ABSTRACT Background School refusal has negative consequences throughout life. While parental education and child poverty are closely linked to school refusal, the mechanism by which parental low education influences school refusal in offspring remains unclear. This cross‐sectional study examined the association between parental low education and several dimensions of child poverty (low income and deprivation) with school refusal among first grade (6–7 years old) elementary school students in Japan. Methods Data were obtained from the Adachi Child Health Impact of Living Difficulty (A‐CHILD) study conducted in 2015, 2017, 2019 and 2021 in Adachi City, Tokyo, Japan ( N = 13 258). Parental education was classified as none, one or both parents graduated from some college or more. Inability to afford essential items or service payments was used to measure deprivation. A multivariate logistic regression model was used for the analysis, adjusting for other sociodemographic characteristics. Results The prevalence of school refusal was 3.1% ( N = 416). We found a positive association between parental low education and school refusal after adjusting for covariates (OR = 1.40, 95% CI: 1.08, 1.82). The association was attenuated by further adjustment by low income and deprivation, which showed a higher risk of school refusal (OR = 1.45, 95% CI: 0.98, 2.13 and OR = 1.62, 95% CI: 1.25, 2.10, respectively). Low income and deprivation explained 9.2% and 39.4% of the association between parental low education and school refusal of the offspring, respectively. Conclusions Lower educational attainment of parents was a risk of school refusal from an early stage of mandatory education in Japan, which can be explained partially by low income and deprivation. Policymakers should be aware that school refusal from an early age is common in families with low socio‐economic status and should proactively reach out to these parents.
Tokumoto et al. (2026) studied this question.