School effects on adolescent pupils' health behaviours and school process associated with these effects

Eight schools, located in Scotland were involved in this study. Four different types of data were collected in the following order: first, 183 semi-structured interviews with a range of staff and pupils across the schools, the interviews covering questions relating to health education, promotion and ethos including quality of relationships; second, a school audit of health education and health promotion in all schools; third, Researcher observations for all schools; and, fourth, questionnaire data collected from 446 pupils across the schools. The Health Promoting School (HPS) concept is based on the belief that schools have the potential to influence their students' health and health behaviour through the school's social organisation, culture and physical environment, as well as through the formal curriculum. To date, there is little empirical evidence to test the effectiveness of the HPS, at least evidence that adjusts for known predictors of the behaviours, a standard set by the more advanced area of 'school effects' research on educational outcomes. This thesis will add to that evidence base. The aims of this study have three main components: first, to quantify 'school effects' on a range of pupils' health behaviours comprising current smoking, weekly alcohol drinking, ever tried drugs and physical activity: second, to assess the extent to which the health behaviour profile of schools are related to health promotion activity as evidenced by an audit: third, to select and analyse qualitative data from three case study schools. The purpose of the second and third aims is to investigate the extent to which school processes are associated with 'school effects' on pupils' health behaviours, triangulating data from different methodologies. The questionnaire data indicated that a strong school effect existed for smoking and drinking to a lesser degree, but not for drugs or physical activity. This addressed the first aim of this study and, in addition, provided the means by which three case study schools were selected. These were the two schools with the lowest (added value) and highest odds (lost value) for smoking after adjustment for known predictors of the health behaviours. Plus, a third school which was significantly different from the school with lowest smoking and located in the same town, as this eased interpretation of the results. Relating to the second aim, the pattern of the 'school effects' on smoking were triangulated with data from three different data sources. First, in the audit, higher levels of action on health education and health promotion were associated with lower (adjusted) rates of smoking. Second, the three case study schools were used to explore the Researcher's observations; the school with added value for smoking was rated more highly than the two with lost value. Regarding the third aim, based on qualitative data from a range of staff and pupils, the analysis showed that the school with added value had progressed furthest towards functioning as a whole school, performing best across all the areas explored. These findings theoretically triangulated with the schools low smoking rates according to the HPS concept. These results confirm the importance of school processes on students' health behaviour, particularly smoking, and support a school-wide or "Health Promoting School" approach to improving health behaviours