Mechanisms Linking Low Educational Attainment with Health Problems: Examining Three Competing Hypotheses

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. The present study seeks to examine potential factors that may account for this link. Specifically, the present study posits and examines the following three competing hypotheses: 1) health behavior hypothesis; 2) access to service hypothesis; and 3) distress hypothesis.

 Method. Data are from the Seattle Social Development Project (n=808). Health outcomes include major depressive disorder, body mass index (BMI), number of self-reported chronic diseases, 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); those who graduated from high school were coded 1, and those who did not graduate were coded 0. Measures related to the health behavior hypothesis include substance use and physical activity (age 33). Measures related to the access to service hypothesis include having health insurance (age 33). Measures related to distress include financial distress, job-related distress, and stressful life events (age 33). Hypotheses were tested using a series of path analyses.

 Results. Lack of health insurance and higher levels of distress including stressful life events and lack of control at work accounted for the link between low educational attainment and major depressive disorder. Stressful life events explained the association between educational attainment and the BMI measure. For the association of educational attainment with chronic disease, two distress measures including stressful life events and financial distress emerged to be statistically significant mediators. Finally, smoking and all the distress measures explained the link between educational attainment and the general health item from the SF-36.

 Conclusions. Findings suggest that the distress hypothesis is supported for both mental and physical health, indicating that prevention efforts that attempt to mitigate the disproportionate levels of emotional and psychological distress that young adults with lower level of educational attainment face may be useful. Study findings also suggest that access to services plays a prominent role in linking low educational attainment with mental health. Prevention efforts should include increasing access to health services in order to reduce disparities in mental health problems among those of lower educational attainment. Future research on how this linkage may change during this time of sweeping changes to health care provision would be informative.