On April 26, 2025, Dr. Sarah Ronis, a Clinical & Translational Science (CTS) Research Program awardee and recent Co-Investigator on a 2024 Annual Pilot award with the Clinical and Translational Science Collaborative (CTSC) of Northern Ohio, shared important new research at the Pediatric Academic Societies (PAS) Annual Meeting held in Honolulu, Hawaii. At this national conference, Dr. Ronis and her team presented a poster titled “Factors Associated with Chronic School Absenteeism Among Medicaid-Insured Children with Asthma,” highlighting early results from a comprehensive study of children in Northeast Ohio.
Asthma is a leading health concern for children in Cuyahoga County, which is part of the so-called “Ohio-Lake Erie Asthma Belt.” Children in this region experience higher rates of emergency department visits and hospital admissions for asthma than the state average. Chronic school absenteeism—defined as missing 10% or more of school days—is recognized as a marker of poor asthma control and is associated with negative academic, developmental, and health outcomes. The study aimed to identify the factors that contribute to chronic absenteeism among Medicaid-insured children with asthma, to inform strategies to improve school attendance and health.
The research team conducted a retrospective analysis of multi-sector administrative data from July 2018 through June 2022, focusing on children aged 6–12 who had encounters with University Hospitals, lived in Cuyahoga County, and were enrolled in Medicaid. Data were drawn from a variety of sources, including birth and school records, housing and juvenile justice data, Medicaid claims, and school attendance records. This approach allowed the researchers to examine both individual and community factors associated with absenteeism.
View Dr. Sarah Ronis' full poster
Early findings presented at the PAS meeting revealed that Medicaid-insured children with asthma who received care at University Hospitals had very high rates of chronic absenteeism. More than two-thirds of these children missed at least 10% of school days in at least one academic year. The risk of absenteeism was even higher for children who had both asthma and behavioral health diagnoses. The study identified several significant predictors of persistent absenteeism: tobacco exposure and behavioral health issues substantially increased the risk, while higher maternal education and residence in more advantaged neighborhoods were associated with lower absenteeism. Additionally, better adherence to asthma medication (measured by an asthma medication ratio above 50%) was linked to reduced absenteeism, although this finding approached but did not reach statistical significance.
These results suggest that improving school attendance among children with asthma requires more than just asthma management. Addressing behavioral health needs, supporting families, and connecting children to community resources are all important strategies. The research highlights opportunities for health systems to intervene by promoting medication adherence, screening for behavioral health concerns, and facilitating access to supportive services.
Moving forward, the research team plans to conduct interviews with parents, educators, and healthcare professionals to explore the reasons for absenteeism further and to develop group models that can guide future interventions. This work exemplifies the CTSC’s mission to support innovative, community-engaged research that addresses pressing health challenges in Northern Ohio.
Author: Richard Badger - Assistant Director of Research Content and Production - CTSC of Northern Ohio
