The Economic Value of Education for Longer Lives and Reduced Disability.

Policy Points Although it is well established that educational attainment improves health and longevity, the economic value of this benefit is unknown. We estimate that the economic value of education for longer, healthier lives is comparable to or greater than the value of education for lifetime earnings. Policies that increase rates of completion of high school and college degrees could result in longer, healthier lives and substantial economic value for the population. We provide a template for assigning an economic value to the health benefits associated with education or other social determinants, allowing policymakers to prioritize those interventions that yield the greatest value for the population. CONTEXT: Policymakers often frame the value of educational attainment in terms of economic outcomes (eg, employment, productivity, wages). But that approach may understate the value of education if it ignores the economic value of both longer lives and the reduced disability associated with more education. METHODS: In this article, we estimated the present value of the longer life and reduced disability associated with higher educational attainment at age 25 through age 84. We used prospective survival data and cross-sectional disability data from the National Health Interview Survey-Linked Mortality Files and drew on published estimates of the economic value of a statistical life. In addition, we used data from the Current Population Survey-Annual Social and Economic supplement to estimate the present value of education for lifetime earnings at age 25 through age 64 in order to provide a benchmark for comparing the value of education for health. FINDINGS: Compared with those with less than a high school degree, the longer lives of those with a high school degree are worth an additional $450,000 for males and $479,000 for females, and the additional disability-adjusted life for those with a high school degree is worth $693,000 for males and $757,000 for females. By comparison, the additional lifetime earnings for those with a high school degree, rather than less than a high school degree, is $213,000 for males and $194,000 for females. Compared with those with a high school degree, the longer lives for those with a baccalaureate degree are worth an additional $446,000 for males and $247,000 for females. The value of the additional disability-adjusted life associated with having a baccalaureate degree rather than a high school degree is $611,000 for males and $407,000 among females. By comparison, the additional lifetime earnings for those with a baccalaureate degree, rather than a high school degree, is $628,000 for males and $459,000 for females. CONCLUSIONS: The value of education for longer, healthier lives may surpass the value for earnings. Estimates of the economic value of the social determinants of health, such as education, can help policymakers prioritize those policies that provide the greatest value for population health.

Body Mass Transitions Through Childhood and Early Adolescence: A Multistate Life Table Approach.

The growing prevalence of overweight and obesity among children is well documented, but prevalence estimates offer little insight into rates of transition to higher or lower body mass index (BMI; weight (kg)/height (m)(2)) categories. We estimated the expected numbers of years children would live as normal weight, overweight, and obese by race/ethnicity and sex, given rates of transition across BMI status levels. We used multistate life table methods and transition rates estimated from prospective cohort data (2007-2013) for Denver, Colorado, public schoolchildren aged 3-15 years. At age 3 years, normal-weight children could expect to live 11.1 of the following 13 years with normal weight status, and obese children could expect to live 9.8 years with obese status. At age 3 years, overweight children could expect to live 4.5 of the following 13 years with normal weight status, 5.1 years with overweight status, and 3.4 years with obese status. Whites and Asians lived more years at lower BMI status levels than did blacks or Hispanics; sex differences varied by race/ethnicity. Children who were normal weight or obese at age 3 years were relatively unlikely to move into a different BMI category by age 15 years. Overweight children are relatively likely to transition to normal weight or obese status.

Mind the gap: race/ethnic and socioeconomic disparities in obesity.

Race/ethnic and socioeconomic status (SES) disparities in obesity are substantial and may widen in the future. We review nine potential mechanisms that recent research has used to explain obesity disparities. Those nine mechanisms fall into three broad groups-health behaviors, biological factors, and the social environment-which incorporate both proximate and upstream determinants of obesity disparities. Efforts to reduce the prevalence of obesity in the US population and to close race/ethnic and SES disparities in obesity will likely require the use of multifaceted interventions that target multiple mechanisms simultaneously. Unfortunately, relatively few of the mechanisms reviewed herein have been tested in an intervention framework.

Cumulative exposure to short sleep and body mass outcomes: a prospective study.

Short sleep duration is associated with excess body mass among adolescents and young adults. The mechanisms theorized to drive that association suggest that persistent exposure to short sleep should be associated with greater accumulations of body mass. We use prospective cohort data from four waves of the National Longitudinal Study of Adolescent to Adult Health (1994-2009; n = 14 800) to examine associations between cumulative exposure to short sleep throughout adolescence and early adulthood and obesity and elevated waist circumference outcomes. We compare several clinical and distribution-based standards of short sleep to assess which measures are associated most strongly with body mass. Cumulative exposure to short sleep exhibits dose-response associations with obesity and elevated waist circumference. Relative to respondents with no instances of short sleep, those who slept -0.50 standard deviations or less than the age and sex-specific average sleep hours in all four waves had 1.45 [95% confidence interval (CI): 1.03, 2.04] times the odds of being obese and 1.45 (95% CI: 1.02, 2.06) times the odds of having an elevated waist circumference. Our findings suggest that cumulative exposure to short sleep during adolescence and young adulthood may play an important role in the etiology of obesity and elevated waist circumference during this important developmental period.

Family structure and multiple domains of child well-being in the United States: a cross-sectional study.

BACKGROUND: We examine the association between family structure and children's health care utilization, barriers to health care access, health, and schooling and cognitive outcomes and assess whether socioeconomic status (SES) accounts for those family structure differences. We advance prior research by focusing on understudied but increasingly common family structures including single father families and five different family structures that include grandparents. METHODS: Our data on United States children aged birth through 17 (unweighted N = 198,864) come from the 1997-2013 waves of the National Health Interview Survey, a nationally representative, publicly available, household-based sample. We examine 17 outcomes across nine family structures, including married couple, cohabiting couple, single mother, and single father families, with and without grandparents, and skipped-generation families that include children and grandparents but not parents. The SES measures include family income, home ownership, and parents' or grandparents' (depending on who is in the household) employment and education. RESULTS: Compared to children living with married couples, children in single mother, extended single mother, and cohabiting couple families average poorer outcomes, but children in single father families sometimes average better health outcomes. The presence of grandparents in single parent, cohabiting, or married couple families does not buffer children from adverse outcomes. SES only partially explains family structure disparities in children's well-being. CONCLUSIONS: All non-married couple family structures are associated with some adverse outcomes among children, but the degree of disadvantage varies across family structures. Efforts to understand and improve child well-being might be most effective if they recognize the increasing diversity in children's living arrangements.

Do sleep-deprived adolescents make less-healthy food choices?

Short sleep duration among children and adolescents has been reported to be associated with elevated BMI and other adverse health outcomes. Food choices are one proposed mechanism through which this association may occur. In the present study, we examined whether self-reported habitual sleep duration is associated with vegetable and fruit consumption and fast food consumption. Using cross-sectional data from the National Longitudinal Study of Adolescent Health (n 13,284), we estimated three nested logistic regression models for two outcome variables: daily vegetable and fruit consumption and previous week's fast food consumption. The adjusted models included demographic and social/behavioural covariates. Self-reported habitual short sleep duration ( < 7 h/night) was associated with reduced odds of vegetable and fruit consumption compared with the recommended sleep duration (>8 h/night) (OR 0·66, P <0·001), even after adjusting for demographic and social/behavioural factors (OR 0·75, P <0·001). Short sleep duration was also associated with increased odds of fast food consumption (OR 1·40, P <0·001) even after adjustment (OR 1·20, P <0·05). Food choices are significantly associated with sleep duration and may play an important role in the mediation of the association between sleep and health among adolescents.

Increasing the percentage of energy from dietary sugar, fats, and alcohol in adults is associated with increased energy intake but has minimal association with biomarkers of cardiovascular risk.

The optimal diet composition to prevent obesity and its complications is unknown. Study aims were to determine the association of diet composition with energy intake, homeostatic model assessment-insulin resistance (HOMA-IR), and C-reactive protein (CRP). Data were from the NHANES for eligible adults aged 20-74 y from 2005 to 2006 (n = 3073). Energy intake and diet composition were obtained by dietary recall. HOMA-IR was calculated from fasting insulin and glucose concentrations, and CRP was measured directly. Changes for a 1-point increase in percentage of sugar, saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), polyunsaturated fatty acids (PUFAs), and alcohol were determined across their means in exchange for a 1-point decrease in percentage of nonsugar carbohydrates. Regression analyses were performed, and means ± SEs were estimated. Increasing the percentage of sugar was associated with increased energy intake in men (23 ± 5 kcal; P < 0.001) and women (12 ± 3 kcal; P = 0.002). In men, increasing percentages of SFAs (58 ± 13 kcal; P = 0.001) and PUFAs (66 ± 19 kcal; P < 0.001) were associated with increased energy intake. In women, increasing percentages of SFAs (27 ± 10 kcal; P = 0.02), PUFAs (43 ± 6 kcal; P < 0.001), and MUFAs (36 ± 13 kcal; P = 0.01) were associated with increased energy intake. Increasing the percentage of alcohol was associated with increased energy intake in men (38 ± 7 kcal; P < 0.001) and women (25 ± 8 kcal; P = 0.001). Obesity was associated with increased HOMA-IR and CRP in both genders (all P ≤ 0.001). Increasing PUFAs was associated with decreasing CRP in men (P = 0.02). In conclusion, increasing the percentage of calories from sugar, fats, and alcohol was associated with substantially increased energy intake but had minimal association with HOMA-IR and CRP.

Excess Deaths in the United States Compared to 18 Other High-Income Countries.

The U.S. is exceptional among high-income countries for poor survival outcomes. Understanding the distribution of excess deaths by age, sex, and cause of death, is essential for bringing U.S. mortality in line with international peers. We use 2016 data from the World Health Organization Mortality Database and the Human Mortality Database to calculate excess deaths in the U.S. relative to each of 18 high-income comparison countries. The U.S. experiences excess mortality in every age and sex group, and for 16 leading causes of death. For example, the U.S. could potentially prevent 884,912 deaths by achieving the lower mortality rates of Japan, the comparison country yielding the largest number of excess deaths, which would be comparable to eliminating all deaths from heart disease, unintentional injuries, and diabetes mellitus. In contrast, the U.S. could potentially prevent just 176,825 deaths by achieving the lower mortality rates of Germany, the comparison country yielding the smallest number of excess deaths, which would be comparable to eliminating all deaths from chronic lower respiratory diseases and assault (homicide). Existing research suggests that policies that improve social conditions and health behaviors are more likely to bring U.S. mortality in line with peer countries than policies that support health care access or new biomedical technologies. Achieving the death rates of peer countries could result in mortality reductions comparable to eliminating leading causes of death. Supplementary Information: The online version contains supplementary material available at 10.1007/s11113-023-09762-6.

Less Time for Health: Parenting, Work, and Time-Intensive Health Behaviors among Married or Cohabiting Men and Women in the United States.

Time spent working or caring for children may reduce the time available for undertaking time-intensive health behaviors. We test competing perspectives about how work hours and the number of children of specific ages will be associated with married or cohabiting men's and women's sleep duration and physical activity. We use data from the 2004 to 2017 waves of the National Health Interview Survey (N = 154,580). In support of the "time availability" perspective, longer work hours and children of any age are associated with shorter sleep hours. However, in support of the "time deepening" perspective, additional hours of work beyond 40 hours per week and children over the age of five are not associated with reduced physical activity. Contrary to our expectations, we did not find gender differences in support of our theories. Our results suggest that the economy of time works differently for sleep and exercise.

Psychological well-being, education, and mortality.

OBJECTIVES: Research on older adults often focuses on mitigating health risks, and less is known about protective factors that contribute to longer, healthier lives. We examine longitudinal associations between psychological well-being and mortality among a national sample of older adults and test competing hypotheses about whether the education/mortality association depends on the level of psychological well-being. METHOD: We use six waves (2006-2016) of the Health and Retirement Study, a national sample of adults over age 50 (n = 21,172), with 14 years of mortality follow-up. Psychological well-being is measured up to three times and includes positive affect, life satisfaction, purpose in life, social support, and optimism. Discrete-time survival models examine (a) the association between time-varying psychological well-being and mortality, and (b) interactions between psychological well-being and education on mortality. RESULTS: Higher purpose in life, positive affect, optimism, social support, and life satisfaction predicted lower mortality. A 1 SD increase in most measures of psychological well-being was associated with a 2-4 year increase in life expectancy at age 50. Positive affect and purpose in life moderated the education/mortality association-the inverse association between education and mortality was stronger for those with high psychological well-being. CONCLUSIONS: We find strong evidence that psychological well-being predicts lower mortality risk and modifies the association between education and mortality. The inverse association between education and mortality becomes stronger at higher levels of purpose in life and positive affect. Therefore, efforts to promote life satisfaction, social support, and optimism may support longer lives without widening education disparities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Developing Health Lifestyle Pathways and Social Inequalities across Early Childhood.

Lifestyles are a long-theorized aspect of social inequalities that root individual behaviors in social group differences. Although the health lifestyle construct is an important advance for understanding social inequalities and health behaviors, research has not theorized or investigated the longitudinal development of health lifestyles from infancy through the transition to school. This study documented children's longitudinal health lifestyle pathways, articulated and tested a theoretical framework of health lifestyle development in early life, and assessed associations with kindergarten cognition, socioemotional behavior, and health. Latent class analyses identified health lifestyle pathways using the US Early Childhood Longitudinal Study - Birth Cohort (ECLS-B; N≈6,550). Children's health lifestyle pathways were complex, combining healthier and unhealthier behaviors and changing with age. Social background prior to birth was associated with health lifestyle pathways, as were parents' resources, health behaviors, and non-health-focused parenting. Developing health lifestyle pathways were related to kindergarten cognition, behavior, and health net of social background and other parent influences. Thus, family context is important for the development of complex health lifestyle pathways across early childhood, which have implications for school preparedness and thus for social inequalities and well-being throughout life. Developing health lifestyles both reflect and reproduce social inequalities across generations.

Gender differences in chronic medical, psychiatric, and substance-dependence disorders among jail inmates.

OBJECTIVES: We investigated whether there were gender differences in chronic medical, psychiatric, and substance-dependence disorders among jail inmates and whether substance dependence mediated any gender differences found. METHODS: We analyzed data from a nationally representative survey of 6982 US jail inmates. Weighted estimates of disease prevalence were calculated by gender for chronic medical disorders (cancer, hypertension, diabetes, arthritis, asthma, hepatitis, and cirrhosis), psychiatric disorders (depressive, bipolar, psychotic, posttraumatic stress, anxiety, and personality), and substance-dependence disorders. We conducted logistic regression to examine the relationship between gender and these disorders. RESULTS: Compared with men, women had a significantly higher prevalence of all medical and psychiatric conditions (P < or = .01 for each) and drug dependence (P < .001), but women had a lower prevalence of alcohol dependence (P < .001). Gender differences persisted after adjustment for sociodemographic factors and substance dependence. CONCLUSIONS: Women in jail had a higher burden of chronic medical disorders, psychiatric disorders, and drug dependence than men, including conditions found more commonly in men in the general population. Thus, there is a need for targeted attention to the chronic medical, psychiatric, and drug-treatment needs of women at risk for incarceration, both in jail and after release.

Gender, acculturation, and health among Mexican Americans.

This study examines whether the relationship between acculturation and physical health varies by gender among Mexican Americans, and if the mechanisms that mediate the acculturation-health relationship operate differently by gender. Using the 1998-2007 National Health Interview Study, we construct a composite measure of acculturation and estimate regression models for the total number of health conditions, hypertension, heart disease, and diabetes. Immigrants with the lowest levels of acculturation are the healthiest, but this association is stronger for men. Medical care plays a central role in accounting for gender and acculturation differences across health outcomes-increased access to and utilization of medical care is associated with worse health, which suggests that better health among recent arrivals (particularly men) partially results from their lack of knowledge about their own poor health.

Invited commentary: toward a more comprehensive social epidemiology of marital trajectories and mortality.

In this issue of the Journal, Dupre et al. (Am J Epidemiol. 2009;170(5):546-555) use data from a nationally representative cohort of older US adults to examine the association of current marital status, timing of first marriage, number and kind of transitions out of marriage, and durations spent in various marital statuses with the risk of all-cause mortality. Their study offers a wealth of empirical findings that make important contributions to research on the relation between marital status and mortality. The richness of their findings suggests the need for future research to provide a more complete account of the mechanisms that lead from specific dimensions of marital status (and family structure more broadly) to mortality or other health outcomes over the life course.

Sleep duration in the United States: a cross-sectional population-based study.

Sleep duration is associated with cardiovascular disease and diabetes risk factors, depression, automobile and workplace accidents, and prospective mortality. Little is known, however, about sleep patterns in the US population. The 2004-2007 National Health Interview Survey-Sample Adult Files provide nationally representative data for 110,441 noninstitutionalized US adults aged 18 years or older, and multinomial logistic regression examines whether variables in 5 domains-demographic, family structure, socioeconomic, health behavior, and health status-are associated with long or short sleep duration. Being older, non-Hispanic black, or a current or former smoker; having low levels of education, income, or few income sources; consuming few or numerous drinks in a week; or reporting cardiovascular disease, diabetes, depression, underweight, or activity limitations is associated with increased odds of both long and short sleep duration. Other variables are associated with shorter (e.g., living with young children, being unmarried, working long hours, more frequent binge drinking) or longer (e.g., being younger, Mexican American, pregnant, or having low levels of physical activity) sleep hours. The authors identify numerous risk factors for long and short sleep; many of those variables are potential confounders of the relation between sleep hours and other health outcomes.

Being poor and coping with stress: health behaviors and the risk of death.

OBJECTIVES: Individuals may cope with perceived stress through unhealthy but often pleasurable behaviors. We examined whether smoking, alcohol use, and physical inactivity moderate the relationship between perceived stress and the risk of death in the US population as a whole and across socioeconomic strata. METHODS: Data were derived from the 1990 National Health Interview Survey's Health Promotion and Disease Prevention Supplement, which involved a representative sample of the adult US population (n = 40335) and was linked to prospective National Death Index mortality data through 1997. Gompertz hazard models were used to estimate the risk of death. RESULTS: High baseline levels of former smoking and physical inactivity increased the impact of stress on mortality in the general population as well as among those of low socioeconomic status (SES), but not middle or high SES. CONCLUSIONS: The combination of high stress levels and high levels of former smoking or physical inactivity is especially harmful among low-SES individuals. Stress, unhealthy behaviors, and low SES independently increase risk of death, and they combine to create a truly disadvantaged segment of the population.

Historical trends in height, weight, and body mass: data from U.S. Major League Baseball players, 1869-1983.

We employ a unique dataset of Major League Baseball (MLB) players - a select, healthy population - to examine trends in height, weight, and body mass in birth cohorts from 1869 to 1983. Over that 115-year time period, U.S. born MLB players have gained, on average, approximately 3 in. (7.6 cm) in height and 27.0 lb (12.2 kg) in weight, which has contributed a 1.6-unit increase in the body mass index. Where comparable data are available, U.S. born MLB players are about 2.0 in. (5.1cm) taller and 20.0 lb (9.1 kg) heavier but substantially less obese than males in the general U.S. population. But both groups exhibit similar height and weight trends; the majority of height and weight gains take place in cohorts that were born prior to World War II, followed by slower gains and occasional declines in height and weight for cohorts born in 1939 and later.

Do rising tides lift all boats? Racial disparities in health across the lifecourse among middle-class African-Americans and Whites.

Although racial inequalities in health are well documented, much less is known about the underlying mechanisms that create and sustain these population patterns, especially among nonpoor subgroups. Using 20 waves of data from the Panel Study of Income Dynamics (PSID), we estimate the magnitude of the Black/White gap in self-rated health among middle-income, working-age (18-65) adults and explore potential sources of this disparity. Findings from multilevel regression models suggest that intragenerational gains in family income result in significantly smaller improvements in self-rated health for middle-class African-Americans than similarly situated Whites. We also note that childhood disadvantage predicts subsequent health trajectories in adulthood, but does little to explain the Black/White gap in the association between family income and self-rated health. We conclude that middle-class status provides restricted health returns to upward mobility for African-Americans and this differential relationship cannot be accounted for by greater exposure to early life disadvantage.

Creating demand for prescription drugs: a content analysis of television direct-to-consumer advertising.

PURPOSE: American television viewers see as many as 16 hours of prescription drug advertisements (ads) each year, yet no research has examined how television ads attempt to influence consumers. This information is important, because ads may not meet their educational potential, possibly prompting consumers to request prescriptions that are clinically inappropriate or more expensive than equally effective alternatives. METHODS: We coded ads shown during evening news and prime time hours for factual claims they make about the target condition, how they attempt to appeal to consumers, and how they portray the medication and lifestyle behaviors in the lives of ad characters. RESULTS: Most ads (82%) made some factual claims and made rational arguments (86%) for product use, but few described condition causes (26%), risk factors (26%), or prevalence (25%). Emotional appeals were almost universal (95%). No ads mentioned lifestyle change as an alternative to products, though some (19%) portrayed it as an adjunct to medication. Some ads (18%) portrayed lifestyle changes as insufficient for controlling a condition. The ads often framed medication use in terms of losing (58%) and regaining control (85%) over some aspect of life and as engendering social approval (78%). Products were frequently (58%) portrayed as a medical breakthrough. CONCLUSIONS: Despite claims that ads serve an educational purpose, they provide limited information about the causes of a disease or who may be at risk; they show characters that have lost control over their social, emotional, or physical lives without the medication; and they minimize the value of health promotion through lifestyle changes. The ads have limited educational value and may oversell the benefits of drugs in ways that might conflict with promoting population health.

Health Lifestyle Behaviors among U.S. Adults.

Existing research that studies individual health behaviors and conceive of behaviors as simplistically reflecting narrow intentions toward health may obscure the social organization of health behaviors. Instead, we examine how eight health behaviors group together to form distinct health behavior niches. Using nationally-representative data from U.S. adults aged 18 and over from the 2004-2009 National Health Interview Survey (NHIS), we use Latent Class Analysis to identify classes of behavior based on smoking status, alcohol use, physical activity, physician visits, and flu vaccination. We identify 7 distinct health behavior classes including concordant health promoting (44%), concordant health compromising (26%), and discordant classes (30%). We find significant race/ethnic, sex, regional, and age differences in class membership. We show that health behavior classes are associated with prospective mortality, suggesting that they are valid representations of health lifestyles. We discuss the implications of our results for sociological theories of health behaviors, as well as for multiple behavior interventions seeking to improve population health.