title: Mechanisms linking high school graduation to health disparities in young adulthood: a longitudinal analysis of the role of health behaviours, psychosocial stressors, and health insurance.
abstract: OBJECTIVE
  This study examined three competing mechanisms in the link between educational attainment and health among young adults: (a) a health behaviour mechanism; (b) a psychosocial stressor mechanism; and (c) a health insurance mechanism. The central research question was the pervasiveness and specificity of these mechanisms in the link between low educational attainment and health outcomes during young adulthood.
  
  
  METHODS
  A prospective longitudinal study was conducted with 808 men and women followed to age 33 years in the USA.
  
  
  METHODS
  Health outcomes included major depressive disorder, obesity, chronic health conditions, and self-rated health. The focal predictor was educational attainment at age 21. The roles of the health behaviour mechanism (heavy episodic drinking, cigarette smoking, and meeting physical activity guidelines), the psychosocial stressor mechanism (stressful life events, perceived financial stress, and lack of control at work), and having health insurance (either through their employer or union or via family members) in the link between education and varying health outcomes were assessed using path analyses.
  
  
  RESULTS
  Lack of health insurance emerged as a statistically significant explanatory factor underlying the association of education with depression and self-rated health. Health behaviours, specifically smoking and physical activity, were statistically significant intervening factors for obesity and self-rated health.
  
  
  CONCLUSIONS
  The processes linking educational attainment to health inequalities begin unfolding during young adulthood. The salience of different mechanisms is specific to a health outcome rather than pervasive across multiple health outcomes. Public health policies with a broad spectrum of components, particularly focussing on smoking, physical activity, and lack of health insurance, are recommended to promote educational equalities in multiple health outcomes among young adults.
authors.affiliation: School of Social Work, University of Southern California, 669 W. 34th Street, Los Angeles, CA 90089-0411, USA. Electronic address: lee363@usc.edu.
authors.forename: J O
authors.initials: JO
authors.lastname: Lee
authors.affiliation: Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave NE, Suite 401, Seattle, WA 98115, USA. Electronic address: rickk@uw.edu.
authors.forename: R
authors.initials: R
authors.lastname: Kosterman
authors.affiliation: Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave NE, Suite 401, Seattle, WA 98115, USA. Electronic address: tjones03@uw.edu.
authors.forename: T M
authors.initials: TM
authors.lastname: Jones
authors.affiliation: Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave NE, Suite 401, Seattle, WA 98115, USA. Electronic address: tih@uw.edu.
authors.forename: T I
authors.initials: TI
authors.lastname: Herrenkohl
authors.affiliation: Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave NE, Suite 401, Seattle, WA 98115, USA. Electronic address: rhew@uw.edu.
authors.forename: I C
authors.initials: IC
authors.lastname: Rhew
authors.affiliation: Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave NE, Suite 401, Seattle, WA 98115, USA. Electronic address: catalano@uw.edu.
authors.forename: R F
authors.initials: RF
authors.lastname: Catalano
authors.affiliation: Social Development Research Group, School of Social Work, University of Washington, 9725 3rd Ave NE, Suite 401, Seattle, WA 98115, USA. Electronic address: jdh@uw.edu.
authors.forename: J D
authors.initials: JD
authors.lastname: Hawkins
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003865:Major Depressive Disorder / Q000453:epidemiology; D059026:Diagnostic Self Evaluation; D004522:Educational Status; D005260:Female; D015438:Health Behavior; D054624:Health Status Disparities; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D009765:Obesity / Q000453:epidemiology; D011446:Prospective Studies; D013315:Stress, Psychological / Q000523:psychology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Education; Health behaviours; Health inequalities; Health insurance; Psychosocial distress; Young adults