These low scores, which reflect children's own perceptions of impaired psychological and physical health, "have potential implications for the success of urban children in their learning environments," according to Mona Mansour, MD, a pediatrician at Cincinnati Children's and the study's lead author.
The study, published in the June issue of Pediatrics, discovered an association between health-related quality of life and school connectedness – an association suggesting that health and educational programs that improve a child's attachment to school could result in improved perceptions of health by urban children.
Dr. Mansour administered a survey to 525 2nd, 3rd and 5th graders from six urban kindergarten through 8th grade schools and to their parents. The children's survey included questions on health-related quality of life and school connectedness. Among the health-related questions were those that referred to whether students felt "sad or blue," whether it was hard for them to engage in sports activities or exercise, and whether it was hard for them to walk more than one block.
On the school connectedness survey, approximately one in five reported having trouble getting along with other students "almost every day or everyday." Fifteen percent reported disagreeing or strongly disagreeing with the statement, "I feel safe in my school." Sixteen percent disagreed or strongly disagreed with the statement, "I feel close to people in this school."
The parents' telephone survey assessed demographics, the child's health, health care utilization and parental health status. Data on school absences and mobility were linked to survey data.
Grade level, relationship of parent to child, employment, family income, health insurance and school connectedness were significantly associated with the health-related quality of life total score.
"As early as the 2nd grade, these young, urban children rate their health-related quality of life below that of children with known, chronic physical health conditions," says Dr. Mansour. "The low scores suggest that urban children need access to programs and services that address their mental and physical health needs."
While many of the predictors of health-related quality of life identified in the study are not easily changed, school connectedness is a potentially modifiable factor that encourages Dr. Mansour.
"Health and educational programs and school health services provided through school-linked and school-based health centers or programs may be one mechanism to improve children's attachment to their schools with concurrent reduction in risk-taking behaviors," she says.
The study was funded by The Health Foundation of Greater Cincinnati.
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PEDIATRICS