165 - The association between adverse childhood experiences and health-related school absenteeism among California adolescents

Poster Number: 165
Publication Number: 165.334

Background: Adverse childhood experiences (ACEs) have been linked to poor educational outcomes and increased morbidity from chronic health conditions associated with school absenteeism, such as asthma and depression. However, little is known about the impact of ACEs on school absenteeism due to health problems. An understanding of the relationship between ACEs and health-related absences may identify opportunities for collaboration between health systems and schools in the provision of trauma-informed care and the prevention of negative outcomes associated with chronic absenteeism.

Objective: To examine the association between exposure to ACEs and health-related school absenteeism in California adolescents.

Design/Methods: In this cross-sectional study, we analyzed data from the 2021-2022 California Health Interview Survey, a representative web- and telephone-based survey. Our sample included 12 to 17-year-old respondents who attended school or were home-schooled in the past week. Participants self-reported on 9 ACEs, missed school days due to health problems in the past month, and sociodemographic characteristics. A design-corrected F test was used to evaluate differences between those exposed and unexposed to ACEs. Weighted logistic regressions tested whether exposure to one or more ACEs was associated with health-related absenteeism and health-related chronic absenteeism (defined as absent at least 10% of school days), adjusting for age, sex, race/ethnicity, parental education, health insurance, and poverty.

Results: The unweighted sample included 1418 adolescents. Over half (57%) reported at least one ACE; 13% missed school in the past month due to health problems, and 8% met the criteria for chronic absenteeism. Those exposed to at least one ACE were more likely to experience health-related absenteeism (18% vs. 8%, p< 0.001) and health-related chronic absenteeism (12% vs. 4%, p< 0.001) than those not exposed to ACEs. After adjusting for covariates, exposure to at least one ACE remained associated with both health-related absenteeism (AOR 2.45, 95% CI 1.47-4.09) and health-related chronic absenteeism (AOR 2.81, 95% CI 1.43-5.53).

Conclusion(s): ACEs are prevalent and associated with health-related school absenteeism in California adolescents. These results support the recognition of school absenteeism as a salient ACE-associated adverse outcome. Pediatricians responding to positive ACEs screens might focus on addressing health concerns that impact attendance. Additionally, they can partner with schools to identify and co-manage toxic stress across both education and health sectors in this important population.