Aims Education is recognised as a social determinant of health with poor academic attainment linked to poorer health. Reverse causal pathways have been largely overlooked. Likewise, exploration of risk factors for youth unemployment have rarely examined the impact of poor adolescent health. This study longitudinally examines causal pathways from poor adolescent health to low academic attainment and unemployment in young adulthood.
Methods We used nationally-representative data from the Longitudinal Study of Young People in England (LSYPE; Wave 1, age 13 N=15,770). Having a chronic condition, poor mental health and poor self-reported general health were assessed between ages 13 and 15. Outcome variables included poor academic performance (non-attainment of expected academic proficiency based on mandated school examinations) at age 16 and NEET status (not in education, employment or training) at age 19. We examined associations between health and subsequent outcomes, and conducted mediator analyses to assess the proportion of the association attributable to hypothesised mediators including school absences, classroom behaviour, truancy, social exclusion, health behaviours and psychological distress.
Results Poor mental and general health and long-term conditions predicted low educational attainment at age 16. Poor mental health and poor general health (but not long-term conditions) predicted unemployment. Social exclusion was a consistent mediating variable. Long-term absences mediated associations between general health and mental health and later outcomes whereas school behaviour, truancy and substance use were significant mediators for general health and mental health.
Conclusion Poor adolescent health disrupts educational and employment pathways. Due to the economic and social costs of educational underachievement and unemployment, policy interventions should focus on improving outcomes for unhealthy adolescents.
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