Assessing the Connection Between Health and Education: Identifying Potential Leverage Points for Public Health to Improve School Attendance

摘要

Objectives. We examined multiple variables influencing school truancy to identify potential leverage points to improve school attendance. Methods. A cross-sectional observational design was used to analyze inner-city data collected in Los Angeles County, California, during 2010 to 2011. We constructed an ordinal logistic regression model with cluster robust standard errors to examine the association between truancy and various covariates. Results. The sample was predominantly Hispanic (84.3%). Multivariable analysis revealed greater truancy among students (1) with mild (adjusted odds ratio [AOR]?=?1.57; 95% confidence interval [CI]?=?1.22, 2.01) and severe (AOR?=?1.80; 95% CI?=?1.04, 3.13) depression (referent: no depression), (2) whose parents were neglectful (AOR?=?2.21; 95% CI?=?1.21, 4.03) or indulgent (AOR?=?1.71; 95% CI?=?1.04, 2.82; referent: authoritative parents), (3) who perceived less support from classes, teachers, and other students regarding college preparation (AOR?=?0.87; 95% CI?=?0.81, 0.95), (4) who had low grade point averages (AOR?=?2.34; 95% CI?=?1.49, 4.38), and (5) who reported using alcohol (AOR?=?3.47; 95% CI?=?2.34, 5.14) or marijuana (AOR?=?1.59; 95% CI?=?1.06, 2.38) during the past month. Conclusions. Study findings suggest depression, substance use, and parental engagement as potential leverage points for public health to intervene to improve school attendance. Truancy, defined as any intentional unauthorized or illegal absence from school, is associated with a variety of adverse behavioral and health outcomes, including school dropout, crime, violence, incarceration, adolescent pregnancy, and substance abuse. 1,2 Truancy is a major problem in the United States. Nationally, 11% of students report skipping school in the past month. 3 In California, the truancy rate—the percentage of students who missed more than 30 minutes of instruction without an excuse for 3 or more days in a given school year—was 28% during the 2009–2010 school year. 4 Truancy rates are frequently higher among Black and Hispanic youths, as compared with Whites, and among youths from lower-income households. 3 School truancy is a complex phenomenon often resulting from a variety of factors including (1) community and home environments; (2) social relationships, including relationships with parents, teachers, and peers; (3) school variables such as student-to-teacher ratio, educational style, safety, and disciplinary procedures; and (4) individual characteristics such as students’ level of engagement with learning, academic performance, risk behaviors (e.g., substance abuse), and mental health problems. 2,5,6 The multifaceted nature of this phenomenon has attracted a number of researchers, as well as professionals, from different sectors (e.g., criminal justice, education, and community-based organizations) to study this problem. However, public health representation is often missing from this important dialogue. In spite of emerging evidence suggesting the interdependence between education and health, only a paucity of public health authorities have regularly engaged school districts, local law enforcement, or the courts to address this social determinant of health. 5,7 Despite significant investments by researchers, practitioners, schools, and policymakers to address truancy over the past several decades, there is little evidence that any positive impact has been made to improve school attendance. 8 Many non-health sector researchers have called for the use of interdisciplinary models to reduce school truancy. Beyond modifying student factors, these models focus on a broader catchment, to include family, school, and community interventions. 9,10 However, in spite of growing interest, much remains unknown about the key steps, design, or program features that are necessary to effectively implement cross-sector strategies. Identifying leverage points where nontraditional, noneducation partners (e.g., public health) can intervene represents a critical need. Although previous research has examined the association between truancy and a variety of modifiable school, student, and health characteristics, most have collected data only on a narrowly defined set of risk factors, independent from one another. 3,11,12 Even among studies that have concurrently considered multiple risk factors for truancy, the analyses have often excluded important information about leverage points for nontraditional partners to act. 13,14 The present study helps fill these gaps in public health research and practice, examining the relative importance of different school, student, and health-related variables in influencing school truancy. This study focused on inner-city, low-income youths, a group that is particularly vulnerable to being chronically truant, dropping out of school, and experiencing health disparities. 4,15.