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Student Health Risk, Resilience, and Academic Performance
Thomas Hanson, Greg Austin, and June Lee-Bayha
WestEd
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CDE (via Stuart Foundation) commissioned examination of two questions:
• Are California students in low performing schools exposed to more health risks and fewer development supports (assets) than students in other schools?
• How are student health risks and resilience assets related to the progress of California schools in raising test scores?
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Data• California Healthy Kids Survey (800,000
students, grades 7, 9 & 11)– Core Module (1,700 schools)– Resilience Module (600 schools)
• API Research Files (1999-2001)
• STAR Research Files (1998-2002)– Standardized Testing and Reporting school-level
test results.
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Analyses• School-level analyses (combined grades)
• Adjusted for racial/ethnic composition, parental education, ELL students, free/reduced meals, and baseline test scores (when appropriate)
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Physical Activity and API Scores (Concurrent Relationship)
77
81
85
89
93
API Score
Per
cen
t w
ho
en
gag
ed i
n a
ny
ph
ysic
al a
ctiv
ity
1st (Lowest)2nd3rd4th5th (Highest)
API Quintile
6
Physical Activity and Annual Changes in Test Scores
-0.4
0.10.6
1.21.7
1.0 1.3 1.6 1.8 2.1
0.71.2
1.62.0
2.4
Reading Language Mathematics
Percent who engaged in any physical activity
-10
-5
0
5
10
Cha
nge
in S
AT
-9 (
NP
R)
76 82 88 94 100 76 82 88 94 100 76 82 88 94 100
Source: California Healthy Kids Survey & STAR data files.
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Nutritious Intake and API Scores (Concurrent Relationship)
72
74
76
78
80
API Score
Per
cen
t re
po
rtin
g a
ny
nu
trit
iou
s in
take
1st (Lowest)2nd3rd4th5th (Highest)
API Quintile
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Nutritious Intake and Annual Changes in Test Scores
-0.1
0.3 0.61.1 1.4
1.0 1.3 1.6 1.9 2.21.5 1.6 1.6 1.7 1.7
Reading Language Mathematics
Percent who report any nutritious intake
-10
-5
0
5
10
Cha
nge
in S
AT
-9 (
NP
R)
71 74 76 79 81 71 74 76 79 81 71 74 76 79 81
Source: California Healthy Kids Survey & STAR data files.
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Breakfast Consumption and API Scores (Concurrent Relationship)
52
57
62
67
72
API Score
Per
cen
t w
ho
ate
bre
akfa
st
1st (Lowest)2nd3rd4th5th (Highest)
API Quintile
10
Breakfast and Annual Changes in Test Scores
-1.0-0.2
0.61.4
2.2
0.71.1
1.51.9
2.4
0.51.0
1.52.0
2.5
Reading Language Mathematics
Percent who ate breakfast
-10
-5
0
5
10
Cha
nge
in S
AT
-9 (
NP
R)
48 55 62 69 76 48 55 62 69 76 48 55 62 69 76
Source: California Healthy Kids Survey & STAR data files.
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Safety at School and API Scores (Concurrent Relationship)
73
79
85
91
97
API Score
Per
cen
t re
po
rtin
g f
eelin
g "
safe
" o
r "v
ery
safe
" at
sch
oo
l
1st (Lowest)2nd3rd4th5th (Highest)
API Quintile
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Safety at School and Annual Changes in Test Scores
-0.1
0.30.7
1.11.5
0.8 1.21.6 2.0
2.3
0.9 1.3 1.6 2.0 2.3
Reading Language Mathematics
Percent reporting feeling safe or very safe at school
-10
-5
0
5
10
Cha
nge
in S
AT
-9 (
NP
R)
73 79 85 91 97 73 79 85 91 97 73 79 85 91 97
Source: California Healthy Kids Survey & STAR data files.
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Lifetime Intoxication and API Scores (Concurrent Relationship)
3
13
23
33
43
API Score
Per
cen
t ev
er in
toxi
cate
d
1st (Lowest)2nd3rd4th5th (Highest)
API Quintile
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Lifetime Intoxication and Annual Changes
in Test Scores
2.21.6
0.6
-0.3-1.2
3.02.4
1.60.7
-0.1
2.92.4
1.60.8
0.1
Reading Language Mathematics
Percent ever intoxicated
-10
-5
0
5
10
Cha
nge
in S
AT
-9 (
NP
R)
0 10 25 40 55 0 10 25 40 55 0 10 25 40 55
Source: California Healthy Kids Survey & STAR data files.
15
0
2
4
6
8
API Score
Per
cen
t re
po
rtin
g a
ny
30-d
ay s
ub
stan
ce u
se o
n s
cho
ol
pro
per
ty
1st (Lowest)2nd3rd4th5th (Highest)
API Quintile
30-day Substance Use at School and API Scores(Concurrent Relationship)
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30-Day Substance Use at School and Annual Changes in Test Scores
1.51.1
0.6 0.3
-0.1
2.0 1.8 1.6 1.4 1.2
2.62.1
1.6 1.20.7
Reading Language Mathematics
Percent in school reporting any 30-day substance use on school property
-10
-5
0
5
10
Ch
an
ge
in S
AT
-9 (
NP
R)
0 3 6 8 11 0 3 6 8 11 0 3 6 8 11
Source: California Healthy Kids Survey
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Offered Illegal Drugs at School and API Scores (Concurrent Relationship)
6
15
24
33
42
API Score
Per
cen
t o
ffer
ed i
lleg
al d
rug
s
1st (Lowest)2nd3rd4th5th (Highest)
API Quintile
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Offered Drugs at School and Annual Changes
in Test Scores
2.01.4
0.7
-0.0-0.7
2.42.0
1.61.2
0.7
2.92.3
1.61.0
0.3
Reading Language Mathematics
Percent offered illegal drugs on school property
-10
-5
0
5
10
Cha
nge
in S
AT
-9 (
NP
R)
1 13 26 38 51 1 13 26 38 51 1 13 26 38 51
Source: California Healthy Kids Survey & STAR data files.
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Sadness/Hopelessness and API Scores (Concurrent Relationship)
23
26
29
32
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API Score
Per
cen
t re
po
rtin
g s
adn
ess/
ho
pel
essn
ess
1st (Lowest)2nd3rd4th5th (Highest)
API Quintile
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Sadness/Hopelessness and Annual Changes
in Test Scores
1.51.0 0.7
0.3
-0.2
2.42.0 1.6
1.20.7
2.62.1
1.71.1
0.6
Reading Language Mathematics
Percent reporting sadness/hopelessness (12 month)
-10
-5
0
5
10
Cha
nge
in S
AT
-9 (
NP
R)
20 25 29 34 39 20 25 29 34 39 20 25 29 34 39
Source: California Healthy Kids Survey & STAR data files.
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Resilience Assets• Caring Relationships – supportive connections
with others who serve as prosocial models and support healthy development.
• High Expectations – direct and indirect messages that students can and will succeed.
• Opportunities for Meaningful Involvement – relevant, engaging, and interesting activities. including opportunities for responsibility and contribution.
Resilience assets enhance school connectedness.
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School Caring Relationships and API Scores (Concurrent Relationship)
53
59
65
71
77
API Score
Car
ing
rel
atio
nsh
ips
at s
cho
ol
1st (Lowest)2nd3rd4th5th (Highest)
API Quintile
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School Caring Relationships and Annual Changes
in Test Scores
-0.3
0.1 0.40.8 1.2
0.8 1.1 1.51.9 2.2
0.51.0
1.52.1
2.7
Reading Language Mathematics
Percent reporting caring relations with adults at school
-10
-5
0
5
10
Cha
nge
in S
AT
-9 (
NP
R)
52 58 64 71 77 52 58 64 71 77 52 58 64 71 77
Source: California Healthy Kids Survey & STAR data files.
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School High Expectations and API Scores (Concurrent Relationship)
60
67
74
81
88
API Score
Hig
h e
xpe
cta
tio
ns
at
sch
oo
l
1st (Lowest)2nd3rd4th5th (Highest)
API Quintile
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School High Expectations and Annual Changes
in Test Scores
-0.5-0.1
0.40.9
1.4 1.0 1.2 1.4 1.7 1.9
0.8 1.11.5
1.92.3
Reading Language Mathematics
Percent reporting high expectations at school
-10
-5
0
5
10
Cha
nge
in S
AT
-9 (
NP
R)
58 65 72 80 87 58 65 72 80 87 58 65 72 80 87
Source: California Healthy Kids Survey & STAR data files.
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Cross-sectional Analyses: Main Findings
• Are California students in low performing schools exposed to more health risks and fewer development supports than students in other schools?– Yes – low performing schools generally have more students
exposed to health risk than other schools, even after accounting for socioeconomic characteristics.
• API scores were related to: – Physical Exercise– Nutrition– Substance Use– Violence and School Safety– School Developmental Supports
• 75% of health risk/resilience measures examined were concurrently related to API scores in expected ways
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Longitudinal Analyses: Main Findings
• How is student health risk related to the progress of California schools in raising test scores?
Test score gains were larger in schools with: – high levels of
• physical activity• healthy eating• school safety• caring relationships at school, high expectations at school, and
participation in meaningful activities in the community
– and low levels of• substance use, particularly substance use at school• drug availability at school• theft and vandalism, insecurity, and weapon possession • sadness and depression
– Results held for 40% of the health risk/resilience outcomes examined.
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Methodological Limitations• Limited to secondary schools that conducted
CHKS– Especially applies to resilience data
• Non-experimental data. – Other unmeasured factors could account for
relationship of health indicators to changes in test scores
• School-level analysis.– Results need to be confirmed using student-level
data.
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Implications
Addressing health and developmental needs of youth is a critical component of a comprehensive strategy for improving academic performance and turning around low-performing schools.
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Program Implications
Physical Activity and Nutrition:
• Increase student access to moderate-to-vigorous physical activity.
• Monitor nutritional content of food offered at school.
• Promote greater awareness among students about their physical health and nutrition.
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Program Implications
Crime, violence, and substance use.• Comprehensive early programs to prevent onset
of risk behaviors– Identify (CHKS) and target high-risk populations– Promote positive youth development
• Targeted intervention programs to address needs of students already demonstrating problems– Provide help-oriented Student Assistance with
referrals to services.
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Program Implications
Youth Development:
• Provide students with supportive, caring connections to adults at school who model and support healthy development.
• Provide clear and consistent messages that students can and will succeed.
• Involve students in meaningful activities.
• Ask students what they think! Hold a Listening to Students Workshop.
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For more information, see:• Hanson, T.L., Austin, G.A. & Lee-Bayha, J. (2004). Ensuring that
no child is left behind: How are student health risks & resilience related to the academic progress of schools. San Francisco, CA: WestEd.
• Hanson, T. L., & Austin, G. A. (2003). Student health risks, resilience, and academic performance in California: Year 2 report, longitudinal analyses. Los Alamitos, CA: WestEd.
• Hanson, T.L. & Austin, G.A. (2003). Are Student Health Risks and Low Resilience Assets an Impediment to the Academic Progress of Schools? (California Healthy Kids Survey Factsheet 3). Los Alamitos, CA: WestEd.
Available from the CHKS Website: www.WestEd.org/hks