Educational Attainment Better Reduces Perceived Economic Hardship for White than Black Americans

Research Article

J Community Med Health Care. 2021; 6(2): 1051.

Educational Attainment Better Reduces Perceived Economic Hardship for White than Black Americans

Assari S1,2*

1Department of Family Medicine, College of Medicine, Charles R Drew University of Medicine and Science, Los Angeles, USA

2Departments of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, USA

*Corresponding author: Shervin Assari, Department of Family Medicine, Charles R Drew University of Medicine and Science, Los Angeles, CA 90059, USA

Received: September 27, 2021; Accepted: November 03, 2021; Published: November 10, 2021


Background: Lower levels of stress are one of many plausible mechanisms that may explain the health effects of educational attainment. Minorities’ Diminished Returns, however, are defined as systemically weaker health effects of educational attainment for Blacks compared to Whites. We are, however, unaware of previous studies on the differential effects of educational attainment on perceived economic hardship across racial groups.

Purpose: The aim was to compare Blacks and Whites for the association between educational attainment and perceived economic hardship in a national sample of American adults.

Methods: This study analyzed cross-sectional data of 24,874 adults who had participated in the National Health Interview Survey (NHIS 2015). Educational attainment was the predictor variable. Perceived economic hardship was the outcome. Race was the moderator. Age, gender, marital status, employment, and income were the covariates.

Results: Overall, higher educational attainment was associated with lower levels of perceived economic hardship. Race interacted with educational attainment, suggesting that the protective effect of educational attainment on reducing perceived economic hardship is smaller for Blacks than Whites. Conclusions: Educational attainment is not similarly protective against perceived economic hardship across all racial groups. Thus, perceived economic hardship may be one mechanism by which Black people receive fewer health benefits from their educational attainment than White people.

Keywords: Stress; Perceived economic hardship; Population groups; Race; Socioeconomic position; Socioeconomic status; Education


According to the Minorities’ Diminished Returns theory (MDRs) [1-5], racial disparities are partially due to “weaker than expected” real life effects of Socioeconomic Position (SEP) indicators [1,6-8]. The MDRs framework suggests that: (a) not all racial disparities are due to lower SEP of Blacks but also because of lower impact of available SEP resources for Black populations, (b) the racial health inequalities may widen rather than narrow at high SEP levels, and (c) health disparities should be addressed across all SEP levels [1-3].

Empirical evidence has documented MDRs for a wide range of SEP and health indicators. MDRs are similarly shown for economic outcomes [1,7,9]. Physical health [10-13], health behaviors [14-16], and mental health [17,18]. outcomes. That means high SEP Blacks report worse health outcomes, across domains, compared to high SEP Whites [14,17,19,20]. In other studies, educational attainment better reduced environmental exposures to environmental pollutants for Whites than for Blacks [21]. Very few investigations, however, have ever explored MDRs of educational attainment on perceived stress. In a recent study, education better reduced work-related stress for Whites than Blacks [22]. In another study, educational mobility altered exposure to stress for Whites but not Blacks 9. Other studies have shown high levels of perceived discrimination in high SEP Blacks [5,23-27].

The U.S. labor market, being a dual system, may be one reason why highly educated Black people have high stress. In the U.S. labor market, one tier of jobs are low-stress, high-pay, and prestigious. Another tier of jobs are stressful, low-paying, and in high demand. The US labor market, similar to other sectors of U.S. society, discriminates against racial minorities, particularly Blacks. As a result, Blacks are employed in the lower-tier jobs that are low-pay and have more stress. The U.S. labor market, similar to U.S. sectors and institutions, tends to discriminate against Blacks [11,28]. This is supported by the literature showing that identical resumes generate unequal outcomes for Black and White job applicants simply because of the racial names of the applicants [29]. As a result, highly educated Black people will likely fight an uphill battle and have more difficulties enhancing their living conditions. Consequently, highly educated Blacks continue to work in lower- quality jobs that are high in stress and environmental exposures and have low benefits [21,28]. In addition to the systemic discrimination by the labor market, job proximity and variability are low for Blacks due to residential segregation. Blacks are more likely to reside in neighborhoods that have limited resources and poor job opportunities. Thus, Blacks with high educational attainment have a lower likelihood of accessing occupational opportunities, even when the labor market does not discriminate against them [21,28]. Finally, as education is lower quality in urban areas, racial minority groups, particularly Blacks, receive lower-quality education. All these differences may alter the effects of educational attainment on occupation quality for Blacks with high educational attainment. All these potentially explain why educational attainment generates less health outcomes for Blacks than Whites [1,6,7,21,30].

Some research suggests that stress may be a mechanism which shows that educational attainment and SEP do not generate the same level of health for Blacks and Whites. In a few studies, perceived discrimination is shown to increase in Blacks who have higher educational attainment, simply because they live in closer proximity to Whites [23,31-33]. High SEP increases not only exposure but also sensitivity to race-related stress [24]. These studies, however, have focused on race-related stress, which makes it more challenging to compare Blacks and Whites. As a result, there is a need to study how other forms of stress, such as perceived economic hardship, changes as a function of SEP in Blacks and Whites.

To extend what is already known on the contribution of various forms of stress to explain MDRs, we performed a secondary analysis of existing data to explore Black/White differences in how educational attainment is associated with perceived economic hardship in the U.S. We expected an inverse association between educational attainment and perceived economic hardship overall (Hypothesis #1), however, we also expected this association to be smaller for Blacks than Whites (Hypothesis #2).


Design and settings

A secondary analysis of the 2015 NHIS data, which is one of the main national health surveys of American residents. The NHIS is funded and performed by the CDC [34].

NHIS ethics

The NHIS study protocol received approval from the Institutional Review Board (IRB) of the National Center for Health Statistics, CDC. All NHIS participants signed and provided written informed consent.

NHIS sample

The NHIS sample was composed of American adults who were civilian, non-institutionalized, US resident, and at least 18 years old. The NHIS sampling strategy was a multistage sampling that involved clustering and stratification to generate a probability sample of U.S. households. Although the NHIS 2015 included 33,672 American adults, this analysis was limited to 24,874 adults who were either White or Black.

Study variables

Variables included demographic characteristics, race, educational attainment (SEP), region, marital status, income, employment, and perceived economic hardship, all measured at an individual level. Race was self-identified and included Blacks versus Whites. Demographic Characteristics included age (years) and gender (male 1 female 0). Number of jobs was a continuous variable. Participants were asked if they were working on more than one job. Educational Attainment, a continuous measure ranging between 0 and 24 years, was the independent variable. Marital Status was 1) married versus non-married. Region of the country was coded as: 1) northeast, 2) Midwest, 3) south, and 4) west (reference group).

The outcome in this study was perceived economic hardship, measured using the following items: “How worried are you about…” 1) money for retirement, 2) medical costs of illness/accident, 3) maintaining standard of living, 4) costs of healthcare, 5) paying for children’s college, 6) paying monthly bills, 7) paying rent/mortgage/ housing costs, and 8) credit card payments. Item responses were on a 1 to 5 scale, with 5 showing worse stress on each item. We calculated an average of all above items. Our overall perceived economic hardship score ranged from 1 to 5, with a score of 5 meaning highest possible perceived economic hardship and a score of 1 meaning no perceived economic hardship in any domain (Cronbach alpha = 925).

Data analytical plan

Applying SPSS 23.0 enabled us to accommodate the NHIS survey weights. After we examined the distribution of our variables and used the Pearson correlation test to measure unadjusted correlations across the variables, we tested the assumptions and requirements of multivariable modeling. Since our data met the requirements such as near to normal distribution of errors and lack of collinearity between our independent variable and our confounders, we fit four linear regression models. We ran two of our models in the pooled sample with and without interaction terms between race and educational attainment. We ran two other models specific to Blacks and Whites.


Descriptive statistics

Table 1 provides a descriptive summary of the participants’ characteristics. From 24,874 American adults who participated, most were White (n = 20,507, 82.4%). Only a minority were Black (n = 4,367, 17.6%). The average age of our participants was 51.8 (SD = 18.4) years. The mean educational attainment of the participants was 15.5 years (Standard Deviation = 2.8 years) (Table 1).