Intended for healthcare professionals


Improving school ethos may reduce substance misuse and teenage pregnancy

BMJ 2007; 334 doi: (Published 22 March 2007) Cite this as: BMJ 2007;334:614
  1. C Bonell, senior lecturer,
  2. A Fletcher, MRC research student,
  3. J McCambridge, lecturer
  1. Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  1. Correspondence to: C Bonell chris.bonell{at}
  • Accepted 12 January 2007

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

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 outcomesw1 w2 w3 and the UK government has made their reduction a priority.w1 w4 w5 w6

Trends suggest existing responses have not produced major population benefits. Rates of illegal drug use and drinking continue to rise, and previous falls in smoking have ceased.1 Conceptions among girls under 16 rose by 1% between 2002 and 2003.3 This may partly be explained by the narrowness of current responses. Classroom interventions on substance misuse and sex education aiming to improve knowledge, develop skills, and modify peer norms are now standard practice in schools.w6 Although systematic reviews report that such interventions can have positive effects on substance misuse and sexual health, these are small, inconsistent, and generally not sustained.4 5 6 7 Although government …

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