Literature DB >> 28580673

Evaluation of Unintended Social and Economic Consequences of an Unplanned School Closure in Rural Illinois.

Victoria Tsai1, Nomana M Khan2, Jianrong Shi3, Jeanette Rainey4, Hongjiang Gao2, Yenlik Zheteyeva2.   

Abstract

BACKGROUND: School closure is one of the primary measures considered during severe influenza pandemics and other emergencies. However, prolonged school closures may cause unintended adverse consequences to schools, students, and their families. A better understanding of these consequences will inform prepandemic planning, and help public health and education authorities in making informed decisions when considering school closures.
METHODS: We conducted a household survey and interviewed school officials following an 8-day long closure of a school district in rural Illinois. We described household responses regarding difficulties of school closure, and summarized main themes from school official interviews.
RESULTS: A total of 208 (27%) household surveys were completed and returned. This school closure caused difficulties to 36 (17%) households; uncertain duration of closure, childcare arrangements, and lost pay were the most often reported difficulties. Having 1 adult in the household losing pay and household income below $25,000 were significantly associated with overall difficulty during this school closure. Concern about student health and safety was the most frequent theme in school administrator interviews.
CONCLUSIONS: Whereas the majority of responding households did not report difficulties during this school closure, households with 1 adult losing pay during the closure reported incurring additional expenses for childcare. Published 2017. This article is a U.S. Government work and is in the public domain in the USA. Journal of School Health published by Wiley Periodicals, Inc. on behalf of American School Health Association.

Entities:  

Keywords:  communicable diseases; disaster preparedness; pandemic planning; public health; school closures

Mesh:

Year:  2017        PMID: 28580673      PMCID: PMC5518179          DOI: 10.1111/josh.12525

Source DB:  PubMed          Journal:  J Sch Health        ISSN: 0022-4391            Impact factor:   2.118


The US Centers for Disease Control and Prevention (CDC) recommends early coordinated school closures during a severe influenza pandemic as an effective measure to reduce or delay the spread of infection in communities before an appropriate vaccine becomes available.1, 2 Unplanned school closures, especially those implemented for an extended period of time, can involve unintended social and economic adverse consequences for school administrators, students, and student families.3, 4, 5, 6, 7 These consequences can disproportionately affect vulnerable populations and raise ethical concerns over school closures.8 Beyond interruptions to education, school‐based services, such as school lunches subsidized through the National School Lunch Program, may also be affected by an unplanned school closure.9 A better understanding of challenges that student families face during school closures can help public health and education authorities inform planning and decision making for school closures during an influenza pandemic and other emergencies. Beardstown Community Unit School District #15 (BCUSD) in Cass County, Illinois, was closed for 8 days from April 25 to May 6, 2013, to prepare for potential flooding. We conducted a household assessment to evaluate the social and economic consequences of this unplanned closure on schools, students, and their families.

METHODS

Participants

Beardstown, in central Illinois, has approximately 6000 residents. The majority (61%) of the population is white non‐Hispanic, 33% are Hispanic, and 6% are black non‐Hispanic. The median household income is $35,469, and 26% of the population lives below the poverty level.10 A major employer in Beardstown is a large meatpacking plant, in which employees work in shifts (Personal communication with BCUSD superintendent). Twenty percent of Beardstown residents are immigrants from Latin America (89%), Africa (10%), and Europe (1%). Among the immigrant population, the primary languages spoken at home are Spanish and French.10 BCUSD is 1 of 3 school districts in Cass County and serves the population of Beardstown. During the 2012‐2013 school year, the district enrolled 1534 students in 4 schools: 149 students in the prekindergarten school, 644 students in 2 elementary (grades K‐5), and 741 students in the junior‐ and senior‐high school (grades 6‐12). About half (47%) of the students are white, 46% are Hispanic, 4% are black, and 3% are other races/ethnicities. The majority (72%) of students are eligible for the National School Lunch Program, which provides free or reduced‐price lunches.10

Instrumentation and Procedure

We conducted a household survey and school administrator interviews in May 2013, 2 weeks after the school closure. A standard questionnaire was used for collecting data on childcare options, interruption of parental employment and income, disruption of subsidized school lunch program, parental perception of difficulties, and communication of information about the school closure. To accommodate the non‐native English speakers, we translated the questionnaire into Spanish and French. All households having school‐aged children enrolled in BCUSD were eligible to participate in the survey. We requested that only 1 questionnaire be completed per household, regardless of the number of children. Survey packets included a cover letter, questionnaire, and prepaid envelope for returning completed surveys. The cover letter explained that respondents provide consent by completing and returning the questionnaire. At the elementary and junior‐ and senior‐high schools, teachers distributed packets to students before school was dismissed for the day. At the prekindergarten school, administrative staff distributed packets to parents and guardians during child pickup hours. All completed questionnaires were returned to investigators by mail. We used a semistructured interview form to obtain information on the perspectives of school administrators regarding the unplanned school closure. The interview consisted of open‐ended questions about communication of school closure information, difficulties faced by schools, and how school‐based services were handled during the school closure.

Data Analysis

We entered data from the household survey into a Microsoft Access database, and performed data management and analysis in SAS 9.3 (Cary, NC). We described demographic information of participating households, the types of difficulties caused by the school closure, and the communication channels used for announcing school closures through univariate analyses. We evaluated factors associated with reporting difficulties during the school closure, difficulties providing food after losing subsidized school lunches, and additional expenses incurred for childcare using univariate and multivariate logistic regression. Variables that were significant at alpha level of 0.10 in univariate analysis were included in multivariate logistic regression models. An alpha level of 0.05 was used to assess statistical significance in multivariate analysis. We recorded school administrator interviews in Microsoft Word and calculated the frequencies of responses by topic.

RESULTS

Household Survey

Of the 1534 surveys distributed to the estimated 775 households, 208 (27%) were completed and returned, representing 423 students. The majority of respondents (106 [51%]) were white non‐Hispanics, and 101 (49%) were high school graduates or had some college or technical school training. Annual household income was reported as below $25,000 by 51 (24%) of households. Seventy (34%) households had 2 children between the ages of 0 and 17, and most households, 144 (69%), had 2 adults. The English version of the survey was completed and returned by 131 (63%) of households, the Spanish version by 61 (29%), and the French version by 16 (8%) (Table 1).
Table 1

Demographic Characteristics of Participating Households. Unplanned School Closure Survey. Beardstown, Illinois – May 2013 (N = 208)

Characteristics of Respondents and HouseholdsN (%)
Race/ethnicity of primary responder
White, non‐Hispanic106 (51)
Black, non‐Hispanic20 (10)
Hispanic71 (34)
Other5 (2)
Missing/refused to answer6 (3)
Education of primary responder
Grades 1‐1146 (22)
High school graduate50 (24)
Some college or technical school training51 (25)
College graduate28 (13)
Graduate or professional school12 (6)
Other3 (1)
Missing/refused to answer18 (9)
Language
English131 (63)
Spanish61 (29)
French16 (8)
Household income
<$25,00051 (24)
$25,000‐$49,99966 (32)
≥$50,00058 (28)
Missing/refused to answer33 (16)
Child enrolled in the free and reduced school meal program?
Yes142 (68)
No53 (26)
Missing/refused to answer13 (6)
Number of children per household
173 (35)
270 (34)
≥361 (29)
Missing/refused to answer4 (2)
Number of adults per household
124 (11.5)
2144 (69)
≥339 (19)
Missing/refused to answer1 (0.5)
Demographic Characteristics of Participating Households. Unplanned School Closure Survey. Beardstown, Illinois – May 2013 (N = 208) The school closure caused difficulties for 36 (17%) of the responding households. The most frequently reported difficulties were related to uncertainty about the duration of closure (23 [11%]), alternative childcare arrangements (21 [10%]), and lost pay during the closure (11 [5%]) (Table 2). Childcare provided by a nonworking adult that lives in the home was the most frequent childcare option, reported by 77 (37%) households. For 41 (20%) households, the caregiver was an adult living in the home and working outside the home (Table 2). In single‐adult households, working adults missed work more frequently compared to 2‐adult households where 1 adult or both adults work (53% vs 33% vs 35%) (Table 2). Of the households where a working adult provided childcare, the majority (30 [75%]) were 2‐adult households; in most of these households (26 [87%]), both adults worked outside the home (data not shown). Eleven (5%) households responded that the schools provided recommendations for alternative childcare.
Table 2

Costs and Consequences of the Unplanned School Closure and Childcare Arrangements, Beardstown, Illinois—May 2013 (N = 208)

Household ResponsesN (%)
Did family experience difficulty during the school closure?
Yes36 (17)
No166 (80)
Missing/refused to answer6 (3)
What made the situation difficult?*
Didn't know how long school would be closed23 (11)
Difficult to make childcare arrangements21 (10)
Lost income due to missed work11 (5)
Expensive to make childcare arrangements9 (4)
Student missed school meals5 (2)
Other4 (2)
Did the school closure cause difficulty to provide food for the family because of the loss of meals provided by the free and reduced school meal program? (N = 142)
Yes21 (15)
No121 (85)
Who cared for child while schools closed?*
Adult who lives in home and doesn't work77 (37)
Adult who lives in home and works outside home41 (20)
Nobody, child old enough to care for him/herself32 (15)
Other adult30 (14)
Older sibling, 18 or younger14 (7)
Adult who lives in home and works from home11 (5)
Childcare program6 (3)
Child home without supervision3 (1)
Took child to work2 (1)
Other 25 (12)
School provided recommendations for alternative childcare arrangements
Yes11 (5)
No182 (88)
Missing/refused to answer15 (7)
Family incurred additional expenses for childcare arrangements
Yes44 (21)
No158 (76)
Missing/refused to answer6 (3)
Cost of additional expenses for childcare arrangements (N = 44) (median, range)$100 ($30‐1500)
Employment and income interruptions for selected family compositions
Single‐adult households, adult works outside the home (N = 17)
Adult missed work9 (53)
Adult lost pay5 (29)
Two‐adult households, only 1 adult works outside the home (N = 57)
Adult missed work19 (33)
Adult lost pay12 (21)
Two‐adult households, both adults work outside the home (N = 82)
At least 1 adult missed work29 (35)
At least 1 adult lost pay13 (16)

Categories are not mutually exclusive.

Category includes different combinations of childcare arrangements listed above.

Costs and Consequences of the Unplanned School Closure and Childcare Arrangements, Beardstown, Illinois—May 2013 (N = 208) Categories are not mutually exclusive. Category includes different combinations of childcare arrangements listed above. Household income below $25,000 (adjusted odds ratio [aOR] = 4.12, 95% CI 1.47‐11.55, p = .007) and having at least 1 adult in household losing pay during the closure (aOR = 3.61, 95% CI 0.92‐14.13, p = .065) were significantly associated with reported difficulty during this school closure (Table 3).
Table 3

Risk Factors Associated With Perceiving School Closures as Difficult, Beardstown, Illinois—May 2013

VariablesReported Experiencing Difficulty Related to School ClosureUnivariate AnalysisMultivariate Analysis
Yes (N = 36) N (%)No (N = 166) N (%)OR (95% CI)p‐Value* aOR (95% CI)p‐Value
Number of adults in household
≥2 Adults30 (85.7)148 (89.2)1.0 reference
1 Adult5 (14.3)18 (10.8)1.37 (0.47‐3.98).562
Number of children in household
1 Child13 (36.1)59 (36.0)1.0 reference
≥2 Children23 (63.9)105 (64.0)0.99 (0.47‐2.11).988
Household income
≥$25 k16 (55.2)106 (74.7)1.0 reference1.0 reference
<$25 k13 (44.8)36 (25.4)2.39 (1.05‐5.45).0384.12 (1.47‐11.55).007
Language of survey respondents
English22 (61.1)108 (65.1)1.0 reference
Non‐English14 (38.9)58 (34.9)1.19 (0.56‐2.49).654
Survey respondent race
White NH15 (46.9)90 (55.9)1.0 reference
Black NH & Hispanic17 (53.1)71 (44.1)1.44 (0.67‐3.07).351
At least 1 adult employed outside the home
No06 (3.7)1.0 reference
Yes34 (100.0)156 (96.3)NA.593
At least 1 adult missed work
No16 (48.5)100 (64.9)1.0 reference1.0 reference
Yes17 (51.5)3 (5.1)1.97 (0.92‐4.20).0800.63 (0.17‐2.38).494
At least 1 adult lost pay
No14 (53.9)85 (78.7)1.0 reference1.0 reference
Yes12 (46.2)23 (21.3)3.17 (1.29‐7.78).0123.61 (0.92‐14.13).065

OR: odds ratio; aOR: adjusted odds ratio; CI: confidence interval; NH: Non‐Hispanic; NA: Not applicable.

Wald chi‐square test.

Fisher's exact test.

Multivariate logistic regression (only variables significant at alpha = 0.1 in univariate analysis were included).

Risk Factors Associated With Perceiving School Closures as Difficult, Beardstown, Illinois—May 2013 OR: odds ratio; aOR: adjusted odds ratio; CI: confidence interval; NH: Non‐Hispanic; NA: Not applicable. Wald chi‐square test. Fisher's exact test. Multivariate logistic regression (only variables significant at alpha = 0.1 in univariate analysis were included). Of the 142 (68%) respondents with children enrolled in the National School Lunch Program, only 21 (15%) responded that they had difficulty providing food for their family as a result of losing access to the program while the schools were closed (Table 2). Although more than half (11 [52%]) of these families had 3 or more children, the number of children did not contribute to the difficulty compared with households that did not report difficulty providing food. (Table 4).
Table 4

Risk Factors Associated With Difficulty Providing Food Because of Interruption of Subsidized School Meals Service, Beardstown, Illinois—May 2013

VariablesReported Difficulty Providing Food to FamilyUnivariate AnalysisMultivariate Analysis
Yes (N = 21) N (%)No (N = 121) N (%)OR (95% CI)p‐Value* aOR (95% CI)p‐Value
Number of adults in household
≥2 Adults15 (71.4)107 (88.4)1.0 reference1.0 reference
1 Adult6 (28.6)14 (11.6)3.06 (1.02‐9.17).0461.90 (0.50‐7.20).345
Number of children in household
1 Child4 (19.1)40 (33.9)1.0 reference
≥2 Children17 (81.0)78 (66.1)2.18 (0.69‐6.91).186
Household income
≥$25 k10 (50.0)64 (64.0)1.0 reference
<$25 k10 (50.0)36 (36.0)1.78 (0.68‐4.68).244
Language of survey respondents
English12 (57.1)65 (53.7)1.0 reference
Non‐English9 (42.9)56 (46.3)0.87 (0.34‐2.22).771
Survey respondent race
White NH11 (52.4)46 (40.4)1.0 reference
Black NH & Hispanic10 (47.6)68 (59.7)0.62 (0.24‐1.57).308
At least 1 adult employed outside the home
No1 (5.3)6 (5.0)1.0 reference
Yes18 (94.7)114 (95.0)0.95 (0.11‐8.34)1.000
At least 1 adult missed work
No7 (36.8)77 (67.0)1.0 reference1.0 reference
Yes12 (63.2)38 (33.0)3.47 (1.27‐9.54).0161.11 (0.26‐4.75).890
At least 1 adult lost pay
No8 (53.3)60 (76.9)1.0 reference1.0 reference
Yes7 (46.7)18 (23.1)2.92 (0.93‐9.15).0662.61 (0.61‐11.27).198

OR: odds ratio; aOR: adjusted odds ratio; CI: confidence interval; NH: Non‐Hispanic.

Wald chi‐square test.

Fisher's exact test.

Multivariate logistic regression (only variables significant at alpha = 0.1 in univariate analysis were included).

Risk Factors Associated With Difficulty Providing Food Because of Interruption of Subsidized School Meals Service, Beardstown, Illinois—May 2013 OR: odds ratio; aOR: adjusted odds ratio; CI: confidence interval; NH: Non‐Hispanic. Wald chi‐square test. Fisher's exact test. Multivariate logistic regression (only variables significant at alpha = 0.1 in univariate analysis were included). Forty‐four (21%) households reported incurring additional expenses for childcare arrangements during the school closure, with a median cost of $100 (range: $30‐$1500). Households with at least 1 adult losing pay during the school closure were more likely to report incurring additional expenses during the school closure (aOR = 4.04, 95% CI 1.44‐11.37, p = .008) (Table 5). There was no significant difference in lost pay and missed work between different family compositions and employment status of the adults (data not shown).
Table 5

Risk Factors Associated With Incurring Additional Expenses, Beardstown, Illinois—May 2013

VariablesIncurred Additional ExpensesUnivariate AnalysisMultivariate Analysis
Yes (N = 44) N (%)No (N = 158) N (%)OR (95% CI)p‐Value* aOR (95% CI)p‐Value
Number of adults in household
≥2 Adults35 (81.4)142 (89.9)1.0 reference
1 Adult8 (18.6)16 (10.1)2.03 (0.80‐5.12).134
Number of children in household
1 Child11 (25.0)62 (39.7)1.0 reference1.0 reference
≥2 Children33 (75.0)94 (60.3)1.98 (0.93‐4.21).0762.16 (0.80‐5.81).127
Household income
≥$25 k24 (64.9)97 (72.4)1.0 reference
<$25 k13 (35.1)37 (27.6)1.42 (0.66‐3.08).374
Language of survey respondents
English27 (61.4)104 (65.8)1.0 reference
Non‐English17 (38.6)54 (34.2)1.21 (0.61‐2.42).584
Survey respondent race
White NH20 (48.8)86 (56.6)1.0 reference
Black NH & Hispanic21 (51.2)66 (43.4)1.37 (0.69‐2.73).374
At least 1 adult employed outside the home
No06 (3.9)1.0 reference
Yes41 (100.0)149 (96.1)NA.347
At least 1 adult missed work
No17 (40.5)100 (68.5)1.0 reference1.0 reference
Yes25 (59.5)46 (31.5)3.20 (1.58‐6.49).0011.79 (0.64‐5.02).271
At least 1 adult lost pay
No16 (47.1)84 (83.2)1.0 reference1.0 reference
Yes18 (52.9)17 (16.8)5.56 (2.37‐13.03)<.00014.04 (1.44‐11.37).008

OR: odds ratio; aOR: adjusted odds ratio; CI: confidence interval; NH: Non‐Hispanic; NA: Not applicable.

Wald chi‐square test.

Fisher's exact test.

Multivariate logistic regression (only variables significant at alpha = 0.1 in univariate analysis were included).

Risk Factors Associated With Incurring Additional Expenses, Beardstown, Illinois—May 2013 OR: odds ratio; aOR: adjusted odds ratio; CI: confidence interval; NH: Non‐Hispanic; NA: Not applicable. Wald chi‐square test. Fisher's exact test. Multivariate logistic regression (only variables significant at alpha = 0.1 in univariate analysis were included). For this school closure, 179 (86%) of households reported receiving information about the school closure through an automated phone call from the school (Figure 1). Automated phone call was also reported as a preferred way to be notified during future closings or emergencies by the majority, 163 (79%) of respondents (Figure 2).
Figure 1

Communication Methods During School Closure in Beardstown, Illinois—May 2013

Figure 2

Preferred Communication Methods for Future School Closings or Emergencies

Communication Methods During School Closure in Beardstown, Illinois—May 2013 Preferred Communication Methods for Future School Closings or Emergencies

School Administrator Interviews

We interviewed 7 school administrators, including 1 superintendent, 2 school principals, and 2 vice principals about the school closure experience. Initial reactions about the school closure included concern about student health and safety, as reported by 4 (57%) administrators, and concerns about evacuation and storage of valuable equipment, as reported by 3 (43%) administrators. All administrators mentioned the usefulness of the automated phone call system to contact parents and guardians during this school closure; 5 (71%) said families used social media and 2 (29%) posted information on official school websites. In terms of communication with parents, guardians, and staff, 3 (43%) administrators said things went smoothly during this closure and they would not do anything different in the event of a future emergency. Suggestions for what can be done differently next time included using social media and mass e‐mail to better communicate with parents prior to the closure regarding evacuation plans. When asked about the preplanning process to prepare for possibility of an unplanned school closure, 5 (71%) said there is a procedure in place for snow days and 3 (43%) mentioned a plan in place for weather‐related emergencies and hazardous spills. Other issues of concern included making up instructional time that was lost during the closure (mentioned by 3 [43%]), and the logistics of moving and reorganizing equipment to avoid potential water damage (mentioned by 2 [29%]).

DISCUSSION

We evaluated the unintended social and economic consequences of an 8‐day long unplanned school closure in Beardstown, Illinois. While the school closure did not cause difficulty for the majority of respondents and their families, uncertainty about duration of the school closure, difficulty making childcare arrangements, missed work, and lost pay were mentioned as some of the main challenges of this school closure. The overall difficulties were more pronounced among households with annual income under $25,000 and households with at least 1 adult losing pay during the closure. These findings are similar to previously described school closures implemented in other settings.3, 5, 11, 12 Although not a problem for the majority of households, some households reported difficulty providing food to their family members as a result of losing subsidized meals during the school closure, similar to previous surveys.12 We did not find a specific household characteristic that would be independently associated with difficulty providing food. For the majority of households, at least 1 adult was available or made arrangements to stay home with their children during the school closure. In more than one third of households, childcare was provided by a household adult not working, suggesting availability of a nonworking parent or an extended family member, similar to what was observed in southeastern Kentucky.13 Although for 1 of 5 families a working adult stayed home with children, it did not contribute to employment and income interruptions during this school closure. For longer school closures that may be implemented during influenza pandemics, however, this arrangement may prompt issues of job security. Of the families reporting difficulty during the closure, 10% specifically cited difficulties in making alternative childcare arrangements. In the CDC and Harvard survey, 20% of respondents reported missing work during H1N1 school closures.11 In a study by Johnson et al on school closures in North Carolina after an influenza B outbreak, 24% of employed adults reported missing more than 1 day of work.6 In Borse et al's study conducted in New York City during the 2009 H1N1 pandemic, at least 1 adult missed work in 17% of households during school closures.12 In our study, the proportion of households that missed work and lost pay is slightly higher than the findings from previous studies, especially among single‐adult households in which the adult works outside the home. However, the proportions of employed adults also varied from study to study and cannot be compared. Both household survey respondents and administrators reported that the automated phone calls were useful for communicating information during this school closure, highlighting the effectiveness and timeliness of this system. The majority of respondents noted that this phone call system is a preferred way to be contacted in case of future emergencies. A major strength of the automated phone call system in Beardstown is that the messages were recorded in English, French, and Spanish. This ensured that language was not a barrier when communicating school closure information in a timely manner.

Limitations

Our findings are subject to several limitations. Since the survey was distributed to all households in the school district and responses were voluntary, we cannot account for households that chose not to participate in the survey. However, the distribution of demographic characteristics of survey respondents compared to the Beardstown population is very similar in race and ethnicity, suggesting that the survey respondents may be representative of Beardstown population, and that the findings are generalizable to this community. Because the survey was distributed toward the end of the school year, it may have contributed to the lower response rate and small sample size; however, this response rate is comparable to that in similar surveys.11, 12 We were unable to assess whether the immigrant population was accurately represented in our sample, as some immigrants may have chosen to fill out the questionnaire in English. The percentage of households in our survey in which English is a second language was 37%, slightly higher than the general population of Beardstown, which suggests that this segment of the population was adequately represented in our study.

Conclusions

Our investigation showed that although the unplanned school closure did not cause difficulties for the majority of the survey respondents, the closure could be challenging for families with at least 1 adult losing pay during the closure and for low‐income families. Families where at least 1 adult loses pay may also be more likely to incur additional expenses for childcare. Parental job security should be discussed as a potential difficulty during school closures. Our study also highlighted the usefulness of an automated phone call system, potentially useful for school districts without an effective communication method in place.

IMPLICATIONS FOR SCHOOL HEALTH

To prepare for unforeseen school closings in the future, school contingency plans should account for the potential unintended consequences for student families. The findings of our survey suggest that although short‐term unplanned school closures do not cause major social and economic disruptions for students and their families, several factors should be considered while planning for emergency school closures. Making alternative childcare arrangements can be challenging for families, particularly among households in which all adults are employed outside of home. Specific recommendations for childcare options available in the area may help these families avoid employment and income interruptions. Arrangement of prepared or prepackaged meals for children enrolled in the National School Lunch Program may help families provide food to their children during school closures, which can be especially critical during prolonged closures. Timely conveyance of school closure information via automated calls can help families plan for school closure‐related contingencies and avoid unnecessary disruptions.

Human Subjects Approval Statement

The Institutional Review Board at the Illinois Department of Public Health (review number 0858) determined that this survey was exempt from full review.
  9 in total

1.  Parental attitudes and experiences during school dismissals related to 2009 influenza A (H1N1) --- United States, 2009.

Authors: 
Journal:  MMWR Morb Mortal Wkly Rep       Date:  2010-09-10       Impact factor: 17.586

2.  Mitigating pandemic influenza: the ethics of implementing a school closure policy.

Authors:  Benjamin E Berkman
Journal:  J Public Health Manag Pract       Date:  2008 Jul-Aug

3.  Social and economic impact of school closure resulting from pandemic influenza A/H1N1.

Authors:  Wan-Chin Chen; Angela S Huang; Jen-Hsiang Chuang; Chen-Chung Chiu; Hsu-Sung Kuo
Journal:  J Infect       Date:  2011-01-20       Impact factor: 6.072

4.  Closing schools in response to the 2009 pandemic influenza A H1N1 virus in New York City: economic impact on households.

Authors:  Rebekah H Borse; Casey Barton Behravesh; Tamara Dumanovsky; Jane R Zucker; David Swerdlow; Paul Edelson; Julia Choe-Castillo; Martin I Meltzer
Journal:  Clin Infect Dis       Date:  2011-01-01       Impact factor: 9.079

5.  Household responses to pandemic (H1N1) 2009-related school closures, Perth, Western Australia.

Authors:  Paul V Effler; Dale Carcione; Carolien Giele; Gary K Dowse; Leigh Goggin; Donna B Mak
Journal:  Emerg Infect Dis       Date:  2010-02       Impact factor: 6.883

6.  Impact of seasonal influenza-related school closures on families - Southeastern Kentucky, February 2008.

Authors: 
Journal:  MMWR Morb Mortal Wkly Rep       Date:  2009-12-25       Impact factor: 17.586

7.  Household effects of school closure during pandemic (H1N1) 2009, Pennsylvania, USA.

Authors:  Thomas L Gift; Rakhee S Palekar; Samir V Sodha; Charlotte K Kent; Ryan P Fagan; W Roodly Archer; Paul J Edelson; Tiffany Marchbanks; Achuyt Bhattarai; David Swerdlow; Stephen Ostroff; Martin I Meltzer
Journal:  Emerg Infect Dis       Date:  2010-08       Impact factor: 6.883

8.  Household responses to school closure resulting from outbreak of influenza B, North Carolina.

Authors:  April J Johnson; Zack S Moore; Paul J Edelson; Lynda Kinnane; Megan Davies; David K Shay; Amanda Balish; Meg McCarron; Lenee Blanton; Lyn Finelli; Francisco Averhoff; Joseph Bresee; Jeffrey Engel; Anthony Fiore
Journal:  Emerg Infect Dis       Date:  2008-07       Impact factor: 6.883

9.  Estimating the costs of school closure for mitigating an influenza pandemic.

Authors:  Md Z Sadique; Elisabeth J Adams; William J Edmunds
Journal:  BMC Public Health       Date:  2008-04-24       Impact factor: 3.295

  9 in total
  5 in total

1.  Assessment of US Public School District Policies for Pandemic Preparedness and Implications for COVID-19 Response Activities.

Authors:  Cassandra A Kersten; Allison T Chamberlain; Sherry Everett Jones; Amra Uzicanin; Faruque Ahmed
Journal:  Disaster Med Public Health Prep       Date:  2020-12-22       Impact factor: 1.385

2.  Simulating the effect of school closure during COVID-19 outbreaks in Ontario, Canada.

Authors:  Elaheh Abdollahi; Margaret Haworth-Brockman; Yoav Keynan; Joanne M Langley; Seyed M Moghadas
Journal:  BMC Med       Date:  2020-07-24       Impact factor: 8.775

Review 3.  COVID-19 and children's health in the United States: Consideration of physical and social environments during the pandemic.

Authors:  Jose R Suarez-Lopez; Maryann R Cairns; Kam Sripada; Lesliam Quiros-Alcala; Howard W Mielke; Brenda Eskenazi; Ruth A Etzel; Katarzyna Kordas
Journal:  Environ Res       Date:  2021-04-20       Impact factor: 8.431

4.  Causes, characteristics, and patterns of prolonged unplanned school closures prior to the COVID-19 pandemic-United States, 2011-2019.

Authors:  Ferdous A Jahan; Nicole Zviedrite; Hongjiang Gao; Faruque Ahmed; Amra Uzicanin
Journal:  PLoS One       Date:  2022-07-29       Impact factor: 3.752

Review 5.  The impact of unplanned school closure on children's social contact: rapid evidence review.

Authors:  Samantha K Brooks; Louise E Smith; Rebecca K Webster; Dale Weston; Lisa Woodland; Ian Hall; G James Rubin
Journal:  Euro Surveill       Date:  2020-04
  5 in total

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