Distressing testing: A propensity score analysis of high-stakes exam failure and mental health

This study used rich individual-level registry data covering the entire Norwegian population to identify students aged 17–21 who either failed a high-stakes exit exam or who received the lowest passing grade from 2006 to 2018. Propensity score matching on high-quality observed characteristics was utilized to allow meaningful comparisons (N = 18,052, 64% boys). Results showed a 21% increase in odds of receiving a psychological diagnosis among students who failed the exam. Adolescents were at 57% reduced odds of graduating and 44% reduction in odds of enrolling in tertiary education 5 years following the exam. Results suggest that failing a high-stakes exam is associated with mental health issues and therefore may impact adolescents more broadly than captured in educational outcomes.publishedVersio

Can school nurses improve the school environment in Norwegian primary schools? A protocol for a randomized controlled trial

This protocol describes a randomized controlled trial where additional school nurse resources are assigned to work systemically with schools to improve the school environment and reduce bullying among and absence of 5th–7th grade students. Approximately 9000 students will have participated each year from 2018 to 2020 from 107 schools located in 12 Norwegian municipalities. Academic performance is studied as a secondary outcome.acceptedVersio

The educational burden of disease: a cohort study

Background Students with health disorders might be at risk of disengaging from education, which can reinforce socioeconomic inequalities in health. We aimed to evaluate the associations between 176 diseases and injuries and later school performance in Norwegian adolescents and to estimate the importance of each disorder using a novel measure for the educational burden of disease (EBoD). Methods We used diagnostic information from government-funded health services for all Norwegian inhabitants who were born between Jan 1, 1995, and Dec 31, 2002, were registered as living in Norway at age 11–16 years, and were participating in compulsory education. School performance was assessed as grade point average at the end of compulsory education at age 16 years. We used a linear regression of school performance on disease in a fixed-effects sibling comparison model (113 411 families). The association (regression coefficients) between disease and school performance was multiplied by disease prevalence to estimate the proportional EBoD among 467 412 individuals participating in compulsory education. Findings Overall, although most diseases were not meaningfully associated with grade point average (regression coefficients close to 0), some were strongly associated (eg, intellectual disability regression coefficients –1·2 for boys and –1·3 for girls). The total educational disease burden was slightly higher for girls (53·5%) than for boys (46·5%). Mental health disorders were associated with the largest educational burden among adolescents in Norway (total burden 44·6%; boys 24·6% vs girls 20·0%), of which hyperkinetic disorder contributed to 22·1% of the total burden (boys 14·6% vs girls 7·5%). Among somatic diseases, those with unknown causes and possibly mental causes were associated with the largest educational burden. Interpretation The EBoD concept could provide a simple metric to guide researchers and policy makers. Because mental health disorders form a large component of the educational burden, investment in mental health might be particularly important for improving educational outcomes in adolescents.publishedVersio

Parental income and mental disorders in children and adolescents:prospective register-based study

Background Children with low-income parents have a higher risk of mental disorders, although it is unclear whether other parental characteristics or genetic confounding explain these associations and whether it is true for all mental disorders. Methods In this registry-based study of all children in Norway (n = 1 354 393) aged 5–17 years from 2008 to 2016, we examined whether parental income was associated with childhood diagnoses of mental disorders identified through national registries from primary healthcare, hospitalizations and specialist outpatient services. Results There were substantial differences in mental disorders by parental income, except for eating disorders in girls. In the bottom 1% of parental income, 16.9% [95% confidence interval (CI): 15.6, 18.3] of boys had a mental disorder compared with 4.1% (95% CI: 3.3, 4.8) in the top 1%. Among girls, there were 14.2% (95% CI: 12.9, 15.5) in the lowest, compared with 3.2% (95% CI: 2.5, 3.9) in the highest parental-income percentile. Differences were mainly attributable to attention-deficit hyperactivity disorder in boys and anxiety and depression in girls. There were more mental disorders in children whose parents had mental disorders or low education, or lived in separate households. Still, parental income remained associated with children’s mental disorders after accounting for parents’ mental disorders and other factors, and associations were also present among adopted children. Conclusions Mental disorders were 3- to 4-fold more prevalent in children with parents in the lowest compared with the highest income percentiles. Parents’ own mental disorders, other socio-demographic factors and genetic confounding did not fully explain these associations

Women, weather, and woes: The triangular dynamics of female-headed households, economic vulnerability, and climate variability in South Africa

Existing gender inequality is believed to be heightened as a result of weather events and climate-related disasters that are likely to become more common in the future. We show that an already marginalized group—female-headed households in South Africa—is differentially affected by relatively modest levels of variation in rainfall, which households experience on a year-to-year basis. Data from three waves of the National Income Dynamics Survey in South Africa allow us to follow incomes of 4,162 households from 2006 to 2012. By observing how household income is affected by variation in rainfall relative to what is normally experienced during the rainy season in each district, our study employs a series of naturally occurring experiments that allow us to identify causal effects. We find that households where a single head can be identified based on residency or work status are more vulnerable to climate variability than households headed by two adults. Single male-headed households are more vulnerable because of lower initial earnings and, to a lesser extent, other household characteristics that contribute to economic disadvantages. However, this can only explain some of the differential vulnerability of female-headed households. This suggests that there are traits specific to female-headed households, such as limited access to protective social networks or other coping strategies, which makes this an important dimension of marginalization to consider for further research and policy in South Africa and other national contexts. Households headed by widows, never-married women, and women with a non-resident spouse (e.g., “left-behind” migrant households) are particularly vulnerable. We find vulnerable households only in districts where rainfall has a large effect on agricultural yields, and female-headed households remain vulnerable when accounting for dynamic impacts of rainfall on income

Gender under Distress: Essays on Climatic and Familial Determinants of Gendered Outcomes in African Populations

This dissertation is about how gender, understood as a pervasive system of patterned inequality (Riley, 2005), depends on the circumstances within which it is situated. Demographic studies are beginning to treat gender as a social construction which is therefore embedded in the societies and cultural contexts in which people live, with its meaning also changing across time (Riley and McCarthy, 2003; Williams, 2010). The five essays in this thesis go beyond time and place to identify situations in which the role of gender changes, and in particular the function of external and intra-household stressors in shaping gendered outcomes. Gender under distress is in this dissertation studied in populations in Sub-Saharan Africa, a large and diverse sub-continent with interesting variation yet also some general patterns in the role of gender in shaping demographic outcomes. For example, sex ratios in infant mortality in the 2000s varied between 106 males per 100 females in the Democratic Republic of Congo and Burkina Faso and 137 males per 100 females in Gabon, which is still above corresponding levels in India (97 per 100) and China (76 per 100) (United Nations Population Division, 2011). The lifetime risk of maternal death is 1 in 36 in Sub-Saharan Africa, more than four times higher than in developing regions all together (World Health Organization et al., 2015). The HIV/AIDS epidemic is an even larger contributor to gender differences in adult mortality than maternal deaths in Sub-Saharan Africa as a whole, with devastating impacts in southern and central regions (Anderson and Ray, 2010). Intimate partner violence is widespread affecting more than a third of women in Africa during their lifetime, and two thirds in central parts (World Health Organization, 2013). Other characteristics such as high fertility (United Nations Population Division, 2015) and high labour participation (Sen, 1990) furthermore contribute to common traits in the role of gender in Sub-Saharan Africa, although as this dissertation also documents, there are vast differences in how gender should be understood in different households and social contexts. Gendered outcomes may change in instances when extraordinary circumstances put pressure on existing gender norms and practices. Erratic rainfall is one source of vulnerability which is particularly salient in Sub-Saharan Africa as it causes large year-to-year variations in yields in rain-fed agricultural production. This is a stressor which is becoming more important as climate change interacts with non-climate drivers and stressors to exacerbate vulnerability of agricultural systems (Niang et al., 2014). Existing gender inequality is believed to be heightened as a result of weather events and climate-related disasters intertwined with socioeconomic, institutional, cultural, and political drivers (Olsson et al., 2014). Three essays in this dissertation study how gendered outcomes are influenced by weather-induced income shocks, providing insights for the global discussion on distributional impacts of climate change. Pressure on economic resources may also come from within the family. Gender inequalities increases the importance of the composition of the family in terms of the number, age, sex, and health of its members for current and future economic vulnerability, and economic and compositional considerations shape gendered behaviours and outcomes. In southern Africa, a history of economic migration and re-settlement, violence against women, and HIV/AIDS has lead to a breakdown of traditional family structures (Wright, Noble, Ntshongwana, Barnes, and Neves, 2013), which has resulted in a continued increase in the number of female-headed households, currently with more than 40% of households in several countries being female-headed (ICF International, 2015). These households often face a ‘triple burden’ with a gender gap in earnings, a high dependency ratio and other disadvantaged household characteristics, and specific constraints related to female heads managing multiple roles (Rosenhouse, 1989). With gender being of importance for economic and care-taking roles, women are often under pressure to produce a balanced sex composition of offspring, and increasingly also committed to restricting overall family size. This stressor again reveals how gender is a situational concept, as investments in child health and survival may depend on whether there is a surplus of either gender relative to parental preferences. Adding to the complexity of studying gender as situated within the familial context is the notion that preferences for the gender and number of offspring may not be constant throughout a woman’s reproductive career, but may change in response to life events such as the birth or death of a child

Conflict, Child Health, and Household Adjustments in Eritrea

Child stunting in growth currently affects 164 million children globally, and has dire consequences for the future well-being of the affected children. Wars disproportionately affect children and is believed to raise levels of stunting due to malnutrition and diseases. Using the 2002 Eritrean Demographic and Health Survey, this thesis adopts a differences-in-differences methodology and finds that the 1998-2000 border war between Eritrea and Ethiopia raised levels of stunting in affected regions by 12 %, which is more than a quarter of the non-conflict level. A second investigation studies idiosyncratic war-related shocks, and does not find any significant and negative effects on child stunting from mobilisation, war-related deaths among male family members, and displacement still ongoing in 2002. Thirdly, this thesis finds that the levels of stunting among children in the Debub region were significantly more severely affected by conflict if living closer to a main road, indicating that dependency on trade with Ethiopia was an important risk factor. The analysis of coping strategies in this thesis further develops the idea that the conflict-stunting relationship is asymmetric and highly influenced by the options available to households in mitigating the effects of negative shocks. An analysis is provided on how households adapted production patterns, asset holdings and fertility to cope with the constraints created by the conflict, and how they made use of supportive networks. Of particular interest is the role of Eritrean women in mitigating the effects of war. Eritrean women have to a significant degree substituted for the labour of men in general, and also for mobilised men. The level of fertility during the 1998-2002 time period was lower in families that were not able to secure the basic needs of their last-born child still alive, of which stunting is a manifestation. Mothers of stunted children have furthermore wanted to postpone further childbearing which implies that a significant part of the reduction has been a desired adjustment for the mothers, yet they have not necessarily reduced their overall fertility desires. Consistent with economic theory, community assistance or mutual insurance systems do a much better job in mitigating crises with repeated risk exposure and when facing idiosyncratic risk than in an extraordinary conflict situation. Stunting due to war is significantly more dependent upon the ability to convert own wealth into emergency consumption and on growing own crops than stunting due to other causes. These findings point to a breakdown in social contracts during war, which is particularly problematic for the most vulnerable

Skolebidragsindikatorer i videregående skole: Indikatorer for skolers bidrag til fullføring, gjennomføring og gjennomsnittskarakterer for skoleåret 2014-2015 og kullet som begynte i videregående skole høsten 2012

Denne rapporten om skolebidragsindikatorer i videregående skole er utarbeidet på oppdrag for Utdanningsdirektoratet. Rapporten presenterer en rekke indikatorer for skolenes bidrag til elevenes resultater, etter at vi har tatt hensyn til det grunnlaget elevene hadde med seg da de begynte i videregående skole. Denne typen indikatorer gir de videregående skolene kvalitativt ny informasjon om deres eget bidrag til elevenes læring

The association between parental internalizing disorders and child school performance

Abstract Parents play a crucial role in children’s lives. Despite high prevalences of anxiety and depression, we do not know how these disorders among parents associate with child school performance in Norway. We use regression models to estimate associations between parental mental disorders and child school performance, while adjusting for some social and genetic confounders. Parental anxiety and depression were assessed from administrative registers of government funded health service consultations for all individuals in Norway with children born between 1992 and 2002. School performance was assessed as standardized grade point average at the end of compulsory education when children are 16 years old. Associations were also considered in samples of adoptees and among differentially affected siblings. We find that 18.8% of children have a parent with an anxiety or depression diagnosis from primary care during the last three years of compulsory education (yearly prevalence: 11.5%). There is a negative association between these parental mental disorders and child school outcomes (z = 0.43). This association was weakened, but statistically significant among differentially exposed siblings (z = 0.04), while disappearing in adoptee children. Many children experience that their parents have anxiety or depression and receive a diagnosis from primary care. On average, these children have lower school performance. The association is attenuated when comparing differentially exposed siblings and disappears in adoptee children. These results have a poor fit with the hypothesis that parental internalizing is an influential causal factor in determining children’s educational success