1
|
Ko MY, Rosenberg SM, Meza BPL, Dudovitz RN, Dosanjh KK, Wong MD. Perceptions of School Climate Shape Adolescent Health Behavior: A Longitudinal Multischool Study. THE JOURNAL OF SCHOOL HEALTH 2023; 93:475-484. [PMID: 36404628 PMCID: PMC10175101 DOI: 10.1111/josh.13274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/05/2022] [Accepted: 11/02/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND Adolescent behaviors and academic outcomes are thought to be shaped by school climate. We sought to identify longitudinal associations between school climate measures and downstream health and academic outcomes. METHODS Data from a longitudinal survey of public high school students in Los Angeles were analyzed. Eleventh-grade health and academic outcomes (dependent variables, eg, substance use, delinquency, risky sex, bullying, standardized exams, college matriculation), were modeled as a function of 10th-grade school climate measures (independent variables: institutional environment, student-teacher relationships, disciplinary style), controlling for baseline outcome measures and student/parental covariates. RESULTS The 1114 student respondents (87.8% retention), were 46% male, 90% Latinx, 87% born in the United States, and 40% native English speakers. Greater school order and teacher respect for students were associated with lower odds of multiple high risk behaviors including 30-day alcohol use (odds ratio [OR] 0.81; 95% confidence interval [CI] [0.72, 0.92] and OR 0.73; [0.62, 0.85]) and 30-day cannabis use (OR 0.74; [0.59, 0.91] and OR 0.76; [0.63, 0.92]). Neglectful disciplinary style was associated with multiple poor health and academic outcomes while permissive disciplinary style was associated with favorable academic outcomes. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY School health practitioners may prospectively leverage school environment, teacher-student relationships, and disciplinary style to promote health and learning. CONCLUSIONS Our findings identify specific modifiable aspects of the school environment with critical implications for life course health.
Collapse
Affiliation(s)
- Michelle Y Ko
- Medical Student, , David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sofia M Rosenberg
- Undergraduate Student, , Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Benjamin P L Meza
- Assistant Professor of Medicine , Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Rebecca N Dudovitz
- Associate Professor of Pediatrics, , Division of General Pediatrics, Department of Pediatrics and Children's Discovery and Innovation Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kulwant K Dosanjh
- Project Director, , Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mitchell D Wong
- Professor of Medicine, , Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
2
|
Dudovitz RN, Chung PJ, Dosanjh KK, Phillips M, Tucker JS, Pentz MA, Biely C, Tseng CH, Galvez A, Arellano G, Wong MD. Outcome of the AVID College Preparatory Program on Adolescent Health: A Randomized Trial. Pediatrics 2023; 151:e2022057183. [PMID: 36524331 PMCID: PMC9830585 DOI: 10.1542/peds.2022-057183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Academic tracking is a widespread practice, separating students by prior academic performance. Clustering lower performing students together may unintentionally reinforce risky peer social networks, school disengagement, and risky behaviors. If so, mixing lower performing with high performing youth ("untracking") may be protective, leading to better adolescent health. METHODS Advancement via Individual Determination (AVID), a nationally-disseminated college preparatory program, supports placing middle-performing students in rigorous college-preparatory classes alongside high-performing peers. We conducted the first randomized, controlled trial of AVID in the United States, randomizing 270 students within 5 large public high schools to receive AVID (AVID group) versus usual school programming (control group). Participants completed surveys at the transition to high school (end of eighth grade/ beginning of ninth grade) and the end of ninth grade. Intent-to-treat analyses tested whether AVID resulted in healthier social networks (primary outcome), health behaviors, and psychosocial wellbeing. RESULTS At follow-up, AVID students had lower odds of using any substance (odds ratio [OR] 0.66, 95% confidence interval [CI] 0.48-0.89) and associating with a substance-using peer (OR 0.74, 95% CI 0.45-0.98), and higher odds of associating with a peer engaged in school (OR 1.73, 95% CI 1.11-2.70). Male AVID students had lower stress and higher self-efficacy, grit, and school engagement than control students (P < .05 for all). No adverse health effects among high-performing peers were observed. CONCLUSIONS AVID positively impacts social networks, health behaviors, and psychosocial outcomes suggesting academic untracking may have substantial beneficial spillover effects on adolescent health.
Collapse
Affiliation(s)
- Rebecca N. Dudovitz
- Departments of Pediatrics and Children’s Development and Innovation Institute
| | - Paul J. Chung
- Departments of Pediatrics and Children’s Development and Innovation Institute
- Department of Health Systems Science, Kaiser Permanente School of Medicine, Pasadena, California
| | - Kulwant K. Dosanjh
- General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California
| | | | | | - Mary Ann Pentz
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | - Christopher Biely
- Departments of Pediatrics and Children’s Development and Innovation Institute
| | - Chi-Hong Tseng
- General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California
| | - Arzie Galvez
- Los Angeles Unified School District, Los Angeles, California
| | | | - Mitchell D. Wong
- General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, California
| |
Collapse
|
3
|
Borba Julião E, Braga-Silveira LMDO. Desempenho escolar e saúde mental em alunos do Ensino Fundamental II da Região Sul do Brasil. REVISTA DE ESTUDIOS E INVESTIGACIÓN EN PSICOLOGÍA Y EDUCACIÓN 2022. [DOI: 10.17979/reipe.2022.9.2.9120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
O estudo do desempenho acadêmico e sua relação com a saúde mental de crianças e adolescentes é uma área de interesse crescente entre educadores e profissionais de saúde. O objetivo deste artigo é identificar o grau de associação entre desempenho acadêmico, saúde mental e dados sociodemográficos, e avaliar se o desempenho acadêmico é uma variável associada à saúde mental em uma amostra de 83 estudantes do Ensino Fundamental II de escolas públicas e seus responsáveis. O estudo utiliza uma metodologia quantitativa de corte transversal, e os dados foram obtidos utilizando os seguintes instrumentos: ficha de dados sociodemográficos, Questionário de Capacidades e Dificuldades (SDQ) para estudantes e responsáveis; e uma pontuação de desempenho acadêmico. A análise dos dados foi realizada por meio de estatística descritiva, correlação e regressão linear múltipla. Dentre os resultados destaca-se a alta percepção entre os estudantes de "total de dificuldades" no SDQ, indicando a presença de problemas de saúde mental clinicamente relevantes. Os resultados também mostraram que os estudantes com desempenho médio e baixo apresentam níveis significativamente mais altos de problemas de saúde mental. O artigo examina a prevalência de problemas de saúde mental infantil e adolescente, possíveis fatores de risco e estudos futuros que possam ampliar a população da amostra. As conclusões gerais indicam altos níveis de adoecimento psíquico, particularmente entre estudantes com desempenho médio e baixo.
Collapse
|
4
|
Wong MD, Quartz KH, Saunders M, Meza BP, Childress S, Seeman TE, Dudovitz RN. Turning Vicious Cycles Into Virtuous Ones: the Potential for Schools to Improve the Life Course. Pediatrics 2022; 149:186909. [PMID: 35503311 PMCID: PMC9113000 DOI: 10.1542/peds.2021-053509m] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/24/2022] Open
Abstract
Adolescence is a critical transition period that sets the stage for adulthood and future health outcomes. Marked by key developmental milestones in brain maturation, increasing independence from parents, and greater connections to peers, adolescence is also a time of heightened risk for behavioral health problems, including substance use, violence, delinquency, and mental health issues. High school completion is a significant life course event and a powerful social determinant of health and health disparities. Jessor's Theory of Problem Behavior suggests that adolescent health behaviors and mental health problems are closely tied to poor educational outcomes and peer network formation in a reinforcing feedback loop, or vicious cycle, often leading to school failure, school disengagement, and drop-out. Schools are a novel platform through which vicious cycles can be disrupted and replaced with virtuous ones, simultaneously improving education and health. This article describes the potential for schools to transform health trajectories through interventions creating positive and supportive school climates. In addition, new models such as the Whole School Whole Community Whole Child Model promote whole child well-being, including cognitive, social, emotional, psychological, and physical development. Full-service community schools can serve as a hub coordinating and integrating all available resources to better respond to the needs of children and families. Present in every neighborhood, schools are a way to reach every school-age child and improve their health trajectories, providing an important platform for life course intervention research.
Collapse
Affiliation(s)
- Mitchell D. Wong
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California,Address correspondence to Mitchell D. Wong, MD, Division of General Internal Medicine and Health Services Research, 1100 Glendon Ave, Suite 850, Los Angeles, CA 90024. E-mail:
| | - Karen Hunter Quartz
- University of California, Los Angeles School of Education and Information Studies, Los Angeles, California
| | - Marisa Saunders
- University of California, Los Angeles School of Education and Information Studies, Los Angeles, California
| | - Ben P.L. Meza
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | | | - Teresa E. Seeman
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Rebecca N. Dudovitz
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
5
|
Kwaning K, Wong M, Dosanjh K, Biely C, Dudovitz R. Gender stigma awareness is associated with adolescent risky health behaviors. PLoS One 2021; 16:e0251332. [PMID: 33979392 PMCID: PMC8115797 DOI: 10.1371/journal.pone.0251332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/25/2021] [Indexed: 12/28/2022] Open
Abstract
Objectives Although racial stigma in school is associated with adolescent risky health behaviors, there are no studies investigating how gender stigma relates to adolescent risky health behaviors among low-income, minority youth. We sought to determine whether gender stigma awareness is associated with adolescent risky health behaviors (delinquency, fighting, and substance use) and whether this association is mediated by school disengagement (low perceived teacher support, low school engagement, cutting classes, and breaking school rules) among low-income, minority students. Methods We analyzed cross-sectional survey data, collected from 2017 to 2019, from 412 high school students. Multi-level logistic regressions tested whether gender stigma awareness was associated with delinquency, fighting, and substance use, controlling for covariates, baseline behaviors, and clustering within schools. Mediation analyses tested whether school disengagement (low school engagement, perceived teacher support, cutting class, and breaking school rules) mediated these associations. Secondary analyses explored whether associations differed for male versus female, high-performing versus low-performing, and Latinx versus non-Latinx students. Results In this predominantly Latinx (83%) sample, gender stigma awareness was associated with delinquency (AOR = 1.48, P< 0.001) and fighting (AOR = 1.15, P< 0.001). School engagement, perceived teacher support, breaking school rules, and cutting classes mediated 42.7% of the association between gender stigma awareness and delinquency and 65.42% of the association between gender stigma awareness and fighting. Gender stigma awareness was also associated with substance use for low-performing (AOR = 1.68, P = 0.003) and non-Latinx adolescents (AOR = 3.80, P = 0.03). School disengagement did not mediate the association between gender stigma awareness and substance use for non-Latinx students but mediated 50% of this association for low-performing students. Conclusions Gender stigma awareness is associated with adolescent risky health behaviors. A decreased sense of acceptance in the school community and increased school misbehavior may mediate these associations. School environments that value and accept all students may better support adolescent health.
Collapse
Affiliation(s)
- Karen Kwaning
- David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- * E-mail:
| | - Mitchell Wong
- UCLA General Internal Medicine and Health Services Research, Los Angeles, California, United States of America
| | - Kulwant Dosanjh
- UCLA General Internal Medicine and Health Services Research, Los Angeles, California, United States of America
| | - Christopher Biely
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Rebecca Dudovitz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| |
Collapse
|