Socioeconomic Disparities Linked to Health-Risk Behaviors: A Trend Analysis-based Test of Fundamental Causality (1977-2005)

Research output: Types of ThesisDoctoral thesis

Abstract

In this thesis I sought to examine socioeconomic differences (high SES group versus low SES group) in five health-risk behaviors (smoking, obesity, overweight, alcohol consumption, and lack of exercise) by way of testing the theory of fundamental causes (Link and Phelan 1995). This theory predicts that those of high SES are better positioned (thanks to their resources) than those of low SES to shield themselves from health risks. I conducted trend analyses of data gathered over two decades. I used National Health Interview Surveys (NHIS) collected during the period from 1977 to 2005 (N=178,695) for descriptive analyses, and from 1977 to 2000 (N=147,267) for convergence/divergence analyses (trend estimations). I expected that all health-risk behavior differentials would widen over time between high and low SES groups (divergence), except for alcohol consumption (convergence). Alcohol consumption is known to be higher among those of high SES; nevertheless, in line with the theory, it was predicted that the high SES group would be moving in the direction of diminishing the gap with the low SES group over time. Support for the theory of fundamental causes was mixed but portions of the theory were supported. Three hypotheses regarding obesity (divergence), overweight (divergence), and alcohol consumption (convergence) were supported. Predicted probabilities of obesity and overweight increased over time for each group, while they decreased for alcohol consumption for each group. Two hypotheses for smoking and lack of exercise were not supported. One estimated regression model did not capture any significant smoking trend differences (neither convergence nor divergence); another estimated regression model captured significant converging lack of exercise trends, with decreasing probabilities of lacking exercise over time for each group. Taken together, the findings are implicative of the persistent SES-health association, and more specifically, one of the many channels through which that association can be maintained – health-risk behaviors. The findings are also suggestive of the importance of addressing social and economic factors that affect diseases (distal factors), besides individually-based factors that are closer to disease in the causal chain (Link and Phelan 1995). If view of that issue, the effects of fundamental causes would otherwise continue to persist in spite of attempts to control more proximal factor effects.
Original languageAmerican English
QualificationDoctor of Philosophy
Awarding Institution
  • Sociology
Supervisors/Advisors
  • Tausig, Mark, Advisor, External person
StatePublished - 2009
Externally publishedYes

Keywords

  • convergence models
  • fundamental causes
  • health-risk behavior trends
  • socioeconomic status and health

EGS Disciplines

  • Sociology

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