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The inverse relationships between socioeconomic status (SES) and unhealthy behaviors such as tobacco use, physical inactivity, and poor nutrition have been well demonstrated empirically but encompass diverse underlying causal mechanisms. These mechanisms have special theoretical importance because disparities in health behaviors, unlike disparities in many other components of health, involve something more than the ability to use income to purchase good health. Based on a review of broad literatures in sociology, economics, and public health, we classify explanations of higher smoking, lower exercise, poorer diet, and excess weight among low-SES persons into nine broad groups that specify related but conceptually distinct mechanisms. The lack of clear support for any one explanation suggests that the literature on SES disparities in health and health behaviors can do more to design studies that better test for the importance of the varied mechanisms.

Educational disparities in U.S. adult mortality are large and have widened across birth cohorts. We consider three policy relevant scenarios and estimate the mortality attributable to: (1) individuals having less than a high school degree rather than a high school degree, (2) individuals having some college rather than a baccalaureate degree, and (3) individuals having anything less than a baccalaureate degree rather than a baccalaureate degree, using educational disparities specific to the 1925, 1935, and 1945 cohorts. We use the National Health Interview Survey data (1986-2004) linked to prospective mortality through 2006 (N=1,008,949), and discrete-time survival models, to estimate education- and cohort-specific mortality rates. We use those mortality rates and data on the 2010 U.S. population from the American Community Survey, to calculate annual attributable mortality estimates. If adults aged 25-85 in the 2010 U.S. population experienced the educational disparities in mortality observed in the 1945 cohort, 145,243 deaths could be attributed to individuals having less than a high school degree rather than a high school degree, 110,068 deaths could be attributed to individuals having some college rather than a baccalaureate degree, and 554,525 deaths could be attributed to individuals having anything less than a baccalaureate degree rather than a baccalaureate degree. Widening educational disparities between the 1925 and 1945 cohorts result in a doubling of attributable mortality. Mortality attributable to having less than a high school degree is proportionally similar among women and men and among non-Hispanic blacks and whites, and is greater for cardiovascular disease than for cancer. Mortality attributable to low education is comparable in magnitude to mortality attributable to individuals being current rather than former smokers. Existing research suggests that a substantial part of the association between education and mortality is causal. Thus, policies that increase education could significantly reduce adult mortality.

Few studies have examined whether sex differences in mortality are associated with different distributions of risk factors or result from the unique relationships between risk factors and mortality for men and women. We extend previous research by systematically testing a variety of factors, including health behaviors, social ties, socioeconomic status, and biological indicators of health. We employ the National Health and Nutritional Examination Survey III Linked Mortality File and use Cox proportional hazards models to examine sex differences in adult mortality in the United States. Our findings document that social and behavioral characteristics are key factors related to the sex gap in mortality. Once we control for women's lower levels of marriage, poverty, and exercise, the sex gap in mortality widens; and once we control for women's greater propensity to visit with friends and relatives, attend religious services, and abstain from smoking, the sex gap in mortality narrows. Biological factors — including indicators of inflammation and cardiovascular risk — also inform sex differences in mortality. Nevertheless, persistent sex differences in mortality remain: compared with women, men have 30% to 83% higher risks of death over the follow-up period, depending on the covariates included in the model. Although the prevalence of ris factors differs by sex, the impact of those risk factors on mortality is similar for men and women.

Objective. This article addresses the relationship between suicide mortality and family structure and socioeconomic status for U.S. adult men and women. Methods. We use Cox proportional hazard models and individual-level, prospective data from the National Health Interview Survey Linked Mortality File (1986-2002) to examine adult suicide mortality. Results. Larger families and employment are associated with lower risks of suicide for both men and women. Low levels of education or being divorced or separated, widowed, or never married are associated with increased risks of suicide among men, but not among women. Conclusions. We find important sex differences in the relationship between suicide mortality and marital status and education. Future suicide research should use both aggregate and individual-level data and recognize important sex differences in the relationship between risk factors and suicide mortality—a central cause of preventable death in the United States.

Epidemiological research typically focuses on the intensity, frequency, or duration of physical activity, without consideration of the socially meaningful dimensions of exercise. The authors use data from the 1998 National Health Interview Survey (N = 17,455) and information on participation in 15 exercise behaviors to examine educational differences in exercise among non-Hispanic whites, non-Hispanic blacks, and Mexican Americans. Factor analysis identifies three types of exercise: team sports (e.g., basketball, football), fitness activities (e.g., running, weight lifting), and activities that require the use of specialized facilities (e.g., golf, tennis). Cultural capital and human capital perspectives offer insight into different dimensions of the relationship between education and exercise. Whites disproportionately undertake facility-based exercise, blacks tend toward team and fitness activities, and Mexican Americans gravitate toward team sports. Our findings offer insight into the social stratification of health and can aid the design of public health interventions.

Objectives. Individuals may cope with perceived stress through unhealthy but often pleasurable behaviors. We examined whether smoking, alcohol use, and physical inactivity moderate the relationship between perceived stress and the risk of death in the US population as a whole and across socioeconomic strata. Methods. Data were derived from the 1990 National Health Interview Survey’s Health Promotion and Disease Prevention Supplement, which involved a representative sample of the adult US population (n=40335) and was linked to prospective National Death Index mortality data through 1997. Gompertz hazard models were used to estimate the risk of death. Results. High baseline levels of former smoking and physical inactivity increased the impact of stress on mortality in the general population as well as among those of low socioeconomic status (SES), but not middle or high SES. Conclusions. The combination of high stress levels and high levels of former smoking or physical inactivity is especially harmful among low-SES individuals. Stress, unhealthy behaviors, and low SES independently increase risk of death, and they combine to create a truly disadvantaged segment of the population.

Objectives. We investigated whether there were gender differences in chronic medical, psychiatric, and substance-dependence disorders among jail inmates and whether substance dependence mediated any gender differences found. Methods. We analyzed data from a nationally representative survey of 6982 US jail inmates. Weighted estimates of disease prevalence were calculated by gender for chronic medical disorders (cancer, hypertension, diabetes, arthritis, asthma, hepatitis, and cirrhosis), psychiatric disorders (depressive, bipolar, psychotic, posttraumatic stress, anxiety, and personality), and substance-dependence disorders. We conducted logistic regression to examine the relationship between gender and these disorders. Results. Compared with men, women had a significantly higher prevalence of all medical and psychiatric conditions (P ≤ .01 for each) and drug dependence (P < .001), but women had a lower prevalence of alcohol dependence (P < .001). Gender differences persisted after adjustment for sociodemographic factors and substance dependence. Conclusions. Women in jail had a higher burden of chronic medical disorders, psychiatric disorders, and drug dependence than men, including conditions found more commonly in men in the general population. Thus, there is a need for targeted attention to the chronic medical, psychiatric, and drug-treatment needs of women at risk for incarceration, both in jail and after release.

The U.S. is exceptional among high-income countries for poor survival outcomes. Understanding the distribution of excess deaths by age, sex, and cause of death, is essential for bringing U.S. mortality in line with international peers. We use 2016 data from the World Health Organization Mortality Database and the Human Mortality Database to calculate excess deaths in the U.S. relative to each of 18 high-income comparison countries. The U.S. experiences excess mortality in every age and sex group, and for 16 leading causes of death. For example, the U.S. could potentially prevent 884,912 deaths by achieving the lower mortality rates of Japan, the comparison country yielding the largest number of excess deaths, which would be comparable to eliminating all deaths from heart disease, unintentional injuries, and diabetes mellitus. In contrast, the U.S. could potentially prevent just 176,825 deaths by achieving the lower mortality rates of Germany, the comparison country yielding the smallest number of excess deaths, which would be comparable to eliminating all deaths from chronic lower respiratory diseases and assault (homicide). Existing research suggests that policies that improve social conditions and health behaviors are more likely to bring U.S. mortality in line with peer countries than policies that support health care access or new biomedical technologies. Achieving the death rates of peer countries could result in mortality reductions comparable to eliminating leading causes of death.

Lifestyles are a long-theorized aspect of social inequalities that root individual behaviors in social group differences. Although the health lifestyle construct is an important advance for understanding social inequalities and health behaviors, research has not theorized or investigated the longitudinal development of health lifestyles from infancy through the transition to school. This study documented children’s longitudinal health lifestyle pathways, articulated and tested a theoretical framework of health lifestyle development in early life, and assessed associations with kindergarten cognition, socioemotional behavior, and health. Latent class analyses identified health lifestyle pathways using the US Early Childhood Longitudinal Study—Birth Cohort (ECLS-B; N ˜ 6550). Children’s health lifestyle pathways were complex, combining healthier and unhealthier behaviors and changing with age. Social background prior to birth was associated with health lifestyle pathways, as were parents’ resources, health behaviors, and nonhealth-focused parenting. Developing health lifestyle pathways were related to kindergarten cognition, behavior, and health net of social background and other parent influences. Thus, family context is important for the development of complex health lifestyle pathways across early childhood, which have implications for school preparedness and thus for social inequalities and well-being throughout life. Developing health lifestyles both reflect and reproduce social inequalities across generations.

Short sleep duration among children and adolescents has been reported to be associated with elevated BMI and other adverse health outcomes. Food choices are one proposed mechanism through which this association may occur. In the present study, we examined whether self-reported habitual sleep duration is associated with vegetable and fruit consumption and fast food consumption. Using cross-sectional data from the National Longitudinal Study of Adolescent Health (n 13 284), we estimated three nested logistic regression models for two outcome variables: daily vegetable and fruit consumption and previous week's fast food consumption. The adjusted models included demographic and social/behavioural covariates. Self-reported habitual short sleep duration ( < 7 h/night) was associated with reduced odds of vegetable and fruit consumption compared with the recommended sleep duration (>8 h/night) (OR 0·66, P <0·001), even after adjusting for demographic and social/behavioural factors (OR 0·75, P <0·001). Short sleep duration was also associated with increased odds of fast food consumption (OR 1·40, P <0·001) even after adjustment (OR 1·20, P <0·05). Food choices are significantly associated with sleep duration and may play an important role in the mediation of the association between sleep and health among adolescents.