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.

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Despite the growing problem of global tobacco use, accurate information on the prevalence and patterns in the world's poorest nations remains sparse. For sub-Sahara Africa, in particular, a weak knowledge base limits the targeting of strategies to combat the potential growth of tobacco use and its harmful effect on future mortality. To describe the prevalence and social patterns of the use of cigarettes and other tobacco in Africa, this study examines population-based data from 16 Demographic Health Surveys (DHS) of men aged 15-54 years and women aged 15-49 years in 14 nations. Descriptive statistics show the highest cigarette use among men in several nations of east central Africa and Madagascar, lowest use in nations of west central Africa, and medium use in nations of southern Africa. Multinomial logistic regression results for men show highest cigarette use among urban, less educated, and lower status workers. Results for women show much lower prevalence than men but similar social patterns of use. The DHS results thus give new and comparable information about tobacco use in low-income nations, disadvantaged social groups, and an understudied region of the world.

Studies of individual countries suggest that socioeconomic status (SES) and weight are positively associated in lower-income countries but negatively associated in higher-income countries. However, this reversal in the direction of the SES-weight relationship and arguments about the underlying causes of the reversal need to be tested with comparable data for a large and diverse set of nations. This study systematically tests the reversal hypothesis using individual- and aggregate-level data for 67 nations representing all regions of the world. In support of the hypothesis, we find not only that the body mass index, being overweight, and being obese rise with national product but also that the associations of SES with these outcomes shift from positive to negative. These findings fit arguments about how health-related, SES-based resources, costs, and values differ across levels of economic development. Although economic and social development can improve health, it can also lead to increasing obesity and widening SES disparities in obesity.

What explains the recent reversal in many countries of century-long trends toward a growing female advantage in mortality? And might the reversal indicate that new roles and statuses of women have begun to harm their health relative to men? Using data on 21 high-income countries that separate smoking deaths from other deaths, this study answers the first question by showing that the reversal in the direction of change in the sex differential results from increased levels of smoking among women relative to men. Using additional cross-national data on cigarette consumption and indicators of gender equality, this article answers the second question in the negative by showing that the declining female advantage in smoking mortality results from patterns of the diffusion of cigarette use rather than from improvements in women's status. Evidence of continued improvement in the female mortality advantage net of smoking deaths, and the likely decline of smoking among women in the future, imply that the recent narrowing of the differential will reverse. Copyright 2002 by The Population Council, Inc..