Could School Function Be an Adolescent Health Vital Sign? Associations Between Gradebook Data and Substance Use Among Middle School Students

ABSTRACT Background Identifying early substance use and at‐risk adolescents is a challenge for public health. The objective was to identify variables in digital school records that might distinguish between youth at high and low risk of adolescent substance use. Methods We performed a secondary analysis of sixth‐grade students followed annually through eighth grade in Los Angeles, California. The composite outcome was self‐reported lifetime use of alcohol, cannabis, or other substances by eighth grade. Independent variables tested were parent‐reported GPA, transcript‐recorded GPA, and gradebook data including summative (quizzes and tests), formative (homework), and engagement (classroom behavior and participation) data. We evaluated models for discriminative ability. Results Of the 234 students included in our sample, 51.7% were female, 82.1% were Latino, and 47 reported the composite outcome. Gradebook formative and engagement scores were most consistently associated with substance use. A model including gradebook engagement score and female sex demonstrated moderate ability to discriminate ( c ‐statistic = 0.79). Implications for School Health Policy, Practice, and Equity Findings support the potential for digital gradebook data to serve as an inexpensive, readily available, and moderately accurate risk indicator of adolescent substance use. Conclusions Schools, families, and health systems may leverage increasingly digitized school data to identify and support youth even where traditional modes of screening are limited