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Schools and adolescent health

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If only we could run schools better then children and adolescents would become more mature, less vulnerable, more socially accomplished, more successful, healthier, and happier people. It’s an attractive thought but is it workable? Do school development programmes produce measurable results? The Health Promoting Schools framework was introduced by the World Health Organization in 1995, stressing the quality of the school environment and the importance of community health programmes in schools. Several programmes of school change have been described but they have not been subjected to rigorous objective assessment. The Gatehouse Project in Melbourne, Australia aims to promote the emotional and behavioural wellbeing of adolescents in secondary schools. The results of a randomised controlled trial have been reported (

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The study included 12 intervention and 14 control schools (2678 students) in Melbourne and surrounding districts. In the intervention schools the three priority areas for action were: building a sense of security and trust, increasing communication skills and opportunities, and building a sense of positive regard for the school by participation in aspects of school life. School based adolescent health teams were established, student surveys were performed to identify good and bad factors in the schools’ social and learning environments, and strategies were developed using the survey results. Teaching resources were developed to allow students to recognise and tackle social and emotional problems and professional support for teachers was provided by school liaison teams. Data were collected at baseline in school year 8 (mean age 14 years) in 1997 and at the end of school years 8, 9, and 10. Students completed self administered questionnaires using laptop computers. At baseline 53% of students said they had been bullied, 35% had low engagement with the school, 18% had depressive symptoms, 5% were regular drinkers, 13% had indulged in binge drinking, 16% had smoked (but only 2% regularly), and 7% had used cannabis. Factors associated with substance abuse included low school engagement, having arguments with many others, and being victimised. There were similar, but stronger, links between social relationships and depressive symptoms.

The intervention had no significant effect on bullying, low school attachment, poor availability of personal attachments, arguments with fellow students, or depressive symptoms. Overall, rates of drinking and smoking were 3–5% less in intervention schools compared with control schools during the period of follow up. There were significant reductions in regular smoking in the intervention schools.

There was some reduction in smoking in the intervention schools but no significant effect on depressive symptoms, social relationships, or school attachment. The authors conclude that the strategy can be effective in reducing adolescents’ health risk behaviour particularly with respect to substance abuse. A barely significant reduction in teenage smoking seems scant reward for much effort but the researchers remain enthusiastic and call for long term commitment by funders, government departments, communities, and schools. Perhaps it takes more than a year or three to change the character of a school. Or perhaps adolescent turmoil and rebelliousness is an essential part of life, susceptible to modification only in part.

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