Open Access Research article

School environment as predictor of teacher sick leave: data-linked prospective cohort study

Jenni Ervasti1*, Mika Kivimäki123, Ichiro Kawachi4, SV Subramanian4, Jaana Pentti1, Tuula Oksanen1, Riikka Puusniekka5, Tiina Pohjonen6, Jussi Vahtera178 and Marianna Virtanen1

Author Affiliations

1 Finnish Institute of Occupational Health, Centre of Expertise for Work Organizations, Topeliuksenkatu 41 a A, 00250, Helsinki, Finland

2 Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK

3 Department of Behavioral Sciences, PB 9, 00014 University of Helsinki, Helsinki, Finland

4 Harvard School of Public Health, Department of Society, Human Development and Health, 677 Huntington Avenue, Kresge Building 7th Floor, 716 Boston, Massachusetts, 2115-6096, USA

5 National Institute for Health and Welfare, PB 30, 00271, Helsinki, Finland

6 City of Helsinki, Occupational Health Centre, PB 5603, 00099, Helsinki, Finland

7 Department of Public Health, University of Turku, Lemminkäisenkatu 1, 20014, Turun yliopisto, Finland

8 Turku University Hospital, PB52, 20521, Turku, Finland

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BMC Public Health 2012, 12:770  doi:10.1186/1471-2458-12-770

Published: 11 September 2012



Poor indoor air quality (IAQ) and psychosocial problems are common in schools worldwide, yet longitudinal research on the issue is scarce. We examined whether the level of or a change in pupil-reported school environment (IAQ, school satisfaction, and bullying) predicts recorded sick leaves among teachers.


Changes in the school environment were assessed using pupil surveys at two time points (2001/02 and 2004/05) in 92 secondary schools in Finland. Variables indicating change were based on median values at baseline. We linked these data to individual-level records of teachers’ (n = 1678) sick leaves in 2001–02 and in 2004–05.


Multilevel multinomial logistic regression models adjusted for baseline sick leave and covariates showed a decreased risk for short-term (one to three days) sick leaves among teachers working in schools with good perceived IAQ at both times (OR = 0.6, 95% CI: 0.5-0.9), and for those with a positive change in IAQ (OR = 0.6, 95% CI: 0.4-0.9), compared to teachers in schools where IAQ was constantly poor. Negative changes in pupil school satisfaction (OR = 1.8, 95% CI: 1.1-2.8) and bullying (OR = 1.5, 95% CI: 1.0-2.3) increased the risk for short-term leaves among teachers when compared to teachers in schools where the level of satisfaction and bullying had remained stable. School environment factors were not associated with long-term sick leaves.


Good and improved IAQ are associated with decreased teacher absenteeism. While pupil-related psychosocial factors also contribute to sick leaves, no effect modification or mediation of psychosocial factors on the association between IAQ and sick leave was observed.

Bullying; Multilevel; Perceived indoor air; School satisfaction; Ventilation