title: Educational attainment and health transitions over the life course: testing the potential mechanisms.
abstract: It has been shown that higher education associates with health outcomes, but the less is known about the specific mechanisms mediating this association. We examined whether higher education would associate with long-term health transitions from childhood to adulthood and whether health behaviors, self-esteem, social support and work-related health hazards could mediate or confound this association.
  
  
  
  The participants were from a population-based sample of 3596 men and women from the Young Finns study aged 3-18 years at the beginning of the study in 1980, and who responded to repeated surveys of educational attainment and self-rated health in four study phases from 1997 to 2012. The associations were tested using multistate Markov models for the health-state transition intensities.
  
  
  
  Our results suggested that a 1-year difference in education was related to a 16% higher transition probability from mediocre to good self-rated health over the 5-year follow-up. Depressive symptoms and job strain seemed to partly mediate or confound the association, but self-esteem and social support did not.
  
  
  
  These results suggest that educational attainment is associated with good self-rated health transitions from childhood to adulthood, and multiple processes rather than a single underlying mechanism are likely to drive the educational differences in self-rated health.
authors.affiliation: Institute of Behavioral Sciences, University of Helsinki, PO Box 9, 00014 Helsinki, Finland National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland.
authors.forename: Marko
authors.initials: M
authors.lastname: Elovainio
authors.affiliation: Institute of Behavioral Sciences, University of Helsinki, PO Box 9, 00014 Helsinki, Finland.
authors.forename: Tom
authors.initials: T
authors.lastname: Rosenström
authors.affiliation: Institute of Behavioral Sciences, University of Helsinki, PO Box 9, 00014 Helsinki, Finland.
authors.forename: Christian
authors.initials: C
authors.lastname: Hakulinen
authors.affiliation: Institute of Behavioral Sciences, University of Helsinki, PO Box 9, 00014 Helsinki, Finland Helsinki Collegium for Advanced Studies, University of Helsinki, Helsinki, Finland.
authors.forename: Laura
authors.initials: L
authors.lastname: Pulkki-Råback
authors.affiliation: Institute of Behavioral Sciences, University of Helsinki, PO Box 9, 00014 Helsinki, Finland.
authors.forename: Sari
authors.initials: S
authors.lastname: Mullola
authors.affiliation: Institute of Behavioral Sciences, University of Helsinki, PO Box 9, 00014 Helsinki, Finland.
authors.forename: Markus
authors.initials: M
authors.lastname: Jokela
authors.affiliation: Institute of Behavioral Sciences, University of Helsinki, PO Box 9, 00014 Helsinki, Finland.
authors.forename: Kim
authors.initials: K
authors.lastname: Josefsson
authors.affiliation: Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland.
authors.forename: Olli T
authors.initials: OT
authors.lastname: Raitakari
authors.affiliation: Institute of Behavioral Sciences, University of Helsinki, PO Box 9, 00014 Helsinki, Finland.
authors.forename: Liisa
authors.initials: L
authors.lastname: Keltikangas-Järvinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D055815:Young Adult
keywords: Markov-models; education; socioeconomic; trajectories; young Finns