Assessing the Impact of Relative Social Position and Absolute Community Resources on Depression and Obesity Among Smokers

Abstract

We tested two competing hypotheses-relative social position and community resources-in regards to their effect on two co-occurring health problems (depression, and obesity) in a sample of smokers participating in an online smoking cessation intervention. Income and education data at the zip code level from the 2000 Census was linked with individual level data. Logistic regression models were used for each co-occurring problem to determine how each SES variable (individually and interactively) was associated with the presence of co-occurring health problems. We found that lower individual education was related to poorer health for all outcomes (Depression: OR = 1.25; Obesity: OR = 1.24; Both: OR = 1.46), lower community education was only related to obesity (OR = 1.20). Lower individual income was related to higher rates of depressive symptoms (OR = 1.64) and both health problems (OR = 1.55); a significant interaction of individual and community income (Wald = 6.13, p < .05) revealed that high income individuals were less likely to be depressed if they lived in lower-income communities and became more likely to be so as community income increased. Relative social position was confirmed for depression, whereas community resources were prominent only for obesity. Higher individual education most consistently predicted positive health outcomes, making it a potentially powerful target to reduce health disparities.