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.

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.

Objective This paper 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.

This article reveals race differentials in obesity as both an individual-and neighborhood-level phenomena. Using neighborhood-level data from the 1990-1994 National Health Interview Survey, we find that neighborhoods characterized by high proportions of black residents have a greater prevalence of obesity than areas in which the majority of the residents are white. Using individual-level data, we also find that residents of neighborhoods in which at least one-quarter of the residents are black face a 13 percent increase in the odds of being obese compared to residents of other communities. The association between neighborhood racial composition and obesity is completely attenuated after including statistical controls for the poverty rate and obesity prevalence of respondents' neighborhoods. These findings support the underlying assumptions of both institutional and social models of neighborhood effects.The causes of obesity, including the social relationships that mediate and moderate the relationship between various risk factors and obesity, are complex (Weinsier et al. 1998;Whitaker 2002;Bloomgarden 2002). As research consistently demonstrates that behaviors affecting health are rooted within individuals' social environments (Berkman and Kawachi 2000), it is critical to broaden the scope of inquiry such that health is understood not only as a function of individual traits, but also as related to the environments in which people live (MacIntyre and Ellaway 2003;Robert 1999). These environments include physical space as well as community attitudes and behaviors that characterize these places (Frolich, Corin, and Potvin 2001). Although literature linking residential context to health has increased sharply in recent years (see Kawachi and Berkman 2003 for an overview), little work has examined obesity as an outcome. This article contributes to the growing body of work focusing on the ecological correlates of health and makes a timely contribution to the recent focus on obesity in both academic and popular settings.It is important to fully understand obesity because obesity prevalence among U.S. adults has increased to epidemic levels; has contributed to an increased risk of disease, disability, and death; and has led to an escalation in health care costs (Allison, Zannolli, and Narayan 1999; Wang et al. 2002). Over the last 25 years, the prevalence of adult obesity has more than doubled; in 1976 only 15 percent of the adult population was obese, but by 2000 adult obesity rates surpassed 30 percent (NCHS 2003). This increase is particularly problematic because obesity is associated with an increased risk of serious health problems including type-2 diabetes, gallbladder disease, high blood pressure, and heart disease (Flegal et al. 2002;Calle et al. 2003;Kaplan 2000;Must et al. 1999). More importantly, obesity increases the risk of a number of causes of death and is believed to contribute to approximately 14 and Fontaine et al. 1999;McGinnis and Foege 1993;Rogers, Hummer, and Krueger 2003;Sturm 2002). NI...