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Young People's Experiences of School and Drug Use: Systematic Review and Case-Study Research Fletcher, Adam (2008) Young people's experiences of school and drug use: systematic review and case-study research. PhD thesis, London School of Hygiene & Tropical Medicine. DOI: https://doi.org/10.17037/PUBS.00682373 Downloaded from: http://researchonline.lshtm.ac.uk/682373/ DOI: 10.17037/PUBS.00682373 Usage Guidelines Please refer to usage guidelines at http://researchonline.lshtm.ac.uk/policies.html or alterna- tively contact [email protected]. Available under license: http://creativecommons.org/licenses/by-nc-nd/2.5/ Young people's experiences of school and drug use: Systematic review and case-study research 4 .r c"ý `ýýE Adam Fletcher Department of Public Health and Policy London School of Hygiene and Tropical Medicine Thesis submitted for the Degree of Doctor of Philosophy (Ph. D. ) at the University of London July 2008 I Abstract Drug use is a cause of health and social problems in the UK. Despite widespread interest in. 'whole-school' interventions, which make changes to school socio-environmental factors in order to reduce young people's drug use, the evidence-base regarding 'school effects' on drug use had not previously been synthesised, and the basis for these potential effects only partly theorised. This thesis examines whether and how schools as institutions can influence young people's attitudes and actions relating to drug use and generates new theoretical insights regarding the processes through which any school effects on students' drug use may occur. Experimental/quasi-experimental studies and longitudinal observational studies were systematically reviewed to determine whether school-level factors influence drug use and if so via what mechanisms. Experimental studies suggested that interventions which aim to increase student participation, improve relationships and promote a positive school ethos can reduce drug use. Observational studies consistently reported that disengagement and poor teacher-student relationships were associated with drug use. However, these studies provide few insights regarding the processes through which schools may inhibit or promote drug use, or how this may vary according to socio-demographic factors. Qualitative data were collected at two case-study schools through semi-structured interviews with students and teachers, and supplemented with observations and documentary evidence, to explore how the school environment might structure drug use and generate new theoretical insights. The case-study research highlights: the connections between education policies, school practices, disengagement and young people's drug use in the UK, particularly the meaning of cannabis use for the most disengaged students as a source of belonging, status and 'escape'; the importance of school social network formation and 'group' identities in determining young people's attitudes and actions relating to drug use; and also, how certain schools may be actively 'hiding' the issue of students' drug use. 2 Contents Abstract p. 2 Contents p. 3-4 Statement of originality p. 5 Acknowledgements p. 6 Abbreviations p. 7 Chapter 1. Young people, drug use and the role of school-based health promotion p. 8- 22 Chapter 2. Theoretical concepts for exploring school influences on young people's drug use p. 23 - 40 Chapter 3. Research questions and methods p. 41- 56 Chapter 4. School effects on young people's drug use: a systematic review of intervention and observational studies p. 57- 72 Chapter 5. Park Grove School case-study p. 73 - 109 Chapter 6. Highbridge School case-study p. 110 - 144 Chapter 7. Summary and discussion p. 145 - 164 Bibliography p. 165 - 182 Appendices p. 183 - 207 Appendix 1: Young people's and teachers' socio-demographic characteristics Appendix 2: Topic guide for student interviews (autumn term) Appendix 3: Topic guide for student interviews (summer term) Appendix 4: Topic guide for teacher interviews Appendix 5: Studentinformation sheet and consentform Appendix 6: Teacherinformation sheet and consentform Appendix 7: Parent/guardian letter, information sheet and consent 'slip' 3 List of Figures & Tables Figure 1: Reporteddrug use in last year by age (NatCen/NFER,2007) p. 10 Figure 2: Stages of a systematic review p. 44 Figure 3: Summaries of interventions studied p. 58 Figure 4: The Healthy School Ethos project intervention 'core components' p. 162 Table 1: Summaries of high-quality intervention studies: study design, p. 66 - 69 sample and intervention effects Table 2: Characteristics and findings of high-quality p. 70 - 72 observational studies 4 Statement of originality I have read and understood the School's definition of plagiarism and cheating given in the Research Degrees Handbook. / declare that this thesis is my own work, and that I have acknowledged all results and quotations from the published or unpublished work of other people. ff6*JvAU Signed: Date: To(, Zig Full name: Adam Fletcher Acknowledgements This researchwas funded by a UK MedicalResearch Council studentship. Thanks to my supervisor, Chris Bonell, for his enthusiasm, guidance and support throughout the research. Thanks also to my advisory committee, Tim Rhodes, Angela Harden and Vicki Strange, for their helpful comments and advice during this project. I would also like to thank James Hargreaves and Judy Green for providing additional support and advice regarding the quantitative and qualitative components of this work respectively. Finally, thanks to all the young people and teachers who participated in this study for giving up their time and sharing their experiences and views with me. 6 Abbreviations CCCS Centre for Contemporary Cultural Studies, University of Birmingham DCSF Department for Children, Schools and Families DfEE Department for Employment and Education DfES Department for Education and Skills DH Department of Health EMCDDA The European Monitoring Centre for Drugs and Drug Addiction ENHPS European Network of Health Promoting Schools EPPI-Centre Evidence for Policy and Practice Information and Coordinating Centre ESPAD The European School Survey Project on Alcohol and Other Drugs ISHN International School Health Network LEA Local Education Authority NatCen National Centre for Social Research NFER National Foundation for Education Research NHSP National Healthy Schools Programme NQT Newly-qualified teacher OFSTED The Office for Standards in Education ONS The Office for National Statistics RCT Randomised controlled trial RIPPLE Randomisedcontrolled trial of peer-ledsex educationin England SES Socio-economic status STI Sexually transmitted infection WHO World Health Organisation 7 Chapter 1. Young people, drug use and the role of school-based health promotion Introduction This thesis examines whether and how schools as institutions can influence young people's attitudes and actions relating to drug use and generates new theoretical insights regarding the processes through which any school effects on students' drug use may occur. Its first aim is to synthesise the existing quantitative evidence on school effects on drug use in order to assess whether schools appear to influence young people's drug use and by what possible mechanisms any such influences might occur. The rationale for this aim is that, despite the considerable policy interest in 'whole-school' interventions to prevent and/or reduce student drug use, the evidence regarding school influences on young people's drug use had not been systematically reviewed and synthesised. The second aim of the thesis is to explore, from the perspective of young people themselves, how young people experience school, how these experiences vary according to social background, gender, ethnicity and level of engagement, and the processes through which any school effects on young people's attitudes and actions relating to drug use may occur. The rationale for this aim is that the social processes through which these potential effects may occur are under-researched and under-theorised (this is outlined in Chapter 2). This first chapter presents an overview of drug use among young people and the public health importance of this, as well as outlining the centrality of school-based health promotion strategies to address this. The origins of 'whole-school' approaches to health promotion and the current UK policy context are then described. An overview of the structure of the rest of the thesis is presented at the end of this chapter. Young people and drug use: prevalence and soclo-demographic patterns Youth is frequently portrayed as a period of peak health and physical fitness. The risk posed by diseases during childhood has subsided while degenerative diseases (e. g. cancer) tend to pose minimal threats until later in the life-course. However, it is misleading to portray adolescence as a period free from health risks. At present, potentially harmful behaviours, such as the use of illegal drugs and the illicit use of volatile substances (henceforth together described as 'drug use'), are widespread among young people in the UK. Adolescent drug use increased dramatically during the 1980s and 1990s (Barton, 2003). UK-wide surveys of secondary school students' health-related 8 behaviours report that between 1987 and 1996 the proportion of 14 and 15 year-olds using illegal drugs increased six-fold: in 1987 only 5% reported having used drugs in the last year compared to 32% in 1996 (Balding, 2000). By the end of the 1990s the UK had the highest prevalence of young drug-users in Europe (EMCDDA, 1998). Although the rate of drug use among young people in Britain has remained relatively constant since the late 1990s (Schools Health Education Unit (SHEU), 2005), in comparison with other European countries the UK continues to far exceed the average in terms of how many young people misuse solvents, smoke cannabis, take ecstasy and use other illegal drugs, such as cocaine and heroin (Hibell et al, 2004; UNICEF, 2007). A large representative survey of 11-15 year-old children in schools in England in 2006 found that 17% of 11-15 years olds reported using drugs in the last year (NatCen/NFER 2007). As in previous years, cannabis was the most commonly used drug. Ten percent of pupils aged 11-15 had used cannabis in the last year.
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