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| Journal of the New Zealand Medical Association,
05-November-2004, Vol 117 No 1205
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The health of alternative education students compared to
secondary school students: a New Zealand study
Simon Denny, Terryann Clark, Peter Watson
Alternative education schools serve students with
behavioural problems, repeated expulsions and/or pregnancy/child care
responsibilities that preclude them from attending their usual secondary
schools. In New Zealand, alternative education (AE) is a relatively new concept.
In 1999, the New Zealand Ministry of Education set up the Alternative Education
Initiative in response to a growing concern by schools, communities and families
about the increasing number of young people who were excluded from school and
had few other educational options. In New Zealand, alternative education is
limited to students in school years 9 through 11 (aged 13 to 15 years). By 2002,
there were 2756 students enrolled in alternative education schools from
throughout New Zealand; this is approximately 1.6% of the total population of
young people aged 13 to 15 years.1,2
Previous research from overseas suggests that young people
excluded from mainstream education are more likely to have significant health
issues compared to students attending mainstream
education.3 We have previously shown that AE
students from New Zealand are similar to AE students in the United States and
engage in high rates of health risking
behaviours.4 What is less clear is the context
for these health issues among AE students in New Zealand and how the health and
wellbeing of AE students compare to students from secondary schools in New
Zealand.
MethodsBackground—In
the year 2000, the Adolescent Health Research Group developed a youth health
questionnaire administered by laptop computers (Youth2000) as part of a national
youth health survey to provide data on the health and wellbeing of New
Zealand’s youth.5 Alternative education
schools from Auckland and northern New Zealand were surveyed in the lead-up to
the national survey using the same youth health questionnaire and laptop
computer methodology.
Questionnaire
development—The questionnaire was developed over a 2-year period
and includes major themes and research questions identified by key stake holders
and end-users, including health providers, youth health researchers, government
agencies, schools, young people, and Maori and Pacific community leaders. A
survey tool using multi-media computer-assisted self-interviewing (M-CASI) was
developed to administer the questionnaire. Using M-CASI, the questionnaire was
pilot tested in a sample of 110 students (aged 12 to 18 years) from a diverse
range of socioeconomic and ethnic backgrounds.6
Revisions of the questionnaire were made based upon the
findings and experiences from the pilot study. The Reynolds Adolescent
Depression Scale (RADS) which measures depressive symptoms was incorporated into
the final survey.7 The RADS also allows for an
empirically derived cutoff score to define a clinically relevant level of
depressive symptomatology (ie, of sufficient severity to be considered
pathological).
Study
populations—All 36 AE schools from Auckland and Northland were
surveyed in 2000. Lists of AE schools were obtained from the Ministry of
Education and local coordinators of alternative education programs. The
requirement for inclusion was that each school receives funding from the
Ministry of Education to provide alternative education to students aged 13 to 15
years who are outside of and alienated from the education system. All 36 AE
schools in the region consented to take part in this study. Of the 365 students
enrolled in the AE schools, 276 completed the survey, 88 students were absent,
one student declined consent and seven student surveys were lost due to computer
error. The reasons for student absence were sickness or illness (16%), pregnancy
related (4%), truancy (23%), at work placement (3%), miscellaneous (14%), and
unknown (40%). The overall AE student response rate for survey analysis was
76%.
The national secondary school youth health survey was
conducted in 2001.5 133 schools were randomly
selected and invited to participate from a total of 389 New Zealand secondary
schools with school rolls greater than 50 students. A total of 114 schools
agreed to participate. At each school, the study administrators randomly
selected 15% of all eligible Year 9 to Year 13 students. A further 15% of the
students were randomly selected to be reserves if the selected students did not
arrive at the study venue on the day of the survey.
Students were ineligible to participate if they were
not New Zealand residents, if they had insufficient English language skills, or
had a disability that preventing them from using a standard laptop computer. For
the majority of students who were selected but did not participate, no reason
could be identified. Twenty-eight percent of non-participating students were
absent on the day of the survey and 2.5% actively declined to participate. A
total of 9567 students completed Youth2000 with an overall response rate of
64.3%.
Because AE schools only enrol students from Year 9
through Year 11, comparisons with the secondary school students were restricted
to students in Year 9 to 11. Only students from Auckland and Northland regions
from the national youth health survey were used for comparison with the
alternative education school data. This resulted in 2104 students in Years 9 to
11 from the national youth survey for comparison with AE data.
Table 1 shows the demographic characteristics of the AE
students and secondary school student sample. The majority of AE students are
male (68%), aged between 14 and 15 years (75%) and Maori (78%). The secondary
school student sample has slightly more female students (58%), mostly aged 13
years to 15 years, and represented a range of ethnic backgrounds.
Consent procedures were the same for both studies.
Information about the survey was sent to all families of students who were
invited to participate in the surveys. Parents were able to withdraw their child
from the study. Informed consent was obtained from all participating young
people. Ethical approval for both studies was obtained from the University of
Auckland Human Subjects Ethics Committee.
Analysis—Estimated
proportions and their 95% confidence intervals were calculated separately for
males and females. Estimates and standard errors were adjusted for the
clustering of data within schools and the unequal probabilities of selection of
students.8 Differences are considered
statistically significant if the 95% confidence intervals do not overlap. The
use of non-overlapping confidence intervals to test for significant differences
has been shown to underestimate significant
differences.9 This method was chosen for this
analysis because of the number of comparisons being made and the small size of
the alternative education sample. Confidence intervals are able to give a better
understanding of the differences between the two populations than more direct
tests of proportions.
Table 1. Demographic characteristics of students at
alternative schools and secondary schools from Auckland and northern New Zealand
(NZ)
*Mean age=14.5; 95% confidence
interval=14.3–14.6; †Mean age = 14.1; 95% confidence
interval=14.0–14.2; AE=Alternative eduction.
ResultsSocioeconomic
and family environments—Table 2 shows that there are large
differences between AE students and secondary school students on a range of
socioeconomic indicators. Over 40% of AE students had moved their home two or
more times in the previous year compared to less than 15% of secondary school
students. Proportionally more AE students said that an adult in their home had a
community services card then secondary school students. Basic household
resources, like a working car, were reported less frequently among AE students
than secondary school students.
AE students were less likely than secondary school students
to report supportive relations with their parents (Table 2). More male AE
students than male secondary school students report that they feel that they
have less supportive home environments and were less likely to report getting
enough time with their mother or father, getting praise from their family, or
feeling close to their mother or father. Both male and female AE students were
less likely to report that their mother or father care a lot about them than
male and female secondary school students. In contrast, similar proportions of
AE and secondary school students report supportive relations with other family
members and relatives who do not live with them.
Table 2. Socioeconomic indicators and family
environments
*Most of the time;
†Usually or always; ‡Non-overlapping confidence intervals between
the AE and secondary school students.
School and Community
Environments—Both AE students and secondary school students report
high levels of supportive school environments (Table 3). A higher proportion of
AE students say that a teacher had gotten to know them well during the school
year than secondary school students. Proportionally fewer female AE students
report that people at their school expect them to do well compared to female
secondary school students.
Similarly, both AE students and secondary school students
report feeling connected to their communities and environments (Table 3). All
students report high levels of connection to friends, and over half of the
students indicated there was an adult in their community they could talk to
about a serious problem. Compared to male students, proportionally more female
students from both AE schools and secondary schools indicated that they had a
friend they could talk to about serious problems and/or that their friends care
a lot.
About half of all students said that their spiritual beliefs
were very important to them. AE students were significantly less likely to
report attending a place of worship regularly than secondary school students.
Less than 10% of AE students reported attending a place of worship regularly,
compared to about 25% of secondary school students.
Table 3. School and community environments
*Non-overlapping confidence
intervals between the AE and secondary school students.
Health risking
behaviours—Most AE students have been sexually active (Table 4).
Over 80% of AE students have had sexual intercourse compared to approximately
25% of secondary school students. More than 70% of AE students have been
sexually active in the previous 3 months compared to less than 20% of secondary
school students. Proportionally more AE students had been pregnant or been
involved in a pregnancy than secondary school students, and more female AE
students reported that they have had a sexually transmitted infection than
female secondary school students. Among those students who were sexually active,
proportionally fewer female AE students had used a condom during previous sexual
intercourse than female secondary school students.
About three-quarters of male AE students reported being
exclusively attracted to the opposite sex which was significantly less than male
secondary school students where almost 90% reported being exclusively attracted
to the opposite sex.
Table 4 shows that AE students were much more likely to
report using cigarettes, alcohol and other drugs than secondary school students.
About 50% of male AE students and 70% of female students report smoking
cigarettes weekly or more often, compared to less than 15% of male and female
secondary school students.
Table 4. Percentages of students who engaged in sexual
behaviours and substance use
*Had sexual intercourse during the 3 months preceding the
survey; †Drank ≥5 drinks of alcohol in one session (within 4 hours)
in the previous 4 weeks; ‡Non-overlapping confidence intervals between the
AE and secondary school students.
Almost half of female AE students reported that they drink
alcohol weekly or more often, and three-quarters of female AE students report
binge drinking during the previous 4 weeks.
Most AE students had tried marijuana, and over half of the
AE students reported using marijuana weekly or more often—compared to less
than 7% of secondary school students. Over one-third of AE students reported
that they had tried other drugs, such as hallucinogens, stimulants, narcotics
and/or cocaine, compared to less than 6% of secondary school students.
Violence, injuries, and
motor vehicle use—A greater proportion of AE students report
experiencing violence and abuse in the previous 12 months compared to secondary
school students (Table 5). Almost 70% of AE students had been in a serious
physical fight in the previous 12 months compared to less than 30% of secondary
school students. A greater proportion of AE students report experiencing sexual
abuse in their lives compared to secondary school students, especially among
female AE students. More than half of female AE students have experienced sexual
abuse, compared to one-quarter of female secondary school students.
Table 5. Experience of violence, injuries, and motor
vehicle use
*During the previous 4 weeks; †Non-overlapping
confidence intervals between the AE and secondary school students.
Table 5 shows that AE students are significantly more
vulnerable to injury due to dangerous motor vehicle use than secondary school
students. Regular seatbelt use was three to four times lower among AE students
compared secondary school students. About half of AE students had been in a car
driven by someone who had been drinking alcohol during the previous 4 weeks
compared to about one-quarter of secondary school students. Similarly, about two
thirds of AE students had been in a car driven by someone who had been taking
drugs and/or driving dangerously such as speeding, car chases and burnouts,
compared to less than one-third of secondary school students.
Emotional
wellbeing—A significantly higher proportion of AE students report
emotional health problems and/or attempted suicide compared to secondary school
students (Table 6). Approximately 30% of female and 20% of male AE students
reported levels of depressive symptoms above the RADS cutoff score indicating a
high likelihood of clinically significant depressive symptoms. Similar
proportions of female and male AE students had made one or more suicide attempts
in the previous 12 months.
Serious suicide attempts that resulted in medical treatment
were made by about 10% of AE students in the previous 12 months, compared to
about 2% of secondary school students. Significantly more male AE students had
made serious suicide attempts in the previous 12 months compared to male
secondary school students.
Table 6. Relative emotional wellbeing of
students
*Reynolds Adolescent
Depression Scale cutoff; †Tried to kill yourself (attempt suicide);
‡Non-overlapping confidence intervals between the AE and secondary school
students.
Discussion
This study compares the health and wellbeing of AE students
to secondary school students in the northern region of New Zealand. This study
also examines the community, school, and family contexts of AE students and
secondary schools students. This study demonstrates that (compared to secondary
school students) AE students are more likely to come from disadvantaged
backgrounds, are vulnerable to behaviours that threaten their health and
wellbeing, and suffer from serious emotional health concerns. These findings
highlight the need for explicit policies and programs to address the health
concerns of AE students.
Compared to secondary school students, AE students are more
likely to come from disadvantaged backgrounds, with proportionally more AE
students reporting socioeconomic difficulty and less parental connection than
secondary school students. These findings are supported by research that has
shown students who are risk of dropping out of secondary school are more likely
to come from families experiencing poverty10
and to experience adverse family
environments.11
In contrast, AE students’ positive connections to
their wider family, school, and community are similar to secondary school
students. AE students were just as likely as secondary school students to report
that other family members, relatives, and their friends care a lot about them.
Of importance is that most AE students in this study report that they feel like
they are part of their school and that people at their school care about them.
Indeed, alternative education schools (more than secondary schools) have been
recognised for providing more supportive and nurturing environments for students
at risk of education failure.12, 13
This study highlights that AE students engage in
significantly higher rates of health-risking behaviours than secondary school
students.
These behaviours place AE students’ health at greater
vulnerability due to:
Several recent studies have shown similar
results.3,14,15 Our study found that AE
students are at higher risk for significant symptoms of depression than students
from secondary schools. Over 25% of AE students had levels of depressive
symptoms indicative of significant psychopathology and a similar proportion had
made one or more suicide attempts in the previous 12 months.
While there have been few direct comparisons of the
emotional wellbeing of AE students compared to secondary school students, the
rates of significant depression symptoms found in this study among AE students
are similar to a study of AE students from a large urban city in southeast
Texas, USA.16 Those findings show that students
who are in alternative educational settings have significant health issues, both
acute and chronic, as a result of a higher prevalence of health risking
behaviours and emotional health concerns.
A major strength of the current study is that the
methodology was the same for both AE and secondary school populations. This
makes comparisons between the two student populations in our study more valid
than studies biased by comparing data from different methodologies and
questionnaires. That said, this study included some limitations. It used
cross-sectional design, and cannot answer questions such as the effect of AE
schools themselves on students’ behaviour. A further limitation of this
study is that the two student populations may not be directly comparable.
The average age of AE students is slightly higher than
students from secondary schools in Year 7 through Year 9. This may account for
higher rates of health jeopardising behaviours among AE students as most health
risking behaviours increase through the secondary school
years.17 However, younger students in AE
schools have been shown to be as likely, or more likely, to be engaging in
health risk behaviours compared to older
students.18 Demographic differences were not
adjusted for in the current study as it is primarily a descriptive study.
A further limitation of the current study was the different
ethnic composition of the AE schools compared to the secondary schools, leading
to the inaccurate conclusion that the health-risking behaviours and emotional
health problems of the AE students are attributable to their different ethnic
and cultural backgrounds.
Post-hoc analyses stratifying by ethnicity showed very few
differences in the findings from the current study (tables available upon
request). This suggests that it is the pathways to school failure that are the
most detrimental to students’ health and wellbeing rather than ethnic or
cultural background. That said, it must be recognised that many secondary
schools are failing significant numbers of Maori students. Maori students are
more likely to be suspended from school than students from other ethnic
groupings, and leave school earlier than other
students.19
In the past, lower socioeconomic status and lower levels of
parental education of Maori were thought to be the main influence on poor school
performance and higher school drop-out rates.20
However, recently there has been a renewed focus on the role of teachers and the
teaching process on student learning and
achievement.21,22
For Maori, creating culturally appropriate and responsive
learning environments has been shown to significantly improve educational
outcomes.23 Compared to secondary schools, it
appears that alternative education schools are providing more supportive
environments, especially for Maori students. It is paramount that secondary
schools take a proactive approach to also improve the learning environments for
Maori students to improve education achievements and retention at
school.
ConclusionThis study highlights the need for
explicit health policies and programs for alternative secondary school students.
Indeed, the high levels of health-risking behaviours and emotional health
problems within the AE population are of serious concern. Given the magnitude of
the health problems that AE students face, collaborations between community
health providers, specialist youth, and mental health services and educators are
vital to most effectively utilise available resources and improve health
services access.
One of the major findings from this study is that AE schools
are providing supportive and caring environments for AE students. This is
significant as one of the most important components of effective alternative
education appears to be a caring environment for students in alternative
schools.13 Furthermore, current research shows
that effective alternative education can improve the outcomes for young people
by improving attitudes towards school and education, reducing drop-out rates,
reducing health-risking behaviours, and improving long-term employment
prospects.12,24,25
Alternative-education schools are in a unique position to
improve the health of their students by:
Lastly, secondary schools can look to AE schools
to model more supportive and caring environment for students at risk of
educational failure.
Author information:
Simon Denny, Senior Lecturer, Department of Paediatrics, Faculty of Medical and
Health Sciences, University of Auckland, Auckland; Terryann Clark, Adolescent
Nurse Specialist, University of Minnesota, Minneapolis, USA; Peter Watson,
Senior Lecturer, Department of Paediatrics, Faculty of Medical and Health
Sciences, University of Auckland, Auckland
Acknowledgements:
This research was supported by Grant 00/208 from the Health Research Council of
New Zealand. Portables Plus Ltd and the Starship Foundation provided support
with laptop computers. We thank the participating school students (and schools),
the project workers, and the project advisory groups for their contributions to
this study. The authors also thank Elizabeth Robinson and Sue Crengle for their
thoughtful comments and suggestions on earlier drafts of this paper.
Correspondence: Dr
Simon Denny, Senior Lecturer, The Centre for Youth Health, Department of
Paediatrics, Faculty of Medical and Health Sciences, University of Auckland; PO
Box 23-562, Auckland. Fax (09) 279 5111; email: sdenny@middlemore.co.nz
References:
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