Poor adolescent health linked to negative education and employment outcomes

The systematic review and meta-analysis of 27 studies suggested that poor health in adolescence was associated with lower education and employment in adulthood.

Evidence rating level: 2 (good)

Summary of the study: Many studies have established the critical roles of education, socioeconomic status, and economic activity on health outcomes. However, less has been done to analyze the inverse relationship, between health and later education and economic outcomes. Adolescence is a critical period of development and transition to the labor market. Disruption of this transition by health problems can have lasting effects well into adulthood. Using various electronic databases, the authors identified 27 studies assessing the effect of adolescent health on adult outcome parameters, such as education and employment. Meta-analyses were conducted to identify significant relationships and trends. In all studies, adolescent health problems were associated with poorer employment and education outcomes in adulthood. The quality and quantity of studies were limited for physical health conditions, while studies assessing various mental health conditions such as depression, ADHD and conduct disorder showed stronger relationships. Mental health problems were associated with incomplete high school and postsecondary education. Adolescent mental health problems were significantly associated with unemployment in adulthood, while this same relationship was not significant among those with physical health problems. Although this study provides a general overview of the impact of adolescent health on future outcomes, it is limited by study heterogeneity in the analysis.

Click to read the study, published today in Pediatrics

Relevant reading: Adolescence and the social determinants of health

Study author Dr. Daniel R. Hale, PhD, speaks to 2 Minute Medicine: University College London Institute of Child Health, London, UK.

“1) Good health is extremely important for maximizing the chances of having good results in education and employment. We should also point out that there is a clear two-way effect (or bi-directional effect) of health on education/employment outcomes, creating a potential vicious cycle of poor health contributing to poor employment outcomes. education and achievement which themselves can contribute to stress and poor health. .

2) Schools should consider the health of their students as their core business. Instead of health education and school-based health services interfering with typical school learning, these activities actively support young people’s success.

In depth [systematic review and meta-analysis]: From a search of 8 databases yielding over 11,000 results, 27 studies were selected for their quality and relevance. Data extraction was performed to standardize the sampling procedure, study characteristics, demographic information, adult outcome measures, and control variables. The mean age of adolescents ranged from 10.5 to 18 years, while the mean age of adult follow-up ranged from 18.5 to 35 years. Seventy separate analyzes were conducted to assess the relationship between chronic adolescent mental or physical conditions and adult outcome variables. Of the reviews, 61 identified poorer education and employment outcomes among adults with adolescent health problems. Of the mental health problems, 26 showed a significant negative association while 27 showed a trend without statistical significance. Overall, the probability of not completing high school was 2.43 (95% CI 1.68-3.53) for adolescents with mental health problems and 2.07 (95% CI 1.68-3.53) 95% 1.50-2.86) for those with physical health problems. Mental health problems were significantly associated with unemployment in adulthood (OR 1.53 95% CI 1.23-1.89). Although reflecting the same trend, physical conditions were found to have a non-significant association with unemployment (OR 1.49 95% CI 0.96-1.99). In only 3 studies, physical and mental health problems in adolescence were significantly associated with lower earnings in adulthood compared to no problems in healthy controls (*Cohen d 0 .2, 95% CI 0.11-0.27).

*Cohen’s d is an effect size used to indicate the standardized difference between two means; it is widely used in meta-analyses.

Picture: PD

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