Ward Joseph L, Viner Russell M
UCL Institute of Child Health, University College London, London, United Kingdom.
PLoS One. 2016 Jun 9;11(6):e0156883. doi: 10.1371/journal.pone.0156883. eCollection 2016.
Education is one of the strongest social determinants of health, yet previous literature has focused on primary education. We examined whether there are additional benefits to completing upper secondary compared to lower secondary education in a middle-income country.
We performed a longitudinal analysis of the Cape Area Panel Study, a survey of adolescents living in South Africa. We undertook causal modeling using structural marginal models to examine the association between level of education and various health outcomes, using inverse probability weighting to control for sex, age, ethnicity, home language, income, whether employed in past year, region of birth, maternal educational status, marital status, whether currently pregnant and cognitive ability. Educational attainment was defined as primary (grades 1-7), lower secondary (grades 8-9) or upper secondary (grades 10-12).
Of 3,432 participants, 165 (4.8%) had completed primary education, 646 (18.8%) lower secondary and 2,621 (76.3%) upper secondary. Compared to those completing lower secondary, males completing upper secondary education were less likely to have a health problem (OR 0.49; 95%CI 0.27-0.88; p = 0.02); describe their health as poor (0.52; 0.29-0.95; p = 0.03) or report that health interferes with daily life (0.54; 0.29-0.99; p = 0.047). Females were less likely to have been pregnant (0.45; 0.33-0.61; p<0.001) or pregnant under 18 (0.32; 0.22-0.46; p<0.001); and having had sex under 16 was also less likely (males 0.63; 0.44-0.91; p = 0.01; females 0.39; 0.26-0.58; p<0.001). Cigarette smoking was less likely (males 0.52; 0.38-0.70; p = <0.001; females 0.56; 0.41-0.76; p<0.001), as was taking illicit drugs in males (0.6; 0.38-0.96; p = 0.03). No associations were found between education and alcohol use, psychological distress, obesity, increased waist circumference or hypertension.
Completing upper secondary education was associated with improved health outcomes compared with lower secondary education. Expanding upper secondary education offers middle-income countries an effective way of improving adolescent health.
教育是健康最强有力的社会决定因素之一，但以往文献主要关注的是初等教育。我们研究了在一个中等收入国家，与完成初中教育相比，完成高中教育是否还有其他益处。
我们对开普地区面板研究进行了纵向分析，该研究是对生活在南非的青少年进行的一项调查。我们使用结构边际模型进行因果建模，以研究教育水平与各种健康结果之间的关联，并使用逆概率加权法来控制性别、年龄、种族、母语、收入、过去一年是否就业、出生地、母亲的教育状况、婚姻状况、当前是否怀孕以及认知能力。教育程度被定义为小学（1 - 7年级）、初中（8 - 9年级）或高中（10 - 12年级）。
在3432名参与者中，165人（4.8%）完成了小学教育，646人（18.8%）完成了初中教育，2621人（76.3%）完成了高中教育。与完成初中教育的人相比，完成高中教育的男性出现健康问题的可能性较小（比值比0.49；95%置信区间0.27 - 0.88；p = 0.02）；将自己的健康状况描述为差的可能性较小（0.52；0.29 - 0.95；p = 0.03），或者报告健康状况影响日常生活的可能性较小（0.54；0.29 - 0.99；p = 0.047）。女性怀孕的可能性较小（0.45；0.33 - 0.61；p<0.001）或18岁以下怀孕的可能性较小（0.32；0.22 - 0.46；p<0.001）；16岁以下发生性行为的可能性也较小（男性0.63；0.44 - 0.91；p = 0.01；女性0.39；0.26 - 0.58；p<0.001）。吸烟的可能性较小（男性0.52；0.38 - 0.70；p = <0.001；女性0.56；0.41 - 0.76；p<0.001），男性使用非法药物的可能性也较小（0.6；0.38 - 0.96；p = 0.03）。未发现教育与饮酒、心理困扰、肥胖、腰围增加或高血压之间存在关联。
与初中教育相比，完成高中教育与更好的健康结果相关。扩大高中教育为中等收入国家改善青少年健康提供了一种有效途径。
