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While the positive association between education and health has been established, the explanations for this association are not . People who are well educated experience better health as reflected in the high levels of self-reported health and low levels of morbidity, mortality, and disability. By extension, low educational attainment is associated with self-reported poor health, shorter life expectancy, and shorter survival when sick. Prior research has suggested that the association between education and health is a complicated one, with a range of potential indicators that include (but are not limited to) interrelationships between demographic and family background indicators  - effects of poor health in childhood, greater resources associated with higher levels of education, appreciation of good health behaviors, and access to social networks. Some evidence suggests that education is strongly linked to health determinants such as preventative care . Education helps promote and sustain healthy lifestyles and positive choices, nurture relationships, and enhance personal, family, and community well-being. However, there are some adverse effects of education too . Education may result in increased attention to preventive care, which, though beneficial in the long term, raises healthcare costs in the short term. Some studies have found a positive association between education and some forms of illicit drug and alcohol use. Finally, although education is said to be effective for depression, it has been found to have much less substantial impact in general happiness or well-being .
It is likely that many children are aware of the threat of climate change. However, it is also quite likely that they are confused about the facts and the magnitude of the threat they personally face, and might feel anxious, concerned or confused. Worries and anxieties about these threats can become difficult for children of all ages to deal with.
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Recruitment strategies vary by field site to accommodate the unique resources available to each site. Generally, the target population is mothers with a young child (2 to 12 years old) with ASD, who would be more likely to become pregnant again than a mother with an older child. For example, for the Pennsylvania and Maryland sites, a primary strategy for reaching potentially eligible mothers is distribution of information through the early intervention and special education systems. The northern California site at the University of California, Davis, identifies and reaches potentially eligible mothers primarily through the state's Department of Developmental Services, whereas the Kaiser Permanente site in northern California can identify Kaiser Permanente members who become newly pregnant and already have children with autism. Clinical service providers in the catchment areas, including ASD evaluation and diagnostic centers, developmental pediatricians and mental health service providers, are also engaged at each site to reach potentially eligible women. The researchers in the EARLI Study have not focused on establishing relationships with providers serving the general population of pregnant women (for example, obstetricians, nurse midwives) or children (for example, general pediatricians) for individual-level outreach but will make available general information about the EARLI Study as requested. All field sites carry out supplementary recruitment efforts through staffed information tables at autism events and through advocacy organizations' websites, listservs and newsletters. Reinforcing information about the EARLI Study through multiple channels increases the chance that mothers of reproductive age who have children with ASD, at a later time when they are pregnant, will remember and consider enrolling in the EARLI Study. To that end, EARLI also maintains an active presence in social media, including Facebook  and YouTube  and has a web presence  that includes content geared toward potentially eligible mothers as well as enrolled participants. Given this recruitment approach, it is possible that participating families might differ from their respective area source population on factors related to the extent of connection to service systems and the degree of immersion in the autism community. To introduce bias, such selection needs to be differential with respect to both exposure and outcome. Although these selection effects could be associated with certain exposure profiles of interest, independent associations with ASD risk, though conceivable, seem less likely. EARLI Study sites, to varying degrees, will be able to explore differences between participating families and source populations. All sites can compare basic characteristics of participating families with families in the region receiving services for a young child with ASD, but only the Kaiser Permanente site has the ability to identify the subgroup in the source population who are becoming pregnant.
As Figure 1 illustrates, the EARLI Study involves extensive data collection, so investigators strive to maximize retention by being as flexible as possible. Both online and paper versions of most questionnaires and documents are available, and home visits and flexible visit scheduling is accommodated when possible. Of the first 177 families enrolled in the study, 97.2% are still participating. Variability in the time of data collection creates challenges and opportunities for research but is also a reality of intensive, prospective follow-up of this study population. Retention in the EARLI Study is also driven by the prospective developmental follow-up offered for the at-risk siblings. EARLI Study sites provide families with summaries of research evaluations, discuss questions with families, provide information on local resources for families concerned with their child's development and make referrals for services for affected siblings. Upon enrollment, the EARLI Study also provides families with a specially developed social storybook about the impending arrival of a baby sibling that parents can use in interactions with the proband. EARLI Study investigators stay connected with enrolled families as a group through the study website, Facebook and study newsletters.
Young people today have direct access to the Internet from personal computers and mobile devices, whether at home, schools or in public places. Reports from 2012 indicate that 95% of American teenagers use the Internet and, of those, 81% use social media . As early as 2009, polls showed that more than half of adolescents were logging on to a social media website more than once per day and that 22% logged on to a preferred website more than 10 times per day . Computer time accounts for up to 1.5 h per day; half of this is spent in social networking, playing games, or viewing videos . 2b1af7f3a8