A natural experimental study of the impact of education on physiologic health, stress, and resilience and the role of socioemotional factors.

摘要 教育通过改善获得社会经济资源和高质量护理(SES)来影响健康 机制)和提高识字和算术能力，这有助于自我护理和导航医疗保健 系统(认知机制)。但教育不仅仅涉及知识或认知的获得。 技能。教育包括在学校环境中的经历，由老师、同龄人、 以及学校的“文化”。也被称为学校氛围，这些特征塑造了社会情感 影响复原力和健康轨迹的因素(复原力机制)。 几乎所有先前关于教育和健康的研究都依赖于观察法。2013年，我们开始了 通过社会和教育变革减少不平等--自然实验后续研究(RISE UP) 利用几所表现优异的公立特许高中的招生抽签来确定可比的 一组青少年被“随机”分到成绩好和成绩差的学校。我们在高中招收学生 入学，并继续跟踪目前(现为22岁)这一群体的平均年保留率 96%。我们发现学校对自我报告的健康和健康行为的影响是立竿见影的， 充实，并在青春期后持续存在。到21岁时，那些参加过高水平表演的人 学校的酒精使用障碍发生率降低了50%，报告身体健康状况良好或较差的比例减少了40%， 肥胖/超重减少33%。然而，在身体健康和肥胖方面的改善只是 在男性中。在女性中，上高分学校与较低的饮酒率有关 使用障碍，但实质上更糟糕的身体健康和肥胖。令人惊讶的是，中级学术 结果(高中毕业、平均成绩、考试成绩和大学入学)不能解释 高水平学校对物质使用或身体健康结果的影响。 了解教育如何影响健康将为未来的干预措施和学校的发展提供信息 让学校对所有学生“更健康”的政策。此外，到目前为止，我们的结果是基于自我报告。 因此，我们建议从23-28岁开始跟踪这一上升队列，以更好地了解学校如何影响 生理健康可能是通过改变社会情感因素和韧性来实现的。我们将测量血液 测定血压和体重指数，取血样测定糖化血红蛋白和C反应蛋白。 我们将研究表观遗传老化(DNA甲基化)、慢性应激(头发皮质醇)和生理弹性。 使用保守的逆境转录反应(CTRA)。CTRA是一种基因表达谱 由交感神经系统发出的战斗或逃跑信号激活，与更大的炎症有关 和较低的I型干扰素先天抗病毒反应。此外，我们将探索性别差异在 教育与生理健康、压力和韧性之间的关系。

ABSTRACT Education impacts health by improving access to socioeconomic resources and high-quality care (SES mechanism) and by improving literacy and numeracy, which aids in self-care and navigating the healthcare system (cognitive mechanism). But education does not just involve the acquisition of knowledge or cognitive skills. Education encompasses the experiences of being in a school environment, shaped by teachers, peers, and the “culture” of the school. Also referred to as school climate, these characteristics shape socioemotional factors that influence resilience and one's health trajectory (resilience mechanism). Almost all prior studies of education and health have relied on observational methods. In 2013, we began the Reducing Inequities through Social and Educational Change Follow-up (RISE Up) Study, a natural experiment using the admissions lottery of several high-performing public charter high schools to identify comparable groups of adolescents “randomized” into high- and lower-performing schools. We recruited students upon high school entrance and continue to follow this cohort currently (now age 22) with average annual retention rates of 96%. We found the impact of schools on self-reported health and health behaviors was immediate, substantial, and persistent beyond adolescence. By age 21, those who had attended a high-performing high school had a 50% lower rate of alcohol use disorder, 40% reduction in reporting fair or poor physical health, and 33% reduction in obesity/overweight. However, the improvements in physical health and obesity were only among males. Among females, attending a high-performing schools was associated with lower rates of alcohol use disorder, but substantially worse physical health and obesity. Surprisingly, intermediate academic outcomes (high school graduation, grade point average, test scores, and college matriculation) did not explain the impact of high-performing schools on substance use or physical health outcomes. Understanding how education influences health will inform the development of future interventions and school policies to make schools “healthier” for all students. Furthermore, our results to date are based on self-report. Thus, we proposed to follow the RISE Up cohort from age 23-28 to better understand how schools impact physiologic health perhaps through changes in socioemotional factors and resilience. We will measure blood pressure and body mass index and obtain blood samples to measure glycohemoglobin and C-reactive protein. We will examine epigenetic aging (DNA methylation), chronic stress (hair cortisol), and physiologic resilience using the Conserved Transcriptional Response to Adversity (CTRA). CTRA is a gene expression profile activated by fight-or-flight signaling from the sympathetic nervous system and related to greater inflammation and lower Type I interferon innate antiviral responses. Furthermore, we will explore sex differences in the relationship between education and physiologic health, stress, and resilience.