School ethos: A relevant concept for school-based health promotion research?

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School ethos A relevant concept for
school-based health promotion research?

• Sherri Bisset

PhD (Cand) Public Health, Université de Montréal
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Outlinean overview of school ethos1)
School ethos definitions, relevance, utility
2) School ethos evidence as an independent
factor on health outcomes3) School ethos
interplay with the implementation health
promotion programs4) School ethos an example
of a theory, its opperationalization and
empirical evidence for an independent effect on
student health
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1) School ethos definitions, relevance, utility
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School ethos definitions relevance

• School ethos, climate, culture is a concept
  which describes a collective attribute of a group
  or organization. It refers to the feel,
  atmosphere, tone, ideology, or milieu of an
  organisation such as a school.
• The use of this concept implies that there is an
  underlying value system which guides individual
  behaviour within a group.
• School climate is often described as open/closed,
  healthy/unhealthy.
• Open school climate is one in which teacher and
  principal behaviour is supportive, genuine, and
  engaged.
• A closed climate is characterized by lack of
  authenticity and disengaged behaviour.

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School ethos utility

• Limitations of school ethos
• Vague, inconsistently defined and variously
  operationalised
• Under theorized where the mechanisms which
  capture the actions are not necessarily clear
  (i.e. what is the process, how do we create
  school ethos)
• Strengths of school ethos
• Reminds researchers and practitioners of the
  social context as a dynamic and interactive
  that is
• more or less health promoting (i.e. Can have an
  independent effect on health behaviours)
• interacts with health promotion planning,
  implementation and evaluation

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2) School ethos evidence as an independent
factor on health outcomes
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School ethos - an independent factor on health
outcomes

• Current strategies (i.e. focussing on individual
  characteristics, such as knowledge and attitudes)
  to improve teenage health are not having the
  desired effects...interventions aiming to promote
  a positive school ethos might provide an
  effective complement to existing interventions
• Bonell, C., Fletcher, A., McCambridge, J. (2007)
  Improving school ethos may reduce substance
  misuse and teenage pregnancy. British Medical
  Journal, 334 614-616.

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School ethos - an independent factor on health
outcomes

• Observational studies
• School effects on pupils drug, alcohol, and
  tobacco.
• School effects statistical relationships that
  remain after controlling for individual, family
  and neighborhood confounding factors.
• Experimental studies
• Introduce change to planning practices in the
  school by broadening partnerships, reviewing
  programs and policies with focus groups,
  diagnosing issues and collective decision making
  (i.e. project Gatehouse)

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3) School ethos interplay with health promotion
program implementation
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School ethos- interplay with implementation
evaluation

• The school climate arises from routine
  organizational practices that are important to an
  organization's members.
• The school climate is created by the
  interpersonal dynamics, perceptions, attitudes
  and behaviours of its members.
• A health promotion program imposes changes among
  school personnel with respect to some of their
  regular activities and routines.

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School ethos- interplay with implementation
evaluation

• The concept school ethos implies that a health
  promotion program implementation is likely to
  play out in a dynamic, iterative process and not
  as a static treatment.

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School ethos- interplay potential for desired
outcomes

• whether or not a study addresses diet and
  activity may be less important than how the
  intervention addresses diet and activity (Doak
  et a., 2006 pg. 126).
• How schools go about promoting health has more
  bearing on the health of students than the
  presence of a specific program (Stewart-Brown,
  2006).  
• Programs with stakeholders in the decision
  making regarding the potential strategies to be
  implemented are more likely to create a
  supportive environment for sustained action and
  positive impact (Summerbell, Waters, Edmunds,
  Kelly, Brown, Campbell, 2007)

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4) School ethos a theoretical approach with
evidence for an independent effect on student
health
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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
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Study Objective

• To determine if a novel school-level measure of
  school performance is associated with the
  prevalence of substance misuse, after controlling
  for the composition of pupil risk factors in the
  school.

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Theoretical proposition

• 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)
• Support, facilitates the acquisition of knowledge
  and skills
• Control refers to the processes used to ensure
  pupils behaviour is acceptable

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Operationalization

• 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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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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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

Laissez-faire schools Indeterminate schools Value-added
Year 7 23.3 20.2 13.7
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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

Laissez-faire schools Indeterminate schools Authoritative schools
Year 7 7.8 7.1 5.6
Year 9 14.6 13.5 10.8
Year 11 27.7 25.9 21.4
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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

Laissez-faire schools Indeterminate schools Authoritative schools
Year 7 1.7 1.5 1.2
Year 9 5.1 4.6 3.6
Year 11 15.0 13.8 11.0
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Conclusions

• School ethos is a concept which attempts to
  account for and measure the social dynamics in
  the school.
• Recent research recognizes these interpersonal
  and professional dynamics as having an importance
  influence on the effectiveness of a health
  promotion program.
• Health promotion researchers have incorporated
  educational and parental theories to understand
  how the school ethos may independently influence
  students health behaviours.

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Slides prepared in anticipation of some specific
queries
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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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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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Table 1. Sample Characteristics
Early initiation to alcohol use n8,037 Heavy alcohol consumption n25,360 Use of illicit drugs n24,771
Year 7 8037 (100) 8125 (32.0) 7786 (31.4)
Year 9 - 9346 (36.9) 9164 (37.0)
Year 11 - 7889 (31.1) 7821 (31.6)
Male 12698 (50.1) 12353 (49.9)
Female 12523 (49.4) 12283 (49.6)
White 21324 (84.1) 20892 (84.3)
Indian 1493 (5.9) 1441 (5.8)
Most deprived 1122 (14.0) 4140 (16.3) 4099 (16.5)
Fairly deprived 1329 (16.5) 4289 (16.9) 4240 (17.1)
Middle 1294 (16.1) 4371 (17.2) 4311 (17.4)
Fairly affluent 1340 (16.7) 4359 (17.2) 4260 (17.2)
Most affluence 1526 (19.0) 4489 (17.7) 4310 (17.4)
Townsand score
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Table 2. Substance use within sample
Early initiation to alcohol use n8,037 Heavy alcohol consumption n25,360 Use of illicit drugs n24,771
Year 7 21.2 (1701) 7.4 (8125) 1.4 (110)
Year 9 - 13.9 (9346) 4.5 (414)
Year 11 - 26.6 (7889) 13.7 (1071)
Girls 17.2 (689) 19.6 (2494) 7.8 (960)
Boys 25.0 (999) 11.8 (1479) 5.1 (622)
Most deprived 22.5 (252) 15.2 (628) 5.7 (235)
Fairly deprived 24.7 (328) 15.4 (660) 6.0 (254)
Middle 24.7 (319) 16.3 (711) 6.2 (269)
Fairly Affluent 19.2 (257) 15.6 (681) 6.7 (284)
Most Affluent 15.6 (238) 13.3 (599) 5.9 (254)
According to Townsand score