title: School Performance: A Matter of Health or Socio-Economic Background? Findings from the PIAMA Birth Cohort Study.
abstract: BACKGROUND
  Performance in primary school is a determinant of children's educational attainment and their socio-economic position and health inequalities in adulthood. We examined the relationship between five common childhood health conditions (asthma symptoms, eczema, general health, frequent respiratory infections, and overweight), health related school absence and family socio-economic status on children's school performance.
  
  
  METHODS
  We used data from 1,865 children in the Dutch PIAMA birth cohort study. School performance was measured as the teacher's assessment of a suitable secondary school level for the child, and the child's score on a standardized achievement test (Cito Test). Both school performance indicators were standardised using Z-scores. Childhood health was indicated by eczema, asthma symptoms, general health, frequent respiratory infections, overweight, and health related school absence. Children's health conditions were reported repeatedly between the age of one to eleven. School absenteeism was reported at age eleven. Highest attained educational level of the mother and father indicated family socio-economic status. We used linear regression models with heteroskedasticity-robust standard errors for our analyses with adjustment for sex of the child.
  
  
  RESULTS
  The health indicators used in our study were not associated with children's school performance, independently from parental educational level, with the exception of asthma symptoms (-0.03 z-score / -0.04 z-score with Cito Test score after adjusting for respectively maternal and paternal education) and missing more than 5 schooldays due to illness (-0.18 z-score with Cito Test score and -0.17 z-score with school level assessment after adjustment for paternal education). The effect estimates for these health indicators were much smaller though than the effect estimates for parental education, which was strongly associated with children's school performance.
  
  
  CONCLUSIONS
  Children's school performance was affected only slightly by a number of common childhood health problems, but was strongly associated with parental education.
authors.affiliation: Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Ruijsbroek
authors.affiliation: Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Alet H
authors.initials: AH
authors.lastname: Wijga
authors.affiliation: Institute for Risk Assessment Sciences (IRAS), University of Utrecht, Utrecht, The Netherlands.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Gehring
authors.affiliation: Department of Epidemiology and Bioinformatics, University of Groningen, Groningen, the Netherlands.
authors.forename: Marjan
authors.initials: M
authors.lastname: Kerkhof
authors.affiliation: Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Mariël
authors.initials: M
authors.lastname: Droomers
mesh_terms: D000124:Achievement; D002648:Child; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D010290:Parents / Q000193:education; D012574:Schools; D012923:Social Class; D011795:Surveys and Questionnaires