摘要：Objectives. We sought to test the efficacy of an intervention that was designed to promote social inclusion and commitment to education, in reducing among students health risk behaviors and improving emotional well-being. Methods. The design was a cluster-randomized trial in 25 secondary schools in Victoria, Australia. The subjects were 8th-grade students (aged 13 to 14 y) in 1997 (n=2545) and subsequent 8th-grade students in 1999 (n=2586) and 2001 (n=2463). The main outcomes were recent substance use, antisocial behavior, initiation of sexual intercourse, and depressive symptoms. Results. At 4-year follow-up, the prevalence of marked health risk behaviors was approximately 20% in schools in the comparison group and 15% in schools in the intervention group, an overall reduction of 25%. In ordinal logistic regression models a protective effect of intervention was found for a composite measure of health risk behaviors in unadjusted models (odds ratio [OR]= 0.69; 95% confidence interval [CI]= 0.50, 0.95) and adjusted models (OR= 0.71; CI =0.52, 0.97) for potential confounders. There was no evidence of a reduction in depressive symptoms. Conclusion. The study provides support for prevention strategies in schools that move beyond health education to promoting positive social environments. Young people spend well over one third of their waking hours in school. For this reason, schools have often been a setting for preventive intervention. The use of school curricula to promote protective attitudes and skills has met with some success in reducing health risk behaviors. 1 – 3 However, there have been some spectacular failures, which have led to calls for a reexamination of current approaches to prevention in schools. 4 One potential but currently neglected focus for prevention is the school’s social milieu. 5 , 6 There is much evidence that the school’s social atmosphere affects patterns of substance use, antisocial and disruptive behaviors, as well as how well students learn. Advocates of health promotion have argued that addressing organizational processes and social relationships are likely to be effective in bringing about behavioral change. 7 – 9 Despite the attractiveness of such a health promotional approach, relatively few strategies have been tested that use this approach. 10 – 12 The Gatehouse Project intervention was designed as a structured process to promote a sense of social inclusion and connection in secondary schools, building on the principles of the Health Promoting Schools Project. 7 , 13 , 14 The process involved use of information about a school’s social climate to assist in setting priorities for action. Intervention elements ranged from establishing an inclusive classroom environment to creating opportunities for student participation in school life beyond the classroom, and included implementing a student curriculum that teaches interpersonal communication and emotional management. 15 , 16 We examine the school-level effects of this intervention on indexes of health and behavior in lower secondary schools. measured at 2-year and 4-year follow-up.
