Preschool Teacher Education and Child-Teacher ra-tio in Relation to Children's Health: A Large-Scale Study of Preschoolers in Stockholm Sweden

ObjectiveTo examine whether teacher education levels and child-teacher ratios are associated with childrens physical activity, psychosocial functioning, and BMI in a large, population-based sample of preschoolers in Stockholm, Sweden. Study designIn a cross-sectional study of 124 public preschools, we analyzed data from two measurement occasions (2020 and 2021) for 3,302 children with accelerometer data, 2,666 with Strengths and Difficulties Questionnaire (SDQ) scores, and 3,518 with measured BMI. Teacher education and child-teacher ratios were obtained from the Swedish National Agency for Education. Mixed-effects regression models accounted for clustering and adjusted for demographic and neighborhood characteristics. ResultsAcross preschools, an average of 31.8% of full-time teachers had a teaching degree, and the mean child-teacher ratio was 5.1 (SD 0.7). No strong associations were observed between teacher education levels or child-teacher ratios and childrens moderate-to-vigorous physical activity (MVPA), inactivity, SDQ, or BMI. Compared with the median, attending preschools with teacher education levels above the 75th percentile was associated with -0.22 minutes (95% CI: -0.84 to 0.40) of daily MVPA, and the 25th percentile with -0.04 minutes (95% CI: -0.77 to 0.69). Similarly, increasing the child-teacher ratio from 5.0 to 5.5 children per teacher corresponded to -0.45 minutes (95% CI: -1.17 to 0.28) of daily MVPA, with negligible differences in SDQ and BMI z-scores. ConclusionsIn this large, representative sample of Stockholm preschoolers, teacher education levels and child-teacher ratios were not associated with childrens physical activity, psychosocial functioning, or BMI, suggesting that factors beyond staffing characteristics may play a more central role in shaping childrens health in preschool settings.