Poor adolescent health linked to negative education, employment outcomes

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

Evidence Rating Level: 2 (Good) 

Study Rundown: 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 reverse relationship, between health and subsequent education and economic outcomes. Adolescence is a critical period of development and transition into the workforce. Disruption of this transition by health problems may have lasting effects into adulthood. Using a variety of 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. Across all studies, adolescent health problems were associated with worse employment and educational outcomes in adulthood. Study quality and quantity were limited for physical health conditions, while studies assessing various mental health problems such as depression, ADHD, and conduct disorder, showed more robust relationships. Mental health problems were associated with incomplete secondary and postsecondary education. Adolescent mental health problems were significantly associated with unemployment in adulthood while this same relationship was just shy of significance in those with physical health problems. While this study provides a general overview of the impact of teen health on future outcomes, it is limited by the heterogeneity among the studies 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, talks to 2 Minute Medicine: University College London Institute of Child Health, London UK.

“1) Good health is extremely important for maximising the chances of having good educational/employment outcomes. We should also point out that there is a clear two-way effect (or bidirectional effect) of health on educational/employment outcome creating a potential vicious cycle of poor health contributing to poor education and attainment outcomes which themselves may contribute to stress and poor health. 

2) Schools should think of their student’s health as their core business. Rather than health education and school-based health services detracting from typical academic learning, these activities actively support young people’s attainment.”

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 sampling procedure, study characteristics, demographic information, adult outcome measures, and control variables. Mean age of adolescents ranged from 10.5 to 18 years while adult follow-up mean age ranged from 18.5 to 35 years. Seventy separate analyses were conducted assessing the relationship between adolescent chronic mental or physical conditions and adult outcome variables. Of the analyses, 61 identified poorer educational and employment outcomes among adults with health problems in adolescence. Among mental health conditions, 26 showed a significant negative association while 27 showed a trend without statistical significance. Overall, odds of not completing secondary school was 2.43 (95% CI 1.68-3.53) for adolescents with mental health problems and 2.07 (95% CI 1.50-2.86) for those with physical health problems. Mental health conditions were significantly associated with unemployment in adulthood (OR 1.53 95% CI 1.23-1.89). Although mirroring the same trend, physical conditions were found to have a non-significant association with unemployment (OR 1.49 95% CI 0.96-1.99). Based on just 3 studies, physical and mental health problems in adolescence were significantly associated with lower incomes in adulthood when compared with no problems in healthy controls (*Cohen’s 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-analysis.

Image: PD

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