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Systematic Review
Whole-school interventions aim to modify the school environment to promote health. A subset aims to promote student commitment to school to prevent outcomes such as substance use (i.e. tobacco, alcohol and other drugs) and violence, which are important, intercorrelated outcomes often associated with disengagement from school. This review synthesises evidence on such interventions and aims to address the following-
(1) What whole-school interventions promoting student commitment to school to prevent substance use and/or violence have been evaluated, what intervention subtypes are apparent and how closely do these align with the theory of human functioning and school organisation? (2) What factors relating to setting, population and intervention affect implementation? (3) What are the effects on student substance use, violence and educational attainment? (4) What is the cost-effectiveness of such interventions? (5) Are intervention effects mediated by student commitment to school or moderated by setting or population?
The authors retrieved 63 eligible reports on 27 studies of 22 interventions. They identified four intervention subtypes focused on student participation in school-wide decisions, improving staff–student relationships, increasing engagement in learning and involving parents. The theories of change of most intervention subtypes aligned closely with the theory of human functioning and school organisation, and informed refinement of an intervention theory of change.
Five outcome evaluations presented findings for substance use up to 1 year post baseline, all RCTs. Twelve outcome evaluations presented findings for this outcome > 1 year post baseline: 10 RCTs and two non-randomised evaluations.
Interventions promoting student participation in school policy decisions
Findings from two RCTs suggested possible, but inconsistent, impacts of interventions promoting student participation in school policy decisions in reducing substance use at up to 1 year post baseline.
A meta-analysis including 16 effect sizes from two studies suggested a non-significant impact in reducing the odds of substance use at up to 1 year post baseline (OR 0.83, 95% CI 0.16 to 4.30).
A separate analysis of smoking outcomes drew on six effect sizes from two studies. This suggested a non-significant impact in reducing the odds of smoking at up to 1 year post baseline (OR 0.81, 95% CI 0.09 to 7.26), with substantial heterogeneity (I2 = 68.9%). However, a sensitivity analysis suggested a significant effect (OR 0.82, 95% CI 0.67 to 0.99).
Findings from seven RCTs and two non-randomised evaluations suggested possible, but inconsistent, impacts of interventions promoting student involvement in school policy decisions in reducing substance use > 1 year post baseline.
Interventions promoting student relationships with teachers, but not student participation in school policy decisions
Intervention students were not significantly less likely to smoke at all (OR 0.89, 95% CI 0.72 to 1.12), but they were less likely than control students to be regular smokers (OR 0.66, 95% CI 0.46 to 0.95).
Interventions promoting student engagement in learning, but not student participation in decision-making or relationships with teachers
Findings from two RCTs suggested possible, but inconsistent, impacts on reducing substance use of interventions promoting student engagement in learning, but not student participation in decision-making or relationships with teachers, at up to 1 year post baseline
Smoking outcomes
Smoking outcomes were meta-analysed for up to 1 year post baseline and for > 1 year post baseline. An analysis drawing on eight effect sizes from four studies suggested a statistically non-significant reduction in smoking, caused by interventions promoting commitment to school, up to 1 year post baseline (OR 0.77, 95% CI 0.54 to 1.09). This finding had substantial heterogeneity (I2 = 70.7%). An analysis drawing on 21 effect sizes from eight studies suggested a statistically non-significant reduction in smoking, caused by interventions promoting commitment to school, > 1 year post baseline (OR 0.87, 95% CI 0.69 to 1.10). This finding had substantial heterogeneity (I2 = 77.3%).
Whole-school interventions aiming to promote student commitment to school to prevent violence and substance use can be categorised into those that promote student participation in school decisions, better staff–student relationships, student engagement in learning and parental involvement in school.
This category of whole-school intervention appears effective in preventing violence victimisation and perpetration, and substance use. However, the effects of such interventions appear to be small, as judged by the authors and by the policy stakeholders. Although such interventions may play a significant role in broader efforts by schools and society to reduce young people’s involvement in violence and substance use, they are unlikely on their own to offer large changes in population behaviours.