Understanding the benefits of different types and timing of education for mental health: A sequence analysis approach.

OBJECTIVES: Individuals increasingly experience delays or interruptions in schooling; we evaluate the association between these non-traditional education trajectories and mental health. METHODS: Using year-by-year education data for 7,501 National Longitudinal Survey of Youth 1979 participants, ages 14-48 (262,535 person-years of education data), we applied sequence analysis and a clustering algorithm to identify educational trajectory groups, incorporating both type and timing to credential. Linear regression models, adjusted for early-life confounders, evaluated relationships between educational trajectories and mental health component scores (MCS) from the 12-item short form instrument at age 50. We evaluated effect modification by race, gender, and race by gender. RESULTS: We identified 24 distinct educational trajectories based on highest credential and educational timing. Compared to high school (HS) diplomas, < HS (beta=-3.41, 95%CI:-4.74,-2.07) and general educational development credentials (GEDs) predicted poorer MCS (beta=-2.07,95%CI:-3.16,-0.98). The following educational trajectories predicted better MCS: some college immediately after High School (beta=1.52, 95%CI:0.68,2.37), Associate degrees after long interruptions (beta=1.73, 95%CI:0.27,3.19), and graduate school soon after Bachelor's completion (beta=1.13, 95%CI:0.21,2.06). Compared to White men, Black women especially benefited from educational credentials higher than HS in predicting MCS. CONCLUSIONS: Both type and timing of educational credential predicted mental health. Black women's mental higher especially benefited from higher educational credentials.

Policy Determinants of Inequitable Exposure to the Criminal Legal System and Their Health Consequences Among Young People.

Criminalizing young people, particularly Black- and Brown-identified young people, has increasingly been a feature of US rhetoric, policies, and practices. Thus, the domains in which young people are exposed to the legal system have continued to expand, encompassing their communities, schools, and homes. Importantly, public health researchers have begun exploring links between legal system exposure and health, although this literature is primarily focused at the interpersonal level and assesses associations within a single domain or in adulthood.Using critical race theory and ecosocial theory of disease distribution, we identified potential policy-level determinants of criminalization and briefly summarized the literature on downstream health outcomes among young people. Our analysis suggests that policy decisions may facilitate the targeting of structurally marginalized young people across domains.Future research should (1) position these legislative decisions as primary exposures of interest to understand their association with health among young people and inform institutional-level intervention, (2) measure the totality of exposure to the criminal legal system across domains, and (3) use theory to examine the complex ways racism operates institutionally to shape inequitable distributions of associated health outcomes.

Can a school-based civic empowerment intervention support adolescent health?

Meaningfully engaging and supporting youth in their communities can promote their sense of efficacy and potentially their health and wellbeing. The objective of this study was to test whether a school-based youth civic empowerment program, Generation Citizen (GC), was associated with self-reported mental and physical health among participants, and whether these associations differed by two potential modifiers: civic self-efficacy and a sense of meaningful contributions to one's community. Participants were middle and high school students (N = 364) who participated in GC in the fall semester of 2014 and completed surveys at the beginning and end of the semester. Analyses revealed a small but statistically significant increase in self-reported physical health after GC and no statistically significant change in self-reported mental health. There was evidence of effect measure modification by civic self-efficacy such that the difference in physical health as civic self-efficacy increased was smaller post-intervention compared to pre-intervention. This could suggest that GC participation is particularly beneficial for those with lower civic self-efficacy. While our findings suggest that public health interventions may benefit from centering empowerment opportunities for youth, future research is warranted to better understand the particular role of civic self-efficacy in that process.

Do the health benefits of education vary by sociodemographic subgroup? Differential returns to education and implications for health inequities.

PURPOSE: Evidence suggests education is an important life course determinant of health, but few studies examine differential returns to education by sociodemographic subgroup. METHODS: Using National Longitudinal Survey of Youth 1979 (n = 6158) cohort data, we evaluate education attained by age 25 years and physical health (PCS) and mental health component summary scores (MCS) at age 50 years. Race / ethnicity, sex, geography, immigration status, and childhood socioeconomic status (cSES) were evaluated as effect modifiers in birth year adjusted linear regression models. RESULTS: The association between education and PCS was large among high cSES respondents (ß = 0.81 per year of education, 95% CI: 0.67, 0.94), and larger among low cSES respondents (interaction ß = 0.39, 95% CI: 0.06, 0.72). The association between education and MCS was imprecisely estimated among White men (ß = 0.44; 95% CI: -0.03, 0.90), while, Black women benefited more from each year of education (interaction ß = 0.91; 95% CI: 0.19, 1.64). Similarly, compared to socially advantaged groups, low cSES Blacks, and low and high cSES women benefited more from each year of education, while immigrants benefited less from each year of education. CONCLUSIONS: If causal, increases in educational attainment may reduce some social inequities in health.