Unique contribution of education to behavioral and psychosocial antecedents of health in a national sample of African Americans

  • Crystal L. ParkEmail author
  • Eddie M. Clark
  • Emily Schulz
  • Beverly Rosa Williams
  • Randi M. Williams
  • Cheryl L. Holt


Education has demonstrated consistent links with many aspects of physical health and is theorized to relate to a variety of behavioral and psychosocial antecedents of health that may ultimately account for these associations. However, many of these associations and the extent to which they manifest specifically for African Americans have not been thoroughly tested. We examined associations of education—distinct from income—with established behavioral and psychosocial antecedents of health in a national sample of African Americans. Education favorably related to many behavioral (e.g., fruit/vegetable intake, lifetime smoking) and psychosocial (e.g., self-efficacy, personality traits, self-esteem, psychological well-being) antecedents of health, but not to all. Some evidence of stronger salutary relations of education for women was found. Results suggest that, for African Americans, education is generally favorably associated with an array of behavioral and psychosocial antecedents of physical health, partially explaining health disparities and providing a point of intervention moving forward.


Education African American Psychosocial resources Health behaviors Health beliefs 



This study was funded by a grant from the National Cancer Institute, (#1 R01 CA 105202). The study was approved by the University of Maryland Institutional Review Board (#373528-1).

Compliance with ethical standards

Conflict of interest

Crystal L. Park, Eddie M. Clark, Emily Schulz, Beverly Rosa Williams, Randi M. Williams, and Cheryl L. Holt declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.


  1. Abdullah, A., Doucouliagos, H., & Manning, E. (2015). Does education reduce income inequality? A meta-regression analysis. Journal of Economic Surveys, 29, 301–316.CrossRefGoogle Scholar
  2. Adler, N. E., Boyce, T., Chesney, M. A., Cohen, S., Folkman, S., Kahn, R. L., et al. (1994). Socioeconomic status and health: The challenge of the gradient. American Psychologist, 49, 15–24.CrossRefGoogle Scholar
  3. Assari, S. (2018a). Health disparities due to diminished return among Black Americans: Public policy solutions. Social Issues and Policy Review, 12, 112–145.CrossRefGoogle Scholar
  4. Assari, S. (2018b). Unequal gain of equal resources across racial groups. International Journal of Health Policy and Management, 7, 1.CrossRefGoogle Scholar
  5. Assari, S., & Mistry, R. (2018). Educational attainment and smoking status in a national sample of American adults; Evidence for the Black’s diminished return. International Journal of Environmental Research and Public Health, 15, 763. CrossRefPubMedCentralGoogle Scholar
  6. Assari, S., Moghani Lankarani, M., Piette, J. D., & Aikens, J. E. (2017a). Socioeconomic status and glycemic control in type 2 diabetes; Race by gender differences. Healthcare, 5, 83.CrossRefPubMedCentralGoogle Scholar
  7. Assari, S., Nikahd, A., Malekahmadi, M. R., Lankarani, M. M., & Zamanian, H. (2017b). Race by gender group differences in the protective effects of socioeconomic factors against sustained health problems across five domains. Journal of Racial and Ethnic Health Disparities, 4, 884–894.CrossRefGoogle Scholar
  8. Assari, S., Preiser, B., & Kelly, M. (2018). Education and income predict future emotional well-being of whites but not blacks: A ten-year cohort. Brain Sciences, 8, 122.CrossRefPubMedCentralGoogle Scholar
  9. Bauman, A. E., Reis, R. S., Sallis, J. F., Wells, J. C., Loos, R. J., Martin, B. W., et al. (2012). Correlates of physical activity: Why are some people physically active and others not? The Lancet, 380, 258–271.CrossRefGoogle Scholar
  10. Block, G., Hartman, A. M., Dresser, C. M., Carroll, M. D., Gannon, J., & Gardner, L. A. (1986). A data-based approach to diet questionnaire design and testing. American Journal of Epidemiology, 124, 453–469.CrossRefGoogle Scholar
  11. Braveman, P., Egerter, S., & Williams, D. R. (2011). The social determinants of health: Coming of age. Annual Review of Public Health, 32, 381–398.CrossRefGoogle Scholar
  12. Brown, D. S., Thompson, W. W., Zack, M. M., Arnold, S. E., & Barile, J. P. (2015). Associations between health-related quality of life and mortality in older adults. Prevention Science, 16, 21–30.CrossRefPubMedCentralGoogle Scholar
  13. Brunello, G., Fort, M., Schneeweis, N., & Winter-Ebmer, R. (2016). The causal effect of education on health: What is the role of health behaviors? Health Economics, 25, 314–336.CrossRefGoogle Scholar
  14. Case, A., & Deaton, A. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences, 112, 15078–15083.CrossRefGoogle Scholar
  15. Center for Disease Control and Prevention. (2018). Accessed September 8, 2018.
  16. Chen, G., Gully, S. M., & Eden, D. (2001). Validation of a new general self-efficacy scale. Organizational Research Methods, 4, 62–83.CrossRefGoogle Scholar
  17. Chen, E., Miller, G. E., Brody, G. H., & Lei, M. (2015). Neighborhood poverty, college attendance, and diverging profiles of substance use and allostatic load in rural African American youth. Clinical Psychological Science, 3, 675–685.CrossRefGoogle Scholar
  18. Cohen, S., Mermelstein, R., Kamarck, T., & Hoberman, H. M. (1985). Measuring the functional components of social support. In I. G. Sarason (Ed.), Social support: Theory, research and applications (pp. 73–94). Dordrecht: Springer.CrossRefGoogle Scholar
  19. Costa, P. T., Jr., Busch, C. M., Zonderman, A. B., & McCrae, R. R. (1986). Correlations of MMPI factor scales with measures of the five factor model of personality. Journal of Personality Assessment, 50, 640.CrossRefGoogle Scholar
  20. Costa, P. T., Jr., & McCrae, R. R. (2004). NEO Personality Inventory—Form S. Lutz: Psychological Assessment Resources, Inc.Google Scholar
  21. Craig, C. L., Marshall, A. L., Sjostrom, M., Bauman, A. E., Booth, M. L., Ainsworth, B. E., et al. (2003). International Physical Activity Questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise, 35, 1381–1395.CrossRefGoogle Scholar
  22. Cutler, D. M., & Lleras-Muney, A. (2010). Understanding differences in health behaviour by education. Journal of Health Economics, 29, 1–28.CrossRefGoogle Scholar
  23. Czekierda, K., Gancarczyk, A., Park, C. L, & Luszczynska, A. (2018). Meaning in life and physical health: Systematic review and meta-analysis. Psychology & Health Review, 11, 387–418.CrossRefGoogle Scholar
  24. Debnam, K. J., Holt, C. L., Clark, E. M., Roth, D. L., Foushee, H. R., Crowther, M., et al. (2012). Spiritual health locus of control and health behaviors in African Americans. American Journal of Health Behavior, 36, 360–372.CrossRefPubMedCentralGoogle Scholar
  25. Diamond, J. B., & Gomez, K. (2004). African American parents’ educational orientations: The importance of social class and parents’ perceptions of schools. Education and Urban Society, 36, 383–427.CrossRefGoogle Scholar
  26. Dinwiddie, G. Y., Zambrana, R. E., Doamekpor, L. A., & Lopez, L. (2016). The impact of educational attainment on observed race/ethnic disparities in inflammatory risk in the 2001–2008 National Health and Nutrition Examination Survey. International Journal of Environmental Resources and Public Health, 13, 42.CrossRefGoogle Scholar
  27. Documet, P., Bear, T. M., Flatt, J. D., Macia, L., Trauth, J., & Ricci, E. M. (2015). The association of social support and education with breast and cervical cancer screening. Health Education & Behavior, 42, 55–64.CrossRefGoogle Scholar
  28. Fuller-Rowell, T. E., Curtis, D. S., Doan, S. N., & Coe, C. L. (2015). Racial disparities in the health benefits of educational attainment: A study of inflammatory trajectories among African American and white adults. Psychosomatic Medicine, 77, 33–40.CrossRefGoogle Scholar
  29. Gaydosh, L., Schorpp, K. M., Chen, E., Miller, G. E., & Harris, K. M. (2018). College completion predicts lower depression but higher metabolic syndrome among disadvantaged minorities in young adulthood. Proceedings of the National Academy of Sciences, 115, 109–114.CrossRefGoogle Scholar
  30. Gilbert, D. J., Harvey, A. R., & Belgrave, F. Z. (2009). Advancing the Africentric paradigm shift discourse: Building towards evidence-based Africentric interventions in social work practice with African Americans. Social Work, 54, 243–252.CrossRefGoogle Scholar
  31. González, M. G., Swanson, D. P., Lynch, M., & Williams, G. C. (2016). Testing satisfaction of basic psychological needs as a mediator of the relationship between socioeconomic status and physical and mental health. Journal of Health Psychology, 21, 972–982.CrossRefGoogle Scholar
  32. Hahn, R. A., & Truman, B. I. (2015). Education improves public health and promotes health equity. International Journal of Health Services, 45, 657–678.CrossRefPubMedCentralGoogle Scholar
  33. Hampson, S. E., Edmonds, G. W., Barckley, M., Goldberg, L. R., Dubanoski, J. P., & Hillier, T. A. (2016). A Big Five approach to self-regulation: Personality traits and health trajectories in the Hawaii longitudinal study of personality and health. Psychology, Health & Medicine, 21, 152–162.CrossRefGoogle Scholar
  34. Haught, H. M., Rose, J. P., & Brown, J. A. (2016). Social-class indicators differentially predict engagement in prevention vs. detection behaviors. Psychology & Health, 31, 21–39.CrossRefGoogle Scholar
  35. Hiza, H. A., Casavale, K. O., Guenther, P. M., & Davis, C. A. (2013). Diet quality of Americans differs by age, sex, race/ethnicity, income, and education level. Journal of the Academy of Nutrition and Dietetics, 113, 297–306.CrossRefGoogle Scholar
  36. Holt, C. L., Clark, E. M., Kreuter, M. W., & Rubio, D. M. (2003). Spiritual health locus of control and breast cancer beliefs among urban African American women. Health Psychology, 22, 294–299.CrossRefGoogle Scholar
  37. Holt, C. L., Clark, E. M., Roth, D. L., Crowther, M., Cohler, C., Fouad, M., et al. (2009). Development and validation of instruments to assess potential religion-health mechanisms in an African American population. Journal of Black Psychology, 35, 271–288.CrossRefGoogle Scholar
  38. Holt, C. L., Clark, E. M., Roth, D. L., Crowther, M., Kohler, C., Fouad, M., et al. (2010). Development and validation of an instrument to assess perceived social influence on health behaviors. Journal of Health Psychology, 15, 1225–1235.CrossRefPubMedCentralGoogle Scholar
  39. Hudson, D. L., Neighbors, H. W., Geronimus, A. T., & Jackson, J. S. (2016). Racial discrimination, John Henryism, and depression among African Americans. Journal of Black Psychology, 42, 221–243.CrossRefGoogle Scholar
  40. Ivcevic, Z., & Brackett, M. (2014). Predicting school success: Comparing conscientiousness, grit, and emotion regulation ability. Journal of Research in Personality, 52, 29–36.CrossRefGoogle Scholar
  41. Johnson-Lawrence, V., Zajacova, A., & Sneed, R. (2017). Education, race/ethnicity, and multimorbidity among adults aged 30–64 in the National Health Interview Survey. SSM-Population Health, 3, 366–372.CrossRefPubMedCentralGoogle Scholar
  42. Kaplan, R. M., Fang, Z., & Kirby, J. (2017). Educational attainment and health outcomes: Data from the Medical Expenditures Panel Survey. Health Psychology, 36, 598–608.CrossRefGoogle Scholar
  43. Keedy, N. H., Keffala, V. J., Altmaier, E. M., & Chen, J. J. (2014). Health locus of control and self-efficacy predict back pain rehabilitation outcomes. The Iowa Orthopaedic Journal, 34, 158–165.PubMedCentralGoogle Scholar
  44. Kelley-Moore, J. A., & Ferraro, K. F. (2004). The black/white disability gap: Persistent inequality in later life? The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 59, S34–S43.CrossRefGoogle Scholar
  45. Krause, N. (2004). Stressors arising in highly valued roles, meaning in life, and the physical health status of older adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 59(5), S287–S297.CrossRefGoogle Scholar
  46. Krause, N. (2018). Assessing the relationships among stress, God-mediated control, and psychological distress/well-being: Does the level of education matter? The Journal of Social Psychology. Scholar
  47. Kreuter, M. W., Skinner, C. S., Holt, C. L., Clark, E. M., Haire-Joshu, D., Fu, Q., et al. (2005). Cultural tailoring for mammography and fruit and vegetable consumption among low-income African American women in urban public health centers. Preventive Medicine, 41, 53–62.CrossRefGoogle Scholar
  48. Lawrence, E. M. (2017). Why do college graduates behave more healthfully than those who are less educated? Journal of Health and Social Behavior, 58, 291–306.CrossRefPubMedCentralGoogle Scholar
  49. Makambi, K. H., Williams, C. D., Taylor, T. R., Rosenberg, L., & Adams-Campbell, L. L. (2009). An assessment of the CES-D scale factor structure in black women: The Black Women’s Health Study. Psychiatry Research, 168, 163–170.CrossRefPubMedCentralGoogle Scholar
  50. McCarthy, J. D., & Hoge, D. R. (1982). Analysis of age effects in longitudinal studies of adolescent self-esteem. Developmental Psychology, 18, 372–379.CrossRefGoogle Scholar
  51. Merkin, S. S., Karlamangla, A., Crimmins, E., Charette, S. L., Hayward, M., Kim, J. K., et al. (2009). Education differentials by race and ethnicity in the diagnosis and management of hypercholesterolemia: A national sample of US adults (NHANES 1999–2002). International Journal of Public Health, 54, 166–174.CrossRefPubMedCentralGoogle Scholar
  52. Miller, G. E., Cohen, S., Janicki-Deverts, D., Brody, G. H., & Chen, E. (2016). Viral challenge reveals further evidence of skin-deep resilience in African Americans from disadvantaged backgrounds. Health Psychology, 35, 1225–1234.CrossRefPubMedCentralGoogle Scholar
  53. Mirowsky, J., & Ross, C. E. (2003). Education, social status, and health. Hawthorne, NY: Aldine de Gruyter.Google Scholar
  54. Mulder, B. C., de Bruin, M., Schreurs, H., van Ameijden, E. J., & van Woerkum, C. M. (2011). Stressors and resources mediate the association of socioeconomic position with health behaviours. BMC Public Health, 11, 798.CrossRefPubMedCentralGoogle Scholar
  55. Murray, A. L., & Booth, T. (2015). Personality and physical health. Current Opinion in Psychology, 5, 50–55.CrossRefGoogle Scholar
  56. O’Keefe, J. H., Bhatti, S. K., Bajwa, A., DiNicolantonio, J. J., & Lavie, C. J. (2014). Alcohol and cardiovascular health: The dose makes the poison… or the remedy. Mayo Clinic Proceedings, 89, 382–393.CrossRefGoogle Scholar
  57. O’Leary, A. O., Jemmott, J. B., III, Stevens, R., Rutledge, S. E., & Icard, L. D. (2014). Optimism and education buffer the effects of syndemic conditions on HIV status among African American men who have sex with men. AIDS Behavior, 18, 2080–2088.CrossRefGoogle Scholar
  58. OBSSR. (2014). Education and health: New frontiers. Meeting summary. Accessed July 26, 2018.
  59. Olshansky, S. J., Antonucci, T., Berkman, L., Binstock, R. H., Boersch-Supan, A., Cacioppo, J. T., et al. (2012). Differences in life expectancy due to race and educational differences are widening, and many may not catch up. Health Affairs, 31, 1803–1813.CrossRefGoogle Scholar
  60. Pampel, F. C., Krueger, P. M., & Denney, J. T. (2010). Socioeconomic disparities in health behaviors. Annual Review of Sociology, 36, 349–370.CrossRefPubMedCentralGoogle Scholar
  61. Parks, S. E., Housemann, R. A., & Brownson, R. C. (2003). Differential correlates of physical activity in urban and rural adults of various socioeconomic backgrounds in the United States. Journal of Epidemiology and Community Health, 57, 29–35.CrossRefPubMedCentralGoogle Scholar
  62. Piedmont, R. L., & Weinstein, H. P. (1994). Predicting supervisor ratings of job performance using the NEO Personality Inventory. Journal of Psychology, 128, 255–265.CrossRefGoogle Scholar
  63. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  64. Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University.CrossRefGoogle Scholar
  65. Roth, D. L., Ackerman, M. L., Okonkwo, O. C., & Burgio, L. D. (2008). The four-factor model of depressive symptoms in dementia caregivers: A structural equation model of ethnic differences. Psychology and Aging, 23, 567–576.CrossRefPubMedCentralGoogle Scholar
  66. Ruiz, J. M., Steffen, P., & Prather, C. C. (2012). Socioeconomic status and health. In A. Baum, T. A. Revenson, & J. E. Singer (Eds.), Handbook of health psychology. Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
  67. Seeman, T., Merkin, S. S., Crimmins, E., Koretz, B., Charette, S., & Karlamangla, A. (2008). Education, income and ethnic differences in cumulative biological risk profiles in a national sample of US adults: NHANES III (1988–1994). Social Science and Medicine, 66, 72–87.CrossRefGoogle Scholar
  68. Signorello, L. B., Cohen, S. S., Williams, D. R., Munro, H. M., Hargreaves, M. K., & Blot, W. J. (2014). Socioeconomic status, race, and mortality: A prospective cohort study. American Journal of Public Health, 104, e98–e107.CrossRefPubMedCentralGoogle Scholar
  69. Sin, N. L., Yaffe, K., & Whooley, M. A. (2015). Depressive symptoms, cardiovascular disease severity, and functional status in older adults with coronary heart disease: The heart and soul study. Journal of the American Geriatrics Society, 63, 8–15.CrossRefGoogle Scholar
  70. Smith, S. G., McGregor, L. M., Raine, R., Wardle, J., Wagner, C., & Robb, K. A. (2016). Inequalities in cancer screening participation: Examining differences in perceived benefits and barriers. Psycho-Oncology, 25, 1168–1174.CrossRefPubMedCentralGoogle Scholar
  71. Stein, A. D., Lederman, R. I., & Shea, S. (1993). The Behavioral Risk Factor Surveillance System questionnaire: Its reliability in a statewide sample. American Journal of Public Health, 83, 1768–1772.CrossRefPubMedCentralGoogle Scholar
  72. Strand, B. H., Grøholt, E. K., Steingrímsdóttir, Ó. A., Blakely, T., Graff-Iversen, S., & Næss, Ø. (2010). Educational inequalities in mortality over four decades in Norway. BMJ, 340, c654.CrossRefPubMedCentralGoogle Scholar
  73. Thornton, R. L., Glover, C. M., Cené, C. W., Glik, D. C., Henderson, J. A., & Williams, D. R. (2016). Evaluating strategies for reducing health disparities by addressing the social determinants of health. Health Affairs, 35, 1416–1423.CrossRefGoogle Scholar
  74. US Census Bureau. (2011). 2011 American Community Survey 1-year estimates. Retrieved from Accessed 5/8/2018.
  75. Viner, R. M., Hargreaves, D. S., Ward, J., Bonell, C., Mokdad, A. H., & Patton, G. (2017). The health benefits of secondary education in adolescents and young adults. SSM-Population Health, 3, 162–171.CrossRefGoogle Scholar
  76. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070.CrossRefGoogle Scholar
  77. Williams, J. S., Lynch, C. P., Voronca, D., & Egede, L. E. (2016). Health locus of control and cardiovascular risk factors in veterans with type 2 diabetes. Endocrine, 51, 83–90.CrossRefGoogle Scholar
  78. Yen, I. H., & Moss, N. (1999). Unbundling education: A critical discussion of what education confers and how it lowers risk for disease and death. Annals of the New York Academy of Sciences, 896, 350–351.CrossRefGoogle Scholar
  79. Zajacova, A., & Lawrence, E. M. (2018). The relationship between education and health: Reducing disparities through a contextual approach. Annual Review of Public Health, 39, 273–289.CrossRefGoogle Scholar
  80. Zou, H., Tian, Q., Chen, Y., Cheng, C., & Fan, X. (2017). Coping styles mediate the relationship between self-esteem, health locus of control, and health-promoting behavior in Chinese patients with coronary heart disease. Journal of Cardiovascular Nursing, 32, 331–338.CrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Department of Psychological SciencesUniversity of ConnecticutStorrsUSA
  2. 2.Saint Louis UniversitySt. LouisUSA
  3. 3.Northern Arizona UniversityFlagstaffUSA
  4. 4.UAB Comprehensive Center for Healthy AgingBirminghamUSA
  5. 5.University of MarylandCollege ParkUSA

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