From the Departments of Psychiatry and Behavioral Sciences and Medicine, and the Behavioral Medicine Research Center, Duke University Medical Center, and the Department of Psychology, Duke University, Durham, NC.
Lower socioeconomic status (SES) is probably the most powerful single
contributor to premature morbidity and mortality, not only in the United States
but worldwide. Since lower SES groups are more likely to engage in a number
of risky health behaviors, it has been tempting to assume that these behaviors
are responsible for the health problems that mount as SES decreases—and
to draw the logical conclusion that simply by bringing about a reduction in
these risky behaviors, the health problems associated with lower SES will
disappear. Unfortunately for this hypothesis, as Lantz et al1
show quite convincingly in this issue of THE JOURNAL, 4 important health behaviors—smoking,
alcohol consumption, body mass index, and physical activity level—explain
no more than a modest "12% to 13% of the predictive effect of income on mortality."
By incorporating in this study a nationally representative longitudinal sample
with both men and women, the authors overcome the limitations of prior studies
that found these and other physical risk factors to account for no more than
a third of the excess mortality associated with lower SES.
Williams RB. Lower Socioeconomic Status and Increased MortalityEarly Childhood Roots and the Potential for Successful Interventions. JAMA. 1998;279(21):1745-1746. doi:10.1001/jama.279.21.1745