In contrast, there are several notable strengths.
Study participants represent an ethnically diverse,
economically disadvantaged, urban population; thus
results may be generalizable to other urban settings
with persistent health and educational disparities.
We used multimethod approaches including objective indicators, standardized test scores, and student
reported survey items. Data were temporally ordered,
such that health assets were measured in advance of
standardized testing. Finally, we included absenteeism
as a potential mediator; while important, absenteeism
did not diminish the impact of health on academic
achievement.
IMPLICATIONS FOR SCHOOL HEALTH
Integration of health-promoting strategies can build
on school districts’ efforts to promote both learning and
health. Potential benefits may outweigh the investment
of time and resources. Murray et al56 suggest
that scientifically rigorous evaluations of school health
programs are limited. However, there are evidencebased
and promising programs/policies such as those
designed to manage chronic conditions like asthma,57
increase physical activity,58,59 and healthy eating,60
improve behavioral and emotional health,61 or provide
healthy school environments, comprehensive
health education, and school-based physical and mental
health services.62 Other interventions might include
implementation and enforcement of District Wellness
Plan recommendations; establishment of school wellness
teams to address health-related priorities; lowcost,
school-wide strategies to promote positive school
climate, healthy behaviors, and school connectedness;
and before-/after-school programs to promote health
and learning. Closing the ‘‘health gap’’ can help close
the ‘‘achievement gap.’’
Human Subjects Approval Statement
All procedures were approved by the Yale University
Human Subjects Committee and the New Haven Public
Schools Board of Education. Ethical guidelines were
strictly followed including parental consent and child
assent in English or Spanish.