by Michelle Haberstroh

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As part of my internship with JPHMP Direct, I had the opportunity to interview Dr. Robert Hahn, one of the authors of a systematic review published ahead-of-print in the Journal of Public Health Management and Practice. A PDF of the article, “Examining the Effectiveness of Year-Round School Calendars on Improving Educational Attainment Outcomes Within the Context of Advancement of Health Equity,” is available on the journal website. The article will appear in an upcoming print issue of the journal later this year.

Dr. Hahn is a coordinating scientist for the Community Guide Branch. He has led reviews on juvenile violence and excessive alcohol consumption and is currently heading systematic reviews of interventions to promote health equity. Dr. Hahn has served as an epidemiologist for CDC since 1986 and is a member of the Senior Biomedical Research Service. Dr. Hahn holds a doctorate in anthropology and a master’s degree in public health in epidemiology. During 1998-1999, he worked as a Capitol Hill fellow in the House of Representatives Committee on Veterans’ Affairs and in the office of Congresswoman Louise Slaughter.

The Guide to Community Preventive Services (The Community Guide) is a collection of evidence-based findings of the Community Preventive Services Task Force (CPSTF). It is a resource to help select interventions to improve health and prevent disease in states, communities, community organizations, businesses, healthcare organizations, or schools.

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Transcript of video:

JPHMP Direct: You recently published a systematic review in the Journal of Public Health Management and Practice, titled “Examining the Effectiveness of Year-Round School Calendars on Improving Educational Attainment Outcomes Within the Context of Advancement of Health Equity.” What factors influenced your decision to conduct a systematic review?

Dr. Robert Hahn: We have been conducting systematic reviews of the evidence on educational interventions to help get minority and low-income populations out of poverty and improve their long term health. We have learned that the loss of educational achievement during summers is an important problem for low-income populations. This loss accumulates over the course of a child’s school years.  Year-Round School Calendars have been proposed as one way to address this problem. The school year is not longer, but shorter school breaks are spread through the school year. So we undertook this review to assess the evidence on this intervention as a way of promoting the well-being of low income student populations. 

JPHMP Direct: Can you walk me through the steps you and your co-authors took when developing your methods? Specifically, regarding your search process? Why did you choose to exclude studies that were not conducted in a high-income economy?

Hahn:

1. Define intervention and outcomes of interest.
2. Specify basic research questions. 
3. Systematically search published literature for studies, evaluations of the intervention.
4. Evaluate each study by established criteria, such as sampling and appropriate analysis. 
5. Combine evidence to assess overall finding. 
6. Present findings to Community Preventive Services Task Force.
7. Revise and write up findings, prepare dissemination information. 
   • In the Community Guide review process, we commonly exclude non-high-income economy nations because the system we are examining is so different in those nations from that in the US that the conclusions of those studies would not apply in the US—the focus of our reviews. 

JPHMP Direct: After the search process was completed, 53 studies were included within the systematic review. How did you organize and review all the literature gathered during your search?

Hahn: We wanted to answer several basic questions. Basically we wanted to know whether the overall evidence indicated that the intervention worked or did not, or whether the evidence was not sufficient to answer the question. We soon discovered that year round schooling was implemented in two distinctive forms–single-track and multi-track, so we analyzed the evidence on these two forms separately. Multi-track programs were implemented mostly to save funds in the short term—schools were open year round and students took short breaks during the school year while other students were in school. The school was almost never empty and could house a larger school population. Thus, the school district might be able to delay building new schools. In single-track programs, the goal was more often to prevent summer loss; all students had the same short breaks during the school year, and there was no long summer break. In addition, some schools had “intersessions” during which students with problems learning could receive extra teaching, and those who wanted accelerated learning could also find this. 

JPHMP Direct: Could you briefly describe how year-round schooling correlates to health equity?

Hahn: Public health researchers have looked at several aspects of the connection between education and health. A major focus of public health is health education, in which students specifically study ways to be healthy. Schools also promote physical activity as a way of fostering student health. And public health researchers also study how the health of students (eg, poor hearing, hunger, asthma) affects their learning and what can be done to improve student health to improve school performance. Our reviews had a different focus: education has long term effect on health—promoting the acquisition of problem solving skills and skills in social interaction and communication. This learning improves the students’ ability to secure good jobs, live in healthy neighborhoods, and be emotionally healthy. We have seen education as a major long term path by which low income and many minority children can escape poverty and enjoy healthy lives. And, last step, programs that help low income and many minority children promote health equity. 

JPHMP Direct: You and your colleagues conclude that there is insufficient evidence to determine the effects of year-round schooling on improved academic achievement. Can you briefly describe some of the inconsistencies found in the literature? What measures do you suggest for future studies to bridge this gap?

Hahn: There were several problems with the evidence. Effects for multi-track programs were inconsistent, with some studies finding benefit, others not. In addition, there was some evidence that in multi-track programs, minority children could be inappropriately assigned to poorly resourced tracks. In single-track programs, while there was some indication of benefit, particularly for minority students, the role of intersession was not clear. Studies did not specify whether intersession was an essential part of the program; if so, the school year would in fact be longer and it was possible that the benefit was attributable not to the year round schooling, but to the intersessions. So, Community Preventive Services Task Force was not able to draw conclusions or make recommendations regarding these potential solutions to the problem of summer loss. 

JPHMP Direct: What future research do you have to look forward to due to these results? How can future research readdress summer academic loss?

Hahn: The Community Guide does not conduct primary research, but rather reviews already available evidence on different public health topics to determine the state of knowledge on these topics. However, we have made recommendations to the research community regarding year round schooling, namely the clarification of the role of intersession in single-track programs and the separation of the roles of the intersession or the different scheduling of school breaks in improving academic outcomes. The Community Guide no longer works on educational interventions and has turned to work on housing as a public health issue. 

JPHMP Direct: Is there anything else you’d like to add?

Hahn: The Community Guide is working to find out what improves the long term health of low-income and minority populations by focusing on what are called the “social determinants of health,” those upstream social forces, like education, housing, transportation, and the justice system, that powerfully determine the resources that affect population health.  This focus bears great potential in the promotion of health equity. 

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Michelle Haberstroh is a graduate student at the University of Illinois Springfield, pursuing an MPH with a certification in Epidemiology, and an MA in Human Services with a concentration in Child and Family Services.