Abstract
BACKGROUND: Recent research recognizing the socioeconomic influence of educational attainment on population health, including cardiovascular health (CVH), suggests that modifying educational policy to improve educational outcomes could be an effective approach to improving health outcomes. Although the positive association of educational level with health status is well documented, the effect of education policy on health outcomes is not as thoroughly studied. Identifying relationships amongst educational policy and CVH could provide a target for public policy initiatives designed to positively impact population health. OBJECTIVE: The objective was to examine the potential effect of varying county educational policy on county and individual CVH outcomes. METHODS: Variables of county educational policy were expenditures per pupil, percent of total revenue from each state and local sources, and pupil teacher ratios. School district data from 1997-2005 sourced from the National Center for Education Statistics were adjusted for inflation using the U.S. Dept. of Labor Consumer Price Index as well as regional cost differences using the NCES Comparable Wage Index by school district, and grouped by county. County and individual CVH for 2011 was scored using the AHA’s CVH metric and data from the Behavioral Risk Factor Surveillance System. Linear regression models were used to compare the county means for each education policy variable with both county and individual CVH scores. RESULTS: Mean percent revenue from local sources and mean pupil teacher ratio were both shown to be positively associated with county level CVH (p=0.007 and p=0.023). Individual CVH was inversely associated with mean expenditures per pupil (p=0.023), and positively associated with mean percent revenue from local (p<0.01), mean percent revenue from state (p<0.01), and mean pupil teacher ratio (p<0.001). There was an interactive effect between mean expenditure per pupil and county urbanicity on county CVH (p<0.05), which differed in rural counties compared to the most urban. There was also an interactive effect between mean percent revenue from local and county urbanicity on county CVH (p<0.001). Although no significant effect was observed for mean expenditures per pupil on county CVH, mean expenditures per pupil was inversely related to county CVH in the most urban counties (b=-3.58e-06), and positively related to county CVH in most rural counties (b=4.62e-06). Evidence of relationships between county educational policies and resources with CVH suggests the need for continued research more thoroughly examining variables of education policy as indicators for CVH. CONCLUSION: Further clarification of these relationships will help determine if educational policy adjustments driven by health improvement initiatives would be a useful addition to current strategies aimed at improving population health.
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