Education and self-rated health: An individual and neighborhood level analysis of Asian Americans, Hawaiians, and Caucasians in Hawaii

Focusing on Asian Americans, Hawaiians, and Caucasians in Hawaii, this study contributes to the literature by examining (I) the geographical distributions of education in relation to self-rated general health at neighborhood levels, and (2) the individual variations in self-rated health by ethnicity and education at both individual and neighborhood levels. Using the 2007 Hawaii Health Survey with linked zip-code information, and applying GIS (Geographic Information System) and binary logistic regression models, this study found that (I) there are significant between ethnic differences in self-rated health in Hawaii, with Hawaiians being the most disadvantaged population compared to Japanese, Chinese, and Caucasians; (2) individual socioeconomic characteristics are all related to self-rated health, and education (in particular) mediates the Japanese vs. Hawaiian and Chinese vs. Hawaiian health differences; (3) the neighborhood level of education has an independent effect on self-rated health over and above individual characteristics for the whole sample and it partially mediates the between ethnic health differences; and (4) the relative importance of education to self-rated health is more significant and salient for Caucasians and Japanese/Chinese than for Filipinos and Hawaiians. In sum, this study not only demonstrates a geographical profile of health and education distributions in Hawaii, but also reveals significant mediating effects of education, at both individual and neighborhood levels, in explaining the between and within ethnic differentials in self-rated health. (C) 2009 Elsevier Ltd. All rights reserved.