The review's findings indicate that there is empirical evidence that features of the school environment influence students' drug use. Experimental studies suggest that changes in a student's school social environment that include more participation in school activities, improved social interactions, and a more satisfying school experience overall may be linked to reduced drug use. School-related and individual-related observational studies consistently report that disengagement from the school environment and poor teacher-student interactions were associated with drug use and other risky health behaviors. This suggests that interventions which promote a positive school environment and reduce students' disaffection with their schools may be an effective complement to drug prevention interventions that address individual knowledge, skills, and peer norms. Such interventions should be piloted in a wider range of settings. Further research is also needed in exploring mechanisms schools can use to decrease risk factors for students' drug use. The literature review included experimental/quasi-experimental studies of "whole-school" drug prevention interventions and longitudinal observational studies of the association between school-related and individual-related factors in the school environment and their impact on drug use. Key words, titles, and abstracts in major commercial bibliographic database and specialist registers were searched in March 2006. The selected studies were conducted in the United States, the United Kingdom, Australia, and the Netherlands. Experimental studies are the most reliable for producing evidence of causation, and observational studies were included to provide evidence on a wider range of possible school-related effects and how school-level influences might be mediated by individual-related factors. 3 tables and 53 references