- National linked records show 14.7% of 11 to 15 year olds resided with an adult with substance misuse contact between 2017 and 2019.
- Children living with adults having both health and justice substance contacts had 2.81% lower attendance and markedly higher exclusion odds (OR 6.67).
- Deprivation independently worsened outcomes and magnified household adversity effects; integrated data sharing and cross-sector support are required for early identification.
J Epidemiol Community Health. 2026 Aug 11:jech-2026-226006. doi: 10.1136/jech-2026-226006. Online ahead of print.
ABSTRACT
BACKGROUND: Children in households affected by adult substance misuse face intersecting educational risks. While associations between household adversity and school disengagement are documented, research often relies on siloed or self-report data. This study used national linked data to estimate associations with children’s school attendance and exclusion, using adult health and justice contacts as administrative proxies for substance misuse exposure during household cohabitation.
METHODS: This retrospective cohort study used the Secure Anonymised Information Linkage (SAIL) Databank in Wales. Children aged 11-15 were followed across academic years between 2017 and 2019. Exposure was defined as residing with an adult having either a substance misuse health contact, a justice contact or both health and justice contacts. Outcomes were attendance rate and ever being excluded from school. Multilevel models adjusted for child mental health, special educational needs, adverse childhood experiences and deprivation.
RESULTS: Among 180 388 children, 14.7% were exposed to household substance misuse. Risks peaked in the combined health and justice group, showing significantly lower attendance (2.81% reduction, CI 2.97 to 2.64) and the highest exclusion odds (OR 6.67, CI 4.01 to 11.08) versus unexposed peers. Deprivation independently predicted poorer outcomes and amplified the negative effects of household adversity.
INTERPRETATION: Household substance misuse, particularly involving the justice system, is associated with extreme education disruption vulnerability. These risks remain largely invisible in educational records. Policy must prioritise integrated data sharing to improve early identification and cross-sectoral support. Current siloed approaches are insufficient to break the link between household adversity and educational disengagement.
PMID:42580883 | DOI:10.1136/jech-2026-226006
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