Eligibility For Free School Meals Research Articles

Behaviour change intervention (education and text) to prevent dental caries in secondary school pupils: BRIGHT RCT, process and economic evaluation.

The presence of dental caries impacts on children's daily lives, particularly among those living in deprived areas. There are successful interventions across the United Kingdom for young children based on toothbrushing with fluoride toothpaste. However, evidence is lacking for oral health improvement programmes in secondary-school pupils to reduce dental caries and its sequelae. To determine the clinical and cost effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in secondary-school pupils. A multicentre, school-based, assessor-blinded, two-arm cluster randomised controlled trial with an internal pilot and embedded health economic and process evaluations. Secondary schools in Scotland, England and Wales with above-average proportion of pupils eligible for free school meals. Randomisation occurred within schools (year-group level), using block randomisation stratified by school. Pupils aged 11-13 years at recruitment, who have their own mobile telephone. Two-component intervention based on behaviour change theory: (1) 50-minute lesson delivered by teachers, and (2) twice-daily text messages to pupils' mobile phones about toothbrushing, compared with routine education. Primary outcome: presence of at least one treated or untreated carious lesion using DICDAS4-6MFT (Decayed, Missing and Filled Teeth) in any permanent tooth, measured at pupil level at 2.5 years. Secondary outcomes included: number of DICDAS4-6MFT; presence and number of DICDAS1-6MFT; plaque; bleeding; twice-daily toothbrushing; health-related quality of life (Child Health Utility 9D); and oral health-related quality of life (Caries Impacts and Experiences Questionnaire for Children). Four thousand six hundred and eighty pupils (intervention, n = 2262; control, n = 2418) from 42 schools were randomised. The primary analysis on 2383 pupils (50.9%; intervention 1153, 51.0%; control 1230, 50.9%) with valid data at baseline and 2.5 years found 44.6% in the intervention group and 43.0% in control had obvious decay experience in at least one permanent tooth. There was no evidence of a difference (odds ratio 1.04, 95% confidence interval 0.85 to 1.26, p = 0.72) and no statistically significant differences in secondary outcomes except for twice-daily toothbrushing at 6 months (odds ratio 1.30, 95% confidence interval 1.03 to 1.63, p = 0.03) and gingival bleeding score (borderline) at 2.5 years (geometric mean difference 0.92, 95% confidence interval 0.85 to 1.00, p = 0.05). The intervention had higher incremental mean costs (£1.02, 95% confidence interval -1.29 to 3.23) and lower incremental mean quality-adjusted life-years (-0.003, 95% confidence interval -0.009 to 0.002). The probability of the intervention being cost-effective was 7% at 2.5 years. However, in two subgroups, pilot trial schools and schools with higher proportions of pupils eligible for free school meals, there was an 84% and 60% chance of cost effectiveness, respectively, although their incremental costs and quality-adjusted life-years remained small and not statistically significant. The process evaluation revealed that the intervention was generally acceptable, although the implementation of text messages proved challenging. The COVID-19 pandemic hampered data collection. High rates of missing economic data mean findings should be interpreted with caution. Engagement with the intervention and evidence of 6-month change in toothbrushing behaviour was positive but did not translate into a reduction of caries. Future work should include work with secondary-school pupils to develop an understanding of the determinants of oral health behaviours, including toothbrushing and sugar consumption, particularly according to free school meal eligibility. This trial is registered as ISRCTN12139369. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 15/166/08) and is published in full in Health Technology Assessment; Vol. 28, No. 52. See the NIHR Funding and Awards website for further award information.

Socio-spatial networks and capital in small rural primary school voluntary activity

ABSTRACT Small primary schools and schools with the lowest number of free school meal (FSM) eligibility are increasingly reliant on voluntary activity for the provision of core services. Significant disparities in where and how this voluntary activity happens risk widening inequalities between schools, especially when policies directly encourage them (and funding cuts necessitate them) to turn to their communities for support. However, we do not know how these differences play out in practice or what the implications might be. Drawing on ethnographic research, this paper explores how voluntary activity undertaken in small rural primaries is facilitated through socio-spatial networks (interpersonal connections rooted in space) and how capital is mobilised (and converted) through these networks. This research revealed how the work of education is carried out through many socio-economic modes, by different people and across a range of spaces, and that this influences the education provided in these environments.

The inequity of education, health and care plan provision for children and young people with intellectual and developmental disabilities.

Children and young people (CYP) with intellectual and developmental disabilities (IDDs) have significant additional educational needs compared with the general population. In England, the government has established a system of education, health and care plans (EHCPs) to support children with special educational needs and disabilities, but disparities exist between the degree of need and the availability of support. We conducted a prospective UK national cohort study (IMAGINE) of children with rare pathogenic genomic variants, all of which are associated with IDD, to investigate associated neuropsychiatric risk. Subsequently, we obtained information from the UK's National Pupil Database on their educational progress through the state school system. We aimed to identify whether they had received EHCP provision and whether that support was associated with their family's socioeconomic status, region of domicile, ethnicity, sex, primary special educational needs (SEN) type, academic performance and mental health well-being. We recruited 2738 CYP from England into the IMAGINE study between 2014 and 2019. The educational histories of the participants (6-28years old, mean±standard deviation= 14±4years, 56% male) were obtained from the Department for Education's National Pupil Database in 2021. Educational data included attainment scores from the Early Year Foundation Stage (<5years) to key stage 4 (15-16years). Each family was assigned an index of multiple deprivation (IMD) score based on their home address postcode. Parents or carers rated their child's emotional and behavioural adjustment on the Strengths and Difficulties Questionnaire (SDQ). The association between receiving an EHCP and the child's IMD score, eligibility for free school meals, English region of domicile, ethnicity, sex, primary SEN type, academic attainment and SDQ score was investigated. In this cohort, 78% of participants had received an EHCP. CYP living in the most deprived IMD deciles were substantially less likely to receive EHCP support than those in the least deprived decile, irrespective of their degree of intellectual developmental disability, academic performance or associated mental health problems. There were no sex differences. Children of Asian heritage were more likely to have been granted an EHCP than White children from equivalent IMD deciles. There were striking regional disparities. Participants living in London were significantly more likely to have been awarded an EHCP than participants living anywhere else in England, regardless of their IMD decile; those in the least deprived decile had almost 100% EHCP provision. This study found evidence for nationwide regional inconsistencies in the awarding of EHCP to CYP with significant intellectual impairments of known genetic aetiology. Disparities in funds available to education authorities could be a contributory factor. EHCP support was potentially influenced by how strongly a parent advocates for their child.

Behaviour change intervention for toothbrushing (lesson and text messages) to prevent dental caries in secondary school pupils: The BRIGHT randomized control trial.

This multicentre, assessor-blinded, two-arm cluster randomized trial evaluated the clinical and cost-effectiveness of a behaviour change intervention promoting toothbrushing for preventing dental caries in UK secondary schools. Pupils aged 11-13 years with their own mobile telephone attending secondary schools with above average free school meals eligibility were randomized (at year-group level) to receive a lesson and twice-daily text messages or to usual care. Year-groups (n = 84) from 42 schools including 4680 pupils (intervention, n = 2262; control, n = 2418) were randomized. In 2383 participants with valid data at baseline and 2.5 years, the primary outcome of presence of at least one treated or untreated carious lesion (D4-6 MFT [Decayed, Missing and Filled Teeth] in permanent teeth using International Caries Detection and Assessment System) was 44.6% in the intervention group and 43.0% in control (odds ratio [OR] 1.04, 95% CI 0.85-1.26, p = .72). There were no statistically significant differences in secondary outcomes of presence of at least one treated or untreated carious lesion (D1-6 MFT), number of D4-6 MFT and D1-6 MFT, plaque and bleeding scores or health-related- (Child Health Utility 9D) or oral health-related- quality of life (CARIES-QC). However, twice-daily toothbrushing, reported by 77.6% of pupils at baseline, increased at 6 months (intervention, 86.9%; control, 83.0%; OR 1.30, 95% CI 1.03-1.63, p = .03), but returned to no difference at 2.5 years (intervention, 81.0%; control, 79.9%; OR 1.05, 95% CI 0.84-1.30, p = .69). Estimated incremental costs and quality-adjusted life-years (QALYs) of the intervention, relative to control, were £1.02 (95% CI -1.29 to 3.23) and -0.003 (95% CI -0.009 to 0.002), respectively, with a 7% chance of being cost-effective (£20 000/QALY gained threshold). There was no evidence of statistically significant difference for caries prevalence at 2.5-years. The intervention's positive 6-month toothbrushing behaviour change did not translate into caries reduction. (ISRCTN 12139369). COVID-19 pandemic adversly affected follow-up.

Factors associated with low school readiness, a linked health and education data study in Wales, UK

Background School readiness is a measure of a child’s cognitive, social, and emotional readiness to begin formal schooling. Children with low school readiness need additional support from schools for learning, developing required social and academic skills, and catching-up with their school-ready peers. This study aims to identify the most significant risk factors associated with low school readiness using linked routine data for children in Wales. Method This was a longitudinal cohort study using linked data. The cohort comprises of children who completed the Foundation Phase assessment between 2012 and 2018. Individuals were identified by linking Welsh Demographic Service and Pre16 Education Attainment datasets. School readiness was assessed via the binary outcome of the Foundation Phase assessment (achieved/not achieved). This study used multivariable logistic regression model and a decision tree to identify and weight the most important risk factors associated with low school readiness. Results In order of importance, logistic regression identified maternal learning difficulties (adjusted odds ratio 5.35(95% confidence interval 3.97–7.22)), childhood epilepsy (2.95(2.39–3.66)), very low birth weight (2.24(1.86–2.70), being a boy (2.11(2.04–2.19)), being on free school meals (1.85(1.78–1.93)), living in the most deprived areas (1.67(1.57–1.77)), maternal death (1.47(1.09–1.98)), and maternal diabetes (1.46(1.23–1.78)) as factors associated with low school readiness. Using a decision tree, eligibility for free school meals, being a boy, absence/low attendance at school, being born late in the academic year, being a low birthweight child, and not being breastfed were factors which were associated with low school readiness. Conclusion This work suggests that public health interventions focusing on children who are: boys, living in deprived areas, have poor early years attendance, have parents with learning difficulties, have parents with an illness or have illnesses themselves, would make the most difference to school readiness in the population.

The oral health of secondary school pupils: baseline data from the Brushing RemInder 4 Good oral HealTh (BRIGHT) trial.

Background This paper describes the sociodemographics and oral health of UK secondary school pupils. They were participants of the BRIGHT trial, which was designed to evaluate the effectiveness of a toothbrushing intervention to reduce dental caries.Methods Overall, 4,680 pupils aged 11-13 years attending 42 secondary schools in England, Scotland and Wales with above average proportion of pupils eligible for free school meals, were recruited to the trial. Sociodemographic data were collected. Participants had a clinical assessment for caries, plaque and bleeding and completed measures of oral and general health-related quality of life and oral health behaviours (frequency of toothbrushing, dental attendance and cariogenic food/drinks consumed). Regression analyses were performed.Results Over one-third (34.7%) of participants had caries experience, with 44.5% reporting their oral health had an impact on their daily lives. Factors associated with a statistically significant increased likelihood of caries experience were older age, being female, eligibility for free school meals, worse oral health-related quality of life, higher cariogenic diet, less than twice-daily toothbrushing, living in a more deprived area and lower school attendance.Conclusions The prevalence and impact of dental caries on the lives of pupils remains high, with further oral health promotion activities needed in targeted secondary schools.

The long-term impact of the Covid-19 pandemic on financial insecurity in vulnerable families: Findings from the Born in Bradford Covid-19 longitudinal study.

There is growing recognition that the public health measures employed to control the spread of the COVID-19 pandemic had unintended consequences on socioeconomic security and health inequalities, having the greatest impact on the most vulnerable groups. This longitudinal study aims to explore the medium to long-term impacts of the COVID-19 pandemic and subsequent public health measures on financial security for families living in the deprived and ethnically diverse city of Bradford. We collected data at four time points before and during the pandemic from mothers who participated in one of two prospective birth cohort studies in Bradford. The findings demonstrate that the risk of experiencing financial insecurity rose sharply during the pandemic and has not returned to pre-COVID-19 baseline levels. Several individual characteristics were found to be possible predictors of financial insecurity, including homeowner status, free school meal eligibility and not working. Protective factors against financial insecurity include: living in more affluent areas; greater levels of educational attainment; and families with two or more adults in the household. Notably, families of Pakistani Heritage were found to have the greatest risk of experiencing financial insecurity throughout the pandemic. Furthermore, this study demonstrated that there were strong associations between financial insecurity and maternal health and wellbeing outcomes, with mothers experiencing financial insecurity being more likely to report unsatisfactory general health and clinically important symptoms of depression and anxiety. The findings of this study highlight that the impact of financial insecurity experienced by mothers and their families throughout the pandemic was severe, wide ranging and affected the most vulnerable. In the wake of the pandemic, the emerging cost of living and energy crisis emphasises the urgent need for policy makers to act to support vulnerable families to prevent further widening of existing health and social inequalities.

Measuring parental income using administrative data. What is the best proxy available?

ABSTRACT Administrative data are increasingly being used to study inequalities in education. Yet a well-known difficulty with such resources is the limited information they hold. A commonly used proxy for children coming from a low-income background is their eligibility for free school meals, yet this is likely to be of little use in measuring academic achievement amongst middle and high-income groups. This study adds to the literature by showing how eligibility for free school meals – averaged over the time a child has spent at school – is the best available proxy for low income during childhood. In contrast, creating a continuous index combining free school meal eligibility with information on the neighbourhood in which they live represents the best way of comparing educational outcomes across children from low, average and high-income backgrounds.

Examining the impact of a universal social and emotional learning intervention (Passport) on internalising symptoms and other outcomes among children, compared to the usual school curriculum: study protocol for a school-based cluster randomised trial

BackgroundSchool-based universal social and emotional learning (SEL) interventions implemented during the transition to adolescence may be efficacious in preventing the development of mental health difficulties. This protocol describes a two-arm parallel cluster randomised controlled trial to investigate the impact of a universal SEL intervention (Passport, compared to usual provision) on internalising symptoms (primary outcome), emotion regulation, well-being, loneliness, social support, bullying, academic attainment, and health-related quality of life in English primary school pupils aged 9–11 years. A developer-led trial demonstrated the feasibility, acceptability, and utility of Passport; this will be the first independent trial.MethodsSixty primary schools will be recruited across the Greater Manchester city region and surrounding areas, involving 2400 pupils aged 8–9 at baseline. Schools will be allocated to the intervention arm to implement Passport over 18 weekly sessions or to the control arm to implement the usual school curriculum. Random allocation will be at school level following completion of baseline measures, with minimisation to ensure balance across trial arms in school size and free school meal eligibility. Measures will be collected at baseline, post-intervention (12 months post-baseline), and at 12 months follow-up (24 months post-baseline). The primary outcome analysis (intervention effects on internalising symptoms at post-intervention) will comprise a two-level (school, child) hierarchical linear model, following the intention-to-treat principle. Additional analyses will be undertaken to assess intervention effects on secondary outcomes, maintenance effects for all outcomes, intervention compliance moderator effects, subgroup moderator effects, and mechanisms underpinning intervention effects on the primary outcome. A mixed-methods implementation and process evaluation will examine factors that influence implementation, and a health economic evaluation will assess the cost-effectiveness of the intervention.DiscussionFindings will provide educators with crucial knowledge of whether and how increasing emotion regulation through a universal intervention impacts internalising symptoms and a range of related outcomes. Findings will also inform policy related to the promotion of mental health among children and young people. If the intervention is found to be efficacious in reducing internalising symptoms and is also cost-effective, it may offer high potential as a preventative intervention for widespread implementation.Trial registrationISRCTN12875599; registered on 24 November 2022

Serving their communities? The under-admission of children with disabilities and ‘special educational needs’ to ‘faith’ primary schools in England

ABSTRACT Around 28 per cent of state primary school children attend ‘faith’ establishments in England, the majority in Catholic or Church of England schools. Research suggests ‘faith’ schools tend to educate proportionally fewer children from low-income families (proxied by eligibility for Free School Meals [FSM]). This paper examines whether they also under-admit children ‘disadvantaged’ according to another key dimension: having special educational needs and/or disability (SEND). Descriptive statistics and modelling use the National Pupil Database census and span 2010–2020. Across years, ‘faith’ primary schools are less likely to include children with SEND, and less likely to admit children with SEND to the first (Reception) year. Accounting for area-level factors, indications of under-admission to Catholic schools become more pronounced. Some disproportionality for Church of England schools is explained by confounders – but even after attenuation, they remain less likely to serve children with SEND than non-‘faith’ schools. Together, FSM and SEND predict a substantively meaningful lowered likelihood of children attending ‘faith’ schools, so these schools, at the national level, seem to have become hubs of relative ‘advantage’. Findings therefore demand interrogation of whose interests these institutions serve, and of their part within the current English system.

Combining commercial assessment products with administrative data to shape education policy: Tracking pupil outcomes during the Covid-19 pandemic

Objectives To inform the government’s response to the COVID-19 pandemic by providing an ongoing analysis of the learning loss and recovery experienced by pupils in England after the cancellation of national statutory assessments. Our aim was to use data from a commercial assessment product linked to large administrative datasets.&#x0D; Methods We constructed a pupil level dataset of assessments in reading and mathematics. The assessments covered multiple time points in the pandemic period and in the years before. We matched this to the National Pupil Database to give a wide range of pupil characteristics information – including eligibility for free school meals, the area they lived in, and information about their school.&#x0D; By constructing a regression model of pupil outcomes in the pre-pandemic period, we produced a counterfactual of what we would have expected each pupil to achieve had the pandemic not occurred and hence estimate the extent of learning loss.&#x0D; Results National lockdowns and restrictions to in-person learning were associated with pupils in England making less progress than normal. By the summer of 2021, learning losses in reading amongst primary-aged pupils amounted to around 0.9 months of learning, and learning losses amongst secondary-aged pupils amounted to around 1.8 months. Learning losses in mathematics were even greater, at 2.8 months. We found that the pandemic’s effects were not felt evenly with larger losses for those from economically disadvantaged backgrounds and larger losses in parts of the north and midlands than in London and the south. Indeed, by the start of the 2021/22 academic year, results in reading for primary aged pupils in London and the south-west were broadly in line with pre-pandemic levels.&#x0D; Conclusion The project demonstrated the power of combining commercial products with administrative datasets to shape policy. The analysis informed the government’s education response to the pandemic including the targeting of additional support to pupils from low-income backgrounds who, as subsequent national tests have confirmed, were disproportionately affected by the pandemic.

Understanding the disparity of educational attainment in Northern Ireland: The role of socio-demographic and school-level factors on GCSE attainment.

ObjectivesThis study examined the individual and collective impacts of socio-demographics and school-level factors on GCSE outcomes in Northern Ireland, using linked administrative data. A pupil’s sex, religious affiliation and socio-economic background (measured by eight measures) were examined, along with parental socio-economic background, attended school type (grammar/non-grammar) and school management structure.&#x0D; MethodThis study used the first linked administrative dataset for education in Northern Ireland. The dataset linked the 2011 household Census, School Leavers Survey (2010-2014) and School Census (2010-2014) for the first time. Data were provided for three pupil cohorts who completed their GCSE examinations in consecutive academic years (2010/2011 – 2012/2013).&#x0D; The study conducted multilevel models to understand the nested effects of pupil-, household- and school-level factors on GCSE attainment outcomes. Interaction models were also executed to examine the multiplicative effects of a pupil’s sex, religious affiliation and socio-economic background on their educational attainment.&#x0D; ResultsThe findings of this study highlight that the impact of socio-economic status is multidimensional, with some measures having a greater impact on GCSE attainment than others. For example, a mother’s education qualifications had the largest impact of socio-economic measures included in the multilevel models. The analysis also found that Free School Meal Eligibility remains an important predictor of attainment outcomes. When considering pupils’ sex, females had higher GCSE attainment scores than males. However, religious affiliation had a varied influence on GCSE outcomes, indicating the need for a more nuanced approach when considering this factor. The importance of interaction terms to gain an in-depth understanding of the multiplicative effect of factors on attainment outcomes was also highlighted in the analysis.&#x0D; ConclusionThrough the use of linked administrative data, this study highlights the hierarchy of socio-economic effects on GCSE attainment outcomes in Northern Ireland. It also highlights the importance of collectively considering the factors that make up a pupil’s demographic profile to garner a holistic understanding of attainment trends in Northern Ireland.

Food insecurity, mental health and in-hospital mortality following the COVID-19 pandemic in a socially deprived UK coastal town

BackgroundPublic health interventions are essential to prevent a long tail of costly, avoidable and worsening ill health in coastal communities following the COVID-19 pandemic, yet no research exists to guide...

Many Mouths: The Politics of Food in Britain from the Workhouse to the Welfare State, by Nadja Durbach

Reviewed by: Many Mouths: The Politics of Food in Britain from the Workhouse to the Welfare State by Nadja Durbach Rebecca Earle (bio) Many Mouths: The Politics of Food in Britain from the Workhouse to the Welfare State, by Nadja Durbach; pp. xii + 363. Cambridge and New York: Cambridge University Press, 2020, £36.99, £30.00 ebook, $46.99, $38.00 ebook. Many Mouths: The Politics of Food in Britain from the Workhouse to the Welfare State explores a series of occasions when the modern British state undertook to feed “some members of its population (but not others) and what government food meant to those who devised, those who executed, those who used, and those who refused the state’s alimentary interventions” (17). These programs of state feeding were motivated by a range of concerns; discontent over the mounting cost of poor relief, desire to ensure the robustness of the labor supply, anxieties that hungry children would be unable to benefit from state education, and humanitarian responses to famine (among other factors) all shaped the diverse occasions on which the modern British state sought to provide food for sections of the population. Precisely because these programs responded to diverse situations, the responses were themselves inconsistent and incoherent, Durbach argues. History, she writes, reveals “no arc of progressive change” (245); she does not trace “a growing state interest in feeding its citizens” (5). Rather, her themes are the agency exercised by the recipients of state feeding, the important role of local authorities in implementing, and modifying, national initiatives, and the limited impact of nutritional science in shaping any of these policies. A particular strength is Durbach’s sustained attention to Britain’s status as an empire. State feeding initiatives demonstrate clearly the unequal levels of responsibility the government felt toward ensuring that different imperial subjects were not hungry. Many Mouths explores these themes through a series of case studies ranging from debates over the provision of Christmas meals in Victorian workhouses to the efforts of the Welfare Foods Service to supply orange juice to small children during and after the Second World War. Other chapters study, inter alia, the attempts to design standard dietaries for nineteenth-century prisons, the principles governing eligibility for free school meals in the interwar years, and the unexpected popularity of British restaurants. Weaving together these case studies are helpful historical synopses that provide a framework for understanding the specificities of each example. The book is based on extensive research in the United Kingdom’s National Archives and other repositories, a mass of printed primary sources, and much engagement with the [End Page 729] considerable scholarship on the evolution of the British diet, biopolitics, and other relevant topics. The result is a readable, compelling, and authoritative book that adds greatly to our understanding of the complexities shaping the alimentary interventions that Durbach studies. Her use of case studies is intended to underscore the contingency and variability of these interventions. Officials rarely learned from past experiences of state feeding, were inconsistent in their use of nutritional science, and responded more to the specifics of each situation than to broader comparisons with other state feeding programs. Consistency, indeed, was rarely the goal. To be sure, as Durbach concedes, there were some overarching trends; over the twentieth century the state began to accept some responsibility for supporting the wellbeing of all members of the nation, but Durbach’s focus is on the “messiness” of these processes (4). As much as she identifies change, she stresses unexpected continuities linking (for instance) Charles Trevelyan and the 1943 London Council of Social Service: both decried the provision of subsidized food to unde-serving eaters. What did it mean to receive food from the state? On occasion, it meant a recognition of the recipient’s membership in the body politic. When inhabitants of the work-house demanded the Christmas meal of roast beef, plum pudding, and beer abolished by the New Poor Law, they were affirming their rights as British citizens to participate in the cultural life of the nation. For this very reason, the guardians of some workhouses refused to comply with the prohibition, allowing inmates this customary “old English fare” on holidays...

Set up and assessment of progression criteria for internal pilots: the Brushing RemInder 4 Good oral HealTh (BRIGHT) trial example

BackgroundDental caries is common in young people and has wide-ranging ramifications for health and quality of life. Text messaging interventions show promise as a means to promote oral health behaviour change among young people. This paper reports the internal pilot of the Brushing RemInder 4 Good oral HealTh (BRIGHT) trial, which is evaluating an intervention comprising an oral health classroom lesson and text messages about toothbrushing, on caries in young people. Pilot trial objectives were to evaluate the feasibility and appropriateness of recruitment and data collection methods, the randomisation strategy, and intervention delivery against progression criteria for the main trial.MethodsThis is an internal pilot trial embedded within an assessor-blinded, two-arm, cluster randomised controlled trial. Participants were pupils aged 11–13 years (in year 7/S1 or year 8/S2) in secondary schools in England, Scotland, and Wales with above average pupil eligibility for free school meals. Following completion of pupil baseline questionnaires and dental assessments, year groups within schools were randomised to the intervention or control arm. Approximately 12 weeks later, participants completed a follow-up questionnaire, which included questions about sources of oral health advice to assess intervention contamination between year groups. At the end of the pilot phase, trial conduct was reviewed against pre-specified progression criteria.ResultsTen schools were recruited for the pilot, with 20 year groups and 1073 pupils randomised (average of 54 pupils per year group). Data collection methods and intervention delivery were considered feasible, the response rate to the follow-up questionnaire was over 80%, there was an indication of a positive effect on self-reported toothbrushing, and interest was obtained from 80% of the schools required for the main trial. Despite partial intervention contamination between year groups, within-school randomisation at the level of the year-group was considered appropriate for the main trial, and the sample size was revised to account for partial contamination. Facilitators and barriers to recruitment and data collection were identified and strategies refined for the main trial.ConclusionsProgression to the main trial of BRIGHT, with some design refinements, was concluded. The internal pilot was an efficient way to determine trial feasibility and optimise trial processes.Trial registrationISRCTN registry, ISRCTN12139369, registered 10/05/2017

Inequalities in Home Learning and Schools' Remote Teaching Provision during the COVID-19 School Closure in the UK.

Millions were affected by COVID-19 school closures, with parents and schools caught unprepared. Education is expected to play a role in creating equal opportunities, so transferring schooling responsibilities to families may have increased learning inequalities generated by family backgrounds. We examined the time students spent on home learning and explored the role of the schools' distance teaching provision in explaining differences traditionally attributed to parental education, eligibility for free school meals, ethnic background and single parenthood. Using the Understanding Society COVID-19 dataset, we found children who received free school meals, single-parent families and children with parents with lower formal education qualifications and Pakistani or Bangladeshi backgrounds spent significantly less time on schoolwork. However, schools' provision of offline and online distance teaching and homework checking significantly increased the time spent on learning and reduced some inequalities, demonstrating the policy relevance of digital preparedness to limit learning loss in school closures.

Autism incidence and spatial analysis in more than 7 million pupils in English schools: a retrospective, longitudinal, school registry study

Understanding how certain factors affect autism incidence can help to identify inequities in diagnostic access. We aimed to investigate the incidence of autism in England as a function of geography and sociodemographics, examining spatial distribution across health service boundaries. In this retrospective, longitudinal, school registry study, we sourced data for the years 2014-17 from the summer school census, which is a component of the National Pupil Database, a government registry of pupils under state education in England. Our main outcome was the incidence of autism in the English state-funded education system, defined by the amount of new autism-specific Education, Health and Care Plans or autism-specific special education needs and disability support recorded during each summer school census year since the 2014 baseline. After excluding prevalent cases in 2014, we calculated unadjusted incidence and age-adjusted, sex-adjusted incidence per 100 000 person-years per subsequent school year and by various sociodemographic categories and local authority districts. We report spatial effects using local indicators of spatial association. We used a three-level mixed-effects logistic regression model with two random intercepts (lower-layer super output area [a geographical area in England containing 1000-3000 residents] and pupil identifier) to calculate odds ratios (ORs) for autism incidence, adjusting for age, sex, ethnicity, claimed eligibility for free school meals, ethnic density quintile, Index of Multiple Deprivation quintile, first language spoken at home, and year, with our reference category being White girls without claimed eligibility for free school meals who speak English as their first language. Between 2014 and 2017, our total sample included 31 580 512 person-years and 102 338 newly diagnosed autistic pupils, corresponding to an unadjusted annual autism incidence of 429·1 cases per 100 000 person-years (95% CI 426·4-431·7) and an age-adjusted, sex-adjusted annual incidence of 426·9 cases per 100 000 person-years (423·5-430·4). The adjusted incidence of autism was slightly higher in 2014-15 than in 2015-16 or 2016-17, and, of the age groups, pupils aged 1-3 years, 4-6 years, and 10-12 years had the highest incidence of autism. Adjusted autism incidence in boys was 3·9-times the incidence in girls (668·6 cases per 100 000 person-years [95% CI 662·5-674·6] vs 173·2 cases per 100 000 person-years [170·1-176·3]). Across ethnic groups, adjusted incidence was highest in pupils who had an unclassified ethnicity (599·4 cases per 100 000 person-years [574·5-624·3]) or were Black (466·9 cases per 100 000 person-years [450·8-483·0]). However, in our fully adjusted mixed-effects logistic regression model, we observed lower odds of autism among Asian (OR 0·65 [0·59-0·71]), Black (0·84 [0·77-0·92]), and Chinese (0·62 [0·42-0·92]) girls compared with White girls when these groups had not claimed free school meals and spoke English as a first language. Boys from all ethnicities irrespective of first language spoken and free school meals status had increased odds of autism compared with White girls with no claimed eligibility for free school meals who spoke English as their first language. We also found that claimed free school meal eligibility, first language spoken, sex, and ethnicity differentially impacted the odds of autism. Our spatial analysis showed significant spatial autocorrelation across lower-layer super output areas in England, with 2338 hotspots (high-incidence areas surrounded by other high-incidence areas). The incidence of autism varies across sex, age, ethnicity, and geographical location. Environmental and social factors might interact with autism aetiology. Speaking a language other than English and economic hardship might increase access barriers to autism diagnostic services, autism-specific Education, Health and Care Plans, and school-level support. The Commonwealth Fund, the Institute for Data Valorization, the Fonds de recherche du Québec-Santé, Calcul Quebec, the Digital Research Alliance of Canada, the Wellcome Trust, the Innovative Medicines Initiative, the Autism Centre of Excellence, the Simons Foundation Autism Research Initiative, the Templeton World Charitable Fund, the Medical Research Council, the National Institute for Health and Care Research Cambridge Biomedical Research Centre, and the National Institute for Health and Care Research Applied Research Collaboration East of England-Population Evidence and Data Science.

A national data linkage study to determine the association of congenital anomalies with standardised education outcomes.

ObjectivesEducation outcomes predict life chances; however disabilities and concurrent learning difficulties are often barriers to school performance. Low educational achievement is also linked with socio-economic deprivation. We aimed to quantify the association of these factors with education outcomes by ages 12 and 17 for children in Wales (UK). ApproachWe linked health, socio-economic and education data for children born after 1997 in Wales, registered with any one of 17 isolated congenital anomalies. Children were included if they had known education outcomes at ages 12 (n=9,223) and 17 (n=4524). A reference population comprised children born similarly but without anomalies, also having education records at 12 (n=261,827) and 17 (n=4,524). Multinomial logistic regressions determined the likelihood of attainment in compulsory subjects by age 12 and of attaining five GCSE qualifications by age 17. We adjusted for socio-economic status by using free school meal eligibility (household deprivation) and area-based indices of deprivation. ResultsWe identified 14 and 11 isolated anomalies that reduced the likelihood of achieving educational standards by ages 12 and 17 respectively. Educational achievements were lower for children with Down syndrome, Turner syndrome, hydrocephalus and limb reduction defects, particularly at age 12, indicating that children with anomalies may catch-up with their peers. While children with anomalies were less likely to achieve five GCSEs by age 17, there was no difference in the grades of those who did so. Deprivation, particularly at household level, further reduced the likelihood of education success. At age 17, household deprivation reduced 3-fold the odds of achieving any five GCSEs grades A*-C. ConclusionsChildren with congenital anomalies from the most deprived communities and households are at particular risk of low education achievement. To realise their potential, these children should be identified from medical records at an early age and offered targeted educational support as soon as possible and at every opportunity.

Is household income a reliable measure when assessing educational outcomes? A Jigsaw of two datasets (Next Steps and National Pupil Database) for understanding indicators of disadvantage

ABSTRACT Robust indicators are important for identifying disadvantaged pupils in education, and for ensuring that they are rightly receiving relevant state-funded assistance. This paper compares the quality and completeness of data from England on student eligibility for free school meals (FSM) based on an administrative census, with more all-encompassing household income measures, from a smaller sample of young people. The first measure comes from the National Pupil Database (NPD), and the second from Next Steps (NS). The two datasets are linked at the individual student level. In this restricted group, FSM data is more complete (97%) than household income (47%). The bias created by missing data on income in NS calls into question its more general usefulness for analysts. FSM cannot be read neatly from income, such as referring to an income below a certain level, and vice versa. Many reportedly low-income children are not listed as FSM-eligible. However, the two values are linked, while each also provides unique information. Both measures predict attainment at school, to some extent. The paper concludes that FSM is the more practical measure at present, but also considers how access to limited income data could be made more widespread while maintaining individual data rights.

Predicting out-of-school suspensions among youth in care in England: A national cohort study

Previous research has indicated that youth in care are at a disproportionally high risk of being suspended from school. Yet, research on this topic is scarce despite the detrimental effects such disciplinary actions can have on the educational development of this vulnerable group. Therefore, the goal of this study was to explore a longitudinal path model of factors associated with the risk of being suspended from secondary school among a national cohort of 3699 children placed in care in England. Using data from the National Pupil Database and the Children Looked after Database, children were tracked from School Year 2 through School Year 9 in order to test the direct and mediated effects of individual factors (i.e., gender, eligibility for free school meals, special educational needs, and belonging to an ethnic minority background), care factors (i.e., age of entry into care, reason for out-of-home placement, placement type and length of time in care) and educational factors (i.e., school type, achievements, absences and suspensions in Year 6 and school type in Year 9) on the risk of suspension in Year 9. Results indicated that approximately 1 in 5 children in care in England (19.4%) are suspended at least once during their secondary School Year 9; these proportions markedly exceed those previously found among their general population peers. Children found to be most at risk for out-of-school suspensions were (a) males; (b) late entrants into care; (c) children who had behavioral, emotional, or social difficulties; and (d) children with a history of suspensions. Surprisingly, being eligible for free school meals and having lower academic achievement was related to a decreased risk of being suspended. These findings are discussed in consideration of the interrelationships among variables and the mediating pathways found. Implications for schools and educators catering for youth in care are also discussed.