For adolescents, academic failure has many negative consequences, ranging from strained parent-adolescent relations in the short-term (Repetti 1996
) to truncated educational attainment in the long-term (Barrington and Hendricks 1989
; Roderick 1993
). Through these effects on collective individuals, academic failure also negatively affects society. Given what we know about long-term individual- and social-level consequences of academic failure in secondary school, an important goal of research is to understand the constellation of forces, both positive and negative, that underlie this social problem in order to identify ways in which social institutions can work together to better serve the needs of children, adolescents, and families.
In the present study, we have applied a social epidemiological framework to the study of academic failure in secondary school, one guided by a need to locate identifiable, manipulable risk factors and protective factors for this individual and social problem. In taking this approach, we have established physical and mental health problems as risk factors for academic failure and have addressed why and under what circumstances these health problems pose a risk to academic achievement.
Adolescent Health and Academic Failure
Establishing both physical and mental health problems as risk factors for academic failure is important for several reasons. First, it helps to move educational research into new areas, beyond academics. While previous research has begun to examine non-academic factors that contribute to academic problems, this is the first nationally-representative, longitudinal study to examine the role of physical and mental health problems in explaining academic failure in secondary school. Second, this basic finding suggests the need to study in tandem educational and health trajectories (or, pathways over time). Research on adult health and well-being finds that higher education predicts better health (Mirowsky and Ross 2003a
). If child and adolescent health problems destabilize student trajectories through the formal schooling system, then the negative long-term association between educational attainment and adult health may be due, in part, to these early health problems. Third, establishing physical and mental health problems as risk factors for academic failure helps schools identify a population of at-risk students requiring special attention and possibly intervention, as has been done in the past for low-income students (Arroyo, Rhoad, and Drew 1999
) and certain racial/ethnic groups (Gandara 2000
Mechanisms Underlying the Academic Risk of Health Problems
Our analyses reveal that physical and mental health problems disrupt multiple aspects of students’ lives in school and lead to negative consequences like excessive absenteeism, trouble completing schoolwork, and weak (individual-level) attachment to teachers. These negative consequences spill over and negatively affect their academic performance. This finding illustrates the complexity of human development in general and the complexity of schooling adolescents in particular. In order to reduce the risk associated with health problems, schools must attend to the whole student. This includes developing intervention strategies targeted at the problems that put physically and mentally ill adolescents at risk.
Adolescent Health, Academic Failure, and School Context
Risk factors are not inalterable, but instead likely vary across social contexts. These contexts offer different levels of protection and may even exacerbate the risks already present. This study focused on school context, aiming our analyses toward potentially protective schooling environments. Another important extension of the epidemiologic framework attempted by this study concerns the possibility that risk status varies with social context. We found only slight evidence to suggest that the association between health problems and course failure varies by schools, a finding that was counterintuitive.
Rather than serving as a protective factor, high levels of student-teacher bonding within a school heightened the risk of course failure among adolescents with mental health problems. One possible explanation for this finding is that emotionally distressed students may feel especially isolated from teachers in environments with high student-teacher bonding. We tested this hypothesis, however, using the individual-level measure of teacher attachment and found no support for it. Future research should examine this finding more closely, since it implies that schools with a seemingly positive and protective climate may not effectively serve as a “safety net” for this particular group of at-risk students. This finding reveals the challenge to designing school interventions, in that selection effects mask apparent protective mechanisms, and programs designed to help may have unintended consequences.
Directions for Future Research
Cross-school, or cross-context, variability in the association between health problems and academic failure is potentially much greater than suggested by our findings. This has been the first study to consider this possibility, and much more can be done. We have examined only between-school factors and not within-school factors. Perhaps the real variation in the association between health and academic performance occurs across different subsets of the school environment—such as curricula, student activities, and peer networks. Although beyond the scope of this study, these possibilities can be addressed with the upcoming educational supplement to Add Health, which includes information from official school transcripts on course registration patterns, course content, and school environment.
At the same time, the examination of contextual variability in this and other risk-related processes can move beyond the school level, which is only one context in the larger ecology of human development. For example, family and neighborhood contexts have been found to contribute to physical and mental health in addition to academic achievement in adolescence, which could moderate the connection between health problems and academic performance (see Catsambis and Beveridge 2001
for an example of this approach). Of course, social structural subpopulations, such as racial and ethnic groups, also serve as social contexts, albeit of the more distal variety. Preliminary analyses have revealed little variation in these processes by gender. We do plan, however, racial/ethnic and class comparisons in the future. These different levels of social context are not isolated from each other. Consequently, future research should take into account how social contexts, both proximate and distal, interact to shape education and health, and the relation between the two. For example, future research might consider whether, if some school factors moderate the association between health problems and academic failure, this moderating role itself might be moderated by race/ethnicity.
Another important avenue of future research, already mentioned, concerns the need to study educational and health trajectories within and across different stages of the life course and, moreover, the degree to which such trajectories intertwine over time. For example, linking together early health status, adolescent academic failure, and later health problems is a necessary first step in linking youth and adult literatures; comparing the academic risk status across three stages of schooling (elementary, secondary, college) would also be valuable. At the same time, examining the extent to which trajectories of health problems and academic problems are interrelated across the transition to young adulthood would demonstrate the interaction among dynamic developmental trajectories in multiple domains.
Surprisingly little research has considered the possibility that education and health, two key developmental domains of the early life course, are related to each other during adolescence. As one of the first studies to explore this possibility in a national-level quantitative framework, this preliminary study provides answers to some old questions but, simultaneously, presents new questions. Our use of the social epidemiological framework to better understand one key adolescent problem suggests that the general study of social problems can benefit from considering how multiple domains of adjustment and functioning come together within a complex tapestry of social contexts, at both the micro- and macro-levels. This study also demonstrates how adolescent research fits into the broader area of social problems. Adolescent phenomena are important because they potentially reveal the origins of social inequalities in later stages of the life course or in society as a whole. Finally, the significance of this study is practical as well as conceptual. Identifying academic risks and the contexts in which these risks are exacerbated or assuaged helps tailor interventions for particular student groups and promote the overall functioning of the educational system.