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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\u2010sectional 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\u20137\u2009years old) elementary school students in Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Data were obtained from the Adachi Child Health Impact of Living Difficulty (A\u2010CHILD) study conducted in 2015, 2017, 2019 and 2021 in Adachi City, Tokyo, Japan (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200913\u2009258). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The prevalence of school refusal was 3.1% (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009416). We found a positive association between parental low education and school refusal after adjusting for covariates (OR\u2009=\u20091.40, 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\u2009=\u20091.45, 95% CI: 0.98, 2.13 and OR\u2009=\u20091.62, 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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\u2010economic status and should proactively reach out to these parents.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cch.70236","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T15:13:47Z","timestamp":1769786027000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Parental Low Education, Low Income, Deprivation and School Refusal Among Japanese Elementary School Students in First Grade: Results From A\u2010CHILD Study"],"prefix":"10.1111","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0920-8400","authenticated-orcid":false,"given":"Atsuna","family":"Tokumoto","sequence":"first","affiliation":[{"name":"Department of Public Health Institute of Science Tokyo  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6785-7867","authenticated-orcid":false,"given":"Nobutoshi","family":"Nawa","sequence":"additional","affiliation":[{"name":"Department of Global Environmental Health Institute of Science Tokyo  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aya","family":"Isumi","sequence":"additional","affiliation":[{"name":"Department of Health Policy Institute of Science Tokyo  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuhiko","family":"Anzai","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, M&amp;D Data Science Center Institute of Science Tokyo  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1074-3954","authenticated-orcid":false,"given":"Takeo","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Public Health Institute of Science Tokyo  Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10964\u2010020\u201001272\u20104"},{"key":"e_1_2_11_3_1","first-page":"11","article-title":"Introduction Factors Affecting Feelings of School Avoidance in Japanese High School Students: A Longitudinal Study of 10th to 12th Graders","volume":"16","author":"Aruga M.","year":"2020","journal-title":"School Health"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/19439342.2014.890362"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.2139\/ssrn.3037901"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10826\u2010015\u20100295\u20103"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.je.2016.09.004"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.psych.58.110405.085551"},{"key":"e_1_2_11_9_1","unstructured":"Darmody M. 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