Socioeconomic differences in selected dietary habits among Norwegian 13-14 year-olds: a cross-sectional study

BACKGROUND

Social inequalities in health are a major and even growing problem in all European countries.

OBJECTIVE

The aim of the present study was to describe 1) differences in dietary habits among Norwegian adolescents by gender and socioeconomic status; 2) differences in self-reported knowledge of dietary guidelines among their parents according to socioeconomic status.

DESIGN

In 2012, a cross-sectional study where students filled in a web-based food frequency questionnaire at school was conducted in nine lower secondary schools in Vest-Agder County, Norway. Socioeconomic status (SES) and knowledge of dietary guidelines were obtained from the parents using a web-based questionnaire. In total, 517 ninth-grade students (mean age 13.9) out of 742 invited students participated in the study, giving a participation rate of 69.7%. The total number of dyads with information on both parents and students was 308 (41.5%).

RESULTS

The findings indicate that there is a tendency for girls to have a healthier diet than boys, with greater intake of fruits and vegetables (girls intake in median 3.5 units per day and boys 2.9 units per day), and lower intake of soft drinks (girls 0.25 l in median versus boys 0.5 l per week). Students from families with higher SES reported a significant higher intake of vegetables and fish, and lower intake of soft drinks and fast food than those from lower SES. Parents with higher SES reported a significantly better knowledge of dietary guidelines compared to those with lower SES.

CONCLUSIONS

Differences in dietary habits were found between groups of students by gender and SES. Differences were also found in parents' self-reported knowledge of dietary guidelines. This social patterning should be recognized in public health interventions.

Assessing the potential impact of increased participation in higher education on mortality: evidence from 21 European populations

Although higher education has been associated with lower mortality rates in many studies, the effect of potential improvements in educational distribution on future mortality levels is unknown. We therefore estimated the impact of projected increases in higher education on mortality in European populations. We used mortality and population data according to educational level from 21 European populations and developed counterfactual scenarios. The first scenario represented the improvement in the future distribution of educational attainment as expected on the basis of an assumption of cohort replacement. We estimated the effect of this counterfactual scenario on mortality with a 10-15-year time horizon among men and women aged 30-79 years using a specially developed tool based on population attributable fractions (PAF). We compared this with a second, upward levelling scenario in which everyone has obtained tertiary education. The reduction of mortality in the cohort replacement scenario ranged from 1.9 to 10.1% for men and from 1.7 to 9.0% for women. The reduction of mortality in the upward levelling scenario ranged from 22.0 to 57.0% for men and from 9.6 to 50.0% for women. The cohort replacement scenario was estimated to achieve only part (4-25% (men) and 10-31% (women)) of the potential mortality decrease seen in the upward levelling scenario. We concluded that the effect of on-going improvements in educational attainment on average mortality in the population differs across Europe, and can be substantial. Further investments in education may have important positive side-effects on population health.

Predictors of subjective age in people aged 40-79 years: a five-year follow-up study. The impact of mastery, mental and physical health

OBJECTIVES

Assessing subjective age perception (SAP) and changes in SAP as well as exploring which variables of socio-demographic, health and personal mastery independently predicted SAP.

METHODS

The panel data are from two waves of the Norwegian Study on the Life Course, Ageing and Generations (NorLAG). Our sample consists of 2471 people aged 40-79 years at baseline who were surveyed in 2002/2003 (T1) and 2007/2008 (T2). Univariate and multiple regressions were performed; multivariate analyses assessing the relative importance of the independent variables (at T1) for the SAP at T2.

RESULTS

Older chronological age, good physical health, good mental health, a high level of personal mastery and having lower education significantly predicted a youthful SAP. For the whole sample, older age and a high level of personal mastery were the most important predictors. For those aged 40-49 being a man, having lower education, good physical health and high personal mastery predicted a younger SAP, whereas in the group aged 50-59 years being married/cohabiting and having a high level of education were predictors of an older SAP. For those aged 60-69, high personal mastery was the only independent predictor of a younger SAP. For those aged 70-79 years, only health - good mental and physical health - independently predicted a younger SAP.

CONCLUSIONS

Most respondents feel younger than their chronological age, the more the older they are. Self-rated physical and mental health and personal mastery are associated with SAP and vary in different age groups.

Conditional health-related benefits of higher education: an assessment of compensatory versus accumulative mechanisms

A college degree is associated with a range of health-related benefits, but the effects of higher education are known to vary across different population subgroups. Competing theories have been proposed for whether people from more or less advantaged backgrounds or circumstances will gain greater health-related benefits from a college degree. This study draws on data from the National Longitudinal Study of Adolescent Health (Add Health) and recently developed models for analyzing heterogeneous treatment effects to examine how the effect of obtaining a college degree on the self-rated health of young adults varies across the likelihood of obtaining a college degree, a summary measure of advantage/disadvantage. Results indicate that a college degree has a greater effect on self-rated health for people from advantaged backgrounds. This finding differs from two recent studies, and possible reasons for the contrasting findings are discussed.

Perceived discrimination and psychological distress among Asian Americans: does education matter?

Using data from the National Latino and Asian American Study, this work examines if and how perceived everyday discrimination is associated with psychological distress among Asian Americans and whether this association varies by important structural factors as education and place of education. Findings reveal that perception of discrimination is associated with increased levels of psychological distress. Most importantly, education moderates the discrimination-distress association such that the detrimental effect of discrimination is stronger for Asian Americans with college or more levels of education than for Asian Americans with less than college levels of education. Place of education further conditions the moderating effect of education: The foreign-educated Asian Americans with higher levels of education are affected most negatively by discrimination compared to others. This study highlights (1) the significant joint role of education and place of education in conditioning the relationship between perceived discrimination and psychological distress, and (2) unique features of education in improving our understanding of Asian Americans' mental health.

THE NONEQUIVALENT HEALTH OF HIGH SCHOOL EQUIVALENTS

OBJECTIVES

Millions of U.S. adults are recipients of the high school equivalency (GED) diploma. Virtually nothing is known about the health of this large group, although literature suggests GED recipients are considerably worse off than high school graduates in numerous economic and social outcomes. We analyze general health among working-age adults with a high school diploma, GED recipients, and high school dropouts.

METHODS

Ordered and binary logistic models of self-rated health and activity limitations were estimated using data from the 1997-2009 National Health Interview Surveys (N=76,703).

RESULTS

GED recipients have significantly and substantially worse health than high school graduates, among both sexes. In fact, the GED recipients' health is generally comparable to that of high school dropouts. Health behaviors and economic factors explain a large proportion of the difference but the gap remains significant.

CONCLUSIONS

In terms of health, adults with a terminal GED are not equivalent to high school graduates. GED recipients report considerably worse general health and activity limitations. The disadvantage is only partly due to the worse economic outcomes and health behaviors; a significant difference remains unexplained and may be due to other, unobserved pathways, or to selection mechanisms.

Changes in sense of control in the second half of life: results from a 5-year panel study

Very few studies have used longitudinal data to examine whether age variations in the sense of control are due to ageing effects or cohort differences. With data from two waves of the Norwegian NorLAG study, with 2673 respondents aged 40 to 75 we ask: Does the sense of control decline over a 5-year period? Are there factors that accelerate the decline or slow it? We find that while cross-sectional comparisons indicate increases in sense of control up to age 75, longitudinal analysis show little to no change over 5 years. Only those 75 and older experienced a significant decline over the next 5 years. Physical health and agentive orientation at baseline can impede or accelerate decline in the sense of control. We also find that decline in sense of control starts 15 years later in this Norwegian sample than in similar studies in the United States, and discuss this finding in light of differences in welfare systems for elderly in the two countries.

The interaction of family background and personal education on depressive symptoms in later life

This study assesses the interaction between personal education and family background during childhood on depressive symptoms in later life by applying Ross & Mirowsky's resource substitution and structural amplification theory of health and education. OLS regression models are estimated using data from the "Survey of Health, Ageing and Retirement in Europe" (SHARE), which covers information on current social and health status as well as retrospective life histories from 20,716 respondents aged 50 or older from thirteen European countries. Higher education helps to overcome the negative consequences of a poor family background. Since people from poor families are less likely to attain higher educational levels, they lack exactly the resource they need in order to overcome the negative consequences their non-prosperous background has on depressive symptoms. Thus, low family background and low personal education amplify each other. Examining the processes described by theory of resource substitution and structural amplification over different age groups from midlife to old-age suggests that the moderating effect of education remains constant over age among people coming from a poor family background. However, there is some evidence for a decrease with age in the buffering effect of a well-off family background on depressive symptoms among the low educated group. Furthermore, the educational gap in depression diverges with age among individuals originating from a well-off family background. Taken together the results cautiously allude to the conclusion that three processes - cumulative (dis-)advantage, age-as-leveler, and persistent inequalities - might take place.

The socioeconomic origins of physical functioning among older U.S. adults

Mounting evidence finds that adult health reflects socioeconomic circumstances (SES) in early life and adulthood. However, it is unclear how the health consequences of SES in early life and adulthood accumulate-for example, additively, synergistically. This study tests four hypotheses about how the health effects of early-life SES (measured by parental education) and adult SES (measured by own education) accumulate to shape functional limitations, whether the accumulation differs between men and women, and the extent to which key mechanisms explain the accumulation. It uses data from the 1994-2010 Health and Retirement Study on U.S. adults 50-100 years of age (N=24,026). The physical functioning benefits of parental and own education accumulated additively among men. While the physical functioning benefits generally accumulated among women, the functioning benefits from one's own education were dampened among women with low-educated mothers. The dampening partly reflected a strong tie between mothers' education level and women's obesity risk. Taken together, the findings reveal subtle differences between men and women in the life course origins of physical functioning. They also shed light on a key mechanism-obesity-that may help explain why a growing number of studies find that early-life SES is especially important for women's health.

Gender in Marriage and Life Satisfaction Under Gender Imbalance in China: The Role of Intergenerational Support and SES

This study examined gender differences in the influence of marital status and marital quality on life satisfaction. The roles of intergenerational support and perceived socioeconomic status in the relationship between marriage and life satisfaction were also explored. The analysis was conducted with data from the Chinese General Social Survey (CGSS) in 2006, representing 1,317 women and 1,152 men at least 25 years old. Chi-squared tests and logistic regression models were used in this process. Marriage, including marital status and relationship quality, has a protective function for life satisfaction. Marital status is more important for males, but marital quality is more important for females. The moderating roles of intergenerational support and perceived socioeconomic status are gender specific, perhaps due to norms that ascribe different roles to men and women in marriage.

Overeducation and depressive symptoms: diminishing mental health returns to education

In general, well-educated people enjoy better mental health than those with less education. As a result, some wonder whether there are limits to the mental health benefits of education. Inspired by the literature on the expansion of tertiary education, this article explores marginal mental health returns to education and studies the mental health status of overeducated people. To enhance the validity of the findings we use two indicators of educational attainment - years of education and ISCED97 categories - and two objective indicators of overeducation (the realised matches method and the job analyst method) in a sample of the working population of 25 European countries (unweighted sample N = 19,089). Depression is measured using an eight-item version of the CES-D scale. We find diminishing mental health returns to education. In addition, overeducated people report more depression symptoms. Both findings hold irrespective of the indicators used. The results must be interpreted in the light of the enduring expansion of education, as our findings show that the discussion of the relevance of the human capital perspective, and the diploma disease view on the relationship between education and modern society, is not obsolete.

Education as a social determinant of health: issues facing indigenous and visible minority students in postsecondary education in Western Canada

The level of educational attainment is increasingly being recognized as an important social determinant of health. While higher educational attainment can play a significant role in shaping employment opportunities, it can also increase the capacity for better decision making regarding one’s health, and provide scope for increasing social and personal resources that are vital for physical and mental health. In today’s highly globalized knowledge based society postsecondary education (PSE) is fast becoming a minimum requirement for securing employment that can afford young adults the economic, social and personal resources needed for better health. Canada ranks high among OECD countries in terms of advanced education, with 66% of Canadians having completed some form of postsecondary education. Yet youth from low income indigenous and visible minority (LIIVM) backgrounds continue to be poorly represented at PSE levels. The current study aimed to understand the reasons for this poor representation by examining the experiences of LIIVM students enrolled in a postsecondary program. Findings show that the challenges they faced during the course of their study had an adverse impact on their health and that improving representation of these students in PSE will require changes at many levels.

The Nonlinear Relationship between Education and Mortality: An Examination of Cohort, Race/Ethnic, and Gender Differences

Researchers investigating the relationship between education and mortality in industrialized countries have consistently shown that higher levels of education are associated with decreased mortality risk. The shape of the education-mortality relationship and how it varies by demographic group have been examined less frequently. Using the U.S. National Health Interview Survey-Linked Mortality Files, which link the 1986 through 2004 NHIS to the National Death Index through 2006, we examine the shape of the education-mortality curve by cohort, race/ethnicity, and gender. Whereas traditional regression models assume a constrained functional form for the dependence of education and mortality, in most cases semiparametric models allow us to more accurately describe how the association varies by cohort, both between and within race/ethnic and gender subpopulations. Notably, we find significant changes over time in both the shape and the magnitude of the education-mortality gradient across cohorts of women and white men, but little change among younger cohorts of black men. Such insights into demographic patterns in education and mortality can ultimately help increase life expectancies.

Clarifying the positive association between education and prostate cancer: a Monte Carlo simulation approach

Using the 1993-2011 data from the Wisconsin Longitudinal Study (N = 5,218), we examine prostate cancer screening, mortality after the diagnosis, and health behaviors as potential mechanisms explaining the paradoxical association between men's higher education and higher prostate cancer risk. Our study combines within-cohort longitudinal hazard models predicting a prostate cancer diagnosis with Monte Carlo simulations estimating the joint effects of socioeconomic differences in prostate cancer screening and mortality after the diagnosis. Our findings strongly suggest that higher utilization of prostate cancer screening and lower mortality after the diagnosis are important explanations for higher prostate rates among more educated men. In addition to applying an innovative method to the issues of prostate cancer incidence and survival, our results have potentially important implications for the current debate about the utility of prostate cancer screening as well as for accurate predictions of future mortality and morbidity trends in the expanding older population.

Design of a randomized controlled trial for multiple cancer risk behaviors among Spanish-speaking Mexican-origin smokers

BACKGROUND

Smoking, poor diet, and physical inactivity account for as much as 60% of cancer risk. Latinos experience profound disparities in health behaviors, as well as the cancers associated with them. Currently, there is a dearth of controlled trials addressing these health behaviors among Latinos. Further, to the best of our knowledge, no studies address all three behaviors simultaneously, are culturally sensitive, and are guided by formative work with the target population. Latinos represent 14% of the U.S. population and are the fastest growing minority group in the country. Efforts to intervene on these important lifestyle factors among Latinos may accelerate the elimination of cancer-related health disparities.

METHODS/DESIGN

The proposed study will evaluate the efficacy of an evidence-based and theoretically-driven Motivation And Problem Solving (MAPS) intervention, adapted and culturally-tailored for reducing cancer risk related to smoking, poor diet, and physical inactivity among high-risk Mexican-origin smokers who are overweight/obese (n = 400). Participants will be randomly assigned to one of two groups: Health Education (HE) or MAPS (HE + up to 18 MAPS counseling calls over 18 months). Primary outcomes are smoking status, servings of fruits and vegetables, and both self-reported and objectively measured physical activity. Outcome assessments will occur at baseline, 6 months, 12 months, and 18 months.

DISCUSSION

The current study will contribute to a very limited evidence base on multiple risk factor intervention studies on Mexican-origin individuals and has the potential to inform both future research and practice related to reducing cancer risk disparities. An effective program targeting multiple cancer risk behaviors modeled after chronic care programs has the potential to make a large public health impact because of the dearth of evidence-based interventions for Latinos and the extended period of support that is provided in such a program.

TRIAL REGISTRATION

National Institutes of Health Clinical Trials Registry # NCT01504919.

Childhood (Mis)fortune, Educational Attainment, and Adult Health: Contingent Benefits of a College Degree?

College-educated adults are healthier than other people in the United States, but selection bias complicates our understanding of how education influences health. This article focuses on the possibility that the health benefits of college may vary according to childhood (mis)fortune and people's propensity to attain a college degree in the first place. Several perspectives from life course sociology offer competing hypotheses as to whether the most or the least advantaged see the greatest return of a college education. The authors use a national survey of middle-age American adults to assess risk of two cardiovascular health problems and mortality. Results from propensity score and hierarchical regression analysis indicate that the protective effect of college attainment is indeed heterogeneous. Further, the greatest returns are among those least likely to experience this life course transition (i.e., compensatory leveling). Explanations for this selection effect are offered, along with several directions for future research on the health benefits of completing college.

Educational differentials in US adult mortality: An examination of mediating factors

We use human capital theory to develop hypotheses regarding the extent to which the association between educational attainment and US adult mortality is mediated by such economic and social resources as family income and social support; such health behaviors as inactivity, smoking, and excessive drinking; and such physiological measures as obesity, inflammation, and cardiovascular risk factors. We employ the NHANES Linked Mortality File, a large nationally representative prospective data set that includes an extensive number of factors thought to be important in mediating the education-mortality association. We find that educational differences in mortality for the total population and for specific causes of death are most prominently explained by family income and health behaviors. However, there are age-related differences in the effects of the mediating factors. Higher education enables individuals to effectively coalesce and leverage their diverse and substantial resources to reduce their mortality and increase their longevity.

Education and health-behaviour among men and women in Sweden: A 27-year prospective cohort study

Background: Previous research has found a positive association between health-behaviour and health. Only a few longitudinal studies have been performed, and as far as we found, none have followed a cohort for 27 years. Methods: This study used a cohort study, the “Northern Swedish Cohort”, which consisted of all graduates, n = 1080, from a compulsory school in a Swedish town. Data were collected with a comprehensive questionnaire; response rate 96.4%. Health-behaviour was analysed with binary logistic regression, with health-behaviour at age 21, 30 and 43 years as dependent variable. Besides baseline health-behaviour, gender, somatic and psychological health and socioeconomic background, the analyses were adjusted for work situation and social network. Results: The main findings were that education reduces the probability of unhealthy behaviour over the life course, which held after controlling for early life health-behaviour and possible confounders. The general education effect on health-behaviour was stronger among men than among women. Conclusions: Higher education reduces the probability of unhealthy behavior. Thus, investments in higher education should be an important public goal.

Education and the gender gaps in health and mortality

The positive associations between education and health and survival are well established, but whether the strength of these associations depends on gender is not. Is the beneficial influence of education on survival and on self-rated health conditioned by gender in the same way, in opposite ways, or not at all? Because women are otherwise disadvantaged in socioeconomic resources that are inputs to health, their health and survival may depend more on education than will men's. To test this hypothesis, we use data from the National Health Interview Survey-Linked Mortality Files (NHIS-LMF). We find that education's beneficial influence on feeling healthy and on survival are conditional on gender, but in opposite ways. Education has a larger effect on women's self-rated health than on men's, but a larger effect on men's mortality. To further examine the mortality results, we examine specific causes of death. We find that the conditional effect is largest for deaths from lung cancer, respiratory disease, stroke, homicide, suicide, and accidents. Because women report worse health but men's mortality is higher, education closes the gender gap in both health and mortality.

Collaborative care management reduces disparities in dementia care quality for caregivers with less education

OBJECTIVES

To examine educational gradients in dementia care and whether the effect of a dementia collaborative care management intervention varied according to the educational attainment of the informal caregiver.

DESIGN

Analysis of data from a cluster-randomized controlled trial.

SETTING

Eighteen clinics in three healthcare organizations in southern California.

PARTICIPANTS

Dyads of Medicare recipients aged 65 and older with a diagnosis of dementia and an eligible caregiver.

INTERVENTION

Collaborative care management for dementia.

MEASUREMENTS

Caregiver educational attainment, adherence to four dimensions of guideline-recommended processes of dementia care (assessment, treatment, education and support, and safety) before and after the intervention, and the adjusted intervention effect (IE) for each dimension stratified according to caregiver education. Each IE was estimated by subtracting the difference between pre- and postintervention scores for the usual care participants from the difference between pre- and postintervention scores in the intervention participants.

RESULTS

At baseline, caregivers with lower educational attainment provided poorer quality of dementia care for the Treatment and Education dimensions than those with more education, but less-educated caregivers had significantly more improvement after the intervention on the assessment, treatment, and safety dimensions. The IEs for those who had not graduated from high school were 44.4 for the assessment dimension, 36.9 for the treatment dimension, and 52.7 for the safety dimension, versus 29.5, 15.7, and 40.9 respectively, for college graduates (P < .001 for all three).

CONCLUSIONS

Collaborative care management was associated with smaller disparities in dementia care quality between caregivers with lower educational attainment and those with more education.

Genetic and environmental influences on the relationship between mastery and alcohol dependence

BACKGROUND

Sense of mastery, a personal resource, is likely to have an inverse association with alcohol dependence. Previous evidence, however, is sparse. In addition, the extent to which an association is due to genetic or environmental factors is unknown.

METHODS

Data were from 3,983 male twins and 2,630 female twins who had ever used alcohol, interviewed in the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Mastery was measured by a 6-item scale. Lifetime diagnosis of alcohol dependence was based on DSM-IV criteria assessed in a structured diagnostic interview. Univariate analyses modeled the relative contributions of genetic and environmental factors to mastery and alcohol dependence using Mx software. Bivariate Cholesky models were fit to the mastery and alcohol dependence raw data.

RESULTS

In the best-fitting model of mastery, genetic factors accounted for about 33% of the observed variance. Nonshared environmental factors, including random measurement error, accounted for the remaining 67%. Fifty-six percent of the variance in liability to alcohol dependence was genetic, and the other 44% was explained by the nonshared environment. The phenotypic polychoric correlation between mastery and alcohol dependence of -0.18 was primarily (67% in the best-fitting model) explained by genes common to both low mastery and alcohol dependence; the rest was explained by nonshared environmental factors.

CONCLUSIONS

The findings indicate that genetic risk for alcohol dependence overlaps with genetic factors that influence sense of mastery. Key challenges for future research are to identify the genes that influence mastery and alcohol dependence, as well as the environmental pathways by which they come to be linked.

Education and obesity at age 40 among American adults

Although many have studied the association between educational attainment and obesity, studies to date have not fully examined prior common causes and possible interactions by race/ethnicity or gender. It is also not clear if the relationship between actual educational attainment and obesity is independent of the role of aspired educational attainment or expected educational attainment. The authors use generalized linear log link models to examine the association between educational attainment at age 25 and obesity (BMI≥30) at age 40 in the USA's National Longitudinal Survey of Youth 1979 cohort, adjusting for demographics, confounders, and mediators. Race/ethnicity but not gender interacted with educational attainment. In a complete case analysis, after adjusting for socioeconomic covariates from childhood, adolescence, and adulthood, among whites only, college graduates were less likely than high school graduates to be obese (RR = 0.69, 95%CI: 0.57, 0.83). The risk ratio remained similar in two sensitivity analyses when the authors adjusted for educational aspirations and educational expectations and analyzed a multiply imputed dataset to address missingness. This more nuanced understanding of the role of education after controlling for a thorough set of confounders and mediators helps advance the study of social determinants of health and risk factors for obesity.

Glitch in the gradient: additional education does not uniformly equal better health

While the relationship between education and general health has been firmly established in the literature, surprisingly little research has analyzed individual components of the global health judgments, such as chronic conditions or pain. We present a systematic account of the health gradient for multiple health outcomes by detailed educational categories among U.S. working-age adults. Using the 1997-2010 National Health Interview Surveys (N = 204,764), we analyze individual health outcomes ranging from cardiovascular disease to vision problems with a series of logistic regression models. The results at the presecondary and baccalaureate levels are consistent with the health gradient. An unexpected finding occurs among adults with some college but no degree, and those with technical/vocational associate degrees: these groups report more pain and a higher prevalence of a broad range of conditions than high school graduates who never attended college. We discuss several explanations for the observed patterns. The findings challenge the broadly accepted educational gradient in health; additionally, the lower postsecondary groups comprise a quarter of American adults. Jointly, there is a clear research and policy impetus to understand the source of this 'glitch' in the health gradient.

Health in working-aged Americans: adults with high school equivalency diploma are similar to dropouts, not high school graduates

OBJECTIVES

We compared health outcomes for adults with the General Equivalency Diploma (GED) and regular high school diploma to determine whether GED recipients are equivalent to regular graduates despite research that documents their disadvantages in other outcomes.

METHODS

We used 1997 to 2009 National Health Interview Survey cross-sectional data on high school dropouts, graduates, and GED recipients aged 30 to 65 years (n = 76,705). Five general health indicators and 20 health conditions were analyzed using logistic models.

RESULTS

GED recipients had a significantly higher prevalence of every health outcome compared with high school graduates (odds ratios = 1.3-2.7). The GED-high school differences attenuated but remained evident after controlling for health insurance, economic status, and health behaviors. For most conditions, the 95% confidence interval for GED earners overlapped with that for high school dropouts.

CONCLUSIONS

The high school equivalency diploma was associated with nonequivalent health: adults with a GED had health comparable to that of high school dropouts, not graduates. GED recipients were at increased risk for many health conditions, and their health should be viewed as distinct from regular graduates. The findings have implications for health and educational policies.

Factors related to health locus of control among lung transplant candidates

As the number of individuals pursuing lung transplantation to treat lung disease increases, transplant team members have an opportunity to maximize patients' chances for post-transplant success through identifying and addressing psychosocial factors that have been previously associated with patients' post-transplant survival, such as health locus of control (HLC). The purpose of this cross-sectional study was to understand the factors associated with HLC in lung transplant candidates. The aims were to (i) identify the demographic factors associated with internal (IHLC), chance (CHLC), and powerful others (PHLC) HLC; (ii) examine the associations between HLC and anxiety, depression, and optimism; and (iii) determine whether these factors explain a significant proportion of variance in HLC. Hierarchical regression analyses indicated that age, education, trait anxiety, and optimism explained 20% of the variance in CHLC; gender, trait anxiety, and depression accounted for 9% of the variance in IHLC; and lower education accounted for 5% of the variance in PHLC. Helping transplant team members understand the factors that influence patients' perceptions that their own behaviors impact their health status is important for maximizing post-transplant success.

The role of early-life socioeconomic status in breast cancer incidence and mortality: unraveling life course mechanisms

OBJECTIVES

We examine (a) how breast cancer onset and survival are affected by various dimensions of early-life socioeconomic status (SES) and (b) the extent to which women's characteristics in adulthood mediate the associations between early-life conditions and breast cancer.

METHOD

We apply Cox regression models and a decomposition analysis to the data from the 4,275 women in the Wisconsin Longitudinal Study.

RESULTS

Higher levels of mothers' education and early-life family income were associated with a greater risk of breast cancer incidence. The effect of mothers' education was mediated by women's adult SES and reproductive behaviors. Fathers' education was related negatively to breast cancer mortality, yet this effect was fully mediated by women's own education.

DISCUSSION

This study identifies mechanisms linking early-life social environment to breast cancer onset and mortality. The findings emphasize the role of social factors in breast cancer incidence and survival.

Healthy lifestyle behaviour among Ghanaian adults in the phase of a health policy change

Background

Many countries have adopted health policies that are targeted at reducing the risk factors for chronic non-communicable diseases. These policies promote a healthy population by encouraging people to adopt healthy lifestyle behaviours. This paper examines healthy lifestyle behaviour among Ghanaian adults by comparing behaviours before and after the introduction of a national health policy. The paper also explores the socio-economic and demographic factors associated with healthy lifestyle behaviour.

Method

Descriptive, bivariate and multivariate regression techniques were employed on two nationally representative surveys (2003 World Health Survey (Ghana) and 2008 Ghana Demographic and Health Survey) to arrive at the results.

Results

While the prevalence of some negative lifestyle behaviours like smoking has reduced others like alcohol consumption has increased. Relatively fewer people adhered to consuming the recommended amount of fruit and vegetable servings per day in 2008 compared to 2003. While more females (7.0%) exhibited healthier lifestyles, more males (9.0%) exhibited risky lifestyle behaviours after the introduction of the policy.

Conclusion

The improvement in healthy lifestyle behaviours among female adult Ghanaians will help promote healthy living and potentially lead to a reduction in the prevalence of obesity among Ghanaian women. The increase in risky lifestyle behaviour among adult male Ghanaians even after the introduction of the health policy could lead to an increase in the risk of non-communicable diseases among men and the resultant burden of disease on them and their families will push more people into poverty.

Trends in Educational Attainment by Race/Ethnicity, Nativity, and Sex in the United States, 1989-2005

Despite the importance of education for shaping individuals' life chances, little research has examined trends and differences in educational attainment for detailed demographic subpopulations in the United States. We use labor market segmentation and cohort replacement theories, linear regression methods, and data from the National Health Interview Survey to understand educational attainment by race/ethnicity, nativity, birth cohort, and sex between 1989 and 2005 in the United States. There have been significant changes in educational attainment over time. In support of the cohort replacement theory, we find that across cohorts, females have enjoyed greater gains in education than men, and for some race/ethnic groups, recent cohorts of women average more years of education than comparable men. And in support of labor market segmentation theories, foreign-born Mexican Americans continue to possess relatively low levels of educational attainment. Our results can aid policymakers in identifying vulnerable populations, and form the base from which to better understand changing disparities in education.

The interaction of personal and parental education on health

The association between education and good health is well established, but whether the strength of the association depends on other social statuses is not. We test a theory of resource substitution which predicts a larger correlation between education and health (measured for physical impairment) for people who grew up in families with poorly-educated parents than for those whose parents were well educated. This is supported in the Aging, Status, and Sense of control (ASOC) survey, a representative national U.S. sample with data collected in 1995, 1998, and 2001. The reason that parental education matters more to people who are poorly educated themselves is due to an unhealthy lifestyle, specifically to smoking and being overweight. Finally, as the poorly educated age, the negative health effects of their parents' low educational attainment get worse.

Education and health in late-life among high school graduates: Cognitive versus psychological aspects of human capital

Just as postsecondary schooling serves as a dividing line between the advantaged and disadvantaged on outcomes like income and marital status, it also serves as a dividing line between the healthy and unhealthy. Why are the better educated healthier? Human capital theory posits that education makes one healthier via cognitive (skill improvements) and noncognitive psychological resources (traits such as conscientiousness and a sense of mastery). I employ the Wisconsin Longitudinal Study (1957-2005) to test the relative strength of measures of cognitive human capital versus noncognitive psychological human capital in explaining the relationship between education and health outcomes among high school graduates. I find little evidence that noncognitive psychological human capital is a significant mediator, but find a relatively significant role for cognitive human capital, as measured by high school academic performance. It is not just higher educational attainment; academic performance is strongly linked to health in later life.

Antecedent-consequent relations of perceived control to health and social support: longitudinal evidence for between-domain associations across adulthood

OBJECTIVES

To examine antecedent-consequent relations of perceived control to health and social support across adulthood and old age.

METHODS

We applied (multigroup) change score models to two waves of data collected 9 years apart from 6,210 participants of the Midlife in the United States survey (MIDUS, 24-75 years at baseline). We used composite measures of perceived control (personal mastery and constraints), health (chronic conditions, acute conditions, and functional limitations), and social support (support and strain associated with spouse/partner, family, and friends).

RESULTS

Analyses revealed evidence for direct and independent multidirectional accounts. Greater initial control predicted weaker declines in health and stronger increases in support. In turn, increases in control were predicted by better initial health and more support. Changes in control were also accompanied by concurrent changes in the other two domains, and relations involving control were larger in size than those between health and support. We found only small sociodemographic differences across age, gender, and education group.

DISCUSSION

We conclude that perceiving control may serve as both a precursor and an outcome of health and social support across the adult age range and suggest routes for further inquiry.

Predictors of mental and physical health: individual and neighborhood levels of education, social well-being, and ethnicity

This study examines how education benefits health through social well-being in Hawaii where the centrality of community life is underscored. The 2007 Hawaii Health Survey with linked zip-code information was used to investigate the effects of education at both individual and neighborhood levels using mixed-effects models. Geographic Information System was applied to map the geographical distributions of education, social well-being, and health. It was found that individual-level education benefits mental health and its effects are largely mediated by respondents' employment status and their social well-being (social integration, social contribution, social actualization, and social coherence). Both individual and neighborhood-level education promotes physical health and their effects are partially mediated by economic well-being and two indicators of social well-being (social integration and social coherence). Results of this study suggest the independent effects of two levels of education on physical health and the importance of education and social well-being to both mental and physical health in the State of Hawaii.

Effects of Prenatal Poverty on Infant Health: State Earned Income Tax Credits and Birth Weight

This study estimates the effects of prenatal poverty on birth weight using changes in state Earned Income Tax Credits (EITC) as a natural experiment. We seek to answer two questions about poverty and child wellbeing. First, are there associations between prenatal poverty and lower birth weights even after factoring out unmeasured potential confounders? Because birth weight predicts a range of outcomes across the life course, lower birth weights that result from poverty may have lasting consequences for children’s life chances. Second, how have recent expansions of a work-based welfare program (i.e., the EITC) affected maternal and infant health? In recent decades, U.S. poverty relief has become increasingly tied to earnings and labor markets, but the consequences for children’s wellbeing remain controversial. We find that state EITCs increase birth weights and reduce maternal smoking. However, results related to AFDC/TANF and varying EITC effects across maternal ages raise cautionary messages.

Contextual Effects on Life Satisfaction of Older Men and Women

Des différences existent entre les sexes dans les variables liées à la démographie, à la santé et aux réseaux sociaux, variables qui sont associés à un vieillissement réussi, mais on n'en trouve généralement pas en ce qui concerne la satisfaction face à la vie. La présente étude avait pour but premier de déterminer s'il y a des différences entre les hommes et les femmes par rapport à leur satisfaction dans des domaines particuliers et en général à l'égard de la vie. Ont également été examinées les différences dans la satisfaction face au parcours de la vie entre les hommes et les femmes. Dans un deuxième temps, nous avons procédé à une analyse de l'ensemble de données recueillies dans l'étudeVieillir dans la communauté(Béland et al., 1989) afin d'évaluer le bien-être des adultes francophones plus âgés (N=958). Des analyses acheminatoires ont révélé une bonne concordance des modèles utilisés pour les échantillons masculins et féminins. Chez les hommes, la satisfaction face à la vie s'explique positivement selon l'âge, le revenu et le contrôle et négativement selon les erreurs de mémoire, la maladie et les limitations fonctionnelles. Chez les femmes, la satisfaction face à la vie s'explique selon l'âge, la scolarité, le revenu, la maladie, les limitations fonctionnelles, le soutien social, le contrô le et le mode de vie. Les résultats ont fait ressortir les aspects positifs et négatifs du soutien social pour les femmes. Tel que nous nous y attendions, les modèles de parcours ont indiqué que, même s'il existe des similitudes dans la satisfaction face au parcours de la vie chez les hommes et chez les femmes plus âgés, on retrouve également des différences importantes.

The adaptive role of perceived control before and after cancer diagnosis: A prospective study

Cancer is generally considered a low-control situation. Stability of perceptions of control before and after cancer was examined, as well as the adaptive value of maintenance versus relinquishment of control in the psychological adjustment to cancer. This study, conducted in the northern Netherlands, was carried out in a prospective design with four assessment points (one pre-morbid and three post-morbid assessments) involving semi-structured interviews and self-report questionnaires. Ninety-nine newly diagnosed cancer patients all aged over 57 years completed all four assessment points. We found that perceptions of control declined before and after disease, possibly as a consequence of the diagnosis of cancer. Further, maintenance of control after cancer diagnosis was related to lower levels of psychological distress 6 and 12 months after diagnosis. These results suggest that maintenance of perceptions of control is beneficial to the psychological adjustment to cancer.

GENDER AND THE HEALTH BENEFITS OF EDUCATION

Does education improve health more for one sex than the other? We develop a theory of resource substitution which implies that education improves health more for women than men. Data from a 1995 survey of U.S. adults with follow-ups in 1998 and 2001 support the hypothesis. Physical impairment decreases more for women than for men as the level of education increases. The gender gap in impairment essentially disappears among people with a college degree. Latent growth SEM vectors also show that among the college educated, men's and women's life course patterns of physical impairment do not differ significantly.

Educational degrees and adult mortality risk in the United States

We present the first published estimates of U.S. adult mortality risk by detailed educational degree, including advanced postsecondary degrees. We use the 1997-2002 National Health Interview Survey (NHIS) Linked Mortality Files and Cox proportional hazards models to reveal wide graded differences in mortality by educational degree. Compared to adults who have a professional degree, those with an MA are 5 percent, those with a BA are 26 percent, those with an AA are 44 percent, those with some college are 65 percent, high school graduates are 80 percent, and those with a GED or 12 or fewer years of schooling are at least 95 percent more likely to die during the followup period, net of sociodemographic controls. These differentials vary by gender and cohort. Advanced educational degrees are associated not only with increased workforce skill level but with a reduced risk of death.

Joining the dots: The links between education and health and implications for indigenous children

This paper provides a general overview of the literature investigating the nexus between education and health; discussing the relationship between these domains at individual, family and community levels. We then briefly examine the programme and research implications of such a framework for interventions aimed at improving education and health, with specific reference to young Indigenous Australians. We find that while education and health are inextricably linked, throughout the life course and at different levels of influence, there is less empirical work exploring this relationship in an Indigenous context. Given the gravity of literacy and numeracy failure rates in school-based education and its potential impact on Indigenous health, we assert an urgent case for rigorous research into interventions that address the barriers to effectiveness in implementing quality educational experiences and opportunities for Indigenous children.

The association between socioeconomic status and overweight/obesity in a Malay population in Singapore

In developed countries in the West, lower socioeconomic status (SES) is associated with a higher prevalence of overweight/obesity. The authors examined the association between SES defined by education and income and overweight/obesity in a population-based cohort of 2807 individuals of Malay ethnicity (age 40-80 years, 51% women) in Singapore. The prevalence of overweight/ obesity (body mass index > or =25 kg/m(2)) in men and women was 50.4% and 65.1%, respectively. In women, the prevalence of overweight/obesity increased with lower levels of education and income. Compared with the higher categories of SES, the odds ratio (95% confidence interval) of overweight/obesity in women was 1.42 (1.06-1.89) for education and 2.08 (1.33-3.26) for income. In contrast, in men, the prevalence of overweight/obesity decreased with lower levels of education and income (P interaction by gender <.05 for all SES variables). Lower SES was positively associated with overweight/obesity in Malay women, and the association was in the opposite direction in Malay men.

Prevalence of Diabetes Mellitus, Glycemic Control, and Associated Factors in a Malay Population in Singapore

There is substantial heterogeneity regarding diabetes mellitus prevalence and glycemic control in Asian populations. The authors examined a population-based sample of 3000 adults (52% women) of Malay ethnicity (40-80 years) in Singapore. The age-standardized prevalence of diabetes mellitus was 18.4% (95% confidence interval = 17.0% to 19.8%). Being overweight, presence of hypertension, presence of cardiovascular disease, and family history of diabetes were found to be positively associated with diabetes mellitus. Higher education, employment status, and current smoking were found to be inversely associated with diabetes mellitus. Among those treated for diabetes, 29% achieved the optimal glycemic goal (glycosylated hemoglobin <7%). Lower levels of low-density lipoprotein cholesterol, total cholesterol, and systolic and diastolic blood pressure were associated with good glycemic control. Nearly 1 in 5 middle-aged Malay adults living in a developed Asian society had diabetes mellitus and a substantial proportion had suboptimal glycemic control.

Social origins, early hardship and obesity: a strong association in women, but not in men?

This study investigates the relation between early life conditions and adult obesity in France, using a rich data set collected through the 2003 nationally representative Life History Survey. No salient factor emerged in men, while in women, after controlling for current socio-demographic characteristics, a relation was found between obesity and the following factors: father's occupation (OR=3.2 for women whose father was a clerical worker, versus those whose father was in a higher-level occupation); experience of economic hardship in childhood (OR=2.0), and; high parity (OR=2.1 for parities of more than 3 versus parity of 1). Neither early family history nor mother's working status surfaced as significant factors. Those findings highlight a definite gender pattern, with a strong association between early disadvantage and obesity in women, but not in men. Potential mechanisms are discussed, particularly the "habitus", the "thrifty phenotype" and the "feast-famine" hypotheses, and possible interactions with childbearing and motherhood. An integration of social and biological perspectives is needed to reach a better understanding of the processes involved, and to achieve progress in primary and secondary prevention.

Development of mastery during adolescence: the role of family problem-solving

A sense of mastery is an important component of psychological health and wellbeing across the life-span; however relatively little is known about the development of mastery during childhood and adolescence. Utilizing prospective, longitudinal data from 444 adolescent sibling pairs and their parents, our conceptual model proposes that family socioeconomic status (SES) in the form of parental education promotes effective family problem-solving, which, in turn, fosters adolescent mastery. Results show: (1) a significant increase in mastery for younger and older siblings, (2) parental education promoted effective problem-solving between parents and adolescents and between siblings but not between the parents themselves, and (3) all forms of effective family problem-solving predicted greater adolescent mastery. Parental education had a direct effect on adolescent mastery as well as the hypothesized indirect effect through problem-solving effectiveness, suggesting both a social structural and social process influence on the development of mastery during adolescence.