Associations between school difficulties and family type and the role of socioeconomic, behavior and health-related difficulties in early adolescents: a population-based study

Abstract

Objectives

Nowadays many early adolescents are living in non-intact families (parents divorced/separated, reconstructed families or single parents) and have many school difficulties (learning difficulty, skipping school, school absence due to family problems, grade repetition, low school performance, and school dropout ideation). This study assessed the associations between school difficulties and family type which remain little addressed and the confounding role of socioeconomic adversities and behavior, social support and health-related difficulties (BSSHDs).

Methods

The study population included 1559 middle-school adolescents from north-eastern France (mean age 13.5 ± 1.3). They completed at the end of school-year a questionnaire gathering socioeconomic adversities, school difficulties and BSSHDs (being obese, substances use, sustained physical/verbal violence, sexual abuse, perpetrated violence, poor social support, depressive symptoms, and suicide attempt; cumulated number noted BSSHD_CM). Data was analyzed using logistic regression models.

Results

The adolescents with parents divorced/separated, reconstructed families or single parents had a much higher risk for various school difficulties than those in intact families (sex-age-adjusted odds ratios 1.60–4.70, mostly with p < 0.001). These risks were robust and remained significant (often with p < 0.01/0.001) after adjustment for socioeconomic adversities and BSSHD_CM. The contributions of socioeconomic adversities plus BSSHD_CM to the risks were mostly elevated (>40%, reaching 65%) while those of socioeconomic adversities alone were mostly moderate (<30%, but reaching 52%).

Conclusions

Family type plays a strong role in school difficulties among early adolescents, mainly due to socioeconomic adversities and BSSHD_CM. Our results may help primary care providers identify at-risk adolescents and their problems and establish timely prevention and care.

Highlights

• Learning difficulty, school absence, grade repetition, low academic performance, and school dropout ideation are common in early adolescents.

• The adolescents with parents divorced/separated, reconstructed families or single parents have up to 4.7-time higher risk for these school difficulties than those in intact families.

• These risks are robust after adjustment for socioeconomic, behavior and health-related difficulties which explain up to 65% of the risks.

• School-difficulty prevention should consider family features and include early monitoring behavior and health-related difficulties in adolescents.

Keywords:

• School problems
• early adolescents
• family type
• socioeconomic and health-related difficulties
• population-based study

Acknowledgements

The authors would like to thank M. J. Chau, E. Aptel, I. Armand, B. Barraud, O. Causin, M. Verdin, C. Richoux, Y. Delacour, C. Grangé, A. Chatton, L. Hiroux, L. Collet, and the staff of the schools for their valuable help in the study. This research involved French National Institute with public funds. The funder has no role in study design, data collection and analysis, decision to publish, or preparing the manuscript.

Ethical approval

This study was approved by the Commission Nationale de l’Informatique et des Libertés (national review board) and the Nancy-Metz regional education authority.

Author contributions

K. Chau conceived and conducted the survey, performed the statistical analysis and wrote the article. B. Kabuth participated in conceiving the survey and in writing the article. C. Schweitzer-Troester and B. Leroy participated in conceiving this article, interpreting the results and in writing the article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research involved French National Institute with public funds.

Notes on contributors

Kénora Chau

Chau, Kénora, general practitioner; born at Nancy, France, in 1982. Married, two children: Margaux and Antoine. Doctor of Medicine in 2012, Master of Public Health and Environment (specialty: Epidemiology, Clinical Research and Evaluation) in 2014, PhD in Life and Health Sciences in 2018, at the University of Lorraine, France. Head of University of General Medicine (2013-2017), Associate Professor (2019-2020), Faculty of Medicine of Nancy, University of Lorraine, France. Secretary General of the Order of Physicians (since 2021). General Medicine Thesis Prize 2013, Stanislas Academy Award 2014. Manuscript reviewer for nine journals. Achievements include 30 papers and 33 communications about the determinants of health, needs and barriers to access to primary care, adolescent health, and cardiovascular remodeling.

Catherine Schweitzer-Troester

Schweitzer-Troester, Catherine, general practitioner at Pont-à-Mousson, France; born at Nancy, France, in 1988. Doctor of Medicine in 2017, Diploma of Specialization Studies in General Medicine in 2017

Bernard Kabuth

Kabuth, Bernard, Psychiatry University Professor - Hospital Practitioner; born at Lille, France, in 1961. Children’s Hospital at Vandoeuvre-lès-Nancy, France. Research areas include pediatrics, psychiatry, development psychology, health psychology, clinical psychology and anorexia nervosa. Achievements include 47 articles and 12 conference papers about child development, youth suicide, and adolescent health, suicide attempt, quality of life, support and substance use.