Three Competing Mechanisms Linking High School Graduation to Health Disparities Among Young Adults

Background. Research provides increasing evidence of the inverse association of educational attainment with mental and physical health. What warrants further inquiry is how lower level of educational attainment is associated with increased susceptibility to health problems.

Furthermore, relatively few relevant studies have focused on young adults. Studies of young adults in this topic area are needed since the prevalence of important health problems, such as obesity is substantial by the 30s, health trajectories that portend worsening health problems are established during young adulthood, and health disparities start widening at this age.

To address this important research gap, the present study seeks to examine factors that may account for this link among young adults. Specifically, the present study posits and examines the following three competing hypotheses: 1) a health behavior hypothesis; 2) an access to health service hypothesis; and 3) a psychosocial stressor hypothesis. The central research question in the present study is the pervasiveness and specificity of multiple mechanisms in this link between low educational attainment and varying health outcomes during young adulthood.

Method. Data are from the Seattle Social Development Project (n=808). Health outcomes include major depressive disorder, obesity, the number of self-reported chronic health conditions, and the general health item from the SF-36, which were all measured in adulthood (age 33). Educational attainment was measured in young adulthood (age 21) by a binary indicator of high school graduation. It has been shown that completion of a degree, rather than an additional year of schooling, is associated with improvement in health, and the majority of participants at the age 21 survey had not completed a postsecondary degree. Measures related to the health behavior hypothesis include heavy episodic drinking, smoking, and physical activity. Access to health services were measured by the presence or lack of health insurance. Measures related to the psychosocial stressor hypothesis include financial distress, job-related distress, and stressful life events. Hypotheses were tested using a series of path analyses.

Results. Lack of health insurance accounted for the link between low educational attainment and major depressive disorder. Physical activity emerged to be a statistically significant explanatory factor underlying the association of education with obesity. Health behaviors, specifically smoking and physical activity, were statistically significant intervening factors for the general health item from the SF-36, along with lack of health insurance.

Conclusions. The process linking educational attainment to health inequalities are already unfolding during young adulthood. To our question of the pervasiveness or specificity of the role of hypothesized mechanisms in the link between educational attainment and varying health outcomes, different intervening factors were evident for varying health measures. The mechanisms accounting for the link between education and health outcomes are not uniform, which may necessitate a broad spectrum of social work practice and policy components to promote educational equalities in a wide range of health outcomes among young adults.