title: The Cumulative Effect of Health Adversities on Children's Later Academic Achievement.
abstract: We aimed to determine whether the accumulation of physical, psychosocial, and combined health adversities measured at age 8 to 9 years predicts worsening of academic scores cross-sectionally at 8 to 9 and longitudinally at 10 to 11 years.
  
  
  
  Design: Longitudinal data from Waves 3 and 4 in the Longitudinal Study of Australian Children (83% of 4983 retained). Exposures (8-9 years): Physical health adversities (yes/no; summed range, 0-5): overweight, special health care needs, chronic illness, PedsQL Physical, and global health. Psychosocial health adversities (yes/no; summed range, 0-4): parent- and teacher-reported behavior, PedsQL Psychosocial, sleep problems. Combined health adversities (range 0-9). Outcomes (8-9, and 10-11 years): National academic standardized test scores.
  
  
  
  Generalized estimating equations, accounting for multiple academic domains in each year and socioeconomic position and cognition.
  
  
  
  At 8 to 9 years, 23.9%, 9.9%, and 5.3% had 1, 2, or ≥3 physical health adversities, respectively, while 27.2%, 9.5%, and 4.9% had 1, 2, or ≥3 psychosocial health adversities. For each additional health adversity at 8 to 9 years, academic scores fell incrementally in year 3 and year 5 (both P < .001), with reductions of at least 0.4 SDs for ≥3 health adversities. Number was more important than type (physical, psychosocial) of adversity.
  
  
  
  The accumulation of health adversities predicts poorer academic achievement up to 2 years later. Interventions might need to address multiple domains to improve child academic outcomes and be delivered across the health-education interface.
authors.affiliation: Melbourne Graduate School of Education, The University of Melbourne, Carlton, Victoria, Australia; Centre for Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia. Electronic address: jon.quach@mcri.edu.au.
authors.forename: Jon
authors.initials: J
authors.lastname: Quach
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Cattram
authors.initials: C
authors.lastname: Nguyen
authors.affiliation: Melbourne Graduate School of Education, The University of Melbourne, Carlton, Victoria, Australia; Centre for Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
authors.forename: Meredith
authors.initials: M
authors.lastname: O'Connor
authors.affiliation: Centre for Community Child Health, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia; Department of Paediatrics and The Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Melissa
authors.initials: M
authors.lastname: Wake
mesh_terms: D000076363:Academic Success; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology / Q000523:psychology*; D000067576:Child Health; D002675:Child, Preschool; D015897:Comorbidity; D019988:Children with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged
keywords: child learning; cumulative health; health-education interface; physical health; psychosocial health