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

For Whom Does Education Convey Health Benefits? A Two-Generation and Life Course Approach

Scholars of social determinants of health have long been interested in how parent's and own education influence health. However, the differing effects of parent's and own education on health-that is, for what socioeconomic group education conveys health benefits-are relatively less studied. Using multilevel marginal structural models, we estimate the heterogeneous effects of parent's and own education over the life course on two health measures. Our analysis considers both parent's and respondent's pre-education covariates, such as childhood health and socioeconomic conditions. We find that the protective effects of college completion against negative health outcomes are remarkably similar regardless of parent's (measured by father's or mother's) education. Meanwhile, parent's education has a larger effect when the average educational level is low in the population. Our results also reveal distinct life course patterns between health measures. We conclude by discussing the implications of our study for understanding the education-health relationship.

Twentieth-Century Change in the Educational Costs of Adolescent Childbearing

Although studies observe heterogeneity in the effects of adolescent childbearing on schooling, little is currently known about when this pattern emerged or how it changed across cohorts of women who lived in distinct periods of US history. This article identifies the potential origins of effect heterogeneity in the educational costs of adolescent childbearing and extends recent advances in causal inference to detect group differences in heterogeneity. The analysis applies this approach to four cohorts of women from the National Longitudinal Surveys (NLS) who entered adolescence before, during, and after expansive economic, demographic, and cultural change in the twentieth century. Results suggest that the educational costs of adolescent childbearing, as well as heterogeneity in those costs, increased for women in the latter half of the twentieth century, especially for millennial women born 1980-84. The authors conclude that midcentury social changes fundamentally altered the educational costs of adolescent childbearing for women.

Educational attainment and emotional well-being in adolescence and adulthood

Education has been conceptualized as a causal factor leading to emotional well-being. However, it is also possible that some of the effect of education may be due to selection factors. Analyzing data from the National Longitudinal Study of Adolescent to Adult Health (n = 10,908), we asked: to what extent does educational attainment increase emotional well-being once stable observed and unobserved individual characteristics are accounted for? Findings from fixed effects models showed that attaining a college degree was associated with greater emotional well-being. However, interactions with gender indicate that the positive association with emotional well-being is primarily for women, although a small negative association between completing college and depressive affect was found for men. These findings point to unmeasured confounding factors as motivating some of the association between educational attainment and emotional well-being among adolescents and adults.

Interactions between parental and personal socioeconomic resources and self-rated health: Adjudicating between the resource substitution and resource multiplication theories

A small body of research has documented intriguing findings, mostly from the United States but also from Europe, which suggest that the positive health effects of socioeconomic resources in adulthood may be conditioned by socioeconomic circumstances in childhood. There are two competing theories in this literature. The first contends that socioeconomic resources have a stronger effect on adult health for people from disadvantaged backgrounds because socioeconomic resources in adulthood substitute or compensate for a paucity of health-related resources earlier in life. The second contends that socioeconomic resources have a stronger effect on adult health for people from advantaged backgrounds because socioeconomic resources in adulthood compound or multiply the health effects of socioeconomic resources earlier in life. We used survey data from the 2012 Longitudinal and International Study of Adults linked to current and historical income data from the Canada Revenue Agency to investigate interactions between parental and personal socioeconomic resources - education and income, treated separately - as predictors of self-rated health in a sample of Canadians aged 25 to 50. Consistent with the resource multiplication theory, we found that the presumed benefits of personal family income for self-rated health were stronger for women from wealthier backgrounds than for women from poorer backgrounds. We found no evidence to support either theory among men. Overall, none of the interactions involving the education of parents or their adult children reached statistical significance. Our results are indicative of the importance of distinguishing between education and income for adults and their parents when adjudicating between these two theories.

Who benefits most from studying abroad? A conceptual and empirical overview

This editorial to the special issue on heterogeneous effects of studying abroad starts with a review of studies on the determinants and individual-level effects of studying abroad. On that basis, it illustrates the necessity to place more emphasis on effect heterogeneity in research on international student mobility. It then develops a typology of heterogeneous effects of studying abroad, which shall function as an agenda for future research in the field. Thereafter, the editorial introduces the contributions to the special issue. It concludes by summarising major findings and directions for future research.

Is College Completion Associated with Better Cognition in Later Life for People Who Are the Least, or Most, Likely to Obtain a Bachelor's Degree?

OBJECTIVES

Drawing on insights from theorizing on cumulative dis/advantage (CDA), we aimed to advance understanding of educational attainment as a protective factor for later-life cognition by examining whether associations between obtaining a bachelor's degree and later-life cognition differ according to individuals' likelihood of completing college based on characteristics in adolescence.

METHODS

We conducted a propensity score analysis with data from the Wisconsin Longitudinal Study (WLS). Measures to predict college completion were assessed prospectively in adolescence, and a global measure of later-life cognition was based on cognitive assessments at age 65.

RESULTS

College completion by age 25 (vs high school only) was associated with better later-life cognition for both men and women. Among men specifically, associations were stronger for those who were less likely as adolescents to complete college.

DISCUSSION

Results indicate the utility of a CDA perspective for investigating the implications of interconnected early life risk and protective factors for later-life cognition, as well as ways in which college education can both contribute to, as well as mitigate, processes of CDA.

Education and health: The joint role of gender and sexual identity

BACKGROUND

Prior research has found that education's association with health can differ by social positions such as gender. Yet, none of the existing work has tested whether the relationship between education and self-rated health is equivalent across sexual orientation groups, and additionally, if these associations differ for men and women. Deploying the intersectionality perspective, we expand current debates of education as a resource substitution or multiplication to include sexual orientation.

METHODS

We answer these questions using data from the Behavioral Risk Factor Surveillance System (BRFSS), a probability-based sample of adults living in 44 US states and territories for selected years between 2011 and 2017 (n = 1,219,382).

RESULTS

Supporting resource multiplication, we find that compared to their same-gender heterosexual counterparts, education is less health-protective for bisexual adults, especially bisexual women. Gay men and lesbian women, on the other hand, seem to have similar associations of education with health as their same-gender heterosexual counterparts. Turning to gender comparisons across sexual identity groups, we find that resource substitution may operate only among heterosexual women when compared with heterosexual men.

CONCLUSIONS

In sum, this study suggests that the relationship between education and health may depend on the intersection of gender and sexual orientation among U.S. adults.

The Effects of Education on Mortality: Evidence From Linked U.S. Census and Administrative Mortality Data

Does education change people's lives in a way that delays mortality? Or is education primarily a proxy for unobserved endowments that promote longevity? Most scholars conclude that the former is true, but recent evidence based on Danish twin data calls this conclusion into question. Unfortunately, these potentially field-changing findings-that obtaining additional schooling has no independent effect on survival net of other hard-to-observe characteristics-have not yet been subject to replication outside Scandinavia. In this article, we produce the first U.S.-based estimates of the effects of education on mortality using a representative panel of male twin pairs drawn from linked complete-count census and death records. For comparison purposes, and to shed additional light on the roles that neighborhood, family, and genetic factors play in confounding associations between education and mortality, we also produce parallel estimates of the education-mortality relationship using data on (1) unrelated males who lived in different neighborhoods during childhood, (2) unrelated males who shared the same neighborhood growing up, and (3) non-twin siblings who shared the same family environment but whose genetic endowments vary to a greater degree. We find robust associations between education and mortality across all four samples, although estimates are modestly attenuated among twins and non-twin siblings. These findings-coupled with several robustness checks and sensitivity analyses-support a causal interpretation of the association between education and mortality for cohorts of boys born in the United States in the first part of the twentieth century.

The Relationship Between Education and Health: Reducing Disparities Through a Contextual Approach

Adults with higher educational attainment live healthier and longer lives compared with their less educated peers. The disparities are large and widening. We posit that understanding the educational and macrolevel contexts in which this association occurs is key to reducing health disparities and improving population health. In this article, we briefly review and critically assess the current state of research on the relationship between education and health in the United States. We then outline three directions for further research: We extend the conceptualization of education beyond attainment and demonstrate the centrality of the schooling process to health; we highlight the dual role of education as a driver of opportunity but also as a reproducer of inequality; and we explain the central role of specific historical sociopolitical contexts in which the education-health association is embedded. Findings from this research agenda can inform policies and effective interventions to reduce health disparities and improve health for all Americans.

The prevalence of suicidal thoughts and behaviours among college students: a meta-analysis

BACKGROUND

Adolescence and young adulthood carry risk for suicidal thoughts and behaviours (STB). An increasing subpopulation of young people consists of college students. STB prevalence estimates among college students vary widely, precluding a validated point of reference. In addition, little is known on predictors for between-study heterogeneity in STB prevalence.

METHODS

A systematic literature search identified 36 college student samples that were assessed for STB outcomes, representing a total of 634 662 students [median sample size = 2082 (IQR 353-5200); median response rate = 74% (IQR 37-89%)]. We used random-effects meta-analyses to obtain pooled STB prevalence estimates, and multivariate meta-regression models to identify predictors of between-study heterogeneity.

RESULTS

Pooled prevalence estimates of lifetime suicidal ideation, plans, and attempts were 22.3% [95% confidence interval (CI) 19.5-25.3%], 6.1% (95% CI 4.8-7.7%), and 3.2% (95% CI 2.2-4.5%), respectively. For 12-month prevalence, this was 10.6% (95% CI 9.1-12.3%), 3.0% (95% CI 2.1-4.0%), and 1.2% (95% CI 0.8-1.6%), respectively. Measures of heterogeneity were high for all outcomes (I 2 = 93.2-99.9%), indicating substantial between-study heterogeneity not due to sampling error. Pooled estimates were generally higher for females, as compared with males (risk ratios in the range 1.12-1.67). Higher STB estimates were also found in samples with lower response rates, when using broad definitions of suicidality, and in samples from Asia.

CONCLUSIONS

Based on the currently available evidence, STB seem to be common among college students. Future studies should: (1) incorporate refusal conversion strategies to obtain adequate response rates, and (2) use more fine-grained measures to assess suicidal ideation.

DO BIOMARKERS VARY BY SOCIAL CLASS, EDUCATION AND REGION AND IS MIGRATION IMPORTANT? EVIDENCE FROM A COHORT OF BRITISH ADULTS

The aim of this study was to test whether Body Mass Index (BMI), waist circumference, systolic and diastolic blood pressure, Forced Expiratory Volume (FEV1) and Peak Expiratory Flow (PEF) vary in relation to social class at birth and adulthood, educational level and region of residence, and also with inter-generational social, educational and regional mobility/migration. The study used 5702 adults (2894 males and 2718 females) from the longitudinal British National Child Development Study (all children born in England, Scotland and Wales during the first week in March 1958 with follow-up throughout childhood and adulthood, most recently at 55 years of age). In both sexes BMI and waist circumference tended to increase from social classes I+II to IV+V and higher social class was associated with higher mean FEV1 and PEF. Better-educated adults tended to have lower BMI and waist circumference, and higher mean FEV1 and PEF. Women from Wales had the highest mean BMI and waist circumference but the lowest mean PEF, while women in Scotland had the highest mean systolic blood pressure and the lowest mean FEV1. For men only, FEV1 and PEF showed regional variation and the lowest mean FEV1 was in Wales and the lowest PEF in Yorkshire & Humberside. Inter-generational social mobility was not found to be associated with any of the biomarkers, while educational mobility was related only to FEV1 and PEF. In both sexes, in unadjusted regression analysis regional migrant cohort members tended to have a lower mean BMI than sedentes. Regional male migrants also tended to have a lower waist circumference and a higher FEV1 and PEF than sedentes.

Family of origin and educational inequalities in mortality: Results from 1.7 million Swedish siblings

Circumstances in the family of origin have short- and long-term consequences for people's health. Family background also influences educational achievements - achievements that are clearly linked to various health outcomes. Utilizing population register data, we compared Swedish siblings with different levels of education (1,732,119 individuals within 662,095 sibships) born between 1934 and 1959 and followed their death records until the end of 2012 (167,932 deaths). The educational gradient in all-cause mortality was lower within sibships than in the population as a whole, an attenuation that was strongest at younger ages (< 50 years of age) and for those with a working class or farmer background. There was substantial variation across different causes of death with clear reductions in educational inequalities in, e.g., lung cancer and diabetes, when introducing shared family factors, which may indicate that part of the association can be ascribed to circumstances that siblings have in common. In contrast, educational inequalities in suicide and, for women, other mental disorders increased when adjusting for factors shared by siblings. The vast variation in the role of childhood conditions for the education-mortality association may help us to further understand the interplay between family background, education, and mortality. The increase in the education gradient in suicide when siblings are compared may point towards individually oriented explanations ('non-shared environment'), perhaps particularly in mental disorders, while shared family factors primarily seem to play a more important role in diseases in which health behaviors are most significant.

Adult health returns to education by key childhood social and economic indicators: Results from representative European data

In the United States, associations between attained education and adult health typically are larger for those from disadvantaged childhood backgrounds. However, it remains unclear how specific key childhood indicators contribute to these adult health patterns, especially outside the United States. Drawing on the 2014 European Social Survey (20 countries; N=31544), we investigate the key childhood and adolescent indicators of parental education, childhood financial strain, and any serious household conflict growing up, given how these early exposures are known to correlate strongly with both educational attainment and adult health. In regressions with country fixed effects, we find across Europe that higher levels of education are more strongly linked to lessened adult depressive symptoms when childhood disadvantage is present in terms of lower levels of parental education or higher childhood financial strain specifically. However, adjusted predictions reveal that childhood financial strain contributes to this heterogeneity in educational returns far more strongly than parental education. For self-rated health, only childhood financial strain enhances estimated educational health benefits when considering all key childhood social and economic factors jointly. Similarly, childhood financial strain in particular enhances educational protection against overall rates of disease in adulthood. Overall, our findings support prior work on United States data revealing higher educational health returns given childhood disadvantage. At the same time, our findings across three distinct adult health indicators suggest the particular importance of childhood financial strain to understanding heterogeneity in educational health returns.

Health returns to education by family socioeconomic origins, 1980-2008: Testing the importance of gender, cohort, and age

Recent studies find that health returns to education are elevated among those who come from disadvantaged families. These findings suggest that education may be a health resource that compensates or “substitutes” for lower parental socioeconomic status. Alternatively, some studies find support for a cumulative (dis)advantage perspective, such that educational health returns are higher among those who already were advantaged, widening initial health (dis)advantages across the life course. However, it remains unclear whether these findings are dependent on gender or cohort, and this is a fundamental oversight given marked differences between men and women in educational and health inequalities across the twentieth century. Drawing on national US data (1980–2002 General Social Survey with 2008 National Death Index Link), I indeed find that the presence or strength of resource substitution or cumulative (dis)advantage depends upon health measure as well as gender and cohort. For self-rated health, cumulative (dis)advantage explains educational health disparities, but among men only. Cumulative (dis)advantage in avoiding fair or poor health is partly explained by cohort and age variation in health returns to education, and cumulative (dis)advantage in excellent health is more robust in earlier cohorts and at older ages. For mortality, resource substitution is instead supported, but for women only. Among those from disadvantaged families, educational mortality buffering increases with cohort but diminishes with age. Taken together, these findings confirm prior research showing that adult health inequalities linked to education depend on family background, and extend this work by demonstrating that the nature and extent of these dynamics differ considerably depending on the health outcome being assessed and on an individual's historical context, life course stage, and gender.

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Health returns to education often are higher for those from disadvantaged families.

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The importance of gender and historical variation to this pattern is unknown.

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Family advantage increases men′s educational gains in self-rated health.

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Educational mortality buffering is not present for advantaged women.

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Cohort and age modify gender-specific health gradients.

An education gradient in health, a health gradient in education, or a confounded gradient in both?

There is a positive gradient associating educational attainment with health, yet the explanation for this gradient is not clear. Does higher education improve health (causation)? Do the healthy become highly educated (selection)? Or do good health and high educational attainment both result from advantages established early in the life course (confounding)? This study evaluates these competing explanations by tracking changes in educational attainment and Self-rated Health (SRH) from age 15 to age 31 in the National Longitudinal Study of Youth, 1997 cohort. Ordinal logistic regression confirms that high-SRH adolescents are more likely to become highly educated. This is partly because adolescent SRH is associated with early advantages including adolescents' academic performance, college plans, and family background (confounding); however, net of these confounders adolescent SRH still predicts adult educational attainment (selection). Fixed-effects longitudinal regression shows that educational attainment has little causal effect on SRH at age 31. Completion of a high school diploma or associate's degree has no effect on SRH, while completion of a bachelor's or graduate degree have effects that, though significant, are quite small (less than 0.1 points on a 5-point scale). While it is possible that educational attainment would have greater effect on health at older ages, at age 31 what we see is a health gradient in education, shaped primarily by selection and confounding rather than by a causal effect of education on health.

Educational Inequalities in the Transition to Adulthood in Belgium: The Impact of Intergenerational Mobility on Young-Adult Mortality in 2001-2009

Several studies have focused on the association between parental and personal socioeconomic position (SEP) and health, with mixed results depending on the specific health outcome, research methodology and population under study. In the last decades, a growing interest is given to the influence of intergenerational mobility on several health outcomes at young ages. This study addresses the following research question: Is educational intergenerational mobility associated with all-cause and cause-specific mortality in young adulthood? To this end, the Belgian 1991 and 2001 censuses are used, providing characteristics of young persons at two time points (T1 = 01/03/91;T2 = 01/10/01) and follow-up information on mortality and emigration between T2 and 31/12/09 (T3). The study population consists of all official inhabitants of Flanders and the Brussels-Capital Region at T2, born between 1972 and 1982 and alive at T2. Parental and personal education are divided into primary (PE), lower secondary (LSE), higher secondary (HSE) and higher education (HE). We analyse mortality between T2 and T3 calculating age-standardised mortality rates (ASMRs) and using Cox regression (hazard ratios = HR). Personal rather than parental education determines the observed mortality rates, with high all-cause mortality rates among those with PE, irrespective of parental education (e.g., among men ASMR_PE-PE = 200.0 [95% CI 158.0–241.9]; ASMR_HE-PE = 319.7 [183.2–456.3]) and low all-cause mortality among those in higher education, regardless of parental education (ASMR_PE-HE = 41.7 [30.8–52.6]; ASMR_HE-HE = 38.0 [33.2–42.8]). There is some variation by gender and according to cause of death. This study shows the strong association between personal education and young-adult mortality.

Educational Inequalities in Health Behaviors at Midlife: Is There a Role for Early-life Cognition?

Education is a fundamental cause of social inequalities in health because it influences the distribution of resources, including money, knowledge, power, prestige, and beneficial social connections, that can be used in situ to influence health. Recent studies have highlighted early-life cognition as commonly indicating the propensity for educational attainment and determining health and age of mortality. Health behaviors provide a plausible mechanism linking both education and cognition to later-life health and mortality. We examine the role of education and cognition in predicting smoking, heavy drinking, and physical inactivity at midlife using data from the Wisconsin Longitudinal Study (N = 10,317), National Survey of Health and Development (N = 5,362), and National Childhood Development Study (N = 16,782). Adolescent cognition was associated with education but was inconsistently associated with health behaviors. Education, however, was robustly associated with improved health behaviors after adjusting for cognition. Analyses highlight structural inequalities over individual capabilities when studying health behaviors.

Variation in the Protective Effect of Higher Education Against Depression

Numerous studies document that higher education is associated with a reduced likelihood of depression. The protective effects of higher education, however, are known to vary across population subgroups. This study tests competing theories for who is likely to obtain a greater protective benefit from a college degree against depression through an analysis of data from the National Longitudinal Study of Adolescent Health and recently developed methods for analyzing heterogeneous treatment effects involving the use of propensity scores. The analysis examines how the effects of two "treatments" (at least some college education and attaining at least a four-year college degree) on latent depressive symptomology vary by background disadvantage, as indicated by having a low propensity for completing some college or attaining a four-year college degree. Results indicate that people from disadvantaged backgrounds realize a greater protective effect of higher education, either completing some college or attaining a four-year degree, against depressive symptomology than people from advantaged backgrounds. This pattern is more pronounced for people who attain at least a four-year degree than for people who complete at least some college education.