Anomaly in the gradient: Health of U.S. adults with subbaccalaureate education.

 亚学士教育程度-那些上过大学但没有获得学士学位的人-占25岁及以上美国成年人的28%，或美国约5400万人令人惊讶的是，对这一主要人群的成年人的健康知之甚少。PI和合作者最近的一项研究发现了健康教育梯度中的一个惊人的异常现象：在中学以下水平的成年人（特别是大学辍学者，但也有一些副学士学位的获得者）报告了比从未上过大学的高中毕业生更多的健康问题。梯度描述了教育与健康之间单调的正相关关系，人们认为它在人口、健康成果和所有成就水平上都是普遍存在的。梯度不适用于28%的人口，这一事实可能为教育程度与健康之间的关系机制提供重要线索。PI研究议程的长期目标是了解教育和健康是如何以及为什么联系在一起的。该项目的目标是比较亚学士组的健康状况与从未上过大学和大学毕业生的高中（HS）毕业生的健康状况，使用三个具有全国代表性的大型数据来源（1997-2013年全国健康访谈调查，1999-2012年全国健康和营养检查调查和1979年全国青年纵向调查）。在目标1中，我们将详细描述多个健康维度、主要人群以及年龄、时期和出生队列的健康模式。在目标2中，我们将探讨特定的中介和混杂机制-就业，经济环境，健康行为，儿童社会条件，认知/非认知技能和早期健康-如何解释在三个教育群体中观察到的健康模式。这项研究是有意义的，因为：（1）低于预期的健康在大型亚学士学位组必须在卫生保健政策和规划解决。(2)解释亚学士级别的异常模式可以激发新的理论来理解学校教育与总体健康之间的关系。这项研究是创新的，因为它试图通过关注梯度模式中的异常来挑战目前关于健康的教育决定因素的研究。该项目完成后，我们将首次对大学辍学生的健康状况进行系统评估， 本研究旨在探讨副学士学位获得者的健康状况，并探讨为什么他们额外的教育并没有转化为相对于HS毕业生的健康优势。因此，我们建议回答一个重要的，最近认识到的问题，相对较差的健康状况在大型subbaccalaureate组，一个问题高度相关的NIH的资金优先事项，美国的健康和教育政策，以及美国人口的健康使用方法论和实质性的创新观点。

 DESCRIPTION (provided by applicant): The subbaccalaureate educational attainment level --those who attended college but did not earn a bachelor's degree-- comprises 28% of American adults age 25 and older, or about 54 million people in the U.S. Surprisingly little is known about the health of adults in this major population group. A recent study by the PI and collaborators found a startling anomaly in the education gradient in health: adults at the subbaccalaureate level (especially college dropouts but also some recipients of associate's degrees) reported more health problems than high school graduates who never attended college. The gradient, which describes the monotonic positive association between schooling and health, has been understood to be universal across populations, health outcomes, and all levels of attainment. The fact that the gradient does not hold for 28% of the population may provide important clues about the mechanisms of the relationship between educational attainment and health. The long-term goal of the PI's research agenda is to understand how and why education and health are linked. The goal of this project is to compare the health of the subbaccalaureate group versus that of high school (HS) graduates who never attended college and college graduates, using three large, nationally-representative sources of data (the National Health Interview Survey 1997-2013, the National Health and Nutrition Examination Survey 1999-2012, and the National Longitudinal Survey of Youth 1979). In Aim 1, we will provide a detailed picture of the health patterns across multiple health dimensions, across major population groups, and across age, period, and birth cohorts. In Aim 2, we will explore how specific mediating and confounding mechanisms-employment, economic circumstances, health behaviors, childhood social conditions, cognitive/non- cognitive skills, and early health-explain the observed health patterns across the three education groups. This research is significant because: (1) Poorer-than-expected health in the large subbaccalaureate group must be addressed in health care policy and planning. (2) Explaining the anomalous patterns at the subbacca- laureate level can spur new theories to understand the relationship between schooling and health in general. This research is innovative because it seeks to challenge current research on the educational determinants of health by focusing on an anomaly in the gradient pattern. At the completion of this project, we will provide the first systematic assessment of the health of college dropouts and recipients of associate's degrees, as well as explore reasons why their additional schooling does not translate into a health advantage relative to HS graduates. We are thus proposing to answer an important, recently recognized issue of relatively poor health in the large subbaccalaureate group-an issue highly pertinent to NIH funding priorities, the U.S. health and educational policies, and the health of the American population-using methodologically and substantively innovative perspectives.