London School of Hygiene & Tropical Medicine

Promoting a positive ethos in schools, in which students are more engaged and enjoy good relationships with their teachers, can lead to lower levels of substance abuse and teen pregnancy, according to a study which appears today in the British Medical Journal.

A team led by Dr Chris Bonell from the London School of Hygiene & Tropical Medicine's Centre for Research on Drugs and Alcohol Behaviour found that improving school ethos to combat disaffection among pupils should be viewed as a promising complement to classroom-based interventions such as substance-misuse and sex-education interventions. Such interventions are the norm in schools and can have positive effects, but systematic reviews have shown that these are small, inconsistent and generally not sustained³,⁴,⁵,⁶.

Young people's substance abuse and teenage pregnancy are major public health problems. School-based surveys indicate that a third of English fifteen year olds have taken illegal drugs in the last year and about a quarter use them monthly or more¹. Among the 40% of fifteen year olds who drink alcohol, average weekly consumption is over ten units¹. A quarter of fifteen year olds smoke¹. Teenage pregnancy rates in the UK are the highest in western Europe².

The authors reviewed evidence from Scotland, Australia and the United States suggesting that interventions aiming to promote positive school ethos might offer an effective complement to existing approaches. The Scottish study showed that 'risky' health behaviour in secondary schools seemed to be linked to large school size and an independently-rated poor school ethos. The Gatehouse project in Australia aimed to promote a sense of social inclusion in schools, improve teacher-student interaction, and develop opportunities for student participation. Students who took part were found to be slightly less likely to report a range of risky health behaviours, including smoking, drinking and using marijuana. The US study, which had similar objectives and approaches to the Australian one, had led to a 34% drop in alcohol, tobacco and cannabis use among the boys.

Dr Bonell comments: 'Our study has shown how policies aimed at improving school ethos could provide a promising complement to classroom-based interventions. A practical intervention package could be developed, informed by the trials reviewed, to help UK schools improve their ethos and reduce disaffection, and the consequent problems within health and education.

'These interventions, which need to be carefully tailored to and piloted within the UK context, would need to start as soon as young people start secondary school, if not before. They should involve staff, parents and students in both the development and implementation stages, and be supported by training programmes for teachers, aimed at improving interactive teaching and developing better relationships with students.

Notes:

1 - Boreham R, Blenkinsop S (eds.) Drug use, smoking and drinking among young people in England in 2003. London, The Stationary Office, 2004.

2 - United Nations Population Division. World Urbanization Prospects: The 2001 revision: Data tables and highlights. New York: United Nations, 2002.

3 - Faggiano F, Vigna-Taglianti FD, Versino E, Zambon A, Borraccino A, Lemma P. School-based prevention for illegal drugs use. Cochrane Database of Systematic Reviews 2005; Issue 2, Art. No. CD003020. DOI@: 10.1002/14651858. CD 003020. pub2

4 - Foxcroft DR, Ireland D, Lowe G, Breen R. Primary prevention for alcohol misuse in young people. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD003024. DOI: 10.1002/14651858.CD003024.

5 - Thomas R & Perera R. School-based programmes for preventing smoking (Cochrane Review). Cochrane Database of Systematic Reviews 2006; 3: CD001293. DOI:10.1002/14651858.CD001293.

6 - DiCenso A, Guyatt G, Willan A, Griffith L. Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials. British Medical Journal 2002; 324, 1426-34.