Role of contextual and compositional characteristics of schools for health inequalities in childhood and adolescence: a scoping review

OBJECTIVES

To synthesise the evidence on the role of compositional or contextual characteristics of schools in the association between students' socioeconomic position and their health in primary and secondary education in developed economies.

DESIGN

Scoping review. We included studies examining the role of at least one school or class characteristic on students' health inequalities and was published since 1 January 2000, in English or German. We searched PubMed/Medline, Web of Science and Education Resources Information Center. We provided a narrative synthesis and an overview of findings. School characteristics were grouped into five broad categories: school composition, school climate, school policies and organisation, food environment and facilities.

RESULTS

Of 8520 records identified, 26 studies were included. Twelve studies found a moderating and 3 a mediating effect. The strongest evidence came from studies examining the moderating effect of school composition, that is, the negative impact of a low individual socioeconomic position on mental health and well-being was aggravated by a low average socioeconomic position of schools. Evidence concerning the role of school climate, school stratification (eg, performance base tracking) and sponsorship, food environment and sport facilities and equipment was generally weak or very weak and mostly based on singular findings. Overall, favourable meso-level characteristics mitigated the negative impact of low individual socioeconomic position on health outcomes.

CONCLUSIONS

School characteristics affect health inequalities in children and adolescents to some degree, but future research is necessary to strengthen the existing evidence and address under-represented aspects in school characteristics and health outcomes.

The relations between students' sense of school belonging, perceptions of school kindness and character strength of kindness

This study explored the associations between secondary school students' sense of school belonging, their perceptions of school kindness, and character strength of kindness, and examined possible differences in these constructs across gender groups. The study, which included 1973 Hong Kong secondary school students, revealed that students' sense of school belonging was positively correlated with their perceptions of school kindness at the school and student levels (0.021 and 0.185, respectively). Furthermore, students' sense of school belonging was positively linked to character strength of kindness at the student level, although this relationship was found to be non-significant at the school level. At both levels of analysis, the positive relationships between students' perceptions of school kindness and character strength of kindness were significant. In addition, girls reported higher levels of character strength of kindness than boys. The findings of this study provide a better understanding of the relationships between sense of school belonging, school kindness, and character strength of kindness. Implications for research are also discussed.

Justice at the Workplace: A Review

Modern work life is characterized by constant change, reorganizations, and requirements of efficiency, which make the distribution of resources and obligations, as well as justice in decisionmaking, highly important. In the work life context, it is a question not only of distributing resources and obligations, but also of the procedures and rules that guide the decisionmaking in the organization. Studies of these rules and procedures have provided the basis for a new line of research that evaluates leadership and social relationships in working communities; that is, distributive, procedural, and relational justice. This review follows the development of research on organizational justice from its origins in early social and motivational psychological theories to its establishment as a major line of research in modern work and organizational psychology. The adverse consequences of injustice include poor team climate, reduced productivity and well-being, and work-related illnesses.

Psychosocial Problems, Indoor Air-Related Symptoms, and Perceived Indoor Air Quality among Students in Schools without Indoor Air Problems: A Longitudinal Study

The effect of students' psychosocial problems on their reporting of indoor air quality (subjective IAQ) and indoor air-related (IA-related) symptoms has not been studied in schools in a longitudinal setting. Therefore, we analyzed whether changes in students' psychosocial problems (socioemotional difficulties and perceived teacher⁻student relations) between the beginning of seventh grade (age 12⁻13 years) and the end of ninth grade (15⁻16 years) predicted subjective IAQ and IA-related symptoms at the end of ninth grade. In order to explore the independent effect of psychosocial factors, we focused only on students in schools without observed indoor air problems. The analysis was of longitudinal data (N = 986 students) using latent change modelling. Increased socioemotional difficulties were related to more IA-related symptoms (standardized beta = 0.20) and deteriorated subjective IAQ (standardized beta = 0.20). Increased problems in teacher⁻student relations were related to deteriorated subjective IAQ (standardized beta = 0.21). Although students' psychosocial problems explained only 9⁻13% of the total variances, our findings support the notion that psychosocial factors also need to be taken into account in the evaluation of IAQ and the prevalence of IA-related symptoms in schools.

Indoor air problems and the perceived social climate in schools: A multilevel structural equation analysis

Indoor air problems in schools appear to influence learning outcomes and absence rates. However, previous research has not investigated whether indoor air problems influence the social climate of schools. Therefore, we studied whether indoor air problems observed in schools associate with students' perceptions of the teacher-student relationship and class spirit. The nationwide sample of Finnish schools (N=194 schools/27153 students) was analyzed using multilevel structural equation modeling. Data on the schools' social climate collected from students were merged with independently collected data on observed indoor air problems from school principals. We found that the teacher-student relationship was reported to be worse in schools with observed indoor air problems compared to those without observed indoor air problems. Furthermore, the reported class spirit was worse in schools with observed indoor air problems, but only among students with a high grade point average. Our findings indicate that indoor air problems may affect the student-perceived social climate.

The Association of School Climate, Depression Literacy, and Mental Health Stigma Among High School Students

BACKGROUND

Although school climate is linked with youth educational, socioemotional, behavioral, and health outcomes, there has been limited research on the association between school climate and mental health education efforts. We explored whether school climate was associated with students' depression literacy and mental health stigma beliefs.

METHODS

Data were combined from 2 studies: the Maryland Safe Supportive Schools Project and a randomized controlled trial of the Adolescent Depression Awareness Program. Five high schools participated in both studies, allowing examination of depression literacy and stigma measures from 500 9th and 10th graders. Multilevel models examined the relationship between school-level school climate characteristics and student-level depression literacy and mental health stigma scores.

RESULTS

Overall school climate was positively associated with depression literacy (odds ratio [OR] = 2.78, p < .001) and negatively associated with stigma (Est. = -3.822, p = .001). Subscales of engagement (OR = 5.30, p < .001) and environment were positively associated with depression literacy (OR = 2.01, p < .001) and negatively associated with stigma (Est. = -6.610, p < .001), (Est. = -2.742, p < .001).

CONCLUSIONS

Positive school climate was associated with greater odds of depression literacy and endorsement of fewer stigmatizing beliefs among students. Our findings raise awareness regarding aspects of the school environment that may facilitate or inhibit students' recognition of depression and subsequent treatment-seeking.

The associations of indoor environment and psychosocial factors on the subjective evaluation of Indoor Air Quality among lower secondary school students: a multilevel analysis

Subjective evaluation of Indoor Air Quality (subjective IAQ) reflects both building-related and psychosocial factors, but their associations have rarely been studied other than on the individual level in occupational settings and their interactions have not been assessed. Therefore, we studied whether schools' observed indoor air problems and psychosocial factors are associated with subjective IAQ and their potential interactions. The analysis was performed with a nationwide sample (N = 195 schools/26946 students) using multilevel modeling. Two datasets were merged: (i) survey data from students, including information on schools' psychosocial environment and subjective IAQ, and (ii) data from school principals, including information on observed indoor air problems. On the student level, school-related stress, poor teacher-student relationship, and whether the student did not easily receive help from school personnel, were significantly associated with poor subjective IAQ. On the school level, observed indoor air problem (standardized β = -0.43) and poor teacher-student relationship (standardized β = -0.22) were significant predictors of poor subjective IAQ. In addition, school-related stress was associated with poor subjective IAQ, but only in schools without observed indoor air problem (standardized β = -0.44).

Occupational well-being and leadership in a school community

Purpose

The purpose of this paper is to present well-being, leadership, and the development of each from a communal perspective in a Finnish primary school in the years 2000-2009.

Design/methodology/approach

The study included five sets of data. The quantitative research data were collected from the school staff using the Well-Being at Your Work index questionnaire in 2004 (n=36), 2005 (n=41), and in 2009 (n=34). In 2006, two group interviews were carried out with the school personnel (n=21), and in 2011, retrospective interview data were collected from an expert classroom teacher (n=1). Quantitative data were analysed statistically using descriptive statistics. The qualitative group interview data were analysed by an inductive content analysis, while the expert interview was analysed according to the methods of factual analysis.

Findings

During this period, several communal interventions were developed in the school to promote occupational well-being. Over the course of the study, staff members’ satisfaction with the actions and the support provided by the principal has improved, and leadership-related problems have decreased.

Research limitations/implications

The results cover research findings from one school and therefore cannot be generalised to other Finnish school communities.

Originality/value

Schools’ work communities must be active in developing interventions to improve their own occupational well-being. Furthermore, leaders must be actively involved in the development of occupational well-being.

The Relationship Among School Safety, School Liking, and Students' Self-Esteem: Based on a Multilevel Mediation Model

BACKGROUND

Perceptions of school safety have an important effect on students' development. Based on the model of "context-process-outcomes," we examined school safety as a context variable to explore how school safety at the school level affected students' self-esteem.

METHODS

We used hierarchical linear modeling to examine the link between school safety at the school level and students' self-esteem, including school liking as a mediator. The data were from the National Children's Study of China (NCSC), in which 6618 fourth- to fifth-grade students in 79 schools were recruited from 100 counties in 31 provinces in China.

RESULTS

Multilevel mediation analyses showed that the positive relationship between school safety at the school level and self-esteem was partially mediated by school liking, controlling for demographics at both student and school levels. Furthermore, a sex difference existed in the multilevel mediation model. For boys, school liking fully mediated the relationship between school safety at the school level and self-esteem. However, school liking partially mediated the relationship between school safety at the school level and self-esteem among girls.

CONCLUSION

School safety should receive increasing attention from policymakers because of its impact on students' self-esteem.

The mental health of children of migrant workers in Beijing: the protective role of public school attendance

The present study aims to understand the mental health status of an understudied group of migrant children - children of migrant workers in China. A total of 1,466 children from Beijing participated in the study that compared migrant children (n = 1,019) to their local peers (n = 447) in public and private school settings. Results showed that overall, migrant children reported more internalizing and externalizing mental health problems and lower life satisfaction than local peers. However, public school attendance served as a protective factor for migrant children's mental health. The mental health status of migrant children attending public schools, including externalizing problems as well as friend and school satisfaction, was not different from local children. In addition, our data indicates that the protective effect of public school attendance for migrant children may be even more salient among girls than boys, and for younger children than older children.

Impact of school staff health on work productivity in secondary schools in Massachusetts

BACKGROUND

Healthy, productive employees are an integral part of school health programs. There have been few assessments of work productivity among secondary school staff. This study describes the frequency of 3 common health risk factors--obesity, depressive symptoms, and smoking--and their impact on work productivity in secondary school employees.

METHODS

Employees of secondary schools in Massachusetts (N = 630) participated in a longitudinal weight gain prevention intervention study. Assessment completed at baseline, 1-year and 2-year follow-up included survey assessments of health risk factors as well as measurements for height, weight, and body mass index (BMI). The survey also included a depression inventory and Work Limitations Questionnaire. Data analysis included multivariate mixed effect models to identify productivity differences in relation to BMI, depressive symptoms, and smoking in this population stratified by position type (teacher and other school staff).

RESULTS

The sample included 361 teachers and 269 other school staff. Obesity, depressive symptoms, and smoking were significantly associated with work productivity, including workdays missed because of health concerns (absenteeism) and decreases in on-the-job productivity because of health concerns (presenteeism).

CONCLUSIONS

Three common health conditions, namely obesity, depressive symptoms, and smoking, adversely affect the productivity of high school employees.

Positive school climate is associated with lower body mass index percentile among urban preadolescents

BACKGROUND

Schools are an important environmental context in children's lives and are part of the complex web of factors that contribute to childhood obesity. Increasingly, attention has been placed on the importance of school climate (connectedness, academic standards, engagement, and student autonomy) as 1 domain of school environment beyond health policies and education that may have implications for student health outcomes. The purpose of this study is to examine the association of school climate with body mass index (BMI) among urban preadolescents.

METHODS

Health surveys and physical measures were collected among fifth- and sixth-grade students from 12 randomly selected public schools in a small New England city. School climate surveys were completed district-wide by students and teachers. Hierarchical linear modeling was used to test the association between students' BMI and schools' climate scores.

RESULTS

After controlling for potentially confounding individual-level characteristics, a 1-unit increase in school climate score (indicating more positive climate) was associated with a 7-point decrease in students' BMI percentile.

CONCLUSIONS

Positive school climate is associated with lower student BMI percentile. More research is needed to understand the mechanisms behind this relationship and to explore whether interventions promoting positive school climate can effectively prevent and/or reduce obesity.

Finding the way out: a non-dichotomous understanding of violence and depression resilience of adolescents who are exposed to family violence

OBJECTIVE

In this cross-sectional study on family violence and resilience in a random sample of 5,149 middle school students with a mean age of 14.5 years from four EU-countries (Austria, Germany, Slovenia, and Spain) we examined the prevalence of exposure to family violence, and we worked from the premise that adolescent can be resilient to family violence. We expanded the definition of resilience to include the absence of both physical aggression and depression symptoms in adolescents who have been exposed to violence in their families and extended our understanding of resilience to include three levels which we describe as: "resilient", "near-resilient" and "non-resilient", thus responding to calls for a more fluid and paths-based understanding of resilience.

METHODS

Data were collected via self-administered surveys consisting of a number of subscales that investigate depression symptoms and physical aggression. The study was analyzed with a three-stage strategy using logistic regression procedures, in which regression analyses were conducted separately for girls and boys using seven steps for modeling the three resilience levels.

RESULTS

More than 30% of our respondents reported experiencing family violence. Contrary to previous research findings, our data showed that structural characteristics like country, gender, socio-economic status and migration status were minimally predictive of violence and depression resilience at any level. Overall, for both sexes, despite some small but significant sex differences, resilience is strongly linked to personal and relational characteristics and the absence of experiences that involved exposure to and direct experiences with violence. Resilience supportive factors confirmed by this study are: higher emotional self-control, talking with parents or friends about violence, seeking help to avoid violence, and not endorsing aggression supportive beliefs. Also key to resilience are irrespective of country, gender, and SES are lower levels of experience with: victimization by boys, engagement in physical altercation with boys, parental abuse, witnessing of physical spousal abuse, exposure to an authoritarian (harsh) parenting style and verbal aggression from teachers.

CONCLUSION

From a content perspective this means that resilience is more than the absence of one or two behavioral factors. This also means that positive changes in resilience levels can be facilitated by supporting constructive personal and social relationships with family members, peers, and teachers. These results are discussed in terms of their practical implications for policy and intervention.

Association of pupil vandalism, bullying and truancy with teachers' absence due to illness: a multilevel analysis

The aim of this study was to examine whether vandalism, bullying, and truancy among pupils at school are associated with absence due to illness among teachers. Data on such problem behaviour of 17,033 pupils in 90 schools were linked to absence records of 2364 teachers. Pupil reported vandalism and bullying at the school-level were associated with teachers' short-term (1- to 3-day) absences. Cumulative exposure to various forms of pupils' problem behaviour was associated with even higher rates of short-term absences among teachers. No association was found between pupils' problem behaviour and teachers' long-term (>3-day) absences. In conclusion, there seems to be a link between pupils' problem behaviour and teachers' short-term absence due to illness. Further work should determine whether problem behaviour is a cause or a consequence of absences or whether the association is noncausal.

Organizational justice at school and its associations with pupils' psychosocial school environment, health, and wellbeing

It has been shown that the psychosocial environment perceived by school staff is associated with children's academic performance and wellbeing. In this study we examined the associations between organizational justice (procedural and relational justice) as reported by school staff and pupils' perceptions of their school environment, health problems, academic performance, and absenteeism. We combined data from two surveys: for the staff (the Finnish Public Sector Study, n = 1946) and pupils (the Finnish school health promotion survey, n = 11,781 boys and 12,842 girls) of 136 secondary schools, collected during 2004-2005. Multilevel cumulative logistic regression analyses showed that after adjustment for potential individual and school-level confounding factors, low procedural justice was associated with pupils' dissatisfaction with school-going. Low relational justice was associated with a 1.30 times higher risk of poor academic performance, 1.15 times higher risk of psychosomatic symptoms and 1.13 times higher risk of depressive symptoms among pupils. Both organizational justice components were associated with truancy. We concluded that staff perceptions of organizational justice at school are associated with pupils' reports of their psychosocial school environment, health, performance, and absenteeism due to truancy. Improving managerial and decision making procedures among school personnel may be an important factor for protecting pupils' academic performance and wellbeing.

Do schools influence student risk-taking behaviors and emotional health symptoms?

PURPOSE

Many schools engage in health promotion, health interventions, and services aimed at improving the health and well-being outcomes for students. The purpose of this study was to examine the effects of schools on student health risk-taking behaviors and depressive symptoms.

METHOD

A nationally representative sample (n = 9,056) of students from 96 secondary schools completed a health and well-being survey using Internet Tablets that included questions on school climate, health risk-taking behaviors, and mental health. Teachers (n = 2,901) and school administrators (n = 91) completed questionnaires on aspects of the school climate which included teacher well-being and burnout, the staff work environment, health and welfare services for students, and school organizational support for student health and well-being. Multilevel models were used to estimate school effects on the health risk-taking behaviors and depression symptoms among students.

RESULTS

Schools where students reported a more positive school climate had fewer students with alcohol use problems, and fewer students engaging in violence and risky motor vehicle behaviors. Schools where teachers reported better health and welfare services for students had fewer students engaging in unsafe sexual health behaviors. Schools where teachers reported higher levels of well-being had fewer students reporting significant levels of depressive symptoms.

CONCLUSIONS

More positive school climates and better school health and welfare services are associated with fewer health risk-taking behaviors among students. However, the overall school effects were modest, especially for cigarette use and suicidal behaviors.