Study Of 5th-Graders: School Is Single Biggest Factor In Health Gaps

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Which school they go to influences fifth-graders' health, a new study finds. (
Which school they go to influences fifth-graders' health, a new study finds. (

Listen to the All Things Considered interview here.

The New England Journal of Medicine has just published the most ambitious study yet of health issues and behaviors in fifth-graders. Led by Boston Children's Hospital researchers, it's an exceedingly complex and rigorous look at health issues, examining multiple behaviors and experiences among 5,000 children in three cities.

So what did it find? Disparities on health issues among children of different races and ethnicities in this age group are large indeed. For example:

[module align="right" width="half" type="pull-quote"]Schools really matter. Individual schools. They matter above and beyond neighborhoods.[/module]

• Black fifth-graders are four times as likely as white ones to have seen a threat or injury with a gun. Twenty percent of black 5th graders report having seen such gun violence, 11% of Latinos and 5% of whites.

• Black and Latino kids tend to have almost double the obesity rates of white kids.

• White kids are more likely to wear seat belts and much more likely to wear bike helmets. Half of white fifth-graders wear bike helmets; only 14% of blacks and 18% of Latinos.


Much of the difference between black and white children can be accounted for by factors such as the child's school, the family's income and the parents' education. But not all. Further research is needed to figure out which factors remain to be identified.

And here's the part I find easy to understand: Schools really matter. Individual schools. They matter above and beyond neighborhoods. (Note to self: Get more active in the PTO.) "School is the single biggest factor associated with the disparities," said the study's lead author, Dr. Mark Schuster, chief of general pediatrics at Children's and William Berenberg professor of pediatrics at Harvard Medical School.

And more broadly about the study: "I was struck by the fact that these disparities across racial and ethnic groups appeared across such a wide array of indicators," Dr. Schuster said, "and it was compelling to me that the school and the family's income and education accounted for so much — though not all — of the disparity."

The findings already suggest some possible interventions, he said.

For example, disparities in bike helmet use are driven almost entirely by family income, so an obvious tactic would be to subsidize the cost of bike helmets. And kids' reports that they've been victimized by their peers is driven almost entirely by school, "so that would suggest school-based bullying programs."

And the takeaway for parents? Should we fight even harder to get our kids into better schools?

"I would say every parent should fight as hard as they can to get the best education for their kids," Dr. Schuster said, "and to advocate for their community to invest in education for the next generation. I think this study supports the idea that schools really matter, even more than neighborhoods. But schools vary. You get a visionary principal in a school and that can change everything. You get a phys-ed program because parents organize and have a fundraiser, and kids start getting more exercise"

From the press release:

Large health gaps among black, Latino, and white fifth-graders, but schools and parents’ income and education make a difference

Findings suggest earlier intervention is crucial for long-term wellness

Substantial racial and ethnic disparities were found for a broad set of harmful health-related issues in a new study of 5th graders from various regions of the U.S. conducted by Boston Children’s Hospital and a consortium of research institutions. Black and Latino children were more likely than white children to report everything from witnessing violence to engaging in less exercise to riding in cars without wearing seatbelts. At the same time, the study found that children of all races and ethnicities did better on these health indicators if they had more highly-educated parents with higher income or had the advantages of attending certain schools. Although white children were more likely to have these advantages than black or Latino children, when children with similar advantages were compared, racial and ethnic differences for most health indicators were smaller or even absent.

The study is the most ambitious effort to date to investigate the potential drivers of racial and ethnic health disparities among preadolescents. Results emphasize the key role that schools and family income and education may play in health disparities. Mark A. Schuster, MD, Ph.D., Chief of General Pediatrics at Boston Children’s Hospital and William Berenberg Professor of Pediatrics at Harvard Medical School, led a research team that conducted the study. Between 2004 and 2006, they interviewed about five thousand 10- and 11-year-olds and their parents, in and around Birmingham, AL, Houston, TX, and Los Angeles, CA. Findings were published in the August 23 issue of the New England Journal of Medicine.

“We found wide gaps between black and white children and between Latino and white children, in 5th grade,” says Dr. Schuster, who began the research while at RAND, the Santa Monica think tank. “When we delved deeper, we found that factors like the child’s school, household income, and parents’ education were strongly related to children’s health. When these key factors are taken into account, differences related to race and ethnicity are not as large. But substantial differences remain, particularly between black and white children. More work is needed to identify what is causing these disparities, so that we can find ways to improve all children’s health.”

This program aired on August 22, 2012. The audio for this program is not available.

Carey Goldberg Twitter Editor, CommonHealth
Carey Goldberg is the editor of WBUR's CommonHealth section.