Hale Daniel R, Patalay Praveetha, Fitzgerald-Yau Natasha, Hargreaves Dougal S, Bond Lyndal, Görzig Anke, Wolpert Miranda, Stansfeld Stephen A, Viner Russell M
General and Adolescent Pediatrics, Institute of Child Health, UCL, 30 Guilford St, London, WC1N 1EH, UK,
Prev Sci. 2014 Aug;15(4):600-10. doi: 10.1007/s11121-013-0414-6.
School factors are associated with many health outcomes in adolescence. However, previous studies report inconsistent findings regarding the degree of school-level variation for health outcomes, particularly for risk behaviours. This study uses data from three large longitudinal studies in England to investigate school-level variation in a range of health indicators. Participants were drawn from the Longitudinal Study of Young People in England, the Me and My School Study and the Research with East London Adolescent Community Health Survey. Outcome variables included risk behaviours (smoking, alcohol/cannabis use, sexual behaviour), behavioural difficulties and victimisation, obesity and physical activity, mental and emotional health, and educational attainment. Multi-level models were used to calculate the proportion of variance in outcomes explained at school level, expressed as intraclass correlations (ICCs) adjusted for gender, ethnicity and socio-economic status of the participants. ICCs for health outcomes ranged from nearly nil to .28 and were almost uniformly lower than for attainment (.17-.23). Most adjusted ICCs were smaller than unadjusted values, suggesting that school-level variation partly reflects differences in pupil demographics. School-level variation was highest for risk behaviours. ICCs were largely comparable across datasets, as well as across years within datasets, suggesting that school-level variation in health remains fairly constant across adolescence. School-level variation in health outcomes remains significant after adjustment for individual demographic differences between schools, confirming likely effects for school environment. Variance is highest for risk behaviours, supporting the utility of school environment interventions for these outcomes.
学校因素与青少年的许多健康结果相关。然而，先前的研究报告了关于健康结果在学校层面的差异程度，特别是风险行为方面的不一致发现。本研究使用来自英国三项大型纵向研究的数据，调查一系列健康指标在学校层面的差异。参与者来自英国青年纵向研究、“我和我的学校”研究以及东伦敦青少年社区健康调查研究。结果变量包括风险行为（吸烟、饮酒/吸食大麻、性行为）、行为困难和受欺负情况、肥胖与身体活动、心理和情绪健康以及教育程度。使用多层次模型来计算在学校层面所解释的结果差异比例，以针对参与者的性别、种族和社会经济地位进行调整后的组内相关系数（ICCs）表示。健康结果的组内相关系数范围从几乎为零到0.28，并且几乎一致低于学业成就的组内相关系数（0.17 - 0.23）。大多数调整后的组内相关系数小于未调整的值，这表明学校层面的差异部分反映了学生人口统计学特征的差异。风险行为的学校层面差异最大。组内相关系数在不同数据集之间以及数据集中不同年份之间在很大程度上具有可比性，这表明健康在学校层面的差异在整个青春期保持相当稳定。在对学校之间个体人口统计学差异进行调整后，健康结果在学校层面的差异仍然显著，证实了学校环境可能产生的影响。风险行为的差异最大，这支持了针对这些结果进行学校环境干预的效用。
