Long-term health implications of school quality.
Individual academic achievement is a well-known predictor of adult health, and addressing education inequities may be critical to reducing health disparities. Disparities in school quality are well documented. However, we lack nationally representative studies evaluating the impact of school quality on adult health. We aim to determine whether high school quality predicts adult health outcomes after controlling for baseline health, socio-demographics and individual academic achievement.



We analyzed data from 7037 adolescents who attended one of 77 high schools in the Unites States and were followed into adulthood from the National Longitudinal Study of Adolescent to Adult Health. Selected school-level quality measures-average daily attendance, school promotion rate, parental involvement, and teacher experience-were validated based on ability to predict high school graduation and college attendance. Individual adult health outcomes included self-rated health, diagnosis of depression, and having a measured BMI in the obese range.



Logistic regressions controlling for socio-demographics, baseline health, health insurance, and individual academic performance demonstrated that school quality significantly predicted all health outcomes. As hypothesized, attending a school with lower average daily attendance predicted lower self-rated health (Adjusted Odds Ratio (AOR) 1.59, p = 0.003) and higher odds of depression diagnosis (AOR 1.35, p = 0.03); and attending a school with higher parent involvement predicted lower odds of obesity (AOR 0.69, p = 0.001). However, attending a school with higher promotion rate also predicted lower self-rated health (AOR1.20, p < 0.001).



High school quality may be an important, but complex, social determinant of health. These findings highlight the potential inter-dependence of education and health policy.
Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave. 12-358 CHS, Los Angeles, CA, 90095, USA, MC: 175217. Electronic address: rdudovitz@mednet.ucla.edu.
Rebecca N
RN
Dudovitz
Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave. 12-358 CHS, Los Angeles, CA, 90095, USA, MC: 175217. Electronic address: bnelson@mednet.ucla.edu.
Bergen B
BB
Nelson
Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave. 12-358 CHS, Los Angeles, CA, 90095, USA, MC: 175217; RAND Health, RAND Corporation, 1776 Main St, Santa Monica, CA, 9040, USA. Electronic address: tcoker@mednet.ucla.edu.
Tumaini R
TR
Coker
Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave. 12-358 CHS, Los Angeles, CA, 90095, USA, MC: 175217. Electronic address: cbiely@mednet.ucla.edu.
Christopher
C
Biely
Department of Biomathematics, University of California Los Angeles, BOX 951766, 5222 Life Sciences, Los Angeles, CA, 90095-1766, USA. Electronic address: nli@biomath.ucla.edu.
Ning
N
Li
Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave. 12-358 CHS, Los Angeles, CA, 90095, USA, MC: 175217. Electronic address: lynne.chang@gmail.com.
Lynne C
LC
Wu
Fielding School of Public Health and Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave. 12-358 CHS, Los Angeles, CA, 90095, USA, MC: 175217; RAND Health, RAND Corporation, 1776 Main St, Santa Monica, CA, 9040, USA. Electronic address: paulchung@mednet.ucla.edu.
Paul J
PJ
Chung
D000293:Adolescent; D000328:Adult; D003863:Depression / Q000453:epidemiology; D004522:Educational Status; D005260:Female; D062489:Health Impact Assessment / Q000379:methods*; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D009765:Obesity / Q000453:epidemiology; D010287:Parent-Child Relations; D000070777:School Teachers / Q000592:standards; D012574:Schools / Q000592:standards*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
Depression; Health; Obesity; School quality