PROJECT SUMMARY (ABSTRACT) Education is a recognized social factor with important implications for health. Educational attainment is associated with mortality and morbidity for a variety of conditions and behaviors. We know less about the mechanisms that connect education to health. In January 2016, NIH released, “Education and Health: New Frontiers” (PAR 16-080) to delve further into this topic. We propose a mixed methods approach to address our overall aim – to investigate if and how different education trajectories affect health and how this association may differ by sex, race/ethnicity, and family and school circumstances. Educational trajectories refer to how people attain their education status, such as high school or college graduate, over time. We will first analyze the 1979 and 1997 waves of data of the National Longitudinal Study of Youth (NLSY). Then, based upon these findings, we will conduct semi-structured interviews in three diverse populations across the US to explore possible mechanisms for the associations observed quantitatively. Finally, we will go to an additional secondary dataset, Reasons for Geographic and Racial Differences in Stroke (REGARDS) that will allow us to explore the possible roles of some of the mechanisms identified qualitatively. The Specific Aims for our mixed methods study are: 1) Using both theory-driven and sequence analysis (data-driven) techniques, determine what the most common education trajectories are for the NLSY 1979 and 1997 cohorts. Examples include: a) straight through or “uninterrupted”; b) dropped out of high school; and c) “interrupted high school,” where students left but returned subsequently to get a high school diploma or a GED. Comparable examples are possible for a college degree, with the additional example of graduated from high school, went to work or unemployed, then went to college; 2)Investigate how educational trajectories are associated with body mass index and obesity, chronic conditions, depression, and mortality. 2a) How do the relationships differ by sex, race/ethnicity, and family characteristics (e.g. maternal education attainment, adverse childhood experiences (in the 1979 cohort)); 2b) How do the relationships differ by school characteristics (e.g. dropout rate, economic composition), school policies, and schooling social milieu (e.g. education level of people in the same community) ? School characteristics include racial/ethnic composition of the school, dropout rate of the school, and/or economic composition of students attending the school. Social milieu includes education level of people in the same community; 3) Based on the results of Aim #2, use intensive semi-structured one-one-one interviews of qualitative methods of people with different demographic characteristics (i.e. men and women; White, African American etc) and educational trajectories in different geographic areas to investigate potential mechanisms linking education trajectories to health, e.g. family dynamics, residential mobility, access to financial and social capital, 4) Based on results from Aim #3, investigate the identified mechanisms with the NLSY79, NLSY97, and Reasons for Geographic and Racial Differences in Stroke (REGARDS) studies.

PROJECT NARRATIVE/RELEVANCE This proposed project is relevant to public health because it addresses the how education attainment is associated with health. In particular, this proposed project will study how different education trajectories (e.g. going straight through getting a high school diploma or college degree or getting a high school diploma with interruption) is associated with different health outcomes, such as obesity, depression, or chronic conditions. We will also ask if these associations differ by sex, race/ethnicity, family circumstances, or school circumstances. It has relevance for public health and education policy.