About School Health
Linking Health and School Success

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Lessons Learned

Linking Health Services and School Success

Teachers and parents want to see all students succeed and become knowledgeable, responsible, caring and healthy adults. The challenge is organizing our educational system to provide the opportunities linked with these outcomes. While there is still much debate about the value and effectiveness of various programs, more and more information that provides answers on how the learning environment in schools needs to be structured is becoming available from both health and educational scientists. 

Health Services (PDF 174K): Some schools providing comprehensive health services in conjunction with other important services have reduced absenteeism,¹ reduced drop-out rates^1-3 and reduced behavioral problems,⁴ raised students’ grade point average^1,2,4 and graduation rates.^1-3 

Nutrition Services (PDF 202K): Students’ cognitive, behavioral and physical performance is impaired by poor nutrition.^5-7 Access to nutritious meals at school facilitates learning. Students that are provided school breakfast perform better on standardized tests,⁷ have less hyperactivity⁷ and experience less absenteeism.^7-10 

Physical Education (PDF 68K): Those schools that provide quality and intensive physical education programs for their students note a positive relationship on school success even though time on academic task is reduced because students are enrolled in a physical education program. ¹¹ Increased concentration, improved mathematic, reading and writing scores have been noted along with a reduction in disruptive behaviors.^11-13 

Health Instruction: One study found that students in health education classes receiving instruction in personal and social skills have improved school achievement, reduced drop-out rates, as well as reduced risk behaviors associated with pregnancy, juvenile delinquency and substance abuse.^14-15 

Counseling Services: Counseling and psychological services provided by schools have improved educational outcomes by addressing behavioral and emotional issues that are barriers to learning. It has been noted that students who have received these mental health services have reduced course failures and disciplinary actions and improved grade point averages.^16-17

Healthy Environment (PDF 61K): A school that promotes a nurturing and caring environment has students that  feel more connected to the school and protected from emotional distress.¹⁸ Teachers who use better classroom management and instructional practices strengthen students’ bonds of attachment and connectedness to school.¹⁵ 

Family and Community Involvement (PDF 197K): Schools that seek active parent involvement have reported improved classroom behavior; improved family functioning;¹⁹ improved academic performance,^20-21 attendance²⁰ and improved prospects for future work. ²⁰ A number of studies have demonstrated that including families in health education increases the likelihood that their children will adopt health-enhancing behaviors. School systems that work with social service providers in the community have noted improved scholastic performance. “The combined academic, health and social programs began to show positive achievement gains by the third year of the project,” noted Mitchell.¹⁹ 

Worksite Wellness (PDF 104K): Worksite health promotion programs are a way to support teachers and improve staff morale, reduce absenteeism and improve the quality of instruction, along with improving perceived perceptions of general well-being.²² 

Adapted by work of the Prevention Research Centers SIP 14-99:University of Texas at Houston — Center for Health Promotion and Prevention Research — Nancy Murray, DrPH and Barbara Low, DrPH University of New Mexico — Center for Health Promotion and Disease Prevention — Sally Davis, PhD and Chris Hollis, MPH, MPS University of North Carolina at Chapel Hill — Center for Health Promotion and Disease Prevention – Alan Cross, MD and Yemisi Adetunji, MD, MPH

References

1. Klein, JD and McCord, MT. Evaluation of the Gillespie Student Health Project, Greensboro, North Carolina. Evaluation and Technical Assistance Report to the Robert Wood Johnson School-Based Adolescent Health Care Program, April 4, 1992.
2. U.S. General Accounting Office. School-Linked Human Services: A Comprehensive Strategy for Aiding Students At Risk for School Failure. GAO/HRD-94-21, Washington, DC: U.S. General Accounting Office, 1993.
3. McCord, MD et al. School-based clinic use and school performance. Journal of Adolescent Health. 1993; 14:91-98.
4. Wagner, M et al. A healthy start for California’s children and families. Early findings from a statewide evaluation of school-linked services. Menlo Park, California: SRI International, June 1994 in Schools & Health: Our Nation’s Investment, eds. D Allensworth et al. Institute of Medicine. Washington DC; National Academic Press. 1997:396-397.
5. Center on Hunger, Poverty, and Nutrition Policy. Statement on the Link Between Nutrition and Cognitive Development in Children. Medford, Mass.: Tufts University School of Nutrition, 1993.
6. Centers for Disease Control and Prevention. Guidelines for school health programs to promote healthy eating. Morbidity and Mortality Weekly Report 1996; 45(RR-9).
7. Meyers AF, et al. School breakfast program and school performance. American Journal of Diseases and Children. 1989; 143(10), 1234-1236.
8. Powell CA, et al. Nutrition and education. A randomized trial of the effects of breakfast in rural primary school children. American Journal of Clinical Nutrition. 1989; 68(4), 873-879.
9. Alaimo K, et al. Food insufficiency and American school-aged children’s cognitive, academic and psycho-social development. Pediatrics. 2001; 108(1), 44-53.
10. Murphy JM, et al. The relationship of school breakfast to psycho-social and academic functioning. Archives Pediatric Adolescent Medicine. 1998; 152 (9), 899-907.
11. Shepard, RJ, et al. Required physical activity and academic grades: A controlled study. In J. Ilmarinen and I Vaelimaeki, eds. Children and Sport. Paediatric Work Physiology. Berlin, Germany: Springer-Verlag. 1984;58-63.
12. Dwyer T, et al. Relation of academic performance to PA and fitness in children. Pediatric Exercise Science. 2001, 13:225-237. 1979; 3:196-202.
13. Sallis JF, et al. Effects of health-related physical education on academic achievement: Project SPARK. Research Quarterly for Exercise and Sport. 1999; 70 (2),127-134.
14. Hawkins, D et al. Preventing adolescent health-risk behaviors by strengthening protection during childhood. Archives of Pediatric and Adolescent Medicine. 1999; 153:226-23
15. O’Donnell J, et al. Preventing school failure, drug use, and delinquency among low-income children: Long term intervention in elementary schools. American Journal of Orthopsychiatry. 1955; 65(1): 87-100.
16. Jennings J et al. Implementing and maintaining school-based health services in a large, urban school district. Journal of School Health, 2000; 70(5), 201-205
17. Nabors L & Reynolds M. Program evaluation activities. Outcomes related to treatment for adolescents receiving school-based mental health services. Child Services Social Policy Research Practice, 2000; 3,175-189.
18. Resnick, MD, et al. Protecting adolescents from harm. JAMA, 1997; (278) 10, 823-832
19. Mitchell, M. Schools as catalysts for healthy communities. Public Health Reports, 2000; 115,222-7.
20. Connect for Success: Building a teacher, parent, teen alliance. Belmont, MA: Recruiting New Teachers, Inc. 2000. p. 85
21. Epstein, JL, Simon, BS & Salinas, KC. Involving parents in homework in the middle grades. Research Bulletin, 1997; 18, 1-4.
22. Blair, S et al Health Promotion for educators: Impact on absenteeism. Preventive Medicine, 1986. 15,166-175.

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