Adolescent Health and Adult Education and Employment: A Systematic Review

OBJECTIVE: Poor health in adolescence has the potential to disrupt education and employment pathways. This study is the first systematic review of the literature examining education and employment outcomes in adulthood of poor adolescent mental and physical health.

METHODS: We conducted searches using a standardized search protocol in 8 electronic databases: PsycINFO, Medline, Embase, ERIC, British Education Index, Australian Education Index, Social Sciences Citation Index, and CINAHL Plus. We identified studies that longitudinally compared adult education and employment outcomes of those with an adolescent chronic condition of clinical severity with healthy controls. We conducted meta-analyses using odds ratios (for dichotomous variables) and Cohen's d (for continuous variables) as our main summary statistics.

RESULTS: We identified 27 studies incorporating 70 relevant analyses. Our meta-analyses suggested that overall, poor health in adolescence was associated with poorer education and employment outcomes in adulthood. However, evidence was much stronger for mental health conditions than for physical health conditions, for which less evidence was available and mixed findings emerged. Compared with mental health conditions, we identified few studies investigating the long-term outcomes of physical health conditions. Age and follow-up times varied considerably across our studies, which potentially resulted in some heterogeneity in effect sizes. The majority of included studies were conducted in the United States, raising questions about the generalizability of the results internationally.

CONCLUSIONS: Health in adolescence contributes to adult attainment and life chances. The results suggest that investment in health may improve life chances and that policy interventions may improve outcomes for those with adolescent chronic conditions.