Childhood socioeconomic position greatly influences educational opportunities and other learning experiences (Kuh et al, 2004c), though the size of this effect may vary by culture, country, and location. Education can have an important role in shaping health behaviors, both in conjunction with and outside of the childhood socioeconomic status, and often provides an important setting for the delivery of targeted health messages. Findings from a number of studies indicate that the educational characteristics of students, such as having low aspirations, leaving school at an earlier age, and poor educational performance are associated with the uptake of smoking (McDermott et al, 2009; Tyas and Pederson, 1998), less healthy eating (Neumark-Sztainer et al, 2003; Sweeting et al, 1994), less physical activity, and more alcohol use and binge drinking (Crum et al, 2006, 1998; Sweeting et al, 1994). In contrast, other findings show that in adolescence the adoption of healthy lifestyle occurs prior to educational attainment and suggests that common factors may be behind the better outcomes in both these domains (Koivusilta et al, 2001, 2003) which we refer to as 'behavioral capital' and discuss in Section 4.6.
In addition, education characteristics have effects on some adult health behaviors independent of childhood and adult socioeconomic status. In the 1946 British birth cohort, after adjustment for socioeconomic effects, lower educational attainment remained strongly associated with smoking, less physical inactivity, and unhealthy diet (low fiber and vitamin C intake), but was not associated with alcohol consumption (Schooling and Kuh, 2002). Thus in addition to the influence of socioeconomic status in adulthood, the independent associations of childhood social class and educational characteristics with adult health behaviors suggest that attachments to cultural norms and the effects of psychosocial conditions first experienced in the home or classroom play a role in the maintenance of health behaviors into adult life. For example the ASSIST cluster randomized school-based trial found that informal peer support from influential role-model students was associated with a reduction of smoking (Campbell et al, 2008).
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