Feasibility study for an intervention to reduce young people's substance misuse via promoting inclusive ethos in schools

Early substance misuse by young people predicts later, more harmful use of drink and drugs. Preventing young people’s substance misuse can be done by improving their knowledge, attitudes and skills, and those of their peers. However, research suggests such approaches are not on their own very effective. Research shows that schools with a more inclusive ethos (i.e. a culture where students feel included and where teachers and students get on well) have lower rates of drug, drink and tobacco use among students. This is not merely a consequence of these schools having different sorts of students in the first place. Studies conducted in other countries indicate that working with schools to improve their ethos can reduce rates of substance misuse among students. We are a team of researchers, with expertise in health and education, collaborating with consultants, with experience running schools. We are trying out such an approach in this country. We want to make sure that this is possible and get an approximate idea of impact in a small-scale project before we move on to attempting a bigger project that would more rigorously look at impact. Our intervention involves consultants going into schools to support them to improve their ethos. Actions in each school are being led by a team of staff and students who use information about what students and staff do and don’t like about the school to inform what actions they take. We will assess whether the intervention seems practical and acceptable by asking the views of staff and students at the school. We will get an initial idea about its impact by surveying year-7 pupils on their views on and use of drugs, alcohol and tobacco before and after the work is done. We will compare their answers to answers from students in similar schools that aren’t involved in the work to improve ethos.

Substance misuse education addressing individuals‘ knowledge, attitudes and skills as well as peer norms is common practice in English secondary schools. Recent systematic reviews reports some positive effects but these are not consistent or substantial and reviewers recommend further research to develop additional school-based approaches. Existing non-UK trials and UK observational research suggests that intervention to promote inclusive school ethos (i.e. a culture which fosters student engagement and belonging, and strong teacher-student relationships) is one such, highly promising approach. Non-UK trials report that interventions involving a structured process aiming to change school policies and teaching practice to promote inclusion lead to reductions in drug, alcohol and tobacco use as well as other health and educational outcomes. We propose to work with experienced education consultants and with the principal investigators of the non-UK trials mentioned above to develop and assess the feasibility and acceptability of such work in England prior to a phase-III trial. Our intervention will involve: needs-assessment interviews/focus-groups with staff/student and needs-assessment surveys with students; initiation of a school-wide action group (staff, students and parents) formally linked to school management to review policies likely to impact on ethos; education consultant attendance at action group to support delivery; and training delivered by a specialist consultant for teachers on developing positive relationships with students. Our evaluation will involve a pilot matched-pair randomized controlled trial with 2 schools per arm (stratified by free-school-meal rates), and an integral process evaluation. We will compare our intervention to current teacher-delivered substance-misuse education, and undertake baseline and follow-up surveys with 220 students per school at the beginning and end of year 7. Our primary outcomes will be self-reported illicit drug use, consumption of 5 or more units of alcohol on one occasion and smoking (all in the previous month). We will also pilot saliva-sample collection and testing for cannabis and cotinine (to incentivize honest self-reports and adjust for under/over-reports). Process evaluation will involve semi-structured interviews/focus groups with 2 education consultants, 10 action-team members (staff, parents, students), 20 other teaching staff and 40 other pupils from various year-groups to explore acceptability and feasibility. Our findings will inform development of a proposal for a phase-III trial. A DH official will sit on the advisory group and advise on policy implications.