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Health improvement and educational attainment in secondary schools: complementary or competing priorities? Exploratory analyses from the School Health Research Network in Wales

Littlecott, Hannah J., Long, Sara ORCID:, Hawkins, Jemma ORCID:, Murphy, Simon ORCID:, Hewitt, Gillian ORCID:, Eccles, Gemma, Fletcher, Adam ORCID: and Moore, Graham F. ORCID: 2018. Health improvement and educational attainment in secondary schools: complementary or competing priorities? Exploratory analyses from the School Health Research Network in Wales. Health Education and Behavior 45 (4) , pp. 635-644. 10.1177/1090198117747659

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Background. Implementing health improvement is often perceived as diverting resource away from schools’ core business, reflecting an assumption of a “zero-sum game” between health and education. There is some evidence that health behaviors may affect young people’s educational outcomes. However, associations between implementation of school health improvement and educational outcomes remains underinvestigated. Methods. The study linked school-level data on free school meal (FSM) entitlement, educational outcomes, and school attendance, obtained from government websites, with data from the School Environment Questionnaire (SEQ) on health improvement activity collected in Wales (2015/2016). Spearman’s rank correlation coefficients and linear regression models tested the extent of association between health improvement activity and attendance and educational outcomes. Results. SEQ data were provided by 100/115 network schools (87%), of whom data on educational performance were obtained from 97. The percentage of pupils entitled to FSM predicted most of the between-school variance in achievement and attendance. Linear regression models demonstrated significant positive associations of all measures of health improvement activity with attainment at Key Stage (KS) 3, apart from mental health education in the curriculum and organizational commitment to health. Student and parent involvement in planning health activities were associated with improved school attendance. There were no significant associations between health improvement and KS4 attainment. Conclusion. Implementing health improvement activity does not have a detrimental effect on schools’ educational performance. There is tentative evidence of the reverse, with better educational outcomes in schools with more extensive health improvement policies and practices. Further research should investigate processes by which this occurs and variations by socioeconomic status.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Social Sciences (Includes Criminology and Education)
Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer)
Additional Information: This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (
Publisher: SAGE
ISSN: 1090-1981
Date of First Compliant Deposit: 13 November 2017
Date of Acceptance: 2 November 2017
Last Modified: 10 Jul 2023 16:30

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