COD E R E D

Overweight and obesity, with prevalence data ranging from 14.2% to 32.6% among Hispanic boysin Texas, has clear implications for public health, given its ties to both adult obesity and diabetes. Recentstudies also indicate that children who are overweight have both lower reading and math scores. Otherstudies indicate that obese children consider themselves to be poor students and are more likely to beheld back a grade. The evidence suggests that obesity not only poses serious health risks but alsojeopardizes academic achievement.Asthma studies in Texas indicate a prevalence of 15%, although many researchers fear that thiscondition is under-diagnosed and underreported. The impact of asthma on academic performance iscomplex; however, there is substantial evidence that children with asthma are more likely to be absentfrom school. This absenteeism translates into lower academic performance, principally among those frompoorer households. Unfortunately, absenteeism also has implications for school funding. Each absentchild costs the average school district about $18 per day in lost state revenue. On average, children withasthma are absent about 5 extra days per year.The prevalence of diabetes is much lower than either obesity or asthma. It is estimated that inchildren, 2.6 per 1000 have diabetes. What is alarming is the sudden increase in type 2 diabetes (formerlyreferred to as adult-onset) among children. Prior to twenty years ago, only 1% to 2% of diabetes cases inchildren were attributed to type 2. More recent estimates indicate 8% to 45% of all new cases of diabetesin children are due to type 2. It is important to note there is a strong correlation between type 2 diabetesand obesity. Because of the recent increase in the occurrence of type 2 diabetes in children, most studiesassessing the impact of diabetes on academic outcomes have been limited to children with type 1diabetes. Nonetheless, children with diabetes are more likely to have a reduction in neuropsychologicalfunctioning, to be absent from school and to perform at lower levels on academic measures over time,particularly in reading.When examining school-based interventions, we assessed those that improved health conditionsas well as academic performance. This is because the majority of school programs intervening uponhealth conditions measure health outcomes as opposed to academic ones. We found that few schoolhealth program evaluations have directly measured factors related to academic performance. Preventionresearchers have mostly had to assume that since chronic health conditions adversely affect schoolperformance, addressing these conditions to improve health then would naturally improve academicoutcomes. This may be true; however, we limit our endorsement to those programs whose consequencesfor improving school performance have been documented in the scientific literature.The second part of the report turns to the adult portion of the cycle. As noted, the childhoodportion of the cycle is related to education and academic performance. The research regarding health andeducation in adults explores educational attainment as opposed to academic performance. There is anextensive body of evidence suggesting that academic performance is predictive of overall educationalattainment. This link is well established, and because of time and space constraints, was not reviewed.Education as an indicator of socioeconomic status (SES) is an important determinant of health. Currentresearch has documented a health gradient based on SES. In other words, the more education one has,the healthier that person will be. It is a dose-response relationship rather than a threshold effect. As levelof education increases, so does a variety of measures of health status; the relationship is not limited tothose with the worst education having the poorest health while everyone else is fine. Studies have shownthat better educated people are healthier, report better health, and have lower mortality, morbidity anddisability. It has also been shown that those who are less educated have lower health literacy (or moredifficulty understanding and acting upon health information), a higher risk of infant mortality, and are morelikely to develop risk factors related to poor health. There are several possible explanations as to whyeducation levels affect adult health. As part of the report, we review the evidence for a range of pathwaysbased on: human capital, personal control, resources associated with education, use of medical care,occupation and social resources.E-ii