1. Healthier Students are Better Learners: Building a research strategy and agenda for improving health and K-12 education outcomes
No matter what improvements are made in … read mater off slide ... The educational benefits to students will be limited if they are not motivated and able to learn.
Charles E. Basch

2. Strategies to Improve Educational Outcomes
Standards and accountability
Revising school financing
Teacher preparation
Rigorous curricula
Charter schools
Reducing educationally relevant health disparities

3. Reciprocal Relationships
Health
Education
Poverty
There are reciprocal causal relationships between children’s health educational attainments and underlying economic and social conditions. The focus today is on how certain health problems influence academic achievement and educational attainment.

4. Criteria for Selecting Strategic Priorities
Extent of health disparities
Causal effects on educational outcomes
Feasibility of school-based programs and policies
School can’t address all health problems. Leaders need a way to prioritize. In my work, I have used three criteria to establish priorities: read 3 criteria on slide.

5. 8 Priority, Educationally Relevant Health Factors
Vision
Asthma
Teen pregnancy
Aggression and violence
Physical activity
Breakfast
ADHD
Oral health problems
Based on these criteria, there are 8 health problems that warrant consideration as priorities. Further, mental and emotional health must be addressed thematically since it is a cause and/or consequence of all the other problems. This list is not meant to say that every school must address all of these problems, or that other problems not included on this list may not be priorities. The intent is that, based on the criteria outlined previously, these health problems warrant consideration as priorities.

6. Mental and Emotional Health … cause and/or consequence of each health issue
And students who are affected by one problem are also more likely to be affected by others, which is why it’s so important for school based initiatives to focus on multiple problems simultaneously

7. High Prevalence Visual problems: ~20% of low-income youth
Asthma: ~13% of youth <18
Teen pregnancy: 6% of 15 to 19 year-olds annually
Violence: 20% of high school students bullied at school annually
Physical activity: ~2 in 3 don’t get enough
Breakfast: ~14% of high school students skip it
ADHD: ~12.2% of year-olds diagnosed
Untreated caries: 23% of 2- to 11-year-olds olds
Read material on slide. Then note that all of these health problems disproportionately affect low-income urban minority youth.

8. Rates of Visual Impairment in US Among Persons Age 12 and Above, by Race/Ethnicity and Income
Compared with whites, Blacks and Hispanics high higher rates of visual impairment. People with low-come have higher rates as well.
*Income below poverty level; **Income >2X poverty level
Source: NHANES

9. Asthma Prevalence for Youth in US, Ages 5 – 14, by Race/Ethnicity
For youth aged 5-14, compared with whites, the prevalence of asthma for Blacks is twice as high (18.8% versus 9.4%). The last two bars in the histogram indicate the importance of disaggregating the Hispanic population. These same disparities exist for poorly controlled asthma, as indicated by overuse of emergency departments for asthma care and underuse of efficacious medications.
Source: CDC, National Surveillance of Asthma: US,

10. Birth Rates Per 1,000 Among 15 – 17 Year Olds in US, by Race/Ethnicity
21.9
Percent
8.4
While teen birth rates have declined dramatically over the past several decades, the U.S. still has high teen birth rates compared with many other nations.
Source: National Vital Statistics Reports, 2012

11. Percentage of High School Students in US Who Were in a Physical Fight,
Percentage of High School Students in US Who Were in a Physical Fight,* by Race/Ethnicity**
34.7
28.4
20.9
Percent
These data, which are nationally representative of high school students in the U.S. show that, compared with white high school students, Black and Hispanic high school students are considerably more likely to have been in a physical fight during the 12 months preceding the YRBD survey, which is conducted biennially by the U.S. Centers for Disease Control and Prevention.
*One or more times during the 12 months before the survey.
** B > H > W
Source: CDC, National Youth Risk Behavior Survey, 2013

12. Percentage of High School Students in US Who Did Not Go to School Because They Felt Unsafe at School or On Their Way to or From School,* by Race/Ethnicity**
7.9
Percent
5.6
This slide show the percentage of high school students that have missed one or more days of school in the past 30 days, and indicates that almost 1 in 10 Hispanic high school students report that they have missed one or more days of school in the past month because they felt unsafe at school or traveling to or from school. We have made very little progress in changing this metric.
*On at least 1 day during the 30 days before the survey.
**H >B > W
Source: CDC, National Youth Risk Behavior Survey, 2013

13. Percentage of Female High School Students in US Who Did Not Participate in Physical Activity,* by Race/Ethnicity**
27.3
20.3
16.1
Percent
Compared with white female high school students, almost 70% more Black female high school students and over 25% more Hispanic female high school students did not participate in in physical activity (for 60 minutes on at least 1 day during the 7 days before being surveyed).
*Did not participate in 60 or more minutes of any kind of physical activity that increased their heart rate and made them breathe hard some of the time on at least 1 day during the 7 days before the survey
**B > H > W
Source: CDC, National Youth Risk Behavior Survey, 2013

14. Percentage of White and Black Girls Who Consumed Breakfast on All 3 Days Assessed
At Age 9
This slide, based on the NHLBI longitudinal Growth and Health Survey, shows that, while 77% of white 9 year-old children consumed breakfast on all 3 days assess, only 57% of black children did so. The proportion of both white and Black children who consumed breakfast on all 3 days assessed declined in both groups. Nevertheless, compared with white children, a lower proportion of Black children consumed breakfast on all 3 days assessed. Note that while the absolute differences between white youth and black youth decline as youth grow older (from 20 percentage points to 10 percentage points), the relative differences between whites and Blacks increased.
Source: NHLBI, Longitudinal Growth and Health Survey; n = 1166 white and 1213 black girls

15. Prevalence of ADHD Among 3 -17 Year Olds in US, by Family Status and Income
12.4
11.7
8.8
8.3
Percent
Compared with youth in families with both parents and with higher incomes, youth in single mother families and in families with household income < $35,000 have higher rates of ADHD.
Source: National Health Interview Survey, 2012

16. Prevalence of Sealants on Permanent Teeth Among Youth 6 -11 Years of Age, 1999 - 2004
40.1
36.1
24.2
21.3
20.9
% with Sealants
These same patterns are seen with respect to sealants on permanent teeth among youth aged 6 to 11.
Source: CDC, Vital Statistics, April Trends in Oral Health Status: United States, 1988 – 1994 and

17. Causal Pathways Sensory perceptions Cognition
School connectedness and engagement
Absenteeism
Temporary or permanent dropping out
There are at least 5 causal pathways through which health problems affect educational outcomes. … Read list and comment on each…

18. Inattention & Hyperactivity
Slide 18
Visual Problems
Inattention & Hyperactivity
Sensory Perceptions
Educational
Outcomes
Give examples based on research of how each health problem affects the causal pathway

19. Inattention & Hyperactivity
Slide 19
Visual Problems
Asthma
Aggression & Violence
Physical Activity
Breakfast
Inattention & Hyperactivity
Oral Health Problems
Cognition
Educational
Outcomes
Give examples based on research of how each health problem affects the causal pathway

20. Inattention & Hyperactivity
Slide 20
Visual Problems
Asthma
Aggression & Violence
Physical Activity
Inattention & Hyperactivity
Oral Health Problems
Educational
Outcomes
Connectedness
Give examples based on research of how each health problem affects the causal pathway

21. Inattention & Hyperactivity
Slide 21
Asthma
Aggression & Violence
Physical Activity
Inattention & Hyperactivity
Oral Health Problems
Educational
Outcomes
Breakfast
Absenteeism
Give examples based on research of how each health problem affects the causal pathway

22. Inattention & Hyperactivity
Slide 22
Teen Pregnancy
Inattention & Hyperactivity
Dropping Out of School
Educational
Outcomes
Give examples based on research of how each health problem affects the causal pathway

23. Synergistic Effects
And students who are affected by one problem are also more likely to be affected by others, which is why it’s so important for school based initiatives to focus on multiple problems simultaneously

24. Our Children Are NOT Served Well by the Silo Approach
SOCIAL SERVICES
In too many cases, funding streams, policies, programs and services are in silos. And there are even silos with siloes. This does not serve students well.
HEALTH
EDUCATION

25. Silos Within Each Silo
Funding
Policies
Programs
Personnel

26. Limited Returns on Investments of Social Resources
Efforts are not strategically planned
Poor quality programs
Efforts are not effectively coordinated
But most efforts appear to be insufficiently financed, are not strategically planned, in too many instances in the past have relied on programs with no evidence of effectiveness, and are not coordinated effectively.

27. Strategies for Supporting School Efforts to Address Priority Health Disparities
Communication
Policy mandates and accountability
Financial support
Guidance, technical assistance, and professional development
Research
There are many examples of policies that can help … read material on slide

28. Policy Development
Integrate health-related measures into accountability systems for school improvement efforts…if we don’t measure it, it must not be important
Augment early warning systems with health information
Include health data on school “report cards”
There are many examples of policies that can help … read material on slide

29. Research
Develop a national research agenda to put into practice what we already know
Determine ways to cultivate political will among elected officials and educational stakeholders to address persistent health barriers to learning
Conduct cluster randomized trials of strategic, high quality, effectively coordinated programs versus categorical efforts
Identify existing health and education data systems to inform research, policy and practice, and gaps in data
While we will always need research to produce new discoveries, what we need now is research to put into practice what we already know.

30. Research Assess workforce preparedness to address health priorities
Evaluate effects of health policies (e.g., school discipline)
Develop reliable, valid and practical measures of social- emotional and self-regulation skills, grit, collaboration, and school connectedness for young children
Build consensus around metrics that warrant inclusion in education accountability structures
While we will always need research to produce new discoveries, what we need now is research to put into practice what we already know.

31. Research (continued)
What are school and community (neighborhood) characteristics that help students learn and practice health behaviors that increase their odds for learning and achievement?
While we will always need research to produce new discoveries, what we need now is research to put into practice what we already know.

32. Slide 32
While there is a tremendous need, this is an opportune time for school health.