Educational inequalities in morbidity and mortality are wide and growing, in spite of goals to eliminate them. People with more education are better positioned to avoid deleterious health effects when they are given new health information. Over time, as people act upon novel information differentially, educational inequalities in health outcomes emerge. Although research has been devoted to observing trends in education and health, less is known about the process by which they are produced. An emerging literature has attempted to understand how novel health information and technological advances influence people to behave differently depending on their socioeconomic status. Given the dearth of data on individual health knowledge levels, though, most often research is limited to observing changes in behavior after recent advances in biomedical research or exogenous shocks of health information. How can we understand the process by which educational inequalities in health emerge at the individual-level? The overall objective of this research is to understand how educational inequalities in health are produced among individuals, using a new approach: It focuses on people's health behaviors after they learn that they are pregnant or diagnosed with a chronic illness for the first time. Early decisions about health behaviors during these periods may serve to stratify later health behaviors among people of varying educational backgrounds. To understand how people behave differently after a new health event, this research proposes an innovative approach by focusing on the role of social relationships. It anticipates that these relationships provide people with new health information and influence their decisions about health behaviors. This conjecture builds upon a bedrock of sociological and public health research, which emphasizes the importance of social ties for both health and medical decision-making, as well as more recent research, which indicates that individuals'social ties influence their health behaviors. To assess the influence of social relationships on the formation of educational inequalities in health among people experiencing new health events, this research will take four approaches, and use data from nationally-representative surveys and qualitative interviews including the following: 1988 U.S. National Maternal and Infant Health Survey and the 1991 Longitudinal Follow-up;the Health and Retirement Study;the National Longitudinal Study of Adolescent Health;and the Relationships and Health Habits study. First, it will examine whether there are educational differences in nulliparous women's prenatal behaviors that are replicated during subsequent pregnancies. Second, it will focus on education differences in early health decisions among people recently diagnosed with an illness. Third, it will test whether social network processes of social learning and social influence differ by education and influence health behavior. Finally, for each set of analysis, it describes how the processes differ by race, ethnicity and gender. In sum, this research is significant because it aims to understand the origins of educational inequalities in health at an individual-level. It takes an innovative approach by merging this with demographic models of the diffusion of health information across social networks to understand how network processes influence health behaviors differently by education-level.

Public Health Relevance

The overall objective of this research is to understand how educational inequalities in health are produced at the individual-level, which holds substantial implications for ameliorating or preventing them from materializing. Understanding educational differences in early decisions about health behaviors following a new health event provides the ideal opportunity to intervene because people are heavy users of the health care system when new health events occur. Explicating the role of social relationships as an important mediator of the relationship between education and health behaviors provides an opportunity to create interventions that have a ripple effect across an entire network.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Postdoctoral Individual National Research Service Award (F32)
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Special Emphasis Panel (ZRG1-F16-B (20))
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Newcomer, Susan
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University of Texas Austin
Schools of Arts and Sciences
United States
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