London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom.
J Adolesc Health. 2010 Dec;47(6):555-63. doi: 10.1016/j.jadohealth.2010.04.011. Epub 2010 Jun 20.
Interventions to improve school ethos can reduce substance use but "upstream" causal pathways relating to implementation and school-level changes are uncertain. We use qualitative and quantitative data from a pilot trial to build hypotheses regarding these.
The Healthy School Ethos intervention involved two schools being provided with facilitation, training, and funding to plan and implement actions (some mandatory and some locally determined) to improve school ethos over one year. The evaluation involved a pilot-trial with two intervention and two comparison schools; semi-structured interviews with facilitators, staff, and students; and baseline and follow-up surveys with students aged 11 to 12 years.
Student accounts linked participation in planning or delivering intervention activities with improved self-regard and relationships with staff and other students. Some activities such as re-writing school rules involved broad participation. Students in receipt of actions such as peer-mediation or motivational sessions reported benefits such as improved safety and relationships. Some student accounts linked improved self-regard and relationships with increased engagement and aspirations, and reduced substance use. At 9-month follow-up, students in intervention schools reported less hurting and teasing of others and feeling unsafe at school. Other outcomes suggested intervention benefits but were not significant.
School-ethos interventions may reduce substance use through upstream pathways involving the aforementioned factors. Future phase-III trials should quantitatively model the extent to which these mediate intervention effects.
改善学校风气的干预措施可以减少物质使用，但与实施和学校层面变化相关的“上游”因果途径尚不确定。我们利用一项试点试验的定性和定量数据来构建这些假设。
健康学校风气干预措施为两所学校提供了促进、培训和资金，以规划和实施改善学校风气的行动（一些是强制性的，一些是由当地确定的），为期一年。该评估涉及一项试点试验，有两所干预学校和两所对照学校；与促进者、工作人员和学生进行半结构化访谈；以及对 11 至 12 岁学生进行基线和随访调查。
学生的叙述将参与规划或实施干预活动与自我尊重的提高以及与工作人员和其他学生的关系联系起来。一些活动，如重写校规，涉及广泛的参与。接受同伴调解或激励课程等活动的学生报告说，他们受益于安全性和人际关系的改善。一些学生的叙述将自我尊重和人际关系的提高与参与度和愿望的增加以及物质使用的减少联系起来。在 9 个月的随访中，干预学校的学生报告说，他们对他人的伤害和嘲笑以及在学校感到不安全的情况减少了。其他结果表明干预有好处，但并不显著。
学校风气干预措施可能通过涉及上述因素的“上游”途径减少物质使用。未来的第三阶段试验应定量模拟这些因素在多大程度上介导干预效果。
