Effectiveness of population level interventions in schools and academic performance

Drexel University, Philadelphia PA

Investigators

Linked publications & trials

Abstract

ABSTRACT African American and Hispanic populations have worse adult health than their White peers (hereafter “health disparities”). These health gaps often begin in childhood and persist to adulthood. Far less research has identified population-level interventions that reduce variation in risk factors across population subgroups. The scant evidence on effective population-level interventions is a significant barrier to reducing health gaps and therefore improving overall population health. Rigorous prior studies have revealed the plausibility for large-scale nutrition interventions to reduce gaps in children’s academic performance—a strong predictor of adult educational attainment, which is one of the most prominent health promoting factors. These prior studies have illuminated the intermediary mechanisms in the pathway between school-based nutrition interventions, (junk) food availability near schools and children’s academic performance. No longitudinal studies have thoroughly investigated the population-level influences on academic performance of large-scale nutrition interventions together with modifiable food-related factors near schools. This longitudinal study capitalizes on a series of natural experiments generated by large-scale interventions that enhance nutrition standards for foods and drinks available to children in schools. The study will determine (a) the effectiveness of population-level school nutrition interventions in improving children’s academic performance and reducing related gaps among African American and Hispanic vs. White peers; (b) the extent to which modifiable, food-related factors near schools influence longitudinal changes in academic performance and related disparities; and (c) the degree to which school nutrition intervention effectiveness varies by the food-related factors near schools. To generate valid inferences about the population-level effectiveness of these interventions on academic performance, this study uses the strongest possible approach to evaluate non-randomized exposures: a difference-in-differences analysis that includes within-child change in exposures. Difference-in-difference analyses will also examine the effects of child-level changes in modifiable food-related factors near their schools and changes in academic performance (and disparities). This study is unparalleled because we use powerful longitudinal data on academic performance among a large population of 11.8 million children. Interventions in and around schools hold potential to reduce gaps given they apply to all children, and use existing infrastructures and networks that facilitate their large-scale implementation and population-level impact. Given its robust design, the study will have a significant impact on evidence-based nutrition interventions to mitigate health gaps; identify opportunities to enhance educational attainment; and broaden the scope of interventions to improve health for all Americans.