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Objectives: It has been suggested that students are healthier in schools where more students are committed to school. Previous research has examined this only using a proxy measure of value-added education (a measure of whether school-level attendance and attainment are higher than predicted by students’ social profile), finding associations with smoking tobacco, use of alcohol and illicit drugs, and violence. These findings do not provide direct insights into the associations between school-level aggregate student commitment and health behaviours, and may simply reflect the proxy measure being residually confounded by unmeasured student characteristics. We examined the previously used proxy measure of value-added education, as well as direct measures at the level of the school and the student of lack of student commitment to school to see whether these were associated with students’ self-reported smoking tobacco, alcohol use and school misbehaviour. Design: Cross-sectional survey. Setting: A total of 40 schools in south-east England. Methods: Multi-level analyses. Results: There were associations between school- and student-level measures of lack of commitment to school and tobacco smoking, alcohol use and school misbehaviour outcomes, but the proxy measure of school-level commitment, value-added education, was not associated with these outcomes. A sensitivity analysis focused only on violent aspects of school misbehaviour found a pattern of associations identical to that found for the measure of misbehaviour. Conclusion: Our study provides the first direct evidence in support of the Theory of Human Functioning and School Organisation. [ABSTRACT FROM AUTHOR]

The integration of realist evaluation principles within randomised controlled trials (‘realist RCTs’) enables evaluations of complex interventions to answer questions about what works, for whom and under what circumstances. This allows evaluators to better develop and refine mid-level programme theories. However, this is only one phase in the process of developing and evaluating complex interventions. We describe and exemplify how social scientists can integrate realist principles across all phases of the Medical Research Council framework. Intervention development, modelling, and feasibility and pilot studies need to theorise the contextual conditions necessary for intervention mechanisms to be activated. Where interventions are scaled up and translated into routine practice, realist principles also have much to offer in facilitating knowledge about longer-term sustainability, benefits and harms. Integrating a realist approach across all phases of complex intervention science is vital for considering the feasibility and likely effects of interventions for different localities and population subgroups. [ABSTRACT FROM AUTHOR]

Drawing on two qualitative studies, we report evidence of pervasive black markets in confectionery, ‘junk’ food and energy drinks in English secondary schools. Data were collected at six schools through focus groups and interviews with students (n = 149) and staff (n = 36), and direct observations. Supermarkets, new technologies and teachers’ narrow focus on attainment have enabled these ‘underground businesses’ to emerge following increased state regulation of school food and drink provision. These activities represent a new form of counter-school resistance to institutional constraints within the context of enduring, although less visible, class-based stratification in British secondary schools. These black markets also appear to be partly driven by the unsafe and unsociable nature of school canteens, which was a recurring theme across all schools. These findings highlight how new school food ‘bans’ ignore the complex, ecological drivers of poor diet in youth and the potential for iatrogenic effects which exacerbate health inequalities. [ABSTRACT FROM AUTHOR]