Health and School Outcomes: The Influence of County Variation in Child and Adolescent Health Status and State-wide School District Performance

Background and Purpose: An emerging line of research links various health characteristics of children and youth to their school performance. Given variability in the prevalence, nature, severity, and management of child health conditions, a recent review of literature posits that the most pronounced effects of child health status on school achievement and performance will likely be in aggregate—reflecting critical densities of affected children across schools, districts, and communities. However, direct evidence supporting such a claim is scarce.

Methods: This study draws on three data sources to estimate county-level child and adolescent (kindergarten-12th grade) health status effects on school district achievement. The California Health Interview Survey (CHIS) was used to derive county estimates of child and adolescent health status. Respondents were selected using a multi-stage sampling design, yielding data from approximately 18,000 children and adolescents in 2001 and 12,000 in 2003. Population-level data on school districts was obtained from California Department of Education archives. Key county-level demographic characteristics were compiled from census and birth records. The study sample encompassed 934 districts (representing 53 out of 58 California counties and 94% of districts in California). The outcome is a dichotomous variable indicating whether, in the academic years 2002-2003 and 2004-2005, a district had either consistently failed to meet its adequate yearly progress goals (AYP) or had changed status from meeting to not meeting AYP goals. The key independent variable is the weighted (by sampling and response patterns) difference (between 2001 and 2003) in the percent of children and adolescents in a given county whose overall health was rated (either by student or knowledgeable adult) and dichotomized as good, very good, or excellent versus fair or poor. A rich set of district- and county-level characteristics (e.g. district demographic, structural, and achievement characteristics; county socio-demographic characteristics) served as controls.

Because there is great potential for biased estimates of county child health status on school districts, the longitudinal and time-lagged structure of these data is used to implement district and county fixed effects techniques to control for the influence of unobservable, time-invariant district and county characteristics. Standard errors in regression models are adjusted for the clustering of districts within counties.

Results: County-level improvement in child and adolescent health status increased the likelihood that a school district met AYP goals over the time period under investigation. As hypothesized, districts in counties with “healthier” children and adolescents, over and above demographic and prior district performance, were more likely to sustain or improve academic performance over time.

Conclusions and Implications: This study provides robust empirical support for the contention that school district variation in child and adolescent health status exerts a contextual effect on academic performance. While much attention has been placed on attributes of settings that promote positive youth development, these findings strongly suggest that aggregate levels of child and youth health status may function as setting-specific source of strength and resilience with respect to district outcomes. Results imply that bolstering area-level child health characteristics could be an important lever for improving district and school performance.