Is there a "school effect" on pupil outcomes? A review of multilevel studies

Are pupils' 'Programme for International Student Assessment (PISA)' scores associated with a nation's fish consumption?

AIMS

Omega-3 fatty acids are essential for neurodevelopment. Fish is a major source of these essential nutrients. We asked whether a nation's fish consumption is associated with its pupils' PISA scores as measures of school achievement, independent of economic status and breastfeeding. Method (Design and Setting): This was a regression analytic study based on published data.

RESULTS

Data on fish consumption and PISA scores were available for 64 countries. A significant regression model explained 72% of the variance in PISA scores. Breastfeeding does not enter the model. After controlling for technical and/or economic development, a nation's fish consumption remains a significant predictor, explaining an additional 4% of the variance.

DISCUSSION

This effect is likely due to the fact that fish, as the major source of omega-3 polyunsaturated fatty acids for a population, is important for the omega-3 supply to mothers and the early neurodevelopment of their children.

CONCLUSIONS

Fish consumption, as a proxy for a population's omega-3 supply, is an independent predictor of pupils' school achievement, in addition to a nation's economic development.

School poverty effects on trajectories of child behaviour: Do they depend on gender and ethnicity?

This study examined English school poverty effects on trajectories of child behaviour across ages 3, 5, 7 and 11, and the moderating roles of ethnicity and gender. School poverty predicted internalising and externalising problems concurrently, and internalising problems longitudinally. In poor schools, girls had a steeper incline in internalising problems, but made greater reductions in externalising problems. Ethnic differences were also found in the association between school poverty and child adjustment. Gender and ethnic background may influence how a child responds emotionally and behaviourally to the composition of peers at school.

Risk factors in the development of behaviour difficulties among students with special educational needs and disabilities: A multilevel analysis

BACKGROUND

Students with special educational needs and disabilities (SEND) are more likely to exhibit behaviour difficulties than their typically developing peers.

AIM

The aim of this study was to identify specific risk factors that influence variability in behaviour difficulties among individuals with SEND.

SAMPLE

The study sample comprised 4,228 students with SEND, aged 5-15, drawn from 305 primary and secondary schools across England.

METHOD

Explanatory variables were measured at the individual and school levels at baseline, along with a teacher-reported measure of behaviour difficulties (assessed at baseline and at 18-month follow-up).

RESULTS

Hierarchical linear modelling of data revealed that differences between schools accounted for between 13% (secondary) and 15.4% (primary) of the total variance in the development of students' behaviour difficulties, with the remainder attributable to individual differences. Statistically significant risk markers for these problems across both phases of education were being male, eligibility for free school meals, being identified as a bully, and lower academic achievement. Additional risk markers specific to each phase of education at the individual and school levels are also acknowledged.

CONCLUSION

Behaviour difficulties are affected by risks across multiple ecological levels. Addressing any one of these potential influences is therefore likely to contribute to the reduction in the problems displayed.

Intraclass correlation values for adolescent health outcomes in secondary schools in 21 European countries

BACKGROUND

Cluster randomised controlled trials (CRCTs) are increasingly used to evaluate the effectiveness of interventions for improving health. A key feature of CRCTs is that individuals in clusters are often more alike than individuals in different clusters, irrespective of treatment. This similarity within clusters needs to be taken into account when planning CRCTs to obtain adequate sample sizes, and when analysing clustered data to obtain correct estimates.

METHODS

Nationally representative data from 15 to 16 year olds were analysed, from 21 of the 35 countries that participated in the 2007 European School Survey Project on Alcohol and Other Drugs. Within country school level intra-class correlation coefficients (ICCs) were calculated for substance use (self-reported alcohol use, regular alcohol use, binge drinking, any smoking, regular smoking, and illicit drug use) and psychosocial health (depressive mood and self-esteem). Unadjusted and adjusted ICCs are presented. ICCs are adjusted for student sex and socioeconomic status.

RESULTS

ICCs ranged from 0.01 to 0.21, with the highest (0.21) reported for regular smoking. Within country school level ICCs varied substantially across health outcomes, and among countries for the same health outcomes. Estimated ICCs were consistently higher for substance use (range 0.01-0.21), than for psychosocial health (range 0.01-0.07). Within country ICCs for health outcomes varied by changes in the measurement of particular health outcomes, for example the ICCs for regular smoking (range 0.06-0.21) were higher than those for having smoked at all in the last month (range 0.03-0.17).

CONCLUSIONS

For school level ICCs to be effectively utilised in informing sample size requirements for CRCTs and adjusting estimates from meta-analyses, the school level ICCs need to be both country and outcome specific.

Short Sleep Duration and Screen-Based Activities: A Longitudinal Multilevel Analysis

Objective. The aim of this study was to identify lifestyle habits that contribute to night sleep reduction in the Kuwaiti population. Methods. Children were 10 to 12 years old and were approximately equally distributed among 138 elementary schools representing the 6 governorates of Kuwait. In the first phase of the study, data were collected from 8317 children. The same data were collected 2 years later from 6316 of the children from the first phase of the study. Calibrated examiners conducted sleep evaluation, lifestyle habits interviews, and body weight measurements. A multilevel random intercept and slope model was conducted to determine the effect of screen-based activities on the daily night sleep hours at 3 levels: within schools, among children, and over time. The primary dependent variable was the number of daily sleep hours. Independent variables assessed were lifestyle habits including screen-based activity variables including TV and video game use. Results. Screen-based activities were significant factors that reduced daily sleep hours (P < .05). There were statistically significant variations between schools and children over time. Conclusion. Longitudinal analysis of Kuwaiti children revealed that TV and video game use were major risk behaviors contributing to decreased sleep duration with strong clustering effect of the observations within schools across time.

Is educational differentiation associated with smoking and smoking inequalities in adolescence? A multilevel analysis across 27 European and North American countries

This study aims to determine whether educational differentiation (i.e. early and long tracking to different school types) relate to socioeconomic inequalities in adolescent smoking. Data were collected from the WHO-Collaborative 'Health Behaviour in School-aged Children (HBSC)' study 2005/2006, which included 48,025 15-year-old students (Nboys = 23,008, Ngirls = 25,017) from 27 European and North American countries. Socioeconomic position was measured using the HBSC family affluence scale. Educational differentiation was determined by the number of different school types, age of selection, and length of differentiated curriculum at the country-level. We used multilevel logistic regression to assess the association of daily smoking and early smoking initiation predicted by family affluence, educational differentiation, and their interactions. Socioeconomic inequalities in both smoking outcomes were larger in countries that are characterised by a lower degree of educational differentiation (e.g. Canada, Scandinavia and the United Kingdom) than in countries with higher levels of educational differentiation (e.g. Austria, Belgium, Hungary and The Netherlands). This study found that high educational differentiation does not relate to greater relative inequalities in smoking. Features of educational systems are important to consider as they are related to overall prevalence in smoking and smoking inequalities in adolescence.

Prevalence and determinants of smoking initiation among school students in Bosnia and Herzegovina

BACKGROUND

Tobacco smoking amongst the young is a matter of public health concern because of the immediate and long-term health consequences associated with tobacco use, such as asthma, cancers, and cardiovascular diseases. The purpose of this study was to identify the determinants of smoking initiation among a sample of high school students in Bosnia and Herzegovina.

METHODS

The study was conducted among 198 high school students in Zvornik, Bosnia and Herzegovina, during April 2013. A self-administered, pre-tested, structured, close-ended questionnaire was used for data collection.

RESULTS

Fourth grade students mainly initiated smoking in high school (45%), while the majority of third and second grade students initiated smoking in primary school. Among students who smoke, an average duration of the smoking habit was <2 years. A multivariate analysis showed that males were 5.27 times more likely to have initiated smoking. For every unit increase in pro-smoking attitude towards smoking, students were 5.3 times more likely to have initiated smoking. Those with parents and friends who are smokers were 6.106 and 5.175 times, respectively, more likely to have initiated smoking.

CONCLUSION

This study indicates that a high proportion of 15-18 year olds in the town of Zvornik are current smokers. Gender, age, and parent and peer influence were identified as important associations with smoking. Interventions should not only be confined to the secondary school environment but they should also extend to their places of residence so that influences in the home environment and social surroundings that contribute to tobacco use are also tackled.

Effects of a settings-based intervention to promote student wellbeing and reduce smoking in vocational schools: A non-randomized controlled study

RATIONALE

School dropout and health risk behavior such as cigarette smoking represent major problems among students attending upper secondary vocational education. Modifications to the social environment may promote educational attainment as well as health and wellbeing of young people. However, there is a need for more evidence-based intervention programs.

OBJECTIVE

The aim of this study was to assess the effectiveness of an intervention targeting the socio-environmental setting at vocational schools on student wellbeing and smoking.

METHODS

We conducted a non-randomized controlled trial of 5794 students (mean age 21 years; 81% male) in 10 (four intervention and six comparison) large vocational schools in Denmark. The intervention involved changes in everyday school practices focusing on four themes: (i) introduction activities, (ii) daily class meetings, (iii) scheduled breaks and (iv) pleasant non-smoking environment. Outcomes were student wellbeing (four subscales: school connectedness, student support, teacher relatedness, positive valuing of the profession) and daily smoking measured at 10-week follow-up.

RESULTS

We found statistically significant between-group difference in school connectedness, but not in student support, teacher relatedness and valuing the profession. The intervention had no effect on daily smoking. However, we found a statistically significant interaction between baseline smoking status and condition. This interaction suggested that baseline occasional smokers in the intervention group had significantly reduced odds ratio (OR) of becoming a daily smoker compared to baseline occasional smokers in the control group (8% versus 16%; OR = 0.44).

CONCLUSION

The positive effects on school connectedness and in preventing occasional smokers becoming daily smokers indicate that it is possible to tackle school-related wellbeing and smoking in a high risk population through settings-based interventions.

School performance after experiencing trauma: a longitudinal study of school functioning in survivors of the Utøya shootings in 2011

BACKGROUND

The psychological impact on survivors of terrorism has been well documented. However, studies on adolescent survivors and the academic performance of high school students following a terrorist attack are lacking.

OBJECTIVE

This study investigated academic performance, absenteeism, and school support amongst survivors of a terrorist attack in Norway.

METHOD

Data from a longitudinal interview study were linked to officially registered grades of students (N=64) who successfully completed their 3-year senior high school program. Statistical tests of mean differences and linear regression were used to compare the survivors' registered grades with the national grade point average, before and after the event, as well as to assess absenteeism, self-reported grades and to test the association with school support.

RESULTS

The students' grades were lower the year after the event than they had been the year before, and they were also lower than the national grade point average (p<0.001). However, their grades improved in the last year of high school, indicating possible recovery. Absence from school increased after the event, compared to the previous year. However, students reported high satisfaction with school support.

CONCLUSION

The results indicate that academic functioning was reduced in the year after the traumatic event, but for students who successfully completed high school, the school situation improved 2 years after the event. The findings underscore the importance of keeping trauma-exposed students in school and providing support over time. A more defined educational approach to maintaining school attendance and educational measures which compensate for learning loss are needed in trauma-sensitive teaching.

Mixed tenure communities as a policy instrument for educational outcomes in a deprived urban context?

This article considers mixed community strategies, enacted through planning and regeneration policies, as a policy approach to the improvement of educational outcomes in schools. Analysis is undertaken of educational outcomes across secondary schools in Glasgow. The level of owner occupation in the catchment is positively associated with both examination results at S4 and positive destinations post-school, particularly at the more deprived end of the school spectrum. The results suggest that tenure mix may be both directly and indirectly related to school performance, with neighbourhood context effects not being entirely mediated through the school context.

Systematic review of reviews of observational studies of school-level effects on sexual health, violence and substance use

For three decades there have been reports that the quality of schools affects student health. The literature is diverse and reviews have addressed different aspects of how the school environment may affect health. This paper is the first to synthesise this evidence using a review of reviews focusing on substance-use, violence and sexual-health. Twelve databases were searched. Eleven included reviews were quality-assessed and synthesised narratively. There is strong evidence that schools' success in engaging students is associated with reduced substance use. There is little evidence that tobacco-control policies and school sexual-health clinics on their own are associated with better outcomes.

School composition, family poverty and child behaviour

PURPOSE

There is little research on the role of school composition in young children's behaviour. School composition effects may be particularly important for children in disadvantaged circumstances, such as those growing up in poverty. We explored the role of school academic and socio-economic composition in internalising problems, externalising problems and prosocial behaviour at age 7 years, and tested if it moderates the effect of family poverty on these outcomes.

METHODS

We used data from 7225 7-year-olds of the Millennium Cohort Study who attended state primary schools in England and for whom we had information on these outcomes. In multiple membership models, we allowed for clustering of children in schools and moves between schools since the beginning of school, at age 5. Our school academic and socio-economic composition variables were school-level achievement and % of pupils eligible for free school-meals, respectively. Poverty (family income below the poverty line) was measured in all sweeps until age 7. We explored the roles of both timing and duration of poverty.

RESULTS

The effects of poverty were strong and robust to adjustment. School socio-economic composition was associated with individual children's internalising and externalising problems, even in adjusted models. School composition did not interact with poverty to predict any of the outcomes.

CONCLUSIONS

Neither the academic nor the socio-economic composition of the school moderated the effect of family poverty on children's behaviour in primary school. However, children attending schools with more disadvantaged socio-economic intakes had more internalising and externalising problems than their counterparts.

Exploring the Potential of a School Impact on Pupil Weight Status: Exploratory Factor Analysis and Repeat Cross-Sectional Study of the National Child Measurement Programme

Schools are common sites for obesity prevention interventions. Although many theories suggest that the school context influences weight status, there has been little empirical research. The objective of this study was to explore whether features of the school context were consistently and meaningfully associated with pupil weight status (overweight or obese). Exploratory factor analysis of routinely collected data on 319 primary schools in Devon, England, was used to identify possible school-based contextual factors. Repeated cross-sectional multilevel analysis of five years (2006/07-2010/11) of data from the National Child Measurement Programme was then used to test for consistent and meaningful associations. Four school-based contextual factors were derived which ranked schools according to deprivation, location, resource and prioritisation of physical activity. None of which were meaningfully and consistently associated with pupil weight status, across the five years. The lack of consistent associations between the factors and pupil weight status suggests that the school context is not inherently obesogenic. In contrast, incorporating findings from education research indicates that schools may be equalising weight status, and obesity prevention research, policy and practice might need to address what is happening outside schools and particularly during the school holidays.

Are school-level factors associated with primary school students' experience of physical violence from school staff in Uganda?

Background

The nature and structure of the school environment has the potential to shape children's health and well being. Few studies have explored the importance of school-level factors in explaining a child's likelihood of experiencing violence from school staff, particularly in low-resource settings such as Uganda.

Methods

To quantify to what extent a student's risk of violence is determined by school-level factors we fitted multilevel logistic regression models to investigate associations and present between-school variance partition coefficients. School structural factors, academic and supportive environment are explored.

Results

53% of students reported physical violence from staff. Only 6% of variation in students' experience of violence was due to differences between schools and half the variation was explained by the school-level factors modelled. Schools with a higher proportion of girls are associated with increased odds of physical violence from staff. Students in schools with a high level of student perceptions of school connectedness have a 36% reduced odds of experiencing physical violence from staff, but no other school-level factor was significantly associated.

Conclusion

Our findings suggest that physical violence by school staff is widespread across different types of schools in this setting, but interventions that improve students' school connectedness should be considered.

A Multilevel Study on Ethnic and Socioeconomic School Stratification and Health-Related Behaviors Among Students in Stockholm

BACKGROUND

This study examines the extent to which high alcohol consumption, drug use, and delinquency vary between schools with different socioeconomic characteristics, over and above the pupil's own sociodemographic background.

METHODS

Analyses are based on data on 5484 ninth-grade students distributed over 93 schools in Stockholm, from the 2010 Stockholm School Survey. School-level information was retrieved from the Swedish National Agency for Education. School disadvantage was determined by combining information on the level of education among parents and the share of pupils with a nonnative background, 2 aspects that have been shown to be central to school segregation in Sweden.

RESULTS

Results indicate significant school-to-school differences in relation to all outcomes. The risk for high alcohol consumption and drug use is greater in more advantaged school settings, adjusting for individual characteristics, whereas the opposite is true in relation to criminal behavior. The school's level of collective efficacy also seems to play an important, albeit not mediating, role.

CONCLUSIONS

Regardless of an adolescent's own background, the risk of having adverse health behaviors is higher at certain schools compared to others. However, school socioeconomic factors do not influence health behaviors consistently; instead, it seems as if the association varies depending on the behavior under study.

School-Level Correlates of Adolescent Tobacco, Alcohol, and Marijuana Use

BACKGROUND

School-level characteristics are related to students' substance use, but little research systematically examined multiple school characteristics in relation to different types of substance use across grade levels.

OBJECTIVES

This study examines multiple school-level characteristics as correlates of students' tobacco, alcohol, marijuana, and combined substance use across three grade levels.

METHODS

Students (N = 23,615) from 42 urban and suburban middle schools and 24 high schools in the U.S. reported on their tobacco, alcohol, and marijuana use. Students' mean age was 14 years; 47% were male, 53% African American, and 41% Caucasian. School-level data included poverty, racial composition, academic achievement, student-teacher ratio, absenteeism, and school size. Multilevel logistic and Poisson regressions tested associations between school-level predictors and adolescent substance use in middle school, early high school, and late high school.

RESULTS

School-level poverty, more ethnic minority students, low achievement, and higher absenteeism were related to alcohol, marijuana, and combined substance use, particularly at lower grade levels. By contrast, cigarette smoking was more prevalent in more affluent high schools with more White students. After adjusting for other school characteristics, absenteeism emerged as the most consistent predictor of student substance use.

CONCLUSIONS/IMPORTANCE

Interventions addressing absenteeism and truancy in middle and high schools may help prevent student substance use. Schools serving poor, urban, and mostly minority students may benefit from interventions targeting alcohol and marijuana use, whereas interventions focusing on tobacco use prevention may be more relevant for schools serving more affluent and predominantly White students.

The Whole School, Whole Community, Whole Child model: a new approach for improving educational attainment and healthy development for students

BACKGROUND

The Whole Child approach and the coordinated school health (CSH) approach both address the physical and emotional needs of students. However, a unified approach acceptable to both the health and education communities is needed to assure that students are healthy and ready to learn.

METHODS

During spring 2013, the ASCD (formerly known as the Association for Supervision and Curriculum Development) and the US Centers for Disease Control and Prevention (CDC) convened experts from the field of education and health to discuss lessons learned from implementation of the CSH and Whole Child approaches and to explore the development of a new model that would incorporate the knowledge gained through implementation to date.

RESULTS

As a result of multiple discussions and review, the Whole School, Whole Community, Whole Child (WSCC) approach was developed. The WSCC approach builds upon the traditional CSH model and ASCD's Whole Child approach to learning and promotes greater alignment between health and educational outcomes.

CONCLUSION

By focusing on children and youth as students, addressing critical education and health outcomes, organizing collaborative actions and initiatives that support students, and strongly engaging community resources, the WSCC approach offers important opportunities that will improve educational attainment and healthy development for students.

Effects of Classroom Ventilation Rate and Temperature on Students' Test Scores

Using a multilevel approach, we estimated the effects of classroom ventilation rate and temperature on academic achievement. The analysis is based on measurement data from a 70 elementary school district (140 fifth grade classrooms) from Southwestern United States, and student level data (N = 3109) on socioeconomic variables and standardized test scores. There was a statistically significant association between ventilation rates and mathematics scores, and it was stronger when the six classrooms with high ventilation rates that were indicated as outliers were filtered (> 7.1 l/s per person). The association remained significant when prior year test scores were included in the model, resulting in less unexplained variability. Students' mean mathematics scores (average 2286 points) were increased by up to eleven points (0.5%) per each liter per second per person increase in ventilation rate within the range of 0.9-7.1 l/s per person (estimated effect size 74 points). There was an additional increase of 12-13 points per each 1°C decrease in temperature within the observed range of 20-25°C (estimated effect size 67 points). Effects of similar magnitude but higher variability were observed for reading and science scores. In conclusion, maintaining adequate ventilation and thermal comfort in classrooms could significantly improve academic achievement of students.

Oral Health-Related Quality of Life and Traumatic Dental Injuries in Young Permanent Incisors in Brazilian Schoolchildren: A Multilevel Approach

BACKGROUND

Traumatic dental injury (TDI) during childhood may negatively impact the quality of life of children.

OBJECTIVE

To describe the association of oral health-related quality of life (OHRQoL) and domains (oral symptons, functional limitation, emotional- and social-well-being) of children with individual and contextual variables.

METHODS

A cross-sectional study was performed using a representative sample of 1,201 schoolchildren, 8-10 years-old, from public and private schools of Belo Horizonte, Brazil. The CPQ8-10 was used to assess OHRQoL, dichotomized in low and high impact. Sociodemographic information was collected through questionnaires to parents. Children were examined at schools, using the Andreasen criteria. Individual variables were gender, age, number of residents in home, parents/caregivers' level of education, family income, and TDI (dichotomized into without trauma/mild trauma and severe trauma). Dental caries and malocclusion were considered co-variables. Contextual variables were the Social Vulnerability Index and type of school. Ethical approval and consent forms were obtained. Data were analyzed using SPSS for Windows 19.0 and HLM 6.06, including frequency distribution, chi-squared test and multilevel approach (p < 0.05).

RESULTS

The prevalence of a negative impact on OHRQoL in children with severe trauma was 55.9%. The TDI negatively impacted emotional and social domains of OHRQoL. A multilevel analysis revealed a significant difference in OHRQoL according to the type of school and showed that 16% of the total variance was due to contextual characteristics (p < 0.001; ICC = 0.16). The negative impact on OHRQoL was higher in girls (p = 0.009), younger children (p = 0.023), with severe TDI (p = 0.014), those from public schools (p = 0.017) and whose parents had a lower education level (p = 0.001).

CONCLUSION

Severe trauma impacts OHRQoL on emotional and social domains. Contextual dimensions add information to individual variability to explain higher impact, emphasizing socioeconomic inequalities.

Relations of participation in organized activities to smoking and drinking among Japanese youth: contextual effects of structural social capital in high school

OBJECTIVES

This cross-sectional study examined the effect of school-level structural social capital on smoking and drinking among Japanese youth.

METHODS

Self-administered anonymous questionnaires were distributed to 3248 students at 29 high schools across Okinawa, Japan in 2008. Structural social capital was measured by students' participation in organized activities: student council, extracurricular activities, volunteer activities, community sports clubs, and youth associations. Contextual-level social capital was measured by aggregated school-level individual responses.

RESULTS

At the individual level, extracurricular activity participation was negatively associated with smoking and drinking, whereas participation in youth associations was positively associated with smoking and drinking. School-level extracurricular activity participation was negatively associated with smoking among boys, whereas school-level participation in youth associations was positively associated with smoking among boys and girls and drinking among boys.

CONCLUSIONS

This study suggests that structural social capital measured by participation in organized activities, especially extracurricular activities, might be an important way for youths to attain good health. This study also supports the idea that particular type of activities, such as youth associations, can lead to the so-called "dark side of social capital".

Shaping the Social: design of a settings-based intervention study to improve well-being and reduce smoking and dropout in Danish vocational schools

Background

The social environment at schools is an important setting to promote educational attainment, and health and well-being of young people. However, within upper secondary education there is a need for evidence-based school intervention programmes. The Shaping the Social intervention is a comprehensive programme integrating social and educational activities to promote student well-being and reduce smoking and dropout in upper secondary vocational education. The evaluation design is reported here.

Methods/design

The evaluation employed a non-randomised cluster controlled design, and schools were selected to either implement the intervention or continue with normal practice for comparison. In the baseline survey conducted 2011–2012, 2,329 students from four intervention schools and 3,371 students from six comparison schools answered a computer-based questionnaire during class, representing 73 % and 81 % of eligible students, and 22 % of all technical/agricultural vocational schools in Denmark. Follow-up assessment was conducted 10 weeks after baseline and at the same time teachers of the intervention classes answered a questionnaire about implementation. School dropout rates will be tracked via national education registers through a 2-year follow-up period.

Discussion

Shaping the Social was designed to address that students at Danish vocational schools constitute a high risk population concerning health behaviour as well as school dropout by modifying the school environment, alongside developing appropriate evaluation strategies. To address difficulties in implementing settings-based interventions, as highlighted in prior research, the strategy was to involve intervention schools in the development of the intervention. Baseline differences will be included in the effectiveness analysis, so will the impact of likely mediators and moderators of the intervention.

Trials registration

ISRCTN57822968. Date of registration: 16/01/2013

School-level variation in health outcomes in adolescence: analysis of three longitudinal studies in England

School factors are associated with many health outcomes in adolescence. However, previous studies report inconsistent findings regarding the degree of school-level variation for health outcomes, particularly for risk behaviours. This study uses data from three large longitudinal studies in England to investigate school-level variation in a range of health indicators. Participants were drawn from the Longitudinal Study of Young People in England, the Me and My School Study and the Research with East London Adolescent Community Health Survey. Outcome variables included risk behaviours (smoking, alcohol/cannabis use, sexual behaviour), behavioural difficulties and victimisation, obesity and physical activity, mental and emotional health, and educational attainment. Multi-level models were used to calculate the proportion of variance in outcomes explained at school level, expressed as intraclass correlations (ICCs) adjusted for gender, ethnicity and socio-economic status of the participants. ICCs for health outcomes ranged from nearly nil to .28 and were almost uniformly lower than for attainment (.17-.23). Most adjusted ICCs were smaller than unadjusted values, suggesting that school-level variation partly reflects differences in pupil demographics. School-level variation was highest for risk behaviours. ICCs were largely comparable across datasets, as well as across years within datasets, suggesting that school-level variation in health remains fairly constant across adolescence. School-level variation in health outcomes remains significant after adjustment for individual demographic differences between schools, confirming likely effects for school environment. Variance is highest for risk behaviours, supporting the utility of school environment interventions for these outcomes.

Disentangling the relative influence of schools and neighborhoods on adolescents' risk for depressive symptoms

OBJECTIVES

Although schools and neighborhoods influence health, little is known about their relative importance, or the influence of one context after the influence of the other has been taken into account. We simultaneously examined the influence of each setting on depression among adolescents.

METHODS

Analyzing data from wave 1 (1994-1995) of the National Longitudinal Study of Adolescent Health, we used cross-classified multilevel modeling to examine between-level variation and individual-, school-, and neighborhood-level predictors of adolescent depressive symptoms. Also, we compared the results of our cross-classified multilevel models (CCMMs) with those of a multilevel model wherein either school or neighborhood was excluded.

RESULTS

In CCMMs, the school-level random effect was significant and more than 3 times the neighborhood-level random effect, even after individual-level characteristics had been taken into account. Individual-level indicators (e.g., race/ethnicity, socioeconomic status) were associated with depressive symptoms, but there was no association with either school- or neighborhood-level fixed effects. The between-level variance in depressive symptoms was driven largely by schools as opposed to neighborhoods.

CONCLUSIONS

Schools appear to be more salient than neighborhoods in explaining variation in depressive symptoms. Future work incorporating cross-classified multilevel modeling is needed to understand the relative effects of schools and neighborhoods.

The Association Between School Bonding and Smoking Amongst Chilean Adolescents

BACKGROUND

The objective of the research was to study the association between school bonding dimensions (school commitment and school attachment) and current adolescent smoking in Chile, controlling for confounding variables using the fifth Chilean School Population National Substance Use Survey, 2003 (CHSS-2003) data set.

METHODS

The CHSS-2003 is a stratified cross-sectional survey that gathers information about personal, familial, peer, and school factors and cigarette use using a self-reported questionnaire. Complete data from 21,956 adolescent students for all the variables of interest were used in the analyses. An exploratory factor analysis (EFA) was performed in order to explore the construct validity of the questionnaire and create the main exposure and potential confounding variables. Multivariable logistic regression analyses were undertaken to study the association between school bonding and smoking.

RESULTS

The construct validity of the school attachment and school commitment scales was mainly supported by the EFA. Multivariable analyses showed strong evidence that, after adjusting for factors from different domains, school commitment (student's good grades and school attendance) appears to have a clear inverse association with current smoking (odds ratio [OR]=0.46, 95% confidence interval [CI]: 0.38-0.56). On the other hand, school attachment (their feelings towards their school and their teachers) was not associated with adolescent smoking (OR=1.16, 95% CI: 0.88-1.53).

CONCLUSIONS

School commitment was strongly associated with current smoking. It is important to further study this variable with the aim of ascertaining whether or not interventions that improve school commitment may prevent or reduce smoking amongst adolescent students.

School policies for preventing smoking among young people

BACKGROUND

School tobacco policies (STPs) might prove to be a promising strategy to prevent smoking initiation among adolescents, as there is evidence that the school environment can influence young people to smoke. STPs are cheap, relatively easy to implement and have a wide reach, but it is not clear whether this approach is effective in preventing smoking uptake.

OBJECTIVES

To assess the effectiveness of policies aiming to prevent smoking initiation among students by regulating smoking in schools.

SEARCH METHODS

We searched seven electronic bibliographic databases, including the Cochrane Tobacco Addiction Group specialized register, MEDLINE, EMBASE, PsycINFO and ERIC. We also searched the grey literature and ongoing trials resources. The most recent search was performed in May 2014.

SELECTION CRITERIA

We included cluster-randomised controlled trials (c-RCTs) in which primary and secondary schools were randomised to receive different levels of smoking policy or no intervention. Non-randomised controlled trials, interrupted time series and controlled before-after studies would also have been eligible. Cross-sectional studies were not formally included but we describe their findings and use them to generate hypotheses to inform future research.

DATA COLLECTION AND ANALYSIS

We independently assessed studies for inclusion in the review, and present a narrative synthesis, as the studies are too limited in quality to undertake a formal meta-analysis.

MAIN RESULTS

We found only one study which was eligible for inclusion in the review. It was judged to be at high risk of bias. The study compared two 'middle schools' from two different regions in China. The experimental conditions included the introduction of a tobacco policy, environmental changes, and communication activities, while the control condition was no intervention. After a year's follow-up the study found no differences in smoking prevalence between intervention and control schools. We also described 24 observational studies, the results of which we considered for hypothesis generation. In these, policy exposure was mainly described using face-to-face interviews with school staff members, and the outcome evaluation was performed using self-administered questionnaires. Most studies reported no differences in students' smoking prevalence between schools with formal STPs when compared with schools without policies. In the majority of studies in schools with highly enforced policies, smoking bans extended to outdoor spaces, involving teachers and including sanctions for transgressions, with assistance to quit for smokers plus support by prevention programmes, there was no significant difference in smoking prevalence when compared to schools adopting weaker or no policies.

AUTHORS' CONCLUSIONS

Despite a comprehensive literature search, and rigorous evaluation of studies, we found no evidence to support STPs. The absence of reliable evidence for the effectiveness of STPs is a concern in public health. We need well-designed randomised controlled trials or quasi-experimental studies to evaluate the effectiveness of school tobacco policies.

Prevalence and Psychosocial Correlates of After-School Activities among Chinese Adolescents in Hong Kong

Using a cross-sectional design, this study (a) explores the prevalence of after-school activities among Chinese early adolescents and (b) assesses the relationships between participation in after-school activities, personal well-being, and family functioning. A total of 3,328 Grade 7 students (mean age = 12.59 years, SD = 0.74) completed a self-administered questionnaire. Results showed that the majority of adolescents returned home under adult supervision. Further analyses showed the associations between after-school activities, positive youth development qualities, academic and school competence, family functioning, and risky behavior. Implications regarding efforts aimed at designing high quality and structured after-school youth programs are discussed.

Variables that Predict Academic Achievement in the Spanish Compulsory Secondary Educational System: A Longitudinal, Multi-Level Analysis

This article presents a study whose objective was to identify certain personal and institutional variables that are associated with academic achievement among Spanish, secondary school students, and to analyze their influence on the progress of those students over the course of that stage of their education. In order to do this, a longitudinal, multi-level study was conducted in which a total of 965 students and 27 different schools were evaluated in Language, Math and Social Science at three different times (beginning, middle and end of the period). The results show progress in all the schools and in all areas. As for the personal, student variables, the longitudinal, HLM analyses confirmed the importance of sex and sociocultural background and, distinguishing it from other studies, also the predictive capacity of meta-cognitive abilities and learning strategies on success in school. On the institutional level, the school climate and teachers' expectations of their students were the most relevant of the variables studied. The size of the school, the percentage of students who repeat grades, and the leadership of the administration also explained a portion of the variance in some areas.

School effects on risk of non-fatal suicidal behaviour: a national multilevel cohort study

OBJECTIVE

Research has demonstrated school effects on health, over and above the effects of students' individual characteristics. This approach has however been uncommon in mental health research. The aim of the study was to assess whether there are any school-contextual effects related to socioeconomic characteristics and academic performance, on the risk of hospitalization from non-fatal suicidal behaviour (NFSB).

METHODS

A Swedish national cohort of 447,929 subjects was followed prospectively in the National Patient Discharge Register from the completion of compulsory school in 1989-93 (≈16 years) until 2001. Multilevel logistic regression was used to assess the association between school-level characteristics and NFSB.

RESULTS

A small but significant share of variation in NFSB was accounted for by the school context (variance partition coefficient <1%, median odds ratio = 1.26). The risk of NFSB was positively associated with the school's proportion of students from low socioeconomic status (SES), single parent household, and the school's average academic performance. School effects varied, in part, by school location.

CONCLUSION

NFSB seems to be explained mainly by individual-level characteristics. Nevertheless, a concentration of children from disadvantaged backgrounds in schools appears to negatively affect mental health, regardless of whether or not they are exposed to such problems themselves. Thus, school SES should be considered when planning prevention of mental health problems in children and adolescents.

Gender differences in the relationship between school problems, school class context and psychological distress: results from the Young-HUNT 3 study

PURPOSE

Few studies have examined the relationship between shared school classroom environment and psychological distress. The aim of this study is to investigate whether there are gender differences in the clustering of psychological distress within school classes as well as to assess individual and contextual effects of school problems.

METHODS

Data were obtained from the Young-HUNT 3 study (2006-2008), a population study of adolescents attending school in the Norwegian county of Nord-Trøndelag. A total of 6,379 pupils were analysed using multilevel models.

RESULTS

The results suggest that the amount of variation in psychological distress attributable to school class context was higher among girls (4.5%) compared to boys (1.0%). Furthermore, individual school problems were associated with psychological distress for both genders, although the effects were greater for girls. The effects of school class variables were limited for both genders, although gender composition was associated with higher levels of psychological distress among girls.

CONCLUSIONS

This study suggests that researchers should account for possible gender differences when examining the association between classroom environment and psychological distress.

The long arm of adolescence: school health behavioral environments, tobacco and alcohol co-use, and the 5HTTLPR gene

Although sociologists, demographers, and others have thoroughly studied contextual and life course influences on tobacco and alcohol use in adolescence and young adulthood, far less attention has been paid to the determinants of tobacco and alcohol co-use. This is important to remedy because co-use has a nonadditive effect on long-term health. In this article, we use nationally representative, longitudinal data from adolescents and young adults to examine patterns of joint tobacco and alcohol use behaviors across the life course. Importantly, we describe how these trajectories are linked to respondents' high school's joint profile of tobacco and alcohol use, measured two ways: as the proportion of tobacco and alcohol co-users, and as the "excess proportion" above that expected based on the marginal probabilities of smoking and drinking in that school. Joint tobacco and alcohol use is associated with both measures, emphasizing the "long arm" of adolescent contexts. Furthermore, we extend previous research to assess whether there is a gene-environment interaction between this school-level measure, 5HTTLPR, and tobacco and alcohol co-use, as suggested by recent work analyzing drinking and smoking separately. We find evidence of such a pattern but conclude that it is likely to be due to population stratification or other forms of confounding.

Association of children's eating behaviors with parental education, and teachers' health awareness, attitudes and behaviors: a national school-based survey in China

BACKGROUND

In China, childhood obesity is a growing health issue. Eating behaviors among children can be influenced by both the family and school environment. We examine the association between these environments and eating habits among children.

METHODS

A total of 11 270 fourth to sixth grade school children, 11 270 of their fathers or mothers, and 1348 teachers from 48 schools were sampled using a multistage cluster random sampling method. Questionnaires collected information on eating behaviors among children, non-communicable chronic disease (NCD)-related health knowledge and behaviors among teachers, and education levels among parents. Mixed effect logistic regression models were used to describe the key associations between eating behaviors among children and teacher and parental characteristics.

RESULTS

Health awareness, positive health attitudes, never-smoking and regular-exercise among teachers was positively associated with healthy eating behaviors among their students (having breakfast, vegetables and dairy products every day; P < 0.05), and negatively associated with the unhealthy behaviors (daily intake of fried foods and desserts and sugary beverages; P < 0.05). More than one parent having a high school level or above was positively related to healthy eating behaviors among their children (P < 0.05), but its associations with high-calorie eating habits were negative in urban and positive in rural areas (P < 0.05).

CONCLUSIONS

School-based interventions which target health-related awareness, attitude and behaviors among school teachers may help improve school-aged children's eating behaviors. Parental education levels may help guide efforts to target children at higher risk of unhealthy eating habits.

Adolescents' utilisation of psychiatric care, neighbourhoods and neighbourhood socioeconomic deprivation: a multilevel analysis

Mental health problems among adolescents have become a major public health issue, and it is therefore important to increase knowledge on the contextual determinants of adolescent mental health. One such determinant is the socioeconomic structure of the neighbourhood. The present study has two central objectives, (i) to examine if neighbourhood socioeconomic deprivation is associated to individual variations in utilisation of psychiatric care in a Swedish context, and (ii) to investigate if neighbourhood boundaries are a valid construct for identifying contexts that influence individual variations in psychiatric care utilization. Data were obtained from the Longitudinal Multilevel Analysis in Scania (LOMAS) database. The study population consists of all boys and girls aged 13–18 years (N=18,417), who were living in the city of Malmö, Sweden, in 2005. Multilevel logistic regression analysis was applied to estimate the probability of psychiatric care utilisation. The results from the study indicate that the neighbourhood of residence had little influence on psychiatric care utilisation. Although we initially found a variation between neighbourhoods, this general contextual effect was very small (i.e. 1.6 %). The initial conclusive association between the neighbourhood level of disadvantage and psychiatric care utilisation (specific contextual effect) disappeared following adjustment for individual and family level variables. Our results suggest the neighbourhoods in Malmö (at least measured in terms of SAMS-areas), do not provide accurate information for discriminating adolescents utilisation of psychiatric care. The SAMS-areas appears to be an inappropriate construct of the social environment that influences adolescent utilisation of psychiatric care. Therefore, public health interventions should be directed to the whole city rather than to specific neighbourhoods. However, since geographical, social or cultural contexts may be important for our understanding of adolescent mental health further research is needed to identify such contexts.

Theories of how the school environment impacts on student health: systematic review and synthesis

Public-health interventions informed by theory can be more effective but complex interventions often use insufficiently complex theories. We systematically reviewed theories of how school environments influence health. We included 37 reports drawing on 24 theories. Narrative synthesis summarised and categorised theories. We then produced an integrated theory of school environment influences on student health. This integrated theory could inform complex interventions such as health promoting schools programmes. Using systematic reviews to develop theories of change might be useful for other types of 'complex' public-health interventions addressing risks at the individual and community levels.

Adolescent alcohol use reflects community-level alcohol consumption irrespective of parental drinking

PURPOSE

Risk factors for adolescent alcohol use are typically conceptualized at the individual level, and school- and community-level risk factors have received little attention. Based on the theoretical understanding of youth alcohol consumption as a reflection of community social practice, we analyzed whether adolescent drunkenness was related to community-level adult alcohol use (AAC), when taking individual and school-level risk factors for drunkenness into account. Furthermore, we investigated whether the association between community-level AAC and adolescent drunkenness was attenuated after inclusion of parental drinking.

METHODS

We used data from three sources: data about adolescent drunkenness from the Health Behavior in School-Aged Children 2010 survey (N = 2,911; 13- to 15-year-olds nested in 175 school classes and 51 schools); data about community-level AAC derived from the Danish National Health Survey 2010 (177,639 participants); and data on school-level variables from Health Behavior in School-Aged Children School Leader Survey 2010. We performed multilevel logistic regression analysis with data from students nested within school classes and schools.

RESULTS

Overall, 33.5% of students had been drunk twice or more. High community-level AAC was significantly associated with adolescent drunkenness (odds ratio [95% confidence interval], 1.94 [1.21-3.11]). Parental drinking was strongly related to adolescent drunkenness but did not attenuate the relationship between community-level AAC and adolescent drunkenness. We found no association between adolescent drunkenness and school-level variables (youth friendly environment, alcohol education, and exposure to alcohol outlets).

CONCLUSIONS

Adolescent drunkenness was associated with community-level AAC and was not explained by parental drinking.

Using student and school factors to differentiate adolescent current smokers from experimental smokers in Canada: a multilevel analysis

OBJECTIVE

In order to understand the factors that differentiate adolescents who have tried smoking from those who have become established smokers, this study examined which student- and school-level factors differentiated current smokers from experimental smokers among a nationally representative sample of Canadian secondary school students.

METHOD

Student-level secondary data from the 2008-2009 Canadian Youth Smoking Survey was linked with school-level data from the 2006 Census and one built environment characteristic, and examined using multilevel logistic regression analyses.

RESULTS

The current smoking rates varied (P<0.001) across schools. The number of tobacco retailers surrounding the schools was associated with current smoking when adjusting for student characteristics. Additionally, students were more likely to be current smokers if they were: male, in higher grades, believed that smoking can help when they are bored, reported low school connectedness, used marijuana, had a sibling or close friend who smoked, and had no smoking bans at home.

CONCLUSIONS

These study findings suggest that school anti-smoking strategies need to target males, increase students' attachment to their school, address tobacco-related beliefs, and include interventions targeting smoking siblings and friends. The government should consider zoning restrictions to limit sales of tobacco products near schools.

Systematic review of the effects of schools and school environment interventions on health: evidence mapping and synthesis

Background

In contrast to curriculum-based health education interventions in schools, the school environment approach promotes health by modifying schools' physical/social environment. This systematic review reports on the health effects of the school environment and processes by which these might occur. It includes theories, intervention outcome and process evaluations, quantitative studies and qualitative studies.

Research questions

Research question (RQ)1: What theories are used to inform school environment interventions or explain school-level health influences? What testable hypotheses are suggested? RQ2: What are the effects on student health/inequalities of school environment interventions addressing organisation/management; teaching/pastoral care/discipline; and the physical environment? What are the costs? RQ3: How feasible/acceptable and context dependent are such interventions? RQ4: What are the effects on student health/inequalities of school-level measures of organisation/management; teaching/pastoral care/discipline; and the physical environment? RQ5: Through what processes might such influences occur?

Data sources

A total of 16 databases were searched between 30 July 2010 and 23 September 2010 to identify relevant studies, including the British Educational Index, the Cumulative Index to Nursing and Allied Health Literature, the Health Management Information Consortium, EMBASE, MEDLINE and PsycINFO. In addition, references of included studies were checked and authors contacted.

Review methods

In stage 1, we mapped references concerning how the school environment affects health and consulted stakeholders to identify stage 2 priorities. In stage 2, we undertook five reviews corresponding to our RQs.

Results

Stage 1: A total of 82,775 references were retrieved and 1144 were descriptively mapped. Stage 2: A total of 24 theories were identified (RQ1). The human functioning and school organisation, social capital and social development theories were judged most useful. Ten outcome evaluations were included (RQ2). Four US randomised controlled trials (RCTs) and one UK quasi-experimental study examined interventions building school community/relationships. Studies reported benefits for some, but not all outcomes (e.g. aggression, conflict resolution, emotional health). Two US RCTs assessed interventions empowering students to contribute to modifying food/physical activity environments, reporting benefits for physical activity but not for diet. Three UK quasi-experimental evaluations examined playground improvements, reporting mixed findings, with benefits being greater for younger children and longer break times. Six process evaluations (RQ3) reported positively. One study suggested that implementation was facilitated when this built on existing ethos and when senior staff were supportive. We reviewed 42 multilevel studies, confining narrative synthesis to 10 that appropriately adjusted for confounders. Four UK/US reports suggested that schools with higher value-added attainment/attendance had lower rates of substance use and fighting. Three reports from different countries examined school policies on smoking/alcohol, with mixed results. One US study found that schools with more unobservable/unsupervised places reported increased substance use. Another US study reported that school size, age structure and staffing ratio did not correlate with student drinking. Twenty-one qualitative reports from different countries (RQ5) suggested that disengagement, lack of safety and lack of participation in decisions may predispose students to engage in health risks.

Limitations

We found no evidence regarding health inequalities or cost, and could not undertake meta-analysis.

Conclusions

There is non-definitive evidence for the feasibility and effectiveness of school environment interventions involving community/relationship building, empowering student participation in modifying schools' food/physical activity environments, and playground improvements. Multilevel studies suggest that schools that add value educationally may promote student health. Qualitative studies suggest pathways underlying these effects. This evidence lends broad support to theories of social development, social capital and human functioning and school organisation. Further trials to examine the effects of school environment modifications on student health are recommended.

Funding

The National Institute for Health Research Public Health Research programme.

Adolescent self-reported health in relation to school factors: a multilevel analysis

The aim of the study was to examine school-related determinants of self-reported health among adolescents. Questionnaire survey data comprising 4,972 students, Grades 7 through 9, from 20 schools in northern Sweden were used. Also, complimentary data about each school were collected from the Swedish National Agency for Education. Using multilevel logistic regression analyses, results showed that most variation in self-reported health was explained by individual-level differences. Truancy, bullying, and poor relations with teachers significantly increased the odds ratio of reporting poor general health, for boys and for girls. Most variables at the school level, for example, school size and student-teacher ratio, did not render significant associations with students' self-reported health. In conclusion, this study indicates that health promotion at school, including school health services, may benefit from focusing primarily on individual-level determinants of health, that is, students' relations to peers and teachers, without ignoring that bullying and weak student-teacher relationships also may induce school-level interventions.

Effect of a smoking ban and school-based prevention and control policies on adolescent smoking in Spain: a multilevel analysis

We evaluated the impact of a smoking ban in schools and of school-based smoking prevention and control policies on adolescent smoking. Annual surveys carried out between 2001 and 2005 that were representative of students in the 4th year of secondary education in the Madrid region, with 203 schools and 9127 students participating. The student questionnaire gathered information about personal and family variables. The contextual factors were: the periods before (years 2001-2002) and after the law; and through a survey of school management boards: compliance with the law, policy reflected in the school regulations, existence of complaints against smoking, and undertaking of educational activities regarding smoking. Multilevel logistic regression models were constructed with two dependent variables: current smoking and the proportion giving up smoking. Smoking declined in 2003, the first year after the law came into force (Odds ratio: 0.80; CI 95%: 0.66-0.96), and this decline was maintained in 2005. By contrast, smoking increased in those schools that did not undertake educational programmes regarding smoking (Odds ratio: 1.34; CI 95%: 1.13-1.59), and in those that received complaints about smoking (Odds ratio: 1.12; CI 95%: 0.96-1.29). This association is partly due to the effect of the increase in giving up smoking. The inclusion of contextual variables into the model with the individual factors reduces the variability of smoking between schools by 32.6%. In summary, the coming into force of a law banning smoking in schools, and the implementing of educational policies for the prevention and control of smoking are related to a lower risk of adolescent smoking.

Violence, bullying and academic achievement: a study of 15-year-old adolescents and their school environment

OBJECTIVES

This study investigated academic achievement among adolescents exposed to violence, sexual abuse and bullying. Moreover, we sought to determine the individual and contextual influence of the adolescents' school environment in terms of bullying, classmate relationships and teacher support on academic achievement. Finally, we wished to assess whether school-level influence is different for the adolescents exposed to violence and sexual abuse versus the adolescents not exposed to these forms of abuse.

METHODS

This is a cross-sectional study of a sample of 7,343 adolescents between the ages of 15 and 16 from 56 schools in Oslo, Norway. We investigated associations between violence, sexual abuse, bullying, classmate relationships, teacher support and academic achievement. Linear regression was used to investigate associations on the individual level. Multilevel analyses were conducted to test for school level differences while controlling for both individual and contextual factors.

RESULTS

On the individual level, all combinations of violence and sexual abuse categories were significantly associated with lower grades. This was also true for bullying, while teacher support resulted in better grades. At the school level, the analysis showed that students in schools with higher levels of bullying performed worse academically. Each unit of increment in bullying in school corresponded to an average 0.98 point decrease in grades (p<.01) when we controlled for sociodemographic characteristics. The association remained significant when the model was tested separately for the nonbullied students, with a small reduction in the coefficient value (-.84, p<.01). No overall significance was found for the interaction between the school environment and adolescent exposure to violence, indicating that the school environment affects all students.

CONCLUSION

Factors on both levels can contribute to reduced grades. This stresses the need to investigate individual and contextual factors simultaneously when examining academic achievement. Our results indicated that students attending schools with higher levels of bullying may show poorer school performance. This was true for all students regardless of previous exposure to violence and sexual abuse. This emphasizes the need for preventive efforts that focus not only on vulnerable groups, but on all students and the school context.