Journal article
Educational attainment, health locus of control and inflammation among cancer survivors in the Midlife in the United States (MIDUS) study
Psychology, health & medicine, pp 1-22
29 Oct 2025
PMID: 41159596
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
The goal of this study was to investigate whether HLOC mediates the relationship between educational attainment and inflammatory proteins in cancer survivors. Data are from 298 cancer survivors (87.54% white; M age = 63.6; M survivorships = 15 years) who participated in the Biomarker protocol of Wave 2 and Refresher phases of the Midlife in the United States (MIDUS) study. Educational attainment was dichotomized (bachelor's degree or above versus lower). The two measures of HLOC were based on whether participants felt others had control over their health outcomes (external HLOC) or if they felt they were in control of their health outcomes (internal HLOC). We used C-reactive protein (CRP) and interleukin-6 (IL-6) as markers of inflammation. Mediation analyses for external and internal HLOC were tested separately. Mediation analyses were conducted using the PROCESS package in R (using 10 000 bootstrapped samples). Analyses were adjusted for age, sex, cohort, body mass index (BMI), smoking status, and race/ethnicity. In the fully adjusted model, educational attainment and external HLOC were significantly associated with CRP. Relative to those with bachelor's degrees, participants with lower educational attainment had elevated CRP (b = -0.25, SE = 0.11, 95% CI = [-0.47, -0.03]). Higher external HLOC was linked to increased CRP (b = 0.10, SE = 0.04, 95% CI = [0.01, 0.18]). The mediation analyses showed that a higher external HLOC was a significant path through which lower educational attainment was associated with elevated CRP (indirect effect = -0.05, bootstrapped SE = 0.02, 95% CI [bootstrapped] = [-0.10, -0.01]. Cancer survivors with lower educational attainment may tend to perceive that their health is outside of their control. These socioeconomic and psychosocial processes may drive an increase in the circulating levels of inflammatory signaling proteins known to be sensitive predictors of age-related chronic diseases.
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Details
- Title
- Educational attainment, health locus of control and inflammation among cancer survivors in the Midlife in the United States (MIDUS) study
- Creators
- Madeline J. Plummer - Drexel UniversityRose Ann Dimaria-Ghalili - Drexel University, College of Nursing and Health ProfessionsAna Maria Lopez - Thomas Jefferson UniversityCarolyn Y. Fang - Fox Chase Cancer CenterChristopher L. Coe - University of Wisconsin–MadisonAgus Surachman - Drexel University, Dana and David Dornsife School of Public Health
- Publication Details
- Psychology, health & medicine, pp 1-22
- Publisher
- Taylor & Francis
- Number of pages
- 22
- Grant note
- P01-AG020166; U19-AG051426 / John D. and Catherine T. MacArthur Foundation Research Network, National Institute on Aging UL1TR001409; UL1TR001881; 1UL1RR025011 / NIH National Center for Advancing Translational Sciences (NCATS) Clinical and Translational Science Award (CTSA) program Thomas Jefferson University-Drexel University Cancer Consortium Pilot Award
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Drexel FIRST (Center for Firefighter Injury Research and Safety Trends); Dana and David Dornsife School of Public Health; Epidemiology and Biostatistics; College of Nursing and Health Professions
- Web of Science ID
- WOS:001604173200001
- Scopus ID
- 2-s2.0-105020595023
- Other Identifier
- 991022125325504721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Public, Environmental & Occupational Health