Invited commentary: Attendance and absence as markers of health status--the example of active and passive cigarette smoking.

Absence from work and school is an important social issue. Four percent of workers in the United States were absent during an average workweek in 2001 (1). Absences from work can lead to lost productivity and can influence the likelihood that a person keeps a job (2). Among the more than 50 million children aged 5–17 years in the United States in 1998, 18 percent missed 6 or more days of school because of illness or injury (3). Absence from school can adversely affect school achievement (4, 5) and hence educational aspirations and eventual educational attainment (6, 7). Attendance patterns result from a complex array of factors, including health status as a major contributor, and are thus potential markers of health status (8). In families with children, a close interrelation exists between parent and child attendance. Child health can affect parental work attendance, and the health of other family members can affect a child’s school attendance. The younger the child, the more likely a school absence will directly impact parental work attendance because younger children require full supervision, even if home because of minor illnesses.