Title: School culture as an influencing factor on youth substance use
1School culture as an influencing factor on youth
substance use
- Sherri Bisset, Wolfgang Markham, Paul
Aveyard
Université de Montréal, Canada University of
Warwick, United Kingdom University of
Birmingham, United Kingdom
Thank you for the generous financial support
from Public Health Agency of Canada, Institute
of Public and Population Health from the Canadian
Institute of Health Research, Léa-Roback
research centre Groupe de recherche
interdisciplinaire en santé (GRIS)
Journal of Epidemiology and Community Health,
accepted in May 2006
2Background
- Markham WA, Aveyard P. A new theory of health
promoting schools based on human functioning,
school organisation and pedagogic practice.
Social Science Medicine 200356(6)1209-20. - Aveyard P, Markham WA, Lancashire E, Almond J,
Griffiths R, Cheng KK. Is inter-school variation
in smoking uptake and cessation due to
differences in pupil composition? A cohort study.
Health Place 200511(1)55-65. - Aveyard P, Markham WA, Cheng KK. A methodological
and substantive review of the evidence that
schools cause pupils to smoke. Social Science
Medicine 200458(11)2253-65. - Markham WA, Aveyard P, Thomas H, Charlton A,
Lopez ML, De Vries H. What determines future
smoking intentions of 12- to 13-year-old UK
African-Caribbean, Indian, Pakistani and white
young people? Health Education Research
200419(1)15-28. - Aveyard P, Markham WA, Lancashire E, Bullock A,
Macarthur C, Cheng KK, et al. The influence of
school culture on smoking among pupils. Social
Science Medicine 200458(9)1767-80. - Aveyard P, Markham WA, Almond J, Lancashire E,
Cheng KK. The risk of smoking in relation to
engagement with a school-based smoking
intervention. Social Science Medicine
200356(4)869-82.
3Study Objective
- To determine if a novel school-level measure of
school performance is associated with the
prevalence of substance use, after controlling
for the composition of pupil risk factors in the
school.
4Theoretical proposition
- Bernstein proposed schools transmit middle class
cultural beliefs and values through instructional
and regulatory orders, and in so doing, exclude
students less familiar with this belief system. - Parenting theories similarly suggest that parents
can inadvertently distance their children when
the balance of support and control, as perceived
by the child, is judged to be inappropriate - Support, in the case of schools, facilitates the
acquisition of knowledge and skills (and is akin
to the instructional order) - Control refers to the processes used to ensure
pupils behaviour is acceptable (and is akin to
the regulatory order)
5Assumptions
- Schools optimize pupil functioning through the
provision of an appropriate balance of support
and control (i.e. support and control are not
normative but adjust to needs of pupils) - Schools which optimize pupil functioning are also
health promoting
6Definitions (1)
- Appropriate support
- schools perform better than would be expected on
academic success, given the socio-demographics of
the pupil composition - Appropriate control
- schools perform better than would be expected on
the rate of truancy, given the socio-demographics
of the pupil composition
7Definitions (2)
- Schools where both academic success and truancy
rates are better than expected given the
socio-demographic pupil composition provide
value-added education - These schools are categorized as authoritative
- Schools where both academic success and truancy
rates are worse than expected given the
socio-demographic pupil composition provide
value-denuded education - These schools are categorized as laissez-faire
8Hypotheses
- Pupils in value-added (i.e. authoritative)
schools, are more likely to internalize the
values of the school, which are inimical to
substance use, and thus be less likely to use
substances. - Pupils in value-denuded (i.e. laissez-faire)
schools would be more likely to reject the values
of the school and therefore seek affiliation
elsewhere, such as with youth cultures that
promote substance misuse.
9Study Design and Methodology
- Cross-sectional self-reported survey of alcohol
and drug consumption - West Midlands Young Peoples Lifestyle Survey
1995/1996 (WMYPLS) - Data were collected across 15 West Midlands
English school districts and included 25,789
grade 7, 9 and 11 pupils from166 UK secondary
schools. - Analysis used two-level logistic modelling to
relate schools providing value-added education
with pupils' substance use. - Model adjusted for individual level confounders
gender, grade, ethnicity, housing tenure,
eligibility for free school meal, drinking with
parents, neighbourhood deprivation
10Substance Use
- Early initiation of alcohol use (regular monthly
alcohol consumption in grade 7), - Heavy alcohol use (consumption of gt10 units of
alcohol per week) - Regular illicit drug use (regular consumption of
any illegal drug or substance)
11Findings
- Substance use varied among the 166 schools
- early alcohol initiation (?231.5, df1, plt
0.001) - heavy alcohol consumption (?247.11, df1,
plt0.001) - regular illicit drug use (?235.2, df1, plt0.001)
- Substance use was significantly associated with
value-added education - Little association was found between substance
use and raw school truancy and academic
achievement
12Findings (1)
- Value-added education was associated with reduced
risk of early alcohol initiation - Odds Ratio (95 confidence interval) of 0.87
(0.78-0.95) - Estimated prevalence of early alcohol initiation
according to the median value-added score
13Findings (2)
- Value-added education was associated with reduced
risk of heavy alcohol consumption - Odds Ratio (95 confidence interval) of 0.91 (0.
85-0.96) - Estimated prevalence of heavy alcohol consumption
according to the median value-added score
14Findings (3)
- Value-added education was associated with reduced
risk of use of illicit drugs - Odds Ratio (95 confidence interval) of 0.90
(0.82-0.98) - Estimated prevalence of use of illicit drugs
according to the median value-added score
15Points for Further Discussion
- Are authoritative schools able to engage pupils
more than laissez-faire and indeterminate? - Does this engagement positively influence health
behaviour? - Could the school play an active role in fostering
social affiliation to enhance competencies which
protect youth from delinquent behaviour? - Does the value-added education measure capture a
distinctive characteristic of the school context?
If so, what are the underlying processes?
16Conclusions
- This study offers supportive evidence that a
novel school-level measure of school performance
is associated with the prevalence of substance
use, after controlling for the composition of
pupil risk factors in the school. - Results suggest that the mechanisms which are
inherent in engaging pupil in their education
might also protect against risk behaviours.
17Slides prepared in anticipation of some specific
queries
18Table 1. Sample Characteristics
Townsand score
19Table 2. Substance use within sample
According to Townsand score