Study objective: The school environment is of importance for child outcomes. Multilevel analyses can separate determinants operating at an individual level from those operating at a contextual level. This paper aims to systematically review multilevel studies of school contextual effects on pupil outcomes. Design: Key word searching of five databases yielded 17 cross sectional or longitudinal studies meeting the inclusion criteria. Results are summarised with reference to type of school contextual determinant. Main results: Four main school effects on pupil outcomes were identified. Having a health policy or antismoking policy, a good school climate, high average socioeconomic status, and urban location had a positive effect on pupil outcomes. Outcomes under study were smoking habits, wellbeing, problem behaviour, and school achievement. Conclusions: Despite the different pupil outcomes and the variety of determinants used in the included papers, a school effect was evident. However, to improve our understanding of school effects, presentations of results from multilevel studies need to be standardised. Intraclass correlation and explained between school variance give relevant information on factors in the school environment influencing pupil outcomes, and should be included in all multilevel studies. Inclusion of pupil level predictors in the multilevel models should be based on theoretical considerations of how schools and communities are interconnected and how pupils and their families are influenced by school contextual factors. C hildren and adolescents spend a considerable amount of their time in school, and the school environment is therefore of importance for child outcomes. Research within the framework of ''effective schools'' has established that factors in the school environment play a part in pupil achievement.1 In the 1970s, Rutter et al showed that pupils demonstrate greater school achievement and social adaptation in schools characterised by strong educational leadership, high expectations, and frequent evaluation by teachers. Furthermore, earlier reviews show that 10% of variation in pupils' achievements can be explained with reference to the school they have attended. School environment also has an impact on child health and wellbeing. Three recent reviews conclude that pupils' problem behaviours, alcohol and drug use, and crime are influenced by the school environment. [6][7][8] Wilson et al showed that interventions focusing on school context, rather than on individual pupils, were effective in preventing problem behaviours.8 Aveyard et al claim that the most effective methods to deter smoking are bans and enforcement. 6 Furthermore, Evans-Whipp et al found that more comprehensive and strictly enforced school policies are associated with less smoking. 7The association between school characteristics and child outcomes has been established mainly in ecological or individual based studies. Such study designs could, however, contain serious sources of error as they do not take into consideration ...

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Objectives. We conducted a systematic review of the health impacts of housing improvement. Methods. Forty-two bibliographic databases were searched for housing intervention studies from 1887 to 2007. Studies were appraised independently by H. T. and S. T. or E. S. for sources of bias. The data were tabulated and synthesized narratively, taking into account study quality. Results. Forty-five relevant studies were identified. Improvements in general, respiratory, and mental health were reported following warmth improvement measures, but these health improvements varied across studies. Varied health impacts were reported following housing-led neighborhood renewal. Studies from the developing world suggest that provision of basic housing amenities may lead to reduced illness. There were few reports of adverse health impacts following housing improvement. Some studies reported that the housing improvement was associated with positive impacts on socioeconomic determinants of health. Conclusions. Housing improvements, especially warmth improvements, can generate health improvements; there is little evidence of detrimental health impacts. The potential for health benefits may depend on baseline housing conditions and careful targeting of the intervention. Investigation of socioeconomic impacts associated with housing improvement is needed to investigate the potential for longer-term health impacts.

Growing up in a poor neighbourhood has negative effects on children and adolescents. In the literature it has been concluded that the risk of low birth weight, childhood injury and abuse, and teenage pregnancy or criminality double in poor areas. However, the validity of such studies has been questioned, as they have been associated with ecological or individualistic fallacies. Studies using multilevel technique might thus contribute important knowledge in this field. The present review clarifies the importance of neighbourhood contextual factors in child and adolescent health outcomes, through considering only studies using multilevel technique. Keyword searching of the Medline, ERIC, PsycInfo, Sociological Abstracts, and Social Citation Index databases was performed. Original studies using multilevel technique to examine the effect of neighbourhood characteristics on child and adolescent health outcomes, and focusing on populations in high-income countries were included. Neighbourhood socioeconomic status and social climate were shown to have small to moderate effects on child health outcomes, i.e. birth weight, injuries, behavioural problems, and child maltreatment. On average, 10% of variation in health outcomes was explained by neighbourhood determinants, after controlling for important individual and family variables. This review demonstrates that interventions in underprivileged neighbourhoods can reduce health risks to children, especially in families that lack resources. An analysis of methodological fallacies indicates that observed effects and effect sizes can be underestimated, and that interventions may well have greater impact than this review was able to establish.

Analysis 5.5. Comparison 5 Standardized effect estimates for general health outcomes following rehousing or retrofitting with or without neighbourhood renewal (post-1995) (non-experimental studies), Outcome 5 Lower Physical Component score (SF-36