Pathways Linking Education/Health in Middle Adulthood

描述（由申请人提供）：关于教育与健康之间关联的研究未能逃脱这样的批评，即教育以外的因素是造成这种反复观察到的、但可能是虚假的关联的原因。如果教育与健康之间存在因果关系，那么教育影响健康的途径仍有待充分阐明。本申请旨在：1）获得教育对多种成人健康结果的影响的估计，这些结果独立于学校教育和成年后健康的几个决定因素; 2）评估假设用于解释教育与健康之间关联的几种潜在途径的贡献。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，并以国家围产期合作项目的新英格兰队列的成人随访研究为基础。第一个目标是对最近从一项家庭研究中获得的数据进行分析，该研究涉及2,000名受试者，这些受试者从出生到40岁一直受到跟踪;这些分析将包括一个 成年人健康状况的详细测量，1959年至1976年收集的社会，家庭和个人教育决定因素的前瞻性措施，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;自我评估的健康状况;以及行为风险因素，包括烟草使用和药物滥用的当前和终身指标。我们还将测试心理过程（抑郁，焦虑，感知社会地位和感知压力）介导教育和健康之间的关联的假设。本研究的第二个和第三个目标涉及从这2,000名受试者中的800名收集新数据。目标二集中于阐明教育对心血管疾病和糖尿病的生物学前兆的因果影响。第三个目标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，父母和儿童变量的全面评估，以及因果关系和潜在机制的假设驱动的测试，使这个项目非常适合评估教育和改善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.