Tracking Health Inequalities from High School to Midlife

A longitudinal analysis of health inequalities from adolescence to young adulthood and their underlying causes

Research suggests that children of low-educated parents face greater health burdens during the passage from adolescence to young adulthood, as they are more likely to become low-educated themselves, establish behavioural and psychosocial disadvantages, or being exposed to unhealthy working conditions. However, studies examining the development and drivers of health inequalities during this particular life stage are limited in number and have produced varied results. This study investigates trajectories of self-rated health and overweight from 14 to 25 years of age, stratified by parental education, and explores the role of potential mediators (educational achievement, health behaviours, psychosocial factors, working conditions). We rely on prospective cohort data from the National Educational Panel Study (NEPS), a representative sample of 14,981 German ninth graders interviewed yearly from 2011 to 2021 (n = 90,096 person-years). First, we estimated random-effects growth curves for self-rated health and overweight over participants' age and calculated the average marginal effect of high versus low parental education. Second, a series of simulation-based mediation analyses were performed to test how much of health inequalities were explained by children's educational attainment (years of school education, years in university), health behaviours (smoking, alcohol, physical inactivity), psychosocial factors (number of grade repetitions, years in unemployment, chronic stress, self-esteem) and working conditions (physical and psychosocial job demands). We accounted for potential confounding by controlling for age, sex, migration background, residential area, household composition, and interview mode. Results show that higher parental education was related to higher self-rated health and lower probabilities of being overweight. Interaction between parental education and age indicated that, after some equalisation in late adolescence, health inequalities increased in young adulthood. Furthermore, educational attainment, health behaviours, psychosocial factors, and early-career working conditions played a significant role in mediating health inequalities. Of the variables examined, the level of school education and years spent in university were particular strong mediating factors. School education accounted for around one-third of the inequalities in self-rated health and one-fifth of the differences in overweight among individuals. Results support the idea that the transition to adulthood is a sensitive period in life and that early socio-economic adversity increases the likelihood to accumulate health disadvantages in multiple dimensions. In Germany, a country with comparatively low educational mobility, intergenerational continuities in class location seem to play a key role in the explanation of health inequalities in youth.

Mindset × Context: Schools, Classrooms, and the Unequal Translation of Expectations into Math Achievement

When do adolescents' dreams of promising journeys through high school translate into academic success? This monograph reports the results of a collaborative effort among sociologists and psychologists to systematically examine the role of schools and classrooms in disrupting or facilitating the link between adolescents' expectations for success in math and their subsequent progress in the early high school math curriculum. Our primary focus was on gendered patterns of socioeconomic inequality in math and how they are tethered to the school's peer culture and to students' perceptions of gender stereotyping in the classroom. To do this, this monograph advances Mindset × Context Theory. This orients research on educational equity to the reciprocal influence between students' psychological motivations and their school-based opportunities to enact those motivations. Mindset × Context Theory predicts that a student's mindset will be more strongly linked to developmental outcomes among groups of students who are at risk for poor outcomes, but only in a school or classroom context where there is sufficient need and support for the mindset. Our application of this theory centers on expectations for success in high school math as a foundational belief for students' math progress early in high school. We examine how this mindset varies across interpersonal and cultural dynamics in schools and classrooms. Following this perspective, we ask: 1. Which gender and socioeconomic identity groups showed the weakest or strongest links between expectations for success in math and progress through the math curriculum? 2. How did the school's peer culture shape the links between student expectations for success in math and math progress across gender and socioeconomic identity groups? 3. How did perceptions of classroom gender stereotyping shape the links between student expectations for success in math and math progress across gender and socioeconomic identity groups? We used nationally representative data from about 10,000 U.S. public school 9th graders in the National Study of Learning Mindsets (NSLM) collected in 2015-2016-the most recent, national, longitudinal study of adolescents' mindsets in U.S. public schools. The sample was representative with respect to a large number of observable characteristics, such as gender, race, ethnicity, English Language Learners (ELLs), free or reduced price lunch, poverty, food stamps, neighborhood income and labor market participation, and school curricular opportunities. This allowed for generalization to the U.S. public school population and for the systematic investigation of school- and classroom-level contextual factors. The NSLM's complete sampling of students within schools also allowed for a comparison of students from different gender and socioeconomic groups with the same expectations in the same educational contexts. To analyze these data, we used the Bayesian Causal Forest (BCF) algorithm, a best-in-class machine-learning method for discovering complex, replicable interaction effects. Chapter IV examined the interplay of expectations, gender, and socioeconomic status (SES; operationalized with maternal educational attainment). Adolescents' expectations for success in math were meaningful predictors of their early math progress, even when controlling for other psychological factors, prior achievement in math, and racial and ethnic identities. Boys from low-SES families were the most vulnerable identity group. They were over three times more likely to not make adequate progress in math from 9th to 10th grade relative to girls from high-SES families. Boys from low-SES families also benefited the most from their expectations for success in math. Overall, these results were consistent with Mindset × Context Theory's predictions. Chapters V and VI examined the moderating role of school-level and classroom-level factors in the patterns reported in Chapter IV. Expectations were least predictive of math progress in the highest-achieving schools and schools with the most academically oriented peer norms, that is, schools with the most formal and informal resources. School resources appeared to compensate for lower levels of expectations. Conversely, expectations most strongly predicted math progress in the low/medium-achieving schools with less academically oriented peers, especially for boys from low-SES families. This chapter aligns with aspects of Mindset × Context Theory. A context that was not already optimally supporting student success was where outcomes for vulnerable students depended the most on student expectations. Finally, perceptions of classroom stereotyping mattered. Perceptions of gender stereotyping predicted less progress in math, but expectations for success in math more strongly predicted progress in classrooms with high perceived stereotyping. Gender stereotyping interactions emerged for all sociodemographic groups except for boys from high-SES families. The findings across these three analytical chapters demonstrate the value of integrating psychological and sociological perspectives to capture multiple levels of schooling. It also drew on the contextual variability afforded by representative sampling and explored the interplay of lab-tested psychological processes (expectations) with field-developed levers of policy intervention (school contexts). This monograph also leverages developmental and ecological insights to identify which groups of students might profit from different efforts to improve educational equity, such as interventions to increase expectations for success in math, or school programs that improve the school or classroom cultures.

Human Capital Development Factors and Black Adolescent Tobacco and Cannabis Use

INTRODUCTION

This study examined the association of four domains of human capital development (cognitive development, social and emotional development, physical health, and mental health) and exclusive and concurrent tobacco and cannabis use (TCU) among black youth.

AIMS AND METHODS

Nationally representative annual cross-sectional data for black adolescents (12-17 years; N = 9017) in the National Survey on Drug Use and Health 2015-2019 were analyzed. Analyses examined the influence of human capital factors (cognitive development, social and emotional development, physical health, and mental health) on exclusive and concurrent TCU.

RESULTS

In total, 50.4% were males; prevalence of 12-month tobacco use fluctuated insignificantly between 5.6% and 7.6% across survey years. Similarly, prevalence of 12-month cannabis use remained relatively stable around 13%, with no significant linear change. Prevalence of concurrent TCU also fluctuated insignificantly between 3.5% and 5.3%. Investment in cognitive development decreased the odds of tobacco (aOR = 0.58, p < .001), cannabis (aOR = 0.64, p < .001), and concurrent tobacco and cannabis (aOR = 0.58, p < .001) use. Similarly, investment in social and emotional development reduced the odds of tobacco (aOR = 086, p < .001), cannabis (aOR = 0.83, p < .001), and concurrent tobacco and cannabis (aOR = 0.81, p < .001) use. Good physical health reduced the odds of tobacco (aOR = 0.52, p < .1), cannabis (aOR = 0.63, p < .05), and concurrent TCU (aOR = 0.54, p < .05). Major depressive episodes increased the likelihood of cannabis use (aOR = 1.62, p < .001).

CONCLUSIONS

Investment in cognitive, social, and emotional aspects of human capital development, and physical health among black youth is protective against TCU. Efforts to sustain human capital development among black adolescents may contribute to reducing TCU disparities.

IMPLICATIONS

This is one of few studies to examine human capital development factors and their associations with TCU among black youth. Efforts to eliminate tobacco/cannabis-related disparities among black youth should also invest in social, emotional, cognitive, and physical health development opportunities.

A values-aligned intervention fosters growth mindset-supportive teaching and reduces inequality in educational outcomes

Group-based educational disparities are smaller in classrooms where teachers express a belief that students can improve their abilities. However, a scalable method for motivating teachers to adopt such growth mindset-supportive teaching practices has remained elusive. In part, this is because teachers often already face overwhelming demands on their time and attention and have reason to be skeptical of the professional development advice they receive from researchers and other experts. We designed an intervention that overcame these obstacles and successfully motivated high-school teachers to adopt specific practices that support students' growth mindsets. The intervention used the values-alignment approach. This approach motivates behavioral change by framing a desired behavior as aligned with a core value-one that is an important criterion for status and admiration in the relevant social reference group. First, using qualitative interviews and a nationally representative survey of teachers, we identified a relevant core value: inspiring students' enthusiastic engagement with learning. Next, we designed a ~45-min, self-administered, online intervention that persuaded teachers to view growth mindset-supportive practices as a way to foster such student engagement and thus live up to that value. We randomly assigned 155 teachers (5,393 students) to receive the intervention and 164 teachers (6,167 students) to receive a control module. The growth mindset-supportive teaching intervention successfully promoted teachers' adoption of the suggested practices, overcoming major barriers to changing teachers' classroom practices that other scalable approaches have failed to surmount. The intervention also substantially improved student achievement in socioeconomically disadvantaged classes, reducing inequality in educational outcomes.

Arts for Whose Sake? Arts Course-taking and Math Achievement in US High Schools

Math achievement in U.S. high schools is a consistent predictor of educational attainment. While emphasis on raising math achievement continues, school-level interventions often come at the expense of other subjects. Arts courses are particularly at risk of being cut, especially in schools serving lower socioeconomic status youth. Evidence suggests, however, that arts coursework is beneficial to many educational outcomes. We use data on 20,590 adolescents from the High School Longitudinal Study of 2009 to answer two research questions: (1) Does student accumulation of fine arts courses across different topic areas relate positively to math test scores in high school? (2) Does school SES differentiate this potential association? Results indicate that youth attending higher-SES schools take more art courses and taking music courses is related to higher math test scores. However, this benefit only seems to only apply to more socially advantaged student bodies. Results reveal a site of additional educational advantage for already privileged youth.

The Roles of Adolescent Occupational Expectations and Preparation in Adult Suicide and Drug Poisoning Deaths within a Shifting Labor Market

Research suggests that economic declines contribute to mortality risks from suicide and drug poisoning, but how the economy impacts individuals' risks of these deaths has been challenging to specify. Building on recent theoretical advances, we investigate how adolescent occupational expectations and preparation contribute to suicide and drug poisoning deaths in a shifting economy. We use High School and Beyond data linked to adult mortality records for men that were exposed to a decline in labor market share and wages in predominantly blue-collar occupations during early adulthood. We find that adolescent men who expected these occupations had increased risks of suicide and drug poisoning death as adults net of educational and occupational attainment in early adulthood. Family background and occupational preparation are risk factors for death by drug poisoning but not suicide. Our findings improve our understanding of how labor market uncertainty shapes individuals' vulnerability to suicide and drug poisoning death.

U.S. Ninth Graders' Math Course Placement at the Intersection of Learning Disability Status, Race, and Socioeconomic Status

This study integrates an intersectional framework with data on 15,000 U.S. ninth graders from the High School Longitudinal Study of 2009 to investigate differences in ninth-grade math course placement at the intersection of adolescents' learning disability status, race, and socioeconomic status (SES). Descriptive results support an increased liability perspective, with the negative relationship between a learning disability and math course placement larger for adolescents more privileged in terms of their race and/or SES. Adjusted results suggest that the lower math course placements of youth with learning disabilities are due to cumulative disadvantage rather than disability-related inequities in the transition to high school for youth of diverse racial and socioeconomic backgrounds. In addition to demonstrating the importance of intersectional perspectives, this study provides a roadmap for future studies by introducing the new perspective of increased liability to be used in conjunction with the widely employed perspective of multiple marginalization.

Educational Inequality Regimes amid Algebra-for-All: The Provision and Allocation of Expanding Educational Opportunities

Schools can approach the task of sorting students to privileged learning opportunities in different ways, potentially creating distinct and durable educational inequality regimes. We test this idea by exploring variation in socioeconomic inequalities in advanced mathematics course-taking across California middle schools during a statewide algebra-for-all initiative. This case provides unique insight into local stratification processes since the state pressured schools to boost advanced course enrollments but provided little guidance about how to do so. We distinguish two critical organizational processes: the provision of different types of opportunities and the allocation of students to opportunities. The former, we argue, creates the potential for inequality; the latter determines what level of inequality is realized. Using panel data for all public middle schools in the state over a decade, we demonstrate a curvilinear association between opportunities and inequality, with disparities highest when opportunities are most differentiated. However, allocations at most schools were less unequal than would be expected under a test-based meritocratic allocation regime. Further, we find substantial school-level variation which is systematically related to organizational characteristics and consistent over time. These patterns provide evidence for local educational inequality regimes.

The relationship between postsecondary education and adult health behaviors

Nearly 80% of American adults between the ages of 33-44 have at least some postsecondary education, which ranges from vocational training to a doctorate or professional degree. However, in education-health studies, postsecondary credentials are often grouped into a limited number of categories. This is an important omission as it obscures differentiations between the various types of postsecondary credentials. This study provides the first comprehensive analysis of disparities in health behaviors across detailed levels of postsecondary education. Data comes from Wave 5 of the 2018 National Longitudinal Study of Adolescent to Adult Health (Add Health). A covariance-weighting technique is used to produce behavioral index scores that identify the full spectrum of health behaviors influenced by postsecondary educational attainment. Estimates are initially produced in aggregate for the total sample population, with interaction models subsequently being used to test differences across gender and race/ethnicity population subgroups. The aggregate results indicate that adults with at least a bachelor's degree exhibit healthier lifestyles; however, no difference is observed among adults with lower-level postsecondary credentials, compared to high school graduates. Women experience steeper gradients at higher levels of postsecondary education, compared to men. Both White and Hispanic American adults exhibit comparable health lifestyles across levels of postsecondary education; however, Black Americans were found to experience no returns except at the doctorate or professional degree level. These findings have important implications particularly as adults in their thirties and forties continue to exhibit troubling health and mortality trends.

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Adult health behaviors across detailed levels of postsecondary education.

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Estimates are provided both in aggregate and by the most influential population subgroups, including gender and race.

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Significant better health behaviors found among BA graduates and above.

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Lower or no returns found among sub-BA holders.

Teacher Mindsets Help Explain Where a Growth-Mindset Intervention Does and Doesn't Work

A growth-mindset intervention teaches the belief that intellectual abilities can be developed. Where does the intervention work best? Prior research examined school-level moderators using data from the National Study of Learning Mindsets (NSLM), which delivered a short growth-mindset intervention during the first year of high school. In the present research, we used data from the NSLM to examine moderation by teachers' mindsets and answer a new question: Can students independently implement their growth mindsets in virtually any classroom culture, or must students' growth mindsets be supported by their teacher's own growth mindsets (i.e., the mindset-plus-supportive-context hypothesis)? The present analysis (9,167 student records matched with 223 math teachers) supported the latter hypothesis. This result stood up to potentially confounding teacher factors and to a conservative Bayesian analysis. Thus, sustaining growth-mindset effects may require contextual supports that allow the proffered beliefs to take root and flourish.

How can we inspire nations of learners? An investigation of growth mindset and challenge-seeking in two countries

Here we evaluate the potential for growth mindset interventions (that teach students that intellectual abilities can be developed) to inspire adolescents to be "learners"-that is, to seek out challenging learning experiences. In a previous analysis, the U.S. National Study of Learning Mindsets (NSLM) showed that a growth mindset could improve the grades of lower-achieving adolescents, and, in an exploratory analysis, increase enrollment in advanced math courses across achievement levels. Yet, the importance of being a "learner" in today's global economy requires clarification and replication of potential challenge-seeking effects, as well as an investigation of the school affordances that make intervention effects on challenge-seeking possible. To this end, the present article presents new analyses of the U.S. NSLM (N = 14,472) to (a) validate a standardized, behavioral measure of challenge-seeking (the "make-a-math worksheet" task), and (b) show that the growth mindset treatment increased challenge-seeking on this task. Second, a new experiment conducted with nearly all schools in 2 counties in Norway, the U-say experiment (N = 6,541), replicated the effects of the growth mindset intervention on the behavioral challenge-seeking task and on increased advanced math course-enrollment rates. Treated students took (and subsequently passed) advanced math at a higher rate. Critically, the U-say experiment provided the first direct evidence that a structural factor-school policies governing when and how students opt in to advanced math-can afford students the possibility of profiting from a growth mindset intervention or not. These results highlight the importance of motivational research that goes beyond grades or performance alone and focuses on challenge-seeking. The findings also call attention to the affordances of school contexts that interact with student motivation to promote better achievement and economic trajectories. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Which Aspects of Education Matter for Early Adult Mortality? Evidence from the High School and Beyond Cohort

What dimensions of education matter for people's chances of surviving young adulthood? Do cognitive skills, non-cognitive skills, course taking patterns, and school social contexts matter for young adult mortality, even net of educational attainment? We analyze data from High School & Beyond-a nationally representative cohort of ~25,000 high school students first interviewed in 1980. Many dimensions of education are associated with young adult mortality, and high school students' math course taking retain their associations with mortality net of educational attainment. Our work draws on theories and measures from sociological and educational research and enriches public health, economic, and demographic research on educational gradients in mortality that has almost exclusively relied on ideas of human capital accumulation and measures of degree attainment. Our findings also call on social and education researchers to engage together in research on the life-long consequences of educational processes, school structures, and inequalities in opportunities to learn.

A national experiment reveals where a growth mindset improves achievement

A global priority for the behavioural sciences is to develop cost-effective, scalable interventions that could improve the academic outcomes of adolescents at a population level, but no such interventions have so far been evaluated in a population-generalizable sample. Here we show that a short (less than one hour), online growth mindset intervention-which teaches that intellectual abilities can be developed-improved grades among lower-achieving students and increased overall enrolment to advanced mathematics courses in a nationally representative sample of students in secondary education in the United States. Notably, the study identified school contexts that sustained the effects of the growth mindset intervention: the intervention changed grades when peer norms aligned with the messages of the intervention. Confidence in the conclusions of this study comes from independent data collection and processing, pre-registration of analyses, and corroboration of results by a blinded Bayesian analysis.

Mindsets: A View From Two Eras

A growth mindset is the belief that human capacities are not fixed but can be developed over time, and mindset research examines the power of such beliefs to influence human behavior. This article offers two personal perspectives on mindset research across two eras. Given recent changes in the field, the authors represent different generations of researchers, each focusing on different issues and challenges, but both committed to "era-bridging" research. The first author traces mindset research from its systematic examination of how mindsets affect challenge seeking and resilience, through the ways in which mindsets influence the formation of judgments and stereotypes. The second author then describes how mindset research entered the era of field experiments and replication science, and how researchers worked to create reliable interventions to address underachievement-including a national experiment in the United States. The authors conclude that there is much more to learn but that the studies to date illustrate how an era-bridging program of research can continue to be generative and relevant to new generations of scholars.