The Short-Term Change in Knowledge of Cannabis-Related Risks After a Brief Curriculum-Integrated School Intervention Among Adolescents: A Quasi-Experimental Pre–Post Study
Highlights
- A brief nurse-led (3 h) cannabis education program was associated with short-term improvement in cannabis-related knowledge among Spanish secondary students.
- The median knowledge score increased from 8 to 13/15 at two weeks, with improvement observed in 96.7% of participants (Wilcoxon r = 0.867).
- This study provides a pragmatic estimate of the short-term change in a proximal cognitive outcome under routine school conditions.
- Controlled studies with longer follow-up and implementation measures are needed before drawing conclusions about effectiveness, sustained impact, feasibility, or scalability.
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Settings and Participants
2.3. Intervention
2.4. Data Collection Procedures
2.5. Variables and Measures
2.6. Sample Size
2.7. Statistical Analysis
2.8. Ethical Considerations
3. Results
3.1. Sample Characteristics
3.2. Pre–Post Change in Knowledge
3.3. Exploratory Subgroup Analyses of Pre–Post Change in Knowledge
3.4. Prevalence of Substance Use and Contextual Characteristics
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
| IQR | Interquartile Range |
| THC | Tetrahydrocannabinol |
| TREND | Transparent Reporting of Evaluations with Nonrandomized Designs |
References
- ESPAD Group. Key Findings from the 2024 European School Survey Project on Alcohol and Other Drugs (ESPAD). 2025, pp. 1–27. Available online: https://www.euda.europa.eu/publications/data-factsheets/espad-2024-key-findings_en (accessed on 31 January 2026).
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Cannabis—The Current Situation in Europe (European Drug Report 2024). Available online: https://www.euda.europa.eu/publications/european-drug-report/2024/cannabis_en (accessed on 31 January 2026).
- Hall, W.; Manthey, J.; Stjepanović, D. Cannabis Use and Cannabis Use Disorders and Their Treatment in the Europe. Eur. Arch. Psychiatry Clin. Neurosci. 2025, 275, 307–313. [Google Scholar] [CrossRef] [PubMed]
- Vernich, F.; Stefani, L.; Fiorelli, D.; Mineo, F.; Pallocci, M.; Treglia, M.; Marsella, L.T.; Tittarelli, R. Trends in Illicit Cannabis Potency Based on the Analysis of Law Enforcement Seizures in the Southern Area of Rome. Toxics 2023, 11, 648. [Google Scholar] [CrossRef]
- National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids the Current State of Evidence and Recommendations for Research; The National Academies Press: Washington, DC, USA, 2017; ISBN 9780309453042. [Google Scholar]
- Wade, N.E.; Wallace, A.L.; Huestis, M.A.; Lisdahl, K.M.; Sullivan, R.M.; Tapert, S.F. Cannabis Use and Neurocognitive Performance at 13–14 Years-Old: Optimizing Assessment with Hair Toxicology in the Adolescent Brain Cognitive Development (ABCD) Study. Addict. Behav. 2024, 150, 107930. [Google Scholar] [CrossRef]
- Harrison, M.E.; Kanbur, N.; Canton, K.; Desai, T.S.; Lim-Reinders, S.; Groulx, C.; Norris, M.L. Adolescents’ Cannabis Knowledge and Risk Perception: A Systematic Review. J. Adolesc. Health 2024, 74, 402–440. [Google Scholar] [CrossRef]
- Vogel, E.A.; Romm, K.F.; Massey, Z.B.; Cohn, A.M. Social Media Use, Cannabis Attitudes, and Cannabis Use among Adolescents: An Observational Study. Prev. Med. Rep. 2025, 55, 103126. [Google Scholar] [CrossRef]
- Balneaves, L.G.; Hammond, D.; Turner, S.; Nickel, N.; Woodgate, R.L.; Watling, C.Z. Youth and Young Adults’ Knowledge and Perceptions of Risks and Benefits Regarding Cannabis Products: A Cross-Sectional Analysis of Over 1700 Individuals. J. Psychoact. Drugs 2025, 57, 347–356. [Google Scholar] [CrossRef] [PubMed]
- Volkow, N.D.; Baler, R.D.; Compton, W.M.; Weiss, S.R.B. Adverse Health Effects of Marijuana Use. N. Engl. J. Med. 2014, 370, 2219–2227. [Google Scholar] [CrossRef]
- Silins, E.; Horwood, L.J.; Patton, G.C.; Fergusson, D.M.; Olsson, C.A.; Hutchinson, D.M.; Spry, E.; Toumbourou, J.W.; Degenhardt, L.; Swift, W.; et al. Young Adult Sequelae of Adolescent Cannabis Use: An Integrative Analysis. Lancet Psychiatry 2014, 1, 286–293. [Google Scholar] [CrossRef] [PubMed]
- Observatorio Español de las Drogas y las Adicciones. Informe 2024. Alcohol, Tabaco y Drogas Ilegales en España; Ministerio de Sanidad, Delegación del Gobierno para el Plan Nacional sobre Drogas: Madrid, Spain, 2024; 294p, Available online: https://pnsd.sanidad.gob.es/profesionales/sistemasInformacion/informesEstadisticas/pdf/2024_OEDA-Informe.pdf (accessed on 31 January 2026).
- Onrust, S.A.; Otten, R.; Lammers, J.; Smit, F. School-Based Programmes to Reduce and Prevent Substance Use in Different Age Groups: What Works for Whom? Systematic Review and Meta-Regression Analysis. Clin. Psychol. Rev. 2016, 44, 45–59. [Google Scholar] [CrossRef]
- Faggiano, F.; Minozzi, S.; Versino, E.; Buscemi, D. Universal School-Based Prevention for Illicit Drug Use. Cochrane Database Syst. Rev. 2014, 2017, CD003020. [Google Scholar] [CrossRef]
- Durlak, J.A.; DuPre, E.P. Implementation Matters: A Review of Research on the Influence of Implementation on Program Outcomes and the Factors Affecting Implementation. Am. J. Community Psychol. 2008, 41, 327–350. [Google Scholar] [CrossRef]
- Zuckermann, A.M.E.; Gohari, M.R.; de Groh, M.; Jiang, Y.; Leatherdale, S.T. The Role of School Characteristics in Pre-Legalization Cannabis Use Change among Canadian Youth: Implications for Policy and Harm Reduction. Health Educ. Res. 2020, 35, 297–305. [Google Scholar] [CrossRef]
- Moore, G.F.; Evans, R.E.; Hawkins, J.; Littlecott, H.; Melendez-Torres, G.J.; Bonell, C.; Murphy, S. From Complex Social Interventions to Interventions in Complex Social Systems: Future Directions and Unresolved Questions for Intervention Development and Evaluation. Evaluation 2019, 25, 23–45. [Google Scholar] [CrossRef]
- Patton, G.C.; Sawyer, S.M.; Santelli, J.S.; Ross, D.A.; Afifi, R.; Allen, N.B.; Arora, M.; Azzopardi, P.; Baldwin, W.; Bonell, C.; et al. Our Future: A Lancet Commission on Adolescent Health and Wellbeing. Lancet 2016, 387, 2423. [Google Scholar] [CrossRef]
- Ennett, S.T.; Ringwalt, C.L.; Thorne, J.; Rohrbach, L.A.; Vincus, A.; Simons-Rudolph, A.; Jones, S. A Comparison of Current Practice in School-Based Substance Use Prevention Programs with Meta-Analysis Findings. Prev. Sci. 2003, 4, 1–14. [Google Scholar] [CrossRef]
- Lize, S.E.; Iachini, A.L.; Tang, W.; Tucker, J.; Seay, K.D.; Clone, S.; DeHart, D.; Browne, T. A Meta-Analysis of the Effectiveness of Interactive Middle School Cannabis Prevention Programs. Prev. Sci. 2017, 18, 50–60. [Google Scholar] [CrossRef]
- Debenham, J.; Birrell, L.; Champion, K.E.; Newton, N. An On-Line School-Based Substance Use Harm Reduction Programme: The Illicit Project Randomized Controlled Trial Results. Addiction 2024, 119, 741–752. [Google Scholar] [CrossRef] [PubMed]
- Fuentes, A.P.M.D.C.; Jiménez Tapia, A.; Ruiz-Cortés, E.M.; Bolaños-Ceballos, F.; Flores Castro, J.C.; Gutiérrez, R.; González-Forteza, C. Effectiveness of a Mobile App to Increase Risk Perception of Tobacco, Alcohol, and Marijuana Use in Mexican High School Students: Quantitative Study. JMIR mHealth uHealth 2023, 11, e37873. [Google Scholar] [CrossRef] [PubMed]
- Castaño, Y.; Gervilla, E.; Martínez-Vispo, C.; Juan, M.; García-Pazo, P.; Al-Halabí, S.; Becoña, E.; Calafat, A. Effectiveness of a School-Based Drug Prevention Program: Tú Decides 2.0. J. Prev. 2026, 47, 191–207. [Google Scholar] [CrossRef] [PubMed]
- Des Jarlais, D.C.; Lyles, C.; Crepaz, N.; The Trend Group. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: The TREND statement. Am. J. Public Health 2004, 94, 361–366. [Google Scholar] [CrossRef]
- Tinner, L.; Palmer, J.C.; Lloyd, E.C.; Caldwell, D.M.; MacArthur, G.J.; Dias, K.; Langford, R.; Redmore, J.; Wittkop, L.; Watkins, S.H.; et al. Individual-, Family- and School-Based Interventions to Prevent Multiple Risk Behaviours Relating to Alcohol, Tobacco and Drug Use in Young People Aged 8–25 Years: A Systematic Review and Meta-Analysis. BMC Public Health 2022, 22, 1111. [Google Scholar] [CrossRef] [PubMed]
- Faggiano, F.; Vigna-Taglianti, F.; Burkhart, G.; Bohrn, K.; Cuomo, L.; Gregori, D.; Panella, M.; Scatigna, M.; Siliquini, R.; Varona, L.; et al. The Effectiveness of a School-Based Substance Abuse Prevention Program: 18-Month Follow-up of the EU-Dap Cluster Randomized Controlled Trial. Drug Alcohol Depend. 2010, 108, 56–64. [Google Scholar] [CrossRef] [PubMed]
- Vigna-Taglianti, F.D.; Galanti, M.R.; Burkhart, G.; Caria, M.P.; Vadrucci, S.; Faggiano, F. “Unplugged,” a European School-Based Program for Substance Use Prevention among Adolescents: Overview of Results from the EU-Dap Trial. New Dir. Youth Dev. 2014, 2014, 67–82. [Google Scholar] [CrossRef]
- Jenkins, E.; Karamouzian, M.; Sabioni, P.; Molyneux, T.; Goodyear, T.; Gadermann, A.; Gunn, H.; Knight, R.; Carwana, M.; Fast, D.; et al. School-Based Substance Use Interventions: An Overview of Systematic Reviews and Meta-Analysis. Int. J. Ment. Health Addict. 2026, 1–71. [Google Scholar] [CrossRef]
- Salloum, N.C.; Krauss, M.J.; Agrawal, A.; Bierut, L.J.; Grucza, R.A. A Reciprocal Effects Analysis of Cannabis Use and Perceptions of Risk. Addiction 2018, 113, 1077–1085. [Google Scholar] [CrossRef]
- González-Roz, A.; Aonso-Diego, G.; Martínez-Loredo, V.; Cuesta, M.; Secades-Villa, R. Effects of Risk Perception and Accessibility on Cannabis Use among Young Population in Spain: Findings from the 2016 National Survey (ESTUDES). Subst. Use Misuse 2022, 57, 36–46. [Google Scholar] [CrossRef] [PubMed]
- European Union Drugs Agency (EUDA). Cannabis—The Current Situation in Europe (European Drug Report 2025); European Union Drugs Agency Publications: Lisbon, Portugal, 2025; pp. 1–24. Available online: https://www.euda.europa.eu/publications/european-drug-report/2025/cannabis_en (accessed on 31 January 2026).
- Madras, B.K.; Han, B.; Compton, W.M.; Jones, C.M.; Lopez, E.I.; McCance-Katz, E.F. Associations of Parental Marijuana Use with Offspring Marijuana, Tobacco, and Alcohol Use and Opioid Misuse. JAMA Netw. Open 2019, 2, E1916015. [Google Scholar] [CrossRef]
- O’Loughlin, J.L.; Dugas, E.N.; O’Loughlin, E.K.; Winickoff, J.P.; Montreuil, A.; Wellman, R.J.; Sylvestre, M.P.; Hanusaik, N. Parental Cannabis Use Is Associated with Cannabis Initiation and Use in Offspring. J. Pediatr. 2019, 206, 142–147.e1. [Google Scholar] [CrossRef]
- Ariza, C.; Pérez, A.; Sánchez-Martínez, F.; Diéguez, M.; Espelt, A.; Pasarín, M.I.; Suelves, J.M.; De la Torre, R.; Nebot, M. Evaluation of the Effectiveness of a School-Based Cannabis Prevention Program. Drug Alcohol Depend. 2013, 132, 257–264. [Google Scholar] [CrossRef]
- Moore, G.F.; Audrey, S.; Barker, M.; Bond, L.; Bonell, C.; Hardeman, W.; Moore, L.; O’Cathain, A.; Tinati, T.; Wight, D.; et al. Process Evaluation of Complex Interventions: Medical Research Council Guidance. BMJ 2015, 350, h1258. [Google Scholar] [CrossRef]


| Variable | Group | n | Pre Median (IQR) | Post Median (IQR) | Change Median (IQR) | Improved n (%) | Within-Group p | r |
|---|---|---|---|---|---|---|---|---|
| Overall | All participants | 151 | 8 (7–10) | 13 (12–14.5) | 5 (3–6) | 146 (96.7) | <0.001 | 0.867 |
| Cannabis use | None | 120 | 8 (7–10) | 13 (12–14) | 5 (3–6) | 116 (96.7) | <0.001 | 0.868 |
| Non-daily | 21 | 8 (7–9) | 13 (13–15) | 5 (4–6) | 20 (95.2) | <0.001 | 0.868 | |
| Daily | 10 | 8 (6.25–9) | 13 (13–14) | 4.5 (3–7.5) | 10 (100) | 0.006 | 0.886 | |
| Reported parental alcohol/cannabis use | No | 130 | 8 (7–10) | 13 (12–14) | 5 (3–6) | 126 (96.9) | <0.001 | 0.866 |
| Yes | 21 | 8 (7–9) | 14 (13–15) | 5 (3–7) | 20 (95.2) | <0.001 | 0.877 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.
Share and Cite
Azón-Belarre, J.C.; Berges-Usán, P.; Gómez-Torres, P.; Romeo-García, J.; García-Guerra, M.T.; Membrive-Jiménez, M.J.; Galarreta-Aperte, S. The Short-Term Change in Knowledge of Cannabis-Related Risks After a Brief Curriculum-Integrated School Intervention Among Adolescents: A Quasi-Experimental Pre–Post Study. Healthcare 2026, 14, 1264. https://doi.org/10.3390/healthcare14101264
Azón-Belarre JC, Berges-Usán P, Gómez-Torres P, Romeo-García J, García-Guerra MT, Membrive-Jiménez MJ, Galarreta-Aperte S. The Short-Term Change in Knowledge of Cannabis-Related Risks After a Brief Curriculum-Integrated School Intervention Among Adolescents: A Quasi-Experimental Pre–Post Study. Healthcare. 2026; 14(10):1264. https://doi.org/10.3390/healthcare14101264
Chicago/Turabian StyleAzón-Belarre, José Carlos, Patricia Berges-Usán, Piedad Gómez-Torres, Jessica Romeo-García, María Teresa García-Guerra, María José Membrive-Jiménez, and Sergio Galarreta-Aperte. 2026. "The Short-Term Change in Knowledge of Cannabis-Related Risks After a Brief Curriculum-Integrated School Intervention Among Adolescents: A Quasi-Experimental Pre–Post Study" Healthcare 14, no. 10: 1264. https://doi.org/10.3390/healthcare14101264
APA StyleAzón-Belarre, J. C., Berges-Usán, P., Gómez-Torres, P., Romeo-García, J., García-Guerra, M. T., Membrive-Jiménez, M. J., & Galarreta-Aperte, S. (2026). The Short-Term Change in Knowledge of Cannabis-Related Risks After a Brief Curriculum-Integrated School Intervention Among Adolescents: A Quasi-Experimental Pre–Post Study. Healthcare, 14(10), 1264. https://doi.org/10.3390/healthcare14101264

