title: How health status affects progress and performance in school: a population-based study.
abstract: OBJECTIVE
  To assess the effects of health status at birth and health status in the preschool years on educational outcomes to age 9 in a population-based birth cohort.
  
  
  METHODS
  Administrative data were used to follow all children born to Winnipeg mothers in 1990, and remaining in Manitoba until September 2004 (N = 5,873). A structural equation model was used, incorporating latent variables to represent Health Status at Birth, Major Illness and Minor Illness during the preschool years. The model also included the child's sex and exact age, along with a number of social, economic, and demographic characteristics of the child's family. The outcome was a combination of marks on Grade 3 Standards Tests and enrollment in the appropriate grade for age.
  
  
  RESULTS
  Major Illness in the preschool years had a significant influence on progress and performance in school (p = 0.0003), predicting 1.26% of the variation in the outcome. Minor Illness was weaker but still significant (p < 0.01). Health Status at Birth was not directly related to the outcome; its effect was mediated by Major and Minor Illness in childhood. Overall, the strongest predictors were the child's age and the area-level income, followed by the mother's age, family receipt of income assistance, the sex of the child, breastfeeding initiation (all p < 0.0001), and Major Illness.
  
  
  CONCLUSIONS
  Health status plays a statistically significant but substantively small role in explaining progress and performance in school among a population-based cohort. Major Illness was more important than Minor Illness, and these two factors completely mediated the influence of Health Status at Birth on the outcome. The strength of the social, economic, and demographic variables underscores the importance of the broader factors that affect both health and educational outcomes.
authors.affiliation: Manitoba Centre for Health Policy and Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, MB. Randy_Fransoo@cpe.umanitoba.ca
authors.forename: Randall R
authors.initials: RR
authors.lastname: Fransoo
authors.forename: Noralou P
authors.initials: NP
authors.lastname: Roos
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Martens
authors.forename: Maureen
authors.initials: M
authors.lastname: Heaman
authors.forename: Benjamin
authors.initials: B
authors.lastname: Levin
authors.forename: Dan
authors.initials: D
authors.lastname: Chateau