies for preventing the use of alcohol and other drugs.Scoping reviews, according to Peters et al. (2015), are a promising method for diagnosing technologies and synthesizing evidence to strengthen health policies.This study was registered on the international Open Science Framework (OSF) platform with a DOI number of 10.17605/OSF.IO/KNJ4Y and can be accessed through the provided link: https://osf.io/knj4y/.This is a descriptive study with a qualitative approach, and data is obtained from secondary sources.The research aims to find scientific, cultural, social, political, and economic contributions related to drug prevention at schools to better understand the real problem being researched (Cervo & Bervian, 2002).

Eligibility Criteria
Inclusion criteria for this study are primary articles, systematic, integrative or narrative review articles with or without meta-analysis, reports articles, monographs, dissertations and theses without temporal restrictions in any language.These articles should address the factors that benefit and hinder intersectoral actions at school for the elaboration of policies to prevent the use of alcohol and other drugs.
Exclusion criteria are incomplete texts, editorials, conference proceedings, newspaper comments, case reports, monographs, dissertations, and partially published theses.Also, those articles that exclusively addressed political and economic aspects or clinical and genetic aspects associated with drugs will be excluded.

Search in Databases
The research question for this project was based on the acronym PCC, which stands for Population, Context (geographic, sociocultural or related to a specific environment), and Concept (intervention, phenomenon of interest and outcomes).The question was, "What are the factors that promote intersectoral actions in the development of policies to prevent the use of alcohol and other drugs in schools?"To identify relevant literature, the Health Sciences Descriptors -DeCS and synonyms in the Medical Subject Headings -MeSH were gathered in Portuguese, English, and Spanish from the title, abstract, and keywords of studies, as shown in Table 1

Context
The process of formulating policies to prevent and control drug abuse.

Concept Intersectoral actions
Source: Prepared by the authors.

Data Extraction and Analysis
To manage the articles and avoid repetition, we utilized version 1.18 of the Mendeley reference manager.To select the articles for our study, we employed the Rayyan QCRI platform (https://rayyan.qcri.org),which allowed two independent researchers (A.M.A and J.M.G) to read the article titles and abstracts.Any discrepancies were resolved by a third researcher (L.F.C.).Data extraction was carried out by two reviewers (A.M.A and J.M.G) independently, using a Microsoft Excel 2016 extraction form.Any disagreements were resolved through consensus with a third researcher (L.F.C.).If necessary, we contacted the authors of the chosen articles to obtain additional information.
The analysis of published articles has taken into consideration several variables such as author/year, country, social actors involved in intersectoral actions, study design, drugs covered, population, total sample size (N), intersectoral action, description of the intersectoral action, main points developed, factors that benefit intersectoral actions, and factors that hinder intersectoral actions.

Results
A total of 81 publications were identified in the literature search.After reading the full text, 5 eligible studies were selected (Figure 1).The scoping review's scientific evidence cited in this text spans over the last two decades.Almost half of the studies (Anderson-Carpenter, 2016;Lachauss, 2008) were conducted in the USA, with no studies conducted in Africa, Asia, and Oceania (Table 2).Regarding study design, 80% of the studies were quantitative (Anderson-Carpenter, 2016;Farrington, 2015;Lachauss, 2008;Schofield, 2003), with 40% being quasi-experimental (Anderson-Carpenter, 2016;Lachauss, 2008).Among social actors involved in intersectoral actions with schools, the community (80%) (Anderson-Carpenter, 2016;Farrington, 2015;Lachauss, 2008;Schofield, 2003) and the government (60%) (Nordmyr, 2021) stood out.Alcohol was the most common drug (Nordmyr, 2021;Anderson-Carpenter, 2016;Farrington, 2015;Lachauss, 2008), and high school students participated in 60% of eligible studies (Anderson-Carpenter, 2016;Lachauss, 2008;Schofield, 2003).Researchers have given more attention to alcohol and tobacco as compared to illicit drugs like cocaine and crack.This is because students usually prefer alcohol and tobacco as their first choice of drugs.Kandel and Yamaguchi (1993) suggest that people usually go through a progression of drugs before using illicit drugs.This scoping review also reveals that private sector involvement in preventing drug use in schools is quite limited.Pereira and Sanchez (2020) confirm that private companies invest more in private schools than public ones, leading to unequal access to information about good health practices.Private companies are important stakeholders in financing public policies in schools, but their lobbying efforts can influence public-private partnerships (Silva, 2017).
It is important to note that schools should play a key role in developing collaborative efforts to prevent alcohol and drug use.However, schools are often overlooked in promoting communication and strengthening support networks as outlined in public health and education policies (Padrão, 2021).Unfortunately, some government officials view young adolescents as less deserving of their rights, leading to exclusionary and prohibitionist measures.These measures are often justified as to prevent social deviance resulting from drug use (Sposito, 2003;Tatmatsu, 2020).As a result, the approach to drug prevention in schools is often limited to repressive measures.This approach neglects the importance of prevention through education and support for overall health.
Brazil has a strict law called the Child and Adolescent Statute (ECA) that punishes the sale, supply, serving, administering, or delivering of drugs.However, despite this law, the National School Health Survey (PeNSE) conducted between 2009 and 2019 showed a 20% increase in the number of adolescents who smoked at least once in their life by the time they reached the 9th year of elementary school.The data on the use of alcoholic beverages was even more concerning, with the percentage increasing from 52.8% in 2012 to 63.2% in 2019, according to IBGE.Despite the existence of prohibitionist legislation, access is still facilitated by friends or as a result of third parties, including within the family.In fact, according to Bahr (2005) apud Paiva and Ronzani (2009), "The lack of parental support, the use of drugs by the parents themselves, permissive attitudes of parents towards consumption and the inability of parents to dialogue with their children children are predisposing factors to the initiation or continuation of drug use".These factors have resulted in the lack of a coherent and organized educational policy in schools that involves students and their families.
It seems that each school has its own unique characteristics and methods when it comes to the prevention of drug use.However, many schools are not adequately prepared to deal with prevention efforts, as evidenced by the lack of a protocol outlining preventive actions to be taken (Tatmatsu, 2020).Despite these challenges, changing the design of schools in the United States could prove beneficial.It is estimated that for every dollar spent on intersectoral drug prevention actions and programs in schools, around 18 dollars can be saved on the social costs associated with drug abuse (Department of Health and Human Services, 2008).

Limitations
During this scoping review, several limitations were identified.These limitations include: 1) a small number of primary and secondary studies on drug prevention in schools that involve intersectoral actions; 2)insufficient and non-detailed evidence regarding the social actors responsible for implementing intersectoral actions; 3) the negative impact of strictly prohibitionist logic on drug prevention outcomes at school; and 4) the lack of subgroup analyses in different ethnic populations globally.

Practical Implications
The identification of intersectoral actions in schools allows the development of educational strategies focused on drug prevention, taking into account the social vulnerabilities of each locality.In addition, it is important to reconsider the various bureaucratic obstacles among the different social actors in order to speed up the process of implementing intersectoral actions.
It is also pointed out that the evaluation of the effectiveness and cost-effectiveness of cross-sectoral-interventions applied in school in different countries may come into conflict with the violence of drug trafficking, arms trafficking and police corruption, which is a relevant need to monitor the durability or temporality of the interventions.In relation to the objectives achieved, it is recommended that new intervention research and observational studies be conducted to further evaluate the results of intersectoral interventions in schools to prevent alcohol and other drugs.

Conclusion
This review found that there is a great need to share and implement cross-sectoral policies globally to contribute to promotion and prevention measures related to the use of alcohol and other drugs in schools.Despite the small number of articles in this review, the cross-sectoral actions identified demonstrate the importance of involvement and accountability of school, health, family, justice, teaching, research, community and government stakeholders in promoting healthy schools and addressing problems, such as alcohol and other drug use.Additional and possibly longer studies are needed to examine the impact of cross-sectoral interventions in school.
Furthermore, it is interesting to note that the components of cross-sectoral actions in school can be improved through the identification and involvement of other stakeholders, in the community itself and in government.This report is innovative, in that it identifies the benefits and difficulties associated with cross-sectoral actions, allowing for future adaptions for the development and continued application of these cross-sectoral interventions.However, it is still a major challenge to shift the focus from interdiction policies to the implementation of intersectoral educational interventions in a more integrated manner with families and the community, and to increase the promotion of health education.

Approval Register
This study is a systematic review was registered on the international Open Science Framework (OSF) platform with DOI: 10.17605/OSF.IO/KNJ4Y with access through the provided the link: https://osf.io/knj4y/ Figure 1.Fl ared by the author lowchart for se rs.

Table 1 .
Descriptors that are defined by the acronym PCC

Table 2 .
Characterization of studies included in the scoping review (n = 5) *Europe = includes all countries on the European continent; **Other drugs were not specified in the study; *** NI = not informed.Source: Prepared by the authors.

Table 3 .
Intersectoral actions, their descriptions and the main points developed in the scoping review that included five studies (n = 5)