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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).

SUBMITTER: Behrman JR

PROVIDER: S-EPMC4323945 | biostudies-literature | 2015 Feb

REPOSITORIES: biostudies-literature

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Cross-sectional schooling-health associations misrepresented causal schooling effects on adult health and health-related behaviors: evidence from the Chinese Adults Twins Survey.

Behrman Jere R JR Xiong Yanyan Y Zhang Junsen J

Social science & medicine (1982) 20141108

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 ...[more]

PMID: 25464872

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Project description:BackgroundLittle attention has been paid to potential relationships between mental health, trauma, and personal exposures to Ebola virus disease (EVD) and health behaviors in post-conflict West Africa. We tested a conceptual model linking mental health and trauma to EVD risk behaviors and EVD prevention behaviors.Methods and findingsUsing survey data from a representative sample in the Western Urban and Western Rural districts of Sierra Leone, this study examines associations between war exposures, post-traumatic stress disorder (PTSD) symptoms, depression, anxiety, and personal EVD exposure (e.g., having family members or friends diagnosed with EVD) and EVD-related health behaviors among 1,008 adults (98% response rate) from 63 census enumeration areas of the Western Rural and Western Urban districts randomly sampled at the height of the EVD epidemic (January-April 2015). Primary outcomes were EVD risk behaviors (14 items, Cronbach's ? = 0.84) and EVD prevention behaviors (16 items, Cronbach's ? = 0.88). Main predictors comprised war exposures (8 items, Cronbach's ? = 0.85), anxiety (10 items, Cronbach's ? = 0.93), depression (15 items, Cronbach's ? = 0.91), and PTSD symptoms (16 items, Cronbach's ? = 0.93). Data were analyzed using two-level, population-weighted hierarchical linear models with 20 multiply imputed datasets. EVD risk behaviors were associated with intensity of depression symptoms (b = 0.05; 95% CI 0.00, 0.10; p = 0.037), PTSD symptoms (b = 0.10; 95% CI 0.03, 0.17; p = 0.008), having a friend diagnosed with EVD (b = -0.04; 95% CI -0.08, -0.00; p = 0.036), and war exposures (b = -0.09; 95% CI -0.17, -0.02; p = 0.013). EVD prevention behaviors were associated with higher anxiety (b = 0.23; 95% CI 0.06, 0.40; p = 0.008), having a friend diagnosed with EVD (b = 0.15; 95% CI 0.04, 0.27; p = 0.011), and higher levels of war exposure (b = 0.45; 95% CI 0.16, 0.74; p = 0.003), independent of mental health. PTSD symptoms were associated with lower levels of EVD prevention behavior (b = -0.24; 95% CI -0.43, -0.06; p = 0.009).ConclusionsIn post-conflict settings, past war trauma and mental health problems are associated with health behaviors related to combatting EVD. The associations between war trauma and both EVD risk behaviors and EVD prevention behaviors may be mediated through two key mental health variables: depression and PTSD symptoms. Considering the role of mental health in the prevention of disease transmission may help fight continuing and future Ebola outbreaks in post-conflict Sierra Leone. This sample is specific to Freetown and the Western Area and may not be representative of all of Sierra Leone. In addition, our main outcomes as well as personal EVD exposure, war exposures, and mental health predictors rely on self-report, and therefore raise the possibility of common methods bias. However, the findings of this study may be relevant for understanding dynamics related to EVD and mental health in other major capital cities in the EVD-affected countries of West Africa.

Project description:BackgroundDuring the COVID-19 pandemic, the internet has significantly spread information, providing people with knowledge and advice about health protection regarding COVID-19. While a previous study demonstrated that health and eHealth literacy are related to COVID-19 prevention behaviors, few studies have focused on the relationship between health literacy, eHealth literacy, and COVID-19-related health behaviors. The latter includes not only preventative behaviors but also conventional health behaviors.ObjectiveThe objective of this study was to develop and verify a COVID-19-related health behavior questionnaire, explore its status and structure, and examine the associations between these behaviors and participants' health literacy and eHealth literacy.MethodsA snowball sampling method was adopted to recruit participants to complete anonymous cross-sectional questionnaire surveys online that assessed sociodemographic information, self-reported coronavirus knowledge, health literacy, eHealth literacy, and COVID-19-related health behaviors.ResultsOf 1873 college students who were recruited, 781 (41.7%) had adequate health literacy; the mean eHealth literacy score was 30.16 (SD 6.31). The COVID-19-related health behavior questionnaire presented a two-factor structure-COVID-19-specific precautionary behaviors and conventional health behaviors-with satisfactory fit indices and internal consistency (Cronbach α=.79). The mean score of COVID-19-related health behaviors was 53.77 (SD 8.03), and scores differed significantly (P<.05) with respect to residence, college year, academic major, family economic level, self-reported health status, having a family member or friend infected with coronavirus, and health literacy level. Linear regression analysis showed that health literacy and eHealth literacy were positively associated with COVID-19-specific precautionary behaviors (βhealth literacy=.149, βeHealth literacy=.368; P<.001) and conventional health behaviors (βhealth literacy=.219, βeHealth literacy=.277; P<.001).ConclusionsThe COVID-19-related health behavior questionnaire was a valid and reliable measure for assessing health behaviors during the pandemic. College students with higher health literacy and eHealth literacy can more actively adopt COVID-19-related health behaviors. Additionally, compared to health literacy, eHealth literacy is more closely related to COVID-19-related health behaviors. Public intervention measures based on health and eHealth literacy are required to promote COVID-19-related health behaviors during the pandemic, which may be helpful to reduce the risk of COVID-19 infection among college students.

Project description:ObjectivesTo investigate health literacy profiles using a multidimensional tool in the elderly, analyze the factors related to health literacy, and explore the relationships between health literacy and health-related behaviors.MethodsA cross-sectional survey including 440 participants was conducted at a community health center and a village health center in Changsha, Hunan Province, between June 2020 and August 2020. We used the Health Literacy Questionnaire (HLQ) to assess the elderly's health literacy. Sociodemographic data and health-related behaviors of them were surveyed with a self-designed questionnaire. Latent profile analysis, Pearson's chi-squared and ordinal logistic regression were used to analyze the data.ResultsThe median age of the 440 respondents was 68 years. The participants had the lowest scores in the "appraisal of health information" subscale (2.22 ± 0.52), followed by "navigating the healthcare system" subscale (2.89 ± 0.81) of HLQ. Based on the analysis of three profiles, respondents who were 60-74 years (OR = 2.06, 95% CI: 1.23-3.42, P = 0.006), living in urban areas (OR = 3.28, 95% CI: 2.17-4.94, P < 0.001), with secondary education or above (OR = 2.86, 95% CI: 1.92-4.27, P < 0.001), and having health insurance (OR = 1.89, 95% CI: 1.02-3.51, P = 0.042) were significantly associated with health literacy. Statistically significant associations were found between health literacy level and health-related behaviors, including medical service-seeking behavior (χ 2 = 25.14, P < 0.001), exercising regularly (χ 2 = 34.08, P < 0.001), and taking a medical examination in the past 12 months (χ 2 = 24.76, P < 0.001).ConclusionThe multidimensional health literacy survey has identified the low health literacy level among the elderly in community settings. It revealed the relationships of sociodemographic characteristics, including age, education level and residence, with health literacy. These findings emphasized the importance of health literacy in promoting health behaviors, guiding a profound understanding of the Chinese elderly's health needs and health literacy to develop community-based health promotion interventions.

Dataset Information

Cross-sectional schooling-health associations misrepresented causal schooling effects on adult health and health-related behaviors: evidence from the Chinese Adults Twins Survey.

Publications

Cross-sectional schooling-health associations misrepresented causal schooling effects on adult health and health-related behaviors: evidence from the Chinese Adults Twins Survey.

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