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Pathways Linking Education and Health in Middle Adulthood (EDHLTH)

Study dates: 2004-2007

Funding provided by NIA (AG023397)

PI: Buka


Overall aims: Through primary data collection and secondary data analyses: 1) determine the impact of education on sub-clinical health conditions by assessing a theoretically-based set of biological precursors of disease (biomarkers); 2) establish the association between education and chronic health conditions, self-rated health, and established behavioral risk factors for disease; and 3) investigate the extent to which the education-health association is mediated by functional literacy skills.


Sample: 914 selected, 618 interviewed


Key Documentation

Sample Selection

Code Book

Master Interview

Complete Content Listing



  1. SES - Socioeconomic Status – race/occupation
  2. SED - Socioeconomic Status – education
  3. GHK - General Health Knowledge
  4. HB1 - Health Behaviors (first half)
  5. HLC - Health Locus of Control
  6. ERG - Emotion Regulation
  7. SOC - Sense of Control
  8. TPR - Time Preference
  9. TIP - TIPI Personality
  10. LOV - Love Measure / Altruism
  11. CBP - Clinical Assessment – blood pressure
  12. CBD - Clinical Assessment – blood draw
  13. CAM - Clinical Assessment – anthropometric measures
  14. PFL - Clinical Assessment – peak lung flow
  15. HLT - Health and Illness
  16. ANX - Anxiety – MMPI
  17. ANG - Anger/Hostility
  18. CDP - Depression CESD
  19. INC - Socioeconomic Status – income
  20. RCL - Woodcock Johnson – story recall
  21. DIR - Woodcock Johnson – understanding directions
  22. PCM - Woodcock Johnson – passage comprehension
  23. LTR - LOT-R Life Orientation
  24. DOP - Dutch Optimism Scale
  25. NUM - Numeracy - Lipkus
  26. HB2 - Health Behaviors (second half)
  27. TEM - Tempra Example
  28. OPT - Other Pathways
  29. GAD - Generalized Anxiety Disorder - diagnostic
  30. CDB - Social Phobia – CIDI short form
  31. FHS - Family History
  32. DEP - Depression - diagnostic
  33. SRS - Stress Role Strain
  34. SON - Social Networks
  35. SSP - Social Support
  36. HEQ - Ending Questions / Conclusions
  37. FWS - Final Words


Additional Documentation

EdHealth Final Grant

Quality Control Documents

Data Cleaning Log Book

Biomarker Data Cleaning Summary

Biomarker Data Cleaning Log Book

Spielberger Anger Manual



Almeida ND, Loucks EB, Kubzansky L, Pruessner J, Maselko J, Meaney MJ, Buka SL. Quality of parental emotional care and calculated risk for coronary heart disease. Psychosom Med. 2010 Feb; 72(2): 148-155. doi:10.1097/PSY.0b013e3181c925cb. Epub 2010 Jan 11. PMID:20064905. PMCID:PMC2837946.

Appleton AA, Buka SL, Loucks EB, Giman SE, Kubzansky LD. Divergent associations ofadaptive and maladaptive emotion regulation strategies with inflammation. Health Psychol. 2013 Jul; 32(7): 748-756. doi: 10.1037/a0030068.  PMID: 23815767  PMCID: PMC3793468

Appleton AA, Buka SL, Loucks EB, Rimm EB, Martin LT, Kubzansky LD. A prospective studyof positive early-life psychosocial factors and favorable cardiovascular riskin adulthood. Circulation. 2013 Feb; 127(8): 905-12. doi: 10.1161/CIRCULATIONAHA.112.115782.   PMID:23339873  PMCID: PMC3762221

Appleton AA, Buka SL, McCormick MC, Koenen KC, Loucks EB, Gilman SE, Kubzansky LD. Emotional functioning at age 7 years is associated with C-reactive protein in middle adulthood. Psychosom Med. 2011 May; 73(4): 295-303. doi:10.1097/PSY.0b013e31821534f6. Epub 2011 May 2. PMID:21536835. PMCID:PMC3090487.

Appleton AA, Buka SL, McCormick MC, Koenen KC, Loucks EB, Kubzansky LD. The association between childhood emotional functioning and adulthood inflammation is modified by early-life socioeconomic status. Health Psychol. 2012 Jul; 31(4): 413-422. doi:10.1037/a0027300. Epub 2012 Feb 13. PMID:22329424. PMCID:PMC3810389.

Appleton A, Loucks EB, Buka SL, Rimm E, Kubzansky LD. Childhood emotional functioning and the developmental origins of cardiovascular disease risk. J Epidemiol Community Health. 2013 May; 67(5): 405-411. doi:10.1136/jech-2012-201008. Epub 2013 Jan 15. PMID:23322856. PMCID:PMC3762244. [Available on 2014/05/01]

Liu SY, Buka SL, Kubzansky LD, Kawachi I, Gilman SE, Loucks EB. Sheepskin effectsof education in the 10-year Framingham risk of coronary heart disease. Soc Sci Med. 2013 Mar; 80:31-36.  doi: 10.1016/j.socscimed.2012.12.026.    PMID: 23415589

Liu SY, Buka SL, Linkletter CD, Kawachi I, Kubzansky L, Loucks EB. The association between blood pressure and years of schooling versus educational credentials: test of the sheepskin effect. Ann Epidemiol. 2011 Feb; 21(2): 128-138. doi:10.1016/j.annepidem.2010.11.004. PMID:21184953.

Liu T, Gatsonis CA, Baylin A, Kubzansky LD, Loucks EB, Buka SL. Maternal smoking during pregnancy and anger temperament among adult offspring. J Psychiatr Res. 2011 Dec; 45(12): 1648-1654. doi:10.1016/j.jpsychires.2011.08.007. Epub 2011 Sep 3. PMID:21890149. PMCID:PMC3210329.

Loucks EB, Buka SL, Rogers ML, Liu T, Kawachi I, Kubzansky LD, Martin LT, Gilman SE. Education and coronary heart disease risk associations may be affected by early-life common prior causes: apropensity matching analysis. Ann Epidemiol. 2012 Apr; 22(4): 221-232. doi:10.1016/j.annepidem.2012.02.005. PMID:22463841. PMCID:PMC3327475.

Loucks EB, Gilman SE, Kawachi I, Kubzansky LD, Martin L, Rogers ML, Wilhelm A, Buka SL. Education and coronary heart disease risk: potential contributions of health literacy, time preference andself-efficacy. J Epidemiol Community Health. 2011 Aug; 65(Suppl 1): A25. doi:10.1136/jech.2011.142976a.66.

Martin LT, Haas A, Schonlau M, Derose KP, Rosenfeld L, Rudd R, Buka SL. Which literacy skills are associated with smoking? J Epidemiol Community Health. 2012 Feb; 66(2): 189-192. doi:10.1136/jech.2011.136341. Epub 2011 Oct 14. PMID:22003080. PMCID:PMC3246123.

Martin LT, Schonlau M, Haas A, Derose KP, Rosenfeld L, Buka SL, Rudd R. Patient activation and advocacy:which literacy skills matter most? J Health Commun. 2011 Sep; 16(Suppl 3): 177-190. doi:10.1080/10810730.2011.604705. PMID:21951251. PMCID:PMC3187917.

Martin LT, Schonlau M, Haas A, Derose KP, Rudd R, Loucks EB, Rosenfeld L, Buka SL. Literacy skills and calculated 10-year risk of coronary heart disease. J Gen Intern Med. 2011 Jan; 26(1): 45-50. doi:10.1007/s11606-010-1488-5. Epub 2010 Aug 31. PMID:20809155. PMCID:PMC3024109.

Maselko J, Kubzansky L, Lipsitt L, Buka SL.  Mother's affection at 8 months predicts emotional distress in adulthood. J Epidemiol Community Health. 2011 Jul; 65(7): 621-625. doi:10.1136/jech.2009.097873. Epub 2010 Jul 26. PMID:20660942. PMCID:PMC3118641.