Comparison of substance use, subjective well-being and interpersonal relationships among young people in foster care and private households: a cross sectional analysis of the School Health Research Network survey in Wales

Abstract

ObjectiveTo investigate the association of living in foster care (FC) with substance use and subjective well-being in a sample of secondary school students (11–16 years) in Wales in 2015/16, and to examine whether these associations are attenuated by the perceived quality of interpersonal relationships.DesignCross-sectional, population-based health behaviour and lifestyle questionnaire.Setting and participantsWales, UK; young people who took part in the 2015/16 School Health Research Network (SHRN) questionnaire (n=32 479).Primary outcomeHealth behaviours among young people in FC were compared with those from private households.ResultsThe prevalence of all adverse outcomes was higher among young people in FC. Those in FC were significantly more likely to report mephedrone use (OR=9.24, 95% CI 5.60 to 15.34), multiple substance misuse behaviours (OR=3.72, 95% CI 2.30 to 6.00), poorer relationships with peers (RR=1.88, 95% CI 1.23 to 2.88) and teachers (RR=1.83, 95% CI 1.31 to 2.56), having experienced bullying (OR=1.80, 95% CI 1.38 to 2.35), dating violence (OR=1.66, 95% CI 1.13 to 2.43) and poor well-being (RR=1.72, 95% CI 1.20 to 2.46). The association between FC and substance use remained significant, though was attenuated after accounting for relationship variables. The association between FC and subjective well-being became non-significant after adjustment for relationship variables.ConclusionsYoung people living in FC experience significantly worse outcomes than young people not in care, likely due to a range of care and precare factors, which impact adversely on subsequent social relationships. The analyses are consistent with the hypothesis that the associations of FC with substance use and life satisfaction are partially explained by poorer quality social relationships. Large scale, longitudinal studies are required to investigate the relationship between being in care and health, educational and social outcomes. Mental health interventions and interventions to reduce substance use and improve well-being in FC should include a focus on supporting healthy social relationships.

School, Peer and Family Relationships and Adolescent Substance Use, Subjective Wellbeing and Mental Health Symptoms in Wales: a Cross Sectional Study

“…The role of peers was however somewhat more ambiguous, including both positive and negative associations with health and wellbeing outcomes. In contrast to some previous studies (Bond et al, 2007 ), though consistent with recent studies from Wales (Long et al, 2017 ), supportive relationships with friends were associated with increased risk of smoking, drinking and drug use, though not subjective wellbeing and mental health. By contrast, young people who reported better connectedness to peers in the school environment reported better wellbeing and mental health (though did not differ in terms of substance use risk).…”

“…In a longitudinal analysis, Bond et al ( 2007 ) found that school connectedness and connectedness to peers independently predicted mental health and substance use outcomes. More recent UK studies have replicated these associations of teacher-pupil relationships with substance use and subjective wellbeing (Long et al, 2017 ; Moore et al, 2017 ).…”

“…While close relationships with family are almost universally discussed as protective for substance use, subjective wellbeing and mental health, peer relationships have been considered simultaneously as risk and protective factors. In recent analyses of data from Wales for example, young people who reported that they could count on friends reported better subjective wellbeing, though greater risk of binge drinking (Long et al, 2017 ).…”

Testing the “Zero‐Sum Game” Hypothesis: An Examination of School Health Policies and Practices and Inequalities in Educational Outcomes

“…Our results provide evidence of better attendance and attainment at KS3 in schools with more health improvement activity. Health improvement action may target a range of causal pathways that influence health and attainment and reduce inequalities . For example, emphasis on staff‐student relationships may mitigate the association between disadvantage and poor outcomes .…”

A Transdisciplinary Complex Adaptive Systems (T-CAS) Approach to Developing a National School-Based Culture of Prevention for Health Improvement: the School Health Research Network (SHRN) in Wales

“…At the population level, the data infrastructure provides partners with a national health surveillance and monitoring system which provides timely data on fast moving issues such as electronic cigarette uptake (de Lacy et al 2017) and on vulnerable groups (Long et al 2017). Related to this, the infrastructure's flexibility means policy-relevant data can readily be collected and used to monitor new policies, such as the new curriculum.…”