Research on the association between education and health has not been able to escape the criticism that factors other than education are responsible for this repeatedly observed, but potentially spurious, association. If the association between education and health is causal, the pathways through which education impact health remain to be fully elucidated. This application seeks to 1) obtain an estimate of the effect of education on multiple adult health outcomes independent of several determinants of both schooling and later adult health, and 2) evaluate the contribution of several potential pathways hypothesized to account for the association between education and health. This proposal is submitted by investigators from developmental and social epidemiology, medicine, health education and literacy, economics, psychology and biostatistics, and is based on adult follow-up studies of the New England cohorts of the National Collaborative Perinatal Project. The first aim is to conduct analyses of data recently obtained from a family study of 2,000 subjects who have been followed from birth through age 40; these analyses will incorporate a detailed measure of adult health status, prospective measures of social, familial, and individual determinants of education that were collected between 1959 and 1976, and a sibling design to account for potential unmeasured familial variables. In these analyses we will determine the 'adjusted' effects of education on the following health outcomes: diagnoses of cancer, cardiovascular disease, asthma and diabetes; self-rated health; and behavioral risk factors including current and lifetime indicators of tobacco use and substance abuse. We will also test the hypothesis that psychological processes (depression, anxiety, perceived social status, and perceived stress) mediate the association between education and health. The second and third aims of this study involve new data collection from 800 of these 2,000 subjects. Aim two focuses on elucidating the causal effects of education on biological precursors of cardiovascular disease and diabetes. The third aim will be to investigate the role of education in improving health through enhancement of functional literacy skills. The prospective nature of this study, the comprehensive assessment of parental and childhood variables, and the hypothesis-driven tests of causation and potential mechanisms make this project uniquely suited to evaluate the link between education and improved health outcomes.