Strategies to improve educational outcomes for youth with childhood-onset chronic illness should include interventions that promote school connectedness, and mentoring relationships

Maslow, G., Haydon, A. A., McRee, A. L. Halpern, C. T. (2012). Protective connections and educational attainment among young adults with childhood-onset chronic illness. Journal of School Health, 82(8), 364-370.

Summarized by Jessica Cunningham, B.A. Lab Manager, Center of Evidence-Based Mentoring


Childhood-onset chronic illnesses, such as diabetes, cancer, heart conditions, and epilepsy can wreak havoc on an individual’s ability to succeed in school and their ability to become independent adults. Missing classes due to illness makes it hard to catch up, colleges are wary of accepting individuals with low grades and lots of absences, and employers who are understanding of chronic absenteeism are hard to come by. Thus, youth with chronic illness are at high risk of low educational attainment and unemployment. Learning what factors influence negative outcomes and which influence positive ones in this population is important. If we know these things, researchers can develop interventions to help youth with chronic illness achieve success as adults, and mentors of these youth will know how best to help their mentees. The researchers of the following study were interested in studying protective factors (or things that insulate people from negative outcomes they are otherwise at risk for) in people with childhood-onset chronic illnesses (spoiler alert: mentors are the most important protective factor for these youth!)



With the improvements of medical interventions for various serious childhood-onset conditions, more children are surviving into adulthood. However, many of these youth struggle to become independent adults; young adults with health problems are less likely to graduate from college and are more likely to be unemployed. Lack of connection to school and other resources may be the reason why these youth struggle in adulthood. The authors of this study wanted to study the impact of relationships and other protective factors on college graduation rates for youth with childhood-onset chronic illness (COCI).



The authors used the National Longitudinal Study of Adolescent Health (Add Health) and pulled data from three waves to investigate these relationships. They used data from Wave I, when participants were 12-19 years old, Wave III when participants were 18-28 years old, and Wave IV when participants were 24-32 years old.

Researchers identified respondents with chronic illness based on their report in Wave IV of ever having been diagnosed with cancer, diabetes, epilepsy, or heart disease. Those who responded affirmatively were asked for their age of diagnosis; anyone who said they were diagnosed before 18 years old were considered to have a childhood-onset chronic illness. Those with adult-onset chronic illness were excluded from analyses.

The researchers coded college graduation as a dichotomous variable based on participants’ reports in Wave IV interviews. They also controlled for this variable based on age (i.e. people who were on the younger end of age in Wave IV were less likely to have completed college than those who were the oldest participants in that sample), socioeconomic status of family (the highest level of education achieved for either parent reported at Wave I), race/ethnicity (based on Wave I self-report), and cognitive function using the Add Health Picture Vocabulary Test, which was based on the Peabody Picture Vocabulary Test. This test was administered at Waves I and III, and the better score of the two was used as a marker of overall cognitive function.

The researchers also used data to measure the different types of relationships the youth engaged in, and their quality.

Participants in Wave III were asked if they had a mentor since the age of 14; those who answered “yes” were asked when their mentor became important to them. The researchers were interested in the impact of mentors before the age of 18, so this variable was coded dichotomously; either a participant had a mentor before they were 18 or they did not.

The researchers assessed parental relationship quality by combining four items from waves of the study that measured parental warmth, satisfaction with the relationship, quality of communication, and overall feeling of closeness. They were asked about both parents if they indicated they had both.

The researchers assessed school connectedness by using five items from the waves of the study which measured feeling close to their school, like they were a part of their school, happy with the school, feeling that teachers were fair, and feeling like they got along with their teachers.

The researchers measured religious attendance by using a single item from one of the interviews asking whether or not participants attended services weekly; any responses that were lower than weekly attendance were coded as “not attending religious services.”

The researchers used multivariate logistic regression analyses to compare participants with childhood-onset chronic illness and those without, and then examined associations with protective factors with the illness group (parental closeness, school connectedness, having a mentor, religious attendance). The researchers considered any association with a p-value of less than .10 as statistically significant.



10, 925 participants were included in the analysis and of those, 230 had experienced a childhood-onset chronic illness. Of those, 53% of participants had epilepsy, 24% had diabetes, 17% had cancer, and 16% had heart conditions. Those with childhood-onset chronic illness did not differ in terms of demographic variables except that their parents were more likely to have low educational attainment than those without childhood-onset chronic illness.

Significantly fewer young adults with childhood-onset chronic illnesses graduated college than their healthy peers; only 20.7% graduated compared with 34.1% for healthy youth. There were no significant differences in the number of protective factors between groups; over 70% of participants in each had at least 2 protective factors.

All protective factors were strongly associated with college graduation rates. Those with a mentor had graduation rates of 36.8% compared to 23.3% of those without mentors. But, among children with childhood-onset chronic illness, only having a mentor was significantly associated with graduating from college, although there was a trend towards significance among those with higher levels of school connectedness. However, when looking only at youth with childhood-onset chronic illness, school connectedness was significantly associated with higher rates of college graduation.

Discussion & Conclusions: Previous studies on youth with experiencing childhood-onset chronic illness have suggested that missing class time, effects of medication on performance, and other factors relating to the illness itself may be responsible for lowered academic achievement among youth with these conditions. However, none of those factors could account for the results of this study.

Based on their findings regarding school connectedness being one of the most important protective factors for educational attainment, the authors posit that “youth with COCI may gain greater benefit from school connectedness because of the other social deficits they face and the loss of other opportunities to participate in social and community activities that would promote their development.”

The authors suggest that strategies to improve educational outcomes for youth with childhood-onset chronic illness should include interventions that promote school connectedness and mentoring relationships. There are some mentoring organizations that serve youth with childhood-onset chronic illness specifically, but their impact on important adult outcomes have yet to be studied. Additionally, the authors suggest that doing a study with a larger sample of chronically ill children would be beneficial and may lend more support to the associations they saw in this data set.

The authors close by highlighting the importance of “understanding factors that promote the educational attainment for this group of at-risk youth is necessary to allow adolescents with COCI to become independent, successful adults.”

To access the original research, click here.