Inequalities In Health Behaviour Research Articles

Modifiable risk factors of inequalities in hypertension: analysis of 100 million health checkups recipients.

Inequalities in health behaviors are thought to contribute to inequalities in hypertension. This study examined the extent to which modifiable mediating factors explain income inequalities in hypertension. This repeated cross-sectional study used data from National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) from 2009 to 2015. Those aged between 40 and 74 were enrollees in the Specific Health Checkups. Hypertension was defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90, or the use of antihypertensive medication. The mediating effects of exercise, obesity, smoking, and alcohol drinking on the association between income, as an indicator of SES, and hypertension were determined by the Karlson-Holm-Breen (KHB) method. The mean age of the 68,684,025 men and 59,118,221 women was 54.7 (SD = 9.6) and 56.7 (SD = 10.0) years, respectively. Prevalence of hypertension was higher in the lowest income group (48.6% for men, 40.2% for women) than in the highest income group (33.3% for men, 21.5% for women). Inequalities tended to increase over time. Inequalities were larger among those who did not use antihypertensive medication. Modifiable risks explained 10.6% of the association between income and hypertension for men and 15.1% for women. In men, drinking and obesity explained 8.8% and 5.5% of the inequalities in hypertension, respectively. In women, obesity explained 18.8%. Exercise increased the proportion mediated over time. Smoking explained 5.5% among women taking antihypertensive medication. There were health inequalities in hypertension among Japanese adults, and the modifiable risk factors partially explained the inequalities.

The Relationship Between Perceived Uncontrollable Mortality Risk and Health Effort: Replication, Secondary Analysis, and Mini Meta-analysis.

The Uncontrollable Mortality Risk Hypothesis (UMRH) states that those who are more likely to die due to factors beyond their control should be less motivated to invest in preventative health behaviors. Greater levels of perceived uncontrollable mortality risk (PUMR) have been associated with lower health effort in previous research, but the topic remains understudied. To examine the evidence for the UMRH by replicating a previous study investigating the effects of PUMR on social gradients in health effort, and conducting a mini meta-analysis of the overall relationship between PUMR and health effort. We replicated Pepper and Nettle (2014), who reported a negative relationship between PUMR and health effort, and that the positive effect of subjective socioeconomic position on health effort was explained away by PUMR. We also compared the predictive effect of PUMR on health effort with that of dimensions from the Multidimensional Health Locus of Control scale-a well-used measure of a similar construct, which is frequently found to be associated with health behavior. Finally, we conducted a mini meta-analysis of the relationship between PUMR and health effort from the available research. PUMR was negatively associated with health effort, and mediated 24% of the total effect of subjective socioeconomic position on health effort, though this mediation effect was weaker than in Pepper and Nettle (2014). PUMR was shown to be a substantially stronger predictor of health effort than the relevant dimensions of the MHLC scale. Finally, our mini meta-analysis indicated a medium-sized negative relationship between PUMR and health effort. Our findings offer support for the role of PUMR in mediating the relationship between subjective socioeconomic position and health effort. The results highlight the importance of measuring and understanding PUMR in studying socioeconomic inequalities in health behaviors. We discuss potential areas for future research, including determining the accuracy of PUMR, investigating influential cues, examining the role of media in shaping risk perceptions, and understanding individuals' awareness of their own perceptions of mortality risk.

Socioeconomic inequalities in smoking and drinking in adolescence: social network dynamics

Abstract Background Network-based interventions have the potential to prevent socioeconomic inequalities in health behaviors but require a good understanding of the underlying social network mechanisms. We investigated whether (1) adolescents selected friends with a similar socioeconomic status (SES), (2) smoking and alcohol consumption spread in networks, and (3) the exclusion of non-smokers or non-drinkers differed between SES groups. Methods We applied Stochastic Actor Oriented Models to the complete social network data (“Wired into Each Other” data) of 253 adolescents in eight Hungarian secondary school classes over three waves between 2010 and 2013. SES was measured based on entitlement to an income-tested regular child protection benefit. Results High SES adolescents were most likely to form friendships with peers from their own SES group (odds ratio [OR] = 1.1, 95% Confidence Interval [CI] = 1.0-1.1). Adolescents adjusted their smoking behavior (OR = 24.0, 95% CI 1.3-454.9) but not their alcohol consumption (OR = 1.6, 95% CI 0.6-4.4) to emulate the behavior of their friends. Smokers did not differ from non-smokers in the likelihood of receiving a friendship nomination (OR = 1.0, 95% CI 0.9-1.1), regardless of their SES. Alcohol consumers received significantly more friendship nominations than non-consumers (OR = 1.2, 95% CI 1.0-1.3), but this association was not significantly different according to SES. Conclusions Socioeconomic inequalities in health behaviors were driven by preferences to form friendships within their own SES group and the spread of smoking and alcohol consumption in the network. These inequalities were not amplified by SES differences in encouraging smoking or drinking. Main messages: In three waves of observations in a Hungarian adolescent cohort, the study found social network effects for inequalities in smoking and alcohol consumption. Key messages • Inequalities in health behaviors arise because adolescents with high socioeconomic backgrounds selected each other as friends and smoking/alcohol consumption spread in networks. • Inequalities were not due to socioeconomic differences in encouraging harmful behaviors.

An investigation of factors affecting changes in health behaviours during the COVID-19 pandemic in a UK population–based cohort study

ObjectivesThe COVID-19 pandemic has led to changes in behaviours, which may have different health effects in population subgroups. We investigated whether within-individual changes in health behaviours from before to during the pandemic differ by socio-economic deprivation, age or sex. Study designProspective cohort study. MethodsParticipants were recruited from the existing UK Fenland cohort study with measurements of health behaviours twice prepandemic (2005 to February 2020) and three times during the pandemic (July 2020 to April 2021). Health behaviours included daily servings of fruit and vegetables, units of alcohol consumed per week, smoking status, sleep duration and total and domain-specific physical activity energy expenditure. Sociodemographic information (English indices of multiple deprivation, education, occupation and ethnicity) and COVID-19 antibody status were also collected. Participants were grouped into three categories based on their English indices of multiple deprivation score: most, middle and least deprived. ResultsParticipants were included if they had completed at least one measurement during the pandemic and one prepandemic (n = 3212). Fruit and vegetable consumption, total physical activity energy expenditure and smoking prevalence decreased during the pandemic compared with prepandemic, whereas average sleep duration increased and alcohol consumption did not change. Decreases in fruit and vegetable intake and physical activity energy expenditure were most pronounced in the most deprived group compared with the least deprived group and were greater in women than men. ConclusionsSocio-economic inequalities in health behaviours have worsened during the pandemic. As the country emerges from the COVID-19 pandemic, strategies to reduce health inequalities need to be put at the forefront of recovery plans.

Trends in material and non-material inequalities in adolescent health and health behaviours: A 12-year study in 23 European countries

Information on trends in adolescent health inequalities is scarce but the available evidence suggests that inequalities are increasing. Prior studies describe associations between material resources of socioeconomic status (SES) and health, while information on non-material SES resources and inequalities in health behaviours is lacking. To improve current understandings of evolutions in adolescent health inequalities, we examined how material and non-material SES resources were associated with changes in selected health outcomes (life satisfaction, physical and psychological symptoms) and health behaviours (physical activity, screen time, breakfast, fruit, vegetables, sweets and soft drinks consumption and alcohol and tobacco use) over a 12-year period. Repeated cross-sectional data came from the 2002, 2006, 2010 and 2014 waves of the Health Behaviour in School-aged Children (HBSC) survey from 23 European countries (n = 480,386). Measures of family affluence and occupational social class were used as indicators of material and non-material SES resources respectively. Regression-based slope indices of inequality indicated that absolute material and non-material inequalities remained stable from 2002 to 2014 in all health outcomes, except for life satisfaction for which a decrease in material inequalities was found between the highest and lowest affluence group (0.81 to 0.68 difference; p < 0.001). In terms of health behaviours, material inequalities decreased in screen time between highest and lowest affluence groups (0.53 to 0.34 h/day difference; p < 0.001), fruit (odds ratio [OR] 1.89 to 1.72 lower odds; p = 0.0088) and soft drinks consumption (OR 1.36 to 1.13 lower odds; p < 0.001) and remained stable in all others. Non-material inequalities increased in all health behaviours (except for sweets consumption) between highest and lowest occupational social class groups: physical activity (0.16 to 0.24 h/day difference; p = 0.0071), screen time (−0.41 to −0.58 h/day difference; p < 0.001), breakfast (0.21 to 0.51 day/week difference; p < 0.001), fruit (OR 1.23 to 1.48 higher odds; p < 0.001), vegetables (OR 1.39 to 1.74 higher odds; p < 0.001) and soft drinks consumption (OR 0.59 to 0.43 lower odds; p < 0.001) and alcohol (OR 0.99 to 0.85 lower odds; p = 0.0420) and tobacco use (OR 0.71 to 0.59 lower odds; p = 0.0183). In summary, non-material inequalities in most health behaviours increased, whereas material inequalities in adolescent health and health behaviours remain stable or decreased. Policies and interventions may consider non-material SES components as these can help in reducing future health inequalities.

Perceived risk factors for severe Covid-19 symptoms and their association with health behaviours: Findings from the HEBECO study

Risk perceptions are important influences on health behaviours. We used descriptive statistics and multivariable logistic regression models to assess cross-sectionally risk perceptions for severe Covid-19 symptoms and their health behaviour correlates among 2206 UK adults from the HEBECO study. The great majority (89–99%) classified age 70+, having comorbidities, being a key worker, overweight, and from an ethnic minority as increasing the risk. People were less sure about alcohol drinking, vaping, and nicotine replacement therapy use (17.4–29.5% responding ‘don't know’). Relative to those who did not, those who engaged in the following behaviours had higher odds of classifying these behaviours as (i) decreasing the risk: smoking cigarettes (adjusted odds ratios, aORs, 95% CI = 2.26, 1.39–3.37), and using e-cigarettes (aORs = 5.80, 3.25–10.34); (ii) having no impact: smoking cigarettes (1.98; 1.42–2.76), using e-cigarettes (aORs = 2.63, 1.96–3.50), drinking alcohol (aORs = 1.75, 1.31–2.33); and lower odds of classifying these as increasing the risk: smoking cigarettes (aORs: 0.43, 0.32–0.56), using e-cigarettes (aORs = 0.25, 0.18–0.35). Similarly, eating more fruit and vegetables was associated with classifying unhealthy diet as ‘increasing risk’ (aOR = 1.37, 1.12–1.69), and exercising more with classifying regular physical activity as ‘decreasing risk’ (aOR = 2.42, 1.75–3.34). Risk perceptions for severe Covid-19 among UK adults were lower for their own health behaviours, evidencing optimism bias. These risk perceptions may form barriers to changing people's own unhealthy behaviours, make them less responsive to interventions that refer to the risk of Covid-19 as a motivating factor, and exacerbate inequalities in health behaviours and outcomes.

Inequalities in body mass index, diet and physical activity in the UK: Longitudinal evidence across childhood and adolescence

We use longitudinal data across a key developmental period, spanning much of childhood and adolescence (age 5 to 17, years 2006–2018) from the UK Millennium Cohort Study, a nationally representative study with an initial sample of just over 19,000. We first examine the extent to which inequalities in overweight, obesity, BMI and body fat over this period are consistent with the evolution of inequalities in health behaviours, including exercise and healthy diet markers (i.e., skipping breakfast) (n = 7,220). We next study the links between SES, health behaviours and adiposity (BMI, body fat), using rich models that account for the influence of a range of unobserved factors that are fixed over time. In this way, we improve on existing estimates measuring the relationship between SES and health behaviours on the one hand and adiposity on the other. The advantage of the individual fixed effects models is that they exploit within-individual changes over time to help mitigate biases due to unobserved fixed characteristics (n = 6,883).We observe stark income inequalities in BMI and body fat in childhood (age 5), which have further widened by age 17. Inequalities in obesity, physical activity, and skipping breakfast are observed to widen from age 7 onwards. Ordinary Least Square estimates reveal the previously documented SES gradient in adiposity, which is reduced slightly once health behaviours including breakfast consumption and physical activity are accounted for. The main substantive change in estimates comes from the fixed effects specification. Here we observe mixed findings on the SES associations, with a positive association between income and adiposity and a negative association with wealth. The role of health behaviours is attenuated but they remain important, particularly for body fat.

How structural and individual factors help explain socioeconomic inequalities in health behaviors

Abstract Socioeconomic inequalities in health behaviors have been attributed to both structural and individual factors, but untangling the complex pathways through which these factors influence inequalities requires more research. We examined whether and how two factors, material conditions and time orientation, sequentially impact socioeconomic inequalities in health behaviors. Dutch adults 25 and older self-reported socioeconomic position (SEP) (educational level); material conditions (financial strain, housing tenure, income); time orientation; health behaviors including smoking and sports participation; and health behavior-related outcomes including body mass index (BMI) and self-assessed health in three waves (2004, 2011, 2014) of the longitudinal GLOBE study. Two hypothesized pathways were investigated during a ten-year time period using sequential mediation analysis, an approach that enabled correct temporal ordering and control for confounders like baseline health behavior. Educational level was negatively associated with BMI, positively associated with sports participation and self-assessed health, and not associated with smoking in the mediation models. For smoking, sports participation, and self-assessed health, a pathway from educational level to the outcome mediated by time orientation followed by material conditions was observed. Time orientation followed by material conditions may help explain socioeconomic inequalities in certain health behaviors, providing empirical support for the interplay between structural and individual factors. Smoking may be determined by prior smoking behavior regardless of SEP, potentially due to its addictive nature. While intervening on time orientation in adulthood may be challenging, the results from this study suggest that policy interventions targeted at material conditions may be more effective in reducing socioeconomic inequalities in certain health behaviors when they account for time orientation. Key messages Socioeconomic inequalities in certain health behaviors were mediated by time orientation followed by material conditions, showing the importance of considering both structural and individual factors. Policy interventions targeted at material conditions may be more effective in reducing socioeconomic inequalities in certain health behaviors when they account for time orientation.

Local Inequalities in Health Behaviours: Longitudinal Findings from the Stockton-On-Tees Cohort Study.

This paper provides a longitudinal examination of local inequalities in health behaviours during a period of austerity, exploring the role of ‘place’ in explaining these inequalities. Data from the Stockton-on-Tees prospective cohort study of 836 individuals were analysed and followed over 18 months (37% follow-up). Generalised estimating equation models estimated the deprivation gap in health behaviours (smoking status, alcohol use, fruit and vegetable consumption and physical activity practices) between the 20% most- and least-deprived neighborhoods (LSOAs), explored any temporal changes during austerity, and examined the underpinning role of compositional and contextual determinants. All health behaviours, except for frequent physical activity, varied significantly by deprivation (p ≤ 0.001). Smoking was lower in the least-deprived areas (OR 0.21, CI 0.14 to 0.30), while alcohol use (OR 2.75, CI 1.98 to 3.82) and fruit and vegetable consumption (OR 2.55, CI 1.80 to 3.62) were higher in the least-deprived areas. The inequalities were relatively stable throughout the study period. Material factors (such as employment, education and housing tenure) were the most-important and environmental factors the least-important explanatory factors. This study suggests that material factors are the most important ‘place’ determinants of health behaviours. Health promotion activities should better reflect these drivers.

Socioeconomic inequalities in health behaviors: exploring mediation pathways through material conditions and time orientation

BackgroundSocioeconomic inequalities in health behaviors have been attributed to both structural and individual factors, but untangling the complex, dynamic pathways through which these factors influence inequalities requires more empirical research. This study examined whether and how two factors, material conditions and time orientation, sequentially impact socioeconomic inequalities in health behaviors.MethodsDutch adults 25 and older self-reported highest attained educational level, a measure of socioeconomic position (SEP); material conditions (financial strain, housing tenure, income); time orientation; health behaviors including smoking and sports participation; and health behavior-related outcomes including body mass index (BMI) and self-assessed health in three surveys (2004, 2011, 2014) of the longitudinal GLOBE (Dutch acronym for “Health and Living Conditions of the Population of Eindhoven and surroundings”) study. Two hypothesized pathways were investigated during a ten-year time period using sequential mediation analysis, an approach that enabled correct temporal ordering and control for confounders such as baseline health behavior.ResultsEducational level was negatively associated with BMI, positively associated with sports participation and self-assessed health, and not associated with smoking in the mediation models. For smoking, sports participation, and self-assessed health, a pathway from educational level to the outcome mediated by time orientation followed by material conditions was observed.ConclusionsTime orientation followed by material conditions may play a role in determining socioeconomic inequalities in certain health behavior-related outcomes, providing empirical support for the interplay between structural and individual factors in socioeconomic inequalities in health behavior. Smoking may be determined by prior smoking behavior regardless of SEP, potentially due to its addictive nature. While intervening on time orientation in adulthood may be challenging, the results from this study suggest that policy interventions targeted at material conditions may be more effective in reducing socioeconomic inequalities in certain health behaviors when they account for time orientation.

Socio-economic differences in smoking among adolescents in a school-based smoking intervention: The X:IT II study.

Aims: Socio-economic inequalities in health behaviour may be influenced by health interventions. We examined whether the X:IT II intervention, aiming at preventing smoking in adolescence, was equally effective among students from different occupational social classes (OSC). Methods: We used data from the multi-component school-based smoking preventive intervention X:IT II, targeting 13- to 15-year-olds in Denmark. The intervention was tested in 46 schools with 2307 eligible students at baseline (response rate=86.6%) and had three main intervention components: smoke-free school time, smoke-free curriculum and parental involvement. We used a difference-in-difference design and estimated the change in current smoking after the first year of implementation in high versus low OSC. Analyses were based on available cases (N=1190) and imputation of missing data at follow-up (N=1967). Results: We found that 1% of the students from high OSC and 4.9% from low OSC were smokers at baseline (imputed data), and 8.2% of the students from high OSC and 12.2% from low OSC were smokers at follow-up. Difference-in-difference estimates were close to zero, indicating no differential trajectory. Conclusions: As intended, the X:IT II intervention, designed to apply equally to students from all socio-economic groups, did not seem to create different trajectories in current smoking among adolescents in high and low socio-economic groups. To diminish social inequality in health, future studies should carefully consider the ability to affect all socio-economic groups equally, or even to appeal mainly to participants from lower socio-economic groups, as they are often the ones most in need of intervention.

Life expectancy inequalities in Hungary over 25 years: The role of avoidable deaths

Using mortality registers and administrative data on income and population, we develop new evidence on the magnitude of life expectancy inequality in Hungary and the scope for health policy in mitigating this. We document considerable inequalities in life expectancy at age 45 across settlement-level income groups, and show that these inequalities have increased between 1991–96 and 2011–16 for both men and women. We show that avoidable deaths play a large role in life expectancy inequality. Income-related inequalities in health behaviours, access to care, and healthcare use are all closely linked to the inequality in life expectancy. Supplementary material for this article is available at: https://doi.org/10.1080/00324728.2021.1877332

Health Behaviors at the Onset of the COVID-19 Pandemic.

Objectives: We examined perceived behavior change since implementation of physical distancing restrictions and identified modifiable (self-rated health, resilience, depressive symptoms, social support and subjective wellbeing) and non-modifiable (demographics) risk/protective factors. Methods: A representative US sample (N = 362) completed an online survey about potential risk/protective factors and health behaviors prior to the pandemic and after implemented/recommended restrictions. We assessed change in perceived health behaviors prior to and following introduction of COVID-19. We conducted hierarchical linear regression to explore and identify risk/protective factors related to physical activity, diet quality, and social isolation. Results: There have been substantial decreases in physical activity and increases in sedentary behavior and social isolation, but no changes in diet quality since COVID-19. We identified modifiable and non-modifiable factors associated with each health behavior. Conclusions: Negative effects indicate the need for universal intervention to promote health behaviors. Inequalities in health behaviors among vulnerable populations may be exacerbated since COVID-19, suggesting need for targeted invention. Social support may be a mechanism to promote health behaviors. We suggest scaling out effective health behavior interventions with the same intensity in which physical distancing recommendations were implemented.

Socioeconomic Inequalities in Health Behaviors among Jordanian Adolescents

Abstract Background Health inequalities as a global problem concerns both developed and developing countries. However, levels of inequalities are not the same in different age groups, e.g., during adolescence there are fewer inequalities in morbidity and mortality, while they are more likely to appear in health behaviors. This study aims to test inequality (gender, parental education, and family affluence) in students' health behaviors (dietary habits, hygienic behavior and smoking). Methods Using a sample of students (N = 2741, aged 13 - 18 years) from public and private schools in Irbid governorate, Jordan, in the year of 2020, measurements included SES indicators), the Global School-based Student Health Survey and health behaviors (tobacco use, personal hygiene, dietary behavior). Results There was a relationship between paternal education and not having enough food at home (p = 0.000), adolescents' brushing their teeth (p = 0.000), eating fruits (p = 0.000), drinking milk (p = 0.000), having fast food (p = 0.000). Results were similar with maternal education, in addition, it was also related to eating vegetables (p = 0.027) and washing their hands before eating (p = 0.005). Smoking was also associated with maternal education (p = 0.009). In terms of family affluence, significant associations can be found between the student's health behavior variables and the self-assessed financial situation in all cases. Finally, females engaged in more healthy dietary and hygienic behaviors and less smoking, while males were more physically active. Conclusions Our findings give important evidence for the association between socioeconomic inequalities and health behaviors among Jordanian adolescents. The strongest associations were found with family affluence, while parents' education may have different roles in various types of health behaviors. These findings strengthen the need for policymakers and researchers to pay greater attention to these inequalities. Key messages In Jordan, health care should face many challenges in terms of inequalities between different groups of the population according to socioeconomic status. Adolescence is a critical life period when besides biological modifications, there are also psychosocial changes which needs severe adjustment.

Moving Upstream: The Effect of Tobacco Clean Air Restrictions on Educational Inequalities in Smoking Among Young Adults.

Education affords a range of direct and indirect benefits that promote longer and healthier lives and stratify health lifestyles. We use tobacco clean air policies to examine whether policies that apply universally-interventions that bypass individuals' unequal access and ability to employ flexible resources to avoid health hazards-have an effect on educational inequalities in health behaviors. We test theoretically informed but competing hypotheses that these policies either amplify or attenuate the association between education and smoking behavior. Our results provide evidence that interventions that move upstream to apply universally regardless of individual educational attainment-here, tobacco clean air policies-are particularly effective among young adults with the lowest levels of parental or individual educational attainment. These findings provide important evidence that upstream approaches may disrupt persistent educational inequalities in health behaviors. In doing so, they provide opportunities to intervene on behaviors in early adulthood that contribute to disparities in morbidity and mortality later in the life course. These findings also help assuage concerns that tobacco clean air policies increase educational inequalities in smoking by stigmatizing those with the fewest resources.

Housing, neighbourhood and sociodemographic associations with adult levels of physical activity and adiposity: baseline findings from the ENABLE London study

ObjectivesThe neighbourhood environment is increasingly shown to be an important correlate of health. We assessed associations between housing tenure, neighbourhood perceptions, sociodemographic factors and levels of physical activity (PA) and...

Are primary-care physician practices related to health behaviors likely to reduce social inequalities in health?

Our objective was to examine patients' health behaviors and the related practices of their primary-care physicians to determine whether physicians' actions might help to reduce the social inequalities in health behaviors among their patients. Fifty-two general practitioners, who were also medical school instructors in the Parisian area, volunteered to participate. A sample of 70 patients (stratified by sex) aged 40-70years was randomly chosen from each physician's patient panel and asked to complete a questionnaire about their social position and health behaviors: tobacco and alcohol use, diet, physical activity, and participation in breast and cervical cancer screening. Each physician reported their practices related to each such behavior of each patient. Mixed models were used to test for social differences. Questionnaires were collected in 2008-2009 from both patient and physician for 71% of the 3640 patients. Our results showed social inequalities disfavored those at the bottom of the social scale for all but one of the health behaviors studied among both men and women (exception: excessive alcohol consumption among women). Physicians' practices related to these health behaviors also appeared to be socially differentiated. Among men, this differentiation favored those with the lowest social position for all behaviors except physical activity. Among women, however, practices favored the most disadvantaged only for breast cancer screening. In all other cases, they were either socially neutral or unfavorable to the most disadvantaged. Physicians' practices related to their patients' health behaviors should focus more on those lowest in the social hierarchy, especially among women.

Social inequalities in health behaviors among Brazilian adults: National Health Survey, 2013.

BackgroundConsidering the high socioeconomic inequalities prevailing in Brazil and lifestyle as a strong determinant of morbidity and premature mortality, our purpose was to evaluate the degree of socioeconomic disparities in the prevalence of health behaviors among Brazilian adult population using data from the 2013 Brazilian National Health Survey.MethodBased on a sample of 49,025 individuals aged 20 to 59 years, we estimated the prevalence of several health behaviors and a score of unhealthy behaviors according to gender, education, race/color and possession of private health insurance. The prevalence ratios adjusted by age and gender were estimated by means of multiple Poisson regression and the analyses took into account the sampling design.ResultsSignificant social inequalities were identified in the Brazilian adults. Higher prevalence of current smoking, leisure-time physical inactivity, sedentary lifestyle, whole milk consumption and low ingestion of greens, vegetables, and fruits were observed among the less educated, in the non-white population, and among those without private health insurance. Higher prevalence of heavy episodic drinking was found in the non-white population, but no difference in the consumption of fatty meat was found according to skin color. Score of unhealthy behavior higher than 6 was more frequent in lower educational strata (PR = 3.74) in the non-white population (PR = 1.39) and among those without private health insurance (PR = 1.78). Compared to women, men had higher prevalence rates of smoking, hazardous alcohol consumption, and fatty meat consumption and lower consumption of greens, vegetables and fruits.ConclusionThe results of the study emphasize the importance of monitoring social inequalities in health as part of national health policies and the urgent need to prioritize actions to promote healthy behaviors, especially among the most socially vulnerable segments of society.

The role of financial strain and self-control in explaining income inequalities in health behaviors

Background Lower income group's unhealthy behaviors can only partly be explained by direct costs of behaving healthily. We hypothesize that low income increases the risk of facing financial strain, which takes up cognitive ‘bandwidth’ and leads to less self-control, and subsequently Results in more unhealthy behavior. Methods Cross-sectional survey data were obtained from participants (25–75 years) in the …

Contribution of time-varying measures of health behaviours to socioeconomic inequalities in mortality: how to understand the underlying mechanisms?

A higher prevalence of unhealthy behaviours in lower socioeconomic groups contributes to socioeconomic inequalities in mortality. Recent cohort studies suggest that the contribution of health behaviours to socioeconomic inequalities in...