Associations of grandparental schooling with adult grandchildren's health status, smoking, and obesity.

Despite persistent schooling-related health disparities in the United States, little is known about the multigenerational effects of schooling on adult health. As expected lifespans increase, direct influences of grandparental schooling on grandchildren's health may become increasingly important. We used multigenerational data spanning 41 years from a national sample of US families to investigate associations of grandparents' educational attainment with global health status, smoking, and obesity in their grandchildren who were aged 25-55 years in 2009. We estimated total effects of grandparental schooling and, by using marginal structural models, we estimated controlled direct effects that were independent of parents' and participants' schooling. Among whites, lower levels of grandparental schooling were monotonically associated with poor health status, current smoking, and obesity in adult grandchildren. There was also evidence suggesting direct effects, which was stronger for poor health status among participants whose highest-educated grandparent lived in the same state. Among blacks, the only association suggesting a total or direct effect of grandparental schooling was for smoking. Despite the relative imprecision of our estimates and possible residual bias, these results suggest that higher levels of grandparental schooling may benefit the health of grandchildren in adulthood, especially among whites. Furthermore, part of those apparent effects, especially for obesity, may not be mediated by parents' and grandchildren's schooling.