Abstract
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.
Similar content being viewed by others
References
Angold, A., Costello, E. J., Messer, S. C., Pickles, A., Winder, F., & Silver, D. (1995). The development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5, 237–249.
Brännström, L. (2005). Does neighbourhood origin matter? A longitudinal multilevel assessment of neighbourhood effects on income and receipt of social assistance in a Stockholm birth cohort. Housing Theory and Society, 22(4), 169–195. doi:10.1080/14036090510011586.
Bridges, S., Gill, V., Omole, T., Sutton, R., & Wright, V. (2011). Smoking, drinking and drug use among young people in England in 2010. London: National Centre for Social Research and the National Foundation for Educational Research.
Browne, W. J., Subramanian, S. V., Jones, K., & Goldstein, H. (2005). Variance partitioning in multilevel logistic models that exhibit overdispersion. Journal of the Royal Statistical Society: Series A (Statistics in Society), 168, 599–613. doi:10.1111/j.1467-985X.2004.00365.x.
Cook, P. J., Gottfredson, D. C., & Na, C. (2010). School crime control and prevention. Crime and Justice, 39, 313–440. doi:10.1086/652387.
Deighton, J., Tymms, P., Vostanis, P., Belsky, J., Fonagy, P., Brown, A., et al. (2012). The development of a school-based measure of child mental health. Journal of Psychoeducational Assessment. doi:10.1177/0734282912465570.
Department for Education. (2011). LSYPE user guide to the datasets: Wave 1 to Wave 7. London: Department for Education.
Department for Education and Skills. (2003). Every child matters. London: Department for Education and Skills.
Department for Education and Skills. (2005). Social and Emotional Aspects of Learning (SEAL): Improving behaviour, improving learning. London: Department for Education and Skills.
Department of Health. (2009). Healthy child programme from 5–19 years old. London: Department of Health.
Department of Health/Department for Education and Employment. (1999). National Healthy Schools Programme—getting started. London: Department of Health/Department for Education and Employment.
Deschesnes, M., Martin, C., & Hill, A. J. (2003). Comprehensive approaches to school health promotion: How to achieve broader implementation? Health Promotion International, 18, 387–396. doi:10.1093/heapro/dag410.
Donaldson, L. (2008). Under their skins: Tackling the health of the teenage nation. London: Department of Health.
Eccles, J. S., & Roeser, R. W. (2011). Schools as developmental contexts during adolescence. Journal of Research on Adolescence, 21, 225–241. doi:10.1111/j.1532-7795.2010.00725.x.
Fletcher, A., Bonell, C., & Hargreaves, J. (2008). School effects on young people’s drug use: A systematic review of intervention and observational studies. Journal of Adolescent Health, 42, 209–220. doi:10.1016/j.jadohealth.2007.09.020.
Gardner, M., & Steinberg, L. (2005). Peer influence on risk taking, risk preference, and risky decision making in adolescence and adulthood: An experimental study. Developmental Psychology, 41, 625–635. doi:10.1037/0012-1649.41.4.625.
Gendron, B. P., Williams, K. R., & Guerra, N. G. (2011). An analysis of bullying among students within schools: Estimating the effects of individual normative beliefs, self-esteem, and school climate. Journal of School Violence, 10, 160–164. doi:10.1080/15388220.2010.539166.
Goldberg, D., & Williams, P. (1988). The users' guide to the general health questionnaire. Windsor: NFER-Nelson.
Goodman, R. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581–586. doi:10.1111/j.1469-7610.1997.tb01545.x.
Gottfredson, D. C., & DiPietro, S. M. (2011). School size, social capital, and student victimization. Sociology of Education, 84, 69–89. doi:10.1177/0038040710392718.
Greenberg, M. T., Weissberg, R. P., O’Brien, M. U., Zins, J. E., Fredericks, L., Resnik, H., et al. (2003). Enhancing school-based prevention and youth development through coordinated social, emotional, and academic learning. American Psychologist, 58, 466–474. doi:10.1037/0003-066X.58.6-7.466.
Hale, D. R., & Viner, R. M. (2012). Policy responses to multiple risk behaviours in adolescents. Journal of Public Health, 34, i11–i19. doi:10.1093/pubmed/fdr112.
Health Education Authority. (1997). Young people and health: Health behaviour in school-aged children. London: Health Education Authority.
Henderson, M., Ecob, R., Wight, D., & Abraham, C. (2008). What explains between-school differences in rates of smoking? BMC Public Health, 8(1), 218. doi:10.1186/1471-2458-8-218.
Hobbs, G., & Vignoles, A. (2010). Is children’s free school meal 'eligibility' a good proxy for family income? British Educational Research Journal, 36, 673–690. doi:10.1080/01411920903083111.
Kessler, R., Berglund, P., Demler, O., Jin, R., Merikangas, K., & Walters, E. (2005). LIfetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602. doi:10.1001/archpsyc.62.6.593.
Lawrence, R. S., Gootman, J. A., & Sim, L. J. (2009). Adolescent health services: Missing opportunities. Washington, DC: National Academies Press.
McGinnis, J. M., Williams-Russo, P., & Knickman, J. R. (2002). The case for more active policy attention to health promotion. Health Affairs, 21, 78–93.
Moffitt, T. E. (1993). Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy. Psychological Review, 100, 674–701. doi:10.1377/hlthaff.21.2.78.
Mokdad, A. H., Marks, J. S., Stroup, D. F., & Gerberding, J. L. (2004). Actual causes of death in the United States, 2000. Journal of the American Medical Association, 291, 1238–1245. doi:10.1001/jama.291.10.1238.
Mooij, T. (1998). Pupil-class determinants of aggressive and victim behaviour in pupils. British Journal of Educational Psychology, 68, 373–385. doi:10.1111/j.2044-8279.1998.tb01298.x.
Mrug, S., Gaines, J., Su, W., & Windle, M. (2010). School-level substance use: Effects on early adolescents' alcohol, tobacco and marijuana use. Journal of Studies on Alcohol and Drugs, 71, 488–495.
Murray, D. M., Catellier, D. J., Hannan, P. J., Treuth, M. S., Stevens, J., Schmitz, K. H., et al. (2004). School-level intraclass correlation for physical activity in adolescent girls. Medicine & Science in Sports & Exercise, 36, 876–882.
National Institute for Health and Clinical Excellence. (2010). School-based interventions to prevent smoking. NICE public health guidance 23. London: NICE.
Ofsted. (2009). Indicators of a school’s contribution to well-being. London: Ofsted.
Parsons, C., Stears, D., & Thomas, C. (1996). The health promoting school in Europe: Conceptualising and evaluating the change. Health Education Journal, 55, 311–321. doi:10.1177/001789699605500306.
Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Newbury Park: Sage.
Resnick, M. D., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J., et al. (1997). Protecting adolescents from harm. Journal of the American Medical Association, 278, 823–832. doi:10.1001/jama.1997.03550100049038.
Richmond, T. K., & Subramanian, S. V. (2008). School level contextual factors are associated with the weight status of adolescent males and females. Obesity, 16(6), 1324–1330. doi:10.1038/oby.2008.48.
Roeger, L., Allison, S., & Martin, G. (2001). Adolescent depressive symptomatology. Australian Journal of Psychology, 53, 134–139. doi:10.1080/00049530108255135.
Sellström, E., & Bremberg, S. (2006). Is there a “school effect” on pupil outcomes? A review of multilevel studies. Journal of Epidemiology and Community Health, 60, 149–155. doi:10.1136/jech.2005.036707.
Stansfeld, S., Haines, M., Booy, R., Taylor, S., Viner, R., Head, J., et al. (2003). Health of young people in East London: The RELACHS study 2001. London: The Stationery Office.
StataCorp (2011). Stata statistical software: Release 12. College Station, TX: StataCorp LP.
Viner, R. M., Ozer, E. M., Denny, S., Marmot, M., Resnick, M., Fatusi, A., et al. (2012). Adolescence and the social determinants of health. The Lancet, 379, 1641–1652. doi:10.1016/s0140-6736(12)60149-4.
Visintainer, P. F. (2008). ICCCONF: Stata module to compute a confidence interval for an intraclass correlation (ICC). [Computer software and manual]. Retrieved March 16, 2012 from http://ideas.repec.org/c/boc/bocode/s456979.html.
Von Hippel, P. T. (2007). Regression with missing Ys: An improved strategy for analyzing multiply imputed data. Sociological Methodology, 37(1), 83–117. doi:10.1111/j.1467-9531.2007.00180.x.
West, P., & Sweeting, H. (2002). A review of young people’s health and health behaviours in Scotland. Glasgow: MRC Social & Public Health Sciences Unit.
West, P., Sweeting, H., & Leyland, A. H. (2004). School effects on pupils' health behaviours: Evidence in support of the health promoting school. Research Papers in Education, 19, 261–291. doi:10.1108/09654280610711370.
Wilcox, P., & Clayton, R. R. (2001). A multilevel analysis of school-based weapon possession. Justice Quaterly, 18, 509–541. doi:10.1080/07418820100095001.
Williams, R. J., & Nowatzki, N. (2005). Validity of adolescent self-report of substance use. Substance Use & Misuse, 40(3), 1–13.
Wolpert, M., Deighton, J., Patalay, P., Martin, A., Fitzgerald-Yau, N., Demir, E., et al. (2011). Me and my school: Findings from the national evaluation of Targeted Mental Health in Schools. Nottingham: DFE Publications.
World Health Organization (2011). Young people: Health risks and solutions. (Fact Sheet No. 345). Retrieved March 10, 2012, from http://www.who.int/mediacentre/ factsheets/fs345/en/index.html.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hale, D.R., Patalay, P., Fitzgerald-Yau, N. et al. School-Level Variation in Health Outcomes in Adolescence: Analysis of Three Longitudinal Studies in England. Prev Sci 15, 600–610 (2014). https://doi.org/10.1007/s11121-013-0414-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11121-013-0414-6