1. School ethos: A relevant concept for school-based health promotion research? Sherri Bisset *PhD (Cand) Public Health, Université de Montréal

2. Outline…an overview of school ethos… 1) School ethos : definitions, relevance, utility 2) School ethos : evidence as an independent factor on health outcomes 3) School ethos : interplay with the implementation health promotion programs 4) School ethos : an example of a theory, it’s opperationalization and empirical evidence for an independent effect on student health

3. 1) School ethos : definitions, relevance, utility

4. 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. 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. 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. 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. 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. A closed climate is characterized by lack of authenticity and disengaged behaviour.

5. School ethos: utility Limitations of “school ethos” Limitations of “school ethos” Vague, inconsistently defined and variously operationalised 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) 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” Strengths of “school ethos” Reminds researchers and practitioners of the social ‘context’ as a dynamic and interactive that is; 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) more or less health promoting (i.e. Can have an independent effect on health behaviours) interacts with health promotion planning, implementation and evaluation interacts with health promotion planning, implementation and evaluation

6. 2) School ethos : evidence as an independent factor on health outcomes

7. 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” “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. Bonell, C., Fletcher, A., McCambridge, J. (2007) Improving school ethos may reduce substance misuse and teenage pregnancy. British Medical Journal, 334: 614-616.

8. School ethos - an independent factor on health outcomes Observational studies; Observational studies; School effects on pupils drug, alcohol, and tobacco. School effects on pupils drug, alcohol, and tobacco. ‘School effects’ statistical relationships that remain after controlling for individual, family and neighborhood confounding factors. ‘School effects’ statistical relationships that remain after controlling for individual, family and neighborhood confounding factors. Experimental studies; 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) 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)

9. 3) School ethos : interplay with health promotion program implementation

10. 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 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. 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. A health promotion program imposes changes among school personnel with respect to some of their regular activities and routines.

11. 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.

12. 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). “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). 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) 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)

13. 4) School ethos : a theoretical approach with evidence for an independent effect on student health

14. “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

15. 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. 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.

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

17. Schools where both academic success and truancy rates are better than expected given the socio-demographic pupil composition provide value-added education 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 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 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 These schools are categorized as laissez-faire Operationalization

18. Study Design and Methodology Cross-sectional self-reported survey of alcohol and drug consumption West Midlands Young People’s 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

19. Findings (1) Value-added education was associated with reduced risk of early alcohol initiation Value-added education was associated with reduced risk of early alcohol initiation Odds Ratio (95% confidence interval) of 0.87 (0.78-0.95) 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 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%

20. Findings (2) Value-added education was associated with reduced risk of heavy alcohol consumption Value-added education was associated with reduced risk of heavy alcohol consumption Odds Ratio (95% confidence interval) of 0.91 (0. 85-0.96) 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; 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%

21. Findings (3) Value-added education was associated with reduced risk of use of illicit drugs 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) 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; 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%

22. Conclusions Conclusions School ethos is a concept which attempts to account for and measure the social dynamics in the school. 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. 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. Health promotion researchers have incorporated educational and parental theories to understand how the school ethos may independently influence students health behaviours.

23. Slides prepared in anticipation of some specific queries…

24. Study Design and Methodology Cross-sectional self-reported survey of alcohol and drug consumption Cross-sectional self-reported survey of alcohol and drug consumption West Midlands Young People’s Lifestyle Survey 1995/1996 (WMYPLS) West Midlands Young People’s 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. 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. 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 Model adjusted for individual level confounders; gender, grade, ethnicity, housing tenure, eligibility for free school meal, drinking with parents, neighbourhood deprivation

25. Background; Markham WA, Aveyard P. A new theory of health promoting schools based on human functioning, school organisation and pedagogic practice. Social Science & Medicine 2003;56(6):1209-20. Markham WA, Aveyard P. A new theory of health promoting schools based on human functioning, school organisation and pedagogic practice. Social Science & Medicine 2003;56(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 2005;11(1):55-65. 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 2005;11(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 2004;58(11):2253-65. Aveyard P, Markham WA, Cheng KK. A methodological and substantive review of the evidence that schools cause pupils to smoke. Social Science & Medicine 2004;58(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 2004;19(1):15- 28. 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 2004;19(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 2004;58(9):1767-80. 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 2004;58(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 2003;56(4):869-82. 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 2003;56(4):869-82.

26. Early initiation to alcohol use n=8,037 Heavy alcohol consumption n=25,360 Use of illicit drugs n=24,771 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%) Table 1. Sample Characteristics * Townsand score

27. Table 2. Substance use within sample Early initiation to alcohol use n=8,037 Heavy alcohol consumption n=25,360 Use of illicit drugs n=24,771 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