This paper investigates the joint effects of academic self-efficacy and stress on the academic performance of 107 nontraditional, largely immigrant and minority, college freshmen at a large urban commuter institution. We developed a survey instrument to measure the level of academic self-efficacy and perceived stress associated with 27 college-related tasks. Both scales have high reliability, and they are moderately negatively correlated. We estimated structural equation models to assess the relative importance of stress and self-efficacy in predicting three academic performance outcomes: first-year college GPA, the number of accumulated credits, and college retention after the first year. The results suggest that academic self-efficacy is a more robust and consistent predictor than stress of academic success.

Adults with higher educational attainment live healthier and longer lives compared with their less educated peers. The disparities are large and widening. We posit that understanding the educational and macrolevel contexts in which this association occurs is key to reducing health disparities and improving population health. In this article, we briefly review and critically assess the current state of research on the relationship between education and health in the United States. We then outline three directions for further research: We extend the conceptualization of education beyond attainment and demonstrate the centrality of the schooling process to health; we highlight the dual role of education as a driver of opportunity but also as a reproducer of inequality; and we explain the central role of specific historical sociopolitical contexts in which the education-health association is embedded. Findings from this research agenda can inform policies and effective interventions to reduce health disparities and improve health for all Americans. URGENT NEED FOR NEW DIRECTIONS IN EDUCATION-HEALTH RESEARCHAmericans have worse health than people in other high-income countries and have been falling further behind in recent decades (137). This pattern is partially due to the large health inequalities and poor health of adults with low education (84). Understanding the health benefits of education is thus integral to reducing health disparities and improving the well-being of twenty-first-century populations. Despite extensive prior research, critical questions about the education-health relationship remain unanswered, in part because education and health are intertwined over the life spans within and across generations and are inextricably embedded in the broader social context. We posit that to inform future educational and heath policy effectively, we need to capture education in action as it generates and constrains opportunity during the early life spans of today's cohorts. First, we need to expand our operationalization of education beyond attainment to consider the long-term educational process that precedes the attainment and its effect on health. Second, we need to reconceptualize education not only as a vehicle for social success, valuable resources, and good health, but also as an institution that reproduces inequality across generations. And third, we argue that investigators need to bring historical, social, and policy contexts into the heart of analyses: How does the education-health association vary across place and time, and how do political forces influence that variation?During the past several generations, education has become the principal pathway to financial security, stable employment, and social success (8). At the same time, American youth have experienced increasingly unequal educational opportunities that depend on the schools they attend, the neighborhoods in which they live, the color of their skin, and families' financial resources. The decline in manufacturing and rise of globali...

Background The purpose of this study is to test whether the predictive power of an individual's self-rated health (SRH) on subsequent mortality risk differs by socioeconomic status (SES) in the United States. MethodsWe use the National Health Interview Survey 1986-94 linked to Multiple Cause of Death Files 1986-97 (NHIS-MCD). Analyses are based on non-Hispanic Black and White adults 25 and older (n ¼ 358 388). Cox proportional hazard models are used to estimate the effect of SRH on mortality risk during follow-up.Interactions of SRH and level of education and SRH and level of income are used to assess differences in the predictive power of SRH for subsequent mortality risk. ResultsThe effect of SRH on subsequent mortality risk differs by level of education and level of income. Lower health ratings are more strongly associated with mortality for adults with higher education and/or higher income relative to their lower SES counterparts.Conclusions Our findings suggest that individuals with different education or income levels may evaluate their health differently with respect to the traditional five-point SRH scale, and hence their subjective health ratings may not be directly comparable. These results have important implications for research that tries to quantify and explain socioeconomic inequalities in health based on self-rated health.

General self-rated health (SRH) is widely used to study trends and inequalities in population health. Recently, there has been an increased interest in understanding the measurement properties of SRH. This study evaluated for the first time the test-retest reliability of SRH among US adults. Analyses were based on a nationally representative sample of 9,235 adults interviewed in the 2005-2008 National Health and Nutrition Examination Survey (NHANES). Respondents reported SRH on 2 occasions (about 1 month apart). Kappa statistics, polyserial correlations, and agreement tabulations were used to assess reliability across population subgroups; regression models tested the association of sociodemographic factors and the stability of the rating. Nearly 40% of respondents changed their health rating between interviews, indicating moderate test-retest reliability of SRH. Reliability differed significantly by sociodemographic characteristics: Racial/ethnic minorities and adults with less education had lower reliability of SRH judgments. Health events between interviews did not influence consistency, but conditional on a rating change, they increased the odds of downgrading one's health. The results suggest that 1) there is a substantial amount of error in individuals' self-assessment of health and 2) reliability is worse for disadvantaged sociodemographic groups, potentially biasing estimates of health inequalities among US adults.

Changes in US state policies since the 1970s, particularly after 2010, have played an important role in the stagnation and recent decline in US life expectancy. Some US state policies appear to be key levers for improving life expectancy, such as policies on tobacco, labor, immigration, civil rights, and the environment. US life expectancy is estimated to be 2.8 years longer among women and 2.1 years longer among men if all US states enjoyed the health advantages of states with more liberal policies, which would put US life expectancy on par with other high‐income countries. Context Life expectancy in the United States has increased little in previous decades, declined in recent years, and become more unequal across US states. Those trends were accompanied by substantial changes in the US policy environment, particularly at the state level. State policies affect nearly every aspect of people's lives, including economic well‐being, social relationships, education, housing, lifestyles, and access to medical care. This study examines the extent to which the state policy environment may have contributed to the troubling trends in US life expectancy. Methods We merged annual data on life expectancy for US states from 1970 to 2014 with annual data on 18 state‐level policy domains such as tobacco, environment, tax, and labor. Using the 45 years of data and controlling for differences in the characteristics of states and their populations, we modeled the association between state policies and life expectancy, and assessed how changes in those policies may have contributed to trends in US life expectancy from 1970 through 2014. Findings Results show that changes in life expectancy during 1970‐2014 were associated with changes in state policies on a conservative‐liberal continuum, where more liberal policies expand economic regulations and protect marginalized groups. States that implemented more conservative policies were more likely to experience a reduction in life expectancy. We estimated that the shallow upward trend in US life expectancy from 2010 to 2014 would have been 25% steeper for women and 13% steeper for men had state policies not changed as they did. We also estimated that US life expectancy would be 2.8 years longer among women and 2.1 years longer among men if all states enjoyed the health advantages of states with more liberal policies. Conclusions Understanding and reversing the troubling trends and growing inequalities in US life expectancy requires attention to US state policy contexts, their dynamic changes in recent decades, and the forces behind those changes. Changes in US political and policy contexts since the 1970s may undergird the deterioration of Americans’ health and longevity.