High School Graduation

Education Access and Quality

About This Literature Summary

This summary of the literature on High School Graduation as a social determinant of health is a narrowly defined examination that is not intended to be exhaustive and may not address all dimensions of the issue. Please note: The terminology used in each summary is consistent with the respective references. For additional information on cross-cutting topics, please see the Early Childhood Development and Education and Employment literature summaries.

Related Evidence-Based Resources (1)

Literature Summary

A high school diploma is a standard requirement for most jobs — and for higher education opportunities.1,2,3 Not completing high school is linked to a variety of factors that can negatively impact health, including limited employment prospects, low wages, and poverty.4,5 A student’s ability to graduate from high school may be affected by factors related to the individual student as well as by broader institutional factors such as family, school, and community.6  

Disparities in high school completion rates exist among racial and ethnic groups in the United States. According to data for the 2018–2019 school year, 93 percent of Asian/Pacific Islander, 89 percent of White, 82 percent of Hispanic, 80 percent of Black, and 74 percent of American Indian/Alaska Native students attending public high schools graduated within 4 years of beginning the 9th grade.7  

Certain environments can play a role in students’ likelihood of completing high school. Students’ home and school environments impact the likelihood that they will graduate from high school.6,8,9,10 Researchers have found that students whose parents are not involved in their schooling are less likely to complete high school.8,9 Studies also show that high school students who attend smaller schools and who rank their teachers as “high quality” are more likely to graduate.6,9 Other school climate factors — such as teachers’ lack of interest and students’ perception of an ineffective and unfair discipline system — are linked to higher rates of student dropout.10 Additionally, dropout rates are higher in schools with higher rates of violence and safety issues.11 Relatedly, lesbian, gay, bisexual, transgender, and queer (LGBTQ) students report that physical and verbal abuse in school often influences their decision to drop out.12  

Students from low-income families often have less access to resources, and they tend to live in communities with underperforming schools.13 These factors may contribute to lower academic achievement and higher dropout rates.13 In 2016, the number of young people ages 16 to 24 years who did not complete high school or were not enrolled in high school was 3.7 times higher in low-income families compared to high-income families.14

Certain risk factors contribute to the likelihood of graduating from high school. Research has indicated that students’ reading skill level by 3rd grade (e.g., proficient, basic, or below basic) can affect their long-term academic achievement, particularly their likelihood of graduating from high school.13 One study found that 23 percent of students with below-basic reading skill levels failed to finish high school on time or at all, compared to 9 percent of students with basic skill levels and 4 percent of students with proficient reading skills.13 Additionally, 26 percent of students who were not reading proficiently in 3rd grade and who lived in poverty for at least a year between 2nd and 11th grades did not finish high school on time or at all — compared to 9 percent of students with basic or below-basic reading skills who had never lived in poverty.13 Among young women, teen pregnancy and teen parenthood are also important risk factors for school dropout.15,16 One analysis found that at age 22, about 89 percent of women who had not given birth as teenagers had earned a high school diploma, while only 51 percent of those who were teen mothers had earned a high school diploma.15,17

There are negative outcomes of not completing high school, as well as positive outcomes of graduating high school. Students who do not complete high school may experience poor health and premature death.4,18,19 Individuals who do not graduate high school are more likely to self-report overall poor health.18,20,21,22,23 They also more frequently report suffering from at least 1 chronic health condition — for example, asthma, diabetes, heart disease, high blood pressure, stroke, hepatitis, or stomach ulcers — than graduates.24 Ultimately, finishing more years of high school, and especially earning a high school diploma, decreases the risk of premature death and increases employment prospects and lifelong earning potential.25,26 Full-time workers with a high school degree earned approximately 24 percent more than their counterparts without a high school degree.27 In 2020, the median weekly earnings for full-time workers with a high school degree but no college was $781. This is $162 higher than the median weekly earnings for full-time workers without a high school degree.28

Programs that encourage high school completion can improve the graduation rates of high-risk students and communities.4,15 Examples of such programs include transition programs that support transitioning from middle into high school and credit-based transition programs that allow students to earn college credit while still in high school.29,30 Increased educational attainment provides individuals with the opportunity to earn a higher income through the acquisition of gainful employment options, which can lead to increased access to better living conditions, healthier foods, and health care services.2,26,31,32,33 Overall, high school graduation has the potential to improve population health.2

Additional research is needed to further understand the effects of high school graduation on health outcomes and disparities. This additional evidence will facilitate public health efforts to address high school graduation as a social determinant of health.



Qu, S., Chattopadhyay, S. K., Hahn, R. A., & Community Preventive Services Task Force. (2016). High school completion programs: A community guide systematic economic review. Journal of Public Health Management and Practice, 22(3), E47–E56. doi: 10.1097/PHH.0000000000000286


Freudenberg, N., & Ruglis, J. (2007). Reframing school dropout as a public health issue. Preventing Chronic Disease, 4(4), A107.


Orfield, G., Losen, D., Wald, J., & Swanson, C. B. (2004). Losing our future: How minority youth are being left behind by the graduation rate crisis. The Civil Rights Project at Harvard University.


Hahn, R. A., Knopf, J. A., Wilson, S. J., Truman, B. I., Milstein, B., Johnson, R. L., Fielding, J. E., Muntaner, C. J. M., Jones, C. P., Fullilove, M. T., Moss, R. D., Ueffing, E., & Hunt, P. C. (2015). Programs to increase high school completion. American Journal of Preventive Medicine, 48(5).


Wilson, S. J., & Tanner-Smith, E. E. (2013). Dropout prevention and intervention programs for improving school completion among school-aged children and youth: A systematic review. Journal of the Society for Social Work and Research, 4(4), 357–372. doi: 10.5243/jsswr.2013.22


Rumberger, R. W. (2001). Why students drop out of school and what can be done. https://escholarship.org/uc/item/58p2c3wp


Institute of Education Studies, National Center for Education Statistics. (n.d.). COE — public high school graduation rates. Retrieved March 8, 2022, from https://nces.ed.gov/programs/coe/indicator/coi


Jeynes, W. H. (2007). The relationship between parental involvement and urban secondary school student academic achievement: A meta-analysis. Urban Education, 42(1), 82–110.


Rumberger, R. W. (1995). Dropping out of middle school: A multilevel analysis of students and schools. American Educational Research Journal, 32(3), 583–625.


Wehlage, G. G., & Rutter, R. A. (1986). Dropping out: How much do schools contribute to the problem? Teachers College Record, 87(3), 374–392.


Bekhuis, T. (April 1995). Unsafe public schools and the risk of dropping out: A longitudinal study of adolescents [Address]. Annual Meeting of the Eastern Psychological Association, Boston, MA.


Kosciw, J. G., Greytak, E. A., Zongrone, A. D., Clark, C. M., & Truong, N. L. (2018). The 2017 National School Climate Survey: The experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation’s schools. Gay, Lesbian, and Straight Education Network (GLSEN).


Hernandez, D. J. (2011). Double jeopardy: How third-grade reading skills and poverty influence high school graduation. Annie E. Casey Foundation. 


McFarland, J. (n.d.). Trends in high school dropout and completion rates in the United States: 2018. National Center for Education Statistics, 101.


Steinka-Fry, K. T., Wilson, S. J., & Tanner-Smith, E. E. (2013). Effects of school dropout prevention programs for pregnant and parenting adolescents: A meta-analytic review. Journal of the Society for Social Work and Research, 4(4), 373–389.


Dalton, B., Glennie, E., & Ingels, S. J. (2009). Late high school dropouts: Characteristics, experiences, and changes across cohorts — descriptive analysis report (NCES 2009-307). National Center for Education Statistics.


Perper, K., & Manlove, J. (2010). Diploma attainment among teen mothers: (507972010-001) [Data set]. American Psychological Association. doi: 10.1037/e507972010-001


Ferraro, K. F., & Farmer, M. M. (1999). Utility of health data from social surveys: Is there a gold standard for measuring morbidity? American Sociological Review, 303–315.


Krueger, P. M., Tran, M. K., Hummer, R. A., & Chang, V. W. (2015). Mortality attributable to low levels of education in the United States. PloS One, 10(7), e0131809.


Hahn, R. A., & Truman, B. I. (2015). Education improves public health and promotes health equity. International Journal of Health Services, 45(4), 657–678.


Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of 27 community studies. Journal of Health and Social Behavior, 21–37.


Prus, S. G. (2011). Comparing social determinants of self-rated health across the United States and Canada. Social Science & Medicine, 73(1), 50–59.


Schiller, J. S., Lucas, J. W., & Peregoy, J. A. (2012). Summary health statistics for US adults: National health interview survey, 2011.


Vaughn, M. G., Salas-Wright, C. P., & Maynard, B. R. (2014). Dropping out of school and chronic disease in the United States. Journal of Public Health, 22(3), 265–270.


Oreopoulos, P. (2007). Do dropouts drop out too soon? Wealth, health and happiness from compulsory schooling. Journal of Public Economics, 91(11–12), 2213–2229.


Levin, H. M., Belfield, C., Muennig, P. A., & Rouse, C. (2007). The costs and benefits of an excellent education for all of America’s children. Teachers College, Columbia University.


U.S. Department of Labor, Bureau of Labor Statistics. (n.d.). Median weekly earnings $606 for high school dropouts, $1,559 for advanced degree holders. The Economics Daily. Retrieved March 10, 2022, from https://www.bls.gov/opub/ted/2019/median-weekly-earnings-606-for-high-school-dropouts-1559-for-advanced-degree-holders.htm


Torpey, E. (June 2021). Data on display: Education pays, 2020. U.S. Department of Labor, Bureau of Labor Statistics. https://www.bls.gov/careeroutlook/2021/data-on-display/education-pays.htm


Roybal, V., Thornton, B., & Usinger, J. (2014). Effective ninth-grade transition programs can promote student success. Education, 134(4), 475–487.


Fowler, M., & Luna, G. (2009). High school and college partnerships: Credit-based transition programs. American Secondary Education, 62–76.


Ross, C. E., & Wu, C. L. (1995). The links between education and health. American Sociological Review, 719–745.


Cutler, D. M., & Lleras-Muney, A. (2006). Education and health: Evaluating theories and evidence. National Bureau of Economic Research, 10.3386/w12352.


Day, J. C., & Newburger, E. C. (2002). The big payoff: Educational attainment and synthetic estimates of work-life earnings. Special  studies. Current population reports.

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