Substance-focused initiatives not only way schools help prevent risky substance use
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Substance-focused initiatives not only way schools help prevent risky substance use

Surveys in the West Midlands indicate that schools which engage pupils in their school and their education also protect them against risky forms of substance use, offering a way to prevent substance misuse by focusing on core educational and social virtues.

FINDINGS Two of the reports derived from the 1995–6 West Midlands Young People's Lifestyle Survey of nearly 26,000 pupils in grades 7, 9 and 11 (ages 11 to 16) in 166 secondary schools who completed an anonymous health and lifestyle questionnaire. The latest was concerned with drinking and use of illegal drugs.1 For the purposes of the study, pupils who admitted drinking at least 10 UK units of alcohol (80g) a week were designated heavy drinkers. Since adolescent drinkers normally consume once or twice a week, they might also be considered 'binge' drinkers. Grade 7 pupils (aged 11–12) who drank alcohol at least monthly were considered early initiators. The survey also asked about regular use of one or more of seven illegal drugs, including cannabis.

At issue was whether in a school the proportions of pupils in these categories would be related to four school performance indicators: the proportion of pupils who achieved five good grades in the GCSE exams at the end of compulsory schooling; the truancy rate; and the degree to which on both measures each school exceeded or fell below the rate expected for schools with a similar pupil mix – indices of 'added value'. These two indices tended to co-vary so could be combined in to a single index thought to reflect Supporting its validity as an index of lack of commitment to the school, the truancy index co-varied with two other such indices: the rate of authorised absence and the proportion of pupils who failed to secure qualifications virtually all could achieve had they tried. the degree to which schools productively engaged pupils in their education.2 The better the engagement, the more pupils were expected to absorb the school's norms regarding substance use.

Relationship between added value and substance use in West Midlands schools

After adjusting for differences between schools in the profiles of their pupils, only the added value measure was significantly related The only other statistically significant relationship in the adjusted analysis was between good exam results and fewer pupils engaging in heavy drinking. to all three substance use measures.3 In each case, the more added value, the fewer pupils used substances. Compared to schools at the bottom end of the scale, in schools towards the top the proportions of early or heavy drinkers were both 7% less and of regular users of illicit drugs, 4% less. Given the relative rarity of these forms of substance use, these figures represent substantial proportional reductions. An earlier report based on the same survey had found a similar relationship with the proportion of pupils who smoked at least a cigarette a week, down by 6% in high versus low added value schools.4

A third report from the same area followed up roughly 7000 pupils initially aged 13–14 for two years.5 The data derived from 52 schools evaluating an anti-smoking intervention. That was ineffective, but school culture reflected by the added value index seemed to curb the uptake of smoking and to restrain consumption among pupils who started the study as smokers. All else being equal, compared to a school at the bottom of the added value scale, by the end of the study a school towards the top would have 7% fewer pupils (18% versus 25%) who smoked at least weekly.

IN CONTEXT These findings echo an earlier report from the Glasgow area where over 2000 pupils were followed up from 1994 when they were ending primary school (age 11) to their last year of compulsory schooling (age 15) in 43 randomly selected secondary schools.6 Differences between schools in the proportions of pupils at age 13 or 15 who regularly drank, were smokers, or had used illegal drugs, could not be accounted for by a battery of pupil, family and social background measures (including substance-related experiences at primary school and parental smoking and drinking) nor by the neighbourhoods the schools drew their pupils from. It was, it seemed, something about the schools which produced the differences. For all three forms of substance use and at both ages, the school's influence was at least partly accounted for by the degree to which its pupils felt disengaged from school and from education and by how many teachers they felt they got along with.

In both areas the greatest influences on levels of substance use in a school were usually the social backgrounds and characteristics of its pupils. Still it seemed that schools could make a worthwhile contribution to mitigating or promoting these influences simply by being good schools which engaged and forged positive relationships with their pupils. Also in both, the relative influence of the school diminished as pupils aged. This might have been an artefact of what was measured. Though worryingly atypical at an earlier age, by school-leaving age the assessed substance use patterns would have been more normative. Had the reports been able to titrate their measures to pupils' ages, they might have found that the school retained its influence.

Despite attempts to eliminate alternative explanations, the major doubt over the reports is whether school culture reflected in the commitment of the pupils was actually instrumental in determining levels of atypical substance use. If it was, then changing the culture to bolster commitment can be expected to curb use. On the other hand, it could be (for example) that good schools attract families whose children are less at risk, or that both culture and substance use reflect some other factor, such as unmeasured quirks of the neighbourhood. In these cases, enhancing school culture would not impact on substance use.

Doubts are allayed by the consistency of the findings and by their compatibility with closely allied findings on pupils' 'connectedness' to school – the sense of being part of a valued school community click here for details. Mainly US studies have linked higher connectedness to healthy development, including avoidance of early and risky substance use.7 Connectedness is higher in warm and supportive schools with a caring, inclusive ethos, which emphasise prosocial values, encourage cooperation, show concern for pupils as individuals, allow pupils to participate in decision-making and offer extracurricular activities. Attempts to foster pupil development and school bonding by creating this kind of climate have sometimes worked, but some schools have been unable to take these interventions on board.

A few studies have also directly tested whether such efforts reduce substance use. The results have at best been inconclusively promising. This could be because the greatest impact is on particularly deviant forms of drug use, frowned on by most pupils as well as by the school, rather than age-typical substance use experimentation. Also, the improvement levers open to researchers fall far short of those available to authorities which can replace staff, inject resources and mandate compliance. This may be partly why findings are muddied by a suspicion that schools able to implement school climate interventions were already on a positive trajectory.

PRACTICE IMPLICATIONS Because they are all-pervasive, school culture improvements might justify themselves on a multiplicity of grounds including academic achievement and crime prevention as well as substance use, and may seem a better bet for schools than diverting resources to dedicated drug prevention activities with their patchy track record. The evidence is strong that schools which (as in the featured studies) develop supportive, engaging and inclusive cultures, and which offer opportunities to participate in school decision-making and extracurricular activities, create better outcomes across many domains, including non-normative substance use.7 As well as facilitating bonding, such schools are likely to make it easier for pupils to seek and receive the support they need. However, these studies document the impacts of normal school development processes. Doubts remain over whether an add-on intervention to improve school culture can be implemented and effective unless these processes have already created fertile ground. The lessons seem to be to attend to the basics through school management, training, pastoral and administrative procedures which foster and demonstrate a caring, cooperative and participative ethos and concern for pupils as individuals, then perhaps to seek to optimise these virtues through targeted interventions.

Thanks for their comments on this entry in draft to Patrick West and Lyndal Bond of the MRC Social & Public Health Sciences Unit and Chris Bonell and Adam Fletcher of the London School of Hygiene & Tropical Medicine. Commentators bear no responsibility for the text including the interpretations and any remaining errors.

1 FEATURED STUDY Bisset S. et al. School culture as an influencing factor on youth substance use. Journal of Epidemiology and Community Health: 2007, 61, p. 485–490.

2 Supporting its validity as an index of lack of commitment to the school, the truancy index co-varied with two other such indices: the rate of authorised absence and the proportion of pupils who failed to secure qualifications virtually all could achieve had they tried.4

3 The only other statistically significant relationship in the adjusted analysis was between good exam results and fewer pupils engaging in heavy drinking.

4 FEATURED STUDY Aveyard P. et al. The influence of school culture on smoking among pupils. Social Science & Medicine: 2004, 58(9), p. 1767–1780.

5 FEATURED STUDY Markham W.A. et al. Value-added education and smoking uptake in schools: a cohort study. Addiction: 2008, 103(1), p. 155–161.

6 West P. et al. School effects on pupils' health behaviours: evidence in support of the health promoting school. Research Papers in Education: 2004, 19, p. 261–291.

7 Fletcher A. et al. School effects on young people's drug use: a systematic review of intervention and observational studies. Journal of Adolescent Health: 2008, 42(3), p. 209–220.

Last revised 09 April 2008

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