School culture as an influencing factor on youth substance use

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School 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
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Background

• 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.

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Study 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.

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Theoretical 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)

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Assumptions

• 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

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Definitions (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

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Definitions (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

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Hypotheses

• 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. 

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Study 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

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Substance 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)

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Findings

• 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

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Findings (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

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Findings (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

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Findings (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

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Points 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?

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Conclusions

• 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.

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Slides prepared in anticipation of some specific
queries
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Table 1. Sample Characteristics
Townsand score
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Table 2. Substance use within sample
According to Townsand score