BMJ  2007;334:614-616 (24 March), doi:10.1136/bmj.39139.414005.AD

Analysis

Improving school ethos may reduce substance misuse and teenage pregnancy

Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London WC1E 7HT

Current strategies to improve teenage health are not having the desired effect. C Bonell, A Fletcher, and J McCambridge examine the evidence for a wider focus

The first 150 words of the full text of this article appear below.

Substance misuse and teenage pregnancy are major public health challenges. Existing responses generally focus on individual characteristics, such as knowledge and attitudes about substances and sexual risk, rather than wider social and institutional influences, and seem to have brought about only limited benefits. We review evidence suggesting that interventions aiming to promote one such wider influence—positive school ethos—might provide an effective complement to existing interventions.

Limitations to current responses

School based surveys indicate that a third of 15 year olds in England have taken illegal drugs in the past year and about a quarter use them monthly or more.¹ Among the 40% of 15 year olds who drink alcohol, average weekly consumption is over 10 units.¹ A quarter of 15 year old girls smoke.¹ Teenage pregnancy rates in the UK are the highest in western Europe.² Early substance misuse and teenage parenthood are associated with subsequent adverse outcomes^{w1 w2 w3} and the UK government has made . . . [Full text of this article]

Evidence of school level effects

Box 1: Aban Aya project to improve school ethos
Interventions
Box 2: Gatehouse project, Australia¹¹
Bullying
Student-teacher communication
Students' self-esteem
Student participation

Scope for action

Conclusion

Summary points

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