{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:54:23Z","timestamp":1791262463652,"version":"4.1.0"},"reference-count":53,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"box\" position=\"anchor\">\n                        <jats:caption>\n                          <jats:title>Policy Points<\/jats:title>\n                        <\/jats:caption>\n                        <jats:p>\n                          <jats:list list-type=\"bullet\">\n                            <jats:list-item>\n                              <jats:p>Chronic absence should be recognized as a public health indicator and early warning sign that systems are failing to meet the developmental, social, and health needs of students.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>Improving student attendance requires cross\u2010sector policy action across education, health, and public health to address the structural and social determinants of chronic absence.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>A prevention\u2010oriented public health approach is essential, focusing on root causes that schools cannot address alone such as poor health, housing instability, and unreliable transportation.<\/jats:p>\n                            <\/jats:list-item>\n                          <\/jats:list>\n                        <\/jats:p>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>Chronic absence, defined as missing more than 10% of time in school, has risen sharply in the United States following the COVID\u201019 pandemic and now affects more than one in four students. It reflects unmet health and social needs and is patterned by deep structural inequalities. Both short\u2010 and long\u2010term consequences include adverse impacts on educational attainment, health, and social outcomes. Despite this, chronic absence remains largely framed and addressed as an education\u2010sector problem, limiting the scope and effectiveness of current responses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This perspective synthesizes interdisciplinary evidence from education, public health, and child development literature, drawing on ecological and life course frameworks to reconceptualize chronic absence as a public health issue. We develop a conceptual model integrating multilevel determinants of attendance across individual, family, school, community, and structural domains, and identify implications for policy and cross\u2010sector action.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Viewing chronic absence through a public health lens reframes it from a purely educational outcome to a signal of unmet need and a multidimensional indicator of system performance. Attendance patterns reflect the interaction of health, social, and structural factors that lie largely outside of the control of schools. Current approaches often emphasize individual responsibility, while overlooking the broader conditions that shape attendance. Reframing chronic absence in this way underscores the need for coordinated cross\u2010sector interventions that address underlying determinants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Positioning chronic absence as a public health priority enables a more coherent response. We propose three principles to guide action: (1) use school attendance data as a vital sign of student and system well\u2010being; (2) develop strategic partnerships to align goals and drive progress; and (3) develop strengths\u2010based policies and programs to prevent chronic absence. Without this shift, efforts to reduce chronic absence are likely to remain fragmented and insufficient to achieve equitable improvements in child health and educational outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1468-0009.70102","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T03:10:07Z","timestamp":1782184207000},"page":"635-653","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Chronic Absence as a Public Health Priority: A Framework for Coordinated Action"],"prefix":"10.1111","volume":"104","author":[{"given":"CATHERINE","family":"FALCONER","sequence":"first","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health"},{"name":"UK Health Security Agency"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MICHELLE","family":"SHANKAR","sequence":"additional","affiliation":[{"name":"Children's Hospital at Montefiore Einstein, Albert Einstein College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"BETH D.","family":"MARSHALL","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SARA B.","family":"JOHNSON","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health"},{"name":"Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MEGAN M.","family":"TSCHUDY","sequence":"additional","affiliation":[{"name":"Johns Hopkins University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ELLIOTT","family":"ATTISHA","sequence":"additional","affiliation":[{"name":"Attendance Works"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JOSH","family":"SHARFSTEIN","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"ChangH BalfanzR ByrnesV.Continued high levels of chronic absence with some improvements require action.Attendance Works Blog. 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