Whitgob Emily E, Loe Irene Marilyn
Stanford University, Stanford, CA, United States.
Front Public Health. 2018 Sep 20;6:267. doi: 10.3389/fpubh.2018.00267. eCollection 2018.
Children in the Child Welfare System (CWS) are at high risk for multiple adverse outcomes. Since involvement in CWS and having a chronic medical condition are both risk factors for poor academic achievement, a logical view is that the combination is additive, increasing the odds of poor performance. However, several factors may complicate such an association. This study explores negative and positive factors that could affect academic achievement in children in CWS with chronic medical conditions. In a secondary data analysis of a nationally representative, longitudinal sample of children in CWS ( = 5,501), subjects were divided into three groups based on chronic medical condition: High Prevalence, Low Severity (HPLS; asthma, eczema, allergy, diabetes), Other (OTH; all other chronic conditions, including those with primary central nervous system involvement), and NONE (children with no chronic condition). Using weighted analyses, hierarchical logistic regression models addressed factors associated with academic achievement. Predictor variables included chronic condition group, sex, income level, case substantiation, home placement, and school engagement. Intelligence quotient was a covariate. Outcome variables were strong performances for reading and math, defined by standard score ≥85. In TOTAL group, 80% had strong reading; more in HPLS (85%) vs. NONE (79%) and OTH (80%), adjusted = 433, < 0.001. In TOTAL group, 67% had strong math; more in NONE (68%) and HPLS (68%) vs. OTH (60%), adjusted = 1,278, < 0.001. Models predicting to strong reading and math achievement were significant, = 0.51, < 0.001 and = 0.43, < 0.001, respectively. HPLS had increased odds of strong reading achievement (aOR 1.3, 95% CI 1.3-1.4); both HPLS and OTH had lower odds of strong math achievement (aOR 0.87 and 0.76), < 0.001, respectively. Male sex had lower odds of strong reading (aOR 0.44) and math achievement (aOR 0.62); positive school engagement had higher odds of strong reading (aOR 1.18) and math achievement (aOR 2.04), all < 0.001. If true, our findings challenge the general belief that chronic illness can only be associated with negative outcomes and that cumulative adversities are simply additive in terms of risk. Increased contact with the medical system may provide an opportunity for improving reading achievement for children in CWS and promoting positive school engagement.
儿童福利系统（CWS）中的儿童面临多种不良后果的高风险。由于参与儿童福利系统和患有慢性疾病都是学业成绩不佳的风险因素，一种合理的观点是，两者结合会产生累加效应，增加成绩不佳的几率。然而，有几个因素可能会使这种关联变得复杂。本研究探讨了可能影响患有慢性疾病的儿童福利系统儿童学业成绩的消极和积极因素。在对全国代表性的儿童福利系统纵向样本（n = 5501）进行的二次数据分析中，根据慢性疾病将受试者分为三组：高患病率、低严重程度组（HPLS；哮喘、湿疹、过敏、糖尿病）、其他组（OTH；所有其他慢性疾病，包括那些有原发性中枢神经系统受累的疾病）和无慢性疾病组（NONE）。使用加权分析，分层逻辑回归模型分析了与学业成绩相关的因素。预测变量包括慢性病组、性别、收入水平、案件证实情况、家庭安置和学校参与度。智商是一个协变量。结果变量是阅读和数学的优异表现，定义为标准分数≥85。在总样本组中，80%的儿童阅读成绩优异；HPLS组（85%）高于NONE组（79%）和OTH组（80%），校正后χ² = 433，P < 0.001。在总样本组中，67%的儿童数学成绩优异；NONE组（68%）和HPLS组（68%）高于OTH组（60%），校正后χ² = 1278，P < 0.001。预测阅读和数学优异成绩的模型具有显著性，分别为χ² = 0.51，P < 0.001和χ² = 0.43，P < 0.001。HPLS组阅读成绩优异的几率增加（调整后比值比[aOR]为1.3，95%置信区间[CI]为1.3 - 1.4）；HPLS组和OTH组数学成绩优异的几率均较低（aOR分别为0.87和0.76），P < 0.001。男性阅读成绩优异（aOR为0.44）和数学成绩优异（aOR为0.62）的几率较低；积极的学校参与度使阅读成绩优异（aOR为1.18）和数学成绩优异（aOR为2.04）的几率更高，均P < 0.001。如果这是真的，我们的研究结果挑战了普遍观点，即慢性病只会与负面结果相关，并且累积的不利因素在风险方面只是简单的累加。与医疗系统增加接触可能为提高儿童福利系统儿童的阅读成绩和促进积极的学校参与度提供机会。
