ORIGINAL ARTICLE Preschool children’s sickness absenteeism from Norwegian regular and outdoor day care centres: A comparative study KARI H. MOEN 1 , HJØRDIS K. BAKKE 1 , ØYVIND BAKKE 2 & EGIL A. FORS 3 1 Queen Maud’s College of Early Childhood Education, Trondheim, Norway, 2 Norwegian University of Science and Technology, Department of Mathematical Sciences, Trondheim, Norway, and 3 Norwegian University of Science and Technology, Department of Neuroscience, Pain Centre, St Olavs Hospital, Trondheim, Norway Abstract Aims: To examine whether there are any differences in sickness absenteeism between children in outdoor day care centres and regular day care centres and also to investigate whether other variables predict sickness absenteeism. Methods: Data on sickness absence during a 4-week period together with several explanatory variables of 531 children in 32 regular and 37 outdoor day care centres were collected and included in the analysis. The data were analysed by generalized linear modelling. Results: The overall frequency of sickness absence was 5.1%. There was no general significant difference between sickness absenteeism in regular and outdoor day care centres. Of the other possible explanatory variables only two were found to contribute significantly: age, with a negative relationship, and the interaction effect of a child with a chronic disease or disability going to an outdoor day care centre, with a positive relationship. Conclusions: The present study indicates that sickness absenteeism of a child without a chronic disease or disability is not affected by whether the child attends a regular or an outdoor day care centre. There seem to be no health benefits for children with chronic diseases or disabilities to attend outdoor day care centres – there is in fact evidence that sickness absence for those children is higher in outdoor centres. Key Words: Children, comparative survey, day care centres, outdoor, preschool, sickness absenteeism Background In Europe, and especially in the Scandinavian countries, the proportion of children who attend day care centres (DCCs) is increasing [1]. In 2004 there were 6,035 DCCs in Norway, and 72% of Norwegian children aged 1–5 years attended one. In 2005 there were 6,300 DCCs and 76.2% of children aged 1–5 and 90.8% of children aged 3–5 attended one [2,3]. It is unclear how this increase influences the children’s general health. Rasmussen et al. [4] reported that the rate of absenteeism decreased in the 1977–90 period for all ages. However, other studies have indicated that children attending DCCs are more prone to infections [5–7]. We must consider that the term ‘‘sickness absentee- ism’’ is a construct [8]. Thus sickness absenteeism in DCCs depends on parents’ and DCC employees’ subjective attitudes and beliefs concerning children and health, and rules for sickness absenteeism in the DCCs, in addition to more or less objective medical, paediatric findings [9]. It is unclear to what extent the time preschool children spend outdoors impacts on their health and sickness absenteeism in DCCs [10,11]. Environ- mental factors probably influence the children’s vulnerability to infectious agents and thus morbidity [12]. The literature indicates that the main reasons for day care absenteeism are upper respiratory tract infections (76% of cases) and other infections (18%), whereas disabilities, injuries and chronic diseases play minor roles [13–16], e.g. surgical operations count for 1.8% and injuries 0.8% [17]. There have been some cues regarding risk factors, e.g. lower age (except age below 1) [4], long total attending periods [18], winter season with low Correspondence: Kari H. Moen, Queen Maud’s College, Thonning Owesens gate 18, NO-7044 Trondheim, Norway. E-mail: khm@dmmh.no (Accepted 8 February 2007) Scandinavian Journal of Public Health, 2007; 35: 490–496 ISSN 1403-4948 print/ISSN 1651-1905 online/07/050490-7 # 2007 Taylor & Francis DOI: 10.1080/14034940701271916