LAUSR

Purpose We examined associations between academic grades and positive health behaviors, individually and collectively, among U.S. high school students. Design Cross-sectional study design. Setting: Data were from the 2017 national Youth Risk Behavior Survey. Response rates were 75% for schools, 81% for students, and 60% overall (n = 14,765 students). Subjects Youth in grades 9th–12th. Measures We focused on youth behaviors that can prevent or delay the onset of chronic health conditions. Seven dietary, 3 physical activity, 2 sedentary screen time, and 4 tobacco product use behaviors were assessed. Variables were dichotomized (0/1) to indicate that a score was given to the positive health behavior response (e.g.,, did not smoke cigarettes = 1). A composite score was created by summing each positive health behavior response among 16 total health behaviors. Analysis Multivariable logistic regression analyses for each individual health behavior, and a multivariable negative binomial regression for the composite score, were conducted with self-reported academic grades, controlling for sex, grade in school, race/ethnicity, and body mass index (BMI) categories. Results Controlling for covariates, students who reported mostly A’s had 2.0 (P < .001) more positive health behaviors; students who reported mostly B’s had 1.3 (P < .001) more positive health behaviors; and students who reported mostly C’s had .78 (P < .001) more positive health behaviors, compared to students who reported mostly D’s/F’s. Conclusions Higher academic grades are associated with more positive individual and cumulative health behaviors among high school students. Understanding these relationships can help inform efforts to create a healthy and supportive school environment and strive for health equity.