research problems in school

364 Education Research Topics about School Issues, Special Education, and More

The field of education encompasses diverse areas of study, ranging from elementary school to higher education. It includes curriculum development, teaching policy-making, and the application of psychology and technology in learning.

Education research explores learning theories and effective teaching practices, examines the impact of sociocultural elements on teaching, and addresses concerns of equality and inclusion. This dynamic discipline continually evolves, driven by innovations and the desire to enhance learning outcomes for all students while creating new avenues for fundamental research.

In this article, you’ll find many education research topics for your projects. You can also find additional ideas in our free essay database .

🏫 15 Controversial School Topics

🔎 research areas & topics in education, 🎒 elementary education research topics, 👩‍🎓 adult education research topics, 🧮 action research topics in education, 🔕 special education research topics, 🚌 school issues topics, 📒 more controversial school topics, 🧠 school psychology research topics, 🔗 references.

• The role of school counselors’ support for students considering abortion.
• Psychedelic therapy: The impact on students’ mental health.
• The role of school religion classes in promoting cultural understanding.
• How do economic policies impact teacher retention and job satisfaction?
• Sexual harassment in schools: Prevalence, structure, and perceptions.
• Free education and its role in reducing educational inequality.
• Why is parental support crucial in achieving academic success?
• Bullying and cyberbullying: The influence on the school environment.
• The effectiveness of school-based sex education programs.
• Promoting school safety for LGBTQ students.
• Inclusive curriculum as a path to better educational performance.
• Cultural diversity in secondary school classrooms.
• The link between alcohol consumption and educational performance.
• Gambling behavior and risk factors in preadolescent students.
• Final exams as the main reason for student depression and anxiety.

Research in education seeks to improve learning outcomes, address the issues of equity and inclusion , and integrate innovative technology into the educational process. Look at the table below to learn what different research areas in education deal with!

• The influence of modern technologies on elementary school education.
• Elementary education: Methods and strategies.
• Elementary School: Picture Communication at the Lesson .
• Promotion of the healthy diet program in elementary schools.
• The role of physical education in elementary schools.
• Addressing Bullying in Elementary and Middle School Classrooms .
• Social studies in the elementary school.
• How to increase motivation among students in elementary school?
• Math Methodology for Elementary Teachers .
• The value of community and family involvement in elementary schools.
• Dominant learning styles among elementary school students.
• Teacher Efficacy of Pre-service Elementary Teachers .
• Elementary education principles: Europe vs. the US.
• The problem of bullying among elementary school students.
• Departmentalization in American Elementary Schools .
• The impact of laptops on elementary school students’ performance.
• The history of elementary education development in Europe.
• Yorktown Elementary School Improvement Plan .
• Corporal punishment as a way of dealing with elementary-level aggressive children.
• Pedagogical Skills in Elementary School .
• Effects of obesity on elementary school students’ development.
• Elementary-level art education and its importance.
• Students’ Academic Performance: Elementary Homework Policies .
• The standards of learning at the elementary educational level.
• Modern approaches to self-studying in elementary school.
• Task-Based Language Teaching Applied in Elementary Classroom .
• Learning English in bilingual elementary schools.
• Lack of proper grooming as a cause of violence among elementary students.
• Proposal for Providing Healthier Food Choices for Elementary Students .
• The need for sexual education in elementary school.
• Differences between adult and child education.
• Main types of adult education and their features.
• Adult Education: Reasons to Continue Studying .
• The most popular adult education agencies and institutions in Europe.
• Adult education: Purpose and theories.
• Adult Education in the “Real World” Classroom .
• Challenges and motivating factors in education for adults.
• Greater social inclusion as one of the crucial benefits of adult education.
• Adult Education for Canadian Immigrants .
• Adult-education movements in the UK.
• What sets adult education apart from traditional education?
• Interaction Strategies in Adult Education .
• Albert Mansbridge and his role in adult education development.
• Adult education in Canada: Key features.
• Adult Educational Pedagogical Philosophies, Theories .
• Peculiarities of learning environment for adult students.
• Critical resources for adult education and training.
• Importance of Adult Education: Risks and Rewards .
• Adult education as a tool for developing leadership capabilities.
• The role of critical thinking in adult education.
• Adult Education: McClusky’s Power-Load-Margin .
• What theories of adult learning are used in UK education?
• Modern technology and its impact on adult learning improvement.
• Michael Collins “Adult Education as Vocation”: Theoretical Positions .
• Theories of adult learning in the context of clinical teaching nurses.
• Adult education: Opportunities and limitations.
• Concept of Lifelong Learning .
• The aid of volunteers in adult education.
• Teaching skills that play a vital role in adult education.

Action research seeks to identify problems, weaknesses, or areas for improvement in different dimensions of the education system — instructional, academic, or organizational. It is a cyclical process, the goal of which is to equip teachers with a mechanism for problem resolution in schools to enhance student learning and teacher effectiveness.

• William Barry: A theory-based educational approach to action research.
• The Effects of Cyberbullying on Students’ Academic Performance .
• Educators’ challenges in conducting action research in classrooms.
• Action research’s importance in teacher education courses.
• Inclusion Policies in Education and Their Effects .
• Primary school education: Action research plan.
• The benefits of using action research in the classroom.
• Learning Disabilities and Intervention Methods .
• The role of action research in college education.
• Parental involvement in student’s education with the help of action research.
• Online Learning and Students’ Mental Health .
• The influence of action research on curriculum development.
• Action research in education: Characteristics and working principles.
• How Is Social Media Affecting College Students?
• Why is action research one of the best ways to improve academic performance?
• Action research for educational reform: Remodeling action research theories.
• College Students’ Weight Gain and Its Causes .
• The use of action research in higher education and its outcomes.
• International educational perspectives through action research.
• Inclusion and Individual Differences in Classroom .
• The contribution of action research to investigating classroom practice.
• How does action research support the development of inclusive classroom environments?
• Homeschooling: Argumentation For and Against .

School & Classroom Management

• Peculiarities of educational management in primary and elementary schools.
• Classroom Management and Techniques to Incorporate in Student’s Reinforcement Plan .
• Preventive approaches to classroom management.
• Educational management: The blue vs. orange card theory.
• Teaching Strategies and Classroom Management .
• What is the role of corporal punishment in educational management?
• Classroom management system: Effective classroom rules.
• Dominance and Cooperation as Classroom Management Strategies .
• Culturally responsive classroom management: Definition and features.
• The influence of school management on student well-being and engagement.
• Blended Learning and Flipped Classrooms .
• Use of information communication technology in school management.
• The problems of classroom management with high school students.
• The Role of Computers in the Classroom .
• Assessment of the role of teachers in school management.
• Online vs. Traditional Classroom Education .

Educational Policies

• Why are education policies and strategies crucial for teachers and students?
• The effectiveness of implementing educational policies.
• Implementation of Federal Educational Policies .
• State policies to increase teacher retention.
• Policies and laws promoting gender equality in education.
• The Separate But Equal Education and Racial Segregation .
• Education policy issues in 2020: Consequences of Covid-19.
• Educational policies for students with disabilities.
• Higher Education Should Be Free for Everyone .
• What education policies and practices does UNESCO prioritize?
• Education policies as a way to improve the school system in the Philippines.
• Where and How Sex Education Should Be Conducted Among the Young People?
• The education policy fellowship program and its value and goal.
• Should Schools Distribute Condoms?
• European education policy regarding the education of adults.
• The main features of the special education process.
• Use of assistive technology in improving education for students with special needs.
• Special Education in New York City .
• Special education: Transforming America’s classrooms.
• The issues faced by parents of students with disabilities.
• Functional Curriculum Goals in Special Education .
• The role of social skills training in the development of special education.
• Paraeducators: Assisting students with special needs in their studies.
• Labeling in Special Education .
• Physical class as a vital part of special education.
• Effects of co-teaching approaches on the academic performance of students with disabilities.
• English Language Learning in Special Education .
• Behavioral strategies for dealing with autism spectrum conditions during lessons.
• Natural Readers Website as Assistive Technology in Education .
• Trauma-informed teaching as a trending issue in special education.
• Special education: The main concepts and legal background.
• Learning Disabilities: Speech and Language Disorders .
• Use of cultural resonance in special education.
• Current issues in special education for children with disabilities.
• Related Services for Students with Disabilities .
• The special education profession and its value.
• Special education: Teaching children with mental disorders.
• Exclusion of Students with Learning Disabilities .
• How to create a perfect curriculum for students with special needs?
• The importance of collaboration between parents and special education teachers.
• General Curriculum for Students with Severe Disabilities .
• The Netherlands as a leader in supporting intellectual disabilities programs.
• Effective Strategies for Students With Learning Disabilities
• The role of cultural sensitivity in multicultural special education.
• Special education: The main aspects and conflicts.
• New Technologies for the Students with Disabilities .
• The frequency and consequences of firearm-related incidents in schools.
• Gun Control and School Shootings .
• The impact of political ideology on educational policies and practices.
• Why is sexual assault a serious problem on American campuses?
• Negative Impact of Media Attention to School Shooting .
• Regulations and procedures for preventing unauthorized access to weapons in schools.
• College accreditation and student loan forgiveness.
• Discrimination in School and Its Effects on Students .
• Modern technologies as a real threat to student privacy and security.
• The issue with learning accommodation for non-traditional students.
• Discrimination and Inequality in the Education System
• Why is standardized testing one of the biggest problems in education?
• The prevalence and patterns of alcohol consumption among students.
• The Early Education Issues: Development and Importance .
• Student poverty and its connection to academic performance and success.
• Teacher salaries: A critical education issue of the 21st century.
• School Bullying and Legal Responsibility .
• What effect does the size of the class have on student outcomes?
• School violence: Dealing with it and minimizing the danger.
• Adolescent Mental Health: Depression .
• Analyzing the impact of technology integration on the increased level of cheating.
• Teacher burnout and its impact on student achievement.
• Adolescent Drug Abuse, Their Awareness, and Prevention .
• What is the influence of socioeconomic status on educational achievement gaps?
• Social Inequality at School .
• High-stakes testing as the main reason for increasing student stress levels.
• Homework: The main disadvantages of self-studying at home.
• Social Inequality and Juvenile Delinquency .
• The effects of drug education campaigns on student knowledge and attitudes.
• Why do college students often become addicted to gambling?

School Bullying

• A method to prevent bias and discrimination in the school system.
• Cyberbullying Among University Students .
• The social consequences of cyberbullying and cyberstalking for students.
• What is the influence of bullying on the academic performance of students?
• School Bullying and Problems in Adult Life .
• Bullying and suicide: Understanding the link and dealing with it.
• School Bullying: Causes and Effects .
• The issue of bullying of children with special needs in school.
• The impact of bullying on school communities.
• Prevention of Bullying in Schools .
• What effect does bullying have on high school-aged students?
• Parenting Style and Bullying Among Children .
• School bullying: Government strategies for managing the problem.
• What steps can parents take to stop bullying at school?
• Cyberbullying of Children in Canada .
• The importance of the anti-bullying program for schools.
• The contribution of technology to the occurrence or prevention of bullying.
• Student Dropouts in Bully-Friendly Schools .
• Bullying and its influence on school climate.
• Bullying and violence in schools: Social psychology perspective.
• The Long-Term Consequences of Being Bullied or Bullying Others in Childhood .
• What are the leading causes of bullying in school?
• Investigating the consequences of online bullying among school-aged children.
• Bullying of Learners with Disabilities .

Lack of Funding

• The impact of school funding issues on the performance of students.
• Children Education. Federal Funding of Preschool .
• School funding issues: Methods and strategies to overcome the problem.
• Why is school funding a key to equitable education?
• The Role of External Funding in Academic Projects .
• The impact of the COVID-19 pandemic on school funding.
• How can an increase in spending on education help boost economic recovery?
• School-Funding System in New Jersey .
• Investigating the link between financial disparities and educational inequality.
• How Misuse of Funding Could Affect Education .
• The influence of budget cuts on teacher recruitment and retention.
• Inadequate funding as one of the biggest problems in education.
• Free College Education: Arguments in Support .
• Problems of insufficient funding for elementary education in Asia.
• The role of private sector partnerships in education funding.
• Should College Education Be Free for All US Citizens?
• Public education funding in the US: Peculiarities.
• The importance of educating children in poor countries.
• Should College Athletes Be Paid or Not?
• How can the issue of improper funding for schools be solved?
• New school funding model in Kenya: Benefits and main problems.
• Evidence-Based Model and Solving Problems with School Funding .
• How do decreasing budgets affect student learning and achievement?

Mental Health of Students

• Why do many college students experience symptoms of severe mental health conditions?
• University Students’ Mental Health in 2000-2020 .
• Depression as a common mental health issue in US students.
• Suicidal ideation and intent in students: The leading causes and symptoms.
• The Effect of Mental Health Programs on Students Academic Performance .
• American Psychological Association and its role in helping students with anxiety.
• Eating disorders: The female college students’ problem.
• Mental Health Issues in College Students .
• Substance misuse and its influence on the social life of students.
• What are the long-term effects of academic stress on student mental health?
• Strategies to Decrease Nursing Student Anxiety .
• Factors contributing to the rise in student anxiety and depression rates.
• Social media use and its connection to the mental health of high school students.
• Adolescent Depression: Modern Issues and Resources .
• Sleep quality and duration’s influence on student mental health.
• How does parental involvement influence the mental health and well-being of students?
• The Problem of Adolescent Suicide .
• Physical activity and its contribution to students’ mental health.
• The impact of the COVID-19 pandemic on student mental health.
• Mental Health Well-Being Notion: Its Effect on Education .
• The effectiveness of school-based mental health programs for students in Europe.
• Education and Motivation for At-Risk Students .
• Creative approaches to support teenagers with mental disorders.

Inclusivity

• The value of inclusive education for high school students.
• Diversity and Inclusivity as Teaching Philosophy .
• Government measures to advance inclusive education.
• Inclusive education: Essential elements, related laws, and strategies.
• Inclusive Education for Students With Autism Spectrum Disorder .
• Inclusive teaching principles at Columbia schools.
• How do open society foundations support inclusive education?
• Student-Teacher Interaction in Inclusive Education .
• Inclusive education and its benefits for students with disabilities.
• Non-competitive learning as the main concept of inclusive education.
• Inclusive Education for Students With Disabilities .
• Increasing inclusivity in the classroom: The main benefits and methods.
• How can parents build an inclusive behavioral model for their children in elementary school?
• Effective Practice in Inclusive and Special Needs Education .
• The role of government in funding inclusive education in the US.
• Respectful language as a key to teaching students to be more tolerant.
• Early Childhood: Inclusive Programs and Social Interactions .
• Diverse groups and their contribution to increasing inclusivity in the classroom.
• The value of inclusive education: Socialization and academic progress.
• Creating Inclusive Classrooms for Diverse Learners .
• Peculiarities of curriculum and pedagogy in inclusive education.
• What are the critical challenges in implementing inclusive education policies?

Other School Issues

• Traditional teaching methods and their negative impact on student performance.
• Shooting in Schools: Trends and Definition .
• The main teaching issues: Constant pressure and a lot of paperwork.
• The lack of effective communication between teachers and students in high school.
• Alcohol Abuse Among Students: Reforming College Drinking .
• Students’ behavior as one of the relevant issues in elementary school.
• The risk of burning out in college students: Causes and symptoms.
• Dormitory Life and Its Tough Sides for Students .
• How does a lack of support outside of the classroom influence students’ grades?
• The connection between administrative workload and teacher retention rates.
• Changes in Diet and Lifestyle for Students .
• Changing educational trends as one of the challenges faced by teachers.
• What are the main limitations of disciplining students?
• Homeschooling Disadvantages for Students and Parents .
• The issue of using mobile devices in the classroom.
• The potential drawbacks and limitations of redundant teaching techniques.
• Dealing With Procrastination Among Students .
• How to deal with the growing discipline problem in US classrooms?
• The effects of educational technology use on college student learning.
• Teaching Students With Attention Deficit Hyperactivity Disorder .
• The emotional and mental toll of lesson planning on teachers.
• What is the impact of pressure from school administrators on teacher performance?
• Cybersecurity Threats for Students & How to Fight Them .
• The community perceptions and concerns regarding armed guards in schools.
• Small-Group Counseling for the High-School Students .
• The need for bilingual education for students in England.
• LGBT+ inclusive sex education: Advantages and disadvantages.
• Challenges Faced by Foreign Students in Adapting to University Culture .
• Why should school uniforms in middle and high school be mandatory?
• The influence of teaching salaries on teacher motivation and performance.
• The Problem of Technology Addiction Among College Students .
• The role of teachers in navigating religious diversity in classrooms.
• What makes private schools in the US better than public ones?
• Why Some Students Cheat .
• The impact of free colleges on the quality of higher education.
• Dissection in school: The value and impact on student’s attitudes toward science.
• How Inclusive Learning Affects Other Students .
• The social and emotional development of students in homeschooling and traditional schooling.
• Why is it necessary to implement college courses in state prisons?
• How to Keep Young Students Engaged and Disciplined in Classroom .
• The effectiveness of school-supplied condoms in preventing teenage pregnancy.
• The impact of implicit bias on racial segregation in education.
• The Problem of Anxiety Among the College Students .
• Race-based school discipline in high school: For and against.
• What are the cons and pros of single-sex schools?
• The Need for Curriculum Change Among African American Students .
• Corporal punishment in schools as a way of controlling undisciplined behavior.
• The role of online education in student-teacher interaction.
• Self-Esteem and Self-Anxiety in Nursing Students .
• The problem of sexually or socially provocative clothes at school and methods of solving it.
• Behavioral Intervention Plan (BIP) For Anxious Students .
• Corruption and emotional manipulations in the educational system.
• How can social and religious issues uniquely affect education?
• Mandatory Drug Tests for Nursing Students .
• What are the main aspects and goals of school psychology?
• Adlerian Theory for School Counseling .
• Historical foundations of American school psychology.
• The role of school psychologists in conceptualizing children’s development.
• Solution-Focused Brief Therapy in School Counseling .
• School psychology: The helping hand in overcoming school crisis.
• The value of professional development programs in high school.
• Therapy Modality for Transformational P-12 School Counselors .
• Job prospects in school psychology in the United States.
• What is the role of school psychologists in supporting students with special needs?
• The McMartin Preschool and Forensic Psychology .
• School psychology in the 21st century: Foundations and practices.
• How do the social-emotional learning programs impact student well-being?
• The effects of school-based crisis interventions on students’ post-traumatic recovery.
• Cognitive Distortions in Middle-School Students.
• School psychology science: Skills and procedures.
• What are the most effective psychological strategies for reducing bullying in schools?
• Instruction Development for Students with Cognitive Disability .
• The effects of crisis intervention work on school psychologists.
• National Association of School Psychologists: Standards and practices.
• The influence of psychologists on the formulation of school policies in the UK.
• Risky Sexual Behaviors Among College Students .
• Counseling students with a sexual abuse history and its impact on academic success.
• Religion and spirituality as diverse topics in school psychology publications.
• Social-Behavioral Skills of Elementary Students with Physical Disabilities .
• School-based considerations for supporting American youths’ mental health.
• The practices for increasing cross-cultural competency in school.
• Classroom Management Ideas: Behavioral Crises and Promotion of Friendship Between Students .
• School psychologists: Principles of professional ethics .

Educational research advances knowledge across diverse disciplines, employing scientific methods to address real-world challenges within the realm of education. By exploring various topics , from innovative pedagogies to the impact of technology, we gain valuable insights to enhance educational practices, ensure inclusivity, and empower future generations with the tools for success.

❓ Educational Research Topics FAQ

What are good research topics for education.

An effective topic is one you can explore in-depth within the length of your assignment. Here are some crucial characteristics of a good research topic:

• Relevant and clear.
• Not too broad or narrow.
• Interesting for the author and target audience.

For example:

• Project-based learning in the classroom: Pros and cons.
• What role did technology play in the development of online tutoring?

How do I find a research topic in education?

You should take 3 simple steps to find a research topic in education:

• Determine the area in education that interests you the most.
• Read all the relevant information to understand the hot issues in your field.
• If you still cannot find the one that suits you best, use our base of the most exciting research topics in education!

What are the top 5 most researched topics?

• Bullying and cyberbullying as significant issues in US schools.
• Why are modern technologies more of a distraction than a helper in education?
• The benefits of inclusive classrooms for students with disabilities.
• How did COVID-19 affect student mental health and the school environment?
• The barriers to education access in underserved communities.
• 10 Challenges Facing Public Education Today | National Education Association
• Education Issues, Explained | EducationWeek
• The Education Crisis: Being in School Is Not the Same as Learning | The World Bank
• The 10 Most Significant Education Studies of 2021 | Edutopia
• Special Education Topics | Wisconsin Department of Public Instruction
• Social Issues That Special Education Teachers Face | Chron
• How Teachers Can Learn Through Action Research | Edutopia
• School Psychology | American Psychological Association
• Issues and Problems in Education | Sociology by University of Minnesota
• Educational Research Design | University of Pittsburgh
• Global Education Issues: Making a Difference Through Policy | American University
• Unequal Opportunity: Race and Education | Brookings
• Higher Education | George Mason University
• Department of Curriculum and Instruction: Research Topics | University of Minnesota
• A Six Step Process to Developing an Educational Research Plan | East Carolina University
• Teaching and Learning Topics | University of Oregon
• Share to Facebook
• Share to Twitter X
• Share to LinkedIn

You might also like

How to start a business as a student – a step-by-step guide, 4000 word essay writing guide: how to structure & how many pages is it, greek life 101: fraternities and sororities explained.

Research Topics & Ideas: Education

170+ Research Ideas To Fast-Track Your Project

If you’re just starting out exploring education-related topics for your dissertation, thesis or research project, you’ve come to the right place. In this post, we’ll help kickstart your research topic ideation process by providing a hearty list of research topics and ideas , including examples from actual dissertations and theses..

PS – This is just the start…

We know it’s exciting to run through a list of research topics, but please keep in mind that this list is just a starting point . To develop a suitable education-related research topic, you’ll need to identify a clear and convincing research gap , and a viable plan of action to fill that gap.

If this sounds foreign to you, check out our free research topic webinar that explores how to find and refine a high-quality research topic, from scratch. Alternatively, if you’d like hands-on help, consider our 1-on-1 coaching service .

Overview: Education Research Topics

• How to find a research topic (video)
• List of 50+ education-related research topics/ideas
• List of 120+ level-specific research topics 
• Examples of actual dissertation topics in education
• Tips to fast-track your topic ideation (video)
• Free Webinar : Topic Ideation 101
• Where to get extra help

Education-Related Research Topics & Ideas

Below you’ll find a list of education-related research topics and idea kickstarters. These are fairly broad and flexible to various contexts, so keep in mind that you will need to refine them a little. Nevertheless, they should inspire some ideas for your project.

• The impact of school funding on student achievement
• The effects of social and emotional learning on student well-being
• The effects of parental involvement on student behaviour
• The impact of teacher training on student learning
• The impact of classroom design on student learning
• The impact of poverty on education
• The use of student data to inform instruction
• The role of parental involvement in education
• The effects of mindfulness practices in the classroom
• The use of technology in the classroom
• The role of critical thinking in education
• The use of formative and summative assessments in the classroom
• The use of differentiated instruction in the classroom
• The use of gamification in education
• The effects of teacher burnout on student learning
• The impact of school leadership on student achievement
• The effects of teacher diversity on student outcomes
• The role of teacher collaboration in improving student outcomes
• The implementation of blended and online learning
• The effects of teacher accountability on student achievement
• The effects of standardized testing on student learning
• The effects of classroom management on student behaviour
• The effects of school culture on student achievement
• The use of student-centred learning in the classroom
• The impact of teacher-student relationships on student outcomes
• The achievement gap in minority and low-income students
• The use of culturally responsive teaching in the classroom
• The impact of teacher professional development on student learning
• The use of project-based learning in the classroom
• The effects of teacher expectations on student achievement
• The use of adaptive learning technology in the classroom
• The impact of teacher turnover on student learning
• The effects of teacher recruitment and retention on student learning
• The impact of early childhood education on later academic success
• The impact of parental involvement on student engagement
• The use of positive reinforcement in education
• The impact of school climate on student engagement
• The role of STEM education in preparing students for the workforce
• The effects of school choice on student achievement
• The use of technology in the form of online tutoring

Level-Specific Research Topics

Looking for research topics for a specific level of education? We’ve got you covered. Below you can find research topic ideas for primary, secondary and tertiary-level education contexts. Click the relevant level to view the respective list.

Research Topics: Pick An Education Level

Primary education.

• Investigating the effects of peer tutoring on academic achievement in primary school
• Exploring the benefits of mindfulness practices in primary school classrooms
• Examining the effects of different teaching strategies on primary school students’ problem-solving skills
• The use of storytelling as a teaching strategy in primary school literacy instruction
• The role of cultural diversity in promoting tolerance and understanding in primary schools
• The impact of character education programs on moral development in primary school students
• Investigating the use of technology in enhancing primary school mathematics education
• The impact of inclusive curriculum on promoting equity and diversity in primary schools
• The impact of outdoor education programs on environmental awareness in primary school students
• The influence of school climate on student motivation and engagement in primary schools
• Investigating the effects of early literacy interventions on reading comprehension in primary school students
• The impact of parental involvement in school decision-making processes on student achievement in primary schools
• Exploring the benefits of inclusive education for students with special needs in primary schools
• Investigating the effects of teacher-student feedback on academic motivation in primary schools
• The role of technology in developing digital literacy skills in primary school students
• Effective strategies for fostering a growth mindset in primary school students
• Investigating the role of parental support in reducing academic stress in primary school children
• The role of arts education in fostering creativity and self-expression in primary school students
• Examining the effects of early childhood education programs on primary school readiness
• Examining the effects of homework on primary school students’ academic performance
• The role of formative assessment in improving learning outcomes in primary school classrooms
• The impact of teacher-student relationships on academic outcomes in primary school
• Investigating the effects of classroom environment on student behavior and learning outcomes in primary schools
• Investigating the role of creativity and imagination in primary school curriculum
• The impact of nutrition and healthy eating programs on academic performance in primary schools
• The impact of social-emotional learning programs on primary school students’ well-being and academic performance
• The role of parental involvement in academic achievement of primary school children
• Examining the effects of classroom management strategies on student behavior in primary school
• The role of school leadership in creating a positive school climate Exploring the benefits of bilingual education in primary schools
• The effectiveness of project-based learning in developing critical thinking skills in primary school students
• The role of inquiry-based learning in fostering curiosity and critical thinking in primary school students
• The effects of class size on student engagement and achievement in primary schools
• Investigating the effects of recess and physical activity breaks on attention and learning in primary school
• Exploring the benefits of outdoor play in developing gross motor skills in primary school children
• The effects of educational field trips on knowledge retention in primary school students
• Examining the effects of inclusive classroom practices on students’ attitudes towards diversity in primary schools
• The impact of parental involvement in homework on primary school students’ academic achievement
• Investigating the effectiveness of different assessment methods in primary school classrooms
• The influence of physical activity and exercise on cognitive development in primary school children
• Exploring the benefits of cooperative learning in promoting social skills in primary school students

Secondary Education

• Investigating the effects of school discipline policies on student behavior and academic success in secondary education
• The role of social media in enhancing communication and collaboration among secondary school students
• The impact of school leadership on teacher effectiveness and student outcomes in secondary schools
• Investigating the effects of technology integration on teaching and learning in secondary education
• Exploring the benefits of interdisciplinary instruction in promoting critical thinking skills in secondary schools
• The impact of arts education on creativity and self-expression in secondary school students
• The effectiveness of flipped classrooms in promoting student learning in secondary education
• The role of career guidance programs in preparing secondary school students for future employment
• Investigating the effects of student-centered learning approaches on student autonomy and academic success in secondary schools
• The impact of socio-economic factors on educational attainment in secondary education
• Investigating the impact of project-based learning on student engagement and academic achievement in secondary schools
• Investigating the effects of multicultural education on cultural understanding and tolerance in secondary schools
• The influence of standardized testing on teaching practices and student learning in secondary education
• Investigating the effects of classroom management strategies on student behavior and academic engagement in secondary education
• The influence of teacher professional development on instructional practices and student outcomes in secondary schools
• The role of extracurricular activities in promoting holistic development and well-roundedness in secondary school students
• Investigating the effects of blended learning models on student engagement and achievement in secondary education
• The role of physical education in promoting physical health and well-being among secondary school students
• Investigating the effects of gender on academic achievement and career aspirations in secondary education
• Exploring the benefits of multicultural literature in promoting cultural awareness and empathy among secondary school students
• The impact of school counseling services on student mental health and well-being in secondary schools
• Exploring the benefits of vocational education and training in preparing secondary school students for the workforce
• The role of digital literacy in preparing secondary school students for the digital age
• The influence of parental involvement on academic success and well-being of secondary school students
• The impact of social-emotional learning programs on secondary school students’ well-being and academic success
• The role of character education in fostering ethical and responsible behavior in secondary school students
• Examining the effects of digital citizenship education on responsible and ethical technology use among secondary school students
• The impact of parental involvement in school decision-making processes on student outcomes in secondary schools
• The role of educational technology in promoting personalized learning experiences in secondary schools
• The impact of inclusive education on the social and academic outcomes of students with disabilities in secondary schools
• The influence of parental support on academic motivation and achievement in secondary education
• The role of school climate in promoting positive behavior and well-being among secondary school students
• Examining the effects of peer mentoring programs on academic achievement and social-emotional development in secondary schools
• Examining the effects of teacher-student relationships on student motivation and achievement in secondary schools
• Exploring the benefits of service-learning programs in promoting civic engagement among secondary school students
• The impact of educational policies on educational equity and access in secondary education
• Examining the effects of homework on academic achievement and student well-being in secondary education
• Investigating the effects of different assessment methods on student performance in secondary schools
• Examining the effects of single-sex education on academic performance and gender stereotypes in secondary schools
• The role of mentoring programs in supporting the transition from secondary to post-secondary education

Tertiary Education

• The role of student support services in promoting academic success and well-being in higher education
• The impact of internationalization initiatives on students’ intercultural competence and global perspectives in tertiary education
• Investigating the effects of active learning classrooms and learning spaces on student engagement and learning outcomes in tertiary education
• Exploring the benefits of service-learning experiences in fostering civic engagement and social responsibility in higher education
• The influence of learning communities and collaborative learning environments on student academic and social integration in higher education
• Exploring the benefits of undergraduate research experiences in fostering critical thinking and scientific inquiry skills
• Investigating the effects of academic advising and mentoring on student retention and degree completion in higher education
• The role of student engagement and involvement in co-curricular activities on holistic student development in higher education
• The impact of multicultural education on fostering cultural competence and diversity appreciation in higher education
• The role of internships and work-integrated learning experiences in enhancing students’ employability and career outcomes
• Examining the effects of assessment and feedback practices on student learning and academic achievement in tertiary education
• The influence of faculty professional development on instructional practices and student outcomes in tertiary education
• The influence of faculty-student relationships on student success and well-being in tertiary education
• The impact of college transition programs on students’ academic and social adjustment to higher education
• The impact of online learning platforms on student learning outcomes in higher education
• The impact of financial aid and scholarships on access and persistence in higher education
• The influence of student leadership and involvement in extracurricular activities on personal development and campus engagement
• Exploring the benefits of competency-based education in developing job-specific skills in tertiary students
• Examining the effects of flipped classroom models on student learning and retention in higher education
• Exploring the benefits of online collaboration and virtual team projects in developing teamwork skills in tertiary students
• Investigating the effects of diversity and inclusion initiatives on campus climate and student experiences in tertiary education
• The influence of study abroad programs on intercultural competence and global perspectives of college students
• Investigating the effects of peer mentoring and tutoring programs on student retention and academic performance in tertiary education
• Investigating the effectiveness of active learning strategies in promoting student engagement and achievement in tertiary education
• Investigating the effects of blended learning models and hybrid courses on student learning and satisfaction in higher education
• The role of digital literacy and information literacy skills in supporting student success in the digital age
• Investigating the effects of experiential learning opportunities on career readiness and employability of college students
• The impact of e-portfolios on student reflection, self-assessment, and showcasing of learning in higher education
• The role of technology in enhancing collaborative learning experiences in tertiary classrooms
• The impact of research opportunities on undergraduate student engagement and pursuit of advanced degrees
• Examining the effects of competency-based assessment on measuring student learning and achievement in tertiary education
• Examining the effects of interdisciplinary programs and courses on critical thinking and problem-solving skills in college students
• The role of inclusive education and accessibility in promoting equitable learning experiences for diverse student populations
• The role of career counseling and guidance in supporting students’ career decision-making in tertiary education
• The influence of faculty diversity and representation on student success and inclusive learning environments in higher education

Education-Related Dissertations & Theses

While the ideas we’ve presented above are a decent starting point for finding a research topic in education, they are fairly generic and non-specific. So, it helps to look at actual dissertations and theses in the education space to see how this all comes together in practice.

Below, we’ve included a selection of education-related research projects to help refine your thinking. These are actual dissertations and theses, written as part of Master’s and PhD-level programs, so they can provide some useful insight as to what a research topic looks like in practice.

• From Rural to Urban: Education Conditions of Migrant Children in China (Wang, 2019)
• Energy Renovation While Learning English: A Guidebook for Elementary ESL Teachers (Yang, 2019)
• A Reanalyses of Intercorrelational Matrices of Visual and Verbal Learners’ Abilities, Cognitive Styles, and Learning Preferences (Fox, 2020)
• A study of the elementary math program utilized by a mid-Missouri school district (Barabas, 2020)
• Instructor formative assessment practices in virtual learning environments : a posthumanist sociomaterial perspective (Burcks, 2019)
• Higher education students services: a qualitative study of two mid-size universities’ direct exchange programs (Kinde, 2020)
• Exploring editorial leadership : a qualitative study of scholastic journalism advisers teaching leadership in Missouri secondary schools (Lewis, 2020)
• Selling the virtual university: a multimodal discourse analysis of marketing for online learning (Ludwig, 2020)
• Advocacy and accountability in school counselling: assessing the use of data as related to professional self-efficacy (Matthews, 2020)
• The use of an application screening assessment as a predictor of teaching retention at a midwestern, K-12, public school district (Scarbrough, 2020)
• Core values driving sustained elite performance cultures (Beiner, 2020)
• Educative features of upper elementary Eureka math curriculum (Dwiggins, 2020)
• How female principals nurture adult learning opportunities in successful high schools with challenging student demographics (Woodward, 2020)
• The disproportionality of Black Males in Special Education: A Case Study Analysis of Educator Perceptions in a Southeastern Urban High School (McCrae, 2021)

As you can see, these research topics are a lot more focused than the generic topic ideas we presented earlier. So, in order for you to develop a high-quality research topic, you’ll need to get specific and laser-focused on a specific context with specific variables of interest.  In the video below, we explore some other important things you’ll need to consider when crafting your research topic.

Get 1-On-1 Help

If you’re still unsure about how to find a quality research topic within education, check out our Research Topic Kickstarter service, which is the perfect starting point for developing a unique, well-justified research topic.

You Might Also Like:

54 Comments

This is an helpful tool 🙏

Special education

Really appreciated by this . It is the best platform for research related items

Research title related to school of students

Research title related to students

Good idea I’m going to teach my colleagues

You can find our list of nursing-related research topic ideas here: https://gradcoach.com/research-topics-nursing/

Write on action research topic, using guidance and counseling to address unwanted teenage pregnancy in school

Thanks a lot

I learned a lot from this site, thank you so much!

Thank you for the information.. I would like to request a topic based on school major in social studies

parental involvement and students academic performance

Science education topics?

How about School management and supervision pls.?

Hi i am an Deputy Principal in a primary school. My wish is to srudy foe Master’s degree in Education.Please advice me on which topic can be relevant for me. Thanks.

Every topic proposed above on primary education is a starting point for me. I appreciate immensely the team that has sat down to make a detail of these selected topics just for beginners like us. Be blessed.

Kindly help me with the research questions on the topic” Effects of workplace conflict on the employees’ job performance”. The effects can be applicable in every institution,enterprise or organisation.

Greetings, I am a student majoring in Sociology and minoring in Public Administration. I’m considering any recommended research topic in the field of Sociology.

I’m a student pursuing Mphil in Basic education and I’m considering any recommended research proposal topic in my field of study

Kindly help me with a research topic in educational psychology. Ph.D level. Thank you.

Project-based learning is a teaching/learning type,if well applied in a classroom setting will yield serious positive impact. What can a teacher do to implement this in a disadvantaged zone like “North West Region of Cameroon ( hinterland) where war has brought about prolonged and untold sufferings on the indegins?

I wish to get help on topics of research on educational administration

I wish to get help on topics of research on educational administration PhD level

I am also looking for such type of title

I am a student of undergraduate, doing research on how to use guidance and counseling to address unwanted teenage pregnancy in school

the topics are very good regarding research & education .

Can i request your suggestion topic for my Thesis about Teachers as an OFW. thanx you

Would like to request for suggestions on a topic in Economics of education,PhD level

Would like to request for suggestions on a topic in Economics of education

Hi 👋 I request that you help me with a written research proposal about education the format

l would like to request suggestions on a topic in managing teaching and learning, PhD level (educational leadership and management)

request suggestions on a topic in managing teaching and learning, PhD level (educational leadership and management)

I would to inquire on research topics on Educational psychology, Masters degree

I am PhD student, I am searching my Research topic, It should be innovative,my area of interest is online education,use of technology in education

request suggestion on topic in masters in medical education .

Look at British Library as they keep a copy of all PhDs in the UK Core.ac.uk to access Open University and 6 other university e-archives, pdf downloads mostly available, all free.

May I also ask for a topic based on mathematics education for college teaching, please?

Please I am a masters student of the department of Teacher Education, Faculty of Education Please I am in need of proposed project topics to help with my final year thesis

Am a PhD student in Educational Foundations would like a sociological topic. Thank

please i need a proposed thesis project regardging computer science

Greetings and Regards I am a doctoral student in the field of philosophy of education. I am looking for a new topic for my thesis. Because of my work in the elementary school, I am looking for a topic that is from the field of elementary education and is related to the philosophy of education.

Masters student in the field of curriculum, any ideas of a research topic on low achiever students

In the field of curriculum any ideas of a research topic on deconalization in contextualization of digital teaching and learning through in higher education

Amazing guidelines

I am a graduate with two masters. 1) Master of arts in religious studies and 2) Master in education in foundations of education. I intend to do a Ph.D. on my second master’s, however, I need to bring both masters together through my Ph.D. research. can I do something like, ” The contribution of Philosophy of education for a quality religion education in Kenya”? kindly, assist and be free to suggest a similar topic that will bring together the two masters. thanks in advance

Hi, I am an Early childhood trainer as well as a researcher, I need more support on this topic: The impact of early childhood education on later academic success.

Submit a Comment Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

• Print Friendly

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

• Knowledge Base
• Starting the research process
• How to Define a Research Problem | Ideas & Examples

How to Define a Research Problem | Ideas & Examples

Published on November 2, 2022 by Shona McCombes and Tegan George. Revised on May 31, 2023.

A research problem is a specific issue or gap in existing knowledge that you aim to address in your research. You may choose to look for practical problems aimed at contributing to change, or theoretical problems aimed at expanding knowledge.

Some research will do both of these things, but usually the research problem focuses on one or the other. The type of research problem you choose depends on your broad topic of interest and the type of research you think will fit best.

This article helps you identify and refine a research problem. When writing your research proposal or introduction , formulate it as a problem statement and/or research questions .

Table of contents

Why is the research problem important, step 1: identify a broad problem area, step 2: learn more about the problem, other interesting articles, frequently asked questions about research problems.

Having an interesting topic isn’t a strong enough basis for academic research. Without a well-defined research problem, you are likely to end up with an unfocused and unmanageable project.

You might end up repeating what other people have already said, trying to say too much, or doing research without a clear purpose and justification. You need a clear problem in order to do research that contributes new and relevant insights.

Whether you’re planning your thesis , starting a research paper , or writing a research proposal , the research problem is the first step towards knowing exactly what you’ll do and why.

Prevent plagiarism. Run a free check.

As you read about your topic, look for under-explored aspects or areas of concern, conflict, or controversy. Your goal is to find a gap that your research project can fill.

Practical research problems

If you are doing practical research, you can identify a problem by reading reports, following up on previous research, or talking to people who work in the relevant field or organization. You might look for:

• Issues with performance or efficiency
• Processes that could be improved
• Areas of concern among practitioners
• Difficulties faced by specific groups of people

Examples of practical research problems

Voter turnout in New England has been decreasing, in contrast to the rest of the country.

The HR department of a local chain of restaurants has a high staff turnover rate.

A non-profit organization faces a funding gap that means some of its programs will have to be cut.

Theoretical research problems

If you are doing theoretical research, you can identify a research problem by reading existing research, theory, and debates on your topic to find a gap in what is currently known about it. You might look for:

• A phenomenon or context that has not been closely studied
• A contradiction between two or more perspectives
• A situation or relationship that is not well understood
• A troubling question that has yet to be resolved

Examples of theoretical research problems

The effects of long-term Vitamin D deficiency on cardiovascular health are not well understood.

The relationship between gender, race, and income inequality has yet to be closely studied in the context of the millennial gig economy.

Historians of Scottish nationalism disagree about the role of the British Empire in the development of Scotland’s national identity.

Next, you have to find out what is already known about the problem, and pinpoint the exact aspect that your research will address.

Context and background

• Who does the problem affect?
• Is it a newly-discovered problem, or a well-established one?
• What research has already been done?
• What, if any, solutions have been proposed?
• What are the current debates about the problem? What is missing from these debates?

Specificity and relevance

• What particular place, time, and/or group of people will you focus on?
• What aspects will you not be able to tackle?
• What will the consequences be if the problem is not resolved?

Example of a specific research problem

A local non-profit organization focused on alleviating food insecurity has always fundraised from its existing support base. It lacks understanding of how best to target potential new donors. To be able to continue its work, the organization requires research into more effective fundraising strategies.

Once you have narrowed down your research problem, the next step is to formulate a problem statement , as well as your research questions or hypotheses .

Receive feedback on language, structure, and formatting

Professional editors proofread and edit your paper by focusing on:

• Academic style
• Vague sentences
• Style consistency

See an example

If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

Methodology

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

All research questions should be:

• Focused on a single problem or issue
• Researchable using primary and/or secondary sources
• Feasible to answer within the timeframe and practical constraints
• Specific enough to answer thoroughly
• Complex enough to develop the answer over the space of a paper or thesis
• Relevant to your field of study and/or society more broadly

Research questions anchor your whole project, so it’s important to spend some time refining them.

In general, they should be:

• Focused and researchable
• Answerable using credible sources
• Complex and arguable
• Feasible and specific
• Relevant and original

Your research objectives indicate how you’ll try to address your research problem and should be specific:

A research aim is a broad statement indicating the general purpose of your research project. It should appear in your introduction at the end of your problem statement , before your research objectives.

Research objectives are more specific than your research aim. They indicate the specific ways you’ll address the overarching aim.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

McCombes, S. & George, T. (2023, May 31). How to Define a Research Problem | Ideas & Examples. Scribbr. Retrieved April 14, 2024, from https://www.scribbr.com/research-process/research-problem/

Is this article helpful?

Shona McCombes

Other students also liked, how to write a problem statement | guide & examples, writing strong research questions | criteria & examples, how to write a strong hypothesis | steps & examples, unlimited academic ai-proofreading.

✔ Document error-free in 5minutes ✔ Unlimited document corrections ✔ Specialized in correcting academic texts

How educational research could play a greater role in K-12 school improvement

Clinical Professor of Applied Human Development, Boston University

Disclosure statement

Detris Honora Adelabu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Boston University provides funding as a founding partner of The Conversation US.

View all partners

For the past 20 years, I have taught research methods in education to students here in the U.S. and in other countries. While the purpose of the course is to show students how to do effective research, the ultimate goal of the research is to get better academic results for the nation’s K-12 students and schools.

Vast resources are already being spent on this goal. Between 2019 and 2022, the Institute of Educational Sciences , the research and evaluation arm of the U.S. Education Department, distributed US$473 million in 255 grants to improve educational outcomes.

In 2021, colleges and universities spent approximately $1.6 billion on educational research .

The research is not hard to find. The Educational Research Information Center, a federally run repository, houses 1.6 million educational research sources in over 1,000 scholarly journals.

And there are plenty of opportunities for educational researchers to network and collaborate. Each year, for instance, more than 15,000 educators and researchers gather to present or discuss educational research findings at the annual meeting of the American Educational Research Association .

Yet, for all the time, money and effort that have been spent on producing research in the field of education, the nation seems to have little to show for it in terms of improvements in academic achievement.

Growing gaps

Even prior to the COVID-19 pandemic, test scores were beginning to decline. Results from the 2019 National Assessment of Educational Progress, , or NAEP – the most representative assessment of what elementary and middle school students know across specific subjects – show a widening gap between the highest and lowest achievement levels on the NAEP for fourth grade mathematics and eighth grade reading between 2017-19. During the same period, NAEP outcomes show stagnated growth in reading achievement among fourth graders. By eighth grade, there is a greater gap in reading achievement between the highest- and lowest-achieving students.

Some education experts have even suggested that the chances for progress get dimmer for students as they get older. For instance, in a 2019-2020 report to Congress , Mark Schneider, the Institute of Educational Sciences director, wrote: “for science and math, the longer students stay in school, the more likely they are to fail to meet even NAEP’s basic performance level.”

Scores on the International Assessment of Adult Competencies , a measure of literacy, numeracy and problem-solving skills, suggest a similar pattern of achievement. Achievement levels on the assessment show a slight decline in literacy and numeracy between 2012-14 and 2017. Fewer Americans are scoring at the highest levels of proficiency in literacy and numeracy.

As an educational researcher who focuses on academic outcomes for low-income students and students of color , I believe these troubling results raise serious questions about whether educational research is being put to use.

Are school leaders and policymakers actually reading any of the vast amount of educational research that exists? Or does it go largely unnoticed in voluminous virtual vaults? What, if anything, can be done to make sure that educational research findings and recommendations are actually being tried?

Here are four things I believe can be done in order to make sure that educational research is actually being applied.

1. Build better relationships with school leaders

Educational researchers can reach out to school leaders before doing their research in order to design research based on the needs of schools and schoolchildren. If school leaders can see how educational research can specifically benefit their school community, they may be more likely to implement findings and recommendations from the research.

2. Make policy and practice part of the research process

By implementing new policies and practices based on research findings, researchers can work with school leaders to do further research to see if the new policies and practices actually work.

For example, The Investing in Innovation (i3) Fund was established by the American Recovery and Reinvestment Act of 2009 to fund the implementation and evaluation of education interventions with a record of improving student achievement. Through the fund, $679 million was distributed through 67 grants – and 12 of those 67 funded projects improved student outcomes. The key to success? Having a “tight implementation” plan, which was shown to produce at least one positive student outcome.

3. Rethink how research impact is measured

As part of the national rankings for colleges of education – that is, the schools that prepare schoolteachers for their careers – engagement with public schools could be made a factor in the rankings. The rankings could also include measurable educational impact.

4. Rethink and redefine how research is distributed

Evidence-based instruction can improve student outcomes . However, public school teachers often can’t afford to access the evidence or the time to make sense of it. Research findings written in everyday language could be distributed at conferences frequented by public school teachers and in the periodicals that they read.

If research findings are to make a difference, I believe there has to be a stronger focus on using research to bring about real-world change in public schools.

• Academic research
• Education research
• Academic results
• Proficiency Level
• K-12 education
• Student test scores
• Higher ed attainment
• Federal role in K-12 education
• K-12 schools

GRAINS RESEARCH AND DEVELOPMENT CORPORATION CHAIRPERSON

Project Officer, Student Program Development

Faculty of Law - Academic Appointment Opportunities

Operations Manager

Audience Development Coordinator (fixed-term maternity cover)

• Our Mission

The 10 Most Significant Education Studies of 2020

We reviewed hundreds of educational studies in 2020 and then highlighted 10 of the most significant—covering topics from virtual learning to the reading wars and the decline of standardized tests.

In the month of March of 2020, the year suddenly became a whirlwind. With a pandemic disrupting life across the entire globe, teachers scrambled to transform their physical classrooms into virtual—or even hybrid—ones, and researchers slowly began to collect insights into what works, and what doesn’t, in online learning environments around the world.

Meanwhile, neuroscientists made a convincing case for keeping handwriting in schools, and after the closure of several coal-fired power plants in Chicago, researchers reported a drop in pediatric emergency room visits and fewer absences in schools, reminding us that questions of educational equity do not begin and end at the schoolhouse door.

1. To Teach Vocabulary, Let Kids Be Thespians

When students are learning a new language, ask them to act out vocabulary words. It’s fun to unleash a child’s inner thespian, of course, but a 2020 study concluded that it also nearly doubles their ability to remember the words months later.

Researchers asked 8-year-old students to listen to words in another language and then use their hands and bodies to mimic the words—spreading their arms and pretending to fly, for example, when learning the German word flugzeug , which means “airplane.” After two months, these young actors were a remarkable 73 percent more likely to remember the new words than students who had listened without accompanying gestures. Researchers discovered similar, if slightly less dramatic, results when students looked at pictures while listening to the corresponding vocabulary. 

It’s a simple reminder that if you want students to remember something, encourage them to learn it in a variety of ways—by drawing it , acting it out, or pairing it with relevant images , for example.

2. Neuroscientists Defend the Value of Teaching Handwriting—Again

For most kids, typing just doesn’t cut it. In 2012, brain scans of preliterate children revealed crucial reading circuitry flickering to life when kids hand-printed letters and then tried to read them. The effect largely disappeared when the letters were typed or traced.

More recently, in 2020, a team of researchers studied older children—seventh graders—while they handwrote, drew, and typed words, and concluded that handwriting and drawing produced telltale neural tracings indicative of deeper learning.

“Whenever self-generated movements are included as a learning strategy, more of the brain gets stimulated,” the researchers explain, before echoing the 2012 study: “It also appears that the movements related to keyboard typing do not activate these networks the same way that drawing and handwriting do.”

It would be a mistake to replace typing with handwriting, though. All kids need to develop digital skills, and there’s evidence that technology helps children with dyslexia to overcome obstacles like note taking or illegible handwriting, ultimately freeing them to “use their time for all the things in which they are gifted,” says the Yale Center for Dyslexia and Creativity.

3. The ACT Test Just Got a Negative Score (Face Palm)

A 2020 study found that ACT test scores, which are often a key factor in college admissions, showed a weak—or even negative —relationship when it came to predicting how successful students would be in college. “There is little evidence that students will have more college success if they work to improve their ACT score,” the researchers explain, and students with very high ACT scores—but indifferent high school grades—often flamed out in college, overmatched by the rigors of a university’s academic schedule.

Just last year, the SAT—cousin to the ACT—had a similarly dubious public showing. In a major 2019 study of nearly 50,000 students led by researcher Brian Galla, and including Angela Duckworth, researchers found that high school grades were stronger predictors of four-year-college graduation than SAT scores.

The reason? Four-year high school grades, the researchers asserted, are a better indicator of crucial skills like perseverance, time management, and the ability to avoid distractions. It’s most likely those skills, in the end, that keep kids in college.

4. A Rubric Reduces Racial Grading Bias

A simple step might help undercut the pernicious effect of grading bias, a new study found: Articulate your standards clearly before you begin grading, and refer to the standards regularly during the assessment process.

In 2020, more than 1,500 teachers were recruited and asked to grade a writing sample from a fictional second-grade student. All of the sample stories were identical—but in one set, the student mentions a family member named Dashawn, while the other set references a sibling named Connor.

Teachers were 13 percent more likely to give the Connor papers a passing grade, revealing the invisible advantages that many students unknowingly benefit from. When grading criteria are vague, implicit stereotypes can insidiously “fill in the blanks,” explains the study’s author. But when teachers have an explicit set of criteria to evaluate the writing—asking whether the student “provides a well-elaborated recount of an event,” for example—the difference in grades is nearly eliminated.

5. What Do Coal-Fired Power Plants Have to Do With Learning? Plenty

When three coal-fired plants closed in the Chicago area, student absences in nearby schools dropped by 7 percent, a change largely driven by fewer emergency room visits for asthma-related problems. The stunning finding, published in a 2020 study from Duke and Penn State, underscores the role that often-overlooked environmental factors—like air quality, neighborhood crime, and noise pollution—have in keeping our children healthy and ready to learn.

At scale, the opportunity cost is staggering: About 2.3 million children in the United States still attend a public elementary or middle school located within 10 kilometers of a coal-fired plant.

The study builds on a growing body of research that reminds us that questions of educational equity do not begin and end at the schoolhouse door. What we call an achievement gap is often an equity gap, one that “takes root in the earliest years of children’s lives,” according to a 2017 study . We won’t have equal opportunity in our schools, the researchers admonish, until we are diligent about confronting inequality in our cities, our neighborhoods—and ultimately our own backyards.

6. Students Who Generate Good Questions Are Better Learners

Some of the most popular study strategies—highlighting passages, rereading notes, and underlining key sentences—are also among the least effective. A 2020 study highlighted a powerful alternative: Get students to generate questions about their learning, and gradually press them to ask more probing questions.

In the study, students who studied a topic and then generated their own questions scored an average of 14 percentage points higher on a test than students who used passive strategies like studying their notes and rereading classroom material. Creating questions, the researchers found, not only encouraged students to think more deeply about the topic but also strengthened their ability to remember what they were studying.

There are many engaging ways to have students create highly productive questions : When creating a test, you can ask students to submit their own questions, or you can use the Jeopardy! game as a platform for student-created questions.

7. Did a 2020 Study Just End the ‘Reading Wars’?

One of the most widely used reading programs was dealt a severe blow when a panel of reading experts concluded that it “would be unlikely to lead to literacy success for all of America’s public schoolchildren.”

In the 2020 study , the experts found that the controversial program—called “Units of Study” and developed over the course of four decades by Lucy Calkins at the Teachers College Reading and Writing Project—failed to explicitly and systematically teach young readers how to decode and encode written words, and was thus “in direct opposition to an enormous body of settled research.”

The study sounded the death knell for practices that de-emphasize phonics in favor of having children use multiple sources of information—like story events or illustrations—to predict the meaning of unfamiliar words, an approach often associated with “balanced literacy.” In an internal memo obtained by publisher APM, Calkins seemed to concede the point, writing that “aspects of balanced literacy need some ‘rebalancing.’”

8. A Secret to High-Performing Virtual Classrooms

In 2020, a team at Georgia State University compiled a report on virtual learning best practices. While evidence in the field is "sparse" and "inconsistent," the report noted that logistical issues like accessing materials—and not content-specific problems like failures of comprehension—were often among the most significant obstacles to online learning. It wasn’t that students didn’t understand photosynthesis in a virtual setting, in other words—it was that they didn’t find (or simply didn't access) the lesson on photosynthesis at all.

That basic insight echoed a 2019 study that highlighted the crucial need to organize virtual classrooms even more intentionally than physical ones. Remote teachers should use a single, dedicated hub for important documents like assignments; simplify communications and reminders by using one channel like email or text; and reduce visual clutter like hard-to-read fonts and unnecessary decorations throughout their virtual spaces.

Because the tools are new to everyone, regular feedback on topics like accessibility and ease of use is crucial. Teachers should post simple surveys asking questions like “Have you encountered any technical issues?” and “Can you easily locate your assignments?” to ensure that students experience a smooth-running virtual learning space.

9. Love to Learn Languages? Surprisingly, Coding May Be Right for You

Learning how to code more closely resembles learning a language such as Chinese or Spanish than learning math, a 2020 study found—upending the conventional wisdom about what makes a good programmer.

In the study, young adults with no programming experience were asked to learn Python, a popular programming language; they then took a series of tests assessing their problem-solving, math, and language skills. The researchers discovered that mathematical skill accounted for only 2 percent of a person’s ability to learn how to code, while language skills were almost nine times more predictive, accounting for 17 percent of learning ability.

That’s an important insight because all too often, programming classes require that students pass advanced math courses—a hurdle that needlessly excludes students with untapped promise, the researchers claim.

10. Researchers Cast Doubt on Reading Tasks Like ‘Finding the Main Idea’

“Content is comprehension,” declared a 2020 Fordham Institute study , sounding a note of defiance as it staked out a position in the ongoing debate over the teaching of intrinsic reading skills versus the teaching of content knowledge.

While elementary students spend an enormous amount of time working on skills like “finding the main idea” and “summarizing”—tasks born of the belief that reading is a discrete and trainable ability that transfers seamlessly across content areas—these young readers aren’t experiencing “the additional reading gains that well-intentioned educators hoped for,” the study concluded.

So what works? The researchers looked at data from more than 18,000 K–5 students, focusing on the time spent in subject areas like math, social studies, and ELA, and found that “social studies is the only subject with a clear, positive, and statistically significant effect on reading improvement.” In effect, exposing kids to rich content in civics, history, and law appeared to teach reading more effectively than our current methods of teaching reading. Perhaps defiance is no longer needed: Fordham’s conclusions are rapidly becoming conventional wisdom—and they extend beyond the limited claim of reading social studies texts. According to Natalie Wexler, the author of the well-received 2019 book  The Knowledge Gap , content knowledge and reading are intertwined. “Students with more [background] knowledge have a better chance of understanding whatever text they encounter. They’re able to retrieve more information about the topic from long-term memory, leaving more space in working memory for comprehension,” she recently told Edutopia .

Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.

1 What is Action Research for Classroom Teachers?

ESSENTIAL QUESTIONS

• What is the nature of action research?
• How does action research develop in the classroom?
• What models of action research work best for your classroom?
• What are the epistemological, ontological, theoretical underpinnings of action research?

Educational research provides a vast landscape of knowledge on topics related to teaching and learning, curriculum and assessment, students’ cognitive and affective needs, cultural and socio-economic factors of schools, and many other factors considered viable to improving schools. Educational stakeholders rely on research to make informed decisions that ultimately affect the quality of schooling for their students. Accordingly, the purpose of educational research is to engage in disciplined inquiry to generate knowledge on topics significant to the students, teachers, administrators, schools, and other educational stakeholders. Just as the topics of educational research vary, so do the approaches to conducting educational research in the classroom. Your approach to research will be shaped by your context, your professional identity, and paradigm (set of beliefs and assumptions that guide your inquiry). These will all be key factors in how you generate knowledge related to your work as an educator.

Action research is an approach to educational research that is commonly used by educational practitioners and professionals to examine, and ultimately improve, their pedagogy and practice. In this way, action research represents an extension of the reflection and critical self-reflection that an educator employs on a daily basis in their classroom. When students are actively engaged in learning, the classroom can be dynamic and uncertain, demanding the constant attention of the educator. Considering these demands, educators are often only able to engage in reflection that is fleeting, and for the purpose of accommodation, modification, or formative assessment. Action research offers one path to more deliberate, substantial, and critical reflection that can be documented and analyzed to improve an educator’s practice.

Purpose of Action Research

As one of many approaches to educational research, it is important to distinguish the potential purposes of action research in the classroom. This book focuses on action research as a method to enable and support educators in pursuing effective pedagogical practices by transforming the quality of teaching decisions and actions, to subsequently enhance student engagement and learning. Being mindful of this purpose, the following aspects of action research are important to consider as you contemplate and engage with action research methodology in your classroom:

• Action research is a process for improving educational practice. Its methods involve action, evaluation, and reflection. It is a process to gather evidence to implement change in practices.
• Action research is participative and collaborative. It is undertaken by individuals with a common purpose.
• Action research is situation and context-based.
• Action research develops reflection practices based on the interpretations made by participants.
• Knowledge is created through action and application.
• Action research can be based in problem-solving, if the solution to the problem results in the improvement of practice.
• Action research is iterative; plans are created, implemented, revised, then implemented, lending itself to an ongoing process of reflection and revision.
• In action research, findings emerge as action develops and takes place; however, they are not conclusive or absolute, but ongoing (Koshy, 2010, pgs. 1-2).

In thinking about the purpose of action research, it is helpful to situate action research as a distinct paradigm of educational research. I like to think about action research as part of the larger concept of living knowledge. Living knowledge has been characterized as “a quest for life, to understand life and to create… knowledge which is valid for the people with whom I work and for myself” (Swantz, in Reason & Bradbury, 2001, pg. 1). Why should educators care about living knowledge as part of educational research? As mentioned above, action research is meant “to produce practical knowledge that is useful to people in the everyday conduct of their lives and to see that action research is about working towards practical outcomes” (Koshy, 2010, pg. 2). However, it is also about:

creating new forms of understanding, since action without reflection and understanding is blind, just as theory without action is meaningless. The participatory nature of action research makes it only possible with, for and by persons and communities, ideally involving all stakeholders both in the questioning and sense making that informs the research, and in the action, which is its focus. (Reason & Bradbury, 2001, pg. 2)

In an effort to further situate action research as living knowledge, Jean McNiff reminds us that “there is no such ‘thing’ as ‘action research’” (2013, pg. 24). In other words, action research is not static or finished, it defines itself as it proceeds. McNiff’s reminder characterizes action research as action-oriented, and a process that individuals go through to make their learning public to explain how it informs their practice. Action research does not derive its meaning from an abstract idea, or a self-contained discovery – action research’s meaning stems from the way educators negotiate the problems and successes of living and working in the classroom, school, and community.

While we can debate the idea of action research, there are people who are action researchers, and they use the idea of action research to develop principles and theories to guide their practice. Action research, then, refers to an organization of principles that guide action researchers as they act on shared beliefs, commitments, and expectations in their inquiry.

Reflection and the Process of Action Research

When an individual engages in reflection on their actions or experiences, it is typically for the purpose of better understanding those experiences, or the consequences of those actions to improve related action and experiences in the future. Reflection in this way develops knowledge around these actions and experiences to help us better regulate those actions in the future. The reflective process generates new knowledge regularly for classroom teachers and informs their classroom actions.

Unfortunately, the knowledge generated by educators through the reflective process is not always prioritized among the other sources of knowledge educators are expected to utilize in the classroom. Educators are expected to draw upon formal types of knowledge, such as textbooks, content standards, teaching standards, district curriculum and behavioral programs, etc., to gain new knowledge and make decisions in the classroom. While these forms of knowledge are important, the reflective knowledge that educators generate through their pedagogy is the amalgamation of these types of knowledge enacted in the classroom. Therefore, reflective knowledge is uniquely developed based on the action and implementation of an educator’s pedagogy in the classroom. Action research offers a way to formalize the knowledge generated by educators so that it can be utilized and disseminated throughout the teaching profession.

Research is concerned with the generation of knowledge, and typically creating knowledge related to a concept, idea, phenomenon, or topic. Action research generates knowledge around inquiry in practical educational contexts. Action research allows educators to learn through their actions with the purpose of developing personally or professionally. Due to its participatory nature, the process of action research is also distinct in educational research. There are many models for how the action research process takes shape. I will share a few of those here. Each model utilizes the following processes to some extent:

• Plan a change;
• Take action to enact the change;
• Observe the process and consequences of the change;
• Reflect on the process and consequences;
• Act, observe, & reflect again and so on.

Figure 1.1 Basic action research cycle

There are many other models that supplement the basic process of action research with other aspects of the research process to consider. For example, figure 1.2 illustrates a spiral model of action research proposed by Kemmis and McTaggart (2004). The spiral model emphasizes the cyclical process that moves beyond the initial plan for change. The spiral model also emphasizes revisiting the initial plan and revising based on the initial cycle of research:

Figure 1.2 Interpretation of action research spiral, Kemmis and McTaggart (2004, p. 595)

Other models of action research reorganize the process to emphasize the distinct ways knowledge takes shape in the reflection process. O’Leary’s (2004, p. 141) model, for example, recognizes that the research may take shape in the classroom as knowledge emerges from the teacher’s observations. O’Leary highlights the need for action research to be focused on situational understanding and implementation of action, initiated organically from real-time issues:

Figure 1.3 Interpretation of O’Leary’s cycles of research, O’Leary (2000, p. 141)

Lastly, Macintyre’s (2000, p. 1) model, offers a different characterization of the action research process. Macintyre emphasizes a messier process of research with the initial reflections and conclusions as the benchmarks for guiding the research process. Macintyre emphasizes the flexibility in planning, acting, and observing stages to allow the process to be naturalistic. Our interpretation of Macintyre process is below:

Figure 1.4 Interpretation of the action research cycle, Macintyre (2000, p. 1)

We believe it is important to prioritize the flexibility of the process, and encourage you to only use these models as basic guides for your process. Your process may look similar, or you may diverge from these models as you better understand your students, context, and data.

Definitions of Action Research and Examples

At this point, it may be helpful for readers to have a working definition of action research and some examples to illustrate the methodology in the classroom. Bassey (1998, p. 93) offers a very practical definition and describes “action research as an inquiry which is carried out in order to understand, to evaluate and then to change, in order to improve educational practice.” Cohen and Manion (1994, p. 192) situate action research differently, and describe action research as emergent, writing:

essentially an on-the-spot procedure designed to deal with a concrete problem located in an immediate situation. This means that ideally, the step-by-step process is constantly monitored over varying periods of time and by a variety of mechanisms (questionnaires, diaries, interviews and case studies, for example) so that the ensuing feedback may be translated into modifications, adjustment, directional changes, redefinitions, as necessary, so as to bring about lasting benefit to the ongoing process itself rather than to some future occasion.

Lastly, Koshy (2010, p. 9) describes action research as:

a constructive inquiry, during which the researcher constructs his or her knowledge of specific issues through planning, acting, evaluating, refining and learning from the experience. It is a continuous learning process in which the researcher learns and also shares the newly generated knowledge with those who may benefit from it.

These definitions highlight the distinct features of action research and emphasize the purposeful intent of action researchers to improve, refine, reform, and problem-solve issues in their educational context. To better understand the distinctness of action research, these are some examples of action research topics:

Examples of Action Research Topics

• Flexible seating in 4th grade classroom to increase effective collaborative learning.
• Structured homework protocols for increasing student achievement.
• Developing a system of formative feedback for 8th grade writing.
• Using music to stimulate creative writing.
• Weekly brown bag lunch sessions to improve responses to PD from staff.
• Using exercise balls as chairs for better classroom management.

Action Research in Theory

Action research-based inquiry in educational contexts and classrooms involves distinct participants – students, teachers, and other educational stakeholders within the system. All of these participants are engaged in activities to benefit the students, and subsequently society as a whole. Action research contributes to these activities and potentially enhances the participants’ roles in the education system. Participants’ roles are enhanced based on two underlying principles:

• communities, schools, and classrooms are sites of socially mediated actions, and action research provides a greater understanding of self and new knowledge of how to negotiate these socially mediated environments;
• communities, schools, and classrooms are part of social systems in which humans interact with many cultural tools, and action research provides a basis to construct and analyze these interactions.

In our quest for knowledge and understanding, we have consistently analyzed human experience over time and have distinguished between types of reality. Humans have constantly sought “facts” and “truth” about reality that can be empirically demonstrated or observed.

Social systems are based on beliefs, and generally, beliefs about what will benefit the greatest amount of people in that society. Beliefs, and more specifically the rationale or support for beliefs, are not always easy to demonstrate or observe as part of our reality. Take the example of an English Language Arts teacher who prioritizes argumentative writing in her class. She believes that argumentative writing demonstrates the mechanics of writing best among types of writing, while also providing students a skill they will need as citizens and professionals. While we can observe the students writing, and we can assess their ability to develop a written argument, it is difficult to observe the students’ understanding of argumentative writing and its purpose in their future. This relates to the teacher’s beliefs about argumentative writing; we cannot observe the real value of the teaching of argumentative writing. The teacher’s rationale and beliefs about teaching argumentative writing are bound to the social system and the skills their students will need to be active parts of that system. Therefore, our goal through action research is to demonstrate the best ways to teach argumentative writing to help all participants understand its value as part of a social system.

The knowledge that is conveyed in a classroom is bound to, and justified by, a social system. A postmodernist approach to understanding our world seeks knowledge within a social system, which is directly opposed to the empirical or positivist approach which demands evidence based on logic or science as rationale for beliefs. Action research does not rely on a positivist viewpoint to develop evidence and conclusions as part of the research process. Action research offers a postmodernist stance to epistemology (theory of knowledge) and supports developing questions and new inquiries during the research process. In this way action research is an emergent process that allows beliefs and decisions to be negotiated as reality and meaning are being constructed in the socially mediated space of the classroom.

Theorizing Action Research for the Classroom

All research, at its core, is for the purpose of generating new knowledge and contributing to the knowledge base of educational research. Action researchers in the classroom want to explore methods of improving their pedagogy and practice. The starting place of their inquiry stems from their pedagogy and practice, so by nature the knowledge created from their inquiry is often contextually specific to their classroom, school, or community. Therefore, we should examine the theoretical underpinnings of action research for the classroom. It is important to connect action research conceptually to experience; for example, Levin and Greenwood (2001, p. 105) make these connections:

• Action research is context bound and addresses real life problems.
• Action research is inquiry where participants and researchers cogenerate knowledge through collaborative communicative processes in which all participants’ contributions are taken seriously.
• The meanings constructed in the inquiry process lead to social action or these reflections and action lead to the construction of new meanings.
• The credibility/validity of action research knowledge is measured according to whether the actions that arise from it solve problems (workability) and increase participants’ control over their own situation.

Educators who engage in action research will generate new knowledge and beliefs based on their experiences in the classroom. Let us emphasize that these are all important to you and your work, as both an educator and researcher. It is these experiences, beliefs, and theories that are often discounted when more official forms of knowledge (e.g., textbooks, curriculum standards, districts standards) are prioritized. These beliefs and theories based on experiences should be valued and explored further, and this is one of the primary purposes of action research in the classroom. These beliefs and theories should be valued because they were meaningful aspects of knowledge constructed from teachers’ experiences. Developing meaning and knowledge in this way forms the basis of constructivist ideology, just as teachers often try to get their students to construct their own meanings and understandings when experiencing new ideas.  

Classroom Teachers Constructing their Own Knowledge

Most of you are probably at least minimally familiar with constructivism, or the process of constructing knowledge. However, what is constructivism precisely, for the purposes of action research? Many scholars have theorized constructivism and have identified two key attributes (Koshy, 2010; von Glasersfeld, 1987):

• Knowledge is not passively received, but actively developed through an individual’s cognition;
• Human cognition is adaptive and finds purpose in organizing the new experiences of the world, instead of settling for absolute or objective truth.

Considering these two attributes, constructivism is distinct from conventional knowledge formation because people can develop a theory of knowledge that orders and organizes the world based on their experiences, instead of an objective or neutral reality. When individuals construct knowledge, there are interactions between an individual and their environment where communication, negotiation and meaning-making are collectively developing knowledge. For most educators, constructivism may be a natural inclination of their pedagogy. Action researchers have a similar relationship to constructivism because they are actively engaged in a process of constructing knowledge. However, their constructions may be more formal and based on the data they collect in the research process. Action researchers also are engaged in the meaning making process, making interpretations from their data. These aspects of the action research process situate them in the constructivist ideology. Just like constructivist educators, action researchers’ constructions of knowledge will be affected by their individual and professional ideas and values, as well as the ecological context in which they work (Biesta & Tedder, 2006). The relations between constructivist inquiry and action research is important, as Lincoln (2001, p. 130) states:

much of the epistemological, ontological, and axiological belief systems are the same or similar, and methodologically, constructivists and action researchers work in similar ways, relying on qualitative methods in face-to-face work, while buttressing information, data and background with quantitative method work when necessary or useful.

While there are many links between action research and educators in the classroom, constructivism offers the most familiar and practical threads to bind the beliefs of educators and action researchers.  

Epistemology, Ontology, and Action Research

It is also important for educators to consider the philosophical stances related to action research to better situate it with their beliefs and reality. When researchers make decisions about the methodology they intend to use, they will consider their ontological and epistemological stances. It is vital that researchers clearly distinguish their philosophical stances and understand the implications of their stance in the research process, especially when collecting and analyzing their data. In what follows, we will discuss ontological and epistemological stances in relation to action research methodology.

Ontology, or the theory of being, is concerned with the claims or assumptions we make about ourselves within our social reality – what do we think exists, what does it look like, what entities are involved and how do these entities interact with each other (Blaikie, 2007). In relation to the discussion of constructivism, generally action researchers would consider their educational reality as socially constructed. Social construction of reality happens when individuals interact in a social system. Meaningful construction of concepts and representations of reality develop through an individual’s interpretations of others’ actions. These interpretations become agreed upon by members of a social system and become part of social fabric, reproduced as knowledge and beliefs to develop assumptions about reality. Researchers develop meaningful constructions based on their experiences and through communication. Educators as action researchers will be examining the socially constructed reality of schools. In the United States, many of our concepts, knowledge, and beliefs about schooling have been socially constructed over the last hundred years. For example, a group of teachers may look at why fewer female students enroll in upper-level science courses at their school. This question deals directly with the social construction of gender and specifically what careers females have been conditioned to pursue. We know this is a social construction in some school social systems because in other parts of the world, or even the United States, there are schools that have more females enrolled in upper level science courses than male students. Therefore, the educators conducting the research have to recognize the socially constructed reality of their school and consider this reality throughout the research process. Action researchers will use methods of data collection that support their ontological stance and clarify their theoretical stance throughout the research process.

Koshy (2010, p. 23-24) offers another example of addressing the ontological challenges in the classroom:

A teacher who was concerned with increasing her pupils’ motivation and enthusiasm for learning decided to introduce learning diaries which the children could take home. They were invited to record their reactions to the day’s lessons and what they had learnt. The teacher reported in her field diary that the learning diaries stimulated the children’s interest in her lessons, increased their capacity to learn, and generally improved their level of participation in lessons. The challenge for the teacher here is in the analysis and interpretation of the multiplicity of factors accompanying the use of diaries. The diaries were taken home so the entries may have been influenced by discussions with parents. Another possibility is that children felt the need to please their teacher. Another possible influence was that their increased motivation was as a result of the difference in style of teaching which included more discussions in the classroom based on the entries in the dairies.

Here you can see the challenge for the action researcher is working in a social context with multiple factors, values, and experiences that were outside of the teacher’s control. The teacher was only responsible for introducing the diaries as a new style of learning. The students’ engagement and interactions with this new style of learning were all based upon their socially constructed notions of learning inside and outside of the classroom. A researcher with a positivist ontological stance would not consider these factors, and instead might simply conclude that the dairies increased motivation and interest in the topic, as a result of introducing the diaries as a learning strategy.

Epistemology, or the theory of knowledge, signifies a philosophical view of what counts as knowledge – it justifies what is possible to be known and what criteria distinguishes knowledge from beliefs (Blaikie, 1993). Positivist researchers, for example, consider knowledge to be certain and discovered through scientific processes. Action researchers collect data that is more subjective and examine personal experience, insights, and beliefs.

Action researchers utilize interpretation as a means for knowledge creation. Action researchers have many epistemologies to choose from as means of situating the types of knowledge they will generate by interpreting the data from their research. For example, Koro-Ljungberg et al., (2009) identified several common epistemologies in their article that examined epistemological awareness in qualitative educational research, such as: objectivism, subjectivism, constructionism, contextualism, social epistemology, feminist epistemology, idealism, naturalized epistemology, externalism, relativism, skepticism, and pluralism. All of these epistemological stances have implications for the research process, especially data collection and analysis. Please see the table on pages 689-90, linked below for a sketch of these potential implications:

Again, Koshy (2010, p. 24) provides an excellent example to illustrate the epistemological challenges within action research:

A teacher of 11-year-old children decided to carry out an action research project which involved a change in style in teaching mathematics. Instead of giving children mathematical tasks displaying the subject as abstract principles, she made links with other subjects which she believed would encourage children to see mathematics as a discipline that could improve their understanding of the environment and historic events. At the conclusion of the project, the teacher reported that applicable mathematics generated greater enthusiasm and understanding of the subject.

The educator/researcher engaged in action research-based inquiry to improve an aspect of her pedagogy. She generated knowledge that indicated she had improved her students’ understanding of mathematics by integrating it with other subjects – specifically in the social and ecological context of her classroom, school, and community. She valued constructivism and students generating their own understanding of mathematics based on related topics in other subjects. Action researchers working in a social context do not generate certain knowledge, but knowledge that emerges and can be observed and researched again, building upon their knowledge each time.

Researcher Positionality in Action Research

In this first chapter, we have discussed a lot about the role of experiences in sparking the research process in the classroom. Your experiences as an educator will shape how you approach action research in your classroom. Your experiences as a person in general will also shape how you create knowledge from your research process. In particular, your experiences will shape how you make meaning from your findings. It is important to be clear about your experiences when developing your methodology too. This is referred to as researcher positionality. Maher and Tetreault (1993, p. 118) define positionality as:

Gender, race, class, and other aspects of our identities are markers of relational positions rather than essential qualities. Knowledge is valid when it includes an acknowledgment of the knower’s specific position in any context, because changing contextual and relational factors are crucial for defining identities and our knowledge in any given situation.

By presenting your positionality in the research process, you are signifying the type of socially constructed, and other types of, knowledge you will be using to make sense of the data. As Maher and Tetreault explain, this increases the trustworthiness of your conclusions about the data. This would not be possible with a positivist ontology. We will discuss positionality more in chapter 6, but we wanted to connect it to the overall theoretical underpinnings of action research.

Advantages of Engaging in Action Research in the Classroom

In the following chapters, we will discuss how action research takes shape in your classroom, and we wanted to briefly summarize the key advantages to action research methodology over other types of research methodology. As Koshy (2010, p. 25) notes, action research provides useful methodology for school and classroom research because:

Advantages of Action Research for the Classroom

• research can be set within a specific context or situation;
• researchers can be participants – they don’t have to be distant and detached from the situation;
• it involves continuous evaluation and modifications can be made easily as the project progresses;
• there are opportunities for theory to emerge from the research rather than always follow a previously formulated theory;
• the study can lead to open-ended outcomes;
• through action research, a researcher can bring a story to life.

Action Research Copyright © by J. Spencer Clark; Suzanne Porath; Julie Thiele; and Morgan Jobe is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

Share This Book

Schools and Health: Our Nation's Investment (1997)

Chapter: 6 challenges in school health research and evaluation, 6 challenges in school health research and evaluation, overview of research and evaluation.

One of the primary arguments for establishing comprehensive school health programs (CSHPs) has been that they will improve students' academic performance and therefore improve the employability and productivity of our future adult citizens. Another argument relates to public health impact—since one-third of the Healthy People 2000 objectives can be directly attained or significantly influenced through the schools, CSHPs are seen as a means to reduce not only morbidity and mortality but also health care expenditures. It is likely that the future of CSHPs will be determined by the degree to which they are able to demonstrate a significant impact on educational and/or health outcomes.

Evaluation of any health promotion program poses numerous challenges such as measurement validity, respondent bias, attrition, and statistical power. The situation is even more challenging for CSHPs, for several reasons. First, these programs comprise multiple, interactive components, such as classroom, family, and community interventions, each employing multiple intervention strategies. Therefore, it is often difficult to determine which intervention components and specific messages, activities, and services are responsible for observed treatment effects. Second, given the broad scope of CSHPs, it is difficult to determine what the realistic outcomes should be, and measuring these outcomes in school-age children (be it the actual behavior or precursors such as communication skills) is often problematic, especially when outcomes have to do

with such sensitive matters as drug use or sexual behavior. Finally, though some aspects of a CSHP (e.g., classroom curricula) can be replicated, many aspects of the CSHP (e.g., staffing patterns, local norms, and community resources) differ across schools, cities, states, and regions. Consequently, the results of even the most rigorous evaluations may not be generalizable to other settings.

This chapter examines these and other issues related to the evaluation of CSHPs. First, general principles of research and evaluation, as applied to school health programs, are reviewed. Then the challenges and difficulties associated with research and evaluation of comprehensive, multi-component programs are examined. Finally, the difficulties and uncertainties related to research and evaluation of even a single, relatively well-defined component of comprehensive programs—the health education component—are be considered. The committee felt that it was appropriate to focus on health education in this chapter, because of the relative maturity of research in this area. Specific aspects of health education research have been chosen that highlight challenges in evaluating school-based interventions, as well as in interpreting ambiguous, if not conflicting, results relevant to other components of the comprehensive program. Discussion of the research and evaluation of other components of CSHPs—health services, nutrition or foodservices, physical education, and so forth—is found in the general discussion of these components in earlier chapters.

Types of School Health Research

Research and evaluation of comprehensive school health programs can be divided into three categories: basic research, outcome evaluation, and process evaluation.

Basic Research

An ultimate goal of CSHPs is to influence behavior. Basic research in CSHPs involves inquiry into the fundamental determinants of behavior as well as mechanisms of behavior change. Basic research includes examination of factors thought to influence health behavior—such as peer norms, self-efficacy, legal factors, health knowledge, and parental attitudes—as well as specific behavior change strategies. Basic research often employs epidemiologic strategies, such as cross-sectional or longitudinal analyses, as well as pilot intervention studies designed to isolate specific behavior change strategies, although often on a smaller scale than full outcome trials. A primary function of basic behavioral research is to in-

form the development of interventions, whose effects can then be tested in outcome evaluation trials.

Outcome Evaluation

Outcome evaluation includes empirical examination of the impact of interventions on targeted outcomes. Possible outcomes (or dependent variables) include health knowledge, attitudes, skills, behaviors, biologic measures, morbidity, mortality, and cost-effectiveness. Interventions (or independent variables) include specific health education curricula, teaching strategies, organizational change, environmental change, or health service delivery models. This type of evaluation in its most basic form resembles the randomized clinical trial with experimental and control groups, along with the requisite null hypothesis assumptions and concern for internal and external validity. Outcome evaluation can further be divided into three stages: efficacy, effectiveness, and implementation effectiveness trials (Flay, 1986).

Efficacy . Efficacy testing involves the evaluation of an intervention under ideal, controlled implementation conditions. During this stage, for example, teachers may be paid to ensure that they implement a health curriculum, or other motivational strategies may be used to ensure fidelity. The goal of efficacy testing is to determine the potential effect of an intervention, with less concern for feasibility or replicability. In drug study parlance, during this stage of research efforts are made to ensure that the ''drug" is taken so that biologic effects, or lack thereof, can be attributed to the drug rather than to degree of compliance.

Effectiveness . In effectiveness trials, interventions are implemented under real-world circumstances with the associated variations in implementation and participant exposure. Effectiveness trials help determine if interventions can reliably be used under real-world conditions and the extent to which effects observed under efficacy conditions are reproduced in natural settings. Some programs, despite being efficacious, may not be effective if they are difficult to implement or are not accepted by staff or students. Effectiveness research is of particular concern because the results of efficacy testing and, to a lesser extent, of effectiveness trials may not always be generalizable to the real world.

Implementation Effectiveness . In implementation effectiveness trials, variations in implementation methods are manipulated experimentally and outcomes are measured (Flay, 1986). For example, the outcomes can be compared when a CSHP is implemented with or without a school

coordinator or when a health education program is implemented by peers rather than adults.

Process Evaluation

Once an intervention has demonstrated adequate evidence for efficacy and effectiveness, it can be assumed that replications of the intervention will yield effects similar to those observed in prior outcomes research trials. The validity of this assumption is enhanced when multiple effectiveness trials have been successfully conducted under varying conditions and the intervention is delivered with fidelity in a setting and with a target population similar to those used in the initial testing.

It is at this point that process evaluation becomes the desired level of assessment. The goal of process evaluation is not to determine the basic impact of an intervention but rather to determine whether a proven intervention was properly implemented, and what factors may have contributed to the intervention's success or failure at the particular site. Implementation and/or participant exposure can be used as proxies for formal outcome evaluation. Key process evaluation strategies include implementation monitoring (e.g., teacher observation), quality assurance, and assessing consumer reactions (e.g., student, teacher, and parent response to the program).

Evaluation at this level may include some elements of outcome evaluation. Desired outcomes are often stated as objectives to be achieved by the program, which can be evaluated pre- and post-intervention, and may include a comparison group or references to normative data. Random selection and assignment of participants are typically not employed, however, and the level of rigor used to collect and analyze data is often less stringent than in formal outcome evaluation. This type of evaluation is sometimes referred to as program evaluation.

Although program evaluation can include rigorous design and analyses, in many real world program evaluations the assessment is often secondary to the intervention. Such interventions often do not bother with randomized design, control groups, or complex statistics. The evaluation is adapted to the intervention, rather than the inverse. For example, pragmatic issues, more than experimental design, often determine sample size and which sites are assigned to treatment or comparison conditions. In basic research and outcome evaluation on the other hand, evaluation is the principal reason that the intervention is being conducted; pragmatic issues often yield to methodologic concerns, and evaluation procedures largely are determined prior to initiating intervention activities.

Linking Outcome and Process Evaluations

Although outcome and process evaluation are described above as being sequential, the two often are conducted concurrently by linking process data to outcome data in order to determine causal pathways. One application of linking process and outcome data is the dose–response analysis—measuring the relationship between intervention dose and level of outcomes. For example, student behavioral outcomes can be examined relative to levels of teachers' curriculum implementation in a health education study or to students' level of clinic usage in a health services study. A positive dose–response relationship is seen as evidence for construct validity—that is, observed outcomes are attributed to the intervention rather than to other influences. Numerous health education studies have established a dose–response relationship between curriculum exposure and student outcomes (Connell et al., 1985; Parcel et al., 1991; Resnicow et al., 1992; Rohrbach et al., 1993; Taggart et al., 1990). Less is known about dose–response in other components of CSHPs.

Who Conducts the Research?

The various types of school health research are conducted by a diverse group of professionals. Basic research and outcome evaluation are typically conducted by doctoral-level professionals from university and freestanding research centers, often with funding from the federal government (though such studies also are supported by private foundations or corporations). Evaluating CSHPs at the level of basic research or outcome evaluation is largely beyond the fiscal and professional capacity of most local and even state education agencies. Process evaluation, on the other hand, can be conducted by local education agencies, perhaps in partnership with local public health agencies. Many models of CSHPs include an evaluation component, and it is important to delineate what type of evaluation schools and education agencies should reasonably be expected to conduct on the local level.

Although carried out by research professionals, basic research and outcome evaluation should not be abstract academic pursuits that are an end in themselves. Greater interaction is needed between researchers and those who actually implement programs. It would be desirable to stimulate and support research and evaluation alliances among colleges of education, schools of public health, and college of medicine. Bringing together the expertise from all three sectors in school health research and evaluation centers may enhance the understanding and interaction between these sectors and produce research and evaluation methods that can address cross-sector issues more accurately. This also will lead to

developing programs that can be disseminated more easily and to reducing the number of researchers working in isolation.

Uses for Research and Evaluation

Basic research, outcome evaluation, and process evaluation are also conducted for different audiences and intentions. The first two are largely intended to build scientific knowledge and are generally published in the peer-reviewed literature. The latter generally is used to demonstrate feasibility of an intervention, as well as to document the facts that program implementation objectives were met and funds were properly spent. Such reports are typically requested by or intended for state education agencies, local education agencies, or funding sources that may have sponsored the local project. Local program evaluations of pilot programs also are used to justify expanding dissemination efforts.

All three types of evaluation can contribute to the development and dissemination of comprehensive school health programs, although it is important that they be applied in their proper sequence. Process evaluation studies are inappropriate for demonstrating intervention efficacy or measuring cost-effectiveness, just as basic research approaches may go beyond what is necessary for local program evaluation. To merit dissemination, programs should first undergo formal experimental efficacy and effectiveness testing; lower standards may result in adoption of suboptimal programs and ultimately impair the credibility of school health programs among their educational and public health constituencies (Ennett et al., 1994).

METHODOLOGICAL CHALLENGES

Although traditional experimental studies using control or comparison groups are appropriate for testing individual program components and specific intervention strategies, this may not be the case for the overall CSHP, which is a complex entity and varies from site to site. In a recent discussion of methods to evaluate such complex systems as CSHPs, Shaw (1995) proposed that the use of the classic experimental design to conduct outcome evaluations may be outmoded and inadequate for several reasons. First, the randomized clinical trial, with its tightly controlled and defined independent and dependent variables, cannot measure and capture large-scale, rapidly changing systems. Traditional experimental design ignores the need for timely formative descriptive data, maintains the artificial roles of the researcher as external expert and the subject as passive recipient of a defined treatment, and fails to recognize the complex nature of multifaceted programs that vary according to community needs.

Furthermore, there may be ethical dilemmas in randomly assigning students to treatment versus control groups when children's health and well-being are at stake.

It will be difficult—and possibly not feasible—to conduct traditional randomized trials on entire comprehensive programs. However, interventions associated with individual program components should be developed and tested by using rigorous methods that involve experimental and control groups, with the requisite concern for internal and external validity. In this section, some of the methodological challenges of demonstrating program impacts are examined.

Challenges in Assessing Validity

A goal of studying CSHPs at the level of efficacy testing is to measure the extent to which programs produce the desired outcomes (internal validity)—that is, to determine whether there is a causal relationship between the independent variable (CSHP) and defined outcomes such as knowledge, health practices, or health status.

Defining the Independent Variable

The first measurement challenge is the difficulty in defining the independent variable (the CSHP) or "treatment." Knapp (1995) has described this dilemma: "The 'independent variable' is elusive. It can be many different kinds of things, even within the same intervention; far from being a fixed treatment, as assessed by many research designs, the target of study is more often a menu of possibilities."

Ironically, the most successful programs—which are, in fact, comprehensive, multifaceted, interdisciplinary and well integrated into the community—may be the most difficult to define and segregate into components readily identifiable as the independent variable. It may be impossible, for example, to separate effects of the school from those of the community (Perry et al., 1992). This poses an important assessment dilemma. While it is vital that comprehensive programs be evaluated as a whole (Lopez and Weiss, 1994), it is unlikely that any individual program could be replicated in its entirety in a different community with its varying infrastructure, needs, and values. Thus, internal validity—the extent to which the effectiveness of the entire program is being accurately measured—may be high, but external validity—the extent to which the findings can be generalized and replicated beyond a single setting—is sacrificed.

Because of limited resources, one might wish to prioritize individual program components based on their relative efficacy. However, the over-

all effect of comprehensive programs may well be more than or different from the sum of its parts. Using a factorial design to examine the effects of individual components or combinations of components would require an unwieldy number of experimental conditions and large sample size. Thus, the independent variables in a CSHP not only may be difficult to define and measure, but it is unlikely that a consensus of what should comprise the intervention can or even should be reached.

Defining the Dependent Variable

In similar ways, defining the appropriate, feasible, and measurable outcomes (dependent variables) of a CSHP is equally challenging. Is it necessary to use change in health-related behaviors, such as smoking or drug use, to measure effectiveness of health education programs, or is the acquisition of knowledge and skills sufficient? If behavior change outside the school is required to declare effectiveness, this would seem to represent an educational double standard. For example, the quality and effectiveness of mathematics education are measured by determining mathematics knowledge and skills, using some sort of school-based assessment, not by determining whether the student actually balances a checkbook or accurately fills out an income tax form as an adult. Likewise, the quality of instruction in literature or political science is measured by the acquisition of knowledge, not by whether the student writes novels, reads poetry, votes, or becomes a contributing citizen.

Similarly, should appropriate outcomes for school health services be improved health status, behaviors, and long-term health outcomes, or is simply access to and utilization of services a sufficient end point? Is a reduction in absenteeism a proxy for improved health status and a reasonable indicator of health outcomes? Dependent variables used to measure effectiveness of school-linked health services have included linking students with no prior care to health services, decreased use of the emergency room for primary care, identification of previously unidentified health problems, access to and utilization of services by students and families, perceptions and health knowledge of students and their parents, decreasing involvement in risk behaviors, and health status indicators (Glick et al., 1995; Kisker et al., 1994; Lewin-VHI and Institute of Health Policy Studies, 1995). Some of these measures simply determine whether school services provide access and utilization, whereas other measures look for a change in health status and behavior. However, if improved health status and behaviors are declared to be the expectation for school health services, does this hold the school to higher standards than those of other health care providers?

The committee points out that, although influencing health behavior

and health status are ultimate goals of CSHPs, such end points involve personal decisionmaking beyond the control of the school. Other factors—family, peers, community, and the media—exert tremendous influence on students, and schools should not bear total responsibility for students' health behavior and health status. Schools should be held accountable for conveying health knowledge, providing a health-promoting environment, and ensuring access to high-quality services; these are the reasonable outcomes for judging the merit of a CSHP. 1 Other outcomes—improved attendance, better cardiovascular fitness, less drug abuse, or fewer teen pregnancies, for example—may also be considered, but the committee believes that such measures must be interpreted with caution, since they are influenced by personal decisionmaking and factors beyond the control of the school. In particular, null or negative outcomes for these measures should not necessarily lead to declaring the CSHP a failure; rather, they may imply that other sources of influence on children and young people oppose and outweigh the influence of the CSHP.

Other Issues

In addition to the above difficulties, all of the potential biases and challenges inherent in any research also apply. Serious threats to validity in measuring effects of CSHP include:

the Hawthorne effect—positive outcomes simply due to being part of an investigation, regardless of the nature of the intervention;

self-reporting biases—responding with answers that are thought to be "correct" and socially desirable;

Type III error—incorrectly concluding that an intervention is not effective, when in fact ineffectiveness is due to the incorrect implementation of the intervention.

ensuring even and consistent distribution of the intervention;

sorting out effects of confounding and extraneous variables;

isolating effective ingredients of multifaceted programs;

control groups that are not comparable;

differential and selective attrition in longitudinal studies;

inadequate reliability and validity of measurement tools; and

vague or inadequate conceptualization of study variables.

Another problem in drawing conclusions from reported research is "reporting bias"—the fact that only positive findings tend to be reported in the literature while studies with negative or inconclusive results are not often published. It is also important to remember that results that are statistically significant may not always have educational and public health significance.

Challenges Related to Feasibility

The kinds of large-scale research studies necessary to assess long-term outcomes of CSHPs are extremely costly and require extensive coordination. Since such programs are usually implemented for entire schools, communities, regions, or states, a majority of the children who participate are at relatively low risk for a number of outcomes of potential relevance. In addition, often only small to moderate outcome effects are sought. Hence, sample size needs are large, particularly when the unit of measurement is the school or the community rather than the individual.

Once efficacy and effectiveness have been demonstrated, the problem of developing a feasible program evaluation plan is compounded by the lack of evaluation expertise at the local or regional level and the inadequate or incompatible information systems for collecting, analyzing, and disseminating information. Local planners often need assistance in selecting and implementing evaluation strategies and in identifying means to make existing data more useful. For school health education, there are numerous guidelines and evaluation manuals from the Centers for Disease Control and Prevention (CDC), the Department of Health and Human Service's Center for Substance Abuse Prevention at the Substance Abuse and Mental Health Services Administration, and the Educational Development Center, to help states develop an evaluation plan. The national evaluation plan for the Healthy Schools, Healthy Communities Program provides helpful information for the evaluation of school health services (Lewin-VHI and Institute of Health Policy Studies, 1995). This plan is facilitated by a standardized data collection system and marks the first time that health education and health services will be systematically analyzed with a management information system that records different types of health education interventions, utilization of health services, and outcomes.

CHALLENGES AND FUTURE DIRECTIONS FOR SCHOOL HEALTH EDUCATION RESEARCH

Health education is one of the essential components of CSHPs. As

described in earlier chapters, health instruction has taken place in schools for many years, and the field is reasonably well defined and developed compared to some of the other aspects of a CSHP. Health education research has been an active field, but considerable knowledge gaps exist and research findings are often ambiguous, unexpected, or sometimes seemingly contradictory. This section focuses on some of the challenges and unresolved questions in classroom health education and suggests issues that merit further study.

Effects of Comprehensive Health Education

The preponderance of school health education research has consisted of outcome evaluations focusing on categorical risk behavior, such as smoking, drug use, sexual behavior, and nutrition. A few notable studies have examined several risk behaviors simultaneously—such as nutrition, physical activity, and smoking—as risk reduction interventions for cardiovascular disease or cancer (Luepker et al., 1996; Resnicow et al., 1991) or have looked at efforts to prevent drug, alcohol, and tobacco abuse (Pentz, 1989a), but there have been very few studies that evaluate comprehensive, multitopic health education programs (Connell et al., 1985; Errecart et al., 1991). The lack of evaluation studies of comprehensive health education is to a large extent the result of how school health research has been funded at the federal level. Generally, health concerns are divided into categorical areas for research and demonstration funding; the result is that funding agencies are interested in funding only research and development projects that address their particular disease area of responsibility. There is a scarcity of hard data about the potential impact of overall comprehensive classroom health education programs. Only a few commercially available multitopic school health curricula have been evaluated to test their effectiveness (e.g., the Know Your Body program). Some of these either are old and or have not made use of the methods demonstrated to be effective in categorical research and demonstration projects, which means that schools are faced with adopting programs that have not been evaluated or attempting to piece together evaluated programs.

How Much Health Education Is Enough?

There is consensus that health education programming should span kindergarten through grade 12 (Lohrman et al., 1987). However, the precise number and sequence of lessons required to achieve significant enduring effects have not been clearly defined. As mentioned previously, such determinations are complicated by uncertainties in what end points

are desirable or feasible—behavior change versus change in knowledge and attitudes. If the desired end point is change in behavior, a greater dose will likely be required. ("Dose" involves two dimensions: intensity, or amount of programming per year, and duration, the number of years of programming.) Moreover, if the end point is long-term behavior change or reductions in adult morbidity and mortality, an even greater dose may be necessary that provides more intensive programming for a longer time.

The ideal means to determine adequate dose would be to deliver the same curriculum using various levels of intensity and duration and then examine differences in student outcomes by differences in curriculum exposure. However, few studies have been designed a priori to test varying format and amount of programming. Instead, most of the evidence derives from post hoc analyses examining dose–response effects between health education programming and student outcomes—that is, the relationship between level of student outcomes and how much intervention students actually received. Despite the methodologic limitations, establishing a dose–response relationship from post hoc analysis is helpful for two reasons. First, a positive dose–response relationship provides evidence for construct validity—observed changes can be attributed to the health education program rather than to other variables. Second, results of these analyses have implications regarding the proper amount and sequence of health education programming.

One of the first major studies to demonstrate a dose–response effect was the School Health Education Evaluation project (Connell et al., 1985). Students from classrooms in which health programs were implemented more fully demonstrated significantly greater improvements in attitude and behaviors, compared to the entire intervention cohort. In addition, students exposed to two years versus one year of programming showed considerably greater changes in attitudes and practices. With regard to specific dose, there was evidence that between 15 and 20 hours of classroom instruction was required to produce meaningful student effects.

Dose–response effects were also evident in the Teenage Health Teaching Modules evaluation. This study found that changes in health knowledge as well as some priority health behaviors were related to teacher proficiency and to how well teachers adhered to the program materials, although these effects were somewhat equivocal (Parcel et al., 1991). In a third study, a three-year evaluation of the Know Your Body program, Resnicow et al. (1992) found significantly larger intervention effects for blood lipids, systolic blood pressure, health knowledge, self-efficacy, and dietary behavior among students exposed to "high-implementation" teachers relative to moderate- and low-implementation teachers, as well as to comparison youth receiving no programming.

There is additional evidence regarding dose–response from a survey conducted for the Metropolitan Life Insurance Company in 1988. This survey of 4,738 students in grades 3 through 12 in 199 public schools revealed that as the years of health instruction increased, students' health-related knowledge and healthy habits increased. With one year of health instruction, 43 percent of the students drank alcohol ''sometimes or more often," a level that decreased to 33 percent for students who had received three years of health instruction. With only one year of health instruction, 13 percent of the students had taken drugs, compared with only 6 percent who had received three years of health instruction. In regard to exercising outside of the school, 80 percent of the students who had three years of health instruction did so, but only 72 percent of those who had one year of instruction exercised outside of school (Harris, 1988).

Duration, Sequence, and Timing of Health Education

Two other aspects of dose include intensity of programming (i.e., concentrated versus dispersed) and booster treatments. With regard to the former, Botvin and colleagues (1983) found that students who received a substance use education program several times a week for 4 to 6 weeks (a "concentrated" format) showed stronger treatment effects than youth receiving the program once a week for 12 weeks (a "dispersed" format). Additionally, in two separate studies, students receiving booster sessions following a year of primary intervention showed larger and more sustained behavior effects than youth receiving only the initial intervention (Botvin et al., 1983; Botvin et al., 1995). Taken together, these findings suggest that the greater the intensity and duration of health education programming, the greater is the effect. It is important to note that "increased dose" can include two elements. The first relates to the number of lessons contained in a curriculum; the second is a function of implementation fidelity on the part of classroom teachers. Thus, a complex, non-user-friendly health education program containing many lessons may, due to low teacher implementation, result in a lower dose than will a more user-friendly program containing fewer lessons.

With regard to specific policy recommendations, there are insufficient data to delineate a requisite number of lessons across content areas and grades. There is, however, some evidence to suggest that at least 10 to 15 initial lessons, plus 8 to 15 booster sessions in subsequent years, are required to produce lasting behavioral effects (Botvin et al., 1983, 1995; Connell et al., 1985). These data, however, are derived primarily from substance use prevention studies of middle school youth. Little is known about the requisite intensity and duration of programming for other content areas or other age groups. It is also unclear to what extent general life

skills training, which targets substance use or sexual risk behaviors, may positively influence other behavioral domains. If spillover, synergistic effects from skills training or other common elements of health education programs (e.g., modifying normative expectations and increasing self-efficacy) occur when categorical programs are delivered within a comprehensive framework, the total number of lessons ultimately required for comprehensive curricula may be fewer than the sum of lessons from isolated categorical programs.

Additionally, whether these findings, which are based on a categorical topic, can be applied to a comprehensive curriculum merits discussion. It may be necessary to stagger content across K–12 and to target programming by developmental needs. For example, programming could be concentrated more heavily on substance use prevention at the middle school level, while in primary grades, nutrition and safety education could comprise the areas of focus. This developmental needs approach is a deviation from currently proposed curriculum frameworks, which suggest that health education address 8 to 12 content areas at each grade level. In view of the research that suggests a minimal number of lessons per grade for each content area, more serious attention should be given to setting priority areas for each stage of student development.

Lasting Effects of School Health Education

In several long-term follow-up studies of substance prevention programs delivered in grades 5 through 8 (Bell et al., 1993; Flay et al., 1989; Murray et al., 1989), positive program effects observed one to four years following the intervention had decayed by grade 12, or shortly after graduation from high school. Decay of program effects has also been observed for curricula addressing other content areas (Bush et al., 1989). There are studies, however, in which behavioral effects decayed but significant effects for knowledge and attitude were maintained (Bell et al., 1993; Flay et al., 1995).

Recently, however, Botvin and colleagues (1995) reported positive long-term results in a study involving more than 3,500 students in grade 12 who were randomly assigned to receive either the Life Skills Training substance use prevention program in grades 7 through 9 or "treatment as usual." Significant reductions in tobacco, alcohol, and marijuana use were evident at the follow-up in grade 12, and effects were greater among students whose teachers taught the program with higher fidelity (i.e., high implementors).

How can the positive effects reported by Botvin et al. be reconciled with the null results reported in prior studies? One explanation is dose. The previous interventions comprised only six to eight lessons in the first

year and, in the Ellickson and Bell (1990) and Flay et al. (1989) studies, three to five booster sessions in subsequent years. Botvin's intervention contained 15 lessons in the first year and 15 additional lessons over the next two years. Other explanations include superiority of the Life Skills Training curriculum, including its content, format, and teacher training procedures, as well as higher levels of teacher implementation. Although the results of Botvin's study of substance use prevention are encouraging, research regarding the optimal dose and timing of curricula addressing other health behaviors is still needed. Given that achieving change in language arts and mathematics skills requires daily instruction for 12 academic years, it is reasonable to conclude that changes in health knowledge and in health behaviors also will require more instruction than one semester, the standard middle and secondary school requirement.

Active Ingredients of Health Education

Many successful health education programs employ several conceptually diverse intervention strategies such as didactic, affective, and behavioral activities directed at students, as well as environmental and policy change. Although there is considerable evidence that such programs as a whole can work, the construct validity of specific subcomponents—that is, "why" programs achieve or fail to achieve their desired effects—remains unclear (McCaul and Glasgow, 1985). Consider, for example, skills training. During the 1980s, numerous skills-based interventions aimed at increasing general and behavior-specific skills were developed and evaluated (Botvin et al., 1984; Donaldson et al., 1995; Flay, 1985; Kirby, 1992; McCaul and Glasgow, 1985). While initial results were encouraging and skills training has become an integral component of many school health education programs (Botvin et al., 1980; CDC, 1988, 1994; Flay, 1985; Glynn, 1989; Kirby, 1992; Pentz et al., 1989b; Schinke et al., 1985; Walter et al., 1988), many "skills-based" programs include other intervention strategies, such as modifying personal and group norms and outcome expectations, which also many have contributed to the reported intervention effects (Botvin et al., 1984; Ellickson and Bell, 1990; Murray et al., 1989; Pentz et al., 1989a; Walter et al., 1987). Several studies specifically designed to test the independent effects of skills training have found this approach to be largely ineffective (Elder et al., 1993; Hansen and Graham, 1991; Sussman et al., 1993). Instead, these studies indicate that modifying normative beliefs—students' assumptions regarding the prevalence and acceptability of substance use—appears to be the ''active ingredient" of many of the skills training programs. Despite the questionable effectiveness of skills training in substance use prevention, skills may be important in other behavioral domains such as sexuality, nutrition, and

exercise (Baranowksi, 1989; Perry et al., 1990; Sikkema et al., 1995; St. Lawrence et al., 1995; Warzak et al., 1995).

Similarly, although there is acceptance on the part of many health educators that peers are effective "messengers," the evidence for the effectiveness of peer-based health education is also somewhat equivocal (Bangert-Drowns, 1988; Clarke et al., 1986; Ellickson et al., 1993; Johnson et al., 1986; McCaul and Glasgow, 1985; Murray et al., 1988; Perry et al., 1989; Telch et al., 1990). The effectiveness of peer-based programs is likely to depend more on how peers are included in the program than on simply having peer-led activities.

In a review of programs to reduce sexual risk behavior, Kirby and coworkers found several differences between programs that had an impact on behavior and those that did not (Kirby et al., 1994). Although the authors warn that generalizations must be made cautiously, ineffective curricula tended to be broader and less focused. Effective curricula clearly focused on the specific values, norms, and skills necessary to avoid sex or unprotected sex, whereas ineffective curricula covered a broad range of topics and discussed many values and skills. Interestingly, the length of the program or the amount of skills practice did not appear to predict the success of programs. The authors suggest, however, that skills practice may be effective only when clear values or norms are emphasized or when skills focus specifically on avoiding undesirable sexual behavior rather than on developing more general communication skills.

Given the limited funding and classroom time available for health education, it is important that school health education programs include primarily those approaches known to influence health behavior. Providing health information is a necessary but certainly not sufficient condition for affecting behavior. Identifying "active ingredients" can be achieved through factorial designs as well as post hoc statistical techniques such as structural models, and discriminant analysis can be used to elucidate mediating variables and specific intervention components that may account for program effects (Botvin and Dusenbury, 1992; Dielman et al., 1989; MacKinnon et al., 1991).

Risk-Factor-Specific Versus Problem Behavior Intervention Models

Numerous studies have found that "problem" behaviors—such as the use of alcohol, marijuana, and tobacco; precocious sexual involvement; and delinquent activity—are positively correlated and occur in clusters. Problem Behavior Theory proposes an underlying psychologic phenomenon of "unconventionality" as the unifying etiologic explanation (see Basen-Engquist et al., 1996; Donovan and Jessor, 1985; Donovan et al., 1988; Resnicow et al., 1995). This conceptualization of health behavior has

significant implications for CSHPs. As opposed to commonly used risk-factor-specific interventions that deal with each behavior separately, Problem Behavior Theory suggests that high-risk and problem behaviors can be prevented by an intervention that addresses common predisposing causes. Such interventions may be not only more effective but also more efficient, since fewer total lessons may be required to alter the common "core" causes. In addition to generic interventions, it may also be necessary to apply general strategies to selected high-risk behaviors. However, most school systems do not conceptualize health education from this perspective. Instead, health instruction is broken down into discrete content areas, more akin to the risk-factor-specific approach. Additional research, particularly studies examining the effects of interventions addressing traits that may underlie clusters of risk behaviors, is needed before health education is restructured toward a more targeted model of health behavior change.

Realistic Outcomes for School Health Education

It can be argued that previous studies reporting weak or null behavioral outcomes employed health education interventions of insufficient dose and breadth. Many of the interventions had no more than 10 lessons, delivered over the course of one year, and few or no subsequent booster lessons. As noted earlier, the positive long-term behavioral effects reported by Botvin and colleagues (1995) may be attributed largely to the increased dose. Additionally, had the categorical programs for which no long-term behavioral effects were observed been delivered within the context of a comprehensive school health program, positive effects may have been observed. It is important to set realistic expectations for school health education, particularly since many of the programs used in our schools provide a dose of insufficient intensity and duration, whose effects are further attenuated by inadequate levels of teacher implementation. As stated earlier, although influencing behavior is an ultimate goal of school health education, schools should not bear the total responsibility for student behavior, given all the other influences on students—family, peers, the media, community norms, and expectations—that are beyond the control of the school. Schools should be held accountable for providing a high-quality, up-to-date health education program that is delivered by qualified teachers using curricula that are based on research and have been validated through outcome evaluation. Schools should be held responsible for arming students with the knowledge, attitudes, and skills to adopt health-enhancing behavior and to avoid health-compromising behavior. If these conditions are met but behavioral outcomes are still less than desired, then other sources of influence on students must be exam-

ined for alignment with school health education messages. In addition, there may be delayed effects on behavior in later life, even if no immediate behavioral impacts are observed.

There is encouraging evidence that when school-based interventions are delivered along with complementary community-wide or media campaigns, significant long-term behavioral effects can be achieved (Flynn et al., 1994; Kelder et al., 1993; Perry et al., 1992; see Flay et al., 1995, for an exception). Therefore, although health education delivered in isolation may not be able to produce lasting behavioral effects, when combined with other activities or implemented within a comprehensive school health program, significant enduring changes in behavior as well as physical risk factors can be achieved.

There is considerable evidence that comprehensive curricula can produce significant short-term effects on multiple health behaviors, including substance use, diet, and exercise (Bush et al., 1989; Connell et al., 1985; Errecart et al., 1991; Resnicow et al., 1992; Walter et al., 1988, 1989). However, many of the assumptions regarding the effectiveness of classroom health education derive from studies of categorical programs, and it is unclear to what degree the effects observed for categorical programs are diminished or magnified when taught within a comprehensive framework. Although it can be argued that incorporating categorical programs within a comprehensive framework would attenuate effects because the focus on any one behavior or health issue would be diminished, it could also be argued that program effects would be enhanced because comprehensive programs provide extended if not synergistic application and reinforcement of essential skills across a wide range of topics. This is another area that calls for further research.

SUMMARY OF FINDINGS AND CONCLUSIONS

Research and evaluation of CSHPs can be divided into three categories: basic research, outcome evaluation, and process evaluation. Basic research involves inquiry into the fundamental determinants of behavior as well as mechanisms of behavior change. A primary function of basic research is to inform the development of interventions that can then be tested in outcome evaluation trials. Outcome evaluation involves the empirical examination of interventions on targeted outcomes, based on the randomized clinical trial approach with experimental and control groups. Process evaluation determines whether a proven intervention was properly implemented and examines factors that may have contributed to the intervention's success or failure. Basic research and outcome evaluation are typically conducted by professionals from university or other research centers and are largely beyond the capacity of local education agencies.

The committee believes that process evaluation is the appropriate level of evaluation in local programs.

Research and evaluation are particularly challenging for CSHPs. Since these programs comprise multiple interactive components, it is often difficult to attribute observed effects to specific components or to separate program effects from those of the family or community. Determining what outcomes are realistic and measuring outcomes in students are often problematic, especially when outcomes involve sensitive matters such as drug use or sexual behavior. Furthermore, since CSHPs are unique to a particular setting, the results of even the most rigorous evaluations may not be generalizable to other situations.

Interventions associated with the separate, individual components of CSHPs—health education, health services, nutrition services, and so forth—should be developed and tested using rigorous methods involving experimental and control groups. However, such an approach is likely to be difficult—and possibly not feasible—for studying entire comprehensive programs or determining the differential effects of individual components and combinations of components.

A fundamental issue involves determining what outcomes are appropriate and reasonable to expect from CSHPs. The committee recognizes that although influencing health behavior and health status is an ultimate goal of a CSHP, such end points involve factors beyond the control of the school. The committee believes that the reasonable outcomes on which a CSHP should be judged are equipping students with the knowledge, attitudes, and skills necessary for healthful behavior; providing a health-promoting environment; and ensuring access to high-quality services. Other outcomes—improved cardiovascular fitness or a reduction in absenteeism, drug abuse, or teen pregnancies, for example—may also be considered, but the committee believes that such measures must be interpreted with caution, since they are influenced by factors beyond the control of the school. In particular, null or negative measures for these outcomes should not necessarily lead to declaring the CSHP a failure; rather, they may imply that other sources of influence oppose and outweigh that of the CSHP or that the financial investment in the CSHP is so limited that returns are minimal.

RECOMMENDATIONS

In order for CSHPs to accomplish the desired goal of influencing behavior, the committee recommends the following:

An active research agenda on comprehensive school health programs should be pursued in order to fill critical knowledge

gaps; increased emphasis should be placed on basic research and outcome evaluation and on the dissemination of these research and outcome findings.

Research is needed about the effectiveness of specific intervention strategies such as skills training, normative education, or peer education; the effectiveness of specific intervention messages such as abstinence versus harm reduction; and the required intensity and duration of health education programming. Evidence suggests that common underlying factors may be responsible for the clustering of health-compromising behaviors and that interventions may be more effective if they address these underlying factors in addition to intervening to change risk behaviors. Additional research is needed to understand the etiology of problem behavior clusters and to develop optimal problem behavior interventions. And finally, since the acquisition of health-related social skills—such as negotiation, decisionmaking, and refusal skills—is a desired end point of CSHPs, basic research is needed to develop valid measures of social skills that can then be used as proxy measures of program effectiveness. Diffusion-related research is critical to ensure that efforts of research and development lead to improved practice and a greater utilization of effective methods and programs. Therefore, high priority should be given to studying how programs are adopted, implemented, and institutionalized. The feasibility and effectiveness of techniques of integrating concepts of health into science and other school subjects should also be examined.

Since the overall effects of comprehensive school health programs are not yet known and outcome evaluation of such complex systems poses significant challenges, the committee recommends the following:

A major research effort should be launched to establish model comprehensive programs and develop approaches for their study.

Specific outcomes of overall programs should be examined, including education (improved achievement, attendance, and graduation rates), personal health (resistance to "new social morbidities," improved biologic measures), mental health (less depression, stress, and violence), improved functionality, health systems (more students with a "medical home," reduction in use of emergency rooms or hospitals), self-sufficiency (pursuit of higher education or job), and future health literacy and health status. Studies could look at differential impacts of programs produced by such factors as program structure, characteristics of students, and type of school and community.

A thorough understanding of the feasible and effective (including

cost-effective) interventions in each separate area of a CSHP will be necessary to provide the basis for combining components to produce a comprehensive program.

The committee recommends that further study of each of the individual components of a CSHP—for example, health education, health services, counseling, nutrition, school environment—is needed.

Additional studies are needed in a number of other areas. First, more data are needed about the advantages (cost and effectiveness) and disadvantages of providing health and social services in schools compared to other community sites—or compared to not providing services anywhere—as a function of community and student characteristics. This information will require overall consensus about the criteria to use for determining the quality of school health programs. It is also important to know how best to influence change in the climate and organizational structure of school districts and individual schools in order to bring about the adoption and implementation of CSHPs. Finally, there is a need for an analysis of the optimal structure, operation, and personnel needs of CSHPs.

Bangert-Drowns, R.L. 1988. The effects of school-based substance abuse education: A meta-analysis. Journal of Drug Education 18:243–264.

Baranowski, T. 1989. Reciprocal determinism at the stages of behavior change: An integration of community, personal and behavioral perspectives. International Quarterly of Community Health Education 10(4):297–327.

Basen-Engquist, K. , Edmundson, E. , and Parcel, G.S. 1996 . Structure of health risk behavior among high school students . Journal of Consulting and Clinical Psychology 64(4):764–775.

Bell, R.M., Ellickson, P.L., and Harrison, E.R. 1993. Do drug prevention effects persist into high school? How Project Alert did with ninth graders. Preventive Medicine 22:463–483.

Botvin, G.J., and Dusenbury, L. 1992. Smoking prevention among urban minority youth: Assessing effects on outcome and mediating variables. Health Psychology 11:290–299.

Botvin, G.J., Eng, A., and Williams, C.L. 1980. Preventing the onset of cigarette smoking through life skills training. Preventive Medicine 9:135–143.

Botvin, G.J., Renick, N.L., and Baker, E. 1983. The effects of scheduling format and booster sessions on a broad-spectrum psychosocial approach to smoking prevention. Journal of Behavioral Medicine 6(4):359–379.

Botvin, G.J., Baker, E., Renick, N.L., Filazzola, A.D., and Botvin, E.M. 1984. A cognitive-behavioral approach to substance abuse prevention. Addictive Behaviors 9:137–147.

Botvin, G.J., Baker, E., Dusenbury, L., and Botvin, E.M. 1995. Long-term follow-up results of a randomized drug abuse prevention trial in a white middle class population. Journal of Behavioral Medicine 273(14):1106–1112.

Bush, P.J., Zuckerman, A.E., Taggart, V.S., Theiss, P.K., Peleg, E.O., and Smith, S.A. 1989. Cardiovascular risk factor prevention in black school children: The "Know Your Body" evaluation project. Health Education Quarterly 16(2):215–227.

Centers for Disease Control and Prevention. 1988. Guidelines for effective school health education to prevent the spread of AIDS. Morbidity and Mortality Weekly Report 37(Suppl.)2:1–14.

Centers for Disease Control and Prevention. 1994. Guidelines for school health programs to prevent tobacco use and addiction. Journal of School Health 64(9):353–360.

Clarke, J.H., MacPherson, B., Holmes, D.R., and Jones, R. 1986. Reducing adolescent smoking: A comparison of peer-led, teacher-led, and expert interventions. Journal of School Health 56(3):102–106.

Connell, D.B., Turner, R.R., and Mason, E.F. 1985. Summary of findings of the school health education evaluation: Health promotion effectiveness, implementation, and costs. Journal of School Health 55(8):316–321.

Dielman, T.E., Shope, J.T., Butchart, A.T., Campaneilli, P.C., and Caspar, R.A. 1989. A covariance structure model test of antecedents of adolescent alcohol misuse and a prevention effort. Journal of Drug Education 19(4):337–361.

Donaldson, S.I., Graham, J.W., Piccinin, A.M., and Hansen, W.B. 1995. Resistance-skills training and onset of alcohol use: Evidence for beneficial and potentially harmful effects in public schools and in private Catholic schools. Health Psychology 14(4):291–300.

Donovan, J.E., and Jessor, R. 1985. Structure of problem behavior in adolescence and young adulthood. Journal of Consulting and Clinical Psychology 53:890–904.

Donovan, J.E., Jessor, R., and Costa, F.M. 1988. Syndrome of problem behavior in adolescence: A replication. Journal of Consulting and Clinical Psychology 56:762–765.

Elder, J.P., Sallis, J.F., Woodruff, S.I., and Wildey, M.B. 1993. Tobacco-refusal skills and tobacco use among high risk adolescents. Journal of Behavioral Medicine 16:629–642.

Ellickson, P.L., and Bell, R.M. 1990. Drug prevention in junior high: A multi-site longitudinal test. Science 247:1299–1305.

Ellickson, P.L., Bell, R.M., and Harrison, E.R. 1993. Changing adolescent propensities to use drugs: Results from Project ALERT. Health Education Quarterly 20(2):227–242.

Ennett, S.T., Tobler, N.S., Ringwalt, C.L., and Flewelling, R.L. 1994. How effective is drug abuse resistance education? A meta-analysis of Project DARE outcome evaluations. American Journal of Public Health 84(9):1394–1401.

Errecart, M.T., Walberg, H.J., Ross, J.G., Gold, R.S., Fielder, J.L., and Kolbe, L.J. 1991. Effectiveness of Teenage Health Teaching Modules. Journal of School Health 61(1):26–30.

Flay, B.R. 1985. Psychosocial approaches to smoking prevention: A review of findings. Health Psychology 4(5):449–488.

Flay, B.R. 1986. Efficacy and effectiveness trials in the development of health promotion programs. Preventive Medicine 15:451–474.

Flay, B.R., Phil, D., Koepke, D., Thomson, S.J., Santi, S., Best, A., and Brown, K.S. 1989. Six-year follow-up of the first Waterloo school smoking prevention trial. American Journal of Public Health 79:1371–1376.

Flay, B.R., Miller, T.Q., Hedeker, D., Siddiqui, O., Britton, C.F., Brannon, B.R., Johnson, C.A., Hansen, W.B., Sussman, S., and Dent, C. 1995. The television, school, and family smoking prevention and cessation project. Preventive Medicine 24:29–40.

Flynn, B.S., Worden, J.K., Secker-Walker, R.H., Pirie, P.L., Badger, G.J., Carpenter, J.H., and Geller, B.M. 1994. Mass media and school interventions for cigarette smoking prevention: Effects two years after completion. American Journal of Public Health 84(7):1148–1150.

Glick, B., Doyle, L., Ni, H., Gao, D., and Pham, C. 1995. School-based health center program evaluation: Perceptions, knowledge, and attitudes of parents/guardians of eleventh graders. A limited dataset presented to the Multnomah County (Oregon) Commissioners, March 21.

Glynn, T.J. 1989. Essential elements of school-based smoking prevention programs. Journal of School Health 59(5):181–188.

Hansen, W.B., and Graham, J.W. 1991. Preventing alcohol, marijuana, and cigarette use among adolescents: Peer pressure resistance training versus establishing conservative norms. Preventive Medicine 20:414–430.

Harris, L. 1988. Health: You've Got to be Taught : An Evaluation of Comprehensive Health Education in American Public Schools . New York: Metropolitan Life Foundation.

Johnson, C.A., Hansen, W.B., Collins, L.M., and Graham, J.W. 1986. High-school smoking prevention: Results of a three-year longitudinal study. Journal of Behavioral Medicine 9(5):439–452.

Kelder, S.J., Perry, C.L., and Kleep, K.I. 1993. Community-wide youth exercise promotion: Long-term outcomes of the Minnesota Heart Health Program and the Class of 1989 Study. Journal of School Health 53(5):218–223.

Kirby, D. 1992. School-based programs to reduce sexual risk-taking behaviors. Journal of School Health 62(7):280–287.

Kirby, D., Short, L., Collins, J., Rugg, D., Kolbe, L., Howard, M., Miller, B., Sonenstein, F., and Zabin, L.S. 1994. School-based programs to reduce sexual risk behaviors: A review of effectiveness. Public Health Reports 109(3):339–359.

Kisker, E.E., Marks, E.L., Morrill, W.A., and Brown, R.S. 1994. Healthy Caring: An Evaluation Summary of the Robert Wood Johnson Foundation's School-Based Adolescent Health Care Program . Princeton, N.J.: Mathtech.

Knapp, M.S. 1995. How shall we study comprehensive, collaborative services for children and families? Educational Research 24(4):5–16.

Lewin-VHI and Institute of Health Policy Studies. 1995. Healthy schools, healthy communities program: National evaluation. Submitted to Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services by Lewin-VHI, Inc., and Institute for Health Policy Studies, University of California at San Francisco, February, 1995.

Lohrman, D.K., Gold, R.S., and Jubb, W.H. 1987. School health education: A foundation for school health programs. Journal of School Health 57(10):420–425.

Lopez, M.E., and Weiss, H.B. 1994. Can we get here from there? Examining and expanding the research base for comprehensive, school-linked early childhood services. Paper commissioned for the Invitational Conference of the U.S. Department of Education and the American Educational Research Association: School-Linked Comprehensive Services for Children and Families, Leesburg, Va., September 28–October 2.

Luepker, R.V., Perry, C.L., McKinlay, S.M., Nader, P.R., Parcel, G.S., Stone, E.J., Webber, L.S., Elder, J.P., Feldman, H.A., Johnson, C.C., Kelder, S.H., and Wu, M. 1996. Outcomes of a field trial to improve children's dietary patterns and physical activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH). Journal of the American Medical Association 275(10):768–776.

MacKinnon, D.P., Johnson, C.A., Pentz, M.A., Dwyer, J.H., Hansen, W.B., Flay, B.R., and Wang, E.Y. 1991. Mediating mechanisms in a school-based drug prevention program: First-year effects of the Midwestern Prevention Project. Health Psychology 10(3):164–172.

McCaul, K.D., and Glasgow, R.E. 1985. Preventing adolescent smoking: What have we learned about treatment construct validity? Health Psychology 4:361–387.

Murray, D.M., Davis-Hearn, M., Goldman, A., Pirie, P., and Luepker, R.V. 1988. Fourth- and five-year follow-up results from four seventh grade smoking prevention strategies. Journal of Behavioral Medicine 11(4):395–405.

Murray, D.M., Pirie, P., Luepker, R.V., and Pallonen, U. 1989. Five- and six-year follow-up results from four seventh-grade smoking prevention strategies. Journal of Behavioral Medicine 12:207–218.

Parcel, G.S., Ross, J.G., Lavin, A.T., Portnoy, B., Nelson, G.D., and Winters, F. 1991. Enhancing implementation of the Teenage Health Teaching Modules. Journal of School Health 61(1):35–38.

Pentz, M.A., Dwyer, J.H., MacKinnon, D.P., Flay, B.R., Hansen, W.B., Wang, E.Y., and Johnson, C.A. 1989a. A multicommunity trial for primary prevention of adolescent drug abuse: Effects on drug use prevalence. Journal of American Medical Association 261:3259–3266.

Pentz, M.A., MacKinnon, D.P., and Flay, B.R., Hansen, W.B., Johnson, C.A., and Dwyer, J.H. 1989b. Primary prevention of chronic diseases in adolescence: Effects of the Midwestern Prevention Project on tobacco use. American Journal of Epidemiology 130(4):713–724.

Perry, C.L., Grant, M., Ernberg, G., Florenzano, R.U., Langdon, M.C., Myeni, A.D., Waahlberg, R., Berg, S., Andersson, K., and Fisher, K.J. 1989. WHO collaborative study on alcohol education and young people: Outcomes of four-country pilot study. International Journal of the Addictions 24(12):1145–1171.

Perry, C.L., Baranowski, T., and Parcel, G. 1990. How individuals, environments and health behavior interact: Social learning theory. In Health Behavior and health Education Theory, Research, and Practice , K. Glanz, F.M. Lewis, and B. Rimer, eds. New York: Jossey-Bass.

Perry, C.L., Kelder, S.H., Murray, D.M., and Klepp, K. 1992. Community-wide smoking prevention: Long-term outcomes of the Minnesota Heart Health Program and the Class of 1989 study. American Journal of Public Health 82(9):1210–1216.

Resnicow, K., Cross, D., and Wynder, E. 1991. The role of comprehensive school-based interventions: The results of four "Know Your Body" studies. Annals of the New York Academy of Sciences 623:285–297.

Resnicow, K., Cohn, L., Reinhardt, J., Cross, D., Futterman, R., Kirschner, E., Wynder, E.L., and Allegrante, J. 1992. A three-year evaluation of the "Know Your Body" program in minority school children. Health Education Quarterly 19(4):463–480.

Resnicow, K., Ross, D., and Vaughan, R. 1995. The structure of problem and conventional behaviors in African-American youth. Journal of Clinical and Consulting Psychology 63(4):594–603.

Rohrbach, L.A., Graham, J.W., and Hansen, W.B. 1993. Diffusion of a school-based substance abuse prevention program: Predictors of program implementation. Preventive Medicine 22(2):237–260.

Schinke, S.P., Gilchrist, L., and Snow, W.H. 1985. Skills intervention to prevent cigarette smoking among adolescents. American Journal of Public Health 75:665–667.

Shaw, K.M. 1995. Challenges in evaluating systems reform. The Evaluation Exchange: Emerging Strategies in Evaluating Child and Family Services 1(1):2–3.

Sikkema, K.J., Winett, R.A., and Lombard, D.N. 1995. Development and evaluation of an HIV-risk reduction program for female college students. AIDS Education and Prevention 7(2):145–159.

St. Lawrence, J.S., Jefferson, K.W., Alleyne, E., and Brasfield, T.L. 1995. Comparison of education versus behavioral skills training interventions in lowering sexual HIV-risk behavior of substance-dependent adolescents. Journal of Consulting and Clinical Psychology 63(1):154–157.

Sussman, S., Dent, C.W., Stacy, A.W., Sun, P., Craig, S., Simon, T.R., Burton D., and Flay, B.R. 1993. Project towards no tobacco use, one-year behavior outcomes. American Journal of Public Health 83(9):1245–1250.

Taggart, V.S., Bush, P.J., Zuckerman, A.E., and Theiss, P.K. 1990. A process of evaluation of the District of Columbia ''Know Your Body" project. Journal of School Health 60(2):60–66.

Telch, M.J., Miller, L.M., Killen, J.D., Cooke, S., and Maccoby, N. 1990. Social influences approach to smoking prevention: The effects of videotape delivery with and without same-age peer leader participation. Addictive Behaviors 15(1):21–28.

Walter, H.J., Hofman, A., and Barrett, L.T., Connelly, P.A., Kost, K.L., Walk, E.H., and Patterson, R. 1987. Primary prevention of cardiovascular disease among children: Three-year results of a randomized intervention trial. In Cardiovascular Risk Factors in Childhood: Epidemiology and Prevention , B. Hetzel and G.S. Berenson, eds. Netherlands: Elsevier.

Walter, H.J., Hofman, A., Vaughan, R., and Wynder, E.L. 1988. Modification of risk factors for coronary heart disease. New England Journal of Medicine 318:1093–1100.

Walter, H.J., Vaughan, R.D., and Wynder, E.L. 1989. Primary prevention of cancer among children: Changes in cigarette smoking and diet after six years of intervention. Journal of the National Cancer Institute 81:995–999.

Warzak, W.J., Grow, C.R., Poler, M.M., and Walburn, J.N. 1995. Enhancing refusal skills: Identifying contexts that place adolescents at risk for unwanted sexual activity. Journal of Developmental and Behavioral Pediatrics 16(2):98–100.

Schools and Health is a readable and well-organized book on comprehensive school health programs (CSHPs) for children in grades K-12. The book explores the needs of today's students and how those needs can be met through CSHP design and development.

The committee provides broad recommendations for CSHPs, with suggestions and guidelines for national, state, and local actions. The volume examines how communities can become involved, explores models for CSHPs, and identifies elements of successful programs. Topics include:

• The history of and precedents for health programs in schools.
• The state of the art in physical education, health education, health services, mental health and pupil services, and nutrition and food services.
• Policies, finances, and other elements of CSHP infrastructure.
• Research and evaluation challenges.

Schools and Health will be important to policymakers in health and education, school administrators, school physicians and nurses, health educators, social scientists, child advocates, teachers, and parents.

READ FREE ONLINE

Welcome to OpenBook!

You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

Do you want to take a quick tour of the OpenBook's features?

Show this book's table of contents , where you can jump to any chapter by name.

...or use these buttons to go back to the previous chapter or skip to the next one.

Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

Switch between the Original Pages , where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

To search the entire text of this book, type in your search term here and press Enter .

Share a link to this book page on your preferred social network or via email.

View our suggested citation for this chapter.

Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

Get Email Updates

Do you enjoy reading reports from the Academies online for free ? Sign up for email notifications and we'll let you know about new publications in your areas of interest when they're released.

45 Research Problem Examples & Inspiration

A research problem is an issue of concern that is the catalyst for your research. It demonstrates why the research problem needs to take place in the first place.

Generally, you will write your research problem as a clear, concise, and focused statement that identifies an issue or gap in current knowledge that requires investigation.

The problem will likely also guide the direction and purpose of a study. Depending on the problem, you will identify a suitable methodology that will help address the problem and bring solutions to light.

Research Problem Examples

In the following examples, I’ll present some problems worth addressing, and some suggested theoretical frameworks and research methodologies that might fit with the study. Note, however, that these aren’t the only ways to approach the problems. Keep an open mind and consult with your dissertation supervisor!

Psychology Problems

1. Social Media and Self-Esteem: “How does prolonged exposure to social media platforms influence the self-esteem of adolescents?”

• Theoretical Framework : Social Comparison Theory
• Methodology : Longitudinal study tracking adolescents’ social media usage and self-esteem measures over time, combined with qualitative interviews.

2. Sleep and Cognitive Performance: “How does sleep quality and duration impact cognitive performance in adults?”

• Theoretical Framework : Cognitive Psychology
• Methodology : Experimental design with controlled sleep conditions, followed by cognitive tests. Participant sleep patterns can also be monitored using actigraphy.

3. Childhood Trauma and Adult Relationships: “How does unresolved childhood trauma influence attachment styles and relationship dynamics in adulthood?

• Theoretical Framework : Attachment Theory
• Methodology : Mixed methods, combining quantitative measures of attachment styles with qualitative in-depth interviews exploring past trauma and current relationship dynamics.

4. Mindfulness and Stress Reduction: “How effective is mindfulness meditation in reducing perceived stress and physiological markers of stress in working professionals?”

• Theoretical Framework : Humanist Psychology
• Methodology : Randomized controlled trial comparing a group practicing mindfulness meditation to a control group, measuring both self-reported stress and physiological markers (e.g., cortisol levels).

5. Implicit Bias and Decision Making: “To what extent do implicit biases influence decision-making processes in hiring practices?

• Theoretical Framework : Cognitive Dissonance Theory
• Methodology : Experimental design using Implicit Association Tests (IAT) to measure implicit biases, followed by simulated hiring tasks to observe decision-making behaviors.

6. Emotional Regulation and Academic Performance: “How does the ability to regulate emotions impact academic performance in college students?”

• Theoretical Framework : Cognitive Theory of Emotion
• Methodology : Quantitative surveys measuring emotional regulation strategies, combined with academic performance metrics (e.g., GPA).

7. Nature Exposure and Mental Well-being: “Does regular exposure to natural environments improve mental well-being and reduce symptoms of anxiety and depression?”

• Theoretical Framework : Biophilia Hypothesis
• Methodology : Longitudinal study comparing mental health measures of individuals with regular nature exposure to those without, possibly using ecological momentary assessment for real-time data collection.

8. Video Games and Cognitive Skills: “How do action video games influence cognitive skills such as attention, spatial reasoning, and problem-solving?”

• Theoretical Framework : Cognitive Load Theory
• Methodology : Experimental design with pre- and post-tests, comparing cognitive skills of participants before and after a period of action video game play.

9. Parenting Styles and Child Resilience: “How do different parenting styles influence the development of resilience in children facing adversities?”

• Theoretical Framework : Baumrind’s Parenting Styles Inventory
• Methodology : Mixed methods, combining quantitative measures of resilience and parenting styles with qualitative interviews exploring children’s experiences and perceptions.

10. Memory and Aging: “How does the aging process impact episodic memory , and what strategies can mitigate age-related memory decline?

• Theoretical Framework : Information Processing Theory
• Methodology : Cross-sectional study comparing episodic memory performance across different age groups, combined with interventions like memory training or mnemonic strategies to assess potential improvements.

Education Problems

11. Equity and Access : “How do socioeconomic factors influence students’ access to quality education, and what interventions can bridge the gap?

• Theoretical Framework : Critical Pedagogy
• Methodology : Mixed methods, combining quantitative data on student outcomes with qualitative interviews and focus groups with students, parents, and educators.

12. Digital Divide : How does the lack of access to technology and the internet affect remote learning outcomes, and how can this divide be addressed?

• Theoretical Framework : Social Construction of Technology Theory
• Methodology : Survey research to gather data on access to technology, followed by case studies in selected areas.

13. Teacher Efficacy : “What factors contribute to teacher self-efficacy, and how does it impact student achievement?”

• Theoretical Framework : Bandura’s Self-Efficacy Theory
• Methodology : Quantitative surveys to measure teacher self-efficacy, combined with qualitative interviews to explore factors affecting it.

14. Curriculum Relevance : “How can curricula be made more relevant to diverse student populations, incorporating cultural and local contexts?”

• Theoretical Framework : Sociocultural Theory
• Methodology : Content analysis of curricula, combined with focus groups with students and teachers.

15. Special Education : “What are the most effective instructional strategies for students with specific learning disabilities?

• Theoretical Framework : Social Learning Theory
• Methodology : Experimental design comparing different instructional strategies, with pre- and post-tests to measure student achievement.

16. Dropout Rates : “What factors contribute to high school dropout rates, and what interventions can help retain students?”

• Methodology : Longitudinal study tracking students over time, combined with interviews with dropouts.

17. Bilingual Education : “How does bilingual education impact cognitive development and academic achievement?

• Methodology : Comparative study of students in bilingual vs. monolingual programs, using standardized tests and qualitative interviews.

18. Classroom Management: “What reward strategies are most effective in managing diverse classrooms and promoting a positive learning environment?

• Theoretical Framework : Behaviorism (e.g., Skinner’s Operant Conditioning)
• Methodology : Observational research in classrooms , combined with teacher interviews.

19. Standardized Testing : “How do standardized tests affect student motivation, learning, and curriculum design?”

• Theoretical Framework : Critical Theory
• Methodology : Quantitative analysis of test scores and student outcomes, combined with qualitative interviews with educators and students.

20. STEM Education : “What methods can be employed to increase interest and proficiency in STEM (Science, Technology, Engineering, and Mathematics) fields among underrepresented student groups?”

• Theoretical Framework : Constructivist Learning Theory
• Methodology : Experimental design comparing different instructional methods, with pre- and post-tests.

21. Social-Emotional Learning : “How can social-emotional learning be effectively integrated into the curriculum, and what are its impacts on student well-being and academic outcomes?”

• Theoretical Framework : Goleman’s Emotional Intelligence Theory
• Methodology : Mixed methods, combining quantitative measures of student well-being with qualitative interviews.

22. Parental Involvement : “How does parental involvement influence student achievement, and what strategies can schools use to increase it?”

• Theoretical Framework : Reggio Emilia’s Model (Community Engagement Focus)
• Methodology : Survey research with parents and teachers, combined with case studies in selected schools.

23. Early Childhood Education : “What are the long-term impacts of quality early childhood education on academic and life outcomes?”

• Theoretical Framework : Erikson’s Stages of Psychosocial Development
• Methodology : Longitudinal study comparing students with and without early childhood education, combined with observational research.

24. Teacher Training and Professional Development : “How can teacher training programs be improved to address the evolving needs of the 21st-century classroom?”

• Theoretical Framework : Adult Learning Theory (Andragogy)
• Methodology : Pre- and post-assessments of teacher competencies, combined with focus groups.

25. Educational Technology : “How can technology be effectively integrated into the classroom to enhance learning, and what are the potential drawbacks or challenges?”

• Theoretical Framework : Technological Pedagogical Content Knowledge (TPACK)
• Methodology : Experimental design comparing classrooms with and without specific technologies, combined with teacher and student interviews.

Sociology Problems

26. Urbanization and Social Ties: “How does rapid urbanization impact the strength and nature of social ties in communities?”

• Theoretical Framework : Structural Functionalism
• Methodology : Mixed methods, combining quantitative surveys on social ties with qualitative interviews in urbanizing areas.

27. Gender Roles in Modern Families: “How have traditional gender roles evolved in families with dual-income households?”

• Theoretical Framework : Gender Schema Theory
• Methodology : Qualitative interviews with dual-income families, combined with historical data analysis.

28. Social Media and Collective Behavior: “How does social media influence collective behaviors and the formation of social movements?”

• Theoretical Framework : Emergent Norm Theory
• Methodology : Content analysis of social media platforms, combined with quantitative surveys on participation in social movements.

29. Education and Social Mobility: “To what extent does access to quality education influence social mobility in socioeconomically diverse settings?”

• Methodology : Longitudinal study tracking educational access and subsequent socioeconomic status, combined with qualitative interviews.

30. Religion and Social Cohesion: “How do religious beliefs and practices contribute to social cohesion in multicultural societies?”

• Methodology : Quantitative surveys on religious beliefs and perceptions of social cohesion, combined with ethnographic studies.

31. Consumer Culture and Identity Formation: “How does consumer culture influence individual identity formation and personal values?”

• Theoretical Framework : Social Identity Theory
• Methodology : Mixed methods, combining content analysis of advertising with qualitative interviews on identity and values.

32. Migration and Cultural Assimilation: “How do migrants negotiate cultural assimilation and preservation of their original cultural identities in their host countries?”

• Theoretical Framework : Post-Structuralism
• Methodology : Qualitative interviews with migrants, combined with observational studies in multicultural communities.

33. Social Networks and Mental Health: “How do social networks, both online and offline, impact mental health and well-being?”

• Theoretical Framework : Social Network Theory
• Methodology : Quantitative surveys assessing social network characteristics and mental health metrics, combined with qualitative interviews.

34. Crime, Deviance, and Social Control: “How do societal norms and values shape definitions of crime and deviance, and how are these definitions enforced?”

• Theoretical Framework : Labeling Theory
• Methodology : Content analysis of legal documents and media, combined with ethnographic studies in diverse communities.

35. Technology and Social Interaction: “How has the proliferation of digital technology influenced face-to-face social interactions and community building?”

• Theoretical Framework : Technological Determinism
• Methodology : Mixed methods, combining quantitative surveys on technology use with qualitative observations of social interactions in various settings.

Nursing Problems

36. Patient Communication and Recovery: “How does effective nurse-patient communication influence patient recovery rates and overall satisfaction with care?”

• Methodology : Quantitative surveys assessing patient satisfaction and recovery metrics, combined with observational studies on nurse-patient interactions.

37. Stress Management in Nursing: “What are the primary sources of occupational stress for nurses, and how can they be effectively managed to prevent burnout?”

• Methodology : Mixed methods, combining quantitative measures of stress and burnout with qualitative interviews exploring personal experiences and coping mechanisms.

38. Hand Hygiene Compliance: “How effective are different interventions in improving hand hygiene compliance among nursing staff, and what are the barriers to consistent hand hygiene?”

• Methodology : Experimental design comparing hand hygiene rates before and after specific interventions, combined with focus groups to understand barriers.

39. Nurse-Patient Ratios and Patient Outcomes: “How do nurse-patient ratios impact patient outcomes, including recovery rates, complications, and hospital readmissions?”

• Methodology : Quantitative study analyzing patient outcomes in relation to staffing levels, possibly using retrospective chart reviews.

40. Continuing Education and Clinical Competence: “How does regular continuing education influence clinical competence and confidence among nurses?”

• Methodology : Longitudinal study tracking nurses’ clinical skills and confidence over time as they engage in continuing education, combined with patient outcome measures to assess potential impacts on care quality.

Communication Studies Problems

41. Media Representation and Public Perception: “How does media representation of minority groups influence public perceptions and biases?”

• Theoretical Framework : Cultivation Theory
• Methodology : Content analysis of media representations combined with quantitative surveys assessing public perceptions and attitudes.

42. Digital Communication and Relationship Building: “How has the rise of digital communication platforms impacted the way individuals build and maintain personal relationships?”

• Theoretical Framework : Social Penetration Theory
• Methodology : Mixed methods, combining quantitative surveys on digital communication habits with qualitative interviews exploring personal relationship dynamics.

43. Crisis Communication Effectiveness: “What strategies are most effective in managing public relations during organizational crises, and how do they influence public trust?”

• Theoretical Framework : Situational Crisis Communication Theory (SCCT)
• Methodology : Case study analysis of past organizational crises, assessing communication strategies used and subsequent public trust metrics.

44. Nonverbal Cues in Virtual Communication: “How do nonverbal cues, such as facial expressions and gestures, influence message interpretation in virtual communication platforms?”

• Theoretical Framework : Social Semiotics
• Methodology : Experimental design using video conferencing tools, analyzing participants’ interpretations of messages with varying nonverbal cues.

45. Influence of Social Media on Political Engagement: “How does exposure to political content on social media platforms influence individuals’ political engagement and activism?”

• Theoretical Framework : Uses and Gratifications Theory
• Methodology : Quantitative surveys assessing social media habits and political engagement levels, combined with content analysis of political posts on popular platforms.

Before you Go: Tips and Tricks for Writing a Research Problem

This is an incredibly stressful time for research students. The research problem is going to lock you into a specific line of inquiry for the rest of your studies.

So, here’s what I tend to suggest to my students:

• Start with something you find intellectually stimulating – Too many students choose projects because they think it hasn’t been studies or they’ve found a research gap. Don’t over-estimate the importance of finding a research gap. There are gaps in every line of inquiry. For now, just find a topic you think you can really sink your teeth into and will enjoy learning about.
• Take 5 ideas to your supervisor – Approach your research supervisor, professor, lecturer, TA, our course leader with 5 research problem ideas and run each by them. The supervisor will have valuable insights that you didn’t consider that will help you narrow-down and refine your problem even more.
• Trust your supervisor – The supervisor-student relationship is often very strained and stressful. While of course this is your project, your supervisor knows the internal politics and conventions of academic research. The depth of knowledge about how to navigate academia and get you out the other end with your degree is invaluable. Don’t underestimate their advice.

I’ve got a full article on all my tips and tricks for doing research projects right here – I recommend reading it:

• 9 Tips on How to Choose a Dissertation Topic

Chris Drew (PhD)

Dr. Chris Drew is the founder of the Helpful Professor. He holds a PhD in education and has published over 20 articles in scholarly journals. He is the former editor of the Journal of Learning Development in Higher Education. [Image Descriptor: Photo of Chris]

• Chris Drew (PhD) https://helpfulprofessor.com/author/chris-drew-phd/ 5 Top Tips for Succeeding at University
• Chris Drew (PhD) https://helpfulprofessor.com/author/chris-drew-phd/ 50 Durable Goods Examples
• Chris Drew (PhD) https://helpfulprofessor.com/author/chris-drew-phd/ 100 Consumer Goods Examples
• Chris Drew (PhD) https://helpfulprofessor.com/author/chris-drew-phd/ 30 Globalization Pros and Cons

Leave a Comment Cancel Reply

Your email address will not be published. Required fields are marked *

• Write my thesis
• Thesis writers
• Buy thesis papers
• Bachelor thesis
• Master's thesis
• Thesis editing services
• Thesis proofreading services
• Buy a thesis online
• Write my dissertation
• Dissertation proposal help
• Pay for dissertation
• Custom dissertation
• Dissertation help online
• Buy dissertation online
• Cheap dissertation
• Dissertation editing services
• Write my research paper
• Buy research paper online
• Pay for research paper
• Research paper help
• Order research paper
• Custom research paper
• Cheap research paper
• Research papers for sale
• Thesis subjects
• How It Works

110+ Exceptional Education Research Topics Ideas

Topics for education research usually comprise school research topics, research problems in education, qualitative research topics in education, and concept paper topics about education to mention a few.

If you’re looking for research titles about education,  you’re reading the right post! This article contains 110 of the best education research topics that will come in handy when you need to choose one for your research. From sample research topics in education, to research titles examples for high school students about education – we have it all.

Educational Research Topics

Research title examples for college students, quantitative research titles about education, topics related to education for thesis, research titles about school issues, ph.d. research titles in education, elementary education research topics, research title examples about online class, research titles about modular learning, examples of research questions in education, special education research titles.

The best research titles about education must be done through the detailed process of exploring previous works and improving personal knowledge.

Here are some good research topics in education to consider.

What Are Good Research Topics Related to Education?

• The role of Covid-19 in reinvigorating online learning
• The growth of cognitive abilities through leisure experiences
• The merits of group study in education
• Merits and demerits of traditional learning methods
• The impact of homework on traditional and modern education
• Student underdevelopment as a result of larger class volumes
• Advantages of digital textbooks in learning
• The struggle of older generations in computer education
• The standards of learning  in the various academic levels
• Bullying and its effects on educational and mental health
• Exceptional education tutors: Is the need for higher pay justifiable?

The following examples of research titles about education for college students are ideal for a project that will take a long duration to complete. Here are some education topics for research that you can consider for your degree.

• Modern classroom difficulties of students and teachers
• Strategies to reform the learning difficulties within schools
• The rising cost of tuition and its burden on middle-class parents
• The concept of creativity among public schools and how it can be harnessed
• Major difficulties experienced in academic staff training
• Evaluating the learning cultures of college students
• Use of scientific development techniques in student learning
• Research of skill development in high school and college students
• Modern grading methods in underdeveloped institutions
• Dissertations and the difficulties surrounding their completion
• Integration of new gender categories in personalized learning

These research topics about education require a direct quantitative analysis and study of major ideas and arguments. They often contain general statistics and figures to back up regular research. Some of such research topics in education include:

• The relationship between poor education and increased academic fees
• Creating a social link between homeschool and traditional schoolgoers
• The relationship between teacher satisfaction and student performance
• The divide between public and private school performance
• The merits of parental involvement in students’ cognitive growth.
• A study on child welfare and its impact on educational development
• The relationship between academic performance and economic growth
• Urbanization in rural areas and its contribution to institutional growth
• The relationship between students and professors in dissertation writing
• The link between debt accumulation and student loans
• Boarding schools and regular schools: The role these two school types play in cognitive development

Educational-related topics used for a thesis normally require a wide aspect of study and enough educational materials.  Here are some education research topics you can use for write my thesis .

• The difficulties of bilingual education in private universities
• Homework and its impact on learning processes in college education
• Dissertation topic selection: Key aspects and research obligations
• Social media research topics and their educational functions
• A detailed educational review of student learning via virtual reality techniques
• Ethnicities in universities and their participation in group activities
• The modern approach to self-studying for college students
• Developing time management skills in modern education
• Guidelines for teacher development in advanced educational institutions
• The need for religious education in boarding schools
• A measure of cognitive development using digital learning methods

A research title about school issues focuses on activities surrounding the school environment and its effects on students, teachers, parents, and education in general. Below are some sample research titles in education, relating to school issues.

• Learning English in bilingual schools
• A study of teachers’ role as parent figures on school grounds
• Addressing the increased use of illegal substances and their effects in schools
• The benefits of after-class activities for foreign students
• Assessing student and teacher relationships
• A study of the best methods to implement safety rules in school
• Major obstacles in meeting school schedules using boarding students as a case study
• The need for counseling in public and private schools: Which is greater?
• Academic volunteering in understaffed public schools
• Modern techniques for curbing school violence among college students
• The advantages and disadvantages of teacher unions in schools

As you create your proposed list of research topics in education, consider scientific journals for referencing purposes. Here are some Ph.D. research titles for education.

• The modern methods of academic research writing
• The role of colleges in advanced mental care
• The merits and demerits of Ph.D. studies in Europe and Africa
• Interpersonal relationships between students and professors in advanced institutions
• A review of community colleges: merits and demerits
• Assessing racism in academic ethnic minorities
• The psychological changes of students in higher education
• The questionable standards of student loan provisions
• The merits of personalized teaching techniques in colleges
• The wage gap between private and public university teachers
• Teacher responsibilities in private universities versus public universities

The research topics in elementary education in 2023 are very different from the elementary education research topics from five or ten years ago. This creates interesting grounds for different research titles for elementary education.

Here are some elementary education title research ideas.

• Assessing quick computer literacy among elementary school pupils.
• The role of video games in childhood brain development
• Male vs female role models in early education periods
• The advantages of digital textbooks in elementary schools
• The impact of modern curriculums on elementary education
• Lack of proper school grooming is a cause of violence.
• Should elementary school children be taught about LGBTQ?
• A review of the need for sexual education in elementary schools
• The effects of emotional dependence in early childhood learners.
• The need for constant technology supervision of elementary school students
• Advantages of computer-guided education in elementary schools

Here are some research title examples for students taking online classes.

• The academic difficulties experienced by online students.
• A study of decreased attention in online classes
• The upsides and downsides of online education
• The rising fees of online and traditional education in universities
• A detailed study on the necessity of college internships
• The need to provide college scholarships based on environmental achievements
• How online education terminates university fraternities and sororities.
• The role of academic supervisors in career selection
• Why interactive assignments improved learning capabilities during the pandemic
• Merits of education in online learning environments
• Why online lessons are the least effective for some college students

The modular learning approach focuses primarily on learning outcomes. Here are some examples of research titles about modular learning.

• Modular learning and the role of teachers in its execution
• Teaching techniques of religious institutions
• Potential risks of accelerated learning
• Modular learning on students’ future performances
• The general overview of modular learning amongst students
• The modern Advantages and disadvantages of inclusive classes
• Observing student developments in modular learning
• Music therapy for fostering modular learning techniques
• The creation of a personalized curriculum for students.
• Applications of modular learning both in home-schooling?
• The benefits of modular learning towards creating a more holistic educational system

These research title examples about education answer important questions and they can also be argumentative essay topics .

Here are some titles of research about education questions.

• What impacts do learning approaches provide for students?
• How can schools manage their increasing gender differences?
• What fosters the provision of learning needs?
• What are the best educational recruitment methods?
• How can cognitive development improve education?
• How can you assess the moral growth of institutions?
• What are the primary causes of educational differences in geographical locations?
• How can institutions address increasing mental health needs?
• Why is early intervention essential in students with mental health setbacks?
• What are the characteristics of mental health deterioration among students?
• What techniques are acceptable in regulating the violence of students in institutions

Some of the research title examples about education include:

• How do schools create more personalized learning methods?
• Evaluating mental health setbacks during education
• The impact of modern technology on special education
• The cognitive improvements via specialized learning in dyslexic children
• The psychological link between dyslexia and bullying in high school
• Impact of social isolation in special education classes
• The difficulties in providing specialized learning environments
• A study of orphan students with disabilities and their aptitudes for learning
• How special classes improve the self-esteem of disabled students.
• How to use modern teaching techniques in unique learning environments.
• A study of the application of digital games to autistic learning

Final words about education research topics

We have provided some reliable examples of a research topic about education you can use for write my thesis . You can use these research titles in education to cultivate your ideas, create inspiration, or for online research. Remember always to select a topic that you’re naturally passionate about and do diligent research, and reach out to our professional writing services if you need any help.

Leave a Reply Cancel reply

Education's Research Problem

The "Threshold of Certainty" and Other Dilemmas

Overpromising: exuberance for evidence-poor practices, underdelivering: ignoring science that might help, causes of misjudgment in the use of science, of values, science, and education, making it better.

Premium Resource

Adams, M. J. (2009). The challenge of advanced texts. In E. Hiedert (Ed.) Reading more, reading better (pp. 163–189). New York, Guilford.

Backes, B., & Hansen, M. (2018). The impact of Teach for America on non-test academic outcomes. Education Finance and Policy, 13 (2), 168–193.

Center for Research on Education Outcomes. (2015). Urban charter school study report on 41 regions . Stanford, CA: Author.

Clark, M. A., Chiang, H. S., Silva, T., McConnell, S., Sonnenfeld, K., Erbe, A., et al. (2013). The effectiveness of secondary math teachers from Teach for America and the teaching fellows programs (NCEE 2013-4015). Washington, D.C.: National Center for Education Evaluation and Regional Assistance, Institute of Education Sciences, U.S. Department of Education.

Cuevas, J., & Dawson, B. L. (2018). A test of two alternative cognitive processing models: Learning styles and dual coding. Theory and Research in Education, 16 , 40–64.

Dee, T. S., & Wyckoff, J. (2015). Incentives, selection, and teacher performance: Evidence from IMPACT. Journal of Policy Analysis and Management, 34 (2), 267–297.

Duckworth, A. L., Peterson, C., Matthews, M. D., & Kelly, D. R. (2007). Grit: Perseverance and passion for long-term goals. Journal of Personality and Social Psychology, 92 , 1087–1101.

Fleming, N. D., & Mills., C. (1992). Not another inventory, rather a catalyst for reflection. To Improve the Academy, 11 , 137–155.

International Literacy Association. (2019). Meeting the challenges of early literacy phonics Instruction [Literacy Leadership Brief]. Newark, DE: Author.

Kane, T. J., Rockoff, J. E., & Staiger, D. O. (2008). What does certification tell us about teacher effectiveness? Evidence from New York City. Economics of Education Review, 27 (6), 615–631.

Kennedy, B. (Oct. 18, 2016). "Most Americans trust the military and scientists to act in the public's interests." Pew Research Center.

Mayer, R. E. (2004). Should there be a three-strikes rule against pure discovery learning? American Psychologist, 59 (1), 14.

Pashler, H., McDaniel, M., Rohrer, D., & Bjork, R. (2009). Learning styles: Concepts and evidence. Psychological Science in the Public Interest, 9 (3), 105–119.

Rousseau, J. J. (1909). Emile: Or, on education . (W. H. Payne, Trans.) New York: Appleton & Co. (Originally published 1762).

Weisberg, D., Sexton, S., Mulhern, J., & Keeling, D. (2009). "The widget effect: Our national failure to acknowledge and act on differences in teacher effectiveness." The New Teacher Project.

Willingham, D. T. (2018) Does tailoring instruction to "learning styles" help students learn? American Educator, 42 (2), 28–36.

Daniel T. Willingham is professor of psychology at the University of Virginia. He is the author of several books, including Why Don’t Students Like School? (Jossey-Bass, 2010) and most recently Outsmart Your Brain (Gallery, 2023).

ASCD is a community dedicated to educators' professional growth and well-being.

Let us help you put your vision into action., related articles.

Let’s Provide Teachers Sabbaticals

A Temperature Check on Student Needs

And Now for Some Good News

What It Takes to Truly Leave No Child Behind

It’s About Skillsets and Support, Not Sainthood

From our issue.

To process a transaction with a Purchase Order please send to [email protected]

• Privacy Policy

Buy Me a Coffee

Home » Research Problem – Examples, Types and Guide

Research Problem – Examples, Types and Guide

Table of Contents

Research Problem

Definition:

Research problem is a specific and well-defined issue or question that a researcher seeks to investigate through research. It is the starting point of any research project, as it sets the direction, scope, and purpose of the study.

Types of Research Problems

Types of Research Problems are as follows:

Descriptive problems

These problems involve describing or documenting a particular phenomenon, event, or situation. For example, a researcher might investigate the demographics of a particular population, such as their age, gender, income, and education.

Exploratory problems

These problems are designed to explore a particular topic or issue in depth, often with the goal of generating new ideas or hypotheses. For example, a researcher might explore the factors that contribute to job satisfaction among employees in a particular industry.

Explanatory Problems

These problems seek to explain why a particular phenomenon or event occurs, and they typically involve testing hypotheses or theories. For example, a researcher might investigate the relationship between exercise and mental health, with the goal of determining whether exercise has a causal effect on mental health.

Predictive Problems

These problems involve making predictions or forecasts about future events or trends. For example, a researcher might investigate the factors that predict future success in a particular field or industry.

Evaluative Problems

These problems involve assessing the effectiveness of a particular intervention, program, or policy. For example, a researcher might evaluate the impact of a new teaching method on student learning outcomes.

How to Define a Research Problem

Defining a research problem involves identifying a specific question or issue that a researcher seeks to address through a research study. Here are the steps to follow when defining a research problem:

• Identify a broad research topic : Start by identifying a broad topic that you are interested in researching. This could be based on your personal interests, observations, or gaps in the existing literature.
• Conduct a literature review : Once you have identified a broad topic, conduct a thorough literature review to identify the current state of knowledge in the field. This will help you identify gaps or inconsistencies in the existing research that can be addressed through your study.
• Refine the research question: Based on the gaps or inconsistencies identified in the literature review, refine your research question to a specific, clear, and well-defined problem statement. Your research question should be feasible, relevant, and important to the field of study.
• Develop a hypothesis: Based on the research question, develop a hypothesis that states the expected relationship between variables.
• Define the scope and limitations: Clearly define the scope and limitations of your research problem. This will help you focus your study and ensure that your research objectives are achievable.
• Get feedback: Get feedback from your advisor or colleagues to ensure that your research problem is clear, feasible, and relevant to the field of study.

Components of a Research Problem

The components of a research problem typically include the following:

• Topic : The general subject or area of interest that the research will explore.
• Research Question : A clear and specific question that the research seeks to answer or investigate.
• Objective : A statement that describes the purpose of the research, what it aims to achieve, and the expected outcomes.
• Hypothesis : An educated guess or prediction about the relationship between variables, which is tested during the research.
• Variables : The factors or elements that are being studied, measured, or manipulated in the research.
• Methodology : The overall approach and methods that will be used to conduct the research.
• Scope and Limitations : A description of the boundaries and parameters of the research, including what will be included and excluded, and any potential constraints or limitations.
• Significance: A statement that explains the potential value or impact of the research, its contribution to the field of study, and how it will add to the existing knowledge.

Research Problem Examples

Following are some Research Problem Examples:

Research Problem Examples in Psychology are as follows:

• Exploring the impact of social media on adolescent mental health.
• Investigating the effectiveness of cognitive-behavioral therapy for treating anxiety disorders.
• Studying the impact of prenatal stress on child development outcomes.
• Analyzing the factors that contribute to addiction and relapse in substance abuse treatment.
• Examining the impact of personality traits on romantic relationships.

Research Problem Examples in Sociology are as follows:

• Investigating the relationship between social support and mental health outcomes in marginalized communities.
• Studying the impact of globalization on labor markets and employment opportunities.
• Analyzing the causes and consequences of gentrification in urban neighborhoods.
• Investigating the impact of family structure on social mobility and economic outcomes.
• Examining the effects of social capital on community development and resilience.

Research Problem Examples in Economics are as follows:

• Studying the effects of trade policies on economic growth and development.
• Analyzing the impact of automation and artificial intelligence on labor markets and employment opportunities.
• Investigating the factors that contribute to economic inequality and poverty.
• Examining the impact of fiscal and monetary policies on inflation and economic stability.
• Studying the relationship between education and economic outcomes, such as income and employment.

Political Science

Research Problem Examples in Political Science are as follows:

• Analyzing the causes and consequences of political polarization and partisan behavior.
• Investigating the impact of social movements on political change and policymaking.
• Studying the role of media and communication in shaping public opinion and political discourse.
• Examining the effectiveness of electoral systems in promoting democratic governance and representation.
• Investigating the impact of international organizations and agreements on global governance and security.

Environmental Science

Research Problem Examples in Environmental Science are as follows:

• Studying the impact of air pollution on human health and well-being.
• Investigating the effects of deforestation on climate change and biodiversity loss.
• Analyzing the impact of ocean acidification on marine ecosystems and food webs.
• Studying the relationship between urban development and ecological resilience.
• Examining the effectiveness of environmental policies and regulations in promoting sustainability and conservation.

Research Problem Examples in Education are as follows:

• Investigating the impact of teacher training and professional development on student learning outcomes.
• Studying the effectiveness of technology-enhanced learning in promoting student engagement and achievement.
• Analyzing the factors that contribute to achievement gaps and educational inequality.
• Examining the impact of parental involvement on student motivation and achievement.
• Studying the effectiveness of alternative educational models, such as homeschooling and online learning.

Research Problem Examples in History are as follows:

• Analyzing the social and economic factors that contributed to the rise and fall of ancient civilizations.
• Investigating the impact of colonialism on indigenous societies and cultures.
• Studying the role of religion in shaping political and social movements throughout history.
• Analyzing the impact of the Industrial Revolution on economic and social structures.
• Examining the causes and consequences of global conflicts, such as World War I and II.

Research Problem Examples in Business are as follows:

• Studying the impact of corporate social responsibility on brand reputation and consumer behavior.
• Investigating the effectiveness of leadership development programs in improving organizational performance and employee satisfaction.
• Analyzing the factors that contribute to successful entrepreneurship and small business development.
• Examining the impact of mergers and acquisitions on market competition and consumer welfare.
• Studying the effectiveness of marketing strategies and advertising campaigns in promoting brand awareness and sales.

Research Problem Example for Students

An Example of a Research Problem for Students could be:

“How does social media usage affect the academic performance of high school students?”

This research problem is specific, measurable, and relevant. It is specific because it focuses on a particular area of interest, which is the impact of social media on academic performance. It is measurable because the researcher can collect data on social media usage and academic performance to evaluate the relationship between the two variables. It is relevant because it addresses a current and important issue that affects high school students.

To conduct research on this problem, the researcher could use various methods, such as surveys, interviews, and statistical analysis of academic records. The results of the study could provide insights into the relationship between social media usage and academic performance, which could help educators and parents develop effective strategies for managing social media use among students.

Another example of a research problem for students:

“Does participation in extracurricular activities impact the academic performance of middle school students?”

This research problem is also specific, measurable, and relevant. It is specific because it focuses on a particular type of activity, extracurricular activities, and its impact on academic performance. It is measurable because the researcher can collect data on students’ participation in extracurricular activities and their academic performance to evaluate the relationship between the two variables. It is relevant because extracurricular activities are an essential part of the middle school experience, and their impact on academic performance is a topic of interest to educators and parents.

To conduct research on this problem, the researcher could use surveys, interviews, and academic records analysis. The results of the study could provide insights into the relationship between extracurricular activities and academic performance, which could help educators and parents make informed decisions about the types of activities that are most beneficial for middle school students.

Applications of Research Problem

Applications of Research Problem are as follows:

• Academic research: Research problems are used to guide academic research in various fields, including social sciences, natural sciences, humanities, and engineering. Researchers use research problems to identify gaps in knowledge, address theoretical or practical problems, and explore new areas of study.
• Business research : Research problems are used to guide business research, including market research, consumer behavior research, and organizational research. Researchers use research problems to identify business challenges, explore opportunities, and develop strategies for business growth and success.
• Healthcare research : Research problems are used to guide healthcare research, including medical research, clinical research, and health services research. Researchers use research problems to identify healthcare challenges, develop new treatments and interventions, and improve healthcare delivery and outcomes.
• Public policy research : Research problems are used to guide public policy research, including policy analysis, program evaluation, and policy development. Researchers use research problems to identify social issues, assess the effectiveness of existing policies and programs, and develop new policies and programs to address societal challenges.
• Environmental research : Research problems are used to guide environmental research, including environmental science, ecology, and environmental management. Researchers use research problems to identify environmental challenges, assess the impact of human activities on the environment, and develop sustainable solutions to protect the environment.

Purpose of Research Problems

The purpose of research problems is to identify an area of study that requires further investigation and to formulate a clear, concise and specific research question. A research problem defines the specific issue or problem that needs to be addressed and serves as the foundation for the research project.

Identifying a research problem is important because it helps to establish the direction of the research and sets the stage for the research design, methods, and analysis. It also ensures that the research is relevant and contributes to the existing body of knowledge in the field.

A well-formulated research problem should:

• Clearly define the specific issue or problem that needs to be investigated
• Be specific and narrow enough to be manageable in terms of time, resources, and scope
• Be relevant to the field of study and contribute to the existing body of knowledge
• Be feasible and realistic in terms of available data, resources, and research methods
• Be interesting and intellectually stimulating for the researcher and potential readers or audiences.

Characteristics of Research Problem

The characteristics of a research problem refer to the specific features that a problem must possess to qualify as a suitable research topic. Some of the key characteristics of a research problem are:

• Clarity : A research problem should be clearly defined and stated in a way that it is easily understood by the researcher and other readers. The problem should be specific, unambiguous, and easy to comprehend.
• Relevance : A research problem should be relevant to the field of study, and it should contribute to the existing body of knowledge. The problem should address a gap in knowledge, a theoretical or practical problem, or a real-world issue that requires further investigation.
• Feasibility : A research problem should be feasible in terms of the availability of data, resources, and research methods. It should be realistic and practical to conduct the study within the available time, budget, and resources.
• Novelty : A research problem should be novel or original in some way. It should represent a new or innovative perspective on an existing problem, or it should explore a new area of study or apply an existing theory to a new context.
• Importance : A research problem should be important or significant in terms of its potential impact on the field or society. It should have the potential to produce new knowledge, advance existing theories, or address a pressing societal issue.
• Manageability : A research problem should be manageable in terms of its scope and complexity. It should be specific enough to be investigated within the available time and resources, and it should be broad enough to provide meaningful results.

Advantages of Research Problem

The advantages of a well-defined research problem are as follows:

• Focus : A research problem provides a clear and focused direction for the research study. It ensures that the study stays on track and does not deviate from the research question.
• Clarity : A research problem provides clarity and specificity to the research question. It ensures that the research is not too broad or too narrow and that the research objectives are clearly defined.
• Relevance : A research problem ensures that the research study is relevant to the field of study and contributes to the existing body of knowledge. It addresses gaps in knowledge, theoretical or practical problems, or real-world issues that require further investigation.
• Feasibility : A research problem ensures that the research study is feasible in terms of the availability of data, resources, and research methods. It ensures that the research is realistic and practical to conduct within the available time, budget, and resources.
• Novelty : A research problem ensures that the research study is original and innovative. It represents a new or unique perspective on an existing problem, explores a new area of study, or applies an existing theory to a new context.
• Importance : A research problem ensures that the research study is important and significant in terms of its potential impact on the field or society. It has the potential to produce new knowledge, advance existing theories, or address a pressing societal issue.
• Rigor : A research problem ensures that the research study is rigorous and follows established research methods and practices. It ensures that the research is conducted in a systematic, objective, and unbiased manner.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

You may also like

Data Collection – Methods Types and Examples

Delimitations in Research – Types, Examples and...

Research Process – Steps, Examples and Tips

Research Design – Types, Methods and Examples

Institutional Review Board – Application Sample...

Evaluating Research – Process, Examples and...

ReviseSociology

A level sociology revision – education, families, research methods, crime and deviance and more!

Issues surrounding researching in schools

There are tens of thousands of schools in the United Kingdom, which means that observational research which focuses on just one, or a handful of schools will be unrepresentative. This is also a  problem with any of the popular documentary programmes which focus on just one school – they are very interesting as they focus on the stories of the school, and some (but only some) of the pupils and teachers, but they are never going to be representative of all schools!

There are a lot of official statistics available on schools, much of it freely available on the DFES website – information on results, attendance, exclusions are all available, as are the latest OFSTED reports, so using a mixture of secondary qualitative and quantitative data may be a good choice for researchers given that schools are ‘data rich’ institutions.

A researcher could also use official statistics to easily select a sample of schools which represent all the regions in the UK, different OFSTED grades, and/ or different school types.

However, official statistics on education can be misleading – exam results may not reflect the underlying ethos of a school, or show us the difficulties a particular school faces, and schools can manipulate their data to an extent – for example, they can reduce their exclusion statistics by ‘off-rolling pupils’ – getting parents to agree to withdraw them before they exclude them.

Schools are potentially very convenient places to conduct research – because the law requires pupils to attend and teachers/ managers need to attend to keep their jobs, you can be reasonably certain that most people you want to research are going to be in attendance! You have a captive audience!

However, school gatekeepers (i.e. head teachers) may be reluctant to allow researchers into schools: they may see research as disruptive, fearing it may interfere with their duty to educate students.

Schools are also highly organised, ‘busy’ institutions – researchers may find it difficult to find the time to ask questions of pupils and teachers during the day, meaning interviews could be a problem, limiting the researcher to less representative observational research.

The researcher will also need to ensure they blend-in, otherwise they may be seen as an outsider by teachers and students alike, which would not be conducive to getting respondents to open up and provide valid information.  

Share this:

• Share on Tumblr

Leave a Reply Cancel reply

This site uses Akismet to reduce spam. Learn how your comment data is processed .

Discover more from ReviseSociology

Subscribe now to keep reading and get access to the full archive.

Continue reading

Psychology: Research and Review

• Open access
• Published: 04 June 2018

Behavioral problems of school children: impact of social vulnerability, chronic adversity, and maternal depression

• Ana Karina Braguim Martineli   ORCID: orcid.org/0000-0003-2549-5583 1 ,
• Fernanda Aguiar Pizeta 1 &
• Sonia Regina Loureiro 1  

Psicologia: Reflexão e Crítica volume  31 , Article number:  11 ( 2018 ) Cite this article

29k Accesses

8 Citations

19 Altmetric

Metrics details

This study’s objective was to identify the predictive effect of indicators concerning social vulnerability, chronic adversity, and maternal depression on behavioral problems among school-aged children, according to the perceptions of mothers and teachers, considering the presence or absence of difficulties in the contexts of family and school. A total of 85 pairs of mothers and school children were distributed into three groups according to the behavioral problems identified. A General Questionnaire, the PHQ-9, the Chronic Adversity Scale, and the (Strengths and Difficulties Questionnaire) SDQ were applied to the mothers; the Raven’s Colored Progressive Matrices were applied to the children; and the SDQ was applied to the teachers. Data were analyzed with descriptive, predictive, and comparative statistical procedures ( p  ≤ 0.05). The results reveal the presence of cumulative risks for children with behavioral problems; mothers more frequently identified behavioral problems than teachers; and maternal depression was a predictor for behavioral problems. Such findings are relevant for devising mental health programs.

The behavior of school-aged children is an important indicator of adaptation in this stage of development; however, not all children are successful and may present externalizing or internalizing behavioral problems, expressed within the family and/or school contexts (Achenbach, Ivanova, Rescorla, Turner, & Althoff, 2016 ; Linhares & Martins, 2015 ; Marturano, 2013 ).

Families present structural and internal dynamics that may contribute to either risk or protective outcomes in terms of child development (Macana & Comim, 2015 ; Walsh, 2016 ) so that adaptive difficulties associated with behavioral problems are frequent among children (Pizato, Marturano, & Fontaine, 2014 ). Considering the relevance of the influence exerted by the family context on school children, various studies have addressed the association of cumulative adversity present in the family context and the outcomes of behavioral problems among children (Duncombe, Havighurst, Holland, & Frankling, 2012 ; Leis, Heron, Stuart, & Mendelson, 2014 ; Pizeta, Silva, Cartafina, & Loureiro, 2013 ).

When analyzing the potential risk factors for the development of psychopathologies in 252 children and adolescents who are victims of domestic violence, Hildebrand, Celeri, Morcillo, and Zanolli ( 2015 ) verified that 92.8% of the participants were exposed to at least one risk factor. The authors also noticed that the association of two or more risk factors were present in 53.2% of the sample, namely family conflicts, mental health problems within the family, gender violence between parents, family involvement with drug trafficking and criminal behavior, and the abusive consumption of alcohol by parents or legal guardians, among others.

Therefore, among the events listed as conditions that predispose children to behavioral problems, we highlight indicators of chronic adversity and mental health conditions affecting the parents, especially maternal depression, as risk conditions acknowledged to have a negative impact on children. Additionally, the presence of variables related to social vulnerability is also identified based on conditions or events of life that may interfere in the course of developmental outcomes for children, contributing to the maladaptation of children in typical developmental tasks when experiencing risk conditions.

Considering social vulnerability in the population in general, low socioeconomic status and unemployment among mothers were identified as predictors of behavioral problems among children in situations of poverty, according to a study conducted by Bele, Bodhare, Valsangkar, and Saraf ( 2013 ) of children in India. In the Brazilian context, Correia, Saur, and Loureiro ( 2014 ) conducted a cohort study and identified an association of behavioral problems with low socioeconomic status for boys and low maternal education and larger families for girls. In the same direction, Pizato et al. ( 2014 ) verified association between improved socioeconomic conditions with fewer behavioral problems and more social skills in school-aged children; Saur and Loureiro ( 2015 ) identified associations between behavioral problems among 10-year-old children with low maternal educational level and low socioeconomic status and families with more than four members. It is also considered that the family socioeconomic condition can influence the cognitive performance of children, being this condition strongly related to other environmental aspects such as maternal depression (Piccolo et al., 2012 ).

In regard to the parents’ mental health, maternal depression, especially given its high prevalence and recurrence (World Health Organization [WHO], 2017a , 2017b ), stands out as a form of adversity in different periods of child development, impacting the behavior of school-aged children (Bagner, Pettit, Lewinsohn, & Seeley, 2010 ; Callender, Olson, Choe, & Sameroff, 2012 ; Edwards & Hans, 2015 ; Loosli, Pizeta, & Loureiro, 2016 ). Such a psychopathology, however, is associated with other adverse contextual conditions, favoring cumulative risk in the family context (Kessler, 2012 ). Note that the condition of cumulative risk has been acknowledged in the literature as having a greater impact for outcomes among children compared to the presence of a single risk (Evans, Li, & Whipple, 2013 ). Thus, this justifies the relevance of studying potential associations between maternal depression and behavioral problems, including other variables in the family environment, as proposed in this paper.

Indicators of social vulnerability and clinical characteristics of maternal depression have been identified as relevant factors to understanding risk conditions for child development. Barker, Copeland, Maughan, Jaffee, and Uher ( 2012 ) monitored children from their first year of life up to the age of 7 and verified that, in comparison to children of mothers without depression, children of mothers with depression were more frequently exposed to 10 out of the 11 risk factors assessed in the study, among which, low socioeconomic status, single parent, physical abuse, low maternal education, and drug and alcohol consumption. The frequency of exposure was at a significant level. Indicators concerning the severity of depression and anxiety were examined by Leis et al. ( 2014 ), in a sample of 2891 mother-child pairs, taking into account the perspectives of mothers and teachers. The authors found an association between severe depressive symptoms during pregnancy and more frequent behavioral problems at the age of 10 and 11 years old, according to the reports of teachers. Conners-Burrow et al. ( 2016 ), who took into account the assessment of mothers, determined that early contact with maternal mild depressive symptoms increased the risk of children presenting internalizing and externalizing behavioral problems during school-age years.

Still considering chronic risk and adversity and their influence on child behavior, we highlight the study by Wang, Christ, Mills-Koonce, Garrett-Peters, and Cox ( 2013 ), who found associations between externalizing problems among 4- to 12-year-old children and the use of more rigid control and low maternal educational levels. The study by Bouvette-Turcot et al. ( 2017 ) reports that exposure to more adversity and low family income during childhood was associated with the development of depressive symptoms in adulthood.

When addressing behavioral problems, one issue that arises refers to the source of assessments, considering that children and adolescents may present problems in a specific context but not in another, for instance, family versus school, indicating a need to obtain assessments from multiple informants, especially from parents or legal guardians and teachers (Martoni, Trevisan, Dias, & Seabra, 2016 ; Miller, Martinez, Shumka, & Baker, 2014 ). In this direction, some studies draw attention to the low to moderate level of agreement obtained between informants and to the relevance of such information to implementing clinical practices intended to address specific contexts in which children present problems (De Los Reyes et al., 2015 ; Martel, Markon, & Smith, 2017 ). Despite disagreement among the various informants, different observers provide different perspectives of the same problem (Miller et al., 2014 ). Each observer, though, can provide potentially valuable data in regard to the same patient (De Los Reyes, Thomas, Goodman, & Kundey, 2013 ; Clark, Durbin, Hicks, Iacono, & McGue, 2017 ), taking into consideration different contexts.

With school-aged children in mind, mothers and teachers have a privileged opportunity to observe the behavior of children, since the family and school are the primary contexts of development where competence in specific tasks inherent to this period is acquired (Achenbach et al., 2008 ), as previously mentioned. Some studies addressing the behavior of children according to the assessments of parents and teachers highlight the discrepancy between such assessments. Johnson, Hollis, Marlow, Simms, and Wolke ( 2014 ) used the Strengths and Difficulties Questionnaire (SDQ) to assess 219 children aged 11 years old who were born prematurely. The authors verified that the parents considered their children to present more emotional, attention, and relationship problems compared to the assessments provided by teachers. The informants agreed only in regard to the assessment of problems related to hyperactivity, which indicates the importance of using combined assessments. Kovess et al. ( 2015 ) conducted a study with 9084 children between 6 and 9 years of age, from seven countries (Italy, the Netherlands, Germany, Romania, Bulgaria, Lithuania, and Turkey), in which both teachers and parents were informants. The objective was to identify risks to the mental health of students. They verified that the teachers found the children to present more externalizing problems and fewer internalizing problems when compared to the parents’ assessments.

Even though assessments provided by multiple informants are considered relevant, the literature still lacks data. This study seeks to fill this gap and is intended to produce new data concerning the behavior of school children assessed by mothers and teachers, considering conditions in which children live with maternal depression and other adversities. Therefore, this study is intended to fill the gaps pointed out by De Los Reyes et al. ( 2015 ) concerning the need for further research using the assessments of multiple informants and addressing the specifics of contexts in which behavioral problems manifest, as a way to improve understanding regarding such problems, focusing on maternal depression. According to Goodman et al. ( 2011 ), there is a need for studies focusing on the multiple adversities presented in the family environment, taking into account the influence of maternal mental health when assessing the behavior of children, as indicated by Leis et al. ( 2014 ).

Therefore, the objective was to identify the behavioral profile of school children and associations between the evaluation of mothers and teachers, identifying the level of agreement among the informants. In addition, we aimed to evaluate the predictive effect of indicators concerning social vulnerability, chronic adversity, and maternal depression on behavioral problems presented by school children, according to the perspectives of mothers and teachers, considering the presence or absence of difficulties in both family and school contexts. The hypothesis guiding this study was that social vulnerability, chronic adversity, and maternal depression predict more frequent behavioral problems among school children in both developmental contexts, family and school, assessed by mothers and teachers, respectively.

A cross-sectional, correlational, predictive, comparative design was adopted using data obtained with different techniques from different sources, namely mothers, teachers, and children. The study was approved by the Institutional Review Board (no. 36415514.5.0000.5407) and complied with the ethical recommendations proposed by the Declaration of Helsinki.

Participants

A total of 85 mother-child pairs and 16 teachers from a public school located in the state of São Paulo, Brazil, took part in this study. The participants were assigned to three groups, according to the children’s indicators of behavioral problems assessed by their mothers and teachers, namely G1 = 18 children with behavioral problems according to their mothers and teachers, G2 = 39 children with behavioral problems according to their mothers or teachers, and G3 = 28 children without behavioral problems according to their mothers and teachers.

According to the inclusion criteria, mothers were aged between 25 and 45 years old, 34.5 years old on average (SD = 5.51), and all were literate. The children were aged between 7 and 10 years old, 8.8 years old on average (SD = 1.06) and were homogeneously distributed into three groups. In regard to the children’s sex, 39 were girls and 46 were boys, making a balanced distribution according to sex impossible: G1 presented significantly more boys than girls when compared to the G2 and G3 ( p  = 0.05; p  = 0.02, respectively). In order to assess the weight of this variable for the presence or absence of behavioral problems among children, as assessed by both their mothers and their teachers, an ordinal regression analysis was performed considering the sex of the children, which revealed a model that did not present the minimum criteria regarding slope homogeneity [chi-square (1) = 5.285; p  = 0.022; D (1) = 5.524; p  = 0.019], that is, it is not a model that fits data under analysis.

The inclusion criteria are that the children live with their biological mothers, rather than adoptive mothers, and have attended at least 1 year of primary school. Institutionalized children or those with apparent physical or mental disabilities were excluded. The assessment of children was initiated after consent was obtained from their mothers, and only one child per family was included in the study. In regard to the teachers, only those who had had at least 3 months of contact with the children and taught the children whose mothers explicitly consented to the assessment of their children at school were included. In accordance with the principles of good research practices, the participation of mothers and teachers was voluntary, without incentive payment mechanisms that stimulated the involvement with the research. A lecture was offered to the school on the behavior and learning of school children.

Instruments

Raven’s colored progressive matrices (raven).

The Raven is an instrument standardized by Angelini, Alves, Custódio, Duarte, and Duarte ( 1999 ), to assess the intellectual level of Brazilian children between 5 and 11 years old. It is a psychological test of non-verbal intelligence; the objective of which is to assess one’s analogical reasoning as a general factor, composed of three series: A, AB, and B, each with 12 problems. It presents good psychometric qualities, inferred by construct validity, internal consistency, with item-total correlation between 0.30 and 0.80 for most items, as well as precision, inter-item coefficient of correlation for the total sample equal to 0.92 (Angelini et al., 1999 ). Children presenting potential cognitive deficits, who presented percentiles lower than 25, were excluded from the study (Muniz, Gomes, & Pasian, 2016 ), balancing groups according to the percentiles obtained by the children.

Patient Health Questionnaire-9 (PHQ-9)

The PHQ-9 is a module directly based on the diagnostic criteria for major depression disorder from the DSM-IV, proposed and validated by Spitzer, Kroenke, and Williams ( 1999 ) and by Kroenke, Spitzer, and Williams ( 2001 ). The questionnaire enables both screening for signs and symptoms of current major depression, as well as classifying levels of severity, from mild to moderate or severe; the greater the score, the more indicators of problems the individual presents. It is composed of nine items assessed by an ordinal scale that measures the frequency of signs and symptoms of depression in the last 2 weeks. According to the instrument’s technical instructions, the total score was used so that scores greater than or equal to 10 indicate the presence of depressive symptoms, while scores lower than 10 indicate an absence of such symptoms. The Brazilian version used in this study was translated by Pfizer (Copyright  © 2005 Pfizer Inc., New York, NY), the reliability of which was verified by Osório, Mendes, Crippa, and Loureiro ( 2009 ), presenting satisfactory psychometric indicators.

Strengths and Difficulties Questionnaire (SDQ)

The SDQ was developed by Goodman ( 1997 ) and is intended to assess the behavior of children and adolescents, aged between 4 and 16 years old, by screening their behavioral strengths and difficulties. There is a version for children and adolescents between 11 and 16 years of age, a version for parents, and another for teachers. The SDQ is composed of 25 items subdivided into five subscales: emotional symptoms, conduct problems, hyperactivity, peer relationship problems, and pro-social behavior, with five items each. It provides raw scores and cutoff points for each of the subscales, as well as a total score for difficulty that is obtained by totaling the four behavioral problem scales. Scores are classified as normal, borderline, and abnormal. It was translated to Portuguese and adapted for Brazilian sociocultural characteristics by Fleitlich, Cortázar, and Goodman ( 2000 ), while psychometric data, concerning validity and reliability, were described by Woerner et al. ( 2004 ), presenting good indicators. In this study, based on individual scores and cutoff points established for the Brazilian population, we considered the outcome variable for children classified as normal or borderline, according to the SDQ, to be “without difficulties,” while those who were classified as abnormal to be “with difficulties.” These outcomes were grouped with the assessments performed by the mothers and teachers, according to the distribution in the groups.

Chronic Adversity Scale (CAS)

The CAS was proposed by Marturano ( 1999 ) and is intended to identify recurrent adverse events that may have taken place in a child’s life and happened repeated times or lasted 1 year or longer. It is composed of 18 items addressing issues concerning chronic adversity regarding the child’s or the parents’ health, parents’ temperament, and potential family or marital conflicts. The scale is completed by the mothers based on a list of adverse conditions that may have developed in the lives of children since birth, specifying the duration in years and the child’s period of life at the time. Each item is scored either 0 (absence of recurrence or chronic nature of the event in the child’s life) or 1 (the event was recurrent or has a chronic nature); the sum of all 18 items results in the total score, which is used to identify the existence of chronic events.

General Questionnaire

This questionnaire addresses sociodemographic data and specific information concerning the mothers’ age, marital status, and educational level; the families’ monthly income and socioeconomic status; and the age, sex, and education of the children included in the study. The items from the Brazil Economic Classification Criteria, developed by the Brazilian Association of Survey Companies ( 2015 ), were used to assess socioeconomic conditions. Such information was used to characterize the participants and groups, as well as to identify social vulnerability indicators, including low maternal and paternal education, single-parent families, low socioeconomic status, and low family income, as well as being recipients of governmental financial support.

Data collection procedures

Preferably, data were collected at school in a private room, or in the families’ homes when requested by the mothers, in which case we sought to preserve the respondents’ privacy and convenience. All interviews were held by the first researcher, who is a psychologist and properly trained in the application of instruments.

Initially, 427 families received an invitation letter, which was delivered to the children in their classrooms. The 260 families who responded to the invitation were contacted by phone with the objective to provide clarification about the study’s objectives and schedule an assessment. A total of 154 families accepted the invitation to cooperate with the study, but nine of these were excluded because the grandmothers were the primary caregivers of these families’ children. Of the 145 mothers scheduled for assessment, 43 did not attend the interviews, resulting in 102 families. Seventeen of these did not meet the inclusion criteria: adolescent mothers or mothers older than 45 years of age, children exclusively living with their fathers, and children with characteristics that were not homogeneous with those presented by the groups. Thus, a total of 85 mother-child pairs were included and assessed.

Of the 427 families initially invited to participate in this research, 316 refused to collaborate with the survey and 26 were excluded because they did not meet the inclusion criteria.

The instruments were individually and in-person applied to mothers in a single section according to the following order: General Questionnaire, PHQ-9, CAS, and SDQ, with an average duration of 60 min. The researcher read the instruments and checked the responses while the mothers had a copy of the instruments to accompany the reading. This procedure was adopted to deal with potential difficulties or fatigue that the reading could produce in the mothers, given their level of education or potential depressive symptoms, though the mothers presented a minimum level of literacy that enabled them to understand the questions posed by the instruments.

The children were assessed at school in individual sessions that lasted an average of 15 min. After briefly establishing rapport, the Raven’s Colored Progressive Matrices was applied. The three groups were compared according to the percentiles children obtained in order to balance the groups in regard to this variable. Note that there were no significant statistical differences between them in regard to the children’s cognitive performances (G1: \( \overline{x} \)  = 75.1; σ  = 19.12; G2: \( \overline{x} \)  = 76.0; σ  = 13.44; G3: \( \overline{x} \)  = 66.9; σ  = 14.97).

The 16 teachers collectively completed the SDQ, focusing on the behavior of 85 children who had been previously assessed by their mothers, at the regular time scheduled for a meeting concerning collective teaching work. Each teacher was supposed to assess up to five students per meeting, with an average duration of 50 min and approximately 10 min per child. The teachers filled in the questionnaire, and the researcher remained in the room during the assessment to clarify potential doubts.

Data treatment and analysis

The PHQ-9, Raven, SDQ, and CAS were coded according to the purpose of each instrument. The assessments concerning the behaviors of children performed by the mothers and teachers using the SDQ were used as distinct sources in paired samples, in order to assign the participants to one of the three groups.

Coded data were typed in an Excel® spreadsheet and checked by independent reviewers. The statistical analyses were performed using IBM SPSS Statistics (v. 23; IBM SPSS, Chicago, IL), and a significance level of 0.05 was adopted.

The reliability of the PHQ-9 was verified for this sample using Cronbach’s alpha, which presented good psychometric quality ( α  = 0.87). The reliability of the SDQ ( n  = 85) for the totality of items regarding difficulties was based on the mothers’ ( α  = 0.77) and teachers’ answers ( α  = 0.89), as well as items of the pro-social behavior scale answered by mothers ( α  = 0.71) and teachers.

Normality tests (Kolmogorov-Smirnov, with Lilliefors significance correlation, and Shapiro-Wilk) were performed to guide decision-making regarding the statistical tests used for each set of variables.

The behavioral profile of children, obtained through the assessments of mothers and teachers and represented by the raw scores obtained on the scales addressing problems and pro-social resources and the total scale of difficulties in the SDQ, was analyzed using descriptive and comparative statistics by means of the Wilcoxon test. Indicators of the presence and absence of behavioral problems among children, assessed by the mothers and teachers using the SDQ, were compared using the McNemar test. Inter-observer agreement was also verified using the Kappa coefficient, while the criterion proposed by Landis and Koch ( 1977 ) was adopted.

The sociodemographic data and profiles of social vulnerability and chronic adversity were analyzed using descriptive statistics, while the groups were compared using chi-square and Kruskal-Wallis tests. After the univariate analysis, the predictive effect of cumulative adverse conditions on school children’s behavioral problems was assessed using ordinal regression analysis (Maroco, 2014 ), adopting criteria proposed by Field ( 2013 ) for the inclusion of predictive variables.

The weight of contextual adverse cumulative variables for the children’s behavioral problems was tested using ordinal regression analysis based on the significant variables identified in the comparison between groups. The predictive variables were included in the model (family income, mother’s education, and maternal depression were included as factors, and the score of chronic adversity was included as a covariant), independently tested, and combined with the sex of children, because the distribution of children in the groups according to sex was not homogeneous. Additionally, the contextual variables of cumulative risk were jointly tested in a multivariate model.

The analysis of the social vulnerability indicators (income and maternal education) and maternal depression, in one analysis disregarding the sex of children and then one considering the sex of children, showed that the models did not fit the data. The analysis of the models that included chronic adversity, as a single variable or associated with the sex of children, revealed statistically significant models, with very small effect sizes, in which independent variables did not predict the behavioral outcome among children, thus did not present relevant results. Afterwards, the multivariate model including maternal depression, social vulnerability indicators, and chronic adversity was tested and presented goodness of fit and is the model presented here.

Based on the objectives proposed, the results are presented taking into account the analyses concerning the children’s behavioral profiles according to the assessments of mothers and teachers as distinct sources, comparisons between G1, G2, and G3 regarding profile of social vulnerability, maternal depression, and chronic adversity, as well as the predictive effect of significant variables on the children’s behavioral problems assessed by mothers and professors, as combined sources of information.

The children’s behavioral profiles

Table  1 presents the behavioral profiles of the children assessed, according to the SDQ, by mothers and teachers as two different sources, adopting the presence or absence of behavioral problems verified by the SDQ and total difficulties as the outcome of the development of school children.

Significant statistical differences were found when comparing mothers and teachers in regard to the four specific scales of difficulties and total difficulties. Note that the mothers considered their children to present more emotional symptoms, conduct problems, hyperactivity, peer relationship problems, and total difficulties than the teachers. In regard to pro-social behavior, no statistically significant differences were found in regard to the comparisons between mothers and teachers.

In regard to the level of agreement obtained between assessments (mothers and teachers), note that reasonable agreement levels were found for conduct problems (kappa = 0.29 p  = 0.003) and total behavioral problems (kappa = 0.21; p  = 0.007), in addition to minimum indexes for hyperactivity (kappa = 0.19; p  = 0.035).

Similarly, the same differences were found for continuous scores. The means of the mothers were greater than those presented by the teachers for the total difficulties score (mothers: \( \overline{x} \)  = 17.5; σ  = 6.98; teachers: \( \overline{x} \)  = 9.33; σ  = 7.28; p  <  0.001) and for the four scales concerning symptoms: emotional symptoms (mothers: \( \overline{x} \)  = 3.19; σ  = 2.52; teachers: \( \overline{x} \)  = 2.26; σ  = 1.89; p  <  0.001), conduct problems (mothers: \( \overline{x} \)  = 3.32; σ  = 2.56; teachers: \( \overline{x} \)  = 1.59; σ  = 2.23; p  < 0.001), hyperactivity (mothers: \( \overline{x} \)  = 6.79; σ  = 2.76; teachers: \( \overline{x} \)  = 4.04; σ  = 3.23; p  < 0.001), and peer relationships (mothers: \( \overline{x} \)  = 2.20; σ  = 2.20; teachers: \( \overline{x} \)  = 1.42; σ  = 1.90; p  < 0.001).

The profiles of families in terms of vulnerability and risk variables

Table  2 presents comparisons concerning social vulnerability, maternal depression, and chronic adversities presented in the family context of children according to their distribution in the three groups.

Statistically significant differences were found between G1, G2, and G3 in regard to maternal education, family income, maternal depression, and chronic adversity. The comparison concerning maternal education revealed significant differences between G1 and G3 ( χ 2  = 5.660, p  = 0.017) and between G2 and G3 ( χ 2  = 12.075, p  < 0.001). Significant differences were also found in terms of family income between G1 and G2 ( χ 2  = 4.349, p  < 0.037) and between G1 and G3 ( χ 2  = 5.841, p  = 0.016). No differences were found between groups in terms of paternal education, marital status, socioeconomic status, or receiving governmental financial aid. Considering the variable maternal depression, however, statistically significant differences were found between G1 and G2 ( χ 2  = 13.876, p  < 0.000) and between G1 and G3 ( χ 2  = 22.489, p  < 0.001). G1 was the group in which mothers more frequently presented current symptoms of depression in comparison to the other two groups, while no differences were found between G2 and G3.

Comparisons concerning chronic adversities revealed significant differences between G2 and G3 ( F  = 363.000, p  = 0.016), but no differences were found between G1 and G2 or between G1 and G3.

The predictive effect of adverse cumulative variables on child behavior

Table  3 presents the weight of adverse cumulative contextual variables on child behavior, including data concerning coefficients and significance of the adjusted ordinal model.

Data suggest that the adjusted model is significantly better than the null model [ G 2 (4) = 24,792, p  < 0.001). Additionally, the multivariate model was statistically significant [chi-square (58) = 50,367, p  = 0.752; D (58) = 57,402, p  = 0.497] and showed moderate effect size (R 2 MF = 0.253; R 2 N = 0.288; R 2 CS = 0.139). According to the model, children are more likely to present behavioral problems when their mothers present indicators of depression, according to the assessments of both mothers and teachers ( b  = 1.955, p  = 0.001).

This study was intended to verify associations between indicators of social vulnerability, chronic adversity, and maternal depression, and the weight of such associations, with behavioral problems among school children, as assessed by their mothers and teachers. In this study, mothers and teachers were considered distinct sources of information, and the information they provided on the children’s behaviors was combined considering the presence or absence of difficulties manifested in the two developmental contexts of family and school. The hypothesis guiding this study that social vulnerabilities, chronic adversity, and maternal depression impact behavioral problems among school children was partially confirmed, as data analysis revealed peculiarities regarding such variables, which deserve to be highlighted.

The assessments of the children’s behavior from the perspectives of mothers and teachers in general showed that mothers identified more behavioral problems in children than did the teachers. This finding is in agreement with those reported in the studies conducted by De Los Reyes et al. ( 2015 ) and Martel et al. ( 2017 ), which indicate low to moderate agreement among informants. In this same direction, Clark et al. ( 2017 ) consider that agreement between assessments of parents, teachers, and children is rarely high, however, emphasizing that varied information enriches the understanding of the associations between academic conditions, personality, psychosocial functioning, behavioral aspects, mental health, and social adjustment of school children. According to the mothers’ assessments, a larger number of children experienced difficulties concerning emotional symptoms, while the teachers identified a larger number of children with externalizing problems expressed through conduct problems and hyperactivity. Such results are similar to those reported by Kovess et al. ( 2015 ), who note that externalizing problems are more visible to teachers than internalizing problems.

Analysis of this discrepancy between assessments should take into account that the interaction of mothers and teachers with children occurs in contexts that exhibit different demands, in addition to the fact that observers are guided by different criteria. In the family context, mothers have a more detailed picture of their children’s behavior due to the large range of daily situations, which are not always structured (Leis et al., 2014 ). In the case of the mothers, the parameter is one specific child. In the classroom, in contrast, teachers have more structured situations to assess children and the teachers’ references include comparing the behavior of a set of children with similar demographic parameters. In this sense, when the assessments of mothers and teachers were combined, we accessed a larger set of information concerning the behavior of children, focusing on aspects of contextual comparisons and individual and collective parameters, as proposed by Miller et al. ( 2014 ) and De Los Reyes et al. ( 2015 ).

The literature has recognized the relevance of assessments performed by teachers; however, few studies address behavioral difficulties of children using multiple informants and combined data as a strategy to identify the presence of problems in more than one context of life. The predominance of the mother as the only informant may compromise the results of assessments, especially when a mother presents a psychopathological disorder (Leis et al., 2014 ), such as depression. Such a disorder may influence the individual’s perception of child behavior, and avoiding this influence justifies the use of distinct and combined sources of information. Therefore, we note that one of the contributions of this study, in addition to including multiple informants, is the combined analysis of children’s behavioral outcomes, which enabled verifying problems in two contexts, family and school, to estimate how many children face these sorts of difficulties, information that is relevant for practices in the mental health field.

Another aspect to be analyzed involves social vulnerability, which was assessed considering different social and economic factors, among which are low maternal educational level and income. These are relevant social determinants associated with the presence of behavioral problems among children, according to the assessments by mothers and/or children, indicating aspects to be considered when planning preventive practices. Note that these findings are consistent with those reported by Correia et al. ( 2014 ), who identified association between child behavioral problems and low socioeconomic status and low maternal educational level, indicating a potential profile of cumulative vulnerability favoring behavioral problems among children. Families with low socioeconomic status generally have high rates of divorce, unemployment, and a larger number of members, while parents with a high socioeconomic level have a higher educational level and invest more in their children’s education (Carneiro, Meghir, & Parey, 2013 ; Piccolo et al., 2012 ).

The associations between mental health conditions and vulnerability indicators have been widely recognized by the World Health Organization (WHO, 2017a , 2017b ), which highlights low schooling, lower income, worse material and economic conditions, and less social support, as possible determinants that negatively influence health mental health of adults and children, favoring the accumulation of vulnerability and risk conditions. This developmental scenario focuses on the relevance of the present study, which encompasses diverse and competing contextual variables that influence children’s developmental outcomes in the perception of different informants.

The presence of current depressive symptoms among the mothers was associated with behavioral problems among the children, as indicated by the mothers and/or teachers, characterizing problems in two contexts, family and school. Such an association was also verified by Leis et al. ( 2014 ) and Conners-Burrow et al. ( 2016 ), who noted an increase in behavioral problems among children who had early experience with maternal depression. In this sense, when we considered the behavior of children from the perspectives of mothers and teachers together, we verified that, regardless of the informant, children living with maternal depression more frequently experienced behavioral problems, including in the school context, characterizing the need for specific mental health practices directed to this group, which was identified as the most vulnerable.

The presence of chronic adversities was also verified to identify variables with a potential negative impact on school-aged children. This study reveals that children facing behavioral difficulties, according to the combined assessments of mothers and teachers, lived in family environments that presented more chronic adversities, indicating cumulative and recurrent adversity in these children’s contexts of life. These findings corroborate the study conducted by Hildebrand et al. ( 2015 ), who identified an association of two or more risk factors for more than half of the sample under study.

The identification of differences among groups, especially for children facing problems in the family and school contexts (G1) in regard to social vulnerability, current maternal depression, and chronic adversity, characterizes a group that requires greater attention, as it is exposed to multiple risks. This information highlights the relevance of investigating the presence of cumulative risk in the family context to understand developmental outcomes among children (Evans et al., 2013 ; Goodman et al., 2011 ).

In regard to the identification of the predictive effect of cumulative risk variables and vulnerability, as potential predictors of behavioral problems among children, only maternal depression appears as an explanatory variable for the presence of behavioral problems among children in the context of multiple adverse conditions. These findings are in agreement with Bagner et al. ( 2010 ), who stress that living with maternal depression increases a child’s likelihood of presenting externalizing and internalizing behavioral problems up to the age of 12 years old. Therefore, maternal depression was the only adverse condition with the power to predict the behavioral problem outcome, confirming the relevance of considering such a variable when addressing child behavior, especially considering the high prevalence of depression among women of childbearing age (World Health Organization [WHO], 2017a , 2017b ).

As the positive aspects of this study, we highlight the presence of multiple informants, the methodological care adopted in the systematic assessment of the participants, and the use of validated instruments, in addition to the inclusion of diverse variables to identify, in the same sample, vulnerability indicators that potentially impact the behavior of school children. It is highlighted as the main strength of the study the inclusion of children in the groups considering the presence or absence of behavioral problems in the two main development contexts for the school period, namely, family and school, thus highlighting relevant variables associated with vulnerability and to developmental resources in both contexts, which may favor preventive care and target groups with potential risks.

This study’s limitations include the sample size, lack of a homogeneous distribution between groups in regard to the sex of children, and the identification of depressive symptoms using a screening instrument, which limit the generalization of results. Further studies adopting longitudinal designs, considering the influence of contextual risks over the course of a child’s development, including other sources of information, in addition to the reports of mothers, are needed, as well as observational measures. The relevance of inclusion in new studies of parents’/stepfathers’ evaluations, as well as studies that address the characteristics of the various family configurations in which children are inserted as conditions that can influence the behavior of the school-aged children, is also highlighted. Another relevant point to be considered in new studies is the inclusion of variables that may function as protective factors, which in a cumulative way to vulnerability and risk conditions may favor a more complete and complex analysis of the mechanisms that favor or hinder children’s behavioral problems.

Conclusions

In this study, low maternal educational level, low family income, the presence of more chronic adversity, and living with current maternal depression are factors associated with the outcome of behavioral problems among children in both family and school contexts, showing the importance of including such factors in assessment protocols intended to address the mental health of school-aged children. Note, however, that among these indicators, current maternal depression emerged as the most relevant variable in comparison to the remaining adversities analyzed here. Therefore, this condition requires specific care when implementing mental health actions.

Finally, these results can contribute to and have implications for the planning of mental health programs, confirming the relevance of identifying maternal depressive symptoms and multiple adversities, including social vulnerability indicators as conditions or events that demand attention.

Achenbach, T. M., Becker, A., Döpfner, M., Heiervang, E., Roessner, V., Steinhausen, H.-C., & Rothenberger, A. (2008). Multicultural assessment of child and adolescent psychopathology with ASEBA and SDQ instruments: Research findings, applications, and future directions. Journal of Child Psychology and Psychiatry , 49 (3), 251–275. https://doi.org/10.1111/j.1469-7610.2007.01867.x .

PubMed   Google Scholar  

Achenbach, T. M., Ivanova, M. Y., Rescorla, L. A., Turner, L. V., & Althoff, R. R. (2016). Internalizing/externalizing problems: Review and recommendations for clinical and research applications. Journal of the American Academy of Child & Adolescent Psychiatry , 55 (8), 647–656. https://doi.org/10.1016/j.jaac.2016.05.012 .

Google Scholar  

Angelini, A. L., Alves, I. C., Custódio, E. M., Duarte, W. F., & Duarte, J. L. (1999). Manual das Matrizes Progressivas Coloridas de Raven: escala especial. Manual . São Paulo: Centro Editor de Testes e Pesquisas em Psicologia.

Associação Brasileira de Empresas de Pesquisa. (2015). Critério Padrão de Classificação Econômica Brasil. Recuperado de http://www.abep.org/ .

Bagner, D. M., Pettit, J. W., Lewinsohn, P. M., & Seeley, J. R. (2010). Effect of maternal depression on child behavior: A sensitive period? Journal of the American Academy of Child & Adolescent Psychiatry , 49 (7), 699–707. https://doi.org/10.1016/j.jaac.2010.03.012 .

Barker, E. D., Copeland, W., Maughan, B., Jaffee, S. R., & Uher, R. (2012). The relative impact of maternal depression and associated risk factors on offspring psychopathology. The British Journal of Psychiatry , 200 (2), 124–129. https://doi.org/10.1192/bjp.bp.111.092346 .

PubMed   PubMed Central   Google Scholar  

Bele, S. D., Bodhare, T. N., Valsangkar, S., & Saraf, A. (2013). An epidemiological study of emotional and behavioral disorders among children in an urban slum. Psychology, Health & Medicine , 18 (2), 223–232. https://doi.org/10.1080/13548506.2012.701751 .

Bouvette-Turcot, A.-A., Unternaehrer, E., Gaudreau, H., Lydon, J. E., Steiner, M., & Meaney, M. J. (2017). The joint contribution of maternal history of early adversity and adulthood depression to socioeconomic status and potential relevance for offspring development. Journal of Affective Disorders , 207 , 26–31. https://doi.org/10.1016/j.jad.2016.08.012 .

Callender, K. A., Olson, S. L., Choe, D. E., & Sameroff, A. J. (2012). The effects of parental depressive symptoms, appraisals, and physical punishment on later child externalizing behavior. Journal of Abnormal Child Psychology , 40 (3), 471–483. https://doi.org/10.1007/s10802-011-9572-9 .

Carneiro, P., Meghir, C., & Parey, M. (2013). Maternal education, home environments, and the development of children and adolescents. Journal of the European Economic Association , 1 , 123–160. https://doi.org/10.1111/j.1542-4774.2012.01096.x .

Clark, D. A., Durbin, C. E., Hicks, B. M., Iacono, W. G., & McGue, M. (2017). Personality in the age of industry: Structure, heritability, and correlates of personality in middle childhood from the perspective of parents, teachers, and children. Journal of Research in Personality , 67 , 132–143. https://doi.org/10.1016/j.jrp.2016.06.013 .

Conners-Burrow, N. A., McKelvey, L., Perry, D., Whiteside-Mansell, L., Kraleti, S., Mesman, G., … Kyzer, A. (2016). Low-level symptoms of depression in mothers of young children are associated with behavior problems in middle childhood. Maternal and Child Health Journal , 20 (3), 516–524. https://doi.org/10.1007/s10995-015-1849-0 .

Correia, S. K. B., Saur, A. M., & Loureiro, S. R. (2014). Behavior of school children stratified by birth weight and gestational age. Psicologia: Teoria e Pesquisa , 30 (2), 179–188. https://doi.org/10.1590/S0102-37722014000200007 .

De Los Reyes, A., Augenstein, T. M., Wang, M., Thomas, S. A., Drabick, D. A., Burgers, D. E., & Rabinowitz, J. (2015). The validity of the multi-informant approach to assessing child and adolescent mental health. Psychological Bulletin , 141 (4), 858–900. https://doi.org/10.1037/a0038498 .

Duncombe, M. E., Havighurst, S. S., Holland, K. A., & Frankling, E. J. (2012). The contribution of parenting practices and parent emotion factors in children at risk for disruptive behavior disorders. Child Psychiatry & Human Development , 43 (5), 715–733. https://doi.org/10.1007/s10578-012-0290-5 .

Edwards, R. C., & Hans, S. L. (2015). Infant risk factors associated with internalizing, externalizing, and co-occurring behavior problems in young children. Developmental Psychology , 51 (4), 489. https://doi.org/10.1037/a0038800 .

Evans, G. W., Li, D., & Whipple, S. S. (2013). Cumulative risk and child development. Psychological Bulletin , 139 (6), 1342–1396. https://doi.org/10.1037/a0031808 .

Field, A. (2013). Discovering statistics using IBM SPSS Statistics. 4th edition. SAGE Publications, London. ISBN 978-1-4462-4971-8.

Fleitlich, B. W., Cortázar, P. G., & Goodman, R. (2000). Questionário de Capacidades e Dificuldades (SDQ). Infanto - Revista de Neuropsiquiatria da Infância e da Adolescência , 8 (1), 44–50.

Goodman, R. (1997). The strengths and difficulties questionnaire: a research note. Journal of Child Psychology and Psychiatry, 38, 581–586. https://doi.org/10.1111/j.1469-7610.1997.tb01545.x .

Goodman, S. H., Rouse, M. H., Connell, A. M., Broth, M. R., Hall, C. M., & Heyward, D. (2011). Maternal depression and child psychopathology: A meta-analytic review. Clinical Child and Family Psychology Review , 14 (1), 1–27. https://doi.org/10.1007/s10567-010-0080-1 .

Hildebrand, N. A., Celeri, E. H. R. V., Morcillo, A. M., & Zanolli, M. D. L. (2015). Domestic violence and risk for mental health in childhood and adolescence. Psicologia: Reflexão e Crítica , 28 (2), 213–221. https://doi.org/10.1590/1678-7153.201528201 .

Johnson, S., Hollis, C., Marlow, N., Simms, V., & Wolke, D. (2014). Screening for childhood mental health disorders using the Strengths and Difficulties Questionnaire: The validity of multi-informant reports. Developmental Medicine & Child Neurology , 56 (5), 453–459. https://doi.org/10.1111/dmcn.12360 .

Kessler, R. C. (2012). The costs of depression. The Psychiatric Clinics of North America , 35 (1), 1–14. https://doi.org/10.1016/j.psc.2011.11.005 .

Kovess, V., Carta, M. G., Pez, O., Bitfoi, A., Koç, C., Goelitz, D., … Otten, R. (2015). The school children mental health in Europe (SCMHE) project: Design and first results. Clinical Practice & Epidemiology in Mental Health , 11 (1), 113–123. https://doi.org/10.2174/1745017901511010113 .

Kroenke, K., Spitser, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine , 16 (9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x .

Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159–174. https://doi.org/10.2307/2529310 .

Leis, J. A., Heron, J., Stuart, E. A., & Mendelson, T. (2014). Associations between maternal mental health and child emotional and behavioral problems: Does prenatal mental health matter? Journal of Abnormal Child Psychology , 42 (1), 161–171. https://doi.org/10.1007/s10802-013-9766-4 .

Linhares, M. B. M., & Martins, C. B. S. (2015). The self-regulation process on child development. Estudos de Psicologia (Campinas) , 32 (2), 281–293. https://doi.org/10.1590/0103-166X2015000200012 .

Loosli, L., Pizeta, F. A., & Loureiro, S. R. (2016). School-age children who live with recurrent maternal depression: Differences between the sexes. Psicologia: Teoria e Pesquisa , 32 (3), 1–10. https://doi.org/10.1590/0102-3772e32322 .

De Los Reyes, A., Thomas, S. A., Goodman, K. L., & Kundey, S. M. (2013). Principles underlying the use of multiple informants’ reports. Annual Review of Clinical Psychology , 9 , 123–149 Recuperado de https://pdfs.semanticscholar.org/4508/6bb381dbf14491e656a95f0d6f57e635adfc.pdf .

Macana, E. C., & Comim, F. (2015). O papel das práticas e estilos parentais no desenvolvimento da primeira infância. In G. A. Pluciennik, M. C. Larazzari, & M. F. Chicaro (Eds.), Fundamentos da família como promotora do desenvolvimento infantil: parentalidade em foco , (pp. 34–47). São Paulo: Fundação Maria Cecília Souto Vidigal Recuperado de http://agendaprimeirainfancia.org.br/arquivos/Fundamentos_Familia.pdf .

Maroco, J. (2014). Análise estatística com o SPSS Statistics . Pêro Pinheiro: Report Number.

Martel, M. M., Markon, K., & Smith, G. T. (2017). Research review: Multi-informant integration in child and adolescent psychopathology diagnosis. Journal of Child Psychology and Psychiatry , 58 (2), 116–128. https://doi.org/10.1111/jcpp.12611 .

Martoni, A. T., Trevisan, B. T., Dias, N. M., & Seabra, A. G. (2016). Funções executivas: relação entre relatos de pais, de professores e desempenho de crianças. Temas em Psicologia , 24 (1), 173–188. https://doi.org/10.9788/TP2016.1-12 .

Marturano, E. M. (1999). Recursos no ambiente familiar e dificuldades de aprendizagem na escola. Psicologia: Teoria e Pesquisa , 15 (2), 135–142 Recuperado de http://dx.doi.org/10.1590/S0102-37721999000200006 .

Marturano, E. M. (2013). A criança, a família, a escola e a transição para o ensino fundamental. In E. C. Konkiewitz (Ed.), Aprendizagem, comportamento e emoções na infância e adolescência: uma visão transdisciplinar , (pp. 47–68). Dourados: UFGD.

Miller, L. D., Martinez, Y. J., Shumka, E., & Baker, H. (2014). Multiple informant agreement of child, parent, and teacher ratings of child anxiety within community samples. The Canadian Journal of Psychiatry , 59 (1), 34–39. https://doi.org/10.1177/070674371405900107 .

Muniz, M., Gomes, C. M. A., & Pasian, S. R. (2016). Factor structure of Raven’s Coloured Progressive Matrices. Psico-USF , 21 (2), 259–272. https://doi.org/10.1590/1413-82712016210204 .

Osório, F. L., Mendes, A. V., Crippa, J. A., & Loureiro, S. R. (2009). Study of the discriminative validity of the PHQ-9 and PHQ-2 in a sample of Brazilian women in the context of primary health care. Perspectives in Psychiatric Care , 45 (3), 216–227. https://doi.org/10.1111/j.1744-6163.2009.00224.x .

Piccolo, L. R., Falceto, O. G., Fernandes, C. L., Levandowski, D. C., Grassi-Oliveira, R., & Salles, J. F. (2012). Psychosocial variables and reading performance of children with low socioeconomic status. Psicologia: Teoria e Pesquisa , 28 (4). https://doi.org/10.1590/S0102-37722012000400004 .

Pizato, E. C. G., Marturano, E. M., & Fontaine, A. M. G. V. (2014). Trajectories of social skills and behavior problems in primary school: Influence of early childhood education. Psicologia: Reflexão e Crítica , 27 (1), 189–197. https://doi.org/10.1590/S0102-79722014000100021 .

Pizeta, F. A., Silva, T. B. F., Cartafina, M. I. B., & Loureiro, S. R. (2013). Maternal depression and risks for children s behavior and mental health: A review. Estudos de Psicologia (Natal) , 18 (3), 429–437. https://doi.org/10.1590/S1413-294X2013000300003 .

Saur, A. M., & Loureiro, S. R. (2015). Mental health of small children for normal gestational age: A cohort study from Southeastern Brazil. Psicologia: Reflexão e Crítica , 28 (1), 204–212. https://doi.org/10.1590/1678-7153.201528122 .

Spitzer, R. L., Kroenke, K., & Williams, J.B.W. (1999). The Patient Health Questionnaire Primary Care Study Group, Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Journal of American Medicine Association, 282(18), 1737–1744. https://doi.org/10.1001/jama.282.18.1737 .

Walsh, F. (2016). Processos normativos da família: diversidade e complexidade . Porto Alegre: Artmed.

Wang, F., Christ, S. L., Mills-Koonce, W. R., Garrett-Peters, P., & Cox, M. J. (2013). Association between maternal sensitivity and externalizing behavior from preschool to preadolescence. Journal of Applied Developmental Psychology , 34 (2), 89–100. https://doi.org/10.1016/j.appdev.2012.11.003 .

Woerner, W., Fleitlich-Bilyk, B., Martinussen, R., Fletcher, J., Cucchiaro, G., Dalgalarrondo, P., … Tannock, R. (2004). The Strengths and Difficulties Questionnaire overseas: Evaluations and applications of the SDQ beyond Europe. European Child & Adolescent Psychiatry , 13 (2), 47–54. https://doi.org/10.1007/s00787-004-2008-0 .

World Health Organization [WHO]. (2017a). Depression and other common mental disordes: global health estimates. World Health Organization . Recuperado de http://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf;jsessionid=D941E8D6BCD7068FF960F8ACF5312F39?sequence=1 . Accessed Jan 2018

World Health Organization [WHO]. (2017b). Policy options on mental health . Recuperado de http://apps.who.int/iris/bitstream/10665/259406/1/9789241513296-eng.pdf?ua=1 . Accessed Jan 2018

Download references

Acknowledgements

Not applicable in this section

To the development of this research, we counted on the financial support of the National Council for Scientific and Technological Development (CNPq/Brazil) under number 307394/2014-0.

Availability of data and materials

All data necessary to understand the results and analyses presented are found throughout the manuscript, and no additional files were submitted.

Author information

Authors and affiliations.

Universidade de São Paulo (USP), Rua Tenente Catão Roxo, 2650, Ribeirão Preto, SP, CEP: 14051-140, Brazil

Ana Karina Braguim Martineli, Fernanda Aguiar Pizeta & Sonia Regina Loureiro

You can also search for this author in PubMed   Google Scholar

Contributions

All authors contributed to the preparation of this manuscript, approved the submission of their current version, and show their agreement with the publication fee, which will be charged if the manuscript obtains final acceptance. All authors contributed to the conceptualization of the research, to the formal analysis. The first author has a master’s degree and was responsible for data collection.

Corresponding author

Correspondence to Ana Karina Braguim Martineli .

Ethics declarations

Ethics approval and consent to participate.

All the ethical aspects described by the Helsinki Declaration were considered in this manuscript and during the data collection, all the participants signed a consent term, and the study was approved by the Research Ethics Committee of the Faculty of Philosophy, Sciences and Letters of Ribeirão Preto (USP) under number 36415514.5.0000.5407.

Consent for publication

The manuscript was not submitted to another journal, and everyone involved in this research agreed that the work was submitted for publication. If the article is accepted for publication, the copyright will be transferred to Psychology: Reflection and Critical.

Competing interests

The authors declare that they have no competing interests and that this manuscript was not submitted for publication to any other periodical or means of publication.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and permissions

About this article

Cite this article.

Martineli, A.K.B., Pizeta, F.A. & Loureiro, S.R. Behavioral problems of school children: impact of social vulnerability, chronic adversity, and maternal depression. Psicol. Refl. Crít. 31 , 11 (2018). https://doi.org/10.1186/s41155-018-0089-9

Download citation

Received : 20 July 2017

Accepted : 02 March 2018

Published : 04 June 2018

DOI : https://doi.org/10.1186/s41155-018-0089-9

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• School children
• Adversities
• Maternal depression
• Social vulnerability

• Share full article

Advertisement

Supported by

current events conversation

What Students Are Saying About Why School Absences Have ‘Exploded’

Chronic absenteeism has increased in American schools since the Covid-19 pandemic. We asked teenagers what they make of the trend.

By The Learning Network

Nationally, an estimated 26 percent of public school students were considered chronically absent last school year, up from 15 percent before the Covid-19 pandemic, according to the most recent data, from 40 states and Washington, D.C., compiled by the conservative-leaning American Enterprise Institute.

The increases have occurred in districts big and small, and across income and race.

In “​ Why School Absences Have ‘Exploded’ Almost Everywhere ,” Sarah Mervosh and Francesca Paris explain:

The trends suggest that something fundamental has shifted in American childhood and the culture of school, in ways that may be long lasting. What was once a deeply ingrained habit — wake up, catch the bus, report to class — is now something far more tenuous. “Our relationship with school became optional,” said Katie Rosanbalm, a psychologist and associate research professor with the Center for Child and Family Policy at Duke University.

In a related Student Opinion question , we asked teenagers if that explanation resonated with them. Had their relationship to school — and school attendance — changed since the pandemic? And if so, what did they make of this shift?

Many students said, yes, school feels different now. Why? They pointed to remote learning changing their routines, an increase in anxiety and a decrease in motivation, the ease of making up schoolwork online and much more. Read their responses in full below.

Thank you to everyone who participated in the conversation on our writing prompts this week, including students from Central Bucks South High School in Warrington, Pa .; Norwood High School in Norwood, Mass.; and West Salem High School in Salem, Ore.

Please note: Student comments have been lightly edited for length, but otherwise appear as they were originally submitted.

Remote learning made students comfortable with missing school.

I believe that there are two main contributors to missing school too much. The first is online school. Myself included. It was very easy to simply leave the call after taking attendance and the teacher wouldn’t realize. Skipping class was easy and you could still get high grades. Transitioning back to real school, kids still held that true. They knew that they could miss school and still do well because covid taught that to them. The second reason is punishment. When you miss school, nothing happens. Class goes on and you have a little extra homework the next day but that’s it. What is the issue with missing class is a very common thought and it’s true. There is very minimal downside to missing school. When I had surgery, I missed a full week of school and within a day and a half, I was fully caught up again. Missing school has just become all too easy.

— Xavier, Pennsylvania

2020 was when our lives completely changed for the worst. We all had to stay inside and stay separate from each other. It was terrible, not being able to talk to my friends, and seeing the death toll on news constantly rise. However, after a year into the pandemic, I believe students realized the power they now had, including me. Now that I am a highschooler, I am going to admit that sometimes I would just mute my class and do whatever I wanted. School became shorter and easier to pass than ever before. That’s why when we all transitioned back into school, it was weird. We all still wanted to get through class the “easy way,” yet now that we were back, it wasn’t possible. This is why we started increasing our absences. The threat of absence has become weak, students are not as afraid to stay out of school. Furthermore the threat of being infected gave just one more reason to be out of school, for the sake of “preventing others from getting sick,” when in reality you feel fine. That is most likely why the absences in school had an exponential increase.

— Joshua, Pennsylvania

Students feel like expectations are lower than they were before the pandemic.

As a student in high school, I’ve come to realize the horrible state our attendance has been in since the pandemic. The reason can be simplified into one idea: laziness. We are lazy, willing to do only enough to get by, no more, no less. If a student doesn’t need to come to a class to obtain the grade they wish to achieve, then they won’t show up. Classes are not challenging enough to make students feel that they are worth going to. My mom is used to getting texts from me during the school day, begging to be excused from a class where “we’re doing nothing” or, “I already finished the work,” which is true, yet I abuse the opportunity to miss class because I know there will be no greater coincidence, I will still be getting an A. Due to my laziness, I would rather be at home taking a nap than sitting in a class with no greater impact on my life.

— Clara, Salem, Oregon

Since the pandemic, schooling has been focused on getting students caught up to where we’re supposed to be. Consequently, more allowances are made for students who don’t do assignments or don’t even show up. And with the switch to all online because of the pandemic, things have never shifted back. If a student misses a day or even a week, they can easily see what they missed and do it and submit it from home. With this option giving them the exact same grade as it would if they actually went to school, it’s no wonder why students are choosing to stay at home or skipping class. Additionally, the pandemic had heightened anxiety levels in students, specifically social anxiety, making them less likely to show up. The allowances made by the school district for students has created a space for students to be lazy and get away with it. This is fostering a negative impact on student work ethic not only now, but also in the future when this generation will be entering the work force.

— Emma, West Salem High School

The period of school shutdowns got students out of their school routines.

When I think back to virtual learning, my brain automatically goes to how stress free it was. I was in sixth grade when Covid first hit and going through a period of my life where I was extremely anxious at school. I believe that this break is exactly what I needed at the time. However, I do believe that in the long run, this online learning time period got a lot of people into the routine of not having a routine. A lot of people at my school would turn their camera off and fall asleep or go on their phones during online learning. I believe that there were times that I did this as well. I also think that this mindset carried through into the grades where I did not have an online/hybrid option. In eighth and ninth grade, I happened to stay home sick, go into school late, or leave early a lot. I think this is due to me not taking school as seriously due to the grading methods that were being used and how some of my teachers were not grading harshly. Now that I am a sophomore in high school, I think I have finally gotten back into the routine of actual schooling and not staying home sick unless I actually feel extremely sick.

— Madison, Pennsylvania

Before the pandemic and as I was growing up, I was the kind of student that wanted perfect attendance. For some odd reason, it made me feel like a better student if I never missed a day. This included turning my parents down when they offered me to go on trips, even though I was only in fourth grade and the work that I would have missed wouldn’t have made an impact in my academic career. However, after the pandemic school began to feel optional. We felt what it was like to fall out of the routine that going to school was and were never able to fully recover from it. I think that having experienced attending school from your bed, in your pajamas has played a major role in the current trend of students receiving more absences. For me, it made me realize that the “0” next to your number of absences didn’t matter as much as I had once thought. As a now highschooler, the school days are long and every class requires an abundance of work and undivided attention that whenever there is a substitute or not much going on, it is easy to decide to leave school. With senior year approaching, everything’s purpose is college and the fact that colleges aren’t able to see how many absences a student has when they apply, does play a role in the increasing number of absences.

— Ava, Miami Country Day School

Because assignments and other materials are online, students find they can keep up with their classes even if they don’t attend school.

Schools have adjusted rules so much that it makes school feel optional. Don’t want to attend class publicly? Take online classes. Don’t want to take “required” state testing? Opt out. Before, school seemed strict, we didn’t have the option to opt out of tests, we didn’t think of taking online school. Yet now, schools make it so easy to skip because everything is simply online. Our assignments, lectures, and teachers are all online. There are no longer requirements in school. What’s the point of attending if we can graduate without taking state testing or attending advisory — also a requirement, yet I no longer have an advisory because my counselors said I don’t need to take it to graduate. It’s confusing. Students have been enabled for over 4 years now since quarantine started. School doesn’t feel mandatory, it’s optional. I’m currently enrolled into 2 AP classes, so I try my best not to miss school. But it’s inevitable, I get sick, I have family situations or maybe I simply don’t feel like attending school. But I see people skip school like nothing. “I didn’t feel like going” is a constant statement I hear. Not many students have the motivation to attend, and simply don’t go because they have a comfort in their head that they can graduate while missing multiple days of school nearly everyday.

— Olivia, Salem, OR

Current absenteeism rates have significantly impacted my learning experience for the past few years. Since the pandemic, there has been a noticeable shift in the perception of the value of education and whether or not attendance is an important factor in a student’s academic success. In the years following 2020, I found myself struggling to make it to class everyday due to my new found efficiency of working at home with my computer. I felt that even if I was not in class personally, I would be able to keep up with my work easily as it was all online regardless. Due to this I would go on trips or skip class purely because I was under the impression that I would be able to continue achieving virtually.

— Ruby, RFHS

Before the pandemic, my attendance was stable but after the pandemic, my absences were piling on. It was difficult to get back in the rhythm of in person school when I had already done a whole year online, but now my attendance in school is definitely getting better. On the other hand, students in my school tend to miss school and it is a rare sight to see a full class. Some students go as far as showing up to class once a week and just do the classwork online. After the pandemic, schools went from paperwork to all online, which is a big reason why students miss all the time, knowing that school work can just be done at home. It has definitely affected students’ grades and goals in life, but hopefully in the future, absences can lower back down.

— Emily, Atrisco Heritage Academy High School

Going to school, and finding the motivation to have as good an attendance record as possible, now feels like more of a struggle.

As students, we’ve developed a comfort in staying in bed during school without having to get ourselves ready to go outside. We had the ability to wake up five minutes before “school” started to get on our zoom calls. Now, we must wake up an hour and a half prior, and make breakfast and pack lunch, before driving to school. The process is tenuous as the article states, but because we’ve accustomed to a different lifestyle, it just makes this one seem like so much more work. I, myself have noticed my difference in attendance after COVID-19. I used to be very obsessed with perfect attendance, but I had 11 absences in my sophomore year, right after coming back from online school. Nowadays, I’m more lenient on myself when it comes to taking a mental health day, because the process can be overwhelming. School is very important, so of course I try to always come in, but sometimes it can be hard. I have not noticed this trend in the world, as well as with myself until this article. It’s enlightening to know that this had not only an effect on me, but all over the country. Hopefully the rates of absenteeism will decrease as time goes on, because we are the future.

— Anisha, New Jersey

Before virtual learning, I never made much of a habit of not turning in work or showing up for class. It was so much easier then but since virtual learning, it had become incredibly difficult for me to focus as well as keep up motivation to continue school. It was easy to skip and nobody really said much about it so it easily became a bad habit. That bad habit eventually leaked into normal school as well and it always sounds so much easier to break out of than it actually is.

— Tayy, NRHS

As the average high school class skipper (only sometimes), in my personal experience, missing out on classes hasn’t really been because of mental health concerns, but more of just lasting laziness from the pandemic. I feel as though I was relatively hard working in middle school/elementary but after a few years off with only half effort assignments, I have grown to become more sluggish and reluctant when it comes to more advanced work while in school. And it makes the option of missing out on classes because of my own reluctance a lot more appealing.

— Luke, Bali, Indonesia

My schedule during the week is get up, get ready for school, go to school, go home, do homework, go to sleep and then I repeat that everyday for 5 days. As much as I don’t want to dread going to school, it’s exhausting having the same schedule repeated everyday of the week. While in school, you have assignments assigned nearly everyday. I feel as though school has had a change in its meaning because of the COVID-19 pandemic. While in quarantine, we were looking at a screen for the whole day and lacked motivation to get assignments done. When we shifted to in person school again, it didn’t change. I now look at school as a task that I need to complete to shape my future. I need to have all my assignments perfect and turned in on time. The meaning of school has turned into a draining task rather than a place that you look forward to going to.

— Jamisan, Salem, Oregon

Some students face challenges in attending class that may have nothing to do with the pandemic.

I don’t believe that students are skipping because it is so easy to catch up and pass, despite their absences. In fact, I know that a lot of people who skip aren’t passing most of their classes. They do this because their parents don’t hold them accountable, and there is always something deeper going on in that student’s life that makes it that much harder for them to find the motivation to go to class. I don’t think making the classes harder will hold students more accountable, but in fact deter them from going to class at all. If a student is aware that they are failing and doesn’t understand the concept of the class, and the class proceeds to become harder, they are going to quickly become unmotivated to go to class in the first place, feeling out of place compared to the other — passing — students in the class. While I don’t have a solution for this problem, myself, I feel that the problem is much broader than we suspect, and the answer will be a much deeper journey to find.

— Kylie, West Salem HS

Schools can do more to get students back in class.

I attend a French school in London and attendance is closely monitored. Absences have to be justified by your parents or you could get into trouble. I think it’s important to attend school as we did before Covid - because as well as learning the curriculum, it is crucial to socialise with your friends and classmates, which is good for your mental health … I wonder if social media could be a factor? If students did not have access to social media or the internet, would they prefer to be in school with their friends? This increase in absenteeism could affect students’ chances of getting into University when they come to finish school or even their opportunities later in life. Students need to be reminded of this more and more perhaps. School helps you to learn not just about facts but also helps to build your emotional quotient & social intelligence — which are all valuable for life.

— Alexandre 14, London

As a current high school junior, my experiences with skipping have been minimal at best, however, I feel strongly that the reason behind skipping is pretty simple. Students don’t care as much about school and the system encourages it. When faced with the choice of sitting in a class and learning about the Patagorian theorem or hanging out with friends, many students are now choosing the latter. The lack of care or effort being put forth in school doesn’t even affect their grades! This is due to certain classes having minimal grades set at 50%, which is 10% away from a pass. This system is actively encouraging people to put minimal effort into a class just to get a pass and graduate. Removing courses like this would certainly raise the importance of getting the work done. Another solution to this problem would be having attendance as a grade, if your grade depends on you being in classes then most would show up. If you have to show up to class to pass then more students would be inclined to do so. The emphasis is on not bending the knee to people who don’t want to show up to class, not giving them a minimal 50%, we should mark attendance for a passing grade, and letting them fail. If we keep letting students skip with minimal consequences then their attitudes won’t change and thus hinder our students’ growth.

— Henry, Salem, OR

Learn more about Current Events Conversation here and find all of our posts in this column .

Read our research on: Gun Policy | International Conflict | Election 2024

Regions & Countries

What’s it like to be a teacher in america today, public k-12 teachers are stressed about their jobs and few are optimistic about the future of education; many say poverty, absenteeism and mental health are major problems at their school.

Pew Research Center conducted this study to better understand the views and experiences of public K-12 school teachers. The analysis in this report is based on an online survey of 2,531 U.S. public K-12 teachers conducted from Oct. 17 to Nov. 14, 2023. The teachers surveyed are members of RAND’s American Teacher Panel, a nationally representative panel of public K-12 school teachers recruited through MDR Education. Survey data is weighted to state and national teacher characteristics to account for differences in sampling and response to ensure they are representative of the target population.

Here are the questions used for this report , along with responses, and the survey methodology .

Low-poverty , medium-poverty and high-poverty schools are based on the percentage of students eligible for free and reduced-price lunch, as reported by the National Center for Education Statistics (less than 40%, 40%-59% and 60% or more, respectively).

Secondary schools include both middle schools and high schools.

All references to party affiliation include those who lean toward that party. Republicans include those who identify as Republicans and those who say they lean toward the Republican Party. Democrats include those who identify as Democrats and those who say they lean toward the Democratic Party.

Public K-12 schools in the United States face a host of challenges these days – from teacher shortages to the lingering effects of COVID-19 learning loss to political battles over curriculum .

In the midst of all this, teachers express low levels of satisfaction with their jobs. In fact, they’re much less satisfied than U.S. workers overall.

Here’s how public K-12 teachers are feeling about their jobs:

• 77% say their job is frequently stressful.
• 68% say it’s overwhelming.
• 70% say their school is understaffed.
• 52% say they would not advise a young person starting out today to become a teacher.

When it comes to how their students are doing in school, teachers are relatively downbeat about both academic performance and behavior.

Here’s how public K-12 teachers rate academic performance and behavior at their school:

• 48% say the academic performance of most students at their school is fair or poor. A third say it’s good, and only 17% describe it as excellent or very good.
• 49% say the behavior of most students at their school is fair or poor; 35% say it’s good and 13% say it’s excellent or very good.

The COVID-19 pandemic likely compounded these issues. About eight-in-ten teachers (among those who have been teaching for at least a year) say the lasting impact of the pandemic on students’ behavior, academic performance and emotional well-being has been very or somewhat negative.

Assessments of student performance and behavior differ widely by school poverty level. 1 Teachers in high-poverty schools have a much more negative outlook. But feelings of stress and dissatisfaction among teachers are fairly universal, regardless of where they teach.

Related: What Public K-12 Teachers Want Americans To Know About Teaching

As they navigate these challenges, teachers don’t feel they’re getting the support or reinforcement they need from parents.

Majorities of teachers say parents are doing too little when it comes to holding their children accountable if they misbehave in school, helping them with their schoolwork and ensuring their attendance.

Teachers in high- and medium-poverty schools are more likely than those in low-poverty schools to say parents are doing too little in each of these areas.

These findings are based on a survey of 2,531 U.S. public K-12 teachers conducted Oct. 17-Nov. 14, 2023, using the RAND American Teacher Panel. 2 The survey looks at the following aspects of teachers’ experiences:

• Teachers’ job satisfaction (Chapter 1)
• How teachers manage their workload (Chapter 2)
• Problems students are facing at public K-12 schools (Chapter 3)
• Challenges in the classroom (Chapter 4)
• Teachers’ views of parent involvement (Chapter 5)
• Teachers’ views on the state of public K-12 education (Chapter 6)

Problems students are facing

We asked teachers about some of the challenges students at their school are facing. Three problems topped the list:

• Poverty (53% say this is a major problem among students who attend their school)
• Chronic absenteeism (49%)
• Anxiety and depression (48%)

Chronic absenteeism (that is, students missing a substantial number of school days) is a particular challenge at high schools, with 61% of high school teachers saying this is a major problem where they teach. By comparison, 46% of middle school teachers and 43% of elementary school teachers say the same.

Anxiety and depression are viewed as a more serious problem at the secondary school level: 69% of high school teachers and 57% of middle school teachers say this is a major problem among their students, compared with 29% of elementary school teachers.

Fewer teachers (20%) view bullying as a major problem at their school, though the share is significantly higher among middle school teachers (34%).

A look inside the classroom

We also asked teachers how things are going in their classroom and specifically about some of the issues that may get in the way of teaching.

• 47% of teachers say students showing little or no interest in learning is a major problem in their classroom. The share rises to 58% among high school teachers.
• 33% say students being distracted by their cellphones is a major problem. This is particularly an issue for high school teachers, with 72% saying this is a major problem.
• About one-in-five teachers say students getting up and walking around when they’re not supposed to and being disrespectful toward them (21% each) are major problems. Teachers in elementary and middle schools are more likely than those in high schools to see these as challenges.

A majority of teachers (68%) say they’ve experienced verbal abuse from a student – such as being yelled at or threatened. Some 21% say this happens at least a few times a month.

Physical violence is less common. Even so, 40% of teachers say a student has been violent toward them , with 9% saying this happens at least a few times a month.

About two-thirds of teachers (66%) say that the current discipline practices at their school are very or somewhat mild. Only 2% say the discipline practices at their school are very or somewhat harsh, while 31% say they are neither harsh nor mild. Most teachers (67%) say teachers themselves don’t have enough influence in determining discipline practices at their school.

Behavioral issues and mental health challenges

In addition to their teaching duties, a majority of teachers (58%) say they have to address behavioral issues in their classroom every day. About three-in-ten teachers (28%) say they have to help students with mental health challenges daily.

In each of these areas, elementary and middle school teachers are more likely than those at the high school level to say they do these things on a daily basis.

And teachers in high-poverty schools are more likely than those in medium- and low-poverty schools to say they deal with these issues each day.

Cellphone policies and enforcement

Most teachers (82%) say their school or district has policies regarding cellphone use in the classroom.

Of those, 56% say these policies are at least somewhat easy to enforce, 30% say they’re difficult to enforce, and 14% say they’re neither easy nor difficult to enforce.

Experiences with cellphone policies vary widely across school levels. High school teachers (60%) are much more likely than middle school (30%) and elementary school teachers (12%) to say the policies are difficult to enforce (among those who say their school or district has a cellphone policy).

How teachers are experiencing their jobs

Thinking about the various aspects of their jobs, teachers are most satisfied with their relationship with other teachers at their school (71% are extremely or very satisfied).

They’re least satisfied with how much they’re paid – only 15% are extremely or very satisfied with their pay, while 51% are not too or not at all satisfied.

Among teachers who don’t plan to retire or stop working this year, 29% say it’s at least somewhat likely they will look for a new job in the 2023-24 school year. Within that group, 40% say they would look for a job outside of education, 29% say they’d seek a non-teaching job in education, and only 18% say they’d look for a teaching job at another public K-12 school.

Do teachers find their work fulfilling and enjoyable?

Overall, 56% of teachers say they find their job to be fulfilling extremely often or often; 53% say their job is enjoyable. These are significantly lower than the shares who say their job is frequently stressful (77%) or overwhelming (68%).

Positive experiences are more common among newer teachers. Two-thirds of those who’ve been teaching less than six years say their work is fulfilling extremely often or often, and 62% of this group says their work is frequently enjoyable.

Teachers with longer tenures are somewhat less likely to feel this way. For example, 48% of those who’ve been teaching for six to 10 years say their work is frequently enjoyable.

Balancing the workload

Most teachers (84%) say there’s not enough time during their regular work hours to do tasks like grading, lesson planning, paperwork and answering work emails.

Among those who feel this way, 81% say simply having too much work is a major reason.

Many also point to having to spend time helping students outside the classroom, performing non-teaching duties like lunch duty, and covering other teachers’ classrooms as at least minor reasons they don’t have enough time to get all their work done.

A majority of teachers (54%) say it’s very or somewhat difficult for them to balance work and their personal life. About one-in-four (26%) say it’s very or somewhat easy for them to balance these things, and 20% say it’s neither easy nor difficult.

Among teachers, women are more likely than men to say work-life balance is difficult for them (57% vs. 43%). Women teachers are also more likely to say they often find their job stressful or overwhelming.

How teachers view the education system

A large majority of teachers (82%) say the overall state of public K-12 education has gotten worse in the past five years.

And very few are optimistic about the next five years: Only 20% of teachers say public K-12 education will be a lot or somewhat better five years from now. A narrow majority (53%) say it will be worse.

Among teachers who think things have gotten worse in recent years, majorities say the current political climate (60%) and the lasting effects of the COVID-19 pandemic (57%) are major reasons. A sizable share (46%) also point to changes in the availability of funding and resources.

Related:  About half of Americans say public K-12 education is going in the wrong direction

Which political party do teachers trust more to deal with educational challenges?

On balance, more teachers say they trust the Democratic Party than say they trust the Republican Party to do a better job handling key issues facing the K-12 education system. But three-in-ten or more across the following issues say they don’t trust either party:

• Shaping school curriculum (42% say they trust neither party)
• Ensuring teachers have adequate pay and benefits (35%)
• Making schools safer (35%)
• Ensuring adequate funding for schools (33%)
• Ensuring all students have equal access to high-quality K-12 education (31%)

A majority of public K-12 teachers (58%) identify or lean toward the Democratic Party. This is higher than the share among the general public (47%).

• Poverty levels are based on the percentage of students in the school who are eligible for free and reduced-price lunch. ↩
• For details, refer to the Methodology section of the report. ↩
• Urban, suburban and rural schools are based on the location of the school as reported by the National Center for Education Statistics (rural includes town). Definitions match those used by the U.S. Census Bureau. ↩

Social Trends Monthly Newsletter

Sign up to to receive a monthly digest of the Center's latest research on the attitudes and behaviors of Americans in key realms of daily life

Report Materials

Table of contents, ‘back to school’ means anytime from late july to after labor day, depending on where in the u.s. you live, among many u.s. children, reading for fun has become less common, federal data shows, most european students learn english in school, for u.s. teens today, summer means more schooling and less leisure time than in the past, about one-in-six u.s. teachers work second jobs – and not just in the summer, most popular.

About Pew Research Center Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping the world. It conducts public opinion polling, demographic research, media content analysis and other empirical social science research. Pew Research Center does not take policy positions. It is a subsidiary of The Pew Charitable Trusts .

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Institute of Medicine (US) Committee on Comprehensive School Health Programs in Grades K-12; Allensworth D, Lawson E, Nicholson L, et al., editors. Schools & Health: Our Nation's Investment. Washington (DC): National Academies Press (US); 1997.

Schools & Health: Our Nation's Investment.

• Hardcopy Version at National Academies Press

6 Challenges in School Health Research and Evaluation

• Overview Of Research And Evaluation

One of the primary arguments for establishing comprehensive school health programs (CSHPs) has been that they will improve students' academic performance and therefore improve the employability and productivity of our future adult citizens. Another argument relates to public health impact—since one-third of the Healthy People 2000 objectives can be directly attained or significantly influenced through the schools, CSHPs are seen as a means to reduce not only morbidity and mortality but also health care expenditures. It is likely that the future of CSHPs will be determined by the degree to which they are able to demonstrate a significant impact on educational and/or health outcomes.

Evaluation of any health promotion program poses numerous challenges such as measurement validity, respondent bias, attrition, and statistical power. The situation is even more challenging for CSHPs, for several reasons. First, these programs comprise multiple, interactive components, such as classroom, family, and community interventions, each employing multiple intervention strategies. Therefore, it is often difficult to determine which intervention components and specific messages, activities, and services are responsible for observed treatment effects. Second, given the broad scope of CSHPs, it is difficult to determine what the realistic outcomes should be, and measuring these outcomes in school-age children (be it the actual behavior or precursors such as communication skills) is often problematic, especially when outcomes have to do with such sensitive matters as drug use or sexual behavior. Finally, though some aspects of a CSHP (e.g., classroom curricula) can be replicated, many aspects of the CSHP (e.g., staffing patterns, local norms, and community resources) differ across schools, cities, states, and regions. Consequently, the results of even the most rigorous evaluations may not be generalizable to other settings.

This chapter examines these and other issues related to the evaluation of CSHPs. First, general principles of research and evaluation, as applied to school health programs, are reviewed. Then the challenges and difficulties associated with research and evaluation of comprehensive, multi-component programs are examined. Finally, the difficulties and uncertainties related to research and evaluation of even a single, relatively well-defined component of comprehensive programs—the health education component—are be considered. The committee felt that it was appropriate to focus on health education in this chapter, because of the relative maturity of research in this area. Specific aspects of health education research have been chosen that highlight challenges in evaluating school-based interventions, as well as in interpreting ambiguous, if not conflicting, results relevant to other components of the comprehensive program. Discussion of the research and evaluation of other components of CSHPs—health services, nutrition or foodservices, physical education, and so forth—is found in the general discussion of these components in earlier chapters.

Types of School Health Research

Research and evaluation of comprehensive school health programs can be divided into three categories: basic research, outcome evaluation, and process evaluation.

Basic Research

An ultimate goal of CSHPs is to influence behavior. Basic research in CSHPs involves inquiry into the fundamental determinants of behavior as well as mechanisms of behavior change. Basic research includes examination of factors thought to influence health behavior—such as peer norms, self-efficacy, legal factors, health knowledge, and parental attitudes—as well as specific behavior change strategies. Basic research often employs epidemiologic strategies, such as cross-sectional or longitudinal analyses, as well as pilot intervention studies designed to isolate specific behavior change strategies, although often on a smaller scale than full outcome trials. A primary function of basic behavioral research is to inform the development of interventions, whose effects can then be tested in outcome evaluation trials.

Outcome Evaluation

Outcome evaluation includes empirical examination of the impact of interventions on targeted outcomes. Possible outcomes (or dependent variables) include health knowledge, attitudes, skills, behaviors, biologic measures, morbidity, mortality, and cost-effectiveness. Interventions (or independent variables) include specific health education curricula, teaching strategies, organizational change, environmental change, or health service delivery models. This type of evaluation in its most basic form resembles the randomized clinical trial with experimental and control groups, along with the requisite null hypothesis assumptions and concern for internal and external validity. Outcome evaluation can further be divided into three stages: efficacy, effectiveness, and implementation effectiveness trials (Flay, 1986).

Efficacy . Efficacy testing involves the evaluation of an intervention under ideal, controlled implementation conditions. During this stage, for example, teachers may be paid to ensure that they implement a health curriculum, or other motivational strategies may be used to ensure fidelity. The goal of efficacy testing is to determine the potential effect of an intervention, with less concern for feasibility or replicability. In drug study parlance, during this stage of research efforts are made to ensure that the ''drug" is taken so that biologic effects, or lack thereof, can be attributed to the drug rather than to degree of compliance.

Effectiveness . In effectiveness trials, interventions are implemented under real-world circumstances with the associated variations in implementation and participant exposure. Effectiveness trials help determine if interventions can reliably be used under real-world conditions and the extent to which effects observed under efficacy conditions are reproduced in natural settings. Some programs, despite being efficacious, may not be effective if they are difficult to implement or are not accepted by staff or students. Effectiveness research is of particular concern because the results of efficacy testing and, to a lesser extent, of effectiveness trials may not always be generalizable to the real world.

Implementation Effectiveness . In implementation effectiveness trials, variations in implementation methods are manipulated experimentally and outcomes are measured (Flay, 1986). For example, the outcomes can be compared when a CSHP is implemented with or without a school coordinator or when a health education program is implemented by peers rather than adults.

Process Evaluation

Once an intervention has demonstrated adequate evidence for efficacy and effectiveness, it can be assumed that replications of the intervention will yield effects similar to those observed in prior outcomes research trials. The validity of this assumption is enhanced when multiple effectiveness trials have been successfully conducted under varying conditions and the intervention is delivered with fidelity in a setting and with a target population similar to those used in the initial testing.

It is at this point that process evaluation becomes the desired level of assessment. The goal of process evaluation is not to determine the basic impact of an intervention but rather to determine whether a proven intervention was properly implemented, and what factors may have contributed to the intervention's success or failure at the particular site. Implementation and/or participant exposure can be used as proxies for formal outcome evaluation. Key process evaluation strategies include implementation monitoring (e.g., teacher observation), quality assurance, and assessing consumer reactions (e.g., student, teacher, and parent response to the program).

Evaluation at this level may include some elements of outcome evaluation. Desired outcomes are often stated as objectives to be achieved by the program, which can be evaluated pre- and post-intervention, and may include a comparison group or references to normative data. Random selection and assignment of participants are typically not employed, however, and the level of rigor used to collect and analyze data is often less stringent than in formal outcome evaluation. This type of evaluation is sometimes referred to as program evaluation.

Although program evaluation can include rigorous design and analyses, in many real world program evaluations the assessment is often secondary to the intervention. Such interventions often do not bother with randomized design, control groups, or complex statistics. The evaluation is adapted to the intervention, rather than the inverse. For example, pragmatic issues, more than experimental design, often determine sample size and which sites are assigned to treatment or comparison conditions. In basic research and outcome evaluation on the other hand, evaluation is the principal reason that the intervention is being conducted; pragmatic issues often yield to methodologic concerns, and evaluation procedures largely are determined prior to initiating intervention activities.

Linking Outcome and Process Evaluations

Although outcome and process evaluation are described above as being sequential, the two often are conducted concurrently by linking process data to outcome data in order to determine causal pathways. One application of linking process and outcome data is the dose–response analysis—measuring the relationship between intervention dose and level of outcomes. For example, student behavioral outcomes can be examined relative to levels of teachers' curriculum implementation in a health education study or to students' level of clinic usage in a health services study. A positive dose–response relationship is seen as evidence for construct validity—that is, observed outcomes are attributed to the intervention rather than to other influences. Numerous health education studies have established a dose–response relationship between curriculum exposure and student outcomes (Connell et al., 1985; Parcel et al., 1991; Resnicow et al., 1992; Rohrbach et al., 1993; Taggart et al., 1990). Less is known about dose–response in other components of CSHPs.

Who Conducts the Research?

The various types of school health research are conducted by a diverse group of professionals. Basic research and outcome evaluation are typically conducted by doctoral-level professionals from university and freestanding research centers, often with funding from the federal government (though such studies also are supported by private foundations or corporations). Evaluating CSHPs at the level of basic research or outcome evaluation is largely beyond the fiscal and professional capacity of most local and even state education agencies. Process evaluation, on the other hand, can be conducted by local education agencies, perhaps in partnership with local public health agencies. Many models of CSHPs include an evaluation component, and it is important to delineate what type of evaluation schools and education agencies should reasonably be expected to conduct on the local level.

Although carried out by research professionals, basic research and outcome evaluation should not be abstract academic pursuits that are an end in themselves. Greater interaction is needed between researchers and those who actually implement programs. It would be desirable to stimulate and support research and evaluation alliances among colleges of education, schools of public health, and college of medicine. Bringing together the expertise from all three sectors in school health research and evaluation centers may enhance the understanding and interaction between these sectors and produce research and evaluation methods that can address cross-sector issues more accurately. This also will lead to developing programs that can be disseminated more easily and to reducing the number of researchers working in isolation.

Uses for Research and Evaluation

Basic research, outcome evaluation, and process evaluation are also conducted for different audiences and intentions. The first two are largely intended to build scientific knowledge and are generally published in the peer-reviewed literature. The latter generally is used to demonstrate feasibility of an intervention, as well as to document the facts that program implementation objectives were met and funds were properly spent. Such reports are typically requested by or intended for state education agencies, local education agencies, or funding sources that may have sponsored the local project. Local program evaluations of pilot programs also are used to justify expanding dissemination efforts.

All three types of evaluation can contribute to the development and dissemination of comprehensive school health programs, although it is important that they be applied in their proper sequence. Process evaluation studies are inappropriate for demonstrating intervention efficacy or measuring cost-effectiveness, just as basic research approaches may go beyond what is necessary for local program evaluation. To merit dissemination, programs should first undergo formal experimental efficacy and effectiveness testing; lower standards may result in adoption of suboptimal programs and ultimately impair the credibility of school health programs among their educational and public health constituencies (Ennett et al., 1994).

• Methodological Challenges

Although traditional experimental studies using control or comparison groups are appropriate for testing individual program components and specific intervention strategies, this may not be the case for the overall CSHP, which is a complex entity and varies from site to site. In a recent discussion of methods to evaluate such complex systems as CSHPs, Shaw (1995) proposed that the use of the classic experimental design to conduct outcome evaluations may be outmoded and inadequate for several reasons. First, the randomized clinical trial, with its tightly controlled and defined independent and dependent variables, cannot measure and capture large-scale, rapidly changing systems. Traditional experimental design ignores the need for timely formative descriptive data, maintains the artificial roles of the researcher as external expert and the subject as passive recipient of a defined treatment, and fails to recognize the complex nature of multifaceted programs that vary according to community needs.

Furthermore, there may be ethical dilemmas in randomly assigning students to treatment versus control groups when children's health and well-being are at stake.

It will be difficult—and possibly not feasible—to conduct traditional randomized trials on entire comprehensive programs. However, interventions associated with individual program components should be developed and tested by using rigorous methods that involve experimental and control groups, with the requisite concern for internal and external validity. In this section, some of the methodological challenges of demonstrating program impacts are examined.

Challenges in Assessing Validity

A goal of studying CSHPs at the level of efficacy testing is to measure the extent to which programs produce the desired outcomes (internal validity)—that is, to determine whether there is a causal relationship between the independent variable (CSHP) and defined outcomes such as knowledge, health practices, or health status.

Defining the Independent Variable

The first measurement challenge is the difficulty in defining the independent variable (the CSHP) or "treatment." Knapp (1995) has described this dilemma: "The 'independent variable' is elusive. It can be many different kinds of things, even within the same intervention; far from being a fixed treatment, as assessed by many research designs, the target of study is more often a menu of possibilities."

Ironically, the most successful programs—which are, in fact, comprehensive, multifaceted, interdisciplinary and well integrated into the community—may be the most difficult to define and segregate into components readily identifiable as the independent variable. It may be impossible, for example, to separate effects of the school from those of the community (Perry et al., 1992). This poses an important assessment dilemma. While it is vital that comprehensive programs be evaluated as a whole (Lopez and Weiss, 1994), it is unlikely that any individual program could be replicated in its entirety in a different community with its varying infrastructure, needs, and values. Thus, internal validity—the extent to which the effectiveness of the entire program is being accurately measured—may be high, but external validity—the extent to which the findings can be generalized and replicated beyond a single setting—is sacrificed.

Because of limited resources, one might wish to prioritize individual program components based on their relative efficacy. However, the overall effect of comprehensive programs may well be more than or different from the sum of its parts. Using a factorial design to examine the effects of individual components or combinations of components would require an unwieldy number of experimental conditions and large sample size. Thus, the independent variables in a CSHP not only may be difficult to define and measure, but it is unlikely that a consensus of what should comprise the intervention can or even should be reached.

Defining the Dependent Variable

In similar ways, defining the appropriate, feasible, and measurable outcomes (dependent variables) of a CSHP is equally challenging. Is it necessary to use change in health-related behaviors, such as smoking or drug use, to measure effectiveness of health education programs, or is the acquisition of knowledge and skills sufficient? If behavior change outside the school is required to declare effectiveness, this would seem to represent an educational double standard. For example, the quality and effectiveness of mathematics education are measured by determining mathematics knowledge and skills, using some sort of school-based assessment, not by determining whether the student actually balances a checkbook or accurately fills out an income tax form as an adult. Likewise, the quality of instruction in literature or political science is measured by the acquisition of knowledge, not by whether the student writes novels, reads poetry, votes, or becomes a contributing citizen.

Similarly, should appropriate outcomes for school health services be improved health status, behaviors, and long-term health outcomes, or is simply access to and utilization of services a sufficient end point? Is a reduction in absenteeism a proxy for improved health status and a reasonable indicator of health outcomes? Dependent variables used to measure effectiveness of school-linked health services have included linking students with no prior care to health services, decreased use of the emergency room for primary care, identification of previously unidentified health problems, access to and utilization of services by students and families, perceptions and health knowledge of students and their parents, decreasing involvement in risk behaviors, and health status indicators (Glick et al., 1995; Kisker et al., 1994; Lewin-VHI and Institute of Health Policy Studies, 1995). Some of these measures simply determine whether school services provide access and utilization, whereas other measures look for a change in health status and behavior. However, if improved health status and behaviors are declared to be the expectation for school health services, does this hold the school to higher standards than those of other health care providers?

The committee points out that, although influencing health behavior and health status are ultimate goals of CSHPs, such end points involve personal decisionmaking beyond the control of the school. Other factors—family, peers, community, and the media—exert tremendous influence on students, and schools should not bear total responsibility for students' health behavior and health status. Schools should be held accountable for conveying health knowledge, providing a health-promoting environment, and ensuring access to high-quality services; these are the reasonable outcomes for judging the merit of a CSHP. 1 Other outcomes—improved attendance, better cardiovascular fitness, less drug abuse, or fewer teen pregnancies, for example—may also be considered, but the committee believes that such measures must be interpreted with caution, since they are influenced by personal decisionmaking and factors beyond the control of the school. In particular, null or negative outcomes for these measures should not necessarily lead to declaring the CSHP a failure; rather, they may imply that other sources of influence on children and young people oppose and outweigh the influence of the CSHP.

Other Issues

In addition to the above difficulties, all of the potential biases and challenges inherent in any research also apply. Serious threats to validity in measuring effects of CSHP include:

• the Hawthorne effect—positive outcomes simply due to being part of an investigation, regardless of the nature of the intervention;
• self-reporting biases—responding with answers that are thought to be "correct" and socially desirable;
• Type III error—incorrectly concluding that an intervention is not effective, when in fact ineffectiveness is due to the incorrect implementation of the intervention.
• ensuring even and consistent distribution of the intervention;
• sorting out effects of confounding and extraneous variables;
• isolating effective ingredients of multifaceted programs;
• control groups that are not comparable;
• differential and selective attrition in longitudinal studies;
• inadequate reliability and validity of measurement tools; and
• vague or inadequate conceptualization of study variables.

Another problem in drawing conclusions from reported research is "reporting bias"—the fact that only positive findings tend to be reported in the literature while studies with negative or inconclusive results are not often published. It is also important to remember that results that are statistically significant may not always have educational and public health significance.

Challenges Related to Feasibility

The kinds of large-scale research studies necessary to assess long-term outcomes of CSHPs are extremely costly and require extensive coordination. Since such programs are usually implemented for entire schools, communities, regions, or states, a majority of the children who participate are at relatively low risk for a number of outcomes of potential relevance. In addition, often only small to moderate outcome effects are sought. Hence, sample size needs are large, particularly when the unit of measurement is the school or the community rather than the individual.

Once efficacy and effectiveness have been demonstrated, the problem of developing a feasible program evaluation plan is compounded by the lack of evaluation expertise at the local or regional level and the inadequate or incompatible information systems for collecting, analyzing, and disseminating information. Local planners often need assistance in selecting and implementing evaluation strategies and in identifying means to make existing data more useful. For school health education, there are numerous guidelines and evaluation manuals from the Centers for Disease Control and Prevention (CDC), the Department of Health and Human Service's Center for Substance Abuse Prevention at the Substance Abuse and Mental Health Services Administration, and the Educational Development Center, to help states develop an evaluation plan. The national evaluation plan for the Healthy Schools, Healthy Communities Program provides helpful information for the evaluation of school health services (Lewin-VHI and Institute of Health Policy Studies, 1995). This plan is facilitated by a standardized data collection system and marks the first time that health education and health services will be systematically analyzed with a management information system that records different types of health education interventions, utilization of health services, and outcomes.

• Challenges And Future Directions For School Health Education Research

Health education is one of the essential components of CSHPs. As described in earlier chapters, health instruction has taken place in schools for many years, and the field is reasonably well defined and developed compared to some of the other aspects of a CSHP. Health education research has been an active field, but considerable knowledge gaps exist and research findings are often ambiguous, unexpected, or sometimes seemingly contradictory. This section focuses on some of the challenges and unresolved questions in classroom health education and suggests issues that merit further study.

Effects of Comprehensive Health Education

The preponderance of school health education research has consisted of outcome evaluations focusing on categorical risk behavior, such as smoking, drug use, sexual behavior, and nutrition. A few notable studies have examined several risk behaviors simultaneously—such as nutrition, physical activity, and smoking—as risk reduction interventions for cardiovascular disease or cancer (Luepker et al., 1996; Resnicow et al., 1991) or have looked at efforts to prevent drug, alcohol, and tobacco abuse (Pentz, 1989a), but there have been very few studies that evaluate comprehensive, multitopic health education programs (Connell et al., 1985; Errecart et al., 1991). The lack of evaluation studies of comprehensive health education is to a large extent the result of how school health research has been funded at the federal level. Generally, health concerns are divided into categorical areas for research and demonstration funding; the result is that funding agencies are interested in funding only research and development projects that address their particular disease area of responsibility. There is a scarcity of hard data about the potential impact of overall comprehensive classroom health education programs. Only a few commercially available multitopic school health curricula have been evaluated to test their effectiveness (e.g., the Know Your Body program). Some of these either are old and or have not made use of the methods demonstrated to be effective in categorical research and demonstration projects, which means that schools are faced with adopting programs that have not been evaluated or attempting to piece together evaluated programs.

How Much Health Education Is Enough?

There is consensus that health education programming should span kindergarten through grade 12 (Lohrman et al., 1987). However, the precise number and sequence of lessons required to achieve significant enduring effects have not been clearly defined. As mentioned previously, such determinations are complicated by uncertainties in what end points are desirable or feasible—behavior change versus change in knowledge and attitudes. If the desired end point is change in behavior, a greater dose will likely be required. ("Dose" involves two dimensions: intensity, or amount of programming per year, and duration, the number of years of programming.) Moreover, if the end point is long-term behavior change or reductions in adult morbidity and mortality, an even greater dose may be necessary that provides more intensive programming for a longer time.

The ideal means to determine adequate dose would be to deliver the same curriculum using various levels of intensity and duration and then examine differences in student outcomes by differences in curriculum exposure. However, few studies have been designed a priori to test varying format and amount of programming. Instead, most of the evidence derives from post hoc analyses examining dose–response effects between health education programming and student outcomes—that is, the relationship between level of student outcomes and how much intervention students actually received. Despite the methodologic limitations, establishing a dose–response relationship from post hoc analysis is helpful for two reasons. First, a positive dose–response relationship provides evidence for construct validity—observed changes can be attributed to the health education program rather than to other variables. Second, results of these analyses have implications regarding the proper amount and sequence of health education programming.

One of the first major studies to demonstrate a dose–response effect was the School Health Education Evaluation project (Connell et al., 1985). Students from classrooms in which health programs were implemented more fully demonstrated significantly greater improvements in attitude and behaviors, compared to the entire intervention cohort. In addition, students exposed to two years versus one year of programming showed considerably greater changes in attitudes and practices. With regard to specific dose, there was evidence that between 15 and 20 hours of classroom instruction was required to produce meaningful student effects.

Dose–response effects were also evident in the Teenage Health Teaching Modules evaluation. This study found that changes in health knowledge as well as some priority health behaviors were related to teacher proficiency and to how well teachers adhered to the program materials, although these effects were somewhat equivocal (Parcel et al., 1991). In a third study, a three-year evaluation of the Know Your Body program, Resnicow et al. (1992) found significantly larger intervention effects for blood lipids, systolic blood pressure, health knowledge, self-efficacy, and dietary behavior among students exposed to "high-implementation" teachers relative to moderate- and low-implementation teachers, as well as to comparison youth receiving no programming.

There is additional evidence regarding dose–response from a survey conducted for the Metropolitan Life Insurance Company in 1988. This survey of 4,738 students in grades 3 through 12 in 199 public schools revealed that as the years of health instruction increased, students' health-related knowledge and healthy habits increased. With one year of health instruction, 43 percent of the students drank alcohol ''sometimes or more often," a level that decreased to 33 percent for students who had received three years of health instruction. With only one year of health instruction, 13 percent of the students had taken drugs, compared with only 6 percent who had received three years of health instruction. In regard to exercising outside of the school, 80 percent of the students who had three years of health instruction did so, but only 72 percent of those who had one year of instruction exercised outside of school (Harris, 1988).

Duration, Sequence, and Timing of Health Education

Two other aspects of dose include intensity of programming (i.e., concentrated versus dispersed) and booster treatments. With regard to the former, Botvin and colleagues (1983) found that students who received a substance use education program several times a week for 4 to 6 weeks (a "concentrated" format) showed stronger treatment effects than youth receiving the program once a week for 12 weeks (a "dispersed" format). Additionally, in two separate studies, students receiving booster sessions following a year of primary intervention showed larger and more sustained behavior effects than youth receiving only the initial intervention (Botvin et al., 1983; Botvin et al., 1995). Taken together, these findings suggest that the greater the intensity and duration of health education programming, the greater is the effect. It is important to note that "increased dose" can include two elements. The first relates to the number of lessons contained in a curriculum; the second is a function of implementation fidelity on the part of classroom teachers. Thus, a complex, non-user-friendly health education program containing many lessons may, due to low teacher implementation, result in a lower dose than will a more user-friendly program containing fewer lessons.

With regard to specific policy recommendations, there are insufficient data to delineate a requisite number of lessons across content areas and grades. There is, however, some evidence to suggest that at least 10 to 15 initial lessons, plus 8 to 15 booster sessions in subsequent years, are required to produce lasting behavioral effects (Botvin et al., 1983, 1995; Connell et al., 1985). These data, however, are derived primarily from substance use prevention studies of middle school youth. Little is known about the requisite intensity and duration of programming for other content areas or other age groups. It is also unclear to what extent general life skills training, which targets substance use or sexual risk behaviors, may positively influence other behavioral domains. If spillover, synergistic effects from skills training or other common elements of health education programs (e.g., modifying normative expectations and increasing self-efficacy) occur when categorical programs are delivered within a comprehensive framework, the total number of lessons ultimately required for comprehensive curricula may be fewer than the sum of lessons from isolated categorical programs.

Additionally, whether these findings, which are based on a categorical topic, can be applied to a comprehensive curriculum merits discussion. It may be necessary to stagger content across K–12 and to target programming by developmental needs. For example, programming could be concentrated more heavily on substance use prevention at the middle school level, while in primary grades, nutrition and safety education could comprise the areas of focus. This developmental needs approach is a deviation from currently proposed curriculum frameworks, which suggest that health education address 8 to 12 content areas at each grade level. In view of the research that suggests a minimal number of lessons per grade for each content area, more serious attention should be given to setting priority areas for each stage of student development.

Lasting Effects of School Health Education

In several long-term follow-up studies of substance prevention programs delivered in grades 5 through 8 (Bell et al., 1993; Flay et al., 1989; Murray et al., 1989), positive program effects observed one to four years following the intervention had decayed by grade 12, or shortly after graduation from high school. Decay of program effects has also been observed for curricula addressing other content areas (Bush et al., 1989). There are studies, however, in which behavioral effects decayed but significant effects for knowledge and attitude were maintained (Bell et al., 1993; Flay et al., 1995).

Recently, however, Botvin and colleagues (1995) reported positive long-term results in a study involving more than 3,500 students in grade 12 who were randomly assigned to receive either the Life Skills Training substance use prevention program in grades 7 through 9 or "treatment as usual." Significant reductions in tobacco, alcohol, and marijuana use were evident at the follow-up in grade 12, and effects were greater among students whose teachers taught the program with higher fidelity (i.e., high implementors).

How can the positive effects reported by Botvin et al. be reconciled with the null results reported in prior studies? One explanation is dose. The previous interventions comprised only six to eight lessons in the first year and, in the Ellickson and Bell (1990) and Flay et al. (1989) studies, three to five booster sessions in subsequent years. Botvin's intervention contained 15 lessons in the first year and 15 additional lessons over the next two years. Other explanations include superiority of the Life Skills Training curriculum, including its content, format, and teacher training procedures, as well as higher levels of teacher implementation. Although the results of Botvin's study of substance use prevention are encouraging, research regarding the optimal dose and timing of curricula addressing other health behaviors is still needed. Given that achieving change in language arts and mathematics skills requires daily instruction for 12 academic years, it is reasonable to conclude that changes in health knowledge and in health behaviors also will require more instruction than one semester, the standard middle and secondary school requirement.

Active Ingredients of Health Education

Many successful health education programs employ several conceptually diverse intervention strategies such as didactic, affective, and behavioral activities directed at students, as well as environmental and policy change. Although there is considerable evidence that such programs as a whole can work, the construct validity of specific subcomponents—that is, "why" programs achieve or fail to achieve their desired effects—remains unclear (McCaul and Glasgow, 1985). Consider, for example, skills training. During the 1980s, numerous skills-based interventions aimed at increasing general and behavior-specific skills were developed and evaluated (Botvin et al., 1984; Donaldson et al., 1995; Flay, 1985; Kirby, 1992; McCaul and Glasgow, 1985). While initial results were encouraging and skills training has become an integral component of many school health education programs (Botvin et al., 1980; CDC, 1988, 1994; Flay, 1985; Glynn, 1989; Kirby, 1992; Pentz et al., 1989b; Schinke et al., 1985; Walter et al., 1988), many "skills-based" programs include other intervention strategies, such as modifying personal and group norms and outcome expectations, which also many have contributed to the reported intervention effects (Botvin et al., 1984; Ellickson and Bell, 1990; Murray et al., 1989; Pentz et al., 1989a; Walter et al., 1987). Several studies specifically designed to test the independent effects of skills training have found this approach to be largely ineffective (Elder et al., 1993; Hansen and Graham, 1991; Sussman et al., 1993). Instead, these studies indicate that modifying normative beliefs—students' assumptions regarding the prevalence and acceptability of substance use—appears to be the ''active ingredient" of many of the skills training programs. Despite the questionable effectiveness of skills training in substance use prevention, skills may be important in other behavioral domains such as sexuality, nutrition, and exercise (Baranowksi, 1989; Perry et al., 1990; Sikkema et al., 1995; St. Lawrence et al., 1995; Warzak et al., 1995).

Similarly, although there is acceptance on the part of many health educators that peers are effective "messengers," the evidence for the effectiveness of peer-based health education is also somewhat equivocal (Bangert-Drowns, 1988; Clarke et al., 1986; Ellickson et al., 1993; Johnson et al., 1986; McCaul and Glasgow, 1985; Murray et al., 1988; Perry et al., 1989; Telch et al., 1990). The effectiveness of peer-based programs is likely to depend more on how peers are included in the program than on simply having peer-led activities.

In a review of programs to reduce sexual risk behavior, Kirby and coworkers found several differences between programs that had an impact on behavior and those that did not (Kirby et al., 1994). Although the authors warn that generalizations must be made cautiously, ineffective curricula tended to be broader and less focused. Effective curricula clearly focused on the specific values, norms, and skills necessary to avoid sex or unprotected sex, whereas ineffective curricula covered a broad range of topics and discussed many values and skills. Interestingly, the length of the program or the amount of skills practice did not appear to predict the success of programs. The authors suggest, however, that skills practice may be effective only when clear values or norms are emphasized or when skills focus specifically on avoiding undesirable sexual behavior rather than on developing more general communication skills.

Given the limited funding and classroom time available for health education, it is important that school health education programs include primarily those approaches known to influence health behavior. Providing health information is a necessary but certainly not sufficient condition for affecting behavior. Identifying "active ingredients" can be achieved through factorial designs as well as post hoc statistical techniques such as structural models, and discriminant analysis can be used to elucidate mediating variables and specific intervention components that may account for program effects (Botvin and Dusenbury, 1992; Dielman et al., 1989; MacKinnon et al., 1991).

Risk-Factor-Specific Versus Problem Behavior Intervention Models

Numerous studies have found that "problem" behaviors—such as the use of alcohol, marijuana, and tobacco; precocious sexual involvement; and delinquent activity—are positively correlated and occur in clusters. Problem Behavior Theory proposes an underlying psychologic phenomenon of "unconventionality" as the unifying etiologic explanation (see Basen-Engquist et al., 1996; Donovan and Jessor, 1985; Donovan et al., 1988; Resnicow et al., 1995). This conceptualization of health behavior has significant implications for CSHPs. As opposed to commonly used risk-factor-specific interventions that deal with each behavior separately, Problem Behavior Theory suggests that high-risk and problem behaviors can be prevented by an intervention that addresses common predisposing causes. Such interventions may be not only more effective but also more efficient, since fewer total lessons may be required to alter the common "core" causes. In addition to generic interventions, it may also be necessary to apply general strategies to selected high-risk behaviors. However, most school systems do not conceptualize health education from this perspective. Instead, health instruction is broken down into discrete content areas, more akin to the risk-factor-specific approach. Additional research, particularly studies examining the effects of interventions addressing traits that may underlie clusters of risk behaviors, is needed before health education is restructured toward a more targeted model of health behavior change.

Realistic Outcomes for School Health Education

It can be argued that previous studies reporting weak or null behavioral outcomes employed health education interventions of insufficient dose and breadth. Many of the interventions had no more than 10 lessons, delivered over the course of one year, and few or no subsequent booster lessons. As noted earlier, the positive long-term behavioral effects reported by Botvin and colleagues (1995) may be attributed largely to the increased dose. Additionally, had the categorical programs for which no long-term behavioral effects were observed been delivered within the context of a comprehensive school health program, positive effects may have been observed. It is important to set realistic expectations for school health education, particularly since many of the programs used in our schools provide a dose of insufficient intensity and duration, whose effects are further attenuated by inadequate levels of teacher implementation. As stated earlier, although influencing behavior is an ultimate goal of school health education, schools should not bear the total responsibility for student behavior, given all the other influences on students—family, peers, the media, community norms, and expectations—that are beyond the control of the school. Schools should be held accountable for providing a high-quality, up-to-date health education program that is delivered by qualified teachers using curricula that are based on research and have been validated through outcome evaluation. Schools should be held responsible for arming students with the knowledge, attitudes, and skills to adopt health-enhancing behavior and to avoid health-compromising behavior. If these conditions are met but behavioral outcomes are still less than desired, then other sources of influence on students must be examined for alignment with school health education messages. In addition, there may be delayed effects on behavior in later life, even if no immediate behavioral impacts are observed.

There is encouraging evidence that when school-based interventions are delivered along with complementary community-wide or media campaigns, significant long-term behavioral effects can be achieved (Flynn et al., 1994; Kelder et al., 1993; Perry et al., 1992; see Flay et al., 1995, for an exception). Therefore, although health education delivered in isolation may not be able to produce lasting behavioral effects, when combined with other activities or implemented within a comprehensive school health program, significant enduring changes in behavior as well as physical risk factors can be achieved.

There is considerable evidence that comprehensive curricula can produce significant short-term effects on multiple health behaviors, including substance use, diet, and exercise (Bush et al., 1989; Connell et al., 1985; Errecart et al., 1991; Resnicow et al., 1992; Walter et al., 1988, 1989). However, many of the assumptions regarding the effectiveness of classroom health education derive from studies of categorical programs, and it is unclear to what degree the effects observed for categorical programs are diminished or magnified when taught within a comprehensive framework. Although it can be argued that incorporating categorical programs within a comprehensive framework would attenuate effects because the focus on any one behavior or health issue would be diminished, it could also be argued that program effects would be enhanced because comprehensive programs provide extended if not synergistic application and reinforcement of essential skills across a wide range of topics. This is another area that calls for further research.

• Summary Of Findings And Conclusions

Research and evaluation of CSHPs can be divided into three categories: basic research, outcome evaluation, and process evaluation. Basic research involves inquiry into the fundamental determinants of behavior as well as mechanisms of behavior change. A primary function of basic research is to inform the development of interventions that can then be tested in outcome evaluation trials. Outcome evaluation involves the empirical examination of interventions on targeted outcomes, based on the randomized clinical trial approach with experimental and control groups. Process evaluation determines whether a proven intervention was properly implemented and examines factors that may have contributed to the intervention's success or failure. Basic research and outcome evaluation are typically conducted by professionals from university or other research centers and are largely beyond the capacity of local education agencies.

The committee believes that process evaluation is the appropriate level of evaluation in local programs.

Research and evaluation are particularly challenging for CSHPs. Since these programs comprise multiple interactive components, it is often difficult to attribute observed effects to specific components or to separate program effects from those of the family or community. Determining what outcomes are realistic and measuring outcomes in students are often problematic, especially when outcomes involve sensitive matters such as drug use or sexual behavior. Furthermore, since CSHPs are unique to a particular setting, the results of even the most rigorous evaluations may not be generalizable to other situations.

Interventions associated with the separate, individual components of CSHPs—health education, health services, nutrition services, and so forth—should be developed and tested using rigorous methods involving experimental and control groups. However, such an approach is likely to be difficult—and possibly not feasible—for studying entire comprehensive programs or determining the differential effects of individual components and combinations of components.

A fundamental issue involves determining what outcomes are appropriate and reasonable to expect from CSHPs. The committee recognizes that although influencing health behavior and health status is an ultimate goal of a CSHP, such end points involve factors beyond the control of the school. The committee believes that the reasonable outcomes on which a CSHP should be judged are equipping students with the knowledge, attitudes, and skills necessary for healthful behavior; providing a health-promoting environment; and ensuring access to high-quality services. Other outcomes—improved cardiovascular fitness or a reduction in absenteeism, drug abuse, or teen pregnancies, for example—may also be considered, but the committee believes that such measures must be interpreted with caution, since they are influenced by factors beyond the control of the school. In particular, null or negative measures for these outcomes should not necessarily lead to declaring the CSHP a failure; rather, they may imply that other sources of influence oppose and outweigh that of the CSHP or that the financial investment in the CSHP is so limited that returns are minimal.

• Recommendations

In order for CSHPs to accomplish the desired goal of influencing behavior, the committee recommends the following:

An active research agenda on comprehensive school health programs should be pursued in order to fill critical knowledge gaps; increased emphasis should be placed on basic research and outcome evaluation and on the dissemination of these research and outcome findings.

Research is needed about the effectiveness of specific intervention strategies such as skills training, normative education, or peer education; the effectiveness of specific intervention messages such as abstinence versus harm reduction; and the required intensity and duration of health education programming. Evidence suggests that common underlying factors may be responsible for the clustering of health-compromising behaviors and that interventions may be more effective if they address these underlying factors in addition to intervening to change risk behaviors. Additional research is needed to understand the etiology of problem behavior clusters and to develop optimal problem behavior interventions. And finally, since the acquisition of health-related social skills—such as negotiation, decisionmaking, and refusal skills—is a desired end point of CSHPs, basic research is needed to develop valid measures of social skills that can then be used as proxy measures of program effectiveness. Diffusion-related research is critical to ensure that efforts of research and development lead to improved practice and a greater utilization of effective methods and programs. Therefore, high priority should be given to studying how programs are adopted, implemented, and institutionalized. The feasibility and effectiveness of techniques of integrating concepts of health into science and other school subjects should also be examined.

Since the overall effects of comprehensive school health programs are not yet known and outcome evaluation of such complex systems poses significant challenges, the committee recommends the following:

A major research effort should be launched to establish model comprehensive programs and develop approaches for their study.

Specific outcomes of overall programs should be examined, including education (improved achievement, attendance, and graduation rates), personal health (resistance to "new social morbidities," improved biologic measures), mental health (less depression, stress, and violence), improved functionality, health systems (more students with a "medical home," reduction in use of emergency rooms or hospitals), self-sufficiency (pursuit of higher education or job), and future health literacy and health status. Studies could look at differential impacts of programs produced by such factors as program structure, characteristics of students, and type of school and community.

A thorough understanding of the feasible and effective (including cost-effective) interventions in each separate area of a CSHP will be necessary to provide the basis for combining components to produce a comprehensive program.

The committee recommends that further study of each of the individual components of a CSHP—for example, health education, health services, counseling, nutrition, school environment—is needed.

Additional studies are needed in a number of other areas. First, more data are needed about the advantages (cost and effectiveness) and disadvantages of providing health and social services in schools compared to other community sites—or compared to not providing services anywhere—as a function of community and student characteristics. This information will require overall consensus about the criteria to use for determining the quality of school health programs. It is also important to know how best to influence change in the climate and organizational structure of school districts and individual schools in order to bring about the adoption and implementation of CSHPs. Finally, there is a need for an analysis of the optimal structure, operation, and personnel needs of CSHPs.

• Bangert-Drowns, R.L. 1988. The effects of school-based substance abuse education: A meta-analysis . Journal of Drug Education 18:243–264. [ PubMed : 3058921 ]
• Baranowski, T. 1989. Reciprocal determinism at the stages of behavior change: An integration of community, personal and behavioral perspectives . International Quarterly of Community Health Education 10(4):297–327. [ PubMed : 20840937 ]
• Basen-Engquist, K. , Edmundson, E. , and Parcel, G.S. 1996. . Structure of health risk behavior among high school students . Journal of Consulting and Clinical Psychology 64(4):764–775. [ PubMed : 8803367 ]
• Bell, R.M., Ellickson, P.L., and Harrison, E.R. 1993. Do drug prevention effects persist into high school? How Project Alert did with ninth graders . Preventive Medicine 22:463–483. [ PubMed : 8415497 ]
• Botvin, G.J., and Dusenbury, L. 1992. Smoking prevention among urban minority youth: Assessing effects on outcome and mediating variables . Health Psychology 11:290–299. [ PubMed : 1425546 ]
• Botvin, G.J., Eng, A., and Williams, C.L. 1980. Preventing the onset of cigarette smoking through life skills training . Preventive Medicine 9:135–143. [ PubMed : 7360727 ]
• Botvin, G.J., Renick, N.L., and Baker, E. 1983. The effects of scheduling format and booster sessions on a broad-spectrum psychosocial approach to smoking prevention . Journal of Behavioral Medicine 6(4):359–379. [ PubMed : 6668603 ]
• Botvin, G.J., Baker, E., Renick, N.L., Filazzola, A.D., and Botvin, E.M. 1984. A cognitive-behavioral approach to substance abuse prevention . Addictive Behaviors 9:137–147. [ PubMed : 6611026 ]
• Botvin, G.J., Baker, E., Dusenbury, L., and Botvin, E.M. 1995. Long-term follow-up results of a randomized drug abuse prevention trial in a white middle class population . Journal of Behavioral Medicine 273(14):1106–1112. [ PubMed : 7707598 ]
• Bush, P.J., Zuckerman, A.E., Taggart, V.S., Theiss, P.K., Peleg, E.O., and Smith, S.A. 1989. Cardiovascular risk factor prevention in black school children: The "Know Your Body" evaluation project . Health Education Quarterly 16(2):215–227. [ PubMed : 2732064 ]
• Centers for Disease Control and Prevention. 1988. Guidelines for effective school health education to prevent the spread of AIDS . Morbidity and Mortality Weekly Report 37(Suppl.)2:1–14. [ PubMed : 2826985 ]
• Centers for Disease Control and Prevention. 1994. Guidelines for school health programs to prevent tobacco use and addiction . Journal of School Health 64(9):353–360. [ PubMed : 7877276 ]
• Clarke, J.H., MacPherson, B., Holmes, D.R., and Jones, R. 1986. Reducing adolescent smoking: A comparison of peer-led, teacher-led, and expert interventions . Journal of School Health 56(3):102–106. [ PubMed : 3634129 ]
• Connell, D.B., Turner, R.R., and Mason, E.F. 1985. Summary of findings of the school health education evaluation: Health promotion effectiveness, implementation, and costs . Journal of School Health 55(8):316–321. [ PubMed : 3932781 ]
• Dielman, T.E., Shope, J.T., Butchart, A.T., Campaneilli, P.C., and Caspar, R.A. 1989. A covariance structure model test of antecedents of adolescent alcohol misuse and a prevention effort . Journal of Drug Education 19(4):337–361. [ PubMed : 2621540 ]
• Donaldson, S.I., Graham, J.W., Piccinin, A.M., and Hansen, W.B. 1995. Resistance-skills training and onset of alcohol use: Evidence for beneficial and potentially harmful effects in public schools and in private Catholic schools . Health Psychology 14(4):291–300. [ PubMed : 7556032 ]
• Donovan, J.E., and Jessor, R. 1985. Structure of problem behavior in adolescence and young adulthood . Journal of Consulting and Clinical Psychology 53:890–904. [ PubMed : 4086689 ]
• Donovan, J.E., Jessor, R., and Costa, F.M. 1988. Syndrome of problem behavior in adolescence: A replication . Journal of Consulting and Clinical Psychology 56:762–765. [ PubMed : 3192793 ]
• Elder, J.P., Sallis, J.F., Woodruff, S.I., and Wildey, M.B. 1993. Tobacco-refusal skills and tobacco use among high risk adolescents . Journal of Behavioral Medicine 16:629–642. [ PubMed : 8126716 ]
• Ellickson, P.L., and Bell, R.M. 1990. Drug prevention in junior high: A multi-site longitudinal test . Science 247:1299–1305. [ PubMed : 2180065 ]
• Ellickson, P.L., Bell, R.M., and Harrison, E.R. 1993. Changing adolescent propensities to use drugs: Results from Project ALERT . Health Education Quarterly 20(2):227–242. [ PubMed : 8491635 ]
• Ennett, S.T., Tobler, N.S., Ringwalt, C.L., and Flewelling, R.L. 1994. How effective is drug abuse resistance education? A meta-analysis of Project DARE outcome evaluations . American Journal of Public Health 84(9):1394–1401. [ PMC free article : PMC1615171 ] [ PubMed : 8092361 ]
• Errecart, M.T., Walberg, H.J., Ross, J.G., Gold, R.S., Fielder, J.L., and Kolbe, L.J. 1991. Effectiveness of Teenage Health Teaching Modules . Journal of School Health 61(1):26–30. [ PubMed : 2027290 ]
• Flay, B.R. 1985. Psychosocial approaches to smoking prevention: A review of findings . Health Psychology 4(5):449–488. [ PubMed : 3908090 ]
• Flay, B.R. 1986. Efficacy and effectiveness trials in the development of health promotion programs . Preventive Medicine 15:451–474. [ PubMed : 3534875 ]
• Flay, B.R., Phil, D., Koepke, D., Thomson, S.J., Santi, S., Best, A., and Brown, K.S. 1989. Six-year follow-up of the first Waterloo school smoking prevention trial . American Journal of Public Health 79:1371–1376. [ PMC free article : PMC1350177 ] [ PubMed : 2782505 ]
• Flay, B.R., Miller, T.Q., Hedeker, D., Siddiqui, O., Britton, C.F., Brannon, B.R., Johnson, C.A., Hansen, W.B., Sussman, S., and Dent, C. 1995. The television, school, and family smoking prevention and cessation project . Preventive Medicine 24:29–40. [ PubMed : 7740012 ]
• Flynn, B.S., Worden, J.K., Secker-Walker, R.H., Pirie, P.L., Badger, G.J., Carpenter, J.H., and Geller, B.M. 1994. Mass media and school interventions for cigarette smoking prevention: Effects two years after completion . American Journal of Public Health 84(7):1148–1150. [ PMC free article : PMC1614753 ] [ PubMed : 8017542 ]
• Glick, B., Doyle, L., Ni, H., Gao, D., and Pham, C. 1995. School-based health center program evaluation: Perceptions, knowledge, and attitudes of parents/guardians of eleventh graders . A limited dataset presented to the Multnomah County (Oregon) Commissioners, March 21.
• Glynn, T.J. 1989. Essential elements of school-based smoking prevention programs . Journal of School Health 59(5):181–188. [ PubMed : 2739360 ]
• Hansen, W.B., and Graham, J.W. 1991. Preventing alcohol, marijuana, and cigarette use among adolescents: Peer pressure resistance training versus establishing conservative norms . Preventive Medicine 20:414–430. [ PubMed : 1862062 ]
• Harris, L. 1988. Health: You've Got to be Taught : An Evaluation of Comprehensive Health Education in American Public Schools . New York: Metropolitan Life Foundation.
• Johnson, C.A., Hansen, W.B., Collins, L.M., and Graham, J.W. 1986. High-school smoking prevention: Results of a three-year longitudinal study . Journal of Behavioral Medicine 9(5):439–452. [ PubMed : 3795263 ]
• Kelder, S.J., Perry, C.L., and Kleep, K.I. 1993. Community-wide youth exercise promotion: Long-term outcomes of the Minnesota Heart Health Program and the Class of 1989 Study . Journal of School Health 53(5):218–223. [ PubMed : 8336479 ]
• Kirby, D. 1992. School-based programs to reduce sexual risk-taking behaviors . Journal of School Health 62(7):280–287. [ PubMed : 1434554 ]
• Kirby, D., Short, L., Collins, J., Rugg, D., Kolbe, L., Howard, M., Miller, B., Sonenstein, F., and Zabin, L.S. 1994. School-based programs to reduce sexual risk behaviors : A review of effectiveness. Public Health Reports 109(3):339–359. [ PMC free article : PMC1403498 ] [ PubMed : 8190857 ]
• Kisker, E.E., Marks, E.L., Morrill, W.A., and Brown, R.S. 1994. Healthy Caring: An Evaluation Summary of the Robert Wood Johnson Foundation's School-Based Adolescent Health Care Program . Princeton, N.J.: Mathtech.
• Knapp, M.S. 1995. How shall we study comprehensive, collaborative services for children and families? Educational Research 24(4):5–16.
• Lewin-VHI and Institute of Health Policy Studies. 1995. Healthy schools, healthy communities program: National evaluation. Submitted to Bureau of Primary Health Care, Health Resources and Services Administration , U.S. Department of Health and Human Services by Lewin-VHI, Inc., and Institute for Health Policy Studies, University of California at San Francisco, February, 1995.
• Lohrman, D.K., Gold, R.S., and Jubb, W.H. 1987. School health education: A foundation for school health programs . Journal of School Health 57(10):420–425. [ PubMed : 3326971 ]
• Lopez, M.E., and Weiss, H.B. 1994. Can we get here from there? Examining and expanding the research base for comprehensive, school-linked early childhood services . Paper commissioned for the Invitational Conference of the U.S. Department of Education and the American Educational Research Association: School-Linked Comprehensive Services for Children and Families, Leesburg, Va., September 28–October 2.
• Luepker, R.V., Perry, C.L., McKinlay, S.M., Nader, P.R., Parcel, G.S., Stone, E.J., Webber, L.S., Elder, J.P., Feldman, H.A., Johnson, C.C., Kelder, S.H., and Wu, M. 1996. Outcomes of a field trial to improve children's dietary patterns and physical activity: The Child and Adolescent Trial for Cardiovascular Health (CATCH) . Journal of the American Medical Association 275(10):768–776. [ PubMed : 8598593 ]
• MacKinnon, D.P., Johnson, C.A., Pentz, M.A., Dwyer, J.H., Hansen, W.B., Flay, B.R., and Wang, E.Y. 1991. Mediating mechanisms in a school-based drug prevention program: First-year effects of the Midwestern Prevention Project . Health Psychology 10(3):164–172. [ PubMed : 1879388 ]
• McCaul, K.D., and Glasgow, R.E. 1985. Preventing adolescent smoking: What have we learned about treatment construct validity? Health Psychology 4:361–387. [ PubMed : 4054080 ]
• Murray, D.M., Davis-Hearn, M., Goldman, A., Pirie, P., and Luepker, R.V. 1988. Fourth- and five-year follow-up results from four seventh grade smoking prevention strategies . Journal of Behavioral Medicine 11(4):395–405. [ PubMed : 3266255 ]
• Murray, D.M., Pirie, P., Luepker, R.V., and Pallonen, U. 1989. Five- and six-year follow-up results from four seventh-grade smoking prevention strategies . Journal of Behavioral Medicine 12:207–218. [ PubMed : 2788222 ]
• Parcel, G.S., Ross, J.G., Lavin, A.T., Portnoy, B., Nelson, G.D., and Winters, F. 1991. Enhancing implementation of the Teenage Health Teaching Modules . Journal of School Health 61(1):35–38. [ PubMed : 2027292 ]
• Pentz, M.A., Dwyer, J.H., MacKinnon, D.P., Flay, B.R., Hansen, W.B., Wang, E.Y., and Johnson, C.A. 1989. a. A multicommunity trial for primary prevention of adolescent drug abuse: Effects on drug use prevalence . Journal of American Medical Association 261:3259–3266. [ PubMed : 2785610 ]
• Pentz, M.A., MacKinnon, D.P., and Flay, B.R., Hansen, W.B., Johnson, C.A., and Dwyer, J.H. 1989. b. Primary prevention of chronic diseases in adolescence: Effects of the Midwestern Prevention Project on tobacco use . American Journal of Epidemiology 130(4):713–724. [ PubMed : 2788994 ]
• Perry, C.L., Grant, M., Ernberg, G., Florenzano, R.U., Langdon, M.C., Myeni, A.D., Waahlberg, R., Berg, S., Andersson, K., and Fisher, K.J. 1989. WHO collaborative study on alcohol education and young people: Outcomes of four-country pilot study . International Journal of the Addictions 24(12):1145–1171. [ PubMed : 2634032 ]
• Perry, C.L., Baranowski, T., and Parcel, G. 1990. How individuals, environments and health behavior interact: Social learning theory . In Health Behavior and health Education Theory, Research, and Practice , K. Glanz, editor; , F.M. Lewis, editor; , and B. Rimer, editor. , eds. New York: Jossey-Bass.
• Perry, C.L., Kelder, S.H., Murray, D.M., and Klepp, K. 1992. Community-wide smoking prevention: Long-term outcomes of the Minnesota Heart Health Program and the Class of 1989 study . American Journal of Public Health 82(9):1210–1216. [ PMC free article : PMC1694332 ] [ PubMed : 1503159 ]
• Resnicow, K., Cross, D., and Wynder, E. 1991. The role of comprehensive school-based interventions: The results of four "Know Your Body" studies . Annals of the New York Academy of Sciences 623:285–297. [ PubMed : 2042837 ]
• Resnicow, K., Cohn, L., Reinhardt, J., Cross, D., Futterman, R., Kirschner, E., Wynder, E.L., and Allegrante, J. 1992. A three-year evaluation of the "Know Your Body" program in minority school children . Health Education Quarterly 19(4):463–480. [ PubMed : 1452447 ]
• Resnicow, K., Ross, D., and Vaughan, R. 1995. The structure of problem and conventional behaviors in African-American youth . Journal of Clinical and Consulting Psychology 63(4):594–603. [ PubMed : 7673537 ]
• Rohrbach, L.A., Graham, J.W., and Hansen, W.B. 1993. Diffusion of a school-based substance abuse prevention program: Predictors of program implementation . Preventive Medicine 22(2):237–260. [ PubMed : 8483862 ]
• Schinke, S.P., Gilchrist, L., and Snow, W.H. 1985. Skills intervention to prevent cigarette smoking among adolescents . American Journal of Public Health 75:665–667. [ PMC free article : PMC1646189 ] [ PubMed : 4003636 ]
• Shaw, K.M. 1995. Challenges in evaluating systems reform . The Evaluation Exchange: Emerging Strategies in Evaluating Child and Family Services 1(1):2–3.
• Sikkema, K.J., Winett, R.A., and Lombard, D.N. 1995. Development and evaluation of an HIV-risk reduction program for female college students . AIDS Education and Prevention 7(2):145–159. [ PubMed : 7619644 ]
• St. Lawrence, J.S., Jefferson, K.W., Alleyne, E., and Brasfield, T.L. 1995. Comparison of education versus behavioral skills training interventions in lowering sexual HIV-risk behavior of substance-dependent adolescents . Journal of Consulting and Clinical Psychology 63(1):154–157. [ PubMed : 7896983 ]
• Sussman, S., Dent, C.W., Stacy, A.W., Sun, P., Craig, S., Simon, T.R., Burton D., and Flay, B.R. 1993. Project towards no tobacco use, one-year behavior outcomes . American Journal of Public Health 83(9):1245–1250. [ PMC free article : PMC1694992 ] [ PubMed : 8362999 ]
• Taggart, V.S., Bush, P.J., Zuckerman, A.E., and Theiss, P.K. 1990. A process of evaluation of the District of Columbia ''Know Your Body" project . Journal of School Health 60(2):60–66. [ PubMed : 2299823 ]
• Telch, M.J., Miller, L.M., Killen, J.D., Cooke, S., and Maccoby, N. 1990. Social influences approach to smoking prevention: The effects of videotape delivery with and without same-age peer leader participation . Addictive Behaviors 15(1):21–28. [ PubMed : 2316409 ]
• Walter, H.J., Hofman, A., and Barrett, L.T., Connelly, P.A., Kost, K.L., Walk, E.H., and Patterson, R. 1987. Primary prevention of cardiovascular disease among children: Three-year results of a randomized intervention trial . In Cardiovascular Risk Factors in Childhood: Epidemiology and Prevention , B. Hetzel, editor; and G.S. Berenson, editor. , eds. Netherlands: Elsevier.
• Walter, H.J., Hofman, A., Vaughan, R., and Wynder, E.L. 1988. Modification of risk factors for coronary heart disease . New England Journal of Medicine 318:1093–1100. [ PubMed : 3281016 ]
• Walter, H.J., Vaughan, R.D., and Wynder, E.L. 1989. Primary prevention of cancer among children: Changes in cigarette smoking and diet after six years of intervention . Journal of the National Cancer Institute 81:995–999. [ PubMed : 2733048 ]
• Warzak, W.J., Grow, C.R., Poler, M.M., and Walburn, J.N. 1995. Enhancing refusal skills: Identifying contexts that place adolescents at risk for unwanted sexual activity . Journal of Developmental and Behavioral Pediatrics 16(2):98–100. [ PubMed : 7790522 ]

This view is consistent with earlier discussion in this chapter that for the local school, the desired level of evaluation is process evaluation. If the school is providing health curricula and health services that have been shown through basic research and outcome evaluation to produce positive health outcomes, the committee suggests that the crucial question at the school level should be whether the interventions are implemented properly.

• Cite this Page Institute of Medicine (US) Committee on Comprehensive School Health Programs in Grades K-12; Allensworth D, Lawson E, Nicholson L, et al., editors. Schools & Health: Our Nation's Investment. Washington (DC): National Academies Press (US); 1997. 6, Challenges in School Health Research and Evaluation.
• PDF version of this title (3.9M)

In this Page

Related information.

• PMC PubMed Central citations
• PubMed Links to PubMed

Recent Activity

• Challenges in School Health Research and Evaluation - Schools & Health Challenges in School Health Research and Evaluation - Schools & Health

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers

• Apply now Enquire now

Study at UniSA

Accounting and Finance Business Management and HRM Marketing Property Tourism, Sports an Events

Architecture Communication Contemporary Art Creative Industries Design Film, Television and Visual Effects Journalism Urban and Regional Planning

Biomedical Science Health Science Human Movement, Sport, Clinical Exercise Physiology Laboratory Medicine Medical Radiation Science Nursing or Midwifery Nutrition and Food Sciences Occupational Therapy Pharmacy Physiotherapy Podiatry Speech Pathology

• Law & Criminal Justice

Aboriginal and Australian Studies Arts Human Services Languages Psychology Social Work

Aviation Construction Management Defence Engineering Environmental Science Information Technology Mathematics Science

• Teaching & Education
• What can I study
• Entry pathways
• Find an education agent
• Sponsorships
• Living in Adelaide
• UniSA Online
• Scholarships
• Postgraduate study
• Research degrees
• Executive Education
• Regional students
• Aboriginal students
• Discover our research Partner with us
• Research projects
• How to apply
• Check your eligibility
• Research scholarships
• Concentrations
• Cooperative Research Centres
• Research studies & volunteers
• Research experts
• Industry & collaboration
• Mawson Lakes
• Mount Gambier
• Psychology Clinic
• Health Clinics
• Disability Hub
• Wirringka Student Services
• Museums and galleries
• Industry & partnerships
• Enterprise Hub

About UniSA

• Our history
• Vice Chancellor
• Achievements
• Mission, values, vision
• Strategic action plan
• Staff directory
• UniSA Allied Health & Performance
• UniSA Business
• UniSA Clinical & Health Sciences
• UniSA Creative
• UniSA Education Futures
• UniSA Justice & Society
• Working at UniSA
• Publications
• Aboriginal engagement
• Login Staff Students Alumni
• Media centre

School suspensions and exclusions put vulnerable children at risk

15 April 2024

Now, new research from the University of South Australia shows that exclusionary practices not only fail to identify the deep-rooted causes of challenging student behaviours but exacerbate negative issues rather than resolve them.

Lead researcher, UniSA’s Professor Anna Sullivan , says schools face difficult decisions around suspensions and expulsions.

“Suspensions and expulsions have been the mainstay of schools’ behaviour management practices for decades, regardless of research finding that they are ineffective for disciplining bad behaviours,” Prof Sullivan says.

“In fact, there is a clear relationship between school suspensions and a range of detrimental health outcomes, including alienation from school, involvement with antisocial peers, use of alcohol and smoking, and a lower quality of school life – and this contributes to a higher risk of dropping out of school and possible illegal behaviour.

“What makes things worse is that vulnerable students have a higher risk of being suspended or expelled, which in many cases exacerbates their circumstances and life chances.

“Boys, Aboriginal students, students from low SES backgrounds, and students with a disability are disproportionately excluded from schools.

“There is a distinct blind spot about how school suspensions and expulsions perpetuate wider social inequalities.

“Schools and policy makers must look beyond challenging behaviours to understand what is contributing to the cause – rather than treating the effect – and it’s this missing information that’s needed to develop new school policies.”

Analysing the recently reviewed NSW Student Behaviour Strategy , researchers found that while there was more behaviour support and management, the new iterations still included punitive practices.

“When a student is suspended or expelled from school, we’re ultimately removing them from their education and limiting their life outcomes. And knowing that vulnerable groups are more at risk, these exclusion policies are ultimately discriminatory,” Prof Sullivan says.

“We also see situations where children with disabilities – some on prescribed medications – are being excluded from school on the basis that ‘they have problems already’. As a consequence, exclusion appears to be a reasonable solution given schools do not have the time, expertise or resources to manage complex and challenging behavioural needs. 

“Adding to such deficit thinking is removing a ‘problem child’ from the learning environment of others. Instead of helping these students, the policies are exacerbating their struggles.

“What we need is more listening, more empathy to students at risk, and a willingness to challenge the impact of wider social inequalities including poverty, race, housing, and unemployment on the most vulnerable people in society. These things do not operate in isolation; they affect families and children and cannot simply be left at the school gate.

“It’s time to look afresh at the complex and challenging circumstances in which many young people find themselves. Only then can we hope to create a more inclusive and fair education system.”

Notes to editors:

• Published paper: Down, B., Sullivan, A., Tippett, N., Johnson, B., Manolev, J., & Robinson, J., (2024). What is missing in policy discourses about school exclusions?, Critical Studies in Education , DOI: 1080/17508487.2024.2312878

…………………………………………………………………………………………………………………………..

Media contact: Annabel Mansfield M: + 61 479 182 489 E: [email protected]

Researcher : Prof Anna Sullivan E: [email protected]

Other articles you may be interested in

Targeted liver cancer treatment kills cancer cells and cuts chemo side effects

Silence is not an option for First Nations’ content in Australian schools

Rural pharmacists are pivotal to home-based palliative care

Australian students

Phone: +61 8 8302 2376 Enquiry: unisa.edu.au/enquiry

International students

Phone: +61 8 9627 4854 Enquiry: unisa.edu.au/enquiry

Classroom Q&A

With larry ferlazzo.

In this EdWeek blog, an experiment in knowledge-gathering, Ferlazzo will address readers’ questions on classroom management, ELL instruction, lesson planning, and other issues facing teachers. Send your questions to [email protected]. Read more from this blog.

The Biggest Policy Challenges Schools Are Facing Right Now

• Share article

There are many education policy challenges facing schools at the moment.

Today, two educators share which ones they think are the most important ones.

‘Legislative Attacks’

Keisha Rembert is a lifelong learner, equity advocate, and award-winning educator. She is the author of The Antiracist English Language Arts Classroom , a doctoral student and an assistant professor/DEI coordinator for teacher preparation at National Louis University. Prior to entering teacher education, Keisha spent more than 15 years teaching middle school English and U.S. history.

George Orwell’s words in his book 1984 resonate deeply today: “Who controls the past controls the future. Who controls the present controls the past.” These words hold immense relevance as we traverse the landmine of educational bills that have enacted book bans; restricted the exploration of race, sexual orientation, and gender identity topics; and prohibited the teaching of historical truths or any discourse that may result in “ discomfort, guilt, or anguish .”

In the past year, education-focused legislative attacks have become palpable and personal. We have seen an influx of anti-LGBTQIA+ bills , totaling a whopping 283, nationwide. In Florida, the value of AP African American Studies has been questioned, undermined, and dismissed as “ lacking educational value. ”

And critical race theory has become persona non grata, a scapegoat to thwart discussions and actions toward racial justice in our polarized American political landscape. These examples highlight the trend of states’ attempts to not only control curricula, learning, and discourse but also to stifle justice and constrict bodies and intellectual progress, negatively impacting the whole of society.

According to a 2022 Rand Corp survey, one-fourth of the teachers reported being influenced by legislative actions, pending and imposed, to change their lessons. It is scary to think that state legislatures, without any educational expertise, wield the power to manipulate knowledge and rewrite history. In the words of Paulo Freire, “Leaders who do not act dialogically, but insist on imposing their decisions, do not organize the people—they manipulate them. They do not liberate, nor are they liberated: they oppress.” And thus, the barrage of these oppressive educational policies are not only unconscionable but also fundamentally untenable for student and societal success.

We find ourselves at a critical juncture, where the exclusion of diverse perspectives and the suppression of uncomfortable truths have the potential to distort our collective consciousness. It is in recognizing and embracing the history of the most marginalized among us that we truly learn about ourselves, our growth as a society, and the ideals to which we aspire.

These dehumanizing legislative impositions hinder our students’ understanding of our shared history and also represent a dangerous path that encroaches on our personal and academic freedoms. They undermine our capacity to nurture students’ critical-thinking skills and hamper our ability to cultivate a citizenry that values democratic ideals and engages thoughtfully in meaningful change.

As educators, we must continue to fight and offer our support to those living under oppressive state regimes. In our classrooms and beyond, we should:

• Advocate academic freedom: We cannot be passive bystanders while the rights of our students, selves, and colleagues are at stake. We must actively engage in discussions and initiatives that protect and promote freedom of all kinds within our schools, communities, and nation. We must reject the notion that any student should be denied the invaluable opportunity to be exposed to truth, diverse and inclusive perspectives, ideas, and experiences. Our championing of freedom creates an environment that fosters critical thinking, humility, and a deeper understanding of our world.
• Foster critical thinking and humility: The Rev. Martin Luther King Jr. said, “The only way to deal with unjust laws is to render them powerless by ignoring them.” It is time to lean into what we know is right and teach our students to do the same. To navigate this time of distortions and mistruths, our students need to be analytical thinkers who are discerning, open-minded, and equipped to challenge rhetoric and resist the manipulative forces that are restricting knowledge and controlling narratives.
• Uphold the ideals of democracy and global humanity: In the face of state-led oligarchies, it is our duty to instill in our students civic literacy, agency, collective responsibility, and the need to dismantle oppressive systems. Our students must be justice seekers who build bridges as compassionate citizens.

If we are not vigilant, we risk facing a fate reminiscent of the residents of Oceania depicted in 1984 , where “every record has been destroyed or falsified, every book rewritten, every picture repainted, every statue and street building renamed, every date altered. And the process is continuing day by day and minute by minute. History has stopped. Nothing exists except an endless present in which the Party is always right.”

Censorship is antithetical to freedom; it begets spirit-murdering curricula violence, posing a direct threat to the mental and emotional well-being of students whose histories, identities, and personhood are silenced and deemed inconsequential and without value. By perpetuating harm, these laws also establish a dangerous precedent for future educational policies. The brevity of this moment demands action. If education is the ultimate pursuit of liberation, then the freedom it promises hangs in the balance.

STEM Access

Kit Golan ( @MrKitMath ) is the secondary mathematics consultant for the Center for Mathematics Achievement at Lesley University in Cambridge, Mass.:

Despite the demand for mathematical thinkers, our country continues to push data-illiterate and math-phobic graduates into the workforce. As such, a vital issue facing public schools today is inequitable access to high-level math courses, which acts as a gatekeeper for many who might enter science, technology, engineering, and math (STEM) careers.

Most course sequences prevent students from reaching rigorous math classes, especially students of color. Often, students who do have access to these courses come from privileged backgrounds whose families have invested time and money outside of the school day to “race to the top.” Regardless, many colleges use AP Calculus as a determining factor for entrance and class placement even though most students don’t reach this or other high-level math courses that better align with their career aspirations due to systemic barriers.

Few districts have created flexible course sequences that allow students to reach high-level math classes by senior year, meaning many students who do not accelerate in middle school may never be able to reach higher math classes without taking multiple math classes simultaneously or attending summer school.

Many middle school students do not know their career trajectory; having the option to delay acceleration until junior year and take a compressed Algebra 2/precalculus course would allow more students to access rigorous courses without being barred in middle school. Additionally, because current Algebra 2 courses focus heavily on symbolic manipulation that modern graphing technology renders obsolete, a compacted course could focus more on developing the conceptual understandings needed by eliminating this content. Yet, few schools have made this transition despite the obvious benefits.

Truly, this is a larger issue of tracking and acceleration for some students. Despite the consensus that sorting practices have a disproportionately negative impact on outcomes for marginalized students (NCTM, 2018), many parents still advocate for their children to be accelerated. Because teachers frequently struggle to differentiate for mixed-ability math classes, students who are ready for additional challenges may slip through the cracks as their teachers attempt to support struggling students’ access to grade-level content.

I’m not advocating separating these students into different streams, as the reality is that no matter how well you think you’ve grouped students by ability, there is no such thing as a truly homogeneous class; student variation is one of the only constants in education! Instead, teachers need additional professional development, time, and support (and reduced class sizes!) to better be able to differentiate their classes to ensure that all students have both access and challenge.

This is a systemic issue that requires structural changes beyond individual teachers. Sadly, most middle and high schools rarely have schedules allowing students to gain additional experience with math unless they are pulled from arts or other elective courses. Meanwhile, community colleges have recently begun to replace “developmental math” (their “low track”) courses with co-requisite models where students would enroll in both a credit-bearing course and an additional support class designed to help them gain access to the math content of the former. How might K-12 schools replicate that idea to provide additional support to students who need it?

Ultimately, the issue facing public schools is whether AP courses should be considered a privilege for the few who have access to outside resources or if it should be accessible to any who are interested in pursuing that pathway. Under the current paradigm, only students who take additional math courses outside of their standard school day or who are able to double up on math courses early in high school are able to reach AP Calculus by senior year. It’s outrageous that students who take Algebra 1 “on time” in 9th grade are considered remedial math students when measured along the path to AP Calculus. It’s past time we updated high school math options to reflect the 21st-century needs rather than settle for the status quo of the past century.

NCTM (National Council of Teachers of Mathematics). (2018). Catalyzing change in high school mathematics: Initiating critical conversations . Reston, VA: Author.

Thanks to Keisha and Kit for contributing their thoughts.

They answered this question of the week:

What do you think is the most important education policy issue facing public schools today, why do you think it is so important, and what is your position on it?

Consider contributing a question to be answered in a future post. You can send one to me at [email protected] . When you send it in, let me know if I can use your real name if it’s selected or if you’d prefer remaining anonymous and have a pseudonym in mind.

You can also contact me on Twitter at @Larryferlazzo .

Just a reminder; you can subscribe and receive updates from this blog via email . And if you missed any of the highlights from the first 12 years of this blog, you can see a categorized list here .

The opinions expressed in Classroom Q&A With Larry Ferlazzo are strictly those of the author(s) and do not reflect the opinions or endorsement of Editorial Projects in Education, or any of its publications.

Sign Up for EdWeek Update

Edweek top school jobs.

Sign Up & Sign In

Solving women’s health issues through engineering focus of course

Women’s health through the lifespan has been getting a new focus in recent years from the local to the federal level, with President Joe Biden recently launching initiatives to boost federally funded research in this long-overlooked area. That focus is also active in the McKelvey School of Engineering at Washington University in St. Louis, where a new Department of Biomedical Engineering elective course is filled with students interested in how they can use engineering to solve problems in women’s health. 

The “Engineering for Women’s Health” course (BME 4780/5780), available to undergraduate and graduate students, is taught by Michelle Oyen, an associate professor of biomedical engineering and director of the Center for Women’s Health Engineering. Initially, Oyen offered 16 seats in the course, but demand quickly led her to increase the number of students to 48. 

The course includes lectures on women’s reproductive anatomy and physiology, guest speakers from FemTech (technology focused on women’s health) companies and startups, research scientists from the School of Medicine, case studies and panel discussions. 

“When we pull in the engineers from these startup companies, students can talk to the people who work in real jobs in the field,” Oyen said. “The FemTech sector has a lot of startups in women’s health, which is a trillion-dollar market. There are a lot of opportunities for young engineers to work in this space.” 

One class meeting recently featured Christine O’Brien, an assistant professor of biomedical engineering and co-founder and chief scientific officer of Armor Medical Inc., and Kelsey Mayo, co-founder and CEO of Armor Medical. O’Brien and Mayo presented students with their investor pitch and details about how the company got started. They also shared information about their device, a wrist-worn early monitoring system for obstetric hemorrhage, severe blood loss that occurs in 5% of all births and is 90% preventable if detected and treated early. 

Mayo, who survived hemorrhage, told students the company is her “passion project” and encouraged them to find their own. 

“Your day job should be where your passion meets the world’s needs,” she said. “That’s a cool thing for biomedical engineers to consider.” 

Oyen said focusing on the FemTech sector is important for students’ education and gives them an idea of what they can do after they graduate. 

“Part of what has happened over the past decade is shining a light on the fact that there are all these issues that were once only whispered about by women and not brought out into the open,” Oyen said. “People have now realized this is really important because there are unmet needs in health care, which has huge implications. The two most common surgeries for women are a C-section and a hysterectomy. Half of women have a hysterectomy by age 65, which is huge.” 

In the course, students are completing group projects to address needs in women’s health, including menopause, osteoporosis, hip fractures and lack of muscle mass. 

Annika Avula, a dual-degree student earning a bachelor’s and a master’s in biomedical engineering, said she wanted to take this course after taking O’Brien’s course “Quantitative Physiology II” (BME 301B) last fall.

“It really opened so many people’s eyes to things that can be done for women’s health,” Avula said. “This course has introduced me to a new way of thinking. I’m more interested in problems and more called to ask questions.” 

Ella Hanson, a senior earning a bachelor’s and a master’s in biomedical engineering, said she took the course because of her interest in women’s health problems. 

“Dr. Oyen and Dr. O’Brien are addressing the huge gap in BME in the women’s health field,” Hanson said. “We are learning that there are more opportunities out there in engineering beyond orthopedics and other biomedical problems.”

Avula’s group project is looking at the effects of menopause, and Hanson’s group project is looking at endometriosis, a chronic disease that affects 11% of women of reproductive age in the U.S. and for which there is no cure. 

Oyen said that while it took her some time to get comfortable using words about women’s health in front of audiences, her students are open to talking about women’s health issues and using the vocabulary, which she finds encouraging for future generations. 

“I realized that I’m not going to be the one to change the world, but I’m going to teach the ones who will,” Oyen said. 

Originally published on the McKelvey School of Engineering website

Comments and respectful dialogue are encouraged, but content will be moderated. Please, no personal attacks, obscenity or profanity, selling of commercial products, or endorsements of political candidates or positions. We reserve the right to remove any inappropriate comments. We also cannot address individual medical concerns or provide medical advice in this forum.

You Might Also Like

Latest from the Newsroom

Recent stories.

Ishida to lead architecture, landscape architecture and urban design programs

Junior Seiler awarded Truman Scholarship

Elmesky receives William H. Danforth St. Louis Confluence Award

WashU Experts

Tremor a reminder that East Coast, Midwest earthquake threat is real

NASPA chair, WashU vice chancellor on the future of student affairs

How Key Bridge collapse could impact U.S. supply chains immediately, long-term

WashU in the News

Chlamydia vaccine shows promise in early trial

The government announced winners of a contest to tell real voices from deepfake audio

The Real Estate Nightmare Unfolding in Downtown St. Louis

• Program Finder
• Admissions Services
• Course Directory
• Academic Calendar
• Hybrid Campus
• Lecture Series
• Convocation
• Strategy and Development
• Implementation and Impact
• Integrity and Oversight
• In the School
• In the Field
• In Baltimore
• Resources for Practitioners
• Articles & News Releases
• In The News
• Statements & Announcements
• At a Glance
• Student Life
• Strategic Priorities
• Inclusion, Diversity, Anti-Racism, and Equity (IDARE)
• What is Public Health?

What’s Happening With Dairy Cows and Bird Flu

Though the virus is circulating in dairy cows, human exposure remains low.

Public Health On Call

Editor’s note: This article was updated on April 10, 2024.

The H5N1 strain of avian influenza—commonly known as bird flu—has been circulating among wild migratory birds for the past two years, with substantial spillover into poultry farms. 

But what's sparking concern among scientists and public health officials alike is the recent discovery of the virus in dairy cows and the subsequent infection of a dairy farm employee—the second person in America ever documented to be infected with H5N1. The virus has now spread to 16 herds in six states according to the USDA, fueling concerns about potential further transmission to humans.

In this Q&A, adapted from the April 8 episode of Public Health On Call , Stephanie Desmon speaks with Meghan Davis , DVM, PhD ’12, MPH ’08, associate professor in Environmental Health and Engineering , and Andrew Pekosz , PhD, professor in Molecular Microbiology and Immunology , about H5N1’s jump between species, what that means for the virus’s pandemic potential, and what the appearance of the virus in dairy means for consumers.

What’s going on with the avian flu?

AP: This virus has been around for over 20 years. It's been mutating over time, and something happened in the last couple of years to cause an explosion of cases in wild birds. Not surprisingly, that's led to spillover infections in some poultry farms. There's also been an increase in mammals that have been infected, such as skunks, bears, and foxes, presumably from feeding on dead infected birds. And recently, we've seen spillover of this virus into dairy cows. 

Cattle have not been reported to be infected with any of the influenza A viruses—human or animal—to date. Anytime this virus enters a new host, we set off some alarm bells in the scientific community to see what's going on.

Can we expect to see more cases in humans?

AP: I expect that over the next few weeks, we're going to be seeing more cases in cows and humans, because humans are in close contact with cows during many dairy processes. Hopefully, this will not be a large outbreak, but we certainly expect to see more cases.

Were you surprised by this outbreak?

MD: I am surprised that it's in dairy cows, because when we think about animal models for influenza, we think about mustelids, like ferrets or mink. We have also seen a number of sick farm cats that tested positive. What is most interesting about seeing [H5N1] in dairy is that researchers haven't been focusing on biosecurity and biocontainment for things like avian influenza—which is typically transmitted from a bird reservoir. Dairy farms are often quite open to the air—birds might spend time in areas where the cows eat, for example.

One of the other things we are seeing is some symptoms of disease in the cows. I've not heard of high mortality yet, but they have been showing fairly nonspecific signs, like not eating or milking well. Most of these tend to be somewhat older cows because adult cows who are lactating are in a different category of susceptibility than young calves. What we don't know yet is if perhaps the virus is in all the populations within the farm, and only some of them are showing symptoms.

Is the milk they produce safe for consumption? 

MD: For the average person buying commercial milk, we don't have any evidence that would suggest concern. If you buy pasteurized milk from a commercial dairy processor, the risk is extremely low. Pasteurization, which involves temperature and pressure and time, is designed to inactivate microbes to make the milk safer to consume and to give it longer shelf life. I strongly advise against consuming raw milk products, no matter where you live, because there are other risks, not just avian influenza. 

What can the surveillance data from infected cows tell us?

AP: Two things are really important. One is: The virus has gone from the respiratory tract through lots of different organs, through the blood, and made it all the way to the milk. In humans, the influenza virus stays within the respiratory tract. We have seen H5N1 move out of the respiratory tract in other animals, but usually that's associated with a really fast mortality. As soon as the virus leaves the lungs, the animals are so sick that they die. We're seeing a case here where the animals don't seem to be really sick, but the virus is making it to other parts of the animal. That's going to tell us something perhaps unique about the H5N1 virus compared to seasonal human viruses. 

The second critical thing is: If there is spread of this virus from cow to cow, is the virus changing and getting better adapted to replicating or spreading in cows? Bird flu jumping to mammals is important because anything that allows the virus to adapt to a mammal has the potential for making it better able to infect humans. Understanding what happens now with the spread of the virus and how the sequence of the virus changes is going to be critically important. The first sequences [from cows] look like the virus is almost identical to the bird virus. But we haven't really sampled animals that presumably acquired the infection from other cows. 

If it's spreading from cow to cow, is that a wholly different problem?

MD: There is a lot of swapping of cows in the dairy industry, and there is a diverse population of farmers, each of them has their own way of doing things. And that means that we may need to educate farmers about perhaps restricting certain sales or trade of dairy cows if evidence shows that you could introduce avian flu through a cow brought in from outside the farm. 

The USDA has released  recommendations  for state animal health officials, veterinarians, and producers, including trying to exclude birds and cats from areas where livestock are kept, not moving sick or exposed cows, using PPE among workers with exposure to dairy cows, and other measures.

Something I'm very interested in is: Where were each of these cows exposed? To what degree was this one event that is now spreading through these networks of sale and trade and movement of dairy cows? Or is this multiple events in which you've had an introduction [of the virus] from birds? Because that also changes the dynamics as we think about genetics and the potential for evolution.

AP: It’s also clear that the USDA has not ruled out that spread from cow to cow is happening via contaminated milking equipment because the amount of virus in the milk is much greater than what is found in the nose of infected cows. If this is contributing to virus spread, it should be straightforward to institute equipment disinfection protocols that could slow or stop virus spread.

Is H5N1 considered a major threat at this time?

AP: H5N1 registers as what we call “a virus with pandemic potential.” Humans presumably all have some immunity to H1 and H3 influenza viruses, which can cause seasonal epidemics, but they can't cause pandemics at the level of what we saw with COVID because there's just too much immunity in the population that limits the spread and dampens down disease severity. 

However, the human population is essentially completely naive—has no preexisting immunity—to H5 viruses. Therefore, similar to what we saw with COVID, in the worst case scenario, if this virus enters humans and starts to spread, all of us are susceptible, and we could see massive increases in numbers of cases. 

H5 viruses are rather deadly in poultry. They're not so deadly in wild birds, but they seem to be deadly in mammals, and we don't know what they'll do in humans.

MD: Right now, the average person should just be aware and avoid things like raw milk products. However, because we are seeing the potential for disease in cats, and we don't know yet if that came from cows or birds or some other pathway—it's a good idea to prevent your cats from having contact with wild birds. If they're indoors, keep them indoors, and if they become ill, consult your veterinarian.

This interview was edited for length and clarity by Morgan Coulson,  an editorial associate in the Office of External Affairs at the Johns Hopkins Bloomberg School of Public Health.

How Concerned Should We Be About Bird Flu?

What You Need to Know About H5N1, the Bird Flu Spilling Over Into Mammals (Podcast)

Related Content

How Dangerous is Dengue?

New Johns Hopkins Institute Aims to Safeguard Human Health on a Rapidly Changing Planet

9 Things to Know About Sun Safety and Skin Cancer

The Omnipresence of PFAS—and What We Can Do About Them

Five Reasons Why the Global Health Community Should Help Save Forests