Improving the institutional culture (ethos) of schools in the UK may help reduce substance abuse and teenage pregnancies, says an article in this week's BMJ.
Researchers from the London School of Hygiene and Tropical Medicine's Centre for Research on Drugs and Health Behaviour say that substance misuse and teenage pregnancy are major public health challenges and argue that existing responses to these issues seem to have brought about only limited benefits.
Previous surveys show that a third of 15 year olds in England have taken illegal drugs in the past year and a quarter of 15 year old girls smoke. Rates of illegal drug use and drinking continue to rise, whilst teenage pregnancy rates in the UK are the highest in western Europe.
So the authors reviewed evidence suggesting that interventions aiming to promote positive school ethos might provide an effective complement to existing approaches.
A study carried out in Scotland found that in some secondary schools 'risky' health behaviours (e.g. substance misuse, alcohol and tobacco use) couldn't be explained by student, family or neighbourhood factors, but did seem to be explained by large school size and independently rated poor school ethos.
And trials in both Australia and the United States showed that projects which aimed to improve school ethos helped improve the health behaviours of their students. Both projects involved a range of activities including improving teacher-student communication, increasing parent and student involvement in school policy-making and better training for teachers.
The US study reported a 34% reduction in a combined measure of alcohol, tobacco and cannabis use among boys, plus significant benefits regarding condom use, frequency of sex, violence and truancy. However, similar benefits were not reported among girls.
The Australian research found that students at schools taking part in the project were slightly less likely to report a range of risky health behaviours (such as regular smoking and drinking and marijuana use). Follow-up research suggested impacts might increase over time as the changes 'bedded down' in schools.
This evidence makes sense, say the authors. After the family, and alongside the media and peers, the most important institution in the lives of most children and young people is their school.
The UK government already recognises that the whole school environment has a key role in promoting young people's health. However, there is little evidence that current government initiatives aiming to make schools healthier are doing much to improve ethos. Improving school ethos to combat disaffection should be viewed as a promising complement to classroom-based interventions, they conclude.