title: The role of poverty status and obesity on school attendance in the United States.
abstract: OBJECTIVE
  Several studies have shown that obesity influences school performance. Little is known about the joint effect of poverty and obesity associated with school attendance.
  
  
  METHODS
  Data are from the National Survey of Children's Health (N = 93,151), a nationally representative sample of U.S. youth aged 10-17 years. Our dependent variable was ≥11 days of school days missed per year. Body mass index was classified as normal, overweight, and obese using age- and sex-specific criteria. Federal poverty level (FPL) was classified as <200%, 200%-399%, and ≥400% (high income). Covariates included gender, age, child's race or ethnicity, maternal physical and mental health, child's health, family composition, and household tobacco use. Logistic regression models and prevalence ratios were estimated, accounting for the complex survey design.
  
  
  RESULTS
  The odds of missing ≥11 days of school among overweight youth was 1.5 times that of normal-weight youth (95% confidence interval (CI) = 1.22-1.85) and 1.7 (95% CI = 1.35-2.13) times among obese youth in fully adjusted models. In joint effects models, the probability of missing school was significantly greater for obese youth in both the <200% FPL group (prevalence ratio = 1.78, CI = 1.36-2.34) and the ≥400% FPL group (prevalence ratio = 2.88, CI = 1.91-4.35), when compared with their normal-weight, higher income peers. Predicted probabilities revealed sharper gradients for higher income youth.
  
  
  CONCLUSIONS
  Obesity influences school absenteeism across all income categories. Nonetheless, there may be distinct reasons for missing school for lower and higher income youth, and the long-term consequences of school absences may also differ for these populations.
authors.affiliation: Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey. Electronic address: Sandra.Echeverria@Rutgers.edu.
authors.forename: Sandra E
authors.initials: SE
authors.lastname: Echeverría
authors.affiliation: Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey.
authors.forename: Enid
authors.initials: E
authors.lastname: Vélez-Valle
authors.affiliation: Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey.
authors.forename: Teresa
authors.initials: T
authors.lastname: Janevic
authors.affiliation: Department of Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey.
authors.forename: Alisha
authors.initials: A
authors.lastname: Prystowsky
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D011203:Poverty; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Obesity; Poverty level; School attendance