Self-Reported School Referrals and Health Behaviors Among a Cohort of High School Students

Background/Purpose:  The purpose of this study was to determine the relationship of self-reported school referrals, along with positive and negative health behaviors in the past 30 days among high school students. Particular emphasis was given to positive health behaviors as these have not been well studied in the present context.  Positive health promoting behaviors included physical activity, nutrition, sleep, and relaxation, and negative health behaviors included alcohol, cigarette, and marijuana use.

Method:  Data were collected from a sample of 413 students attending an ethnically and socioeconomically diverse public high school in the southeastern United States. Students were recruited from all high school grades in classroom settings by trained personnel following a strict protocol that included the study’s aims, procedures, benefits, and risks. The exploratory survey research design provides a cross-sectional examination of health behaviors and demographics. The mean age of participants was 16 years old (SD=.938).  Males were slightly more represented with 53.8% (n=222).  Most students were African-American (38%, n=157) followed by White (34.5%, n=142), and Other (27%, n=112).  Twenty-seven percent (n=110) of students self-reported no referrals, 35% (n=144) reported 1 or 2 referrals, and 38% (157) reported 3 or more referrals.  Logistic regression models were used to analyze data for predicting health behaviors.

Results:  Students self-reporting the highest number of referrals were 4.58 times more likely to report using alcohol (p=.003), 3.22 times more likely to use cigarettes, (p=.006), and 4.63 times more likely to use marijuana (p=.001) than students self-reporting no referrals.  Those students reporting the highest number of referrals were also 2.19 times more likely to report using alcohol (p=.001), and 2.59 times more likely to report using marijuana (p=.001) than students with moderate self-reported referrals.  Heavy use of alcohol, cigarettes, and marijuana was also significant for students reporting the highest number of referrals. Results demonstrated males were more likely to report eating good carbohydrates, p=.001, and healthy fats, p=.006, and to participate in moderate physical activity, p=.04.  Additionally, students with the highest rate of referrals were more likely to report participating in vigorous physical activity (.04).  African American students reported they were more likely than Whites to eat good carbohydrates, p=.04, and eat healthy fats, p=.000.  African American students also reported engaging significantly more in relaxation or meditation to relieve stress, p=.05.

Conclusions and Implications:  This study presents novel findings regarding the association between both health risk behaviors and health promoting behaviors with school referrals.  Students self-reporting the highest number of referrals were significantly more likely to report engaging in health risk behaviors.  Significant differences were also noted with African Americans reporting better nutritional behaviors and relaxation exercises.  School social workers are oftentimes the first to identify problems that include health behavior issues for students.  Additional inquiry is warranted looking into positive and negative health behaviors of students relative to referrals in order to capitalize on a pro-active stance for effective school social work practice.