Pathways Linking Education/Health in Middle Adulthood

描述(由申请人提供)：关于教育和健康之间的联系的研究一直未能逃脱批评，即教育以外的因素应为这种反复观察到的、但可能是虚假的联系负责。如果教育和健康之间的联系是因果的，那么教育影响健康的途径仍有待充分阐明。这项申请寻求1)获得教育对多种成人健康结果的影响的估计，独立于教育和后来的成人健康的几个决定因素，以及2)评估几个假设的潜在途径的贡献，以说明教育和健康之间的联系。这项建议是由来自发展和社会流行病学、医学、健康教育和扫盲、经济学、心理学和生物统计学的研究人员提交的，并基于对国家合作围产期项目新英格兰队列的成人跟踪研究。第一个目标是对最近从2000名受试者的家庭研究中获得的数据进行分析，这些受试者从出生到40岁；这些分析将包括 对成人健康状况的详细测量，对1959年至1976年间收集的社会、家庭和个人教育决定因素的预期测量，以及考虑潜在的未测量的家庭变量的兄弟姐妹设计。在这些分析中，我们将确定教育对以下健康结果的“调整”影响：癌症、心血管疾病、哮喘和糖尿病的诊断；自我评估的健康；以及行为风险因素，包括当前和终身烟草使用和药物滥用指标。我们还将测试心理过程(抑郁、焦虑、感知到的社会地位和感知到的压力)在教育和健康之间的联系中起中介作用的假设。这项研究的第二个和第三个目标涉及从这2000名受试者中的800人收集新的数据。目的二重点阐明教育对心血管疾病和糖尿病生物前兆的因果效应。第三个目标将是调查教育在通过提高实用识字技能改善健康方面的作用。这项研究的前瞻性，对父母和儿童变量的全面评估，以及对因果关系和潜在机制的假设驱动的测试，使该项目特别适合于评估教育和改善的健康结果之间的联系。

DESCRIPTION (provided by applicant): Research on the association between education and health has not been able to escape the criticism that factors other than education are responsible for this repeatedly observed, but potentially spurious, association. If the association between education and health is causal, the pathways through which education impact health remain to be fully elucidated. This application seeks to 1) obtain an estimate of the effect of education on multiple adult health outcomes independent of several determinants of both schooling and later adult health, and 2) evaluate the contribution of several potential pathways hypothesized to account for the association between education and health. This proposal is submitted by investigators from developmental and social epidemiology, medicine, health education and literacy, economics, psychology and biostatistics, and is based on adult follow-up studies of the New England cohorts of the National Collaborative Perinatal Project. The first aim is to conduct analyses of data recently obtained from a family study of 2,000 subjects who have been followed from birth through age 40; these analyses will incorporate a detailed measure of adult health status, prospective measures of social, familial, and individual determinants of education that were collected between 1959 and 1976, and a sibling design to account for potential unmeasured familial variables. In these analyses we will determine the 'adjusted' effects of education on the following health outcomes: diagnoses of cancer, cardiovascular disease, asthma and diabetes; self-rated health; and behavioral risk factors including current and lifetime indicators of tobacco use and substance abuse. We will also test the hypothesis that psychological processes (depression, anxiety, perceived social status, and perceived stress) mediate the association between education and health. The second and third aims of this study involve new data collection from 800 of these 2,000 subjects. Aim two focuses on elucidating the causal effects of education on biological precursors of cardiovascular disease and diabetes. The third aim will be to investigate the role of education in improving health through enhancement of functional literacy skills. The prospective nature of this study, the comprehensive assessment of parental and childhood variables, and the hypothesis-driven tests of causation and potential mechanisms make this project uniquely suited to evaluate the link between education and improved health outcomes.