BACKGROUND: Previous research suggests links between poor adolescent health and poor academic achievement, and between academic achievement and future health outcomes. This study explored individual and combined relationships between health risk factors and academic risk among adolescents in King County, WA.
METHODS: Data came from the Healthy Youth Survey (HYS), a survey assessing health factors of middle and high school students in Washington State public schools. Analyses were conducted using combined 2012 and 2014 HYS data from 8th, 10th and 12th grade students across all 19 King County school districts, weighted to account for the complex survey design. The prevalence rates of 23 risk factors (categorized as: healthy eating/active living, physical health, mental-behavioral health/substance use, and unintentional injury/violence-related behaviors) were assessed individually and stratified by demographic groups. Bivariate and multivariate logistic regression analyses were conducted to explore associations between health risk factors and academic risk (receiving mostly Cs, Ds or Fs in school). Using a stepwise approach, a final multivariate model identified the strongest predictors of academic risk, adjusted for potential confounders (grade, gender, race/ethnicity, mother’s education, and King County region).
RESULTS: Rates of individual risk factors varied significantly (p<0.05) by grade, gender, sexual orientation, race/ethnicity, maternal education and/or region. Individually, 14 risk factors were most strongly associated with academic risk [Odds Ratio (OR) ≥ 2.0]. The strongest individual associations included students reporting sexual initiation [OR=3.0; 95% Confidence Interval (CI): 2.6-3.4], marijuana use [OR=3.0; 95% CI: 2.6-3.5], cigarette use [OR=4.4; 95% CI: 3.5-5.5], or e-cigarette use [OR=3.7; 95% CI: 2.6-5.4]. Students with these health behaviors were at least three times as likely to be at academic risk, compared to students without these risk factors. Students with six or more risk factors were more than twice as likely to be at academic risk [Adjusted Odds Ratio (AOR)=2.9; 95% CI: 2.6-3.3] compared to students with one or fewer risk factors. The final multivariate logistic regression model suggests the strongest predictors of academic risk include inadequate diet, soda/sugary drink consumption, food insecurity, sedentary behaviors, obesity, sexual initiation, inadequate dental health, substance use, and depressive feelings.
CONCLUSIONS: Overall, a diverse range of health risk factors was strongly associated with being at academic risk. Students with a greater number of risk factors were more likely to be at academic risk, regardless of demographic characteristics. Thus, school-based interventions may be instrumental in improving not only students’ health, but also their academic achievement.