Project Summary / Abstract The SCHOOL (Social Confounders for Health Outcomes Linked to Education) study will utilize an existing sample and infrastructure from prior NICHD-funded studies (SAFE [Study of Attitudes and Factors Effecting Infant Care Practices] and SMART [Social Media and Risk Reduction Training for Infant Care Practices]) to identify factors that mediate and moderate the impact of education on child health. Using our already collected data, we have begun this work by identifying maternal attitudes and beliefs that mediate the impact of education on whether mothers place their infants in the supine position for sleep, thereby decreasing the risk of Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Infant Death (SUID). For the SCHOOL Study, we will further analyze these existing data and conduct qualitative research with SMART participants to gain insight into additional factors that mediate the association between education and child health. Further, we will develop a new comprehensive protocol and collect data with SMART participants to illuminate specific pathways between education and child health. Our Specific Aims are: Aim 1: To determine the association between maternal education and children’s early home experiences, including home resources, parental well-being, quality of family relationships and parental child health care practices. Aim 2: To determine the extent to which the association between parental education and children’s health is mediated by children’s early home experiences, including home resources, parental well-being, quality of family relationships and parental child health care practices. Aim 3: To determine the extent to which, after controlling for home experiences, the association between parental education and children’s health is further mediated by children’s participation in and quality of early education experiences.

Project Narrative Our ability to utilize an existing prospectively obtained mother/infant birth cohort and the infrastructure we have established to continue to follow these families provides a unique opportunity to better understand the early childhood experiences underlying the associations between education and child health. Identification of these factors, some of which may be modifiable, can lead to targeted interventions to improve health outcomes across educational experiences and serve as a model for addressing health-related practices across age groups.