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Background: Based on the socio-ecological model of health, socioeconomic policy is an important determinant of population health. Spending decisions by public health units (PHU) have been shown to be associated with population health outcomes. Some studies have found greater PHU spending to be associated with improved population health, while others report mixed findings, warranting further research. The objective of this study was to investigate the association between per capita PHU spending and self-reported substance use among Canadian adolescents. Methods: Cross-sectional, multilevel modelling was conducted using student data from the 7th wave (2018/19) of the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behaviour (COMPASS) study, as well as spending data from the audited financial statements of Ontario's PHUs. The sample included 29,056 students in grades 9–12 attending 61 secondary schools in 15 PHUs across Ontario. Substance use was measured as the self-reported use of alcohol, cannabis, cigarettes and e-cigarettes, at least once per month on average. Results: Approximately 50 % of the study sample was female and the majority identified as being White. Per capita spending ranged from $54.07 to $224.95, with a median spending amount of $89.62. The highest quartile of PHU spending was significantly associated with higher alcohol use (adjusted odds ratio (AOR): 1.41, 95 % CI: 1.04, 1.91), binge drinking (AOR: 1.71, 95 % CI: 1.18, 2.48), and cigarette use (AOR: 2.19, 95 % CI: 1.23, 3.91) in adolescents, while the second highest quartile was associated with lower e-cigarette use (AOR: 0.74, 95 % CI: 0.56, 0.98), relative to the lowest quartile. Conclusion: Public health spending is associated with adolescent substance use. The present study reports mixed results, warranting further prospective research to explore the directions and mechanisms of the associations found.

North America's overdose crisis is one of the most urgent public health issues of our time and parents bereaved from substance use are a prominent voice within the news media. To date, however, the experiences of bereaved mothers who have shared their stories with the media has not been well-documented, leaving a significant gap in our understanding of their political advocacy efforts.In 2017, we conducted qualitative interviews with 43 mothers across Canada who participated in drug policy advocacy following the substance-related death of their child. We used a narrative interview approach and thematic analysis to distill key themes in recounting bereaved mothers’ stories of engaging with reporters, their perspectives on media representation and the personal impacts of sharing their stories with news media.Participants viewed the news media as powerful allies in educating the public, changing attitudes, and ultimately influencing policy in support of people who use substances. However, there was a personal cost that accompanied this media advocacy which included the potential for sensationalism, news media complacency, insensitive comments by journalists, and having one's story misrepresented.Our study highlights the complex relationship between mothers bereaved by substance use and the news media who hold tremendous power in framing their stories. By examining bereaved mothers as social movement actors and reflecting on the structural context in which news stories are delivered, we outline strategies to ensure parents bereaved by substance use can safely share their stories with media and continue their work in countering stigma and misinformation.