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George C. Patton, MD, Lyndal Bond, PhD, John B. Carlin, PhD, Lyndal Thomas, BSc(Hons), Helen Butler, BA(Hons), Dip Ed, G Dip in Adol Health, Sara Glover, PhD, Richard Catalano, PhD and Glenn Bowes, PhD

George Patton is with the Centre for Adolescent Health and Murdoch Children’s Research Institute, Melbourne, Australia. Lyndal Bond is with the Centre for Adolescent Health and Department of Pediatrics, University of Melbourne, Melbourne. John Carlin is with the Clinical Epidemiology and Biostatistics Unit, Department of Pediatrics, University of Melbourne. At the time of the study, Lyndal Thomas and Sara Glover were with the Centre for Adolescent Health and Department of Pediatrics, University of Melbourne. Helen Butler is with the Centre for Adolescent Health and Murdoch Children’s Research Institute. Richard Catalano is with the Seattle Social Development Research Group, University of Washington, Seattle, Washington. Glenn Bowes is with the Department of Pediatrics, University of Melbourne.

Correspondence: Requests for reprints should be sent to George C Patton, William Buckland House, 2 Gatehouse St, Parkville, Victoria 3052, Australia. (e-mail: george.patton{at}rch.org.au; lyndal.bond{at}rch.org.au).

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.

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