BHI researchers Dr. Tracy Vaillancourt and Dr. Daphne Korczak are leading a groundbreaking longitudinal study examining how youth peer relationships and school climate can shape lifelong brain and heart health. The findings from this ongoing study have already informed and catalyzed interventions in school boards, positively improving student experiences. Beyond this, the results of this unique study will help guide national policy on youth health and education, with the potential to reduce long-term risks for chronic neurological, psychiatric, and cardiovascular diseases.
Raising Awareness for Youth Brain Health
Caring for brain health requires lifelong attention. Brain Awareness Week in March aims to improve public understanding of how the brain works, why brain health matters, and how neuroscience research improves lives. Although both brain and cardiovascular diseases likely emerge in adulthood, their foundations are often laid much earlier, during childhood and adolescence. Experiences such as bullying, violence, and discrimination can trigger biological changes, including heightened stress responses and inflammation, that increase long-term health risks. Research has shown that poor mental health in childhood is linked to poorer physical health in adulthood, including a greater risk of chronic cardiovascular and neurological illness (1,2).
Despite this, Canada lacks a uniform system or guidelines to routinely monitor these risks or inform interventions within schools. To address this gap, BHI researchers and co-leads Dr. Tracy Vaillancourt of the University of Ottawa and Dr. Daphne Korczak of the University of Toronto and SickKids have launched a transformative research initiative. Together, they are leading one of the largest longitudinal studies of its kind, a study that is working to strengthen youth health today while also identifying patterns that can improve brain and heart health in adulthood. The project is being carried out in multiple school boards across Ontario and uses an online survey to explore key questions about health, well-being, and peer relationships. Known as the Health and Peer Relationships Study (HPRS), its goal is to generate population-level, equity-informed surveillance data that will identify emerging risks, key social and environmental influences, and modifiable school-based factors shaping youth mental and physical health.
The Health and Peer Relationships Study (HPRS)
HRPS is an accelerated longitudinal, population-based study. This means it follows a large group of children and adolescents of different ages over time, allowing researchers to gather and share results quickly. During school hours, students in Grades 4 to 12 are invited to complete a 20-minute online survey, available in English and French. The survey is created to answer the central question: “How are school climate and peer relationships associated with child and adolescent mental and physical health across development, and how are these associations patterned by social inequities and school context?” (3)Importantly, the survey was designed with equity and diversity at its core. The researchers are deeply committed to understanding how factors such as race/ethnicity, gender, and intersectionality influence health outcomes.
Dr. Vaillancourt explains, “Our goal is to treat schools as critical public health settings. By generating population-level, equity-informed data on school climate, peer relationships, and youth health, the HPRS allows us to detect emerging risks early, identify where inequities are concentrated, and provide timely evidence to support healthier developmental trajectories for young people.”
The survey covers factors included in Life’s Essential 8 (e.g., sleep, nutrition, smoking/vaping), a framework created by the American Heart Association that defines the key contributors to cardiovascular health (4). It also includes factors known to affect brain health, including discrimination and bullying, mental health, screen time, and school climate. Once collected, the results are analyzed and returned to participating school boards within four weeks of collection, enabling timely, evidence-based strategies to promote student health, reduce violence, and improve school environments. Research shows that these early social interventions can have lasting positive effects on both cardiovascular and brain health well into adulthood (5–8).
Early Insights from HPRS Data
To date, the study has partnered with 14 school boards across Ontario and has surveyed over 300,000 students, including at the pilot round and the first time point. These students will be followed at five additional time points as part of the study’s longitudinal design. Early results show that 30% of students struggle with mental health symptoms, with rates as high as 75% among gender-diverse youth. Bullying remains prevalent, disproportionately affecting marginalized students. Encouragingly, students with strong peer relationships and supportive school environments show better brain and heart health indicators, including lower stress levels, and fewer symptoms of depression and anxiety.
Importantly, these findings are more than data points, they are catalysts for real-world action. The researchers return the results to school boards quickly, allowing for evidence-based interventions that improve students’ health and daily life. Initiatives already implemented include measures to address food insecurity and improve bathroom safety. These social experiences are tied to real biological stress responses that can affect both brain and heart health. By providing near real-time results, school boards are taking action to enhance student well-being today, which will promote long-term brain and cardiovascular health.
“We know that mental health problems in childhood increase the risk of premature heart disease, but by the time that individuals present for clinical care, the window of opportunity for prevention has closed. This study provides us with an exciting new opportunity to identify the earliest possible window at which modifiable risk factors for cardiovascular disease might serve as targets for novel public mental health interventions in childhood and adolescence,” Dr. Korczak highlights.
Co-Production and Knowledge Sharing
The HPRS research team has been exemplary in putting the BHI cross-cutter enabler of co-production into practice. Survey questions and study design are developed collaboratively with each participating school board, ensuring that the survey is accessible and appropriate to local needs rather than a one-size-fits-all approach. This process allows the priorities of individual school boards to be meaningfully reflected in the research. Over time, the team has built strong, long-lasting relationships with the school boards, allowing for constant communication back and forth.
The researchers then integrate a second cross-cutter enabler, knowledge mobilization, by developing online dashboards that give school boards easy, direct access to their data. The team also provides additional guidance whenever support with interpretation is needed. This reciprocal relationship between researchers and knowledge users fosters shared ownership of the data and a dynamic partnership, helping translate research findings into real-world action that benefits students.
As Dr. Vaillancourt emphasizes, “Co-production ensures that the science is shaped by the people who will use it. By working alongside school boards, we produce evidence that is both rigorous and immediately relevant to student well-being.”
Implications and Future Directions
This ongoing project is one of the largest and most inclusive population-based studies of youth mental and physical health conducted within school systems and will generate an unprecedented dataset for monitoring developmental, social, and environmental factors affecting brain-heart health. This study positions Canada as a leader in preventative medicine and has the means to inform and shape national policy. In addition, plans to house this extensive dataset on an open science platform (i.e., freely and widely available) will enable researchers around the world to build on these findings and advance the field globally.
The Health and Peer Relations Study will reveal key insights for the early detection and prevention of harmful school interactions and environments. By identifying these risks early, the study will help reduce the development of unhealthy stress responses in childhood and adolescence, ultimately lowering the likelihood of future chronic conditions, including neurological and cardiovascular diseases. In addition, the study will shed light on health inequities among youth and provides evidence to support positive changes to national health and education policy.
This transformative research uses science to help create safer, healthier school environments for Ontario students. Understanding the brain-heart connection in real-world school settings can guide programs that reduce stress, build relationships, and strengthen mental and physical health. Peer relationships and school climates are not just social concerns—they are public health priorities that shape the health of the developing brain and heart.
References
- Nelson CA, Bhutta ZA, Burke Harris N, Danese A, Samara M. Adversity in childhood is linked to mental and physical health throughout life. BMJ. 2020 Oct 28;m3048.
- Danese A, Moffitt TE, Harrington H, Milne BJ, Polanczyk G, Pariante CM, et al. Adverse Childhood Experiences and Adult Risk Factors for Age-Related Disease: Depression, Inflammation, and Clustering of Metabolic Risk Markers. Arch Pediatr Adolesc Med [Internet]. 2009 Dec 1 [cited 2026 Feb 5];163(12). Available from: http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/archpediatrics.2009.214
- Health and Peer Relations Study [Internet]. Health and Peer Relations Study. Available from: https://hprs.ca/
- Life’s Essential 8 [Internet]. American Heart Association. 2025. Available from: https://newsroom.heart.org/facts/life-s-essential-8
- Tan J, Wang Y. Social Integration, Social Support, and All-Cause, Cardiovascular Disease and Cause-Specific Mortality: A Prospective Cohort Study. IJERPH. 2019 Apr 27;16(9):1498.
- Van Der Velpen IF, Melis RJF, Perry M, Vernooij-Dassen MJF, Ikram MA, Vernooij MW. Social Health Is Associated With Structural Brain Changes in Older Adults: The Rotterdam Study. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. 2022 Jul;7(7):659–68.
- Kosterman R, Hawkins JD, Hill KG, Bailey JA, Catalano RF, Abbott RD. Effects of Social Development Intervention in Childhood on Adult Life at Ages 30 to 39. Prev Sci. 2019 Oct;20(7):986–95.
- Cundiff JM, Matthews KA. Friends With Health Benefits: The Long-Term Benefits of Early Peer Social Integration for Blood Pressure and Obesity in Midlife. Psychol Sci. 2018 May;29(5):814–23.