Explaining the Education-Health Gradient in Preventing STIs in Andean Peru: Cognitive Executive Functioning, Awareness and Health Knowledge

Ismael G. Muñoz, The Pennsylvania State University David P. Baker, The Pennsylvania State University Ellen Peters, University of Oregon

First published online:

| DOI: https://doi.org/10.1363/46e9320
Abstract / Summary

Little is known about the pathways mediating the relationship between education and health. It is widely assumed that formal schooling leads to awareness of health risks (e.g., STIs) and, in turn, to adoption of preventive behavior (e.g., condom use); however, evidence supporting this mechanism has been limited.


Survey data were collected in 2010 from a sample of 247 adults aged 30-62 living in an isolated Andean district of Peru; these individuals had widely varying exposure to schooling, and their community had recently experienced elevated risks of STIs. Structural equation modeling was used to estimate the degree to which schooling is associated with cognitive resources, STI awareness and sexual health knowledge, and how these jointly are associated with ever-use of condoms.


Thirty-two percent of respondents reported ever-use of condoms. One additional year of schooling was associated with a 2.7-percentage-point increase in the probability of condom use, after adjustment for covariates. The pathway between education and condom use was mediated by cognitive executive functioning (CEF) skills (0.26 standard deviations), STI awareness (0.09) and sexual health knowledge (0.10); CEF skills were associated with condom use both directly and indirectly, through STI awareness and sexual health knowledge, and accounted for two-thirds of the education-condom use gradient.


The relationship between education and STI prevention may be more complex than is often assumed and is mediated by CEF skills, STI awareness and sexual health knowledge. Studies should examine whether STI prevention interventions are more effective if they enhance cognitive skills used to translate information into protective behaviors.

Author's Affiliations

Ismael G. Muñoz is a graduate research assistant in the Department of Education Policy Studies, and David P. Baker is professor in the Departments of Sociology, Education and Demography— both at The Pennsylvania State University, University Park, PA, USA. Ellen Peters is professor, School of Journalism and Communication, University of Oregon, Eugene, OR, USA.


The authors thank their Peruvian study collaborators Martín Benavides and Juan León from The Group for the Analysis of Development (GRADE). Funding for the research was provided by the National Science Foundation (SES-0826712; SES-1155924). The authors acknowledge assistance provided by the Population Research Institute at Penn State University, which is supported by infrastructure grant #P2CHD041025 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.


The views expressed in this publication do not necessarily reflect those of the Guttmacher Institute.