Education and health knowledge: evidence from UK compulsory schooling reform

The burden of acute lymphoid leukemia among adolescents and young adults in the Western Pacific Region: evidence from Global Burden Disease 2019

PURPOSE

Acute lymphoblastic leukemia (ALL) is a type of blood cancer that affects white blood cells. Here, we use data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, to estimate the burden and incidence rate changes in adolescents and young adults (AYA) ALL in the Western Pacific Region and to reveal potential risk factors of incidence- and mortality rates.

METHODS

The GBD 2019 study data was stratified by sex, age, country, and territory. We calculated the Estimated annual percentage changes (estimated APC) in mortality and incidence rates for each of the 25 countries and territories of the western Pacific region from 1990 to 2019.

RESULTS

This study found global AYA ALL incidence rates had increased while the mortality rates had decreased between 1990 and 2019. Moreover, healthcare access and quality (HAQ), and government per capita health spending were identified as country-level risk factors of AYA ALL incidence rates, while HAQ, male education, and sex were identified as mortality rate predictors in 25 Western Pacific Region countries.

CONCLUSION

To address and reduce the burden of incidence and mortality among AYA, various regions around the world, particularly developing countries, could revise their AYA prevention and treatment strategies.

Does higher education matter for health in the UK?

Using six sweeps of data from the 1958 British National Child Development Study (NCDS), we employ a quasi-parametric approach of propensity score matching to estimate the impacts of higher education attainment on a wide range of health-related outcomes for cohorts at ages 33, 42, and 50. The non-pecuniary benefits of higher education on health are substantial. Cohorts with higher levels of education are more likely to report better health, maintain a healthy weight, refrain from smoking, exhibit a lower frequency of alcohol consumption, and are less likely to be obese. The effects on self-reported health, body mass index (BMI), drinking alcohol increase with age, but continuously decrease with smoking frequency. When considering gender heterogeneity, higher education has a more significant effect on BMI and the likelihood of obesity for males, while it has a greater impact on self-reported health, drinking alcohol, and smoking frequencies for females. Furthermore, we find no significant evidence that higher education reduces the likelihood of depression. The results of the Rosenbaum bounds sensitivity analysis suggest that, although our overall results demonstrate robustness, there may still be unobserved hidden bias in the relationship between higher education and self-reported health.

Declined prevalence, improved awareness and control of hypertension are associated with spousal educational attainment: A mega-data study

Cardiovascular diseases, including hypertension, have posed a serious threat to human health in recent decades. Family-centered health promotion and disease control for the management of hypertension is gaining attention. In this study, we assessed the association between spousal educational attainment (SEA) and hypertension prevalence, awareness, and control, intending to provide new directions for family health care. A total of 71 211 191 reproductive-aged participants from the National Free NFPCP during 2013-2019 were included in the current study. Inverse probability weighting (IPW) via propensity models were used to adjust for the imbalance by SEA. Both multivariable-adjusted ORs and inverse-probability-weighted ORs were used to assess the association between SEA and the prevalence, awareness, and control of hypertension. ORs of prevalence, awareness, and control of hypertension with SEA stratified by sex, age, and residency type were also reported. Compared with participants with SEA of compulsory education, the inverse-probability-weighted ORs for hypertension were 0.97 (0.96-0.97), 0.99 (0.98-1.00), and 0.91 (0.88-0.93) for participants with SEA of senior high, college, and postgraduate, respectively. The corresponding ORs for hypertension awareness were 1.12 (1.10-1.13), 1.15 (1.13-1.16), and 1.38 (1.34-1.41). The increment of hypertension control associated with SEA was only identified in urban areas. Modification analyses revealed that urban participants were observed to have more healthy benefits associated with SEA; additional decreased prevalent hypertension and increased hypertension awareness associated with SEA were observed in wives and husbands respectively. Thus, SEA was associated with decreased prevalent hypertension and increased awareness and control of hypertension. Our findings call for increased participation of spouses in family-centered healthcare, with consideration of modified effects by gender, age, and residency type, to improve chronic disease prevention and control including hypertension.

Does Schooling Have Lasting Effects on Cognitive Function? Evidence From Compulsory Schooling Laws

This study assesses whether an additional year of secondary schooling has lasting causal effects on cognitive function. I use data from Understanding Society, the largest longitudinal household study in the United Kingdom, and exploit quasi-experimental variation in schooling from the 1972 raising of the school-leaving age in England and Wales. This reform increased the minimum secondary school‒leaving age from 15 to 16 years. Cognitive function outcomes were measured when participants were aged 48 to 60. Using a fuzzy regression discontinuity design, I show that remaining in school until age 16 improved working memory by one third to one half of a standard deviation. I find limited evidence for causal effects on verbal fluency and measures of numeric ability. Analyses of potential mechanisms showed statistically significant effects of remaining in school until age 16 on the type of occupation entered immediately after leaving school and at older ages. These patterns are consistent with basic education improving cognitive outcomes through occupation choice. The findings are robust to sensitivity analyses.

Does Children's Education Improve Parental Health and Longevity? Causal Evidence from Great Britain

Parents with better-educated children are healthier and live longer, but whether there is a causal effect of children's education on their parents' health and longevity is unclear. First, we demonstrate an association between adults' offspring education and parental mortality in the 1958 British birth cohort study, which remains substantial-about two additional years of life-even when comparing parents with similar socioeconomic status. Second, we use the 1972 educational reform in England and Wales, which increased the minimum school leaving age from 15 to 16 years, to identify the presence of a causal effect of children's education on parental health and longevity using census-linked data from the Office for National Statistics Longitudinal Study. Results reveal that children's education has no causal effects on a wide range of parental mortality and health outcomes. We interpret these findings discussing the role of universal health care and education for socioeconomic inequality in Great Britain.

Does comprehensive education reduce health inequalities?

This article analyses the impact of comprehensive education on health inequalities. Given that education is an important social determinant of health, it is hypothesised that a more equitable comprehensive system could reduce health inequalities in adulthood. To test this hypothesis, we exploited the change from a largely selective to a largely comprehensive system that occurred in the UK from the mid-1960s onwards and compare inequalities in health outcomes of two birth cohorts (1958 and 1970) who attended either system. We studied physical and mental health, health behaviours and life satisfaction in middle age as outcomes and absolute and relative inequalities by social class (of origin and destination) and education. Inverse probability weighting was used to control confounding by socio-economic and education background, and ability test score taken prior to secondary school entry. We did not find consistent evidence that health inequalities were smaller under the comprehensive compared to the selective system and the results were robust under different model specifications. Our study adds to the sparse but growing literature that assesses the impact of social policy on health inequalities.

Spillover effects of adult children's schooling on parents' smoking cessation: evidence from China's compulsory schooling reform

OBJECTIVE

As elderly parents today will share a longer life with their children than ever before, the spillover effects of children's human capital on parents' well-being become increasingly important. This study investigated whether children's schooling leads parents to give up smoking and whether the effects were moderated by their education or child-parent contact frequency.

METHODS

Using data from the China Health and Retirement Longitudinal Study, we conducted an instrumental variable (IV) analysis using China's compulsory schooling reform in the 1980s as a natural experiment.

RESULTS

The IV estimates suggest that elderly parents of more highly educated children are more likely to quit smoking. Moreover, the effects are more significant among parents who had not finished primary school and also slightly stronger among parents who live close to their children or meet their children frequently.

DISCUSSION

Our findings add to current evidence regarding spillover effects of education on smoking cessation. A child's education may exert an impact through the spillover of health knowledge.

The Path Analysis of Family Doctor's Gatekeeper Role in Shanghai, China: A Structural Equation Modeling (SEM) Approach

Studies globally have provided substantial evidence that PHC could conduct doctor-visiting behaviors, control medical expense, and improve population health. This study aimed to map how family doctor (FD) in Shanghai achieved gate-keeper goals including health management, medical expense control, and conducting ordered doctor-visiting behavior. A total of 2754 and 1995 valid questionnaires were collected in 2013 and 2016 respectively in Shanghai. The data were analyzed using structural equation modeling (SEM). Invariance analysis was also performed for 2 waves of data. We found that the coefficient of cognition on health management (β₅ = 0.26, P < .05) was larger than that of signing with FD (β₄ = 0.06, P < .05). SEM model also showed that first-contact at community health service center (CHSC) had a positive effect on health management (β₆ = 0.30, P < .05), and the latter also affected health management results positively (β₈ = 0.39, P < .05), suggesting that the path for FD was through first-contact and health management. Besides, the gate-keeper role of medical expense control was significant through the first-contact (β₁₀ = −0.12, P < .05) mediation rather than health management (β₉ = 0.03, P > .05). The model fit was acceptable (RMSEA = 0.033). A “cognition-behavior-outcomes (health and medical expense)” path of FD’s gate-keeper role was found. It is necessary to consolidate FD contracted services rather than reimbursement discount the latter of which is proved to be unsustainable.

Do Health-Seeking Populations Know the Link Between Human Papillomavirus and Oropharyngeal Cancer? A Cross-Sectional Study in a Nigerian Population

BACKGROUND

The human papillomavirus (HPV) has been causally linked to oropharyngeal cancers. The extent to which the population is aware of this link has not been explored in Nigeria. We aim to investigate the knowledge of the link between HPV and oropharyngeal cancers in a health-seeking population in Nigeria.Methodology: We used a cross-sectional study design, with a multi-stage sampling method comprising a cluster of four health facilities and first-time adult patients attending the general outpatient clinics of the selected health facilities. An interviewer-administered questionnaire was be used to obtain demographic information, social history, HPV awareness, HPV vaccination and the link between HPV and oropharyngeal cancer.

RESULTS

A total of 1,000 respondents completed the survey from four health facilities in Lagos, Nigeria. Majority of respondents were below 40 years (61.5%), and female (53.4%). About 13.4% of the study population were aware of HPV, and 7.9% of HPV vaccines. The most common source of HPV information for respondents who were aware of HPV was the internet (65.4%). Only 7.7% of respondents knew the link between HPV and oropharyngeal cancer. Significant predictors of knowledge of the link between HPV and oropharyngeal cancer were higher education [p: 0.012], higher overall knowledge of HPV risk factors and complications [p: 0.000]; and awareness of HPV vaccine [p: 0.020].

CONCLUSIONS

Our findings suggest a lack of public knowledge of the link between HPV and oropharyngeal cancer. These findings could inform health promotion measures for oropharyngeal cancer, particularly for groups where knowledge is lowest.

Sex differences in the association between latent class of lifestyle and disability among older adults in China

Background

A healthy lifestyle may prevent disability for older adults. But research to date is limited to a single lifestyle behavior and ignore sex difference in the lifestyle-disability association. This study aimed at identifying sex-specific latent classes of lifestyle and their relationship with disability among older Chinese adults.

Methods

Data were obtained from adults aged 65 years or above in the 2018 Chinese Longitudinal Healthy Longevity Survey, a nationally representative sample of older adults in China. We used latent class analysis to categorize participants into subgroups based on three dimensions of lifestyle factors: health behaviors, psychological wellbeing, and social engagement. Disability was assessed by the activities of daily living (ADL). Multivariable logistic regression was used to evaluate the associations between the latent lifestyle classes and disability.

Results

A total of 15,771 older adults were included in this analysis, of whom 56% were women and 66% aged 80 years or above. We identified four latent lifestyle classes among older women: “Health Promoting” (28%), “Isolated and Health Harming” (34%), “Restless and Dismal” (21%), and “Restless” (17%). A different set of four lifestyle classes were identified in older men: “Health Promoting” (21%), “Isolated and Health Harming” (26%), “Restless and Dismal” (20%), and “Discordant” (33%). Compared with the “Health Promoting” class, the “Isolated and Health Harming” class (OR = 1.88, 95% CI: 1.46–2.43) and the “Restless and Dismal” class (OR = 1.67, 95% CI: 1.27–2.20) had higher risk of disability in women. The “Discordant” class had lower risk of disability in men (OR = 0.52, 95% CI: 0.37–0.72).

Conclusions

Our analyses revealed different lifestyle patterns for older women and men in China. Sex differences in the associations between lifestyle and disability need to be considered when formulating interventions to prevent disability.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02087-z.

The causal effect of education on chronic health conditions in the UK

We study the causal impact of education on chronic health conditions by exploitng two UK education policy reforms. The first reform raised the minimum school leaving age in 1972 and affected the lower end of the educational attainment distribution. The second reform is a combination of several policy changes that affected the broader educational attainment distribution in the early 1990s. Results are consistent across both reforms: an extra year of schooling has no statistically identifiable impact on the prevalence of most chronic health conditions. The exception is that both reforms led to a statistically significant reduction in the probability of having diabetes, and this result is robust across model specifications. However, even with the largest survey samples available in the UK, we are unable to statistically rule out moderate size educational effects for many of the other health conditions, although we generally find considerably smaller effects than OLS associations suggest.

The association between work related factors and breastfeeding practices among Chinese working mothers: a mixed-method approach

Background

Breastfeeding rates remain low in China and some mothers stop breastfeeding shortly after returning to work. Our study aimed to investigate the association between breastfeeding practices of working mothers and their employment status (formal versus informal) and occupational fields (agriculture related, industry related, and business and white collar). We also identified key work-related factors that influence breastfeeding practices in Chinese working mothers.

Methods

This is a mixed-method research consisted of two components. We conducted a cross-sectional study of 10,408 breastfeeding mothers with children under 12 months old from 12 regions in China from July 2017 to January 2018. Multiple logistic regression was used to calculate adjusted odds ratios (AdjORs) and 95% confidence intervals (CIs) for breastfeeding practices. For the qualitative component, semi-structured interviews were conducted with 84 breastfeeding mothers in the study areas from July to December 2017, Content analysis was used for the qualitative component.

Results

Agriculture related occupations were positively associated with early initiation of breastfeeding (AdjOR 1.32, 95% CI 1.15, 1.51), current breastfeeding (AdjOR 1.76, 95% CI 1.41, 2.20), ever breastfed (AdjOR 1.69, 95% CI 1.09, 2.62), exclusive breastfeeding (AdjOR 1.30, 95% CI: 1.04, 1.62), and predominant breastfeeding (AdjOR 1.72, 95% CI 1.44, 2.05). Business and white collar occupations were positively associated with early initiation (AdjOR1.38, 95% CI 1.23, 1.56) and ever breastfed (AdjOR 1.64, 95% CI 1.12, 2.39), and inversely associated with predominant breastfeeding (AdjOR 0.81, 95% CI 0.68, 0.95). For industry related and business and white collar occupations, informal employment was negatively related to current breastfeeding. In qualitative analysis, four main themes were developed to identify key work-related factors that influence breastfeeding practices: 1) employment benefits; 2) commute time; 3) workplace environment; 4) labor intensity. Mothers who experienced difficulties in one or more of the above would choose to lower breastfeeding frequency or stop breastfeeding.

Conclusions

Having flexible work schedules and proximity of workplace to home can assist continuance of breastfeeding. Policies promoting supportive breastfeeding environment at work ought to be implemented. Additionally, informally employed mothers require more attention due to limited legal protection.

Prevalence of Dietary Behavior and Determinants of Quality of Diet among Beneficiaries of Government Welfare Assistance in Poland

Diet, as a modifiable factor for good health maintenance, reduces the risk of numerous non-communicable chronic diseases and prevents premature death. The aim of the study was to examine the prevalence of a dietary behavior and to find out what the determinants of diet quality among the low socio-economic status population are. The studied sample consisted of 1710 respondents. Only 3% of the beneficiaries had healthy dietary habits. Unhealthy dietary habits dominated in all the study group regardless of the subjects' level of education (p < 0.001). Higher odds of unhealthy dietary habits were reported among the respondents with primary, vocational, and secondary education than among the respondents with high education (for the primary education OR = 11.10; 95% CI: 5.86⁻21.01; p ≤ 0.001; for vocational education OR = 10.54; 95% CI: 5.79⁻19.18; p ≤ 0.001 and for secondary education OR = 5.83; 95% CI: 3.48⁻9.79; p ≤ 0.001). The unhealthy dietary behavior prevalence among beneficiaries of government welfare assistance in Poland is much higher than in the general population. Since only educational level is a determinant which is significantly correlated with the unhealthy dietary behavior, promotion of a healthy diet among disadvantaged individuals should be focused on this factor.

The health knowledge mechanism: evidence on the link between education and health lifestyle in the Philippines

Studies have found substantial differences in health-related behavior and health care usage between educational groups, which may explain part of the well-documented educational gradient in health. The allocative efficiency hypothesis offers a behavioral explanation for these reported differences. According to this theory, the educated possess more health knowledge and information, allowing them to make better health choices. We perform a mediation analysis to study this mechanism using original survey data from the Philippines, a lower-middle-income country. As an extension of previous empirical research, we construct a comprehensive index that captures different dimensions of health knowledge. Using generalized propensity scores, we find strong support for the allocative efficiency argument. Schooling is significantly associated with health knowledge levels, which explain up to 69% of the education effect on health lifestyle. This corresponds to twice the mediation strength of economic resources, suggesting an important role of this factor in explaining education effects on health decisions.

Comprehensive evaluation of male health in four communities in rural Honduras

PODEMOS (Partnership for Ongoing Developmental, Educational and Medical Outreach Solutions) has been a long-standing healthcare provider in 4 communities in northern rural Honduras. In this study, we sought to understand and quantify the health challenges faced by men in the rural communities served by PODEMOS in order to improve the way PODEMOS delivers healthcare. Between June and July of 2015, we conducted 104 structured survey interviews with men 18 years and older in rural Honduras. We found that most men face significant economic limitations in their ability to pay for healthcare and health-determining services and due to low formal education levels face health literacy challenges. Furthermore, we found that a quarter are at risk for health problems due to smoking, and the majority are at risk for musculoskeletal problems due to work in strenuous outdoor labor. However, we found that zero respondents drank alcohol heavily, which is defined as more than 14 drinks in one week. Lastly, we found varying opinions on female contraception use. Our findings indicate that medical brigades to the developing world should understand and quantify the relevant health challenges faced by their target populations.

How and why studies disagree about the effects of education on health: A systematic review and meta-analysis of studies of compulsory schooling laws

Rich literatures across multiple disciplines document the association between increased educational attainment and improved health. While quasi-experimental studies have exploited variation in educational policies to more rigorously estimate the health effects of education, there remains disagreement about whether education and health are causally linked. The aim of this study was to conduct a systematic review and meta-analysis to characterize this literature, with a focus on quasi-experimental studies of compulsory schooling laws (CSLs). Articles from 1990 to 2015 were obtained through electronic searches and manual searches of reference lists. We searched for English-language studies and included manuscripts if: (1) they involved original data analysis; (2) outcomes were health-related; and (3) the primary predictor utilized variation in CSLs. We identified 89 articles in 25 countries examining over 25 health outcomes, with over 600 individual point estimates. We systematically characterized heterogeneity on key study design features and conducted a meta-analysis of studies with comparable health outcome and exposure variables. Within countries, studies differed in terms of birth cohorts included, the measurement of health outcomes within a given category, and the type of CSL variation examined. Over 90% of manuscripts included multiple analytic techniques, such as econometric and standard regression methods, with as many as 31 "primary" models in a single study. A qualitative synthesis of study findings indicated that educational attainment has an effect on the majority of health outcomes-most beneficial, some negative-while the meta-analysis demonstrated small beneficial effects for mortality, smoking, and obesity. Future work could focus on inconsistent findings identified by this study, or review the health effects of other types of educational policies.

[Impact of HIV status on the overall prevalence of chronic hepatitis B infection in Parakou, Benin]

INTRODUCTION

The prevalence of hepatitis B is very variable across geographic areas and seems to be influenced by HIV infection. This study aims to evaluate the impact of serologic HIV status on the overall prevalence of hepatitis B in a Hospital in Parakou, Benin.

METHODS

We conducted a cross-sectional study of adults aged 18 years old and over hospitalized in the Departmental University Hospital Center in Parakou between May 2011 and June 2012. The diagnosis of hepatitis B was made on the basis of rapid HBsAg tests while the diagnosis of HIV was made on the basis of rapid HIV tests using venous blood samples. Data were analyzed using EpiInfo software. Multivariate logistic regression model was implemented to investigate factors associated with hepatitis B.

RESULTS

Out of 1516 subjects included, 744 were HIV seropositive. The average age was 31.3 + 11.1 years and 65.1% were women. The prevalence rate of hepatitis B in the whole sample was 13.9% [CI95:12.2%-15.7%]. This prevalence was higher in HIV seropositive subjects (16.9% vs 10.9%; p < 0.0006), however there was not a more significant difference in multivariate analysis, except for the group of subjects from Borgou/Alibori (p < 0.02). A consistent association was observed between age group 24-44 years (p < 0.03), male sex (p < 0.01), primary school education (p < 0.02) and a high prevalence of hepatitis B.

CONCLUSION

The prevalence of hepatitis B was higher in HIV seropositive subjects. This was influenced by age, sex, education level and geographical origin.

Evaluating the Health Impact of Large-Scale Public Policy Changes: Classical and Novel Approaches

Large-scale public policy changes are often recommended to improve public health. Despite varying widely-from tobacco taxes to poverty-relief programs-such policies present a common dilemma to public health researchers: how to evaluate their health effects when randomized controlled trials are not possible. Here, we review the state of knowledge and experience of public health researchers who rigorously evaluate the health consequences of large-scale public policy changes. We organize our discussion by detailing approaches to address three common challenges of conducting policy evaluations: distinguishing a policy effect from time trends in health outcomes or preexisting differences between policy-affected and -unaffected communities (using difference-in-differences approaches); constructing a comparison population when a policy affects a population for whom a well-matched comparator is not immediately available (using propensity score or synthetic control approaches); and addressing unobserved confounders by utilizing quasi-random variations in policy exposure (using regression discontinuity, instrumental variables, or near-far matching approaches).

Public awareness of the link between alcohol and cancer in England in 2015: a population-based survey

BACKGROUND

Public knowledge of the association between alcohol and cancer is reported to be low. We aimed to provide up-to-date evidence for England regarding awareness of the link between alcohol and different cancers and to determine whether awareness differs by demographic characteristics, alcohol use, and geographic region.

METHODS

A representative sample of 2100 adults completed an online survey in July 2015. Respondents were asked to identify which health outcomes, including specific cancers, may be caused by alcohol consumption. Logistic regressions explored whether demographic, alcohol use, and geographic characteristics predicted correctly identifying alcohol-related cancer risk.

RESULTS

Unprompted, 12.9% of respondents identified cancer as a potential health outcome of alcohol consumption. This rose to 47% when prompted (compared to 95% for liver disease and 73% for heart disease). Knowledge of the link between alcohol and specific cancers varied between 18% (breast) and 80% (liver). Respondents identified the following cancers as alcohol-related where no such evidence exists: bladder (54%), brain (32%), ovarian (17%). Significant predictors of awareness of the link between alcohol and cancer were being female, more highly educated, and living in North-East England.

CONCLUSION

There is generally low awareness of the relationship between alcohol consumption and cancer, particularly breast cancer. Greater awareness of the relationship between alcohol and breast cancer in North-East England, where a mass media campaign highlighted this relationship, suggests that population awareness can be influenced by social marketing.

The association between lower educational attainment and depression owing to shared genetic effects? Results in ~25,000 subjects

An association between lower educational attainment (EA) and an increased risk for depression has been confirmed in various western countries. This study examines whether pleiotropic genetic effects contribute to this association. Therefore, data were analyzed from a total of 9662 major depressive disorder (MDD) cases and 14,949 controls (with no lifetime MDD diagnosis) from the Psychiatric Genomics Consortium with additional Dutch and Estonian data. The association of EA and MDD was assessed with logistic regression in 15,138 individuals indicating a significantly negative association in our sample with an odds ratio for MDD 0.78 (0.75-0.82) per standard deviation increase in EA. With data of 884,105 autosomal common single-nucleotide polymorphisms (SNPs), three methods were applied to test for pleiotropy between MDD and EA: (i) genetic profile risk scores (GPRS) derived from training data for EA (independent meta-analysis on ~120,000 subjects) and MDD (using a 10-fold leave-one-out procedure in the current sample), (ii) bivariate genomic-relationship-matrix restricted maximum likelihood (GREML) and (iii) SNP effect concordance analysis (SECA). With these methods, we found (i) that the EA-GPRS did not predict MDD status, and MDD-GPRS did not predict EA, (ii) a weak negative genetic correlation with bivariate GREML analyses, but this correlation was not consistently significant, (iii) no evidence for concordance of MDD and EA SNP effects with SECA analysis. To conclude, our study confirms an association of lower EA and MDD risk, but this association was not because of measurable pleiotropic genetic effects, which suggests that environmental factors could be involved, for example, socioeconomic status.