Drug and Alcohol Findings home page in a new window Background notes April 2008

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

‘Connectedness’ expresses a sense of being part of and bonded to a valued school community. Its components include favourable perceptions of pupils and staff and of how well and fairly pupils are treated. Mainly US studies have consistently linked higher connectedness to healthy development, including the avoidance of early and risky substance use.1 2 3 4 5 In the words of a recent review, such studies have "overwhelmingly found that disengagement from school and poor teacher–student relations were associated with subsequent drug use and other risky health behaviors."19 In one not just the individual pupil’s connectedness, but even after this had been taken in to account, the overall level of connectedness across the school, was linked to a lower likelihood that pupils would have recently drunk alcohol and to less pro-drinking attitudes, an indication that the school climate was itself an active ingredient.6

In natural school settings, connectedness and allied feelings among the pupils are related to a caring ethos and to teachers and schools which are warm, supportive and inclusive, emphasise prosocial values, encourage cooperation and cooperative learning activities, show concern for pupils as individuals, give pupils opportunities to be influential and to participate in classroom and school decision-making, and offer extracurricular activities.5 19 As well as facilitating bonding such schools are likely to make it easier for pupils to seek and receive the support they need. Attempts to intervene to bolster these attributes (and often too class management skills and the fairness and consistency of school rules and their implementation) have sometimes resulted in the intended increase in pupil bonding to the school and in overall more positive youth development, but not all schools have been able to respond to such interventions.5

US trials of school climate interventions

Some studies have directly tested whether intervening to foster a culture which encourages connectedness to school reduces substance use. A meta-analysis combining substance use outcomes from 207 school-based prevention programmes found that those which aimed to create system-wide change across the school had the greatest effects.7 Whether these initiatives were among the active ingredients is unclear, because most such programmes included also drug-focused lessons and attempted to create community-wide change. Few focused on improving school climate. All these programmes were among those featuring interactive teaching, found more effective than those which did not. However, this finding has been called in to question by a reanalysis of the data.8 It is unclear whether these doubts extend to system-wide programmes in particular.

A recent review found just four well designed evaluations of whole school approaches to drug use prevention. The tentative conclusion was that "changes to the school social environment that increase student participation, improve relationships and promote a positive school ethos may be associated with reduced drug use" among other risky behaviours but the same limitation applies – these interventions also included drug-focused components and attempts at community-wide change.19

Individual studies have often been at best ambiguous about whether school climate interventions do reduce substance use. It could be that such interventions have their greatest impacts on particularly deviant forms of drug use, frowned on by most pupils as well as by the school, rather than on substance use as such. It is also important to remember that the levers open to researchers fall far short of those potentially available. Normally research projects are in no position to replace governors, administrators, heads or other teachers, renovate premises, inject large amounts of new resources, or compel the tardy or recalcitrant to make to make the required changes. Such levers are potentially available to school and public authorities. The most researchers can do is guide, train, and encourage, and offer information and structure, one reason perhaps why findings are sometimes muddied by a suspicion that schools which take on and are able to implement research programmes were already on a positive trajectory.

For example, in some of the schools in a US study, a programme to improve how primary schools related to their pupils had the intended effect on connectedness and also curbed early (age 10–12) uptake of smoking and drinking.9 However, substance use reductions were seen only in the five schools which managed to implement the programme, not across the 12 which tried. These 12 had been chosen on the basis of their willingness to try the intervention and because they seemed most likely to be able to do so successfully,10 yet most were unable to make any greater advances than comparison schools. This leaves a strong suspicion that outcomes were at least as much to do with the nature of the five schools before the project as with any impact of the project. A further analysis established that the intended effects on pupils’ attitudes, beliefs and feelings were attributable to the development of a sense of community in the high implementation schools, but did not test whether this also accounted for substance use reductions.10 11

Another US study mounted an intervention which though not targeted specifically at connectedness, could have been expected to bolster it, yet it had little impact on substance use.12 Between roughly ages 11 and 14, adding measures to make teaching methods more interactive and sensitive to pupils’ needs, plus enhancing school-parent and community links, added little to the impact on substance use of an intensive set of lessons intended to foster social skills, self-esteem and decision-making abilities. Both substantially reduced substance use relative to a health promotion curriculum, but to roughly the same degree. In contrast, deviant behaviour in school was reduced more by the wider ranging intervention. Impacts were seen only among the boys in these schools, whose pupils were primarily black and from relatively impoverished homes.

The final US study was conducted in schools in deprived areas of Charleston County which had been selected to implement a whole school development programme.13 Among other things, the aim was to improve school climate and attachment to the school and to reduce pupil alienation. In these it modestly succeeded, and among the high schools there was also a small but statistically significant reduction in delinquent behaviour and in substance use from before to after the intervention. Similar reductions were not seen in a comparison school. The fact that schools were not randomly allocated, and that intervention and comparison schools were not selected to be comparable on key variables, means the findings may have had as much to do with pre-existing characteristics of the schools as with the programme.

Gatehouse Project

Before the Australian Gatehouse Project’s programme was implemented, at age 13–14 drinking, smoking and cannabis use among the pupils in the study were strongly related to poorer connectedness to school.14 In relation to comparison schools, once other influences had been taken in to account, over the years to age 15–16 an intervention intended to improve connectedness was followed by generally small and statistically insignificant changes in these forms of substance use, the largest being a roughly 30% reduction in regular smoking which reached statistical significance in one of the three follow-up years. In another report from the project, all the measures of cannabis use (any, weekly, and uptake of use or weekly use) favoured the intervention schools, but none to a statistically significant degree.15

Supplementing the analysis of the same pupils as they aged, another Gatehouse report instead assessed successive classes of eighth grade (age 13–14) pupils from before the intervention to after it had been completed four years later.16 Compared to comparison schools, a composite measure of substance use was reduced in the later classes exposed to the intervention, but not significantly so. Stronger intervention-related reductions were seen in respect of early sexual intercourse and on an omnibus measure of risky behaviour including substance use.

In contrast to these somewhat promising but inconclusive effects of the intervention, higher pre-intervention connectedness with school was strongly related to less cannabis use on all the relevant measures two years later15 and also to less smoking and drinking, especially among pupils with emotionally supportive peer networks.17 Moreover, only when connectedness with school was high to begin with did the intervention have its most noticeable impact, the reduction in the proportion of pupils who were regular smokers. The same limitation applied to reduced smoking overall.17

Gatehouse’s modus operandi was to provide school-based action teams with feedback on the health of their school’s social climate, then to support them in the development and implementation of their own strategies to address any concerns through a whole school approach with connectedness at its core.18 Though generally in the right direction, the authors acknowledge that the results signify a "small effect at best"14 and testify to the challenges of using school-based interventions to intervene with pupils already disengaged or disengaging from school.17

Its patchy results may reflect the fact that in practice the project failed to improve connectedness with school (at least, as measured by the study) either in subsequent cohorts of eighth-grade pupils16 or among the initial cohort as they aged14 – in the latter case, if anything, the reverse. This left pre-intervention ‘natural’ levels of connectedness as a more consistent influence on later substance use than whether pupils had experienced the intervention. Where the intervention had its greatest impact (on smoking), this only occurred when high starting levels of connectedness provided a platform for the lessons and other intervention components to have an effect. Nevertheless, if this proves a reliable and persisting outcome, the health benefits could be substantial. Conceivably an earlier intervention before the connectedness die had been too firmly cast might have been more consistently effective.19

1 Bonell C. et al. School connectedness and the transition into and out of health-risk behavior among adolescents: a comparison of social belonging and teacher support. British Medical Journal: 2007, 334, p. 614–616.

2 McNeely C.A. et al. Title of article. Journal of School Health: 2004, 74(7), p. 284–292.

3 Resnick M.D. et al. Protecting adolescents from harm. Journal of the American Medical Association: 1997, 278(10), p. 823–2832.

4 Karcher M.J. et al. How connectedness contributes to experimental smoking among rural youth: developmental and ecological analyses. Journal of Primary Prevention: 2005, 26(1), p. 25–36.

5 Schaps E. et al. The role of the school’s social environment in preventing student drug use. Journal of Primary Prevention: 2003, 23(3), p. 299–328.

6 Henry K.L. et al. The contextual effect of school attachment on young adolescents' alcohol use. Journal of School Health: 2007, 77(2), p. 67–74.

7 Tobler N.S. et al. School-based adolescent drug prevention programs: 1998 meta-analysis. Journal of Primary Prevention: 2000, 20, p. 275–336.

8 McCambridge J. A case study of publication bias in an influential series of reviews of drug education. Drug and Alcohol Review: 2007, 26(5), p. 463–468. See also: Researchers look at which school-based drug education programs are most effective.

9 Battistich, V. et al. Effects of the Child Development Project on students' drug use and other problem behaviors. Journal of Primary Prevention: 2000, 21(1), p. 75–99.

10 Solomon D. et al. A six-district study of educational change: direct and mediated effects of the Child Development Project. Social Psychology of Education: 2000, 4(1), p. 3–51.

11 Though Schaps E. et al op cit say cigarette smoking was included in the analysis this does not seem to be the case in the published results.

12 Flay B.R. et al. Effects of 2 prevention programs on high-risk behaviors among African American youth. A randomized trial. Archives of Pediatric and Adolescent Medicine: 2004, 158, p. 377–384.

13 Gottfredson D.C. An empirical test of school-based environmental and individual interventions to reduce the risk of delinquent behavior. Criminology: 1986, 24, p. 705–731.

14 Bond L. et al. The Gatehouse Project: can a multilevel school intervention affect emotional wellbeing and health risk behaviours? Journal of Epidemiology and Community Health: 2004, 58(12), p. 997–1003.

15 Bond L. et al. Long-term impact of the Gatehouse Project on cannabis use of 16-year-olds in Australia. Journal of School Health: 2004, 74(1), p. 23–29.

16 Patton G.C. et al. Promoting social inclusion in schools: a group-randomized trial of effects on student health risk behavior and well-being. American Journal of Public Health: 2006, 96(9), p. 1582–1587.

17 Bond L. et al. Social and school connectedness in early secondary school as predictors of late teenage substance use, mental health, and academic outcomes. Journal of Adolescent Health: 2007, 40(4), p. 357.e9–357.e18.

18 Patton G. et al. Changing schools, changing health? Design and implementation of the Gatehouse Project. Journal of Adolescent Health: 2003, 33, p. 231–239.

19 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.

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