A new measure of unhealthy school environments and its implications for critical assessments of health promotion in schools

Abstract

The theory of human functioning and school organisation informed by Basil Bernstein’s sociology of education suggests that to gain the commitment and promote the health of students, particularly those from disadvantaged backgrounds, schools require radical transformations eroding various ‘boundaries’: between and among staff and students; between students’ academic learning and broader social development and welfare; and between schools and their local communities. Existing research examining this theory has reported associations between school-level proxy measures of student commitment and lower rates of student smoking, drinking alcohol, use of drugs and violence. But this research has not directly assessed whether reduced school boundaries explain this. We piloted a new scale derived from teacher reports to measure unhealthy school boundaries and examined its inter-item reliability and its criterion validity in terms of associations with various measures of school commitment and smoking. Data on boundaries came from 101 teachers across 40 schools. Data on student commitment and smoking came from 6667 students. We assessed reliability by examining correlations between scale-items and criterion validity in terms of associations with student-reported commitment and smoking. Inter-item reliability was sub-optimal but better within the subscales about boundaries between academic/broader learning and schools/local communities. The scale had good criterion validity, strongly associated with reduced student-reported school commitment and increased student-reported smoking. We reflect on the implications of these findings in terms of critical perspectives on health promotion in schools and the strengths and limitations of quantitative research in examining health behaviours as opposed to practices.

Keywords:

• Schools
• smoking
• multi-level models
• environment

Acknowledgements

We would like to thank the other co-investigators working on the INCLUSIVE trial as well as the students and staff of the participating schools.

Funding

This project is funded from a grant by the National Institute for Health Research Public Health Research Programme [grant number 12/153/60]. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the National Institute for Health Research Public Health Research Programme or the Department of Health. The work was undertaken with the support of The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UKCRC Public Health Research Centre of Excellence. Joint funding (MR/KO232331/1) from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.

Author contributions

CB co-directed the study and led the planning and drafting of this paper. NS designed and implemented statistical analyses with support from EA and both contributed to drafting the paper. FJ and AF contributed to planning and drafting the paper, and FJ collected staff data. WM and PA advised on construction of the VAE measure and contributed to planning and drafting. AM led data collection and contributed to the methods sections. RV co-directed the study and contributed to planning the paper.