How does education lead to healthier behaviours? Testing the mediational roles of perceived control, health literacy and social support

Objectives: Educational attainment is increasingly recognised as a unique dimension of socioeconomic status (SES) and a powerful determinant of health behaviour—and thus physical health and mortality. However, very little is known about the specific pathways through which education influences these health behaviours. Design: The present study used a nationally representative US survey to test three potential psychosocial pathways (perceived control, health literacy and social support) through which education might influence intake of fruits and vegetables (FV), physical activity (PA) and sedentary behaviour (SB), controlling for other aspects of SES (income, health insurance status) and demographics (age, gender, race/ethnicity). Results: Both aspects of perceived control (locus of control, cancer fatalism) mediated the impact of education on FV and PA while only locus of control mediated the impact of education on SB. Further, only one aspect of health literacy (ability to understand recommendations) mediated education’s effect on any health behaviour (FV). Social support did not mediate any of the effects of education on health behaviors. Conclusion: Future work explicitly assessing and testing these mediational pathways is needed to better understand how education influences people’s health behaviours throughout their lives.