High School Composition and Health Outcomes in Adulthood: A Cohort Study.

Alison K Cohen,David H Rehkopf,Emily J Ozer,Barbara Abrams

doi:10.3390/ijerph18073799

Abstract

Background: A multitude of empirical evidence documents links between education and health, but this focuses primarily on educational attainment and not on characteristics of the school setting. Little is known about the extent to which aggregate characteristics of the school setting, such as student body demographics, are associated with adult health outcomes. Methods: We use the U.S. nationally representative National Longitudinal Survey of Youth 1979 cohort to statistically assess the association between two different measures of high school student composition (socioeconomic composition, racial/ethnic composition) and two different health outcomes at age 40 (self-rated health and obesity). Results: After adjusting for confounders, high school socioeconomic composition, but not racial/ethnic composition, was weakly associated with both obesity and worse self-rated health at age 40. However, after adding adult educational attainment to the model, only the association between high school socioeconomic composition and obesity remained statistically significant. Conclusions: Future research should explore possible mechanisms and also if findings are similar across other populations and in other school contexts. These results suggest that education policies that seek to break the link between socioeconomic composition and negative outcomes remain important but may have few spillover effects onto health.

Highlights

Myriad researchers have identified education as a key social determinant of health.The empirical research to support this claim focuses almost entirely on the positive association between educational attainment and health [1,2,3,4]
Since only one study has focused on adult obesity as an outcome, we found that school racial composition was associated with body mass index (BMI) cross-sectionally among adolescent girls [37] and that school socioeconomic composition in adolescence was associated with BMI in young adulthood [38]
Out of the 7961 respondents with information about both high school characteristics and self-rated health, 21.6% rated their health as excellent, 37.3% as very good, 27.9% as good, 11.0% as fair, and 2.2% as poor. Both those who were obese at age 40 and those with poorer health went to high schools with less advantaged student bodies, had less highly educated mothers and fathers, and had lower educational attainment themselves at age 25

Summary

Introduction

Myriad researchers have identified education as a key social determinant of health.The empirical research to support this claim focuses almost entirely on the positive association between educational attainment and health [1,2,3,4]. Education is comprised of the amount attained (quantity) and the quality of the education, including characteristics of the school setting. Reviews of research on education and health suggest that the quality of the school experience, not just the quantity, may affect health [5,6]. Education researchers and practitioners have focused on policies to improve the school setting. There is a long history of education policies focusing on school composition—primarily racial/ethnic, and socioeconomic—with the goal of positive life outcomes for students. About the extent to which such school setting characteristics, especially in the decades following court-mandated desegregation, are associated with health outcomes in adulthood (Figure 1). This paper investigates the relationship between the composition of the high school student body and health outcomes at age 40 in a recent, nationally representative American cohort

Methods

Results

Discussion

Conclusion