Associations of health behaviors, school performance and psychosocial problems in adolescents in the Netherlands

School-based health-promoting interventions show promising results in improving various health outcomes of adolescents. Unfortunately, much is still unknown about the relations between health behaviors and school performances, while improving these would give schools a stronger incentive to invest in health promotion. This paper presents the associations of several health behaviors with school performances and studies the mediating effects of psychosocial problems. Health behavior and socio-demographic data were gathered from 905 Dutch high school students via an online survey, completed in-class. These data were matched with school records of the students' overall grade average (GA) on the three core subjects in Dutch high schools (Dutch, English and Math). The associations between health behaviors and school performances, and the potentially mediating effects of psychosocial problems, were studied via mixed-effects regression models. Smoking, being bullied, compulsive and excessive internet use and low physical activity were directly associated with lower school grades. Additionally, being bullied, bullying, smoking, excessive and compulsive internet use were associated with students' grades via mediation of psychosocial problems. This means that lower school grades were (also) associated with those behaviors through the effects of psychosocial problems in those students. This study showed the strong links between health behaviors and academic achievements among adolescents. Schools and health promoters should be educated more on these relations, so that they are aware of this common interest to get more support for health-promoting interventions. Additionally, the role of psychosocial problems in the relations between behaviors and school performances should be studied further in future research.