Dundas Ruth, Leyland Alastair H, Macintyre Sally, Leon David A
MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
Int J Epidemiol. 2006 Apr;35(2):458-65. doi: 10.1093/ije/dyi239. Epub 2005 Nov 12.
Adult health and its determinants are influenced by the environment in childhood. The school attended is known to affect the health behaviours of pupils while still at school. Little is known about the long-term influence of school attended on health.
A total of 7,095 respondents (mean age 47 years) to a follow-up questionnaire who attended primary school in Aberdeen, UK, provided information on self-reported health; self-reported high blood pressure; GHQ-4; smoking status; alcohol intake; and obesity. Variance partition coefficients (VPCs) summarized the variation in adult health outcomes and behaviours across schools. Multilevel logistic regression was used to estimate the contribution of school to variation in the outcomes taking into account individual-level and school-level factors.
There was some variation across schools in the proportion of adults reporting poor self-rated health (VPC = 0.020) and smoking (0.019). Higher VPCs were found for factors potentially confounded with school: paternal social classes (I&II) (0.45) and gender (0.44). Age at leaving secondary education (0.28) and income (0.10) varied across schools. The effects of primary school diminished after adjusting for individual-level childhood risk factors. The further addition of adult risk factors attenuated these childhood effects. After full adjustment there was no effect of the primary school attended for high blood pressure, current smoking, alcohol intake, and obesity, and negligible effects for the other outcomes.
Contrary to our expectations, we found little evidence of any relationship between primary school and adult self-reported health or behaviour. This is surprising given the extent to which characteristics known to be associated with adult health were clustered within schools.
成人健康及其决定因素受童年时期环境的影响。众所周知，就读的学校会影响学生在校期间的健康行为。但对于就读学校对健康的长期影响知之甚少。
对7095名在英国阿伯丁上小学的随访问卷受访者（平均年龄47岁），收集了关于自我报告健康状况、自我报告高血压、GHQ-4、吸烟状况、饮酒量和肥胖情况的信息。方差分解系数（VPC）总结了各学校成人健康结果和行为的差异。采用多水平逻辑回归来估计学校对结果差异的贡献，同时考虑个体层面和学校层面的因素。
各学校在报告自我健康评分差的成年人比例（VPC = 0.020）和吸烟比例（0.019）上存在一定差异。在可能与学校混淆的因素方面发现了更高的VPC：父亲的社会阶层（I&II）（0.45）和性别（0.44）。中学毕业年龄（0.28）和收入（0.10）在各学校也有所不同。在调整个体层面的童年风险因素后，小学的影响减弱。进一步加入成人风险因素后，这些童年影响进一步减弱。在进行全面调整后，就读的小学对高血压、当前吸烟、饮酒量和肥胖没有影响，对其他结果的影响可忽略不计。
与我们的预期相反，我们几乎没有发现小学与成人自我报告的健康或行为之间存在任何关系的证据。鉴于已知与成人健康相关的特征在学校内部聚集的程度，这一结果令人惊讶。
