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Mann MJ, Kristjansson AL, Smith ML, Lilly CL, Thrisdottir IE, Havlicak A. Beyond School Climate: Conceptualizing the School as a Protective Factor Approach. THE JOURNAL OF SCHOOL HEALTH 2024. [PMID: 38962928 DOI: 10.1111/josh.13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND The school climate concept has been promising, but has long-standing critiques that have not been adequately addressed to date. The School as a Protective Factor approach represents one attempt to offer a new approach that builds on and extends beyond the concept of school climate while addressing previously identified limitations. CONTRIBUTIONS TO THEORY The School as a Protective Factor approach offers a new framework for conceptualizing, measuring, and establishing protective school social and learning environments that co-promote academic achievement and student health in schools, especially student mental health and substance use/abuse prevention. This new framework includes clear definitions, explicit goals, firmly established constructs, validated measures, and an intentionally parsimonious approach that prioritizes the implementation of well-established, high-impact constructs. CONCLUSIONS AND IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: The School as a Protective Factor approach presents a simple, easy-to-use means of ensuring a school social environment that meets the developmental, academic, and health needs of all children and adolescents while maximizing protection across a range of desired outcomes. Perhaps most importantly, it does so in a manner that is manageable and easily integrated into every aspect of schooling, resonates with the practical experience of school personnel, and includes brief, effective, and free measurement tools.
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Affiliation(s)
- Michael J Mann
- School of Public and Population Health, Boise State University, 1910 University Drive, Boise, ID, 83725-1835
| | - Alfgeir L Kristjansson
- School of Public Health, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506-9190; Planet Youth, Lágmúli 6, 108, Reykjavík, Iceland
| | - Megan L Smith
- School of Public and Population Health, Boise State University, 1910 University Drive, Boise, ID, 83725-1835
| | - Christa L Lilly
- School of Public Health, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506-9190
| | | | - Ashley Havlicak
- School of Public and Population Health, Boise State University, 1910 University Drive, Boise, ID, 83725-1835
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Minter W. Recontextualization and Imagination: The Public Health Professional and the U.S. Health Care System. HEALTH CARE ANALYSIS 2024:10.1007/s10728-024-00482-2. [PMID: 38767781 DOI: 10.1007/s10728-024-00482-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 05/22/2024]
Abstract
Based on a qualitative study, this paper explores how United States public health professionals view and think about the existing U.S. healthcare system, while also allowing these study participants to imagine new ways of structuring and practicing public health. Using semi-structured qualitative interviews, I show how public health professionals engage with the concept of "the social" and their personal experiences with public health to question the status quo. By giving public health professionals space in which to imagine changes and different ways of practicing public health, I demonstrate the effectiveness of imagination as a capacity that public health professionals possess to take the lead in creating the changes they hope for.
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Zhang YS, O’Shea B, Yu X, Cho TC, Zhang KP, Kler J, Langa KM, Weir DR, Gross AL, Kobayashi LC. Educational Attainment and Later-Life Cognitive Function in High- and Middle-Income Countries: Evidence From the Harmonized Cognitive Assessment Protocol. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae005. [PMID: 38284333 PMCID: PMC10997278 DOI: 10.1093/geronb/gbae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVES Identifying social policies that can promote cognitive health is crucial for reducing the global burden of dementia. We evaluated the importance of educational attainment for later-life cognitive function in various social and geographic settings. METHODS Using harmonized data for individuals aged ≥65 years from the United States Health and Retirement Study (HRS) and its international partner studies in England, Mexico, China, and India, and each study's respective Harmonized Cognitive Assessment Protocol (HCAP), we conducted a cross-national comparative study to examine the role of educational attainment in later-life cognitive function across countries (n = 14,980, 2016-2019). We used multivariable-adjusted regression to estimate associations between educational attainment and harmonized global cognitive function scores. RESULTS In Mexico, China, and India, the general cognitive function scores on average are approximately one standard deviation of the HRS-HCAP cognitive function score distribution lower compared to the United States and England, paralleling patterns of educational attainment across countries. In all countries, higher educational attainment was associated with progressively higher later-life cognitive function scores. Population-level differences in educational attainment explained about 50%-90% of the observed differences in cognitive function scores across countries. DISCUSSION The relationship between education and later-life cognitive function across social and geographic contexts underscores the crucial role of education to promote cognitive health and reduce dementia risk. Continual improvement of educational attainment in low- and middle-income settings may yield a significant pay-off in later-life cognitive health.
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Affiliation(s)
- Yuan S Zhang
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, New York, USA
- Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Brendan O’Shea
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Xuexin Yu
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Tsai-Chin Cho
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Kelvin Pengyuan Zhang
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jasdeep Kler
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kenneth M Langa
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - David R Weir
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lindsay C Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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McCabe E, Grunin L, Jameson B. Advancing School Health: Building a Partnership Between School Nurses and the Centers for Disease Control and Prevention. J Sch Nurs 2024; 40:123-124. [PMID: 38291717 DOI: 10.1177/10598405241227884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Affiliation(s)
- Ellen McCabe
- Hunter College, Hunter-Bellevue School of Nursing, The City University of New York, USA
| | - Laura Grunin
- Rory Meyers College of Nursing, New York University, USA
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Askari MS, Belsky DW, Olfson M, Mojtabai R, Breslau J, Keyes KM. Poverty and birth cohort effects of experiencing the 2007-2009 Great Recession during adolescence on major depressive episodes and mental health treatment of young adults in the United States. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02640-2. [PMID: 38528215 DOI: 10.1007/s00127-024-02640-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 02/12/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE Household economic adversity during adolescence is hypothesized to be a risk factor for poor mental health later in life. To test this hypothesis, we conducted a quasi-experimental analysis of an economic shock, the Great Recession of 2007-2009. We tested if going through adolescence during the Great Recession was associated with increased risk of major depressive episodes (MDE) and mental health treatment in young adulthood with potential moderation by household poverty to explore differences by economic adversity. METHODS We analyzed data on young adults age 18-29 years from the 2005-2019 National Survey on Drug Use and Health (N = 145,394). We compared participants who were adolescents during the recession to those followed-up prior to the recession. Regression analysis tested effect modification by household poverty status. RESULTS Adolescent exposure to the Great Recession was associated with higher likelihood of MDE during young adulthood (aOR = 1.30, 95% CI = 1.23, 1.37); there was no relationship with mental health treatment. Effects on MDE were stronger among those in households with higher incomes compared to those living in poverty. CONCLUSION Findings support the hypothesis that exposure to the Great Recession during adolescence may have increased risk for MDE, but raise questions about whether the mechanism of this association is economic distress.
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Affiliation(s)
- Melanie S Askari
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168 St, New York, NY, 10032, USA.
| | - Daniel W Belsky
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168 St, New York, NY, 10032, USA
| | - Mark Olfson
- New York State Psychiatric Institute, Columbia University, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Ramin Mojtabai
- Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House 797, Baltimore, MD, 21205, USA
| | - Joshua Breslau
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA, 15213, USA
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168 St, New York, NY, 10032, USA
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Suiter SV, Meadows ML. Educational Attainment and Educational Contexts as Social Determinants of Health. Prim Care 2023; 50:579-589. [PMID: 37866832 DOI: 10.1016/j.pop.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Research demonstrates that nearly all health outcomes are patterned by level of education. Specifically, adults with lower educational attainment report more chronic conditions, more functional limitations, and worse overall health. In addition to affecting educational attainment, schools provide an important context in which students spend a substantial portion of their time. Because access to salutogenic school environments, as well as opportunities for educational attainment and advancement are themselves unequal, education is considered a social determinant of health. In this article, we explore the relationships between educational attainment and health. We also emphasize the importance of educational contexts as determinants of health that precede educational attainment and contribute to related health outcomes. Finally, we discuss implications for primary care practitioners and their efforts to address disparities in health and education.
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Affiliation(s)
- Sarah V Suiter
- Department of Human & Organizational Development, Vanderbilt University, 230 Appleton Place, Peabody #90, Nashville, TN 37212, USA.
| | - Meredith L Meadows
- Department of Human & Organizational Development, Vanderbilt University, 230 Appleton Place, Peabody #90, Nashville, TN 37212, USA
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Walsemann KM, Fisk CE, Farina MP, Abbruzzi E, Ailshire JA. Race, gender, and cohort differences in the educational experiences of Black and White Americans. POPULATION RESEARCH AND POLICY REVIEW 2023; 42:86. [PMID: 39206094 PMCID: PMC11349311 DOI: 10.1007/s11113-023-09831-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 09/28/2023] [Indexed: 09/04/2024]
Abstract
Federal legislation and judicial intervention led to significant transformation in the U.S. education system during the early to mid-20th century. These changes may differentiate older adults in their experiences of aging, particularly at the intersection of race, gender, and cohort, but are not well documented among current cohorts of older adults. Our study addresses this gap by providing rich, descriptive information on the educational experiences of U.S. adults who attended primary or secondary school between 1915 and 1977. We used data from the Health and Retirement Study (HRS), a nationally representative, prospective study of U.S. adults over age 50 years. The HRS collected information on respondents' schooling history and experiences through a Life History Mail Survey (LHMS). We restricted our sample to age-eligible HRS-LHMS respondents who self-identified as non-Hispanic White or non-Hispanic Black and completed at least 75% of their primary or secondary schooling in the U.S. (n=10,632). Educational experiences, defined as pre-k to post-secondary education, varied across cohort, regardless of race or gender. Greater course offerings, improvements in learning support, and increasing exposure to integrated schools occurred across successive cohorts. We found the highest rates of enrollment in college preparatory curriculum and foreign-language courses as well as diagnosed learning differences in cohorts born after 1948. Among White adults, many of the gender differences in educational experiences documented in the oldest cohort were still found among the most recent cohort. Few gender differences, however, were found for Black adults regardless of cohort. Conversely, most race inequities in educational experiences persisted. Such inequities may be an important source of continued differences in experiences of aging observed across demographic groups.
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Affiliation(s)
- Katrina M. Walsemann
- School of Public Policy and Maryland Population Research Center, University of Maryland, College Park
| | - Calley E. Fisk
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles
| | - Mateo P. Farina
- Department of Human Development and Family Sciences and Population Research Center, University of Texas, Austin
| | - Emily Abbruzzi
- School of Public Policy and Maryland Population Research Center, University of Maryland, College Park
| | - Jennifer A. Ailshire
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles
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Joo YS, Kim Y. Role of School Quality and Neighborhood Disadvantage in Educational Attainment: Do They Vary by Race? CHILDREN & SCHOOLS 2023; 45:211-221. [PMID: 37781500 PMCID: PMC10541081 DOI: 10.1093/cs/cdad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/24/2022] [Accepted: 11/09/2022] [Indexed: 10/03/2023]
Abstract
Schools and neighborhoods are adolescents' primary environments, and each has a significant influence on their academic success. The majority of studies on educational attainment have examined the impact of a single context-either the school or the neighborhood-suggesting mixed findings on school and neighborhood effects as well as potential disparities across racial groups. To address this gap, the present study examined the roles of school quality and neighborhood disadvantage on educational attainment for White and Black adolescents. This study used the National Longitudinal Study of Adolescent to Adult Health data collected from a nationally representative sample of U.S. adolescents, merging multiple data sources including in-home surveys, school administrator surveys, student-level educational records, and contextual data. Educational attainment was measured using college enrollment and graduation status. School quality was a significant predictor of college enrollment and graduation for both White and Black adolescents. Neighborhood disadvantage is significantly associated with college enrollment for both racial groups; however, college graduation is significant only for White adolescents. These findings suggest that improving school quality is particularly important for educational attainment regardless of racial background. The article concludes with a discussion on the differential roles of school quality and neighborhood disadvantage in relation to White and Black adolescents.
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Affiliation(s)
- Young Sun Joo
- PhD, is assistant professor, Department of Social Welfare, Myongji University, Seoul, 03674, Republic of Korea (South)
| | - Youngmi Kim
- PhD, is associate professor, School of Social Work, Virginia Commonwealth University, Richmond, VA, USA
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Vernet E, Sberna M. Does the Andersen Behavioral Model for health services use predict how health impacts college students' academic performance? JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:2454-2461. [PMID: 33522447 DOI: 10.1080/07448481.2020.1865978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/10/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
Objective: The purpose of this research study is to examine the use of the Andersen Behavioral Model of Health Services Use in predicting how health impacts the academic performance of college students through predisposing, enabling, and need factors. Participants: Data were collected from 428 college students attending a large university in the Southeast. Methods: Students answered questions about their demographic characteristics, health, healthcare use, and academics using a survey adapted from the 2018 National College Health Assessment (NCHA) II conducted by the American College Health Association (ACHA). Bivariate and multivariate statistical analyses were run on the data and summarized. Results: Enabling factors were more likely to predict health impact on academic performance, while predisposing factors were least likely to predict these impacts. Conclusion: Results indicate that the Andersen Model is a useful model for framing the relationship between health and academic performance among college students.
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Affiliation(s)
- Emily Vernet
- Department of Health Sciences, University of Central Florida, Orlando, Florida, USA
| | - Melanie Sberna
- Department of Sociology, University of Central Florida, Orlando, Florida, USA
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10
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Higher education and health at midlife: Evaluating the role of college quality. SSM Popul Health 2022; 19:101228. [PMID: 36164493 PMCID: PMC9508472 DOI: 10.1016/j.ssmph.2022.101228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 11/20/2022] Open
Abstract
Using the longitudinal data from the National Longitudinal Survey of Youth-1979 linked with external data on college characteristics (N = 7056), this study illustrates an independent stratifying role of college quality in shaping health. College quality has significant and positive influences on physical health, and this positive association tends to strengthen across 40 and 50. By contrast, attending higher-quality colleges is not associated with mental health at either age 40 or age 50. Decompositions were conducted to assess the extent to which early life and demographic characteristics, employment and economic conditions, health behaviors, and family relationships account for observed patterns. Our study highlights the necessity for future research on education and health to incorporate characteristics of schools attended; reveals variation in the college quality-health nexus by specific health outcomes; and provides new insights into understanding health inequalities across the life course. This study illustrates an independent stratifying role of college quality in shaping health. College quality has significant and positive influences on physical health, and this positive association tends to strengthen across 40 and 50. Attending higher-quality colleges is not associated with mental health at either age 40 or age 50.
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Polos JA, Koning SM, Hargrove TW, Kershaw KN, McDade TW. Structural racism in school contexts and adolescent depression: Development of new indices for the National Longitudinal Study of Adolescent to Adult Health and beyond. SSM Popul Health 2022; 19:101237. [PMID: 36203473 PMCID: PMC9530614 DOI: 10.1016/j.ssmph.2022.101237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022] Open
Abstract
Racial discrimination is an important predictor of racial inequities in mental and physical health. Scholars have made progress conceptualizing and measuring structural forms of racism, yet, little work has focused on measuring structural racism in social contexts, which are especially relevant for studying the life course consequences of racism for health. Using the National Longitudinal Study of Adolescent to Adult Health, we take a biosocial, life course approach and develop two life stage-specific indices measuring manifestations of structural racism in school contexts in adolescence, a sensitive period of development. The first is a school contextual disadvantage index (CDI), which captures differences in resources and opportunities across schools that have been partly determined by socio-historic structural racism that has sorted Black students into more disadvantaged schools. The second is a school structural racism index (SRI), which measures differences in resources and opportunities between Black and white students within schools. Then, we relate these indices to adolescent depressive symptoms. We find that among both Black and white students of both genders, higher CDI levels are associated with more depressive symptoms. However, Black students are twice as likely to be in schools with a CDI above the median compared to white students. We also find that, controlling for the CDI, the SRI is positively associated with depressive symptoms among Black boys and girls only. Finally, the CDI and the SRI interact to produce a pattern where the likelihood of depressive symptoms increases as the SRI increases, but only among Black boys and girls in low-disadvantage schools. These findings underscore the importance of measuring structural racism in social contexts in multifaceted ways to study life course health inequities.
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Affiliation(s)
- Jessica A. Polos
- Institute for Policy Research, Northwestern University, 2040 Sheridan Road, Evanston, IL, 60208-4100, USA
- Public Health Program, DePaul University, 14 East Jackson Boulevard, Chicago, IL, 60604, USA
| | - Stephanie M. Koning
- Institute for Policy Research, Northwestern University, 2040 Sheridan Road, Evanston, IL, 60208-4100, USA
| | - Taylor W. Hargrove
- Department of Sociology, Faculty Fellow, Carolina Population Center, University of North Carolina at Chapel Hill, 155 Pauli Murray Hall, Chapel Hill, NC, 27599-3210, USA
| | - Kiarri N. Kershaw
- Feinberg School of Medicine, Northwestern University, 680 North Lake Shore Drive, Chicago, IL, 60611, USA
| | - Thomas W. McDade
- Institute for Policy Research, Northwestern University, 2040 Sheridan Road, Evanston, IL, 60208-4100, USA
- Department of Anthropology, Northwestern University, 1810 Hinman St, Evanston, IL, 60208-1310, USA
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Lleras-Muney A, Price J, Yue D. The association between educational attainment and longevity using individual-level data from the 1940 census. JOURNAL OF HEALTH ECONOMICS 2022; 84:102649. [PMID: 35793610 DOI: 10.1016/j.jhealeco.2022.102649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
We combine individual data from the 1940 full-count census with death records and other information available on the Family Tree at familysearch.org to create the largest individual dataset to date (17 million) to study the association between years of schooling and age at death. Conditional on surviving to age 35, one additional year of education is associated with roughly 0.4 more years of life for both men and women for cohorts born 1906-1915 and smaller for earlier cohorts. Focusing on the 1906-1915 cohort we find that this association is identical when we use sibling or twin fixed effects. This association varies substantially by place of birth. For men, the association is stronger in places with greater incomes, higher quality of school, and larger investments in public health. Women also exhibit great heterogeneity in the association, but our measures of the childhood environment do not explain it.
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Affiliation(s)
- Adriana Lleras-Muney
- Department of Economics, University of California Los Angeles, Los Angeles, CA, United States
| | - Joseph Price
- Department of Economics, Brigham Young University, Provo, UT, United States
| | - Dahai Yue
- Department of Health Policy and Management, University of Maryland, College Park, MD, United States.
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Valdovinos C, Perez-Aguilar G, Huerta RG, Barrios C, Gutierrez G, Mendez C, Abhat A, Moreno G, Brown A, Casillas A. Electronic Health Literacy among Linguistically Diverse Patients in the Los Angeles County Safety Net Health System. Ethn Dis 2022; 32:21-30. [PMID: 35106041 PMCID: PMC8785863 DOI: 10.18865/ed.32.1.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Electronic health (eHealth) literacy may affect telehealth uptake, yet few studies have evaluated eHealth literacy in underserved populations. OBJECTIVE The objective of this study was to describe technology access and use patterns as well as eHealth literacy levels among English-speaking and LEP patients in a Los Angeles safety net health system. METHODS Patients, aged ≥18 years with a diagnosis of diabetes mellitus and/or hypertension, and their caregivers were recruited from three primary care safety-net clinics in Los Angeles County (California) between June - July 2017. Participants' electronic health literacy was assessed by the eHealth Literacy Scale (eHEALS); participants were also asked about technology access and use. We examined these measures in English-speaking and limited English proficient (LEP) Spanish-speaking patients. RESULTS A total of 71 participants (62 patients and 9 caregivers) completed the questionnaire. The mean age of the respondents was 56 years old. More than half of participants used a phone that could connect to the Internet (67%). The mean score for 10 eHEALS items was in the moderate range (26/50 points). There was no difference in mean eHEALS between language groups. However, 47% of Spanish-speaking participants "agreed/strongly agreed" that they knew how to use the Internet to answer their health questions, compared to 68% of English-speaking participants (P<.05). CONCLUSIONS In this sample of patients from a diverse safety net population, perceived skills and confidence in engaging with electronic health systems were low, particularly among LEP Spanish-speakers, despite moderate levels of electronic health literacy. More studies are needed among diverse patient populations to better assess eHealth literacy and patients' digital readiness, and to examine how these patient metrics directly impact telehealth utilization.
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Affiliation(s)
- Cristina Valdovinos
- David Geffen School of Medicine at UCLA, Los Angeles, CA,Charles R. Drew University of Medicine and Science, Los Angeles CA
| | - Giselle Perez-Aguilar
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA
| | | | - Chesca Barrios
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Griselda Gutierrez
- Harbor-UCLA Medical Center, Los Angeles County Department of Health Services, Los Angeles, CA
| | - Carmen Mendez
- Harbor-UCLA Medical Center, Los Angeles County Department of Health Services, Los Angeles, CA
| | - Anshu Abhat
- Harbor-UCLA Medical Center, Los Angeles County Department of Health Services, Los Angeles, CA
| | - Gerardo Moreno
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Arleen Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, Address correspondence to Alejandra Casillas, MD, MSHS; Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA;
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14
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Cohen AK, Ozer EJ, Rehkopf DH, Abrams B. High School Composition and Health Outcomes in Adulthood: A Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3799. [PMID: 33917294 PMCID: PMC8038652 DOI: 10.3390/ijerph18073799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND A multitude of empirical evidence documents links between education and health, but this focuses primarily on educational attainment and not on characteristics of the school setting. Little is known about the extent to which aggregate characteristics of the school setting, such as student body demographics, are associated with adult health outcomes. METHODS We use the U.S. nationally representative National Longitudinal Survey of Youth 1979 cohort to statistically assess the association between two different measures of high school student composition (socioeconomic composition, racial/ethnic composition) and two different health outcomes at age 40 (self-rated health and obesity). RESULTS After adjusting for confounders, high school socioeconomic composition, but not racial/ethnic composition, was weakly associated with both obesity and worse self-rated health at age 40. However, after adding adult educational attainment to the model, only the association between high school socioeconomic composition and obesity remained statistically significant. CONCLUSIONS Future research should explore possible mechanisms and also if findings are similar across other populations and in other school contexts. These results suggest that education policies that seek to break the link between socioeconomic composition and negative outcomes remain important but may have few spillover effects onto health.
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Affiliation(s)
- Alison K. Cohen
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, CA 94158, USA
| | - Emily J. Ozer
- School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA; (E.J.O.); (B.A.)
| | - David H. Rehkopf
- Departments of Epidemiology & Population Health and Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA;
| | - Barbara Abrams
- School of Public Health, University of California Berkeley, Berkeley, CA 94720, USA; (E.J.O.); (B.A.)
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15
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Dudovitz RN, Biely C, Barnert ES, Coker TR, Guerrero AD, Jackson N, Schickedanz A, Szilagyi PG, Iyer S, Chung PJ. Association between school racial/ethnic composition during adolescence and adult health. Soc Sci Med 2021; 272:113719. [PMID: 33545496 DOI: 10.1016/j.socscimed.2021.113719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/24/2020] [Accepted: 01/24/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVES School racial/ethnic segregation in U.S. schoolsDifferences in school racial/ethnic composition may increase health disparities by concentrating educational opportunities that confer long-term health benefits in schools serving predominantly wwhite students. For racial minority students, high concentrations of white students may increase exposure to racismis also associated with psychologicstress, which may ultimately reduceing the long-term health benefits from educational opportunities. Meanwhile associations of racial/ethnic academic tacking within schools and health have been mixed. We sought to test whether: 1) differences in racial/ethnic composition between schools and, 2) racial/ethnic distribution of students in academic tracks within schools are associated with long-term health benefits or risks for white, Black and Latinx students. METHODS We analyzed the National Longitudinal Study of Adolescent to Adult Health (12,438 participants, collected 1994-2008), to test whether the school-level segregation (percent of non-Latinx white students at participants' school during adolescence) was associated with adult health outcomes at ages 18-26 & 24-32, controlling for contextual factorscomparing Black, Latinx, and white students, and controlling for contextualf factors. A secondary analysis explored whether racial/ethnic cohorting across levels of English courses was associated with each health outcome. RESULTS Attending a school with a higher percent of white students was associated with higher adult depression scores, substance abuse, and worse self-rated health for black Black students; lower depression scores, better self-rated health, and alcohol abuse for white students; and no health differences for Latinx students. Greater within school racial/ethnic cohorting across English courses was associated with increased odds of alcohol abuse for white students; decreased odds of alcohol abuse for Black and Latinx students; and decreased odds of drug abuse for Black students. CONCLUSION Among Bblack youth, attending a school with a higher percentage of white students is associated with worse behavioral health in adulthood. Understanding the potential impacts of school racial/ethnic composition on health is critical to designing policies that maximize access to opportunity and health.Education policies should comprehensively address school quality and racism to maximize adult health.
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Affiliation(s)
- R N Dudovitz
- UCLA Department of Pediatrics and Children's Development and Innovation Institute, United States.
| | - C Biely
- UCLA Department of Pediatrics and Children's Development and Innovation Institute, United States
| | - E S Barnert
- UCLA Department of Pediatrics and Children's Development and Innovation Institute, United States
| | - T R Coker
- University of Washington Center for Child Health Behavior and Development, United States
| | - A D Guerrero
- UCLA Department of Pediatrics and Children's Development and Innovation Institute, United States
| | - N Jackson
- UCLA Division of General Internal Medicine and Health Services Research, United States
| | - A Schickedanz
- UCLA Department of Pediatrics and Children's Development and Innovation Institute, United States
| | - P G Szilagyi
- UCLA Department of Pediatrics and Children's Development and Innovation Institute, United States
| | - S Iyer
- UCLA Department of Pediatrics and Children's Development and Innovation Institute, United States
| | - P J Chung
- Kaiser Permanente School of Medicine, Health System Science, United States
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16
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Garcia S, Moorman SM. College Selectivity and Later-Life Memory Function: Evidence From the Wisconsin Longitudinal Study. Res Aging 2020; 43:14-24. [DOI: 10.1177/0164027520927137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research has shown a consistent association between college completion and laterlife cognition. We extend this work by examining whether college selectivity—the achievement level required to gain admission to a college—is associated with memory functioning more than 50 years later. We analyze data from 10,317 participants in the 1957–2011 Wisconsin Longitudinal Study to examine the relationship between college selectivity and later-life memory. Models control for childhood, midlife socioeconomic status, and later-life health and adjust for selection bias. Selective college attendance was associated with small benefits in memory at age of 72 even after accounting for socioeconomic status in both childhood and midlife and later-life health. The results of this study suggest that college selectivity may be an important component of the education–cognitive functioning relationship that has modest implications for intracohort differences in later-life cognition.
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Affiliation(s)
- Sarah Garcia
- Department of Sociology, University of Minnesota, Minneapolis, MN, USA
| | - Sara M. Moorman
- Department of Sociology, Boston College, Chestnut Hill, MA, USA
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17
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Chung SH, Biely C, Dudovitz R. Firearm access and adolescent health: Safety in numbers? SSM Popul Health 2020; 11:100568. [PMID: 32258356 PMCID: PMC7115163 DOI: 10.1016/j.ssmph.2020.100568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 12/01/2022] Open
Abstract
Access to firearms and perceived unsafe school environments are associated with negative adolescent health outcomes. Whether widespread acceptance of firearms alters these associations, however, is unknown. To address this literature gap, we examined whether peer acceptance of firearms moderates associations between personal firearm access and health outcomes. In 2018-2019, we analyzed Wave I of the National Longitudinal Study of Adolescent to Adult Health (collected 1994-1995) to assess personal firearm access and school-level percentage of firearm access, using weighted multilevel analyses with interactions to determine associations among personal access, school-level percentage of access, and adolescent depression, suicidality, general health, and perceived school safety. Models controlled for age, sex, race, region, urbanicity, family structure, parental income and education level, school type, school size, and school quality. Results showed that personal firearm access was associated with depression (OR 1.20 p = 0.03), suicidal ideation (OR 1.73, p < 0.001), and perceiving school as unsafe (OR 1.59, p < 0.001). A higher school-level percentage of access, however, was associated with lower rather than higher odds of perceiving school as unsafe (OR 0.83, p = 0.003). With interaction terms included, the association between personal access and suicidal ideation was weaker when school-level access was more common. Similarly, the association between school-level access and poor general health was negative among students with personal access but positive among students with no access. These findings suggest firearm access is a complex social phenomenon. In a low-access environment, personal firearm access may signify a high-risk physical and mental state. In schools where access is common, however, personal access may signify social belonging, possibly mitigating some potential negative health effects. Although evidence that firearm access is harmful remains clear, local norms may have a substantial moderating impact.
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Affiliation(s)
- Samantha H Chung
- Marlborough School, USA.,Department of Pediatrics, David Geffen School of Medicine at UCLA, USA.,Children's Discovery & Innovation Institute, UCLA Mattel Children's Hospital, USA
| | - Christopher Biely
- Department of Pediatrics, David Geffen School of Medicine at UCLA, USA.,Children's Discovery & Innovation Institute, UCLA Mattel Children's Hospital, USA
| | - Rebecca Dudovitz
- Department of Pediatrics, David Geffen School of Medicine at UCLA, USA.,Children's Discovery & Innovation Institute, UCLA Mattel Children's Hospital, USA
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18
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Moorman SM, Greenfield EA, Garcia S. School Context in Adolescence and Cognitive Functioning 50 Years Later. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:493-508. [PMID: 31912762 PMCID: PMC7007773 DOI: 10.1177/0022146519887354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
To advance understanding of how social inequalities from childhood might contribute to cognitive aging, we examined the extent to which school context in adolescence was associated with individuals' cognitive performance more than 50 years later. Using data from 3,012 participants in the Wisconsin Longitudinal Study (WLS), we created an aggregate measure of school-level structural advantage, with indicators such as the proportion of teachers who had at least five years of teaching experience and spending per pupil. Multilevel models indicated that secondary school advantage was associated with small benefits in language/executive function at age 65 among older adults who had lower academic achievement in secondary school. Findings suggest that school advantage is a developmental context of adolescence that has modest implications for intracohort differences in aspects of later life cognition.
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Affiliation(s)
| | | | - Sarah Garcia
- University of Minnesota, Minneapolis, Minnesota, USA
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19
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Gray HL, Buro AW, Barrera Ikan J, Wang W, Stern M. School-level factors associated with obesity: A systematic review of longitudinal studies. Obes Rev 2019; 20:1016-1032. [PMID: 31013544 DOI: 10.1111/obr.12852] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/16/2019] [Accepted: 02/25/2019] [Indexed: 01/27/2023]
Abstract
Although school has been an important intervention venue for obesity prevention, the role of school-level factors in obesity development or prevention has not been well-documented. This study aimed to systematically examine the current evidence on school-level factors associated with obesity outcomes in longitudinal studies. The literature search was performed in PubMed, EMBASE, CINHAL, and PsycINFO. Peer-reviewed articles using longitudinal study designs and published in English from 1991 to 2018 were eligible. Twelve articles met eligibility criteria for final systematic review. Nine studies reported significant long-term associations between school-level factors and obesity outcomes. Higher parental education, longer minutes of recess, meeting recommended recess and physical education time, higher socio-economic status, suburban compared with rural area, higher parental involvement in school, and healthful school food environment were significantly associated with lower rates of obesity or obesity trajectory. However, due to the small number of studies and heterogeneity of measures and variables used in their analytic models, the overall level of evidence from this review suggests the importance of further, systematic study. Empirically rigorous research is needed to identify additional aspects of the school context and environment that may contribute to the risk of obesity throughout the life course.
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Affiliation(s)
- Heewon L Gray
- College of Public Health, University of South Florida, Tampa, Florida
| | - Acadia W Buro
- College of Public Health, University of South Florida, Tampa, Florida
| | | | - Wei Wang
- College of Public Health, University of South Florida, Tampa, Florida.,Centre for Addiction and Mental Health, Ontario, Canada
| | - Marilyn Stern
- Department of Child & Family Studies, College of Behavioral & Community Sciences, University of South Florida, Tampa, Florida
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20
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Dudovitz RN, Chung PJ, Reber S, Kennedy D, Tucker JS, Shoptaw S, Dosanjh KK, Wong MD. Assessment of Exposure to High-Performing Schools and Risk of Adolescent Substance Use: A Natural Experiment. JAMA Pediatr 2018; 172:1135-1144. [PMID: 30383092 PMCID: PMC6350909 DOI: 10.1001/jamapediatrics.2018.3074] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE Although school environments are thought to influence health behaviors, experimental data assessing causality are lacking, and which aspects of school environments may be most important for adolescent health are unknown. OBJECTIVE To test whether exposure to high-performing schools is associated with risky adolescent health behaviors. DESIGN, SETTING, AND PARTICIPANTS This natural experiment used admission lotteries, which mimic random assignment, to estimate the association of school environments and adolescent health. A survey of 1270 students who applied to at least 1 of 5 high-performing public charter schools in low-income minority communities in Los Angeles, California. Schools had an academic performance ranked in the top tertile of Los Angeles County public high schools, applicants outnumbered available seats by at least 50, and an admissions lottery was used. Participants included lottery winners (intervention group [n = 694]) and lottery losers (control group [n = 576]) from the end of 8th grade and beginning of 9th grade through the end of 11th grade. Intention-to-treat (ITT) and instrumental variable techniques estimated the association of winning the lottery and attending high-performing schools with health behaviors and whether the association varied by sex. Data were collected from March 11, 2013, through February 22, 2017, and analyzed from October 1, 2017, through July 1, 2018. EXPOSURES Schools were considered high performing if they placed in the top tercile of public high schools in LA County on 2012 state standardized tests. Most students attended that same school for 3 years (9th-11th grades). MAIN OUTCOMES AND MEASURES Primary self-reported outcomes were 30-day and high-risk self-reported marijuana use. Additional health outcomes included 30-day alcohol use, alcohol misuse, ever being in a fight, ever having sex, and past-year delinquency. Potential intermediate factors (time studying, truancy, school mobility, school culture, school order, teacher support for college, and proportion of substance-using peers in students' social networks) were also examined. RESULTS Among the 1270 participating students (52.6% female; mean [SD] age at enrollment, 14.3 [0.5] years), ITT analysis showed that the intervention group reported less marijuana misuse than the control group (mean marijuana misuse score, 0.46 vs 0.71), as well as fewer substance-using peers (9.6% vs 12.7%), more time studying (mean, 2.63 vs 2.49 hours), less truancy (84.3% vs 77.3% with no truancy), greater teacher support for college (mean scores, 7.20 vs 7.02), more orderly schools (mean order score, 7.06 vs 6.83), and less school mobility (21.4% vs 28.4%) (all P < .05). Stratified analyses suggest that among boys, intervention participants had significantly lower marijuana use (mean misuse score, 0.43 vs 0.88; difference, -0.45; 95% CI, -0.78 to -0.13) and alcohol misuse (mean misuse score, 0.52 vs 0.97; difference, -0.44; 95% CI, -0.80 to -0.09) scores compared with control participants, whereas no significant health outcomes were noted for girls. CONCLUSIONS AND RELEVANCE This natural experiment provides evidence that school environments can improve risky behaviors for low-income minority adolescents.
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Affiliation(s)
- Rebecca N. Dudovitz
- Department of Pediatrics and Children’s Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital
| | - Paul J. Chung
- Department of Pediatrics and Children’s Discovery & Innovation Institute, David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital,Department of Health Policy & Management, UCLA Fielding School of Public Health,RAND Health, RAND Corporation
| | - Sarah Reber
- Department of Public Policy, UCLA Luskin School of Public Affairs and National Bureau of Economic Research
| | | | | | - Steve Shoptaw
- Department of Family Medicine and Department of Psychiatry and Biobehavioral Sciences David Geffen School of Medicine at UCLA, Department of Psychiatry, University of Cape Town
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21
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Abstract
Community schools link students, families, and communities to educate children and strengthen neighborhoods. They have become a popular model for education in many US cities in part because they build on community assets and address multiple determinants of educational disadvantage. Since community schools seek to have an impact on populations, not just the children enrolled, they provide an opportunity to improve community health. Community schools influence the health and education of neighborhood residents though three pathways: building trust, establishing norms, and linking people to networks and services. Through such services as school-based health centers, nutrition education, family mental health counseling, violence prevention, and sexuality education, these schools build on the multiple reciprocal relationships between health and education. By developing closer ties between community schools and neighborhood health programs, public health professionals can help to mobilize a powerful new resource for reducing the health and educational inequalities that now characterize US cities. We suggest an agenda for research, practice, and policy that can build the evidence needed to guide such a strategy.
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