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Silent Dropouts in Health Surveys:: Are Nonrespondent Absent Teenagers Different From Those Who Participate in School-Based Health Surveys?

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Abstract

Objective: To compare the health problems, needs and behavior of pupils absent from school with participants in the Swiss Multicenter Adolescent Survey on Health.

Methods: The present pupils’ group (N = 3324; adolescents between 15 and 20 years old, randomly selected from high schools and professional centers of French-speaking Switzerland) answered a self-administered anonymous questionnaire. The absent pupils group (N = 96) was questioned on the phone by means of a shorter but similar version of the questionnaire.

Results: The proportion of respondents reporting skin problems, weight concerns, sleep difficulties, headaches, stomach aches, as well as vision or dental problems was higher in the present pupils sample (p < 0.01). The percentages of teenagers reporting the need for help were higher in the present pupils sample than in the absent group: nutrition (21.8 vs. 9.4, p < 0.01) stress (44.2 vs. 31.3, p < 0.05), depression (28.4 vs. 18.9, p < 0.05), sleep problems (21.3 vs. 12.1, p < 0.05), sports (9.2 vs. 4.2, p < 0.05), and love life (31.5 vs. 14.5, p < 0.01). The rates of hospitalizations and injuries were lower among absent pupils (28.2 vs. 40.1, p < 0.01). A higher proportion of absent students were sexually active (p < 0.05). They had a tendency to use tobacco, alcohol, and cannabis more frequently than did present pupils (p < 0.05).

Conclusion: Within the Swiss context, nonparticipation owing to school absenteeism is probably related less to physical or chronic health problems than to lifestyles which predispose these students to truancy.

Section snippets

The Sample

The Swiss Multicenter Adolescent Survey on Health (SMASH) is a nationwide survey that addressed the health and lifestyles of in-school teenagers aged 15–20 years. It was conducted during 1992 and 1993 7, 15, 16. A total of 9268 young people enrolled in the first to fourth grade of postmandatory school in Switzerland answered an anonymous self-administered questionnaire. One-step cluster sampling procedure was used, including all public secondary schools, technical schools, and schools for

Results

In the French-speaking sample which had been originally randomly selected (N = 3694), 188 pupils (5%) were absent on the day the questionnaires were completed. Taking into account refusals to participate (n = 2; 0.02%), exclusion of older subjects (4%; > 20 years old) and nonusable questionnaires (1.5%), the present pupils sample was finally composed of 3324 individuals. Half of the schools, both professional centers and high schools, refused to give the students’ addresses, which precluded

Discussion

Upon planning this study, we expected to find, among the students who were absent on the day the questionnaires were distributed, a higher rate of health problems. The findings gave another, interesting answer in that absent teenagers actually reported fewer health problems and needs than participants, in the somatic as well as in the psychosocial areas. Thus, they did not seem to suffer from chronic health problems and they reported fewer hospitalizations and accidents. However, absent

Acknowledgements

This study was presented at the annual meeting of the Society for Adolescent Medicine, Los Angeles, March 1994. This research was supported by a grant from the Federal Office for Public Health of Switzerland, Contract No. 316.92.5321.

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