The role of poverty status and obesity on school attendance in the United States

Relationship between obesity and school absenteeism in Australian children: Implications for carer productivity

BACKGROUND

Economic evaluations of childhood obesity interventions are often used to assist decision making when presented with alternative course of action. Including indirect costs related to productivity losses is recommended; in children this would include school absenteeism. Our aim was to determine the association between school absenteeism and weight status among Australian children and estimate the indirect costs of this.

METHODS

We used data from a nationally representative sample of 8551 Australian children in the Longitudinal study of Australian Children (LSAC) with follow-up between 2006 and 2018. A mixed-effects negative binomial regression model was used to investigate the relationship between school absenteeism and weight status, controlling for age, sex, socio-economic position, indigenous status, rural/remote status and long-term medical conditions. We used average daily wages for the year 2018 to value the indirect costs of school absenteeism (through caregiver lost productivity).

RESULTS

Australian children with obesity aged 6-13 years missed on average an extra day of school annually compared to children of a healthy weight (p = 0.004), while adolescents with obesity aged 14-17 years missed on average an extra 0.69 days of school annually (p = 0.006). The estimated national cost for children with obesity aged 6-13 years was approximately $64 million AUD ($43 million USD) or $338 AUD ($230 USD) per child through caregiver lost productivity in 2018.

CONCLUSIONS

There is a small but significant association between school absenteeism and childhood obesity in Australia which is estimated to generate a considerable national cost through caregiver productivity losses. Our results will assist health economists evaluating childhood obesity interventions capture the full extent of the associated costs with this condition.

Continuous Eligibility for Medicaid Associated With Improved Child Health Outcomes

Fluctuating insurance coverage, or churning, is a recognized barrier to health care access. We assessed whether state policies that allow children to remain covered in Medicaid for a 12-month period, regardless of fluctuations in income, are associated with health and health care outcomes, after controlling for individual factors and other Medicaid policies. This cross-sectional study uses a large, nationally representative database of children ages 0 to 17. Continuous eligibility was associated with improved rates of insurance, reductions in gaps in insurance and gaps due to application problems, and lower probability of being in fair or poor health. For children with special health care needs, it was associated with increases in use of medical care and preventive and specialty care access. However, continuous eligibility was not associated with health care utilization outcomes for the full sample. Continuous eligibility may be an effective strategy to reduce gaps in coverage for children and reduce paperwork burden on Medicaid agencies.

School absenteeism is linked to household food insecurity in school catchment areas in Southern Nevada

OBJECTIVES

Food security and school attendance are both important for health, well-being and academic performance of children and adolescents. However, their intersection remains underexamined, especially in the USA. The current study considered the association between elementary school-level absenteeism and household food insecurity.

DESIGN

The current study linked school-level absenteeism and household food insecurity rates using geographic information system mapping and applied the tobit regression model to examine their association.

SETTING

The Clark County, Nevada, public school district - the fifth largest in the USA and in a state with disproportionate food insecurity and chronic school absenteeism rates.

PARTICIPANTS

Data consisted of school-level absenteeism rates from 185 elementary schools and census tract-level household food insecurity rates.

RESULTS

Average daily attendance rates were lower for schools with catchment areas that had higher average household food insecurity (FI), decreasing by -0·0232 % per 1 % increase in FI rate (P-value = 0·022). They were also significantly associated with most absenteeism risk factors. Average daily attendance rate was negatively associated with Free and Reduced Lunch eligibility percentage (-0·010 per 1 % increase in FI, P-value < 0·001) and Individualized Education Program participation percentage (-0·039 % per 1 % increase in FI, P-value = 0·033), but positively associated with parent-teacher conference participation rate (0·006 % per 1 % increase in FI, P-value = 0·025) and white student percentage (0·011 % per 1 % increase in FI, P-value = 0·022).

CONCLUSIONS

The current study suggests a link between household food insecurity and elementary school-level absenteeism. Understanding this link is important for policy and practice because schools are frequent settings for food insecurity mitigation interventions.

Association Between Malocclusion and Academic Performance Among Mongolian Adolescents

Objective: Malocclusion has been reported to affect the daily lives of schoolchildren adversely, but little is known regarding the association between malocclusion and academic performance. We aimed to investigate the association between malocclusion and academic performance among adolescents in Mongolia.

Methods: We conducted a cross-sectional study of 767 students aged 7–16 years from two public schools in Ulaanbaatar, Mongolia. Three orthodontists evaluated the need for malocclusion treatment in the participants and determined the type of malocclusion using the Index of Orthodontic Treatment Need and dental casts. The academic scores of study participants in 20 subjects were provided by their schools. Z-scores within subjects were calculated and aggregated into both overall and in six groups of subject categories comprised of mathematics, science, social science, language, arts, and physical education. A multiple linear regression analysis was performed to determine the association between malocclusion, malocclusion type, and academic score adjusted for gender, age, school, and family income.

Results: Of the 767 students, 32.6% had malocclusion, and dental crowding was the most prevalent type (162 cases, 21.1%). Malocclusion was not significantly associated with the z-score of overall academic score [coefficient: 0.04, 95% confidence interval (CI): −0.11 to 0.19]; however, dental crowding was significantly associated with the overall academic score (coefficient: −0.19, 95% CI: −0.35 to −0.03), after adjusting for covariates. Other types of malocclusion were not associated with academic scores. Among the six subject categories, arts (coefficient: −0.20, 95% CI: −0.36 to −0.04) and physical education (coefficient: −0.24, 95% CI: −0.42 to −0.07) were significantly associated with dental crowding.

Conclusions: Schoolchildren in Mongolia with dental crowding may be prone to poor academic performance, particularly in arts and physical education classes. Further randomized controlled trials are needed to determine whether the treatment of crowding boosts academic performance.

Diabetes Risk and Control in Multi-ethnic US Immigrant Populations

PURPOSE OF REVIEW

The goal of this review is to assess current evidence on diabetes risk and control among adult immigrants in the USA.

RECENT FINDINGS

Patterns of diabetes risk in US immigrants may reflect global diabetes trends. Asian, Black, and Latinx immigrants all see a diabetes disadvantage relative to US-born Whites. Diabetes risk in Asian immigrants also surpasses US-born Asians. Relative diabetes risk among all groups increases with time in the USA. Research to explain patterns in diabetes risk and control among immigrants has broadened from lifestyle factors to include multi-level, life course influences on trajectories of risk. Some determinants are shared across groups, such as structural racism, healthcare access, and migration stress, whereas others such as diet are embedded in sending country culture. Current literature on diabetes in immigrant populations suggests a need to shift towards a transnational lens and macro-level social determinants of health framework to understand diabetes risk and potential prevention factors.

Risk Factors for School Absenteeism and Dropout: A Meta-Analytic Review

School absenteeism and dropout are associated with many different life-course problems. To reduce the risk for these problems it is important to gain insight into risk factors for both school absenteeism and permanent school dropout. Until now, no quantitative overview of these risk factors and their effects was available. Therefore, this study was aimed at synthesizing the available evidence on risk factors for school absenteeism and dropout. In total, 75 studies were included that reported on 781 potential risk factors for school absenteeism and 635 potential risk factors for dropout. The risk factors were classified into 44 risk domains for school absenteeism and 42 risk domains for dropout. The results of a series of three-level meta-analyses yielded a significant mean effect for 28 school absenteeism risk domains and 23 dropout risk domains. For school absenteeism, 12 risk domains were found with large effects, including having a negative attitude towards school, substance abuse, externalizing and internalizing problems of the juvenile, and a low parent-school involvement. For dropout, the risk domains having a history of grade retention, having a low IQ or experiencing learning difficulties, and a low academic achievement showed large effects. The findings of the current study contribute to the fundamental knowledge of the etiology of school absenteeism and dropout which in turn contributes to a better understanding of the problematic development of adolescents. Further, more insight into the strength of effects of risk factors on school absenteeism and dropout is important for the development and improvement of both assessment, prevention and intervention strategies.

Effect of Sociodemographics, Health-Related Problems, and Family Structure on Chronic Absenteeism Among Children

BACKGROUND

From 5 to 7.5 million schoolchildren are chronically absent, defined as missing ≥15 days of school within a year. Students miss schools due to various reasons such as health, socioeconomic status, and environmental factors. We examined child's health and behavior, family structure, and sociodemographics to understand chronic absenteeism.

METHODS

The population included children ages 6 to 17 years from the Medical Expenditure Panel Survey years 2008-2013. Multivariable logistic regressions were used to identify the risk factors of chronic absenteeism, adjusting for the complex sampling design.

RESULTS

Among sociodemographic variables, age ≥14 years, race/ethnicity, lower-income family, public health insurance, US born, and speaking English at home were associated with absenteeism. Asians, Mexican Hispanics, and blacks have lower absenteeism than whites. Among health-related variables, children using an inhaler for asthma, having behavioral problems, and less healthy than other children were more likely to be chronically absent. Among family variables, a smaller family size was a risk factor for absenteeism.

CONCLUSIONS

Asthma and behavioral problems were highly associated with chronic absenteeism. The identification of children at risk for chronic absenteeism will help the educational professionals identify the barriers to academic achievements and develop integrated educational interventions and policies to support disadvantaged children.

School-supervised use of a once-daily inhaled corticosteroid regimen: A cluster randomized trial

BACKGROUND

School-supervised use of a once-daily inhaled corticosteroid regimen (supervised therapy) can improve medication adherence and asthma control.

OBJECTIVE

We sought to evaluate the effectiveness of supervised therapy in a unique setting and population.

METHODS

We conducted a cluster randomized trial of supervised therapy in 20 elementary schools with a disproportionate enrollment of low-income Latino students. Schools were purposively selected, matched, and randomized to receive 9 months of supervised therapy with mometasone furoate or usual care. All English- or Spanish-speaking students with self-reported asthma were eligible. The Asthma Control Questionnaire (ACQ) was interviewer administered quarterly at school. Students in supervised therapy schools were hypothesized to have lower ACQ scores than students in usual-care schools.

RESULTS

Of 393 enrolled students, 189 students receiving immediate intervention and 143 students receiving delayed intervention provided 1 or more ACQ data points, were between 6 and 10 years of age, and were included in the primary analysis. At baseline, 39% of students reported taking a controller medication, and 24% had well-controlled asthma. Eighty percent of students receiving immediate intervention were prescribed mometasone. Schools administered 98% of prescribed doses when students attended school. Absences, weekends, and holidays reduced calendar adherence to 53%. During the first year, the mean ACQ score for students receiving immediate and delayed intervention was 1.55 (95% CI, 1.41-1.70) and 1.64 (95% CI, 1.47-1.80), respectively. The estimated treatment effect was -0.08 (95% CI, -0.31 to 0.14).

DISCUSSION

Compared with usual care, supervised therapy did not improve asthma control among this population of Latino students. Additional research is warranted to confirm these results.

An individually tailored family-centered intervention for pediatric obesity in primary care: study protocol of a randomized type II hybrid effectiveness-implementation trial (Raising Healthy Children study)

BACKGROUND

Pediatric obesity is a multi-faceted public health concern that can lead to cardiovascular diseases, cancers, and early mortality. Small changes in diet, physical activity, or BMI can significantly reduce the possibility of developing cardiometabolic risk factors. Family-based behavioral interventions are an underutilized, evidence-based approach that have been found to significantly prevent excess weight gain and obesity in children and adolescents. Poor program availability, low participation rates, and non-adherence are noted barriers to positive outcomes. Effective interventions for pediatric obesity in primary care are hampered by low family functioning, motivation, and adherence to recommendations.

METHODS

This (type II) hybrid effectiveness-implementation randomized trial tests the Family Check-Up 4 Health (FCU4Health) program, which was designed to target health behavior change in children by improving family management practices and parenting skills, with the goal of preventing obesity and excess weight gain. The FCU4Health is assessment driven to tailor services and increase parent motivation. A sample of 350 families with children aged 6 to 12 years who are identified as overweight or obese (BMI ≥ 85th percentile for age and gender) will be enrolled at three primary care clinics [two Federally Qualified Healthcare Centers (FQHCs) and a children's hospital]. All clinics serve predominantly Medicaid patients and a large ethnic minority population, including Latinos, African Americans, and American Indians who face disparities in obesity, cardiometabolic risk, and access to care. The FCU4Health will be coordinated with usual care, using two different delivery strategies: an embedded approach for the two FQHCs and a referral model for the hospital-based clinic. To assess program effectiveness (BMI, body composition, child health behaviors, parenting, and utilization of support services) and implementation outcomes (such outcomes as acceptability, adoption, feasibility, appropriateness, fidelity, and cost), we use a multi-method and multi-informant assessment strategy including electronic health record data, behavioral observation, questionnaires, interviews, and cost capture methods.

DISCUSSION

This study has the potential to prevent excess weight gain, obesity, and health disparities in children by establishing the effectiveness of the FCU4Health and collecting information critical for healthcare decision makers to support sustainable implementation of family-based programs in primary care.

TRIAL REGISTRATION

NCT03013309 ClinicalTrials.gov.

Childhood obesity and school absenteeism: a systematic review and meta-analysis

Regular school attendance is a key determinant of student's academic achievement and psychosocial development. Obesity may affect children's school attendance through its detrimental impact on their physical and mental health. A literature search was conducted in the PubMed, Web of Science and Cochrane Library for articles published until April 2017 that examined the relationship between unhealthy body weight and school absenteeism among children and adolescents. Thirteen studies total (10 cross-sectional and three longitudinal) conducted in seven countries were identified. The mean and median sample sizes were 24,861 and 3,113, respectively. Ten studies objectively measured children's height and weight, and three were based on parents' self-report. Four studies measured absenteeism using school administrative data, and nine administered questionnaires on children's parents. Among them, 11 reported a statistically significant positive association between childhood overweight/obesity and school absence, whereas two reported null effect. The meta-analysis found that the odds of being absent from school was 27% and 54% higher among children with overweight and obesity than among their normal weight counterparts, respectively. Future studies should adopt an experimental study design and accurate measures on school attendance and delineate the underlining pathways linking childhood obesity to school absenteeism through obesity-related illnesses and psychosocial problems.

The Association Between Electronic Bullying and School Absenteeism Among High School Students in the United States

BACKGROUND

We examined the relationship between exposure to electronic bullying and absenteeism as a result of being afraid.

METHODS

This multivariate, multinomial regression analysis of the 2013 Youth Risk Behavior Survey data assessed the association between experiencing electronic bullying in the past year and how often students were absent in the last month due to feeling unsafe at/in transit to school. The model controlled for other predictors of school absence including demographics, physical/behavioral health, and risk factors. Missing data were multiply imputed.

RESULTS

Electronic bullying was significantly associated with absences. Controlling for model covariates, the relative risk of missing 1 day of school was 1.77 times higher, the relative risk of missing 2 to 3 days of school per month increased by a factor of 2.08, and the relative risk of missing 4 or more days of school per month increased by a factor of 1.77 for those who experienced electronic bullying in the past year compared with those who were not electronically bullied.

CONCLUSIONS

Electronic bullying's association with absenteeism places it among already recognized negative influences such as depression and binge drinking, necessitating schools to implement policies to mediate the resulting harmful effects.

Correlation between obesity and emotional, social, and behavioral problems associated with physical limitation among children and adolescents in Western Saudi Arabia

Objectives:

To evaluate the impact of body mass index (BMI) on limitation of physical activity and the associated effect on behavioral, school, and social problems among obese children in Western Saudi Arabia.

Methods:

A cross-sectional obesity survey was conducted in Jeddah, Saudi Arabia. Data were collected between August 2014 and February 2015 from 281 obese children aged between 2-18 (girls: 130, boys: 151). Participants were selected randomly to represent different economic status, level of education, and family structure.

Results:

The mean age of participants was 10.5 years for girls and 10.6 years for boys. Higher BMI was associated with physical activity problems in walking (50.6%), running (55.8%), and exercise (44.3%), with school problems in attention (37.4%) and follow-up duties fade (31.3%), and with social problems in doing things other children could do (42.8%), playing with others (46%), and continuing play (33.4%). There was no significant relationship between BMI and emotional problems and school attendance.

Conclusion:

Higher BMI significantly increased physical limitation, problems maintaining attention in school, and social problems among obese children. However, emotional problems and school attendance did not show a significant correlation with BMI.

Body mass index, depression, and suicidality: The role of self-esteem in bariatric surgery candidates

BACKGROUND

Previous research suggests a relationship between weight and depression/suicidality, although few studies have examined the mechanisms underlying this association. This study examined the mediating role of self-esteem in the relationship between BMI and depression/suicidality, as well as the moderating role of gender in the mediated pathways.

METHODS

As part of a screening process in consideration for bariatric surgery, 3,101 adults (81.4% female, 18.6% male) were assessed one time. Five univariate mediation and five univariate moderated-mediation models were hypothesized and analyzed. For the mediation models, we entered five outcome variables separately: 1) severity of depressed mood, 2) diagnosis of Major Depressive Disorder, 3) lifetime history of suicide attempts, 4) suicidal ideation at the time of evaluation, and 5) severity of suicidality, BMI as the independent variable, and self-esteem as the mediator. For the moderated-mediated models, gender was examined as a moderator to examine whether self-esteem was a stronger mediator for one gender, compared to the other.

RESULTS

Findings supported the mediating role of self-esteem across all five outcomes. Further, the mediated effect was moderated by gender, such that the mediation effect was stronger for males, compared to females.

LIMITATIONS

The majority of the sample consisted of White females, limiting broad applicability of findings. All variables were assessed simultaneously, at baseline, limiting the ability to make causal attributions.

CONCLUSIONS

Study findings suggest that self-esteem may help explain the relationship between BMI and depression/suicidality, particularly for men. Thus, interventions targeting self-esteem may be useful for improving psychological outcomes among those presenting for bariatric surgery.

The relationship between student health and academic performance: Implications for school psychologists

Children who are unhealthy are at higher risk for school problems than students who are free from medical problems. Students with poor health have a higher probability of school failure, grade retention, and dropout. The relationship between student health and academic success is complex. Common manageable factors of student health are nutrition, maintaining healthy weight, and physical fitness. Through a comprehensive literature review the relationships among school achievement and nutrition, maintaining healthy weight, and physical fitness are examined. Furthermore, the efficacy of educational programs to improve nutrition, maintain healthy weight, and increase physical fitness is evaluated. The complexity of the relationship among variables is presented and areas for future research and practice for school psychologists are described.