Health and Its Effect to Academic Performance

The impact of health and health behaviours on educational outcomes in high-income countries: a review of the evidence Marc Suhrcke, School of Medicine, Health Policy and Practice, niversity of !ast "nglia, nited #ingdom $armen de Pa% &ieves, 'undaci(n )deas, Madrid, Spain

)S*& +,- +. -+/ /../ . #eywords H!"0TH *!H"1)23 - H!"0TH ST"T S !4 $"T)2&"0 ST"T S - 3)S# '"$T23S - S2$)2!$2&2M)$ '"$T23S - 3!1)!5 0)T!3"T 3! Suggested citation Suhrcke M, de Pa% &ieves $ 6./7789 The impact of health and health behaviours on educational outcomes in highincome countries: a review of the evidence9 $openhagen, 5H2 3egional 2f:ce for !urope9 "ddress re;uests about publications of the 5H2 3egional 2f:ce for !urope to: Publications 5H2 3egional 2f:ce for !urope Scher:gsve< - 4#-.7// $openhagen =, 4enmark "lternatively, complete an online re;uest form for documentation, health information, or for permission to ;uote or translate, on the 3egional 2f:ce web site 6http:>>www9euro9who9int>pubre;uest89 ? 5orld Health 2rgani%ation ./77 "ll rights reserved9 The 3egional 2f:ce for !urope of the 5orld Health 2rgani%ation welcomes re;uests for permission to reproduce or translate its publications, in part or in full9 The designations employed and the presentation of the material in this publication do not imply the e@pression of any opinion whatsoever on the part of the 5orld Health 2rgani%ation concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries9 4otted lines on maps represent appro@imate border lines for which there may not yet be full agreement9 The mention of speci:c companies or of certain manufacturersA products does not imply they are endorsed or recommended by the 5orld Health 2rgani%ation in preference to others of a similar nature that are not mentioned9 !rrors and omissions e@cepted, the names of proprietary products are distinguished by initial capital letters9 "ll reasonable precautions have been taken by the 5orld Health 2rgani%ation to verify the information contained in this publication9 However, the published material is being distributed without warranty of any kind, either e@press or implied9 The responsibility for the interpretation and use of the material lies with the reader9 )n no event shall the 5orld Health 2rgani%ation be liable for damages arising from its use9 The views e@pressed by authors, editors, or e@pert groups do not necessarily represent the decisions or the stated policy of the 5orld Health 2rgani%ation9 !dited by !li%abeth Boodrich *ook design and layout by Marta Pas;ualato $over photo ?iStockphoto9com>&eustock The photographs in this material are used for illustrative purposes onlyC they do not imply any particular health status, attitudes, behaviours, or actions on the part of any person who appears in the photographs9

5H2 !uropean 2ce for )nvestment for Health and 4evelopment The 5H2 !uropean 2f:ce for )nvestment for Health and 4evelopment, which coordinated the activities leading to this publication, was set up by the 5H2 3egional 2f:ce for !urope, with cooperation and support from the Ministry of Health and the 1eneto 3egion of )taly9 2ne of its key responsibilities is to provide evidence on and act upon the social and economic determinants of health9 The 2f:ce systematically reviews what is involved in drawing together the concepts, scienti:c evidence, technology and policy action necessary to achieve effective investment for the promotion of health and synergy between social, economic and health development9 The 2f:ce ful:ls two interrelated main functions: DD to monitor, review and systemati%e the policy implications of the social and economic determinants of population healthC and to provide services to help Member States in the 5H2 !uropean 3egion increase their capacity to invest in health by addressing these policy implications and integrating them into the agenda for development9 "cknowledgements 5e gratefully acknowledge the :nancial and other support provided by the 5H2 !uropean 2f:ce for )nvestment for Health and 4evelopment, 5H2 3egional 2f:ce for !urope and the &ational Health Service Health Scotland 6&HS Health Scotland8 in its capacity of 5H2 collaborating centre for health promotion and public health development, in the production of this work9 5e have bene:ted greatly from the comments made by 4avid Pattison 6&HS Health Scotland8 and $hris *rown 65H2 !uropean 2f:ce for )nvestment for Health and 4evelopment, 5H2 3egional 2f:ce for !urope8, and the production coordination provided by $ristina $omunian 65H2 !uropean 2f:ce for )nvestment for Health and 4evelopment, 5H2 3egional 2f:ce for !urope89 5e are also indebted to !li%abeth Boodrich who copy-edited the te@t9 "ny errors are the sole responsibility of the authors9 The views e@pressed in this publication do not necessarily reEect the of:cial views of &HS Health Scotland9 Marc Suhrcke, School of Medicine, Health Policy and Practice, niversity of !ast "nglia, nited #ingdom $armen de Pa% &ieves, 'undaci(n )deas, Madrid, Spain iii

$ontents "cknowledgements 999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 999999999999999999999999999iii "bbreviations 999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 9999999999999999999999999999 v !@ecutive summary 99999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 9999999999 vi 79 )ntroduction 999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 999999999999999999999999 7 .9 The association between education and health 999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 . F9 'rom health to education: a conceptual framework 99999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 F Health outcomes and conditions 999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 F Mediating factors and educational outcomes 9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 G !@ternal or control factors affecting both health and education 999999999999999999999999999999999999999999999999999999999999999999999999999999 H )mpact of health on future prospects through education and intergenerational transmission of ine;ualities 9999999999 I G9 Search methodology99999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 999999999999 , H9 3esults of the literature review 99999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 + Selected summary statistics 9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 + )mpact of health-related behaviours and risk factors on educational outcomes: detailed :ndings 99999999999999999999999 7. )mpact of health conditions on educational outcomes: detailed :ndings 99999999999999999999999999999999999999999999999999999999999999 .7 I9 $onclusions 999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 9999999999999999999999 .+ "nne@ 79 2nline databases used 999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 F/ 3eferences 99999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 99999999999999999999999999 F. 0ist of tables Table 79 &umber of papers reviewed, by health behaviours and conditions 9999999999999999999999999999999999999999999999999999999999999999 + Table .9 &umber of papers reviewed, by educational outcome 999999999999999999999999999999999999999999999999999999999999999999999999999999999 7/ Table F9 &umber of papers reviewed, by year of publication 9999999999999999999999999999999999999999999999999999999999999999999999999999999999999 7/ Table G9 &umber of papers reviewed, by country 9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 77 Table H9 &umber of papers reviewed, by methodology 999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 77 Table I9 &umber of papers reviewed, by <ournal article versus working paper 999999999999999999999999999999999999999999999999999999999 7. Table ,9 &umber of papers reviewed, by :eld 999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 7. Table -9 &umber of

papers reviewed, by :ndings 999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 7. Table +9 "lcohol drinking 9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 7G Table 7/9 Mari<uana use 9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 7I Table 779 Smoking 99999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 9999999999 7, Table 7.9 Poor nutrition 999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 9 7+ Table 7F9 2besity and overweight 999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 ./ Table 7G9 Physical e@ercise 99999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 .7 Table 7H9 Sleeping problems 999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 .. Table 7I9 Mental health and wellbeing 9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 .G Table 7,9 "sthma 9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 9999999999 .I Table 7-9 Beneral health 999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 ., 0ist of :gures 'ig9 79 "nalytical framework of the causal association between health and education 99999999999999999999999999999999999999999999999 F 'ig9 .9 Study selection criteria and process9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999 iv

"bbreviations "4H4 "&21" *M) $! !SS !TS B"T23 B!! BP" H) M"P M04" &*!3 &H"&!S ))) &0S$J &0SJ &0SJ,+ &T4S &S0 2!$4 2!2 P4SS P)"T P)"T3 PP1T-3 PS)4 P MS S2!P TS)1 5)$ 5)S$-))) attention de:cit hyperactivity disorder analysis of variance body mass inde@ coordinative e@ercise !pworth Sleepiness Scale environmental tobacco smoke Beorgetown "dolescent Tobacco 3esearch generali%ed estimating e;uation grade point average hyperactivity-impulsivity Missouri "ssessment Program minimum legal drinking age &ational *ureau of !conomic 3esearch Third &ational Health and &utrition !@amination Survey $anadian &ational 0ongitudinal Survey of $hildren and Jouth &ational 0ongitudinal Surveys of Jouth 6 nited States of "merica8 7+,+ &ational 0ongitudinal Surveys of Jouth 6 nited States8 &ational Public School-Head Start Transition 4emonstration Study normal sports lesson 2rganisation for !conomic $o-operation and 4evelopment 2f:ce of !;ual 2pportunity 6 nited States8 paediatric daytime sleepiness scale Peabody )ndividual "chievement Test Peabody )ndividual "chievement TestK3evised Peabody Picture 1ocabulary TestK3evised Panel Survey of )ncome 4ynamics Public- se Microdata Sample Berman Socioeconomic Panel Two-Sample )nstrumental 1ariables Special Supplement &utrition Program for 5omen, )nfants, and $hildren 6 nited States8 5eschler )ntelligence Scale for $hildrenK))) v

!@ecutive summary 5hile the importance of education is widely appreciated as a public policy priority in industriali%ed countries and cross-country comparative rankings of educational performance typically provoke ma<or national debates, comparably little attention, outside of health, is paid to the impact of child and adolescent health on education9 Part of the reason could be the perception that child health is but a by-product of education rather than a factor that could determine educational outcomes9 This report casts doubt on this perception by critically e@amining the evidence on the effect of health on education in industriali%ed countries9 *ased on seemingly underrecogni%ed evidence, our overall :nding is that there is reason to believe health does have an impact on education9 This :nding should serve as a basis for raising the pro:le of child health in the public policy debate, and by illustrating the potential for mutual gains, it should help stimulate cross-sectoral collaboration between the health and education sectors9 !ducation and health are known to be highly correlated K that is, more education indicates better health and vice versa K but the actual mechanisms driving this correlation are unknown9 The effect of health on education has been well researched in developing countries, as has the effect of education on health in both developing and industriali%ed countries9 Such imbalance could signal lack of attention not only in research but also in the public policy debate9 5hile children in developing countries face more serious health challenges than those in industriali%ed ones, the potentially relevant effect of health on their educations 6and perhaps on labour force participation8 cannot be ruled out9 The analytical framework we used to guide our research posits a path leading from health behaviours 6e9g9 smoking8 and health conditions 6e9g9 asthma8 to educational attainment 6level of education8 and educational performance 6e9g9 grades89 5e searched literature in the :elds of health, socioeconomic research, and education and ultimately narrowed our selected publications to HF, all of them based in countries belonging to the 2rganisation for !conomic $o-operation and 4evelopment9 *ased on the evidence reviewed, some of our more important :ndings are the following9 D 2verall child health status positively affects educational performance and attainment9 'or e@ample, one study found that very good or better health in childhood was linked to a third of a year more in schoolC another concluded that the probability of sickness signi:cantly affected academic success: sickness before age .7 decreased education on average by 79G years9 The evidence indicates that the negative effect on educational outcomes of smoking or poor nutrition is greater than that of alcohol consumption or drug use9 )nitial research has found a signi:cant positive impact of physical e@ercise on academic performance9 2besity and overweight are associated negatively with educational outcomes9 Sleeping disorders can hinder academic performance9 Particularly underresearched, especially considering their growing signi:cance, is the effect of an@iety and depression on educational outcomes9 "sthma on average has not been shown to affect school performance9 The preponderance of research was based in the nited States of "merica, but overall this :eld has grown markedly since .//7, including in !urope9 'rom a methodological perspective it is important to note that several papers undertake serious efforts to tackle the challenge of proving causality in the relationship9

DDDDDDDD )n light of the comparative lack of !uropean evidence, there is a genuine need to undertake further targeted research in this somewhat neglected area9 &evertheless, the evidence that already e@ists should be actively disseminated across both education and health ministries and agencies9 "cademics and practitioners should be encouraged to share the wide range of evidence sources they haveC doing so may contribute to a greater understanding of this area of work9 This evidence should include recognition of the value of ;ualitative evidence and grey literature9 vi

79 )ntroduction The relationship between health and education is doubtless a close one9 )n particular, the public health literature has widely documented the correlation between these two dimensions of human capital in both developing and industriali%ed countries9 More often than not, this association is interpreted or even shown to represent, especially in industriali%ed countries, a causal effect running from education to health: a better education leads to better health9 This publication e@plores, speci:cally in high-income countries, the e@tent to which a causal link may also run the other way, from health to education9 That is, does better health lead to a better educationL 5e start with the hypothesis that this direction of the relationship has been somewhat ignored both in research and, arguably, in the public policy debate9 To date, far more attention has been paid to the importance of health for education in the research on developing countries, documenting in particular very clearly the importance of child and adolescent health for educational attainment and performance9 5hile there is obvious reason to believe that the health challenges children face in rich countries affect education to a lesser e@tent than the more life-threatening health challenges in poor countries, a potentially relevant effect of health on education in the industriali%ed world cannot be automatically ruled out9 This study aims to systematically review the current knowledge of the effect that different health conditions and unhealthy behaviours can have on educational outcomes in the conte@t of rich countries9 Speci:cally, we e@amine research on the following ;uestions9 DD 4oes poor health during childhood or adolescence have a signi:cant impact on educational achievement or performanceL 4oes the engagement of children and adolescents in unhealthy behaviours determine their educational attainment and academic performanceL "s it turns out, although these ;uestions have not been a ma<or research focus, the evidence that does e@ist offers a lot to suggest a causal contribution of health to various educational outcomes9 5hile gaps in the research do remain, its results already bear relevant policy implications both for the wider importance of child health in rich countries 6e@tending beyond the health bene:ts per se8 and for the ways in which educational outcomes might be improved9 The publication is structured as follows9 )n section . we review brieEy some of the evidence and hypotheses behind the linkage between health and education in general9 Section F presents a conceptual framework to organi%e the different ways in which health may impact education9 Section G describes the literature search methodology9 Section H presents the core results of the literature review, :rst in terms of basic summary statistics and second in a more detailed, synthesis format9 The :nal section draws together our conclusions9 7

.9 The association between education and health " fairly large body of evidence both in the economics and public health literature documents a positive correlation between health and education9 4ue to the empirical challenges involved in assessing causality in the relationship, there is less agreement on what the precise mechanisms are that drive this correlation9 "s :rst highlighted by Brossman 67+,F8 and more recently by other authors including $utler and 0leras-Muney 6.//I8C 4ing et al9 6.//I8C Ban and Bong 6.//,8, health and education may interact in three not mutually e@clusive ways: 78 education may determine healthC .8 one or more other factors may determine both health and education simultaneouslyC and F8 health may determine education9 !ducation may determine health9 The predominant view appears to be that the effect of education on health is primarily driving the correlation in high-income countries9 " set of ;uasi-e@perimental studies across different countries con:rmed this view and was summari%ed, for instance, by $utler and 0leras-Muney 6.//I89 Similarly, a recent study by 0undborg 6.//-8, using data on identical twins to estimate the health returns to education, concluded that higher educational levels positively affect selfreported health and reduce the number of chronic conditions9 The link between education and health has different potential e@planations9 'irst, education as a long-term investment provides an incentive to individuals to stay healthy and reap the bene:ts of such investment9 $utler and 0leras-Muney 6.//I8 in this regard highlight differences in preferences and an individualAs valuation of his or her future that may both be affected by the level of education as relevant factors e@plaining health outcomes9 Second, as a key MinputN in the health production function, education may also help individuals maintain or improve their health, mostly by means of their enhanced knowledge of health issues, information availability and cognitive skills 6Brossman, 7+,FC $utler and 0leras-Muney, .//I89 'inally, educational achievement is correlated with higher earnings through access to better <ob opportunities and social networks, which in the long term is e@pected to translate into higher health e@penditure and thus better health 6Brossman, 7+,HC #enkel, 7++7C 3osen%weig and Schult%, 7++7 as cited in Ban and Bong, .//,C 0lerasMuney, .//I89 2ne or more other factors may determine both health and education simultaneously9 Some researchers suggest that it is mostly e@ternal factors that simultaneously affect both education and health9 'or instance, $ase, 'ertig and Pa@son 6.//H8, using panel data from the nited #ingdom, found that childrenAs health was signi:cantly affected by the socioeconomic status of their family9 $urrie et al9 6.//G8 concluded similarly that around I/O of the variation in childrenAs health in a sample of !nglish siblings was e@plained by MunobservedN family characteristics, i9e9 not investments in health or education9 )n line with these :ndings from the nited #ingdom, Smith 6.//-8 concluded on the basis of a sample in the nited States that signi:cant differences e@isted in the estimated impact of health outcomes on education between regular and within-sibling models, reinforcing the hypothesis that family background likely plays a key role in both childrenAs health and education9 Health may determine education9 0ast but not least and in accordance with the prime focus of this study, health may also be a determinant of educational outcomes 6Ban and Bong, .//,89 2f the three potential mechanisms this one appears to be the least researched in high-income countries9 The subse;uent section describes in more detail the potential mechanisms that might e@plain such a causal impact9 Parts of the relevant literature in this :eld were recently reviewed by $urrie 6.//-8 and Taras and Potts-4atema 6.//H a, b, c and d89 2ur review builds on these efforts and complements them in various ways9 $urrieAs 6.//-8 e@cellent review did not comprehensively cover all the available literature on the

topic9 &either her nor the Taras and Potts-4atema 6.//H a, b, c, and d8 reviews e@haustively covered the evidence on the impact of different health behaviours on educational outcomes9 )n addition, since Taras and Potts4atemaAs reviews were published in .//H, they could not capture the notably growing research output K albeit from a low base K in more recent years9 To the best of our knowledge, this is the :rst effort to comprehensively study the effect of health behaviours and health conditions on educational outcomes within a common analytical framework9 .

F9 'rom health to education: a conceptual framework This section presents the framework we use to conceptuali%e the causal association between health and education 6see 'ig9 7 for a graphical illustration89 'ig9 79 "nalytical framework of the causal association between health and education $hild and adolescent health-related behaviours D "lcohol drinking D 4rug use D Smoking D &utritional de:ciencies D 2besity and overweight D Physical activity Mediating factors D $ognitive abilities development D 4iscrimination in classroom D Self-esteem D 0earning skills D Physical energy D How teachers and peers treat children and adolescents !ducational attainment D 0evel or year of education D 4ropping out D $ollege enrolment "cademic performance D Brade point average 6BP"8 scores D Brade repetition D Truancy 2ther adult outcomes D Health D Marital status D 'ertility control D 'uture childrenAs schooling D $riminal activity $hild and adolescent health conditions D Sleeping disorders D Mental problems D "sthma )ncome 6through labour market outcomes8 !@ternal factors and controls D Micro: family socioeconomic background, personal ability, perceived value of the future, gender, ethnicity D Meso: community and school environment, geographical location, friendsA habits, social networks D Macro: national income, national policies Health outcomes and conditions The two bo@es on the left of the diagram represent the main e@planatory variables in the model, i9e9 children and adolescentsA health indicators, which we classify into health conditions and health behaviours 6or Mrisk factorsN89 )n our review we took into account the following healthrelated behaviours: DD alcohol drinking drug use F

DDDD smoking nutritional de:ciencies obesity and overweight physical activity9 The health conditions we systematically studied in this review included: DDD sleeping disorders mental health and well-being 6comprising an@iety and depression8 asthma9 These health conditions and risk factors tend to coincide with and affect each other, as indicated by the double-headed arrow connecting the left-hand bo@es9 2ne study illustrated this clearly: studying adolescents in the nited States, 4ing et al9 6.//I8 found striking differences in the estimated impacts of depression and obesity when e@amining a single health state in isolation9 That research also concluded that individuals with health disorders such as obesity or depression were signi:cantly more likely to smoke9 $on:rming these :ndings, students reporting higher levels of sleepiness during the day tended to also report more fre;uent illness 64rake et al9, .//F8, and several studies reviewed here highlight a relevant association between nutritional de:ciencies and mental health problems 6"laimo, 2lson and 'rongillo, .//7C 4atar and Sturm, .//I89 Students who binge drank were more likely than both non-drinkers and drinkers who did not binge to report involvement in other risky health behaviours according to $utler, Miller and &orton 6.//,89 )n addition, !llickson et al9 6.//G8 found that early smokers were at least three times more likely by grade 7. than non-smokers to regularly use mari<uana and hard drugs9 Sleepiness has also been associated with a higher incidence of an@iety and behavioural problems 6Bibson et al9, .//I89 Therefore, in assessing the impact of health behaviours on education, it is important to avoid considering the health behaviours and>or health conditions in isolation of each other9 Mediating factors and educational outcomes The focus of this review and the main ;uestion to be addressed within the framework is the e@tent to which the selected risk factors and health conditions have a signi:cant effect on educational outcomes9 This core link is highlighted in the central, blue-background bo@ in the :gure9 However, health can inEuence education not only directly but also through the mediating mechanisms listed in the Mmediating factorsN bo@ in the diagram9 Buo and Harris 6.///8, for instance, demonstrated that cognitive stimulation is one of the main mechanisms through which poverty affects childrenAs intellectual development and thus school achievement9 Mediating factors include all those aspects determined by health that in turn can have an impact on educational outcomes e9g9 64ing et al9, .//I8: DDDDD cognitive and learning skills development treatment received by children in the classroom in connection with their health condition6s8 discrimination by peers self-esteem studentsA physical energy9

!ducational outcomes are classi:ed for the purpose of this review into longer and shorter term indicators9 The longterm outcome considered is educational attainment, pro@ied by: DDD level or years of education achieved dropping out college enrolment9 "cademic performance is the shorter term educational indicator, measured by: G

DDD BP" or grades grade repetition days of class missed or skipped 6truancy89 "lthough most articles included here analyse the direct relationship between health conditions and behaviours and educational outcomes, some go a step further and attempt to assess this relationship through the impact of certain policies and programmes related to different health aspects on education9 !@ternal or control factors aecting both health and education "s highlighted in the previous section, both health and education outcomes of children and adolescents can be determined by a set of e@ternal or MthirdN factors, represented in the bo@ at the bottom of the diagram9 The presence of both observable and 6in particular8 unobservable common determinants of health and education tends to complicate the empirical estimation of the relationship between health and education, as discussed in subse;uent sections9 "spects such as family background and individual characteristics of children 6e9g9 preferences8 play an important role in shaping the relationship between health and education9 Hence failure to take those often hard to observe factors into account would seriously bias any coef:cients on the health variable9 Most studies try to mitigate this problem by controlling for as many additional and relevant observable variables as possible through multivariate regression analysis9 However, this effort in itself is mostly not suf:cient to entirely rule out the inEuence of unobservable characteristics9 2ther studies attempt to control for unobservable factors that do not vary over time or within a family, e9g9 through the use of siblings and>or twins data 6M:@ed-effects modelsN89 Still others attempt to overcome endogeneity problems through the use of alternative methodologies such as instrumental variables, difference-in-differences, matching estimates and discontinuity design9 The e@ternal factors that published studies have considered 6or have suggested as important8 in their analyses of the relationship between health and education may operate at the micro, meso and macro levels9 "t the micro level some of the main determinant factors include 6$utler and 0leras Muney .//IC 'uchs 7+-.C Smith, .//-C $urrie, .//-8: DDDDDD family socioeconomic status ethnic factors gender order among siblings value associated with the future or discount rate personal 6MinnateN8 ability9 Smith 6.//-8, for instance, emphasi%ed the possibility of large biases from unobserved family effects in studies assessing the potential interdependence between health and education9 2ther research has illustrated the gender difference in the impact of obesity 6$awley and Spiess, .//-8 or mental health 6'letcher, .//-8 on educational outcomes9 'actors that can determine childrenAs and adolescentsA development at the meso level include 6#lingeman, .//F8: DDD

community, neighbourhood and school characteristics access to information and social networks friendsA habits9 Pate et al9 6.//I8 demonstrated the importance of girlsA living environments to their physical activity9 2ther meso factors seem to be particularly relevant in the development of health-related behaviours: 4uarte, !scarioa and Molina 6.//I8, for instance, found that individual mari<uana use was positively correlated with adolescentsA nightlife and friendsA smoking habits, but inversely related to school information campaigns9 'inally, the macro-level policy framework may also affect both health and education9 $ross-country or cross-regional H

variation in health- and>or education-related policies and programmes can provide natural e@periments that help us more reliably identify the causal pathways between health and education9 Studying data from the nited States, where minimum legal drinking ages varied over time, 4ee and !vans 67++,8 used an instrumental variable approach to e@ploit within-state variations in alcohol availability to estimate the impact of drinking on education9 0udwig and Miller 6.//I8 used a discontinuity in the funding of the nited States Head Start 6early education8 programme providing schooling and health support to poor counties to :nd a parallel discontinuity in educational attainment among participants9 )mpact of health on future prospects through education and intergenerational transmission of ine;ualities Taken together, childrenAs education, health and third factors account for differences in employment status and income when they become adults, as well as their adult health outcomes, marital status, fertility control and engagement in criminal activities and in the educational achievement of their own children9 sing within-sibling models on panel data in the nited States, Smith 6.//-8 found that good health during childhood increased adult family incomes by .GO, when compared to poor health9 7 $ase, 'ertig and Pa@son 6.//H8 also support the main hypothesis of lifecourse models that childhood health conditions have a lasting impact on health and socioeconomic status in middle adulthood9 "ccording to these authors, health at ages .F and FF was a signi:cant predictor of health at age G., as were indicators of socioeconomic status at the younger ages9 These adult outcomes in turn are likely to inEuence the health conditions and behaviours of the ne@t generation, which would affect educational outcomes and overall future prospects in a self-reinforcing cycle9 Health differences affecting the intergenerational transmission of poverty through educational outcomes may therefore e@plain a signi:cant share of the e@isting socioeconomic ine;ualities in developing but also in industrial countries 6$urrie, .//-89 $urrie and Stabile 6.//,8 speci:cally suggest that variations in the incidence of health insults during childhood may be important in e@plaining the gap in the long-term health status between rich and poor9 The inter-generational transmission of health is represented by the connection through the e@ternal factors and controls at the bottom of the diagram between the bo@es representing adult outcomes at the right-hand side of the diagram and, on the left, child and adolescent health behaviours and conditions9 The above, conceptual inter-linkages by themselves pose important challenges for any empirical test of the conceptual model, in particular for the assessment of the true causal impact of health on education9 There are at least three ma<or dif:culties in estimating the contribution of individual health to educational outcomes: reverse causality, omitted variable bias and measurement error9 )f a standard single e;uation regression is applied, those problems can lead to biased estimates of the coef:cient of the health variable 6and of the other independent variables8, because they lead to the error term being correlated with the health variable, a feature known as MendogeneityN of the health variable9 "s discussed below, several studies e@plicitly recogni%ed this challenge and adopted econometric techni;ues that can at least in principle help reduce or eliminate the otherwise resulting bias9 7

The health measure in Smith 6.//-8 is based on a :ve-point scale, including the categories poor, fair, good, very good and e@cellent9 The last two categories were de:ned as Mgood healthN and all other categories taken together as Mpoor healthN9 I

G9 Search methodology 2nline databases were the primary source of the reviewed literature9 The search was conducted in three main thematic areas: health and public health, socioeconomic studies and research, and education9 79 nder the category of health and public health we used both general online databases, such as Science4irect, )nterScience and Scirus, and health-speci:c databases, mainly PubMed, *ioMed and $ochrane9 " further online search of all issues between .//H and .//was conducted to ensure e@haustiveness in the case of speci:c online <ournals, i9e9 the "merican Pournal of Public Health, Pournal of Health !conomics, Pournal of School Health and The Pournal of Pediatrics9 'or socioeconomic studies and research, )ngenta$onnect, 3ePec, PST23, Palgrave, SagePub, Springer0ink and )S) were the most important databases9 2ther speci:c online resources included the &ational *ureau of !conomic 3esearch 6&*!38 database and the Pournal of Health !conomics9 'or education, we conducted an e@haustive online search of the *ritish Pournal of !ducational Psychology and the !conomics of !ducation 3eview9 .9 F9 The essential search criteria for the main databases used are detailed in "nne@ 79 " recent literature review by $urrie 6.//-8 and four reviews by Taras and Pott-4atemas 6.//Ha, b, c and d8 provide a comprehensive, initial picture mainly concerning speci:c chronic conditions such as sleeping disorders, mental health problems, asthma and some health-related behaviours, including de:cient nutrition, obesity and physical e@ercise9 2ther relevant reviews used included that of Murray et al9 6.//-8 on the literature assessing the impact of school health programmes on academic achievement, $ueto 6.//78 reviewing the effect of breakfast programmes on educational outcomes and Trudeau and Shephard 6.//-8 on the relationship between physical education and physical activity and academic performance9 5hile the main conclusions of those reviews have been considered and are indeed referred to fre;uently throughout this study, we did not review the original literature covered in those previous reviews9 5e adopted the so-called MsnowballingN process in our search9 3elevant references in the most signi:cant papers were searched and, when appropriate, included in the review, and in every database we always searched readings related to those that were pre-selected, typically yielding relevant results9 5e initially selected .,F articles on the basis of the research topic, broadly considered9 The selection was narrowed to 7.F using the speci:c relevant indicators 6discussed in the subse;uent section8 as the main inclusion criteria9 The search was further restricted to ,/ based on the age range of the study sub<ects, the country and the publication year9 "ll papers were stored in an !ndnote database, and in the process their abstracts and in most cases the entire paper were screened and a :nal selection on the basis of the source and methodology used was carried out9 )n the end, HF papers remained 6'ig9 .89 ,

'ig9 .9 Study selection criteria and process 'irst selection 3esearch topic, broadly considered .,F Second stage Speci:c, selected health and education indicators 7.F Third stage "ge range, country and publication year ,/ 'inal selection Source, methodology !@cluded !@cluded !@cluded HF -

H9 3esults of the literature review )n this core section of the publication, we present the :ndings of our review, :rst at a very generic, descriptive level and subse;uently in a more detailed, analytical format9 Selected summary statistics The most basic characteristics according to which the papers reviewed can be disaggregated in a fairly simple manner are as follows: health and education indicators usedC publication dateC country of studyC age range of study sub<ectsC sourceC methodologyC and ;ualitative result of the research9 Health and education indicators The focus of the review and therefore of the literature search was the impact of health behaviours and health conditions on educational outcomes9 Table 7 shows that most reviewed papers 6nQF/8 e@plored the connections between alcohol drinking, mari<uana use, smoking, nutrition and physical e@ercise, and educational outcomes9 !vidence was particularly profuse in the case of alcohol drinking 6nQ+8 and mari<uana use 6nQ,8 compared to the other healthrelated behaviours9 " total of .F papers studied the effect of three health conditionsRsleeping disorders, an@iety and depression, and asthmaR on education as well as the impact of overall health on educational outcomes9 The numbers in Table 7 do not imply that there has necessarily been less research on health conditions than health behaviours9 Taras and Potts-4atema 6.//H a, b, c and d8 and $urrie 6.//-8 have already included in their review a considerable number of studies, and to avoid duplication we e@cluded those studies from our review9 Table 79 &umber of papers reviewed, by health behaviours and conditions Health risk factors "lcohol drinking Mari<uana use Smoking &utritional problems and obesity Physical e@ercise Health conditions Sleeping disorders Mental health problems 3espiratory problems 2verall health T2T"0 F/ + , G I G .F H I G - HF Table . shows the distribution of the studies by outcome variable considered9 Most studied the relationship between different health indicators and academic performance, mainly measured through scores, both self-reported and actual9 2nly 7. of the HF papers looked at the effect of health on what we call mediating factors, typically cognitive skills development, as measured, for instance, through the Peabody )ndividual "chievement Test 6P)"T89 . P)"T is an individually administered measure of academic achievement that is norm-referenced9 4esigned to provide a wide-range screening measure in :ve content areas that can be used with students in kindergarten through 7.th grade, its content areas are mathematics, reading recognition, reading comprehension, spelling and general information9 . +

Table .9 &umber of papers reviewed, by educational outcome !ducational attainment School readiness High school dropout High school completion Jears of education achieved 0evel of education achieved "cademic performance Scores Self-reported performance Brade repetition Missed days, truancy Mediating factors .. 7 H I G I FH 7H , H - 7. &ote: Total e@ceeds HF because some papers reported more than one educational outcome9 4ate of publication 5e considered only studies published between 7 Panuary 7++H, and F/ Pune .//-9 Sophisticated econometric analysis of the relationship between the factors of interest was barely conducted before the 7++/s, and its relevance today would be ;uestionable if only due to changes in perceptions, habits and health and educational standards in the countries studied9 2ver two thirds of the papers we reviewed were conducted after .//7, further indicating a recent upsurge in the academic interest in this topic 6see Table F89 Table F9 &umber of papers reviewed, by year of publication 7 Panuary 7++H K F7 4ecember .//7 7 Panuary .//. K F/ Pune .//- T2T"0 7. G7 HF The country of study 2nly literature on countries in the 2rganisation for !conomic $o-operation and 4evelopment 62!$48 was reviewed9 "s highlighted in the introduction, the relevance and implications of the relationship between health and education are likely to differ between developing and highincome conte@ts9 The role of health in determining educational outcomes has been more e@tensively studied in developing countries, while remaining comparatively scarce in highincome countries9 "s seen in Table G, most of the studies focus on the nited States and make use of their datasets 6G/ of HF8, indicating a clear gap in research on the topic in !uropean and other 2!$4 countries9 The most common data sources are longitudinal or panel data from of:cial surveys, such as the &ational 0ongitudinal Survey of Jouth 6&0SJ8, the &ational Jouth 3isk *ehaviour Survey and the nited States Third &ational Health and &utrition !@amination Survey9 "dditionally, narrower samples and data from small natural and randomi%ed e@periments are used9 "ge range of study sub<ects The ages of the sample of children and adolescents studied were to be between 7 and 7- years9 0iterature on pre-natal health factors and their impact on child development 6see e9g9 $urrie, .//-8, although profuse, was e@cluded from this review mainly due to the rather different set of policy implications it relates to9 7/

Table G9 &umber of papers reviewed, by country nited States !urope Bermany )taly Spain nited #ingdom 2thers T2T"0 G/ + F 7 . F G HF !mpirical methodology 5e gave priority to studies that performed some form of more advanced econometric analysis, by which we mean the application of at least single e;uation multivariate regression analysis9 "s Table H indicates, the ma<ority of studies used this methodology, implying that most studies did not undertake speci:c efforts to overcome the endogeneity problem mentioned above9 F " signi:cant minority undertook efforts to correct for endogeneity issues, mainly by using ;uasie@perimental techni;ues and in rare occasions through randomi%ed e@perimental design of the study9 5hile not visible in Table H, we did note a trend towards the increased use of more sophisticated approaches in attempts to ad<ust for endogeneity, such as via instrumental variables, :@ed effects, difference-in-differences, matching and discontinuity design9 Table H9 &umber of papers reviewed, by methodology Single-e;uation multivariate analysis )nstrumental variables 'i@ed effects Matching estimates 4iscontinuity design 4ifference-in-differences 2ther .I - I 7 7 7 7. &ote: Total e@ceeds HF because some studies used more than one analytic method9 Source The selected readings were mostly <ournal articles, all peer-reviewed9 5e did however take into account speci:c working paper series that meet certain ;uality criteria, mostly &*!3 working papers9 The decision to include these papers was driven by the impression that in most recent years there has been a growing interest in this :eld of research, the insights of which would be missed if we limited ourselves to <ournal articles9 The <ournal versus working paper ratio is in Table I9 5hile it can sometimes be hard to unambiguously attribute a given <ournal to a speci:c sub<ect, most of the <ournals in which the articles appeared were health related, although a signi:cant number came from economic sources, including the &*!3 working papers 6see Table ,89 F That said, there are of course cases in which a single e;uation multivariate regression is suf:cient to assess causality but this cannot be assumed as given and would need to be tested9 77

Table I9 &umber of papers reviewed, by <ournal article versus working paper Pournal 5orking papers and discussion papers T2T"0 GF 7/ HF Table ,9 &umber of papers reviewed, by :eld Health !conomics !ducation Policy Sociology 4emography F. ./ F F . . &ote: Total number of reviewed papers by :eld e@ceeds HF because some sources address more than one :eld9 Sualitative :ndings "ll relevant evidence on the relationship between health and education outcomes was to be e@amined in the review9 However, the e@isting research overwhelmingly suggests, as shown in Table -, that health conditions and risk factors are signi:cantly and negatively correlated with educational achievement and academic performance, while physical e@ercise appears to be positively correlated with educational outcomes9 "t least on the face of it, this is a rather impressive result, even with the caveat that most empirical research may bear a bias in published work9 Table -9 &umber of papers reviewed, by :ndings Signi:cant impact &o signi:cant impact T2T"0 G+ G HF )mpact of health-related behaviours and risk factors on educational outcomes: detailed :ndings nderage drinking, increasing mari<uana use since the 7++/s, smoking and obesity are some of the key public health concerns in high-income countries 6$hatter<i, .//IC Miller, .//,C Jolton et al9, .//H, 4atar and Sturm, .//I89 4espite the general association between these risky behaviours during childhood and adolescence and poorer long-term developmental outcomes, it is only recently that researchers have attempted to accurately estimate this effect, particularly with regard to education9 To the best of our knowledge, this is the :rst systematic review conducted to date of the literature assessing the impact of these health-related behaviours on educational outcomes9 Potential endogeneity issues, sample representativeness and measurement problems account for the main dif:culties faced in estimating the causal impact of health-related behaviours on education9 "s mentioned in the description of the framework, all these health risk factors are often correlated between them, plus there may be a third set of unobservable factors that inEuence both education and health9 3ecent research attempts to overcome these confounding problems using panel data and methodological techni;ues such as instrumental variables9 5hile the need remains for further research that allows establishing causality with certainty, the e@isting literature does provide a fair amount of good-;uality evidence with relevant policy implications9 2verall, there is an additional need to further e@plore these linkages in 2!$4 countries other than the nited States, since such research is lacking in the former9 7.

The studies we reviewed sometimes led to inconsistent conclusions, but some general conclusions are as follows9 DDDDDD *inge drinking G seems to have a signi:cant negative effect on educational attainment, although some studies conclude it is likely to be small9 )n the case of academic performance, causality is less unambiguous, although all studies investigating this risk behaviour indicate that a signi:cant negative impact e@ists9 Mari<uana use shows a signi:cant negative impact on educational attainment and academic performance according to all available evidence9 Smoking is a strong predictor of educational underperformance9 3elevant evidence remains limited and faces methodological problems that demand caution in the interpretation of results9 !vidence on the association between nutritional issues and school success is particularly scarce in industriali%ed countries, although e@isting research indicates that a relevant connection likely e@ists between these factors9 2besity and overweight are negatively associated with educational outcomes, although evidence is contradictory concerning the gender-differentiated effect of these risk factors, and endogeneity issues also persist as obstacles in the estimation of causality9 3ecent and limited research indicates that physical e@ercise might have a positive impact on short-term aspects related to academic achievement, although causality remains particularly dif:cult to assess9 5e now describe the reviewed studies in order of health behaviours and then health conditions9 "fter a te@tual description of the studies for each behaviour or condition, we provide a table with more systematic detail of each study9 "lcohol drinking The available empirical evidence on the impact of alcohol drinking on educational attainment offers mi@ed results9 2n the one hand, the studies by 4ee and !vans 67++,8 and #och and 3ibar 6.//78, using instrumental variables and family :@ed-effects models on samples from the nited States, suggest that the actual effect of alcohol use is likely to be small and sensitive to the model speci:cation9 2n the other hand, :ndings by Jamada, #endi@ and Jamada 67++I8, also in a sample of students in the nited States, indicate that fre;uent drinking signi:cantly reduced the probability of high school graduation, in line with 3ennaAs 6.//G8 results indicating that alcohol policies affect the probability that students in the nited States graduate on time9 This hypothesis was further con:rmed by $hatter<i and 4eSimone 6.//H8, whose instrumental variable regression indicates that binge or fre;uent drinking among 7HK7I-year-old students lowered the probability of having graduated from or being enrolled in high school four years later by at least 77O9 5ith regard to academic performance, the studies by 0ope%-'rias 6.//78, 4eSimone and 5olaver 6.//H8 and Miller et al9 6.//,8 unanimously conclude that fre;uent and binge drinking can have a signi:cant impact on BP" scores or grades9 These last two studies in this sense found, using data from the nited States, that students who binge drank were more likely to selfreport and actually achieve poorer school performance9 $ausality, however, cannot be established very con:dently in these studies9 !@cept for 0ope%-'rias 6.//78, all the studies reviewed made use of datasets from the nited States9 The link between alcohol use and

education needs thus to be further e@plored, particularly in the !uropean conte@t, where the minimum drinking age tends to be lower than in the nited States and where young peopleAs perceptions and habits among youth likely differ from their counterparts in other 2!$4 countries9 The seemingly robust :nding of a harmful impact of alcohol consumption on educational performance complements in interesting ways the rather mi@ed :ndings concerning the effect of alcohol consumption on certain adult labour supply and productivity indicators9 Several authors have found a counter-intuitive, positive impact of alcohol consumption on such economic outcomes among adults 6'rench and Tarkin, 7++HC Hamilton and Hamilton, 7++,C Tarkin et al9, 7++-C Mac4onald and Shields, .//789 Peters and Stringham 6.//I8 showed that drinking led to higher earnings by increasing social capital through the strengthening and widening of social networks9 These G *inge drinking is typically de:ned as consuming :ve or more drinks on an occasion 6Miller et al9, .//,89 7F

authors used repeated cross-sections from the Beneral Social Survey in the nited States to prove that men and women who drank earn 7/O and 7GO more, respectively, than abstainers9 )ssues of reverse causality however remain an obstacle in the assessment of this relationship and call for future research 6Table +89 Table +9 "lcohol drinking "uthor Title $hatter<i and 4eSimone "dolescent drinking and school dropout Source $ountry, year &*!3 5orking Paper &o9 77FF, nited States of "merica, .//H 4ata Methodology &ational 0ongitudinal Survey of Jouth 7+,+ 6&0SJ,+8 and young adults Multivariate regression analysis )nstrumental variables 0ongitudinal data: individuals recruited from F/ $alifornia and 2regon schools at grade , 67+-H8 and again at grade 7. 67++/8 and age .F 67++H8 0ogistic regression analysis Huber variance estimates 79F million respondents from 7+I/K7+I+ birth cohorts in the 7++/ Public- se Microdata Sample 6P MS8 !@ploit within-state variation in alcohol availability over time .//7 and .//F Jouth 3isk *ehaviour Survey Multivariate regression analysis 4ata on same-se@ sibling pairs from 7+,+K7++/ &0SJ panels 'amily :@ed effect )nstrumental variables Students aged 7GK7+ years, attending high school during the academic year 7++GK7++H in the city of Branada in southern Spain Multiple logistic regression analysis Health indicator !ducation indicator "dolescentsA heavy drinking School dropout 'indings *inge or fre;uent drinking among 7HK7I-year-old students lowered the probability of having graduated from or being enrolled in high school four years later by at least 77O9 !arly drinkers and e@perimenters were more likely than nondrinkers to report academic problems9 !llickson P0, Tucker PS, #lein 4P9 Ten-year prospective study of public health problems associated with early drinking Pediatrics, 7776H Pt 78:+G+K+HH nited States of "merica, .//F Self-reported alcohol consumption: early non-drinkers, e@perimenters and drinkers Self-reported prevalence of academic dif:culties

4ee TS, !vans 5& Teen drinking and education attainment: evidence from twosample instrumental variables 6TS)18 estimates 4eSimone P, 5olaver "M 4rinking and academic performance in high school #och S, 3ibar 4 " siblings analysis of the effects of alcohol consumption onset on educational attainment 0(pe%-'rUas M et al9 "lcohol consumption and academic performance in a population of Spanish high school students &*!3 5orking Paper &o9 I/-. nited States of "merica, 7++, &*!3 5orking Paper &o9 77/FH nited States of "merica, .//H Minimum legal drinking age 6M04"8 High school completion, college entrance and completion "lcohol use, binging BP" scores $hanges in M04" had small effects on educational attainment9 *inge drinking slightly worsened academic performance9 )mpact was negligible for students who were less risk averse, heavily discounted the future or used other drugs9 !ffects remained signi:cant after accounting for unobserved heterogeneity in risk-averse, future-oriented and drug-free students9 !stimates of the schooling conse;uences of youthful drinking were very sensitive to speci:cation issues9 The actual effects of youthful drinking on education are likely to be small9 3isk of academic failure increased considerably when more than 7H/g of alcohol were consumed per week9 $ontemporary !conomic Policy 7+6.8:7I.K7,G nited States of "merica, .//7 Pournal of Studies on "lcohol and 4rugs, I.6I8:,G7K ,GG Spain, .//7 Jouthful alcohol drinking !ducational attainment Total alcohol consumption 6grams 6g8 of alcohol per week and per day for three categories of alcoholic drinks: wine, beer and distilled spirits8 Self-reported school performance 7G

"uthor Title Miller P5 et al9 *inge drinking and associated health risk behaviors among high school students Source $ountry, year Pediatrics, 77+6H8:7/FHC author reply 7/FHK7/FI nited States of "merica, .//, 4ata Methodology .//F &ational Jouth 3isk *ehaviour Survey Multivariate logistic regression analysis Health indicator !ducation indicator 4ifferent patterns of alcohol consumption, current drinking, binge drinking and other health risk behaviours Self-reported grades in school "lcohol consumption High school graduation and on time graduation "lcohol and mari<uana use High school graduation 'indings Students who binge drank were more likely than both non-drinkers and current drinkers who did not binge to report poor school performance and involvement in other risky behaviours9 3enna ' TeensA alcohol consumption and schooling Jamada T, #endi@ M, Jamada T The impact of alcohol consumption and mari<uana use on high school graduation !conomics of !ducation 3eview .,678:I+K,- nited States of "merica, .//G Health !conomics H678:,,K+. nited States of "merica, 7++I &0SJ,+ Two-stage probit with instrumental variables 6alcohol-related policies8 &0SJ Multivariate regression analysis "lcohol policies did not affect the dropout rate measured at the age of .H, but they did affect the probability that a student would graduate on time9 )ncreases in incidence of fre;uent drinking, li;uor and wine consumption and mari<uana use signi:cantly reduced the probability of high school graduation9 4rug use Most of the studies investigating the relationship between drug use and school achievement focus on mari<uana use9 )n this case all research similarly concludes that using mari<uana resulted in a signi:cant negative impact on both short- and long-term educational outcomes9 However, as in the case of alcohol drinking, most of the evidence is based on data from the nited States, which indicates a gap in research in other 2!$4 countries9 "gain, although probably to a lesser e@tent, differences in perceptions and habits related to drugs between countries might account for

signi:cant variations in the estimated relationship between both factors $oncerning educational attainment, *ray et al9 6.///8 found a probability that mari<uana users would drop out .9F times more than non-users in a sample from the nited States9 The lack of controls for unobservable variables and issues of nonrepresentativeness of the sample used, however, remained as obstacles to establishing a causal relationship between mari<uana use and educational outcomes in this study9 " study by 3oebuck, 'rench and 4ennis 6.//G8 used a probit model and instrumental variable estimation 6measures of religiosity8 on a much larger sample of youth in the nited States to show that mari<uana users were more likely to be school dropouts and to skip school relative to non-mari<uana users9 4espite concerns over the validity of the instrument and the use of cross-sectional data, these results reinforce the hypothesis of causality, further con:rmed by a more recent study by $hatter<i 6.//I89 This author proved, also using an instrumental variable approach on panel data from the nited States, that past-month mari<uana use in 7/th and 7.th grades may detract from educational attainment9 5ith regard to academic performance, most research indicates that it can be signi:cantly affected by drug use9 Mari<uana use proved to be a determinant of school failure 6grade repetition8 among Spanish students according to 4uarte, !scarioa and Molina 6.//I8, who also found no signi:cant correlation in the opposite direction using a ma@imum likelihood estimation on repeated cross-sections of a national survey9 Pacula, 3oss, and 3ingel 6.//F8 further concluded using a differences-in-differences estimation on panel data from the nited States that mari<uana use was statistically associated with a 7HO reduction in performance on standardi%ed mathematics tests9 'inally, $aldeira et al9 6.//-8 found that school absenteeism was one of the main cannabis-related problems among :rst-year college students in a sample in the nited States 6Table 7/89 7H

Table 7/9 Mari<uana use "uthor Title *ray P5 et al9 The relationship between mari<uana initiation and dropping out of high school $aldeira #M et al9 The occurrence of cannabis use disorders and other cannabisrelated problems among :rst-year college students $hatter<i P )llicit drug use and educational attainment Source $ountry, year Health !conomics, +678:+K7- nited States of "merica, ./// "ddictive *ehaviors, FF:F+,KG77 nited States of "merica, .//4ata Methodology 0ongitudinal survey of 7F+. adolescents aged 7IK7- years 0ogit regression analysis Participants recruited as part of the $ollege 0ife Study at a public university in the nited States mid-"tlantic region Multivariate logistic regression analysis &ational !ducation 0ongitudinal Study Multivariate regression analysis, :@ed effects and instrumental variables 6measure of prices and availability8 $onsecutive waves from the Spanish Surveys on 4rug se in the School Population 67++I, 7++- and .///8 Ma@imum likelihood estimation Students in Pro<ect "0!3T for middleschool students, F/ control and treatment schools drawn from - $alifornia and 2regon districts Multivariate regression analysis &ational !ducation 0ongitudinal Survey 4ifferenceindifferences estimates 7++, and 7++- &ational Household Surveys on 4rug "buse: sample of 7H7I- adolescents aged 7.K7- who had not completed high school Tero-inEated negative binomial regression analysis )nstrumental variable for mari<uana use 6religiosity measures8 'irststage ordered probit model Health indicator !ducation indicator 'indings Mari<uana initiation Mari<uana usersA odds of dropping out of school were about .9F times School dropout that of non-users9 se of cannabis in past year Missed classes in past year $oncentration problems 6G/97O8, driving while high 67-9IO8 and missing class 67F9+O8 were among the most prevalent cannabisrelated problems9 Health !conomics, 7H:G-+KH77 nited States of "merica, .//I "lcohol, mari<uana and cocaine use &umber of years of schooling completed by ./// interview se of mari<uana during the last F/ days Brade repetition

)t is likely that past-month mari<uana use in grades 7/ and 7. and lifetime cocaine use by grade 7. may detract from educational attainment9 4uarte 3, !scarioa PP, Molina P" Mari<uana consumption and school failure among Spanish students !conomics of !ducation 3eview, .H:G,.KG-7 Spain, .//H Mari<uana use was a determinant of school failure among Spanish students9 !llickson P0 et al9 "ntecedents and outcomes of mari<uana use initiation during adolescence Preventive Medicine, F+:+,IK +-G nited States of "merica, .//G Self-reported mari<uana use Self-reported fre;uency of cigarette and alcohol use Brades at grades , and + 67 Q mostly "s to H Q mostly 's8 Mari<uana use Performance on standardi%ed tests Brade , initiates were more likely than grade + initiates to engage in hard drug use, earn poor grades and have low academic intentions9 Pacula 30, 3oss #!, 3ingel P 4oes mari<uana use impair human capital formationL 3oebuck M$, 'rench M, 4ennis M0 "dolescent mari<uana use and school attendance &*!3 5orking Paper &o9 ++IF nited States of "merica, .//F !conomics of !ducation 3eview, .F:7FFK7G7 nited States of "merica, .//G Mari<uana use was statistically associated with a 7HO reduction in performance on standardi%ed mathematics tests9 "ll mari<uana users are more likely to be school dropouts and, conditional on being enrolled in school, skip more school days than non-users9 Mari<uana use during the past year "dolescent school dropout &umber of days truant in the past F/ 7I

Smoking The evidence on the association between smoking and education reveals a negative correlation between them9 )n this sense, $ook and Hutchinson 6.//I8 found using data from the nited States that smoking in grade 77 was a powerful predictor of whether students :nished high school and, if they did, whether they matriculated in a fouryear college, while a $ollins et al9 6.//,8 study of 7+H- data from the nited #ingdom showed that teen smoking was a signi:cant predictor of academic performance, with higher smoking rates increasing the likelihood of failure9 $ausality, however, cannot be inferred from these :ndings9 )n line with both of the above, an analysis by !llickson, Tucker and #lein 6.//78 of longitudinal, self-reported data from the nited States concluded that compared with non-smokers early smokers were at higher risk of low academic achievement and behavioural problems at school and were more likely to drop out9 "dditionally, Jolton et al9 6.//H8 used data from the nited States to :nd a noteworthy inverse association between environmental tobacco smoke 6!TS8 e@posure and cognitive development among children even at e@tremely low e@posure levels9 4ifferent methodological issues, however, call for a cautious interpretation of these results9 'inally, 4ing et al9 6.//I8 more recently found in their innovative analysis of Beorgetown 6 nited States8 "dolescent Tobacco 3esearch data that smokers tend to have lower BP"sC they used genetic markers as instrumental variables to deal with endogeneity and measurement problems 6Table 7789 Table 779 Smoking "uthor Title $ollins *& et al9 "dolescent environmental tobacco smoke e@posure predicts academic achievement test failure Source $ountry, year Pournal of "dolescent Health, G7:FIFKF,/ nited #ingdom, .//, 4ata Methodology 0ongitudinal analysis of birth cohort data, including IF-/ pregnant women and offspring from the 7+H- &ational $hild 4evelopment Study 6&$4S8 0ogistic regression analysis Health indicator !ducation indicator "dolescent smoking status nveri:ed, retrospective, self-reported achievement when offspring was .F years old 6pass versus fail, determined by performance on nationally standardi%ed achievement tests taken at 7I 62-0evel8 and 7- years 6"-0evel88 'indings Teen smoking was a signi:cant predictor of 2- and "-0evel performance, with higher smoking rates increasing the likelihood of failure9

$ook P, Hutchinson 3 Smoke signals: adolescent smoking and school continuation 4ing 5 et al9 The impact of poor health on education: new evidence using genetic markers &*!3, 5orking Paper &o9 7.G,. nited States of "merica, .//I &*!3 5orking Paper &o9 7.F/G nited States of "merica, .//I &0SJ,+ Multivariate logit regression analysis $hoices of whether Smoking in grade 77 was a to smoke or drink powerful predictor of whether School continuation students :nished high school and, if so, whether they matriculated in a fouryear college9 Smoking, depression, attention de:cit hyperactivity disorder 6"4H48, body mass inde@ 6*M)8 BP" 4epression and obesity both lead to a decrease of /9GH BP" points on average 6i9e9 roughly one standard deviation8C substantial heterogeneity in the impact of health on academic performance across genders: in females, academic performance is strongly and negatively affected by poor physical and mental health conditionsC hardly any effect for males9 4ata from Beorgetown "dolescent Tobacco 3esearch 6B"T238 study, longitudinal 7+++K.//F 7,

Table 779 contd "uthor Title !llickson P0, Tucker PS, #lein MS High-risk behaviors associated with early smoking: results from a H-year follow-up Source $ountry, year Pournal of "dolescent Health, .-:GIHKG,F nited States of "merica, .//7 4ata Methodology 0ongitudinal selfreported data from GF., $alifornia and 2regon students Multivariate logistic regression $omputed Huber variance estimates Health indicator !ducation indicator Smoking in grade , 6smoked F or more times in the past year or at all in the past month8 "cademic problems in grade ,: skipped school or was sent out of class more than once in the last year, missed :ve or more days of school during the current year, earned grades of $ or worse and ever repeated a grade9 )n grade 7.: dropped out, fre;uent absences and being sent out of the classroom, being suspended and dropping out of school Serum cotinine used as a biomarker of environmental tobacco smoke e@posure $ognitive and academic abilities 6reading and mathematics subtests of 53"T3evised and design and digit span subtests of the 5eschler )ntelligence Scale for $hildrenK))) 65)S$-)))8 IK77-year-old 'indings $ompared with non-smokers, early smokers were at higher risk for low academic achievement and behavioural problems at school9 Jolton # et al9 !@posure to environmental tobacco smoke and cognitive abilities among 9S9 children and adolescents !nvironmental Health Perspectives, 77F 678:+-K7/F nited States of "merica, .//H Third &ational Health and &utrition !@amination Survey 6&H"&!S )))8, conducted from 7+-to 7++G Multivariate logistic regression analysis There was an association between !TS e@posure and cognitive de:cits in children even at e@tremely low levels of e@posure9 Poor nutrition

The $urrie 6.//-8 literature review on the relationship between poor nutrition and education focused mostly on developing countries9 $urrie highlights that it is not as easy to prove this correlation in richer countries9 )ncreasing evidence in the industriali%ed world mostly in connection with breakfast programmes and the development of cognitive abilities and>or academic performance shows that insuf:cient nutrition can have a relevant impact on education9 Studies evaluating the impact of 5)$ 6 nited States Special Supplement &utrition Program for 5omen, )nfants, and $hildren8 have found for instance a positive correlation with educational outcomes of children from participant families 6$urrie, .//-89 $on:rming these :ndings, a review of the evidence on school breakfast programmesA effectiveness conducted by $ueto 6.//78 concluded that school breakfast interventions can have a positive effect on the nutritional status of children, on school attendance and probably on dropout rates9 "s pointed out by BranthamMcBregor 6.//H8, however, most of the small e@periments used to evaluate the correlation between nutrition and education are faced with methodological problems that need to be considered in the interpretation of their results9 "laimo, 2lson and 'rongillo 6.//78 found that IK77-year-old, food-insuf:cient children in the nited States had signi:cantly lower arithmetic scores and were more likely to have repeated a grade, have seen a psychologist and have had dif:culty getting along with other childrenC while food-insuf:cient teenagers were more likely to have seen a psychologist, 7-

have been suspended from school and have had dif:culty getting along with other children9 Biven that the authors used regular regression analysisRalthough strati:ed by risk level and ad<usting for some confounding factorsRand used selfreported measures of nutrition in the analysis, biases due to endogeneity and measurement errors could be e@pected9 Torres et al9 6.//,8 concluded that rural students in a Spanish province ingested more carbohydrates and fewer lipids at breakfast and that academic performance was signi:cantly better in rural children than in those from urban areas9 These results however need to be regarded in light of the fact that the study was limited to a small sample of children in only one province, did not include controls and was not fully randomi%ed 6Table 7.89 Table 7.9 Poor nutrition "uthor Title "laimo #, 2lson $, 'rongillo ! 'ood insuf:ciency and "merican schoolaged childrenAs cognitive, academic, and psychosocial development Source $ountry, year Pediatrics, 7/-:GGKHF nited States of "merica, .//7 4ata Methodology &H"&!S ))) Multivariate linear and logistic regression analysis strati:ed by risk level Health indicator !ducation indicator 'ood insuf:ciency $ognitive, academic and psychosocial measures in general and within lower risk and higher risk groups 'indings IK77-year-old, food-insuf:cient children had signi:cantly lower arithmetic scores and were more likely to have repeated a grade, have seen a psychologist and have had dif:culty getting along with other children9 'ood-insuf:cient teenagers were more likely to have seen a psychologist, have been suspended from school and have had dif:culty getting along with other children9 The associations between food insuf:ciency and childrenAs outcomes varied by level of risk9 3ural population ingested more carbohydrates and fewer lipids than urban population at breakfast9 "cademic performance was signi:cantly better in rural children than urban ones9 *M) was signi:cantly higher in the urban than rural children9 Torres M4 et al9 *reakfast, plasma glucose and betahydro@ybutyrate, body mass inde@ 6*M)8 and academic performance in children from !@tremadura, Spain &utrici(n Hospitalaria, ..6G8:G-,KG+/ Spain, .//,

3epresentative samples of schoolchildren from !@tremadura, Spain, F to 7. years old 3andom cluster sampling in schools *reakfast composition "cademic performance reported by teachers 2besity and overweight "ccording to Taras and Potts-4atema 6.//Hc8, although an increasing body of evidence shows a correlation between obesity and overweight and educational outcomes, causality has not been proved to date, and only some studies such as Schwimmer, *urwinkle and 1arni 6.//F8 attribute to obesity a signi:cant causal effect on education through higher absenteeism rates9 Since the Taras and Potts-4atema 6.//Hc8 review, new and relevant evidence has become available, mostly con:rming that a signi:cant correlation e@ists, although still not conclusive with regard to causality9 #aestner and Brossman 6.//-8 found in their analysis of panel youth data from the nited States that generally children who are overweight or obese have achievement test scores that are about the same as children with average weight9 However, other recent studies suggest otherwise9 4atar and Sturm 6.//I8 and $awley and Spiess 6.//-8 concluded that a negative relationship e@ists between overweight and education, with signi:cant gender differences9 4atar and SturmAs 6.//I8 analysis of a sample of children in the nited States who entered kindergarten in 7++- found that moving from not-overweight to overweight status between kindergarten entry and the end of third grade was signi:cantly associated with reductions in test scores only for girls9 $awley and Spiess 6.//-8, on the contrary, concluded from their study of a Berman sample that obesity was a signi:cant risk factor for lagged development in verbal skills, social skills and activities of daily living only among boys9 "lthough both studies used panel data, which allowed controlling for unobserved time-invariant variables, causality is not yet clear, since biases due to other omitted factors that vary over time were not totally eliminated9 " paper by 'alkner et al9 6.//78 based on data from the nited States seems to con:rm the hypothesis that overweight can have a signi:cant impact on education9 However, and overall, further research that corrects for endogeneity and makes use of more recent datasets would help establish the causal link 6if any8 with a higher degree of certitude 6Table 7F89 7+

Table 7F9 2besity and overweight "uthor Title $awley P, Spiess $# 2besity and developmental functioning among children aged .KG years 6also reported in 2besity and skill attainment in early childhood, &*!3 5orking Paper8 4atar ", Sturm 3 $hildhood overweight and elementary school outcomes Source $ountry, year 4eutsches )nstitut fVr 5irtschaftsforschung *erlin 4iscussion Paper &o9 ,-I S2!P WBerman Socioeconomic PanelX Paper &o9 +, Bermany, .//4ata Methodology Berman Socioeconomic Panel Multivariate regression analysis Health indicator !ducation indicator *M) and obesity status 1erbal skills, activities of daily living, motor skills and social skills 'indings "mong boys, obesity was a signi:cant risk factor for lagged development in verbal skills, social skills and activities of daily living9 "mong girls, weight generally does not have a statistically signi:cant association with these developmental outcomes9 Moving from not-overweight to overweight between kindergarten entry and end of third grade was signi:cantly associated with reductions in test scores, teacher ratings of social-behavioural outcomes and approaches to learning among girls9 However, this link was mostly absent among boys9 )nternational Pournal of 2besity, F/6+8:7GG+K7GI/ nited States of "merica, .//I &ationally representative sample of children in the nited States who entered kindergarten in 7++-, with longitudinal data on *M) and school outcomes at kindergarten entry and end of third grade Multivariate linear and logistic regression analysis *M) and indicators of overweight status Mathematics and reading standardi%ed test scores, teacher reports of internali%ing and e@ternali%ing behaviour problems, social skills and approaches to learning, school absences and grade repetition *M) Self-reported academic performance 'alkner &' et al9 Social, educational and psychological correlates of weight status in adolescents 2besity 3esearch, +678:FFKG. nited States of "merica, .//7

Population-based sample of G,G. male and H./7 female public school students in grades ,, + and 77 Multivariate regression analysis 2bese girls were 79H7 times more likely to report being held back a grade and .9/+ times more likely to consider themselves poor students compared with averageweight girls9 2bese boys were 79GI times more likely to consider themselves poor students, and .97- times more likely to e@pect to ;uit school9 Benerally, children who are overweight or obese had achievement test scores that were about the same as children with average weight9 #aestner 3, Brossman M !ffects of weight on childrenAs educational achievement &*!3 5orking Paper &o9 7F,IG nited States of "merica, .//&0SJ,+ 'irst differences instrumental variable 5eight !ducational achievement as measured by the scores on the P)"T in mathematics and reading The impact of physical activity on educational outcomes )nterest in the potential, positive impact of physical activity on educational outcomes has accelerated ;uite recently9 )n .//H Taras and Potts-4atema published a comprehensive review of the e@isting research on this relationship and overall concluded that despite evidence on shortterm improvements related to physical activity, such as to concentration, long-term improvements in academic achievement were not well substantiated 6Taras and Potts4atema, .//Hc89 Trudeau and Shepherd 6.//-8 in a more recent review of ;uasi-e@periments assessing the effect of physical education and physical activity in schools highlighted that allocating up to an additional hour per day of curricular time to physical activity may result in small absolute gains in BP"9 "ccording to these authors, cross-sectional observations showed a positive association between academic performance and physical activity, but physical :tness did not seem to show such association9 3ecent e@periments have con:rmed these :ndings9 Through a randomi%ed e@periment in a sample of Berman high school students, Henning *uddea et al9 6.//-8 found that 7/ minutes of coordinative e@ercise 6$!8 and of a normal ./

sports lesson 6&S08 signi:cantly improved concentration and attention9 Singh and McMahan 6.//-8 assessed the link between physical :tness and overall academic achievement among a wider sample of elementary school students in $alifornia and found that they were positively related9 5hile most of the 7/ lowest scoring schools did not have a designated physical education teacher, all of the 7/ highest scoring schools did have such teachers and followed the physical education guidelines recommended by the stateAs education board9 However, as the authors highlight, it is not possible to infer causality from the results due to methodological issues9 $astelli et al9 6.//,8 con:rmed these results using a different sample of secondary-school students in the nited States9 )n addition, $arlson et al9 6.//-8 concluded, using panel national data from the nited States, that a small but signi:cant bene:t for academic achievement in mathematics and reading was observed for girls enrolled in higher amounts of physical education, but that the same did not have any impact on academic achievement among boys 6Table 7G89 Table 7G9 Physical e@ercise "uthor Title $arlson S" et al9 Physical education and academic achievement in elementary school: data from the early childhood longitudinal study Source $ountry, year "merican Pournal of Public Health, +-6G8:,.7K,., nited States of "merica, .//4ata Methodology !arly $hildhood 0ongitudinal Study, kindergarten class of 7++-K7+++ Multivariate regression analysis Health indicator !ducation indicator Time spent in physical education 6minutes per week8 reported by classroom teachers "cademic achievement 6mathematics and reading8 scored on an item response theory scale Tests of physical :tness, *M) and aerobic capacity Total academic achievement, mathematics achievement and reading achievement9 7/ minutes of $! and &S0 d.-test 6test of attention and concentration8 results Physical :tness test scores 3eading, mathematics and science scores on the $alifornia Standards test 'indings " small but signi:cant bene:t for academic achievement in mathematics and reading was observed for girls enrolled in more physical education9 More physical education was not associated with academic achievement among boys9 $astelli 4M et al9 Physical :tness and academic achievement in third- and :fth-grade students

Pournal of Sport and !@ercise Psychology, .+6.8:.F+K.H. nited States of "merica, .//, .H+ public school students in grades F and H 'ield tests of physical :tness were positively related to academic achievement9 Speci:cally, aerobic capacity was positively associated with achievement, whereas *M) was inversely related9 Henning *uddea H et al9 "cute coordinative e@ercise improves attentional performance in adolescents Singh S, McMahan S "n evaluation of the relationship between academic performance and physical :tness measures in $alifornia schools &euroscience 0etters, GG76.8:.7+K..F Bermany, .//3andomi%ed e@periment $! and &S0 enhanced d.-test performance from pre- to post-test signi:cantly9 Those who had $! were more effective in completing the concentration and attention task9 Most of the 7/ lowest scoring schools did not have a designated physical education teacher, and all of the 7/ highest scoring schools did and followed the physical education guidelines recommended by the $alifornia !ducation *oard9 $alifornian Pournal of Health Promotion, G6.8:./,K.7G nited States of "merica, .//I !lementary schools in 2range $ounty, $alifornia $orrelation analysis )mpact of health conditions on educational outcomes: detailed :ndings Sleeping problems, mental health problems 6broadly understood as an@iety and depression problems8 and asthma are some of the most prevalent health conditions with relevant potential impacts on future developmental outcomes among schoolchildren and adolescents 6$urrie, .//-C Tara and Potts-4atema, .//Ha89 "lthough different reviews of the literature analysing the correlation between most of these problems and educational outcomes e@ist, new or additional research :ndings are considered here9 .7

Potential endogeneity and reverse causality remain the main obstacles in the estimation of the effect of these variables on education9 )n addition, the measurement of health conditions still widely relies on self-reported 6and hence often biased8 health indicators9 Some general conclusions, however, can be outlined from the e@isting research9 DDDD Sleeping disorders and academic performance tend to be inversely correlated, although there is a need to address measurement and other methodological problems to properly assess causality in this relationship9 "n@iety and depression appear to be signi:cantly and negatively associated with both short-and long-term educational outcomes9 'urther research is particularly re;uired in the case of depression and its effect on education9 "sthma is clearly correlated with school attendance, but does not seem to show such a strong connection with performance measured through scores9 2verall, childrenAs and adolescentsA health proves to have an effect on different measures of educational outcomes, despite persistent measurement and endogeneity problems in the assessment of this relationship9 Sleeping disorders Taras and Potts-4atemaAs 6.//Hb8 review on the relationship between sleep disorders and education complemented the earlier reviews by *lunden et al9 6.//78 and 5olfson and $arskadon 6.//F89 "s highlighted by all of these reviews, few studies identify a relationship between sleeping disorders and academic performance, and those that do face three ma<or shortcomings9 The :rst shortcoming is that data collection to date mostly relies on parentsA, teachersA and studentsA self-reports, which demand validation 6Bibson et al9, .//I89 'uture studies would therefore ideally go beyond sub<ective and probably biased self-reported measures9 Second, as stated by 'allone et al9 6.//78, de:nitions of what is considered MgoodN versus MpoorN sleep vary9 Bibson et al9 6.//I8 asserted that it is the ;uality and not the ;uantity of sleep that might need to be considered, generating particular measurement challenges9 Third, most of the studies aiming to establish a statistical relationship between different measures of sleep disorders and education rely on small, schoolbased e@periments that often are not fully randomi%ed9 "dditional research on this relationship includes a study by rschit% et al9 6.//F8, which concluded that Berman children who snored habitually had at least twice the risk of performing poorly at school, with this association becoming stronger with increasing snoring fre;uency9 Bibson et al9 6.//I8 provide further evidence of this direct link9 The authors found that sleep deprivation and e@cessive daytime sleepiness were common in two cross-sectional samples of $anadian high school students and were associated with a decrease in academic achievement and e@tracurricular activity9 *oth studies present methodological limitations9 5hile the rschit% et al9 6.//F8 analysis did not ade;uately address endogeneity issues K omitted variables and reverse causality K and included self-reported measures of sleeping problems K parentsA responses K the Bibson et al9 6.//I8 e@periment was not totally randomi%ed: participants were informed and gave consent prior to participation9 "lso using $anadian data, Touchette et al9 6.//,8 estimated that shortened sleep duration, especially before the age of G7 months, is associated with e@ternali%ing problems such as hyperactivity-impulsivity 6H)8 and lower cognitive performance on neurodevelopmental tests 6Table 7H89 Table 7H9 Sleeping problems

"uthor Title 4rake $ et al9 The pediatric daytime sleepiness scale 6P4SS8: sleep habits and school outcomes in middle-school children Source $ountry, year Sleep, .I6G8:GHHK GH- nited States of "merica, .//F 4ata Methodology 7H/ 77K7H-year-old students in grades I, , and - from a public middle school in 4ayton, 2hio 2ne-way analyses of variance and trend analyses Health indicator !ducation indicator 0evels of daytime sleepiness School achievement, rates of absenteeism and school en<oyment 'indings 4aytime sleepiness was related to reduced educational achievement and other negative, schoolrelated outcomes9 ..

"uthor Title Bibson !S et al9 MSleepinessN is serious in adolescence: two surveys of F.FH $anadian students Source $ountry, year *M$ Public Health, I:77I $anada, .//I 4ata Methodology $ross-sectional survey of ../7 high school students in the Hamilton 5entworth 4istrict School *oard and the &ear &orth 4istrict School *oard in 2ntario in 7++->7+++ Survey in .//7K.//. of 7/FG students in the Brand !rie 4istrict School *oard in 2ntario Benerali%ed estimating e;uation 6B!!8 Sample of births from 7++, to 7++- in a $anadian province 5eighted, multivariate logistic regression analysis Health indicator !ducation indicator !pworth Sleepiness Scale 6!SS8 was used to measure self-reported sleepiness Self-reported grades, school attendance and e@tracurricular activity 'indings Sleep deprivation and e@cessive daytime sleepiness were common in both student samples and were associated with a decrease in academic achievement and e@tracurricular activity9 Touchette ! et al9 Sleep, F/6+8:7/,+K 7/-/ "ssociations between sleep duration patterns $anada, .//, and behavioral> cognitive functioning at school entry H), inattention and daytime sleepiness scores Peabody Picture 1ocabulary TestK 3evised 6PP1T-38 was administered at H years of age and the *lock 4esign subtest 5)S$-))) at I years Symptoms of sleep-disordered breathing and intermittent hypo@ia during sleep Scores in the most recent school report Shortened sleep duration, especially before the age of G7 months, was associated with e@ternali%ing problems such as H) and lower cognitive performance on neurodevelopmental tests9 rschit% MS et al9 Snoring, intermittent hypo@ia and academic performance in primary school children "merican Pournal of 3espiratory and $ritical $are Medicine, 7I-6G8:GIGKGI- Bermany, .//F ., of the H+ public primary schools within the city limits of Hannover, Bermany nconditional logistic regression $lass :@ed effects

$hildren who snored habitually had at least twice the risk of performing poorly at school, with this association becoming stronger with increasing snoring fre;uency9 The study found a weak association between )H and poor academic performance in these primary schoolchildrenC the association was not, however, independent of snoring9 Students with shorter and less regular sleep reported lower school performance9 5olfson M3, $arskadon M$ Sleep schedules and daytime functioning in adolescents $hild 4evelopment, I+6G8:-,HK--, nited States of "merica, 7++Sleep Habits Survey administered in homeroom classes to F7./ high school students at four public high schools from three 3hode )sland school districts Multivariate analysis of variance Self-reported total sleeping time Self-reported school success Mental health and well-being The evidence on the effect of mental health problems on education, although scarce relative to the high and increasing incidence of these problems throughout industriali%ed countries, generally suggests a strong association between these factors9 3everse causality issues are in this case better addressed in the e@isting literature, which mostly follows students over time 6Mc0eod and #aiser, .//G8 and, as in $urrie and Stabile 6.//,8, applies sibling :@ed-effects models9 $oncerning an@iety and academic performance, Ma%%one et al9 6.//,8 con:rmed previous research :ndings in their analysis of )talian students: the prevalence of abnormally high, selfreported levels of an@iety increased in fre;uency with age and was negatively associated with school performance9 )n line with these results Spernak et al9 6.//I8 concluded using data from Head Start children in the nited States that measures of mental health status were signi:cantly and independently associated with academic achievement scores in kindergarten and third grade9 $urrie .F

and Stabile 6.//,8 in turn found that different mental health conditions can have large negative effects on future test scores and schooling attainment9 'ocusing on educational attainment, 1an "meringen, Mancini and 'arvolden 6.//F8 studied a sample of $anadian children and concluded that an@iety disorders and especially generali%ed social phobia were associated with premature withdrawal from school9 5hile !gger, $ostello, and "ngold 6.//F8 showed in their analysis of a sample of students in the nited States that pure, an@ious school refusal was signi:cantly associated with depression and separation an@iety disorder9 The speci:c impact of childrenAs and adolescentsA depression on educational outcomes has been barely investigated to date, partly due to the lack of ade;uate longitudinal data9 2ne of the main studies on this relationship is 'letcherAs 6.//,8, which used longitudinal data from the nited States and found a robust negative association between depression in high school and subse;uent educational attainmentC the association was mainly con:ned to female students9 'emale adolescents with depression were F9H percentage points less likely to graduate from high school, and depressed adolescents were almost si@ percentage points less likely to enrol in college, with the effect being larger for females K the decrease in attending a four-year college for females was 7/ percentage points9 However, causality cannot be inferred from these results as the effect of unobserved heterogeneity was not controlled for 6Table 7I89 Table 7I9 Mental health and well-being "uthor Title $urrie P, Stabile M Mental health in childhood and human capital !gger H0, $ostello, P!, and "ngold " School refusal and psychiatric disorders: a community study 'letcher PM "dolescent depression: diagnosis, treatment and educational attainment Source 4ata $ountry, year Methodology &*!3 5orking Paper &o9 7F.7, $anada and nited States of "merica, .//, "merican "cademy of $hild and "dolescent Psychiatry, G.6,8:,+,K-/, nited States of "merica, .//F Health !conomics, 7,6778:7.7HK 7.FH nited States of "merica, .//- $anadian &ational 0ongitudinal Survey of $hildren and Jouth 6&0S$J8 and &0SJ 'i@ed effects 4ata from eight annual waves of structured psychiatric interviews with +K7I-year-olds and their parents from the Breat Smokey Mountains Study 3egression analysis Health indicator !ducation indicator Hyperactivity score, emotional behaviour score and aggressive behaviour score Brade repetition, mathematics scores, reading scores and special education Psychiatric disorders incidence: an@iety and depression among others "n@ious school refusal and truancy 'indings Mental health conditions, especially "4H4, had large negative effects on future test scores and schooling attainment, regardless of family income and maternal education9 "n@ious school refusal and truancy were distinct but not mutually e@clusive and were signi:cantly associated with psychopathology and adverse e@periences at home and in school9

&ational 0ongitudinal 4epressive symptoms Study of "dolescent School dropout, college enrolment Health 6adolescents in and enrolment in a four-year college grades , through 7.8 Multivariate regression analysis 0og regression, probit regression 'emale adolescents with depression were F9H percentage points less likely to graduate from high school9 4epressed adolescents were almost I percentage points less likely to enrol in collegeC the effect was larger for females9 The decrease in attending a four-year college for females was 7/ percentage points9 )nternali%ing and e@ternali%ing problems at ages IK- signi:cantly and strongly diminished the probability of receiving a high school degree9 "mong youth who receive such degree, e@ternali%ing problems diminished the probability of subse;uent college enrolment9 Mc0eod P 4, #aiser # $hildhood emotional and behavioral problems and educational attainment "merican Sociological 3eview, I+:IFIKIH- nited States of "merica, .//G $hildren of the &0SJ data set 67+-IK.///8 Multivariate logistic regression analysis $hild emotional and behavioural problems 6*ehavior Problems )nde@8 reported by mothers in 7+-I and 7++/ and self-reported in 7++G and 7++-9 4epression measure: $enter for !pidemiological Studies: 4epression Scale 4ropout and college enrolment, mathematics and reading scores 6P)"T8, mothersA and childrenAs reports on grade repetition, childAs self-reports of having received a high school degree by ./// and having entered college as of ./// .G

"uthor Title Ma%%one 0 et al9 The role of an@iety symptoms in school performance in a community sample of children and adolescents Source 4ata $ountry, year Methodology *M$ Public Health, ,:FG, )taly, .//, Health indicator !ducation indicator 'indings The prevalence of abnormally high self-reported levels of an@iety increased in fre;uency with age and were negatively associated with school performance9 Samples of Multidimensional "n@iety Scale for elementary 6age $hildren -K7/ years8, middle $urrent academic grades 6age 77K7F years8, and high school 6age 7GK7I years8 children recruited from four public schools in a predominantly middle-class community in $atania, )taly Y. test was applied to analysis of categorical data9 $ontinuous variables were compared across categorical variables using StudentAs t-test or analysis of variance 6"&21"89 5hen the omnibus "&21" was signi:cant, post-hoc contrasts between a pair of groups 6Tukey-#ramer Honestly Signi:cant 4ifference test8 were conducted9 ./7 patients meeting criteria from the 4iagnostic and Statistical Manual of Mental 4isorders )1 for a primary an@iety disorder Self-reported measures of an@iety, depression and social ad<ustment Self-reported school achievement, rates of absenteeism and school en<oyment 1an "meringen M, Mancini $, 'arvolden P9 The impact of an@iety disorders on educational achievement Pournal of "n@iety 4isorders, 7,6H8:GI7KG,7 $anada, .//F "n@iety disorders, perhaps especially generali%ed social phobia, are associated with premature withdrawal from school9 "sthma The Taras and Potts-4atema 6.//Hd8 literature review on the relationship between asthma and education concluded that although a positive correlation between school absenteeism and asthma could be established, only a third of the studies reviewed found that asthma had a signi:cant impact on scores9 )n line with these :ndings Silverstein et al9 6.//78 provided further evidence that although in a speci:c community children in the nited States with asthma had two e@cess days of absenteeism, their school performance was similar to that of children without asthma9 3ecent studies in the nited States by *onilla et al9 6.//I8 and Moonie et al9 6.//-8 reached similar conclusions9 The :rst found that children with known asthma missed on average two

more days of school than children with low or high probability of asthma9 5hile the second concluded that although an inverse relationship between absenteeism and performance on standardi%ed tests could be established, there was no overall difference in test performance between those with and without asthma9 )n addition, Halterman et al9 6.//78 argued that asthmatic children had lower scores on a test of school readiness skills based on the analysis of a comprehensive survey of children beginning kindergarten in 7++- in an urban school system in &ew Jork state 6Table 7,89 .H

Table 7,9 "sthma "uthor Title *onilla S et al School absenteeism in children with asthma in a 0os "ngeles inner city school Halterman PS et al9 School readiness among urban children with asthma Source $ountry, year Pediatrics, 7G,6I8:-/.K-/I nited States of "merica, .//I 4ata Methodology H.- students of predominantly Hispanic ethnicity from a 0os "ngeles innercity school "&21" Health indicator !ducation indicator #nown asthma, high probability of asthma and low probability of asthma "verage number of school days missed 'indings $hildren with known asthma missed on average two more days of school than those with low or high probability of asthma9 "sthmatic children had lower scores on the test of school readiness skills9 niversity of 3ochester Medical $enter 6.//I, 'ebruary ,8 nited #ingdom, .//7 $omprehensive survey "sthma incidence of children beginning Scores on a test of school kindergarten in 7++- readiness skills in the urban school system in 3ochester, &ew Jork, collected parent reports of demographic, medical and developmental data 0inear and logistic regression analysis Previously identi:ed 3ochester, Minnesota, cohort of children with asthma and age- and se@-matched children without asthma Matching estimates $ross-section, F -7. students 6aged -K7, years8 who took the Missouri "ssessment Program 6M"P8 standardi%ed test during the .//.K.//F academic year $hi-s;uared test of independence used to assess the relationship between the presence of asthma and test-level performance9 The relationship between absenteeism and the presence of asthma was assessed using "&21"9 "sthma incidence School attendance, standardi%ed achievement test scores, BP", grade promotion and class rank of graduating students Presence of asthma and asthma severity level "bsenteeism and standardi%ed test performance Silverstein M4 et al9 School attendance and school performance: a population-based study of children with asthma Pediatrics, 7F+6.8:.,-K-F nited States of "merica, .//7

"lthough children with asthma had . e@cess days of absenteeism, the school performance of children with asthma was similar to that of children without asthma9 "fter ad<usting for covariates, a signi:cant inverse relationship was found between absenteeism and test performance on the M"P in all children9 There was no overall difference in test achievement between those with and without asthma9 Moonie S et al9 The relationship between school absence, academic performance, and asthma status Pournal of School Health, ,-6F8:7G/K 7G- nited States of "merica, .//Beneral health status indicators Most of the few studies that attempted to estimate the overall impact of health on educational outcomes conclude that health during childhood and adolescence can have a signi:cant effect on both academic performance and educational attainment9 Particular dif:culties in the assessment of this relationship include the de:nition of a measurable indicator of overall health and endogeneity issues9 Self-reported measures of health involve measurement error problems, as highlighted in previous sections, while the use of a set of speci:c conditions might not provide a complete picture9 How health is to be ob<ectively measured remains a hard fought research ;uestion9 $ase, 'ertig and Pa@son 6.//H8 considered the incidence of different chronic conditions during childhood as an indicator of health status and estimated their impact on 2levels H passed9 2n average each childhood condition at age , was associated with a /9F reduction in the number of 2-levels passed, and each condition at age 7I with an e@tra /9. reduction9 H The 2rdinary 0evel 62-level8 e@ams used to be sub<ect-based ;uali:cations taken at the end of secondary schools at the age of 7I in the *ritish educational system9 They have recently been replaced by a new system, the Beneral $erti:cate of Secondary !ducation9 .I

Buo and Harris 6.///8 used measures of child ill health as overall health indicators to :nd that poor child health at birth was an intervening factor in childrenAs intellectual development in a sample of young people in the nited States9 #aestner and $orman 67++H8, on the other hand, found evidence using data from the same survey that the relationship between health during childhood and cognitive development was weak9 "t the same time, endogeneity 6in particular resulting from reverse causality8 further deters an accurate estimation of the causal relationship between health and education9 3ecent attempts to tackle these problems used panel data and within-siblings models 6Smith et al9, .//-8, twins samples 62reopoulos et al9, .//-8 or dynamic models 6Ban and Bong, .//,89 Smith et al9 6.//-8 is one of the most complete and recent studies attempting to assess the connection between adult self-reports of general childhood health and mean schooling9 sing panel data from the nited States and within-family and across-siblings models to control for the effect of family characteristics, the author found that those with e@cellent or very good health achieved a third of a year more schooling than those whose health was worse9 Similarly, 2reopoulos et al9 6.//-8 made use of a $anadian twins sample to correct for endogeneity and concluded that infant health is a strong predictor of high school completion9 'inally, Ban and Bong 6.//,8 attempted to clarify the mechanisms by which health and education interact using a dynamic model that allowed for several potential links between health and education outcomes9 sing panel data from the nited States, the authors concluded that an individualAs health status measured by the probability of sickness signi:cantly affects academic success9 "ccording to their results, e@periencing sickness before the age of .7 decreases education on average by 79G years 6Table 7-89 Table 7-9 Beneral health "uthor Title $ase ", 'ertig ", Pa@son $ The lasting impact of childhood health and circumstance Source $ountry, year Pournal of Health !conomics, .G:FIHKF-+ nited #ingdom, .//H 4ata Methodology The 7+H- &ational $hild 4evelopment Study Multivariate regression analysis Health indicator !ducation indicator $hronic health conditions at ages , and 7I 2-level e@ams the child has passed by age 7I 'indings 2n average, each childhood condition was associated with a /9F reduction in 2-levels at age , and an e@tra /9. reduction at age 7I9 $hronic conditions at age , had a larger association with educational attainment for all measures of human capital investment than did chronic conditions at age 7I9 4epression and inattention both led to a decrease of /9H BP" points on average9 Mental and physical conditions show a strong correlation for females, not males9

4ing 5 et al9 The impact of poor health on education: new evidence using genetic markers &*!3 5orking Paper &o9 7.F/G nited States of "merica, .//I B"T23 study of a longitudinal dataset of adolescents that combines information from a series of :ve ;uestionnaires given over four years of high school 67+++K.//F8 along with four genetic markers Benetic markers across individuals as instrumental variables for health outcomes &0SJ,+ Structural e;uation model and four-stage estimation method "4H4, depression and obesity 6genetic markers8 BP" scores Ban 0i, Bong B !stimating interdependence between health and education in a dynamic model &*!3 5orking Paper &o9 7.-F/ nited States of "merica, .//, Probability of sickness Passing or failing a grade 6high-study and low-study types8 "n individualAs health status affected his or her academic success9 .,

Table 7-9 contd "uthor Title Buo B, Harris #M The mechanisms mediating the effects of poverty on childrenAs intellectual development Source $ountry, year 4emography, F,6G8: GF7KGG, nited States of "merica, ./// 4ata Methodology &0SJ Structural e;uation model Multivariate unweighted regression Health indicator !ducation indicator $hildAs ill health at birth and in childhood Scores on different tests measuring cognitive development 6P)"T3, P)"T, PP1T-38 0imiting conditions re;uiring treatment in last 7. months, number of illnesses in last 7. months and serious illnesses P)"T scores Head Start participation and funding High school completion, high school graduation rate, discontinuity in schooling and years of school completed Self-reports about general childhood health status Mean schooling 'indings $ognitive stimulation in the home and poor child health at birth were mediating factors that inEuenced childrenAs intellectual development9 #aestner 3, $orman H The impact of child health and family inputs on child cognitive development &*!3 5orking Paper &o9 H.H, nited States of "merica, 7++H &0SJ Multivariate regression analysis, child :@ed effects " weak relationship e@isted between several measures of child health and child cognitive development9 0udwig P, Miller 4 4oes Head Start improve childrenAs life chancesL !vidence from a regression discontinuity design niversity of $alifornia 4iscussion paper nited States of "merica, .//I

nited States 2f:ce of !;ual 2pportunity 62!28 data sources and data from a special tabulation by the nited States $ensus *ureau on 7++/ census data to measure long-term schooling outcomes 4iscontinuity design 4ata derived from Panel Survey of )ncome 4ynamics 6PS)48 following groups of siblings and their parents for F/ years 0og-linear regression analysis with controls 6demographic factors and family characteristics8 "cross siblings, within:@ed effects 'ormer Head Start children who participated in the &ational Public SchoolHead Start Transition 4emonstration Study 6&T4S8 as they entered kindergarten in 7++. and progressed to third grade Multivariate regression analysis " discontinuity e@isted at the 2!2 cutoff in educational attainment in the 7++/ census9 Smith PP The impact of childhood health on adult labor market outcomes $4 6 niversity $ollege 4ublin8 Beary )nstitute 0abor and Population 5orking Paper 7G>.//nited States of "merica, .//3espondents who self-reported e@cellent or very good health achieved a third of a year more schooling than those who reported worse health, and the impact was signi:cant9 Spernak SM et al9 $hild health and academic achievement among former Head Start children $hildren and Jouth Services 3eview, .-67/8:7.H7K7.I7 nited States of "merica, .//I Health status in both kindergarten and third grade "chievement scores Measures of general and mental health status were signi:cantly and independently associated with academic achievement scores in kindergarten and third grade9 .-

I9 $onclusions This publication reviews the e@isting evidence of the potential impact of health behaviours and conditions on educational outcomes among children and adolescents in high-income countries9 5e had observed that most of the work documenting the no doubt close correlation between health and education in rich countries either assumed or tried to show that it was education that determines health rather than the reverse9 However, e@tensive evidence from poor countries had documented the impact of health on education9 5e felt the imbalance was un<usti:ed9 'ifty-three studies met our selection criteria9 "s the topic is potentially multidisciplinary, we speci:cally e@plored <ournals from multiple :elds to minimise the risk of missing relevant research9 Most of the work we found was published by public health researchers or economists9 "lthough the amount of research is limited, interest has clearly been growing, especially since .//79 5hile we cannot be sure to have e@hausted the entire literature, the evidence we found provides overwhelming support for the relationship between childhood and adolescent health and educational outcomes9 2verall, the studies reviewed found a negative correlation between risky health behaviours and 6ill8 health conditions one the one hand and, on the other, education as measured through both educational achievement and academic performance9 )mportant research challenges remain9 5e noted a geographical bias in the research, which has been mostly based in the nited States and possibly driven by the availability of more appropriate data sources9 This :nding recommends the development of more data sets in !uropean countries and the use of those data sets to further e@plore the likelihood that investments in health would lead to better educational outcomes9 )n addition, despite growing, well-substantiated evidence of the causal link between health and education, more research ade;uately addressing methodological issues is re;uired to verify a causal relationship between most of the health indicators considered and education9 Speci:cally, in the case of health behaviours, research is particularly scarce or less conclusive with regard to smoking and nutritional problems as compared to alcohol drinking and drug use9 )n addition and although an incipient body of literature points to a signi:cant impact of physical e@ercise on academic performance, further research effectively establishing causality in this association is re;uired9 $oncerning health conditions, research on the relationship between an@iety and depression 6on the one hand8 and children and adolescentsA educational outcomes 6on the other8 remains particularly limited, especially considering the likely increasing relevance of these problems in industriali%ed countries9 4espite these limitations and gaps, the results of the literature review support our view that there are good reasons to believe that there is also a causal impact in high-income countries running from the selected health behaviours and conditions to education9 This has important implications for how the health of children should be viewed in the general policy debate and for the ways in which we might consider improving educational outcomes in children and adolescents9 .+

"nne@ 79 2nline databases used Science4irect 79 .9 F9 G9 H9 I9 ,9 "dvanced search "ll sources Terms Wchild health, children health, adolescent health, health outcomesX "&4 Weducational attainment, school achievement, academic performance, dropout, educational statusX "ll sources Sub<ect area Weconomics, econometrics and :nanceC medicine and dentistryC nursing and health professionsC psychologyC social sciencesX 4ates: 7++H to present )nterScience 79 .9 F9 G9 H9 I9 ,9 -9 "dvanced search Search for WhealthX "&4 Wacademic performanceX "&4 WchildrenX Product type WPournalX Sub<ects W"llX 4ate range between W7++H and .//-X 2rder by WO matchX The option related articles allowed further restriction of the search9 Scirus 79 .9 F9 G9 H9 "ll of the words Wchildren, child, teenager, alcohol drinking, smoking, asthma, an@ietyX "&4 Weducational status, educational attainment, academic performanceX "&4 Wchildren, teenagerX 4ates W7++HK .//-X 2nly results in Wall sub<ect areasX !ach reading would allow searching similar studies through the similar results option9 PubMed 79 .9 F9 G9 H9 I9 ,9 -9 +9 MeSh 4atabase Search Wasthma or sleep apnea, sleep deprivation, nutrition assessment, nutrition policy, child nutrition disorders, obesity, alcohol, drugs, smoking, depression, inattention, hyperactivity, an@iety, physical activity, e@erciseX Send to search bo@ with and $lear search :eld Search Weducation, cognitive developmentX Send to search bo@ with and Select Weducational status, learning disordersX $lear search :eld Search Wchildren or adolescentsX 7/9 Select Wchild or adolescent, adolescent behaviour, adolescent psychology, adolescent psychiatryX 779 Send to search bo@ with and 7.9 Search PubMed F/

#ey selected readings on the relevant topics in turn led to other related research and literature through the option related readings and the systematic review of cited references9 *ioMed *oolean search 4ate from W7++, to .//-X Sueries: 79 .9 F9 G9 H9 I9 ,9 -9 +9 health status "&4 6educational attainment8 children health "&4 6education8 children health "&4 academic performance children health "&4 6academic performance8 children health "&4 educational attainment children health "&4 6educational attainment8 children health "&4 6education level8 children chronic disease "&4 school achievement children chronic disease "&4 grades 7/9 adolescence health "&4 academic performance 779 disease "&4 school achievement 7.9 asthma "&4 6academic performance8 7F9 obesity "&4 school achievement 7G9 adolescence health "&4 academic performance 7H9 adolescence health "&4 educational attainment 7I9 children asthma "&4 education 7,9 children asthma "&4 school 7-9 children asthma "&4 academic performance The option related articles allowed to further restrict the search within each topic of interest9 $ochrane 79 .9 F9 G9 H9 Search for: WHealth outcomesX "&4 Wacademic performanceX "&4 WchildrenX 4ate range: W7++HK.//-X )S) 5eb of #nowledge 79 .9 Search all databases Topic WHealth outcome or health status, asthma, sleep, alcohol, drugs, smoking, "4H4X "&4 Weducation or academic performance, academic achievement, educational attainment, educational outcomes, schoolX in topic "&4 Wchildren or adolescent, adolescence, young adult, teenagerX in topic 0imit to Wlatest H yearsX F9 G9 "gain the key papers helped restrict the search through the option view related records and the review of main references9 F7

3eferences "laimo #, 2lson $, 'rongillo ! 6.//789 'ood insuf:ciency and "merican school-aged childrenAs cognitive, academic, and psycho-social development9 Pediatrics, 7/-:GGKHF9 *lunden S et al9 6.//789 $ognitive and behavioural performance in children with sleep-related obstructive breathing disorders9 Sleep Medicine 3eviews, H6I8:GG,KGI79 *onilla S et al9 6.//I89 School absenteeism in children with asthma in a 0os "ngeles inner city school9 Pediatrics, 7G,6I8:-/.K -/I9 *ray P5 et al9 6.///89 The relationship between mari<uana initiation and dropping out of high school9 Health !conomics, +678:+K 7-9 $aldeira #M et al9 6.//-89 The occurrence of cannabis use disorders and other cannabis-related problems among :rst-year college students9 "ddictive *ehaviors, FF:F+,KG779 $arlson S" et al9 6.//-89 Physical education and academic achievement in elementary school: data from the early childhood longitudinal study9 "merican Pournal of Public Health, +-6G8:,.7K,.,9 $ase ", 'ertig ", Pa@son $ 6.//H89 The lasting impact of childhood health and circumstance9 Pournal of Health !conomics, .G:FIHKF-+9 $astelli 4M et al9 6.//,89 Physical :tness and academic achievement in third- and :fth-grade students9 Pournal of Sport and !@ercise Psychology, .+6.8:.F+K.H.9 $awley P, Spiess $# 6.//-89 2besity and developmental functioning among children aged .KG years9 *erlin, 4eutsches )nstitut fVr 5irtschaftsforschung 64iscussion Paper &o9 ,-I89 $hatter<i P 6.//I89 )llicit drug use and educational attainment9 Health !conomics, 7H:G-+KH779 $hatter<i P, 4eSimone P 6.//H89 "dolescent drinking and school dropout9 $ambridge, M", &*!3 65orking Paper &o9 w77FF,89 $ollins *& et al9 6.//,89 "dolescent environmental tobacco smoke e@posure predicts academic achievement test failure9 Pournal of "dolescent Health, G7:FIFKF,/9 $ook P, Hutchinson 3 6.//I89 Smoke signals: adolescent smoking and school continuation9 $ambridge, M", &*!3 65orking Paper &o9 7.G,.89 $ueto S 6.//789 *reakfast and performance9 Public Health &utrition, G, 7G.+-7GF79 $urrie P 6.//-89 Healthy, wealthy and wise: socioeconomic status, poor health in childhood and human capital development9 $ambridge, M", &*!3 65orking Paper &o9 7F+-89 $urrie P, Stabile M 6.//,89 Mental health in childhood and human capital9 $ambridge, M", &*!3 65orking Paper &o9 7F.7,89 $urrie P et al9 6.//G89 )s the child health>family income gradient universalL evidence from !ngland9 *onn, 'orschungsinstitut %ur Tukunft der "rbeit BmbH 65orking Paper &o9 7F.-89 $utler 4M, Miller B, &orton 4 6.//,89 !vidence on early-life income and late-life health from "mericaAs 4ust *owl era9 Proceedings of the &ational "cademy of Sciences, 7/G6FF8:7F.GGK7F.G+9 $utler 4M, 0leras-Muney " 6.//I89 !ducation and health: evaluating theories and evidence9 $ambridge, M", &*!3 65orking Paper &o9 7.FH.89 4alton 3, #lingemann H 6eds8 6.//,89 The 2@ford handbook of political behavior9 2@ford, 2@ford niversity Press9 4atar ", Sturm 3 6.//I89 $hildhood overweight and elementary school outcomes9 )nternational Pournal of 2besity, F/6+8:7GG+K 7GI/9 4eSimone P, 5olaver "M 6.//H89 4rinking and academic performance in high school9 $ambridge, M", &*!3 65orking Paper &o9 77/FH89 4ee TS, !vans 5& 67++,89 Teen drinking and education attainment: evidence from two-sample instrumental variables 6TS)18 estimates9 $ambridge, M", &*!3 65orking Paper &o9 I/-.89 4ing 5 et al9 6.//I89 The impact of poor health on education: new evidence using genetic markers9 $ambridge, M", &*!3 65orking Paper &o9 7.F/G89 F.

4rake $ et al9 6.//F89 The pediatric daytime sleepiness scale 6P4SS8: sleep habits and school outcomes in middle-school children9 Sleep, .I6G8:GHHKGH-9 4uarte 3, !scarioa PP, Molina P" 6.//I89 Mari<uana consumption and school failure among Spanish students9 !conomics of !ducation 3eview, .H6G8:G,.KG-79 !gger H0, $ostello, P!, "ngold 6.//F89 School refusal and psychiatric disorders: a community study9 "merican "cademy of $hild and "dolescent Psychiatry, G.6,8:,+,K-/,9 !llickson P0, Tucker PS, #lein 4P 6.//F89 Ten-year prospective study of public health problems associated with early drinking9 Pediatrics, 7776H Pt 78:+G+K+HH9 !llickson P0, Tucker PS, #lein 4P 6.//789 High-risk behaviors associated with early smoking: results from a H-year follow-up9 Pournal of "dolescent Health, .-:GIHKG,F9 !llickson P0 et al9 6.//G89 "ntecedents and outcomes of mari<uana use initiation during adolescence9 Preventive Medicine, F+:+,IK+-G9 'allone B et al 6.//789 !ffects of acute sleep restriction on behavior, sustained attention, and response inhibition in children9 Perceptual and Motor Skills, +F678:.7FK .+9 'alkner &' et al9 6.//789 Social, educational and psychological correlates of weight status in adolescents9 2besity 3esearch, +678:FFKG.9 'letcher PM 6.//-89 "dolescent depression: diagnosis, treatment and educational attainment9 Health !conomics, 7,6778:7.7HK 7.FH9 'rench MT, B" Tarkin 67++H89 )s moderate alcohol use related to wagesL evidence from four worksites9 Pournal of Health !conomics, 7G:F7+KFGG9 'uchs 13 67+-.89 Time preferences and health: an e@planatory study9 )n: 'uchs 13, ed9 !conomic aspects of health9 $hicago, )0, niversity of $hicago Press:+FK7./9 Ban 0, Bong B 6.//,89 !stimating interdependence between health and education in a dynamic model9 $ambridge, M", &*!3 65orking Paper &o9 7.-F/89 Bibson !S et al9 6.//I89 MSleepinessN is serious in adolescence: two surveys of F.FH $anadian students9 *M$ Public Health, May ., I:77I9 Brantham-McBregor S 6.//H89 $an the provision of breakfast bene:t school performanceL 'ood and &utrition *ulletin, Pune, .I 6. Suppl .8:S7GGH-9 Brossman M 67+,H89 The correlation between health and schooling: household production and consumption9 )n Terlecky< &!, ed9 Studies in income and wealth, 1ol9 G/9 &ew Jork, &J, $olumbia niversity Press9 Brossman M 67+,F89 The correlation between health and schooling9 $ambridge, M", &*!3 65orking Paper &o9 w//..89 Buo B, Harris #M 6.///89 The mechanisms mediating the effects of poverty on childrenAs intellectual development9 4emography, F,6G8:GF7KGG,9 Halterman PS et al9 6.//789 School readiness among urban children with asthma9 "mbulatory Pediatrics, 76G8:./7K./H9 Hamilton 1, Hamilton * 67++,89 "lcohol and earnings: does drinking yield a wage premium9 $anadian Pournal of !conomics, F/:7FHK 7H79 Henning *uddea H et al9 6.//-89 "cute coordinative e@ercise improves attentional performance in adolescents9 &euroscience 0etters, GG76.8:.7+K..F9 #aestner 3, $orman H 67++H89 The impact of child health and family inputs on child cognitive development9 $ambridge, M", &*!3 65orking Paper &o9 H.H,89 #aestner 3, Brossman M 6.//-89 !ffects of weight on childrenAs educational achievement9 $ambridge, M", &*!3 65orking Paper &o9 7F,IG89 #enkel 4S 67++789 Health behavior, health knowledge and schooling9 Pournal of Political !conomy, ++:.-,KF/H9 #och S, 3ibar 4 6.//789 " siblings analysis of the effects of alcohol consumption onset on educational attainment9 $ontemporary !conomic Policy, 7+6.8:7I.K7,G9 0(pe%-'rUas M et al9 6.//789 "lcohol consumption and academic performance in a population of Spanish high school students9 Pournal of Studies on "lcohol and 4rugs, I.6I8:,G7K,GG9 FF

0udwig P, Miller 4 6.//I89 4oes Head Start improve childrenAs life chancesL !vidence from a regression9 4avis, $", niversity of $alifornia 64iscussion paper89 0undborg P 6.//-89 The health returns to education: what can we learn from twinsL *onn, 'orschungsinstitut %ur Tukunft der "rbeit 65orking Paper FF++89 Mac4onald T, Shields M" 6.//789 The impact of alcohol consumption on occupational attainment in !ngland9 !conomica, I-6.,78:G.,KGHF9 Ma%%one 0 et al9 6.//,89 The role of an@iety symptoms in school performance in a community sample of children and adolescents9 *M$ Public Health, ,:FG,9 Mc0eod P4, #aiser # 6.//G89 $hildhood emotional and behavioral problems and educational attainment9 "merican Sociological 3eview, I+:IFIKIH-9 Miller P5 et al9 6.//,89 *inge drinking and associated health risk behaviors among high school students9 Pediatrics 77+678:,IK -H9 Moonie S et al9 6.//-89 The relationship between school absence, academic performance, and asthma status9 Pournal of School Health, ,-6F8:7G/K 7G-9 Murray &B et al9 6.//-89 $oordinated school health programs and academic achievement: a systematic review of the literature9 Pournal of School Health, ,,P6+8:H-+KI//9 2reopoulos P et al9 6.//-89 Short-, medium-, and long-term conse;uences of poor infant health: an analysis using siblings and twins9 Pournal of Human 3esources, GF678:--K7F-9 Pacula 30, 3oss #!, 3ingel P 6.//F89 4oes mari<uana use impair human capital formationL $ambridge, M", &*!3 65orking Paper &o9 ++IF89 Pate 33 et al9 6.//I89 Promoting physical activity in children and youth: a leadership role for schools: a scienti:c statement from the "merican Heart "ssociation $ouncil on &utrition, Physical "ctivity, and Metabolism 6Physical "ctivity $ommittee8 in collaboration with the councils on $ardiovascular 4isease in the Joung and $ardiovascular &ursing9 Pournal of the "merican Heart "ssociation, 77G:7.7GK7..G9 Peters *0, Stringham !P 6.//I89 &o boo%eL you may lose: why drinkers earn more money than nondrinkers9 0os "ngeles, $", 3eason 'oundation 6Policy *rief &o9 GG89 3enna ' 6.//G89 TeensA alcohol consumption and schooling9 !conomics of !ducation 3eview, .,678:I+K,-9 3oebuck M$, 'rench M, 4ennis M0 6.//G89 "dolescent mari<uana use and school attendance9 !conomics of !ducation 3eview, .F:7FFK7G79 3osen%weig M3, Schult% TP 67+-789 !ducation and household production of child health9 )n Proceedings of the "merican Statistical "ssociation9 5ashington, 4$, "merican Statistical "ssociation9 Schwimmer P*, *urwinkle, TM, 1arni P5 6.//F89 Health-related ;uality of life of severely obese children and adolescents9 Pournal of the "merican Medical "ssociation, .-+67G8:7-7FK7-7+9 Silverstein M4 et al9 6.//789 School attendance and school performance: a population-based study of children with asthma9 Pediatrics, 7F+6.8:.,-K.-F9 Singh S, McMahan S 6.//I89 "n evaluation of the relationship between academic performance and physical :tness measures in $alifornia schools9 $alifornian Pournal of Health Promotion, G6.8:./,K.7G9 Smith PP 6.//-89 The impact of childhood health on adult labor market outcomes9 4ublin, $4 Beary )nstitute 60abor and Population 5orking Paper 7G>.//-89 Spernak SM et al9 6.//I89 $hild health and academic achievement among former Head Start children9 $hildren and Jouth Services 3eview, .-67/8:7.H7K7.I79 Taras H, Potts-4atema 5 6.//Ha89 $hronic health conditions and student performance at school9 Pournal of School Health, ,H6,8:.HHK.II9 Taras H, Potts-4atema 5 6.//Hb89 Sleep and student performance at school9 Pournal of School Health, ,H6,8:.G-K.HG9 Taras H, Potts-4atema 5 6.//Hc89 2besity and student performance at school9 Pournal of School Health, ,H6-8:.+7K.+H9 Taras H, Potts-4atema 5 6.//Hd89 $hildhood asthma and student performance at school9 Pournal of School Health, ,H6-8:.+IK F7.9 Torres M4 et al9 6.//,89 *reakfast, plasma glucose and beta-hydro@ybutyrate, body mass inde@ 6*M)8 and academic performance in children from !@tremadura, Spain9 &utrici(n Hospitalaria, ..6G8:G-,KG+/9

FG

Touchette ! et al9 6.//,89 "ssociations between sleep duration patterns and behavioral>cognitive functioning at school entry9 Sleep, F/6+8:7/,+K7/-/9 Trudeau ', Shephard 3P 6.//-89 )s there a long-term health legacy of re;uired physical educationL Sports Medicine, F-6G8:.IHK .,/ rschit% MS et al9 6.//F89 Snoring, intermittent hypo@ia and academic performance in primary school children9 "merican Pournal of 3espiratory and $ritical $are Medicine, 7I-6G8:GIGKGI-9 1an "meringen M, Mancini $, 'arvolden P 6.//F89 The impact of an@iety disorders on educational achievement9 Pournal of "n@iety 4isorders, 7,6H8:GI7KG,79 5olfson M3, $arskadon M$ 67++-89 Sleep schedules and daytime functioning in adolescents9 $hild 4evelopment, I+6G8:-,HK --,9 Jamada T, #endi@ M, Jamada T 67++I89 The impact of alcohol consumption and mari<uana use on high school graduation9 Health !conomics, H678:,,K+.9 Jolton # et al9 6.//H89 !@posure to environmental tobacco smoke and cognitive abilities among 9S9 children and adolescents9 !nvironmental Health Perspectives, 77F678:+-K7/F9 Tarkin B" et al9 67++-89 "lcohol use and wages: new results from the national household survey on drug abuse9 Pournal of Health !conomics, 7,678:HFKI-9