Do child mental & physical health explain inequalities in adolescent NEET status? A UK Cohort Study

Abstract

Abstract Around 1 in 10 young people (YP) (16-24 years) are Not in Education, Employment, or Training (NEET) in the United Kingdom (UK). Socioeconomically disadvantaged YP are more likely to become NEET. Poor physical and mental health and disability are known risk factors for NEET status, yet their potential to mediate the relationship between socioeconomic circumstances (SEC) and NEET status remains unclear. We aimed to quantify which childhood health pathways explain inequalities in adolescent NEET status. We analysed data on 5,786 YP from the Millennium Cohort Study (MCS), a nationally representative sample of the UK population. Early life SEC was measured by highest parental occupational status at birth. NEET status was derived from four questions on education, employment, and training at 17 years. Mediators across childhood were grouped into family health (parental limiting illness, mental and general health, and young carer status) perinatal health (birth weight, smoking during pregnancy, school readiness score), physical health (weight status, asthma, general health, longstanding illness at 11 years), and mental health (mental health score, self-esteem, and ASD/ADHA statement). We used logistic regression to examine the total effect of SEC on adolescent NEET status whilst adjusting for confounders (sex, maternal age, and education), then adjusted for potential mediators. Using causal mediation analysis, we will estimate the proportion mediated by blocks of mediators and the natural indirect effect (NIE) via each block of mediators. After adjustment for confounding, YP whose parents were unemployed were more than 8 times as likely to be NEET at 17 years compared with those whose parents had managerial occupations (Odds Ratio (OR) 8.55, 95% CI 3.73 to 19.64). After adjustment for all childhood health conditions, there was a 34% reduction to aOR 5.99 (95% CI 2.42 to 14.85). Childhood health conditions partially contribute to inequalities in adolescent NEET status. Key messages • Childhood mental and physical health are important for targeting interventions to reduce inequalities in adolescent NEET status. • More than a third of the social inequality in NEET status was explained by perinatal, physical, and mental health during childhood.