Substance use--when people use drugs, alcohol, or tobacco in ways that can harm themselves or others--remains a persistent problem in the United States. Substance use can result in negative consequences, including poor school performance and diminished mental health. Research suggests that prevention programs for school-aged children may help address substance use before it occurs. The U.S. Departments of Education and Health and Human Services (HHS) and the Office of National Drug Control Policy manage most federal programs that can support substance use prevention activities in K-12 public schools and other settings. These agencies provide funds and informational resources to states and schools. According to the 2024 National Drug Control Strategy, such efforts should focus on preventing initial substance use and promoting good mental health among school-aged children. National efforts to address drug misuse have been included on GAO's High-Risk List since 2021. Senate Report 118-84 includes a provision for GAO to examine the extent to which states require the use of evidence-based drug education and prevention programs in public schools, and how the federal government helps address challenges schools face implementing these programs. This report provides information about states' approaches to substance use prevention programs in public schools, and the resources federal agencies offer to help public schools implement these programs. GAO surveyed all 50 states, Washington, D.C., and eight territories; 56 of the 59 state education agencies completed the survey. Throughout this report, the 56 respondents are referred to as "states."