title: Cross-sectional schooling-health associations misrepresented causal schooling effects on adult health and health-related behaviors: evidence from the Chinese Adults Twins Survey.
abstract: Adult health outcomes and health behaviors are often associated with schooling. However, such associations do not necessarily imply that schooling has causal effects on health with the signs or magnitudes found in the cross-sectional associations. Schooling may be proxying for unobserved factors related to genetics and family background that directly affect both health and schooling. Recently several studies have used within-monozygotic (MZ) twins methods to control for unobserved factors shared by identical twins. Within-MZ estimates for developed countries are generally smaller than suggested by cross-sectional associations, consistent with positive correlations between unobserved factors that determine schooling and those that determine health. This study contributes new estimates of cross-sectional associations and within-MZ causal effects using the Chinese Adults Twins Survey, the first study of its type for developing countries. The cross-sectional estimates suggest that schooling is significantly associated with adult health-related behaviors (smoking, drinking, exercising) but not with own or spouse health outcomes (general health, mental health, overweight, chronic diseases). However, within-MZ-twins estimators change the estimates for approximately half of these health indicators, in one case declining in absolute magnitudes and becoming insignificant and in the other cases increasing in absolute magnitudes. Within-MZ estimates indicate significant pro-health effects for at least one of the indicators for own health (better mental health), own health-related behaviors (less smoking) and spouse health (less overweight).
authors.affiliation: William R. Kenan, Jr. Professor of Economics and Sociology, McNeil 160, 3718 Locust Walk, University of Pennsylvania, Philadelphia, PA 19104-6297, USA. Electronic address: jbehrman@econ.upenn.edu.
authors.forename: Jere R
authors.initials: JR
authors.lastname: Behrman
authors.affiliation: Associate Professor, School of Economics and Management, Southeast University, Nanjing, Jiangsu, China. Electronic address: xiongyanyan@seu.edu.cn.
authors.forename: Yanyan
authors.initials: Y
authors.lastname: Xiong
authors.affiliation: Wei Lun Professor of Economics, Department of Economics, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China. Electronic address: szhang@cuhk.edu.hk.
authors.forename: Junsen
authors.initials: J
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D015984:Causality; D002681:China / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004522:Educational Status; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006304:Health Status; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D050177:Overweight / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D064890:Social Determinants of Health; D012959:Socioeconomic Factors; D018454:Spouses / Q000706:statistics & numerical data*; D014430:Twins, Monozygotic / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Causal effects; China; Cross-spouse effects; Health; Schooling; Within-MZ-twins estimators