Health Behavior Factors that Influence Achievement ...

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a lot of earwax, dirty and rarely changed school clothes, unhealthy snack consumption, smoking, glue inhaling and fighting. These behaviors impact the quality ...
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Health Behavior Factors that Influence Achievement of School-Age-Children in Agam District, Indonesia Putri Nilam Sari Faculty of Public Health,Universitas Andalas, Padang, Indonesia Correspondence author: [email protected]

School-age-children who have poor health status have lower cognitive ability and performance. They also potentially more likely to repeat grades and drop out of school than children who did not experience similar problems. This study aims to identify health behavior factors that influence achievement of school-agechildren in Agam District, Indonesia. This study used a cross-sectional study. Respondents in this study were elementary school students level four, five and six, and selected by cluster sampling method. Data analysis was performed using simple linear regression. The results showed that the variables that had a significant relationship with academic achievement were bullying, breakfast habits, eating fruit habits, eating vegetable habits and smoking behavior. Schools need to implement anti-violence curriculum in teaching and learning activities to avoid bullying and fighting habits in students. The school and its surrounding community should work together to establish a healthy canteen to provide nutritious snacks for students, so that good nutrition can be meet. Tobacco control policies are needed to limit students’ access to get cigarettes. School Health Unit need to be improved so students know about good behavior in maintaining their health. Keywords: school age children; health behavior; school achievement

INTRODUCTION School-age-children with health problems had lower performance as well as more likely to repeat grades and drop out of school than children who had never experienced similar problems (Rosso and Arlianti 2010). Public health experts and policy makers in education sector have been focusing on health problems of school-age-children and their impact on academic achievement. In the last 30 years, the World Health Organization (WHO) in collaboration with a network of Health Behaviour in School Aged Children (HBSC) assessed the health status of school-agechildren in the world. The goal was to improve children’s quality of life (HBSC Network 2014). School-age-children is not a high-risk group for death. This makes the school-age-population in a low priority in many health sector intervention programs. However, school-age-children begin to make independent decisions about their health, to establish and to adopt behaviors that will affect their current and future health status, as well as the health of their future children. In the 1970s, government of Indonesia ran health programs at the primary level called the School Health Unit (UKS). But there is no valid data on the development of UKS health programs and what was done as an effort to improve students’ health (Rosso and Arlianti 2010). Schools in Agam District won the UKS contest event and awarded with Adiwiyata School (pro-environment award) at national level. From interviews with teachers, headmaster and observations there were students who had bad behavior in health, including no breakfast before school, no shower in the morning, long and dirty fingernails, a lot of earwax, dirty and rarely changed school clothes, unhealthy snack consumption, smoking, glue inhaling and fighting. These behaviors impact the quality of learning. Students were feeling sleepy, easily ill, not attending classes, and so on. It also influences student’s cognitive abilities, and affect academic values and achievements. So many factors affect academic achievement in school-age-children. Stor et al. (2013) found that each bullying

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incidence decreases an average of 0.98 of student’s academic achievement. Hammig and Jozkowski (2013) states that fighting affects student’s performance at school. Rampersaud and Girard (2005) found that a healthy breakfast can improve cognitive ability and academic achievement. This is in line with Sigfusdottir et al. (2006) findings that habit of eating fruits and vegetables had significant effect on student achievement. Content of micronutrients contained in meal are substances needed by the body to improve performance in learning. According to research by Seirawan (2012), children who have a toothache has academic skills four points lower than children who have healthy mouth. Allegrante (2004) states that physical activity improves concentration, forming discipline thus improving academic skills. Other factor is smoking, which can greatly affect mental decline at a young age and frailty in old age. Smoking habits that carried out at a young age will reduce levels of memory and reasoning ability (Sabia and Dugravot 2012). Futhermore, Donnelly (2011) found that Body Mass Index (BMI) outside the normal categories affects academic achievement. The aim of this research is to know about relationship between healthy behavior (bullying, fighting, breakfast habit, eating fruit habit, eating vegetable habit, oral hygiene, physical activity, smoking, and BMI) and academic achievement.

METHOD This research was conducted by quantitative methods with cross sectional design. The study was conducted in elementary schools located in Agam District during September-October 2015. Samples were 103 students, recruited using cluster sampling method. The dependent variable of this study was academic achievement, which was obtained from the report card. The independent variables were bullying, fighting, breakfast habit, eating fruits and vegetables habit, oral health, physical activity, smoking, and BMI. Al data were obtained from questionnaire and direct observations. The data was analyzed with simple linear regression.

RESULTS Bullying Relation with Academic Achievement The research found that there were 18.4% of students who were always bullied at school. There was a significant relationship between bullying and academic achievement (p value= 0.001). According to Hymel (2015) bullying will have negative effects for the victim, both physically and psychologically. Children who are being bullied will experience difficulty in socializing, afraid to come to school, and difficulty in concentrating which affect academic achievement (Rigby 2007). Children who are victims of bullying will spend a lot of time to think about how to avoid disruptions in school and have little energy to learn (Myklestad and Tambs 2015). Fighting Relations with Academic Achievement This study found that only 12.6% of students never fights, approximately 87.4% had experienced fights. In this study, there was no significant relationship between fights with academic achievement (p value = 0.329). Fighting among children are not regulated by law in detail. But if children have fighting habit, they will get used to violence in society (Stoddard,Varela, and Zimmerman 2015). Breakfast Habits Relations with Academic Achievement In this research there were 14.6% of students who did not have breakfast before going to school. There was a significant relationship between breakfast habits with academic achievement (p value=0.006). For school children, breakfast can improve learning ability. Variety breakfasts will meet their needs for fibers, carbohydrates and total

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fat (Deshmusk, Nicklas, and O’Neil 2010). Children who don’t have breakfast are lacking concentration and learning ability, causing fatigues and drowsiness. School activities require high glucose levels which are obtained from breakfast intakes (Hoyland, Dye, and Lawton 2009). Habits of Eating Fruit and Vegetables Relation with Academic Achievement The results showed that there were 43.7% students who consumed fruit once a day or more. The same thing with the habit of eating vegetables, there were 10.7% students who never eat vegetables. The habit of eating fruits (p value = 0.007) and vegetables (p value = 0.0001) have significant relationship to academic achievement. Oral Hygiene Relations with Academic Achievement There was only 35% of students who brush their teeth more than one time a day. There was no significant relationship between oral hygiene with achievement (p value= 0.53). Children with oral problems are at risk for malnutrition, mouth and teeth pain, which will reduce appetites. Disruption in mouth can reduce learning concentration and make school absenteeism higher, therefore contributes to academic achievement (Koivusilta and Honkala 2013). Physical Activity Relations with Academic Achievement In Agam District about 7.8% of the students had never had physical activity. There was no significant relationship between physical activity and academic achievement (p value=0.387). If children have activities that drain a lot of energy, there will be imbalance energy intake and uptake, and their body will become tired. Smoking Behavior Relations with Academic Achievement The study found that 62.1% students had never smoked. There was a significant relationship between smoking behavior and academic achievement (P value=0.006). This is in line with research from The Sheba Medical Center Israel which shows that smokers have lower intelligence levels than those who do not smoke. The research found that active smokers had only average IQ score of 94. In fact, the average IQ score of non-smokers were 101 (Weiser et al. 2010). Body Mass Index Relations with Learning Achievement This study found only 22.3% students had a normal BMI. There was no significant relationship between BMI and academic achievement (p value= 0.249). Hannum and Frongillo (2014) states that malnutrition is directly caused by lack of food consumption and the presence of infectious diseases.

DISCUSSION Schools can work together with the community to improve the behavior of good health so that children can increase learning achievement. To reduce bullying at school, the school can implement anti-bullying school programs that enhance students’ skills in improving social and emotional relationships, resolve personal conflicts, and emotional management (Shetgiri, Espelage, and Caroll 2015). This activity will reduce bullying in school as much as 20-23% (Ttofi, Farrington, and Lösel 2011). If possible, school could held regular meetings with parents related to the issue of violence among students. Thus, parents know about their children progress in schools so teachers and parents can together raise theie attention about the issues of violence. Fighting is one form of aggressive behavior. According to Navarre (2012), aggression is a behavior with the intention

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to hurt, attacked or damage persons or objects around them in defending themselves. It was also a result of dissatisfaction. The role of the school to solve this problem is to develop and to influence students in building a mutual respect culture among friends. Another thing that can be done is by placing posters containing message to be kind to each other in strategic places (Taylor et al. 2013). This can reduce 20-23% incidence of fights between students (Ttofi, Farrington, and Losel 2011). Another issue to consider is the number of students who smoke. It is therefore expected for schools and governments to work together to oversee the distribution of cigarettes in the stalls that are not easily purchased by children. It was also necessary to have supervision from parents or from people that can influence children to smoke. School meetings with parents may also be used to promote the importance of breakfast and its impact for child’s intelligence. Another alternative is to provide healthy school canteen. Healthy snack and meal can be provided by local communities who work together with school’s management. School can minimize the unhealthy snacks that are sold outside of school. The majority of schools in Europe have implemented programs and policies of nutrition by providing healthy meals and snacks to students, to meet the nutritional needs of students who do not have breakfast before going to school (WHO Europe 2006). Agam District still have a lot of agricultural land. Therefore, the local government may provide land near the school to create a school garden containing vegetables and fruits that can be the object of learning for students and for their consumption. Research conducted by Ratcliffe et al. (2009) found that students who join school’s garden activities are more willing to eat vegetables and consume vegetables more frequently. Children who are not eating properly have poor body resistance, vulnerable to illness, lack of appetite and eventually susceptible to malnutrition. In this study, nutritional status was determined by anthropometric measurement. Yet, biochemical was not measured so it specific body nutrients were unknown. Despite good nutritional status measured by BMI anthropometric measurements, anemic children may suffer from low concentration, which will affect their academic achievement. All circumstances that lead to malnutrition will also create structural and functional changes in children’s brain (Gibney 2009). This study suggests schools to promote balanced nutrition through UKS (Health School Programs) program for students. UKS officer can provide regular counseling and BMI monitoring for students. Schools should also pay attention to students who have heavy work at home, such as helping parents to work in the fields. When appropriate, school can suggest parents to provide adequate nutrition and energy as well as to provide opportunity for children to take a rest, so that it will not disrupt their lessons at school. Furthermore, schools can implement dental health program and train peers to give a good example in maintaining dental health (Stella and Pine 2005). In Indonesia, this program is called dental school program (UKGS) to prevent mouth and teeth problems that can affect academic achievement.

CONCLUSION This research shows that variables that had a significant relationship with academic achievement were bullying, breakfast habits, eating fruit habits, eating vegetable habits, and smoking behavior. Schools need to implement anti-violence curriculum in teaching and learning activities to avoid bullying and fighting habits in students. School and its surrounding community can work together to establish a healthy canteen to provide nutritious snacks for students, so that good nutrition can be meet. Tobacco control policies are needed so that students have limited access to get cigarettes. School Health Unit need to be improved so students know about good behavior in maintaining their health.

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Ttofi, M. M., D. P. Farrington, and F. Lösel. 2011. “Effectiveness of school-based programs to reduce bullying: a systematic and meta-analytic review.” Journal of Experimental Criminology 7: 27-56. Weiser, S. Z., N. Werbeloff, E. Kravitz, and G. Lubin. 2010. “Cognitive test scores in male adolescent cigarette smokers compared to non-smokers: a population base study.” Addiction 105 (2): 358-363. WHO Europe. 2006. Food and nutrition policy for schools. Copenhagen: WHO Regional Office for Europe.

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