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Objectives This article investigates sickness presence among secondary school students in 5 European countries. The research questions asked are: What characterizes students with high sickness presence in secondary schools? Does high sickness presence influence future sickness absence? Material and Methods A group of 7008 students aged 16–19 years participated in the first study (2016), and 5002 of them also participated in the follow-up study (2017). The participants came from 25 schools in Belgium, Estonia, Finland, Italy and Latvia. The response rate was high. A multivariate binomial logistic regression analysis was used. Results In 2016 high sickness presence (≥ 5 incidents) was reported by 16% of the students, and in 2017 by 15% of them. In 2016 there were significant differences between countries, and students from Latvia were most likely to report high sickness presence (adjusted odds ratio [aOR] = 3.45). Students with high absence (aOR = 1.86) and high school motivation (aOR = 1.16, for 1 pt increase on a 5-point scale) were overrepresented among those reporting high sickness presence. Country, absence and motivation were also significant factors for sickness presence in 2017. Furthermore, there was a significant positive association between high sickness presence and high sickness absence the following year. Conclusions Country, absence, and motivation were important factors for high sickness presence in secondary schools. Engaging in high sickness presence seemed to influence future sickness absence. Int J Occup Med Environ Health. 2019;32(6):797–804
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