br Conclusion br Acknowledgements br Introduction Questions

Conclusion
Acknowledgements
Introduction Questions about the nature of the education–health gradient are central to social epidemiology and THZ2 health. The gradient refers to the positive relationship between educational attainment and health (Conti, Heckman & Urzua, 2010) and is thought to be universal across populations, health outcomes, and across the entire range of attainment (Mirowsky & Ross, 2003). A recent study, however, found an intriguing anomaly: subbaccalaureate adults – who attended college but did not earn a bachelor\'s degree – reported more physical health problems and diagnoses than high school (HS) graduates who never attended college (Zajacova, Rogers, & Johnson-Lawrence, 2012). Several other studies also suggested that adults with “some college” did not always compare positively to HS graduates, for instance with respect to health behaviors (Rosenbaum, 2012; Skalamera & Hummer, 2016). This pattern is important because it contradicts the expectation that the college education beyond HS would yield health payoffs. If corroborated, the anomaly may provide valuable clues about the mechanisms of the relationship between educational attainment and adult health. It is also important because the “some college” category is now the modal educational-attainment level for working-age Americans: 28% are college dropouts or have earned associate (AA) degrees (U.S. Census Bureau, 2012). The studies above that detected the subbaccalaureate anomaly used self-reported health measures, however. This is a potential problem because respondents with different levels of education may also differ in how they report health (Bago d’Uva, O’Donnell & van Doorslaer, 2008). Adults with more education are more likely to have adequate health insurance (NCHS, 2012), receive preventive care (Bennett, Jing, Soroui & White, 2009) and have more health care interactions (Blackwell, Martinez, Gentleman, Sanmartin & Berthelot, 2009), and may thus have a better understanding of their health problems (Kawachi, Adler & Dow, 2010). Previous studies have shown that adults with more education report general health with higher reliability (Zajacova & Dowd, 2011) and higher predictive validity (Zajacova & Woo, In press). If adults at the subbaccalaureate level report their health differently, in particular if they overreport health problems relative to HS graduates, then the findings from self-reports could be biased. On the other hand, adults who do not complete college may be unable to convert their additional schooling into a significant health return. The economic returns to subbaccalaureate schooling are significant for AA degrees but not for “some college” (Belfield & Bailey, 2011). Psychologically, the “college dropout” status may be stigmatizing (Dorn, 1993) and its ongoing psychological burden may gradually damage health (Link & Phelan, 2006). Selection factors into the subbaccalaureate level, such as own cognitive and noncognitive skills or family background, may also play a role: adults who attend college but do not complete a college degree may differ from those who completed college (Hoachlander, Sikora, Horn & Carroll, 2003), but also from those who just completed high school (Rosenbaum, 2012). Such selection factors may also influence health and thus drive the health anomaly among subbaccalaureate adults. Two competing theories can be used to form hypotheses about the subbaccalaureate patterns. According to the human capital theory (Becker, 1964), any college education should translate to better health compared to just a HS diploma because the additional schooling increase skills and resources. Under the credential model (Collins, 1979), only the attainment of an AA degree should be associated with better health than a HS diploma. An important further nuance exists at the AA level. There are two types of AA degrees, both requiring about 60 credit-hours of study. The technical/vocational AA is a terminal degree that prepares students for specific occupations, such as paralegal, computer technician, or nursing. The academic AA is a stepping stone; it provides a general education applicable toward a BA and thus those who do not complete the additional 2 years toward a BA could be conceptualized as “dropouts”. There may be important selection factors into the two AA degrees: those who earn the academic AA may be more similar to those enrolled in 4-year colleges in their intention to eventually earn a BA, compared to the vocational AA students who may be more like HS students in their intention to work in blue-collar or lower-prestige white-collar occupations.