FROM THE R21 VERSION:
In 2003, NIH issued a Funding Opportunity Announcement (FOA) to advance scientific understanding on the plausible causal pathways that explain the widely accepted, but poorly understood positive association between education and health. Based on a competitive peer review process, 13 grants were awarded by OBSSR. The scientific contribution of this programmatic effort produced an impressive bibliography of several dozen original peer reviewed publications. Both a brief history and listing of the resulting publications of the 2003 FOA can be read here: https://obssr-archive.od.nih.gov/scientific_areas/social_culture_factors_in_health/health_disparities/index.aspx
From an NIH perspective, the findings built on previous research by formalizing how education is clearly linked to a variety of specific and important health behaviors and conditions, therefore bringing the science closer to a mechanistic understanding of the causal pathways. For instance, some researchers found a moderate to strong association between educational attainment and several different biological risk factors, such as markers of inflammation, higher/lower cardiovascular risks, and hypercholesterolemia. Other researchers focused on a wide variety of specific illnesses and health problems, including diabetes, depression, and mental well-being. Still others examined how education is linked to positive and negative health behaviors, such as smoking cigarettes, drug and alcohol abuse, and utilization of medical screening programs.
As is often the case in science, these advances in our understanding also raised new questions.
For instance, many of these studies didn’t specifically study the education process, per se, making it difficult to parse out the contributions of education from overall socioeconomic status (SES). Additionally, due to data limitations, many of the studies utilized very limited measurements of education, such as high school completion verses not completed, or cognitive performance and IQ as surrogates for education. Although this is not an unreasonable empirical strategy when faced with data limitations, these approaches limit our ability to determine which specific features of the educational experience are linked to improved health. For example, what types of skills and knowledge are relevant to speci?c positive health outcomes, and how does schooling lead to the acquisition of these skills and knowledge?
Related, are there critical periods in the life course during which education has a greater impact on the trajectory of an individual’s health than at other times—for example, during pre-school, adolescence, or college? Are health benefits associated with adult education and occupational training or continuing education later in life? Are the health benefits of additional years of schooling constant no matter what the baseline level of education? Does it matter what kind of education you get: private, public, home-school, or for higher level education; technical/vocational or liberal arts; online or in a traditional setting? Does the quality of education matter, and if so, which aspects of quality? How do you measure ‘quality’? How does the role of the teacher versus the family affect the linkage to positive or negative health outcomes?
The goals of this FOA are to further elucidate the pathways involved in the relationship between education and health outcomes and in doing so to carefully identify the specific aspects and qualities of education that are responsible for this relationship and what the mediating factors are that affect the nature of the causal relationship.
In June 2014, OBSSR convened a workshop that brought together clinicians and researchers in education and health in order to identify opportunities and gaps in the field as well as to develop strategies to ensure that education and health research remains a national priority. A summary of the meeting can be read here: https://obssr-archive.od.nih.gov/pdf/OBSSR_Education_and_Health_REV_8-22-2014_FINAL_RLA.pdf
Areas of research that were emphasized included: developing better measures of health outcomes (including cognitive function, subjective well-being, etc.), improving study designs, identifying mechanisms underlying the relationship between education and health, and considering contextual issues. Additionally, it was noted that there must also be attention to longitudinal research to understand long-term implications of early interventions and replication of studies to verify results. Themes evident throughout the meeting included the nature of the causal relationship between education and health, contextual issues, the need for more and better data, and interventions in education and health.
A number of private foundations have current initiatives which examine the links between health and education. The William T. Grant Foundation has recently examined the infrastructure to improve the use and usefulness of research in education (http://blog.wtgrantfoundation.org/). The Robert Wood Johnson Foundation is exploring education and health within its series on the social determinants of health (http://www.rwjf.org/en/how-we-work/grants/programs-and-initiatives.html). Their work examines the interrelated pathways through which educational attainment is linked to health outcomes, including through employment and income, and social and psychological factors. The W. K. Kellogg Foundation is addressing the health and well-being of children and families from interrelated fronts, including nutrition and education (http://www.wkkf.org/grantseekers). The Open Society Foundation is committed to supporting quality education across the globe, imagining education as a key to civic participation and healthy lives (http://www.opensocietyfoundations.org/). This FOA seeks to supplement the work of these foundations by promoting an examination of the specific mechanisms through which educational experiences and activities are linked to health outcomes, elucidate pathways and inform causal models that can inform more targeted interventions.
Recent contemporary work on educational attainment and adult health has demonstrated that the treatment of health is multi-dimensional and the treatment of education is not limited to a simple operationalization. Both health and education need to be examined in complex ways, using novel methodological tools and datasets, as well as situating analyses across diverse global spaces and within specific historical time periods to better understand the macro mechanisms which link educational attainment with health outcomes.
For this FOA, education refers to the comprehensive formal instruction that spans the human experience, from early childhood programs to pre-school, elementary and secondary schooling, college and adult learning programs. It includes the social and behavioral processes that are combined with formal instruction in educational environments. A better scientific understanding of the mechanisms linking education and health could lead to additional and improved prevention and therapeutic intervention strategies for important health problems. NOTE: This FOA is not directed at studies which limit their focus to the impact of specific health education courses or programs on health behaviors; rather, the focus is on the impact of more general education experiences.
In order to better understand these pathways, it will be necessary to explore which components or dimensions of education are important to health. The association or pathway between formal education and important health behaviors or diseases may not be causal. Instead it may reflect the influence of confounding or co-existing determinants or bi-directionality. Appropriate research topics for this FOA may involve pilot studies, new analyses of existing data, longitudinal studies, or a balance of approaches tailored for the study hypotheses. It is strongly encouraged that an application involve new teams of multidisciplinary researchers with expertise in both health and education domains.
Applications for R21 awards should describe projects distinct from those supported through the traditional R01 activity code. For example, long-term projects, or projects designed to increase knowledge in a well-established area, are not appropriate for R21 awards. Applications submitted to this FOA should be exploratory and novel. These studies should break new ground or extend previous discoveries toward new directions or applications.
To achieve the goal of a more comprehensive understanding of the mechanisms linking education and health outcomes, this FOA encourages the exploration of research perspectives and themes described below. The NIH believes these approaches may move current research efforts to the next level of accomplishment. Applicants are not required to incorporate all of the themes below into their research applications; however, applicants should explicitly address at least one.
Education and Health Across the Age Spectrum
Formal education often occurs at the stage of the life cycle when significant formation of health behaviors is also occurring; these specific formal educational experiences as well as the social context provided by the school and the behavior and norms of the other students may either directly or indirectly influence the development of health behaviors. Education may improve health by laying the foundation for the individual’s integration in to society, not only in terms of the content of the curriculum, but also in terms of social competencies and the ability to function in hierarchical, structured settings (i.e., universities and colleges, employment settings, civic society, etc.). Because of the critical need for additional information on the pathways that link education with a variety of diseases and health risk factors, researchers are encouraged, but not required, to include in any research project objectives directed at both (1) better understanding the relationship between education and a specific disease or important macro- and/or micro- health risk factor and (2) better understanding the relationship between one or more pathways that explain the association between education and general health and wellbeing. Examples of possible relevant topics might include the following (but are in no way limited to this suggested list):
- Through which biological pathways (including neurological, inflammatory, and endocrinological networks) does education affect health?
- What is the effect(s) of education on the function or structure of the brain (eg. prefrontal cortex, temporal lobe, etc.), during the period of formal education; is there the evidence of the persistence of these alterations into adulthood?
- What mechanisms account for the impact of education on the risk of neurological diseases later in life such as mild cognitive impairment, Alzheimer’s disease, or cancer-related cognitive impairment?
- How does sleep moderate or mediate the relationship between education and health?
- How might education buffer against the acute and chronic effects of physiological and psychological stress in adulthood? Does education have its effect by an enhancement of coping resources or strategies?
- What impacts do the demands of various educational programs (at all levels) have on students’ stress levels and subsequent health outcomes, both in the short and long term? Do stress management programs moderate these effects?
- How does education affect mental health outcomes, including depression and other mental disorders?
- What is the effect of education and moderating factors such as peer/group effects and/or social context formation provided by the school on the development of health behaviors?
- The effect of education and educational outcomes on the initiation, maintenance, and/or cessation of risky behaviors such as substance abuse. Compare/contrast trajectories of risky behavior with initiation, maintenance, and/or cessation of healthy behaviors. Also, how do these risky/healthy behaviors support or interfere with the pursuit of education?
- How do specific formal education experiences (e.g. public, private, charter, homeschooling, online, etc.) influence health outcomes and behaviors?
- Do changes in educational policies and requirements at the local, state, tribal, and national level result in changes in educational outcomes, attitudes towards education, and health outcomes?
- How does the timing of education, (e.g. Education obtained in adulthood versus the more traditional educational trajectory of grade school and high school) affect health outcomes?
- How do parental inputs, including parental educational status and attitudes towards education, influence educational outcomes? How do the influences of educational trajectories and health outcomes of siblings and other household members alter this relationship?
- Research on the sensitive periods in prenatal, early and middle childhood development (e.g. small class sizes in kindergarten through 3rd grade, early childhood interventions) and their impact on education and health outcomes.
- How does the changing distribution of mental health diagnoses (e.g., how conditions are defined such as of LD, ADHD, etc.) and how this changes the perception of the link between education and health? Is this different over time and what are the mechanisms?
- Are the behavioral, psychological, and neurobiological risk factors associated with poor early educational experiences plastic or malleable in mid-life? Can we identify targets for intervention in mid-late life that might compensate for or remediate deficits associated with these risk factors?
- Research on the mechanisms that account for links between personality and other non-cognitive skills and capacities to educational attainment, and the associated pathways linking these individual difference factors to health outcomes in later life.
- How malleable are personality and non-cognitive skills and capacities throughout the lifespan? Do these factors have an impact on the effectiveness of educational programs at any life stage?
- Research on the supported education for individuals with mental illness or with autism spectrum disorders (ASD) in all levels of formal education including post-secondary and its effects on health and quality of life measures, including longer term functioning and employment outcomes.
Innovative Data and Methodologies
Particular school-based studies have included the collection of health data, and allow for potentially important research on the links between education and health. For instance, both the “Early Childhood Longitudinal Study-Birth Cohort” (ECLS-B; birth through kindergarten) and the “Early Childhood Longitudinal Study-Kindergarten” (ECLS-K; kindergarten through eighth grade) include data on children’s cognitive, physical, social, and emotional development in the home, childcare, and school settings. The National Center for Education Statistics (NCES) “High School and Beyond” includes data on general health, access to health care, and health insurance status. It is the intention of this FOA to inspire collaborative work across disciplines, and through innovative methodologies to explore the mechanisms linking health outcomes to educational experiences.
Examples of possible relevant topics may include the following (but are in no way limited to this list):
- How can we more accurately or completely characterize or measure education (including teacher- student interaction in a more formal education setting, but also non-formal social forms of education, e.g., tribal, church, scouts, musical instruction, school clubs etc.), beyond simply as years of education without regard to the characteristics or nature of the educational experience?
- How do we measure “quality” of education, such as the relationship between teacher instructional styles and quality of teaching and health outcomes?
- Equivalently, are there innovations in metrics of resilience/personality, either on the individual or structural supports (e.g., family, church, other) that may confer some protection from risk and may help predict why someone in a poor quality education institution can do well later in life?
- In what ways do education quality, content, and/or appropriateness of the curriculum moderate the association between educational attainment and health?
- Cross-national comparisons of education’s effects on health behaviors.
Deadline: January 07, 2019 (for all three)
Filed Under: Funding Opportunities