title: The search for healthy schools: A multilevel latent class analysis of schools and their students.
abstract: The objective of this study was to establish and investigate a taxonomy of school health among high school students in Ontario, Canada. Data analyzed were based on 3358 9th-12th graders attending 103 high schools who participated in the 2011 Ontario Student Drug Use and Health Survey. Based on 10 health-related indicators, multilevel latent class analysis was used to extract 4 student-level latent classes and 3 school-level latent classes. Unhealthy schools (19% of schools) had the lowest proportion of healthy students (39%) and the highest proportion of substance-using (31%) and unhealthy (18%) students. Healthy schools (66%) contained the highest proportion of healthy students (56%) and smaller proportions of substance-using (22%) and unhealthy students (8%). Distressed schools (15%) were similar to healthy schools in terms of the proportions of healthy and unhealthy students. Distressed schools, however, were characterized by having the largest proportion of distressed students (35%) and the lowest proportion of substance-using students (4%). Meaningful categories of schools with respect to healthy environments can be identified and these categories could be used for focusing interventions and evaluating school health programs.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6 Floor, Toronto, Ontario M5T 3M7, Canada.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Allison
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6 Floor, Toronto, Ontario M5T 3M7, Canada; Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Adlaf
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
authors.forename: Hyacinth M
authors.initials: HM
authors.lastname: Irving
authors.affiliation: Schoueri Consulting, Toronto, Ontario, Canada.
authors.forename: Nour
authors.initials: N
authors.lastname: Schoueri-Mychasiw
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6 Floor, Toronto, Ontario M5T 3M7, Canada; Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, Ontario M5S 2S1, Canada.
authors.forename: Jurgen
authors.initials: J
authors.lastname: Rehm
keywords: Healthy schools; High school students; Nonparametric multilevel latent class analysis