Addiction prevention & mental health support in Hungarian elementary schools: a mixed-methods study

Substance and behavioural addictions are growing problems of children and adolescents, and prevention requires reducing risk factors and strengthening protective factors, such as mental health support (MHS). The current Hungarian policy emphasises the role of schools in addiction prevention (AP), but few data exist on school-level implementation. This was a mixed-methods study supported by the Scientific Foundations of Education Research Program of the Hungarian Academy of Sciences, investigating the implementation of AP and MHS in Hungarian elementary schools (N = 2892) with a nationwide cross-sectional survey-based study and by focus groups on teachers’ views about such programmes and ways to improve them (37 teachers from 21 schools). Schools covered the topics of tobacco (74%), drugs (71%), alcohol (62%), and electronic devices (61%) most commonly. Of schools, 55% had regular MHS programmes, and this differed significantly by school type and size. More addiction-, and mental health-related topics were covered with greater diversity of implementers (p < 0.001). A school environment conducive of MHS was more prevalent with higher frequency of community building within the teaching staff (p < 0.001). Logistic regression revealed that school type, support for teachers’ work, and diversity of implementers were significantly associated with the quality of implementation of AP and MHS. Six themes emerged from the focus groups: development of addictions and mental health, health education, role of teachers in addiction prevention, cooperation, factors hindering addiction prevention at schools, and factors supporting it. Teachers claimed that they can do the most for children's health at school, but they need support for effective implementation. Our results indicate the importance of school characteristics in AP implementation and call for the support and empowerment of teachers and greater organisational capacity to ensure the effectiveness of school-based AP and MHS. KEY MESSAGES: • Multistakeholder engagement approaches are necessary to address a wider, more diverse range of addiction-related topics in the school curricula. • The training and mental health support of teachers and their collectives are important intervention points that should be invested in to increase the effectiveness of addiction prevention.