摘要：Objectives. We compared health outcomes for adults with the General Equivalency Diploma (GED) and regular high school diploma to determine whether GED recipients are equivalent to regular graduates despite research that documents their disadvantages in other outcomes. Methods. We used 1997 to 2009 National Health Interview Survey cross-sectional data on high school dropouts, graduates, and GED recipients aged 30 to 65 years (n = 76 705). Five general health indicators and 20 health conditions were analyzed using logistic models. Results. GED recipients had a significantly higher prevalence of every health outcome compared with high school graduates (odds ratios = 1.3–2.7). The GED–high school differences attenuated but remained evident after controlling for health insurance, economic status, and health behaviors. For most conditions, the 95% confidence interval for GED earners overlapped with that for high school dropouts. Conclusions. The high school equivalency diploma was associated with nonequivalent health: adults with a GED had health comparable to that of high school dropouts, not graduates. GED recipients were at increased risk for many health conditions, and their health should be viewed as distinct from regular graduates. The findings have implications for health and educational policies. The General Equivalency Diploma (GED) has been available since 1942 as a credential certifying the completion of secondary education, an alternative to a regular high school graduation. The annual number of recipients has been increasing steadily to about half a million in recent years, representing between 10% and 25% of all high school credentials. 1–3 A typical test taker is about 25 years old. Approximately 40% of the diplomas are awarded to women, 60% to Whites, and about 18% each to Black and Hispanic adults. 4 Over the course of the past 70 years, 18 million adults have earned the GED. 4 The GED's value is predicated on the assumption that the degree is comparable to the regular high school diploma. Most population and education statistics, for instance, count GED recipients together with regular graduates. 5,6 In some ways, this equivalence assumption is true. The knowledge and cognitive skills required of successful GED test takers are comparable to those of regular graduates. 1 College admission procedures almost uniformly accept the GED as a marker of the completion of secondary education. 7 In numerous important ways, however, research showed that the outcomes of the GED recipients are not equivalent to those of regular high school graduates. Two benchmark studies published in the 1990s established that adults with a GED had consistently and considerably worse labor market outcomes than regular graduates. 8,9 More than a dozen studies since then have corroborated this difference. 10–12 Additionally, researchers also documented the GED disadvantage in outcomes such as lower college completion rates, 1 higher attrition from the military, 9 higher crime rates, 13 and higher rates of substance use. 13 Little if anything is known about the health of adults with a GED, despite the fact that the links between education in general and health were studied extensively. 14–16 One reason why health outcomes among GED recipients had been neglected is that until recently, few representative health surveys distinguished between a GED and a regular high school diploma. Recently, some researchers began examining health-related outcomes. GED recipients were found to have higher rates of smoking and alcohol use compared with graduates, 17,18 and possibly also higher rates of depression. 13,19 A recent study of mortality found that GED earners had higher risks of dying than regular graduates, 20 although only among younger cohorts. We compared GED and regular high school recipients using 25 health outcomes in a large, nationally representative sample of US working-aged adults. In addition to the GED–high school comparison, we also included high school dropouts in our analyses. GED recipients were assumed to be equivalent to high school graduates in knowledge and ability. In 2 key aspects, however, adults with GEDs were more comparable to high school dropouts: both groups attended school for about 10 years, on average, 9 and both groups made the decision to drop out of high school before completion. The inclusion of dropouts allowed us to better describe where the GEDs fall: are they equivalent to high school graduates as they theoretically can be expected to be on the basis of their credentials, or are they similar to the dropouts, to whom they can be compared on the basis of years of schooling and the decision to discontinue secondary schooling?
