Daniel R. Hale

How adolescent health influences education and employment: investigating longitudinal associations and mechanisms

Background Education is recognised as a strong determinant of health. Yet there is increasing concern that health in adolescence may also influence educational attainments and future life chances. We examined associations between health in early adolescence and subsequent academic and employment outcomes, exploring potential mediators of these relationships to inform intervention strategies. Methods We used data from the Longitudinal Study of Young People in England. Adolescent health was measured at waves 1 and 2. Outcomes included educational attainment at age 16 years and being NEET (not in education, employment or training) at age 19 years. Associations were adjusted for ethnicity, area-level deprivation and early adolescent academic attainment. Where significant associations were identified, we examined the role of hypothesised mediators including attendance and truancy, classroom behaviour, substance use and psychological distress. Results Health conditions in early adolescence predicted poor subsequent education and employment outcomes (ORs ranged from 1.25 to 1.72) with the exception of long-term chronic conditions and NEET status, which were unassociated. The most consistent mediating variable was social exclusion. School behaviour, truancy and substance use were significant mediators for mental health. Long-term absences mediated associations between mental health and physical health and later outcomes. Conclusions Health is a key component of academic and vocational achievement. Investment in health is a way of improving life chances. The identification of key mediators such as social exclusion and truancy indicate areas where screening for health conditions and provision of targeted support could improve educational, employment and health outcomes.

Effectiveness of Universal Self-regulation–Based Interventions in Children and Adolescents: A Systematic Review and Meta-analysis

Importance Childhood and adolescence self-regulation (SR) is gaining importance as a target of intervention because of mounting evidence of its positive associations with health, social and educational outcomes. Objective To conduct a systematic review and meta-analysis of rigorously evaluated interventions to improve self-regulation in children and adolescents. Data Sources Keyword searches of the PsycINFO, PubMed, EMBASE, CINAHL Plus, ERIC, British Education Index, Child Development and Adolescent Studies, and CENTRAL were used to identify all studies published through July 2016. Study Selection To be eligible for this review, studies had to report cluster randomized trials or randomized clinical trials, evaluate universal interventions designed to improve self-regulation in children and adolescents aged 0 to 19 years, include outcomes associated with self-regulation skills, and be published in a peer-reviewed journal with the full text available in English. Data Extraction and Synthesis A total of 14 369 published records were screened, of which 147 were identified for full-text review and 49 studies reporting 50 interventions were included in the final review. Results were summarized by narrative review and meta-analysis. Main Outcomes and Measures Self-regulation outcomes in children and adolescents. Results This review identified 17 cluster randomized trials and 32 randomized clinical trials evaluating self-regulation interventions, which included a total of 23 098 participants ranging in age from 2 to 17 years (median age, 6.0 years). Consistent improvement in self-regulation was reported in 16 of 21 curriculum-based interventions (76%), 4 of the 8 mindfulness and yoga interventions (50%), 5 of 9 family-based programs (56%), 4 of 6 exercise-based programs (67%), and 4 of 6 social and personal skills interventions (67%), or a total of 33 of 50 interventions (66%). A meta-analysis evaluating associations of interventions with self-regulation task performance scores showed a positive effect of such interventions with pooled effect size of 0.42 (95% CI, 0.32-0.53). Only 24 studies reported data on distal outcomes (29 outcomes). Positive associations were reported in 11 of 13 studies (85%) on academic achievement, 4 of 5 studies on substance abuse (80%), and in all studies reporting on conduct disorders (n = 3), studies on social skills (n = 2), studies on depression (n = 2), studies on behavioral problems (n = 2), and study on school suspensions (n = 1). No effect was seen on 2 studies reporting on academic achievement, 1 study reporting on substance abuse, and 1 additional study reporting on psychological well-being. Conclusions and Relevance A wide range of interventions were successful in improving self-regulation in children and adolescents. There was improvement in distal academic, health, and behavioral outcomes in most intervention groups compared with controls.

Conduct problems trajectories and psychosocial outcomes: a systematic review and meta-analysis

There is increasing evidence that youth who follow the early onset persistent (EOP), adolescent-onset (AO) and childhood-limited (CL) trajectories of conduct problems show varying patterns of health, mental health, educational, and social outcomes in adulthood. However, there has been no systematic review and meta-analysis on outcomes associated with different conduct problems trajectories. We systematically reviewed the literature of longitudinal studies considering outcomes of three conduct problems trajectories: EOP, AO, and CL compared with individuals with low levels of conduct problems (low). We performed a series of meta-analyses comparing each trajectory to the low group for eight different outcomes in early adulthood or later. Thirteen studies met our inclusion criteria. Outcomes were mental health (depression), cannabis use, alcohol use, self-reported aggression, official records of antisocial behaviour, poor general health, poor education, and poor employment. Overall, EOP individuals showed significant higher risk of poor outcome followed by AO individuals, CL individuals, and finally participants in the low group. All conduct problems trajectories showed higher risk of poor psychosocial outcomes compared to the low group, but the magnitude of risk differed across trajectories, with a general trend for the EOP to perform significantly worse, followed by the AO and CL. Early intervention is recommended across domains to maximise likelihood of desistance from antisocial behaviour and improvement on several psychosocial outcomes.

Effectiveness of universal self-regulation-based interventions to improve self-regulation, and effects on distant health and social outcomes in children and adolescents: a systematic review and meta-analysis

Abstract Background Self-regulation is a psychological construct that encompasses a range of competencies including controlling ones emotions, positive interactions with others, and self-directed learning. Self-regulation is gaining importance as an intervention target because of mounting evidence suggesting its positive impact on health, social, and educational outcomes. In a systematic review, we rigorously evaluated interventions designed to improve self-regulation in children and adolescents. Methods Keyword searches of the databases PsycINFO, PubMed, EMBASE, CINAHL Plus, ERIC, British Education Index, Child Development & Adolescent Studies, and CENTRAL were performed from inception to July 15, 2016 (see appendix for search strategy). Eligibility criteria included randomised controlled trials (RCTs) and cluster RCTs, universal interventions for self-regulation in children and adolescents, at least one self-regulation outcome measure, and peer-reviewed publications with full text available in the English language. References of the included articles were also reviewed. Data were extracted on self-regulation and distant outcome measures. All but eight studies were high-to-moderate quality when assessed with the Effective Public Health Practice Project quality assessment tool. Findings From 14 369 records screened, 147 were identified for full text review, and 50 cluster RCTs and RCTs including 23 098 participants were eligible for final review. Consistent improvement in self-regulation was reported in 16 of the 21 curriculum-based, four of the eight mindfulness and yoga-based, six of the nine family-based, four of the six exercise-based, and four of the six social and personal skills interventions. A meta-analysis of self-regulation task performance scores of intervention group versus controls showed a pooled standardised mean effect size of 0·43 (95% CI 0·35–0·51). Positive impact was reported in 11 of 13 studies studying academic achievement, all three studies reporting conduct disorders, two studies each on social skills, mental health (depression), and behavioural problems, one study on school suspensions, and four of five studies on substance misuse. The follow-up period for such outcomes varied from 1 to 5 years. Interpretation A wide range of interventions were successful in improving self-regulation in children and adolescents. There was improvement in distant academic, health, and behavioural outcomes in most intervention groups compared with controls. Funding Department of Health Policy Research Programme.