Does this strike you as painfully obvious?

American high school students with poor grades are much more likely to have unhealthy behaviors — including illegal drug use — than teens at the top of the class, federal health officials say.


Which comes first for these students — unhealthy behaviors or poor grades? Robert Preidt reviews results from a CDC survey published in last week’s Morbidity and Mortality Weekly Report (MMWR) thatĀ comes up short in answering that question. Still, the results are striking, if not surprising:

Analyzing data from a 2015 federal government survey, the researchers found that compared to students with mostly A’s, students with mostly D’s and F’s were:

  • nine times more likely to say they’d injected illegal drugs.
  • five times more likely to say they’d skipped school at least one day in the past month due to safety concerns.
  • four times more likely to say they’d had four or more sexual partners.


And compared to students with mostly D’s and F’s, the A-range students reported healthier behaviors. The better students were:

  • twice as likely to eat breakfast every day in the past week.
  • 1.5 times more likely to have been physically active at least 60 minutes a day on five or more days in the past week.


Will eating breakfast every day and getting more exercise increase the chances that your child will get good (or, at least better) grades? The evidence seems to support that. Are children who get poor grades — for the variety of reasons that may exist, including learning differences, chronic medical conditions, emotional, behavioral, and psychological issues, and substance abuse — more likely to engage in unhealthy behaviors? There is evidence to support that, too. Nevertheless, parents and students are not helpless in identifying social obstacles that get in the way of students doing the best they possibly can in school. And parents and students — and their teachers, too — need to view poor grades asĀ red flags for underlying social, physical, or mental health problems.

The authors of the review find evidence that schools can play a positive role in improving student health and school performance:

School health interventions can promote positive health behaviors by 1) offering students opportunities to practice healthy behaviors; 2) increasing student knowledge and skills through school nutrition programs and services, physical education, and comprehensive health education (including sexual health education); 3) enhancing protective factors such as school connectedness or parent engagement; and 4) shaping school health services and environments more broadly.


Student health and academic performance are closely linked. Recognizing that is more important than figuring out which one comes first.


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