Health-Related Behaviors and Academic Achievement Among High School Students

United States, 2015

Catherine N. Rasberry, PhD; Georgianne F. Tiu, DrPH; Laura Kann, PhD; Tim McManus, MS; Shannon L. Michael, PhD; Caitlin L. Merlo, MPH; Sarah M. Lee, PhD; Michele K. Bohm, MPH; Francis Annor, PhD; Kathleen A. Ethier, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2017;66(35):921-927. 

In This Article

Abstract and Introduction

Introduction

Studies have shown links between educational outcomes such as letter grades, test scores, or other measures of academic achievement, and health-related behaviors.[1–4] However, as reported in a 2013 systematic review, many of these studies have used samples that are not nationally representative, and quite a few studies are now at least 2 decades old.[1] To update the relevant data, CDC analyzed results from the 2015 national Youth Risk Behavior Survey (YRBS), a biennial, cross-sectional, school-based survey measuring health-related behaviors among U.S. students in grades 9–12. Analyses assessed relationships between academic achievement (i.e., self-reported letter grades in school) and 30 health-related behaviors (categorized as dietary behaviors, physical activity, sedentary behaviors, substance use, sexual risk behaviors, violence-related behaviors, and suicide-related behaviors) that contribute to leading causes of morbidity and mortality among adolescents in the United States.[5] Logistic regression models controlling for sex, race/ethnicity, and grade in school found that students who earned mostly A's, mostly B's, or mostly C's had statistically significantly higher prevalence estimates for most protective health-related behaviors and significantly lower prevalence estimates for most health-related risk behaviors than did students with mostly D's/F's. These findings highlight the link between health-related behaviors and education outcomes, suggesting that education and public health professionals can find their respective education and health improvement goals to be mutually beneficial. Education and public health professionals might benefit from collaborating to achieve both improved education and health outcomes for youths.

The national YRBS is a biennial, school-based survey of U.S. high school students conducted by CDC. For the 2015 survey, a three-stage cluster sample design was used to produce a nationally representative sample of students in grades 9–12 who attended public and private schools.[6] The school response rate was 69%, the student response rate was 86%, and the overall response rate (the school response rate multiplied by the student response rate) was 60%. Data were weighted based on sex, race/ethnicity, and school grade to adjust for nonresponse and oversampling of black and Hispanic students. The final data set included data from 15,624 students in grades 9–12.

School-level parental permission procedures were followed before survey administration, and participation was voluntary. Survey procedures were designed to protect students' privacy by allowing for anonymous participation. Students completed the self-administered questionnaire during a single class period and recorded their responses on a computer-scannable booklet or answer sheet.

Academic achievement was measured with a question on self-reported letter grades in school: "During the past 12 months, how would you describe your grades in school?" Students could select one of the following response options: mostly A's, mostly B's, mostly C's, mostly D's, mostly F's, none of these grades, and not sure. Data from additional questions were used to measure five dietary behaviors, three physical activity behaviors, two sedentary behaviors, seven substance use behaviors, five sexual risk behaviors, five violence-related behaviors, and three suicide-related behaviors. The dietary behaviors included (for the 7 days before the survey): ate breakfast on all 7 days; ate fruit or drank 100% fruit juices one or more times per day; ate vegetables one or more times per day; drank one or more glasses of milk per day; and did not drink a can, bottle, or glass of soda or pop. The physical activity behaviors included being physically active at least 60 minutes per day on 5 or more days during the 7 days before the survey, played on at least one sports team during the 12 months before the survey, and attended physical education classes on 1 or more days in an average week when they were in school. The sedentary behaviors included having watched television 3 or more hours per day on an average school day, and played video or computer games or used a computer for something that was not school work 3 or more hours per day on an average school day.

The substance use behaviors included current alcohol use (on at least 1 day during the 30 days before the survey); current marijuana use (one or more times during the 30 days before the survey); ever use of cocaine, ever use of heroin, ever use of methamphetamines, ever injection of any illegal drug, and ever took prescription drugs without a doctor's prescription. The sexual risk behaviors included ever had sexual intercourse, had sexual intercourse with four or more persons, currently sexually active (had sexual intercourse during the 3 months before the survey), did not use a condom during last sexual intercourse, and did not use any method to prevent pregnancy during last sexual intercourse. The violence-related behaviors included having experienced, during the 12 months before the survey, physical violence by someone they were dating or going out with, sexual violence by someone they were dating or going out with, being bullied on school property, and being electronically bullied, and, during the 30 days before the survey, not going to school because of safety concerns. Finally, the suicide-related behaviors included having, during the 12 months before the survey, seriously considered attempting suicide, made a plan about how they would attempt suicide, and attempted suicide. Four additional questions on sex, race, ethnicity, and grade in school were used to create control variables for the statistical analyses.

Unadjusted prevalence estimates were calculated. Logistic regression models were used to determine whether the categorical variable of self-reported grades in school was associated with each health-related behavior while controlling for sex, race/ethnicity, and grade (9th, 10th, 11th, or 12th). Wald F p-values from the logistic regressions were used to determine statistically significant associations between overall self-reported letter grades in school and each behavior with an alpha level of 0.05. Comparisons of students with specific self-reported grades (mostly A's, mostly B's, or mostly C's) against a combined referent group of students with mostly D's/F's were also assessed.

Unadjusted percentages showed a general gradient of association between self-reported letter grades and health behaviors ( Table 1 ). After adjusting for sex, race/ethnicity, and grade level, overall self-reported grades in school were significantly associated with each behavior (p<0.05), except for physical education attendance (p = 0.6416) ( Table 2 ). Students with mostly A's, mostly B's, or mostly C's had significantly higher prevalence estimates for most protective health-related behaviors and significantly lower prevalence estimates for most health-related risk behaviors, including all substance use, sexual risk, violence-related, and suicide-related behaviors ( Table 2 ). Prevalence estimates for students with mostly C's were not significantly different from those for students with mostly D's/F's for two behaviors: ate vegetables one or more times per day during the past 7 days and watched television 3 or more hours per day on an average school day.

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